TurboTax vs. TaxACT vs. H&R Block at Home: 2012 Lightning Review

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AppId is over the quota

According to a MyMoneyBlog.com reader poll taken last year, 52% used TurboTax, 18% used TaxACT, and 14% used H&R Block at Home to prepare their tax returns, which agreed with the most popular software overall in the US. The remaining 16% either used an accountant (10%), filed on paper (4%), or used another software (2%).

Last year, I used each of “The Big 3? to do my taxes in order to compare and contract in detail the three software programs. (As an example, my TurboTax 2011 review talks about comma-insertion as a feature…) I plan to do the same thing this year, but to help you early-birds, here’s the highly-condensed version of my reviews:

Accuracy and Maximum Refund Guarantees
In terms of accuracy and interview style, I think all three are comparable if not nearly identical. In fact, I’m certain they all dissect each other’s products annually to ensure this. As such, all three offer a “Maximum Refund Guarantee” as well as a “Accuracy Guarantee” that states that they will pay any penalty and interest assessed by the IRS or your state due to calculation errors on their part (though H&R Block limits this to $10,000).

In my opinion, the remaining major differentiating factors are price, time-saving features, and audit support. Now, there are various discounts and sales that pop up, but here I’m just comparing regular sticker prices.

TurboTax Online

The most popular and most polished-looking user interface.Federal Deluxe regular price is $29.99. State return price is $36.99.Best import support from payroll providers and financial institutions for automatic import of W-2 and 1099 forms.Moderate audit support (you get help, but no in-person representation)

Bottom line: The time-saving choice if you have a lot of brokerage and/or bank 1099s to electronically import, or a lot of details to import from last year’s return and you used them last year. For those like me that would pay extra to avoid all that tax lot data entry.

TaxACT Online

Cheapest overall with Federal Deluxe regular price at $9.99. Many can get by with Federal Free version. Cheapest state return at $8.00.Again, just as accurate as the others.Limited import support (worst of the three).Limited audit support (worst of the three).

Bottom line: The value choice if you just want reliable DIY tax return software and don’t need any extras.

H&R Block at Home Online

Federal Deluxe regular price is $29.95. State return price is $34.95.Moderate import support for 1099s and W-2 (not as broad at TurboTax, better than TaxACT)Best free audit support, as it includes an H&R Block Enrolled Agent actually attending your audit in-person. Neither TurboTax and TaxAct not offer representation. However, you must think about whether you would hire your own representative in the actual event of an IRS audit (probably depends on severity).

Bottom line: The sleep-well-at-night choice if you want the assurance that a federally-authorized enrolled agent will guide you for free through a potential albeit unlikely audit.

Find more in Reviews, Taxes | 1/10/13, 8:51pm | Trackback

Book Review: Man’s Search for Meaning by Viktor Frankl

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AppId is over the quota

Viktor Frankl was a respected doctor and therapist before he became a concentration camp prisoner during the Holocaust. After somehow surviving the unthinkable only to find that he had lost both his parents and his pregnant wife, he wrote the book Man’s Search for Meaning.

I’ve visited the Dachau concentration camp, but reading this book was so much more vivid. You’re not just sent somewhere to die. You’re forced to relocate to a “labor camp”, and so you pack up your entire life into a few bags. Your bags are confiscated, so you hide some photos or jewelry in your clothes. You are stripped completely naked, and given a dead man’s rags to wear. You don’t even have a name anymore, you’re just a number (Frankl was 119104). And this is before the coming years of physical and mental torture.

With this background, Frankl introduces logotherapy, a form of existentialism that says that humans are driven not by the pursuit of pleasure (Freud) or the pursuit of power (Adler), but the pursuit of meaning. There are three ways to achieve meaning:

Creating a work or doing a deed,Experiencing something or encountering someone (love),By taking a proper attitude when faced with unavoidable suffering

This last part is hard to explain unless you read the book, but the unavoidable part should be emphasized. We’re not talking about “pain is good”. In my mind, I think of it as maintaining honor and self-respect no matter what. Frankl writes:

Everything can be taken from a man but one thing, the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.

He also quotes Nietzsche, “He who has a Why to live for can bear almost any How.”

How does this relate to personal finance and the pursuit of financial freedom? I think of it in two ways. First, in terms of yourself. We are all attracted to material things like houses, cars, clothes, and I’d include money. Imagine if all that was taken away. You’d still have your body, your mind, your unique meaning and purpose in the world. We should develop those things. The things you’ve learned, your memories, your experiences, your skills, all those can’t be taken away. All the good deeds that you have already accomplished, those also can never be taken away.

Second, it relates to motivation. Why do you want more money? Why do you want financial freedom? Is it enough to just want to avoid work? Maybe your goal is to spend time with your loved ones. Maybe you want to create beautiful art. Maybe you want to build an orphanage in Cambodia. Maybe you just want to try every ramen restaurant in Japan.

I have some meanings that I am pursuing, but I’m still searching for others.

Find more in Book Reviews, Inspirational | 1/27/13, 11:32pm | Trackback

Discover It Card Review: New, Improved… Game Changer?

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AppId is over the quota

For 2013, scrappy little Discover is trying something bold. They’ve chucked everything and started fresh with only one card – the new Discover it Card. (Yes, lowercase, don’t ask me why.) No longer promoted are the Discover More, Motiva, Open Road, Escape, and Miles cards. You may have noticed a lot of commercials about it recently, claiming it to be a “Game Changer”.

After a closer look, the new card is a definite improvement over the old products, with many positive changes in direct response to the competition. Here are the highlights:

5% cash back on rotating categories. My favorite feature. As with the Discover More card, you’ll get 5% cash back from select categories each quarter. From January to March 2013, you’ll get 5% cashback at all restaurants and movies on up to $1,500 in purchases.1% flat cashback on all other purchases. Previous cash back cards had an initial tier that only gave you 0.25% cash back on the first $3,000 in purchases, and then 1% after that. They’ve finally matched competitors and went for 1% flat.Late payment forgiveness. There is no late fee for your first late payment, and your APR won’t automatically increase either. You can also pay-by-phone for free, up to midnight Eastern on your due date. We all make mistakes, so this is a nice addition.Direct-to-human, 100% US-based customer service reps. Instead of an intentionally-complicated robot phone tree, you can now select at any time to go straight to a human. I’m a little bummed that this has to be touted as a feature, but sadly it is…No annual fee, no fee for going over your limit.0% Intro APR on both purchases and balance transfers for 14 months. 14 months is pretty long for purchases. Intro offer has a 3% balance transfer fee with no minimum.No foreign transaction fee. Okay, but I wouldn’t take a Discover internationally anyway. Discover acceptance is good inside the US, but much worse outside.Silly things. Things that shouldn’t matter, but still might. The card arrives via UPS/FedEx mail in a sleek-looking box. The card front is made to look like brushed stainless steel with no raised embossing – your name and card number are only on the back. I wonder where they got that idea?

Is it really a game-changer? Well, no. It’s not quite “one card to rule them all”, but it does combine the good bits from several other popular cards (Chase Sapphire, Chase Freedom, Citi Simplicity) to create a competitive offering. I like the 5% categories that are usually different from my Citi Dividend and Chase Freedom.

