Little progress made in reducing health disparities for people with disabilities

Psychological distress in people with disabilities is associated with increased prevalence of other chronic conditions and reduced access to health care and preventive care services, finds a new study in the Journal of Health Care for the Poor and Underserved.

30 jun 2014--The U.S. Department of Health and Human Services' Healthy People series established goals to reduce disparities among people with disabilities, but there has been very little progress toward reaching these goals, says lead author Catherine Okoro, Ph.D., of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

"It's important to find out why there has been so little progress, since the prevention, detection, and treatment of secondary illnesses is critical for health maintenance, halting progression of disability, and helping people with disabilities to participate in life activities," she says.

The study analyzed data from the Behavioral Risk Factor Surveillance System, a telephone survey conducted in 2007 by most state health departments in conjunction with the CDC. Approximately 30 percent of adults with disabilities reported having moderate to serious psychological distress, with over 12 percent reporting serious psychological distress.

Adults who reported having a disability and serious psychological distress had a higher prevalence of seven chronic diseases and conditions—arthritis, asthma,coronary heart disease, diabetes, hypertension, high cholesterol, and stroke—when compared to adults with no psychological distress. Disabled adults with moderate psychological distress also had higher rates of these conditions, with the exception of diabetes.

"We found a strong association between increasing numbers of physical chronic conditions and prevalence of serious psychological distress," Okoro says. "For example, the prevalence of serious psychological distress was about two times as high among those with five to seven chronic conditions compared to those with no conditions."

Adults ages 18 to 64 with disabilities and moderate-to-serious psychological distress were also found to have several barriers to accessing health care. They were more likely to be uninsured and unable to afford care than those with no distress. Researchers found that the use of mental health services increased with the severity of psychological distress, but a larger proportion of older adults with serious psychological distress reported not receiving mental health care when compared to their younger counterparts. "It's possible this may be due to competing health conditions, stigma, or avoidance," Okoro comments.

The study illustrates that a relatively small but highly vulnerable population bears the majority of burden of poor physical and psychological health, says Benjamin Druss, M.D., a psychiatrist at Emory University. "These problems tend to be tangled up with one another so a person who has physical problems tends to be more stressed about their problems—particularly if they can't get health care," he comments. "It's not easy to untangle all these issues, but these individuals should be treated in a holistic way, looking at their mental problems, their physical health, and their psychosocial issues," he adds.

More information: Okoro A, Dhingra SS, and Li C. "A triple play: psychological distress, physical comorbidities, and access and use of health services among US adults with disabilities." J of Health Care for the Poor and Underserved. 2014;(25):814-836.

Provided by Health Behavior News Service

Aging with HIV and AIDS: A growing social issue

As the first people with HIV grow old, a new study from St. Michael's Hospital questions whether the health care system and other government policies are prepared to meet their complex medical and social needs.

29 jun 2014--In high-income countries such as Canada, 30 per cent of people living with HIV are 50 or older, and many are living into their 60s and 70s. In San Francisco, more than half the people with HIV are over 50.

"It's a positive thing that people are aging with HIV," said Dr. Sean B. Rourke, a neuropsychologist who heads the Neurobehavioural Research Unit at St. Michael's. "This shows that Ontario is doing its job to help people living with HIV have access to the medical systems and antiretroviral medications to keep HIV at bay. But a very significant crisis is looming."

In a study to be published in the July issue of the journal Current Opinion in HIV and AIDS, Dr. Rourke noted that aging for people with HIV may be more challenging than for the general population because of HIV-related stigma, loss of friends and social networks, and the detrimental health effects of the virus and medications taken to combat the virus.

Older people with HIV are more likely to experience mental health and neurocognitive impairments than other people of the same age, as well as more social isolation. A study in the United States found that 94 per cent of people with HIV who were over 50 have at least one other chronic illness, with an average of three conditions.

Pension plans and health care facilities are not designed for, or expecting, people to have these issues at younger ages, Dr. Rourke said. Geriatric physicians are not trained for working with HIV, and those trained for HIV are not trained in geriatrics.

As a large number of people with HIV approach retirement age, policy makers need to develop new policies or adapt the existing ones to improve their social and economic outlook. He said people aging with HIV who are still working may need more time off to take care of themselves or rest breaks during their shifts; reforming retirement benefit programs could allow people with HIV to remain in the workforce as long as possible; retirement homes and long-term facilities need to be more welcoming places for older people living with HIV.

Individuals with HIV continue to live with health consequences that limit their ability to participate in society. This could mean the inability to work or engage in a community. Some people have to remain jobless or in low-paying jobs so they can receive social assistance and government-funded drugs.

Dr. Rourke said a growing body of research is exploring interventions and other coping strategies to minimize the negative impact of aging with HIV, including being proactive and managing treatment appropriately. Eating properly, exercising regularly and taking care of health needs earlier are much more important with a chronic illness like HIV, he said.

Provided by St. Michael's Hospital

Diet or exercise? "Energy balance" is real key to disease prevention

28 jun 2014—A majority of Americans are overweight or obese, a factor in the rapid rise in common diseases like diabetes, heart disease, cancer, high blood pressure and more. According to a paper published in this month's issue of the official journal of the American College of Sports Medicine (ACSM), energy balance is a viable public health solution to address the obesity epidemic. The paper outlines steps to incorporate energy balance principles into public health outreach in the U.S.

"It is time we collectively move beyond debating nutrition or exercise and focus on nutrition and exercise," said co-author and ACSM member Melinda Manore, Ph.D., R.D., C.S.S.D., FACSM of Oregon State University. "Nutrition and exercise professionals working collaboratively, combined with effective public health messaging about the importance of energy balance, can help America shape up and become healthier."

