Best of Last Year—The top medical  articles of 2018

It was a good year for medical science as a team at Cincinnati Children's Hospital Medical Center reported that the Epstein-Barr virus could be linked to seven serious diseases. Best known for causing mononucleosis, it was also found to play a role in systemic lupus, erythematosus, multiple sclerosis, rheumatoid arthritis, juvenile idiopathic arthritis, inflammatory bowel disease, celiac disease and type 1 diabetes.
And a team with members from the University of Milan and the University of Pavia found that leg exercise is critical to brain and nervous system health. In their study with mice, the researchers found that restricting movement for a period of 28 days led to a reduced number of neural stem cells by 70 percent, and neurons did not fully mature.

26 dec 2018--A team at the University of Reading found that bilingual children who spoke their native language at home had higher intelligence than did those who spoke only one language. They found that Turkish children who spoke one language at school and another at home scored better on IQ tests.
And a team at the Stanford University School of Medicine announced that they had developed a cancer 'vaccine' that eliminated tumors in mice. Injecting small amounts of immune-stimulating agents directly into solid tumors caused the immune system to attack the tumors, resulting in the elimination of all traces of them—including distant cells that had metastasized.
Also, a combined team of researchers from the University of Aberdeen and the Chinese Academy of Sciences announced that fat consumption is the only cause of weight gain. In their study with mice, they found that sugar and carbohydrates did not lead to weight gain no matter how much was consumed.
And a team with members from South Africa and Germany found that footwear habits influenced child and adolescent motor skill development. In studying children in South Africa, they found that children who went mostly barefoot from age six to 10 developed better motor skills. They found going shoeless improved balance and made them better jumpers.
Also, a study led by Eric Brewe of Drexel University showed that new parts of the brain become active after students learn physics. They found that a part of the brain not normally associated with learning science became active when students worked on physics problems. Their study using fMRI showed that learning physics activated the dorsal lateral prefrontal cortex.
And a team at the University of Cincinnati College of Medicine found that a ritual for orthodox Jewish men may offer heart benefits. They found that the practice of wearing tefillin during daily prayers could offer some cardiovascular benefits. Tefillin involves tightly wrapping the non-dominant arm with a strap, which could be protective against acute ischemic reperfusion injury.
Another team of researchers made headlines this past year when they announced that most popular vitamin and mineral supplements provide no health benefits. The group with members from St. Michael's Hospital and the University of Toronto conducted a systematic review of popular vitamins and supplements over the years 2012 to 2017 and found the majority offered no positive benefits whatsoever.
Also, a team at UC Davis unveiled human images from the world's first total-body scanner. Called EXPLORER, the imaging system captures 3-D imagery of the entire human body all at once. The images can be viewed as a rotating figure with internal organs on display. The researchers combined PET and CT scanners to create the new system and reports that image captures take just a few seconds.
And a team at the Max Planck Institute for Human Cognitive and Brain Sciences found that the brains of jazz and classical pianists work differently. Thirty professional musicians engaged in piano exercises while the researchers studied their brainwaves using EEG sensors attached to their heads. The researchers found that different musical genres require musicians to take different approaches to planning and weighing the steps involved in playing the piano.
Also, a team at the Medical College of Georgia found a link between probiotic use and brain fogginess and severe bloating. They found that patients taking probiotics had large colonies of bacteria breeding in their small intestines, which led to severe bloating and the production of D-lactic as a byproduct of fermentation. Prior research has shown that D-lactic can lead to problems with cognition, thinking and the perception of time.
And a pair of researchers with the Ragnar Frisch Centre for Economic Research in Norway found that IQ scores have been dropping since the 1970s. In their study of 730,000 men entering the national service between the years 1970 to 2009, Bernt Bratsberg and Ole Rogeberg found that volunteer scores had dropped by an average of seven points per generation.
Also, a team led by Sebastian Dieguez of the University of Fribourg, found that a core thinking error underlies beliefs in creationism and conspiracy theories. In their study, 150 college students answered questionnaires, and the researchers found a connection between belief in creationism and conspiracy theories. They suggest this example of teleological thinking is due to a perception of final causes and overriding purpose in naturally occurring events and entities.
And John Leach with the University of Portsmouth reported that people can die from giving up the fight. In his research efforts, he found instances of people simply losing the will to live—quite often after surviving a traumatic event. He notes that giving up the will to live is not the same as suicide, as victims do not cause their own deaths directly; their bodies simply react to their desire to cease living.
Also, a team at the Medical College of Georgia found that drinking baking soda could be an inexpensive, safe way to combat autoimmune disease. They found daily consumption of the common baking ingredient resulted in signaling to the spleen (or more precisely its mesothelial cells) that prevented it from setting off unnecessary autoimmune alarms.
And a team with members from several institutions in the U.K. and one in the U.S. reported that e-cigarette vapor disables key immune cells in the lungs and boosts inflammation. More specifically, they found that the vapor impaired the activity of alveolar macrophages that are responsible for keeping the lungs clean and free of dust, bacteria and allergens. With their activity impaired, a person would be more susceptible to infections and inflammation.
In an unrelated study, a team led by Silvia Balbo gave a presentation at the 256th National Meeting & Exposition of the American Chemical Society, reporting evidence that e-cigarettes can damage DNA. They identified three compounds in e-cigarette vapor that were responsible for the damage: formaldehyde, acrolein and methylglyoxal.
A team at the Sanders-Brown Center on Aging at the University of Kentucky found that the Ketogenic Diet appears to prevent cognitive decline in mice. The diet, which is heavy on fats and light on carbohydrates, has been popular in the media for most of the year, and appears to offer more than just weight loss. They found it improved neural blood flow, improved the gut biome balance, lowered glucose levels and resulted in weight loss in mice. They also found it helped clear amyloid-beta from the brain—the hallmark of Alzheimer's disease.
And a team led by Ido Kanter from Bar-Ilan University reports evidence that the brain learns completely differently than we've assumed since the 20th century. Since the 1940s, medical scientists have believed that the brain learns by modifying the strength of the synapse. In this new effort, the researchers found evidence of changes to the brain during learning in dendrites—the long arms of neurons. This finding suggests learning is more complicated in the brain than has been thought.
Also, Mel Greaves with The Institute of Cancer Research in the U.K. revealed the likely cause of childhood leukemia. He suggested that the disease happens due to a two-step process. The first is a genetic mutation and the second is exposure to some type of infectious agent. He further suggested that these findings indicated that the disease may be preventable by stimulating the immune system in infants.
And The Institute for Health Metrics and Evaluation in the U.S. produced a report for the Lancet claiming that there is no safe level of alcohol consumption. Their findings overturned previous studies suggesting that consumption of small amounts of alcohol might have health benefits. The study was part of the Global Burden of Disease effort, and concluded that there are no beneficial health outcomes from alcohol, only negative ones.
The World Health Organization added a revision to its classification manual that suggested compulsive video game playing could be a mental health problem. The problem, they said, was that it could lead to an adverse mental health condition in which a gamer becomes addicted and unable to stop playing. They suggested it is already adversely impacting gamers and their families.
And a team at Brigham and Women's Hospital reported that the gut influences neurologic disease. In studies involving animal models and human cells, they found a pathway between immune and brain cells that involved central nervous system cells in the brain. They also found that microglia can secrete compounds that induce neurotoxic properties in brain cells, leading to many neurological diseases.
And finally, a team at the University of Wisconsin reported evidence that yogurt may dampen chronic inflammation linked to multiple diseases
. More specifically, they found that the effect results from yogurt improving the integrity of the intestinal lining. Their study involved monitoring 120 pre-menopausal women, half of whom were obese, who ate yogurt for nine weeks.

