Many Americans have used telehealth and would turn to it for mental health care, a new online poll shows.
31 may 20221--Conducted by the American Psychological Association (APA) from March 26 to April 5, the poll found that 38% had used telehealth to consult with a health professional, up from 31% last fall.
In all, 82% have used it since the start of the pandemic, the poll found. Most consultations were done via video (69%). Thirty-eight percent of respondents said they had used phone calls only.
"The quick pivot to providing telehealth services at the start of the pandemic was vital to providing continued access to care, and this poll shows the important potential role for telehealth going forward," said APA President Dr. Vivian Pender.
"Telepsychiatry especially helps those facing barriers such as lack of transportation, the inability to take time off work for appointments, or family responsibilities," she added in an APA news release.
The poll found that confidence in telehealth is growing.
Respondents were slightly more likely this year than last to say telehealth can provide the same quality care as in-person services (45% versus 40%), and that they would use telehealth for mental health services (59% versus 49%).
In the new survey, 66% of 18- to 29-year-olds said they would do so, compared to 36% of seniors.
Similar percentages (between 58% and 61% each) of Black respondents, Hispanic respondents and white respondents said they would use telehealth for mental health care.
Overall, about 43% of respondents said they want to continue using telehealth when the pandemic is over and 34% said they'd prefer it to an office visit—up from 31% in 2020. Acceptance was highest among 18- to 44-year-olds, at 45%.
The survey also found that 57% of respondents would consider using a support line or online chat when struggling with personal difficulty and mental anxiety, and 7% said they had already done so. Only 21% would not consider it.
The online poll has a margin of error of plus or minus 3.1 percentage points.
More information: The U.S. Department of Health and Human Services has more on telehealth.
Provided by American Psychological Association
Tuesday, May 25, 2021
Telomere length, a longevity measure, may be determined early in life
Human chromosomes (grey) capped by telomeres (white). Credit: PD-NASA; PD-USGOV-NASA
Telomeres are protective caps on DNA that shorten as we grow older. Now, one of the first studies to examine telomere length (TL) in childhood finds that the initial setting of TL during prenatal development and in the first years of life may determine one's TL throughout childhood and potentially even into adulthood or older age. The study also finds that TL decreases most rapidly from birth to age 3, followed by a period of maintenance into the pre-puberty period, although it was sometimes seen to lengthen.
25 may 2021--The study, which followed children from birth to age 9, was led by researchers at the Columbia Center for Children's Environmental Health at Columbia University Mailman School of Public Health. Results appear in the journalPsychoneuroendocrinology.
The researchers discovered that a mother's TL is predictive of newborn TL and tracks with her child's TL through pre-adolescence. While all telomeres are expected to shorten with age, the reasons why some children have telomeres that shorten faster are unknown, one explanation may be that telomeres are susceptible to environmental pollutants. It is also unknown why some children had telomeres that lengthened across the study period though it is notable that this phenomenon has also been observed in other studies.
"Given the importance of telomere length in cellular health and aging, it is critical to understand the dynamics of telomeres in childhood," says senior author Julie Herbstman, Ph.D., director of CCCEH and associate professor of environmental health science at Columbia Mailman School. "The rapid rate of telomere attrition between birth and age 3 years may render telomeres particularly susceptible to environmental influences during this developmental window, potentially influencing life-long health and longevity."
In the new study, researchers used polymerase chain reaction to measure TL in white blood cells isolated from cord blood and blood collected at ages 3, 5, 7, and 9, from 224 children. They also measured maternal TL at delivery in a subset of mothers.
The researchers say more research is needed to understand the biological mechanisms driving variability in the rate of TL change during the first years of life, as well as modifiable environmental factors that contribute to shifts in the rate of attrition.
More information: Whitney Cowell et al, Telomere dynamics across the early life course: Findings from a longitudinal study in children, Psychoneuroendocrinology (2021). DOI: 10.1016/j.psyneuen.2021.105270
Provided by Columbia University's Mailman School of Public Health
No link between milk and increased cholesterol according to new study of 2 million people
Regular consumption of milk is not associated with increased levels of cholesterol, according to new research.
25 may 2021--A study published in theInternational Journal of Obesitylooked at three large population studies and found that people who regularly drank high amounts of milk had lower levels of both good and bad cholesterol, although their BMI levels were higher than non-milk drinkers. Further analysis of other large studies also suggests that those who regularly consumed milk had a 14% lower risk of coronary heartdisease.
The team of researchers took a genetic approach to milk consumption by looking at a variation in the lactase gene associated with digestion of milk sugars known as lactose.
