Saturday, September 23, 2017

Bicycling 'overloads' movement networks with Parkinson's

Bicycling 'Overloads' movement networks with parkinson's
Bicycling suppresses abnormal beta synchrony in the Parkinsonian basal ganglia, according to a study published online Sept. 11 in the Annals of Neurology.

23 sept 2017--Lena Storzer, Ph.D., from Heinrich Heine University Düsseldorf in Germany, and colleagues compared bicycling and walking in Parkinson's disease patients (five patients with and eight patients without freezing of gait) with electrodes implanted in the subthalamic nuclei for deep brain stimulation. Low (13 to 22 Hz) and high (23 to 35 Hz) beta power changes were analyzed in 13 patients (57.5 years; four female).
The researchers found that in patients without freezing of gait, both bicycling and walking led to a suppression of subthalamic beta power (13 to 35 Hz), and this suppression was stronger for bicycling. For those with freezing of the gait, a similar pattern was observed, in general. However, a movement-induced, narrowband power increase around 18 Hz was evident even in the absence of freezing.
"Abnormal ~18 Hz oscillations are implicated in the pathophysiology of freezing of gait, and suppressing them may form a key strategy in developing potential therapies," the authors write.
Several authors disclosed financial ties to the medical device industry.

More information: Abstract
Full Text (subscription or payment may be required)

Friday, September 22, 2017

Pelvic Floor Society statement—use of mesh surgeries for constipation and rectal prolapse

In light of ongoing concerns by the media and the public surrounding the use of mesh in women with pelvic organ prolapse and urinary incontinence, the Pelvic Floor Society has issued a consensus statement addressing the use of mesh for the treatment of constipation and rectal prolapse (via a surgical procedure called ventral mesh rectopexy, or VMR). The Statement is published in Colorectal Disease.

22 sept 2017--Mesh is a synthetic or biological material used to offer extra internal support. In a small number of patients, such meshes may cause problems, but according to the Pelvic Floor Society, evidence suggests that mesh-related complications for VMR are far lower than those seen in transvaginal procedures. The Society's statement addresses proper training and accreditation regarding VMR, as well as recommendations on tracking and recording complications and providing detailed consent forms and information booklets to patients.
"This important paper presents the evidence to support the use of Ventral Mesh Rectopexy in the treatment of constipation and rectal prolapse. It should reassure the profession and public that we take potential mesh complications very seriously," said Andrew Williams, Chair of the Pelvic Floor Society. "We are doing everything possible to improve education, provide detailed patient information, and record any complications to better understand the outcomes following this surgery."

More information: Colorectal DiseaseDOI: 10.1111/codi.13893


Provided by Wiley

Thursday, September 21, 2017

Do ketogenic diets help you lose weight?

Do ketogenic diets help you lose weight?
Ketogenic diets involve eating mostly fats. 
Is a ketogenic diet effective for weight loss? The answer depends on whether it achieves a reduction in total kilojoule intake or not.

What is a ketogenic diet?

A classical ketogenic diet follows a strict ratio for total grams of fat to combined grams of carbohydrate and protein and typically has 80-90% of total kilojoules coming from fat, which is very high fat. Carbohydrate intake varies from 20 to 50 grams a day, or 5-10% of total energy, while protein intakes are moderate.
The difference between a strict ketogenic diet and diets that are described as low-carb is that ketogenic diets specifically aim to achieve elevated blood levels of ketone bodies which are chemicals produced as a consequence of your body burning fat. Hence general low-carb diets are not as high in fat as classical ketogenic diets.
Research on the use of classical ketogenic diets for weight loss is limited. But there are many studies that compare lower-carb diets to other approaches.
These show that aiming for a carbohydrate restriction of 20-30 grams a day, without setting a daily kilojoule target, leads to 2-4 kilograms greater weight loss compared to a low kilojoule diet, in studies up to six months.
In longer studies with follow-up between one to five years there is no difference in weight loss. A review of weight loss diets with a moderate carbohydrate restriction (45% or less of total energy intake) compared to low fat diets (under 30% fat) found they were equally effective in reducing body weight in studies from six months to two years.

How much carbohydrate do we eat?

