Wednesday, December 6, 2017

The human race has peaked



Humans may have reached their maximum limits for height, lifespan and physical performance. A recent review suggests humans have biological limitations, and that anthropogenic impacts on the environment - including climate change - could have a deleterious effect on these limits. Published in Frontiers in Physiology, this review is the first of its kind spanning 120 years worth of historical information, while considering the effects of both genetic and environmental parameters.

Despite stories that with each generation we will live longer and longer, this review suggests there may be a maximum threshold to our biological limits that we cannot exceed.

A transdisciplinary research team from across France studied trends emerging from historical records, concluding that there appears to be a plateau in the maximum biological limits for humans' height, age and physical abilities.

"These traits no longer increase, despite further continuous nutritional, medical, and scientific progress. This suggests that modern societies have allowed our species to reach its limits. We are the first generation to become aware of this" explains Professor Jean-François Toussaint from Paris Descartes University, France.

Rather than continually improving, we will see a shift in the proportion of the population reaching the previously recorded maximum limits. Examples of the effects of these plateaus will be evidenced with increasingly less sport records being broken and more people reaching but not exceeding the present highest life expectancy.

However, when researchers considered how environmental and genetic limitations combined may affect the ability for us to reach these upper limits, our effect on the environment was found to play a key role.

"This will be one of the biggest challenges of this century as the added pressure from anthropogenic activities will be responsible for damaging effects on human health and the environment." Prof. Toussaint predicts. "The current declines in human capacities we can see today are a sign that environmental changes, including climate, are already contributing to the increasing constraints we now have to consider."

"Observing decreasing tendencies may provide an early signal that something has changed but not for the better. Human height has decreased in the last decade in some African countries; this suggests some societies are no longer able to provide sufficient nutrition for each of their children and maintain the health of their younger inhabitants," Prof. Toussaint explains.

To avoid us being the cause of our own decline, the researchers hope their findings will encourage policymakers to focus on strategies for increasing quality of life and maximize the proportion of the population that can reach these maximum biological limits.

"Now that we know the limits of the human species, this can act as a clear goal for nations to ensure that human capacities reach their highest possible values for most of the population. With escalating environmental constraints, this may cost increasingly more energy and investment in order to balance the rising ecosystem pressures. However, if successful, we then should observe an incremental rise in mean values of height, lifespan and most human biomarkers." Prof. Toussaint warns however, "The utmost challenge is now to maintain these indices at high levels."

Some video games are good for older adults' brains


If you're between 55 and 75 years old, you may want to try playing 3D platform games like Super Mario 64 to stave off mild cognitive impairment and perhaps even prevent Alzheimer's disease.

That's the finding of a new Canadian study by Université de Montréal psychology professors Gregory West, Sylvie Belleville and Isabelle Peretz. Published in PLOS ONE, it was done in cooperation with the Institut universitaire de gériatrie de Montréal (IUGM), Benjamin Rich Zendel of Memorial University in Newfoundland, and Véronique Bohbot of Montreal's Douglas Hospital Research Centre.

In two separate studies, in 2014 and 2017, young adults in their twenties were asked to play 3D video games of logic and puzzles on platforms like Super Mario 64. Findings showed that the gray matter in their hippocampus increased after training.

The hippocampus is the region of the brain primarily associated with spatial and episodic memory, a key factor in long-term cognitive health. The gray matter it contains acts as a marker for neurological disorders that can occur over time, including mild cognitive impairment and Alzheimer's.

West and his colleagues wanted to see if the results could be replicated among healthy seniors.

The research team recruited 33 people, ages 55 to 75, who were randomly assigned to three separate groups. Participants were instructed to play Super Mario 64 for 30 minutes a day, five days a week, take piano lessons (for the first time in their life) with the same frequency and in the same sequence, or not perform any particular task.

The experiment lasted six months and was conducted in the participants' homes, where the consoles and pianos, provided by West's team, were installed.

The researchers evaluated the effects of the experiment at the beginning and at the end of the exercise, six months later, using two different measurements: cognitive performance tests and magnetic resonance imaging (MRI) to measure variations in the volume of gray matter. This enabled them to observe brain activity and any changes in three areas:
    - the dorsolateral prefrontal cortex that controls planning, decision-making and inhibition; - the cerebellum that plays a major role in motor control and balance; and
    - the hippocampus, the centre of spatial and episodic memory.
According to the MRI test results, only the participants in the video-game cohort saw increases in gray matter volume in the hippocampus and cerebellum. Their short-term memory also improved.
The tests also revealed gray matter increases in the dorsolateral prefrontal cortex and cerebellum of the participants who took piano lessons, whereas some degree of atrophy was noted in all three areas of the brain among those in the passive control group.

What mechanism triggers increases in gray matter, especially in the hippocampus, after playing video games? "3-D video games engage the hippocampus into creating a cognitive map, or a mental representation, of the virtual environment that the brain is exploring.," said West. "Several studies suggest stimulation of the hippocampus increases both functional activity and gray matter within this region."

Conversely, when the brain is not learning new things, gray matter atrophies as people age. "The good news is that we can reverse those effects and increase volume by learning something new, and games like Super Mario 64, which activate the hippocampus, seem to hold some potential in that respect," said West. Added Belleville: "These findings can also be used to drive future research on Alzheimer's, since there is a link between the volume of the hippocampus and the risk of developing the disease."

"It remains to be seen," concluded West, "whether it is specifically brain activity associated with spatial memory that affects plasticity, or whether it's simply a matter of learning something new."

Higher physical endurance = better working memory


Mount Sinai researchers have found a positive relationship between the brain network associated with working memory -- the ability to store and process information relevant to the task at hand -- and healthy traits such as higher physical endurance and better cognitive function.

These traits were associated with greater cohesiveness of the working memory brain network while traits indicating suboptimal cardiovascular and metabolic health, and suboptimal health habits including binge drinking and regular smoking, were associated with less cohesive working memory networks.

This is the first study to establish the link between working memory and physical health and lifestyle choices.

The results of the study was e published online in Molecular Psychiatry on Tuesday, December 5.

The research team took brain scans of 823 participants in the Human Connectome Project (HCP), a large brain imaging study funded by the National Institutes of Health, while they performed a task involving working memory, and extracted measures of brain activity and connectivity to create a brain map of working memory.

The team then used a statistical method called sparse canonical correlation to discover the relationships between the working memory brain map and 116 measures of cognitive ability, physical and mental health, personality, and lifestyle choices. They found that cohesiveness in the working memory brain map was positively associated with higher physical endurance and better cognitive function.

Physical traits such as high body mass index, and suboptimal lifestyle choices including binge alcohol drinking and regular smoking, had the opposite association.