The study identified that having the genetic variation where people can digest lactose was a good way for identifying people who consumed higher levels of milk.
Prof Vimal Karani, Professor of Nutrigenetics and Nutrigenomics at the University of Reading said:
"We found that among participants with a genetic variation that we associated with higher milk intake, they had higher BMI, body fat, but importantly had lower levels of good and bad cholesterol. We also found that those with the genetic variation had a significantly lower risk of coronary heart disease. All of this suggests that reducing the intake of milk might not be necessary for preventing cardiovascular diseases."
The new research was conducted following several contradictory studies that have previously investigated the causal link between higher dairy intake and cardiometabolic diseases such as obesity and diabetes. To account for inconsistencies in sampling size, ethnicity and other factors, the team conducted a meta-analysis of data in up to 1.9 million people and used the genetic approach to avoid confounding.
Even though the UK biobank data showed that those with the lactase genetic variation had 11% lower risk of type 2 diabetes, the study did not suggest that there is any strong evidence for a link between higher milk intake and increased likelihood of diabetes or its related traits such as glucose and inflammatory biomarkers.
Professor Karani said:
"The study certainly shows that milk consumption is not a significant issue for cardiovascular disease risk even though there was a small rise in BMI and body fat among milk drinkers. What we do note in the study is that it remains unclear whether it is the fat content in dairy products that is contributing to the lower cholesterol levels or it is due to an unknown 'milk factor'".
More information: Karani Santhanakrishnan Vimaleswaran et al, Evidence for a causal association between milk intake and cardiometabolic disease outcomes using a two-sample Mendelian Randomization analysis in up to 1,904,220 individuals, International Journal of Obesity (2021). DOI: 10.1038/s41366-021-00841-2
Provided by University of Reading
Music may benefit older adults with cognitive impairment
Active music-making can provide cognitive benefits to older adults with mild cognitive impairment or dementia, according to an analysis of all relevant studies. The analysis, which is published in the Journal of the American Geriatrics Society, also found that music may help improve their quality of life and mood.
25 may 2021--The analysis included nine studies with a total of 495 participants. The authors noted that music-based interventions could potentially provide millions of older adults with critical support for their cognitive, emotional, and social well-being.
"We are excited to see these results because participating in music, like singing in a choir or playing in a drum circle, is a safe, engaging activity that our research demonstrates can support cognition at a critical time for older adults facing cognitive decline," said lead author Jennie L. Dorris, MM, of the University of Pittsburgh.
More information: Jennie L. Dorris et al. Effects of music participation for mild cognitive impairment and dementia: A systematic review and meta-analysis. Journal of the American Geriatrics SocietyDOI: 10.1111/jgs.17208
Provided by Wiley
Pulsations driving the brain's cleaning system completely different in patients with Alzheimer's disease
by University of Oulu
A new method was developed to track individual heart impulses within the brain. Biggest changes in Alzheimer’s disease patients follow the vascular tree structure of the brain. Depending on the brain region, pulses propagate faster (red arrow), slower (blue arrow), or even reversed (green arrow) in brains of Alzheimer’s disease patients. Credit: Zalán Rajna, University of Oulu
Research into Alzheimer's disease took another major leap forward as researchers at the University of Oulu, Finland, succeeded in describing in detail how the pulsations of the cerebral arteries maintaining the brain's cleaning system differ in Alzheimer's disease patients. Significant pulsation changes were found especially in the areas of the brain associated with memory functions.
25 may 2021--"Both the propagation speed of the pulse waves and their direction differ in Alzheimer's patients in comparison to healthy controls. In certain parts of the brain, including the hippocampus andparietal lobes, the direction of propagation of pulse waves was reversed compared to healthy individuals. These parts of the brain play a major role in memory functions," says Zalán Rajna, head researcher of the study and a member of the Oulu Functional Neuroimaging and Biosignal Analysis research groups at the University of Oulu.
The purpose of the glymphatic system is to clean the brain of waste material. In humans, the system activates during deep sleep. If disturbances occur in the cleaning system, waste material starts to accumulate in the brain, leading to premature brain degeneration. The driving force of the glymphatic system is created as a result of the heartbeat, respiratory movement and pulsation of the blood vessels. Pulsations are measured using rapid functional magnetic resonance imaging.
In Alzheimer's disease, two kinds of waste materials in particular are accumulated in the brain, beta-amyloids and tau proteins, and these cause the brain to deteriorate, weakening memory functions and data processing abilities. Research has shown that in Alzheimer's disease, harmful amyloid plaque is formed not only around the brain tissue but also around the cerebral arteries, stiffening them.