In Australia, current carbohydrate intakes range from approximately 210 to 260 grams a day, or about 45% of total energy intake. More than a third of what Australians currently eat comes from discretionary, or "junk" foods. It is definitely a good idea to cut down on discretionary foods. These are commonly ultra-processed and contain refined carbohydrates and include burgers, chips, pizza, crumbed foods, biscuits, cake, pastry, lollies, cordial, sugar sweetened juices and soft drink.
The problem is most people do not eat enough minimally processed, nutrient rich foods that contain carbohydrate, like legumes, wholegrain breads, cereals and other grains, vegetables, fruit, nuts, milk and yoghurt. These foods contain important nutrients, from dietary fibre, to B vitamins, and minerals and trace elements like iron, zinc, magnesium, calcium, selenium and iodine.
Your body needs these nutrients for digestion, metabolism, growth and repair of cells and to help protect the brain, heart, muscles and nerves.

What happens when you go on a ketogenic diet to lose weight?

If you severely limit all foods that contain carbohydrate, such as during a ketogenic diet, you end up cutting out many foods. This means you eat less total kilojoules and therefore lose weight.
Whether you follow a classical ketogenic diet or a very low energy diet you may end up producing "ketone bodies", which may help with weight loss, particularly fat mass.
Carbohydrate is used in the body as the major source of fuel, like petrol is used to fuel a car. Your body has a store of carbohydrate in the liver and muscles called glycogen. When glycogen stores are low your body switches to burning fat, which leads to production of ketone bodies.
Glycogen becomes limited when your total energy intake is very low, such as during a strict weight loss diet, a fast, or when you do not eat foods containing carbohydrate. This means your body burns the fat you eat, as well as body fat, leading to a loss of stored body fat. You still produce small amounts of glucose through a process called gluconeogenesis by breaking down protein and some fat.
Ketogenic diets and appetite
A systematic review evaluated how people perceived their appetite before and during a very low energy diet that contained less than 3,300 kilojoules a day or a ketogenic low carbohydrate diet containing less than 10% energy from carbohydrate (50 grams or less per day). Those following the very low energy diet reported less hunger and greater fullness and satiety during weight loss, while those following the ketogenic diet reported feeling less hunger and having less desire to eat. The authors concluded that although the absolute change in subjective appetite ratings were small, they were important in terms of helping people stick to a weight loss diet.
One research study followed 18 obese men during eight weeks of a ketogenic very low energy diet of 2300-2700 kilojoules per day, followed by four weeks of weight maintenance. They measured changes in appetite and blood concentrations of appetite hormones and ketones.
While hunger increased significantly by day three and up until the men lost 5% of their starting body weight, it did not get worse after that while they were dieting. Once they increased their food intake during maintenance, they had an increase in hunger. The good news was that while they were producing ketones, they appeared to be able to tolerate feeling hungry.

Ketogenic diets and weight loss

One randomised controlled trial randomly allocated 45 obese adults to either a ketogenic low energy diet of 2500-300 kilojoules per day for about two months or a low kilojoule diet where total daily energy intake was reduced by 10%.
As you would expect, those in the low energy group lost significantly more weight after one year. After two years, and accounting for those who dropped out, both groups lost weight (low energy 7kg versus 5.3kg low kilojoule). Of note was that a greater number in the low energy group lost 5% or more of their initial body weight at 12 months.
systematic review of nine studies in adults with type 2 diabetes following lower-carb diets (less than 130 grams a day or less than 25% energy from carbohydrate) compared to control weight loss diets found weight loss was greater up to one year in the lower-carb groups.
While there was no long-term difference in weight loss between dietary approaches, blood triglyceride concentrations were significantly lower and HDL (good) cholesterol concentrations were higher, but there was no reduction in total or LDL (bad) cholesterol.

Should you or shouldn't you?

If you have a family history of bowel cancer then don't follow a ketogenic weight loss diet. The World Cancer Research Fund has shown convincing evidence for a higher risk of colorectal cancer in association with low fibre and higher red and processed meat intakes.
Prevention guidelines recommend having greater variety, and higher intakes, of legumes, wholegrains, non-starchy vegetables and fruit.
When it comes to weight management, reduce your carbohydrate intake by reducing energy-dense, nutrient-poor foods. Increase minimally processed foods high in fibre and phytonutrients, including vegetables, legumes/pulses and wholegrains and only use classical ketogenic diets under supervision of your health care team.
This article was originally published on The Conversation. Read the original article.The Conversation

Provided by The Conversation

Sunday, September 17, 2017

Seven steps to keep your brain healthy from childhood to old age

brain

A healthy lifestyle benefits your brain as much as the rest of your body—and may lessen the risk of cognitive decline (a loss of the ability to think well) as you age, according to a new advisory from the American Heart Association/American Stroke Association.

