Patients 65 years of age or older with hip or spine fracture should be treated for osteoporosis

A coalition of the world's top bone health experts, physicians, specialists, and patient advocacy groups today released their clinical recommendations to tackle the public health crisis in the treatment of osteoporosis and the debilitating and often deadly hip and spine fractures caused by the disease.

30 sept 2018--The recommendations from the American Society for Bone and Mineral Research Secondary Fracture Prevention Initiative Coalition—more than 40 top U.S. and international bone health experts, health care professional organizations and patient advocacy organizations dedicated to reducing avoidable secondary fractures—were presented at the ASBMR 2018 Annual Meeting in Montréal, the premier global scientific meeting on bone, mineral and musculoskeletal science. The full recommendations and more data about the crisis in osteoporosis treatment are available on the Coalition's new website: http://www.secondaryfractures.org.

The Coalition's recommendations are the first to outline the best course of clinical care for women and men, age 65 years or older, with a hip or vertebral (spine) fracture. They were developed in response to growing evidence of an alarming trend of an increase in the expected number of hip fractures and high-risk osteoporosis patients who need treatment but are either not being prescribed appropriate medications, or if prescribed, are simply not taking them despite research showing their effectiveness in preventing fractures. Recent patient surveys also show that critical information about the connection between osteoporosis and fracture risk is not getting through to patients.
"I think many people are shocked to learn that these conversations are not happening and simple steps not being taken," said Michael Econs, M.D., ASBMR President and Division Chief of the Division of Endocrinology and Metabolism and Professor of Medicine at the Indiana University School of Medicine. "As doctors, it's our duty to help our patients and their loved ones understand what they can do to prevent another fracture. We must do a better job communicating with them and one another to help rein in this crisis."
According to a recent survey by the National Osteoporosis Foundation, 96 percent of postmenopausal women who say they have not been diagnosed with osteoporosis and have experienced a fracture or break were not told by their doctor it could be linked to osteoporosis. The survey also found that one-third of women in the survey with a fracture were not referred for follow-up visits by health care providers.
"Heart attack patients don't leave the hospital without beta blockers to prevent another one. But every day, patients hospitalized for hip or spine fractures are not receiving treatments that research shows help prevent a second fracture that could lead to disability or death," said Coalition Co-Chair Douglas P. Kiel, M.D., MPH, and past President of ASBMR, who serves as the Director of the Musculoskeletal Research Center at the Institute for Aging Research, Hebrew SeniorLife and a Professor of Medicine at Harvard Medical School. "We've joined forces to provide a roadmap to ensure all care givers from orthopedists to primary care doctors, and many other health professionals, understand what they need to be doing to prevent fractures and how they can partner with patients to make informed choices about osteoporosis treatment options."

The Problem

• Only 23 percent of elderly patients who suffer a hip fracture receive osteoporosis medication to reduce future fracture risk compared to 96 percent of heart attack patients who receive beta blockers to prevent a future heart attack.
• The risk of further fractures after a first major osteoporotic fracture is greatest immediately following the first event.
• Recently, a 30-year downward trend in the number of hip fractures in the United States has plateaued, raising concerns that this may be due to doctors and patients not following diagnostic and treatment guidelines.

The Costs: Human and Economic

While osteoporosis is a highly treatable disease, it is on the rise globally and responsible for more than two million fractures in the United States alone. It is also one of the 10 most costly chronic conditions to Medicare.

• Of the 300,000 hip fractures each year in the U.S., one of every two patients never reaches their previous functional capacity.
• One of every four hip fracture patients ends up in a nursing home.
• One of every four hip fracture patients dies within one year.

Barriers to Care

Although there are many reasons for the "gap" in the treatment of osteoporosis, a major factor is physician and patient concerns over the risk of very rare side effects, especially atypical femur fractures (AFFs) related to the use of osteoporosis drugs called bisphosphonates.
"Patients who have suffered hip or vertebral fractures are at very high risk for suffering from serious and life-threatening fractures in the first one to two years after those fractures. These recommendations focus on actions they can take to reduce their risk of future fractures, that include medication, exercise, nutrition, and reducing their risk of falling," said Sundeep Khosla, M.D., co-chair of the Coalition and past President of ASBMR, who serves as Director of the Center for Clinical and Translational Science at the Mayo Clinic in Rochester, Minnesota. "The research shows that risks for atypical femur fractures are very rare and the benefits of taking bisphosphonates far outweigh the risks."
The following top recommendations for clinical care for women and men, age 65 years or older, with a hip or vertebral fracture, were developed by Coalition members through a consensus process.

The ASBMR Secondary Fracture Prevention Initiative Clinical Care Recommendations

An overarching principle for these recommendations is that women and men, age 65 years or older, with a hip or vertebral fracture, optimally should be managed in the context of a multi-disciplinary clinical system that includes case management, such as a fracture liaison service, to assure that they are appropriately evaluated and treated for osteoporosis and risk of future fractures.
1. Communicate three simple messages to patients and their family/caregivers throughout the fracture care and healing process:

• their broken bone likely means they have osteoporosis and are at high risk for breaking more bones, especially over the next 1-2 years;
• breaking bones means they may, for example, have to use a walker, cane, or wheelchair, or move from their home to a residential facility) and will be at higher risk for dying prematurely;
• most importantly, there are actions they can take to reduce their risk.

2. Ensure that the patient's primary healthcare provider is made aware of the occurrence of the fracture. If unable to determine whether the patient's primary healthcare provider has been notified, take action to be sure the communication is made.
3. Regularly assess the risk of falling of women and men, age 65 or older, who have ever had a hip or vertebral fracture.

• At a minimum, take a history of their falls within the last year.
• Minimize use of medications associated with an increased risk for falls.
• Evaluate patients for conditions associated with an increased risk for falls.
• Strongly consider referring patients to physical and/or occupational therapy or a physiatrist for evaluation and interventions to improve impairments in mobility, gait, and balance, and to reduce the risk for falls.

4. Offer pharmacologic therapy for osteoporosis to women and men, age 65 years or older, with a hip or vertebral fracture, to reduce their risk of additional fractures.

• Pharmacologic therapy (oral or intravenous) can begin in the hospital and be included in their discharge orders, although some practitioners prefer to delay intravenous zoledronic acid for a few weeks.
• Do not delay initiation of therapy for bone mineral density ("BMD") testing. Although BMD testing may be performed to monitor responses to treatment, therapy should be offered regardless of BMD levels.
• Consider patients' oral health before starting therapy with bisphosphonates or denosumab.

5. Because osteoporosis is a life-long chronic condition, routinely follow and re-evaluate women and men, age 65 years or older, with a hip or vertebral fracture, who are being treated for osteoporosis. Purposes include:

• reinforcing key messages about osteoporosis and associated fractures
• identifying any barriers to treatment adherence;
• assessing the risk of falling;
• evaluating the effectiveness of the treatment plan;
• monitoring for adverse effects;
• determining whether any changes in treatment should be made, including whether any osteoporosis pharmacotherapy should be changed or discontinued.

"All patients with hip or vertebral fractures need to be told that their broken bone most likely means they have osteoporosis and they are at very high risk for breaking more bones. Our goal is for patients, families, and their health care professionals to understand this and take actions to prevent future fractures, said Dr. Econs."
To read the full recommendations and learn more about the ASBMR Secondary Fracture Prevention Initiative, go to: http://www.secondaryfratures.org


Provided by American Society for Bone and Mineral Research

Plant-rich diets may prevent depression – new evidence

Credit: DronG/Shutterstock.com

Being depressed can negatively affect your appetite and what you eat, but can bad eating habits bring your mood down? Our latest study, a systematic review of the best available evidence, found a clear link between the quality of a person's diet and their risk of depression. And it goes beyond the effect of diet on body size or other aspects of health that can affect mental health.

