Telemedicine and data science can improve patient care

by Medical University of Vienna

Credit: CC0 Public Domain

The care of patients with chronic diseases could be improved by regular telemonitoring. This is the finding of a recent study conducted by Daniela Haluza, a health expert at MedUni Vienna's Center for Public Health. Austrian doctors who treat diabetes patients were surveyed, since this population of patients, in particular, benefits from continuous monitoring of their blood glucose levels, making their treatment more successful. Telemedicine applications also proved to be practicable and helpful for the treating doctors.

28 feb 2019--At the present time, there are approximately 600,000 people in Austria suffering from the chronic metabolic disorder diabetes mellitus, which is characterised by an excessively high blood glucose level. A distinction is made between two completely different forms of the disease. Type I diabetes is an autoimmune disease, in which a malfunction on the part of the immune system leads to deficiency of the vital hormone insulin. This rare form can manifest itself as early as childhood or adolescence and has to be treated by the life-long administration of insulin. It affects approximately 30,000 people in Austria.

The vast majority of diabetes patients suffer from Type II diabetes, where the key problem is insulin resistance. The response of the body's cells to insulin declines over time until the pancreas is no longer able to compensate for this resistance. This form of the disease is treated by lifestyle changes and by the use of specific medication. In both types of diabetes, regular monitoring of blood glucose levels is important, so that treatment can be adjusted to daily eating habits.

For a few years now, it has been possible to register these measurements via a mobile app on a smartphone, replacing the laborious blood glucose and food diary. This monitoring system also incorporates an alarm function, which immediately notifies the patient's doctor, who is also incorporated into the system, about any problems. The latter can then see the latest measurements on their computer screen or smart phone and adjust the treatment by making immediate contact with the patient, if necessary.

Daniela Haluza, Assistant Professor and medical specialist at MedUni Vienna's Center for Public Health says: "Telemedicine services could greatly improve the care of diabetes patients, while simultaneously reducing healthcare expenditure."

In order to assess the potential for the increased use of telemedicine in diabetes care in the future, Haluza and colleagues have now conducted a study to survey the experiences of doctors caring for diabetes patients. The doctors were asked about advantages and disadvantages, from their perspective, and about their readiness to offer these services.

The survey results show an overall positive picture for the use of telemedicine. Those questioned described themselves as being open to innovation and the majority of respondents reported that the quality of care had improved significantly due to the use of telemedicine. For example, patients did not have any travelling time and minimal waiting time. Plus, treatment regulation was much more efficient.

The disadvantages reported by respondents were that telemedicine reduces the personal interaction between doctors and patients. It also takes up more of the doctors' time, for which they are not yet adequately compensated by the service providers. Some people also said that the legal situation was problematic in terms of data protection.

Summing up the study, Daniela Haluza says: "Our data show a moderate readiness among Austrian doctors to use telemedicine in diabetes care. Joint efforts are required on the part of all healthcare stakeholders to firmly establish the contemporary use of telemedicine services within diabetes care. This would help that medical practitioners can overcome the perceived financial, organisational and technical obstacles."

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More information: Domenik Muigg et al. Readiness to use telemonitoring in diabetes care: a cross-sectional study among Austrian practitioners, BMC Medical Informatics and Decision Making(2019). DOI: 10.1186/s12911-019-0746-7

Provided by Medical University of Vienna

New 2019 guidelines for patients with atrial fibrillation

by University of Minnesota

Nearly 3 million Americans are living with atrial fibrillation (AFib), which is described as quivering or irregular heartbeat (arrhythmia). With increasing lifespan and increasing prevalence of risk factors such as obesity, experts believe the number of people living with AFib will increase at an exponential rate in the next decade. This has important public implications since AFib is associated with a higher risk of stroke, heart failure, cognitive decline and dementia, and death.

25 feb 2019--Lin Yee Chen, MD, MS, Associate Professor with Tenure, Cardiovascular Division, in the Department of Medicine with the University of Minnesota Medical School was part of a Writing Committee tasked with updating the 2014 guidelines for patients with AFib. The 2019 American College of Cardiology/American Heart Association/Heart Rhythm Society Guidelines for the Management of Patients with Atrial Fibrillationwere just published in Circulation, the Journal of the American College of Cardiology, and Heart Rhythm as the standard for the management of Afib in the U.S.

