Massive study confirms that loneliness increases risk of dementia
Angelina Sutin, associate professor in the College of Medicine’s Department of Behavioral Sciences. Credit: Florida State UniversityA new Florida State University College of Medicine study involving data from 12,000 participants collected over 10 years confirms the heavy toll that loneliness can take on your health: It increases your risk of dementia by 40 percent.
31 oct 2018--The risk is across the board, regardless of gender, race, ethnicity or education—or whether you have regular social contact with friends and family.
The study was published in the Journal of Gerontology: Psychological Sciences.
"We are not the first people to show that loneliness is associated with increased risk of dementia," said Angelina Sutin, the principal investigator on the study. "But this is by far the largest sample yet, with a long follow-up. And the population was more diverse."
The Sutin team's paper made use of the federally funded Health and Retirement Study, a longitudinal look at Americans 50 and older and their spouses. Participants reported on their loneliness and were also administered a cognitive battery every two years, up to 10 years after their reports of loneliness. During this time, 1,104 people developed dementia.
Participants who reported greater feelings of loneliness were more likely to develop dementia over the next 10 years. Individuals who feel lonely are likely to have several risk factors for dementia, including diabetes, hypertension and depression, and are less likely to be physically active and more likely to smoke. Even after adjusting for those shared risks, loneliness still predicted dementia.
"Lonely" can have many interpretations, said Sutin, an associate professor in the college's Department of Behavioral Sciences and Social Medicine. Her team's study referred to "the subjective experience of social isolation," which is separate from actual social isolation.
"It's a feeling that you do not fit in or do not belong with the people around you," Sutin said. "You can have somebody who lives alone, who doesn't have very much contact with people, but has enough—and that fills their internal need for socializing. So even though objectively you might think that person is socially isolated, they don't feel lonely. The flip side is that you can be around a lot of people and be socially engaged and interactive and still feel like you don't belong. From the outside it looks like you have great social engagement, but the subjective feeling is that you're not part of the group."
Sutin urges against blaming the victim for feelings of loneliness.
"People might say, 'You're lonely. Go make a friend,'" she said. "But it's not that easy."
There are significant long-term consequences to having these kinds of feelings. It's not the individual's fault or choice to be lonely.
"I think this study adds to the literature highlighting the importance of psychological factors and how individuals subjectively interpret their own situation," Sutin said. "That's equally important and separate from what we objectively measure. It also lends credibility to the idea of asking people how they feel about things—in this case, how they feel about their social interactions."
There are a number of ways that loneliness may put one at risk for dementia. One way may be physiological, such as through higher inflammation—the body's natural response to infection that can be harmful when it lasts a long time. A second way may be through behavior. People may cope with loneliness through behaviors that can damage the brain, such as heavy drinking or being sedentary. A third way is through lack of meaningful social interaction. Keeping the mind engaged in a meaningful way can promote cognitive health that provides the motivation and structure to help maintain cognitive functioning.
In the end, Sutin said, loneliness is a signal that your social needs are not being met. And there are ways to counter that.
"Loneliness is a modifiable risk factor," she said. "Most people might describe periods where they felt lonely and then periods where they didn't feel lonely. So just because you feel lonely now, you don't always have to feel this way."
More information: Angelina R Sutin et al. Loneliness and Risk of Dementia, The Journals of Gerontology: Series B (2018). DOI: 10.1093/geronb/gby112
Provided by Florida State University
Tuesday, October 30, 2018
New guidelines on best practices for videoconferencing-based telemental health
Credit: Mary Ann Liebert, Inc., publishersNew guidance is available from the American Psychiatric Association (APA) and the American Telemedicine Association (ATA) to assist in the development and delivery of effective and safe interactive videoconferencing-based mental health services. This kind of telemental health service can increase access to quality healthcare, and has shown in some settings to be more effective than in-person treatment. These new best practices are published in Telemedicine and e-Health.
30 oct 2018--The article entitled "Best Practices in Videoconferencing-Based Telemental Health" was a team effort, coauthored by Jay Shore, MD, MPH, University of Colorado Anschutz Medical Campus (Aurora) and colleagues from University of California, Davis (Sacramento), The University of Louisville School of Medicine (KY), HealthLinkNow (Sacramento CA), The University of Iowa, Carver College of Medicine (Iowa City), Emory University School of Medicine (Atlanta, GA), Seattle Children's Hospital (WA), Portland Veterans Affairs Health Care System (OR), Orbit Health Telepsychiatry (Encino, CA), and Northern California Veterans Affairs Health Care System (Sacramento).
The new best practices are based on expert consensus, research evidence, available resources, and patient needs. They cover a wide range of topics including emergency situations, technical considerations, choice of location for the videoconference, and privacy, security, and HIPAA. The section on clinical considerations includes patient and setting selection, ethical considerations, and cultural issues. The guidance also covers special populations, such as children and adolescents, geriatric patients, and those individuals who work within correctional facilities, work with active military personnel or veterans, substance use disorder treatment, and those who work in inpatient or residential facilities.
"These guidelines are an attestation of the expertise this collection of subject matter experts, who have devoted their careers to enhancing healthcare through the integration of telemedicine and telehealth, have brought to the challenges of mental health," says Co-Editor-in-Chief Charles R. Doarn, MBA, Professor of Family and Community Medicine, University of Cincinnati, Ohio.
More information: Jay H. Shore et al, Best Practices in Videoconferencing-Based Telemental Health April 2018, Telemedicine and e-Health (2018). DOI: 10.1089/tmj.2018.0237
Provided by Mary Ann Liebert, Inc
Sunday, October 28, 2018
Novel combination therapy promotes wound healing
Mouse skin was burned and treated with either a standard burn treatment or new wound-healing therapy. After two weeks, cross sections of burned skin show control skin (top image) had clearly not healed, with no hair follicles, sebaceous glands or other higher order structures present in the burn area. Burns treated with therapeutic gel (bottom image) showed progressive healing and tissue regeneration, including new hair follicles. Credit: Sharp Lab/Albert Einstein College of MedicineBy incorporating a gene-suppressing drug into an over-the-counter gel, researchers at Albert Einstein College of Medicine and their colleagues cut healing time by half and significantly improved healing outcomes compared to control treatments. Results from the combination therapy, which was tested in mice, were published online today in Advances in Wound Care.
28 oct 2018--"Not only did wound healing occur more rapidly and completely, but actual regeneration occurred, with hair follicles and the skin's supportive collagen network restored in wounded skin—clinically important improvements that are unprecedented in wound care," says senior author David J. Sharp, Ph.D, professor of physiology & biophysics at Einstein. "We foresee this therapy having broad application for all sorts of wounds, from playground cuts to battlefield injuries to chronic wounds."
Chronic wounds alone affect 6.5 million Americans and cost $25 billion in annual healthcare costs. Over the past several decades, few advances have been made in treating wounds of any type.
In 2015, Dr. Sharp and colleagues discovered that an enzyme called fidgetin-like 2 (FL2) puts the brakes on skin cells as they migrate towards wounds to heal them. He reasoned that reducing FL2 levels might enable healing cells to reach their destination faster. So he and his colleagues developed small interfering RNA molecules (siRNAs) that specifically inhibit the gene that codes for FL2. When the siRNAs were encased in nanoparticles and sprayed on skin wounds in mice, the treated wounds healed faster than untreated wounds.
In the current study, Dr. Sharp enhanced the siRNAs' wound-healing potential by combining them with PluroGel—a protective gel that keeps wounds moist and has antimicrobial properties when applied to bandages and other wound dressings. In addition, Dr. Sharp incorporated the siRNAs into microparticles made of collagen, a naturally occurring protein that readily releases its siRNA "cargo" after coming in contact with the skin.
