How excess holiday eating disturbs your 'food clock'

31 dec 2012—If the sinful excess of holiday eating sends your system into butter-slathered, brandy-soaked overload, you are not alone: People who are jet-lagged, people who work graveyard shifts and plain-old late-night snackers know just how you feel.

All these activities upset the body's "food clock," a collection of interacting genes and molecules known technically as the food-entrainable oscillator, which keeps the human body on a metabolic even keel. A new study by researchers at UCSF is helping to reveal how this clock works on a molecular level.

Published this month in the journal Proceedings of the National Academy of Sciences, the UCSF team has shown that a protein called PKCγ is critical in resetting the food clock if our eating habits change.

The study showed that normal laboratory mice given food only during their regular sleeping hours will adjust their food clock over time and begin to wake up from their slumber, and run around in anticipation of their new mealtime. But mice lacking the PKCγ gene are not able to respond to changes in their meal time – instead sleeping right through it.

The work has implications for understanding the molecular basis of diabetes, obesity and other metabolic syndromes because a desynchronized food clock may serve as part of the pathology underlying these disorders, said Louis Ptacek, MD, the John C. Coleman Distinguished Professor of Neurology at UCSF and a Howard Hughes Medical Institute Investigator.

It may also help explain why night owls are more likely to be obese than morning larks, Ptacek said.  

"Understanding the molecular mechanism of how eating at the "wrong" time of the day desynchronizes the clocks in our body can facilitate the development of better treatments for disorders associated with night-eating syndrome, shift work and jet lag," he added.

Resetting the Food Clock

Look behind the face of a mechanical clock and you will see a dizzying array of cogs, flywheels, reciprocating counterbalances and other moving parts. Biological clocks are equally complex, composed of multiple interacting genes that turn on or off in an orchestrated way to keep time during the day.

In most organisms, biological clockworks are governed by a master clock, referred to as the "circadian oscillator," which keeps track of time and coordinates our biological processes with the rhythm of a 24-hour cycle of day and night.

Life forms as diverse as humans, mice and mustard greens all possess such master clocks. And in the last decade or so, scientists have uncovered many of their inner workings, uncovering many of the genes whose cycles are tied to the clock and discovering how in mammals it is controlled by a tiny spot in the brain known as the "superchiasmatic nucleus."

Scientists also know that in addition to the master clock, our bodies have other clocks operating in parallel throughout the day. One of these is the food clock, which is not tied to one specific spot in the brain but rather multiple sites throughout the body.

The food clock is there to help our bodies make the most of our nutritional intake. It controls genes that help in everything from the absorption of nutrients in our digestive tract to their dispersal through the bloodstream, and it is designed to anticipate our eating patterns. Even before we eat a meal, our bodies begin to turn on some of these genes and turn off others, preparing for the burst of sustenance – which is why we feel the pangs of hunger just as the lunch hour arrives.

Scientist have known that the food clock can be reset over time if an organism changes its eating patterns, eating to excess or at odd times, since the timing of the food clock is pegged to feeding during the prime foraging and hunting hours in the day. But until now, very little was known about how the food clock works on a genetic level.

What Ptacek and his colleagues discovered is the molecular basis for this phenomenon: the PKCγ protein binds to another molecule called BMAL and stabilizes it, which shifts the clock in time.

More information: The article, "PKCγ participates in food entrainment by regulating BMAL1" is authored by Luoying Zhang, Diya Abrahama, Shu-Ting Lin, Henrik Oster, Gregor Eichele, Ying-Hui Fu, and Louis J. Ptácek and appears in the Proceedings of the National Academy of Sciences. www.pnas.org/conte… 679.abstract

Provided by University of California, San Francisco

Study shows how dark chocolate may be good for our health—particularly if you are male

Dr Baukje de Roos

30 dec 2012—Cocoa-rich dark chocolate might help protect against heart disease and stroke, but probably more so if you are a man.

That's one of the findings of scientists at the University of Aberdeen Rowett Institute of Nutrition and Health who studied what happened in the blood of volunteers after they ate dark chocolate specially boosted with cocoa extract.

Cardiovascular disease (CVD) - diseases of the heart and circulatory system - is one of the biggest killers in the industrial world, accounting for more deaths each year than any other disease in Europe and America. One characteristic of CVD is impaired blood flow and the increased formation of blood clots.

Clots are formed when platelets in our blood - normally responsible for the prevention of bleeding - become over-active and stick together. This increases the risk of blockage of blood vessels which can result in heart attacks and strokes.

Platelet function can be affected by several medications but also by compounds from various foods. Some found in fruit, vegetables, herbs, spices, teas and wines have been linked to improved platelet function.

However compounds called flavanols which are found in cocoa appear to produce the most consistent beneficial effects on platelet function. Until now the number of studies looking at the effects of flavanols on platelet function has been limited.

Researchers set out to investigate platelet function in the blood of healthy volunteers after they had eaten dark chocolate enriched with a specially manufactured cocoa extract to boost the levels of flavanols.

This was compared with platelet function in those who had eaten dark chocolate - with a lower cocoa and flavanol content - and white chocolate. Blood and urine samples were taken and then analysed two hours and six hours after chocolate consumption.

Dr Baukje de Roos, from the University of Aberdeen Rowett Institute of Nutrition and Health, led the study. She said: "Platelets play a key role in wound healing, but certain conditions, such as being obese, having diabetes or being a smoker, can cause platelets to go into overdrive, resulting in the formation of blood clots or thrombosis and obstruction of blood vessels.

"Cocoas is a rich source of flavanols and we already knew that flavanols can stop platelets sticking together but we didn't know how they did this."

The scientists were looking at a range of platelet function tests such as platelet activation - a reversible process where platelets are starting to get stressed and sticky - and platelet aggregation - an irreversible process when sticky platelets clump together.

They discovered that the specially enriched dark chocolate significantly decreased both platelet activation and aggregation in men; however it only decreased platelet aggregation in women. The strongest effects were seen two hours after the chocolate had been eaten.

Researchers also measured bleeding time – which shortens as platelets become stickier. They found that the specially enriched dark chocolate significantly increased bleeding time after six hours in both men and women, possibly caused by the metabolites that our bodies produce from flavanols.