The paper, published in the July edition of Medicine & Science in Sports & Exercise and in the Journal of the Academy of Nutrition and Dietetics gives the following recommendations:

• Integrate energy balance into curriculum and training for both exercise science and nutrition professionals and strengthen collaborative efforts between them
• Develop competencies for school and physical education teachers and position them as energy balance advocates
• Develop core standards for schools that integrate the dynamic energy balance approach
• Work with federally-funded nutrition programs to incorporate energy balance solutions like the Cooperative Extension Service and school lunch programs
• Develop messaging and promotional strategies about energy balance that American consumers can understand and apply to their lifestyle
• Map out and support existing programs that emphasize energy balance

"Our health professionals are currently working in silos and must work together to educate and promote energy balance as the key to better health" said Manore. "The obesity crisis is one of the greatest public health challenges of our generation. Energy balance can help us work toward a solution so our children aren't saddled with the same health challenges we currently face. "

More information: The paper is available online: journals.lww.com/acsm-msse/Ful… nslating_the.24.aspx

Provided by American College of Sports Medicine

Scientists establish proof-of-concept for host-directed tuberculosis therapy

M. tuberculosis bacterial colonies. Credit: Centers for Disease Control and Prevention.

27 jun 2014--in a new study published in Nature, scientists describe a new type of tuberculosis (TB) treatment that involves manipulating the body's response to TB bacteria rather than targeting the bacteria themselves, a concept called host-directed therapy. TB remains a major cause of disability and death worldwide as an estimated 8.6 million people fell ill with TB and 1.3 million people died from the disease in 2012, according to the World Health Organization. Although TB is curable, adherence to therapy is difficult as treatment requires taking antibiotic drugs for at least six months and sometimes up to two years. Poor adherence to medication and other factors have resulted in drug-resistant strains, and currently no effective TB vaccine exists.

To address the need for alternative interventions, scientists from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, demonstrated proof-of-concept for a host-directed strategy to treat tuberculosis. They found that interleukin-1, a type of protein that regulates the body's immune response to infection, can help protect the body from TB infection. Their studies in cells and in mice and human patients infected with TB bacteria demonstrated that interleukin-1 induces a mediator, prostaglandin E2 (PGE2), that limits the production of type-I interferons, which are associated with increased TB disease severity.

The scientists found that host-directed immunotherapy using PGE2 and zileuton, a clinically-approved drug typically used to treat asthma, prevented death in TB-infected mice. This strategy could be of particular benefit to people infected with drug-resistant TB strains who have limited options for effective antibiotics because the treatment increased bacterial control and limited disease even in the absence of TB chemotherapy. In principle, this approach is compatible with standard antibiotic regimens, according to the authors. In future studies, NIAID scientists will test adjunct host-directed therapies in TB-infected individuals.

More information: KD Mayer-Barber et al. Host-directed therapy of tuberculosis based on interleukin-1 - type I interferon crosstalk. Nature. DOI: 10.1038/nature13489 (2014).

Provided by NIH/National Institute of Allergy and Infectious Diseases

Watching too much TV may increase risk of early death in adults 

Adults who watch TV for three hours or more each day may double their risk of premature death compared to those who watch less, according to new research published in the Journal of the American Heart Association.

26 jun 2014--"Television viewing is a major sedentary behavior and there is an increasing trend toward all types of sedentary behaviors," said Miguel Martinez-Gonzalez, M.D., Ph.D., M.P.H., the study's lead author and professor and chair of the Department of Public Health at the University of Navarra in Pamplona, Spain. "Our findings are consistent with a range of previous studies where time spent watching television was linked to mortality."

Researchers assessed 13,284 young and healthy Spanish university graduates (average age 37, 60 percent women) to determine the association between three types of sedentary behaviors and risk of death from all causes: television viewingtime, computer time and driving time. The participants were followed for a median 8.2 years. Researchers reported 97 deaths, with 19 deaths from cardiovascular causes, 46 from cancer and 32 from other causes.

The risk of death was twofold higher for participants who reported watching three or more hours of TV a day compared to those watching one or less hours. This twofold higher risk was also apparent after accounting for a wide array of other variables related to a higher risk of death.

Researchers found no significant association between the time spent using a computer or driving and higher risk of premature death from all causes. Researchers said further studies are needed to confirm what effects may exist between computer use and driving on death rates, and to determine the biological mechanisms explaining these associations.

"As the population ages, sedentary behaviors will become more prevalent, especially watching television, and this poses an additional burden on the increased health problems related to aging," Martinez-Gonzalez said. "Our findings suggest adults may consider increasing their physical activity, avoid long sedentary periods, and reduce television watching to no longer than one to two hours each day."

The study cited previous research that suggests that half of U.S. adults are leading sedentary lives.

Provided by American Heart Association

USPSTF says evidence doesn't support vitamin D screening

25 jun 2014—Current evidence is insufficient to weigh the benefits and harms of screening for vitamin D deficiency to improve health outcomes in asymptomatic adults, according to a draft evidence report from the U.S. Preventative Service Task Force.

Erin LeBlanc, M.D., from Oregon Health & Science University, and colleagues on behalf of the U.S. Agency for Healthcare Research and Quality conducted a literature search to develop evidence regarding the benefits of vitamin D treatment(with or without calcium) compared with placebo, calcium alone, or no treatment. Included studies evaluated asymptomatic populations from the United States, Canada, and Europe with serum 25(OH)D concentrations of ≤ 30 ng/mL.

The researchers found that in treatment studies, mortality was decreased in those randomized to vitamin D treatment (with or without calcium; 11 studies; pooled RR, 0.83; 95 percent confidence interval [CI], 0.70 to 0.99). However, the risk reduction was limited to studies of older, institutionalized persons (three trials; pooled RR, 0.72; 95 percent CI, 0.56 to 0.94). Vitamin D treatment was not associated with a decreased risk for falling (five studies; pooled RR, 0.84; 95 percent CI, 0.69 to 1.02), but it was associated with fewer falls per person (five studies; pooled RR, 0.66; 95 percent CI, 0.50 to 0.88). There was no association between vitamin D treatment and decreased fracture risk (five studies; pooled RR, 0.98; 95 percent CI 0.82 to 1.16).

"More research is needed to determine vitamin D treatment's effects in younger, non-institutionalized adults and to clarify the subpopulations that are most likely to benefit from treatment," the authors write.

More information: Draft Recommendation Statement
Draft Evidence Report

Low number of taste buds linked to older age, higher fasting blood sugar

A study finds that the number of taste buds we have on our tongue decreases as we get older, and that the lower the number of taste buds, the more likely for fasting blood glucose (sugar) levels to be higher than normal. The results were presented Sunday at the joint meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014 in Chicago.

