Levodopa + carbidopa does not modify disease in early Parkinson
For patients with early Parkinson disease, treatment with levodopa combined with carbidopa has no disease-modifying effect, according to a study published in the Jan. 24 issue of the New England Journal of Medicine.
31 jan 2019--Constant V.M. Verschuur, M.D., from Amsterdam Neuroscience, and colleagues randomly assigned patients with early Parkinson disease to receive eitherlevodopa(three times per day) in combination with carbidopa for 80 weeks (early-start group) or placebo for 40 weeks followed by levodopa in combination with carbidopa for 40 weeks (delayed-start group; 222 and 223 patients, respectively).
The researchers found that the change in the Unified Parkinson's Disease Rating Scale (UPDRS) score was −1.0 ± 13.1 and −2.0 ± 13.0 points in the early-start and delayed-start groups, respectively, from baseline to week 80 (difference, 1.0 point; 95 percent confidence interval, −1.5 to 3.5; P = 0.44). Between weeks 4 and 40, the rate of symptom progression as measured in UPDRS points per week was 0.04 ± 0.23 and 0.06 ± 0.34 in the early-start and delayed-start groups, respectively (difference, −0.02; 95 percent confidence interval, −0.07 to 0.03). Between weeks 44 and 80, the corresponding rates were 0.10 ± 0.25 and 0.03 ± 0.28 (difference, 0.07; two-sided 90 percent confidence interval, 0.03 to 0.10); the difference did not meet the criterion for noninferiority of early versus delayed receipt of levodopa.
"Whether higher doses of the drug, longer periods of administration, or initiation of the drug at later stages of the disease could alter the course of Parkinson disease warrants evaluation in future trials," the authors write.
We can all agree that older people should have the choice to stay at home, and be cared for there, if that is what they wish to do. But the push for choice in elder care comes at a time where many governments are disinvesting in home-care public services.
30 jan 2019--While governments pay lip service to the notion of choice, their disinvestment in public home care services means that older people and their families often have no choice but to "choose" for-profit home care providers, as these are becoming the norm for elder home care. In the past decade, there has been a change from government-operated public facilities into private, autonomous facilities and services, organised for profit.With the view of reducing healthcare costs – and under the pretext of increasing choice – the UK and Irish governments have outsourced a great proportion of their home care services to for-profit providers. This is having several implications: no meaningful choice, increased loneliness among older people, a dissatisfied and sometimes exploited care work force and poor quality care.
And there are further problems with this situation, beyond transformation of care into a commodity. Home care is not a typical product on a supermarket shelf. Care is a complex bundle of activities, tasks and interactions. Home care is a high involvement purchase, which requires considerable time and emotional investment. But people in need of care might not have all the necessary information, skills or time required to navigate intricate care markets.
In the course of our research into the needs of the growing ageing populations in Ireland, social workers admitted that clients have little information on home care agencies. The little information they have comes from marketing communication activities, not from an objective source. But this might not matter anyway, as participants told us that good care was down to the individual carer: "You couldn't say one home care agency is better than the other, it's all about the actual person" delivering the care.
Market-driven
The increased view of home care as a product has led to the reduction of care as a set of clearly defined units of work (such as showering, washing, dressing, toileting and cleaning) leaving little time for companionship and meaningful engagement with clients. In the UK between 2010 and 2013, more than half a million care slots lasted five minutes or less. In Ireland, participants told us that a 30-minute slot is now the norm. Carers spoke about the disappointment service users experienced as they hurried out the door to the next client.
Paradoxically, many home care agencies promote themselves on the emotional capacities of care workers and the potential friendships that can be formed. But older adults told us about feeling lonely and wishing that carers spent more time with them. The carer is the only person many clients see all day.
Loneliness is a major problem among older people that can lead to depression and can have a serious effect on health. Many participants agreed that providing "companionship time" should be part of the home care package, but this is not generally seen as a productive and efficient use of resources.
The carers
There is also a dark side to today's market promotion of choice for care workers themselves. When profits and efficiency are prioritised, there is pressure to keep costs down.
Agency directors told us that unfortunately the tender process, whereby governments invite bids from home-care agencies, is a race to the bottom as price is an important criterion to secure a contract. Low costs have created a system characterised by casual and zero-hour contracts and low wages. The insecurity and low wages in the sector causes recruitment and retention problems.
