Would a longer lifespan make us happier? A philosopher's take

Credit: cdrin/Shutterstock

One of the biggest questions in ageing research is whether there is a ceiling on how long human beings can live. A recent study, published in Science, suggests there isn't. The study measured the survival probabilities of 3,896 people in Italy aged 105 and older. It found that, while we are much more likely to die at 75 than at 55, once we reach about 105, the odds of death remain about the same each year of life.

18 july 2018--This effect is often referred to as a "mortality plateau". If it were impossible to live past a certain age, we would expect mortality rates to continue rising as people age, rather than plateau. The fact that the odds of dying don't appear to increase past 105 suggests that we have not yet approached our maximum lifespan as a species. But is potentially living for over a century something we ought to look forward to? Here, philosophy can offer some important insights.
Of course, we still don't know for sure that there is no ceiling. Some researchers argue that there is a natural "expiration date" for human beings, at about 125 years. Chiyo Miyako is currently the oldest known person in the world, at 117 years old. Jeanne Calment, who died in 1997, had the longest recorded lifespan, at 122 years.
In the UK, the number of people over the age of 100 has more than doubled since 2002, and could reach 36,000 by 2030. If there is a mortality plateau, by the year 2300 the oldest person alive could be about 150 years old.

Pleasure versus pain

Would a maximum lifespan of 150 make our lives better or just longer? One way of thinking about this is in terms of pleasure and pain: the more pleasure (and the less pain) we have over the course of our lives, the better our lives are. Other things being equal, a life which lasts 100 years is better than one that lasts 80 years, as long as the extra 20 years contain more pleasure than they do pain.
How likely an outcome is this? As people age, they are much more likely to develop degenerative conditions that could lead to a lower quality of life. But these conditions can be mitigated by a healthy lifestyle and adequate support services. While elderly life may be restricted in some ways, there is no reason that it cannot be, on balance, pleasurable.
On the other hand, an extended lifespan might influence our earlier quality of life. In 2017, there were about 3.5 people of working age (16-64) for every person over age 65, but this ratio is expected to fall to 2.1 to one by 2040. This means that there will be relatively more people claiming pension benefits, and fewer people in the workforce paying taxes to support them. This could lead to the working population being required to pay additional taxes and remain in the workforce for longer, or a reduction in other services to cover pension costs.

An unwanted postscript

We might also think that our lives go better when we get the things we want. Having a longer life might give us more time to accomplish our goals and projects. But we might also think that a desirable life is one with a certain narrative structure.
The late philosopher Ronald Dworkin distinguished between "experiential interests" and "critical interests" to shed light on how people may view their life goals. Experiential interests are for things like pleasure – anything we enjoy. Critical interests are those what we value becoming a reality – essential to what we think constitutes a good life. This could be a parent's interest in the happiness of their child, for example.
We can imagine a person having a critical interest in avoiding the perceived indignity of dementia, which may accompany extreme old age. Even if the person doesn't seem bothered by their cognitive decline in the moment, this may not have been how they wanted their life to go. We might think it would be better for this person, taking the whole of their life into account, if they had died prior to this period of decline.
In other words, there could be many circumstances in which we might live for too long. Sometimes it might be better for us to die earlier than we otherwise might have, if doing so is more consistent with the "life story" we wanted for ourselves – for example, being active and independent throughout our lives.

Declining desires?

A similar concern has been raised by the late philosopher Bernard Williams. Williams argued that the things which give meaning to our lives are "categorical desires", which are essential to our identity. They include things like writing a novel, raising children or pulling off a charity project. These sit alongside more "meaningless" desires, such as the need for food or sex, which he argued can't make us happy in the long run.
Williams believed that, if we live long enough, we will fulfil all our categorical desires – losing an important driver of our happiness. We are then faced with a remaining life of oppressive boredom, or replacing our fundamental desires and radically changing who we are.
However, as I see it, life can remain rich and complex even for the very elderly, and taking on new projects need not undermine who we are. This is especially true if our friends and loved ones are living longer as well. While our desires and interests may change, connection to others can help to promote continuity among the various stages of our lives.
What each of these views shows is that living longer does not in itself make us better off. As our population continues to age, we will need to make important and potentially difficult choices about how we want to care for the elderly. Crucially, strategies to promote healthy ageing may not only ease the burdens on society, but help to ensure that our longer lives are better lives – even in a philosophical sense.

This article was originally published on The Conversation. Read the original article.

Provided by The Conversation

Study finds potential link between alcohol and death rates

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Drinking heavily results in uncontrolled iron absorption into the body, putting strain on vital organs and increasing the risk of death, according to a new study published in the journal Clinical Nutrition.
The study looked at health outcomes in 877 women in sub-Saharan Africa over a median follow-up time of nine years. The results of the study showed levels of ferritin, a blood marker of the extent of body iron loading, were higher in drinkers than non-drinkers.

17 july 2018--Iron loading is when the regulation of iron in the body is compromised by alcohol consumption, leading to more of it being absorbed. It is known to cause health issues such as heart attacks, liver disease and diabetes.
The study found that higher levels of ferritin and its statistical interaction with alcohol in these subjects predicted all-cause and cardiovascular mortality. This means that the prognostic significance of iron loading depends on alcohol consumption.
Dr. Rudolph Schutte, Course Leader of the BSc (Hons) Medical Science at Anglia Ruskin University, and lead author of the study, said: "Iron loading puts strain on especially the cardiovascular system through oxidisation, which can cause damage to cells, proteins and DNA.
"The link between iron and mortality has been disputed for around 30 years, but this study is the first to investigate the significance of the interaction between iron loading and alcohol intake.

"These findings may have health implications globally for people who consume large quantities of alcohol."

More information: Rudolph Schutte et al, Iron loading, alcohol and mortality: A prospective
study, Clinical Nutrition (2018). DOI: 10.1016/j.clnu.2018.05.008


Provided by Anglia Ruskin University

Health coaching might sound 'new age,' but it could help you reach old age

OMG. Credit: Fred Ho

There are two ways of tackling chronic lifestyle diseases such as cancer, heart disease and diabetes: discover new drugs and treatments or persuade people to make positive lifestyle changes to avoid developing them in the first place.

15 july 2018--Health coaching is one of the most powerful ways of changing people's mindsets for the long term. Practitioners are rapidly taking their place alongside executive coaches, life coaches and personal trainers as another means of making us better people through one-to-one improvement sessions.
It has only been around a couple of decades, but the techniques date all the way back to the 5th century BC – specifically Socrates' famous method of questioning his students to uncover truths. Coaches ask clients questions to help them gain a clearer insight into who they are and their potential. It's a process of self-discovery that helps people to take actions that change their behaviour.
Specialists often group together the likes of cancer, heart conditions and obesity as the non-communicable diseases, meaning you can't catch them from someone else. Together they kill some 40m people each year, about 70% of all deaths around the world – and poor lifestyles frequently increase the risks. This looks like getting worse – adult obesity levels are forecast to reach 40% by 2030 in the UK, for example, while diabetes prevalence is expected to rise by almost a third in the next couple of decades.
This is making healthcare expenditure unsustainable. UK spend was £192 billion in 2016, for example, and is rising at around 4% a year. Long-term illnesses account for about 70% of spending. For this reason, the direction of travel in the UK and elsewhere is to focus on the common risk factors behind these diseases and work towards reducing them by promoting behaviour change. This is where health coaching comes in.
The modern coaching phenomenon dates back to Timothy Gallwey, an American tennis player who wrote a series of very successful books about sports coaching in the 1970s and early 1980s called The Inner Game. They were all about using techniques that focused on gameplay to prevent the brain from interfering with your performance.
Gallwey then began applying similar techniques to leadership, kicking off a whole new industry in executive coaching. Health coaching grew out of this and began to spark interest from the early 1990s, but has only really taken off in the past five years. It is now common in the US and Australia, though still somewhat novel in the UK – but this looks set to change.
The NHS ran a health coaching pilot for training practice nurses in Suffolk at the beginning of the decade, which was then rolled out to nearly 800 doctors, nurses and other health professionalsacross the east of England in 2013. More recently, NHS England has launched a wider programme for disseminating coaching techniques to health professionals. The intention is to offer nine-month coaching programmes to the five million people in England with blood sugar levels that put them at high risk of diabetes.