24jun 2014--Because high fasting blood sugar level is a main characteristic of diabetes, the study findings suggest that the number of taste buds plays a role in glucose metabolism—how the body uses sugar—during aging, the authors proposed.

"The reduced number of taste buds with advancing age might be linked to the increased incidence of Type 2 diabetes among older adults," said the study's lead investigator, Chee Chia, MD, a medical officer at the National Institute of Aging (NIA) in Baltimore.

Diabetes affects more than 25 percent of Americans over age 65, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Chia explained why she and a co-worker at the NIA, Josephine Egan, MD, thought there might be a connection between taste buds and diabetes. Taste buds at the tip of the tongue, whose medical term is "fungiform papillae," contain sweet taste receptors, and past studies show that people with Type 2 diabetes have impaired sweet taste. Furthermore, animal studies suggest that taste buds produce hormones that are important for glucose metabolism and that, in rodents, taste buds decrease in number with age.

To learn whether humans also have an age-related decline in the density of taste buds, Chia and Egan analyzed data from 353 adults who participated in the NIA's Baltimore Longitudinal Study of Aging between 2011 and 2014. This ongoing observational study of normal aging in community-dwelling volunteers included counts of the density, or number, of taste buds at the tip of the tongue after staining the subject's tongue with blue food dye.

The researchers found that older age was associated with fewer taste buds, a finding also seen in a larger clinical study published last October (Beaver Dam Offspring Study).

In addition, Chia reported that the fewer taste buds that subjects had, the higher their fasting blood sugar levels were and the less they had of a beneficial fat cell hormone called adiponectin. Prior studies found that obesity and Type 2 diabetes are associated with lower adiponectin levels.

"To my knowledge, this is the first association found between the number of taste buds and fasting glucose," Chia said. "It's very possible they could be unrelated, so we plan to do the study over a longer time, to confirm our findings."

"It's also possible," she added, "that having fewer taste buds means fewer hormones are secreted that may control glucose metabolism."

Provided by The Endocrine Society

Vitamin D can lower weight, blood sugar via the brain

Women with type 2 diabetes and high cholesterol are less likely than their male peers to reach treatment goals to lower their "bad" cholesterol, or low-density lipoprotein (LDL) cholesterol, despite access to cholesterol-lowering medication, a Canadian study finds. The results were presented on Saturday at the joint meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014 in Chicago.

24 jun 2014--Although other research has shown a similar gender gap in reduction of LDL cholesterol among adults with diabetes, the new study found that access to medication is not responsible for this difference. All patients, who were in a database from pharmacies in four Canadian provinces, had social insurance and could afford their medications, according to the study's principal investigator, Pendar Farahani, MD, MSc, an endocrinologist at Queen's University, Kingston, Ontario.

The finding that women were not able to lower their so-called bad cholesterol sufficiently is a concern, Farahani noted. Abnormal cholesterol levels are a risk factor for heart disease and stroke, as is diabetes.

"Women with diabetes have a considerably higher rate of cardiovascular-related illness and death than men with diabetes," Farahani said. "This pattern is likely related to poorer control of cardiovascular risk factors."

To evaluate whether biological sex influenced the results of cholesterol-lowering drug treatment, the investigators included nearly equal numbers of men and women (101 and 97) in their study. The average age for men was 65 years and for women was 63. All patients had Type 2 diabetes and had filled prescriptions for statin medication to treat high cholesterol between 2003 and 2004.

With treatment, only 64 percent of women lowered their LDL cholesterol to the recommended level compared with 81 percent of men, the investigators reported. The average LDL cholesterol level was 2.39 millimoles per liter (mmol/L) among women and 2.07 mmol/L for men.

At the time of the study, the Canadian Diabetes Association recommended that people with diabetes achieve an LDL cholesterol level of 2.5 mmol/L or less (now 2.0 mmol/L). In the U.S., LDL cholesterol goals are ideally below 100 milligrams per deciliter (mg/dL), the equivalent of less than 2.59 mmol/L, according to the American Diabetes Association.

The study did not explore the reasons why women had poorer LDL cholesterol. However, past research supports that women have poorer adherence to taking their statin medicine. Farahani said statins theoretically appear to have somewhat dissimilar pharmacological properties in a woman's body than a man's, which might explain why women typically have more bothersome side effects such as muscle pain.

Despite their differences in LDL cholesterol, male and female subjects reportedly achieved similar long-term control of their blood glucose, or sugar, as measured by a hemoglobin A1C level of 6.8 percent for each group. Most people with diabetes should have an A1C below 7 percent.

"Additional clinical investigations of the reasons for gender differences are needed to eliminate fundamental inequalities between men and women in the treatment and prevention of cardiovascular disease in patients with diabetes," Farahani said. "The findings suggest the need for gender-based evaluation and treatment of cardiovascular risk factors in these patients."

Provided by The Endocrine Society

Meta-analysis confirms serum 25(OH)D, mortality link

23 jun 2014-—Serum 25-hydroxyvitamin (25[OH]D) levels are associated with all-cause and cardiovascular mortality, according to a meta-analysis published online June 17 in BMJ.

Ben Schöttker, Ph.D., from the German Cancer Research Center in Heidelberg, and colleagues conducted a meta-analysis of individual participant data to examine the correlation between 25(OH)D and mortality. Participants included 26,018 men and women, aged 50 to 79 years, from the general population in Europe and the United States, enrolled in eight prospective cohort studies.

The researchers found that there was strong variation in 25(OH)D concentrations by season, country, and sex. A total of 6,695 participants died during follow-up, including 2,624 of cardiovascular diseases and 2,227 of cancer. For all-cause mortality, the pooled risk ratio was 1.57 comparing the bottom with the top quintile of 25(OH)D. Risk ratios of similar magnitude to that of all-cause mortality were seen forcardiovascular mortality for individuals with and without a history of cardiovascular disease at baseline. For cancer mortality, there was an association only for individuals with a history of cancer (risk ratio, 1.70). Curvilinear, inverse dose-response curves were seen for these correlations based on analyses using all quintiles. In most meta-analyses, heterogeneity was low.

"Results from a long-term randomized controlled trial addressing longevity are being awaited before vitamin D supplementation can be recommended in most individuals with low 25(OH)D levels," the authors write.