17 sept 2017--Both the heart and brain need adequate blood flow, but in many people, blood vessels slowly become narrowed or blocked over the course of their life, a disease process known as atherosclerosis, the cause of many heart attacks and strokes. Many risk factors for atherosclerosis can be modified by following a healthy diet, getting enough physical activity, avoiding tobacco products and other strategies.
"Research summarized in the advisory convincingly demonstrates that the same risk factors that cause atherosclerosis, are also major contributors to late-life cognitive impairment and Alzheimer's disease. By following seven simple steps—Life's Simple 7—not only can we prevent heart attack and stroke, we may also be able to prevent cognitive impairment," said vascular neurologist Philip Gorelick, M.D., M.P.H., the chair of the advisory's writing group and executive medical director of Mercy Health Hauenstein Neurosciences in Grand Rapids, Michigan.
Life's Simple 7 outlines a set of health factors developed by the American Heart Association to define and promote cardiovascular wellness. Studies show that these seven factors may also help foster ideal brain health in adults.
The Life's Simple 7 program urges individuals to:
  • Manage blood pressure
  • Control cholesterol
  • Keep blood sugar normal
  • Get physically active
  • Eat a healthy diet
  • Lose extra weight
  • Don't start smoking or quit
A healthy brain is defined as one that can pay attention, receive and recognize information from our senses; learn and remember; communicate; solve problems and make decisions; support mobility and regulate emotions. Cognitive impairment can affect any or all of those functions.
The advisory, which is published in the American Heart Association's journal Stroke, stresses the importance of taking steps to keep your brain healthy as early as possible, because atherosclerosis—the narrowing of the arteries that causes many heart attacks, heart failure and strokes—can begin in childhood. "Studies are ongoing to learn how heart-healthy strategies can impact brain health even early in life," Gorelick said. Although more research is needed, he said, "the outlook is promising."
Elevations of blood pressure, cholesterol and blood sugar can cause impairment of the large and smaller blood vessels, launching a cascade of complications that reduce brain blood flow. For example, high blood pressure—which affects about 1 in 3 U.S. adults—is known to damage blood vessels that supply oxygen and nutrients to the heart and the brain, Gorelick noted. The damage can lead to a buildup of fatty deposits, or atherosclerosis as well as associated clotting. This narrows the vessels, can reduce blood flow to the brain, and can cause stroke or "mini-strokes." The resulting mental decline is called vascular cognitive impairment, or vascular dementia.
Previously, experts believed problems with thinking caused by Alzheimer's disease and other, similar conditions were entirely separate from stroke, but "over time we have learned that the same risk factors for stroke that are referred to in Life's Simple 7 are also risk factors for Alzheimer's disease and possibly for some of the other neurodegenerative disorders," Gorelick said.
The advisory also recognizes that it is important to follow previously published guidance from the American Heart Association, Institute of Medicine and Alzheimer's Association, which include controlling cardiovascular risks and suggest social engagement and other related strategies for maintaining brain health.
The action items from Life's Simple 7, which are based on findings from multiple scientific studies, meet three practical rules the panel developed in pinpointing ways to improve brain health—that they could be measured, modified and monitored, Gorelick said. Those three criteria make it possible to translate knowledge into action because healthcare providers can assess Life's Simple 7 elements—like blood pressure—easily; they can encourage proven, health-promoting steps and they can gauge changes over time.
The AHA advisory provides a foundation on which to build a broader definition of brain health that includes other influential factors, Gorelick said, such as the presence of atrial fibrillation, a type of irregular heartbeat that has been linked to cognitive problems; education and literacy; social and economic status; the geographic region where a person lives; other brain diseases and head injuries.
It is also a starting point for expanding research into areas such as whether there might be detectable markers, like genetic or brain imaging findings, that represent a susceptibiity for cardiovascular or brain illness, Gorelick said. "At some point in our lives, a 'switch' may be getting ready to 'flip,' or activate, that sets us in a future direction whereby we become at-risk for cognitive impairment and dementia."
Dementia is costly to treat. Direct care expenses are higher than for cancer and about the same for heart disease, estimates show. Plus, the value of unpaid caregiving for dementia patients may exceed $200 billion a year.
As lives stretch longer in the U.S. and elsewhere, about 75 million people worldwide could have dementia by 2030, according to the advisory. "Policy makers will need to allocate healthcare resources for this," Gorelick said. Monitoring rates of dementia in places where public health efforts are improving heart health "could provide important information about the success of such an approach and the future need for healthcare resources for the elderly," he said.
The authors of the advisory reviewed 182 published scientific studies to formulate their conclusions that following Life's Simple 7 has the potential to help people maintain a healthy brain throughout life.