29 sept 2018--We took extra care in including only studies that took age, sex, income, body size, general health, smoking and physical activity into account in their analyses. That way we could be sure that the associations between diet and the risk of depression are independent of these factors.
We aggregated the results of several studies and found a clear pattern that following a healthier, plant-rich, anti-inflammatory diet can help prevent depression. Of the 41 studies in our review, four specifically looked at the link between a traditional Mediterranean diet and depression over time on 36,556 adults. We found that people with a more Mediterranean-like diet had a 33% lower risk of developing depression than people whose diet least resembled a Mediterranean diet.
Following a traditional Mediterranean diet, that is avoiding processed foods and foods that are high in saturated fat and sugar (pro-inflammatory foods) and favouring foods rich in omega-3, fibre, vitamins, magnesium and polyphenols, can reduce the risk of depression.

Biological explanation

Diet can influence mental health by causing damage to the brain. This can be due to oxidative stress (a harmful chemical process), insulin resistance, changes in blood flow and inflammation. A diet rich in anti-inflammatory and anti-oxidant components, commonly found in fruit, vegetables, nuts and wine (which should be drunk in moderation), can directly affect the brain by protecting it from oxidative stress and inflammation. Inflammation can also affect the neurotransmitters (the brain's messenger molecules) responsible for regulating emotion.
Recent research in humans also suggests that diet can affect the formation of brain cells (neurons), particularly in a part of the brain called the hippocampus, which is associated with mood regulation.
There is also new evidence regarding the microbes in your gut, known as the gut microbiota. These microbes can break down the nutrients we eat and create molecules that may be inflammatory or that stimulate neural activity. They communicate with the gut and brain neurons and can therefore influence behaviour.
Diet is a key modulator of gut microbiota. In animal studies, eating plant-based foods improves the microbial composition in the gut, whereas high-fat diets appear to disrupt the microbial balance. When there is an imbalance in the microbes in your gut, it can cause the intestines to become permeable, letting big molecules pass into the bloodstream, and these molecules can interact with brain function.

Nutritional psychiatry

The field of nutritional psychiatry has emerged recently – around a decade ago – and it is growing rapidly. But results from observational studies, despite giving us an indication on the direction of the association, can't tell us if the link is causal – only a randomised controlled trial can do this.
The recent SMILES trial was the first study to provide evidence that diet can affect depression. People allocated to the Mediterranean diet group improved their depressive symptoms after 12 weeks, compared with the control group who received social support.
The growing evidence for nutritional psychiatry suggests that GPs and mental health professionals should now seriously consider including dietary counselling for patients who are at risk of depression.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Provided by The Conversation

Many proxies unaware of centenarians' thoughts on death

Many proxies of centenarians are not well-informed about the centenarians' thoughts and plans regarding the end of life (EOL), according to a study published in the July issue of the Journal of the American Geriatrics Society.

29 sept 2018--Kathrin Boerner, Ph.D., from the University of Massachusetts in Boston, and colleagues conducted a population-based study with semistructured in-person interviews to explore how centenarians think about and plan for EOL. Seventy-eight centenarians were interviewed and reported on their thoughts about EOL, perception of EOL as threatening, longing for death, and engagement in EOL planning; the same set of questions was answered by proxies based on what they thought the centenarians' perspective was.
The researchers found that proxies misjudged whether the centenarian thought about EOL in 44.3 percent of cases. Just 1.5 percent of centenarians perceived EOL as threatening, and 24.2 percent reported longing for death; however, proxies over- and underestimated the former and the latter, respectively. Compared with centenarians, proxies reported more centenarian EOL planning.
"Health care professionals should be aware that, even for very old adults approaching the end of their lives, discussions about EOL and EOL planning may need to be actively encouraged and supported," the authors write.

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

Early Parkinson's patients waiting too long to seek medical evaluation

Figure 1. Relationship between time of diagnosis, need for symptomatic therapy and the opportunity for a patient to participate in an early PD disease modifying therapy trial. Credit: University of South Florida

The time between diagnosis and the institution of symptomatic treatment is critical in the effort to find a cure for Parkinson's Disease (PD). A paper published in Nature Partner Journal: Parkinson's Disease notes too many early PD patients wait too long before seeking medical attention, or start taking symptomatic medications before they are required, thereby dramatically shrinking the pool of candidates for clinical trials.

28 sept 2018--Parkinson's disease is a disorder of the central nervous system that affects movement. Symptoms include tremors, stiffness, and slow and small movement. The pace of progression varies among patients, making the months following diagnosis crucial to researchers studying the disease's progression.
"The critical time of about one year from when the patient can be diagnosed with early PD based on mild classic motor features until they truly require symptomatic therapy can be considered the Golden Year," said lead author Robert A. Hauser, MD, director of the Parkinson's & Movement Disorder Center at the University of South Florida. "It is during this early, untreated phase, that progression of clinical symptoms reflects the progression of the underlying disease."
Hauser says that in order to determine whether or not a potential disease slowing therapy is actually working, they must be able to compare the therapy to a placebo without interference from symptomatic treatment. Otherwise, they won't know if the therapy is slowing the disease's progression or if they are just seeing the effects of symptomatic treatment.
This requires patients to seek assessment soon after they notice the onset of tremor or slow movement. In addition, physicians should consider referring patients to clinical trials soon after diagnosis and delay prescribing symptomatic medication until it's necessary. If a patient waits until symptomatic treatment is necessary, the opportunity to participate in these crucial clinical trialsis lost.

More information: Robert A. Hauser. Help cure Parkinson's disease: please don't waste the Golden Year, npj Parkinson's Disease (2018). DOI: 10.1038/s41531-018-0065-1


Provided by University of South Florida

Crash diets are highly effective – new evidence

Credit: Voyagerix/Shutterstock.com

If you've ever tried to lose weight, you've probably heard that crash dieting isn't the best way to go about it. Although you may lose lots of weight initially, you won't be able to keep the weight off and may even end up being heavier than you were before. But our latest research suggests that this isn't always the case.

27 sept 2018--Most people are aware that being overweight is bad for their health, so it's not surprising that about half of the UK population is trying to lose weight at any given time. But many people struggle to stick to traditional diets long enough to achieve results.
Some people opt for a quicker, more drastic solution: crash dieting. These diets, otherwise known as total diet replacement (TDR) programmes, involve drastically reducing calorie intake to between 800-1,200 calories per day. (The usual calorie intake for a woman is 2,000 calories, and for a man it's 2,500 calories.) People on these diets consume nothing but specially formulated soups, shakes and bars for up to 12 weeks.
Although lots of retailers sell these TDR products, they are more effective when combined with support and encouragement from a dietitian or trained counsellor. This professional support helps dieters develop the skills to stick with the programme and keep the weight off once the programme is complete.
However, in the UK, GPs don't tend to refer people who are looking to lose weight to these programmes. This is because NICE, the agency that evaluates treatments for the NHS, doesn't recommend TDR programmes, perhaps because there wasn't enough evidence to support TDR when NICE published their guidance. But recent studies suggest that it may be time for NICE to reevaluate the evidence.

Time to reevaluate crash diets

For our study, which is published in the BMJ, we recruited 278 obese patients. Half were randomly assigned to a 12-week TDR programme, while the other half were assigned to see the practice nurse for advice on how to lose weight ("usual care").
After one year, those assigned to receive the TDR programme lost an average of 11kg, while those in the usual care group lost an average of 3kg. Using a tool that helps GPs estimate a patient's risk of having a heart attack or stroke in the next ten years, the people in the TDR group had significantly reduced their risk score.
The TDR group also had significantly greater improvements in blood glucose control than the usual care group. Perhaps most important of all, participants in the TDR group reported bigger increases in quality of life than people in the usual care group.
More people in the TDR group reported side effects, but the number of more serious side effects was similar across groups. Side effects that were more common in the TDR group than in the usual care group included constipation, headache, fatigue and dizziness.
This new evidence suggests that TDR is a safe and effective way to lose a large amount of weight. For now, though, TDR programmes are not available on the NHS. Those interested in losing weight using TDR have to pay for it themselves, which means that many people who could benefit from this treatment may be unable to access it.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Provided by The Conversation

Alarmingly low awareness of urology across Europe

Public awareness of urological conditions is alarmingly low throughout Europe. Credit: European Association of Urology (EAU)

Public awareness of urological conditions is alarmingly low throughout Europe. Results of a new international survey¹ of more than 2,500 responders from 5 countries show that women know more about men's health issues than men do, men have poor knowledge of key urological symptoms and don't take early signs of potentially life-threatening urological conditions seriously.

