The study found those in the group eating prunes as part of a healthy life-style diet lost 2kg in weight and shed 2.5cm off their waists
31 may 2014--Research by the University of Liverpool has found that eating prunes as part of a weight control diet can improve weight loss.
Consumption of dried fruit is not readily recommended during weight loss despite evidence it enhances feelings of fullness.
Low fibre consumers
However, a study by the University's Institute of Psychology, Health and Society of 100 overweight and obese low fibre consumers tested whether eating prunes as part of a weight loss diet helped or hindered weight control over a 12-week period.
It also examined if low fibre consumers could tolerate eating substantial numbers of prunes in their diet, and if eating prunes had a beneficial effect on appetite.
To assess the effects of prunes on weight and appetite, participants in the study were divided into two groups – those who ate prunes every day (140g a day for women and 171g a day for men) and those who were given advice on healthy snacks over the period of active weight loss.
The researchers found that members of the group which ate prunes as part of a healthy life-style diet lost 2kg in weight and shed 2.5cm off their waists. However, the people in the group which was given advice on healthy snacks lost only 1.5kg in weight and 1.7cm from their waists.
The study also found that the prune eaters experienced greater weight loss during the last four weeks of the study. After week eight, participants showed increased feelings of fullness in the prune group. Moreover, despite the high daily doses, prunes were well tolerated.
Useful and convenient addition
Liverpool psychologist, Dr Jo Harrold who led the research, said: "These are the first data to demonstrate both weight loss and no negative side effects when consuming prunes as part of a weight management diet. Indeed in the long term they may be beneficial to dieters by tackling hunger and satisfying appetite; a major challenge when you are trying to maintain weight loss."
Professor Jason Halford, Professor of Experimental Psychology and Director of the University's Human Ingestive Behaviour Laboratory, added: "Maintaining a healthy diet is challenging. Along with fresh fruit and vegetables, dried fruit can provide a useful and convenient addition to the diet, especially as controlling appetite during dieting can be tough."
Provided by University of Liverpool
Stopping statins may benefit terminally ill patients
This image depicts Jean Kutner, MD, MSPH, CU Cancer Center investigator and professor of medicine at the University of Colorado School of Medicine. Credit: CU Cancer Center
31 may 2014--Results presented today at the 50th Annual Meeting of the American Society for Clinical Oncology (ASCO) and June 6 at the European Association of Palliative Care Research Conference show that stopping statins for cholesterol management in the late stages of cancer or other terminal illnesses may offer quality-of-life and even life-extending benefits. The results highlight the larger question of when, if ever, it is appropriate in patients with life-limiting illnesses to discontinue medications prescribed for other conditions that will likely not lead to their death.
Researchers from the University of Colorado Cancer Center and the Palliative Care Research Cooperative Group report that discontinuing statins in patients with advanced illnesses resulted in improved overall quality of life, lower costs and no increased deaths. In fact, the patients who stopped taking statins appeared to live slightly longer.
"Based on the study, for patients that are on medications for primary or secondary prevention – for example, those who have not just had a stroke or heart attack – and have a limited life expectancy of less than one year, I would recommend discussing with their physicians the potential to stop taking statins," says Jean Kutner, MD, MSPH, CU Cancer Center investigator and professor of medicine at the University of Colorado School of Medicine.
"We tend to be so focused on which medications are effective to start but there's no research on if and when to stop them. It's a new line of investigation. Especially in the context of end-of-life care, we believe there are many situations in which preventative drugs may be doing more harm than good," Kutner says.
Kutner points to medicines taken to prevent osteoporosis, blood clots, high blood pressure, and diabetes as candidates for future study. These are things people take to prevent something or treat a chronic illness. But particularly in the advanced cancer population, they may not be achieving the intended benefits," Kutner says.
The study enrolled 381 patients who faced the likelihood of dying within a year. All patients had been taking statins for at least three months; roughly half were randomized to continue taking the drug, the other half to discontinuing it.
The researchers followed the patients for up to a year to monitor survival, cardiovascular events and changes in quality of life.
Among the 192 study patients who continued statins, the median survival was 190 days; the 192 participants who stopped taking the drugs had a median survival of 229 days.
Those who discontinued the drugs reported a better overall quality of life, particularly in their psychological wellbeing, and saved money: $716 per person over the course of the trial for name-brand drugs, and $629 for generics.
Using U.S. population estimates, the researchers reported that as much as $603 million a year could be saved if patients in the late stages of fatal illnesses were to cut out statins.
"One thing we found during the study was clinicians saying, 'hey I never thought about stopping people's statins.' The study raised awareness. Here's a setting in which these drugs may not be doing most patients any good any more and bringing up the subject of stopping unneeded medications offers the opportunity for shared decision-making. There's power in individual choice," Kutner says.
Provided by University of Colorado Denver
Friday, May 30, 2014
Study examines variation in cardiology practice guidelines over time
An analysis of more than 600 class I (procedure/treatment should be performed/administered) American College of Cardiology/American Heart Association guideline recommendations published or revised since 1998 finds that about 80 percent were retained at the time of the next guideline revision, and that recommendations not supported by multiple randomized studies were more likely to be downgraded, reversed, or omitted, according to a study in the May 28 issue of JAMA.
30 may 2014--As adherence to recommended clinical practice guidelines increasingly is used to measure performance, guidelines play a major role in policy efforts to improve the quality and cost-effectiveness of care. Past research has established the importance of revising guidelines over time to address advances in research and population-level changes in health risks. Nonetheless, unwarranted variability across guidelines can reduce trust in guideline processes and complicate efforts to promote consistent use of evidence-based practices. Moreover, policies based on recommendations that prematurely endorse practices subsequently found to be ineffective can lead to waste and potential harm. Little is known regarding the degree to which individual guideline recommendations endure or change over time, according to background information in the article.
Mark D. Neuman, M.D., M.Sc., of the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and colleagues analyzed variations in class I American College of Cardiology/American Heart Association (ACC/AHA) guidelines (n = 11) published between 1998 and 2007 and revised between 2006 and 2013. The researchers reviewed and recorded all class I recommendations from the first of the 2 most recent versions of each guideline and identified corresponding recommendations in the subsequent version. Recommendations replaced by less determinate or contrary recommendations were classified as having been downgraded or reversed; recommendations for which no corresponding item could be identified were classified as having been omitted.