"We observed that upon arrival, the pulse propagation is abnormal in Alzheimer's patients: too fast in small vessels and too slow in large ones," Rajna says.
As of yet, it remains uncertain whether the accumulation of amyloid plaque in the brain of an Alzheimer's patient is caused by abnormal pulsation or whether the plaque accumulated around the arteries cause the abnormal pulsation.
The glymphatic system was first described in 2012 by the research group of Danish professor Maiken Nedergaard, after which it has been a subject of active research. Last year, the Oulu Functional Neuroimaging research group published a new method for the magnetic resonance imaging of the functioning of the glymphatic system and the changes within. Already at the time, it was observed that the cerebral vascular pulsations of Alzheimer's patients differed from those of healthy controls.
The currently published research delves deeper and describes in great detail the abnormalities of individual pulse waves in the brains of Alzheimer's patients. This finding is crucial for understanding the dynamic brain mechanisms leading to Alzheimer's disease and, in the long term, for the prevention and treatment of the disease.
It is estimated that there are 200,000 dementia patients in Finland. Approximately 70% of them suffer from Alzheimer's disease. Although there is currently no treatment available for Alzheimer's disease and its progress cannot be stopped, the disease can be prevented by maintaining good cardiovascular health and ensuring sufficient, high-quality sleep.
More information: Zalán Rajna et al. Cardiovascular brain impulses in Alzheimer's disease, Brain (2021). DOI: 10.1093/brain/awab144
Provided by University of Oulu
Sunday, May 16, 2021
What is repetitive transcranial magnetic stimulation and how does it actually work?
A line in this week's federal budget allocating A$288.5 million to repetitive transcranial magnetic stimulation (rTMS) therapy might pass most people by.
16 may 2021--This is a brain stimulation technique that's been used to treat conditions such asdepressionfor almost ten years in Australia, but which has not been funded through Medicare and so has had very limited availability.
Soon, it will be available on the Medicare Benefits Schedule for people with depression that hasn't responded to other treatments, funding I've led applications for since 2012, and treatment I provide.
While we know rTMS can work, and is generally safe, we're not entirely sure how it works. Here's what the evidence says so far.
What is it?
In rTMS, a machine produces and applies a highly targeted, pulsed magnetic field to a specific area of the brain, towards the front, known as the prefrontal cortex. This is an area we believe isn't working normally in people with depression.
During treatment, an electrical current passes through an electromagnetic coil held near the scalp to stimulate the nerve cells.
The person sits in a comfortable chair, awake and alert during treatment. It's quite different from electroconvulsive therapy (ECT, the modern version of shock treatment). Unlike ECT, rTMS does not involve producing a seizure and does not require the person to be asleep and under an anesthetic.
How does it work?
We know repeated rTMS stimulation, over the course of weeks, increases nerve activity in the area under the coil. It also changes the strength of connections between different areas of the brain. This is thought to help restore the normal interaction between brain regions, although these ideas are still theoretical and definitely not proven.
Antidepressant medications may act in similar ways, but less directly. The chemicals they affect can influence brain function quite widely:tuning activityor connectivity in brain circuits up or down. rTMS probably does this more directly. By directly making nerve cells fire we can directly change their activity levels. These more direct actions could possibly explain why rTMS may work in some people who have not responded to medication.
Trials show rTMS treatments result in a gradual improvement in depression. A person's mood will slowly lift, usually over the course of several weeks, they will become more interested in things, sleep better, be more motivated and have more energy.
In people who respond, depression can go away for several months up to many years. If depression returns, most people will get better again with further treatment.
People are awake and alert during rTMS treatment. Author provided
Does it work? Is it safe?
Evidence collected over the past 25 years and collated shows rTMS is a safe and effective treatment for people with treatment-resistant depression. These are the 30-40% of people diagnosed with depression who have tried antidepressant medications, usually two or more, and haven't seen any or sufficient relief. They have persistent, ongoing depression with major effects on their ability to function, work and lead normal family lives.
The treatment is usually well-tolerated. Although some people experience a strong tapping sensation on the scalp, scalp pain during treatment, or a headache afterwards.
Studies have also compared the effectiveness of rTMS with other treatments, such as different medications. This study, written by authors from the pharmaceutical industry, only reports the benefits of medications in the study abstract but rTMS was clearly the superior intervention on outcomes across the full analysis.