"It was especially interesting to see that both men and women had improvements in their platelet function, but in different ways. The strength of the effects seems to be more pronounced in men," said Dr De Roos.

"Our study found that compounds deemed responsible for the beneficial effects, flavanols and their metabolites, are appearing in the blood stream and in our urine within hours of consumption, and are having a positive impact on platelet function effects.

"Nevertheless, it is important to remember that these findings are not a carte blanche to eat chocolates as they are extremely rich in fat and sugar. But if you are going to eat chocolate - and there will be plenty on offer over the festive spell - it's better to choose dark chocolate, containing at least 70% cocoa.

"We hope that our findings could ultimately help with the development of healthier foods and food supplements."

More information: The study is published in Molecular Nutrition Food Research.

Provided by University of Aberdeen

Study links disease, poverty and biodiversity

Poverty and disease often come together. That much is well understood. But how much does poverty foster disease? Or, how much can disease perpetuate poverty? And what's the role of nature, given that so many infectious diseases are spread by mosquitoes or spend part of their life cycle outside of the human body?

29 dec 2012--A new study finds that certain types of infectious and parasitic diseases have a significant influence on economic development across the world and accounts for some of the differences in per-capita income between those who live in countries in the tropics or those in temperate latitudes.

And the team of economists and ecologists suggests that healthy forests or other ecosystems, with broad diversity of plants and animals, can ease the burden of parasitic diseases and those spread by mosquitoes or other vectors.

The authors, writing in the Public Library of Science Biology, make these assertions based on an extensive analysis of data from the World Bank on per-capita income in 139 countries and the burden of parasitic and vector-borne diseases as measured by lives lost as well as time lost to illness.

Although many economists now recognize that malaria and hookworm can hamper economic growth, the authors write, "an intense debate remains on the relative importance of general disease burden on global patterns of wealth and poverty."

Many of the extremely poor live in the tropics, the latitudes that tend to harbor more infectious diseases.

The study, led by Matthew H. Bonds, an economist and ecologist at Harvard Medical School's department of global health and social medicine, wanted to look beyond how the differences in latitudes correlate with disease and poverty. They also wanted to control for other economic influences, such as well-functioning government, legal and economic institutions.

Disentangling cause and effect can be tricky, and the authors used a statistical approach to evaluate the relative importance of various causal factors, while controlling for variables.

"Our model indicates that vector-borne and parasitic diseases (VBPDs) have systematically affected economic development," the authors write. "Importantly, we show that the burden of VBPDs is, in turn, determined by underlying ecological conditions. In particular, the model predicts that the burden of disease will rise as biodiversity falls."

The study explains that some diseases, such as Lyme disease and malaria, rely on other hosts for part of their life cycle and can increase as these non-human hosts multiply with the loss of predators and competitors. For example, rodent populations soar when coyotes, wolves, owls or other predators aren't around to eat them.

"Our study shows that biodiversity also seems important in boosting economic welfare - probably through its impact on buffering disease outbreaks," said Andrew P. Dobson, a co-author who studies infectious diseases at Princeton University's department of ecology and evolutionary biology.

Their findings suggest, he said, "that the U.S. and many tropical nations would have much healthier economies if they spent more on health care and saved more biodiversity."

(c)2012 Los Angeles Times 
Distributed by MCT Information Services

Early menopause tied to greater type 2 diabetes risk

Women who experience early menopause have a greater risk of type 2 diabetes, according to a study published online Dec. 10 in Diabetes Care.

28 dec 2012—Women who experience early menopause have a greater risk of type 2 diabetes, according to a study published online Dec. 10 in Diabetes Care.

Judith S. Brand, from the University Medical Center Utrecht in the Netherlands, and colleagues analyzed data from 3,691 postmenopausal case subjects with type 2 diabetes and 4,408 subcohort members included in the InterAct study, a prospective case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition study.

The researchers found that, over a median follow-up of 11 years, relative to women with menopause at age 50 to 54 years, for women with menopause at ages younger than 40; 40 to 44; 45 to 49; and 55 years and older, the hazard ratios (HRs) for type 2 diabetes were 1.32 (95 percent confidence interval [CI], 1.04 to 1.69); 1.09 (95 percent CI, 0.90 to 1.31); 0.97 (95 percent CI, 0.86 to 1.10); and 0.85 (95 percent CI, 0.70 to 1.03), respectively. There was a higher diabetes risk with shorter reproductive life span (HR per SD lower reproductive life span, 1.06; 95 percent CI, 1.01 to 1.12). The effect was not significantly modified by body mass index, waist circumference, or smoking.

"Early menopause is associated with a greater risk of type 2 diabetes," Brand and colleagues conclude.

One author disclosed receiving funding from Novo Nordisk.

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

Men with fibromyalgia often go undiagnosed, Mayo Clinic study suggests

Fibromyalgia is a complex illness to diagnose and to treat. There is not yet a diagnostic test to establish that someone has it, there is no cure and many fibromyalgia symptoms—pain, fatigue, problems sleeping and memory and mood issues—can overlap with or get mistaken for other conditions. A new Mayo Clinic study suggests that many people who have fibromyalgia, especially men, are going undiagnosed. The findings appear in the online edition of the journal Arthritis Care & Research.

27 dec 2012--More research is needed, particularly on why men who reported fibromyalgia symptoms were less likely than women to receive a fibromyalgia diagnosis, says lead author Ann Vincent, M.D., medical director of Mayo Clinic's Fibromyalgia and Chronic Fatigue Clinic.

"Health care providers may not think of this diagnosis when face to face with a male patient with musculoskeletal pain and fatigue," Dr. Vincent says. "These findings need to be explored further."

Researchers focused on Olmsted County, Minn., home to a comprehensive medical records pool known as the Rochester Epidemiology Project, and used multiple methods to try to get at the number of people over age 21 with fibromyalgia.

They used the epidemiology project to identify just over 3,000 patients who looked like they might have fibromyalgia: Roughly a third had a documented fibromyalgia diagnosis. That amounted to 1.1 percent of the county's population 21 and older.