Out of 619 index recommendations, 495 (80.0 percent) were retained in the subsequent version; 8.9 percent were downgraded, 0.3 percent were reversed, and 10.8 percent were omitted. The percentage of recommendations retained varied across guidelines from 15.4 percent to 94.1 percent.
Among recommendations with available information on level of evidence, 90.5 percent of recommendations supported by multiple randomized studies were retained, vs 81.0 percent of recommendations supported by 1 randomized trial or observational data and 73.7 percent of recommendations supported by opinion. After accounting for guideline-level factors, the odds of a downgrade, reversal, or omission were more than 3 times greater for recommendations based on a single trial, observational data, consensus opinion, or standard of care than for recommendations based on multiple randomized trials.
"… our results may have important implications for health policy and medical practice. The categorization of medical evidence, through guidelines, into stronger and weaker recommendations, influences definitions of good medical practice and informs efforts to measure the quality of care on a large scale. Our findings stress the need for frequent re-evaluation of practices and policies based on guideline recommendations, particularly in cases where such recommendations rely primarily on expert opinion or limited clinical evidence," the authors write.
"Moreover, our results suggest that the effectiveness of clinical practice guidelines as a mechanism for quality improvement may be aided by systematically identifying and reducing unwarranted variability in recommendations. Finally, our work emphasizes the importance of greater efforts on the part of guideline-producing organizations to communicate the reasons that specific recommendations are downgraded, reversed, or omitted over time."
In an accompanying editorial, Paul G. Shekelle, M.D., Ph.D., of the VA West Los Angeles Medical Center, Los Angeles, and RAND Corporation, Santa Monica, discusses the importance of keeping clinical practice guideline recommendations up-to-date.
"The need for surveillance and updating of practice guidelines is increasingly gaining attention. To meet the need, guideline development organizations need to change their focus. This change is not easy. It is not just a matter of resources, although guideline organizations are going to have to devote more resources to active surveillance and maintenance of their guidelines than most probably do at present. It also has to be a change to the mindset, recognizing that keeping existing guidelines up-to-date in a timely way is an important goal for good patient care."
Disturbance in blood flow leads to epigenetic changes and atherosclerosis
This image shows the effects of 5aza on atherosclerosis model. Credit: Dunn et al JCI (2014)
Disturbed patterns of blood flow induce lasting epigenetic changes to genes in the cells that line blood vessels, and those changes contribute to atherosclerosis, researchers have found. The findings suggest why the protective effects of good blood flow patterns, which aerobic exercise promotes, can persist over time. An epigenetic change to DNA is a chemical modification that alters whether nearby genes are likely to be turned on or off, but not the letter-by-letter sequence itself.
30 may 2014--The results are scheduled for publication in the Journal of Clinical Investigation.
Atherosclerosis is the buildup of fats and inflammatory cells in arteries, a process that can lead to heart attacks and strokes. The curvature of arteries and resulting disturbed flow influence where atherosclerotic plaques develop. Biomedical engineer Hanjoong Jo and his colleagues have developed a model that allows them to see the inflammatory effects of disturbed blood flow quickly. Jo is professor of biomedical engineering in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University.
"This new study shows that disturbed blood flow induces epigenetic changes that lead to atherosclerosis," Jo says. "It had been known for a long time that plaques preferentially develop in curved and branched arteries, but our lab has been able to prove that disturbed blood flow can actually trigger atherosclerosis, in the presence of risk factors such as high blood cholesterol."
Despite the demonstrated importance of blood flow patterns in atherosclerosis, it can be blocked in mouse models with a drug that interrupts the process of DNA methylation, an epigenetic change that often turns genes off. Jo's team has identified several genes that become turned off under disturbed flow conditions, in a way that requires DNA methylation. Some of these genes may represent new therapeutic targets in atherosclerosis.
The co-first authors of the JCI paper are biomedical engineering graduate students Jessilyn Dunn and Haiwei Qiu, and postdoc Soyeon Kim, PhD.
In the Jo lab's mouse model, researchers restrict blood flow in three carotid arteries on one side, in the presence of a high-fat diet. In a 2010 paper in Blood, they had found that one of the genes induced by disturbed blood flow is DNMT1, encoding a DNA methyltransferase enzyme.
DNMT1 carries out DNA methylation, an epigenetic modification of DNA. Changes in DNA methylation are important for cells differentiating into different tissues such as blood, muscle or bone, and for the development of cancer.
Dunn and her colleagues found that treatment with 5-aza-2'-deoxycytidine, a drug that is now used to treat acute myeloid leukemia, can prevent atherosclerotic plaques fr om forming in the mouse model.
"While we do not envision using 5-aza for atherosclerosis treatment clinically, our results do revealpotential therapeutic targets," Jo says.
A broader implication is that improving blood flow patterns, through aerobic exercise for example, can induce a lasting imprint on gene expression in the blood vessels, he says.
Provided by Emory University
Gene expression signature identifies patients at higher risk for cardiovascular death
Georgia Tech Professor Gregory Gibson poses with a chart showing death rate differentials between groups of coronary artery disease patients identified with a new gene expression profile. Credit: Rob Felt
30 may 2014--A study of 338 patients with coronary artery disease has identified a gene expression profile associated with an elevated risk of cardiovascular death. Used with other indicators such as biochemical markers and family history, the profile – based on a simple blood test – may help identify patients who could benefit from personalized treatment and counseling designed to address risk factors.
Researchers found the risk signature by comparing gene expression profiles in 31 study subjects who died of cardiovascular causes against the profiles of living members of the study group. Twenty-five of the 31 deaths occurred in the group with the high-risk profile, though coronary deaths were also recorded among the lower risk members of the study group. All of the patients studied had coronary artery disease (CAD), and about one in five had suffered a heart attack prior to the study.
Researchers from the Georgia Institute of Technology, Emory University and Princeton University participated in the study, which obtained gene expression profiles from blood samples taken from patients undergoing cardiac catheterization at Emory University clinics in Atlanta. The results are scheduled to be published in the open-access journal Genome Medicine on May 29, 2014.