Finally, research including more than 5,000 people having the treatment shows it provides meaningful and valuable clinical benefits in the real world, outside clinical trials.
This treatment isn't perfect
Like many medical treatments, rTMS is not perfect. We are trying to develop ways to improve outcomes by better individualizing the treatment. For example, we are trying to better understand the exact spot to target in the brain and how to match the frequency of stimulation to an individual person's pattern of brain activity.
We're also trying to get around one of the biggest issues: its relative inefficiency.
A course of rTMS typically involves going to a clinic for a 30-minute treatment session, five days a week, for up to six weeks, which is time-consuming and requires a significant commitment. We are working to make the application less time-consuming and potentially shorten the duration of therapy.
One of the most significant implications of the government funding of rTMS therapy through Medicare is that it will become more widely available, including in outer suburban and rural areas.
The funding will take some months to be implemented but once available will be accessible by a referral from a GP or psychiatrist.
Provided by The Conversation
Saturday, May 15, 2021
Study finds that obesity drug semaglutide supresses appetite, food cravings and energy intake
by European Association for the Study of Obesity
Credit: Unsplash/CC0 Public Domain
New research presented at this year's European Congress on Obesity (held online, 10-13 May) shows that the obesity drug semaglutide reduces appetite, food cravings and energy intake in people given a meal where they could eat as much as they liked. The study is by Dr. Dorthe Skovgaard, Novo Nordisk A/S (the manufacturer of the drug), Søborg, Denmark, and colleagues.
15 may 2021--Semaglutide, in the glucagon-like peptide-1 (GLP-1) analogue drug class, is currently available at the dose of 1.0 mg injected once weekly for the treatment of type 2 diabetes and is under development for chronic weight management at the dose 2.4 mg injected once weekly. It is currently not approved for obesity anywhere in the world, however new drug applications are under review by the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), and other health agencies across the world.
The STEP trials, that have been published in various journals over the past year, have established the efficacy and safety of semaglutide 2.4 mg to treat people living with obesity. Semaglutide lowers body weight by reducing appetite and hunger, increasing satiety, reducing food cravings, altering food preferences and reducing energy intake. GLP-1 receptor agonists can lead to delays in gastric emptying, which may be important for the uptake of other drugs.This trial investigated the effect of semaglutide 2.4 mg on gastric emptying, energy intake, appetite and control of eating in subjects with obesity.
Adults aged 18-65 years, with a body mass index (BMI) 30-45 kg/m² (with various stages of obesity) and without type 2 diabetes, were randomised in a double-blind, parallel-group trial to treatment with semaglutide 2.4 mg (dose gradually escalated: 0.25, 0.5, 1.0 and 1.7 mg for 4 weeks each; 2.4 mg for 5 weeks) or placebo. The dose of semaglutide was gradually scaled up, as is standard to improve gastrointestinal tolerability.
Gastric emptying (using a standard test called the paracetamol absorption test, 1.5 g paracetamol given with a standardised breakfast) was assessed during in-house visits at baseline and week 20.
Postprandial (after-meal) appetite was evaluated using standard tests called visual analogue scales pre-meal and following a standardised breakfast, followed by assessment of energy intake during a lunch in which participants could freely choose how much they ate (an 'ad libitum' lunch). Control of eating and food cravings were evaluated by the Control of Eating Questionnaire (CoEQ) - a questionnaire to assess the severity and type of food cravings an individual experiences over the previous 7 days. Safety was also evaluated.
In total, 72 subjects were randomised (44 males, mean age 42.8 years, BMI 34.4 kg/m²); 70 completed the study. There was no evidence of delayed gastric emptying at week 20, as assessed indirectly via paracetamol absorption. Mean energy intake during the ad libitum lunch test meal at week 20 was 35% lower with semaglutide 2.4 mg vs placebo (1736 vs 2676 kJ); estimated treatment difference 940 kJ, both statistically significant findings.
The overall appetite score showed significant reduction in appetite with semaglutide 2.4 mg vs placebo; individual appetite components showed significant reductions in 'hunger' and 'prospective food consumption' and increases for 'fullness' and 'satiety'. In general, CoEQ indicated fewer and weaker food cravings, notably reduced cravings for savoury foods and better control of eating with semaglutide 2.4 mg vs placebo. All results detailed here were statistically significant. No new safety signals were seen.
The authors conclude: "In subjects with obesity, semaglutide 2.4 mg suppressed appetite and reduced the frequency and strength of food cravings. Energy intake during a lunch at week 20 in which participants were free to eat as much as they wanted was 35% lower with semaglutide 2.4 mg vs placebo. There was also no clinically relevant effect on gastric emptying with semaglutide 2.4 mg at steady state, measured by paracetamol uptake."