More information: Stroke: Journal of the American Heart AssociationDOI: 10.1161/STR.0000000000000148


Provided by American Heart Association

Saturday, September 16, 2017

Talking to older adults about health prognosis may be helpful

Prognosis is the term for the most likely outcome of a medical condition. When it comes to health care, talking about your prognosis can be difficult for you, your family/friends, and even your healthcare providers. However, many of us prefer to talk to our healthcare providers about the expected course of an illness and about our life expectancy when living with a chronic or terminal illness. This is according to new research on advanced care planning (the technical term for having early conversations with our healthcare providers about our care needs, preferences, and expectations).

16 sept 2017--In a new study published in the Journal of the American Geriatrics Society, researchers examined how older adults with disabilities later in life might react to learning their prognosis, and how they evaluated their own prognosis compared to "official" estimates.
The study participants were 35 adults 70-years-old and older from four geriatrics clinics in the San Francisco Bay area. All the participants required help with daily activities, and they all participated in a 45-minute interview as part of the study.
The researchers asked older adults questions about how they would want to receive information about their life expectancy. For example, did they prefer hearing or reading news about their prognosis? Would they prefer receiving information about their prognosis while at home by themselves?
Additionally, participants circled the shortest, longest, and most likely number of years they thought they might live on a scale from zero to 30 years. Researchers then offered to give the participants an estimate of life expectancy with a visual presentation using an estimate system created for people older than age 50. Next, participants were given the option to see their prognosis. If they chose to see it, they discussed their reactions with the researchers. Afterward, researchers asked the participants 10 questions about their feelings based on hearing about estimated life expectancy. The researchers called the participants two to four weeks later to check on their reactions as a follow-up.
Over the course of the study, the researchers learned that:
  • 16 participants (46 percent) had life expectancy estimates that were within two years of the "most likely" estimate from a healthcare professional.
  • 15 participants (43 percent) over-estimated their own life expectancy by more than two years compared to the "most likely" estimate.
  • 4 participants (11 percent) under-estimated their own life expectancy by more than two years compared to the "most likely" estimate.
  • Overall, 30 participants (86 percent) estimated their life expectancy in a way that at least overlapped with the "official" estimated calculation.
The researchers concluded that most older adults wanted a health care practitioner to be present when discussing life expectancy. People in the study did not react with sadness or anxiety when they learned about life expectancies, though several disputed the calculated results.
"Health care practitioners may offer to discuss life expectancy with their older, disabled patients and expect the patients to tie the information into their own life narratives," said the researchers.
According to other research, key reasons for a healthcare professional's reluctance to have these discussions with their older adults may include:
  • Fear of taking away hope
  • Concern for a negative reaction
  • Time restraints
  • Poor training
  • Worry about giving someone a mistaken prognosis, leading to incorrect information about a person's future
Addressing these and other important concerns remains key to advance care planning, which has been shown to improve the quality of care we receive as we age.

More information: Theresa W. Wong et al, Prognosis Communication in Late-Life Disability: A Mixed Methods Study, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15025


Provided by American Geriatrics Society

Friday, September 15, 2017

Older drivers who experience falls may be at a higher risk for car crashes

As we age, our ability to drive may help us live independently, shop for ourselves, and maintain social connections. Although car crash rates are low among older adults and are declining, older adults do still have higher rates of fatal crashes. Falls, which are a common and preventable cause of injury among older adults, may lower our ability to drive safely.