"These guidelines are written for all physicians in all specialties," said Chen. "It doesn't matter whether the clinician is an orthopedic surgeon, gynecologist, oncologist or brain surgeon, everyone is bound to encounter AFib in their patients because it is so prevalent."

One section of the new guidelines speaks to guiding practitioners across the whole spectrum of medicine, focusing on the use of new blood thinners or anticoagulants in people with AFib. The new guidelines help determine how and when to use these new agents, including in a situation that involves surgery.

Another portion of the document addresses the management of AFib in different scenarios, such as patients who have developed heart attacks.

"AFib patients are put on blood thinners to prevent stroke. When we need to perform procedures like a coronary angioplasty to open up any blockage in the heart arteries during a heart attack

 in AFib patients, we will also have to prescribe other agents called antiplatelets which when used in combination with blood thinners can elevate significantly the risk of bleeding, which is a real dilemma." said Chen. "Current research is now in favor of double therapy- one antiplatelet agent and one anticoagulant, as opposed to two antiplatelets and an anticoagulant."

A final section addresses the importance of weight-loss and weight management in improving the outcomes in people with AFib. In recent years, there is increasing evidence to suggest that lifestyle modification such as weight loss and physical activity can reduce the frequency and the burden of AFib. This has been incorporated into the new guidelines.

"The University of Minnesota could potentially make some significant contributions in the field of lifestyle modification and AFib," explained Chen. "Currently, I am the Principal Investigator of an Academic Health Center Faculty Research and Development grant which funds a randomized controlled trial aimed at evaluating different exercise protocols in reducing the burden of AFib.

"Being represented on the Writing Committee is a great honor for the University of Minnesota Medical School, because ultimately, the point of our research is to influence and impact the way we practice medicine," said Chen. "I think this is testimony to the outstanding research we perform for AFib at the University of Minnesota which is recognized by the American Heart Association and the American College of Cardiology."

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Provided by University of Minnesota

Evening exercise will not ruin sleep and might even reduce appetite: study

by The Physiological Society

Credit: CC0 Public Domain

Must cook dinner. Need to pick the kids up from school. Have to catch up on my favourite TV series. Live too far from the gym. Any of these sound familiar? With growing time demands, many middle-aged adults are finding time to engage in exercise increasingly difficult. For many, even the thought of fitting exercise in after a busy day at work can be as tiring as it is unappetising. The standing belief that high-intensity exercise should be avoided in the early evening due to its effect on sleep only serves to act as another barrier to exercise at this time.

24 feb 2019--However, encouraging new research published in Experimental Physiology has suggested that 30 minutes of high-intensity exercise performed in the early evening does not negatively affect subsequent sleep, and may also reduce feelings of hunger.

Researchers at Charles Sturt University in Australia recruited eleven middle-aged men to complete three experimental trials to investigate sleep and appetite responses to exercise performed in the morning (6—7 am), afternoon (2—4 pm) and evening (7—9 pm). Participants were required to perform high-intensity cycling involving six one-minute, maximal intensity sprints interspersed by four minutes of rest. Blood collections were taken prior to exercise and following exercise to examine appetite-related hormones, and multiple tests were performed during sleep to assess sleep stages.

The results not only showed that evening exercise did not have a detrimental impact on subsequent sleep, but also that afternoon and evening high-intensity exercise were associated with greater reductions of the hunger stimulating hormone, ghrelin. It is important to note that a single bout of exercise was not linked to reduced hunger, but nevertheless, the observations from this study support high-intensity exercise early in the evening as a viable time-of day for exercise.

As this study's sample size was relatively small, the findings extrapolated to other population groups beyond middle-aged men may be limited, given that sleep and appetite regulation are influenced by sex and age.

Penelope Larsen, lead author of the study, commented said:

"In the future, we hope to conduct similar studies recruiting women, to determine whether sleep and appetite responses may be different depending on sex. Also, this study only considered a single bout of exercise; therefore, it would be beneficial to investigate long-term sleep and appetite adaptations to high-intensity exercise training performed either in the morning, afternoon or evening."

Interestingly, power output during the sprint efforts was higher for the afternoon and evening trials compared to the morning trial, indicating that participants were able to perform better during latter parts of the day. Therefore, time-of-day may also need to be considered when planning training schedules."