In the second method, researchers randomly surveyed Olmsted County adults using the American College of Rheumatology's fibromyalgia research survey criteria. The criteria include the hallmarks of fibromyalgia: widespread pain and tenderness, fatigue, feeling unrested after waking, problems with memory or thinking clearly and depression or anxiety, among other symptoms. Of the 830 who responded to the survey, 44, or 5.3 percent, met those criteria, but only a dozen had been diagnosed with fibromyalgia.

Based on the study's findings, the researchers estimate that 6.4 percent of people 21 and older in Olmsted County have fibromyalgia—far more than have been officially diagnosed with it.

Fibromyalgia is more common in women, but men can get it too. The discrepancy between the number of people reporting fibromyalgia symptoms and the number actually diagnosed with the condition was greatest among men, the study found. Twenty times more men appeared to have fibromyalgia based on their survey response than had been diagnosed, while three times more women reported fibromyalgia symptoms than were diagnosed.

"It is important to diagnose fibromyalgia because we have effective treatments for the disorder," says co-author Daniel Clauw, M.D., director of the University of Michigan Health System Chronic Pain & Fatigue Research Center.

Studies also show that properly diagnosing people with fibromyalgia reduces health care costs, because they often need far less diagnostic testing and fewer referrals looking for the cause of their pain, Dr. Clauw says.

More information: onlinelibrary.wile… 896/abstract

Provided by Mayo Clinic

Elevated levels of C-reactive protein appear associated with psychological distress, depression

Elevated levels of C-reactive protein, a marker of inflammatory disease, appear to be associated with increased risk of psychological distress and depression in the general population of adults in Denmark, according to a report published Online First by Archives of General Psychiatry, a JAMA Network publication.

26 dec 2012--Depression is one of the leading causes of disability and previous studies suggest that low-grade systemic inflammation may contribute to the development of depression. C-reactive protein (CRP) is a commonly used marker of inflammation, and inflammatory disease is suspected when CRP levels exceed 10 mg/L. Researchers are unclear whether and to what extent elevated CRP levels are associated with psychological distress and depression in the general population, according to the study background.

Marie Kim Wium-Andersen, M.D., of Herlev Hospital and Copenhagen University Hospital, Denmark, and colleagues examined whether elevated plasma levels of CRP were associated with distress and depression. Researchers analyzed CRP levels using data from two general population studies in Copenhagen, which included 73,131 men and women ages 20 to 100 years.

"The main finding of this study consisted of an association of elevated CRP levels with an increased risk for psychological distress and depression in the general population," the authors comment.

Increasing CRP levels were associated with increasing risk for psychological distress and depression in analyses. For self-reported antidepressant use, the odds ratio was 1.38 for CRP levels of 1.01 to 3 mg/L, 2.02 for 3.01 to 10 mg/L, and 2.7 for greater than 10 mg/L compared with 0.01 to 1 mg/L. For prescription of antidepressants, the corresponding odds ratios were 1.08, 1.47 and 1.77, respectively; for hospitalization with depression they were 1.30, 1.84 and 2.27 respectively. Other analyses suggest that increasing CRP levels also were associated with increasing risk for hospitalization with depression, according to the study results.

"More research is needed to establish the direction of the association between CRP and depression because this study and others are primarily cross-sectional. The results also support the initiation of intervention studies to examine whether adding anti-inflammatory drugs to antidepressants for treatment of depression will improve outcome," the authors conclude.

More information: Arch Gen Psychiatry. Published online December 24, 2012. doi:10.1001/2013.jamapsychiatry.102

Provided by JAMA and Archives Journals

Study links personality changes to changes in social well-being 

Researchers show that certain personality traits are associated with higher social well-being. Credit: Chelsey B. Coombs

25 dec 2012—Researchers report that changes in social well-being are closely tied to one's personality, with positive changes in one corresponding to similar changes in the other. Their study reveals potential new mechanisms that can help individuals thrive as they age.

Their findings appear in Social Psychological and Personality Science.

Psychologists often use the "big five" traits – extroversion, openness to experience, conscientiousness, agreeableness and neuroticism – to describe personality. A person who scores high in extroversion, for example, is highly outgoing, friendly and active. Those who score high in conscientiousness are organized, responsible and hardworking. Although previous studies have shown that these traits tend to stabilize over time, evidence also has shown that they can change as a person ages.

Social well-being is related to an individual's connectedness to the larger community and the belief that he or she can contribute to society's growth. It is a good predictor of general mental and physical health, and people with higher social

well-being often are more civically engaged and are more apt to behave in a pro-social manner.

University of Illinois psychology professor Brent Roberts and postdoctoral researcher Patrick Hill used data from the Mid-Life Development in the U.S. (MIDUS) study to determine how the Big Five personality traits and social well-being of adults relate to each other over time.

"We all know people who we get along with well and the characteristics of those people," Hill said. "And the question is how that kind of social well-being, that kind of social connectedness, might coincide with those dispositional characteristics that are in the kinds of people that we like to seek out in the world."

In the MIDUS study, participants answered survey questions to determine their big five personality traits and social well-being on two separate occasions about nine years apart.

An analysis of the responses revealed that adult social well-being is linked to personality over time. Those who scored higher on extroversion, agreeableness, conscientiousness, emotional stability and openness had higher social well-being. Those who gained in these traits over time often showed comparable gains in their social well-being.

"If you change the traits that help you in your social life, your social life also improves. Similarly, if you improve your social life, you're going to see the benefits with respect to an improvement in your disposition," Hill said.

Roberts believes that the application of these results can lead to benefits as people age.

"This shows that social well-being and social structures are related to personality development, which is also related to thriving health," he said. "So this is identifying a whole new pathway through which some of these mechanisms might actually help older people thrive."

The paper, "Examining Concurrent and Longitudinal Relations Between Personality Traits and Social Well-Being in Adulthood," is available online.

Provided by University of Illinois at Urbana-Champaign

Stack your plate high this Christmas, but with consideration, author suggests

The author of a new RSC book on the science behind obesity is urging Christmas diners to stack their festive plates high with food.