If someone hurt you this year, forgiving them may improve your health (as long as you're safe, too)

What better gift this Christmas than a peace offering? Credit: JESHOOTS.COM/Unsplash

During the end-of-year holidays families often come together to exchange gifts and, sometimes, to confront long-held grudges. What better gift than a peace offering?
Conflict is rarely pleasant and arguments in families can be particularly upsetting. We all know that knot in the pit of the stomach, the flushed face and sweaty hands we experience when we feel we have been dealt with unjustly.

24 dec 2018--This is a primal stress response to when we feel personally or socially threatened. Our natural reaction is to fight or avoid the person. Revenge might feel instinctive, but that can lead to a cycle of unpleasantness that rolls on and on.
Trying to forget or rationalise a hurtful incident, usually to avoid further confrontation, seldom works. Even if the unpleasant feelings might start to fade, they generally linger in our subconscious and any reminder can reignite them. A constructive way of getting rid of them is to forgive.
But how do we do this and what helps us in the process? We've been asking these questions since we started doing research with the South African Truth and Reconciliation Commission (set up by the South African government to help deal with the trauma of apartheid) witnesses more than 20 years ago.
Victims who had indicated they had forgiven perpetrators were less angry and distressed than those who did not. We also found victims were more notably forgiving if they received an apology.

What actually is forgiveness?

Forgiveness does not mean forgetting or minimising the pain we feel; nor is it about excusing others. Forgiveness means making a conscious and deliberate decision to let go of our feelings of resentment or revenge, regardless of whether the person who has upset us deserves it.
Forgiveness is, in the first place, not about others. It is about stopping us from allowing resentment towards others to make life miserable for us.
People want to return to how they felt before the offending incident occurred. And they want to think of the event without bitterness and anger, a tightness in the chest, and endless rumination.
Forgiveness takes time. It sometimes helps to think of occasions when we have offended people in the past or to try to look genuinely at the situation through the offender's eyes.
We must start by forgiving ourselves for any contribution we think we might have made to the incident. People often blame themselves partly for what may have happened.
Survivors of sexual abuse or harassment say the most difficult part of the forgiveness process is accepting they were not to blame and to stop being angry with themselves.
After forgiving yourself, it's easier to then privately forgive other people involved. Research shows forgiveness helps us feel better and may help us live longer.
We can also tell or show someone we have forgiven them, such as by helping them out in some way without them asking.

A successful apology

One thing that often helps people to forgive is receiving an apology. While we may dread apologising, we usually think back positively about the times we've offered apologies.
A good apology ideally has three parts: an admission of responsibility, a demonstration of sorrow, and doing something to remedy the offence, or prevent a repetition of it. This could even just involve promising not to do it again.
When we asked people who had been offended by an intimate partner what convinced them their partner was truly sorry, they said actions spoke louder than words. One said it would help if their partner went out of their way to do something that would be an inconvenience for them.
An apology is not telling others we feel sorry they are angry; it is telling them we understand why they are angry with us, regret making them feel that way, and want to take their anger away. An effective apology is showing the person we understand why they are hurting.
A study that explored medical errors and the responses of those affected showed an apology was most effective where it focused on the needs of the patient. We might not always know how we can take away the anger, so it is usually good to ask the person we are apologising to what their needs are.
If the apology wasn't good enough the first time, you can try again, but first listen carefully to what the person you are apologising to is saying, and address those concerns.
Misdirected apologies can make a situation worse, they can make people more angry and make it more difficult for them to forgive. So, don't apologise unless it's sincere.

Prioritise your safety

Forgiving ourselves is always good. But forgiving others is only beneficial if the advantages exceed the potential costs. We should therefore not forgive others if that might expose us to further abuse or exploitation.
The stress response we experience to being hurt is protective because it motivates us to stop people from abusing or taking advantage of us. Anger is sometimes functional.
We should also not feel guilty if we do not forgive because some behaviour is simply unforgiveable and carrying our anger might be less harmful than the potential harm of forgiving.
There are also times when everyone may feel they are the victim or some people may not realise they have hurt others even if they can sense someone is unhappy with them.
A good way forward is to ask people what the issue is and then listen to understand, rather than listening to be able to respond. When we listen without instinctively thinking of a way to defend ourselves, we may realise there has been a misunderstanding or we've behaved inappropriately.
And if you feel offended by something that's said or done, you could avoid unpleasant feelings by telling the other person how you feel.

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

Provided by The Conversation

Dancing may help older women maintain the ability to perform daily tasks

A new study published in the Scandinavian Journal of Medicine and Science in Sports examined the potential effects of 16 different exercise types for reducing disability for activities of daily living (ADL) in older women.

21 dec 2018--The prospective study enrolled 1,003 community-dwelling older Japanese women without ADL disability at the start. In the baseline survey, all participants were asked whether or not they participated in any of 16 exercise types through a face-to-face interview. ADL disability during eight years of follow-up was defined as dependence in at least one ADL task (walking, eating, bathing, dressing, or toileting).
ADL disability was noted in 130 participants (13 percent) during follow-up. After adjusting for confounders, participation in dancing, compared with non-participation, was associated with a 73 percent significantly lower likelihood for developing ADL disability. There were no significant associations between other exercise types and ADL disability.
"Although it is unclear why dancing alone reduced the risk of ADL disability, dancing requires not only balance, strength, and endurance ability, but also cognitive ability: adaptability and concentration to move according to the music and partner, artistry for graceful and fluid motion, and memory for choreography," said lead author Dr. Yosuke Osuka, of the Tokyo Metropolitan Institute of Gerontology." We think that these various elements may contribute to the superiority of dancing in maintaining a higher ADL capacity."

More information: Yosuke Osuka et al, Exercise type and activities of daily living disability in older women: An 8-year population-based cohort study, Scandinavian Journal of Medicine & Science in Sports (2018). DOI: 10.1111/sms.13336


Provided by Wiley

Music evokes powerful positive emotions through personal memories

Credit: CC0 Public Domain

Music is known to evoke emotions through a range of mechanisms. A new study gives insights into the way positive emotional reactions can be triggered by music and pictures.

20 dec 2018--We all have experiences of being emotionally moved after listening to music that we have strong personal memories of or to seeing an image that captures particularly important memories from our life. This new research critically examined the idea of how memories are able to influence our emotional responses induced by music and images. The volunteers who participated in this study brought music and images to the experiment which evoked pleasure based on their own personal memories, as well as other pieces of music and pictures that operated similarly but the pleasure was not related to memories but just to the way the music sounds or the picture looks. In addition, the volunteers brought additional music examples and pictures to the experiment that evoked unpleasant emotions, again based either on memories or the actual qualities of the music or the images. This setup allowed to pinpoint the contribution of the underlying emotion induction mechanisms accurately and contrast another plausible mechanism that is related to the actual qualities of the art leading to emotions.
To obtain indicators of the emotions, participants provided ratings of the emotions they experienced during the listening or watching their selection of the examples. The electrical activity (EEG) related to the neural processing of the emotions was also recorded. The results from music and pictures showed similar overall pattern of results, and the most fascinating insight that the study yielded concerned the contribution of memory, which led to strong emotional reactions in the case of music and pictures, including positive and negative emotions. These results were particularly strong for social and positive emotions such as tenderness and joy but the important boosting of the emotional experiences by personal memories was also apparent in the case of sad emotions for both music and pictures. Music typically did not really induce strong sad emotions, whereas pictures were able to trigger such negative emotional experiences.
The results give insights into the way positive emotional reactions can be triggered by music and pictures and how such processes might be linked with musical interventions that attempt to harness the effect of positive mood through memories in emotional disorders or in dementia.