More information: Abstract
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Biggest World Cup comeback so far: beer

Brazil fought hard when FIFA insisted it overturn its ban on alcohol in stadiums, but the World Cup hosts lost, and with the tournament now under way it's official: beer is back.

22 jun 2014--After 11 years of stadium sobriety, FIFA and its sponsor Budweiser celebrated the suspension of Brazil's law against alcohol sales at matches—a bid to stop crowd violence—by pouring thousands of cold ones for fans.

Fans could also buy Bud Zero and local brands Brahma and Brahma Zero, all owned by AB InBev, the world's biggest brewer.

Those will be the only alcoholic beverages on sale at matches, thanks to Budweiser's contract to sponsor the World Cup until 2022, a deal estimated to be worth several million dollars a year.

Fans looking for caipirinhas or any other beer will have to find a street vendor—who, in another concession to FIFA, are kept well away from the stadium.

Last month the German Centre for Addiction Issues, a health lobby group, condemned the lifting of the ban for the World Cup and last year's Confederations Cup warm-up tournament.

"It is a health, political and security scandal," said Raphael Gassmann, the organization's director, warning alcohol sales were linked to violence.

"Economic interests must not prevail over the health and security of spectators."

FIFA rejected the group's criticism.

"Budweiser and AB InBev have long been involved in promoting moderate alcohol consumption around the world," said a spokesman.

"They will continue to do so during the World Cup, to ensure that fans have an exceptional experience while consuming beer responsibly."

'Bullied' on beer

Two days before the opening match, the British Medical Journal published a report criticizing FIFA's conduct in Brazil and football's links with the booze business.

"Whichever country hoists aloft the trophy on 13 July the real winner will be the alcohol industry," it said.

FIFA "has a long record of championing the financial interests of its commercial partners, including Budweiser, the tournament's official beer partner, by imposing extreme conditions on governments around the world."

These include tax waivers on any profits made by commercial partners during the World Cup and "bullying" the Brazilian government into suspending its stadium alcohol ban, it said.

FIFA said it just wants to put on a good World Cup and sought to highlight the benefits of beer sales.

"Our commercial partners share FIFA's ambition to have a positive influence on health and sport," the spokesman told AFP.

"The revenues from sponsorship operations allow FIFA to put in place football development projects in its 209 member countries, as well as 'FIFA 11 for Health'"—a program to promote football as exercise.

Though it lost the alcohol battle, Brazil did manage to win some small victories in its wrangling with FIFA.

Petitions in host cities Salvador and Recife forced FIFA to cave in and allow stadium sales of two favorite local foods—acaraje, an iconic black-eyed pea fritter, and tapioca, a crepe made with cassava flour.

It's up to fans whether or not to wash them down with a cold Bud.

Recreational football reduces high blood pressure in mature women

New research has shown that playing football could help lower blood pressure in women aged 35-50. Credit: Bo Kousgaard

21 jun 2014---The World Cup in Brazil may be attracting a global armchair audience of millions, but new research has shown that playing football could help lower blood pressure in women aged 35-50.

Women within this age group with mild high blood pressure achieve a significant reduction in blood pressure and body fat percentage through playing recreational football for 15 weeks. This is the finding of a new study conducted in a collaboration between researchers across four countries, including Professor Peter Krustrup of the University of Exeter.

The acclaimed Scandinavian Journal of Medicine & Science in Sports is today publishing two articles on recreational football for older women. The first article shows that 35‒50-year-old untrained women with mild high blood pressure achieve a significant improvement in physical fitness and a considerable reduction in blood pressure and body fat percentage after 3 x 1-hour football training sessions per week over 15 weeks. The second article describes the enthusiasm of women for the recreational football concept Football Fitness, which is currently being rolled out in football clubs across Denmark.

"After 15 weeks of participation in recreational football, systolic and diastolic blood pressure had fallen by 12 and 6 millimetres of mercury (mmHg) and the women had lost 2.3 kg of fat on average," says project leader Magni Mohr. "The football training produced an impressive reduction in blood pressure that was more than twice as big as with swimming performed over the same period as the football."

The researchers also found that women like playing football even if they have no previous experience of the game. Magni Mohr added: "The players faithfully attended training, with an attendance rate of over 90%. In fact, through the project period they came to enjoy playing so much that they have now started up their own football club."

"Our previous studies have shown that 16 weeks of football training reduces blood pressure in 20‒45-year-old women with normal blood pressure, but this is the first study that has looked at the effects of recreational football in women with high blood pressure," says Professor Peter Krustrup, who has been studying the health effects of recreational football and many other forms of physical activity for the past 10 years.

"As well as the impressive effects on blood pressure and body composition, we also saw a drop in cholesterol and a big improvement in physical fitness as a result of the 15 weeks of football training," says Krustrup. "In fact, the women were able to run more than twice as far in a Yo-Yo Intermittent Endurance Test and their heart rate was 14 beats per minute lower when working at moderate intensity. Recreational football is an effective therapy for poor fitness and high blood pressure in 35‒50-year-old women."

"Traditionally, there haven't been so many older female players in English, Faroese or Danish football clubs, but the relatively new Danish initiative of Football Fitness has really caught on with women," says sports sociologist Laila Ottesen, currently engaged in an extensive study of the Football Fitness concept, which was started in 2011 by the Danish Football Association and the Danish Sports Confederation.

"At present, there are 180 football clubs across Denmark offering Football Fitness. In just a few years, the initiative has become hugely popular with women, who currently make up almost 75% of players. Football Fitness is about training in a fun, sociable and healthy way and not about playing matches against local rivals," says Ottesen.

"Matches are not part of the package, and consequently Football Fitness appeals to a lot of women who have never been in a football club before, in Denmark and and probably also many other countries" concludes Ottesen.

In the training project, 41 untrained women aged 35‒50 years with mild high blood pressure of around 140/90 mmHg were randomly assigned to either a football training group or an inactive control group. The football group trained for 1 hour three times a week for 15 weeks. The training was performed on artificial grass in Torshavn in the Faroes. An extensive testing protocol was used before the start of training and on completion of the 15-week period.

The project was conducted as a collaboration between the University of Exeter (UK), the University of Gothenburg (Sweden), University of the Faroe Islands, Faroese National Hospital, The Faroese Football Association, Rigshospitalet and the Copenhagen Centre for Team sport and Health at the University of Copenhagen (Denmark).