The FL2-siRNA/PluroGel combination was applied to mice with either skin excisions or burns. For comparison, studies involving both types of skin injuries also used two control groups: mice treated with PluroGel alone and mice treated with PluroGel plus siRNA that did not target the gene for FL2. Wounds were treated on the day of the skin excision or burn and again two, four and six days later. For 14 days following the injuries, wounds were assessed by investigators who were "blinded" as to the treatment the mice received.
On the fourth day after mice treated for excision wounds, the open wound areas of mice in the two control groups were nearly twice as large as the wound areas in mice treated with the FL2-siRNA/PluroGel combination. Several mice treated with the combination therapy also had hair follicles present in the wound zone, while no such structures were seen in the control mice.
For mice treated for burns: by 14-days post injury, the wounds of mice in both control groups were more than one-third larger than in the mice treated with the FL2-siRNA/PluroGel combination. In addition, the burn wounds of all mice treated with the FL2-siRNA/PluroGel combination had closed completely by day 14; by comparison, 25 percent and 30 percent of treated wounds in the PluroGel and PluroGel/nontarget siRNA control groups, respectively, remained unhealed at that time.
"These results show that FL2-siRNA plus PluroGel is a highly promising wound treatment," says Adam Kramer, a Ph.D. candidate in Dr. Sharp's lab and co-lead author. "By lowering FL2 levels in skin cells, the FL2-siRNA helps cells reach wound sites much faster than they ordinarily would—essential for minimizing scarring and preventing wounds from becoming chronic. And by hydrating wounds and inhibiting microbes, PluroGel offers important additional wound-healing benefits."
Dr. Sharp and Brian O'Rourke, Ph.D., the paper's co-lead author and chief scientist at MicroCures, Inc., have achieved similar success in treating skin wounds in pigs—animals with skin that closely resembles human skin. Dr. Sharp's team plans to seek permission from the U.S. Food and Drug Administration to test their wound-healing therapy in clinical trials.
The paper is titled "Fidgetin-like 2 siRNA Enhances the Wound Healing Capability of a Surfactant Polymer Dressing."
Provided by Albert Einstein College of Medicine
New guidance recommends minimal oxygen use for most people in hospital
Routine oxygen therapy is not recommended for hospital patients because the benefit is uncertain and there are clear harms, say a panel of international experts in The BMJ today.
28 oct 2018--Their advice is based on new evidence that too much oxygen increases risk of death and is part of The BMJ's 'Rapid Recommendations' initiative—to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.
Oxygen therapy is widely used in hospitals and it is usual care to give extra oxygen to sick patients, often with relatively little attention paid to when to start and stop it. Guidelines also vary in their advice on when to give oxygen and how much to give.
Oxygen levels are measured by blood saturation (SpO2) - the amount of hemoglobin in the bloodstream that is saturated with oxygen to carry it through the body. Normal oxygen saturation is usually between 96% and 98%, but sick patients are often kept close to 100%.
However, a recent evidence review published in The Lancet found that giving extra oxygen to hospital patients with normal oxygen levels increases mortality. Its authors concluded that oxygen should be given conservatively, but they did not make specific recommendations on how to do it.
So an international panel—made up of specialist doctors, a nurse, a surgeon, and patients—met to discuss this latest evidence and formulate a recommendation.
Using the GRADE approach (a system used to assess the quality of evidence), they make a strong recommendation to stop oxygen therapy in patients with a saturation of 96% or higher.
For patients who have had a heart attack or stroke, they suggest not starting oxygen therapy when levels are between 90% and 92% saturation, and they strongly recommend not starting oxygen therapy when levels are at or above 93% saturation.
There was not enough evidence to say exactly when oxygen should be started for many other medical conditions such as infections.
For most patients, they say a target of 90-94% saturation seems reasonable and is low enough to avoid harm. In all cases, they advise using the minimum amount of oxygen necessary.
The authors point out that while their recommendations apply to most patients, they do not apply to surgical patients, babies, or patients with a few other uncommon conditions. And they say their recommendations may be altered as new evidence emerges.
Credit: University of MelbourneTwo studies from a landmark 20-year Melbourne research project have shed more light on how the brain ages and what can affect the process. The results have led experts to encourage women to watch their cholesterol and blood pressure.
27 oct 2018--Two studies from a landmark 20-year Melbourne research project have shed more light on how the brain ages and what can affect the process. The results have led experts to encourage women to watch their cholesterol and blood pressure.
Both studies were published in the journal Brain Imaging and Behaviour. In the first, a person's brain volume (size) at the age of 60 predicted their memory at 70.
In this study, an MRI scan at 60 could identify those at risk of memory decline at 70, and this is supported by other international research that has identified a link between brain shrinkage and cognitive decline.
The study involved the University of Melbourne's radiology and medicine departments, Australian Catholic University's Institute for Health and Ageing and Austin Health's Aged Care Services Department.
Researchers used subjects from the population-based Women's Healthy Ageing Project, which has run at the University of Melbourne since the early 1990s. It is the first time Australian women's brain pathology has been measured alongside cognition over decades.
Sixty women had their first 3T MRI scan around the age of 59, of which 40 completed follow-up cognitive assessments over a decade. Of the 40, 23 had follow-up MRI scans.
The follow-up scans indicated that in addition to the expected age-related atrophy rate (breakdown of brain tissue), the study participants who had smaller regions of grey matter 10 years earlier were more likely to have increased rates of cognitive decline.
"This study suggests useful neuroimaging biomarkers for the prediction of cognitive decline in healthy older women," the researchers found.
The second study examined 135 Women's Healthy Ageing Project participants and found high cardiovascular risk in midlife to late life meant a higher likelihood of vascular brain damage aged over 60.
High vascular risk includes high cholesterol, low levels of the 'good cholesterol' HDL, high blood pressure, diabetes and smoking. These risks generally worsen with age.
Researchers looked at Cerebral White Matter Hyperintensity (WMH) lesions that have been identified as cerebrovascular (brain blood vessel disease) markers and are associated with increased cognitive impairment risk.
They investigated the relationship between midlife cardiovascular risk factors and late life WMH volumes two decades later, and their association with cognitive performance.
"These findings suggest intervention strategies that target major cardiovascular risk factors at midlife might be effective in reducing the development of WMH lesions and thus late life cognitive decline," the researchers found.
Study co-author Professor Cassandra Szoeke said this was the first time more than 20 years of information about Australian women had been used in this way. She said researchers looked inside the live brain using imaging data to see what impact different factors had over that time on actual brain pathology changes as well as brain function.
"In this study we showed that those women with WMH had worse cognition – the type that helps you plan, organise and get tasks done," Professor Szoeke said.
"To help reduce these risks, people should take care of their good cholesterol and blood pressure with healthy diets, activity and annual health checks."
More information: Rowa Aljondi et al. A decade of changes in brain volume and cognition, Brain Imaging and Behavior (2018). DOI: 10.1007/s11682-018-9887-z
Rowa Aljondi et al. The effect of midlife cardiovascular risk factors on white matter hyperintensity volume and cognition two decades later in normal ageing women, Brain Imaging and Behavior (2018). DOI: 10.1007/s11682-018-9970-5
Provided by University of Melbourne
Friday, October 26, 2018
Systematic review of clinical studies suggests newer shingles vaccine far more effective
Dr. Andrea Tricco, a scientist with St. Michael's Hospital's Li Ka Shing Knowledge Institute and associate professor at the University of Toronto's Dalla Lana School of Public Health. Credit: St. Michael's HospitalA systematic review of clinical studies involving more than two million patients aged 50 years and older suggests a recently released shingles vaccine was far more successful in preventing the painful condition compared to the older vaccine—but also carried greater risk of side-effects. The research was published Thursday by The BMJ.