"Working memory accounts for individual differences in personal, educational, and professional attainment," said Sophia Frangou, MD, PhD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai. "Working memory is also one of the brain functions that is severely affected by physical and mental illnesses. Our study identified factors that can either support or undermine the working memory brain network. Our findings can empower people to make informed choices about how best to promote and preserve brain health."





Air pollution cancels positive health effects of exercise in older adults


Exposure to air pollution on city streets is enough to counter the beneficial health effects of exercise in adults over 60, according to a new study led by scientists at Imperial College London and Duke University.

The findings, published Dec. 5 in The Lancet, show that short-term exposure to traffic exhaust on a busy street can cancel out the positive effects a two-hour stroll would otherwise have on older adults' heart and lungs.

This is the first study to document these negative effects on healthy people as well as those with pre-existing cardiorespiratory conditions such as chronic obstructive pulmonary disease (COPD) or coronary heart disease.

"This adds to the growing body of evidence showing the negative cardiovascular and respiratory impacts of even a short, two-hour exposure to motor traffic pollution," said Junfeng "Jim" Zhang, professor of global and environmental health at Duke. "It highlights the need for stricter air quality limits and better traffic-control measures in our cities."

"Combined with evidence from other recent studies, our findings underscore that we can't really tolerate the levels of air pollution that we currently find on our busy streets," said Fan Chung, professor of respiratory medicine and head of experimental studies medicine at the National Heart & Lung Institute at Imperial College.

Because the research also showed that volunteers who walked for two hours in a large city park -- away from direct exposure to street-side traffic fumes -- experienced significant improvements in lung and vascular functions, "we call for greater access to urban green spaces for people to exercise," Zhang added.

To conduct the study, the researchers recruited 119 volunteers over the age of 60 who were either healthy, had stable COPD, or stable ischemic heart disease. Volunteers walked for two hours midday at one of two London locations: in a relatively quiet part of Hyde Park or along a busy section of Oxford Street, where pollution -- including black carbon, nitrogen dioxide and fine particulate matter from diesel exhaust fumes -- regularly exceeds air quality limits set by the World Health Organization. Physical measurements taken before and after the walks revealed the effects activity had on each volunteer's cardiopulmonary health, including lung capacity, blood pressure, blood flow and arterial stiffness.

Following a stroll in Hyde Park, volunteers' lung capacity improved significantly within the first hour and this improvement lasted for more than 24 hours in many cases. By comparison, a walk along Oxford Street led to a smaller increase during the first hours and no increase later.

Walking in Hyde Park reduced arterial stiffness by more than 24 percent in healthy and COPD volunteers and more than 19 percent in heart disease patients. Walks along Oxford Street yielded much smaller gains. Healthy volunteers experienced a maximum reduction in arterial stiffness of just 4.6 percent; COPD patients saw a 16 percent reduction; and those with heart disease saw an 8.6 percent reduction.

The researchers noted that stress could account for some of the physiological differences seen between the two settings, with the increased noise and activity of Oxford Street having an effect. They also noted that patients with heart disease who took medication to improve their cardiovascular health experienced less severe effects following exposure to the pollution. The medication had a stabilizing effect.


"For many people, such as the elderly or those with chronic disease, the only exercise they very often can do is to walk," Chung said. "Our study suggests that we might advise these people to walk in green spaces, away from built-up areas and pollution from traffic. But for those living in inner cities, this may be difficult to do, and there may be a cost associated with it as they have to travel further away from where they live or work."



Polyunsaturated fatty acids linked to reduced allergy risk


New research from Karolinska Institutet in Sweden reveals that high levels of polyunsaturated fatty acids in children's blood are associated with a reduced risk of asthma or rhinitis at the age of 16 years. The study is published in the Journal of Allergy and Clinical Immunology.

Allergic diseases such as asthma and rhinitis are common and often debut in childhood. Today we know that disease risk is affected by both hereditary and environmental factors.

To date, the present study is the largest to investigate the association between levels of long-chain omega-3 and omega-6 fatty acids in the blood and subsequent development of asthma and other allergic diseases. This study was conducted as part of the Swedish birth cohort BAMSE, and is based on analyses of omega-3 and -6 fatty acids in blood samples from 940 children.

The results show that children who had higher blood levels of long-chain omega-3 fatty acids at the age of 8 years were less likely to have developed asthma or rhinitis by the age of 16 years. High levels of an omega-6 fatty acid called arachidonic acid were associated with a reduced risk of asthma and rhinitis at 16. Among children with asthma or rhinitis at the age of 8 years, higher blood levels of arachidonic acid were associated with a higher probability of being symptom-free at age 16 years.

"Since allergies often debut during childhood it is of particular interest to study if children's environment and lifestyle affect the development of these diseases," says study leader Anna Bergström, researcher at the Institute of Environmental Medicine, Karolinska Institutet.

Polyunsaturated fatty acids are essential to life, and the omega-3 and omega-6 fatty acids that the body is unable to produce itself must be sourced from foods such as nuts and certain vegetable oils; and long-chain omega-3 fatty acids are primarily found in oily fish.

"These new results and those of a previous study we carried out support the current dietary guidelines to eat fish two to three times a week and to vary between oily and lean fish," says Dr Anna Bergström.

Physical activity in mid-life may help protect joint health during aging Wiley

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In an Arthritis Care & Research analysis of 6661 participants in the Australian Longitudinal Study on Women's Health, maintaining at least low levels of physical activity throughout middle age was associated with lower prevalence and incidence of joint symptoms later in life.

The potential protective effect of physical activity on joint symptoms was stronger in obese women than in under or normal weight women, and it was not related to menopausal status or use of hormone therapy.

FDA May Revoke Soy's Heart Health-Claim


The FDA has called into question its health claim finding a link between consumption of soy protein and reduced risk of heart disease. Since 1999, the FDA has allowed manufacturers and advertisers to label soy products with an "authorized" claim of soy's heart-health benefits.  However, proposed rulemaking may reduce it to a "qualified" claim of such benefits, which has a lower scientific standard, or rescind the claim altogether. 

The potential revocation follows numerous studies published since 1999 that present inconsistent findings on the relationship between soy protein and heart disease.

This proposal has been a long time coming. The American Heart Association (AHA) has challenged the FDA's authorization of the health claim as far back as 2008.  The AHA reiterated this position when the FDA announced its decision to review soy's heart-health benefits last month. 

The FDA has opened a 75-day public comment period before it will decide whether to proceed with a final rulemaking stripping soy of its authorized health claim or allowing it to remain.  It would be the first time the FDA has proposed a rule to revoke a health claim.