15 sept 2017--Experts believe that falls are related to driving in four ways:
  • They can cause physical injury that limits mobility (our ability to move) and interferes with driving performance.
  • Falling can increase the fear of falling, which leads to a reduction in physical activity . Reduced physical activity can weaken our physical strength, which also could reduce fitness for driving.
  • Falls can affect an older adult's mental well-being, making them more fearful and leading to changes in driving behaviors.
  • Falls and difficulty driving may be caused by common factors, such as vision problems.
A research team created a study to see whether falls were related to driving risks and behaviors among older adults. Their study was published in the Journal of the American Geriatrics Society.
To test their theory that falls are related to car crashes, crash-related injuries, and changes in driving performance, the researchers reviewed 15 studies of driving behavior among older adults involving nearly 47,000 people.
The researchers learned that older adults who had fallen were 40 percent more likely to experience a car crash after their fall than older adults who had not fallen.
Based on estimates of car crashes involving older drivers and older adults who fall, falls—or the things that cause falls and crashes—accounted for more than 177,000 additional car crashes each year.
Researchers also learned that falls may be an independent factor impairing an older adult's ability to drive safely, suggesting that some motor vehicle crashes might be caused by the falls themselves - regardless of the driver's underlying health and functioning.
The researchers suggested that taking steps to reduce the conditions that contribute to both falls and car crashes could reduce the occurrence of both. Some strategies for doing so include:
  • Cataract surgery (a type of eye surgery that helps address cloudy vision)
  • Exercise to improve physical and mental well-being
  • Efforts to improve mental function
The researchers also suggested that for older adults who fall, post-fall rehabilitation might help improve functional ability and enable them to drive more safely.

More information: Kenneth A. Scott et al, Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta-Analysis, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15047


Provided by American Geriatrics Society

Thursday, September 14, 2017

Study shows so-called 'healthy obesity' is harmful to cardiovascular health

Study shows so-called 'healthy obesity' is harmful to cardiovascular health

Clinicians are being warned not to ignore the increased cardiovascular health risks of those who are classed as either 'healthy obese' or deemed to be 'normal weight' but have metabolic abnormalities such as diabetes.
Academics at the University of Birmingham's Institute of Applied Health Research carried out the largest study of its kind to date comparing weight and metabolic status to cardiovascular disease risks, published today (September 11th) in the Journal of the American College of Cardiology.

14 sept 2017--The study showed that individuals who are 'metabolically healthy obese' (MHO) - those who are obese but do not suffer metabolic abnormalities such as diabetes, high blood pressure and high cholesterol - have an increased risk of cardiovascular disease events compared to those who are normal weight without metabolic abnormalities.
The academics used electronic health records of 3.5 million British adults who were all initially free of cardiovascular disease (CVD). They then revisited each patient's record, at an average of 5 years and four months later, in order to assess whether they had gone on to develop each of four kinds of CVD events - coronary heart disease (CHD), cerebrovascular disease (in particular strokes), heart failure, or peripheral vascular disease (PVD).
Patients were divided into four 'body size phenotypes' using Body Mass Index (BMI), which is calculated by dividing body weight (kg) by height (m) squared:
1. Underweight (BMI less than 18.5)
2. Normal weight (more than 18 but less than 25)
3. Overweight (more than 25 but less than 30)
4. Obese (more than 30).
Three metabolic abnormalities were taken into consideration during the study: diabetes, hypertension and hyperlipidaemia. A metabolically healthy person was classified as having no metabolic abnormalities.
The results showed that those who were MHO had a 49 per cent higher risk of coronary heart disease, seven per cent higher risk of cerebrovascular disease and a 96 per cent increased risk of heart failure than normal weight metabolically healthy individuals.
Importantly, it also showed that 'normal' weight individuals with one or more metabolic abnormalities had an increased risk of CHD, cerebrovascular disease, heart failure and PVD compared to normal weight individuals without metabolic abnormalities.
The research results raise questions around the concept of 'healthy obesity'. Whether metabolically healthy obesity is associated with excess risk of cardiovascular disease has remained a subject of debate for many years due to limitations in previous studies. Academics at the University of Birmingham sought to address these limitations in the largest prospective study of its kind.
Lead author and epidemiologist Dr Rishi Caleyachetty, of the Institute of Applied Health Research University of Birmingham, said: "In our study, we had unprecedented statistical power to examine body size phenotypes by the number of metabolic abnormalities, potentially reflecting several definitions of the 'metabolically healthy' phenotype in relation to a range of CVD events.
"Obese individuals with no metabolic risk factors are still at a higher risk of coronary heart disease, cerebrovascular disease and heart failure than normal weight metabolically healthy individuals.
"So-called 'metabolically healthy' obesity is clearly not a harmless condition and the term should no longer be used in order to prevent misleading individuals that obesity can be healthy."
Senior author Professor Neil Thomas, also of the University of Birmingham, said it was important that clinicians took on board the research findings.
"The finding that normal weight individuals with metabolic abnormalities also had similar risk of cardiovascular disease events than normal weight metabolically healthy individuals has important implications." he added.
"In many countries it is currently recommended that clinicians in primary care settings use overweight and obesity as the main criteria to screen adults for cardiovascular risk factors as part of cardiovascular risk assessment. Our research suggests that this could result in the failure to identify metabolic abnormalities, such as diabetes, high blood pressure and high cholesterol, in many normal weight patients."
Senior author and Public Health physician Dr Krish Nirantharakumar, also of the University of Birmingham, said: "We conclude that obese patients, irrespective of their metabolic status, should be encouraged to lose weight and that early detection and management of normal weight individuals with metabolic abnormalities will be beneficial in the prevention of CVD events."