Care managers complained about capacity problems and the difficulty in attracting people to the profession. Since care markets deliver efficiency at the expense of workers' pay and conditions, care workers tend to be drawn from vulnerable groups in society: traditionally women and increasingly migrants, who have few job opportunities. Carers in our research told us they do not feel valued or trusted and wished for better working conditions and a better funded sector.
Questioning choice
So what can we do? We need to question the extent to which choice should be the most important characteristic of a care model. Not because choice isn't intrinsically good, but because the current neoliberal environment, in which governments are seeking to disinvest themselves of care responsibilities, makes such an ideal unattainable.
In his well-known book Being Mortal: Medicine and What Matters in the End, the surgeon Atul Gawande asks us to think about what brings the most meaning and purpose to our lives and fill our days with those things, to the best of our ability, until we die. In principle, choice is a good thing, but it is only valid if we are able to choose among meaningful alternatives.
And maybe choice should not be the most important factor in elder care. Guaranteeing good quality care that includes companionship, independence and safety for all older people should be what matters the most. We need to think further about what we want good quality care to mean. Determining how people can be properly cared in a way that exploits no older person or carer is a profound challenge of our society.
Skeletal muscle tissue. Credit: University of Michigan Medical School
The old adage "use it or lose it" tells us: if you stop using your muscles, they'll shrink. Until recently, scientists thought this meant that nuclei—the cell control centers that build and maintain muscle fibers—are also lost to sloth.
28 jan 2019--But according to a review published inFrontiers in Physiology, modern lab techniques now allow us to see that nuclei gained during training persist even whenmuscle cellsshrink due to disuse or start to break down. These residual 'myonuclei' allow more and faster growth when muscles are retrained—suggesting that we can "bank"musclegrowth potential in our teens to prevent frailty in old age. It also suggests that athletes who cheat and grow their muscles with steroids may go undetected.
Our biggest cells are in our muscles, and they're all fused together
Syncytium. Sounds like a neo-noir comic book series. It's actually a special type of tissue in your body, where cells are fused together extra close—so close, that they behave a like a giant single cell.
"Heart, bone and even placenta are built on these networks of cells," says Lawrence Schwartz, Professor of Biology at the University of Massachusetts. "But by far our biggest cells—and biggest syncytia—are our muscles." Like the Sin City series, it appeared at first that everything was black and white with syncytia.
"Muscle growth is accompanied by the addition of new nuclei from stem cells to help meet the enhanced synthetic demands of larger muscle cells," explains Schwartz. "This led to the assumption that a given nucleus controls a defined volume of cytoplasm—so that when a muscle shrinks or 'atrophies' due to disuse or disease, the number of myonuclei decreases."
A muscle can gain nuclei, but never loses them
This assumption long seemed valid, with many researchers reporting the presence of disintegrating nuclei in muscle tissue during atrophy induced by inactivity, injury or paralysis. But modern cell-type-specific dyes and genetic markers have shown that the dying nuclei other researchers had detected were in fact inflammatory and other cells recruited to atrophic muscle.
The new evidence paints a very different picture of muscle syncytium.
"Two independent studies—one in rodents and the other in insects—have demonstrated that nuclei are not lost from atrophying muscle fibers, and even remain after muscle death has been initiated."
This suggest that once a nucleus has been acquired by a muscle fiber, it belongs to the muscle syncytium—probably for life. But Schwartz, for one, is unsurprised by the new findings.
"Muscles get damaged during extreme exercise, and often have to weather changes in food availability and other environmental factors that lead to atrophy. They wouldn't last very long giving up their nuclei in response to every one of these insults."
"Use it or lose it—until you use it again"
Since myonuclei are the synthetic engine of muscle fibers, retaining them should enable muscle size and strength to recover more quickly after one of these insults, and help to explain the phenomenon of 'muscle memory'.
"It is well documented in the field of exercise physiology that it is far easier to reacquire a certain level of muscle fitness through exercise than it was to achieve it the first place, even if there has been a long intervening period of detraining. In other word, the phrase "use it or lose it" is might be more accurately articulated as 'use it or lose it, until you work at it again'."
As such, the findings have important implications beyond understanding muscle biology.
"Informing public health policy, the discovery that myonuclei are retained indefinitely emphasizes the importance of exercise in early life. During adolescence muscle growth is enhanced by hormones, nutrition and a robust pool of stem cells, making it an ideal period for individuals to "bank" myonuclei that could be drawn upon to remain active in old age."
The findings also support frequent drugs testing for competitive athletes, with permanent bans for proven steroid cheats since they will benefit from the steroids long after their use has ended.