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More information: Experimental Physiology, physoc.onlinelibrary.wiley.com … doi/10.1113/EP087455

Provided by The Physiological Society

People with osteoporosis should avoid spinal poses in yoga, study says

by Rhoda Madson, Mayo Clinic

Credit: CC0 Public Domain

Yoga postures that flex the spine beyond its limits may raise the risk of compression fractures in people with thinning bones, according to research from Mayo Clinic. The results appear in Mayo Clinic Proceedings.

23 feb 2019--Researchers at Mayo Clinic and elsewhere have described injuries from yoga. This study examines injuries in people with osteoporosis and osteopenia—conditions characterized by low bone density.

Osteoporosis is a disease in which bones become thinner and more porous from loss of mineral content. Bone loss that has not reached the stage of an osteoporosis diagnosis is called osteopenia.

Researchers reviewed the health records of 89 people—mostly women—referred to Mayo Clinic from 2006 to 2018 for pain they attributed to their yoga practice. Some were new to yoga. Others had practiced for years. They had pain in the back, neck, shoulder, hip, knee or a combination.

Patients identified 12 poses they said caused or aggravated their symptoms. The most common postures involved extreme flexing or extending of the spine. Researchers used patients' health records, medical exams and imaging to confirm and categorize the injuries as soft tissue, joint or bone injuries.

Researchers identified 29 bony injuries, including degeneration of disks, slippage of vertebrae and compression fractures. The latter appeared to be related to postures that put extra pressure on the vertebra and disks.

"Yoga has many benefits. It improves balance, flexibility, strength and is a good social activity," says Mehrsheed Sinaki, M.D., a Mayo Clinic physical medicine and rehabilitation specialist and the study's senior author. "But if you have osteoporosis or osteopenia, you should modify the postures to accommodate your condition. As people age, they can benefit by getting a review of their old exercise regimens to prevent unwanted consequences."

Patients who incorporated recommendations to modify their movements reduced their pain and improved their symptoms.

In a separate commentary, Edward Laskowski, M.D., co-chair of Mayo Clinic Sports Medicine, called on providers, patients and yoga teachers to work together to produce an individualized exercise prescription that considers the yoga student's medical history to protect against injury and provide optimal benefit.

The authors noted study limitations. The patients were seen in a musculoskeletal clinic at a tertiary care center, which makes generalizations difficult. Researchers received follow-up reports on 22 patients, as most lived out of state.

More information: Melody Lee et al, Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management, Mayo Clinic Proceedings (2019). DOI: 10.1016/j.mayocp.2018.09.024

Provided by Mayo Clinic

Having a sense of meaning in life is good for you. So how do you get one?

by Lisa A Williams, University of New South Wales

There’s a high degree of overlap between experiencing happiness and meaning. Credit: Shutterstock/KieferPix

The pursuit of happiness and health is a popular endeavour, as the preponderance of self-help books would attest.

22 feb 2019--Yet it is also fraught. Despite ample advice from experts, individuals regularly engage in activities that may only have short-term benefit for well-being, or even backfire.

The search for the heart of well-being – that is, a nucleus from which other aspects of well-being and health might flow – has been the focus of decades of research. New findings recently reported in Proceedings of the National Academy of Sciences point towards an answer commonly overlooked: meaning in life.

Meaning in life: part of the well-being puzzle?

University College London's psychology professor Andrew Steptoe and senior research associate Daisy Fancourt analysed a sample of 7,304 UK residents aged 50+ drawn from the English Longitudinal Study of Ageing.

Survey respondents answered a range of questions assessing social, economic, health, and physical activity characteristics, including: "To what extent do you feel the things you do in your life are worthwhile?"

Follow-up surveys two and four years later assessed those same characteristics again.

One key question addressed in this research is: what advantage might having a strong sense of meaning in life afford a few years down the road?

The data revealed that individuals reporting a higher meaning in life had:

• lower risk of divorce
• lower risk of living alone
• increased connections with friends and engagement in social and cultural activities
• lower incidence of new chronic disease and onset of depression
• lower obesity and increased physical activity
• increased adoption of positive health behaviours (exercising, eating fruit and veg).

On the whole, individuals with a higher sense of meaning in life a few years earlier were later living lives characterised by health and well-being.

You might wonder if these findings are attributable to other factors, or to factors already in play by the time participants joined the study. The authors undertook stringent analyses to account for this, which revealed largely similar patterns of findings.