"We envision that with our gene expression-based marker, plus some biochemical markers, genotype information and family history, we could produce a tiered evaluation of people's risks of adverse coronary events," said Gregory Gibson, director of the Center for Integrative Genomics at Georgia Tech and one of the study's senior authors. "This could lead to a personalized medicine approach for people recovering from heart attack or coronary artery bypass grafting."
Coronary artery disease is the leading cause of death for both men and women in the United States. Manifested in the narrowing of blood vessels through the buildup of plaque, CAD sets the stage for heart attacks and long-term heart failure.
As many as half of Americans over the age of 50 suffer from CAD to some extent, so the researchers wondered if they could single out those with the highest risk of death. From a cohort of more than 3,000 persons known as the Emory Cardiovascular Biobank (EmCD), they selected two groups of patients for extensive gene expression analysis based on blood samples.
After following the patients for as long as five years, the researchers examined gene expression patterns in a total of 31 persons from the study group who had suffered coronary deaths. Comparing these patterns against those of other study subjects revealed a pattern in which genes affecting inflammation were up-regulated, while genes affecting T-lymphocytes were down-regulated.
The patients studied ranged in age from 51 to 73, were mostly Caucasian, and 65 percent male. Seventy percent of the subjects had significant CAD, and 18 percent were experiencing an acute myocardial infarction when blood samples were taken. Gene expression was analyzed using microarrays and two different normalization procedures to control for technical and biological covariates. Whole genome genotyping was used to support comparative genome-wide association studies of gene expression. Two phases of the study were conducted independently with the two different groups, and produced similar results.
"What's new in this research is the recognition that this risk pathway exists and that it relates to particular aspects of immune system functions that include T-cell signaling," said Gibson, who is also a professor in Georgia Tech's School of Biology. "We went beyond the signature of coronary artery disease to really provide a signature for adverse outcomes in that high-risk population."
The pattern, said Gibson, doesn't indicate the causes of the disease. The researchers would now like to expand the study to include a larger group of patients and learn more about what causes the disease. They'd also like to know whether the risks can be reversed through diet, exercise or drug therapy.
Cardiologist Arshed Quyyumi, the paper's other senior author, directs Emory University's Clinical Cardiovascular Research Center and created the Biobank five years ago to facilitate cardiovascular research. He says that identifying patients at highest risk could help encourage their compliance with treatment programs, and prioritize introduction of newer therapeutics, such as cholesterol lowering medications like PCSK9 inhibitors.
"A number of patients with CAD are currently not maximally treated," said Quyyumi, who is a professor in Emory's School of Medicine. "In those that appear to have been prescribed adequate medication, a significant proportion of subjects are non-compliant with their medications. Thus, knowledge of a high risk genetic profile in a patient can prompt both the patient and physician to maximize currently available medications and improve patient compliance."
Approximately 15,000 genes are expressed in human blood, but analyzing them is not as daunting as it sounds. Most of the gene expression is correlated, so there may be only a few dozen independent measurements that can be related to disease states, Gibson said. In the study, researchers identified nine "axes" that represented specific biological pathways to disease. Two of them were relevant to the high-risk profile.
Gibson believes identifying the high-risk signatures in CAD patients may lead to opportunities for improving their health.
"Our dream would be a hand-held device that would allow patients to take a droplet of blood, much like diabetics do today, and obtain an evaluation of these transcripts that they could track at home," he said. "If we can use this information to help people adopt healthier behaviors, it will be very positive."
Provided by Georgia Institute of Technology
Study links unexpected death of a loved one with onset of psychiatric disorders
The sudden loss of a loved one can trigger a variety of psychiatric disorders in people with no history of mental illness, according to researchers at Columbia University's Mailman School of Public Health and colleagues at Columbia's School of Social Work and Harvard Medical School. While previous studies have suggested there is a link between sudden bereavement and an onset of common psychiatric disorders, this is the first study to show the association of acute bereavement and mania in a large population sample. Findings are published online in the American Journal of Psychiatry.
30 may 2014--In people aged 30 years or older, the unexpected death of a loved one roughly doubled the risk for new-onset mania after controlling for prior psychiatric diagnoses, other traumatic experiences, and certain demographic variables like sex, race, income, education, and marital status.
The researchers analyzed data from 27,534 participants in the National Epidemiologic Survey on Alcohol and Related Conditions. Between about 20% and 30% of these participants identified the unexpected death of a loved one as the most traumatic event in their lives. This was still the case among those reporting 11 or more lifetime traumatic events, where losing a loved one unexpectedly was most traumatic for 22%.
"Our findings should alert clinicians to the possible onset of a wide range of psychiatric disorders, including disorders such as mania, after an unexpected death in otherwise healthy individuals," says Katherine Keyes, PhD, assistant professor of Epidemiology at the Mailman School of Public Health, and principal investigator. "However, it is also notable that the majority of individuals in the present study did not develop mental health issues in the wake of an unexpected death of a loved one."
Losing a loved one suddenly also raised the risk of major depression, excessive use of alcohol, and anxiety disorders, including panic disorder, post-traumatic stress disorder, and phobias. The largest risk increases were for post-traumatic stress disorder, which was seen across age groups with an increased risk as high as 30-fold. Most other disorders were concentrated in the older age groups.
While developing a psychiatric disorder for the first time in old age is relatively rare, these data indicate that psychiatric disorder onset in older age is commonly associated with the death of a loved one, according to the authors.
"Clinically, our results highlight the importance of considering a possible role for loss of close personal relationships through death in assessment of psychiatric disorders. When someone loses a close personal relationship, even late in life, there is a profound effect on sense of self and self reflection. These data indicate that, even in adults with no history of psychiatric disorders, it is also a vulnerable risk period for the onset of a potentially disabling psychiatric disorder," says Dr. Keyes.
Provided by Columbia University's Mailman School of Public Health
Most Baby Boomers have no intention of retiring
Research from the University of Adelaide shows that almost three-quarters of South Australian Baby Boomers do not intend to completely give up work.
30 may 2014--In a survey of almost 900 people aged 50-65, only 26% said they would completely retire, while 74% said they would either: move from full-time to part-time employment (42%); reduce their part-time hours (25%); or not retire at all (7%).