24 dec 2012--But, says Dr Claire Allardyce, their eyes should feast on the plate's contents before the fork is lifted.

Scientist Dr Claire Allardyce, writer of Fat Chemistry said today: "The mind has a powerful influence over what we think we have eaten and how satisfied we become.

"Recent research suggests that our memory of a meal is important in determining how full we feel. If our memory is of holding back or half-filling our plates, we are likely to be more hungry in the short-term than if we remember eating our fill."

"Load up your plate, but stick to single servings: When it comes to food maths, the brain has an annoying habit of forgetting second and subsequent servings. If you visualize your whole meal on a plate - take time to look at it in detail - you can help your supercomputer take stock of what you ate.

"And the despondence of depriving yourself of that once-a-year treat may do more harm than good."

Dr Allardyce added: Christmas has been a dieters' nightmare for decades because of the well-known high calorie content of roast spuds, Christmas pudding and the dreaded cheese board, not to forget the more welcome alcoholic accompaniments.

"Christmas may be the one time of year your body gets a good feed. Focus on filling up your plate with vegetables and forget about the calories in your favorite indulgences."

"Enjoying food with family and friends gives a feel-good factor as powerful against weight gain as some of the pills and potions sold over the counter."

But what about the calories? Can we really throw caution to the wind?

Dr Allardyce suggests that we can - if we follow some simple guidelines.

Start with a salad

Studies show a low-calorie salad starter dramatically reduces how much volunteers ate during their main course. On the other hand an energy-dense appetizer - those cheese stuffed potato skins, for example - has the opposite effect.

Be traditional with turkey

Turkey is a low fat meat and delicious if cooked correctly. If you find it dry, go American and soak it overnight in water before roasting it upside down.

Don't be shy with the vegetables

Christmas is a time when there is the opportunity to go to town on vegetables. Cook as many different vegetable accompaniments as you feel able. It is proven that we humans like variety and will eat more when various flavours are on offer. As vegetables are central to good health and weight control, there is rarely such a thing as too much.

Think about condiments

Most condiments are loaded with sugar and salt. Yes it is Xmas, but reducing salt intake was singled out by the World Health Organisation as the educational program that was likely to reap the biggest dividends in terms of world health. Instead, flavour up the meal with lashings of gravy (low salt of course) and loads of vegetables.

Accompany the meal with a high calcium mineral water

Calcium supplements have been shown to help weight loss on a calorie controlled diet, not least because this mineral binds to fat preventing its absorption. Cleanse your palate during Christmas dinner with a glass of high calcium mineral water and you could also be going some way to reduce the calories that enter your body.

Provided by Royal Society of Chemistry

Alcohol may trigger serious palpitations in heart patients

The term "holiday heart syndrome" was coined in a 1978 study to describe patients with atrial fibrillation who experienced a common and potentially dangerous form of heart palpitation after excessive drinking, which can be common during the winter holiday season. The symptoms usually went away when the revelers stopped drinking. Now, research from UCSF builds on that finding, establishing a stronger causal link between alcohol consumption and serious palpitations in patients with atrial fibrillation, the most common form of arrhythmia.

23 dec 2012--In a paper scheduled to be published August 1 in the American Journal of Cardiology, the UCSF researchers report that people with atrial fibrillation had almost a four and a half times greater chance of having an episode if they were consuming alcohol than if they were not.

"One of the remaining big unknowns is why or how this happens," said senior author Gregory Marcus, MD, assistant professor of medicine at the UCSF Division of Cardiology. "In a previous publication, we suggested that there was an effect on the electrical activity of the atrium that leads to these arrhythmias but we do need additional studies to prove that."

Alcohol and Heart Palpitations

In the study, conducted from September 2004 to March 2011, UCSF researchers interviewed 223 patients with documented cardiac arrhythmia, a term that encompasses both atrial fibrillation and supraventricular tachycardia (SVT), or rapid heart rate originating above the ventricles. Researchers asked patients, "Does alcohol trigger your heart palpitations?" Participants ranked their symptoms on a scale from one to five (i.e. never, rarely, sometimes, frequently, and always).

"We defined 'yes' as frequently or always versus the rest of the responses," Marcus said, "and found that, after adjusting for potential confounders, atrial fibrillation patients had statistically significant greater odds of reporting that alcohol would trigger their symptoms." Of those patients interviewed, 133 reported intermittent or paroxysmal atrial fibrillation, or irregular heart palpitations, when drinking, and 90 had SVT, without any atrial fibrillation. After adjusting for variables, the paroxysmal atrial fibrillation group had a 4.42 greater chance of reporting alcohol consumption as an arrhythmia trigger, compared to the SVT group. Patients' claims of atrial fibrillation were verified by surface electrocardiograms and invasive cardiac studies.

The mean age of the study participants was 59 years. Eighty percent were Caucasian; 11 percent were Asian; 5 percent Latino, and 4 percent declined to state their ethnicity in the atrial fibrillation group. All were referred to and studied at UCSF.

"We didn't find any clear associations between age and race as a trigger, but we probably had insufficient number of people in the study," Marcus said.

Studying the Effects of Alcohol

Other studies have suggested that alcohol could help decrease the chance of developing atherosclerosis, which clogs or narrows the arteries. One of the proposed sources of benefit is the antioxidant in red wine called resveratrol, which may help prevent heart disease by increasing the "good" cholesterol in a person's body.

"There may be some beneficial effects to alcohol, but it's important to look at actual heart outcomes, like stroke and death," Marcus said. "Keep in mind that we used to think estrogen was good for your heart based on observational studies, and now we know that's not exactly true."

He says there's insufficient information at this time to recommend any lifestyle changes related to alcohol and heart disease risk. Still he points out that this report and previous reports indicate alcohol can cause cardiomyopathy and worsen hypertension.

"If someone has heart palpitations or atrial fibrillation, I'm often asked, 'Can I drink at all?'" Marcus said. "And I don't know the answer, but it may be that certain people are susceptible.

"The clinical evidence suggests that some people are susceptible and other people aren't, but if they know that they're susceptible they should avoid alcohol," he said.