The findings join a body of prior research documenting longitudinal relationships between meaning in life and social functioning, net wealth and reduced mortality, especially among older adults.

What is meaning in life?

The historical arc of consideration of the meaning in life (not to be confused with the meaning of life) starts as far back as Ancient Greece. It tracks through the popular works of people such as Austrian neurologist and psychiatrist Victor Frankl, and continues today in the field of psychology.

One definition, offered by well-being researcher Laura King and colleagues, says, "…lives may be experienced as meaningful when they are felt to have a significance beyond the trivial or momentary, to have purpose, or to have a coherence that transcends chaos."

This definition is useful because it highlights three central components of meaning:

1. purpose: having goals and direction in life
2. significance: the degree to which a person believes his or her life has value, worth, and importance
3. coherence: the sense that one's life is characterised by predictability and routine.

Curious about your own sense of meaning in life? You can take an interactive version of the Meaning in Life Questionnaire, developed by Steger and colleagues, yourself here.

This measure captures not just the presence of meaning in life (whether a person feels that their life has purpose, significance, and coherence), but also the desire to search for meaning in life.

Routes for cultivating meaning in life

Given the documented benefits, you may wonder: how might one go about cultivating a sense of meaning in life?

We know a few things about participants in Steptoe and Fancourt's study who reported relatively higher meaning in life during the first survey. For instance, they contacted their friends frequently, belonged to social groups, engaged in volunteering, and maintained a suite of healthy habits relating to sleep, diet and exercise.

Backing up the idea that seeking out these qualities might be a good place to start in the quest for meaning, several studies have causally linked these indicators to meaning in life.

For instance, spending money on others and volunteering, eating fruit and vegetables, and being in a well-connected social network have all been prospectively linked to acquiring a sense of meaning in life.

For a temporary boost, some activities have documented benefits for meaning in the short term: envisioning a happier future, writing a note of gratitude to another person, engaging in nostalgic reverie, and bringing to mind one's close relationships.

Happiness and meaning: is it one or the other?

There's a high degree of overlap between experiencing happiness and meaning—most people who report one also report the other. Days when people report feeling happy are often also days that people report meaning.

Yet there's a tricky relationship between the two. Moment-to-moment, happiness and meaning are often decoupled.

Research by social psychologist Roy Baumeister and colleagues suggests that satisfying basic needs promotes happiness, but not meaning. In contrast, linking a sense of self across one's past, present, and future promotes meaning, but not happiness.

Connecting socially with others is important for both happiness and meaning, but doing so in a way that promotes meaning (such as via parenting) can happen at the cost of personal happiness, at least temporarily.

Given the now-documented long-term social, mental, and physical benefits of having a sense of meaning in life, the recommendation here is clear. Rather than pursuing happiness as an end-state, ensuring one's activities provide a sense of meaning might be a better route to living well and flourishing throughout life.

Provided by University of New South Wales

End-of-life care should focus on quality of life, not prolonging it

by Lachlan Gilbert, University of New South Wales

Credit: Shutterstock

Terminally ill, older adults would prefer to receive higher quality supportive care rather than aggressive end-of-life treatments to prolong their lives, a UNSW Sydney study has found.

21 feb 2019--In an article published recently in the journal Health Expectations, the authors interviewed 24 older adults in NSW who were either terminally ill or cared for a person faced with advanced or irreversible disease, to determine whether their end-of-life (EOL) care needs were being met. The researchers were then able to identify a list of common themes that patients or their caregivers expressed about their health care experience.

The seven themes were identified as follows: quality as a priority; a desire for a sense of control; living a life on hold; the need for health system support; a preference for being at home; talking about death; and dealing with competent and caring health professionals. An underpinning priority throughout the seven themes was knowing and adhering to patient's wishes.

To date, much of the research concerning consumer preferences around end-of-life care has been undertaken in the oncology setting. But according to lead author of the study, UNSW School of Public Health and Community Medicine's Ebony Lewis, the latest findings look at older terminal patients with a range of chronic conditions beyond cancer, as well as including caregivers.

Ms Lewis says the study found that older terminally ill health care consumers and caregivers have a strong community-based preference for less aggressive EOL treatments and higher quality supportive care in line with their personal values. But despite this, many older Australians are still spending their last weeks of life in hospital.