More information: Johanna Maksimainen et al, The Effect of Memory in Inducing Pleasant Emotions with Musical and Pictorial Stimuli, Scientific Reports (2018). DOI: 10.1038/s41598-018-35899-y


Provided by University of Jyväskylä

Age is the biggest risk for heart disease, but lifestyle and meds have impact

Credit: CC0 Public Domain

Of all the risk factors for heart disease, age is the strongest predictor of potential trouble.
While no one can stop the march of time, making healthy lifestyle choices or adhering to medication regimens for conditions such as high cholesterol, hypertension or diabetes can substantially reduce the risk of heart disease.

19 dec 2018--Understanding which risk factors modifications are actually effective, and by how much, is increasingly important for doctors and patients to understand in light of new blood pressure and cholesterol guidelines that drive medical care.
In a study published online Dec. 7 in the journal Circulation, a research team led by the Duke Clinical Research Institute provided a statistical analysis that answers the question of what works to lower heart disease risk, and by how much.
"Guidelines of who to treat for cardiovascular disease depend on risk, so we need to accurately estimate that risk," said lead author Michael Pencina, Ph.D., vice dean for Data Science and Information Technology at Duke School of Medicine and member of DCRI.
"Although taken individually, each modifiable risk factors contributes only modestly to the heart disease risk model performance," Pencina said. "But our analysis indicates that eliminating or controlling these factors can lead to substantial reductions in serious cardio-vascular events."
Pencina and colleagues analyzed key modifiable heart disease risk factors, including lipids/cholesterol, systolic blood pressure, diabetes and smoking. Each of those factors was assessed for associations with major heart events such as myocardial infarction, angina or cardiac arrhythmia.
Using pooled participant-level data from four National Heart, Lung and Blood Institute studies that included more than 22,000 people aged 45-85, the researchers found that:

• Age, sex, and race account for about 80 percent of the predictive power of cardiovascular risk models, with age being the main predictor.
• Adding either systolic blood pressure, high cholesterol, diabetes, or smoking to a model with other risk factors only minimally increases the ability of the model to determine who will suffer heart disease events.
• Lowering blood pressure to current recommendations (systolic measurement of less than 130) and lowering low-density lipoprotein cholesterol by 30 percent could reduce the 10-year coronary heart disease risk by as much as a third.

Pencina said there are two ways to achieve lower blood pressure and cholesterol: Never acquire the adverse conditions by maintaining a healthy weight and exercising, or manage them with appropriate lifestyle modifications and medications. The better of the two approaches is, not surprisingly, not developing risk factors.
"Our models suggest that when making individual treatment decisions, clinicians and patients should consider not only the 10-year risk of coronary heart disease, but also the expected benefit from the intervention," Pencina said. "We are moving from models that focus either on the causes or the risks, to a model that combines both and focuses on potential risk reduction."

More information: Quantifying Importance of Major Risk Factors for Coronary Heart Disease. Circulation. www.ahajournals.org/doi/10.116 … LATIONAHA.117.031855


Provided by Duke University

Harmful placebos

Harmful placebos. Credit: Shutterstock

How could a sugar pill placebo cause harm? A new review of data from 250,726 trial participants has found that 1 in 20 people who took placebos in trials dropped out because of serious adverse events (side effects). Almost half of the participants reported less serious adverse events. The adverse events ranged from abdominal pain and anorexia to burning, chest pain, fatigue, and even death. The study found that the apparently strange phenomena of sugar pills producing harm can be explained by misattribution and negative expectations.

Misattribution

17 dec 2018--Someone in a trial might have a symptom like a stomach ache for any number of reasons that are not related to the trial. Because they are in a trial, they think the trial intervention caused the ache. This gets reported as an adverse event when it would have happened anyway.

Negative expectations

The way patients are warned about adverse events can sometimes cause an adverse event. Effects of negative expectations are called 'nocebo' ('negative placebo') effects. "Our study provided preliminary data indicating that some trial participants experience nocebo effects," reports lead author Jeremy Howick. Other studies provide more definitive evidence that the way patients are warned about adverse events can affect whether they report them. For example, a study found that patients in a randomised trial of aspirin or sulfinpyrazone for treating unstable angina who were warned about gastrointestinal adverse events were six times more likely to withdraw from the study due to reported gastrointestinal adverse events. A more recent study published last year in The Lancet found that patients were more likely to report adverse events when they knew they were taking statins, compared to when they didn't. This is probably because the belief that statins cause adverse events like muscle pain can actually produce the muscle pain.
Finding ways to reduce adverse events among patients in placebo groups is important for improving trial quality (since fewer participants will drop out), and improving trial ethics (by avoiding harm). The question is: how?
"Misattribution can be hard to avoid," says Jeremy Howick, 'because it's hard for someone to know whether a symptom like a stomachache would have occurred anyways or whether it was because of the trial. However, I believe we can reduce the harm caused by negative expectations."
For example, telling patients that a new treatment is safe for 90% of patients contains the same information as saying it causes adverse events like headaches in 10% of patients. But the second way may be more likely to actually cause the adverse events than the first.
Unfortunately, guidance for informing trial participants about trial intervention harms, in a way that is ethical, understandable, and does not produce nocebo effects, is currently under-researched. A recent study suggested that information provided to trial participants often fails to tell them what they wish to know, and that it is presented in a way that is difficult to understand. Ongoing research at the Universities of Oxford and Cardiff is looking at ways to inform patients in trials about the best way to provide balanced information about the benefits and harms of participating in trials. Their preliminary research suggests that patients are provided more information about trial harms than trial benefits.
Says co-author Professor Kerry Hood (Director of Cardiff Centre for Trials Research): "We believe it is possible to balance the information about trial benefits and harms in a way that is fact-based and that does not cause unnecessary harm. This can be achieved by ensuring that the benefits, as well as the harms, are explained in a way patients understand."
The full paper, "Rapid Overview of Systematic Reviews of Nocebo Effects Reported by Patients Taking Placebos in Clinical Trials," is published in Trials.

More information: Jeremy Howick et al. Rapid overview of systematic reviews of nocebo effects reported by patients taking placebos in clinical trials, Trials (2018). DOI: 10.1186/s13063-018-3042-4


Provided by University of Oxford

Regular trips out guard against depression in old age

Credit: CC0 Public Domain

Regular visits to the cinema, theatre or to museums could dramatically reduce the chances of becoming depressed in older age a new study has found.