Provided by University of California, San Francisco

Tips for having a heart-healthy holiday

22 dec 2012—It's the season of joy, peace and goodwill, but it's also the time of year that brings a spike in heart attacks with most occurring on Christmas Day, Boxing Day and New Year's Day.

Dubbed by heart researchers as the "Merry Christmas Coronary," it can be triggered by stressful events or other risk factors, says cardiologist Dr. Greg Curnew, an associate clinical professor of medicine of McMaster's Michael G. DeGroote School of Medicine, on staff at Hamilton Health Sciences.

A heart attack – caused by a rupture of plaque in the wall of a coronary artery - strikes when you least suspect it, says Curnew. "It's like a volcano erupting."

Most heart deaths occur out of hospital, with one in four of those dying within one hour of their first-ever symptoms. He outlines heart attack signs as: 

• Chest pain that lasts for at least 10 minutes – coming on suddenly or slowly – and feeling like heaviness or a steel band tightening around the chest.
• Chest discomfort that spreads to the neck, throat, jaw and shoulder, the back, arms and even the hands.
• For those who don't experience chest pain, be aware of discomfort in upper parts of the body.
• A choking feeling in the throat, or arms that feel heavy or useless.
• Breathlessness, nausea or vomiting, a cold sweat, light-headedness.

"If you think you are having a heart attack, this is not the time to call telemedicine or your family doctor. Get straight to the hospital," says Curnew.

He recommends chewing two baby Aspirins or taking one or two nitroglycerine tables three to five minutes apart – but not if you are on medication for sexual dysfunction, such as Viagra – and call 911 immediately.

While it's the time of year for overindulging in rich, salty foods, Curnew warns that eating just one fatty meal constricts blood flow in arteries for the next three to four hours.

He advises anyone taking cholesterol-lowering drugs to not stop taking their prescribed dosage.

Curnew offers potential New Year's resolutions for consideration: 

• Learn basic life support skills and how to use an external defibrillator.
• Become an active participant in your health with your doctor and develop a health binder that you constantly update.
• Join the Good Food Box program; a non-profit fresh fruit and vegetable distribution program which makes fresh, high quality produce affordable and accessible to everyone.
• If you want to lose weight, join a group or find a health buddy.

"For me, this is a time of year to celebrate and to feel lucky to be here for the holidays, and with a wish to be here next year, too," says Curnew.

Provided by McMaster University

Aging, end-of-life expert offers advice for coping with holiday blues

It may be the most wonderful time of the year. But the holidays can also be a time of sadness and loneliness, especially for those dealing with recent death, illness or changes in family life.

21 dec 2012--Wendy Lustbader, an affiliate associate professor at the School of Social Work at the University of Washington and an expert on how to cope with aging, disability and end-of-life issues, has advice on how to deal with these issues through the holidays.

Lustbader writes occasionally on aging issues at the Huffington Post. In an entry she posted last week, she described talking to a group of elders at Market Heritage House in downtown Seattle about what they missed most during the holiday season. Many of the residents were nearing their mid-80s, and they shared yearnings for their parents, nostalgia for homes where they used to gather, and other kinds of sadness that creep in this time of year.

"The mood of the group became warm and convivial as each person thrust aside the curtain of aloneness and took comfort from each other," Lustbader wrote.

Lustbader prompted the conversation during one of her weekly group discussions she leads with the elders, because commiseration can relieve pain. Grief over death or estrangement of loved ones, homesickness, money woes and other sorrows can make it hard to muster holiday cheer.

"If you are having a rough time during the holidays and you're forced to be cheerful, it creates loneliness," she said. "But if you can say who you are missing or what you're going through, then you aren't so alone and you might be able to enjoy yourself a bit."

Lustbader offers some advice below for coping with bereavement, illness, homesickness and other issues during the holiday season.

For those mourning a death in the past year, what might make things easier as they go through the holidays for the first time without their loved one?

It's important for people to realize that the first holiday season without a loved one is the hardest. Accordingly, many people choose to break with their longstanding traditions and do something totally different, like take a trip out of town or spend the holiday volunteering at a soup kitchen. For those who choose to go forward with enacting holiday traditions the way they always have, building in some kind of acknowledgment of the loss is essential. For instance, setting aside time during the holiday dinner for each person to speak about their memories of the person can be enormously comforting.

Injuries, illnesses and grief can make preparations for the holidays too exhausting. Any suggestions on how people should modify their plans?

Here again, the key is not to pretend that everything is fine. Those who don't have the energy or spirit to meet traditional expectations – like baking a certain kind of pie or putting up the decorations everyone expects – should tell the truth of their feelings. It's better to say, "I just don't have it in me this year" than to force oneself to put on a performance. In fact, altering the tradition calls attention to the loss or the difficulty, and this allows others to be respectful toward those who are having a hard time in the midst of the festivities.

Some people can't make it home for the holidays. What can they do to not feel homesick?

Homesickness is like any other grief – we feel better when we talk about it. Getting together with other people who are far from home is especially helpful, because of the shared understanding. Those who can't go home again, due to parents going through a divorce or the family home finally being sold, also need to give voice to the loss. It doesn't matter how old we are. These feelings are universal and can run deep in us.

How can holiday festivities be made more enjoyable for aging family members who face physical and cognitive challenges?

It is helpful beforehand to try to put yourself in the shoes of your older relative. For example, at gatherings a hearing aid often doesn't function well with so many conversations going on at once. Planning to take turns sitting off in a corner with someone where there is less commotion may provide much welcome relief, as well as the pleasure of individual attention. Similarly, bringing someone to the gathering who resides in a care facility may require advance planning about strategies for handling the front stairs, preparing the right food items, and being sensitive to the rush of emotion that may arise as the person is flooded with memories. For those with cognitive challenges, having someone posted by this person's side at all times during the gathering can keep anxiety to a minimum for everyone. Thoughtfulness pays off in creating an experience that will be cherished.

How can families deal with difficult decisions that are looming, such as whether it is time to urge an older relative to move to a supported living residence or care facility?