25 sept 2018--The low level of awareness indicated by the survey is of particular concern as urological conditions are on a rise due to the ageing European population. Prevention and early diagnosis are crucial to save lives and to control increasing costs.

Fundamental Lack of Knowledge of Urology

Responses showed that urology as a medical speciality still has a long way to go to reach general awareness: 40% of respondents were unable to identify what a urologist does, 10% stated that they had never even heard of a urologist and almost 15% believe that a urologist treats disorders of the skeletal, nervous or circulatory systems.
"The results of our latest survey clearly demonstrate that people are ill-informed when it comes to urological conditions. Men in particular have less knowledge than women and turn a blind eye to symptoms and early diagnosis" comments Prof. Hein Van Poppel, urologist and Adjunct Secretary General of the EAU. "Persuading men to take their health seriously presents a serious challenge. They need to have a better understanding of the risk and symptoms of their conditions. They should be encouraged to seek support from a medical professional if they suspect anything unusual."

54% of men think that women have a prostate. Just over 37% of the women think they have a prostate. Credit: European Association of Urology (EAU)

The Prostate Remains a Mystery to Many Men

Every year, almost 450,000 men across the continent will be diagnosed with prostate cancer, leading to 92,000 deaths in Europe2. Despite prostate cancer being the most common cancer in males throughout Europe, three quarters of men admitted that they have limited knowledge of its symptoms. Men are, in fact, more confident in recognising the symptoms of breast cancer (31%) than they are of prostate cancer (27%).
In addition to the low awareness of prostate cancer symptoms, just 1 in 4 respondents could correctly identify the location of the prostate and surprisingly, a higher proportion of women (28%) were able to identify the location of the prostate than males (22%). Worryingly, 54% of men believe that women have prostates.

Erectile Dysfunction and Incontinence Still Taboos

Erectile dysfunction (ED) prevalence in Europe is estimated at 50%3 of the sexually active men of 50 years and older. However, the topic remains a taboo leading to misunderstanding and ignorance. 75% of the respondents were not aware of the numbers of men that suffer from erectile dysfunction in their country. Similarly, 85% were unaware of the amount of people in their country that suffer from urinary tract issues.
"Men's health issues involve partners too", says Prof. Van Poppel. "Women are more used to checking their bodies. They should encourage men to do the same and discuss their health more in detail. Women should actively participate in conversations with their male partners and doctors."

The percentage of European men aged 50-80 years suffering from erectile dysfunction in your country. Credit: European Association of Urology (EAU)

International Differences in Testicular Cancer Knowledge

Testicular cancer is the most common type of cancer to affect younger men. However, survey results stated that only 18% of male respondents knew that men aged 16 to 44 years have the highest risk. Whilst knowledge was found to be low throughout Europe, there were stark differences; only 10% of the respondents from Spain know the at-risk age group compared to 27% in the UK.
Symptom awareness was also low with 70% of men lacking confidence in recognising the symptoms of testicular cancer, which may include a swelling or lump in one of the testicles and a dull ache or sharp pain in the testicles or scrotum.

Significant Delays in Visiting the Doctor

Symptom awareness is recognised as a leading factor in the early diagnosis of urological conditions. The majority of deaths in male cancers occur because most men do not address their conditions in time. Despite this, they continue to ignore their symptoms and delay seeing their doctors.
The survey reveals that 43% of people would not go to their doctor straight away if they notice blood in their urine; 23% would wait longer than a month if they suffered a frequent urge to urinate; 28% would wait for more than a week if they suffered burning or pain during urination; and only 17% of people surveyed associate pain in their lower abdomen with a serious problem.
Professor of urology and Executive Member for Communications at the EAU, Manfred Wirth adds "Urological diseases are extremely common; they cause a lot of discomfort and at times, can be life-threatening. It's time for Europe to change its attitude towards urology and invest in educational campaigns to increase urological knowledge and to break taboos."


Provided by European Association of Urology

Crunched for time? High-intensity exercise = same cell benefits in fewer minutes

Credit: CC0 Public Domain

A few minutes of high-intensity interval or sprinting exercise may be as effective as much longer exercise sessions in spurring beneficial improvements in mitochondrial function, according to new research. The small study is published ahead of print in the American Journal of Physiology—Regulatory, Integrative and Comparative Physiology.

23 sept 2018--Mitochondria, the energy centers of the cells, are essential for good health. Previous research has found that exercise creates new mitochondria and improves the function of existing mitochondria. Altered mitochondrial function in response to a single session of exercise generates signals that may lead to beneficial changes in the cells, lowering the risk for chronic disease. High-intensity interval exercise consists of short bursts of high-intensity aerobic exercise—physical activity that raises the heart rate—alternating with brief recovery periods. Whether the intensity of a workout affects mitochondrial response is unclear.
A team of researchers studied eight young adult volunteers as they participated in cycling workouts of varying intensity.

• Moderate intensity consisted of 30 minutes of continuous exercise at 50 percent peak effort.
• High-intensity interval exercise consisted of five four-minute cycling sessions at 75 percent peak effort, each separated by one minute of rest.
• Sprint cycling consisted of four 30-second sessions at maximum effort, each separated by 4.5 minutes of recovery time.

The research team measured the amount of energy the volunteers spent on each workout and compared mitochondrial changes in the participants' thigh muscles before and after each exercise session. The researchers found that levels of hydrogen peroxide—a type of molecule involved in cell signaling called "reactive oxygen species" that contains oxygen and hydrogen—in different parts of the mitochondria change after exercise. While too much reactive oxygen species can be damaging to the cells, the researchers noted that the volunteers' levels were an appropriate amount to potentially promote cell responses that benefit metabolic function rather than cause damage.
In addition, the research team found that fewer minutes of higher-intensity exercise produced similar mitochondrial responses compared to a longer moderate-intensity activity. "A total of only two minutes of sprint interval exercise was sufficient to elicit similar responses as 30 minutes of continuous moderate-intensity aerobic exercise," the researchers wrote. "This suggests that exercise may be prescribed according to individual preferences while still generating similar signals known to confer beneficial metabolic adaptions. These findings have important implications for improving our understanding of how exercise can be used to enhance metabolic health in the general population."

More information: Adam James Trewin et al, Acute HIIE elicits similar changes in human skeletal muscle mitochondrial H2O2 release, respiration and cell signaling as endurance exercise even with less work, American Journal of Physiology-Regulatory, Integrative and Comparative Physiology (2018). DOI: 10.1152/ajpregu.00096.2018


Provided by American Physiological Society

Your Apple Watch can now record your ECG – but what does that mean and can you trust it?

Apple’s smart watch can now read your heart current. Credit: shutterstock.com

Apple's new, fourth-generation watch has an electrical heart rate sensor. This can record your electrocardiogram or ECG, which Apple says: "… can classify if the heart is beating in a normal pattern or whether there are signs of atrial fibrillation (AFib), a heart condition that could lead to major health complications."

23 sept 2018--So, what actually is an ECG and can you really rely on a watch to read it?

How does the heart beat?

As a quick summary, your heart is divided into four chambers. The two top chambers (called atria) receive blood and push it towards the two bottom chambers (ventricles), which pump blood out to the body (left side) and the lungs (right side).
At the top of the right atrium is a little collection of cells called the sinoatrial node, or SA node. These generate an electrical signal which travels toward the middle of the heart (atrioventricular node). Finally, this electrical impulse spreads into the ventricles, which makes them squeeze blood for what we feel as a heartbeat or pulse. A normal heart rate can vary significantly between different people.
So, these small electrical currents help co-ordinate each beat. In the early 1900s, Willem Einthoven developed a machine to be able to record these signals (for which he was awarded the Nobel Prize) – a device that developed into the modern-day ECG machine.
An ECG involves having small stickers applied to your chest, shoulders and ankles, which can then read the electricity coming from your heart. You don't feel anything when it is taken and it takes only a few seconds to make a recording. It can be done at your local GP clinic or in hospital.