What the research says

Health coaching is not the same as counselling, therapy or handing out advice. Typically a first session would be about helping the client to arrive at an overall health or lifestyle goal – cutting their weekly alcohol intake in half, say. The health coach would use the questioning technique to uncover what that goal means to the person in terms of their personal values, and draw up a specific action plan for reaching it.
Coach and client would look at what makes change a good thing and what is getting in the way – avoiding "why" questions, which are seen as judgemental. The emphasis is about turning barriers into opportunities, focusing on the future rather than the reasons why the person got into that cycle of behaviour.
Over a few follow-up sessions, clients come back and discuss their progress, what they have found challenging, how to proceed and so on. If they are succeeding, the coach may get them to start working on another goal – running twice a week, for example.
There are certainly research findings to support this new approach to healthcare. Health coaching has been shown to be one of the most effective methods for managing lifestyle diseases. It helps people make physical changes such as losing weight and lowering their cholesterol and blood pressure.
Health coaching has been found to help diabetic sufferers to take more responsibility for their condition and change their behaviour. One review article from 2016 found it to be an effective way of improving blood sugar levels, for example.
A more recent study in which I was involved in Turkey and Denmark found that around 150 diabetic patients receiving health coaching for a year reduced their three-month blood glucose levels by 6%, while a similar-sized group who received health education saw little improvement. The International Diabetes Federation considers a 1% reduction in three-month blood glucose to be a significant improvement in diabetes management.
I have also looked at health coaching beyond diabetes, including in my own original specialism, dentistry. My co-authored work has found that it can enhance people's oral health, help them to take more exercise, eat better and improve their quality of life – again we studied Turkey and Denmark, suggesting that health coaching may be benefical regardless of differences in healthcare systems.
In short, health coaching appears to have a bright future. One thing that doesn't exist yet in the UK is professionally accredited health coaches – a step beyond the NHS training in England which requires at least 100 hours of training.
To that end, I'm trying to get a masters programme in health coaching off the ground at the University of Dundee, in association with the World Health Organization Collaborating Center. If we are going to create a new workforce of health coaches, we will need evidence-based academic training that meets international standards across the country.

This article was originally published on The Conversation. Read the original article.

Provided by The Conversation

DBS treatment may slow the progression of Parkinson's tremor in early-stage patients

Immunohistochemistry for alpha-synuclein showing positive staining (brown) of an intraneural Lewy-body in the Substantia nigra in Parkinson's disease. Credit: Wikipedia

Deep brain stimulation (DBS) may slow the progression of tremor for early-stage Parkinson's disease patients, according to a Vanderbilt University Medical Center study released in the June 29 online issue of Neurology, the medical journal of the American Academy of Neurology.

11 july 2018--The study is the first evidence of a treatment that slows the progression of one of the cardinal features of Parkinson's, but a larger-scale clinical trial across multiple investigational centers is needed to confirm the finding.
"The finding concerning tremor progression is truly exceptional," said senior author David Charles, MD, professor and vice-chairman of Neurology. "It suggests that DBS applied in early-stage Parkinson's disease may slow the progression of tremor, which is remarkable because there are no treatments for Parkinson's that have been proven to slow the progression of any element of the disease."
Patients in the Vanderbilt study were randomized to receive DBS plus drug therapy or drug therapy alone; the drug therapy alone group was seven times more likely to develop new rest tremor after two years in comparison to the DBS plus drug therapy group.
The trial, which began in 2006, was controversial because it recruited patients with early-stage Parkinson's disease for DBS brain surgery. At that time, DBS was approved for only advanced-stage Parkinson's disease when symptoms were no longer adequately controlled by medication.
"Since this was the first early DBS trial, it was unknown whether there were individual motor symptoms very early in Parkinson's disease that may be more potently improved by DBS," said lead author Mallory Hacker, Ph.D., research assistant professor of Neurology.
The post hoc analysis showed that 86 percent of the drug therapy patients developed rest tremor in previously unaffected limbs over the course of the two-year period, while that occurred in only 46 percent of patients who had received DBS therapy in addition to drug therapy. Four of the DBS patients had rest tremor improvement and rest tremor completely disappeared from all affected limbs for one DBS patient.
The FDA has approved Vanderbilt to lead a large-scale, Phase III multicenter study that will enroll 280 people with very early-stage Parkinson's disease, beginning in 2019, and 17 other U.S. medical centers have joined the DBS in Early Stage Parkinson's Disease Study Group to participate.
"The field of DBS therapy for Parkinson's disease is moving toward earlier stages of treatment, therefore, we must conduct the pivotal trial to ensure patient safety and provide the Parkinson's community with the best possible medical evidence to guide treatment," Charles said.


Provided by Vanderbilt University Medical Center

Wearable, at-home patch could spot your A-fib early

Zio®XT patch. Photo: iRhythm Technologies

The common but dangerous heart rhythm disorder known as atrial fibrillation—or a-fib—can go undetected for years. Now, research suggests a high-tech, wearable patch might spot the condition early.

11 july 2018--Use of the Zio XT wireless patch, made by iRhythm, produced "an almost threefold improvement in the rate of diagnosis of a-fib in those actively monitored compared to usual care," said study lead author Dr. Steven Steinhubl. He directs digital medicine at the Scripps Translational Science Institute, in La Jolla, Calif.
The patch monitors electrocardiogram (ECG) readings via the skin, looking for telltale signs of arrhythmia—an irregular heartbeat.
Spotting the irregular heartbeat is key, Steinhubl said, since a-fib greatly raises stroke risk.
"Timely diagnosis of a-fib more effectively can enable the initiation of effective therapies and help reduce strokes and death," Steinhubl said in a Scripps news release.
One heart specialist not tied to the study said that the late detection of a-fib—which plagues nearly 6 million Americans—is a real issue.
"Many patients who come in with a diagnosis of atrial fibrillation have had it for quite some time prior to seeing a doctor," said Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City. "By catching it early—that is, before symptoms of palpitations, passing out and stroke—one can lower the incidence of stroke related to undiagnosed atrial fibrillation."
The new study was funded by Janssen Pharmaceuticals as well as the U.S. National Institutes of Health. The study involved more than 5,200 people from across the United States, many of whom received and returned the small wearable patch by mail. Participants were all deemed to have risk factors that boosted their odds for a-fib.
About one-third of the participants wore the patch— which adheres to the skin—and were monitored continuously for up to two weeks.
The other two-thirds served as a comparison group. These patients received usual care, typically routine visits to their primary care physician. If they were diagnosed with a-fib that information turned up in their medical claims records.
The result: After one year, a-fib was diagnosed in 109 people in the patch-monitored group (6.3 percent) versus 81 people in the unmonitored group (2.4 percent), Steinbhul's group reported. That's a near tripling of the diagnosis rate, the study authors noted.
"This study demonstrates the utility of a digital approach not only to diagnosing asymptomatic a-fib, but to the clinical research field as a whole," Steinhubl said.
Dr. Marcin Kowalski directs cardiac electrophysiology at Staten Island University Hospital, in New York City. He believes the advent of devices like the Zio XT patch could be a boon to medical care, but it might also bring new problems.
Aside from spotting a-fib, these devices are "capable of diagnosing other arrhythmias," which otherwise might go undetected, Kowalski said.
The potential downside, he said, is more work for an already overloaded health care system.
"One must be mindful of the increase in data volume and the resources necessary to process," Kowalski explained. "This technology could increase the number of transmissions, which may burden a health care provider's limited resources."
The study was published July 10 in the Journal of the American Medical Association.