Sometimes families do take advantage of being together over the holidays to broach complicated subjects about an elder's care situation. Recognizing that there may be several perspectives on what is best is a useful first step. Agreeing to disagree and putting the emphasis on hearing each other out, rather than competing for control, is an approach that tends to reduce conflict. The holidays can be better spent scouting out possibilities and exchanging ideas, rather than allowing old issues and past tensions to get in the way of hashing out the options.

Provided by University of Washington

Sleeping pills owe half their benefits to placebo effect, study finds

Half of the benefit of taking sleeping pills comes from the placebo effect, according to a major new study published in the British Medical Journal.

20 dec 2012--Researchers re-analysed results from more than a dozen clinical trials of the most common type of sleeping tablets, known as Z-drugs (non-benzodiazepine hypnotics).

These drugs are frequently used in the UK and USA as a short-term treatment for insomnia with almost £25m worth of prescriptions handed out in Britain each year. However, some health experts have questioned whether the benefits of Z-drugs justify their side effects, which can include memory loss, fatigue and impaired balance.

Questions have also been raised about the validity of published research into the effects of these drugs based on trials sponsored by pharmaceutical companies themselves.

Academics from the University of Lincoln, Harvard Medical School and University of Connecticut conducted a meta-analysis of data from clinical trials of Z-drugs comparing drug effects with placebo effects. This type of comparison enables researchers to determine how much of the drug effect comes from the constituents of the drug itself, and how much is due to other factors (like the placebo response or regression to the mean).

They used data submitted by pharmaceutical companies to the US Food and Drug Administration (FDA) for approval of new products. This included 13 clinical trials containing 65 different comparisons and more than 4,300 participants.

The FDA collates results from both published and unpublished studies, enabling researchers to avoid common types of bias (such as reporting bias) which can undermine other research based on sponsored trials.

Their findings, published in this week's British Medical Journal, indicate that once the placebo effect is discounted, the drug effect is of 'questionable clinical importance'.

Lead author Professor Niroshan Siriwardena, from the School of Health and Social Care at the University of Lincoln, said: "Our analysis showed that Z-drugs did reduce the length of time it took for subjects to fall asleep, both subjectively and as measured in a sleep lab, but around half of the effect of the drug was a placebo response.

"There was not enough evidence from the trials to show other benefits that might be important to people with sleep problems, such as sleep quality or daytime functioning.

"We know from other studies that around a fifth of people experience side effects from sleeping tablets and one in one hundred older people will have a fall, fracture or road traffic accident after using them.

"Psychological treatments for insomnia can work as effectively as sleeping tablets in the short-term and better in the long-term, so we should pay more attention to increasing access to these treatments for patients who might benefit."

He said future studies of sleeping tablets should investigate a broader range of outcomes, not just time taken to fall asleep, and that pharmaceutical companies should be more transparent in disclosing results from their studies so that researchers can independently analyse their results.

The paper 'Effectiveness of non-benzodiazepine hypnotics in the treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration' was published in the British Medical Journal on 17th December 2012.

More information: 'Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration'; Tania B Huedo-Medina, Irving Kirsch, Jo Middlemass, Markos Klonizakis, A Niroshan Siriwardena; BMJ 2012; 345 doi: dx.doi.org/10.1136/bmj.e8343 (Published 17 December 2012)

Provided by University of Lincoln

40 percent of cancer patients receive opioids at end of life

For patients with one of five common cancers, 43.6 percent receive at least one prescription of opioids in the last three months of life, according to a study published in the Dec. 10 issue of the Journal of Clinical Oncology.

19 dec 2012—For patients with one of five common cancers, 43.6 percent receive at least one prescription of opioids in the last three months of life, according to a study published in the Dec. 10 issue of the Journal of Clinical Oncology.

Irene J. Higginson, B.M.B.S., Ph.D., and Wei Gao, Ph.D., from King's College London, used data from the United Kingdom General Practice Research Database to examine opioid prescribing rates in the last three months of life in a cohort of 29,825 patients diagnosed with lung, colorectal, female breast, prostate, and head and neck cancers. All patients died between 2000 and 2008.

The researchers found that 43.6 percent of patients received at least one prescription of opioids during the last three months of life, including the most prescribed opioids: 33.4 percent morphine, 11.6 percent diamorphine, and 10.2 percent fentanyl family. For opioids predominant during specific time periods, especially oxycodone, prescription rates increased over time. Compared with patients younger than 50 years, patients older than 60 years had significantly lower chances of receiving opioids, even after adjustment for comorbidity (prevalence ratio range, 0.14 to 0.78). Compared with men, women were slightly but significantly more likely to receive any opioid (prevalence ratio, 1.07). Compared with prostate cancers, morphine and diamorphine were more commonly prescribed for lung and colorectal cancers, while fentanyl family drugs were more commonly prescribed for head and neck cancers.

"We found an encouraging increasing trend of opioid prescribing by general practitioners in the United Kingdom for patients with cancer who are in the last three months of life," the authors write. "However, people older than age 60 years were significantly underprescribed opioidsand should be targeted for improvement in their end-of-life cancer care."

More information: Abstract 
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Palliative care improves outcomes for seniors

Seniors in long-term care experienced a significant reduction in emergency room visits and depression when receiving palliative care services, according to a recent collaborative study by researchers at Hebrew SeniorLife's Hebrew Rehabilitation Center (HRC) and Institute for Aging Research, both affiliated with Harvard Medical School (HMS).

18 dec 2012--The results of the study, published today in The Gerontologist, demonstrate the potential for improved end-of-life quality of care when palliative services are implemented in a long-term care setting.

The researchers analyzed the composite outcomes of utilization patterns, depression, pain and other clinical indicators of 250 long-term care patients at Hebrew Rehabilitation Center, half of whom received palliative care services, over a two-year period. Those who received palliative care had about half as many emergency room visits and significantly less depression.

"The national health care crisis has created a mandate to cut costs while improving care for millions of aging Americans who would otherwise experience frequent hospitalizations and futile aggressive care in their last months," says Jody Comart, Ph.D., palliative care director at Hebrew SeniorLife and the study's lead author.

"Many patients and families fear a painful, undignified death. The palliative care team is an elegant model that can improve care for long-term care residents and, at the same time bring down costs. This study showed a decrease in emergency room visits for palliative care patients, avoiding an often frightening event for patients and families, while decreasing the high cost of this expensive service for our health care system.