Discover is still the underdog to American Express/Visa/Mastercard, but it has its own perks. There are bonuses above cash back value for gift card redemptions. For example, you can regularly redeem $40 in cashback rewards for a $50 gift card to Wal-mart or Sam’s Club, that’s 25% extra that you can use even on the 5% back earnings. (Hint: If only Sam’s Club is available, you can use a Sam’s Club gift card at Wal-mart.) Their ShopDiscover cashback portal also often has the highest percentages for online shopping merchants, like 10% at Sears, better than eBates and such. Finally, Discover card has a lot of consumer features like return protection and an extended warranty that extends the manufacturer’s warranty for up to an extra year.

Basically, this Discover card is certainly a worthwhile addition to your wallet, just don’t make it the only card in your wallet.

Existing cardholders. I have not gotten any communication from Discover that my existing cards will be converted to an “it” card in the near future, let me know in the comments if you have. I’m assuming that we’ll eventually get switched over at some point, hopefully soon because it (pun intended) seems to be better.

Update: Readers report that if you call them up, they will convert you to the new card manually (it will not happen automatically). You get to keep your same card number and thus credit history. Certain people with annual fee miles-type cards may prefer to stay, but again I think this card is definitely better than the plain Discover and Discover More cards.

Find more in Credit Cards, Deals & Offers | 1/6/13, 6:08pm | Trackback

American Express OPEN Business Gold Rewards Card Review

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AppId is over the quota

The Business Gold Rewards Card® from American Express OPEN is an premium charge card for small businesses where you must pay off the balance each month, but you get the AMEX perks like purchase price protection, extended product return protection, and the famous AMEX extended warranty that actually pays out. Here are the highlights:

3X points on airfare2x points on purchases in the U.S. for advertising in select media, gasoline at U.S. stand-alone gas stations, and shipping1X points on other purchasesPoints are earned only on eligible purchases. Bonus points limitations apply.$0 introductory annual fee for the first year, then $175Introductory annual fee for Additional Gold Cards in the first year is $0; then, $50 for the first Additional Gold Card and no fee for other Additional CardsTerms & Restrictions Apply. Offer expires January 28th, 2013.

Many people aren’t aware of the fact that they can apply for business credit cards, even if they are not a corporation or LLC. Why? Because any individual can be a small business as well. The business type is called a sole proprietorship. Perhaps you sell items on eBay, Craiglist, or Etsy. Maybe you do some graphic design, web design, freelancing and/or consulting. If you earned more than $600 from a single client, you probably got a 1099-MISC tax form and filled out a Schedule C. Boom! You have business income, you’re paying self-employment taxes (meaning you’re an employer), and you’re a sole proprietorship. This is the simplest business entity, but it is fully legit and recognized by the IRS. On a business credit card application, you should use your own legal name as the business name, and your Social Security Number as the Tax ID.

This card will require you to personally guarantee that you’ll pay them back what you charge on the card, which means they’ll check your personal credit score like any other consumer card. However, as the card is a business card, American Express won’t have it show up on your personal credit report, so it won’t change things like your credit limits, average account age, or credit utilization ratio.

Find more in Credit Cards, Deals & Offers | 1/21/13, 10:18pm | Trackback

Book Review: Bossypants Memoir by Tina Fey

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AppId is over the quota

I have a goal this year to read and review more books, ideally a book per week on average. Recently, I’ve been into reading biographical books about interesting people pursuing their passions. Feel free to send me some suggestions.

Tina Fey’s Bossypants seemed like a funny auto-biography about someone who grew up in a “normal” working-class family and took a little while to become a respected writer, actor, producer, and comedian. Wealthy, too: Fey reportedly makes $500,000 per episode of 30 Rock and has an estimated net worth of $45 million. I should add that I have never seen a full episode of 30 Rock, although I have seen some SNL Weekend Updates, all the Sarah Palin skits, and a few of her movies.

The book was definitely Tiny-Fey-style funny and a quick read, but it wasn’t very revealing. I should have known, as the book is crosslisted under both “Humor & Entertainment” and “Biographies & Memoirs”. Indeed, I get the impression that she’s actually quite a private person and is reluctant to share anything truly intimate. She considered herself an ugly, unpopular nerd in high school. Well, that applies a lot of people. She worked a menial job at the YMCA while supporting her improv education. Eh, okay. Besides the funny bits, here are my highlighted quotes:

On being a leader:

It is an impressively arrogant move to conclude that just because you don’t like something, it is empirically not good. I don’t like Chinese food, but I don’t write articles trying to prove it doesn’t exist.

On discrimination:

When faced with sexism or ageism or lookism or even really aggressive Buddhism, ask yourself the following question: “Is this person in between me and what I want to do?” If the answer is no, ignore it and move on. Your energy is better used doing your work and outpacing people that way.

On teamwork:

Whatever the problem, be part of the solution. Don’t just sit around raising questions and pointing out obstacles. We’ve all worked with that person. That person is a drag.

On being a career-oriented woman:

This is what I tell young women who ask me for career advice. People are going to try to trick you. To make you feel that you are in competition with one another. “You’re up for a promotion. If they go with a woman, it’ll be between you and Barbara.” Don’t be fooled. You’re not in competition with other women. You’re in competition with everyone.

I suppose I feel somewhat disappointed because I sense that she has an inner fire and tenacity that she’s unwilling to explain or share with us. Fey was the first female head writer for Saturday Night Live, no small feat. Yes, she got a lucky break with the Palin thing, but that’s how showbiz works:

You have to be resilient in that world. You have to fight your way in and hopefully you are playing with good players and their give and take is good and they will let you in. I always liken it to basketball. If you get passed to once in a game, you have to learn to make that basket or you don’t get passed to again.

Find more in Book Reviews, Funny, Inspirational | 1/21/13, 6:55pm | Trackback

Best of Medical Blogs-weekly review and blog carnival

The "Best of Medical Blogs-weekly review and blog carnival" is a weekly summary of the best medical Blog post. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best medical blog (BMB) is published every Tuesday, just like the old Grand Rounds.

Cultivate followers on social media, if you want to communicate science

From the blog science Soapbox http://goo.gl/cPQq1 and medical Museion http://goo.gl/QmEU7:

Social media platforms can be very limiting. For example, you can define genotype and Phenotype in 140 characters or less? If you want to use social media to communicate effectively, necessary for readers to drive somewhere.

Write a blog gives substance to your social media presence. You have the opportunity to talk about science in a meaningful way, which ultimately helps people better understand the world around them. Answering these questions is probably because you have first in science. Don't be afraid to share what you've discovered.

Are the doctors are afraid to be wrong?

From blogging to surgeon skeptical Scalpel: «I once did some work as an expert on a malpractice insurance company. Rarely there is a case that doesn't have many opportunities for second-guessing. When you know the outcome, you can always find something in the medical record that could have been done differently.

The current security climate and medicolegal patient creates a feeling among doctors that any mistake is to be extensively examined. This results in a similar situation to an athlete trying not to lose a game instead of trying to win. For those of you unfamiliar with the sport, that the strategy usually fails. Fear of being wrong can lead to excessive test too. " http://goo.gl/FWTbC

When did stop teaching the basics for residents and medical students?

Dr.% of the blog Rants Medical db loves ACGME competency 6 just fine, but also suggests a simple list of http://goo.gl/2sqip:

1. Take a complete history, relevant, accurate
2. make a proper physical examination
3. order the appropriate laboratory tests and interpret them completely and accurately
4. order the correct images and interventions and interpret them

Happy 5th Blogiversary!