Your heart is made up of four chambers. Credit: shutterstock.com

How does an ECG work?

With every beat, there is a characteristic appearance of each signal on the ECG, with separate "waves" that correspond to electrical activity from different parts of the heart.
The P wave (before the spike) represents the atria squeezing blood down towards the ventricles. The QRS looks like a spike and represents the two ventricles squeezing blood to the body and lungs. And the T wave at the end reflects the recovery of the ventricles as they relax to receive blood again.
By analysing various segments, the person reading the ECG can understand about problems, signalled by an abnormal-looking ECG, in the heart. The ECG can usually detect severe or urgent heart attacks, which cause elevation of the segment between the QRS and T waves. Smaller heart attacks sometime show signs, but not always.
The ECG is good for detecting arrhythmias, which are abnormal rhythms. The most common arrhythmia is atrial fibrillation (AF) – this is where the top chambers (the atria) don't squeeze properly. As a result blood can stagnate and form a clot, which can then go to the brain and cause a stroke.
You can see atrial fibrillation on an ECG when no P wave is visible. Instead there are often small irregular blips indicating that the atrium is beating in a weak and disorganised way. An ECG can also pick up other arrhythmias, though it is most useful if the person is in the abnormal rhythm at the time the ECG is done.

Each beat is represented by a separate wave or spike on the ECG. Credit: shutterstock.com

The ECG can also pick up abnormal heart structures. Sometimes it can show signs of the heart being weak (heart failure) or if the muscle is unusually thick, such as when people have high bloodpressure for a long time.

So, can the Apple Watch actually read your heart?

The ECG at your local doctor is called a 12-lead ECG. Only ten leads are physically attached to you, but the machine derives 12 based on the direction of electrical flow. Each of these leads provide a different view of the heart.
Imagine you are peering into a room through several windows. Each window would give you a different perspective, and putting these together can give you an overall impression of the room.
Wearable ECGs, like that with the Apple Watch, can pick up only one lead (for your further reading, it's lead I). This can tell if your heart is irregular and sometimes if there is no P wave (so it could potentially detect atrial fibrillation).
A key advantage of having the Apple Watch is the ability to take a 30-second ECG (this requires you to put your right hand on the watch to form a circuit so the electrical signals can be read from both arms through your heart) at the time you feel symptoms. It can understand the context as well (for example, your activity level at the time).

An ECG involves several stickers placed on your chest. Credit: shutterstock.com

There are drawbacks, though. The watch can only give a single-window view of what's happening in the heart, and won't be able to detect heart attacks or abnormal heart structure accurately. Wearable devices are also more prone to interference with the signal as they rely on just one lead, whereas a 12-lead ECG remains the gold standard.
And, of course, the actual ECG must be read by a professional. Apple gives you the option to download your reading as a PDF.
Ultimately, if you have concerns about your heart, an ECG is a simple, non-invasive, cheap test, which your local doctor can interpret. It should always be accompanied by a detailed history of your symptoms and a physical examination.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Provided by The Conversation

Alcohol responsible for one in 20 deaths worldwide: WHO

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Alcohol kills three million people worldwide each year—more than AIDS, violence and road accidents combined, the World Health Organization said Friday, adding that men are particularly at risk.
The UN health agency's latest report on alcohol and health pointed out that alcohol causes more than one in 20 deaths globally each year, including drink driving, alcohol-induced violence and abuse and a multitude of diseases and disorders.

22 sept 2018--Men account for more than three quarters of alcohol-related deaths, the nearly 500-page report found.
"Far too many people, their families and communities suffer the consequences of the harmful use of alcohol through violence, injuries, mental health problems and diseases like cancer and stroke," WHO chief Tedros Adhanom Ghebreyesus said in a statement.
Drinking is linked to more than 200 health conditions, including liver cirrhosis and some cancers.
Alcohol abuse also makes people more susceptible to infectious diseases such as tuberculosis, HIV and pneumonia, the report found.
The some three million alcohol-related deaths registered globally in 2016—the latest available statistics—account for 5.3 percent of all deaths that year.
For young people, the numbers are even more alarming, with a full 13.5 percent of all deaths among 20-29-year-olds considered to be alcohol-related, the study found.

'Unacceptably high'

In comparison, HIV/AIDS was responsible for 1.8 percent of global deaths in 2016, road injuries accounted for 2.5 percent and violence for 0.8 percent, it said.
The latest numbers are lower than those in WHO's last report on global alcohol consumption, published in 2014.
There are "some positive global trends", the agency said, noting shrinking prevalence of heavy episodic drinking and alcohol-related deaths since 2010.
But it warned that "the overall burden of disease and injuries caused by the harmful use of alcohol is unacceptably high," especially in Europe and the Americas.
Globally, an estimated 237 million men and 46 million women suffer from alcohol use disorders, WHO said.
Alcohol abuse affects nearly 15 percent of men and 3.5 percent of women in Europe, and 11.5 percent of men and 5.1 percent of women in the Americas, it pointed out.
Alcohol consumption overall is unevenly distributed around the globe, with well over half of the world's population over the age of 15 abstaining completely.
On average, the 2.3 billion people currently considered drinkers—meaning they have drunk alcohol at least once in the past year—consume 33 grammes of pure alcohol per day.

A beer a day

That is roughly equivalent to two glasses of wine, a large bottle of beer or two shots of spirits.
Europe clearly has the highest per capita consumption, which despite a more than 10-percent drop since 2010 still registered a per capita consumption of 10 litres of pure alcohol or more per year.
Alcohol consumption has dropped in three-quarters of European countries, with the biggest declines seen in Russia, Moldavia and Belarus.
In Russia, average annual alcohol consumption plunged from 18.7 litres of pure alcohol per person over 15 in 2005 to 11.7 litres in 2016, the report said.
This "dramatic decrease" is linked to a range of "positive policies" introduced by Moscow, Vladimir Poznyak, who coordinates WHO's substance abuse unit, told reporters.
He pointed to the introduction of a minimum price for vodka and an alcohol advertising ban.

Sport sponsorships

WHO however warned that outside of Europe, alcohol consumption has continued to rise, especially in Asia, with China and India registering significant hikes.
It urged countries to do more to counter harmful drinking and to reach a goal of cutting global consumption by 10 percent between 2010 and 2025.
"Based on all trends and predictions, we can expect an increase in overall alcohol consumption and alcohol-related harm in the next 10 years," Poznyak warned, stressing that "this will definitely result in increased number of deaths and suffering around the world."
WHO is urging countries to tax alcohol and ban advertising of such beverages to reduce consumption.
Poznyak said blocking alcohol companies from sponsoring big sporting events could make a big difference.
"These events are being watched by millions and sometimes billions of young people, and it's impossible to prevent exposure to this kind of advertising to those who are under the legal age," he said.

Despite some progress, Alzheimer's fight falling flat

Friday September 21 is World Alzheimer's Day, an event launched in 2012 to raise global awareness of the disease

It's a devastating disease driving a dementia epidemic ruining tens of millions of lives, but with no new medical treatment since the turn of the century the fight against Alzheimer's is foundering.
Despite decades of research and hundreds of millions of dollars, the precise cause of the neurodegenerative disease—which leaves victims suffering from memory loss, disorientation and behavioural problems—remains poorly understood.