The Football Fitness project comprises research into Danish football clubs and was carried out by, among others, associate professor Laila Ottesen and PhD student Søren Bennike of the Copenhagen Centre for Team Sport and Health.

Provided by University of Exeter

Football improves strength in men with prostate cancer

Some of the participants in the FC Prostate Cancer research project after a training session. Credit: 'Copenhagen Centre for Teamsport and Health'.

20 jun 2014--Men with prostate cancer aged 43‒74 achieve bigger and stronger muscles, improve functional capacity, gain positive social experiences and the desire to remain active through playing football for 12 weeks. These are the findings of the "FC Prostate" trial, jointly conducted by the University Hospitals Centre for Health Care Research at The Copenhagen University Hospital, Rigshospitalet and the Copenhagen Centre for Team Sport and Health at the University of Copenhagen.

Some of the participants in the FC Prostate Cancer research project after a training session. Download free press photo here. Credit: 'Copenhagen Centre for Teamsport and Health'.

The acclaimed Scandinavian Journal of Medicine & Science in Sports is today publishing two articles on recreational football (soccer) for 43‒74-year-old men with prostate cancer. The first article shows that twice-weekly 1-hour football training sessions for 12 weeks produce an increase in muscle mass and muscle strength despite concurrent androgen deprivation therapy. The second article describes how recreational football is a promising novel approach for health promotion in prostate cancer patients as the participants regain pride in their bodies, develop team spirit and mutual concern increasing their motivation for long-term participation in sport.

Regained body pride and strong social cohesion

"This is the first study of its kind in the world, and the results clearly show the potential of recreational football in the rehabilitation of prostate cancer patients," says project leader Julie Midtgaard, a psychologist at The Copenhagen University Hospital Rigshospitalet. "Just 12 weeks of football training resulted in the men regaining control and developing a unique exchange of feelings and recognition centered around the sport."

The attendance rate was high over the 12 weeks, and many of the participants are still playing football two years after the project began.

"The provision of football proved to be a good way of developing friendships between the men and a unique model for men with prostate cancer to take responsibility of their own health without giving up their claim to feel and behave like men," concludes Midtgaard.

Bigger and stronger muscles in spite of anti-hormone treatment

"Androgen deprivation therapy through medical castration is an effective treatment of prostate cancer patients but has adverse effects in the form of reduced muscle mass, higher fat percentage and reduced physical activity," explains Professor Peter Krustrup, who co-initiated the study with Midtgaard and has been studying the effects of recreational football for the past 10 years.

"Twelve weeks of football training increased muscle mass by half a kilo in the football group in spite of the anti-hormone treatment and contributed to a 15% increase in muscle strength. The players in the FC Prostate team thus achieved excellent gains in functional capacity as a result of 12 weeks of football training, measured among other things as a 8% improvement in performance in the stand-sit test," says Krustrup.

"Our study also showed that recreational football was fun and inclusive for the participants in FC Prostate, and for every training session the intensity was high, with an average heart rate of 85% of the participants' maximum heart rate," says Krustrup.

Football is good rehabilitation for prostate cancer patients

"Previously, we showed that recreational football is effective for preventing and treating lifestyle diseases. With this study, we can add that recreational football can also be used for rehabilitation of a large group of cancer patients," says Krustrup.

Midtgaard concludes: "The study indicates that men with prostate cancer benefit greatly from recreational football, both physically and mentally. It has also proved to be easy to keep the men involved in physical activity once they have started playing football. They look forward to going to training and enjoy it tremendously when they get there. The next step is to evaluate the effectiveness of football in a more natural setting. Therefore we are delighted that we have received the necessary funding to pursue an even bigger project in collaboration with the Danish Football Association in which more than 300 prostate cancer patients will be invited to play football in local football clubs in Denmark."

More information: The two articles are today being published in a special issue of the Scandinavian Journal of Medicine & Science in Sports on the topic of football for health.

Provided by University of Copenhagen

Why reaching the top in football is all in the mind, not the feet

19 jun 2014—As a youthful England football team prepares to take on Uruguay in World Cup 2014, new research has uncovered the rare mental attributes needed for talented young players to rise to the top of the English Premier League pyramid.

Sports scientists from the University of Lincoln, UK, and Liverpool John Moores University (LJMU) interviewed academy coaches at an unnamed Premiership club to understand the psychological qualities which marked out talented individuals for greatness.

The researchers were interested in understanding how academy coaches identified and defined 'mental toughness' – a quality found in elite athletes across many sporting disciplines, including swimming and athletics.

Youth players at an English Premier League football academy who would eventually go onto success showed mental toughness from an early age. This enabled them to deal with criticism, confront challenges after repeated failures, and not be intimidated by others.

The study also revealed that discipline off the field, such as sacrificing normal teenage life to ensure the chance of success, also contributed to future triumphs.

The researchers found the mentally toughest players were more independent, taking greater personal responsibility for their development. Academy recruits are subject to tough physical training drills, high expectations and sometimes harsh criticism, coaches said.

In contrast, young players who were high maintenance, requiring a lot of supervision, support, or relying on others to solve their problems were less likely to make it to the top of their profession.

Dr Lee Crust, a sport psychologist in the School of Sport & Exercise Science at the University of Lincoln, collaborated with LJMU on the research.

He said: "The study asks the question 'what makes you mentally strong enough to take the knocks and keep going, to lead the group?' We wanted to look at what might separate a player in the Premier League from another in the lower levels, how they are able to kick things up to a level of competitiveness which drives them to succeed.

"The report found that mentally tough players demonstrated a commitment to learning, had a strong level of trust with their coach, were more compliant with instructions and were always seeking ways to improve.

"These players were not afraid to make mistakes, and actually relished challenging situations; they were committed to learning how to cope with their own limitations by working on weaknesses whilst also playing to strengths.

"We found that coaches sought to foster independence and resourcefulness in the young players to enhance mental toughness, but that attention to the psychological development of young players was reported to be inadequately addressed in comparison with other aspects of performance such as technical skill or physical conditioning."

The research saw eight coaches and a director from an unnamed Premier League football academy interviewed.