Former plastic surgeon and blogger extraordinaire Dr. Bates of Ramona reflects on his 5 years of blogging and the medical community blogging. http://goo.gl/0EVJW

As blogging has helped me academically. According to Dr. cent: why I write almost everyday, my writing has improved dramatically http://goo.gl/GLNsL

Medicine-Stanford University Grand Rounds and social media

Graham Walker was one of the first medical blogger. Went on a break during his residency in emergency medicine (EM) and now has found new reasons to blog like a EM attending at Stanford University medical center. This is his talk on social media and medicine at Stanford University Grand Rounds: http://youtu.be/qtkggenLmlE

Dr. Walker: "my speech on the dissemination of medical information over time, as the internet and social networking are changing medication, how to use digital tools to be a better doctor at the bedside."

Here is the list of Graham of digital tools to improve the specialty.

Paper-based charts: how soon we forget http://goo.gl/Vspmp -Dr. Wes: suddenly, don't miss the paper charts anymore.

Dr. Wes: is how bad the cardiovascular risk of azithromycin? http://goo.gl/yVgfo -"Big data" related to "big mistake"?

Comments from Twitter:

Seth Trueger @ MDaware: some great stuff in there

Skeptical scalpel @ Skepticscalpel: thanks for including me.

View the original article here

Best of Medical Blogs-weekly review and blog carnival

The "Best of Medical Blogs-weekly review and blog carnival" is a weekly summary of the best medical Blog post. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best medical blog (BMB) is published every Tuesday, just like the old Grand Rounds.

Cultivate followers on social media, if you want to communicate science

From the blog science Soapbox http://goo.gl/cPQq1 and medical Museion http://goo.gl/QmEU7:

Social media platforms can be very limiting. For example, you can define genotype and Phenotype in 140 characters or less? If you want to use social media to communicate effectively, necessary for readers to drive somewhere.

Write a blog gives substance to your social media presence. You have the opportunity to talk about science in a meaningful way, which ultimately helps people better understand the world around them. Answering these questions is probably because you have first in science. Don't be afraid to share what you've discovered.

Are the doctors are afraid to be wrong?

From blogging to surgeon skeptical Scalpel: «I once did some work as an expert on a malpractice insurance company. Rarely there is a case that doesn't have many opportunities for second-guessing. When you know the outcome, you can always find something in the medical record that could have been done differently.

The current security climate and medicolegal patient creates a feeling among doctors that any mistake is to be extensively examined. This results in a similar situation to an athlete trying not to lose a game instead of trying to win. For those of you unfamiliar with the sport, that the strategy usually fails. Fear of being wrong can lead to excessive test too. " http://goo.gl/FWTbC

When did stop teaching the basics for residents and medical students?

Dr.% of the blog Rants Medical db loves ACGME competency 6 just fine, but also suggests a simple list of http://goo.gl/2sqip:

1. Take a complete history, relevant, accurate
2. make a proper physical examination
3. order the appropriate laboratory tests and interpret them completely and accurately
4. order the correct images and interventions and interpret them

Happy 5th Blogiversary!

Former plastic surgeon and blogger extraordinaire Dr. Bates of Ramona reflects on his 5 years of blogging and the medical community blogging. http://goo.gl/0EVJW

As blogging has helped me academically. According to Dr. cent: why I write almost everyday, my writing has improved dramatically http://goo.gl/GLNsL

Medicine-Stanford University Grand Rounds and social media

Graham Walker was one of the first medical blogger. Went on a break during his residency in emergency medicine (EM) and now has found new reasons to blog like a EM attending at Stanford University medical center. This is his talk on social media and medicine at Stanford University Grand Rounds: http://youtu.be/qtkggenLmlE

Dr. Walker: "my speech on the dissemination of medical information over time, as the internet and social networking are changing medication, how to use digital tools to be a better doctor at the bedside."

Here is the list of Graham of digital tools to improve the specialty.

Paper-based charts: how soon we forget http://goo.gl/Vspmp -Dr. Wes: suddenly, don't miss the paper charts anymore.

Dr. Wes: is how bad the cardiovascular risk of azithromycin? http://goo.gl/yVgfo -"Big data" related to "big mistake"?

Comments from Twitter:

Seth Trueger @ MDaware: some great stuff in there

Skeptical scalpel @ Skepticscalpel: thanks for including me.

View the original article here

Best of Medical Blogs-weekly review and blog carnival

The "Best of Medical Blogs-weekly review and blog carnival" is a weekly summary of the best medical Blog post. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best medical blog (BMB) is published every Tuesday, just like the old Grand Rounds.

Cultivate followers on social media, if you want to communicate science

From the blog science Soapbox http://goo.gl/cPQq1 and medical Museion http://goo.gl/QmEU7:

Social media platforms can be very limiting. For example, you can define genotype and Phenotype in 140 characters or less? If you want to use social media to communicate effectively, necessary for readers to drive somewhere.

Write a blog gives substance to your social media presence. You have the opportunity to talk about science in a meaningful way, which ultimately helps people better understand the world around them. Answering these questions is probably because you have first in science. Don't be afraid to share what you've discovered.

Are the doctors are afraid to be wrong?

From blogging to surgeon skeptical Scalpel: «I once did some work as an expert on a malpractice insurance company. Rarely there is a case that doesn't have many opportunities for second-guessing. When you know the outcome, you can always find something in the medical record that could have been done differently.

The current security climate and medicolegal patient creates a feeling among doctors that any mistake is to be extensively examined. This results in a similar situation to an athlete trying not to lose a game instead of trying to win. For those of you unfamiliar with the sport, that the strategy usually fails. Fear of being wrong can lead to excessive test too. " http://goo.gl/FWTbC

When did stop teaching the basics for residents and medical students?

Dr.% of the blog Rants Medical db loves ACGME competency 6 just fine, but also suggests a simple list of http://goo.gl/2sqip:

1. Take a complete history, relevant, accurate
2. make a proper physical examination
3. order the appropriate laboratory tests and interpret them completely and accurately
4. order the correct images and interventions and interpret them

Happy 5th Blogiversary!

Former plastic surgeon and blogger extraordinaire Dr. Bates of Ramona reflects on his 5 years of blogging and the medical community blogging. http://goo.gl/0EVJW

As blogging has helped me academically. According to Dr. cent: why I write almost everyday, my writing has improved dramatically http://goo.gl/GLNsL

Medicine-Stanford University Grand Rounds and social media

Graham Walker was one of the first medical blogger. Went on a break during his residency in emergency medicine (EM) and now has found new reasons to blog like a EM attending at Stanford University medical center. This is his talk on social media and medicine at Stanford University Grand Rounds: http://youtu.be/qtkggenLmlE

Dr. Walker: "my speech on the dissemination of medical information over time, as the internet and social networking are changing medication, how to use digital tools to be a better doctor at the bedside."

Here is the list of Graham of digital tools to improve the specialty.

Paper-based charts: how soon we forget http://goo.gl/Vspmp -Dr. Wes: suddenly, don't miss the paper charts anymore.

Dr. Wes: is how bad the cardiovascular risk of azithromycin? http://goo.gl/yVgfo -"Big data" related to "big mistake"?