"While the government recognises the importance of providing high-quality and safe end-of-life care, and has developed guiding principles for its provision, our consultation found that 'real life' alternative options for end-of-life care outside the acute hospital may not be available,"Ms Lewis says.

"Urgent strategies are needed to support terminal care outside the acute hospital as well as tools to give health care professionals the ability to deliver more skilled end-of-life communication that incorporates the patients' personal values."

Ms Lewis says such action would address this gap in services as well as the unmet care needs of older adults and relatives caring for dying patients, which ultimately affects everyone in society.

"The general community is also affected by the traumatic experiences of their elders whose suffering and dying processes are prolonged without gains in quality end-of-life. This can leave families with great regret and can cause dissatisfaction with health services."

Ageing population

The fact that the proportion of those over 65 in the Australian population is expected to double in the next 30 years is also a pressing concern for Ms Lewis.

"Our growing ageing population will have an impact on the efficiency and workload of emergency services and hospitals. Our health system needs to start getting ready to face this challenge." Ms Lewis says.

"An increase in demand for services will end up contributing to the escalating cost of non-beneficial intensive care or surgical treatments. Doing everything that is technically available for older people dying of natural causes is not necessarily appropriate and leads to inequities of access available to the rest of the general population."

Rather than persisting with care guidelines that have evolved out of top-down delegation of health policy and practice, Ms Lewis and her co-authors call for a community-based approach for terminal care services.

This would require better communication between medical staff and patients and between patients and their families to ensure expectations are met in palliative and supportive care.

"Much work remains in the area of increasing public awareness of the need to hold the conversations with their family and GP about what people consider unacceptable and what they are prepared to go through in the event of a health crisis when they cannot speak for themselves," says Ms Lewis.

The research authors also call for the development of planning tools for medical staff enabling them to identify earlier those people who are near the end of life and whose end-of-life care needs have not been articulated.

"We're working on improving shared decision-making to facilitate advance care planning," Ms Lewis says. "We hope that using these in routine clinical care may offer a valuable strategy to reduce both unnecessary hospitalisations and low-value care."

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Provided by University of New South Wales

Improved access to greenspace for older adults needs to be considered

by University of Otago

Credit: CC0 Public Domain

Older people's inability to engage in nature can leave them feeling sad, frustrated and angry, a University of Otago study has found.

20 feb 2019--Lead author, Associate Professor Yolanda van Heezik, of the Department of Zoology, says contact with nature enhances people's physical, mental and spiritual well-being – from reducing stress and blood pressure to enhancing mood and social interactions.

However, older adults' ability to experience nature is often diminished by declining health and mobility, and home type.

"As most people living into advanced old age often experience significant physical disability, the restorative benefits derived from the natural environment are not as readily accessible.

"Nearby green spaces such as home gardens become increasingly important as sites where people can see and interact with nature," Associate Professor van Heezik says.

The researchers investigated older adults occupying family, downsized, and rest homes to determine factors related to changes in nature engagement, and the quality of available nature as people age.

Their findings, published in the journal Environment and Behavior, revealed older people spent less time in natural places as they aged, and that garden variability meant the quality of nature experience was likely lower for those living in downsized and rest homes.

While many people were quite happy and accepting of their situation, others conveyed the opposite.

"Although a strong personal connection to nature reduced the decline in time older adults spent in natural landscapes, a significant proportion of those reporting negative impacts with regard to nature encounters and engagement, expressed feelings of sadness, frustration, and anger," she says.

Co-author Associate Professor Debra Waters says participants reported that gardens became an important place to feel close to nature when reduced mobility prevented them from visiting more natural spaces.

"Gardens of family homes were found to be most effective in supporting well-being as they contained more trees, woody plants, and the types of shrubs that attract birds.

"For those with limited mobility, window views have been found to be restorative, and family homes offered views with more natural features," she says.

Associate Professor van Heezik hopes the study will help people understand the value of green spaces with diverse vegetation.

"Private gardens are becoming threatened in the face of policies for more compact urban growth, but these are the spaces where older adults can enjoy nature, largely irrespective of age and frailty," she says.

Co-author Professor Claire Freeman, of the School of Geography, says it is important for policy makers and planners to incorporate accessible green spaces when designing environments.