How saturated fatty acids damage cells

Unsaturated fats like those from fish oil can be protective


In our increasingly health-conscious society, a new fad diet seems to pop up every few years. Atkins, Zone, Ketogenic, Vegetarian, Vegan, South Beach, Raw -- with so many choices and scientific evidence to back each, it's hard to know what's healthy and what's not. One message, however, has remained throughout: saturated fats are bad.

A new Columbia University study reveals why.

While doctors, nutritionists and researchers have known for a long time that saturated fats contribute to some of the leading causes of death in the United States, they haven't been able to determine how or why excess saturated fats, such as those released from lard, are toxic to cells and cause a wide variety of lipid-related diseases, while unsaturated fats, such as those from fish and olive oil, can be protective.

To find answers, Columbia researchers developed a new microscopy technique that allows for the direct tracking of fatty acids after they've been absorbed into living cells. The technique involves replacing hydrogen atoms on fatty acids with their isotope, deuterium, without changing their physicochemical properties and behavior like traditional strategies do. By making the switch, all molecules made from fatty acids can be observed inside living cells by an advanced imaging technique called stimulated Raman scattering (SRS) microscopy.

What the researchers found using this technique could have significant impact on both the understanding and treatment of obesity, diabetes and cardiovascular disease.

Published online December 1st in Proceedings of the National Academy of Sciences (PNAS), the team reports that the cellular process of building the cell membrane from saturated fatty acids results in patches of hardened membrane in which molecules are "frozen." Under healthy conditions, this membrane should be flexible and the molecules fluidic.

The researchers explained that the stiff, straight, long chains of saturated fatty acids rigidify the lipid molecules and cause them to separate from the rest of the cell's membrane. Under their microscope, the team observed that those lipid molecules then accumulate in tightly-packed "islands," or clusters, that don't move much -- a state they call "solid-like." As more saturated fatty acids enter the cell, those islands grow in size, creating increasing inelasticity of the membrane and gradually damaging the entire cell.

"For a long time, we believed that all cell membrane is liquid-like, allowing embedded proteins to change their shape and perform reactions," said Principal Investigator Wei Min, a professor of chemistry. "Solid-like membrane was hardly observed in living mammalian cells before. What we saw was quite different and surprising."

Lipid molecules made from unsaturated fatty acids on the other hand bear a kink in their chains, Min said, which makes it impossible for these lipid molecules to align closely with each other as saturated ones do. They continue to move around freely rather than forming stationary clusters. In their movement, these molecules can jostle and slide in between the tightly-packed saturated fatty acid chains.

"We found that adding unsaturated fatty acids could 'melt' the membrane islands frozen by saturated fatty acids," said First Author Yihui Shen, a graduate student in Min's lab. This new mechanism, she said, can partly explain the beneficial effect of unsaturated fatty acids and how unsaturated fats like those from fish oil can be protective in some lipid disorders.

The study represents the first time researchers were able to visualize the distribution and dynamics of fatty acids in such detail inside living cells, Shen added, and it revealed a previously unknown toxic physical state of the saturated lipid accumulation inside cellular membranes.

"The behavior of saturated fatty acids once they've entered cells contributes to major and often deadly diseases," Min said. "Visualizing how fatty acids are contributing to lipid metabolic disease gives us the direct physical information we need to begin looking for effective ways to treat them. Perhaps, for example, we can find a way to block the toxic lipid accumulation. We're excited. This finding has the potential to really impact public health, especially for lipid related diseases."

Monday, December 4, 2017

Mindfulness meditation reduce the stress of waiting for potentially bad news can be at least as difficult as receiving the news

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Popular music and clichés aren't the only evidence that the waiting is the hardest part. Research backs it up as well; waiting for potentially bad news can be at least as difficult as receiving the news.

People try lots of things to mitigate the suffering that comes with waiting for exam scores, hospital test results, or the outcome of a job interview. They try to distract themselves. They try to stay positive. They brace for the worst.

Past research by UC Riverside "worry and waiting" expert Kate Sweeny has studied the effectiveness of those techniques. None of it works, her research has found. Those tactics not only fail to reduce distress - they can even backfire and make it worse.

But now, Sweeny's research finds something that can help: supplementing those ineffective strategies with "mindfulness" meditation. That is, focusing on the present using meditation.

In the journal Personality and Social Psychology Bulletin, research funded by the National Science Foundation asserts that mindfulness is a sort of antidote to the "curse" of waiting. That curse is a focus on the past or on the future, represented by questions such as "Why did I say that?" and "What if things don't go my way?"

"We try to predict our fate and regain a sense of certainty and control over our life," said Sweeny, who is an associate professor of psychology at UCR. "We know from lots of research that rumination (repetitive thoughts about the past) and worry (repetitive thoughts about the future) are quite unpleasant and even harmful to our health and well-being, so it's important to seek solutions to this painful form of mental time-travel."

Better to focus on the present, Sweeny said, and accept your thoughts and feelings as they arise rather than engage in tactics to avoid them. It means you'll process your emotions differently and - Sweeny argues - more effectively.

The study was performed using 150 California law students who had taken the bar exam and were awaiting the exam results. It takes four months after taking the exam before results are posted online. The students completed a series of questionnaires in that four-month waiting period.

There are few "waiting" scenarios more stressful than the potentially career-killing bar exam. The magnitude of the distress is represented in several sample statements Sweeny and her team collected.

Among them:
  • I had a nightmare where I couldn't determine whether I had passed or failed the bar exam and I spent the entire dream trying to find out my results. I have these sort of bar exam nightmares once every couple weeks.
  • I got sick, like fever flu sick, and I think it's because my anxiety levels have slowly been building up to today!! I was constantly thinking and thinking about the results.
During the four-month waiting period, the students were asked to participate in a 15-minute audio-guided meditation session at least once a week.

Sweeny found the mindfulness meditation served to postpone the phenomenon of "bracing." Bracing is essentially preparing for the worst. Previous research by Sweeny and others shows bracing can be an effective technique for managing expectations, but its benefits erode when it occurs too early in the waiting process.

"Optimism feels good; it just does a poor job of preparing us for the blow of bad news," Sweeny said. "That's where bracing comes in. In a perfect world, we'd be optimistic as long as possible to get all the good feelings we can from assuming the best, and then we'd brace for the worst at the moment of truth to make sure we're prepared for bad news."

The benefits of mindfulness meditation have long been asserted, but Sweeny said this is the first research to demonstrate its effectiveness coping with waiting.

"We know that meditation is a great way to reduce everyday stress, but our study is the first to see if it also makes it easier to wait for personally significant news. This study is also one of the first to identify any strategy that helps people wait better, and it also shows that even brief and infrequent meditation can be helpful," Sweeny said.