21 sept 2018--"It's a bit like solving a jigsaw puzzle without knowing what the end result needs to look like," said Pierre Tariot, director of the Banner Alzheimer's Institute in Phoenix, Arizona.
This year alone, pharmaceutical giants—including Lundbeck, Takeda, Merck & Co, Janssen Biotech, AstraZeneca and Eli Lilly—have either halted or failed in their search for a new Alzheimer's drug.
US drug giant Pfizer said in January it was abandoning all research into the disease.
The problem, according to Marie Sarazin, director of neurology at the Saint-Anne hospital in Paris, is that scientific research has followed "the same track" for decades.
After trials on mice focused on diseased neurons in the brain appeared to produce a breakthrough in the early 2000s, many corporations "thought they'd hit the jackpot", Sarazin said.
But follow up research has so far failed to produce a new medical treatment for Alzheimer's. Indeed, the long-held hypothesis over what causes the disease in the first place is now being reconsidered.

How Alzheimer's disease develops

Astronomical cost

Alzheimer's occurs when neurons in the brain lose their ability to communicate with one another, leading patients to struggle to remember names and places, orientate themselves or interact with loved ones.
Worldwide, about seven percent of people over 65 suffer from the disease or some form of dementia, a percentage that rises to 40 percent above the age of 85.
The number afflicted is expected to triple by 2050 to 152 million, according to the World Health Organization, posing a huge challenge to healthcare systems.
Alzheimer's cost an estimated $818 billion (700 billion euros) in 2015—equivalent to around one percent of global GDP, and this is predicted to double by 2030.
Friday is World Alzheimer's Day, an event launched in 2012 to raise global awareness of the disease.
It comes this year with a glimmer of promise for a breakthrough: a joint US-Japanese clinical trial of an antibody designed to breakdown proteins thought to hamper neuroactivity significantly helped the brain function of test subjects.
On Wednesday, a team of scientists in the US said they had eliminated dead-but-toxic cells occurring naturally in the brains of mice designed to mimic Alzheimer's and slowed neuron damage and memory loss associated with the disease.
But with developed nations dealing with the health challenges posed by ageing populations, many experts agree that more attention must focus on prevention as well as cure.
Exercise, drinking less alcohol and eating a balanced diet have all shown to reduce the risk of developing Alzheimer's.
"It seems that like in any other neurodegenerative disease, the key will be to go into prevention, as early as possible before signs and symptoms of the pathology occurs," Danny Bar-Zohar, global head of neuroscience development at Novartis, told AFP.

Discovery could explain failed clinical trials for Alzheimer's, and provide a solution

PET scan of a human brain with Alzheimer's disease. Credit: public domain

Researchers at King's College London have discovered a vicious feedback loop underlying brain degeneration in Alzheimer's disease which may explain why so many drug trials have failed. The study also identifies a clinically approved drug which breaks the vicious cycle and protects against memory-loss in animal models of Alzheimer's.

21 sept 2018--Overproduction of the protein beta-amyloid is strongly linked to development of Alzheimer's disease but many drugs targeting beta-amyloid have failed in clinical trials. Beta-amyloid attacks and destroys synapses—the connections between nerve cells in the brain—resulting in memory problems, dementia and ultimately death.
In the new study, published in Translational Psychiatry, researchers found that when beta-amyloid destroys a synapse, the nerve cells make more beta-amyloid driving yet more synapses to be destroyed.
"We show that a vicious positive feedback loop exists in which beta-amyloid drives its own production," says senior author Dr. Richard Killick from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN). "We think that once this feedback loop gets out of control it is too late for drugs which target beta-amyloid to be effective, and this could explain why so many Alzheimer's drug trials have failed."
"Our work uncovers the intimate link between synapse loss and beta-amyloid in the earliest stages of Alzheimer's disease," says lead author Dr. Christina Elliott from the IoPPN. "This is a major step forward in our understanding of the disease and highlights the importance of early therapeutic intervention."
The researchers also found that a protein called Dkk1, which potently stimulates production of beta-amyloid, is central to the positive feedback loop. Previous research by Dr. Killick and colleagues identified Dkk1 as a central player in Alzheimer's, and while Dkk1 is barely detectable in the brains of young adults its production increases as we age.
Instead of targeting beta-amyloid itself, the researchers believe targeting Dkk1 could be a better way to halt the progress of Alzheimer's disease by disrupting the vicious cycle of beta-amyloid production and synapse loss.
"Importantly, our work has shown that we may already be in a position to block the feedback loop with a drug called fasudil which is already used in Japan and China for stroke." says Dr. Killick. "We have convincingly shown that fasudil can protect synapses and memory in animal models of Alzheimer's, and at the same time reduces the amount of beta-amyloid in the brain."
The researchers found that in mice engineered to develop large deposits of beta-amyloid in their brains as they age, just two weeks of treatment with fasudil dramatically reduced the beta-amyloid deposits.
Researchers at King's College London are now seeking funding to run a trial in early stage sufferers of Alzheimer's to determine if fasudil improves brain health and prevents cognitive decline.
Professor Dag Aarsland from the IoPPN said "As well as being a safe drug, fasudil appears to enter the brain in sufficient quantity to potentially be an effective treatment against beta-amyloid. We now need to move this forward to a clinical trial in people with early stage Alzheimer's disease as soon as possible."

More information: Christina Elliott et al, A role for APP in Wnt signalling links synapse loss with β-amyloid production, Translational Psychiatry (2018). DOI: 10.1038/s41398-018-0231-6


Provided by King's College London

US Alzheimer's cases to nearly triple by 2060

By 2060, almost 14 million Americans will suffer from Alzheimer's disease, a number that's nearly three times as high as today, a new report projects.

21 sept 2018--"This study shows that as the U.S. population increases, the number of people affected by Alzheimer's disease and related dementias will rise, especially among minority populations," said Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention.
The agency report noted that 5 million Americans—1.6 percent of the population—had Alzheimer's disease in 2014.
But that number is estimated to increase to 13.9 million by 2060, equaling nearly 3.3 percent of a projected population of 417 million people.
Currently, Alzheimer's disease is the fifth leading cause of death for Americans age 65 and older, the CDC said. The new report finds that white Americans will continue to comprise the majority of Alzheimer's cases, simply due to their sheer numbers. But minorities will be hit especially hard.
Among people 65 and older, blacks currently have the highest prevalence of Alzheimer's disease and related dementia at 13.8 percent, the CDC said. That's followed by Hispanics (12.2 percent), and whites (10.3 percent).
By 2060, the CDC researchers estimated that 3.2 million Hispanics and 2.2 million black Americans will be afflicted with Alzheimer's or a related dementia.
One reason for the increase in U.S. Alzheimer's cases could be inroads made against other diseases of aging. As people are able to live longer with chronic illnesses such as heart disease or diabetes, their odds for developing a dementia in old age rises, the CDC explained.
All of this means more Americans will also become caregivers for loved ones with dementia. That makes spotting the disease early even more important, Redfield said.
"Early diagnosis is key to helping people and their families cope with loss of memory, navigate the health care system, and plan for their care in the future," he said in a CDC news release.
Planning can help ease caregiver burden, added study lead author Kevin Matthews, of the CDC's National Center for Chronic Disease Prevention and Health Promotion.
"It is important for people who think their daily lives are impacted by memory loss to discuss these concerns with a health care provider," Matthews said. "An early assessment and diagnosis is key to planning for their health care needs, including long-term services and supports, as the disease progresses."
The study was published online Sept. 19 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

More information: SOURCE: Sept. 20, 2018, news release, U.S. Centers for Disease Control and Prevention

There's more on Alzheimer's disease at the Alzheimer's Association.

Study clarifies ApoE4's role in dementia

Cerebral vasculature imaged by 3-photon microscopy in a living mouse. This technology enabled investigators to analyze blood flow in areas deep in the substance of the brain, where ApoE4 promotes damage implicated in vascular dementia and Alzheimer’s disease. Credit: Weill Cornell Medical College

ApoE4, a protein linked to both Alzheimer's disease and a form of dementia caused by damage of blood vessels in the brain, increases the risk of cognitive impairment by reducing the number and responsiveness of blood vessels in the organ, a study by Weill Cornell Medicine researchers suggests.