More information: Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women, Journal of the American College of Cardiology (2017). DOI: 10.1016/j.jacc.2017.07.763


Provided by University of Birmingham

Vitamin D deficiency tied to neuropathic pain

Vitamin D deficiency tied to neuropathic pain
Vitamin D deficiency may be associated with increased neuropathic pain (NP) in patients with rheumatoid arthritis (RA), according to a study published online Aug. 31 in the International Journal of Rheumatic Diseases.

14 sept 2017--Hilal Yesil, from Afyon Kocatepe University in Turkey, and colleagues used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire to evaluate NP in 93 patients with RA. Other data were obtained from medical records and interviews.
The researchers found that 80 percent of patients were female and one-third were diagnosed with NP according to the LANSS. There was a negative correlation between vitamin D levels and the LANSS score (P = 0.001). Among patients with serum vitamin D levels <20 0.71="" 5.8="" a="" area="" curve="" d="" diagnoses="" good="" higher="" in="" levels="" ml.="" ml="" ng="" np="" of="" p="" patients="" predictor="" prevalence="" ra="" serum="" than="" the="" times="" under="" vitamin="" was="" were="" with="">"Although further research is needed to clarify the association between serum vitamin D levels and NP, our study raises awareness of the need to screen for vitamin D deficiency in RA patients with NP," the authors write.

More information: Abstract
Full Text (subscription or payment may be required) 

Wednesday, September 13, 2017

Frailty and older men: Study identifies factors that speed/slow progression

As we age, we may be less able to perform daily activities because we may feel frail, or weaker than we have in the past. Frailer older adults may walk more slowly and have less energy. Frailty also raises a person's risks for falling, breaking a bone, becoming hospitalized, developing delirium, and dying.

13 sept 2017--No one knows exactly how many older adults are frail—estimates range from 4 percent to 59 percent of the older adult population, according to a 2015 study. Researchers say that frailty seems to increase with age, and is more common among women than men and in people with lower education and income. Being in poorer health and having several chronic illnesses also have links to being frail.
Frailty also tends to worsen over time, but in at least two studies, a small number (9 percent to 14 percent) of frail older adults became stronger and less frail as they aged. A team of researchers decided to find out what factors might predict whether frailty in older men worsens or improves over time. The researchers' findings were published in the Journal of the American Geriatrics Society.
The researchers examined information gathered from more than 5,000 men aged 65 or older (average age was about 73) who had volunteered for a study about bone fractures caused by osteoporosis (the medical term for a thinning of the bones, a loss of bone density, or increasingly fragile bones). At the start of the study, between 2000 and 2002, the men all lived independently and could walk; none had had hip replacements. Most of the men participated in a second examination about four years after the study began.
At the start of the study, the researchers determined the participants' frailty status by measuring levels of weakness, exhaustion, lean muscle mass, walking speed, and physical activity. They also asked the participants to fill out a questionnaire about their race, ethnicity, education, marital status, tobacco and alcohol use, and any diseases they had, as well as how they would self-rate their health.
The men were categorized as frail, pre-frail (had one or more signs of frailty, such as low grip strength, low energy, slow walking speed, low activity level or unintentional weight loss), or robust (showing no signs of frailty). The researchers tested the men to measure their ability to think and make decisions. They also assessed their ability to perform daily tasks such as eating, bathing, and performing other necessary activities. A group of 950 participants took blood tests to look for signs of inflammation.
At the start of the study, nearly 8 percent of the men were frail and 46 percent were pre-frail. The most common problems for the frail men were weakness, slowness, and low activity. Over four and a half years, the number of frail men increased while the proportion of robust men decreased. Among the men who were frail at both visits:
  • 56 percent had no change in frailty status
  • 35 percent had become frailer or had died
  • 15 percent of pre-frail or frail men improved
Having greater leg power, being married, and reporting good or excellent health were linked to improvements in frailty status. In fact, married men were 3.6 times more likely to improve their frailty status. Men who had trouble performing their daily activities, as well as those with diabetes or COPD/, were less likely to improve their frailty level.
Activities that preserve strength and exercises that target leg muscles, prevent chronic conditions like diabetes and COPD, and improve social support might be good ways to improve frailty and slow its progression, suggested the researchers.