14 dec 2018--Researchers at University College London found a clear link between the frequency of 'cultural engagement' and the chances of someone over 50 developing depression. It is the first such study to show that cultural activities not only help people manage and recover from depression but can actually help to prevent it.
Their study, published in the British Journal of Psychiatry, found people who attended films, plays or exhibitions every few months had a 32 per cent lower risk of developing depression, with those attending once a month or more having a 48 per cent lower risk.
Now its lead author, Dr. Daisy Fancourt, wants to encourage greater awareness of the benefits so that people can take better control of their own mental health.
She said: 'Generally speaking, people know the benefits of eating their five-a-day and of exercise for their physical and mental health, but there is very little awareness that cultural activities also have similar benefits. People engage with culture for the pure enjoyment of doing so, but we need to be raising awareness of their wider benefits too.'
The study looked at data on more than 2,000 people over the age of 50, who took part in the long-running English Longitudinal Study of Ageing (ELSA). This provides a rich source of information for researchers like Dr. Fancourt and her colleagues, covering the health, social, wellbeing and economic circumstances of older people in England.
Along with her colleague, Urszula Tymoszuk, Dr. Fancourt was able to look at data collected from people's answers to questionnaires and in one-to-one interviews over the course of ten years. This included information about how often they visited the theatre, concerts or the opera, the cinema, art galleries, exhibitions or museums. Their answers also revealed when participants reported being diagnosed with depression, and when they experienced symptoms that the pair could then measure on a scale widely used to spot people at risk of depression.
Even when the results were adjusted to take account of differences in people's age, gender, health and their levels of wealth, education and exercise, the benefits of cultural activities remained clear. Those benefits were also independent of whether or not people had contact with friends and family or took part in social activities like clubs and societies.
The researchers believe the power of these cultural activities lies in the combination of social interaction, creativity, mental stimulation and gentle physical activity they encourage.
Dr. Fancourt said: 'We were very pleasantly surprised by the results. Notably we find the same relationship between cultural engagement and depression amongst those of high and low wealth and of different levels of education—the only thing that differs is the frequency of participation.
'Cultural engagement is what we call a "perishable commodity". For it to have long-term benefits for mental health, we need to engage in activities regularly. This is similar to exercise: going for a run on the first of January won't still have benefits in October unless we keep going for runs.'
She added: 'Depression is a major issue affecting millions of people. If we are starting to feel low or isolated then cultural engagement is something simple that we can do to proactively help with our own mental health, before it gets to the point where we need professional medical help.'
Dr. Amanda Thompsell, chair of the old age faculty at the Royal College of Psychiatrists, said: 'This paper highlights the good news story that doing something enjoyable is not just for pleasure—it can be positively beneficial for older people's mental health. The findings suggest that engaging in regular cultural activities such as visiting the theatre or cinema could be a way to reduce the risk of developing depression.
'However, such activities on their own won't treat depression. This requires an approach based on the use of talking therapies, complemented by the use of medication where an older person doesn't respond or when they have more severe depression.
'The College welcomes this paper and encourages further research into the important area of old age mental health.'

More information: Daisy Fancourt et al, Cultural engagement and incident depression in older adults: evidence from the English Longitudinal Study of Ageing, The British Journal of Psychiatry(2018). DOI: 10.1192/bjp.2018.267


Provided by Cambridge University Press

Driving with dementia—New guidance for doctors

New guidelines have been published to help doctors and health care professionals assess and manage when people living with dementia should stop driving. Credit: Newcastle University

New guidance on when people living with dementia should stop driving has been published to support doctors and other health care professionals.
'Driving with Dementia or Mild Cognitive Impairment' helps medical teams with the appropriate assessment and management of patients.

13 dec 2018--Researchers from Newcastle University, supported by the National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre have worked with a number of external partners, researchers and carers to create the guidelines.
Many people with dementia, particularly in the early stages, are safe to drive so it is important that they are not prevented from doing so but making the decision to ask someone to stop can be difficult and hard to broach.
Dr. John-Paul Taylor is a Clinical Senior Lecturer at Newcastle University, and the Deputy Lead for the NIHR Newcastle Biomedical Research Centre's Dementia research theme, led the group that developed the guidelines. He said: "This can be a difficult conversation for anyone to have, whether you're a family member or doctor, because losing the ability to drive can have a significant impact on someone's independence and wellbeing. However, someone who is no longer safe to drive can be a source of concern for families and loved ones, and may also put the driver and others at risk."
Tim Beanland, Head of Knowledge Management at Alzheimer's Society said: "We hear regularly from people with dementia that being able to drive for as long as safely possible after their diagnosis is really important to maintaining their independence and identity.
"While a dementia diagnosis isn't in itself a reason to stop driving, a decision has to be made as to whether someone is still able to drive safely. That decision requires individual judgements which can be clinically difficult and need sensitive handling.
"People with dementia have the right to remain independent for as long as possible. When being assessed for fitness to drive they have the right to be treated in a fair and open way. We've worked with a range of stakeholders including the DVLA to encourage decision-making and communication by professionals to be as dementia-friendly as possible.
"Alzheimer's Society strongly supports the issuing of new guidance in this area for clinicians. This guidance should also give much greater clarity to people with dementia and those supporting them as to what to expect when being assessed for fitness to drive."
Dr. Paul Donaghy, Academic Clinical Lecturer at Newcastle University, and one of the key contributors to the guidelines adds: "This isn't about taking away the independence of people diagnosed with dementia, it's about clarifying the situation for clinicians though a clinical framework which works with people with people with mild cognitive impairment or dementia to support their independence and maintain their safety."
The working group that developed the guidelines included people from a range of backgrounds including people affected by dementia, the DVLA, Alzheimer's Society, old age psychiatry, occupational therapy, clinical psychology, nursing and general practice.
Newcastle University researchers are working on the biomedical aspects of dementia to dementia care following a diagnosis, as well as creating awareness, tools and information for people with dementia and their families. The Newcastle Biomedical Research Centre, funded by the National Institute for Health Research has supported biomedical dementia research between the Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University for the past 12 years and has led to a number of developments, including how to better diagnose and treat dementia with Lewy bodies, which was, before this, considered to be a form of Alzheimer's disease.
Changes in driving safety that may indicate that driving is starting to become unsafe:

* Visuospatial judgement

- Changes to the proximity of the car the individual is driving to stationary vehicles or when overtaking

New guidelines have been published to help doctors and health care professionals assess and manage when people living with dementia should stop driving. Credit: Newcastle University

- Unable to hold a steady course in a defined lane—Difficulty in following subtle changes in the course of the road


* Response to hazards

- Repeated failure to respond in busy environments such as junctions or crossings

* Reduction in attention

- Seeming 'overwhelmed' in everyday driving situations

* Decision making

- Decline in ability to make independent decisions when driving
- Verbal prompt required by passenger
- Over-correction or erratic correction to changes in road direction or the environment

* Errors in sequencing

- Failing to release the handbrake
- Failing to check for hazards before moving off
- Trouble changing gears or missed gear changes

* Heightened passenger vigilance

- Passengers becoming more aware of changes in driving ability when travelling in the car
- A change from being a passive traveller to providing prompts or cue

Available to download: Driving with Dementia or Mild Cognitive Impairment Consensus Guidelines


Provided by Newcastle University

Paternal grandfather's high access to food may indicate higher mortality risk in grandsons

Potato harvesting in Kristinebergsparken, Stockholm, early 1900's. Credit: Svenska Dagbladet, unknown photographer/Stockholmskällan

A paternal grandfather's access to food during his childhood is associated with mortality risk, especially cancer mortality, in his grandson, shows a large three-generational study from Stockholm University. The reason might be epigenetic – that environmental exposures in one generation may influence health outcomes in following generations.