The study was conducted by a team of researchers in the University's Population Research and Outcome Studies unit (School of Medicine) and the Australian Population and Migration Research Centre (School of Social Sciences) to better understand the health, social and economic factors involved in people's intentions to retire.
"What surprised us about the results of this survey is the large number of Baby Boomers who indicated that they would either just reduce their hours and keep working beyond the age of 65 years, or not retire at all," says study co-author Dr Helen Feist, Deputy Director of the Australian Population and Migration Research Centre at the University of Adelaide.
"This group represents almost three-quarters of Baby Boomers surveyed, which is a significant number with major implications for the future of the Australian workforce."
"Australia's culture of early retirement, which has been so pervasive over so many years, is being replaced by a culture of gradual retirement, with continued part-time employment."
"At a time when there is national debate about the retirement age being lifted to 70 by 2035, studies such as this will help us to better understand what our population is intending to do, and why. Importantly, this survey was conducted before the current Federal Government was elected," Dr Feist says.
The survey shows that Baby Boomer women, those with lower education levels, and those who save their money regularly are the most likely to retire completely from the workforce. The authors also believe that the Global Financial Crisis of 2008 has impacted on people's intentions to retire.
"There are many implications here for policymakers across the workplace, employment and health sectors," says Dr Feist. "We need to ensure that policies are in place so that workplaces remain safe, welcoming, flexible and productive for ageing workers."
The results of this survey were published online in the international journal BMC Public Health.
More information: "A survey of retirement intentions of baby boomers: an overview of health, social and economic determinants." Anne W Taylor, et al. BMC Public Health 2014, 14:355. DOI: 10.1186/1471-2458-14-355
Provided by University of Adelaide
Thursday, May 29, 2014
Most physicians would forgo aggressive treatment for themselves at the end of life
Most physicians would choose a do-not-resuscitate or "no code" status for themselves when they are terminally ill, yet they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis, according to a study from the Stanford University School of Medicine to be published May 28 in PLOS ONE.
29 may 2014--It's a disconnect that needs to be better understood, said VJ Periyakoil, MD, clinical associate professor of medicine and lead author of the study.
"Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn't choose it for ourselves?" said Periyakoil, director of the Stanford Palliative Care Education and Training Program. "The reasons likely are multifaceted and complex."
In the study, Periyakoil and her colleagues set out to determine how physicians' attitudes have changed toward advance directives since passage of the Self-Determination Act in 1990, a law designed to give patients more control over determining end-of-life-care decisions. Advance directives are documents that patients can use to indicate end-of-life care preferences.
The study involved two sets of subjects: One comprised 1,081 physicians who in 2013 completed a web-based advanced directive form and a 14-item advance directive attitude survey at Stanford Hospital & Clinics and the Veterans Affairs Palo Alto Health Care System; the other comprised 790 physicians from Arkansas who were asked the same 14 survey questions—but did not complete an advance directive form—in a 1989 study published in the Journal of the American Medical Association.
Surprisingly, results showed that doctors' attitudes toward advance directives have changed little in 25 years.
"The needle has not moved very much," Periyakoil said, who is also associate director of palliative care services at the Palo Alto VA center.
The lack of change in physicians' attitudes toward advance directives mirrors what the study describes as the medical system's continued focus on aggressive treatment at the end of life, despite the fact that most Americans now say they would prefer to die at home without life-prolonging interventions.
"A big disparity exists between what Americans say they want at the end of life and the care they actually receive," the study said. "More than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life, but their wishes are often overridden."
In fact, the type of treatments they receive depends not on the patients' care preferences or on their advance directives, but rather on the local health-care system variables, such as institutional capacity and individual doctors' practice style, according to the study.
"Patients' voices are often too feeble and drowned out by the speed and intensity of a fragmented health-care system," Periyakoil said.
Other results from the study showed that because of the Self-Determination Act, doctors now feel they are less likely to be sued for not providing the most aggressive care if a patient has an advance directive. The law requires hospitals to inform patients about advance directives, but it doesn't ensure that the directives be followed.
Physicians' attitudes toward end-of-life care also differed depending on their ethnicity and gender. Emergency physicians, pediatricians, obstetrician-gynecologists and those in physical medicine and rehabilitation had more favorable attitudes toward advance directives. Radiologists, surgeons, orthopaedists and radiation oncologists were less favorable. Caucasian and African American doctors were the most favorable; Latino physicians were the least favorable.
An overwhelming percentage of the 2013 doctors surveyed—88.3 percent—said they would choose "no-code" or do-not-resuscitate orders for themselves.
As a geriatrics and palliative care physician who sits at the bedside of sick patients herself, Periyakoil said she understands the disconnect between the type of care doctors want for themselves at the end of life and what they actually do for their patients. It's not because doctors are trying to make more money or because they are intentionally insensitive to their patients' desires. At the core of the problem is a biomedical system that rewards doctors for taking action, not for talking with their patients.
"Our current default is 'doing,' but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself," said Periyakoil, who trains physicians in palliative medicine. "It's tricky, but physicians don't have to figure it out by themselves. They can talk to the patients and their families and to the other interdisciplinary team members, and it becomes much easier.
"But we don't train doctors to talk or reward them for talking. We train them to do and reward them for doing. The system needs to be changed."
Provided by Stanford University Medical Center
Nearly one-third of the world's population is obese or overweight, new data show
This is an image of a weight scale. Credit: CDC/Debora Cartagena
29 may 2014--Today, 2.1 billion people—nearly 30% of the world's population—are either obese or overweight, according to a new, first-of-its kind analysis of trend data from 188 countries. The rise in global obesity rates over the last three decades has been substantial and widespread, presenting a major public health epidemic in both the developed and the developing world.
The study, "Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013," conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and published in The Lancet on May 29, found that the number of overweight and obese individuals globally increased from 857 million in 1980 to 2.1 billion in 2013. Overweight is defined as having a Body Mass Index (BMI), or weight-to-height ratio, greater than or equal to 25 and lower than 30, while obesity is defined as having a BMI equal to or greater than 30.
Over the course of the study, rates of overweight and obesity among adults have increased for both men (from 29% to 37%) and women (from 30% to 38%). In developed countries, men had higher rates of overweight and obesity, while women in developing countries exhibited higher rates. Also in developed countries, the peak of obesity rates is moving to younger ages.
