Most doctors ignore one of the most potent ways to improve health, experts say

Escalating rungs of social support. Credit: Penn Medicine

Leveraging existing relationships with friends and family may be a more effective way to improve patients' health and encourage new healthy habits and behaviors than increasing interactions with physicians or other clinicians. In a new perspective published by the New England Journal of Medicine, Penn Medicine behavioral economists suggest a five-step ladder to effectively engineering social engagements that promote health and to test their acceptability and effectiveness.

30 dec 2016--"Spouses and friends are more likely to be around patients when they are making decisions that affect their health - like taking a walk versus watching TV, or what to order at a restaurant. Patients are also more likely to adopt healthy behaviors - like going to the gym - when they can go with a friend," explains co-author David Asch, MD, MBA, a professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Medicine Center for Health Care Innovation. "Though people are more heavily influenced by those around them every day than they are by doctors and nurses they interact with only occasionally, these cost-free interactions remain largely untapped when engineering social incentives for health. That's a missed opportunity."
Because of these lost opportunities, and the high costs when doctors and nurses keep tabs on their patients, the authors say it's important to engineer social engagements that enlist the social support patients already have, and allow organizations to test their acceptability. "Concerns about privacy are often the reason doctors and hospitals avoid organizing social support," Asch says. "But while privacy is very important to some patients under some circumstances, more often patients would love if their friends and family helped them manage their diabetes, and those friends and family want to help people get their health under control."
The authors define a ladder with escalating rungs of social support ranging from no social engagement - such as when a patient is expected to take medication as part of a routine, without anyone seeing them do it or holding them accountable - to a design that relies on reputational or economic incentives, and incorporates teams or other designs that hold patients accountable for their health behaviors and habits.
"Although we don't normally think of competition or collaboration among patients are part of managing chronic diseases like high blood pressure, heart failure, or diabetes, research shows that behavior is contagious, and programs that take advantage of these naturally occurring relationships can be very effective," said co-author Roy Rosin, MBA, chief innovation officer at Penn Medicine. "Most health care interventions are designed for the individual patient, but there's a growing body of research that shows how health care organizations can use social engagement strategy to enhance health for patients who want to be involved in group activities or team competitions aimed at improving health."
For example, in the fourth rung, where social incentives are designed with reciprocal support, the authors point to a study in which some patients with diabetes were asked to talk on the phone weekly with peers—a technique known as reciprocal mentorship—and others received more typical nurse-led management. Results showed that those who worked directly with peers saw a more significant decline in glycated hemoglobin levels than those who worked with clinical staff.
"Sure, health care is serious business," Asch says, "but who says it can't be social?"


Provided by Perelman School of Medicine at the University of Pennsylvania

Post-lunch napping tied to better cognition in elderly

Moderate post-lunch napping is tied to better cognition in older adults, according to a study published online Dec. 20 in the Journal of the American Geriatrics Society.

29 dec 2016--Junxin Li, Ph.D., from Johns Hopkins University in Baltimore, and colleagues examined associations between self-reported post-lunch napping and structured cognitive assessments in older Chinese adults (≥65 years).
The researchers found that 57.7 percent of participants reported napping (mean time, 63 minutes). There was a significant association between cognitive function and napping (P < 0.001). Moderate nappers had better overall cognition than non-nappers (P < 0.001) or extended nappers (P = 0.01). Non-nappers also had significantly poorer cognition compared to short nappers (P = 0.03). After controlling for demographic characteristics, body mass index, depression, instrumental activities of daily living, social activities, and nighttime sleep duration, moderate napping was significantly associated with better cognition than non- (P = 0.004), short (P = 0.04), and extended napping (P = 0.002).
"Longitudinal studies with objective napping measures are needed to further test this hypothesis," the authors write.

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

Scientific reasons for keeping your New Year's resolutions

Credit: University of California, San Francisco

More than half of Americans make a New Year's resolution each year, and though most people set out with the best of intentions, just a small percentage are successful in following through on their resolutions.