21 sept 2018--The study, published Sept. 19 in Nature Communications, helps explain the connection between ApoE4 and vascular dementia—the second most common form of dementia after Alzheimer's disease—as well as vascular lesions that occur frequently in Alzheimer's disease patients.
"We found that the brains of mice with ApoE4 have less blood flow in the resting state, and are also less able to increase blood flow when brain activity demands it—which leaves them much more vulnerable to brain damage," said senior author Dr. Costantino Iadecola, director and chair of the Feil Family Brain and Mind Research Institute (BMRI) and the Anne Parrish Titzell Professor of Neurology at Weill Cornell Medicine.
Apolipoprotein-E (ApoE) is a cholesterol carrier produced in the brain and other tissues. ApoE4 is one of its three common variants in humans, present in about 14 percent of people worldwide. ApoE4 also brings a higher risk of heart disease and stroke, and in recent years has been linked to vascular dementia—a form of cognitive impairment that accounts for about 20 percent of all dementia cases. For reasons that are not entirely clear, it is the strongest genetic risk factor for Alzheimer's disease.
Vascular dementia may have multiple specific causes, but due to inadequate local blood supply, generally features small patches of damage in the nerve fiber tracts, or white matter, that connect different brain regions. These lesions are also present in Alzheimer's disease brains and, together with the accumulation of amyloid plaques and neurofibrillary tangles from the protein tau, are thought to cause cognitive deterioration. How ApoE4 promotes this damage has been a challenge to determine because of the technical difficulty of studying blood vessels deep in the substance of the brain.
Dr. Iadecola's team overcame this hurdle with the help of an advanced imaging technology known as 3-photon microscopy. The technology, originally developed at the School of Applied and Engineering Physics on Cornell's Ithaca campus, enabled Drs. Chris Schaffer and Sung Gi Ahn of the Meinig School of Biomedical Engineering, collaborators in the study, to image at high resolution blood vessels and nerve fiber tracts deep within the brains of living mice.
The scientists examined mice whose ApoE gene had been replaced with the gene for ApoE4, which normally occurs only in humans. Comparing these ApoE4 mice to normal mice, they found that the former, while at rest, had 14 and 19 percent less blood flow, respectively, in two brain regions, the caudate nucleus and the somatosensory cortex—representing areas affected in humans with vascular dementia. By contrast, mice engineered with ApoE3, the most common human ApoE variant, had the same level of cerebral blood flow as normal mice. Close inspection of the ApoE4 mice's cerebral vessels revealed the reason for the reduced blood flow: the density of vessels was lower.
Further experiments showed that the cerebral vessels of the ApoE4 mice were also less able to dilate themselves to increase their flow, as they normally do in response to increased brain activity. When the major arteries supplying blood to the brain were narrowed artificially, modeling the age-related thickening of arterial walls that happens in humans, the lower baseline flow and reduced responsiveness of the ApoE4 mice's cerebral vessels led to much greater brain damage. The pattern of brain damage resembled that seen in human vascular dementia and in a large number of Alzheimer's disease patients.
Initial tests suggested that ApoE4 exerts these deleterious effects by causing certain immune cells in the brain to release superoxide and other highly reactive oxygen-containing molecules. These potentially damaging molecules inhibit vessel development, and interfere with vessels' abilities to increase local blood flow as needed.
"We suspect that this 'oxidative stress' is the driver of the vascular impairment in ApoE4-positive individuals," said Dr. Laibaik Park, an assistant professor of research in neuroscience in the BMRI and the co-senior author of the study.
Dr. Iadecola and his laboratory are continuing to investigate how ApoE4 harms normal cerebral vessel function. The research could lead to future therapies that block ApoE4-induced oxidative stress to ameliorate vascular dementia and potentially other ApoE4-linked conditions such as Alzheimer's disease.

More information: Kenzo Koizumi et al. Apoε4 disrupts neurovascular regulation and undermines white matter integrity and cognitive function, Nature Communications (2018). DOI: 10.1038/s41467-018-06301-2


Provided by Weill Cornell Medical College

New method enables accurate diagnosis of Alzheimer's disease

Tau PET imaging shows substantial levels of tau pathology in temporal and parietal regions in patients with Alzheimer’s disease. Credit: Oskar Hansson

Diagnosing Alzheimer's disease can be difficult, as several other conditions can cause similar symptoms. Now a new brain imaging method can show the spread of specific tau protein depositions, which are unique to cases with Alzheimer's.

21 sept 2018--"The method works very well. I believe it will be applied clinically all over the world in only a few years," says Oskar Hansson. Hansson is a professor of clinical memory research at Lund University in Sweden who has led a major international study on the new method.
There are two proteins that are known to be linked to Alzheimer's disease – beta-amyloid, which forms what is known as plaque in the brain, and tau, which forms tangles within the brain cells. Beta-amyloid spreads throughout the brain at an early stage, decades before the patient notices signs of the disease. Tau, on the other hand, starts to spread at a later stage, from the temporal lobes to other parts of the brain.
"It is when tau begins to spread that the neurons start dying and the patient experiences the first problems with the disease. If we scan a patient with memory difficulties and he or she proves to have a lot of tau in the brain, we know with a high degree of certainty that it is a case of Alzheimer's," says senior researcher Rik Ossenkoppele, Lund University and Amsterdam University Medical Center.
He is the first author, and Oskar Hansson the last author, of an article recently published in the reputable medical journal JAMA (Journal of the American Medical Association). The article presents a study of over 700 patients. Besides Lund-Malmö in southern Sweden, researchers from San Francisco and Seoul took part in the study, and the patients were diagnosed in memory clinics from these regions.
The presence of tau in the brain was revealed by a PET scanner, a medical imaging technology which uses radioactive markers that make their way to different areas in the body.
"We administer the special tau marker intravenously to the patient. If the patient has tau in certain parts of the brain, the marker will detect it. The result –whether Alzheimer tau is present or not – is very clearly visible on the PET images," says Oskar Hansson.
The international study showed that the new tau-PET method had both great sensitivity and specificity: it detected 90-95 per cent of all cases of Alzheimer's and gave only few false positive results in patients with other diseases. The tau-PET method had clearly superior diagnostic accuracy compared to MRI, and fewer false positive results than beta-amyloid PET, two methods that are routinely used today. Tau-PET should therefore be of great use in the investigation of patients with memory problems, as soon as the method is approved for clinical use.
"If you are found to have tau in the brain according to tau-PET, it is, with few exceptions, due to Alzheimer's disease. If you have normal tau-PET and mild to moderate dementia, your memory problems are most likely due to other neurological diseases," summarises Oskar Hansson.
Although there is currently no cure for Alzheimer's, it is still important for patients to receive the correct diagnosis. On the one hand, the patient can be given symptom-relieving medication, and on the other, physical activity, a good diet and a correct dosage of the patient's other medication can optimize cognitive ability. The tau-PET method could also be valuable in trials of new medication against Alzheimer's, as it can show whether new drugs have succeeded in preventing the spread of tau in the brain.

More information: Discriminative Accuracy of [18F]flortaucipir Positron Emission Tomography for Alzheimer Disease vs Other Neurodegenerative Disorders. JAMA. 2018;320(11):1151-1162. DOI: 10.1001/jama.2018.12917


Provided by Lund University

Thinking beyond yourself can make you more open to healthy lifestyle choices

Credit: CC0 Public Domain

Public health messages often tell people things they don't want to hear: Smokers should stop smoking. Sedentary people need to get moving. Trade your pizza and hot dogs for a salad with lean protein.
For many people, these messages trigger our natural defenses. They make us feel bad about ourselves and our choices, leading our subconscious to reject the healthy encouragement.