The Palliative Care Program at HRC combines medical, emotional and spiritual support services provided by an interdisciplinary team—a palliative care physician, clinical nurse specialist, chaplain, social worker and psychologist—providing the expertise and structure for improved symptom management and earlier identification of residents' goals for care.

According to Comart, providing palliative care services in a long-term care setting can offer significant benefits to patients and their loved ones: 

• Patients and families often face very intense, emotionally laden and ethically burdensome decisions about treatment options.
• Palliative care provides them with medical and technical information that fosters informed conversations about end-of-life care—often for the first time.
• By treating pain and other symptoms, decreasing unnecessary hospitalizations and helping patients find closure during their final days, palliative care can reduce patient suffering and ease the burden on families.

"Some patients prefer less aggressive treatment and improved quality of life, while others want intensive interventions that may involve hospitalization and procedures," Comart explains. "Whatever the choice, patient-centered care is the primary goal, focusing on treatment that is consistent with the resident's wishes or, in the case of patients who are unable to comprehend the decisions at hand, with prior stated wishes."

Provided by Hebrew SeniorLife Institute for Aging Research

World population gains more than a decade's life expectancy since 1970

In the first Global Burden of Disease Study 2010 paper, published in The Lancet, the authors present new estimates of life expectancy for the last four decades in 187 different countries. While overall life expectancy is increasing globally, the gap in life expectancy between countries with the highest and lowest life expectancies has remained similar since 1970.

17 dec 2012--The new estimates show that, globally, in 2010 a man's average life expectancy at birth had increased by 11.1 years (19.7%) since 1970, from 56.4 years in 1970, to 67.5 years in 2010. For women, life expectancy increased by 12.1 years (19.8%) during the same period, from 61.2 years in 1970, to 73.3 years in 2010.

Deaths in children under five years old have declined by almost 60% since 1970, from 16.4 million deaths in 1970 to 6.8 million in 2010. However, while overall life expectancy is increasing globally, the gap in life expectancy between countries with the highest and lowest life expectancies has remained similar since 1970, at around 32 – 47 years, even when significant mortality shocks such as the 1994 Rwanda genocide are discounted.

In 2010, Japanese women had the highest life expectancy at birth in the world, at 85.9 years; for men, Iceland had the highest life expectancy, at 80.0 years. Haiti had the lowest life expectancy at birth in 2010 for both men and women (32.5 and 43.6, respectively), largely due to the disastrous earthquake in January 2010. The largest overall gain in life expectancy since 1970 was in the Maldives, which saw an increase in male life expectancy of 54.4% since 1970 (from 50.2 to 77.5) and a 57.6% increase in women's life expectancy, from 51 in 1970, to 80.4 in 2010. Other countries which experienced gains in life expectancy greater than 20 years since 1970 were Bangladesh, Bhutan, Iran, and Peru.

Some countries in Central and Eastern sub-Saharan Africa also experienced substantial gains in life expectancy since 1990, with men in Angola undergoing a 31.9% increase in life expectancy (from 43.9 in 1990 to 57.9 in 2010), and an increase of 23.6% in women's life expectancy in the same period (from 51.7 in 1990 to 63.9 in 2010). Ethiopia and Rwanda also experienced substantial gains in life expectancy during this period.

Despite these encouraging figures, some countries have experienced substantial declines in life expectancy. Overall, men's life expectancy in Southern sub-Saharan Africa decreased by 1.3 years between 1970 and 2010, and women's life expectancy decreased by 0.9 years in the same period, with the decline attributed to the catastrophic HIV / AIDS epidemic. Lesotho experienced the second-largest decline in life expectancy 1970 – 2010, with men in 2010 living for 4.6 fewer years in 2010 compared to 1970, and women living for 6.4 fewer years in the same period. Belarus and Ukraine in Eastern Europe also underwent notable declines in life expectancy, thought to be due to high rates of alcohol-related deaths in these countries.

According to Assistant Professor Haidong Wang, of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and one of the study authors, "Because more children are now surviving to adulthood compared to earlier decades, health policy makers globally will need to pay much more attention to preventing deaths in young adults, aged 15 – 49, in coming years."

While most developed countries, and some developing countries such as China and Argentina, have experienced declining numbers of deaths in this age group since 1970, some high-income regions – including Albania, Greece, Israel, Lithuania, and Russia – have experienced increased numbers of deaths in this age group in the same period. In Botswana, South Africa, Zambia, and Zimbabwe, deaths in this age group have increased by more than 500% since 1970.

More information: www.thelancet.com/… n-of-disease

Provided by Lancet

Mental illness the largest contributor to disability worldwide

Mental illness is the largest contributor to disability, according to a report card on the world's health, The Global Burden of Disease 2010 (GBD 2010). The seven papers and two commentaries that make up the report  published in The Lancet   this week. 

16 dec 2012--GBD 2010 is a collaborative project led by the Institute for Health Metrics and Evaluation at the University of Washington (UW) in the US and involves 302 institutions across 50 countries. This is the first report since the inaugural study was published in the early 1990s.

Close to a quarter of the world's disability burden is attributed to mental and behavioural disorders combined (22.7 per cent). These include major depressive disorder, anxiety, Alzheimer's, schizophrenia and bipolar disease.

Major depressive disorder alone accounts for 8.1 per cent of the disability burden and is second only to low back pain. This compares with cardiovascular and circulatory diseases, which account for 2.8 per cent of the disability burden.

"This report looks at the total impact of disease over a person's life. So serious conditions like heart disease and cancer contribute relatively small amounts to the disability burden because they usually occur in later life," says UNSW Professor Philip Mitchell, who assisted in assessing the impact of bipolar disease around the world for the report.

"The mental illnesses present very commonly when people are in their 20s and 30s and they often reoccur, so the lifetime disability is greater," says Professor Mitchell, Head of Psychiatry at UNSW, who is based at the Black Dog Institute.