Local councils should play a role in educating the public by modelling how small spaces can be landscaped to include a range of vegetation and support biodiversity, while landscaping of rest home gardens could move away from a focus on colourful shrubs to include more trees and native species likely to attract birds.

"We know that even where there is good greenspace provision it may not be accessible for older adults as they can't walk or drive to it, so they need green immediately around their home.

"Gardens that attract birds are also highly valued by urban residents and were specifically mentioned by a number of people in the study," she says.

Ways for family and friends to help older people engage in nature:

• Help them in the garden if they are physically unable to maintain it
• If they live in a down-sized home, help plan a small garden that is still diverse and will attract birds
• If they live in a rest home help them go outside and sit in the garden when they visit; take them for drives to places that are meaningful to them

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More information: Yolanda van Heezik et al. Factors Affecting the Extent and Quality of Nature Engagement of Older Adults Living in a Range of Home Types, Environment and Behavior (2018). DOI: 10.1177/0013916518821148

Provided by University of Otago

Flu shot much more effective this year, CDC says

by Steven Reinberg, Healthday Reporter

This year's flu shot is already outperforming the vaccine issued during the tough 2017-2018 influenza season, federal health officials reported Thursday.

18 feb 2019--The 2017-2018 flu shot offered just 25 percent effectiveness against the predominant strain of flu that season, H3N2. But this year's shot offers 47 percent protection against all circulating strains, according to researchers at the U.S. Centers for Disease Control and Prevention.

In other words, getting the current vaccinecould nearly cut in half your odds of acquiring a severe case of the flu.

The news was even better for vaccinated kids.

"For children aged 6 months to 17 years, overall vaccine effectiveness was 61 percent," the CDC team reported.

That's based on data up to Feb. 2 on nearly 3,300 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness Network, said investigators led by Dr. Joshua Doyle of the CDC's Influenza Division.

Still, the latest agency statistics show that the United States remains in the grip of the flu and the season may not have peaked yet.

As of Feb. 2, flu is widespread in 47 states, and 24 states are experiencing high levels of the disease. In addition, hospitalizations are increasing, CDC research showed.

"Flu activity has continued to increase," Lynnette Brammer, the lead of CDC's domestic influenza surveillance team, said when the stats were released last Friday.

The most common type of flu around is still the influenza A strain H1N1. But it may be waning, Brammer said, as the level of influenza A H3N2 has increased.

Both of these flu strains are included in this year's vaccine.

The CDC stressed that everyone over 6 months of age should get the flu shot.

Even during last year's brutal season, when the flu shot had relatively low effectiveness, the vaccine saved many lives.

"Vaccination [during 2017-2018] was estimated to prevent 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations and 8,000 deaths," Doyle's team reported.

This flu season is expected to continue for several more weeks, probably well into March, Brammer noted.

"There's still a lot more flu season to come," she said. "I expect activity to continue for several more weeks."

That's why she's urging anyone who hasn't yet been vaccinated to get a flu shot. "It's not too late," Brammer said.

One underrated benefit of the vaccine is that even if you do get sick, your flu will likely be milder than if you haven't been vaccinated. A milder flu can prevent complications like pneumonia that can be deadly, especially to the very young and very old.

Brammer also stressed that getting vaccinated not only protects you, but those around you, as well.

According to the CDC, flu activity is high in New York City, Alabama, Alaska, Arkansas, Colorado, Connecticut, Georgia, Indiana, Kansas, Kentucky, Massachusetts, Mississippi, Nebraska, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia and West Virginia.

It's still too early to tell how severe this season will be, Brammer said. So far, the season has been much less severe than last year when the H3N2 virus predominated. Last year, flu sent nearly 1 million Americans to the hospital and killed about 80,000.

This season is still classified as a less severe season, Brammer said. "But we're not finished yet," she said. "We'll have to see how it plays out."

The CDC doesn't track adult deaths from flu, but they do keep tabs on pediatric deaths. As of the latest data, a total to 28 children have died from flu.

If you get the flu, antiviral drugs such as Tamiflu and Relenza can make your illness less severe. But if you're sick, the CDC recommends that you stay home so you don't infect others.

The vaccine effectiveness study was published Feb. 15 in the CDC's Morbidity and Mortality Weekly Report.