26 oct 2018--The adjuvant, recombinant subunit vaccine—sold under the brand name Shingrix—was found to be 85 per cent more effective in reducing cases of shingles, also known as herpes zoster, compared to Zostavax, which is a live-attenuated shingles vaccine available for use in Canada since 2006.
The use of Shingrix did lead to 30 per cent more injection-site adverse events, such as redness or swelling. No statistically significant differences were identified between the two vaccines for serious adverse events and deaths.
"There haven't been any head-to-head studies comparing the two shingles vaccines, so the results from our systematic review can be employed by policy-makers, clinicians, and patients to make their decisions on the use of these vaccines," said Dr. Andrea Tricco, a scientist with St. Michael's Hospital's Li Ka Shing Knowledge Institute and associate professor at the University of Toronto's Dalla Lana School of Public Health.
"If you have to choose between two vaccines and you have evidence showing that one of the vaccines is a little more effective, or a little safer than the other, then you might be more willing to take the safer and more effective one."
Shingles is a viral infection that occurs through reactivation of latent varicella zoster virus, which causes chickenpox.
About one in four people will develop shingles in their lifetime and about two-thirds get it after the age of 50.
More information:BMJ (2018). DOI: 10.1136/bmj.k4029 , http://bmj.com/cgi/content/full/bmj.k4029?ijkey=uacOnzgVx9acQsC&keytype=ref
Provided by St. Michael's Hospital
Thursday, October 25, 2018
Heart patients advised to move around every 20 minutes to prolong life
Credit: CC0 Public DomainHeart patients are being advised to move around every 20 minutes in a bid to prolong life following a study presented at the Canadian Cardiovascular Congress (CCC) 2018. CCC 2018 is being held 20 to 23 October in Toronto, Canada. Visiting experts from the European Society of Cardiology (ESC) will participate in joint scientific sessions with the Canadian Cardiovascular Society (CCS) as part of the ESC Global Activities programme.
25 oct 2018--Heart patients spend most of their waking hours sitting, lying down, and watching television Previous research has shown that being sedentary for long periods could shorten life but taking breaks to move around may counteract the risk, particularly if it means burning more than 770 kcal a day. This study investigated how many breaks, and for what duration, are needed to expend 770 kcal.
"Our study shows that heart patients should interrupt sedentary time every 20 minutes with a 7 minute bout of light physical activity," said study author Dr. Ailar Ramadi, postdoctoral fellow, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada. "Simple activities such as standing up and walking at a casual pace will expend more than 770 kcal in a day if done with this frequency and duration."
The study enrolled 132 patients with coronary artery disease. The average age was 63 years and 77% were male. Participants wore an armband activity monitor for an average of 22 hours a day for five days. The activity monitor recorded the amount of energy spent during breaks from inactivity, the amount of inactive time, and the number and duration of breaks during each sedentary hour.
Dr. Ramadi said: "There is a lot of evidence now that sitting for long periods is bad for health. Our study suggests that during each hour of sitting time, heart patients should take three breaks which add up to 21 minutes of light physical activity. This will expend 770 kcal a day, an amount associated with a lower risk of premature death."
Regarding limitations of the research, Professor Joep Perk, ESC Prevention Spokesperson, noted that this was a small, observational study with no control group. "A randomised controlled trial is needed before this can become a firm recommendation," he said. "Nevertheless, regular physical activity is key to achieving a healthy life, whether you are a cardiac patient or not."
Dr. Michelle M. Graham, Scientific Programme Committee Chair of CCC 2018, said: "We are delighted to have innovative studies such as that by Ramadi and colleagues being presented at CCC. Their novel work has very practical implications, not only for patients with cardiovascular disease, but for improving prevention by altering how people work in sedentary environments."
Professor Jeroen Bax, Past President of the ESC and course director of the ESC programme at CCC 2018, said: "Sedentary lifestyles affect more than half of the world's population. ESC guidelines on the prevention of cardiovascular disease recommend a minimum of 150 minutes of moderate activity or 75 minutes of vigorous activity per week. Any activity is better than none and more activity is better than some."
More information: Karjalainen JJ, Kiviniemi AM, Hautala AJ, et al. Effects of exercise prescription on daily physical activity and maximal exercise capacity in coronary artery disease patients with and without type 2 diabetes. Clin Physiol Funct Imaging. 2012;32:445–454.
Ramadi A, Stickland MK, Rodgers WM, et al. Impact of supervised exercise rehabilitation on daily physical activity of cardiopulmonary patients. Heart Lung. 2015;44:9–14.
Healy GN, Matthews CE, Dunstan DW, et al. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003-06. Eur Heart J 2011;32:590–597.
Healy GN, Dunstan DW, Salmon J, et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care.2008;31:661–666.
Dunstan DW, Kingwell BA, Larsen R, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012;35:976–983.
Judice PB, Silva AM, Sardinha LB. Sedentary bout durations are associated with abdominal obesity in older adults. Journal Nutr Health Aging. 2015;19:798–804.
Manini TM, Everhart JE, Patel KV, et al. Daily activity energy expenditure and mortality among older adults. JAMA. 2006;296:171–179.
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37:2315–2381.
Provided by European Society of Cardiology
Tuesday, October 23, 2018
Blood type, Pioppi, gluten-free and Mediterranean – which popular diets are fads?
People with type B blood can still eat chicken and corn. Credit: ShutterstockEach year, new weight loss diets appear that promise to reveal the ultimate secret of success – if only you buy the book, pills or potions. Fad diets might achieve short-term results but they are difficult to sustain in the long term.
23 oct 2018--They often eliminate entire food groups, which means they're unlikely to provide adequate amounts of key nutrients that are essential for our health and well-being.
Fad diets and rapid weight loss can also increase the risk of serious health problems such as gall bladder disease and gallstones.
contradict advice from qualified health professionals?
promote or ban specific foods or whole food groups?
promote a one-size-fits-all strategy?
promise quick, dramatic or miraculous results with minimal effort?
focus only on short-term results?
promote "miracle" pills, supplements or products touted to "burn fat"?
make claims based on personal testimonials or one random study?
If the answer to two or more of these questions is "yes," it's probably a fad.
So, how do today's popular diets measure up? Here we road-test the blood type, Pioppi, gluten-free, and Mediterranean diets.
Blood type diet
The blood type diet has been around for some time. It's based on the idea that your blood type is a key factor in predicting your body weight, nutritional requirements, risk of chronic disease, and overall well-being.
According to this diet, those with blood type A should follow what resembles a vegetarian diet. Type Os are supposed to limit carbohydrates and increase their protein intake. Type Bs should avoid chicken, corn, wheat, lentils, tomatoes, peanuts, and sesame seeds; while type ABs should avoid caffeine, alcohol, and cured meats.
But a comprehensive review of 16 studies found there is no scientific literature to back up this list of dos and don'ts. Verdict: Fad diet. It's highly restrictive and may increase the risk of nutrient deficiencies.
Pioppi diet
The Pioppi diet is promoted as resembling the food patterns of people living in the small village of Pioppi, southern Italy, who live long, healthy lives.
The traditional eating habits of the people of Pioppi are in line with the Mediterranean diet, and include lots of vegetables, legumes, grains, fruit, fish, olive oil and nuts, as well as modest amounts of cheese, yoghurt, coffee and red wine, small amounts of meat, and very little sugar or highly processed foods.
But the 21-day Pioppi plan is very different to this. It forbids bread and other grains typically consumed in the Mediterranean. It promotes foods not usually consumed by the people of Pioppi, such as coconut fat.
There’s no need to forgo whole grains unless you have coeliac disease. Credit: Shutterstock/wideonetPeople who follow the Pioppi diet might lose weight because they're consuming less energy, having eliminated entire food groups. But consuming saturated fats (polyunsaturated fat) and cutting out grains goes against the current evidence for good heart health. Verdict: Fad diet.