12 dec 2018--If a paternal grandfather had good access to food and experienced unusually high yields as a young boy, his grandson – but not granddaughter – has a higher mortality risk, the study shows. Especially high was the risk of cancer mortality. The researchers traced approximately 9,000 grandparents and examined the mortality of their grandchildren, more than 11,000 individuals. "Paternal grandfather's access to food predicts all-cause and cancer mortality in grandsons" is published in the journal Nature Communications.
"The results are very clear when it comes to the correlation between a grandfather's access to food and his grandson's mortality. A previous Swedish smaller study, the Overkalix study, showed the same result. However, we have been unable to determine other correlations over the generations," says Denny Vågerö, one of the authors of the paper and professor at the Department of Public Health Sciences, Stockholm University.
Previous research has suggested that the pre-pubertal, slow growth period (ages 9-12) is particularly vulnerable to nutritional effects. Denny Vågerö and colleagues' new study confirms this is true when it comes to men. However, there is no difference in mortality risk between grandsons whose paternal grandfather had low or average access to food.
Accounting for social factors, such as education, family size and income, the correlation between access to food and mortality in grandsons was enhanced.
The researchers do not claim to explain the causal relationship but believe that epigenetics might be the key.
"Introduction of chemical pesticides was limited in the end of the 1800's and it's not likely that it would have led to new, large-scale mutations. Therefore, the most reasonable explanation would be that boys', but not girls', germ line cells are open for epigenetic change such as nutritional effects, during pre-puberty. If that is the case, these changes might be passed on to following generations, something that is also shown in animal experiments. However, more research is needed, both in epidemiology and molecular biology," says Denny Vågerö.
The study, "Paternal grandfather's access to food predicts all-cause and cancer mortality in grandsons," expands on Uppsala Birth Cohort Multigeneration Study. Grandparents (9,039) have been traced and regional data on the yields of harvests have been used to determine the grandparents' access to food during their childhood, 1874-1910. These results were followed up by data on mortality from 1961-2015 for their grandchildren (11,561).
The study has been published in Nature Communications on December 6, 2018.

More information: Denny Vågerö et al. Paternal grandfather's access to food predicts all-cause and cancer mortality in grandsons, Nature Communications (2018). DOI: 10.1038/s41467-018-07617-9


Provided by Stockholm University

You make decisions quicker and based on less information than you think

You’re probably wrong about how long it would take you to know they’re ‘the one.’ Credit: rawpixel/Unsplash, CC BY

We live in an age of information. In theory, we can learn everything about anyone or anything at the touch of a button. All this information should allow us to make super-informed, data-driven decisions all the time.

11 dec 2018--But the widespread availability of information does not mean that you actually use it even if you have it. In fact, decades of research in psychology and behavioral science find that people readily make data-poor snap judgments in a variety of instances. People form lasting impressions of others in the span of milliseconds, evaluators judge teachers in less than a minute and consumers make shopping decisions based on little deliberation. Even voting decisions can seemingly be predicted from preliminary impressions formed during incredibly brief time periods.
If these findings seem remarkable to you, recent research by my colleague and me suggests that you are not alone. The immediacy of human judgment generally surprises people. Individuals fail to anticipate how little information they and others use when making decisions.
And this disconnect can have implications in daily life: After all, recognizing how much – or little – information people actually use to make judgments and decisions could influence how much you try to share with others. A job candidate should have a sense of how much of her resume prospective employers will actually read so she can prioritize her efforts accordingly.
And it would help when you're deciding how much information to acquire when making your own decisions. How long should you try out a subscription service before deciding whether you like it enough to pay? How much time should you date a love interest before deciding to tie the knot?

Comparing predictions and reality

In our research, my co-author Ed O'Brien and I tested whether people can correctly anticipate how much information they and others use when making varied judgments. We consistently found that people were surprised by how quickly they make judgments and how little information they use doing so.
In one study, we asked participants to imagine having pleasant or unpleasant interactions with another person. In comparison, we asked another group of participants to predict how many of those interactions they would need to experience to determine someone's character. We found that people believed they would need many interactions to make this judgment, when in fact the first group needed few.
In another study, we asked MBA students to write applications for hypothetical management positions, and then asked actual HR people to read their materials. Our applicants wrote and shared much more material than the hiring professionals cared to read.
We also asked people who have never been married to predict how long, after meeting their future spouse, it would take them to decide that this person is "the one." Fully 39 percent of these never-marrieds thought they would need to date this person more than year before they'd feel ready to spend the rest of their lives with him or her. In contrast, married people reported having made this judgment much more quickly, with only 18 percent stating that it took them more than a year to do so.
Similar mispredictions occur when evaluating subscription services based on trial periods, tasting novel beverages, and evaluating streaks of luck, athletic performances and academic grades. In all cases, people believed they would use more information than they actually did.

Misunderstanding this human tendency

There are several reasons why people might have the wrong impression about how quickly they and others make judgments.
One possibility is a belief that the human mind processes information incrementally. A naive perspective might imagine that new information stacks on top of old information until some mental threshold is reached for making a decision. In reality, however, preliminary research suggests that information aggregation is much closer to an exponential function; the first few pieces of information are weighted much more heavily than later information.
Another possibility is that people fail to realize how rich and engrossing each separate piece of information is. In psychology, this is called an empathy gap. Consider the question of how many interactions are necessary for you to decide whether you like and trust someone. It may be tempting to believe you'll rationally evaluate each interaction as you would a dry statistic. But social encounters are vivid and engaging, and the first experience may simply be so absorbing as to tilt your judgment irrevocably, making future interactions unnecessary.

Recognizing the rush to judgment

It's not clear that quick decisions are always bad. Sometimes snap judgments are remarkably accurate and they can save time. It would be crippling to comb through all the available information on a topic every time a decision must be made. However, misunderstanding how much information we actually use to make our judgments has important implications beyond making good or bad decisions.
Take the problem of self-fulfilling prophesies. Imagine a situation in which a manager forms a tentative opinion of an employee that then cascades into a series of decisions that affect that employee's entire career trajectory. A manager who sees an underling make a small misstep in an insignificant project may avoid assigning challenging projects in the future, which in turn would hamstring this employee's career prospects. If managers are unaware how willing they are to make quick and data-poor initial judgments, they'll be less likely to nip these self-fulfilling destructive cycles in the bud.
Another example might be the human tendency to rely on stereotypes when judging other people. Although you may believe that you'll consider all the information available about another person, people in fact are more likely to consider very little information and let stereotypes creep in. It may be a failure to understand how quickly judgments get made that make it so hard to exclude the influence of stereotyping.
Modern technology allows virtually any decision made today to be more informed than the same decision made a few decades ago. But the human reliance on quick judgments may forestall this promise. In the quest for more informed decision-making, researchers will need to explore ways to encourage people to slow down the speed of judgment
.
More information: Nadav Klein et al. People use less information than they think to make up their minds, Proceedings of the National Academy of Sciences (2018). DOI: 10.1073/pnas.1805327115


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


Provided by The Conversation

Move more, sit less – great advice, but how can we make time for exercise?

It doesn’t matter what exercise you choose, just move. Credit: robuart / SHutterstock.com

It's that time again. The U.S. Department of Health and Human Services just released a new edition of the Physical Activity Guidelines for Americans. That sound you hear is Americans collectively sighing.

10 dec 2018--Let's be honest: Physical activity guidelines can be tough. As behavioral scientists with expertise in exercise motivation, we will be the first to admit that maintaining a physically active lifestyle isn't easy. This is what we do, and we don't even always hit the goal. Life is messy and often gets way of even the best intentions. Let's take a deep breath, unwrap these new guidelines and talk strategy.