Best of all, Sweeny said, the mindfulness tactic requires no training, no money, and minimal time and effort.

"Meditation isn't for everyone, but our study shows that you don't have to be a master meditater or go to a silent meditation retreat to benefit from mindfulness," she said. "Even 15 minutes once a week, which was the average amount of meditation practiced by our participants, was enough to ease the stress of waiting."

Urinary incontinence


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Nearly 40 percent of older women and up to 35 percent of older men live with distressing urinary symptoms, including difficulty with bladder control and urinating (sometimes known as "voiding"), which often compromise quality of life and overall health. The lack of truly effective and safe therapies for these challenges stems from insufficient knowledge of the biological mechanisms for urinary control, the impact of aging and disease on urinary control, and the relationships of symptoms to urinary health and overall well-being, so say researchers reporting on a prestigious conference hosted by the American Geriatrics Society (AGS) and funded by a grant from the National Institute of Aging (NIA) to George A. Kuchel, MD, FRCP, AGSF, Director of the UConn Center on Aging and Travelers Chair in Geriatrics and Gerontology at UConn Health.

A summary report published today in the Journal of the American Geriatrics Society emphasizes that the conference--the third in a series on common geriatric syndromes like incontinence, delirium, and sleep disturbances--holds promise for pin-pointing gaps in knowledge and building a better research agenda to improve care for us all as we age.

"Despite its prevalence among older adults, incontinence remains under-reported and under-treated, a reality for many of the conditions addressed through the AGS-NIA conference series," said Phillip P. Smith, MD, Associate Professor of Surgery at UConn Health, an NIA-funded Beeson scholar, and a co-author of the report. "Bringing renowned leaders together to look critically at what we know, what we don't know, and how we can bridge that divide will not only lead to better treatments but also will help model the way to high-quality, person-centered care for all older adults."

That process begins by identifying gaps in clinicians' understanding of serious health concerns like incontinence, according to the expert panel of conference attendees. Principal among these gaps, for example, are unanswered questions about social, health, and personal factors that contribute to urinary control failures such as overactive bladder, voiding symptoms, and urinary retention (the inability to completely or partially empty the bladder), impacting more than 30 million Americans.

Focusing on urinary incontinence, a leading cause of social isolation and distress for older adults, the panel also highlighted research questions not typically included in clinical data sets that drive new and better treatments. In this context, conference experts from many different disciplines reported on the current state of urinary incontinence research across four critical areas: basic science, translation of discoveries from the bench to the clinic, healthcare delivery, and the frequent yet under-recognized clinical overlap between incontinence and other common geriatric syndromes in the same individual--a critical focus of the AGS-NIA conference series.

"Risk factors common to all geriatric syndromes include older age, decline in functional independence, impaired mobility, and impaired cognition," notes the conference report. "Identifying common shared risk factors and pathophysiological mechanisms [will be key to] future research efforts."

Among other highlights, the conference report notes that behavioral therapy (forms of treatment that seek to identify and help change specific behaviors linked to health problems) has emerged as one of the most successful treatment options for addressing bladder control, though it still is not offered to most older adults. Lack of provider awareness for behavioral techniques may be one reason for the gap, along with reimbursement models that fail to account for the time it takes to teach behavioral therapy skills. Future goals for treating urinary incontinence should include improving behavioral training to make it more effective, as well as offering that training more widely.

Thursday, November 30, 2017

Fish oil component protects eyes from future injury or disease



A team of LSU Health New Orleans scientists discovered that a component of fish oil not only protects cells critical to vision from potentially lethal initial insults, but also from those that occur in the future. The study showed that the omega-3 fatty acid, DHA, and its derivatives "precondition" photoreceptor and retinal pigment epithelial (RPE) cells to survive. The results are published in the November 2017 online issue of the journal Cellular and Molecular Neurobiology.
"Our findings support the proposed concept that DHA and docosanoids (molecules made in the brain at the onset of injury or disease) are responsible for activating sustained cellular mechanisms that elicit long-term preconditioning protection," says Nicolas Bazan, MD, PhD, Boyd Professor and Director of LSU Health New Orleans Neuroscience Center of Excellence. 

According to the authors, a preconditioning (PC) stimulus is a sub-lethal or pharmacologic stressor that activates a counter-regulatory protective response to a future lethal stimulus. Preconditioning takes place when, for example, the blood supply to an organ is interrupted for a short time and then reestablished. The protective response from that first injury would carry over to a subsequent blood supply shortage, much like the immunity a vaccine confers against future exposures to disease. 

"This happens in the heart, brain and retina, as well as other organs," Dr. Bazan says. "To harness the therapeutic potential of preconditioning, it is very important to identify the molecules directly involved." 

Fish oil contains two types of polyunsaturated fatty acids (PUFAs) -- omega-3 (docosahexaenoic acid or DHA) and omega-6 (arachidonic acid or AA). They have distinctly different actions. Omega-3 PUFAs and their enzymatic metabolic derivatives, docosanoids, display potent anti-inflammatory and pro-resolving properties in contrast to the pro-inflammatory actions of omega-6 PUFA derivatives. The researchers found that although they are released concomitantly, DHA can alter the action of AA. When they supplemented DHA prior to the oxidative stress insult, the synthesis of protective DHA derivatives increased while AA synthesis decreased over time. 

"Our findings demonstrate that DHA and the induction of docosanoid synthesis is necessary for preconditioning protection, and thus daily survival, of photoreceptor and RPE cells," adds Bazan. "Since omega-3 impairments are associated with neuroinflammation, which contributes to photoreceptor cell dysfunction and death, enhancing the synthesis of docosanoids may provide an opportunity for halting or ameliorating debilitating retinal degenerative diseases, such as the dry form of age-related macular degeneration," concludes Bazan.

Lack of communication puts older adults at risk of clashes between their medicines



Most older Americans take multiple medicines every day. But a new poll suggests they don't get -- or seek -- enough help to make sure those medicines actually mix safely.

That lack of communication could be putting older adults at risk of health problems from interactions between their drugs, and between their prescription drugs and other substances such as over-the-counter medicines, supplements, food and alcohol.

The new results, from the National Poll on Healthy Aging, show that only about one in three older Americans who take at least one prescription drug have talked to anyone about possible drug interactions in the past two years.

Even among those taking six or more different medicines, only 44 percent had talked to someone about possible drug interactions.

The results come from a nationally representative sample of 1,690 Americans between the ages of 50 and 80. The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, U-M's academic medical center.

Disjointed sources of care

Part of the reason for lack of communication about drug interactions may lie in how older Americans get their health care and their medicines. One in five poll respondents said they have used more than one pharmacy in the past two years, including both retail and mail-order pharmacies. Three in five see multiple doctors for their care.