More information: The U.S. National Heart, Lung, and Blood Institute has more on atrial fibrillation.

Senolytic drugs reverse damage caused by senescent cells in mice

Injecting senescent cells into young mice results in a loss of health and function but treating the mice with a combination of two existing drugs cleared the senescent cells from tissues and restored physical function. The drugs also extended both life span and health span in naturally aging mice, according to a new study in Nature Medicine, published on July 9, 2018. The research was supported primarily by the National Institute on Aging (NIA), part of the National Institutes of Health (NIH).

10 july 2018--A research team led by James L. Kirkland, M.D., Ph.D., of the Mayo Clinic in Rochester, Minnesota, found that injecting even a small number of senescent cells into young, healthy mice causes damage that can result in physical dysfunction. The researchers also found that treatment with a combination of dasatinib and quercetin could prevent cell damage, delay physical dysfunction, and, when used in naturally aging mice, extend their life span.
"This study provides compelling evidence that targeting a fundamental aging process—in this case, cell senescence in mice—can delay age-related conditions, resulting in better health and longer life," said NIA Director Richard J. Hodes, M.D. "This study also shows the value of investigating biological mechanisms which may lead to better understanding of the aging process."
Many normal cells continuously grow, die, and replicate. Cell senescence is a process in which cells lose function, including the ability to divide and replicate, but are resistant to cell death. Such cells have been shown to affect neighboring ones because they secrete several pro-inflammatory and tissue remodeling molecules. Senescent cells increase in many tissues with aging; they also occur in organs associated with many chronic diseases and after radiation or chemotherapy.
Senolytics are a class of drugs that selectively eliminate senescent cells. In this study, Kirkland's team used a combination of dasatinib and quercetin (D+Q) to test whether this senolytic combination could slow physical dysfunction caused by senescent cells. Dasatinib is used to treat some forms of leukemia; quercetin is a plant flavanol found in some fruits and vegetables.
To determine whether senescent cells caused physical dysfunction, the researchers first injected young (four-month-old) mice with either senescent (SEN) cells or non-senescent control (CON) cells. As early as two weeks after transplantation, the SEN mice showed impaired physical function as determined by maximum walking speed, muscle strength, physical endurance, daily activity, food intake, and body weight. In addition, the researchers saw increased numbers of senescent cells, beyond what was injected, suggesting a propagation of the senescence effect into neighboring cells.
To then analyze whether a senolytic compound could stop or delay physical dysfunction, researchers treated both SEN and CON mice for three days with the D+Q compound mix. They found that D+Q selectively killed senescent cells and slowed the deterioration in walking speed, endurance, and grip strength in the SEN mice.
In addition to young mice injected with senescent cells, the researchers also tested older (20-month-old), non-transplanted mice with D+Q intermittently for 4 months. D+Q alleviated normal age-related physical dysfunction, resulting in higher walking speed, treadmill endurance, grip strength, and daily activity.
Finally, the researchers found that treating very old (24- to 27-month-old) mice with D+Q biweekly led to a 36 percent higher average post-treatment life span and lower mortality hazard than control mice. This indicates that senolytics can reduce risk of death in old mice.
"This is exciting research," said Felipe Sierra, Ph.D., director of NIA's Division of Aging Biology. "This study clearly demonstrates that senolytics can relieve physical dysfunction in mice. Additional research will be necessary to determine if compounds, like the one used in this study, are safe and effective in clinical trials with people."
The researchers noted that current and future preclinical studies may show that senolytics could be used to enhance life span not only in older people, but also in cancer survivors treated with senescence-inducing radiation or chemotherapy and people with a range of senescence-associated chronic diseases.

More information: Senolytics improve physical function and increase lifespan in old age, Nature Medicine (2018). DOI: 10.1038/s41591-018-0092-9 , https://www.nature.com/articles/s41591-018-0092-9


Provided by National Institutes of Health

New research finds 'mind over matter' key to a healthy lifestyle

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People who want to increase their participation in regular exercise and adopt a healthier lifestyle may be best to mentally visualise it, new research by Curtin University has found.

09 july 2018--The research, published in the leading journal Health Psychology, found that 'mental imagery interventions', or visualising an activity or task, may be effective in helping people change their behaviours, including moderating alcohol consumption and participating in regular physical activity.
Lead Australian author John Curtin Distinguished Professor Martin Hagger, from the School of Psychology at Curtin University, said the research aimed to explore the link between visualisation and increasing healthy behaviour.
"There are strong links between chronic illnesses like heart disease and diabetes and behaviour, and imagery-based interventions offer an inexpensive, effective way of promoting healthy behaviours such as physical activity and healthy eating," Professor Hagger said.
"We found that people who simply visualised the steps necessary to do the healthy behaviour on a regular basis were more likely to be motivated, and actually do, the healthy behaviour."
Mental imagery was also more effective in promoting healthy behaviours when the visualisation lasted longer, when people were reminded to do their imagery by text message, and when the person was given detailed instructions on how to conduct the imagery exercise.
Professor Hagger explained that the research could have important implications for health professionals and the broader community around the world.
"Previous studies have shown that imagery interventions have been used in various contexts including enhancing athletes' performance, flight simulation training for aircraft pilots and for symptom relief in hospital settings. Our research shows that imagery is also effective for promoting participation in healthy behaviours," Professor Hagger said.
"Our findings may not only be of interest to health professionals around the world, but could be of interest and potentially implemented within other industries."

More information: Dominic Conroy et al. Imagery interventions in health behavior: A meta-analysis., Health Psychology (2018). DOI: 10.1037/hea0000625


Provided by Curtin University

How support groups can boost your health and make chronic conditions easier to live with

Peer support groups don’t cost much, and thousands of Australians find them useful. Credit: www.shutterstock.com

People want to look after their own health, and with new technology, there are more tools than ever to help people manage it. But the greatest gains could come from a little help from your friends.
For people living with chronic health conditions such as arthritis, diabetes and cancer, the health system can seem impersonal and impractical.

08 july 2018--A large inhibiting factor to patients feeling involved in their own health care is the outdated medical model that sees the patient as a passive recipient of treatment and advice. The clinical nature of medical care doesn't take enough account of how people live their lives or how they'd like to. The focus is on managing disease, not promoting well-being.
Support from peers – people already living with health conditions – could help fill in the gaps. Instead of just helping combat the disease, peer support groups can help improve quality of life.
Promoting peer-based support from and for people living with chronic health conditions has the potential to improve outcomes, increase access and improve efficiency in health care.

What do peer support groups do?

The internet provides endless access to health information to people seeking more involvement in the management of their own conditions. But finding reliable and relevant sources can be difficult without guidance and support.
Peer-support groups offer advocacy, assistance and education; led and managed by people living with health conditions, for people like them. Traditionally peer support groups are location-based groups that meet regularly, but an increasing number of online groups are expanding access to support.
For example, the Young Women's Arthritis Support Group provides links to research, encouragement and "life-hacks" both online and with regular meetings.
Their Facebook page regularly includes comments seeking information and ideas for living with a range of musculoskeletal conditions, with topics such as work, relationships, pregnancy, exercise and technical questions about research. They talk among themselves and also link to experts who can provide clinical, legal and practical advice.
Peer support groups can offer real, practical advice the medical system is unlikely to bring up. For example, making a cup of tea in the morning to hang on to so the hands can warm up and lose some of the overnight stiffness with arthritis, or how to have a conversation with your boss about a condition they may never have heard of, such as fibromyalgia.