More information: "'What it takes': perceptions of mental toughness and its development in an English Premier League Soccer Academy," Clive Cook, et al. Qualitative Research in Sport, Exercise and Health. 13 Jun 2013. DOI: 10.1080/2159676X.2013.857708

Provided by University of Lincoln

Beta-blocker therapy cuts all-cause mortality in STEMI

19 jun 2014—For patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), beta-blocker therapy at discharge correlates with reduced all-cause mortality, according to a study published in the June issue of JACC: Cardiovascular Interventions.

Jeong Hoon Yang, M.D., from Samsung Medical Center in Seoul, South Korea, and colleagues examined the correlation of beta-blocker therapy at discharge with clinical outcomes using data from 8,510 patients with STEMI undergoing primary PCI. Patients were classified into a beta-blocker group (6,873 patients) and no-beta-blocker group (1,637 patients). Propensity-score matching analysis was conducted in 1,325 patient triplets. Patients were followed for a median of 367 days for the primary outcome of all-cause death.

The researchers found that all-cause death occurred in 2.1 percent of the beta-blocker group and 3.6 percent of the no-beta-blocker group (P < 0.001). Beta-blocker therapy correlated with lower incidence of all-cause death after 2:1 propensity-score matching (2.8 versus 4.1 percent; adjusted hazard ratio, 0.46; P = 0.004). In terms of all-cause death, the correlation of beta-blocker therapy with better outcomes was consistent across subgroups, including patients with relatively low-risk profiles such as ejection fraction >40 percent or single-vessel disease.

"Our results support the current American College of Cardiology/American Heart Association guidelines, which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile," the authors write.

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

Guidelines issued for stroke prevention in women

18 jun 2014--—New guidelines have been released that highlight unique stroke risk factors for women and address prevention strategies, according to a synopsis article published in the June 17 issue of the Annals of Internal Medicine.

Cheryl Bushnell, M.D., M.H.S., from the Wake Forest Baptist Medical Center in Winston-Salem, N.C., and Louise McCullough, M.D., Ph.D., from the University of Connecticut Health Center in Farmington, discuss the newly released American Heart Association/American Stroke Association guideline focusing on stroke prevention in women. Members of a multidisciplinary expert panel reviewed the literature and devised evidence-based tables and developed recommendations.

The researchers discuss stroke risk factors for women, including hypertension, atrial fibrillation, diabetes, and migraine headache, which are stronger risk factors or more prevalent among women; hormonal contraception; menopause and hormone replacement; and depression and psychosocial stress, which may be a stronger risk factor in women. Stroke prevention strategies include maintenance of a healthy lifestyle, with recommendations for lifestyle intervention identical for men and women; treatment of carotid stenosis, with similar guideline recommendations for both sexes; and use of aspirin. Gaps in the literature limit the ability to provide strong, sex-specific recommendations. New recommendation were provided for pregnancy and pregnancy-associated complications.

"We hope that this guideline will spur additional research to determine the best approaches to stroke prevention for both men and women," the authors write.

One author disclosed financial ties to Genentech.

More information: Full Text

Research toward world's first vaccine for heart disease advanced

Research toward the world's first vaccine for heart disease continues to advance at the La Jolla Institute for Allergy and Immunology, with researchers demonstrating significant arterial plaque reduction in concept testing in mice.

18 jun 2014--Ley, M.D., a pioneer in vascular immunology, is leading the vaccine effort, which seeks to reduce plaque buildup in the arteries by targeting inflammation. In his latest finding, published recently in the journal Frontiers in Immunology, Ley used two mouse peptides, identified by Harley Tse, Ph.D., of Wayne State University, which he incorporated into testing the vaccine approach. In the study, vaccinated mice had about 40 percent less arterial plaque than mice that didn't receive the vaccine.

"Heart disease remains our nation's number one killer," says Mitchell Kronenberg, Ph.D., La Jolla Institute president &chief scientific officer. "We are excited by Dr. Ley's studies, which show promise for creating a vaccine that may one day reduce the incidence of this terrible illness." If successful, the vaccine could be given to aid in preventing heart disease and also to stop or reduce disease progression. In addition to heart disease, the vaccine could target strokes, which are also fueled by plaque buildup in the arteries.

The research drew praise from several cardiology experts. Stanley Hazen, M.D., Ph.D., section head of Preventive Cardiology at the Cleveland Clinic, one of the nation's top cardiology hospitals, called the research "elegant and tremendously exciting."

"This lays the groundwork for someday being able to prevent or even eradicate heart disease by giving a vaccine. Truly a remarkably important advance," says Hazen, also chairman of the Department of Cellular & Molecular Medicine.

Eric Topol, M.D., chief academic officer of Scripps Health and professor of genomics at The Scripps Research Institute, stressed the importance of Ley's work. "If successful, the potential development of a vaccine to prevent atherosclerosis would be a monumental advance in medicine," says Topol.

About 600,000 Americans die of heart disease every year, amounting to 1 in every 4 U.S. deaths. Most people know that cholesterol is a major factor in creating artery-clogging plaque leading to heart disease. However, many people may not be aware that inflammation is also a very important contributor to arterial plaque buildup. "Many research studies over the last 15 years have demonstrated inflammation's critical role in heart disease," says Ley. "By creating a vaccine to reduce inflammation in the arteries, we hope to significantly lessen the accompanying plaque buildup."

Ley's study was published December 27th in a paper "Atheroprotective vaccination with MHC-II restricted peptides from ApoB-100" in Frontiers in Immunology

Ley says the vaccine type he is exploring is different than those people get for the flu and other infections. "A flu vaccine's purpose is to teach your immune system to launch an attack if it encounters the virus," he says. "Our vaccine works more like the desensitization process used in allergy shots. Allergy shots are designed to teach the individual's immune system to tolerate the allergen. Our vaccine would work on the same principle—only in this case we'd be teaching the immune system to tolerate certain molecules of our own bodies that it mistakenly attacks, which causes inflammation."

In an earlier study, published August 13, 2012 in the Journal of Clinical Investigation, Ley identified that a specific type of immune cells (CD4 T cells) orchestrate the inflammatory attack on the artery wall by receiving antigen-specific signals from other inflammatory cells in the vessel wall. Further, he discovered that these immune cells behave as if they have previously seen the antigen that causes them to launch the attack. An antigen is a peptide derived from a virus, bacteria or, in the case of autoimmune diseases, one of our own proteins that the immune system mistakenly views as foreign and attacks.