And even though 63 percent said their doctor and pharmacist are equally responsible for spotting and talking about possible drug interactions, only 36 percent said their pharmacist definitely knew about all the medications they're taking when they fill a prescription.

"Interactions between drugs, and other substances, can put older people at a real risk of everything from low blood sugar to kidney damage and accidents caused by sleepiness," says Preeti Malani, M.D., the director of the poll and a professor of internal medicine at the U-M Medical School.

"At the very least, a drug interaction could keep their medicine from absorbing properly," she adds. "It's important for anyone who takes medications to talk with a health care professional about these possibilities."

Malani notes that although 90 percent of poll respondents said they were confident that they knew how to avoid drug interactions, only 21 percent were very confident.

Given the wide range of prescription and over-the-counter drugs on the market, and the number of drugs that interact with supplements, alcohol and certain foods, Malani says it's hard for even medical professionals to catch all potential interactions.

Newer medical computer systems that flag patients' records for potential interactions automatically, based on the names of their drugs, are helping, Malani says.

Also helpful is Medicare coverage for prescription drug reviews, called Medication Therapy Management, for people who take medicines for multiple chronic conditions. But not all medical computer systems talk to one another, and an MTM must be approved by the patient's Medicare prescription drug benefit provider.

"Even with trackers and systems in place, patients need to be open with their providers and tell them all the medications and supplements they're taking, including herbal remedies," says Alison Bryant, Ph.D., senior vice president of research for AARP. "It's especially important for older adults to be vigilant about this because they tend to take multiple medications."

AARP has put together a free online drug interaction tracker that can identify potential risks. It's available at http://healthtools.aarp.org/drug-interactions, but should be used in conjunction with a patient's conversations with their health care providers and pharmacists.

Recommendations for patients and providers

Malani and her colleagues say that it is up to patients, pharmacists and doctors alike to reduce drug interaction risks.

Patents should write down the names and dosages of their prescription medicines, and of any supplements and over-the-counter drugs they take, and bring it all to their doctors' appointments or pharmacies, she says. It is also important to be truthful about alcohol consumption when asked, since alcohol use can affect many medications. And patients shouldn't just stop taking a medicine if they think they're experiencing a side effect -- they should also call their doctor's office or speak with a pharmacist first.

Meanwhile, health care providers should ask patients more about what medicines and supplements they take, and counsel patients at risk of side effects using language they can understand.

The poll results are based on answers from those who said they took at least one prescription drug, among a nationally representative sample of about 2,000 people ages 50 to 80. The poll respondents answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.


Allergens widespread in U.S. homes



Allergens are widespread, but highly variable in U.S. homes, according to the nation’s largest indoor allergen study to date. Researchers from the National Institutes of Health report that over 90 percent of homes had three or more detectable allergens, and 73 percent of homes had at least one allergen at elevated levels. The findings (link is external) were published November 30 in the Journal of Allergy and Clinical Immunology.

“Elevated allergen levels can exacerbate symptoms in people who suffer from asthma and allergies, so it is crucial to understand the factors that contribute,” said Darryl Zeldin, M.D., senior author and scientific director at the National Institute of Environmental Health Sciences (NIEHS), which is part of NIH.

Using data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES), the researchers studied levels of eight common allergens – cat, dog, cockroach, mouse, rat, mold, and two types of dust mite allergens – in the bedrooms of nearly 7,000 U.S. homes.

They found that the presence of pets and pests had a major influence on high levels of indoor allergens. Housing characteristics also mattered – elevated exposure to multiple allergens was more likely in mobile homes, older homes, rental homes, and homes in rural areas.

For individual allergens, exposure levels varied greatly with age, sex, race, ethnicity, and socioeconomic status. Differences were also found between geographic locations and climatic conditions. For example, elevated dust mite allergen levels were more common in the South and Northeast, and in regions with a humid climate. Levels of cat and dust mite allergens were also found to be higher in rural areas than in urban settings.

To provide a more complete picture, the research team also compared allergen exposure and previously reported sensitization patterns from this survey. Sensitization, which makes a person’s immune system overreactive to allergens, may increase the risk of developing allergies and asthma. NHANES 2005-2006 allowed national level comparisons of exposure and sensitization for the first time.

The team uncovered several differences. Although males and non-Hispanic blacks were less likely to be exposed to multiple allergens, sensitization was more common in these groups, compared to females and other racial groups, respectively. Patterns also differed for urban and rural settings. Exposure to several elevated allergens was most prevalent in rural areas, whereas sensitization rates were shown to be higher in urbanized areas.

Overlaps were also found. For dust mite allergens, exposure and sensitization was most prevalent in the Southern and Northeastern regions, and for cockroach allergen in the South. Patterns also reflected socioeconomic variations, especially for pet and cockroach allergens.

The researchers emphasized that the relationships between allergen exposures, allergic sensitization, and disease are complex. Studies are still investigating how allergen exposures interact with other environmental and genetic factors that contribute to asthma and allergies.

In the meantime, the following preventive actions may help reduce exposure to indoor allergens and irritants.
  • Vacuuming carpets and upholstered furniture every week.
  • Washing sheets and blankets in hot water every week.
  • Encasing mattresses, pillows, and box springs in allergen-impermeable covers.
  • Lowering indoor humidity levels below 50 percent.
  • Removing pets from homes or at least limiting their access to bedrooms.
  • Sealing entry points and eliminating nesting places for pests, as well as removing their food and water sources.

Wednesday, November 29, 2017

90 percent of senior drivers don't make vehicle adjustments that can improve safety


 Nearly 90 percent of older drivers do not make inexpensive adaptations to their vehicles that can improve safety and extend their time behind the wheel, according to new research from the AAA Foundation for Traffic Safety. Common vehicle adaptations like pedal extensions, seat cushions and steering wheel covers can help to improve safety by reducing a senior driver's crash risk. Seniors aged 65 and over are more than twice as likely as younger drivers to be killed when involved in a crash. AAA urges seniors to consider making the necessary adaptations to their vehicles in order to reduce crash risk and extend the time they can continue to drive.

"While many seniors are considered to be safe drivers, they are also the most vulnerable," said Dr. David Yang, executive director of the AAA Foundation for Traffic Safety. "Our research suggests that most senior drivers are not taking advantage of simple and inexpensive features like steering wheel covers that can greatly improve their safety and the safety of others on the road."