Gluten-free diet
Gluten is a protein naturally found in wheat, rye and barley, plus some food additives.
People with diagnosed coeliac disease must eliminate gluten from their diet to avoid serious damage to their gut, but many people choose to avoid gluten as a weight-loss strategy.
Eliminating gluten does not automatically reduce your kilojoule intake or induce weight loss. But some gluten-containing foods such as pizza, bread, pasta and cakes are energy-dense, so removing them completely will reduce your total energy intake, which may lead to weight loss.
Gluten-free alternatives can be just as high in kilojoules as the gluten containing version, and sometimes can be higher in kilojoules.
Removing gluten-containing without considering what foods will replace them can also reduce your intake of important nutrients such as fibre, folic acid and other B vitamins.
Recent studies discourage unnecessary gluten-free diets due to the reduced intake of beneficial whole grains, which are key to a healthy diet and are associated with lower heart disease and cancer risk. Verdict: Fad diet when used for weight loss in people who don't have coeliac disease.
Mediterranean diet
The Mediterranean diet has a strong focus on intake of core foods in addition to olive oil, coffee and wine, and low intake of meat, sugar and highly processed foods.
While the main focus of the Mediterranean diet is not weight loss, when combined with a kilojoule restriction, it can be effective for weight loss.
Among studies that did not prescribe an energy restriction, following the Mediterranean diet was not associated with gaining weight. The Mediterranean diet has also been shown to improve components of metabolic syndrome, even without weight loss. Verdict: The Mediterranean diet isn't a fad but it doesn't guarantee weight loss unless you also restrict your total kilojoule intake.
The best approach to weight loss is to follow a healthy, balanced eating plan and to be physically active. Try to make small changes to your usual eating habits that you can live with.
If you need help or to check whether you are meeting your nutrient needs, consult your GP or a dietitian.
If you would like to learn more about weight loss, you can enrol in our free online course The Science of Weight Loss – Dispelling Diet Myths.
We're doing drug trials wrong – here's how to fix it
Credit: Jason Salmon/Shutterstock.comBy the age of 65, at least half of us will suffer from two or more long-term diseases. And the chance of having multi-morbidity, as it is known, increases with age. Only 9% of people with coronary heart disease have no other condition. The other 91% have various combinations of hypertension (high blood pressure), heart failure, stroke, diabetes, chronic obstructive pulmonary disease, depression, dementia, chronic kidney disease and so on.
22 oct 2018--And it's not just the elderly who suffer from several long-term conditions – young people do too. In poor areas, the occurrence of two or more diseases in the young can occur ten to 15 years earlier compared with those in wealthier regions.
People with multi-morbidities have to take a range of drugs: one or more for each disease. But whether drugs developed to treat single diseases are effective in patients with multi-morbidity is a matter of debate. In some patients, their body attacks the drug as though it were a pathogen. In other patients, the treatment causes [side effects] that are worse than the disease being treated, including an increased risk of infection.
A new class of drugs, so-called disease-modifying anti-rheumatic drugs, are being used to treat rheumatoid arthritis. These drugs treat the underlying disease rather than just ease the symptoms. This is a major advance, but at least 40% of the people taking them won't see an improvement in their symptoms. This is probably because most patients have another disease, which may stop the drug working properly.
The root of the problem in developing all new medicines lies in the tendency to research, diagnose and treat diseases as a single entity. The single disease approach goes right back to the way biology is taught at school and university.
Multi-morbidity is the norm
A growing number of medical researchers think we should learn from disease combinations. This may seem like an impossible task, given the number of possible combinations, but some combinations are very common, such as heart disease and high blood pressure. And not taking multi-morbidities into account affects every stage of introducing a new drug, from its discovery to testing it in patients.
The decision to develop a new drug is based on the careful analysis of thousands of patient groups. But these groups are not divided based on the presence of other existing diseases. By not grouping patients based on pre-existing conditions, many relevant new drugs specific for particular disease combinations may be missed.
Once new drugs have been developed, they are first tested in animal models of a particular disease or in tissue culture, containing an individual cell type. There is no guarantee that this type of test is relevant for human disease, and there is also no guarantee that relevant drugs won't be missed that might have worked in more complex disease combinations.
Multi-morbidities are also not taken into account when new drugs are tested in patients. Remarkably, the patients who have the most severe disease combinations, and are the most problematic to treat, are mostly excluded from clinical trials. In coronary heart disease, for example, on average, 69% of patients with multi-mobidities are excluded from clinical trials because clinicians are wary of making their disease even worse. Yet these are the patients that most need the treatment. Also, how the drug works may differ in patients with one disease compared with patients with more than one disease.
The situation is even worse for dementia patients where 95% have other diseases, yet in 86% of trials, patients with other conditions are excluded. Instead, recruitment for clinical trials picks those patients who are potentially less affected by the disease in question, as they do not have any of the commonly associated multi-morbidities, which could also mean they are in a younger age group that responds differently to the drug.
Appetite for a new approach
Is it any wonder that little progress has been made in the treatment of the most debilitating conditions affecting the human race? New targets for drugs should not be chosen irrespective of what else is wrong with the patient. Rather patients with a particular disease should be sub-categorised and studied based on the other diseases they have, and treatment specifically tested and tailored to their needs.
Also, science funding bodies and the pharmaceutical industry should drive the development of new animal and tissue culture models in which to test new drugs that encompass patient diseasecomplexity. There is an appetite among researchers for this approach, but the momentum needs to increase.
Credit: DECIFor the elderly with cognitive impairment, living alone can prove detrimental to their health. Assistance services can provide appropriate discreet support for independent living and a high life quality.
21 oct 2018--The DECI project has successfully defined an innovative environment for independent living of the elderly with cognitive impairment. "The project revolved around a business model to supply assistance services in-house with a remote-based approach, allowing independent living for elderly people affected by mild cognitive impairment (MCI) and mild dementia (MD)," outlines project coordinator Prof. Paolo Locatelli.
Including an up-to-date modular, flexible and scalable organisational model, and the support of an IT platform based on innovative and easy-to-replicate technologies, the system enables a high level of independence with good quality of life.
Three solutions for supported independence at home
The technological solution includes an integrated care platform and a web-based interface. This enables professionals to share information about the patients as well as patients-to-professional communication (patients interact with the case manager and gain access to educational material). A smartwatch activity monitor records the number of steps and intensity of patient physical activity. There is also a coaching app where patients follow a computer-based cognitive simulation and physical activity programme.
The service and organisational model includes remote monitoring of patients' physical activities for adherence to cognitive and physical exercises and continuous communication among clinicians and patients/caregivers. The case manager follows the patient during his/her overall care path and accesses the DECI system. In Sweden, there is an additional innovation with a DECI mobile and multidisciplinary team that visit patients at home.
Support for an EU country or region in defining its own business model according to its specific needs is available within the general business model with the coherence matrix. The tool also underlines the common needs and technological functionalities among the different areas.
Four pilot sites and three groups for a wide range of test circumstances
Four very different sites were selected in Spain, Italy, Sweden and Israel. The goal was to provide individual, local instances for design and application of the business and organisational models, ICT tools and evaluate their impacts.
More than 500 patients took part in the trial for 6 months. At each site, a control group received care according to local guidelines and routines (standard care). There were two different intervention groups – one that used the organisational approach and the DECI medical staff. The other (complete) accessed both the service and organisational model, and the overall technological solution (including the activity monitoring system and the coaching and training system).
Significant results
Patients who received the full intervention presented more stability in basic activities of daily living (BADL), as demonstrated by the statistically significant difference of the BADL scales. Moreover, in the two intervention groups, a reduction in caregiver burden was observed, in particular in the Spanish pilot site.