"Anabolic steroids produce a permanent increase in users' capacity for muscle development. In keeping with this, studies show that mice given testosterone acquire new myonuclei that persist long after the steroid use ends."
More information: Lawrence M. Schwartz, Skeletal Muscles Do Not Undergo Apoptosis During Either Atrophy or Programmed Cell Death-Revisiting the Myonuclear Domain Hypothesis, Frontiers in Physiology (2019). DOI: 10.3389/fphys.2018.01887
Cancer patients who experienced tachycardia within one year of cancer diagnosis had higher mortality rates up to 10 years after diagnosis of tachycardia, according to research presented at the American College of Cardiology's Advancing the Cardiovascular Care of the Oncology Patient conference. The course convenes in Washington on Jan. 25-27, 2019, bringing together top experts in both cardiology and oncology to review new and relevant science in this rapidly evolving field.
26 jan2019--Sinustachycardiais when theheartbeats faster than normal while at rest and may cause palpitations and discomfort. In addition tocancer treatment, it can also occur as a result of other conditions such as blood clots that cause heart attack or stroke, heart failure, fainting or sudden death. In the study, researchers defined sinus tachycardia as a heart rate over 100 beats per minute (bpm) diagnosed via electrocardiogram.
"Tachycardia is a secondary process to an underlying disease and reflective of significant multi-system organ stress and disease in cancer patients," said Mohamad Hemu, MD, a resident at Rush University Medical Center in Chicago and one of the study authors. "As a result, the most important initial step is to figure out what is causing the tachycardia. Reversible causes like dehydration and infections should be ruled out. Additionally, cardiopulmonary processes such as pulmonary embolism and other arrhythmias must be taken into consideration. Once these and all other causes of tachycardia are ruled out, then it is more likely that sinus tachycardia is a marker of poorer prognosis in these patients."
Researchers analyzed 622 cancer patients, including lung cancer, leukemia, lymphoma or multiple myeloma, from Rush University Medical Center from 2008 to 2016. The patients were 60.5 percent women, 76.4 percent white and an average age of 70 years; 69.4 percent of the cohort was classified with stage 4 cancer and 43 percent had lung cancer. The study included 50 patients with tachycardia and 572 control patients without tachycardia. Patients included in the study had tachycardia at more than three different clinic visits within one year of diagnosis, excluding history of pulmonary embolism, thyroid dysfunction, ejection fraction less than 50 percent, atrial fibrillation and a heart rate over 180 bpm.
Researchers assessed mortality for patients adjusting for age and other characteristics that were significantly different between a heart rate of more than 100 bpm and less than 100 bpm, characteristics included race, albumin, hemoglobin, beta blockers, kidney disease, use of blood thinners, and type of cancer. They also examined mortality adjusting for age and other clinically relevant characteristics, such as race, coronary artery disease, stroke, diabetes, smoking and radiation. Tachycardia was a significant predictor of overall mortality in both models. Of the patients who experienced tachycardia, 62 percent died within 10 years of diagnosis compared to 22.9 percent of the control group.
"We are continuously learning about the unique heart disease risks that face cancer patients, and our study shows that tachycardia is a strong prognosticator regardless of cancer type. That's why it is critically important to be co-managing both cancer and heart conditions to ensure patients receive the most effective treatment possible," said senior author Tochi M. Okwuosa, DO, director of the cardio-oncology program at Rush University Medical Center. "However, we need to do more studies to determine whether management of tachycardia in cancer patients will have any effect on survival."
Some people have an emotional reaction to many of their possessions, making it a challenge to get rid of anything. Credit: Shutterstock
Australia is the sixth-largest contributor of household waste per capita in the world. We spend more than $A10.5 billion annually on goods and services that are never or rarely used.
One-quarter of Australians admit to throwing away clothingafter just one use, while at the other end of the extreme, 5% of the population save unused items with such tenacity that their homes becomedangerously cluttered.
If unnecessary purchases come at such a profound cost, why do we make them?
Why do we buy so much stuff?
We acquire some possessions because of their perceived usefulness. We might buy a computer to complete work tasks, or a pressure cooker to make meal preparation easier.
But consumer goods often have a psychological value that outweighs their functional value. This can drive us to acquire and keep things we could do without.
Possessions can act as an extension of ourselves. They may remind us of our personal history, our connection to other people, and who we are or want to be. Wearing a uniform may convince us we are a different person. Keeping family photos may remind us that we are loved. A home library may reveal our appreciation for knowledge and enjoyment of reading.