28 dec 2016--To give you a bit of scientific motivation, UC San Francisco gathered some of the latest research behind the most popular health-related New Year's resolutions that attest to why it really is good for your body to see them through.
Eat Healthier
Tired of counting calories? A more effective way to boost your health through diet may be simply to cut down on added sugars. The average American consumes 66 pounds of added sugar per year, and increasing evidence shows all that excess sugar isn't just making us fat; it's making us sick.
Recent studies by UCSF researchers found that putting obese children on a sugar-restricted diet for just 10 days, while allowing them to consume the same total calories, led to a sharp decline in factors associated with heart disease in adulthood, including triglycerides, the protein ApoC-III, and LDL-cholesterol.
"Everyone thinks sugar are 'empty' calories. But the data show that sugar's detriment is unrelated to its calories. It damages the liver by overwhelming mitochondria, and driving liver fat, which drives chronic disease," explained Robert Lustig, MD, a pediatric endocrinologist and an author on the studies.

Credit: University of California, San Francisco

Sugar overconsumption is a well-documented cause of heart disease and diabetes, yet many people are unaware of the risks – and that's no accident. Earlier this year, UCSF researchers uncovered documents showing that the sugar industry colluded with nutrition scientists in the 1960s to single out fat and cholesterol as contributors to coronary heart disease while downplaying the role of sugar. The media and health policy are beginning to catchup to the truth, and emerging research now suggests too much sugar is also a factor in cancer, Alzheimer's disease and aging.
Sleep More
Getting a good night's sleep affects more than just how you feel the next day. Increasing evidence links poor sleep to serious and chronic health problems like hypertension, diabetes, cancer and obesity.
For the vast majority of the population, the need for eight to eight-and-half hours of sleep is genetically determined. Though people may take pride in sleeping less and getting more work done, those missed hours take their toll, according to Aric Prather, PhD, assistant professor of psychiatry.
Prather's research shows that sleep is essential for the immune system. In one study, people who slept less than six hours a night were four times more likely to succumb when exposed to the cold virus. In another, short sleepers were more than 11 times more likely to fail to develop adequate immunity after receiving a hepatitis B vaccination.

Credit: University of California, San Francisco

Drink Less Alcohol
The common assumption that moderate alcohol use is "heart healthy" is being questioned through new research from the lab of Gregory Marcus, MD, the Endowed Professorship of Atrial Fibrillation Research.
Although some research shows that moderate alcohol use can reduce the risk of heart attacks, the issue is much more complex. The same amount of alcohol can also change the structure of the heart in ways that increase the risk of atrial fibrillation, which in turn increases the risk of stroke.
Alcohol's abilities to protect and harm the heart likely operate through different mechanisms and vary from person to person, said Marcus. A nightly glass of red wine might do you more harm than good, but most people don't think beyond heart attacks when thinking about heart health.
Regardless, one clear pattern has emerged from research: people who believe alcohol is good for the heart tend to drink more.

Credit: University of California, San Francisco

Reduce Stress
Stress has long been linked to cardiovascular disease and weakened immune function, and UCSF researchers are now uncovering how this happens on a cellular level.
They've found that women under chronic stress have lower levels of klotho, a hormone that regulates aging and enhances cognition. In animal studies, when klotho is disrupted, the animals don't live as long and suffer from hardening of arteries, and loss of muscle and bone.
Chronic psychological stress also shortens the length of telomeres, the protective caps on the ends of chromosomes that forestall DNA degradation. Telomeres naturally shorten as we age, but stress can speed up this cellular aging.
A recent study by Elizabeth Blackburn, PhD, Nobel laureate and Morris Herzstein Endowed Chair of Biology and Physiology, and Elissa Epel, PhD, professor of psychiatry, found that healthy older women who experienced stressful life events, such as the death of a loved one or unemployment, had significantly shortened telomeres after just one year.
But relax, there's good news: The same study found that those with a healthier daily lifestyle, including physical activity, healthy diet and good sleep quality, appeared to be protected against the cellular effects of stress. And earlier research found that men who made improvements in diet, exercise, social support and stress management (such as regular meditation) could even increase their telomere length. Blackburn and Epel describe more research-based strategies to reduce stress in their new book.