Better disease management

We know wealth affects health – chronic disease prevalence is greater in lower socio-economic populations. We also know health care is heavily influenced by culture, setting and population.
Social interactions have a vital relationship to health outcomes, but medical culture often neglects the importance of social relationships in disease management health and well-being.
The medical model is particularly poor at achieving behaviour change such as diet and exercise. But there's evidence to suggest people who attend "illness-affiliated" peer-support groups better manage their chronic conditions and have better health outcomes than those who solely rely on medical interventions.
For example, a 2013 study showed improved blood glucose management during peer support group attendance among diabetics.
A recent review also found people who attend illness-affiliated peer-support groups better manage their chronic conditions, with research showing:

• better health outcomes than those who solely rely on medical interventions
• improved access and exposure to additional health services, as well as greater confidence in people approaching or going through treatment
• peer-support groups are a cost-effective strategy.

Improving peer support

While all Australian state and territory governments contribute financially in some capacity to peer-support services, there is little consistency between jurisdictions' approaches.
Some state health departments explicitly recognise peer-support services as an essential component of public health strategies and have written policy plans of how to incorporate and build a peer workforce to help organise and lead groups, while others lack a coherent peer support infrastructure. The result is an ad hoc approach with patchy referrals, little quality control and no systemic evaluation.
As chronic disease becomes more prevalent, government and communities should consider a better structure to build upon peer support services to maximise health outcomes. Peer-support has the capacity to provide nuanced assistance and education to those living with chronic health conditions in a compassionate and non-judgemental way.
Government can assist a peer support group for people with arthritis for as little as $5,000 a year, to allow for things such as venue hire, catering and administration expenses. As the average cost of one knee replacement is between A$18-$30,000, it's likely even small changes in how people manage their diseases will provide a return on investment.

This article was originally published on The Conversation. Read the original article.

Provided by The Conversation

WHO calls for renewed effort to combat chronic disease

The World Health Organization (WHO) Independent High-Level Commission has proposed six recommendations to address the growing epidemic of non-communicable diseases (NCDs), according to a report published online June 1 in The Lancet.

07 july 2018--According to the Commission, nations are not on track to meet the Sustainable Development Goal for NCDs: to reduce premature deaths from NCDs (cardiovascular diseases, cancers, respiratory diseases, and diabetes) by one-third by 2030, reduce premature mortality from NCDs, and promote mental health. Because of this, the Commission urges governments and heads of state to take bold actions to meet the goal.
The report includes six recommendations: (1) increased political leadership and responsibility from heads of state and governments; (2) prioritization and scaling up of a specific set of priorities within the overall NCD and mental health agenda; (3) identification of synergies within existing chronic care platforms; (4) increased government regulation and collaboration with the private sector and civil society; (5) increased financing of programs addressing NCDs; and (6) improved accountability to ensure commitments made by governments and the private sector are delivered.
"The challenge is not only to gain political support, but also to guarantee implementation, whether through legislation, norms and standards setting, or investment," the authors write. "There is no excuse for inaction, as we have evidence-based solutions."

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

Robots may soon join ranks of Alzheimer's caregivers

MARIO and nursing home resident. Photo: NUI Galway

Robots work on assembly lines and assist doctors in the operating room. They manage inventory in warehouses and vacuum floors in homes.And one day soon, they could help care for Alzheimer's patients.

04 july 2018--Several teams of scientists from around the world are investigating ways in which robots might help manage the daily living tasks of people with Alzheimer's disease.
Some robots help patients in and out of bed, remind them to take medication, measure their mood and provide regular updates to human caregivers.
A South Korean-made robot called Silbot3 has shown promise in this area, said researcher Elizabeth Broadbent. She's an associate professor of health psychology with the University of Auckland in New Zealand.
"It is designed to enable people to stay at home for longer before needing to go into a care home," Broadbent said.
"While a human could help with these things, the burden on caregivers of people with dementia is very high. Some people do not have a caregiver at home and caregivers often need a break during the day to get other things done. Robots can help provide extra care," she explained.
Other research teams have focused on using robots to combat the loneliness and isolation that can affect some Alzheimer's patients.
Broadbent and her colleagues have found that a Japanese baby seal robot called Paro can help calm people with dementia and keep them company.
"It can be good for people who cannot look after a real animal," Broadbent suggested.
Another team has taken this approach a step further, using a robot named MARIO.
MARIO has been built and programmed to "provide companionship and support the person with dementia to connect and/or remain connected to their family and friends, and stay engaged in activities and events that interest them," said researcher Dympna Casey. She's a professor with the National University of Ireland-Galway's School of Nursing and Midwifery.
The robot offers a number of individualized applications that promote social connectivity, Casey said.
These include more general offerings like game apps, news apps and apps that play music, as well as programs more specifically geared to helping the patient feel less lonely:

• The "My Memories" app presents photographs from the patient's past, with the robot prompting a conversation about the content of the photo.
• "My Family and Friends" gathers social media information to keep patients informed about loved ones and friends.
• "My Calendar/Events" reminds users of special events happening in their families or communities.

Tests of MARIO in hospitals and residential care facilities have provided positive results, Casey said.
"People with dementia were overall very accepting of the robot, as were carers and relatives. They had positive perceptions toward MARIO, and of having social robots in dementia care," Casey said. "People with dementia enjoyed their interactions with MARIO and they often referred to MARIO as he or she, and some referred to MARIO as 'a friend.'"
James Hendrix, director of global science initiatives for the Alzheimer's Association, said that robots could prove very useful in helping patients with dementia.
Robots could provide badly needed assistance for weary caregivers, he said.
"Caregivers of people with dementia carry a really heavy burden," Hendrix said. "If there's a way we can lighten that burden for folks a little bit, make it a little easier for them, that's going to help the person with dementia as well. Their care partner is just going to be that much more rested, that much more healthy, and that much more happy."
These robots also could help doctors better care for patients, by collecting data that tracks their mental decline and other health problems, Hendrix said.
On the other hand, Hendrix believes there should always be a role for human caregivers.
"I don't want to see that we totally impersonalize the care and support of people with dementia, that we warehouse them somewhere and they're managed by robots," Hendrix said. "The robotics provide tools of support for the human caregiver, and we still have that human touch."

More information: The MARIO Horizon 2020 project has more about the MARIO robot.

Who wants to live to 100?

A lonely life. Credit: Robert Kneschke/Shutterstock.com

While the ageing of society has become one of the givens in today's world, less is made of the lived experience of the very elderly in society. And although there is some suggestion that the much trumpeted steady expansion of the human lifespan has begun to slow down, the numbers of very old people continue to grow. Despite this, debates about the resourcing of universal health and social care tend not to examine the costs associated with extreme ageing. Yet the problem of chronic conditions and multiple morbidity is greatest among octagenerians and nonagenarians.


02 july 2018--Very old age, if commented upon, is presented as if it were a kind of extreme sports competition. Centenarians are celebrated simply for reaching 100. Nonagenarians hit the news when they run a mile, climb a mountain or pilot a plane. Otherwise, silence reigns. Yet the focus of most social care is on people aged 80 and over – a group for whom care is needed because health cures have failed them. The morbidities and infirmities that beset the extremely aged are not so much ignored as abandoned to the efforts of medical services and social care.
At UCL, we are trying to throw some light on this darker side of ageing. There are of course a number of ways that such "hyper-ageing" can be approached and understood. One view celebrates the fact that the more and more people can expect to live for 100 years or more. Another sees it as an apocalyptic disaster, as agedness "swamps" the resources of society needed to maintain itself. Yet another view juggles between the successes of more years of healthy active life and the failings of more years of living with disability and infirmity.