Testament to the success of the system, the enrolled patients and the involved professionals expressed their willingness to use DECI in the future.
Delays in patients' enrolment translated into hold-ups in the implementation of the DECI solution in the pilot sites. "However, to guarantee a full six months intervention for each patient involved in the project, we at DECI decided to go on with the experimentation after the project end until August 2018," explains Prof. Locatelli.
The DECI legacy
After completion of work at the pilot sites, full analysis and data will be published in peer-reviewed journals. Significantly, the DECI organisational models in Italy and in Sweden are already part of the offered home care services. The Fondazione Don Gnocchi (Italy) is going to integrate the DECI functionalities in the ICT tools of their institute to support the new service and organisational model.
The project coordinator sums up the success of the DECI initiative: "Each country has a different way to treat MCI and MD patients. This fact was crucial to the strength of the methodological approach of the project and a critical point in the application of the DECI models and services. For this reason the change in management processes in applying the DECI models and tools was a critical success factor in the project."
Provided by CORDIS
Saturday, October 20, 2018
Nutrition has a greater impact on bone strength than exercise
Credit: CC0 Public DomainOne question that scientists and fitness experts alike would love to answer is whether exercise or nutrition has a bigger positive impact on bone strength.
20 oct 2018--University of Michigan researchers looked at mineral supplementation and exercise in mice, and found surprising results—nutrition has a greater impact on bone mass and strength than exercise. Further, even after the exercise training stopped, the mice retained bone strength gains as long as they ate a mineral-supplemented diet.
"The longer-term mineral-supplemented diet leads to not only increases in bone mass and strength, but the ability to maintain those increases even after detraining," said David Kohn, a U-M professor in the schools of dentistry and engineering. "This was done in mice, but if you think about the progression to humans, diet is easier for someone to carry on as they get older and stop exercising, rather than the continuation of exercise itself."
The second important finding is that the diet alone has beneficial effects on bone, even without exercising. This surprised Kohn, who expected exercise with a normal diet to fuel greater gains in bone strength, but that wasn't the case.
"The data suggests the long-term consumption of the mineral-supplemented diet could be beneficial in preventing the loss of bone and strength with age, even if you don't do exercise training," he said.
Combining the two amplifies the effect.
Most other studies look at effects of increasing dietary calcium, Kohn said. The U-M study increased calcium and phosphorous, and found benefits to increasing both.
This isn't to suggest that people run out and buy calcium and phosphorus supplements, Kohn said. The findings don't translate directly from mice to humans, but they do give researchers a conceptual place to start.
It's known that humans achieve peak bone mass in their early 20s, and after that it declines. The question becomes how to maximize the amount of bone when young, so that when declines do begin, people start from a better position, Kohn said.
In addition to testing bone mass and strength, Kohn and colleagues performed a full battery of mechanical assessments on the bone, which is important because the amount of bone doesn't always scale with or predict the mechanical quality of the tissue.
They tested the mice after eight weeks of training and supplemented diet or normal diet, and then after eight weeks of detraining.
The study was published online in PLOS ONE.
Provided by University of Michigan
Friday, October 19, 2018
Does herpes cause Alzheimer's?
What causes Alzheimer's disease? The answer could be right under our noses, says leading expert Professor Ruth Itzhaki. Her latest paper presents a lifetime of research evidence that the herpes virus responsible for cold sores can also cause Alzheimer's—and new data which show antiviral drugs drastically reduce risk of senile dementia in patients with severe herpes infections. The review in Frontiers in Ageing Neuroscience raises the tantalizing prospect of a simple, effective preventive treatment for one of humanity's costliest disorders.
The HSV1 theory of Alzheimer's disease
19 oct 2018--Herpes viruses are the dreaded 'gift that keeps on giving'. They remain lifelong in our neurons and immune cells, reactivating and resurfacing in characteristic blisters when we're run down by stress or illness. Most people are infected by Herpes Simplex Virus 1 (HSV1) by the time they reach old age.
But what happens to infected neurons in our brain during this reactivation?
"HSV1 could account for 50% or more of Alzheimer's disease cases," says Professor Itzhaki, who has spent over 25 years at the University of Manchester investigating a potential link.
HSV1 is better known as the cause of cold sores. Itzhaki has shown previously that cold sores occur more frequently in carriers of APOE-ε4—a gene variant that confers increased risk of Alzheimer's.
"Our theory is that in APOE-ε4 carriers, reactivation is more frequent or more harmful in HSV1-infected brain cells, which as a result accumulate damage that culminates in development of Alzheimer's."
Proving the theory
Few countries collect the population data required to test this theory—for example, to find out whether antiviral treatments reduce dementia risk.
In Taiwan however, researchers have done just that. There, 99.9% of the population is enrolled in a National Health Insurance Research Database, which is being extensively mined for information on microbial infections and disease. In 2017-2018 three studies were published describing Taiwanese data on the development of senile dementia—of which Alzheimer's is the main cause—and the treatment of patients with marked overt signs of infection with HSV or varicella zoster virus (VZV, the chickenpox virus).
"The striking results include evidence that the risk of senile dementia is much greater in those who are infected with HSV, and that anti-herpes antiviral treatment causes a dramatic decrease in number of those subjects severely affected by HSV1 who later develop dementia."
Previous findings from Itzhaki's own research group provide a mechanistic link which supports these epidemiological findings. They found that HSV1 causes protein deposits characteristic of Alzheimer's: 'plaques' between neurons, and 'tangles' inside of them.
"Viral DNA is located very specifically within plaques in postmortem brain tissue from Alzheimer's sufferers. The main proteins of both plaques and tangles accumulate also in HSV1-infected cell cultures—and antiviral drugs can prevent this."
Towards a cure
"It should be stressed that the results of these Taiwanese studies apply only to severe HSV1 (or VZV) infections, which are rare," admits Itzhaki. "Ideally, we would study dementia rates amongst people who have suffered mild HSV1 infection, including herpes labialis (cold sores) or mild genital herpes, but these are far less likely to be documented."
Although further work is needed to confirm and define a causal link between HSV1 infection and Alzheimer's, Itzhaki is enthusiastic about the treatment prospects.
"Considering that over 150 publications strongly support an HSV1 role in Alzheimer's, these Taiwan findings greatly justify usage of antiherpes antivirals—which are safe and well-tolerated—to treat Alzheimer's disease.
"They also incentivize development of an HSV1 vaccine, which would likely be the most effective treatment."
This echoes the growing use worldwide of human papillomavirus (HPV) vaccination to prevent cervical cancer—another virus-disease link which emerged in a similar process of research.
More information: Ruth F. Itzhaki, Corroboration of a Major Role for Herpes Simplex Virus Type 1 in Alzheimer's Disease, Frontiers in Aging Neuroscience (2018). DOI: 10.3389/fnagi.2018.00324
Provided by Frontiers
Thursday, October 18, 2018
How healthy will we be in 2040?
Credit: CC0 Public DomainA new scientific study of forecasts and alternative scenarios for life expectancy and major causes of death in 2040 shows all countries are likely to experience at least a slight increase in lifespans. In contrast, one scenario finds nearly half of all nations could face lower life expectancies.
18 oct 2018--The rankings of nations' life expectancies offer new insights into their health status.
For example, China, with an average life expectancy of 76.3 years in 2016, ranked 68th among 195 nations. However, if recent health trends continue it could rise to a rank of 39th in 2040 with an average life expectancy of 81.9 years, an increase of 5.6 years.
In contrast, the United States in 2016 ranked 43rd with an average lifespan of 78.7 years. In 2040, life expectancy is forecast to increase only 1.1 years to 79.8, but dropping in rank to 64th. By comparison, the United Kingdom had a lifespan of 80.8 years in 2016 and is expected to increase to 83.3, raising its rank from 26th to 23rd in 2040.