Credit: University of California, San Francisco

Get in Shape
Besides helping to shed those extra holiday pounds, exercise has profound health benefits that don't show up on the scales. In fact, exercise may be one of the best ways to counter the cellular damage caused by stress and trauma.
In one study of women who were primary caregivers for a family member with dementia, those who had regular physical activity were protected against stress-related telomere shortening. (Shorter telomeres are associated with increased incidence of disease and shorter lifespan.)
Exercise can also help prevent diseases ranging from dementia to cancer. A study last year found that in men ages 40 to 75, those who engaged in regular intense exercise and had other healthy lifestyle factors had a 69 percent lower risk of lethal prostate cancer.
"Exercise has the capacity to help us keep stress at bay and can limit the impact of stress on our minds and bodies," said Eli Puterman, PhD, former assistant professor of psychiatry at UCSF and now at the University of British Columbia. "This is really one more great reason to develop a healthy relationship with exercise and try to incorporate more movement into our daily lives."

Provided by University of California, San Francisco

Head off 'holiday heart syndrome'

Overindulging over the holidays can take a toll on the heart, according to experts at UT Southwestern Medical Center in Dallas.
Heavy drinking and eating too much, especially salty foods, can trigger atrial fibrillation. A-fib is an irregular heartbeat that causes the upper chambers of the heart to contract rapidly, increasing the risk for stroke.

26 dec 2016--People with the condition may feel short of breath, have heart palpitations and feel like their heart is beating much faster than usual.
During December when holiday revelry peaks, emergency rooms see a surge of patients with what's unofficially dubbed "holiday heart syndrome" from too much food and drink, according to UT Southwestern cardiologist Dr. Sharon Reimold.
"It's common for people to go to multiple parties during this time of year. You go to one party and have a drink or two, go to the next party and have a couple more. It's the cumulative effect of alcohol that can put you at risk, sending your heart into atrial fibrillation," Reimhold said in a hospital news release.
Healthy adults should get no more than 1,500 milligrams of sodium a day, according to the American Heart Association. That's less than a teaspoonful. Reimhold said it's important to watch what you're eating and drinking at holiday celebrations and avoid overdoing it.

More information: The American Heart Association provides more information on holiday heart syndrome.

Twenty-second test could identify frailty in hospitalized older adults

Falls and fall-related injuries are a common concern in older adults and can have significant consequences. For older adults who are hospitalized for ground-level falls, their level of frailty can be an important indicator of adverse health outcomes upon discharge. 

19 dec 2016--Experts at Baylor College of Medicine and the University of Arizona recently developed a 20-second upper-extremity function test to help identify frailty in this group of adults and found that the test can be used in the trauma setting to predict adverse outcomes in older adults after discharge. Their report appeared in the journal Gerontology.
The upper-extremity function test uses wearable sensors to identify frailty by testing repetitive elbow flexion (bending) and extension for 20 seconds. The assessment of frailty is based on quantifying weakness, slowness and exhaustion during the 20-seconds of flexion and extension.
"In a previously study, we demonstrated that this simple test could identify frailty status just as well as conventional assessments," said Dr. Bijan Najafi, professor in the Michael E. DeBakey Department of Surgery at Baylor and director of clinical research in the division of vascular surgery and endovascular surgery. Najafi, a biomedical engineer, is the director of the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) at Baylor.
In this study, Najafi and colleagues examined whether the test could predict adverse health outcomes upon discharge in bedbound older adults admitted to the hospital due to ground-level fall injuries.
Researchers recruited 101 older adults with an average age of 79 who were admitted to a trauma setting. Participants underwent the test at the time of admission and were followed for up to two months with phone calls and chart reviews. Researchers measured health outcomes including discharge disposition (favorable: discharged home or to rehabilitation versus unfavorable), hospital length of stay, 30-day readmission, 60-day readmission and 30-day prospective falls.
They found that the only predictor of 30-day prospective falls postdischarge were patient demographics, which include age, gender and body mass index. The upper-extremity function test was a predictor of discharge disposition, 30-day readmission and 60-day readmission. The indicators of slowness, weakness and exhaustion within the test were highly associated with an unfavorable discharge disposition.
"The study suggests that a 20-second upper-extremity test is practical for a busy hospital setting and could be used as a quick measure for predicting adverse events and outcomes in bedbound patients postdischarge," said Najafi. "It may help in planning discharge disposition and hospital resource allocation among geriatric inpatients as well as in establishing prevention and preoperative strategies to improve both short- and long-term outcomes in these patients."