More information: Lauren R. Pollack et al, Patterns and Predictors of Frailty Transitions in Older Men: The Osteoporotic Fractures in Men Study, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15003


Provided by American Geriatrics Society

Monday, September 11, 2017

Alcohol industry misleading the public about alcohol-related cancer risk

alcohol

Led by the London School of Hygiene & Tropical Medicine with the Karolinska Institutet, Sweden, the team analysed the information relating to cancer which appears on the websites and documents of nearly 30 alcohol industry organisations around the world between September 2016 and December 2016.

11 sept 2017--Most of the organisational websites (24/26) showed some sort of distortion or misrepresentation of the evidence about alcohol-related cancer risk, with breast and colorectal cancers being the most common focus of misrepresentation.
The most common approach involves presenting the relationship between alcohol and cancer as highly complex, with the implication or statement that there is no evidence of a consistent or independent link. Others include denying that any relationship exists or claiming inaccurately that there is no risk for light or 'moderate' drinking, as well discussing a wide range of real and potential risk factors, thus presenting alcohol as just one risk among many.
According to the study, the researchers say policymakers and public health bodies should reconsider their relationships to these alcohol industry bodies, as the industry is involved in developing alcohol policy in many countries, and disseminates health information to the public.
Alcohol consumption is a well-established risk factor for a range of cancers, including oral cavity, liver, breast and colorectal cancers, and accounts for about 4% of new cancer cases annually in the UK1. There is limited evidence that alcohol consumptionprotects against some cancers, such as renal and ovary cancers, but in 2016 the UK's Committee on Carcinogenicity concluded that the evidence is inconsistent, and the increased risk of other cancers as a result of drinking alcohol far outweighs any possible decreased risk².
This new study analysed the information which is disseminated by 27 AI-funded organisations, most commonly 'social aspects and public relations organisations' (SAPROs), and similar bodies. The researchers aimed to determine the extent to which the alcohol industry fully and accurately communicates the scientific evidence on alcohol and cancer to consumers. They analysed information on cancer and alcohol consumption disseminated by alcohol industry bodies and related organisations from English speaking countries, or where the information was available in English.
Through qualitative analysis of this information they identified three main industry strategies. Denying, or disputing any link with cancer, or selective omission of the relationship, Distortion: mentioning some risk of cancer, but misrepresenting or obfuscating the nature or size of that risk and Distraction: focussing discussion away from the independent effects of alcohol on common cancers.
Mark Petticrew, Professor of Public Health at the London School of Hygiene & Tropical Medicine and lead author of the study, said: "The weight of scientific evidence is clear - drinking alcohol increases the risk of some of the most common forms of cancer, including several common cancers. Public awareness of this risk is low, and it has been argued that greater public awareness, particularly of the risk of breast cancer, poses a significant threat to the alcohol industry. Our analysis suggests that the major global alcohol producers may attempt to mitigate this by disseminating misleading information about cancer through their 'responsible drinking' bodies."
A common strategy was 'selective omission' - avoiding mention of cancer while discussing other health risks or appearing to selectively omit specific cancers. The researchers say that one of the most important findings is that AI materials appear to specifically omit or misrepresent the evidence on breast and colorectal cancer. One possible reason is that these are among the most common cancers, and therefore may be more well-known than oral and oesophageal cancers.
When breast cancer is mentioned the researchers found that 21 of the organisations present no, or misleading, information on breast cancer, such as presenting many alternative possible risk factors for breast cancer, without acknowledging the independent risk of alcohol consumption.
Professor Petticrew said: "Existing evidence of strategies employed by the alcohol industry suggests that this may not be a matter of simple error. This has obvious parallels with the global tobacco industry's decades-long campaign to mislead the public about the risk of cancer, which also used front organisations and corporate social activities."
The researchers say the results are important because the alcohol industry is involved in conveying health information to people around the world. The findings also suggest that major international alcohol companies may be misleading their shareholders about the risks of their products, potentially leaving the industry open to litigation in some countries.
Professor Petticrew said: "Some public health bodies liaise with the industry organisations that we analysed. Despite their undoubtedly good intentions, it is unethical for them to lend their expertise and legitimacy to industry campaigns which mislead the public about alcohol-related harms. Our findings are also a clear reminder of the risks of giving the AI the responsibility of informing the public about alcohol and health.
"It has often been assumed that, by and large, the AI, unlike the tobacco industry, has tended not to deny the harms of alcohol. However, through its provision of misleading information it can maintain what has been called 'the illusion of righteousness' in the eyes of policymakers, while negating any significant impact on alcohol consumption and profits.
"It's important to highlight that if people drink within the recommended guidelines they shouldn't be too concerned when it comes to cancer. For accurate and accessible information on the risks, the public can visit the NHS website."
The authors acknowledge limitations of their study including that there are many other mechanisms and organisations through which industry disseminates health-related information which they did not examine, although it is unlikely that the messages would be different.
The researchers also say there is an urgent need to examine other industry websites, documents, social media and other materials in order to assess the nature and extent of the distortion of evidence, and whether it extends to other health information, for example, in relation to cardiovascular disease.