Comments from Twitter:

Seth Trueger @ MDaware: some great stuff in there

Skeptical scalpel @ Skepticscalpel: thanks for including me.

View the original article here

Best of Medical Blogs-weekly review and blog carnival

The "Best of Medical Blogs-weekly review and blog carnival" is a weekly summary of the best medical Blog post. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best medical blog (BMB) is published every Tuesday, just like the old Grand Rounds.

Cultivate followers on social media, if you want to communicate science

From the blog science Soapbox http://goo.gl/cPQq1 and medical Museion http://goo.gl/QmEU7:

Social media platforms can be very limiting. For example, you can define genotype and Phenotype in 140 characters or less? If you want to use social media to communicate effectively, necessary for readers to drive somewhere.

Write a blog gives substance to your social media presence. You have the opportunity to talk about science in a meaningful way, which ultimately helps people better understand the world around them. Answering these questions is probably because you have first in science. Don't be afraid to share what you've discovered.

Are the doctors are afraid to be wrong?

From blogging to surgeon skeptical Scalpel: «I once did some work as an expert on a malpractice insurance company. Rarely there is a case that doesn't have many opportunities for second-guessing. When you know the outcome, you can always find something in the medical record that could have been done differently.

The current security climate and medicolegal patient creates a feeling among doctors that any mistake is to be extensively examined. This results in a similar situation to an athlete trying not to lose a game instead of trying to win. For those of you unfamiliar with the sport, that the strategy usually fails. Fear of being wrong can lead to excessive test too. " http://goo.gl/FWTbC

When did stop teaching the basics for residents and medical students?

Dr.% of the blog Rants Medical db loves ACGME competency 6 just fine, but also suggests a simple list of http://goo.gl/2sqip:

1. Take a complete history, relevant, accurate
2. make a proper physical examination
3. order the appropriate laboratory tests and interpret them completely and accurately
4. order the correct images and interventions and interpret them

Happy 5th Blogiversary!

Former plastic surgeon and blogger extraordinaire Dr. Bates of Ramona reflects on his 5 years of blogging and the medical community blogging. http://goo.gl/0EVJW

As blogging has helped me academically. According to Dr. cent: why I write almost everyday, my writing has improved dramatically http://goo.gl/GLNsL

Medicine-Stanford University Grand Rounds and social media

Graham Walker was one of the first medical blogger. Went on a break during his residency in emergency medicine (EM) and now has found new reasons to blog like a EM attending at Stanford University medical center. This is his talk on social media and medicine at Stanford University Grand Rounds: http://youtu.be/qtkggenLmlE

Dr. Walker: "my speech on the dissemination of medical information over time, as the internet and social networking are changing medication, how to use digital tools to be a better doctor at the bedside."

Here is the list of Graham of digital tools to improve the specialty.

Paper-based charts: how soon we forget http://goo.gl/Vspmp -Dr. Wes: suddenly, don't miss the paper charts anymore.

Dr. Wes: is how bad the cardiovascular risk of azithromycin? http://goo.gl/yVgfo -"Big data" related to "big mistake"?

Comments from Twitter:

Seth Trueger @ MDaware: some great stuff in there

Skeptical scalpel @ Skepticscalpel: thanks for including me.

View the original article here

Best of Medical Blogs-weekly review and blog carnival

The "Best of Medical Blogs-weekly review and blog carnival" is a weekly summary of the best medical Blog post. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best medical blog (BMB) is published every Tuesday, just like the old Grand Rounds.

Cultivate followers on social media, if you want to communicate science

From the blog science Soapbox http://goo.gl/cPQq1 and medical Museion http://goo.gl/QmEU7:

Social media platforms can be very limiting. For example, you can define genotype and Phenotype in 140 characters or less? If you want to use social media to communicate effectively, necessary for readers to drive somewhere.

Write a blog gives substance to your social media presence. You have the opportunity to talk about science in a meaningful way, which ultimately helps people better understand the world around them. Answering these questions is probably because you have first in science. Don't be afraid to share what you've discovered.

Are the doctors are afraid to be wrong?

From blogging to surgeon skeptical Scalpel: «I once did some work as an expert on a malpractice insurance company. Rarely there is a case that doesn't have many opportunities for second-guessing. When you know the outcome, you can always find something in the medical record that could have been done differently.

The current security climate and medicolegal patient creates a feeling among doctors that any mistake is to be extensively examined. This results in a similar situation to an athlete trying not to lose a game instead of trying to win. For those of you unfamiliar with the sport, that the strategy usually fails. Fear of being wrong can lead to excessive test too. " http://goo.gl/FWTbC

When did stop teaching the basics for residents and medical students?

Dr.% of the blog Rants Medical db loves ACGME competency 6 just fine, but also suggests a simple list of http://goo.gl/2sqip:

1. Take a complete history, relevant, accurate
2. make a proper physical examination
3. order the appropriate laboratory tests and interpret them completely and accurately
4. order the correct images and interventions and interpret them

Happy 5th Blogiversary!

Former plastic surgeon and blogger extraordinaire Dr. Bates of Ramona reflects on his 5 years of blogging and the medical community blogging. http://goo.gl/0EVJW

As blogging has helped me academically. According to Dr. cent: why I write almost everyday, my writing has improved dramatically http://goo.gl/GLNsL

Medicine-Stanford University Grand Rounds and social media

Graham Walker was one of the first medical blogger. Went on a break during his residency in emergency medicine (EM) and now has found new reasons to blog like a EM attending at Stanford University medical center. This is his talk on social media and medicine at Stanford University Grand Rounds: http://youtu.be/qtkggenLmlE

Dr. Walker: "my speech on the dissemination of medical information over time, as the internet and social networking are changing medication, how to use digital tools to be a better doctor at the bedside."

Here is the list of Graham of digital tools to improve the specialty.

Paper-based charts: how soon we forget http://goo.gl/Vspmp -Dr. Wes: suddenly, don't miss the paper charts anymore.

Dr. Wes: is how bad the cardiovascular risk of azithromycin? http://goo.gl/yVgfo -"Big data" related to "big mistake"?

Comments from Twitter:

Seth Trueger @ MDaware: some great stuff in there

Skeptical scalpel @ Skepticscalpel: thanks for including me.

View the original article here

Best of Medical Blogs-weekly review and blog carnival

The "Best of Medical Blogs-weekly review and blog carnival" is a weekly summary of the best medical Blog post. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best medical blog (BMB) is published every Tuesday, just like the old Grand Rounds.

Cultivate followers on social media, if you want to communicate science

From the blog science Soapbox http://goo.gl/cPQq1 and medical Museion http://goo.gl/QmEU7:

Social media platforms can be very limiting. For example, you can define genotype and Phenotype in 140 characters or less? If you want to use social media to communicate effectively, necessary for readers to drive somewhere.

Write a blog gives substance to your social media presence. You have the opportunity to talk about science in a meaningful way, which ultimately helps people better understand the world around them. Answering these questions is probably because you have first in science. Don't be afraid to share what you've discovered.

Are the doctors are afraid to be wrong?

From blogging to surgeon skeptical Scalpel: «I once did some work as an expert on a malpractice insurance company. Rarely there is a case that doesn't have many opportunities for second-guessing. When you know the outcome, you can always find something in the medical record that could have been done differently.