They add: "Control of appetite and reduced frequency and strength of food cravings are important for weight management in people living in obesity, especially in a society which promotes unhealthy lifestyles and overeating."
More information: Martin Friedrichsen et al. The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity, Diabetes, Obesity and Metabolism (2020). DOI: 10.1111/dom.14280
Provided by European Association for the Study of Obesity
Saturday, May 08, 2021
Does eating a Mediterranean diet protect against memory loss and dementia?
Eating a Mediterranean diet that is rich in fish, vegetables and olive oil may protect your brain from protein build up and shrinkage that can lead to Alzheimer's disease, according to a new study. The research is published in the May 5, 2021, online issue of Neurology.
08 may 2021--The study looked at abnormal proteins called amyloid and tau. Amyloid is a protein that forms into plaques, while tau is a protein that forms into tangles. Both are found in the brains of people with Alzheimer's disease but may also be found in the brains of older people with normal cognition.
The Mediterranean diet includes high intake of vegetables, legumes, fruits, cereals, fish and monounsaturated fatty acids such as olive oil, and low intake of saturated fatty acids, dairy products and meat.
"Our study suggests that eating a diet that's high in unsaturated fats, fish, fruits and vegetables, and low in dairy and red meat may actually protect your brain from the protein build-up that can lead to memory loss and dementia," said study author Tommaso Ballarini, Ph.D., of the German Center for Neurodegenerative Diseases (DZNE) in Bonn, Germany. "These results add to the body of evidence that show what you eat may influence your memory skills later on."
The study looked at 512 people. Of those, 169 were cognitively normal, while 343 were identified as being at higher risk of developing Alzheimer's disease.
Researchers looked at how closely people followed the Mediterranean diet based on their answers to a questionnaire asking how much they ate of 148 items over the previous month. People who often ate healthy foods typical of the Mediterranean diet, like fish, vegetables and fruit, and only occasionally ate foods non-typical of the Mediterranean diet, like red meat, received the highest scores, for a maximum score of nine.
Cognitive skills were assessed with an extensive test set for Alzheimer's disease progression that looked at five different functions, including language, memory and executive function. All the participants had brain scans to determine their brain volume. In addition, the spinal fluid of 226 was tested for amyloid and tau protein biomarkers.
Researchers then looked at how closely someone followed the Mediterranean diet, and the relationship to both their brain volume, tau and amyloid biomarkers, and cognitive skills.
After adjusting for factors like age, sex and education, researchers found that in the area of the brain most closely associated with Alzheimer's disease, every point lower people scored on the Mediterranean diet scale was equal to almost one year of brain aging.
When looking at amyloid and tau in people's spinal fluid, those who did not follow the diet closely had higher levels of biomarkers of amyloid and tau pathology than those who did.
When it came to a test of memory, people who did not follow the diet closely scored worse than those who did.
"More research is needed to show the mechanism by which a Mediterranean diet protects the brain from protein build up and loss of brain function, but findings suggest that people may reduce their risk for developing Alzheimer's by incorporating more elements of the Mediterranean diet into their daily diets," Ballarini said.
A limitation of the study is the fact that people's diets were self-reported in the questionnaire. People may have made errors recalling exactly what and how much they ate.
More information: Mediterranean Diet, Alzheimer Disease Biomarkers and Brain Atrophy in Old Age, Ballarini et al., Neurology (May 2021), DOI: doi.org/10.1212/WNL.0000000000012067
Provided by American Academy of Neurology
Wednesday, May 05, 2021
USPSTF: Evidence lacking for use of vitamins for CVD, cancer prevention
05 may 2021--The U.S. Preventive Services Task Force (USPSTF) concludes that evidence is currently insufficient for determining the benefits and harms of most single or paired and multivitamin supplements but recommends against use of beta-carotene and vitamin E for prevention of cardiovascular disease (CVD) and cancer. These findings form the basis of a draft recommendation statement published online May 4.