"Obesity is an issue affecting people of all ages and incomes, everywhere," said Dr. Christopher Murray, director of IHME and a co-founder of the Global Burden of Disease (GBD) study. "In the last three decades, not one country has achieved success in reducing obesity rates, and we expect obesity to rise steadily as incomes rise in low- and middle-income countries in particular, unless urgent steps are taken to address this public health crisis."
Looking at individual countries, the highest proportion of the world's obese people (13%) live in the United States. China and India together represent 15% of the world's obese population. Rates in the study were age-standardized, meaning they were adjusted for differences in population size and ages over time and across countries.
Among children and adolescents, obesity has increased substantially worldwide. Between 1980 and 2013, the prevalence of overweight or obese children and adolescents increased by nearly 50%. In 2013, more than 22% of girls and nearly 24% of boys living in developed countries were found to be overweight or obese. Rates are also on the rise among children and adolescents in the developing world, where nearly 13% of boys and more than 13% of girls are overweight or obese. Particularly high rates of child and adolescent obesity were seen in Middle Eastern and North African countries, notably among girls.
"The rise in obesity among children is especially troubling in so many low- and middle-income countries," said Marie Ng, Assistant Professor of Global Health at IHME and the paper's lead author. "We know that there are severe downstream health effects from childhood obesity, including cardiovascular disease, diabetes, and many cancers. We need to be thinking now about how to turn this trend around."
Regionally, countries in the Middle East and North Africa, Central America, and Island nations in the Pacific and Caribbean have already reached exceptionally high rates of overweight and obesity—44% or higher. In 2013, the highest rates of overweight and obesity were seen in the Middle East and North Africa, where more than 58% of men and 65% of women age 20 or older were found to be either overweight or obese. More than two-thirds of the countries in the region had overweight and obesity rates of over 50% in adult men and women. In Central America, more than 57% of adult men and more than 65% of adult women were overweight or obese, with the highest prevalence—greater than 50% among men and women—found in Colombia, Costa Rica, and Mexico. In the Pacific Islands, nearly 44% of men and more than 51% of women are overweight or obese, as are nearly 38% of men and more than 50% of women in the Caribbean.
While the percentage of people who are either overweight or obese has risen substantially over the last 30 years, there have been marked variations across regions and countries. In developed countries, increases in obesity that began in the 1980s and accelerated from 1992 to 2002 have slowed since 2006. Conversely, in developing countries, where almost two-thirds of the world's obese people currently live, increases are likely to continue.
Key findings:
More than 50% of the world's 671 million obese live in 10 countries (ranked beginning with the countries with the most obese people): US, China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia.
The US, United Kingdom, and Australia are among the high-income countries with large gains in obesity among men and women.
Over the 33-year period of research, several countries in the Middle East showed the largest increase in obesity globally. These countries include Bahrain, Egypt, Saudi Arabia, Oman, and Kuwait.
In six countries, all in the Middle East and Oceania—Kuwait, Kiribati, the Federated States of Micronesia, Libya, Qatar, and Samoa—the prevalence of obesity for women exceeds 50%. In Tonga, both men and women have obesity prevalence over 50%.
In sub-Saharan Africa, the highest obesity rates (42%) are seen among South African women. Health risks such as cardiovascular disease, cancer, diabetes, osteoarthritis, and chronic kidney disease increase when a person's BMI exceeds 23. In 2010, obesity and overweight were estimated to have caused 3.4 million deaths, most of which were from cardiovascular causes. Research indicates that if left unchecked, the rise in obesity could lead to future declines in life expectancy.
Provided by Institute for Health Metrics and Evaluation
Tuesday, May 27, 2014
Study proves physical activity helps maintain mobility in older adults
Credit: Peter Griffin/public domain
It's something we've all heard for years: Exercise can help keep older adults healthy. But now a study, the first of its kind to look at frail, older adults, proves that physical activity can help these people maintain their mobility and dodge physical disability.
A new University of Florida study shows daily moderate physical activity may mean the difference between seniors being able to keep up everyday activities or becoming housebound. In fact, moderate physical activity helped aging adults maintain their ability to walk at a rate 18 percent higher than older adults who did not exercise. "The very purpose of the study is to provide definitive evidence that physical activity can truly improve the independence of older adults," said principal investigator Marco Pahor, Ph.D., director of the UF's Institute on Aging.
What's more, moderate physical activity not only helped older adults maintain mobility but also helped prevent the occurrence of long-term mobility loss. Co-principal investigator Jack Guralnik, Ph.D., a professor of epidemiology and public health at the University of Maryland School of Medicine, said there was a 28 percent reduction in people permanently losing the ability to walk easily.
"The fact that we had an even bigger impact on persistent disability is very good," said Guralnik, who also holds a faculty position at UF. "It implies that a greater percentage of the adults who had physical activity intervention recovered when they did develop mobility disability."
The results will be published in the May issue of the Journal of the American Medical Association and will be presented at 1 p.m. Tuesday (May 27) at the annual meeting of the American College of Sports Medicine in Orlando.
Researchers showed that prescribed daily physical activity can prevent older adults' loss of mobility, defined in the study as the ability to walk 400 meters, or about a quarter of a mile. Although 400 meters might sound like an arbitrary number, it's an important figure for older adults, researchers said.
"Four hundred meters is once around the track, or from the parking lot to the store, or two or three blocks around your neighborhood," Guralnik said. "It's an important distance in maintaining an independent life." Called the Lifestyle Interventions and Independence for Elders, or LIFE, study, the study took place across eight field centers. There were two Florida field center recruitment sites at the University of Florida and Jacksonville Brooks Rehabilitation as well as field centers at Northwestern University, Pennington Biomedical Research Center, the University of Pittsburgh, Stanford University, Tufts University, Wake Forest School of Medicine and Yale University.
The researchers recruited 1,635 sedentary men and women ages 70 to 89 for the study. The participants could walk a quarter mile within 15 minutes but were at risk of losing that ability. Low physical performance can be a predictor of early death and higher hospitalization and institutionalization rates, and patients with low physical performance are not often recruited to large studies, Pahor said.
"These are people who are patients we see every day. This is why this study is so important: It includes a population that is typically understudied," Pahor said.