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More information: Lynnette Brammer, M.P.H., lead, domestic influenza surveillance team, U.S. Centers for Disease Control and Prevention; Feb. 15, 2019, Morbidity and Mortality Weekly Report

For more about the flu, visit the U.S. Centers for Disease Control and Prevention.

Removing the stigma surrounding the sex lives of the over 60s will help improve sexual health

by University of Sheffield

Credit: CC0 Public Domain

The stigma surrounding the sex lives of older adults is being tackled with a pioneering website which aims to improve sexual health in the over 60s.

17 feb 2019--Age, Sex and You is the first website in the UK dedicated solely to providing advice about sex and intimate relationships for older peoplewho feel reluctant to talk to their doctor or get advice from family and friends.

The website has been launched by researchers from the University of Sheffield who, in a recent study, found the prejudice and discrimination that older people face when seeking support for their sexual needs significantly affects their health and wellbeing.

Sexually transmitted infection (STI) diagnosis in people aged between 50 and 70 has risen by a third in recent years. However, the Sheffield study found that age-related stereotypes and embarrassment can prevent older adults from getting appropriate care for a sexual concern or advice about practising safe sex.

Dr. Sharron Hinchliff from the University of Sheffield's School of Nursing and Midwifery led the study and the creation of the pioneering website.

"A third of over-70s have sex at least twice a month but they face huge barriers particularly when it comes to seeking advice about sexual health," said Dr. Hinchliff.

"We know that many older adults enjoy sex and intimacy, and both are important factors in their quality of life," said Dr. Hinchliff.

"Our bodies change as we get older, which can lead to sexual changes, and it is really important to understand what changes are common with age, but importantly when to seek professional help.

"Erectile dysfunction affects around 30 per cent of men aged 65-74 and uncomfortable vaginal dryness affects 20 per cent of women in the same age group, however many are too embarrassed to go to the doctor. This can impact on your psychological wellbeing and cause stress, anxiety or relationship difficulties.

"We are now living well, for longer, so it is increasingly important that we tackle the stigma surrounding the sex lives of older people. We hope the website will become a vital resource for people looking for evidence—based advice they can trust."

Dr. Hinchliff is a Reader in Psychology and Health and the founder of #SexRightsAge, a national campaign to recognise the sexual rights of older adults. She leads a programme of research which explores ageing, sexual health, intimate relationshipsand psychological factors of health, in order to improve patient quality of life and inform healthcare practice.

For more information about Age, Sex and You please visit: www.agesexandyou.com

Your exercise performance is a better predictor of longevity than your chronological age

by European Society of Cardiology

Credit: CC0 Public Domain

Sophia Antipolis, 14 February 2019: It's often said: It's not how old you are, it's how old you feel. New research shows that physiological age is a better predictor of survival than chronological age. The study is published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

16 feb 2019--"Age is one of the most reliable risk factors for death: the older you are, the greater your risk of dying," said study author Dr. Serge Harb, cardiologist at the Cleveland Clinic in the United States. "But we found that physiological health is an even better predictor. If you want to live longer then exercise more. It should improve your health and your length of life."

Based on exercise stress testing performance, the researchers developed a formula to calculate how well people exercise—their "physiological age—which they call A-BEST (Age Based on Exercise Stress Testing). The equation uses exercise capacity, how the heart responds to exercise (chronotropic competence), and how the heart raterecovers after exercise.

"Knowing your physiological age is good motivation to increase your exercise performance, which could translate into improved survival," said Dr. Harb. "Telling a 45-year-old that their physiological age is 55 should be a wake-up call that they are losing years of life by being unfit. On the other hand, a 65-year-old with an A-BEST of 50 is likely to live longer than their peers."

The study included 126,356 patients referred to the Cleveland Clinic between 1991 and 2015 for their first exercise stress test, a common examination for diagnosing heart problems. It involves walking on a treadmill, which gets progressively more difficult. During the test, exercise capacity, heart rate response to exercise, and heart rate recovery are all routinely measured. The data were used to calculate A-BEST, taking into account gender and use of medications that affect heart rate.

The average age of study participants was 53.5 years and 59% were men. More than half of patients aged 50-60 years—55% of men and 57% of women—were physiologically younger according to A-BEST. After an average follow-up of 8.7 years, 9,929 (8%) participants had died. As expected, the individual components of A-BEST were each associated with mortality.