The current security climate and medicolegal patient creates a feeling among doctors that any mistake is to be extensively examined. This results in a similar situation to an athlete trying not to lose a game instead of trying to win. For those of you unfamiliar with the sport, that the strategy usually fails. Fear of being wrong can lead to excessive test too. " http://goo.gl/FWTbC

When did stop teaching the basics for residents and medical students?

Dr.% of the blog Rants Medical db loves ACGME competency 6 just fine, but also suggests a simple list of http://goo.gl/2sqip:

1. Take a complete history, relevant, accurate
2. make a proper physical examination
3. order the appropriate laboratory tests and interpret them completely and accurately
4. order the correct images and interventions and interpret them

Happy 5th Blogiversary!

Former plastic surgeon and blogger extraordinaire Dr. Bates of Ramona reflects on his 5 years of blogging and the medical community blogging. http://goo.gl/0EVJW

As blogging has helped me academically. According to Dr. cent: why I write almost everyday, my writing has improved dramatically http://goo.gl/GLNsL

Medicine-Stanford University Grand Rounds and social media

Graham Walker was one of the first medical blogger. Went on a break during his residency in emergency medicine (EM) and now has found new reasons to blog like a EM attending at Stanford University medical center. This is his talk on social media and medicine at Stanford University Grand Rounds: http://youtu.be/qtkggenLmlE

Dr. Walker: "my speech on the dissemination of medical information over time, as the internet and social networking are changing medication, how to use digital tools to be a better doctor at the bedside."

Here is the list of Graham of digital tools to improve the specialty.

Paper-based charts: how soon we forget http://goo.gl/Vspmp -Dr. Wes: suddenly, don't miss the paper charts anymore.

Dr. Wes: is how bad the cardiovascular risk of azithromycin? http://goo.gl/yVgfo -"Big data" related to "big mistake"?

Comments from Twitter:

Seth Trueger @ MDaware: some great stuff in there

Skeptical scalpel @ Skepticscalpel: thanks for including me.

View the original article here

Is obstructive sleep apnea associated with cortisol levels? A systematic review of the research evidence

a San Diego State University & University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, UCSD Mail Code 0804, La Jolla, CA, United Statesb Department of Psychiatry, University of California, San Diego, CA, United StatesReceived 8 March 2011. Revised 21 May 2011. Accepted 23 May 2011. Available online 30 July 2011.View full text The pathophysiology of obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic pituitary adrenal (HPA) axis; however a relationship between OSA and altered cortisol levels has not been conclusively established. We conducted a systematic review using the PRISMA Guidelines based on comprehensive database searches for 1) studies of OSA patients compared to controls in whom cortisol was measured and 2) studies of OSA patients treated with continuous positive airway pressure (CPAP) in whom cortisol was measured pre and post treatment. Five electronic databases were searched along with the reference lists of retrieved studies. The primary outcomes were 1) differences in cortisol between OSA and control subjects and 2) differences in cortisol pre-post CPAP treatment. Sampling methodology, sample timing and exclusion criteria were evaluated. Fifteen studies met the inclusion criteria. Heterogeneity of studies precluded statistical pooling. One study identified differences in cortisol between OSA patients and controls. Two studies showed statistically significant differences in cortisol levels pre-post CPAP. The majority of studies were limited by assessment of cortisol at a single time point. The available studies do not provide clear evidence that OSA is associated with alterations in cortisol levels or that treatment with CPAP changes cortisol levels. Methodological concerns such as infrequent sampling, failure to match comparison groups on demographic factors known to impact cortisol levels (age, body mass index; BMI), and inconsistent control of variables known to influence HPA function may have limited the results.

prs.rt("abs_end");Obstructive sleep apnea; Cortisol; Continuous positive airway pressure; Systematic review

Figures and tables from this article:

Fig. 1. PRISMA trial flow used to identify studies for detailed analysis of cortisol in 1) patients with obstructive sleep apnea and healthy controls and 2) patients with obstructive sleep apnea before and after treatment with continuous positive airway pressure. AHI = Apnea hypopnea index; CPAP = Continuous positive airway pressure.

View Within ArticleTable 1. The 7 included studies of cortisol in patients with OSA versus controls.

Na = No information; OSA = Obstructive sleep apnea; BMI = Body mass index; AHI = Apnea hypopnea index; EDS = Excessive daytime sleepiness; w = with; wo = without.

View Within ArticleTable 2. The 8 included studies of cortisol in patients with OSA treated with CPAP.

Na = No information; OSA = Obstructive sleep apnea; BMI = Body mass index; AHI = Apnea hypopnea index; EDS = Excessive daytime sleepiness; SE = Standard error of the mean; w = with; wo = without.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Is obstructive sleep apnea associated with cortisol levels? A systematic review of the research evidence

a San Diego State University & University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, UCSD Mail Code 0804, La Jolla, CA, United Statesb Department of Psychiatry, University of California, San Diego, CA, United StatesReceived 8 March 2011. Revised 21 May 2011. Accepted 23 May 2011. Available online 30 July 2011.View full text The pathophysiology of obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic pituitary adrenal (HPA) axis; however a relationship between OSA and altered cortisol levels has not been conclusively established. We conducted a systematic review using the PRISMA Guidelines based on comprehensive database searches for 1) studies of OSA patients compared to controls in whom cortisol was measured and 2) studies of OSA patients treated with continuous positive airway pressure (CPAP) in whom cortisol was measured pre and post treatment. Five electronic databases were searched along with the reference lists of retrieved studies. The primary outcomes were 1) differences in cortisol between OSA and control subjects and 2) differences in cortisol pre-post CPAP treatment. Sampling methodology, sample timing and exclusion criteria were evaluated. Fifteen studies met the inclusion criteria. Heterogeneity of studies precluded statistical pooling. One study identified differences in cortisol between OSA patients and controls. Two studies showed statistically significant differences in cortisol levels pre-post CPAP. The majority of studies were limited by assessment of cortisol at a single time point. The available studies do not provide clear evidence that OSA is associated with alterations in cortisol levels or that treatment with CPAP changes cortisol levels. Methodological concerns such as infrequent sampling, failure to match comparison groups on demographic factors known to impact cortisol levels (age, body mass index; BMI), and inconsistent control of variables known to influence HPA function may have limited the results.

prs.rt("abs_end");Obstructive sleep apnea; Cortisol; Continuous positive airway pressure; Systematic review

Figures and tables from this article:

Fig. 1. PRISMA trial flow used to identify studies for detailed analysis of cortisol in 1) patients with obstructive sleep apnea and healthy controls and 2) patients with obstructive sleep apnea before and after treatment with continuous positive airway pressure. AHI = Apnea hypopnea index; CPAP = Continuous positive airway pressure.

View Within ArticleTable 1. The 7 included studies of cortisol in patients with OSA versus controls.

Na = No information; OSA = Obstructive sleep apnea; BMI = Body mass index; AHI = Apnea hypopnea index; EDS = Excessive daytime sleepiness; w = with; wo = without.

View Within ArticleTable 2. The 8 included studies of cortisol in patients with OSA treated with CPAP.