The guidelines

The guidelines recommend that all adults do at least 150 minutes per week of physical activity at an intensity that elevates the heart rate. Older adults should add balance exercises. And with the exception of women who are pregnant or nursing, adults should lift weights using all major muscle groups at least twice a week.
The guidelines also recommend that school-aged children and adolescents be active for 180 minutes per week. Preschoolers should be active throughout the day. Right now you might be thinking, who has time for all this exercise?

The good news

The good news is that the guidelines now recognize that fitting in big blocks of time for exercise is not necessary to get health benefits. For the first time, the guidelines don't require that physical activity occurs in bouts of 10 consecutive minutes or more to be valid. All activity counts. So that climb up and down the stairs at work every day counts toward your goal (as long as you're raising your heart rate).
The new guidelines also emphasize a "move more, sit less" message to encourage everyone to do just a little more physical activity and to spend a little bit less time sitting. Physical activity isn't all or nothing. Every little bit comes with health benefits, so if reaching the guideline seems overwhelming, that's OK. Just try to do a bit more than you did yesterday. Improvement counts as success whether you meet the guidelines or not.

The new guidelines suggest that adults lift weights at least twice a week. Credit: bunnygraphy / Shutterstock.com

But how? And when?


If you feel the guidelines are overwhelming, you are not alone – this is one of the most common complaints about the guidelines we hear from the thousands of people we have studied and counseled in exercise programs. People often feel hopeless about changing their lifestyle dramatically. One way to tackle a large goal is to break it down into smaller pieces.
Consider a marathon runner. No new runner starts off running 26 miles; each one has to build up to it. They break monstrous goals into smaller pieces that increase steadily over many months. You can approach the new physical activity guidelines in the same way. By tracking your progress, using incrementally more challenging goals, and celebrating milestones of achievement, you can move yourself closer to reaching the big goal.
The first goal you set should be a pretty easy goal – so easy you should be thinking, "Oh, come on! That is too easy!" Say, for example, you get about 30 minutes of exercise per week. Could you increase to 35 minutes per week for the next three weeks? Once you've nailed 35 minutes for 2-3 weeks, bump it up to 40 minutes. The idea here is that you are building slowly, getting used to each step before moving onto the next step. Each step is also enhancing your physical fitness and conditioning so the next step won't feel much more difficult than the one before. From a time management perspective, sneaking in an extra five minutes here and there is also far easier than finding time blocks of 30 to 60 minutes.
If you are far from 150 minutes right now, forget about 150 right now. Come up with a goal that is "Oh, come on!" easy and then go from there. You can track your progress with wearable devices, smartphone apps or good old-fashioned pen and paper. However you track your progress, it is important to have a plan that you can track and keep trying to raise the bar for yourself – ever so gently.

The best thing you can do for your health

The experts call physical activity the "best buy" in public health. And the guidelines are based on evidence from thousands of studies. Based on this evidence, an expert panel concluded that exercise increases our lifespans, prevents that sneaky annual weight gain and reduces the risk of almost every chronic disease: cardiovascular disease, diabetes and many cancers. No other single behavior can do as much good for your health. By investing some time into exercise now, you get to cash in later. Think of it as the 401K for a long, healthy and happy life.
Of course, we don't always make decisions in our long-term self-interest. We are wired more toward immediate rewards, and many health benefits of physical activity take years to appear. Some may be hard to notice at all, like preventing heart disease.
Fortunately, exercise has many immediate benefits. One of the biggest is the "feel good" effect afterwards. People consistently feel more focused, less stressed and more energized after physical activity. In fact, studies now show that regular physical activity can actually reduce anxiety and depression – with effects equal to antidepressant medication or psychotherapy. We are all just one workout away from feeling better than we do right now.
One word of caution: Be careful not to push too hard too soon. Exercising hard can feel unpleasant. Most people don't repeat activities that feel unpleasant. Find something you enjoy and keep it fun if you want that behavior change to stick. When you hear all the news about the new physical activity guidelines, try not to let it discourage you. Set the numbers aside for now and just ask yourself, "How can I move a little more and sit a little less than I do now – and how can I make it fun?"
You got this.

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

Provided by The Conversation

Researchers explore what's behind Mediterranean diet and lower cardiovascular risk

Credit: CC0 Public Domain

A new study by investigators from Brigham and Women's Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health offers insights from a cohort study of women in the U.S. who reported consuming a Mediterranean-type diet. Researchers found a 25 percent reduction in the risk of cardiovascular disease among study participants who consumed a diet rich in plants and olive oil and low in meats and sweets. The team also explored why and how a Mediterranean diet might mitigate risk of heart disease and stroke by examining a panel of 40 biomarkers, representing new and established biological contributors to heart disease. The team's results are published in JAMA Network Open.

08 dec 2018--"Our study has a strong public health message that modest changes in known cardiovascular disease risk factors, particularly those relating to inflammation, glucose metabolism and insulin resistance, contribute to the long-term benefit of a Mediterranean diet on cardiovascular disease risk. This understanding may have important downstream consequences for the primary prevention of cardiovascular disease," said lead author Shafqat Ahmad, Ph.D., a research fellow at the Brigham and at the Harvard Chan School.
Randomized trials in Mediterranean countries and observational studies have previously linked a Mediterranean diet to reductions in cardiovascular disease, but the underlying mechanisms have been unclear. The current research draws on data from more than 25,000 female health professionals who participated in the Women's Health Study. Participants completed food intake questionnaires about diet, provided blood samples for measuring the biomarkers, and were followed for up to 12 years. The primary outcomes analyzed in the study were incidences of cardiovascular disease, defined as first events of heart attack, stroke, coronary arterial revascularization and cardiovascular death.
The team categorized study participants as having a low, middle or upper Mediterranean diet intake. They found that 428 (4.2 percent) of the women in the low group experienced a cardiovascular event compared to 356 (3.8 percent) in the middle group and 246 (3.8 percent) in the upper group, representing a relative risk reduction of 23 percent and 28 percent respectively, a benefit that is similar in magnitude to statins or other preventive medications
The team saw changes in signals of inflammation (accounting for 29 percent of the cardiovascular disease risk reduction), glucose metabolism and insulin resistance (27.9 percent), and body max index (27.3 percent). The team also found connections to blood pressure, various forms of cholesterol, branch-chain amino acids and other biomarkers, but found that these accounted for less of the association between Mediterranean diet and risk reduction.
"While prior studies have shown benefit for the Mediterranean diet on reducing cardiovascular events and improving cardiovascular risk factors, it has been a black box regarding the extent to which improvements in known and novel risk factors contribute to these effects," said corresponding author Samia Mora, MD, MHS, a cardiovascular medicine specialist at the Brigham and Harvard Medical School. "In this large study, we found that modest differences in biomarkers contributed in a multi-factorial way to this cardiovascular benefit that was seen over the long term."

More information: Shafqat Ahmad et al, Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet, JAMA Network Open (2018). DOI: 10.1001/jamanetworkopen.2018.5708


Provided by Brigham and Women's Hospital

Drug dramatically reduces risk of dangerous blood clots in cancer patients

Blood clots in the legs can cause swelling, redness and pain. If a clot forms in the lungs, it can be deadly. New research provides the first approach for safely preventing these clots in people with cancer. Credit: The Ottawa Hospital

A Canadian clinical trial published in the New England Journal of Medicine provides the first approach for safely preventing blood clots (or venous thromboembolism) in people with cancer. About half of people newly diagnosed with a solid cancer could be candidates for the strategy, which involves a low dose of a direct oral anticoagulant called apixaban.