The participants were randomly separated into two groups and followed for an average of 2.6 years. The first group of 818 walked 150 minutes per week and did strength, flexibility and balance training. They were monitored by two visits to field centers per week. The second group of 817 attended health education classes and performed stretching exercises. This phase of the study occurred between February 2010 and December 2013.
Staff members assessed study participants every six months, checking their ability to walk, their body weight, blood pressure and pulse rate, among other measurements. The staff was not told which participants were assigned to physical activity or to the education classes.
The study did turn up one unanticipated result: The number of people reporting hospitalizations in the physical activity group was slightly higher than in the education group, though the number was not statistically significant. The researchers think this is in part because the physical activity group had more frequent contact with research staff, possibly resulting in a higher reporting of hospitalizations. The physical activity could also have triggered underlying heart trouble and other health problems. Researchers plan to study this occurrence more closely, Pahor said.
"It's quite a vulnerable and high-risk population," Pahor said. "Both age and poor health were factors. We selected people who had low physical performance, which is a strong predictor for future morbidity, hospitalization, institutionalization and mortality."
Wendy Kohrt, Ph.D., professor of medicine in the division of geriatric medicine at the University of Colorado, helped review the scientific merit of the study before the launch of the main LIFE trial. She said the information produced by this study fills gaps in researchers' knowledge of the types of people enrolled in the study.
"As an exercise scientist, I believe this type of research is absolutely critical to establish scientific evidence on which to make recommendations for how lifestyle can beneficially influence health status," Kohrt said. "There is a general belief among the public and the scientific and medical communities that we know exercise is good for you, so why do we need to do more research in this area? However, we still do not know whether certain types or doses of exercise are better than others, particularly for specific health conditions or diseases. The LIFE trial demonstrated that a modest increase in physical activity has the potential to help older adults maintain functional independence."
Pahor and Guralnik said there is still a vast amount of data to unpack from the study, including looking at the effects of physical activity on the participants' emotional well-being. The research team also plans to determine how physical activity impacted the participants' physiological, social and biological factors.
Research shows why ketamine is an effective antidepressant but memantine is not
One 10 ml vial of 1000 mg ketamine. Credit: Psychonaught/Wikipedia
27 may 2014—Ketamine is a fast-acting antidepressant. However, it can create symptoms that mimic psychosis. Therefore, doctors don't give it to depressed patients. Memantine, a similar drug, does not have psychotomimetic effects, but it also does not appear to alleviate depression. Lisa M. Monteggia of the University of Texas Southwestern Medical Center and her colleagues have determined that these drugs have different effects on neurotransmitter pathways. In particular, ketamine promotes the expression of neurotrophic factors but memantine doesn't. The research appears in the Proceedings of the National Academy of Sciences.
Traditional antidepressants target the monoamine system. Patients who take them require several weeks of treatment before they begin to feel an effect. In some cases, for example, if the patient is suicidal, waiting this long can be dangerous. A fast-acting antidepressant would be a preferable treatment.
Ketamine is such a fast-acting drug. Patients have reported experiencing its antidepressant effects within 30 minutes to a few hours after a single intravenous dose. Unlike traditional antidepressants, ketamine does not affect the monoamine system. It is an NMDA receptor antagonist. Unfortunately, it can cause psychotic symptoms; therefore, doctors do not prescribe it for treatment of depression.
As an alternative to ketamine, pharmacologists have considered using the drug memantine, another NMDA receptor antagonist. Memantine, used to treat patients with Alzheimer's disease, does not cause psychotic symptoms and therefore would be safer to use. Clinical studies, however, have shown that it does not behave as an antidepressant. Until now, researchers haven't understood why.
To understand the differences between these two drugs, Monteggia's team first tested their antidepressant properties on mice. Tests confirmed previous observations that ketamine acts as an antidepressant but memantine does not.
The team then used electrophysiology to examine the effect of ketamine and memantine on cultured mouse hippocampal neurons. They found key functional differences in how the drugs suppress NMDA receptor function at rest and how they inhibit the eukaryotic elongation factor 2 kinase (eEF2K) signaling pathway.
When the extracellular recording solution did not contain magnesium, both ketamine and memantine antagonized NMDA receptors. However, with the addition of magnesium, ketamine blocked NMDA receptors, but memantine did not. In addition, ketamine inhibited the phosphorylation of eeF2 and augmented expression of brain derived neurotrophic factor (BDNF). Memantine did not produce these effects. Augmentation of BNDF makes ketamine an effective antidepressant.
These findings could help scientists develop new, fast-acting antidepressants with fewer side effects.
More information: Mechanisms underlying differential effectiveness of memantine and ketamine in rapid antidepressant responses, PNAS, 2014. www.pnas.org/cgi/doi/10.1073/pnas.1323920111
Team explores broader definition of successful aging
An aging population poses challenges for governments around the globe as nations grapple with how to satisfy the physical, social and economic needs of older adults. About 126 million adults 65 years and older live in China - the country with the largest population of senior citizens, while 40 million adults 65 years and older live in the United States.
27 may 2014--In an article published today in Journal of Transcultural Nursing, University of Louisville School of Nursing assistant professor Valerie Lander McCarthy, PhD, RN; Ji Hong, MSN, a visiting scholar from Shandong University, China; and Jiying Ling, PhD, MS, RN, post-graduate fellow, Michigan State University College of Nursing, explore whether a broader definition of successful aging could positively influence research, clinical practice and health policy in the United States and China.
McCarthy argues it is unrealistic to measure positive aging solely on good physical and cognitive function and active social engagement, as traditionally defined by J. W. Rowe, M.D., and Robert L. Kahn.
"In reality the definition applies to only about 10-percent of the older adult population, then older adults feel guilty when they get sick because they think they are not succeeding – and in the U.S. succeeding is important. In China, individual success is not as important, but the negative effect of the cost to care for the older population is a major problem," McCarthy said.
Even in the presence of chronic illness and functional limitations, older adults still report aging successfully, McCarthy said. She concludes nurse scientist Meredith Flood's definition is most accurate. Flood describes successful aging as a person's ability to cope and adapt while maintaining a sense of connectedness and meaning in life.