Changing patterns of disease

Across the world, the burden of disease has been receding. But this is more the case for illnesses affecting younger people and those that are likely to lead to death, rather than disablement. By contrast, conditions that are degenerative and disabling more often than causing death remain largely unchanged.
Rates of osteo-arthritis, for example, which disables but does not kill you, have been rising over the last 25 years (from 213·4 cases per 100,000 in 1990 to 232·1 cases per 100,000 in 2016). Rates for Alzheimer's disease, which disables more than it causes death, have also grown but in a less pronounced manner, (rising from 460·9 cases per 100,000 in 1990 to 470·6 cases per 100,000 in 2016).
Although some chronic conditions affecting older people, such as chronic obstructive pulmonary disease, which kills and disables you, have been falling (from 1666·8 cases per 100,000 in 1990 to 945·3 cases per 100,000 in 2016), the really large falls in disease prevalence have been in conditions affecting the young, such as cases of diarrhoea and related common infectious diseases, which have dropped remarkably, from 8951·2 in 1990 to 3275·6 in 2016.
In Denmark, one of the few national surveys of nonagenerians was conducted around the turn of this century. The researchers found that the majority contacted had some disability and that women were more often affected than men. The same researchers also observed that "about 10% of the octogenarians and more than 55% of the centenarians live in nursing homes, while dependency rises from approximately 30% to 70%, and the prevalence of dementia rises from approximately 7% to 50%".
In the UK, one study of 85-year-olds found a median number of five diseases per person, with more than half suffering from hearing impairment, just over half from osteoarthritis, and just under half suffering from high blood pressure. Just under a quarter had some form of cancer. Less than 5% told the researchers that their health was poor: most said it was good.

The silent issue

This last point emphasises how extreme ageing presents issues that easily go unremarked upon. Its problems are largely confined within the individual household or in long-term care institutions. Wider society scarcely acknowledges these problems and most of those on the receiving end, whether carers or people being cared for, are simply too overwhelmed to do much about them.
Although not closed off to the public, the nursing home remains more present in the imagination than in most people's everyday experience. The social networks of the frail elderly, whether living at home or in a nursing home, tend to be so much smaller than those of the rest of the population. Most people over 80 live alone. They often have only a few people to talk with. Meantime, stories of abuse, or TV footage of the inside of the nursing home paint a grim picture to all who watch, read or hear them.
These isolation and neglect of these spaces help preserve the distance between an "us" who are, if we are ageing, ageing well clear of such scenarios, and a "them", who are not. To be old and frail is not an identity to be acclaimed and the old and frail are generally unable or unwilling to represent themselves as such.
For many of these people, life can be difficult. Estimates suggest that chronic pain "in people aged 85 years or older is common", affecting the majority of people from this age group. Aged lives of quiet desperation are sadly not rare, nor are most lived in the heroic terms of the marathon-running nonagenarian that hits the news.
In drawing attention to this, we are not attempting to promote further victimhood. What we hope to achieve is to cast a little light upon the darker side of our ageing and of our ageing societies. Old age should not be sought out just for the sake of it.

This article was originally published on The Conversation. Read the original article

Provided by The Conversation

First guidelines for applying placebo effect in clinical practice

Credit: Leiden University

It is becoming increasingly clear that the placebo effect has a great influence on medical treatment. An international, interdisciplinary team of researchers led by Professor of Health Psychology Andrea Evers from Leiden University has now written a first set of guidelines on how to apply the placebo effect in clinical practice. Publication in Psychotherapy and Psychosomatics.

01 july 2018--The effect of many health-care treatments is explained in part by factors other than the medication or treatment itself, Andrea Evers explains. For instance, the doctor's confidence that the treatment will work , people's expectations of the treatment and any previous experiences they might have of a treatment. The placebo effect describes how a person's positive expectation of a treatment can have a positive effect on it. In contrast, the nocebo effect is a negative effect: for instance, if a patient experiences side-effects due to negative expectations of the medication.
'Placebo and nocebo effects influence the outcome of the treatment. We know this from scientific research,' says Evers. 'But the regular health-care system takes very little account of these findings when this knowledge would enable us to optimise treatments and at the same time reduce any adverse effects (such as side-effects).'
The publication in Psychotherapy and Psychosomatics is a first step in this direction. It was the result of the first official conference of the Society for Interdisciplinary Placebo Studies (SIPS), which was held in Leiden last year. During an interdisciplinary workshop led by Evers, a group of leading international researchers reached the consensus that knowledge about placebo and nocebo effects could lead to better treatment results with fewer side-effects. According to the researchers, it is crucial that patients receive more information about these effects, and that doctors receive training on the best doctor-patient communication to maximise placebo effects and minimise nocebo effects.
The group believes that future research should look at how to implement these recommendations in clinical practice. Evers: 'Now we have reached an international consensus on this, we can research how doctors and patients can benefit in everyday practice.'


Provided by Leiden University

Largest ever multimorbidity trial in primary care challenge current thinking

In the largest ever trial of an intervention to treat people with multiple long-term conditions (multimorbidity) in primary care, researchers at the Universities of Bristol, Manchester, Dundee and Glasgow found that the patient-centred approach taken improved patients' experience of their care but did not improve their health-related quality of life. This is a challenge to current thinking on which UK and international guidelines are based.

30 jun 2018--In a study involving 1,546 patients from England and Scotland, they found that by making health reviews more patient-centred, such as involving patients in the planning and delivery of their care, overall patient satisfaction improved significantly. However, their health-related quality of life, which included measures of mobility, self-care, pain and discomfort, and anxiety and depression, did not.
The findings, published in The Lancet today, provide the best evidence to date of the effectiveness of a person-centred approach for multimorbidity, for which there is international consensus but little evidence.
One in four people in the UK and the US have two or more long-term health conditions, increasing to two-thirds for patients aged over 65, placing a major strain on health services. Conditions include diabetes, heart disease and asthma, and can include mental health conditions such as depression and dementia. Multimorbidity is associated with reduced quality of life, worse physical and mental health, and increased mortality. Treatment for multimorbidity places an additional burden on patients, who may have to take large numbers of drugs, make lifestyle changes and attend numerous appointments for health care.
The study, funded by the National Institute for Health Research (NIHR), tested a new approach to caring for people with three or more long-term conditions, which aimed to improve their health-related quality of life and experience of patient-centred care, and reduce their burden of illness and treatment compared with usual care. The '3-D' approach, which encourages clinicians to think broadly about the different dimensions of health, simplify complex drug treatment and consider mental health (depression) as well as physical health, was designed to treat the whole person and overcome the disadvantages of treating individual conditions in isolation.
Professor Chris Salisbury, from the University of Bristol's Centre for Academic Primary Care and lead author of the study, said: "Existing treatment is based on guidelines for each separate condition meaning that patients often have to attend multiple appointments for each disease which can be repetitive, inconvenient and inefficient. They see different nurses and doctors who may give conflicting advice. Patients with multiple physical health problems frequently get depressed and they also sometimes complain that no-one treats them as a 'whole person' or takes their views into account.
"Internationally, there is broad consensus about the key components of an approach to improve care for people with multimorbidity but we found little evidence about their effectiveness. We incorporated these components in the 3-D approach, including a regular review of patients' problems according to their individual circumstances. We were surprised to find no evidence of improved quality of life for patients as a result of the intervention but this was balanced by significant improvements in patients' experience of care.
"The question now is whether improved patient experience is sufficient justification for this approach. Given that improving patient experience is one of the triple arms of health care, alongside improving health and reducing costs, our view is that providing care that significantly improves patients' experience is justification in itself."
Patients from 33 primary care practices in Bristol, Greater Manchester and Ayrshire in Scotland took part in the study. Roughly half of the practices offered the 3-D intervention (to 797 patients) and other half offered usual care (to 749 patients). Patients were aged 18 and older. The 3-D intervention replaced disease-focused reviews of each health condition with one comprehensive 'patient-centred' review every 6 months with a nurse and doctor. These reviews focused on discussing the problems that bothered the patients most, how to improve their quality of life and how to improve management of their health conditions. A pharmacist reviewed the patient's medication. A health care plan was then devised with each patient and reviewed six months later.
All measures of patient experience showed benefits after 15 months, with patients widely reporting that they felt their care was more joined up and attentive to their needs. However, there was no difference between the two groups in their reported quality of life at the end of the study period.