The research brief, In-Vehicle Technologies, Vehicle Adaptations, and Older Drivers: Use, Learning, and Perceptions is the first phase in the AAA Foundation for Traffic Safety's groundbreaking Longitudinal Research on Aging Drivers (LongROAD) project. Researchers are currently engaged in generating the largest and most comprehensive senior driver database in existence. This critical information will support in-depth research to better understand the risks and transportation needs of our aging population.

For this phase of the study, researchers investigated 12 vehicle adaptations and found that fewer than nine percent of senior drivers reported using any of the devices in their vehicles. Some of the inexpensive devices that can be purchased and put to use in new or existing vehicles are:

Vehicle Device
  • Cushions and seat pads: Improves line of sight and can help alleviate back or hip pain.
  • Convex/ multifaceted mirrors: Improves visibility and minimizes blind spots.
  • Pedal extension: Helps drivers obtain a safe distance from the steering wheel/airbag and optimize visibility.
  • Steering wheel covers: Improves grip for drivers with arthritic hand joints.
  • Hand controls: Allows the driver to perform all vehicle maneuvers and functions without the use of lower extremities.
Choosing the right features and working with a trained technician is imperative to safety behind the wheel. Of those drivers who have a device, almost 90 percent reported that they did not work with a trained professional to install the modification, a key recommendation by both the National Highway Traffic Safety Administration (NHTSA) and the American Occupational Therapy Association (AOTA). AAA urges drivers to consult with a trained technician to guide them in making adjustments to their vehicle.

"When an ache or pain begins hindering driving ability, many older drivers are able to continue driving safely after making a few adjustments," says Elin Schold Davis, project coordinator of the American Occupational Therapy Association's Older Driver Initiative. "Occupational therapy practitioners trained in driving rehabilitation are especially valuable in connecting the dots between medical challenges that can affect driving and the appropriate equipment and adaptations needed to remain safely independent in the vehicle."

Vehicle adaptions also benefit seniors' mental health by extending their time on the road. Previous research from the AAA Foundation for Traffic Safety shows that seniors who have stopped driving are almost two times more likely to suffer from depression and nearly five times more likely to enter a long-term care facility than those who remain behind the wheel.

In the LongROAD study, more than 70 percent of senior drivers had experienced health conditions that impact muscles and bones such as arthritis, hip/knee replacement and joint pains. Some seniors in the study reduced their driving due to these conditions. The installation of certain devices like steering wheel covers can help lessen the impact of arthritis while larger mirrors and assistive devices on seats can help with limited neck mobility.

"It's surprising that more seniors are not utilizing simple and inexpensive vehicle adaptations when you consider the large number who are dealing with muscle and joint conditions," said Jake Nelson, AAA director of traffic safety and advocacy. "Knowledge is power when it comes to extending time behind the wheel, and AAA is committed to providing seniors with the information they need to make sound decisions."

AAA is promoting the report in partnership with the American Occupational Therapy Association (AOTA) to support Older Driver Safety Awareness Week. AAA and AOTA worked in collaboration with the American Society on Aging and AARP to develop CarFit to help senior drivers better utilize the features and technologies in their vehicles. The community-based program allows trained professionals to conduct a quick, yet comprehensive 12-point check of a senior's personal vehicle and make recommendations for needed adjustments or adaptations. Older drivers can sign up for an event online. AAA also offers the Smart Features for Older Drivers tool, which can help senior drivers identify in-expensive devices and vehicle features that optimize their comfort and safety.

HPV vaccine is effective, safe 10 years after it's given

 A decade of data on hundreds of boys and girls who received the HPV vaccine indicates the vaccine is safe and effective long term in protecting against the most virulent strains of the virus, researchers report.
The findings support more widespread and early administration of the HPV vaccine before preadolescents and adolescents are exposed to the nation's most common sexually transmitted infection and the most common cause of cervical cancer, they report in the journal Pediatrics.

Some 79 million Americans, most in their late teens and early 20s, are infected with human papillomavirus, according to the Centers for Disease Control and Prevention. About half of those are infected with the most virulent strains of the virus, which are targeted by the quadrivalent vaccine given to study participants.

"The vaccine was virtually 100 percent effective in preventing disease in these young individuals," says Dr. Daron G. Ferris, professor in the Department of Obstetrics and Gynecology at the Medical College of Georgia and at the Georgia Cancer Center at Augusta University.

The quadrivalent vaccine protects against HPV types 6, 11, 16 and 18. Types 16 and 18 account for essentially all cervical cancer and for most other HPV-related cancers like penile and anal cancers, according to the National Cancer Institute. Types 6 and 11 account for about 90 percent of genital warts as well as non-cancerous tumor growths in the respiratory tract.

No cases of disease related to these four HPV types were found in study participants, who received a three-dose regimen of the vaccine when they were ages 9-15 and sexually inactive, Ferris says.
Ferris, first author of the new study who led trials of the quadrivalent vaccine in 2002, says the earlier, shorter-term evaluation clearly indicated the vaccine worked.

"We also needed to look at long-term efficacy, safety and immunogenicity," he says. "We needed to answer questions like if we vaccinate earlier in life, will it last. The answer is yes, this cancer prevention vaccine is working incredibly well 10 years later. A booster vaccine likely will not be needed by these young people. I think now we have come full circle."

The study was the longest follow up to date on the vaccine. Follow-up data on safety and efficacy has been assessed at up to six years in women age 15-26 and the current team of investigators also looked at data on the large cohort of young people two years ago.

Participants were followed at 34 sites in nine countries, including MCG and the Georgia Cancer Center in Augusta. Initially about one third of the 1,661 study participants received placebo, however the placebo group also received the vaccine 30 months into the study so those individuals were followed a shorter period of time, the researchers note.

While all participants remained disease free, the earlier vaccinations produced the most robust initial and long-term antibody response, Ferris says, of levels of the infection fighters that can be measured in the blood.

While about two-thirds of infected individuals can eventually clear the virus, it persists and can cause a wide range of health problems in the remainder, Ferris says. The vaccination is designed to better arm everyone's immune system to eliminate the virus.

The Food and Drug Administration approved the first quadrivalent vaccine, Gardasil, in June 2006. The vaccine is currently approved for patients ages 9-26.

Effectiveness assessments included looking for genital warts, precancerous and cancerous growths on the cervix and genitals as well as persistent HPV infections. Effectiveness evaluation began at 3.5 years and continued twice yearly during the 10-year-period.

Two-dose vaccines that cover nine HPV strains are rapidly replacing the three-dose quadrivalent vaccine, Ferris says.

"Now we need to push for more young people to get vaccinated," he says. "We are doing miserably in the United States."

About 43 percent of U.S. teens are up to date on recommended doses of the HPV vaccine, according to the CDC. The HPV vaccine can be given along with the meningococcal and tetanus, diphtheria and pertussis vaccines, to 11- and 12-year-olds, the researchers note.