More information: Mark Petticrew et al, How alcohol industry organisations mislead the public about alcohol and cancer, Drug and Alcohol Review (2017). DOI: 10.1111/dar.12596


Provided by London School of Hygiene & Tropical Medicin

Thursday, September 07, 2017

New diagnostic tool spots first signs of Parkinson's disease

New diagnostic tool spots first signs of Parkinson's disease
The customized software records how a person draws a spiral and analyses the data in real time. A pen, paper and a large digital drawing tablet are the only equipment needed to run the test.
07 sept 2017--Researchers have developed the first tool that can diagnose Parkinson's disease when there are no physical symptoms, offering hope for more effective treatment of the condition.
There are currently no laboratory tests for Parkinson's and by the time people present to a neurologist with symptoms, nerve cells in their brains have already suffered irreversible damage.
The new diagnostic software developed by researchers from RMIT University in Melbourne, Australia, works with readily available technologies and has an accuracy rate of 93 per cent.
The research team hope the tool could one day be used as a standard screening test to spot the condition in its earliest stages.
Chief investigator Professor Dinesh Kumar said many treatment options for Parkinson's were effective only when the disease was diagnosed early.
"Pushing back the point at which treatment can start is critical because we know that by the time someone starts to experience tremors or rigidity, it may already be too late," Kumar said.
"We've long known that Parkinson's disease affects the writing and sketching abilities of patients, but efforts to translate that insight into a reliable assessment method have failed - until now.
"The customised software we've developed records how a person draws a spiral and analyses the data in real time. The only equipment you need to run the test is a pen, paper and a large drawing tablet.
"With this tool we can tell whether someone has Parkinson's disease and calculate the severity of their condition, with a 93 per cent accuracy rate.
"While we still have more research to do, we're hopeful that in future doctors or nurses could use our technology to regularly screen their patients for Parkinson's, as well as help those living with the disease to better manage their condition."
More than 10 million people worldwide are estimated to be living with Parkinson's disease, including 80,000 Australians. Parkinson's is the second most common neurological disease in Australia after dementia, with about 20 per cent of sufferers under 50 years old and 10 per cent diagnosed before the age of 40.
PhD researcher Poonam Zham led the study by the RMIT biomedical engineering research team, which specialises in e-health and the development of affordable diagnostic technologies.
Working with Dandenong Neurology in south-east Melbourne, the study involved 62 people diagnosed with Parkinson's disease - half had no visible symptoms and half ranged from mildly to severely affected.
Parkinson's severity assessed through drawing
The researchers developed specialized software and combined it with a tablet computer that can measure writing speed, and a pen that can measure pressure on a page. They used the system to measure pen speed and pressure during a simple spiral sketching task in a sample of healthy volunteers and Parkinson's patients with different levels of disease severity. 
The researchers compared the effectiveness of different dexterity tasks - writing a sentence, writing individual letters, writing a sequence of letters and sketching a guided Archimedean spiral - and determined that the spiral was the most reliable and also the easiest for participants to complete.
"Our study had some limitations so we need to do more work to validate our results, including a longitudinal study on different demographics and a trial of patients who are not taking medication," Zham said.
"But we're excited by the potential for this simple-to-use and cost-effective technology to transform the way we diagnose Parkinson's, and the promise it holds for changing the lives of millions around the world."
The research is published on 6 September in the journal Frontiers in Neurology.

More information: Poonam Zham et al, Distinguishing Different Stages of Parkinson's Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral, Frontiers in Neurology (2017). DOI: 10.3389/fneur.2017.00435


Provided by RMIT University