Elizabeth A. O'Connor, Ph.D., from the Kaiser Permanente Evidence-Based Practice Center in Portland, Oregon, and colleagues examined the benefits and harms of vitamin and mineral supplementation for preventing CVD and cancer among healthy adults. Data were included from 78 studies, with 694,084 participants. The researchers found that compared with placebo, vitamin D, with or without calcium, was associated with alower riskfor all-cause mortality (odds ratio, 0.94; 95 percent confidence interval, 0.89 to 1.00) and cancer mortality (odds ratio, 0.88; 95 percent confidence interval, 0.79 to 0.97). Beta-carotene, with or without vitamin A, was associated with an increased risk for cardiovascular mortality and lung cancer (odds ratios [95 percent confidence intervals], 1.10 [1.02 to 1.19] and 1.20 [1.01 to 1.42]). Clear evidence suggested that vitamin E offered no benefit for all-cause mortality, CVD events, and cancer. Multivitamins, vitamin A, vitamin C, calcium, and selenium also had no effect on all-cause mortality, CVD, or cancer.
Based on these findings, the USPSTF recommends against use of beta-carotene or vitamin E supplements for prevention of CVD or cancer (D recommendation). With respect to other multivitamin supplements and single or paired nutrient supplements, the current evidence is insufficient for assessing the balance of benefits and harms of use for the prevention of CVD or cancer (I statement).
The draft recommendation statement and evidence review have been posted for public comment. Comments can be submitted from May 4 through June 1, 2021.
People have become accustomed to having their temperature checked during the pandemic because fever is a key indicator of COVID-19. A new commentary by Washington State University College of Nursing Associate Professor Catherine Van Son and Clinical Assistant Professor Deborah Eti proposes that taking a temperature is a less useful indicator of infection in older adults and that a pulse oximeter be used instead.
The paper, published in Frontiers in Medicine, said baseline temperatures are lower in older adults. A lower baseline temperature means a fever may be overlooked using the CDC's standard definition of 100.4 degrees Fahrenheit or greater.
"In fact," the paper says, "upwards of 30% of older adults with serious infections show mild or no fever."
Other common signs of COVID may also be dismissed and attributed to aging, such as fatigue, body aches and loss of taste or smell.
Additionally, some COVID-19 patients have no visible signs of having low oxygen levels, such as shortness of breath, yet have oxygen saturation below 90%. Such asymptomatic hypoxia can be associated with extremely poor outcomes.
Van Son and Eti say inexpensive, portable pulse oximeters should be considered for wide use in COVID-19 screenings of older adults because the devices can detect changes in oxygen saturation without other indications of infection.
"Detecting (asymptomatic hypoxia) is critical for the prevention of infection progression and initiating treatment," they wrote. "Earlier interventions could help patients avoid highly invasive procedures (i.e., intubation) and improve the allocation of scarce healthcare resources."
More information: Catherine R. Van Son et al, Screening for COVID-19 in Older Adults: Pulse Oximeter vs. Temperature, Frontiers in Medicine (2021). DOI: 10.3389/fmed.2021.660886
Provided by Washington State University
International task force determines current Parkinson's disease subtyping may not fit all patients
Immunohistochemistry for alpha-synuclein showing positive staining (brown) of an intraneural Lewy-body in the Substantia nigra in Parkinson's disease. Credit: Wikipedia
The clinical presentation and underlying biology of Parkinson's disease (PD) varies significantly, but attempts to cluster cases into a limited number of subtypes have questionable applicability and relevance, reports the international Task Force for PD Subtypes in the Journal of Parkinson's Disease. Their systematic review of studies reporting a subtyping system for the first time concludes that new approaches are needed that acknowledge the individual nature of the disease and are more aligned with personalized medicine.
03 may 2021--In 2018, the International Parkinson's Disease and Movement Disorders Society (MDS) convened the Task Force for PD Subtypes to critically appraise available PD subtyping studies and to provide guidance for the design and conduct of future studies.
"Subtyping of PD attempts to explain the disease mechanisms, its natural history and, more importantly, to inform therapeutic development, which has justified a large number of studies by different groups over the last 30 years. However, the impact of such efforts remains unclear. They have failed to substantially change the understanding of PD or clinical care thus far. Our current review critically appraises the state of the art in PD subtyping," explained lead authors Tiago A. Mestre, MD, Ph.D., Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, and Connie Marras, MD, Ph.D., Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network.
The Task Force conducted a systematic review of PD subtypes presented in 38 studies divided into two publication periods (1980-2014 and 2015-2019), which yielded a balanced distribution of included studies into a more recent group representing the current state of the field and older studies to test for temporal trends. They also compared two subtyping methodologic approaches (data-driven versus hypothesis-driven) and critically assessed the methodologic quality and clinical applicability of each study.