Building on Flood's ideas, McCarthy's own studies have found transcendence - a sense of meaning, well-being and life satisfaction, to be the best predictor of positive aging. The concept involves relationships, creativity, contemplation, introspection and spirituality. Thanks to a grant from the nursing honor society Sigma Theta Tau International and the National Gerontological Nurses Association, she is working to develop a program of activities to increase transcendence.
An example of one intervention involves a time for quiet solitude in natural beauty followed by a discussion about a person's outlook, helping to develop a broadened perspective on life or a feeling of being an integral part of the cycle of life. A second example may provide an opportunity for storytelling, increasing a sense of belonging to a group.
"Successful aging is important for the rapidly growing population of older adults and their families and caregivers," McCarthy said. "It also is significant for society as a whole, which will bear the burden of unprecedented demands on health and social services. This is one reason we are developing interventions to increase positive aging."
Being Sardinian puts a smile on the face of the elderly
Residents of the Italian island of Sardinia are known for their longevity. Now, a new study also shows that elderly Sardinians are less depressed and generally are in a better mental frame of mind than peers living elsewhere. The study, led by Maria Chiara Fastame and Maria Pietronilla Penna of the University of Cagliari in Italy and Paul Hitchcott from the Southampton Solent University in UK, is published in Springer's journal Applied Research in Quality of Life.
26 may 2014--Various tests to measure the mental state and capacity of elderly people were performed on 191 cognitively healthy native-born residents between the ages of 60 years and 99 years old. They were recruited from the rural areas of Lombardy in Northern Italy, from the Sardinian city of Sassari and the agro-pastoral villages of Bargagia and Ogliastra on the Mediterranean island. These areas were chosen because of the high prevalence of centenarians who live on the isle. Fastame and colleagues showed in a previous study that residents from Ogliastra enjoy greater levels of psychological well-being than those of Lombardy. Her team now wanted to find out if depression among the elderly was influenced by factors such as gender, marital status, age, lifestyle choices, levels of brain functioning and the environment.
Findings from the latest study highlight the effect that one's region of residence has on psychological well-being. It was noted that the Sardinian way of life trumps all else, with older Sardinians being less depressed and experiencing higher levels of personal satisfaction and coping strategies than is true for the norm. In contrast, the elderly from Northern Italy struggled with depression.
These findings are ascribed to the fact that elderly people from Sardinia, and especially those from Ogliastra, are physically active until late in life and feel more valued, respected and supported by younger generations. In turn, elderly Sardinians living in Sassari benefit from higher levels of wealth and physical health. They have mental health services nearby, and are involved in ongoing social, recreational and cultural activities.
More symptoms of depression were noted among women than men; and city dwellers reported more symptoms of depression than those from rural areas. Also, very old participants between 75 and 99 years old tended to be more depressed than those between 65 and 74 years old.
The researchers expressed worry about the marked signs of depression noted among residents of Northern Italy. They advise that psychology-based intervention programs be implemented to help strengthen the self-image and self-esteem of the elderly living in these areas, to ultimately improve the quality of their later life and to ward off feelings of depression.
"Positive ageing is more evident in Sardinia, especially in rural areas, where the maintenance of an adequate social status and physical activity help guarantee a positive level of mental health in later life," conclude Fastame and her colleagues.
More information: Fastame, M.C. et al (2014). Mental Health in Late Adulthood: What Can Preserve It? Applied Research in Quality of Life. DOI: 10.1007/s11482-014-9323-5
Provided by Springer
Saturday, May 24, 2014
Medical conditions add to premature mortality risk of people with mental illness
Dr Ruth Cunningham
24 may 2014—People using mental health services in New Zealand are dying prematurely from both natural and external causes, a new University of Otago Wellington study has revealed.
While suicide and accidents are contributors to these high death rates, chronic medical conditions such as heart disease and cancer are a significant cause, the study has found.
Published today in the New Zealand Medical Journal, the study of 266,093 people who had contact with mental health services between 2002 and 2010 shows that the death rate for people who experience mental health problems severe enough to lead to contact with psychiatric services is twice that of the total population.
People with the most severe mental illnesses such as schizophrenia and bipolar disorder have three times the overall death rate of the total population, the study shows.
Lead author Dr Ruth Cunningham says the findings highlight the need to understand and meet the physical health needs of people with mental illness.
More than 7000 adults who had used mental health services died before the age of 65 during the study period. The main cause of death for both women and men were natural (71% and 58% respectively), due mainly to cancer and heart disease. Suicide accounted for 15% of deaths in women and 22% of deaths in men, and accidents were also common, Dr Cunningham says.
High smoking rates and antipsychotic medications are recognised health risks for people with mental illness that lead to medical conditions such as cancer and heart disease, but there are other less obvious risks, such as lack of appropriate treatment for medical conditions, that need to be acknowledged and addressed, she says.
Discrimination and social deprivation will also be contributing to the mortality gap, she adds.
"For example, both here and overseas, people using mental health services are saying they experience discrimination by health service providers. This can lead to a lack of adequate preventative care and treatment."
Discrimination can occur against anyone with mental illness, especially those with severe mental illness, and can make it extremely difficult to secure a job and decent housing, which further impacts on health, Dr Cunningham says.
"We found that those using mental health services were more likely to be living in socially deprived areas, which also drives up the risk of premature death."
This critical health issue has been well researched internationally, but this is the first time it has been documented in New Zealand, Dr Cunningham says.
The next step must be coordinated action to address these health inequalities, through initiatives such as the "Equally Well" project, which was initiated in September 2013 by Te Pou and Platform Trust, she says.
"Equally Well" is a New Zealand initiative which has been gathering evidence on the extent of physical health problems for people with a severe mental illness and/or addiction, including the results of this study. Its next phase will focus on coordinating action across key organisations, including medical colleges, and government and non-government agencies, to improve the physical health outcomes of people with a severe mental illness and/or addiction.
Ongoing monitoring of the physical health and mortality of people with mental illness is essential, in order to evaluate the effectiveness of any interventions and to ensure that the health of this group is no longer neglected, Dr Cunningham says.
Provided by University of Otago
Friday, May 23, 2014
Newly separated most at risk of suicidal thoughts
Credit: Lloyd Morgan on flickr
Men and women are most likely to have suicidal thoughts within a year of a marriage or de-facto relationship breakup, new ANU research has found.