Na = No information; OSA = Obstructive sleep apnea; BMI = Body mass index; AHI = Apnea hypopnea index; EDS = Excessive daytime sleepiness; SE = Standard error of the mean; w = with; wo = without.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Secular trends in adult sleep duration: A systematic review

Little evidence exists to support the common assertion that adult sleep duration has declined. We investigated secular trends in sleep duration over the past 40 years through a systematic review.

Systematic search of 5 electronic databases was conducted to identify repeat cross-sectional studies of sleep duration in community-dwelling adults using comparable sampling frames and measures over time. We also attempted to access unpublished or semi-published data sources in the form of government reports, theses and conference proceedings. No studies were excluded based on language or publication date. The search identified 278 potential reports, from which twelve relevant studies were identified for review.

The 12 studies described data from 15 countries from the 1960s until the 2000s. Self-reported average sleep duration of adults had increased in 7 countries: Bulgaria, Poland, Canada, France, Britain, Korea and the Netherlands (range: 0.1–1.7 min per night each year) and had decreased in 6 countries: Japan, Russia, Finland, Germany, Belgium and Austria (range: 0.1–0.6 min per night each year). Inconsistent results were found for the United States and Sweden.

There has not been a consistent decrease in the self-reported sleep duration of adults from the 1960s to 2000s. However, it is unclear whether the proportions of very short and very long sleepers have increased over the same period, which may be of greater relevance for public health.

Table 1. Literature search strategy and number of results for each database.

View Within ArticleTable 2. Summary of included results by country (some studies have multiple results).

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

View the original article here

Secular trends in adult sleep duration: A systematic review

Little evidence exists to support the common assertion that adult sleep duration has declined. We investigated secular trends in sleep duration over the past 40 years through a systematic review.

Systematic search of 5 electronic databases was conducted to identify repeat cross-sectional studies of sleep duration in community-dwelling adults using comparable sampling frames and measures over time. We also attempted to access unpublished or semi-published data sources in the form of government reports, theses and conference proceedings. No studies were excluded based on language or publication date. The search identified 278 potential reports, from which twelve relevant studies were identified for review.

The 12 studies described data from 15 countries from the 1960s until the 2000s. Self-reported average sleep duration of adults had increased in 7 countries: Bulgaria, Poland, Canada, France, Britain, Korea and the Netherlands (range: 0.1–1.7 min per night each year) and had decreased in 6 countries: Japan, Russia, Finland, Germany, Belgium and Austria (range: 0.1–0.6 min per night each year). Inconsistent results were found for the United States and Sweden.

There has not been a consistent decrease in the self-reported sleep duration of adults from the 1960s to 2000s. However, it is unclear whether the proportions of very short and very long sleepers have increased over the same period, which may be of greater relevance for public health.

Table 1. Literature search strategy and number of results for each database.

View Within ArticleTable 2. Summary of included results by country (some studies have multiple results).

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

View the original article here

Longitudinal associations between sleep duration and subsequent weight gain: A systematic review

a Doctoral Program in Population Health and Clinical Outcomes Research, Department of Preventive Medicine, HSC Level 3, Stony Brook University, Stony Brook, NY 11794-8338, USAb Department of Preventive Medicine, Graduate Program in Public Health, HSC Level 3, room 071, Stony Brook University, Stony Brook, NY 11794-8338, USAReceived 31 December 2010. Revised 19 May 2011. Accepted 23 May 2011. Available online 23 July 2011.View full text To systematically examine the relationship between sleep duration and subsequent weight gain in observational longitudinal human studies.

Systematic review of twenty longitudinal studies published from 2004–October 31, 2010.

While adult studies (n = 13) reported inconsistent results on the relationship between sleep duration and subsequent weight gain, studies with children (n = 7) more consistently reported a positive relationship between short sleep duration and weight gain.

While shorter sleep duration consistently predicts subsequent weight gain in children, the relationship is not clear in adults. We discuss possible limitations of the current studies: 1) the diminishing association between short sleep duration on weight gain over time after transition to short sleep, 2) lack of inclusion of appropriate confounding, mediating, and moderating variables (i.e., sleep complaints and sedentary behavior), and 3) measurement issues.

prs.rt("abs_end");Sleep; Obesity; Weight gain; Longitudinal studiesBMI, Body mass index; CDC, Centers for Disease Control and Prevention

Figures and tables from this article:

Fig. 1. Illustration of literature search.

View Within ArticleFig. 2. Patel & Hu Model2 with media use added.

View Within ArticleTable 1. Adult studies.

View Within ArticleTable 2. Adult Study Independent Variables.

View Within ArticleTable 3. Children Studies.

View Within ArticleTable 4. Children Study Independent Variables.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Longitudinal associations between sleep duration and subsequent weight gain: A systematic review

a Doctoral Program in Population Health and Clinical Outcomes Research, Department of Preventive Medicine, HSC Level 3, Stony Brook University, Stony Brook, NY 11794-8338, USAb Department of Preventive Medicine, Graduate Program in Public Health, HSC Level 3, room 071, Stony Brook University, Stony Brook, NY 11794-8338, USAReceived 31 December 2010. Revised 19 May 2011. Accepted 23 May 2011. Available online 23 July 2011.View full text To systematically examine the relationship between sleep duration and subsequent weight gain in observational longitudinal human studies.

Systematic review of twenty longitudinal studies published from 2004–October 31, 2010.

While adult studies (n = 13) reported inconsistent results on the relationship between sleep duration and subsequent weight gain, studies with children (n = 7) more consistently reported a positive relationship between short sleep duration and weight gain.

While shorter sleep duration consistently predicts subsequent weight gain in children, the relationship is not clear in adults. We discuss possible limitations of the current studies: 1) the diminishing association between short sleep duration on weight gain over time after transition to short sleep, 2) lack of inclusion of appropriate confounding, mediating, and moderating variables (i.e., sleep complaints and sedentary behavior), and 3) measurement issues.

prs.rt("abs_end");Sleep; Obesity; Weight gain; Longitudinal studiesBMI, Body mass index; CDC, Centers for Disease Control and Prevention

Figures and tables from this article:

Fig. 1. Illustration of literature search.

View Within ArticleFig. 2. Patel & Hu Model2 with media use added.

View Within ArticleTable 1. Adult studies.

View Within ArticleTable 2. Adult Study Independent Variables.

View Within ArticleTable 3. Children Studies.

View Within ArticleTable 4. Children Study Independent Variables.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Restless legs syndrome and conditions associated with metabolic dysregulation, sympathoadrenal dysfunction, and cardiovascular disease risk: A systematic review

Kim E. Innesa, b, , , Terry Kit Selfea, b, c, , Parul Agarwala, d, a Department of Community Medicine, West Virginia University School of Medicine, PO Box 9190, Morgantown, WV 26506-9190, USAb Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, PO Box 800782, McLeod Hall, Charlottesville, VA 22908-0782, USAReceived 1 February 2011. Revised 7 April 2011. Accepted 11 April 2011. Available online 5 July 2011.View full text Restless legs syndrome (RLS) is a distressing sleep and sensorimotor disorder that affects a large percentage of adults in the western industrialized world and is associated with profound reductions in quality of life. However, the etiology of RLS remains incompletely understood. Enhanced understanding regarding both the antecedents and sequelae of RLS could shed new light on the pathogenesis of RLS. Evidence from an emerging body of literature suggests associations between RLS and diabetes, hypertension, obesity, and related conditions linked to sympathetic activation and metabolic dysregulation, raising the possibility that these factors may likewise play a significant role in the development and progression of RLS, and could help explain the recently documented associations between RLS and subsequent cardiovascular disease. However, the relation between RLS and these chronic conditions has received relatively little attention to date, although potential implications for the pathogenesis and treatment of RLS could be considerable. In this paper, we systematically review the recently published literature regarding the association of RLS to cardiovascular disease and related risk factors characterized by sympathoadrenal and metabolic dysregulation, discuss potential underlying mechanisms, and outline some possible directions for future research.

prs.rt("abs_end");Restless legs syndrome; RLS; Ekbom disease; Cardiovascular disease; Hypertension; Diabetes; Impaired glucose tolerance; Obesity; Weight gain; Dyslipidemia; Autonomic dysfunction; HPA axis dysfunction

Figures and tables from this article:

Table 1. Summary table of study characteristics. N = 30 studies (1995-2010).