Ley says that the discovery was particularly exciting since it meant the immune cells had 'memory' of the molecule brought forth by the antigen-presenting cells. "Immune memory is the underlying basis of successful vaccines," he explains. "This meant that conceptually it was possible to consider the development of a vaccine for heart disease."

Ley collaborated with fellow La Jolla Institute scientist Alessandro Sette, Ph.D. and Dr. Tse of Wayne State University in Michigan, to identify the specific peptides, which prompt the arterial attack in mice – the byproduct of which is inflammation. The mouse peptides were used in the test vaccine to teach the body, through gradual exposure, to tolerate rather than attack those proteins.

In parallel with that research Ley has worked with Sette, who is an internationally recognized vaccine biologist, to identify more candidate peptides with the goal of eventually creating a heart disease vaccine for people. "The next step is to test promising candidate peptides in specially engineered mice with an immune system more similar to humans," he says. If successful, the vaccine could begin human clinical trials in as little as three years, Ley adds.

The vaccine effort reflects the power of bringing top immunologists together in one institution, Ley notes. "It just shows what can happen when you have an institute like ours dedicated to immunology," says Ley. "Sette is a world renowned expert on vaccines and I have specialized knowledge in cardiovascular immunology. It's the combination of our two areas of expertise that is enabling this vaccine initiative to proceed. I don't think this could have happened anywhere else."

$1,000-a-pill Sovaldi jolts US health care system (Update)

This undated handout photo provided by Gilead Sciences shows the Hepatitis-C medication Sovaldi. Sovaldi, a new pill for hepatitis C, cures the liver-wasting disease in 9 of 10 patients, but treatment can cost more than $90,000. Leading medical societies recommend the drug and patients are clamoring for it. But insurance companies and state Medicaid programs are gagging on the price. In Oregon, officials propose to limit how many low-income patients can get it. (AP Photo/Gilead Sciences)

17 jun 2014--The latest pill for hepatitis C sounds like a difficult choice. Sovaldi cures the liver-wasting disease in 9 of 10 patients, but treatment can cost more than $90,000.

Leading medical societies recommend the drug as a first-line treatment, and patients are clamoring for it. But insurance companies and state Medicaid programs are gagging on the price. In Oregon, officials propose to limit how many low-income patients can get Sovaldi.

Yet if Sovaldi didn't exist, insurers would still be paying in the mid-to-high five figures to treat the most common kind of hepatitis C, a new pricing survey indicates. Some of the older alternatives involve more side effects, and are less likely to provide cures.

So what's a fair price?

The cost of this breakthrough drug is highlighting cracks in the U.S. health care system at a time of heightened budget concerns. The Obama administration has a huge political stake in controlling treatment costs, but its critics may cry rationing.

"People are going to want to try to dodge this hot potato," says economist Douglas Holtz-Eakin.

For insurers, there's a frustrating twist: For each middle-aged person they pay to cure with Sovaldi, any financial benefits from preventing liver failure are likely to accrue to Medicare, not to them.

More than 3 million Americans carry the hepatitis C virus, and many don't realize it. It's a public health concern since the disease can be transmitted by contact with infected blood, and sometimes through sexual activity. Health officials advise all baby boomers to get tested.

This undated handout photo provided by Gilead Sciences shows the Hepatitis-C medication Sovaldi. Sovaldi, a new pill for hepatitis C, cures the liver-wasting disease in 9 of 10 patients, but treatment can cost more than $90,000. Leading medical societies recommend the drug and patients are clamoring for it. But insurance companies and state Medicaid programs are gagging on the price. In Oregon, officials propose to limit how many low-income patients can get it. (AP Photo/Gilead Sciences)

The illness is complex, with distinct virus types requiring different treatments. While it progresses gradually, it can ultimately destroy the liver, and transplants average $577,000.

An estimated 15,000 people died from hepatitis C in the U.S. in 2007, when it surpassed AIDS as a cause of death.

"If it's going to get me the medicine, I'll put my hand out there with a tin cup," said Stuart Rose, a hepatitis C patient in New York City. His insurance would pay only $4,000 a year for medications, but Rose was able to get assistance from charitable foundations. He recently started taking Sovaldi.

Until the drug's approval late last year, standard treatment for the most common type of the disease required daily pills and extended use of interferon, an injection that can produce debilitating flu-like symptoms. "Brain fog," said Rose.

Taken once a day for 12 weeks, Sovaldi greatly reduces the length of interferon treatment, making things more tolerable for patients. Now, many more people might want to try the cure.

A similar drug, Olysio, also approved last year, is priced a bit lower.

The nation's largest care provider for chronic hepatitis C, the federal Veterans Administration, sees promise. With 175,000 patients, the VA has started more than 1,850 of them on Sovaldi.

"After 20 years in infectious diseases, I never thought we would be in a position to cure this disease," said Dr. David Ross, head of the VA's program.

By law, the VA gets drug discounts of over 40 percent. Will the agency break even by avoiding the disease's worst complications?

Not necessarily, said Ross. "If it leads to cost benefits in the long run, that's gravy."

Private insurers will probably introduce Sovaldi gradually. "Not everybody is going to get this all at once," said former Medicare administrator Mark McClellan.

Drug maker Gilead Sciences, Inc., reported Sovaldi sales of $2.3 billion worldwide in just the first three months of this year. Gilead will not disclose its pricing methods, but vice president Gregg Alton said the drug's high cure rate makes it "a real huge value."

In many countries, the government sets drug prices. In the US, insurers negotiate with drug companies. Medicare, the government health program for the elderly, is forbidden from bargaining, a situation that critics say saddles U.S. patients with high costs while subsidizing the rest of the world.

With handy app, Brazilians hope to fight dengue

Aberdal Varela Da Fe, a Natal municipality agent, tests areas infestd with mosquitoes to prevent dengue fever spreading on June 14, 2014

While World Cup referees finally have goal-line technology to prevent mistakes, doctors in Brazil will soon have their own computer gizmo to contain dengue outbreaks.