Acquiring and holding onto possessions can bring us comfort and emotional security. But these feelings cloud our judgement about how useful the objects are and prompt us to hang onto things we haven't used in years.
When this behaviour crosses over into hoarding disorder, we may notice:
a persistent difficulty discarding possessions, regardless of their actual value
that this difficulty arises because we feel we need to save the items and/or avoid the distress associated with discarding them
that our home has become so cluttered we cannot use it as intended. We might not be able to sit on our sofa, cook in our kitchen, sleep in our bed, or park our car in the garage
the saving behaviour is impacting our quality of life. We might experience significant family strain or be embarrassed to invite others into our home. Our safety might be at risk, or we may have financial problems. These problems can contribute to workplace difficulties.
Will the KonMari method help?
According to Japanese tidying consultant Marie Kondo, "everyone who completes the KonMari Method has successfully kept their house in order".
But while some aspects of the KonMari method are consistent with existing evidence, others may be inadvisable, particularly for those with clinical hoarding problems.
Kondo suggests that before starting her process, people should visualise what they want their home to look like after decluttering. A similar clinical technique is used when treating hoarding disorder. Images of one's ideal home can act as a powerful amplifier for positive emotions, thereby increasing motivation to discard and organise.
Next, the KonMari Method involves organising by category rather than by location. Tidying should be done in a specific order. People should tackle clothing, books, paper, komono (kitchen, bathroom, garage, and miscellaneous), and then sentimental items.
Organising begins with placing every item within a category on the floor. This suggestion has an evidence base. Our research has shown people tend to discard more possessions when surrounded by clutter as opposed to being in a tidy environment.
However, organising and categorising possessions in any context is challenging for people with hoarding disorder.
Marie Kondo gives sage advice about whether to keep possessions we think we'll use in the future. A focus on future utility is a common thinking trap, as many saved items are never used. She encourages us to think about the true purpose of possessions: wearing the shirt or reading the book. If we aren't doing those things, we should give the item to someone who will.
Another Kondo suggestion is to thank our possessions before we discard them. This is to recognise that an item has served its purpose. She believes this process will facilitate letting go.
However, by thanking our items we might inadvertently increase their perceived humanness. Anthropomorphising inanimate objects increases the sentimental value and perceived utility of items, which increases object attachment.
One of Kondo's key messages is to discard any item that does not "spark joy".
But for someone with excessive emotional attachment to objects, focusing on one's emotional reaction may not be helpful. People who hoard things experience intense positive emotions in response to many of their possessions, so this may not help them declutter.
Think about how you get rid of things
Sustainability Victoria recently urged Netflix-inspired declutterers to reduce, reuse, and recycle rather than just tossing unwanted items into landfill.
Dumping everything into the op-shop or local charity bin is also problematic. Aussie charities are paying A$13 million a year to send unusable donations to landfill.
Ultimately, we need to make more thoughtful decisions about both acquiring and discarding possessions. We need to buy less, buy used, and pass our possessions on to someone else when we have stopped using them for their intended purpose.
Better use of standard assessment tools could help long-term care homes identify which new residents are at risk of hospitalization or death in the first 90 days of admission.
A study from the University of Waterloo and Schlegel-UW Research Institute for Aging has found that newly admitted residents' history of heart failure, as well as their score on the interRAI Changes to Health, End-Stage disease, Signs and Symptoms (CHESS) scale, can accurately determine which residents are most at risk.
24 jan 2019--"Being able to identify at-risk residents early can help long-term care homes ensure they have the necessary care and management strategies in place," said George Heckman, associate professor in the School of Public Health and Health Systems at Waterloo and Schlegel Research Chair in Geriatric Medicine. "These assessments can also help health providers determine which conditions require a trip to the hospital or which would be better managed as a hospice-type condition within the homes themselves."
He added, "It is not always advisable to take someone who is closing in on the end of life out of their home and put them into a hospital setting. These residents are very complex and frail, and not only might they not benefit from the hospital visit, the transition itself can lead to harms such as delirium and further disability."
The study examined data collected from 143,067 residents aged 65 years or older, admitted to long-term care homes in Ontario, Alberta and British Columbia, between 2010 and 2016.
It found that over 15 percent of residents had a history of heart failure. Residents with heart failure were more likely to be hospitalized than those without (18.9 percent versus 11.7 percent). Residents with a history of heart failure were also twice as likely to have higher mortality rates than those without, 14.4 per cent versus 7.6 per cent. At the one-year mark, residents with a history of heart failure had a mortality rate of more than 10 per cent higher, at 28.3 percent compared to 17.3 percent.