The clinical and biological signature of PD may be unique to the individual, rendering PD resistant to meaningful cluster solutions. This review revealed that subtyping studies undertaken to date have significant methodologic shortcomings, and most had questionable clinical applicability and unknown biological relevance. Twenty-six of the studies were cross-sectional and used a data-driven approach. Nonclinical biomarkers were rarely used. Motor characteristics were most commonly reported to differentiate PD subtypes. Most of the studies did not achieve high ratings across a Methodologic Quality Checklist. In a Clinical Applicability Checklist, the clinical importance of differences between subtypes, potential treatment implications, and applicability to the general population were rated poorly, and subtype stability over time and prognostic value were largely unknown.
Quality ratings revealed clear areas for improvement. More extensive use of longitudinal data was regarded as critical for gaining a better understanding of the stability of proposed subtypes and their prognostic value. Although historically, there is a paucity of longitudinal studies, the Task Force found that the use of longitudinal data to define or evaluate subtypes was more common in the last five years due to the public availability of large datasets. They noted that only one study had used longitudinal profiling as the basis for defining subtypes, incorporating data on the evolution of clinical or biological features across time into the definition of subtypes.
The Task Force proposed that serial cluster analyses could provide data about the stability of proposed subtypes and the influence of disease duration on their characteristics. Such approaches could provide additional prognostic value, using information about the early evolution of disease to inform later prognosis or underlying biology.
Contemporary medicine is increasingly focusing on personalized treatment, which extends to patients with PD, noted the Task Force. Subtyping places individuals in groups with similar but not identical features. While this may represent an important step toward identifying individuals who can respond preferentially to certain treatments, placing individuals within a group will inevitably fall short of the truly "personal" goal.
Many of the recommendations in this review could apply to future studies in which the unit of measure is the individual's disease fingerprint rather than the group phenotype, acknowledged the Task Force, while recognizing that such an individual approach poses financial and logistical challenges which will have to be overcome when it comes to clinical trials.
"Having reviewed the existing literature on subtyping and explored the methodologic pitfalls and challenges associated with performing the optimal subtyping studies described above, it is time to reevaluate our approach to understanding and describing PD heterogeneity," commented Dr. Mestre and Dr. Marras. "We have provided recommendations and formulated questions that, once addressed, will inform new approaches to better explain the variability in PD including emphasis on the variability at an individual level, more aligned with future application of personalized medicine principles."
PD is a slowly progressive disorder that affects movement, muscle control, and balance and is characterized by a broad range of motor and non-motor symptoms. It is the second most common age-related neurodegenerative disorder affecting about 3% of the population by the age of 65 and up to 5% of individuals over 85 years of age.
More information: Tiago A. Mestre et al, Parkinson's Disease Subtypes: Critical Appraisal and Recommendations, Journal of Parkinson's Disease (2021). DOI: 10.3233/JPD-202472
Provided by IOS Press
Study: Older adults found resilience during pandemic through community, human connection
Older adults were significantly affected by isolation and stress during Oregon's initial COVID-19 lockdown last spring, but they were also able to find connection and meaning in community, new hobbies and time for themselves, a recent Oregon State University study found.
03 may 2021--Ifresilienceis understood as the ability to see positives in the midst of a negative situation, then many of the study's participants demonstrated resilience during that time, the researchers said.
"A lot of times we think about resilience as a personality trait, and it's true that there are some qualities that may help people experience that. But in the end, resilience is something that is shared," said Heidi Igarashi, first author on the study and a recent doctoral graduate of OSU's College of Public Health and Human Sciences. "One of the things that came out in our study was the degree to which the people-connection was really significant."
The study, published in the Journals of Gerontology: Psychological Sciences, surveyed 235 adults ages 51 to 95 about their experiences from April 28-May 4, 2020, when Oregon's statewide stay-at-home order had been in place for about a month.
The online survey asked participants about recent and ongoing difficulties in their lives caused by COVID-19, as well as recent positive experiences.
People shared experiences at the personal, interpersonal and societal levels. Personal difficulties included the stress of constant vigilance around ensuring safety in everyday activities, as well as fear of death and uncertainty about the future. Interpersonal challenges included social isolation, lack of physical contact and fear for loved ones' health. Societal stressors were centered on lack of scientific leadership and concerns for the community at large.
While 94% of participants listed difficulties, roughly 63% shared positive experiences. At the personal level, these included things like trying new projects—gardening, cooking—and increased gratitude for the simpler, slower pace of life. Interpersonal joys were found in new friendships or reconnecting with old friends, and in people caring for one another. At the societal level, some noted the benefit to the environment from people driving less and the sense of increased community solidarity.