More information: 'Improving the management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach' by Chris Salisbury et al in The Lancet, www.thelancet.com/journals/lan … (18)31308-4/fulltext


Provided by University of Bristol

USPSTF favors osteoporosis screening to prevent fracture

The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis to prevent fractures for women aged ≥65 years 

29 jun 2018--Meera Viswanathan, Ph.D., from RTI International-University of North Carolina at Chapel Hill, and colleagues conducted a systematic review of the literature to update the evidence on screening and treatment to prevent osteoporotic fractures.
The researchers found that there was convincing evidence for the accuracy of bone measurement tests for detecting osteoporosis and predicting osteoporotic fractures in women and men. Adequate evidence was found that clinical risk assessment tools are moderately accurate for identifying risk of osteoporosis and osteoporotic fractures. Convincing evidence was found that drug therapies can reduce the rates of subsequent fractures in postmenopausal women. Based on these findings, the USPSTF recommends screening for women aged 65 years and older and in younger women who have been through menopause and are at increased risk (B recommendations). Insufficient evidence was found to recommend screening for osteoporosis to prevent fractures in men (I statement).
"We recommend screening for women over the age of 65 and younger women who have been through menopause and are at increased risk for osteoporosis," one of the task force members said in a statement.

More information: Final Recommendation
Evidence Review
Editorial

Can older, frail patients benefit from 'prehabilitation' before heart surgery?

The "new' approach -- components of "new" prehabilitation in cardiac surgery patients. Credit: Canadian Journal of Cardiology

High risk, frail heart patients might derive benefits from "prehabilitation," a strategy designed to enhance the recovery process after heart surgery by maintaining or improving the patient's overall physical and mental status before surgery, according to a group of eminent cardiac specialists writing in the Canadian Journal of Cardiology. The authors reviewed the current evidence regarding the benefits of prehabilitation and described two ongoing Canadian randomized controlled trials, examining prehabilitation in vulnerable heart disease patients.

28 jun 2018--The demand for surgical services is increasing as a result of an expanding "ageing population." Advances in healthcare practices and delivery have led to an increase in overall life expectancy. Currently, 8.5 percent of the world's population (approximately 620 million people) is older than 65 years of age. This percentage of older adults is projected to increase to 17 percent (1.6 billion) of the world's population by 2050. As a consequence, there has been an increase in the number of frail, older patients with advanced heart disease presenting for complex cardiac surgery procedures.
"The increasing number of older adults with a heart disease and subsequent increase in demand for heart procedures represents a veritable 'silver tsunami'," explained lead investigator Dr. Rakesh C. Arora, MD, Ph.D., from the University of Manitoba/St. Boniface General Hospital, Winnipeg, Manitoba, Canada. "Many of these patients have low physiological reserve. So when they undergo cardiac surgery, they experience a disproportionate decline in their health condition resulting in a long recovery time. In some instances, these vulnerable patients are discharged to a long-term care facility. In such cases, they experience poorer postoperative outcomes and worse quality of life despite a successful heart treatment or procedure. There is, therefore, an urgent need for the heart care team to ensure that the patients are not only liberated of cardiac disease symptoms, but also experience a better postoperative health-related quality of life, so they don't just survive, but thrive after their procedure."
In Canada, patients who require elective cardiac surgery are placed on a "waiting list" for up to two months. Previous investigations have established that patients on surgical waiting lists engage in minimal physical activity as they wait "in fear." There is some evidence to support the effectiveness of "prehabilitation" (prehab), a combination of exercise training, education, and social support, affecting patients' physical and psychological readiness for surgery, but these types of programs are not widespread. Prehab has the overarching goal to reduce postoperative complications and hospital length of stay as well as ideally improving the transition from the hospital back home. However, there is no formal consensus regarding what this should involve. While prehab has been used in patients undergoing bowel or bone surgery, it has not been widely considered for heart patients before surgery.
Dr. Arora and colleagues describe how new treatment protocols, also known as Enhanced Recovery Programs (ERPs), can help the heart team decide on the best treatment plan for vulnerable older adult patients before their procedures. The goals of an ERP are to maintain or improve the overall physical and mental status of the heart patient and reduce the impact of profound stress response following a cardiac procedure. They analyzed evidence from previous trials to support the use of prehab and evaluated how the NEW approach, a three-way approach including nutrition optimization, exercise training, and anxiety (worry) reduction (nutrition, exercise, and worry = NEW) may benefit heart patients.
Part of the barrier to the use of prehab in cardiac patients is the need for well done, multicenter, prospective studies. At present, there are two Canadian randomized controlled trials examining prehab in vulnerable cardiac patients that will hopefully provide new insights into the effectiveness of this intervention in the future:
The Pre-Operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery (PREHAB) is a Canadian multicenter trial that endeavors to provide safety information on the utility of prehab in this vulnerable patient population. The objective is to evaluate the feasibility of exercise intervention before elective cardiac surgeries and its efficacy in improving postoperative outcomes including length of hospitalization, health-related outcomes, and health-related quality of life outcomes.
A new multicenter study that will begin enrolling soon seeks to improve patient-centered outcomes and transitions of care in frail older adults undergoing transcatheter aortic valve replacement (TAVR). The PERFORM-TAVR trial (led by Dr. Jonathan Afilalo, McGill University) will use a combination of a home-based physical activity program that combines walking and strength-building exercises under the supervision of a trained physiotherapist, and nutritional supplementation that seeks to empower patients to adopt self-care behaviors before the procedure that will improve their recovery and diminish their likelihood of progressive deconditioning after a TAVR procedure.
"The fundamental premise behind prehab ERP is that improving patients' functional reserve before their procedure will improve postoperative outcomes that are important to older adults, including preserving mental and functional independence and enhancing postoperative recovery," noted Dr. Arora. "The prehab ERP depends on collaboration and engagement of the patient, their caregivers, and heart team to ensure their success."

More information: "'NEW' Prehabilitation: A 3-way Approach to Improve Postoperative Survival and Health-Related Quality of Life in Cardiac Surgery Patients," Journal of Cardiology(2018). DOI: 10.1016/j.cjca.2018.03.020


Provided by Elsevier

Aging LGBT seniors a major public health issue

Credit: American Heart Association

LGBT people of all ages have experienced health inequalities, but researchers have begun to delve into the consequences of a lifetime of that inequity – and what happens to their health as they grow older.
"They've been relatively invisible, undercounted and underserved," said Dr. Karen Fredriksen Goldsen. "We're talking about a major public health issue."