20sept 2018--However, a new study published in PNAS found that a simple priming exercise in which sedentary people think beyond themselves before viewing health messages can make those messages more effective. Not only did participants' brain activity show that they were more receptive to the messages, but they actually became more physically active in the weeks that followed.
The study involved 220 sedentary adults who were either overweight or obese—people whose lack of physical activity puts them at increased risk for a variety of negative health outcomes.
"One of the things that gets in the way of people changing their behavior is defensiveness," explains senior author Emily Falk, Associate Professor of Communication, Psychology, and Marketing at the University of Pennsylvania's Annenberg School for Communication. "When people are reminded that it's better to park the car further away and get in a few more steps, or to get up and move around at work to lower their risk for heart disease, they often come up with reasons why these suggestions might be relevant for somebody else, but not for them."
To combat those defensive feelings, researchers engaged the participants in one of two self-transcendence tasks and compared their responses to those in a non-transcendent control group. Self-transcendence tasks required participants to think about values bigger than themselves—such as people they loved and cared about—and did so while the subjects were in an fMRI machine, allowing researchers to see their brain activity in real time.
The first self-transcendence group reflected on things that mattered most to them. If they chose "friends and family," they might be asked to think about times in the future when they might feel close to their friends and family. If they chose "spirituality," they might be asked to think about times when they might connect with God or other sources of higher power.
A second self-transcendence group was asked to make repeated positive wishes for both people they knew and for strangers. These included hopes that your friends would be joyful or that others would be well.
Meanwhile, a control group reflected on their least important values.
Then all the participants viewed blunt health messages that encouraged them to be more active, or explained why their current behaviors put them at risk. For example:

• Getting more active will strengthen your muscles. Stronger muscles will make it easier for you to get around and do the things you enjoy for longer.
• Make a habit of walking up and down the stairs whenever you can. Avoid taking the elevator as often as possible.
• The American Heart Association says sedentary people like you are at serious risk for heart disease. This means more pills and higher risk of sickness and death.

In the month that followed, participants received daily text messages that repeated the experiment in miniature, priming them to think self-transcendent thoughts (or neutral control thoughts) before they received health messages. The also wore fitness trackers to monitor their activity.
Those who had completed either of the self-transcendence tasks were significantly more active in the month that followed, with less time spent being sedentary.
In addition, the researchers found that during the self-transcendence tasks, people showed greater activity in brain regions involved in reward and positive-valuation, when compared to the control group.
"People often report that self-transcendence is an intrinsically rewarding experience," says lead author Yoona Kang, a postdoctoral fellow with the Annenberg School for Communication at the University of Pennsylvania. "When you are having concerns for others, these can be rewarding moments."
These rewarding feelings, the researchers believe, can lead people to be more open to hearing otherwise-unwelcome health advice.
"If you let people first 'zoom out' and think about the things and people that matter most to them," says Falk, "then they see that their self-concept and self-worth aren't tied to this particular behavior—in this case, their lack of physical activity."
Kang also points out that allowing people to feel part of something larger than themselves can have positive health effects.
"People are capable of doing things for their loved ones that they'd probably never do for themselves," she says. "The idea of self-transcendence—caring for others beyond one's own self-interest—is a potentially powerful source of change."
The researchers are currently testing a phone app for the general public which delivers daily pairs of self-affirming and health messages, like those used in the study. Click here to download the app from the iTunes store.
"Effects of Self-Transcendence on Neural Responses to Persuasive Messages and Health Behavior Change" was published today in PNAS.

More information: Yoona Kang el al., "Effects of self-transcendence on neural responses to persuasive messages and health behavior change," PNAS (2018). www.pnas.org/cgi/doi/10.1073/pnas.1805573115


Provided by University of Pennsylvania

Suicide among men—and the myth of impulsive acts

A USC expert offers insight on coping mechanisms during National Suicide Prevention Week. Credit: iStock

The recent death of chef and documentarian Anthony Bourdain sparked widespread media attention and a broader cultural discussion about depression and impulsive suicide, especially among middle-aged men. With the nation marking National Suicide Prevention Week this week, the conversation seems more relevant than ever, considering that men account for a staggering 80 percent of suicides, according to the American Foundation for Suicide Prevention. What's more, the highest rates of suicide in recent years have been among those who are 45 to 54 years old.

19 sept 2018--Clinical social worker Susan Lindau is an adjunct professor at the USC Suzanne Dworak-Peck School of Social Work in its Department of Adult Mental Health and Wellness. She spoke about the cultural stigma that may correlate to higher suicidality among men, offering techniques for helping at-risk individuals in times of crisis.

Can you tell us about your professional background?
My path to social work has been unique: First I pursued an MSW, which I received in 1972. Then, because I was not sure I wanted to be a social worker, I did everything from running a catering business to attending film school. I returned to social work in 1995 and I've been teaching at USC since 2006.
As a therapist, I specialize in working with individuals who have borderline personality disorder, depression and anxiety. The treatment that I provide is known as Dialectical Behavior Therapy. I enjoy using DBT because it recognizes the struggles that come with facing change. Sometimes we can only tolerate inches of change, rather than massive leaps—and that's OK. I often tell clients: Change is inevitable, growth is optional.

What is your approach to working with depressed patients and what factors do you believe may contribute to a higher rate of suicidality among men?
I believe that Western cultures place particular pressure on men to perform socially and financially in ways that prevent them from expressing vulnerability. Society expects men to be strong, unemotional and conventionally "successful."
When they reach middle age, many people face thoughts along the lines of, "I should have …" or "I wish I had …" If he hasn't reached a certain fabricated benchmark of "success" that his culture dictates he should have reached, he may feel like a failure. When societal norms don't grant men the permission to be vulnerable or express the need for help, these perceived shortcomings can lead to depression. I don't discount the commensurate pressure that women endure, but statistics do indicate that men may suffer higher rates of suicidality due, at least in part, to an inability to cope with these stressors in a healthy way. Sadly, the number of women attempting suicide is also on the rise.
Other hardships that characterize this period of life may also contribute. Marriages and friendships may not feel as effortless as they may once were—and if these relationships aren't allowed the flexibility to evolve as the individuals within them evolve, this may feel like another failure. Too often, these perceived failures are endured in silence due to the fear of reaching out for help. I hope that the tragedy of individuals taking their own lives may force us to examine the stigma we place on emotional vulnerability in our culture.

Is there a difference between impulsive and premeditated suicide?
A lot of research is currently being conducted on the role of impulsivity in suicide. However, I believe that suicide cannot be deemed absolutely impulsive unless it's drug-induced or the victim is already a fairly impulsive person.
Those who choose to take their own lives are often experiencing excruciating sadness and isolation and may have difficulty expressing that vulnerability. Outwardly successful individuals—especially men such as Robin Williams or Anthony Bourdain—may feel especially unable to express their pain. Again, this is compounded by the pressure to demonstrate their masculine strength within certain boundaries defined by our culture.

What are some methods for addressing an apparent impulse toward suicide?
Research shows that when individuals make the decision to attempt suicide, nearly half of people will attempt it within 20 minutes. That's why I begin many of my coaching phone calls with clients by saying, "What actions can we take to get through the next 20 minutes?"
DBT methods for mitigating suicidality in the moment come from the module defined as "Distress Tolerance." The idea is to help the client take an action that makes it possible to think of almost anything except harming himself. Together the client and I discuss an action that he feels comfortable doing. If it is during the day, I might suggest a long, hard run and ask the client to describe the route he will take. If it is late at night, I might suggest taking a long, hot shower.
The tool is identified as TIP: Abruptly change the Temperature, perform Intense exercise, and Paced breathing. Temperature refers to the act of dipping your hands or face in ice water, which can initiate shock that breaks the chain of impulsive thought. Intense exercise such as running or swimming creates a flow of endorphins that can mediate the sensation of intense pain or impulsivity. Finally, paced breathing is a meditative strategy of inhaling and exhaling in measures of four counts to relax the mind and body. Each of these actions forces the client to think about something other than his pain.

How can individuals help family members or friends who may be struggling with depression or suicidal thoughts?
The most important thing that we can do is create the space for our friends and family to feel safe expressing vulnerability. We have to have the courage to step up and say, "Let me help you find the resources you need." Those who are struggling may initially reject help, but it's important to reach out and be persistent. Often the person who is feeling terrible doesn't know what to say when you ask: "What can I do to help?" We must be willing to validate our friend our family member who is feeling horrible and offer a specific action: "I can see you're feeling awful. Can we talk?" Or, "let's go for a walk."
I'm optimistic about the future because I believe millennials and Gen Z value vulnerability and emotional expression more than previous generations. Clients in their 20s to mid-30s come to me feeling less ashamed to say, "I'm feeling depressed." The conversation about mental health is finally happening, and people are learning the values of practicing mindfulness—which can promote better physical and mental health. These trends make me hopeful about reducing suicide rates in future generations.