Abbreviations: CVD = cardiovascular disease; DM = diabetes; DM2 = type 2 diabetes; dx = diagnosis; IGT = impaired glucose tolerance: IRLSSG = international restless legs syndrome study group; Min freq/sev = minimum frequency and/or severity; pts = patients; pts = patients; VA = veterans administration; w/ = with.

View Within ArticleTable 2. Relation of RLS to cardiovascular disease. Summary of study characteristics and findings (N = 15 studies published between 1995 and 2010).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CAD = Coronary artery disease; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD = International Classification of Diseases; ICSD = international classification of sleep disorders; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infraction; MONICA = monitoring trends and determinants in CVD survey-Augsburg; n’s = numbers; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OR = odds ratio (95% Confidence Interval); pt = patient; RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/o = without.*Calculated from data provided in paper.

View Within ArticleTable 3. Relation of RLS to hypertension: Summary of study characteristics and findings (N = 17 studies published between 1995 and 2010).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DBP = diastolic blood pressure; DM = diabetes mellitus; DM2 = type 2 diabetes; DM1 = type 1 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD9CM = international classification of diseases, 9th revision, clinical modification; ICSD = international classification of sleep disorders; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infarction; MONICA = monitoring trends and determinants in CVD survey-Augsburg; n’s = numbers; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OR = odds ratio (95% Confidence Interval); Pt = patient; RLS = restless legs syndrome; SBP = systolic blood pressure; SDB = Sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/in = within; w/o = without.* Calculated from data provided in paper.

View Within ArticleTable 4. Relation of RLS to diabetes and impaired glucose tolerance: Summary of study characteristics and findings (N=26 studies (1995-2010)).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BG = blood glucose; BMI = body mass index; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM1 = type 1 diabetes; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HOMA = homeostasis model assessment; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD9CM = international classification of diseases, 9th revision, clinical modification; IGT = impaired glucose tolerance; ICSD = international classification of sleep disorders; IGR = impaired glucose regulation; IGT = impaired glucose tolerance; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MONICA = monitoring trends and determinants in CVD survey-Augsburg; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OGTT = oral glucose tolerance test; OR = odds ratio (95% Confidence Interval); pts = patients; RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = Strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/in = within; w/o = without.*Calculated from data provided in table.

View Within ArticleTable 5. Relation of RLS to obesity, weight gain, and dyslipidemia: Summary of study characteristics and findings (N=18 studies with data on the association of RLS to obesity/weight gain, 7 studies with data on the association of RLS to lipid profiles).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BMI = body mass index; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM1 = type 1 diabetes; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICSD = international classification of sleep disorders; IRLS = intl RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infarction; MONICA = Monitoring trends and determinants in CVD survey-Augsburg; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OGTT = oral glucose tolerance test; OR = odds ratio (95% confidence interval); RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/o = without.*Calculated from data provided in paper.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Restless legs syndrome and conditions associated with metabolic dysregulation, sympathoadrenal dysfunction, and cardiovascular disease risk: A systematic review

Kim E. Innesa, b, , , Terry Kit Selfea, b, c, , Parul Agarwala, d, a Department of Community Medicine, West Virginia University School of Medicine, PO Box 9190, Morgantown, WV 26506-9190, USAb Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, PO Box 800782, McLeod Hall, Charlottesville, VA 22908-0782, USAReceived 1 February 2011. Revised 7 April 2011. Accepted 11 April 2011. Available online 5 July 2011.View full text Restless legs syndrome (RLS) is a distressing sleep and sensorimotor disorder that affects a large percentage of adults in the western industrialized world and is associated with profound reductions in quality of life. However, the etiology of RLS remains incompletely understood. Enhanced understanding regarding both the antecedents and sequelae of RLS could shed new light on the pathogenesis of RLS. Evidence from an emerging body of literature suggests associations between RLS and diabetes, hypertension, obesity, and related conditions linked to sympathetic activation and metabolic dysregulation, raising the possibility that these factors may likewise play a significant role in the development and progression of RLS, and could help explain the recently documented associations between RLS and subsequent cardiovascular disease. However, the relation between RLS and these chronic conditions has received relatively little attention to date, although potential implications for the pathogenesis and treatment of RLS could be considerable. In this paper, we systematically review the recently published literature regarding the association of RLS to cardiovascular disease and related risk factors characterized by sympathoadrenal and metabolic dysregulation, discuss potential underlying mechanisms, and outline some possible directions for future research.

prs.rt("abs_end");Restless legs syndrome; RLS; Ekbom disease; Cardiovascular disease; Hypertension; Diabetes; Impaired glucose tolerance; Obesity; Weight gain; Dyslipidemia; Autonomic dysfunction; HPA axis dysfunction

Figures and tables from this article:

Table 1. Summary table of study characteristics. N = 30 studies (1995-2010).

Abbreviations: CVD = cardiovascular disease; DM = diabetes; DM2 = type 2 diabetes; dx = diagnosis; IGT = impaired glucose tolerance: IRLSSG = international restless legs syndrome study group; Min freq/sev = minimum frequency and/or severity; pts = patients; pts = patients; VA = veterans administration; w/ = with.

View Within ArticleTable 2. Relation of RLS to cardiovascular disease. Summary of study characteristics and findings (N = 15 studies published between 1995 and 2010).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CAD = Coronary artery disease; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD = International Classification of Diseases; ICSD = international classification of sleep disorders; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infraction; MONICA = monitoring trends and determinants in CVD survey-Augsburg; n’s = numbers; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OR = odds ratio (95% Confidence Interval); pt = patient; RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/o = without.*Calculated from data provided in paper.

View Within ArticleTable 3. Relation of RLS to hypertension: Summary of study characteristics and findings (N = 17 studies published between 1995 and 2010).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DBP = diastolic blood pressure; DM = diabetes mellitus; DM2 = type 2 diabetes; DM1 = type 1 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD9CM = international classification of diseases, 9th revision, clinical modification; ICSD = international classification of sleep disorders; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infarction; MONICA = monitoring trends and determinants in CVD survey-Augsburg; n’s = numbers; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OR = odds ratio (95% Confidence Interval); Pt = patient; RLS = restless legs syndrome; SBP = systolic blood pressure; SDB = Sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/in = within; w/o = without.* Calculated from data provided in paper.