08 dec 2018--"Cancer increases the risk of blood clots, which in turn can cause pain, reduce quality of life and increase the risk of death," said senior author Dr. Philip Wells, a hematologist, senior scientist and Chief of Medicine at The Ottawa Hospital and the University of Ottawa. "Our study shows for the first time that we can safely prevent these clots in many people with cancer."
A key part of the study was the identification of cancer patients with a higher risk of developing blood clots. This was done using the Khorana score, which is based on blood tests results and other clinical factors. The researchers found that about half of all people starting cancer chemotherapy were in the higher risk group. They enrolled 563 of these patients from 13 Canadian centres in the trial and randomly assigned them to receive apixaban (2.5 mg twice a day for six months) or a placebo.
Of the 275 patients in the placebo group, 28 suffered a blood clot within six months (10.2 percent) compared to 12 of 288 in the apixaban group (4.2 percent). The researchers also looked at side effects related to bleeding, as these are known to increase with the use of anticoagulants. Three patients in the placebo group suffered a major bleed (1 percent) compared to six patients in the apixaban group (2.1 percent), but all bleeds were treatable.
"Anticoagulants are commonly used to prevent blood clots in other high-risk groups, but the traditional thinking has been that these drugs would cause too much bleeding in people with cancer," said first author Dr. Marc Carrier, a hematologist, senior scientist and associate professor at The Ottawa Hospital and the University of Ottawa. "Our study shows that if you select the right patients and use a relatively low dose of a direct oral anticoagulant, the benefits easily outweigh the risks."
With about 1.9 million people diagnosed with cancer every year in Canada and the U.S., the researchers estimate that about half, or 950,000 could be considered for the blood clot prevention strategy tested in the study. In this population, the strategy would be expected to prevent clots in six percent, or 57,000 people. The preventative strategy would also save money, as treating blood clots can be very expensive.
This research means a lot to Harold Black, 76, who developed a cancer-associated blood clot in his lungs (pulmonary embolism) in September 2018. The large clot required two days of treatment and monitoring at The Ottawa Hospital, followed by ongoing daily heparin injections in the belly.
"I feel very lucky because I was told that the first sign of a pulmonary embolism is often death," said Black. "If this research prevents people like me from developing blood clots, that will make a big difference for a lot of people."
The blood clot (thrombosis) program at The Ottawa Hospital and the University of Ottawa is the largest and the most research-intensive in the world. With four publications in the New England Journal of Medicine since 2015, their research is transforming lives both in Ottawa and around the world.
"I want to thank the outstanding physicians, nurses, research coordinators and other members of our thrombosis team," said Dr. Wells. "But above all, I want to thank our patients for participating in our research and helping us improve care for them and others around the world."
This study was sponsored by the Ottawa Hospital Research Institute, with funding primarily from the Canadian Institutes of Health Research. The BMS-Pfizer Alliance also provided funding but had no role in designing the study or analyzing the results. The study was also supported by the CanVECTOR research network and the Ottawa Methods Centre. Research at The Ottawa Hospital is possible because of generous donations to The Ottawa Hospital Foundation.

More information: Marc Carrier et al, Apixaban to Prevent Venous Thromboembolism in Patients with Cancer, New England Journal of Medicine (2018). DOI: 10.1056/NEJMoa1814468


Provided by The Ottawa Hospital

New recommendations for the conduct of economic evaluations in osteoporosis

Economic evaluations that compare interventions in terms of costs and outcomes are increasingly used by decision makers, with economic evaluations now playing an increasing role in pricing and reimbursement decisions.
In the field of osteoporosis, the number of economic evaluations has increased markedly, however the variable quality and considerable heterogeneity of the evaluations often limit their comparability and use by decision makers.

08 dec 2918--To address this handicap, an expert working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US Branch of the International Osteoporosis Foundation (IOF), met at a consensus meeting to establish recommendations for the design and conduct of economic evaluations in osteoporosis, as well as guidance for reporting these evaluations. Additionally, a set of minimum criteria for evaluations and an osteoporosis-specific checklist of items to incorporate in economic reports were established.
Download Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an Experts' consensus meeting
Lead author Dr. Mickael Hiligsmann, Associate Professor in Health Economics and Health Technology Assessment at CAPHRI Care and Public Health Research Institute of Maastricht University, stated: "Although disease-specific recommendations for economic evaluations have been developed in other disease areas previously, this study is to our knowledge the first that provides a list of recommendations and minimum requirements for the design, conduct and reporting of an osteoporosis-specific economic evaluation. The recommendations are intended for researchers in the field of osteoporosis, as well as to help decision makers, reviewers and editors assess the quality of economic studies."
He added: "These osteoporosis-specific recommendations should be viewed as supplemental to general and national guidelines for economic evaluations. We encourage health economists and researchers in the field to make use of the recommendations and thereby to improve the transparency and comparability of their work. By promoting high-quality methodology standards, we hope to increase the use of economic evaluations by decision makers—which ultimately should lead to a more effective allocation of resources to our patients with osteoporosis."

More information: M. Hiligsmann et al, Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts' consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation, Osteoporosis International (2018). DOI: 10.1007/s00198-018-4744-x


Provided by International Osteoporosis Foundation

Fasting for lab tests isn't good for patients with diabetes

Fasting before getting your blood drawn for cholesterol tests is common practice, but new research from Michigan State University shows it is a contributing factor of low blood sugar, or hypoglycemia, in patients who take diabetes medications.

08 dec 2018--The study, published in the International Journal of Endocrinology, shows that people with diabetes are more likely to experience FEEHD—fasting-evoked en route hypoglycemia in diabetes—than they would if they hadn't fasted. The "en route" comes from patients who have an episode while driving to a lab for blood work.
Saleh Aldasouqi, an endocrinologist in the College of Human Medicine, explained that eating before a lab test does not alter the results of the pivotal components of the cholesterol test as previously thought. In fact, fasting for these tests can incite hypoglycemia in patients with diabetes.
"Hypoglycemia is an overlooked problem that we see from time-to-time in patients with diabetes who show up for lab tests after skipping breakfast," Aldasouqi said. "Patients continue taking their diabetes medication but don't eat anything, resulting in low blood sugar levels that cause them to have a hypoglycemic event while driving to or from the lab, putting themselves and others at risk. Our new motto is 'Feed not FEEHD', to remind patients of this danger and get them to eat."
Hypoglycemia happens when blood sugar levels drop below 70 mg/dl and can cause faintness, confusion and even a loss of consciousness. Severe hypoglycemia can cause acute harm to the patient or others, especially if it causes falls or motor vehicle accidents.
Aldasouqi said that routine fasting is based off guidelines from the 1970s and newer studies show it may not be necessary anymore. Canada and Europe have already changed their guidelines and no longer require fasting for lipid tests, the most commonly ordered fasting labs. Similar U.S. guidelines have not yet become mainstream. In view of the risk of FEEHD, Aldasouqi hopes for diabetes organizations to take a lead in disseminating these emerging changes on lipid testing.
The study showed proper education about fasting and diabetes also is lacking. Only 35 percent of patients surveyed indicated having received any FEEHD prevention instructions from their doctor prior to their lab visit.
"We encourage patients who receive orders for a lab test to ask their doctor if fasting is really necessary, and if so, how they should handle their diabetes medications during the fasting period to account for the changes in their blood sugar levels," Aldasouqi said. "FEEHD is overlooked in clinical practice, and we aim to bring this problem to light and further educate doctors and patients about the consequences of fasting while on diabetes medications."
The study involved 525 patients with diabetes and was conducted at two endocrinology practices in Michigan. Patients completed a two-page survey and were excluded if data was missing or they reported no fasting labs in the previous 12 months. Aldasouqi plans to conduct a larger, population-based study to determine the prevalence of FEEHD in the general population.