Study participants reported sexual activity rates similar to other studies and numbers of new sexual partners were higher among males than females. Other sexually transmitted diseases, including gonorrhea and chlamydia, were found in a small percentage of study participants over the years of follow up. Half of all sexually transmitted diseases occur in people age 15-24 and 1 in 4 sexually adolescent females have a sexually transmitted disease like chlamydia or HPV, according to the CDC.

Tuesday, November 28, 2017

Eating raw dough could make you sick


Do you find it hard to resist gobbling up a piece of raw dough when making cookies, or letting your children scrape the bowl? Do your kids use raw dough to make ornaments or homemade “play” clay? Do you eat at family restaurants that give kids raw dough to play with while you’re waiting for the food?

If your answer to any of those questions is yes, that could be a problem. Eating raw dough or batter—whether it’s for bread, cookies, pizza or tortillas—could make you, and your kids, sick.  And even though there are websites devoted to “flour crafts,” don’t give your kids raw dough or baking mixes that contain flour to play with.

Why? Flour, regardless of the brand, can contain bacteria that cause disease. In 2016, the U.S. Food and Drug Administration (FDA), along with the Centers for Disease Control and Prevention (CDC) and state and local officials, investigated an outbreak of infections that illustrated the dangers of eating raw dough. Dozens of people across the country were sickened by a strain of bacteria called Shiga toxin-producing E. coli O121.

The investigation found that raw dough eaten or handled by some of the patients was made with flour found in subsequent tests by the FDA to have the same bacterium that was making people sick. Ten million pounds of flour were recalled, including unbleached, all-purpose, and self-rising varieties.
Some of the recalled flours had been sold to restaurants that allow children to play with dough made from the raw flour while waiting for their meals. CDC advises restaurants not to give customers raw dough.

Why Flour?

People often understand the dangers of eating raw dough due to the presence of raw eggs and the associated risk with Salmonella. However, consumers should be aware that there are additional risks associated with the consumption of raw dough, such as particularly harmful strains of E. coli in a product like flour.

“Flour is derived from a grain that comes directly from the field and typically is not treated to kill bacteria,” says Leslie Smoot, Ph.D., a senior advisor in FDA’s Office of Food Safety and a specialist in the microbiological safety of processed foods. So if an animal heeds the call of nature in the field, bacteria from the animal waste could contaminate the grain, which is then harvested and milled into flour.

Common “kill steps” applied during food preparation and/or processing (so-called because they kill bacteria that cause infections) include boiling, baking, roasting, microwaving, and frying. But with raw dough, no kill step has been used.

And don’t make homemade cookie dough ice cream either. If that’s your favorite flavor, buy commercially made products. Manufacturers should use ingredients that include treated flour and pasteurized eggs.

Symptoms and Who Gets Sick

Common symptoms for Shiga toxin-producing E. coli are diarrhea (often bloody) and abdominal cramps, although most people recover within a week. But some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS). HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems.
Parents of young children should be particularly aware. For instance, if your child is in day care or kindergarten, a common pastime may be art using “play” clay that is homemade from raw dough. Even if they’re not munching on the dough, they’re putting their hands in their mouth after handling the dough. Childcare facilities and preschools should discourage the practice of playing with raw dough.

Handle Foods Safely

FDA offers these tips for safe food handling to keep you and your family healthy:
  • Do not eat any raw cookie dough, cake mix, batter, or any other raw dough or batter product that is supposed to be cooked or baked.
  • Follow package directions for cooking products containing flour at proper temperatures and for specified times.
  • Wash hands, work surfaces, and utensils thoroughly after contact with flour and raw dough products.
  • Keep raw foods separate from other foods while preparing them to prevent any contamination that may be present from spreading. Be aware that flour may spread easily due to its powdery nature.
  • Follow label directions to chill products containing raw dough promptly after purchase until baked.

Three to four cups of coffee a day linked to longer life



Drinking coffee is "more likely to benefit health than to harm it" for a range of health outcomes, say researchers in The BMJ today.

They bring together evidence from over 200 studies and find that drinking three to four cups of coffee a day is associated with a lower risk of death and getting heart disease compared with drinking no coffee. Coffee drinking is also associated with lower risk of some cancers, diabetes, liver disease and dementia.

However, they say drinking coffee in pregnancy may be associated with harms, and may be linked to a very small increased risk of fracture in women.

The included studies used mainly observational data, providing lower quality evidence, so no firm conclusions can be drawn about cause and effect, but their findings back up other recent reviews and studies of coffee intake. As such, they say, excluding pregnancy and women at risk of fracture, "coffee drinking appears safe within usual patterns of consumption" and they suggest that coffee could be safely tested in randomised trials.

Coffee is one of the most commonly consumed beverages worldwide and could have positive health benefits. But existing evidence is of lower quality from observational research and randomised controlled trials are needed to strengthen the evidence of benefits.

To better understand the effects of coffee consumption on health, a team led by Dr Robin Poole, Specialist Registrar in Public Health at the University of Southampton, with collaborators from the University of Edinburgh, carried out an umbrella review of 201 studies that had aggregated data from observational research and 17 studies that had aggregated data from clinical trials across all countries and all settings.

Umbrella reviews synthesise previous meta-analyses and provide a high-level summary of research on a particular topic

Drinking coffee was consistently associated with a lower risk of death from all causes and from heart disease, with the largest reduction in relative risk of death at three cups a day, compared with non-coffee drinkers. Increasing consumption to above three cups a day was not associated with harm, but the beneficial effect was less pronounced.

Coffee was also associated with a lower risk of several cancers, including prostate, endometrial, skin and liver cancer, as well as type 2 diabetes, gallstones and gout. The greatest benefit was seen for liver conditions, such as cirrhosis of the liver.

Finally, there seemed to be beneficial associations between coffee consumption and Parkinson's disease, depression and Alzheimer's disease.

There was less evidence for the effects of drinking decaffeinated coffee but it had similar benefits for a number of outcomes.

Many of the included studies may have adjusted for factors that may be associated with both the health outcome and with coffee drinking, such as smoking. This was not comprehensive and varied from study to study. The authors can therefore not rule out the effect of such factors on the apparent harmful or beneficial associations.

The authors conclude that coffee drinking "seems safe within usual patterns of consumption, except during pregnancy and in women at increased risk of fracture." And they call for robust randomised controlled trials "to understand whether the key observed associations are causal."

In a linked editorial, Eliseo Guallar at the Johns Hopkins Bloomberg School of Public Health says, although we can be reassured that coffee intake is generally safe, doctors should not recommend drinking coffee to prevent disease -- and people should not start drinking coffee for health reasons.