The CHESS scale identifies frailty and health instability, and is embedded within the MDS, an interRAI instrument mandated in almost all long-term care homes across Canada. Higher health instability, identified through higher CHESS scores, were associated with a greater risk of hospitalization and death at three months. Most notably, residents with high CHESS scores were more likely to die even when sent to hospital, regardless of whether they had heart failure or not. Mortality rates for the highest CHESS scores were 80 percent; most of these residents died in hospital.
"Together, these two factors independently identified this increased risk," Heckman said. "By making clinical assessments early, advance care planning discussions can take place. Furthermore, by ensuring that the entire long-term care home care team, including personal support workers, understand these risks, they can help monitor resident health and optimize their quality of life in the long-term care home."
The study, Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents with Heart Failure, appears in the Journal of the American Medical Directors Association.
More information: George A. Heckman et al, Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure, Journal of the American Medical Directors Association (2018). DOI: 10.1016/j.jamda.2018.10.031
Final verdict on finasteride: Safe, effective prevention for prostate cancer
by SWOG Cancer Research Network
Ian Thompson, MD, SWOG principal investigator of the Prostate Cancer Prevention Trial. Credit: SWOG Cancer Research Network
Finasteride, a generic hormone-blocking drug, was found to reduce the risk of prostate cancer by 25 percent in the landmark Prostate Cancer Prevention Trial (PCPT). Long- term data, published today in the New England Journal of Medicine, show that reduction in prostate cancer risk has continued and fewer than 100 men on the trial died from the disease.
23 jan 2019--SWOG Cancer Research Network, an internationalcancerclinical trials group funded by the National Cancer Institute (NCI), part of the National Institutes of Health, opened the PCPT for enrollment 25 years ago. The PCPT enrolled 18,882 men from 1993 to 1997, making it one of the largestprostate cancerclinical trials ever conducted. New results, which reported participant deaths over two decades, show thatfinasteridehas the lasting effect of reducingprostatecancer risk. Results also eliminate concerns over initial findings of a possible risk of more aggressive cancers with finasteride use.
"Finasteride is safe, inexpensive, and effective as a preventive strategy for prostate cancer," said Ian Thompson, Jr, MD, principal investigator of the PCPT for SWOG. "Doctors should share these results with men who get regular prostate-specific antigen tests that screen for the presence of prostate cancer. The drug will have its greatest effect in this group of men."
Thompson is chair of SWOG's genitourinary cancer committee and serves as president of CHRISTUS Santa Rosa Hospital—Medical Center in San Antonio, Texas and as emeritus professor at the University of Texas Health Science Center. Along with SWOG biostatisticians Catherine Tangen, DrPH, and Phyllis Goodman, MS, of Fred Hutchinson Cancer Research Center, Thompson sought to determine whether the increased number of high-grade cancers detected through the PCPT years ago would result in more prostate cancer deaths over time.
SWOG published the first PCPT results in 2003. Investigators reported a significant, positive result: finasteride reduced prostate cancer risk by 25 percent. But the study also cast a shadow on the drug, the first 5-alpha-reductase inhibitor which targets and blocks the action of androgens like testosterone and is commonly used to treat lower urinary tract problems in men and also male pattern baldness. The results showed that finasteride increased the number of high-grade prostate cancers—a finding that resulted in a drug label warning posted by the U.S. Food and Drug Administration. That warning persists to this day.
So is finasteride safe in the long run? Thompson, Tangen, and Goodman matched participants to the National Death Index, a centralized database of death record information managed by the U.S. Centers for Disease Control and Prevention. This analysis allowed the SWOG team to determine if a trial participant had died, and if so, the cause of death. With almost 300,000 person-years of follow-up and a median follow-up of 18.4 years, they found 42 deaths due to prostate cancer on the finasteride arm and 56 on the placebo arm. Thus, there was no statistically significant increased risk of prostate cancer death with finasteride.
In the NEJM letter, the team notes that a cheap, reliable prostate cancer prevention drug will have a big impact on public health. Due to a rise in screening for the disease, prostate cancer diagnoses are on the rise, with the American Cancer Society estimating that 164,690 American men would be diagnosed in 2018. While many of these cancers will be slow-growing, and not life-threatening, they are still often treated with surgery and radiation, resulting in common complications such as impotence and incontinence.