In addition, the study, published today in the international medical journal The Lancet, projects a significant increase in deaths from non-communicable diseases (NCDs), including diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and lung cancer, as well as worsening health outcomes linked to obesity.
However, there is "great potential to alter the downward trajectory of health" by addressing key risk factors, levels of education, and per capita income, authors say.
"The future of the world's health is not pre-ordained, and there is a wide range of plausible trajectories," said Dr. Kyle Foreman, Director of Data Science at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and lead author on the study. "But whether we see significant progress or stagnation depends on how well or poorly health systems address key health drivers."
The top five health drivers that explain most of the future trajectory for premature mortality are high blood pressure, high body mass index, high blood sugar, tobacco use, and alcohol use, Foreman said. Air pollution ranked sixth.
In addition to China, several other nations are expected in 2040 to increase substantially in their rankings in terms of life expectancy, including:
Syria is expected to rise most in rank globally—from 137th in 2016 to 80th in 2040 -likely, according to the authors, due to a conservative model for conflict;
Nigeria from 157th to 123rd; and
Indonesia from 117th to 100th
In contrast, Palestine is expected to drop the most in its life expectancy ranking—from 114th in 2016 to 152nd in 2040. Moreover, several high-income nations are forecast to drop substantially in their rankings, including:
United States, dropping the most for high-income countries, from 43rd in 2016 to 64th in 2040;
Canada from 17th to 27th ;
Norway from 12th to 20th ;
Taiwan (Province of China) from 35th to 42nd ;
Belgium from 21st to 28th ;
Netherlands from 15th to 21st ;
The rankings also find that Spain is expected to place first in the world in 2040 (average lifespan of 85.8 years), a rise from fourth in 2016 (average lifespan of 82.9 years). Japan, ranked first in 2016 (average lifespan 83.7 years), will drop to second place in 2040 (average lifespan 85.7 years).
Rounding out the top 10 for 2040 are:
Singapore (average lifespan 85.4 years) ranked third, as compared to 83.3 years in 2016 and ranking also of third
Switzerland (average lifespan 85.2 years), as compared to 83.3 years in 2016 and ranking of second
Portugal (average lifespan 84.5 years), as compared to 81.0 years in 2016 and ranking of 23rd
Italy (average lifespan 84.5 years), as compared to 82.3 years in 2016 and ranking of seventh
Israel (average lifespan 84.4 years), as compared to 82.1 years in 2016 and ranking of 13th
France (average lifespan 84.3 years), as compared to 82.3 years in 2016 and ranking also of eighth
Luxembourg (average lifespan 84.1 years) as compared to 82.2 years in 2016 and ranking of 10th
Australia (average lifespan 84.1 years), as compared to 82.5 years in 2016 and ranking of fifth.
Among those top 10 nations, even their 'worse' scenarios in 2040 remain above 80 years. In stark contrast, the bottom-ranked nations, which include Lesotho, Swaziland, Central African Republic, and South Africa, the "better" and "worse scenarios" in 2040 range from a high of 75.3 years in South Africa ("better" scenario) to a low of 45.3 years in Lesotho ("worse scenario"), a 30-year difference.
"Inequalities will continue to be large," said IHME Director Dr. Christopher Murray. "The gap between the 'better' and 'worse' scenarios will narrow but will still be significant. In a substantial number of countries, too many people will continue earning relatively low incomes, remain poorly educated, and die prematurely. But nations could make faster progress by helping people tackle the major risks, especially smoking and poor diet."
In a "worse" scenario, life expectancy decreases in nearly half of all countries over the next generation. Specifically, 87 countries will experience a decline, and 57 will see an increase of one year or more. In contrast, in the "better" scenario, 158 countries will see life expectancy gains of at least five years, while 46 nations may see gains of 10 years or more.
The future shift toward increased premature mortality from NCDs and injuries and away from communicable diseases is apparent by the changing proportions of the top 10 causes of premature death.
In 2016, four of the top 10 causes of premature mortality were NCDs or injuries; in contrast, in 2040, that number increases to eight. The eight NCD or injury causes in the top ten in 2040 are expected to be ischemic heart disease, stroke, COPD, chronic kidney disease, Alzheimer's disease, diabetes, road injuries, and lung cancer.
The study is unprecedented in scope, Foreman said, and provides more robust statistical modeling and more comprehensive and detailed estimates of risk factors and diseases than previous forecasts from the United Nations and other population studies institutes.
IHME researchers leveraged data from the Global Burden of Disease (GBD) study to produce forecasts and alternative "better" and "worse" scenarios for life expectancy and mortality due to 250 causes of death for 195 countries and territories.
Researchers produced forecasts of independent drivers of health, including sociodemographic measurements of fertility, per capita income, and years of education, along with 79 independent drivers of health such as smoking, high body mass index, and lack of clean water and sanitation. They then used information on how each of these independent drivers affects specific causes of death to develop forecasts of mortality.
"The range of 'better' and 'worse' scenarios enables stakeholders to examine potential changes to improve health systems—locally, nationally, and globally," Murray said. "These scenarios offer new insights and help to frame health planning, especially regarding long lag periods between initial investments and their impacts, such as in the research and development of drugs."
In addition to calling attention to the growing importance of non-communicable diseases, the analysis exposes a substantial risk of HIV/AIDS mortality rebounding, which could undo recent life expectancy gains in several nations in sub-Saharan Africa.
Furthermore, while NCDs are projected to rise in many low-income countries, communicable, maternal, neonatal, and nutritional diseases are likely to remain among the leading causes of early death, thereby creating a "double burden" of disease.
The study is entitled "Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories."
The study is available at http://www.healthdata.org.
Accompanying collateral materials, including comprehensive listings and supporting data of all nations' rankings, are available under embargo at https://cloud.ihme.washington.edu/index.php/s/AkAfRKXFaKwLpFr
More information: Kyle J Foreman et al, Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories, The Lancet (2018). DOI: 10.1016/S0140-6736(18)31694-5
Provided by University of Washington
Lifespan 2040 ranking: US down, China up, Spain on top
Life expectancy in 2040 is set to rise at least a little in all nations but the rankings will change dramatically, with Spain taking the top spot while China and the United States trade places, researchers said Wednesday. With a projected average lifespan of nearly 85.8 years, Spain—formerly in 4th place—will dethrone Japan, which sits atop the rankings today with a lifespan of 83.7 years, and will drop to 2nd place in 2040.
18 oct 2018--In a shift that will be seen by some to reflect a superpower changing-of-the-guard, the world's two largest economies effectively swap positions compared to 2016: in 2040 the US drops from 43rd to 64th (79.8 years), while China rises from 68th to 39th (81.9 years).
The researchers found other nations set to lose ground in the race towards longevity include Canada (from 17th to 27th), Norway (12th to 20th), Australia (5th to 10th), Mexico (69th to 87th), Taiwan (35th to 42nd) and North Korea 125th to 153rd).
Moving up the ranking are Indonesia (117th to 100th), Nigeria (157th to 123rd), Portugal (23rd to 5th), Poland (48th to 34th), Turkey (40th to 26th), Saudi Arabia (61st to 43rd).
Assuming its interminable and devastating war comes to an end, Syria is set to rise from 137th in 2016 to 80th in 2040.
For the world as a whole, the researchers' study projected a five-year gain in lifespan, from 73.8 in 2016 to 77.7 in 2040.
They also forecast more optimistic and pessimistic scenarios, in which life expectancy increases to 81 years in the first case, and essentially stagnates in the second.
"The future of the world's health is not pre-ordained," said lead author Kyle Foreman, head of data science at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
"But whether we see signficant progress or stagnation depends on how well or poorly health systems address key health drivers."