More information: Saleh Aldasouqi et al, Fasting-Evoked En Route Hypoglycemia in Diabetes (FEEHD): An Overlooked Form of Hypoglycemia in Clinical Practice, International Journal of Endocrinology (2018). DOI: 10.1155/2018/1528437


Provided by Michigan State University

Researchers classify Alzheimer's patients in six subgroups

Genetic data supported the contention that a particular way of sorting people resulted in biologically coherent subgroups (pictured lower right). Credit: University of Washington School of Medicine

Researchers studying Alzheimer's disease have created an approach to classify patients with Alzheimer's disease, a finding that may open the door for personalized treatments.

07 dec 2018--"Alzheimer's, like breast cancer, is not one disease," said lead author Shubhabrata Mukherjee, research assistant professor in general internal medicine at the University of Washington School of Medicine. "I think a good drug might fail in a clinical trial because not all the subjects have the same kind of Alzheimer's.
This study, published in the recent issue of Molecular Psychiatry, involves 19 researchers from several institutions, including Boston University School of Medicine, the VA Puget Sound Health Care System and Indiana University School of Medicine.
The researchers put 4,050 people with late-onset Alzheimer's disease into six groups based on their cognitive functioning at the time of diagnosis and then used genetic data to find biological differences across these groups.
"The implications are exciting," said corresponding author Paul Crane, professor of general internal medicine at the University of Washington School of Medicine. "We have found substantial biological differences among cognitively defined subgroups of Alzheimer's patients."
Identification of cognitive subgroups related to genetic differences is an important step toward developing a precision medicine approach for Alzheimer's disease.
The participants received cognitive scores in four domains: memory, executive functioning, language, and visuospatial functioning.
The largest group (39%) had scores in all four domains that were fairly close to each other. The next largest group (27%) had memory scores substantially lower than their other scores. Smaller groups had language scores substantially lower than their other scores (13%), visuospatial functioning scores substantially lower than their other scores (12%), and executive functioning scores substantially lower than their other scores (3%). There were 6% who had two domains that were substantially lower than their other scores.
The participants came from five studies, and it took more than two years to standardize the neuropsychological test scores across all the studies in order to detect meaningful patterns. The mean age was 80, 92 percent self-reported white race, and 61 percent were female.
The investigators used genome-wide genetic data to find out if the subgroups are biologically distinct.
Investigators found 33 single nucleotide polymorphisms (SNPs) - specific locations throughout the genome—where the genetic association was very strong for one of the subgroups. These genetic relationships were stronger than the strongest effects found by an earlier and much larger international consortium study where Alzheimer's disease was treated as a single homogeneous condition.
Several years ago, the International Genomics of Alzheimer's Project Consortium published the largest genome-wide association study of Alzheimer's disease and found about 20 SNPs associated with Alzheimer's disease risk.
This study found 33 additional SNPs with even stronger relationships with a single subgroup.
The study also found a particularly strong relationship between a particular variant of the APOE gene and risk for the memory subgroup. The APOE e4 allele is a very strong risk factor for developing Alzheimer's disease for people with European ancestry, and it also appears to influence which cognitive subtype of Alzheimer's a person is likely to develop.
People can currently find out if they have an APOE e4 allele with direct-to-consumer testing; however, the researchers note that many people with an APOE e4 allele never develop Alzheimer's disease, and many who don't carry any known genetic risk factor nevertheless end up with the condition.
While world leaders want to find a cure for Alzheimer's by 2025, so far no one has been able to develop an effective treatment let alone a cure. But this study suggests that thinking of Alzheimer's disease as six distinct conditions may provide a way forward.
"This study is not the end, it's a start," said Mukherjee.

More information: et al, Genetic data and cognitively defined late-onset Alzheimer's disease subgroups, Molecular Psychiatry (2018). DOI: 10.1038/s41380-018-0298-8


Provided by University of Washington

As married couples age, humor replaces bickering

Credit: CC0 Public Domain

Honeymoon long over? Hang in there. A new University of California, Berkeley, study shows those prickly disagreements that can mark the early and middle years of marriage mellow with age as conflicts give way to humor and acceptance.

07 dec 2018--Researchers analyzed videotaped conversations between 87 middle-aged and older husbands and wives who had been married for 15 to 35 years, and tracked their emotional interactions over the course of 13 years. They found that as couples aged, they showed more humor and tenderness towards another.
Overall, the findings, just published in the journal Emotion, showed an increase in such positive behaviors as humor and affection and a decrease in negative behaviors such as defensiveness and criticism. The results challenge long-held theories that emotions flatten or deteriorate in old age and point instead to an emotionally positive trajectory for long-term marrried couples.
"Our findings shed light on one of the great paradoxes of late life," said study senior author Robert Levenson, a UC Berkeley psychology professor. "Despite experiencing the loss of friends and family, older people in stable marriages are relatively happy and experience low rates of depression and anxiety. Marriage has been good for their mental health."
Consistent with previous findings from Levenson's Berkeley Psychophysiology Laboratory, the longitudinal study found that wives were more emotionally expressive than their husbands, and as they grew older they tended toward more domineering behavior and less affection. But generally, across all the study's age and gender cohorts, negative behaviors decreased with age.
"Given the links between positive emotion and health, these findings underscore the importance of intimate relationships as people age, and the potential health benefits associated with marriage," said co-lead author Alice Verstaen, who conducted the study as a Ph.D. student at UC Berkeley and is currently a postdoctoral fellow at the VA Puget Sound Health Care System.
The results are the latest to emerge from a 25-year UC Berkeley study headed by Levenson of more than 150 long-term marriages. The participants, now mostly in their 70s, 80s and 90s, are heterosexual couples from the San Francisco Bay Area whose relationships Levenson and fellow researchers began tracking in 1989.
In their investigation of marital relationships, researchers viewed 15-minute interactions between spouses in a laboratory setting as they discussed shared experiences and areas of conflict. They tracked the emotional changes every few years.
The spouses' listening and speaking behaviors were coded and rated according to their facial expressions, body language, verbal content and tone of voice. Emotions were coded into the categories of anger, contempt, disgust, domineering behavior, defensiveness, fear, tension, sadness, whining, interest, affection, humor, enthusiasm and validation.
Researchers found that both middle-aged and older couples, regardless of their satisfaction with their relationship, experienced increases in overall positive emotional behaviors with age, while experiencing a decrease in overall negative emotional behaviors.
"These results provide behavioral evidence that is consistent with research suggesting that, as we age, we become more focused on the positives in our lives," Verstaen said.

More information: Alice Verstaen et al, Age-related changes in emotional behavior: Evidence from a 13-year longitudinal study of long-term married couples., Emotion (2018). DOI: 10.1037/emo0000551


Provided by University of California - Berkeley