"There are significant negative consequences to patients' health and quality of life that can result from prostate cancer treatment, as well as to their finances and their peace of mind," Thompson said. "If we can save people from surgeries, and scores of examinations and tests, and spare them from living for years with fear, we should. The best-case scenario for patients is prevention, and this trial has found an inexpensive medication that gets us there."
Provided by SWOG Cancer Research Network
Sunday, January 20, 2019
Acupressure relieves long-term symptoms of breast cancer treatment, study finds
Credit: University of Michigan Rogel Cancer Center
A new study finds acupressure could be a low-cost, at-home solution to a suite of persistent side effects that linger after breast cancer treatment ends.Researchers from the University of Michigan Rogel Cancer Center reported in 2016 that acupressure helped reduce fatigue in breast cancer survivors.
20 jan 2019--In the new study, they looked at the impact of acupressure on symptoms that frequently accompany fatigue in this population: chronic pain, anxiety, depression and poor sleep. They found acupressure improved all of these symptoms compared with standard care.
In the study, breast cancer survivors who reported fatigue were randomized to one of two types of acupressure or to usual care, which included typical sleep-management techniques. The women were taught how to find and stimulate the acupressure points so that they could perform it at home once per day for six weeks.
Of the 424 survivors experiencing fatigue from the original study, researchers found half had at least one other symptom and 17 percent experienced all of them.
"It was actually unusual for a woman to have just fatigue. These long-term side effects are a big problem. For some women, they are significant barriers in their life," says study author Suzanna M. Zick, N.D., MPH, research associate professor of family medicine at Michigan Medicine.
The new analysis focused on the 288 patients who reported symptoms in addition to fatigue. They were asked weekly about fatigue, sleep quality, depressive symptoms, anxiety and pain. Results are published in JNCI Cancer Spectrum.
Acupressure is derived from traditional Chinese medicine. It involves applying pressure with fingers, thumbs or a device to specific points on the body. Researchers tested two types of acupressure: relaxing acupressure, which is traditionally used to treat insomnia, and stimulating acupressure, which is used to increase energy. The two techniques differ by which points on the body are stimulated.
After six weeks, relaxing acupressure was significantly better than stimulating acupressure or standard care at improving depressive symptoms and sleep. Both types of acupressure were more effective than standard care for improving anxiety, severity of pain and pain interfering with daily life.
"If you have a person who is fatigued and depressed, it would be the obvious conclusion to use relaxing acupressure. For anxiety or pain, either approach might work," Zick says.
The researchers also assessed whether improving one symptom helped improve other symptoms. They found that improving symptoms of depression improved sleep quality, accounting for about 20 percent of the improvement in fatigue.
"That means we don't know 80 percent of what's impacting fatigue. Depressive symptoms and sleep quality are a small part, and it makes sense. But clearly, there are other factors," Zick says.
She suspects these symptoms impact several different mechanistic pathways, possibly impacting the brain in multiple ways. This means treatments will likely need to be tailored and varied based on a woman's symptoms and other factors.
The researchers plan to gather more information using neuroimaging to understand the brain pathways involved. They're also currently conducting two clinical trials to look at using an acupressure app. Working with U-M College of Engineering experts, they developed a special wand to assist patients in performing acupressure. The wand helps ensure appropriate pressure and tracks how long patients use it.
Acupressure is an appealing option because it can be done at home with minimal negative effects. The study showed that women could learn to apply correct pressure to the appropriate points. Some women reported minor bruising at the acupressure sites.
More information: Suzanna Maria Zick et al, Impact of Self-Acupressure on Co-Occurring Symptoms in Cancer Survivors, JNCI Cancer Spectrum (2018). DOI: 10.1093/jncics/pky064
Fifty-year-olds who walk around with a secret seem to be more satisfied with their lives than seniors who share their secrets with others. Yet not everyone is happily old with a secret—invaders and worriers suffer from it. This is shown by researchers (Joyce Maas, Andreas Wismeijer and Marcus van Assen) from the Tilburg School of Social and Behavioral Sciences (TSB).
19 jan 2019--Their study examined the effects ofsecrecyonquality of lifein a sample consisting of older adults (>50 years; N=301). Three key components of secrecy were examined: possession of a secret, self-concealment, and cognitive preoccupation. The scientists distinguish between the tendency to conceal personal information (self-concealment) and the tendency to worry or ruminate about the secret (cognitive preoccupation), thereby enabling investigation of the effects of secrecy onqualityof life in detail.