27 jun 2018--LGBT people face health disparities due to stigma, discrimination and violence, according to the Centers for Disease Control and Prevention study Healthy People 2020. But those problems spike as lesbian, gay, bisexual and transgender people age, said Fredriksen Goldsen, a researcher behind the ongoing Aging with Pride: National Health, Aging, and Sexuality/Gender Study. It's a federally funded project following 2,450 LGBT adults from age 50 to over 100.
"We've found a constellation of high-risk factors, including a history of victimization and not getting access to the services they need," said Fredriksen Goldsen, professor and director of Healthy Generations Hartford Center of Excellence at the University of Washington.
"Not everyone is experiencing poor health – in fact, most are doing very well," she said. "But we wanted to understand the poor health outcomes in this community."
According to the report, about 2.7 million U.S. adults 50 and older identify as LGBT, including 1.1 million age 65 and older. Those numbers are expected to nearly double by 2060.
About 13 percent of LGBT older adults report being denied health care or given poor care because of their sexual or gender identities. Among transgender participants, that number jumped to 40 percent.
"So many people have been denied care or received inferior care that they've become more hesitant now to obtain care," Fredriksen Golden said.
Older LGBT adults are more likely than heterosexuals to smoke, drink excessively and report depression, according to the study.
And disparities exist even among subgroups within the LGBT community, with some struggling with their health more than others:

• Both Hispanic and African-American LGBT older adults in the project are more likely to report having HIV than their white counterparts.
• Hispanic LGBT adults are more likely to report asthma, diabetes and visual impairment.
• African-American LGBT older adults are more likely to be obese and have high blood pressure.
• Native American LGBT older adults are less likely to report cancer than whites but more likely to report poor physical health, disability, obesity, asthma and cardiovascular disease.
• Asian/Pacific Islander LGBT older adults are more likely to have visual impairment, but less likely to be obese or have cancer.

Compounding the problem is a lack of access to high-quality health and senior services. According to a recent AARP survey, about 48 percent of big city residents and 10 percent of rural and small-town residents say they have access to LGBT senior services in their community.
"People in rural areas are more dependent on the luck of the draw," said Lisa Krinsky, director of the LGBT Aging Project at Fenway Health, a Boston-based health care, research and advocacy center.
Some LGBT residents in smaller New England towns regularly band together and make road trips to Boston for medical appointments.
"That's a creative, resilient solution, but I'm concerned about what happens when people age and can no longer do the car ride. What happens when they become less mobile and lose their social connections?" Krinsky said, citing a study that reported social isolation can be as damaging to your health as smoking 15 cigarettes a day. She said Fenway Health recently launched a pilot program to use video-conferencing to reduce social isolation among older LGBT adults.
Another ongoing health issue for older LGBT adults is HIV. Thanks to the success of antiretroviral drugs, people with the disease are living longer, and those 50 and older make up 45 percent of all Americans living with diagnosed HIV, according to the CDC.
"That's a data point that doesn't get much attention," Krinsky said. "We think of it still as a young person's disease."
Yet as HIV patients age, health disparities continue. A recent study reported that those with HIV have about a 50 percent to 100 percent higher risk of heart attack or stroke compared with people who are negative for HIV, partly because doctors were less likely to prescribe them cholesterol-lowering drugs or aspirin.
Statistics like that underscore the unique health roadblocks facing older LGBT adults – including Baby Boomers, a group that's been more open about their identity than older generations, Krinsky said.
"Boomers don't want to have to go back into the closet to receive health care," she said. "But if they perceive themselves as being in an unsafe place, they may have to go back."
Fredriksen Goldsen said the Aging with Pride study has been expanded to explore dementia and other issues. The ongoing study has a high retention rate – 96 percent of the original participants are still in the study five years later – which gives her hope for the future.
"People are very interested in learning how to improve health in the community," she said. "They really want to reduce disparities and create better health opportunities for the next generation."


Provided by American Heart Association

Effect of shock wave treatment for erectile dysfunction wanes

Low-intensity shock wave treatment is effective for short-term treatment of erectile dysfunction, but its efficacy declines after two years, particularly in those with initial severe dysfunction, according to a study published in the July issue of The Journal of Urology.

24 jun 2018--Noam D. Kitrey, M.D., from Sheba Medical Center in Ramat Gan, Israel, and colleagues studied the long-term efficacy of penile low intensity shock wave treatment two years after an initially successful outcome among 156 patients.
The researchers found that at one month, treatment was successful in 99 patients (63.5 percent), but during follow-up a gradual decrease in efficacy was observed. At two years, the beneficial effect was maintained in only 53.5 percent of patients in whom success was initially achieved. Over follow-up the treatment effect was lost in all patients with diabetes who initially had severe erectile dysfunction. However, for patients with milder forms of erectile dysfunction without diabetes there was a 76 percent chance that the beneficial effect of low-intensity shock wave treatment would be preserved after two years.
"Low-intensity shock wave treatment is effective in the short term but treatment efficacy was maintained after two years in only half of the patients," the authors write. "In patients with milder forms of erectile dysfunction the beneficial effect is more likely to be preserved."

More information: Abstract/Full Text

Ketamine acts fast to treat depression and its effects last—but how?

Credit: CC0 Public Domain

In contrast to most antidepressant medications, which can take several weeks to reduce depressive symptoms, ketamine—a commonly used veterinary anesthetic—can lift a person out of a deep depression within minutes of its administration, and its effects can last several weeks. Researchers have long-wondered how ketamine can both act quickly and be so long-lasting.

23 jun 2018--Now, researchers led by Mark Rasenick, distinguished professor of physiology and psychiatry in the University of Illinois at Chicago College of Medicine, describe the molecular mechanisms behind ketamine's ability to squash depression and keep it at bay. They report their findings in the journal Molecular Psychiatry.
Two-thirds of participants in clinical studies who did not respond to traditional antidepressants experienced fast and lasting resolution of their depressive symptoms after being given ketamine intravenously, Rasenick explained. The effects of ketamine typically lasted about a week—much longer than would be expected with ketamine's six-hour half-life in the body.
Rasenick and his colleagues used a cellular model system to investigate how ketamine acted.
In previous research, Rasenick and his colleagues showed that SSRIs—the most commonly prescribed class of antidepressants, which includes Prozac and Zoloft—work in the brain by moving molecules called G proteins off of "lipid rafts" on the cell membrane, where the G proteins are held inactive. G proteins produce cyclic AMP, which nerve cells need to signal properly. People with depression, Rasenick found, tend to have a greater proportion of their G proteins packed into these membrane patches, along with dampened brain cell signaling, which may contribute to symptoms of depression, including a feeling of overall numbness.
In the earlier research, when Rasenick exposed rat brain cells to SSRIs, the drug accumulated in the lipid rafts, and G proteins moved out of the rafts. The movement was gradual, over the span of several days, which Rasenick thinks is the reason why SSRIs and most other antidepressants can take a long time to begin working.
In his current research, Rasenick and his colleagues performed a similar experiment with ketamine and noticed that the G proteins left the rafts much faster. G proteins began migrating out of the lipid rafts within 15 minutes. And the long-lasting effects of ketamine may be due to the fact that the G proteins were very slow to move back into the lipid rafts, Rasenick explained.
The finding contradicts the long-held idea that ketamine works solely by blocking a cellular receptor called the NMDA receptor, which sits on the surface of nerve cells and helps transmit signals.
In fact, when the researchers knocked out the NMDA receptor, ketamine still had the same effect on the cells—quickly moving G proteins out of lipid rafts on the cell membrane.
"When G proteins move out of the lipid rafts, it allows for better communication among brain cells, which is known to help alleviate some of the symptoms of depression," Rasenick said. "Whether they are moved out by traditional antidepressants or ketamine, it doesn't matter, although with ketamine, the G proteins are very slow to move back into the lipid rafts, which would explain the drugs long-term effects on depressive symptoms."
"This further illustrates that the movement of G proteins out of lipid rafts is a true biomarker of the efficacy of antidepressants, regardless of how they work," Rasenick explained. "It confirms that our cell model is a useful tool for showing the effect of potential new antidepressant drug candidates on the movement of G proteins and the possible efficacy of these drugs in treating depression."