Smoking and poor diet
The top five "drivers", or determinants, of average lifespans two decades from now are all related to so-called "lifestyle" diseases: high blood pressure, being overweight, high blood sugar, along with alcohol and tobacco use.
More generally, the world will see an acceleration of the shift already under way from communicable to non-communicable diseases, along with injuries, as the top cause of premature death.
Ranking a close sixth is air pollution, which scientists estimate claims a million lives a year in China alone.
After Spain and Japan, the countries with the greatest longevity in 2040 are projected to be Singapore (85.4 years), Switzerland (85.2 years), Portugal and Italy (84.5 years), Israel (84.4 years), France (84.2 years), Australia and Luxembourg (84.1 years).
The world's poorest countries in 2018 will continue to fair poorly when it comes to life expectancy, according to the study, published in The Lancet.
With the exception of Afghanistan, the bottom 30 countries in 2040—with projected lifespans between 57 and 69 years—are either in sub-Saharan Africa or small island states in the Pacific.
Lesotho, the Central African Republic, Zimbabwe, Somalia and Swaziland are in the rankings basement.
"Inequalities will continue to be large," said IHME Director Christopher Murray.
"In a substantial number of countries, too many people will continue earning relatively low incomes, remain poorly educated, and die prematurely.
"But nations could make faster progress by helping people tackle the major risks, especially smoking and poor diet," he added in a statement.
Tobacco consumption alone claims about seven million lives each year, according to the World Health Organization.
In 2016, four of the top-ten causes of premature mortality were non-communicable diseases or injuries. In 2040, that figure is expected to rise to eight-out-of-ten.
Ketamine is a safe, effective alternative to opioids in treating acute pain in the ED
Systematic review and meta-analysis: Randomized controlled trials 1946-2017; adult emergency department patients.Intravenous, low-dose ketamine (LDK) is as effective as intravenous morphine in the control of acute pain in adults in the emergency department (ED). That is the finding of a study to be published in the October 2018 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM). The results indicate that ketamine can be considered as an alternative to opioids for ED short-term pain control.
17 oct 2018--The lead author of the study is Nicholas Karlow, MPHS, a medical student at the Washington University School of Medicine in St. Louis, Missouri. The findings of the study are discussed in the featured episode of SGEM Hop (Skeptics Guide to EM Hot Off the Press).
The systematic review and meta-analysis by Karlow, et al. maintains that there is a role for opioids in the treatment of pain in the ED, but suggest that as physicians continue to face pressure to reduce opioid use, it is important to establish that alternatives such as ketamine are comparable in providing patients with appropriate analgesia in a similar time frame.
The study further suggests that for patients with opioid use disorders or substance use disorders that require a potent analgesic in the emergency department, ketamine may be a favorable option compared to an opioid.
Moving forward, the authors suggest that observational studies assessing adverse events should use similar outcome measures and time frames, and that researchers should explore patient and physician satisfaction with ketamine analgesia and side effects compared to other opioid alternatives for acute pain.
"Karlow and colleagues provide persuasive evidence that emergency physicians can reasonably expect sub-dissociative ketamine to be as effective as morphine for patients with acute abdominal or musculoskeletal pain. Minor ketamine adverse effects will likely prevent this therapy from becoming routinely first line, but low dose ketamine represents a good alternative choice for selected patients," commented Steven M. Green, MD, professor of emergency medicine and residency director at Loma Linda University, California.
Dr. Green's principal research interest has been on procedural sedation and analgesia, with numerous studies of ketamine dating back to 1990 and more recent works relating to sedation's optimal practice, politics, and future. He is a deputy editor at Annals of Emergency Medicine journal.
More information: Nicholas Karlow et al, A Systematic Review and Meta‐analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department, Academic Emergency Medicine (2018). DOI: 10.1111/acem.13502
Provided by Society for Academic Emergency Medicine
Tuesday, October 16, 2018
Many supplements contain unapproved, dangerous ingredients: study
U.S. health officials have issued more than 700 warnings during the last decade about the sale of dietary supplements that contain unapproved and potentially dangerous drug ingredients, new research reveals.
16 oct 2018--In nearly all cases (98 percent), the presence of such ingredients was not noted anywhere on supplement labeling, the U.S. Food and Drug Administration found.
From 2007 to 2016, the lion's share of FDA warnings—46 percent—concerned supplements that touted enhanced sexual pleasure, while weight-loss products were cited in 41 percent of the warnings. Most of the remaining warnings (12 percent) concerned supplements marketed as muscle-builders, the findings showed.
The tainted-supplement problem appears to have grown in scope in recent years, with 57 percent of all warnings having been issued since 2012, the researchers said.
"Over the past decade, ever since I first began tracking the problem, I have only seen the number of supplements adulterated with drugs increase rapidly," said Dr. Pieter Cohen. He is a general internist with the Cambridge Health Alliance, and an associate professor at Harvard Medical School in Boston.
"Back in 2009, it appeared that there might be less than 150 brands of supplements that contain drugs," he added. "Now it's clear that there are well over 1,000 brands of supplements that contain active drugs."
Cohen is the author an editorial that accompanies the new analysis, which was published online Oct. 12 in JAMA Network Open. The study was led by Madhur Kumar, of the California Department of Public Health's Food and Drug Branch.
Kumar's team noted that more than half of all American adults routinely take some form of dietary supplement, with estimated annual sales of $35 billion.
The FDA explicitly warns that supplements aren't a replacement for either over-the-counter or prescription medications, and should not be viewed as a way to treat or prevent disease.
The agency classifies dietary supplements—including vitamins, minerals, botanicals, amino acids and enzymes—under the category of food, rather than drugs.
That distinction is important.
"Supplements are handled completely different than either prescription medications or over-the-counter drugs," Cohen explained. "Those two categories are carefully vetted by the FDA. Supplements are not vetted by the FDA, and do not require that any evidence of safety or efficacy is presented to the agency before they are sold to consumers."
The FDA's Dietary Supplement Health and Education Act of 1994 essentially places the burden for evaluating supplement safety, content and labeling primarily on the shoulders of the manufacturers, he said.
Experts point out that this arrangement means that, while the FDA has the authority to remove from the market any supplement reported as causing harm, as a practical matter it does so only after the fact. This raises the risk for a wide range of "serious adverse events" involving tainted supplements—including stroke, kidney failure, liver injuries, blood clots and even death—critics of the arrangement contend.
The study team said prior estimates suggest that such events result in roughly 23,000 emergency department visits and 2,000 hospitalizations in the United States every year.
The new analysis reviewed a decade's worth of information contained in an FDA database titled "Tainted Products Marketed as Dietary Supplements."
Almost 800 tainted warnings were issued during the review period for supplements manufactured by 147 different companies, though some involved multiple warnings about the same supplement, the study authors said.
About 20 percent of the warnings identified products containing more than one unapproved ingredient, the investigators found. Sildenafil (commonly known as Viagra) was the ingredient in nearly half of the warnings concerning sexual enhancement supplements.
Sibutramine—an appetite suppressant taken off the market in 2010 due to cardiovascular risks—was cited in nearly 85 percent of weight-loss supplements, according to the report.
And among muscle-building supplements, synthetic steroids or steroid-like ingredients were the cause for concern nearly 90 percent of the time, the researchers said.
Cohen said any meaningful solution will require a change in the laws that govern the way the FDA monitors supplements. Barring that, you should "ask your doctor if you need to take supplements," he advised.
"If your doctor doesn't advise supplements for your health, then they will likely not help you," Cohen stressed. "However, for my patients who still want to use supplements, I advise them to purchase supplements that list only one ingredient on the label and to avoid any supplement that has a health claim on the label, such as improving immunity or strengthening muscles."