17jun 2014--In the tropical northeastern city of Natal, a new smartphone application could allow residents to alert authorities about the location of concentrations of mosquitos and cases of dengue with the touch of a finger.

The app was developed by university researcher Ricardo Valentim in collaboration with epidemiologist Ion de Andrade, who works for the Natal city council.

"If someone identifies dengue, they pinpoint it on the (application's) map and that allows us to see where it is developing and to react immediately to stop it spreading," Andrade said.

The "Dengue Observatory" app is in beta mode for now but is expected to come online this month. Once up and running, it will allow authorities to know exactly where to act.

"If it's mosquitos, we can locate and treat the water source. If a suspected case is confirmed, we can treat the victim," Andrade said.

There is no cure for the mosquito-borne disease.

Brazil has been hit harder than any other country this century, with seven million cases reported since 2000, including 800 fatalities in the last five years.

In the Sao Paulo state city of Campinas, where Portugal's team and star Cristiano Ronaldo are based, three women aged 27, 69 and 81 died of dengue this year.

World Cup plan

Doctors will soon have an app to aid battle against dengue fever, pictured are city workers searching for mosquito clusters near Rio de Janeiro on April 2, 2008

The World Cup's northeastern host cities of Natal, Recife and Fortaleza were flagged as danger zones in a paper published by European and Brazilian scientists in The Lancet Infectious Diseases last month.

Natal has recorded 3,000 cases this year, and the city has endured torrential rain since the World Cup started last Thursday.

Sitting at the local hospital, Joana was waiting to undergo a blood analysis.

"I have a sore head, my joints are sore and I'm feverish. On Sunday, I had pain in my eyes," she complained.

Although all are symptoms of dengue, she may be suffering from a simple virus.

"We've seen several cases of dengue recently, but we're nowhere near epidemic levels," said local doctor Mario Toscano.

The poorer neighborhoods of Natal often do not have ready access to running water, never mind computers or telephones with mobile applications.

So in some of the city's favelas, where the children run barefoot and waste water runs in open gutters, the risk of dengue is potentially greater.

"This is exactly the kind of place that would attract mosquitos," said Aberdal Varela Da Fe, pointing at a concrete bath of stagnant water used by several families for cooking and washing in their tiny, one-room concrete shacks.

In stagnant water, female mosquitos can lay eggs which grow into the larvae which can then become disease-carrying mosquitoes.

After visiting another house nearby, Varela Da Fe, one of 380 health inspectors employed by the city to control dengue, received better news.

"Your house is very well kept," he told the elderly occupant Iivanilda Firmino. "All the water receptacles are covered."

Firmino has reason to be very vigilant. "I'm really careful, because my son has had dengue four times already," said Firmino.

With hundreds of thousands of foreign visitors travelling across Brazil until the World Cup final on July 13, authorities are being careful.

"There's always a risk, but this year it's not so big," said Alessandre de Medeiros Tavares, the chief doctor in Natal city council's dengue task force.

"Thanks to our work on the ground, we've had less cases. But if we do have more, we have a 'World Cup' plan ready to go into action," he said.

"But according to our analyses, it is likely we won't have to."

Are the new ACC/AHA guidelines for lipids appropriate for people with diabetes?

New guidelines for the treatment of high cholesterol are not appropriate for people with type 2 diabetes – or are they? Two researchers will debate the topic at a symposium to be held on Tuesday, June 17, at the American Diabetes Association's 74th Scientific Sessions.

16 jun 2014--At issue are the newest guidelines issued jointly by the American College of Cardiology and American Heart Association in November 2013. Previous guidelines for treating people with high cholesterol were based upon cutpoints for low-density lipoprotein (LDL) cholesterol levels (the so-called "bad" cholesterol). People whose cholesterol levels hit those cutpoints were asked to initiate dietary changes, and, if that failed to lower levels sufficiently, statin therapy was recommended.

The new guidelines divide patients into four groups for whom statin treatment is recommended: individuals with cardiovascular disease; individuals with LDL cholesterol (LDL-C) levels higher than 190 mg/dL; individuals with diabetes, between the ages of 40-75, with LDL-C levels 70-189 mg/dL; and individuals without diabetes or cardiovascular disease, with LDL-C 70-189 mg/dL, and an estimated risk of cardiovascular disease greater than 7.5 percent. There are no specific target levels for lowering cholesterol, only the recommendation that statins be used to reduce it.

Under the new guidelines, the vast majority of people with type 2 diabetes would be recommended for statin therapy. But is that the right call?

Robert H. Eckel, MD, Professor of Medicine and Charles A. Boettcher Chair in Atherosclerosis at the University of Colorado, Anschutz Medical Campus, says, "Yes. Almost all people with diabetes should be on a statin. That's what the evidence tells us. You may not like the new guidelines, but these are evidence-based and this is what the evidence says."

Henry Ginsberg, MD, Irving Professor of Medicine and Director of the Irving Institute for Clinical and Translational Research at Columbia University, disagrees. "The guideline committee used the evidence-based construct much too narrowly," he said.

Ginsberg explained that he agreed with the recommendation to examine a person's risk for cardiovascular disease as well as their cholesterol level when determining whether to prescribe a statin. But he did not agree with the removal of target LDL cholesterol goals once a person is being treated with medication, or with the lack of recommendations for additional or alternative therapies.

"There are people who can't take a high dose of a statin, or who won't respond as well to a high dose," he said. "In that case, you should be adding another medication. The new guidelines try to make it too simple."

Ginsberg said the new guidelines actually ignore evidence that shows the lower a patient's LDL-C level, the better. "How do you get to those lower levels if statins alone aren't enough?" he asked. "You add a non-statin."

But Eckel said that exceptions, which often come up in patients with diabetes, are addressed in the new guidelines by suggesting that physicians make a judgment call. "It should be an educated judgment, though, based on an understanding of the increased risk of heart disease and stroke for people with diabetes."

The American Diabetes Association recommends that people with diabetes keep LDL-C levels at or below 100 mg/dL, or under 70 mg/dL if they also have cardiovascular disease. The Association recommends using high-dose statin therapy to reach those goals.

Ginsberg said he agrees with the Association's present guidelines, noting that they are based on a wealth of data that includes, but is not restricted to, randomized clinical trials.

Provided by American Diabetes Association