Confirming previous findings in younger samples, they found a positive effect of possession of a secret on quality of life, after controlling for both self-concealment and cognitive preoccupation. This suggests that keeping secrets may have a positive association with quality of life in older adults as well, as long as they do not have the tendency to self-conceal and are not cognitively preoccupied with their secret.
The burden of a secret
Most people hold secrets. Secrets range from the most trivial events (such as not washing one's hands after visiting the toilet or one's caloric intake) to major secrets that have an enormous impact on the secret-keeper (such as having sexually abused your child). It is important to realize, however, that the way secrets affect us is idiosyncratic; an individual may be deeply affected by a secret that most of us would regard as irrelevant. That is, the burden of the secret is more important than its content.
Secrecy is a complex and multifaceted phenomenon. Maas, Wismeijer and Van Assen define secrecy as the conscious and active process of social selective information exchange that uses cognitive resources and can be experienced as an emotional burden with possible physical consequences.
Components of secrecy
Secrecy consists of several components that should be distinguished. First, it is essential to distinguish between the act of keeping a secret, or possession of a secret (secrecy as a state), and being a secretive person, or a self-concealer (secrecy as a trait).
The researchers show that next to the two already defined components of secrecy—possession of a secret and self-concealment—a third component has to be considered: cognitive preoccupation. The degree of cognitive preoccupation refers to the amount of time and energy the individual spends thinking and worrying about the secret. Cognitive preoccupation therefore affects the influence the secret may have in terms of behavioral and emotional outcomes. Each secret may pose a different cognitive burden for different people, which stresses the strong idiosyncratic nature of secrets.
The data were collected through an online questionnaire, called the Senioren Barometer (www.seniorenbarometer.nl), which is used to explore opinions about varying aspects of life in a population consisting of Dutch citizens aged 50 years and older. The large majority of participants (84.5 percent) indicated that they have had their secret for more than 10 years. A total of 680 people started this study's survey, of which 301 participants (44.26 percent) completed the full majority of the questionnaire.
More research is needed to understand how important the (emotional) content of secrets is in relation to quality of life. In this study, the scientists did not ask people about the content, its emotional valence, or the emotional distress surrounding their secret and they also did not assess whether the secret regards oneself or regards secret information of others. This is a limitation. However, the relevance of a secret for the secret-keeper is not as much determined by its exact content or whether it is someone's own secret or a secret from others. The toxicity of a secret lies primarily in the accompanying cognitive preoccupation it causes.
Content of a secret
Respondents would probably quit their participation when asked about the content of their secret. Furthermore, there is an almost infinite number of variations of secrets possible. For example, one can be unfaithful in very different ways and degrees. Hence, likely little is to be gained by exploring the correlations between topics of secrecy and the level of emotional distress or cognitive preoccupation. Notwithstanding, Maas, Wismeijer and Van Assen encourage future studies to assess the degree of emotional distress surrounding the secret as an emotional indicator of the secret.
The results suggest that disclosing secrets might not always be beneficial for quality of life, which is in line with previous studies that investigated younger samples. The findings also indicate that it is important to distinguish between self-concealment and cognitive preoccupation. Self-concealment and cognitive preoccupation seem to affect self-reported quality of life negatively, whereas sole possession of a secret has a positive effect on self-reported quality of life.
More information: Joyce Maas et al. Associations Between Secret-Keeping and Quality of Life in Older Adults, The International Journal of Aging and Human Development (2018). DOI: 10.1177/0091415018758447
After decades in which the number of people choosing to cut out meat from their diet has steadily increased, 2019 is set to be the year the world changes the way that it eats. Or at least, that's the ambitious aim of a major campaign under the umbrella of an organisation simply called EAT. The core message is to discourage meat and dairy, seen as part of an "over-consumption of protein" – and specifically to target consumption of beef.
16 jan 2019--The push comes at a time when consumer behaviour already seems to be shifting. In the three years following 2014, according to research firm GlobalData, there was asix-fold increasein people identifying as vegans in the US, a huge rise – albeit from a very low base. It's a similar story in the UK, where the number of vegans has increased by 350%, compared to a decade ago, at least according toresearchcommissioned by the Vegan Society.
And across Asia, many governments are promoting plant-based diets. New government dietary guidelines in China, for example, call on the nation's 1.3 billion people to reduce their meat consumption by 50%. Flexitarianism, a mostly plant-based diet with the occasional inclusion of meat, is also on the rise.