Older adults took comfort in seeing neighbors and friends taking care of each other, while simultaneously adding to community resilience by looking after friends and neighbors themselves and joining group efforts like mask-sewing drives, said co-author Carolyn Aldwin, the Jo Anne Leonard Endowed Director of the Center for Healthy Aging Research at OSU.
"It's a mistake to think ofolder adultsas just being sort of victims during COVID," Aldwin said. "They're a lot more resilient than we think they are, and they're important for the community."
Many of the survey respondents engaged in Zoom calls with family and friends, enjoyed time spent in nature and finally finished projects that had been sitting in the closet or garage.
Retired folks had a harder time than those who are employed because the lockdown was more disruptive to their routine, including closing off regular volunteer opportunities because of older adults' high-risk status. But some respondents reported feeling relief at being able to focus on themselves for a change, with pursuits like meditation and journaling, rather than spending all their time caring for other people.
The study was conducted via internet survey, which affected response rates; the majority of participants were white, female, retired and highly educated, as opposed to the racial, ethnic and socioeconomic groups that have been hardest hit by COVID-19 infections and death, the researchers said.
But Aldwin cautions against assumptions about resilience among less-advantaged groups. While they may have experienced more loss and financial distress, a key factor in resilience is being able to find purpose in life, which can occur through helping others.
"There's this meaning that's found in caregiving, a reason for living, where our study group often didn't have these demands on them, and they were feeling a lack of sense of meaning," she said. "If you're the person who's holding the family together during this crisis, that's a source of meaning. Clearly we would have seen more loss and more difficulty, but we also might have seen sources of resilience that we didn't see in the study group."
More information: Heidi Igarashi et al, Resilience in Older Adults During the COVID-19 Pandemic: A Socioecological Approach, The Journals of Gerontology: Series B (2021). DOI: 10.1093/geronb/gbab058
Provided by Oregon State University
Doctors overestimate risk leading to over-diagnosis, overtreatment, study finds
Primary care practitioners often over-estimate the likelihood of a patient having a medical condition based on reported symptoms and laboratory test results. Such overestimations can lead to overdiagnosis and overtreatment, according to a recent study conducted by researchers at the University of Maryland School of Medicine (UMSOM) published in JAMA Internal Medicine.
03 may 2021--"A large gap exists between practitioner estimates and scientific estimates of the probability of disease," said study leader Daniel Morgan, MD, a Professor of Epidemiology & Public Health at UMSOM. "Practitioners who overestimate the probability of disease might use that overestimation when deciding whether to initiate therapy, which could lead to the overuse of risky medications and procedures."
To conduct the study, Dr. Morgan and his colleagues surveyed 553 primary health practitioners, including residents, attending physicians, nurse practitioners and physician assistants, in Maryland and seven other states. Survey respondents were asked to determine how well they could estimate the risk of four well-known health conditions based on hypothetical diagnostic scenarios. The researchers found, based on symptoms and test results, that health care providers significantly overestimated the likelihood of conditions. For example, health care providers, on average, estimated a 70 percent likelihood of cardiac ischemia in patients who had a positive finding on a stress test. In reality, based on evidence from medical studies, the real likelihood of cardiac ischemia is 2 to 11 percent.
The study also found that survey respondents estimated a 50 percent risk of breast cancer after a positive finding on a mammogram when evidence suggests 3 to 9 percent chance of breast cancer. They estimated an 80 percent likelihood of a urinary tract infection from a positive urine culture, and the vast majority of survey respondents said they would treat with antibiotics in these cases. The real risk of a UTI with a positive urine culture, however, is at most 8 percent.
"Solving this problem is not about asking health care providers to memorize numbers or practice math in order to improve their understanding of risks," Dr. Morgan said. "We should, however, use probability and better utilization of decision-making tools to help them make better estimates."
He developed a free tool called Testing Wisely, funded by the National Institutes of Health, that is designed to improve clinician understanding and ordering of diagnostic tests to make patient care safer. The site also includes a risk calculator to assess patients' symptoms, exposure, and local positivity rates where they live to calculate their individual risk of having COVID-19.
"Informed medical decision-making is incredibly important, and physicians should have access to tools that make their job easier and improve patient safety," said E. Albert Reece, MD, Ph.D., MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. "This study demonstrates the need for better decision-making tools to help healthcare providers provide the best possible care to their patients."
More information: Daniel J. Morgan et al, Accuracy of Practitioner Estimates of Probability of Diagnosis Before and After Testing, JAMA Internal Medicine (2021). DOI: 10.1001/jamainternmed.2021.0269
Provided by University of Maryland School of Medicine