More information: Bellal Joseph et al. Upper-Extremity Function Predicts Adverse Health Outcomes among Older Adults Hospitalized for Ground-Level Falls, Gerontology (2016). DOI: 10.1159/000453593


Provided by Baylor College of Medicine

A handful of nuts a day cuts the risk of a wide range of diseases

Credit: Lawrencekhoo / Wikipedia.

A large analysis of current research shows that people who eat at least 20g of nuts a day have a lower risk of heart disease, cancer and other diseases.

11 DEC 2016--The analysis of all current studies on nut consumption and disease risk has revealed that 20g a day - equivalent to a handful - can cut people's risk of coronary heart diseaseby nearly 30 percent, their risk of cancer by 15 percent, and their risk of premature death by 22 percent.
An average of at least 20g of nut consumption was also associated with a reduced risk of dying from respiratory disease by about a half, and diabetes by nearly 40 percent, although the researchers note that there is less data about these diseases in relation to nut consumption.
The study, led by researchers from Imperial College London and the Norwegian University of Science and Technology, is published in the journal BMC Medicine.
The research team analysed 29 published studies from around the world that involved up to 819,000 participants, including more than 12,000 cases of coronary heart disease, 9,000 cases of stroke, 18,000 cases of cardiovascular disease and cancer, and more than 85,000 deaths.
While there was some variation between the populations that were studied, such as between men and women, people living in different regions, or people with different risk factors, the researchers found that nut consumption was associated with a reduction in disease risk across most of them.
Study co-author Dagfinn Aune from the School of Public Health at Imperial said: "In nutritional studies, so far much of the research has been on the big killers such as heart diseases, stroke and cancer, but now we're starting to see data for other diseases.
"We found a consistent reduction in risk across many different diseases, which is a strong indication that there is a real underlying relationship between nut consumption and different health outcomes. It's quite a substantial effect for such a small amount of food."
The study included all kinds of tree nuts, such as hazel nuts and walnuts, and also peanuts - which are actually legumes. The results were in general similar whether total nut intake, tree nuts or peanuts were analysed.
What makes nuts so potentially beneficial, said Aune, is their nutritional value: "Nuts and peanuts are high in fibre, magnesium, and polyunsaturated fats - nutrients that are beneficial for cutting cardiovascular disease risk and which can reduce cholesterol levels.
"Some nuts, particularly walnuts and pecan nuts are also high in antioxidants, which can fight oxidative stress and possibly reduce cancer risk. Even though nuts are quite high in fat, they are also high in fibre and protein, and there is some evidence that suggests nuts might actually reduce your risk of obesity over time."
The study also found that if people consumed on average more than 20g of nuts per day, there was little evidence of further improvement in health outcomes.
The team are now analysing large published datasets for the effects of other recommended food groups, including fruits and vegetables, on a wider range of diseases.

More information: Dagfinn Aune et al, Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies, BMC Medicine (2016). DOI: 10.1186/s12916-016-0730-3


Provided by Imperial College London

Association between steps, functional decline in older hospitalized patients

Is walking fewer than 900 steps per day associated with functional decline in older hospitalized patients? A new research letter published online by JAMA Internal Medicine suggests it is.