'Conquering the world'
Big food companies have noticed the shift and have jumped onto the vegan wagon, the most prominent ones tightly associated with EAT through its FReSH program. Unilever, for instance, is a very vocal partner. Recently, the multinational announced it was acquiring a meat-substitute company called "The Vegetarian Butcher". It described the acquisition as part of a strategy to expand "into plant-based foods that are healthier and have a lower environmental impact". Currently, Unilever sells just under 700 products under the "V-label" in Europe.
"The Vegetarian Butcher" was conceived in 2007 by farmer Jaap Kortweg, chef Paul Brom and marketer Niko Koffeman, a Dutch Seventh-Day Adventist who is vegetarian for religious and ideological reasons. Koffeman is also at the origin of the Partij voor de Dieren, a political party advocating for animal rights in The Netherlands. Like EAT, the Vegetarian Butcher seeks to "conquer the world". Its mission is "to make plant-based 'meat' the standard" – and the alliance with Unilever paves the way.
The dietary shift would require a remarkable turn around in consumer habits. Of course, there is much that both can and should be done to improve the way that we eat, both in terms of consumer health and environmental impact. And yes, a key plank of the strategy will be shifting consumers away from beef. But the extreme vision of some of the campaign's backers is somewhat startling. Former UN official Christiana Figueres, for example, thinks that anyone who wants a steak should be banished. "How about restaurants in ten to 15 years start treating carnivores the same way that smokers are treated?", Figueres suggested during a recent conference. "If they want to eat meat, they can do it outside the restaurant."
This statement is typical of what social scientists call "bootlegger and Baptist" coalitions, in which groups with very different ideas – and values – seek to rally under a common banner. And this is what worries us. The campaign to "conquer the world" can be rather simplistic and one-sided, and we think this has some dangerous implications.
A skewed view?
EAT, for example, describes itself as a science-based global platform for food system transformation. It has partnered with Oxford and Harvard universities, as well as with the medical journal The Lancet. But we have concerns that some of the science behind the campaign and the policy is partial and misleading.
It is long on things that we all know are bad, such as some excesses of factory farming and rainforest clearing to raise beef cattle. But it is mostly silent on such things as the nutritional assets of animal products, especially for children in rural African settings, and the sustainability benefits of livestock in areas as diverse as sub-Saharan Africa to traditional European upland valleys. And, if vegetarian diets show that traditional markers for heart disease, such as "total cholesterol", are usually improved, this is not the case for the more predictive (and thus valuable) markers such as the triglyceride/HDL (or "good" cholesterol) ratio, which even tend to deteriorate.
More importantly, most nutritional "evidence" originates from epidemiology, which is not able to show causation but only statistical correlations. Not only are the associations weak, the research is generally confounded by lifestyle and other dietary factors. Not to mention that part of the epidemiological data, such as the PURE study, show that the consumption of meat and dairy can be associated with less – rather than more – chronic disease.
Not so simple
In any case, even if plant-based diets can in theory provide the nutrients people need, as long as they are supplemented with critical micronutrients (such as vitamin B12 and certain long-chain fatty acids), that is not to say that in practice shifting people towards them will not result in a great many people following poorly balanced diets and suffering ill health in consequence. And when a vegan diet fails, for instance due to poor supplementation, it may result in serious physical and cognitive impairment and failure to thrive.
The approach seems particularly risky during pregnancy and for the very young, as also documented by a long list of clinical case reports in medical literature. Animal products are exceptionally nutrient-dense dietary sources – removing them from the diet compromises metabolic robustness. Without sufficient insight in the complexities of nutrition and human metabolism, it is easy to overlook important issues as the proportion of nutrients that can be absorbed from the diet, nutrient interactions and protein quality.
The same debate needs to be had when it comes to consideration of the environmental question. Too fast or radical a shift towards "plant-based" diets risks losing realistic and achievable goals, such as increasing the benefits of natural grazing and embracing farming techniques that reduce the wasteful feeding of crops to animals, lower climate impact and enhance biodoversity.
A shift towards a radically plant-based planetary diet loses the many benefits of livestock – including its deployment on land that is not suitable for crop production, its contribution to livelihoods, and the many other benefits that animals provide. It mistakenly assumes that land use can be swiftly altered and ignores the potential for of farming techniques that may even have mitigating effects.
Sustainable, ecological and harmonious animal production really should be part of the solution of the "world food problem", considered from both the nutritional and environmental scenarios. The Earth is an extraordinarily complex ecosystem – any one-size-fits-all solution risks wreaking havoc with it.