23 may 2014--The vulnerability may be due to the trauma of the breakup, along with subsequent changes in social networks affecting people's sense of belonging, said lead author of the study Dr Philip Batterham, from the ANU Centre for Mental Health Research.
"The prevalence of suicidal thoughts among recently separated men and women is three times higher than for those who remain married, or in de-facto relationships," he said.
He said the study highlights the need for governments and health services to better target mental health services to people who have recently separated from a marriage or a relationship.
"It is important to intervene early, to reduce suicidal thoughts and suicidal behaviours, before they end up as a suicide," he said.
Dr Batterham's study began in 2000 and has looked at more than 6,600 people aged between 20 and 64 from Canberra and nearby Queanbeyan. The study investigated whether periods before and after a relationship breakup presented increased risk of suicidal thoughts and behaviours.
Follow up interviews will continue every four years, until 2020.
Results found the period up to four years before a separation was also a time of increased risk. However, suicidal thoughts were more prevalent after a relationship break up.
Suicidal thoughts and behaviour were most common among people aged in their 20s, and lowest for those in their 60s. The 20s age group also reported a higher number of more recent and impending separations.
Rates of suicidal thoughts began to fall gradually among those in their second year of separation. After five years or more after separation, the risk further declined, but remained 'significantly elevated, Batterham said.
The study was conducted by researchers at the Centre for Mental Health Research and the Centre for Research on Ageing, Health and Wellbeing at the Australian National University, with support from a number of other Australian researchers linked through the NHMRC Centre of Research Excellence in Suicide Prevention.
Findings are to be published in the June edition of Social Science & Medicine.
Provided by Australian National University
Swiss organisation extends assisted suicide to elderly
A Swiss assisted suicide group has expanded its services to help elderly patients who are sick but not terminally ill end their lives, it said Thursday.
23 may 2014--Exit A.D.M.D., a group that provides assisted suicide in the French-speaking part of Switzerland, officially broadened the scope of who it can help during its general assembly last month, its leader Doctor Jerome Sobel told AFP.
The group's larger sister organisation, Exit, which operates in the German and Italian speaking parts of the country, is planning to follow suit in a few days, he added.
"We are helping people who are sick and opt for quality of life over a quantity of time surviving with a poor quality of life," Sobel said, insisting the organisation's activities remained "well within Swiss law."
"Passive" assisted suicide has been legal in Switzerland since the 1940s, provided the person is in his or her right mind and anyone helping them is not motivated by self-interest or financial gain.
A number of groups work to help the terminally ill and those suffering who wish to end their lives to do so, usually by supplying them with a lethal dose of a drug they must administer themselves.
Exit A.D.M.D., which only assists in suicides for people who live in Switzerland, helped 155 people—mainly terminally ill cancer patients—end their lives last year.
Exit helped 459 people end their lives in 2013.
Sobel said the membership of his group is ageing and many people had demanded that it officially include the infirm but not terminally ill elderly among those it is willing to help.
He said that if a person over the age of 75, who is for example already deaf and going blind, "calls us and asks us to help them, we will help them."
"If we don't, some might accuse us of abusing them, since forcing them to continue living can be torture," he explained.
Last year, the European Court of Human Rights called on Switzerland to clarify the guidelines for assisted suicide after an octogenarian who wanted to end her life failed to convince doctors to assist her because she was not ill enough.
Sobel said his group's decision to broaden the official scope of who to assist in dying had not been impacted by that case.
Cognitive test can differentiate between Alzheimer's and normal aging
Jim Monti (right), a postdoctoral research associate in the lab of Illinois psychology professor Neal Cohen (left), developed a cognitive task that helps differentiate older adults with very early Alzheimer's disease from those experiencing normal aging. Credit: L. Brian Stauffer
22 may 2014--Researchers have developed a new cognitive test that can better determine whether memory impairments are due to very mild Alzheimer's disease or the normal aging process.
Their study appears in the journal Neuropsychologia.
The Alzheimer's Association estimates that the number of Americans living with Alzheimer's disease will increase from 5 million in 2014 to as many as 16 million by 2050. Memory impairments and other early symptoms of Alzheimer's are often difficult to differentiate from the effects of normal aging, making it hard for doctors to recommend treatment for those affected until the disease has progressed substantially.
Previous studies have shown that a part of the brain called the hippocampus is important to relational memory – the "ability to bind together various items of an event," said Jim Monti, a University of Illinois postdoctoral research associate who led the work with psychology professor Neal Cohen, who is affiliated with the Beckman Institute at Illinois. Being able to connect a person's name with his or her face is one example of relational memory. These two pieces of information are stored in different parts of the brain, but the hippocampus "binds" them so that the next time you see that person, you remember his or her name, Monti said.
Previous research has shown that people with Alzheimer's disease often have impairments in hippocampal function. So the team designed a task that tested participants' relational memory abilities.
Researchers asked participants to study a circle divided into three patterned parts then pick an exact match from a series of 10 other circles. This task measures the performance of a part of the brain called the hippocampus, which has been shown to sustain damage in Alzheimer's disease. Credit: Jim Monti
Participants were shown a circle divided into three parts, each having a unique design. Similar to the process of name-and-face binding, the hippocampus works to bind these three pieces of the circle together. After the participants studied a circle, they would pick its exact match from a series of 10 circles, presented one at a time.
People with very mild Alzheimer's disease did worse overall on the task than those in the healthy aging group, who, in turn, did worse than a group of young adults. The task also revealed an additional memory impairment unique to those with very mild Alzheimer's disease, indicating the changes in cognition that result from Alzheimer's are qualitatively different than healthy aging. This unique impairment allows researchers to statistically differentiate between those who did and those who did not have Alzheimer's more accurately than some of the classical tests used for Alzheimer's diagnosis, Monti said.
"That was illuminating and will serve to inform future work aimed at understanding and detecting the earliest cognitive manifestations of Alzheimer's disease," Monti said.
Although this new tool could eventually be used in clinical practice, more studies need to be done to refine the test, he said.
"We'd like to eventually study populations with fewer impairments and bring in neuroimaging techniques to better understand the initial changes in brain and cognition that are due to Alzheimer's disease," Monti said.