More information: Pieter A. Cohen, M.D., general internist, Cambridge Health Alliance, and associate professor, Harvard Medical School, Boston; Oct. 12, 2018, JAMA Network Open, online
There are many types of obesity – which one matters to your health?
Some forms of obesity severely disrupt the metabolic pathways that keep us healthy. Credit: Farik gallery, MarShot / Shutterstock.com / Evans LoveOur society seems to have accepted that gaining weight is an inevitable consequence of growing up in a place with easy access to calories and where physical activity plays a declining role in our professional and private lives. Aging just makes weight loss even more difficult.
14 oct 2018--In the short term, the consequences of excess weight seem remote or unimportant; a problem of aesthetics, a minor limitation in mobility. But it may eventually lead to higher rates of diabetes and heart disease, and present a significant challenge for enjoying an active lifestyle. My own work and that of my collaboratorshereandintheU.K. shows that obesity is more than just some more fat under the skin – it is a true modification of our metabolism. It alters the way we process nutrients and modifies the chemical reactions that sustain our existence. Our most recent work, published in Cell Metabolism, examined the consequences of obesity on our metabolism. My colleagues and I undertook this project because we recognized that there are many types of obesity – each one has different consequences for each person's health. This is what we call disease "heterogeneity." If we understand heterogeneity, we can personalize obesity treatments, hopefully with more success.
My obesity, my metabolome
We are a team of researchers with different backgrounds including medicine, technology and the analysis of complex data. We studied close to 2,500 obese people with two powerful new technologies: We sequenced the entire genome of each study participant, and we analyzed more than 1,000 blood chemicals, or metabolites. This collection of metabolites is what we now call the "metabolome" and includes well-known compounds such as glucose and uric acid, as well as tongue twisters such as 1-stearoyl-2-dihomo-linolenoyl-GPC.
We included the genome analysis to understand how an individual's genes predisposes him or her to obesity. We chose the metabolome to capture in real time the impact of having excess weight. Many of the study participants were followed for more than 10 years; this enabled the assessment of long-term consequences of our observations.
This graphical abstract shows that the metabolome captures clinically relevant types of obesity and is a better health predictor than genetic risk. Credit: Cirulli et al. / Cell Metabolism, CC BY-SAThe surprising and disturbing news is that the levels of many hundreds of unique metabolites are affected by changes in weight. Some of these changes were expected: Fats or lipids – including cholesterol – rise rapidly with increasing weight. However, we also observed changes for other types of metabolites and body processes: protein and carbohydrate metabolism, energy production and hormone concentrations.
The overall picture was that weight dramatically perturbs the body's metabolism. The good news is that the alterations can be reversed with weigh loss.
The healthy obese and the unhealthy skinny
A second and fundamental observation was that the metabolic alterations carried more health consequences than the mere physical aspect: Some of the participants had what we labeled as an "obese" metabolome despite having a normal weight. On the other hand, some obese individuals had a pretty normal metabolome that was similar to those individuals with a healthy body mass index.
It is not clear to us how an obese person could have a normal metabolome. We do not know whether it is their genes or environment that are responsible for keeping this group of individuals more healthy. That will take more research to figure out.
Because we had medical information at the time that the metabolic analyses were performed and we had long-term follow up data, we could see the consequences of abnormal metabolism.
Body mass index vector illustration from underweight to extremely obese. BMI may not be an accurate reflection of whether an individual is in good or poor health. Credit: MarShot / Shutterstock.comThose obese individuals who suffered the greatest deregulation of the metabolism developed diabetes, heart disease and hypertension. These same participants were also the ones that accumulated fat tissue inside the abdomen and in the liver – the "bad" locations – as opposed to just adding it under the skin of the waist or buttocks. Thus, physical obesity was important – but how the excess weight uniquely affected the inner workings of each individual was a more accurate measure of overall health.
Metabolome report may say more than your BMI
It may be tempting to think of obesity as the consequence of genes – inherited from our parents. It is true, but the impact of our genes pales in comparison to the overwhelming impact of high caloric intake and sedentary lives.
There was one exception. We identified a few very obese individuals who had changes in a gene that controls appetite – the so-called melanocortin-4 receptor (MC4R). These patients had a genetic mutation that made them permanently hungry and led them to eat more than they needed. There is great hope that this particular type of obesity will be soon treated with specific drugs. As expected, this form of obesity severely disrupted the metabolism of the affected person.
We see all the time that science provides new understanding on important health problems that seems to fade once the news cycle is over. But after the hype comes the incubation of new strategies that may eventually find their place in medical practice.
Specific to research in obesity, I believe that bringing attention to the important changes in the metabolism provides a sense of urgency to the field. This work also provides a new way to measure the harmful impacts of obesity and to screen populations to identify those who could benefit from participation in clinical trials of new drugs. This includes individuals who are skinny and have an unhealthy metabolome, but are unaware of their state of health and would benefit from early intervention.
Have an irregular heartbeat? You may have an increased risk of dementia
Credit: CC0 Public DomainPeople with a particular kind of irregular heartbeat called atrial fibrillation may experience a faster decline in thinking and memory skills and have a greater risk of dementia than those without atrial fibrillation, according to a study published in the October 10, 2018, online issue of Neurology, the medical journal of the American Academy of Neurology.
12 oct 2018--With atrial fibrillation, a form of arrhythmia, the heart's normal rhythm is out of sync. As a result, blood may pool in the heart, possibly forming clots that may go to the brain, causing a stroke.
The good news from the study is that people with atrial fibrillation who were taking anticoagulants, or blood thinners, to keep their blood from clotting were actually less likely to develop dementia than those who did not take blood thinners.
"Compromised blood flow caused by atrial fibrillation may affect the brain in a number of ways," said study author Chengxuan Qiu, Ph.D., of the Karolinska Institute and Stockholm University in Sweden. "We know as people age, the chance of developing atrial fibrillation increases, as does the chance of developing dementia. Our research showed a clear link between the two and found that taking blood thinners may actually decrease the risk of dementia."
For the study, researchers looked at data on 2,685 participants with an average age of 73 who were followed for an average of six years as part of a larger study. Participants were examined and interviewed at the start of the study and then once after six years for those younger than 78 and once every three years for those 78 and older. All participants were free of dementia at the start of the study, but 243 people, or 9 percent, had atrial fibrillation.
Through face-to-face interviews and medical examinations, researchers gathered lifestyle and medical data on participants at the start of the study and during each follow-up visit. All were screened for atrial fibrillation, for overall thinking and memory skills, as well as dementia.
Over the course of the study, an additional 279 people, or 11 percent, developed atrial fibrillation, and 399, or 15 percent, developed dementia.
Researchers found that those who had atrial fibrillation had a faster rate of decline in thinking and memory skills than those without the condition and were 40 percent more likely to develop dementia. Of the 2,163 people who did not have irregular heartbeat, 278 people developed dementia, or 10 percent. Of the 522 people with irregular heartbeat, 121 developed dementia, or 23 percent.
Researchers also found that people who took blood thinners for atrial fibrillation had a 60 percent decreased risk of dementia. Of the 342 people who did not take blood thinners for the condition, 76 people developed dementia, or 22 percent. Of the 128 people taking blood thinners, 14 developed dementia, or 11 percent. There was no decreased risk among people who took an antiplatelet treatment like aspirin.
"Assuming that there was a cause-and-effect relationship between using blood thinners and the reduced risk of dementia, we estimated that about 54 percent of the dementia cases would have been hypothetically prevented if all of the people with atrial fibrillation had been taking blood thinners," Qiu said. "Additional efforts should be made to increase the use of blood thinners among older people with atrial fibrillation."
A limitation of the study was that researchers could not distinguish subtypes of atrial fibrillation such as persistent or permanent. It is also possible that some cases of atrial fibrillation may have been missed among people who did not show any symptoms.