Provided by University of Southern California

Single, fixed-dose combo pills improve hypertension outcomes

Single-pill, fixed-dose combination (FDC) treatment may be more effective for improving blood pressure control in older patients, according to a study recently published in PLOS Medicine.

16 sept 2018--Amol A. Verma, M.D., from St. Michael's Hospital in Toronto, and colleagues used linked clinical and administrative databases to compare clinical outcomes and medication adherence for patients prescribed one angiotensin-converting enzyme inhibitor or angiotensin II-receptor blocker plus one thiazide diuretic, either as a single-pill FDC or as a multi-pill combination. The authors performed a retrospective cohort study, with five year follow-up, of 13,350 patients aged 66 years or older.

The researchers observed no significant difference in outcomes between groups while patients were on treatment (hazard ratio, 1.06; 95 percent confidence interval, 0.86 to 1.31; P = 0.60). The proportion of total follow-up days covered with medications was significantly greater in the FDC group (70 percent) versus the multi-pill group (42 percent; P < 0.01), and a composite of death or hospitalization for acute myocardial infarction, heart failure, or stroke was less frequent in FDC recipients (3.4 versus 3.9 events per 100 person-years; hazard ratio, 0.89; 95 percent confidence interval, 0.81 to 0.97; P < 0.01).
"Among older adults initiating combination antihypertensive treatment, FDC therapy was associated with a significantly lower risk of composite clinical outcomes, which may be related to better medication adherence," the authors write.
One author disclosed financial ties to the pharmaceutical industry.

More information: Abstract/Full Text

Apple's smartwatch has a heart monitor now

There will soon be another way to monitor your heart—from your wrist.


The Apple Watch 4 that was unveiled Wednesday will include electrocardiogram testing. Often referred to as an EKG or ECG, this is how health care providers check the electrical signals in a patient's heart. To a layman, these are the squiggly lines across a monitor.

14 sept 2018--Usually, it takes several electrodes patches stuck to a person's chest to get this information. Having it accessible through the watch could lead to quicker diagnosis of atrial fibrillation, an irregular and often rapid heart rate that can increase a person's risk of stroke, heart failure and other heart-related complications.
"This can be an addition to our growing armamentarium to diagnose AFib, which can be intermittent and asymptomatic," said Dr. Lin Yee Chen, co-director of the Atrial Fibrillation Center at University of Minnesota Health Heart Care. He had not seen the device or learned any details beyond the basics provided by Apple.
"We need to make sure that the technology can be validated and that it actually translates to changes in outcomes," he said. "That's not a given. Just because you have a technology, doesn't necessarily mean a public health burden of disease will be reduced."
AFib affects up to 6.1 million people in the United States, a number that researchers expect will double by 2050. Untreated, AFib doubles the risk of heart-related death and increases a person's chance of having a stroke fivefold.
Apple considered this development so important that it invited Dr. Ivor Benjamin, president of the American Heart Association, to be on stage for the announcement at company headquarters in Cupertino, Calif.
"Capturing meaningful data about a person's heart, in real time, is changing the way we practice medicine," said Benjamin, who is also director of the Cardiovascular Center at the Medical College of Wisconsin. "In my experience, people often report symptoms that are absent during their medical visits. That's why information is vital information about a person's daily lifestyle choices and their specific health data."
Every time you heart beats, it sends an electrical impulse—or a "wave"—through your heart. The visual representation of those waves provides two types of crucial information:

1. How long it takes for each electrical wave to pass through the heart. This determines whether a heartbeat is slow, fast, irregular—or normal.
2. How much electricity is passing through the heart. This can indicate if the heart is too large or overworked.

To take the test via the Apple Watch 4, a user must launch the ECG app and follow on-screen instructions to place a finger on the screen for 30 seconds. Using electrodes in the watch face and a new electrical heart rate sensor in the back crystal, the app will determine if the heart is beating normally or whether it detects signs of atrial fibrillation.
All recordings and any noted symptoms are stored in the Health app and can generate a PDF that can be shared with health care experts.
While the watch comes out later this month, Apple said the ECG app will be available in the United States later this year. The company also said the app received a type of classification from the Food and Drug Administration that allows the release of low- to moderate-risk devices.
The Apple Watch joined the market in 2015 and already has become the leader in the crowded field of smartwatches, many of which already measure pulse rate. As competition seeks to catch up or get ahead on the technologies offered, further refinements to heart monitoring could become available.
While the AHA does not endorse the watch, or any other products and had no role in Apple's ECG app—Benjamin said that the organization is all for any advancements in the tools that can help fight heart disease, the No. 1 killer of Americans.

Source: American Heart Association

New toolkit to assess musculoskeletal health in older people

Credit: CC0 Public Domain

A new way to assess the impact of normal ageing on bones, joints and muscles has been proposed that could provide a benchmark for how well older people are able to keep moving.

11 sept 2018--The composition of the body changes as we get older, as muscle strength and bone density decline. But the challenge to date has been distinguishing between the normal effects of ageing and the first signs of disease.
As a result there has been limited consensus on appropriate biomarkers of normal ageing. This has led to an unreliable picture of musculoskeletal health in older people as bone, joints and muscle have been looked at in isolation, not as a complete system.

Assessment toolkit

To address this, experts at the Medical Research Council-Arthritis UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA) – a collaboration between Newcastle, Liverpool and Sheffield universities – have now proposed a set of measurements that can be used as a toolkit to assess bone, joint and muscle health.
Publishing in the journal Age and Ageing, the CIMA team say that the new toolkit will provide a consistent and holistic way to measure the gradual loss of function that everyone experiences as we get older.
In particular, they recommend the use of two biomarkers to assess bone condition – PINP and CTX, both well-established indicators of bone turnover. High levels of these biomarkers are often associated with greater fracture risk and faster rates of bone loss, particularly in older women.
The toolkit also proposes reliable indicators of cartilage damage, muscle mass, body composition and assessment of functional capability.
Professor John Mathers, from Newcastle University's Institute for Ageing, said: "We know that when older people have limited mobility or stop being active altogether it can have a significant, negative impact on their cardio-vascular health, their neurological health and their quality of life overall, increasing the risk of disease.
"This new toolkit will help us better understand how well the whole musculoskeletal system functions as we age so that we can help people stay physically active and healthy for longer."

First step

The toolkit is a first step towards a comprehensive framework that could be used by researchers and clinicians – both with individuals as needed and, potentially, as part of a public health screening programme for older people.
Over time, this could identify parameters for normal musculoskeletal ageing according to gender and age. To aid this, the CIMA team say that the toolkit could be used earlier—when people are in their 50s and early 60s, before age-related disease or disability can occur – in order to get a better picture of how the musculoskeletal system ages.
Professor Eugene McCloskey, Professor in Adult Bone Disease, University of Sheffield, said: "The burden of musculoskeletal diseases on individuals and society is huge and increasing.
"The ability to measure the impact of ageing and, equally importantly, of lifestyle and therapeutic interventions, on all of the tissues comprising the musculoskeletal system is an absolute necessity to make progress in this important area.
"The publication of the CIMA Toolkit provides a strong base from which this research can be developed."
Professor Graham Kemp, Institute of Ageing and Chronic Disease, University of Liverpool, added: "This toolkit is the first systematic effort to evaluate methods for assessing the effects of ageing in the bone, muscle, tendons and cartilage, and to make recommendations for practical use."

More information: Graham J Kemp et al. Developing a toolkit for the assessment and monitoring of musculoskeletal ageing, Age and Ageing (2018). DOI: 10.1093/ageing/afy143


Provided by Newcastle University