10 dec 2016--Recent research has suggested 900 steps per day were normative for frail older adults and for older adults hospitalized in internal medicine units. Maayan Agmon, Ph.D., and Anna Zisberg, Ph.D., of the University of Haifa, Israel, and coauthors examined whether that amount of steps differentiated those patients who do, or don't, experience hospitalization-associated functional decline.
The authors used patients within an ongoing study of a newly designed program that promotes in-hospital mobility. The study included 177 older patients hospitalized in internal medicine units at an academic medical center in Israel during the last three months of 2015. Total steps per day were calculated and the evaluation included cognitive, functional and mobility assessments.
Walking fewer than 900 steps per day was associated with hospitalization-associated functional decline, according to the results. Among the 41.8 percent of patients who walked less than 900 steps per day, 55.4 percent (57 patients) reported hospitalization-associated functional decline. Among the 58.2 percent of patients who walked 900 steps per day or more, only 18.4 percent (14 patients) experienced hospitalization-associated functional decline.
Limitations of the study include its sample of a relatively high-functioning group of older adults from a single site.
"Nonetheless, this study adjusts for a broad range of intervening variables and relies on gold-standard, sensor-based data collection. Thus, it fills the gaps uncovered by previous studies and provides preliminary evidence to support the recommendation of 900 steps per day for HAFD [hospitalization-associated functional decline] prevention. These findings should be confirmed by future studies involving diverse groups of older adults," the study concludes.

More information: JAMA Intern Med. Published online December 5, 2016. DOI: 10.1001/jamainternmed.2016.7266


Provided by The JAMA Network Journals

Researchers identify link between brain and bone in Alzheimer's disease

Researchers at NEOMED have just identified a major connection between areas of the brainstem - the ancient area that controls mood, sleep and metabolism - and detrimental changes to bone in a preclinical model of Alzheimer's disease (AD). 

01 dez 2016--The study, titled "Early Evidence of Low Bone Density and Decreased Serotonergic Synthesis in the Dorsal Raphe of a Tauopathy Model of Alzheimer's Disease," is led by Christine Dengler-Crish, Ph.D., assistant professor of pharmaceutical sciences, and anatomy and neurobiology, and will be published in the upcoming issue of the Journal of Alzheimer's Disease, an international multidisciplinary journal that reports progress in understanding the causes, symptoms, and treatment of Alzheimer's.
More than five million Americans are living with Alzheimer's disease. Along with being the sixth leading cause of death in the U.S., Alzheimer's has major social, emotional and financial consequences for patients and their families. Incurable and seemingly unstoppable, less than 5 percent of AD cases are due to a clear genetic reason, so it is hard to predict who will be at risk for acquiring this devastating disease.
Dr. Dengler-Crish and her research team that included graduate students Matthew Smith (NEOMED) and Gina Wilson (Kent State University) report that early reductions in bone mineral density (BMD) that occur in a preclinical model of AD are due to degeneration in an area of the brainstem that produces the majority of the brain's serotonin—a neurochemical that controls mood and sleep, which are two processes that are also affected early in AD.

One's bones may be one of the earliest indicators of brain degeneration in Alzheimer's disease

Reduced BMD, which sometimes leads to osteoporosis, translates to increased bone fracture risk, decreased quality of life, and increased mortality for AD patients. Furthermore, Dr. Dengler-Crish's research suggests that early bone loss and serotonin deficiency in AD may tell us something very important about how we approach diagnosing and treating this disease.
"Measurement of bone density, which is routinely performed in the clinic, could serve as a useful biomarker for assessing AD risk in our aging population," notes Dr. Dengler-Crish. "The findings of this study motivate us to explore the serotonin system as a potential new therapeutic target for this devastating disease."
Dengler-Crish, who received her bachelor's degree from Baldwin Wallace University, her master's in psychology from the University of Illinois at Chicago and her Ph.D. in neuroscience from Vanderbilt University, has now been named an associate editor for the Journal of Alzheimer's Disease. She is excited to facilitate the work of other scientists in this important area. "I am thrilled to be able to assist the publication of researchers' innovative work, here and across the world, that is desperately needed to combat these currently incurable chronic diseases. Now more than ever, there is hope that we soon will be able to slow, stop or reverse the progression of these destructive neurodegenerative conditions."
"This is extremely exciting and has significant translational potential and relevance to early detection of the disease," noted Jason R Richardson, Ph.D., DABT, director for Neurodegenerative Disease and Aging Research at NEOMED.


Provided by Northeast Ohio Medical University