More information: Nathan H. Wray et al, NMDAR-independent, cAMP-dependent antidepressant actions of ketamine, Molecular Psychiatry (2018). DOI: 10.1038/s41380-018-0083-8


Provided by University of Illinois at Chicago

Many physicians not prepared for end-of-life talks with patients

While nearly all physicians say end-of-life conversations are important, many report lacking the training to have such conversations, according to a brief report published online May 23 in the Journal of the American Geriatrics Society.

22 jun 2018--Terry Fulmer, Ph.D., from the John A. Hartford Foundation in New York City, and colleagues conducted a 37-item telephone survey to measure attitudes and perceptions of barriers and facilitators to advance care planning among 736 physicians (primary care specialists; pulmonology, cardiology, oncology subspecialists) regularly seeing patients aged ≥65 years.
The researchers found that 99 percent of respondents agreed that it is important to have end-of-life conversations, yet only 29 percent reported that they have received formal training for such conversations. Younger physicians and those caring for a racially and ethnically diverse population were more likely to have had training. The strongest motivating factors in having advance care planning conversations were patient values and preferences. The vast majority of respondents (95 percent) reported supporting a new Medicare fee-for-service benefit reimbursing advance care planning. Time was the biggest barrier reported to advance care planning, as well as not wanting a patient to give up hope and feeling uncomfortable.
"Given the gap between what people want at the end of life and the care they receive, we need to build on available training tools and embed them systematically into practice," the authors write. "Addressing clinician barriers to advance care planning to meet the needs of their older patients and families requires the integration of existing, proven tools into a three-pronged strategy that includes education and training, formal systems, and reimbursement for these critical conversations."

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

New recommendations guide arthritis pain management

The European League Against Rheumatism has released recommendations—published in the June issue of the Annals of the Rheumatic Diseases—for health professionals to use in approaching pain management in inflammatory arthritis (IA) and osteoarthritis (OA).

22 jun 2018--Rinie Geenen, Ph.D., from Utrecht University in the Netherlands, and colleagues on a multidisciplinary task force including professionals and patient representatives conducted a systematic literature review to assess evidence regarding effects on pain of multiple treatment modalities. The authors included 186 reviews in their analysis.
The task force emphasized the importance for the health professional of adopting a patient-centered framework within a biopsychosocial perspective, having sufficient knowledge of IA and OA pathogenesis, and being able to differentiate localized and generalized pain. Pain treatment usually includes education, which can be complemented with physical activity and exercise; orthotics; psychological and social interventions; sleep hygiene education; weight management; pharmacological and joint-specific treatment options; or interdisciplinary pain management. Pain was consistently positively affected by physical activity and exercise interventions as well as psychological interventions.
"Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA," the authors write.

More information: Abstract/Full Text

Pelvic floor problems and incontinence—autoprosthesis significantly improves quality-of-life

Due to their anatomical difference and also the particular stresses associated with pregnancy and childbirth, incontinence and pelvic floor problems are particularly prevalent in women. Apart from incontinence, women can also develop pelvic floor muscle weakness, overstretching of the pelvic connective tissue and displacement of the pelvic organs. Their quality-of-life can be significantly improved by surgical transplantation of endogenous tissue to strengthen the affected area of the pelvic floor.

22 jun  2018--"This is therefore a form of autoprosthesis," summarises Heinz Kölbl, Head of the Division of General Gynecology and Gynecologic Oncology at the Department of Obstetrics and Gynecology, MedUni Vienna/Vienna General Hospital. Kölbl is also head of the local organising committee for the 43rd Annual Meeting of IUGA (International Urogynecological Association), the largest conference in the world in this field, which will take place in the Austria Center Vienna on 27 – 30 June 2018.
In this surgical procedure – which is performed when conservative techniques or medications have failed to achieve the desired result – endogenous tissue is taken from an area adjacent to the affected area, tautened and allowed to scar over, thereby producing the desired strength. Says Kölbl: "On average that improves quality-of-life for affected patients by at least 30 percent." Research is also being conducted into the use of external stem cell tissue. Says Kölbl: "It is our vision that, in future, we will be able to insert external tissue that is even stronger and more functional, using minimally invasive techniques." Currently many patients still suffer a relapse, requiring a second or even third operation to strengthen their pelvic floor.
Researchers in Vienna are currently conducting studies using gene patterns to develop risk profiles for subsequent major pelvic floor damage. "So that we can potentially establish in advance that women from the high-risk group should not be allowed to give birth naturally, for example, in order to prevent subsequent incontinence or other pelvic floor damage," explains Kölbl, who is also a member of MedUni Vienna/Vienna General Hospital's Comprehensive Cancer Center. A similar risk profile already exists for women who are less than 160 cm tall: they should no longer be allowed to give birth naturally, if the embryo weighs more than 4,000 g. Says Kölbl: "That would give them a 100 percent risk of developing pelvic floor problems."
One in three women has bladder problems over the course of her life and one in 25 women experiences pelvic floor problems after childbirth. And around 3 percent of all women are affected by symptomatic forms of pelvic floor prolapse.


Provided by Medical University of Vienna

Financial decision-making capacity need not decline in healthy advanced aging

Credit: CC0 Public Domain

New research from The Center for BrainHealth at The University of Texas at Dallas shows that advancing age alone is not the defining factor in impaired financial decision-making.

22 jun 2018--The study, published in Frontiers in Psychology, assessed how—and whether—age influences cognitive processes that may be involved in financial decision-making. The researchers investigated how factors such as cognition, education and gender affected monetary choices. "All too often, as people age, we tend to develop a bias expecting diminished capacities, which in turn overlooks, short-changes or discounts their competence to remain actively engaged in personal financial matters," said study author Dr. Sandra Bond Chapman, founder and chief director of the Center for BrainHealth, and Dee Wyly Distinguished University Professor.
The study examined the influence of age on financial decision-making in terms of sure options versus gamble options in 200 cognitively healthy adults between 28 and 79 years old.
In the study, participants completed three hours of cognitive testing and several rounds of financial decision-making questions. They were tested on a large battery of cognitive measures in the domains of executive function, memory and complex attention.
At the beginning of each trial, participants received a virtual financial nest egg. They then were asked to choose between taking a guaranteed amount that was less than the initial endowment, or gambling the entire amount for a chance to win—or lose—the larger pot.
"We found that individuals who performed better on certain cognitive tests, regardless of age, were less likely to make risky financial decisions. This research is particularly important because the findings caution against attributing impaired decision-making to age alone," Dr. Chapman continued.
The study also found that older adults were more likely to demonstrate risky financial behavior only when faced with larger amounts of money.
Stronger performance on measures of both strategic learning and delayed memory may predict that a person is better at analytic processing, which is necessary to assess financial risk, Chapman added.
"Future studies are warranted to examine whether these cognitive abilities directly relate to measures of analytic processing and how older adults can be prompted to use analytic processing to avoid potentially fraudulent scams," said Alison Perez MS'13, Ph.D.'16, lead author of the study who conducted the research at the Center for BrainHealth before joining Lockheed Martin Advanced Technology Laboratories as a research scientist.
"When we see declines in decision-making, these problems may signal early changes related to abnormal health or cognitive decline as opposed to age alone. The key is that retained decision-making is possible at any age with a commitment to keeping mentally active and in the absence of neurologic disease or injury," Dr. Perez said.

More information: Alison M. Perez et al, Influential Cognitive Processes on Framing Biases in Aging, Frontiers in Psychology (2018). DOI: 10.3389/fpsyg.2018.00661


Provided by Center for BrainHealth