Other key findings relating to mental health: 

• The burden of major depression and anxiety have each increased by 37 per cent in 20 years
• Alzheimer's disease has increased by 80 per cent
• Major depressive disorders account for 63 million years spent living with a disability (YLD)

Other contributions from UNSW experts include: 

• UNSW Conjoint Professor Guy Marks contributed to the work on respiratory diseases. Pneumonia, tuberculosis, chronic obstructive pulmonary disease (or COPD, the occurrence of chronic bronchitis or emphysema) and lung cancer are major contributors to the global burden of disease and premature death. One of the key findings is that the disability-adjusted life years (DALYs) due to pneumonia and other lower respiratory infections has decreased by 44 per cent over the past 20 years. However, the burden of lung cancer has increased while COPD, asthma and tuberculosis have remained relatively unchanged.
• Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre at UNSW co-chaired the Expert Group on Mental Disorders and Illicit Drug Use. The results will be published in detail next year, but illicit drugs have become a bigger contributor to the global burden of disease over the past 20 years (from 1990 to 2010).

More information: www.thelancet.com/… n-of-disease

We're living longer but with more disability

The Global Burden of Disease Study 2010 (GBD 2010), has found people around the world are living longer but often with many years of compromised health.

15 dec 2012--The study is co-authored by the Head of The University of Queensland's School of Population Health, Professor Alan Lopez and the Director for the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Dr Christopher Murray.

It reveals the leading causes of death, disability and injury.

GBD 2010 – set to be launched at London's Royal Society on 14 December - is the world's largest ever investigation of global health.

Involving 1000 collaborators over five years, the study examines 291 conditions and 67 risk factors for 21 global regions.

Professor Lopez said that the study's update was driven by need.

"We know that dozens of countries have taken the methodology of GBD and applied it to their own situation to better inform local health planning and policies. However, we knew we could improve it," Professor Lopez said.

"We knew we needed to update our 20-year-old estimates and make use of today's better methods, enhanced availability of data and increased expertise and there was a huge demand for it.

"Studies such as this which provide us with comprehensive and reliable health information are essential if countries are to be better informed about their health priorities and how these are changing."

Results of the study will be featured in a special issue of The Lancet, which will be devoted entirely to GBD 2010 findings.

These findings include: 

• People are living longer all over the world but especially in high-income countries.
• Life expectancy in Australia has risen so much since 1990 that the country now has among the 10 longest life expectancies in the world for both women and men.
• The years that people are living with a disability is growing, particularly in high-income countries.
• The increase in disability has largely been driven by increases in population and population ageing, and has important implications for health services.
• Child mortality is do
• Dietary risk factors and physical inactivity collectively caused 10 per cent of the disease burden.
• wn, even in sub-Saharan Africa and other poor countries, but much less progress has been made in preventing death among young adults, particularly men, who are dying, mostly due to violence, injuries, suicide and HIV/AIDS.
• High blood pressure is the world's leading cause of mortality and disability.
• It is no longer just the rich world's problem, with a high salt diet seeing the issue surface in poor countries as well.
• The second biggest burden on world health is tobacco smoking which is falling in the developed world but rising in the developing world.
• Child malnutrition has decreased, as has the burden of disease from unsafe water and sanitation, showing global health progress has been made.
• But while malnutrition is down, GBD 2010 found that rising rates of obesity and other lifestyle-related risk factors were becoming the dominant forces in disease.These latest findings update the original GBD 1990, which was the first study to measure not just mortality, but the impact of disease and years lived with disability.

It is one of the world's most cited investigations and has influenced health policies and budgets around the globe.

Provided by University of Queensland

Olympians live longer than general population... But cyclists no survival advantage over golfers

Olympic medallists live longer than the general population, regardless of country of origin, medal won, or type of sport played, finds a study in the Christmas issue published on BMJ today.

14 dec 2012--A second study comparing athletes who trained at different physical intensities, found that those from high or moderate intensity sports have no added survival benefit over athletes from low intensity sports. But those who engage in disciplines with high levels of physical contact, such as boxing, rugby and ice hockey, are at an increased risk of death in later life, the data show.

An accompanying editorial adds that everyone could enjoy the "survival advantage" of elite athletes by just meeting physical activity guidelines.

In the first study, researchers compared life expectancy among 15,174 Olympic athletes who won medals between 1896 and 2010 with general population groups matched by country, sex, and age.

All medallists lived an average of 2.8 years longer – a significant survival advantage over the general population in eight out of the nine country groups studied.

Gold, silver and bronze medallists enjoyed roughly the same survival advantage, as did medallists in both endurance and mixed sports. Medallists in power sports had a smaller, but still significant, advantage over the general population.

The authors say that, although their study was not designed to determine why Olympic athletes live longer, "possible explanations include genetic factors, physical activity, healthy lifestyle, and the wealth and status that come from international sporting glory."

In the second study, researchers measured the effect of high intensity exercise on mortality later in life among former Olympic athletes.

They tracked 9,889 athletes with a known age at death, who took part in at least one Olympic Games between 1896 and 1936. Together they represented 43 disciplines requiring different levels of exercise intensity and physical contact.

After adjusting for sex, year of birth and nationality, they found that athletes from sports with high cardiovascular intensity (such as cycling and rowing) or moderate cardiovascular intensity (such as gymnastics and tennis) had similar mortality rates compared with athletes from low cardiovascular intensity sports, such as golf or cricket.

However, the researchers did find an 11% increased risk of mortality among athletes from disciplines with a high risk of body collision and with high levels of physical contact, such as boxing, rugby and ice hockey, compared with other athletes. They suggest this reflects the impact of repeated collisions and injuries over time.

In an accompanying editorial, two public health experts point out that people who do at least 150 minutes a week of moderate to vigorous intensity physical activity also have a survival advantage compared with the inactive general population. Estimates range from just under a year to several years.

But they argue that, compared with the successes that have been achieved in tobacco control, "our inability to improve physical activity is a public health failure, and it is not yet taken seriously enough by many in government and in the medical establishment."

"Although the evidence points to a small survival effect of being an Olympian, careful reflection suggests that similar health benefits and longevity could be achieved by all of us through regular physical activity. We could and should all award ourselves that personal gold medal," they conclude.

Provided by British Medical Journal