Patients who died were ten years older than those who survived. But A-BEST was a significantly better predictor of survival than chronological age, even after adjusting for sex, smoking, body mass index, statin use, diabetes, hypertension, coronary artery disease, and end-stage kidney disease. This was true for the overall cohort and for both men and women when they were analysed separately.

Dr. Harb said doctors could use A-BEST to report results of exercise testing to patients "Telling patients their estimated age based on exercise performance is a powerful estimate of longevity and easier to understand than providing results for the individual components of the examination."

Dr. Harb noted that this type of approach has shown merit in specific disease areas. For example, ESC guidelines advocate using "cardiovascular risk age—based on risk factors including smoking, blood cholesterol and blood pressure—to communicate with patients.

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More information: Serge C Harb et al, Estimated age based on exercise stress testing performance outperforms chronological age in predicting mortality, European Journal of Preventive Cardiology(2019). DOI: 10.1177/2047487319826400

Massimo F. Piepoli et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice, European Heart Journal (2016). DOI: 10.1093/eurheartj/ehw106

Provided by European Society of Cardiology

Study finds upsurge in 'active surveillance' for low-risk prostate cancer

by Dana-Farber Cancer Institute

A section of a prostate gland containing numerous cancer cells. Credit: Dana-Farber Cancer Institute

Many men with low-risk prostate cancer who most likely previously would have undergone immediate surgery or radiation are now adopting a more conservative "active surveillance" strategy, according to an analysis of a new federal database by scientists from Dana-Farber Cancer Institute.

13 feb 2019--The use of active surveillance increased from 14.5 percent to 42.1 percent of men with low-risk prostate cancer between 2010 and 2015, said the researchers, led by Brandon Mahal, MD, from the department of radiation oncology at Dana-Farber/Brigham and Women's Cancer Center who led the study published by JAMA.

During that same period, the percentage of men undergoing radical prostatectomy (removal of the prostate gland) declined from 47.4 percent to 31.3 percent. The use of radiotherapy for low-risk disease dropped from 38.0 percent to 26.6 percent.

"What we know from high level evidence is that conservative management of low-risk prostate cancer is associated with a very favorable prognosis," said Mahal. "Many men with low-risk disease are able to be spared the toxicity of treatment so it's an important discussion to have between clinicians and patients."

National guidelines advocating conservative management rather than immediate "definitive treatment" with surgery or radiotherapy were established in 2010 for men with low-risk prostate cancer. Low-risk disease is defined as a small tumor confined to the prostate gland that is assigned a grade of 6 on the Gleason scale following a biopsy; an early pathological stage, and a low PSA (prostate-specific antigen) blood level. 

Brandon Mahal, MD from the department of radiation oncology at Dana-Farber/Brigham and Women's Cancer Center explains research findings on conservative management for low-risk prostate cancer. Credit: Dana-Farber Cancer Institute

"This encouraging finding suggests that clinicians are better adhering to current recommendations and guidelines for men with low-risk prostate cancer, as the use of active surveillance in appropriately selected men will reduce rates of overtreatment," said Howard Soule, Ph.D., executive vice president and chief science officer of the Prostate Cancer Foundation.

Mahal said men with low-risk tumors have a "very, very low risk of dying" from prostate cancer, and that invasive treatments don't necessarily improve survival odds. In the current study, Mahal and his colleagues, including senior author Paul Nguyen, MD, a Dana-Farber/Brigham and Women's Cancer Center radiation oncologist, made use of a federal database that for the first time specified whether patients made use of watchful waiting or active surveillance. (Patients adopting a watchful waiting approach are told to report symptoms such as changes in urinary habits, pain, or irritation, or bone pain that could reflect metastatic progression. Active surveillance involves periodic follow-up tests for PSA levels, repeat biopsies, and exams by a doctor every six to 12 months).

The study also revealed changes in treatment for high-risk prostate cancer from 2010 to 2015—though the researchers were somewhat surprised by the findings. The use of radical prostatectomy increased from 38 percent to 42.8 percent during that period, while radiotherapy decreased from 60.1 percent to 55 percent.

"This shift in management patterns away from radiation therapy and toward more radical prostatectomy is not supported by any recent high-level studies," said Mahal. "This finding is provocative and may be a focal point of debate."

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More information: JAMA (2019). DOI: 10.1001/jama.2018.19941

Provided by Dana-Farber Cancer Institute