View Within ArticleTable 4. Relation of RLS to diabetes and impaired glucose tolerance: Summary of study characteristics and findings (N=26 studies (1995-2010)).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BG = blood glucose; BMI = body mass index; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM1 = type 1 diabetes; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HOMA = homeostasis model assessment; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD9CM = international classification of diseases, 9th revision, clinical modification; IGT = impaired glucose tolerance; ICSD = international classification of sleep disorders; IGR = impaired glucose regulation; IGT = impaired glucose tolerance; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MONICA = monitoring trends and determinants in CVD survey-Augsburg; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OGTT = oral glucose tolerance test; OR = odds ratio (95% Confidence Interval); pts = patients; RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = Strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/in = within; w/o = without.*Calculated from data provided in table.

View Within ArticleTable 5. Relation of RLS to obesity, weight gain, and dyslipidemia: Summary of study characteristics and findings (N=18 studies with data on the association of RLS to obesity/weight gain, 7 studies with data on the association of RLS to lipid profiles).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BMI = body mass index; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM1 = type 1 diabetes; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICSD = international classification of sleep disorders; IRLS = intl RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infarction; MONICA = Monitoring trends and determinants in CVD survey-Augsburg; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OGTT = oral glucose tolerance test; OR = odds ratio (95% confidence interval); RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/o = without.*Calculated from data provided in paper.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

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Restless legs syndrome and conditions associated with metabolic dysregulation, sympathoadrenal dysfunction, and cardiovascular disease risk: A systematic review

Kim E. Innesa, b, , , Terry Kit Selfea, b, c, , Parul Agarwala, d, a Department of Community Medicine, West Virginia University School of Medicine, PO Box 9190, Morgantown, WV 26506-9190, USAb Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, PO Box 800782, McLeod Hall, Charlottesville, VA 22908-0782, USAReceived 1 February 2011. Revised 7 April 2011. Accepted 11 April 2011. Available online 5 July 2011.View full text Restless legs syndrome (RLS) is a distressing sleep and sensorimotor disorder that affects a large percentage of adults in the western industrialized world and is associated with profound reductions in quality of life. However, the etiology of RLS remains incompletely understood. Enhanced understanding regarding both the antecedents and sequelae of RLS could shed new light on the pathogenesis of RLS. Evidence from an emerging body of literature suggests associations between RLS and diabetes, hypertension, obesity, and related conditions linked to sympathetic activation and metabolic dysregulation, raising the possibility that these factors may likewise play a significant role in the development and progression of RLS, and could help explain the recently documented associations between RLS and subsequent cardiovascular disease. However, the relation between RLS and these chronic conditions has received relatively little attention to date, although potential implications for the pathogenesis and treatment of RLS could be considerable. In this paper, we systematically review the recently published literature regarding the association of RLS to cardiovascular disease and related risk factors characterized by sympathoadrenal and metabolic dysregulation, discuss potential underlying mechanisms, and outline some possible directions for future research.

prs.rt("abs_end");Restless legs syndrome; RLS; Ekbom disease; Cardiovascular disease; Hypertension; Diabetes; Impaired glucose tolerance; Obesity; Weight gain; Dyslipidemia; Autonomic dysfunction; HPA axis dysfunction

Figures and tables from this article:

Table 1. Summary table of study characteristics. N = 30 studies (1995-2010).

Abbreviations: CVD = cardiovascular disease; DM = diabetes; DM2 = type 2 diabetes; dx = diagnosis; IGT = impaired glucose tolerance: IRLSSG = international restless legs syndrome study group; Min freq/sev = minimum frequency and/or severity; pts = patients; pts = patients; VA = veterans administration; w/ = with.

View Within ArticleTable 2. Relation of RLS to cardiovascular disease. Summary of study characteristics and findings (N = 15 studies published between 1995 and 2010).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CAD = Coronary artery disease; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD = International Classification of Diseases; ICSD = international classification of sleep disorders; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infraction; MONICA = monitoring trends and determinants in CVD survey-Augsburg; n’s = numbers; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OR = odds ratio (95% Confidence Interval); pt = patient; RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/o = without.*Calculated from data provided in paper.

View Within ArticleTable 3. Relation of RLS to hypertension: Summary of study characteristics and findings (N = 17 studies published between 1995 and 2010).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DBP = diastolic blood pressure; DM = diabetes mellitus; DM2 = type 2 diabetes; DM1 = type 1 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD9CM = international classification of diseases, 9th revision, clinical modification; ICSD = international classification of sleep disorders; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infarction; MONICA = monitoring trends and determinants in CVD survey-Augsburg; n’s = numbers; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OR = odds ratio (95% Confidence Interval); Pt = patient; RLS = restless legs syndrome; SBP = systolic blood pressure; SDB = Sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/in = within; w/o = without.* Calculated from data provided in paper.

View Within ArticleTable 4. Relation of RLS to diabetes and impaired glucose tolerance: Summary of study characteristics and findings (N=26 studies (1995-2010)).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BG = blood glucose; BMI = body mass index; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM1 = type 1 diabetes; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HOMA = homeostasis model assessment; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICD9CM = international classification of diseases, 9th revision, clinical modification; IGT = impaired glucose tolerance; ICSD = international classification of sleep disorders; IGR = impaired glucose regulation; IGT = impaired glucose tolerance; IRLS = international RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MONICA = monitoring trends and determinants in CVD survey-Augsburg; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OGTT = oral glucose tolerance test; OR = odds ratio (95% Confidence Interval); pts = patients; RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = Strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/in = within; w/o = without.*Calculated from data provided in table.

View Within ArticleTable 5. Relation of RLS to obesity, weight gain, and dyslipidemia: Summary of study characteristics and findings (N=18 studies with data on the association of RLS to obesity/weight gain, 7 studies with data on the association of RLS to lipid profiles).

Abbreviations: appt = appointment; ARIC = atherosclerosis risk in communities; BMI = body mass index; BOLD = the burden of obstructive lung diseases study; BP = blood pressure; btwn = between; CHF = congestive heart failure; CHS = cardiovascular health study; condn = condition; CVD = cardiovascular disease; DM = diabetes mellitus; DM1 = type 1 diabetes; DM2 = type 2 diabetes; dx = diagnosis; ECA = epidemiologic catchment area; F=female; FBG = fasting blood glucose; FHS = framingham heart study; Freq = frequency; Hgb = hemoglobin; HPFS = health professionals follow-up study; HTN = hypertension; hx = history; ICSD = international classification of sleep disorders; IRLS = intl RLS study group rating scale; IRLSSG = international restless legs syndrome study group; M = male; MEMO = the memory and morbidity in augsburg elderly study; MI = myocardial infarction; MONICA = Monitoring trends and determinants in CVD survey-Augsburg; NC-FP-RN = north carolina family practice research network; NHS II = nurses health study II; NSF = national sleep foundation poll; NY cohorts = new york hypertension cohorts; OGTT = oral glucose tolerance test; OR = odds ratio (95% confidence interval); RLS = restless legs syndrome; SDB = sleep disordered breathing; SHHS = sleep heart health study; SHS = strong heart study; SPAR = the official database covering the total population of Sweden; Sx = symptoms; TG = triglycerides; Tucson cohorts = tucson epidemiologic study of airways obstructive diseases and the health and environment study; tx = treatment; VA = veterans administration; w/ = with; w/o = without.*Calculated from data provided in paper.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

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