As this study shows, some people may be at higher risk of adverse effects, he writes, and there is "substantial uncertainty" about the effects of higher levels of intake. Finally, coffee is often consumed with products rich in refined sugars and unhealthy fats, "and these may independently contribute to adverse health outcomes," he adds.

However, even with these caveats, "moderate coffee consumption seems remarkably safe, and it can be incorporated as part of a healthy diet by most of the adult population," he concludes.


Maintaining sufficient vitamin D levels may help to prevent rheumatoid arthritis



Maintaining sufficient vitamin D levels may help to prevent the onset of inflammatory diseases like rheumatoid arthritis, research led by the University of Birmingham has discovered.

The research also found that while Vitamin D can be effective at preventing the onset of inflammation, it is less effective once inflammatory disease is established because diseases such as rheumatoid arthritis leads to vitamin D insensitivity.

Another key finding of the research was that the impact of vitamin D on inflammatory disease cannot be predicted using cells from healthy individuals or even from the blood of patients with inflammation as cells from the disease tissue are very different.

The researchers concluded that if vitamin D is to be used in patients with rheumatoid arthritis, clinicians may need to prescribe much higher doses than currently employed or provide a treatment that also corrects the vitamin D insensitivity of immune cells within the joint.

In addition to its well-established actions on the skeleton, vitamin D is a potent modulator of the immune system. In particular, vitamin D can suppress inflammation in autoimmune diseases such as rheumatoid arthritis. Patients with rheumatoid arthritis are frequently vitamin D deficient and may receive vitamin D supplementation.

The study, published in the Journal of Autoimmunity, involved using paired peripheral blood and synovial fluid from the inflamed joint of patients with rheumatoid arthritis.

Professor Martin Hewison, of the University of Birmingham's Institute of Metabolism and Systems Research, said: "Our current understanding of vitamin D and rheumatoid arthritis is based on studies of patient blood which may not truly represent the situation at the site of inflammation -- the joints.
"We therefore investigated responses to the active form of vitamin D in immune cells from the inflamed joints of patients with rheumatoid arthritis.

"Compared to blood from the same patients, the inflamed joint immune cells were much less sensitive to active vitamin D.

"This appears to be because immune cells from the joints of rheumatoid arthritis patients are more committed to inflammation, and therefore less likely to change, even though they have all the machinery to respond to vitamin D."

Dr Louisa Jeffery, also of the University of Birmingham, said: "Our research indicates that maintaining sufficient vitamin D may help to prevent the onset of inflammatory diseases like rheumatoid arthritis.

"However, for patients who already have rheumatoid arthritis, simply providing vitamin D might not be enough. Instead much higher doses of vitamin D may be needed, or possibly a new treatment that bypasses or corrects the vitamin D insensitivity of immune cells within the joint."

Senior author Professor Karim Raza, also of the University of Birmingham, said: "Our findings were unexpected as we initially thought that cells from the inflamed rheumatoid joint would respond just as well to vitamin D as cells from the blood. The fact that they don't has important implications for how we think about using vitamin D to treat inflammation.

"Unlike previous studies we isolated different immune cell types from the actual site of disease to determine whether specific subsets of immune cells (specific T cell groups) have equal sensitivity to vitamin D."

This is the first research of its kind to characterise the effects of vitamin D in both peripheral blood and inflamed joints of patients with inflammatory disease.

The study, carried out in collaboration with Professor David Sansom at University College London, is part of an ongoing research project which first began in 2011.

The university now hopes to embark on new research to determine why rheumatoid arthritis leads to vitamin D insensitivity, how we can overcome this and whether this effect is seen in other inflammatory diseases.


More thinking and problem-solving = less anxiety


 
Boosting activity in brain areas related to thinking and problem-solving may also buffer against worsening anxiety, suggests a new study by Duke University researchers.

Using non-invasive brain imaging, the researchers found that people at-risk for anxiety were less likely to develop the disorder if they had higher activity in a region of the brain responsible for complex mental operations. The results may be a step towards tailoring psychological therapies to the specific brain functioning of individual patients.

"These findings help reinforce a strategy whereby individuals may be able to improve their emotional functioning -- their mood, their anxiety, their experience of depression -- not only by directly addressing those phenomena, but also by indirectly improving their general cognitive functioning," said Ahmad Hariri, a professor of psychology and neuroscience at Duke. The results are published Nov. 17 in the journal Cerebral Cortex.

Previous findings from Hariri's group show that people whose brains exhibit a high response to threat and a low response to reward are more at risk of developing symptoms of anxiety and depression over time.

In the current work, Hariri and Matthew Scult, a clinical psychology graduate student in the department of psychology and neuroscience at Duke, wanted to investigate whether higher activity in a region of the brain called the dorsolateral prefrontal cortex could help shield these at-risk individuals from future mental illness.

"We wanted to address an area of understanding mental illness that has been neglected, and that is the flip side of risk," Hariri said. "We are looking for variables that actually confer resiliency and protect individuals from developing problems."

The dorsolateral prefrontal cortex is our brain's "executive control" center, helping us focus our attention and plan complex actions. It also plays a role in emotion regulation, and well-established types of psychotherapy, including cognitive behavioral therapy, engage this region of the brain by equipping patients with strategies to reframe or re-evaluate their emotions.

The team drew on data from 120 undergraduate students who participated in the Duke Neurogenetics Study. Each participant completed a series of mental health questionnaires and underwent a type of non-invasive brain scan called functional Magnetic Resonance Imaging (fMRI) while engaged in tasks meant to activate specific regions of the brain.

The researchers asked each participant to answer simple memory-based math problems to stimulate the dorsolateral prefrontal cortex. Participants also viewed angry or scared faces to activate a region of the brain called the amygdala, and played a reward-based guessing game to stimulate activity in the brain's ventral striatum.

Scult was particularly interested in "at-risk" individuals with the combination of high threat-related activity in the amygdala and low reward-related activity in the ventral striatum. By comparing participants' mental health assessments at the time of the brain scans, and in a follow-up occurring on average seven months later, he found that these at-risk individuals were less likely to develop anxiety if they also had high activity in the dorsolateral prefrontal cortex.

"We found that if you have a higher functioning dorsolateral prefrontal cortex, the imbalance in these deeper brain structures is not expressed as changes in mood or anxiety," Hariri said.

The dorsolateral prefrontal cortex is especially skilled at adapting to new situations, the researchers say. Individuals whose brains exhibit the at-risk signatures may be more likely to benefit from strategies that boost the brain's dorsolateral prefrontal activity, including cognitive behavioral therapy, working memory training, or transcranial magnetic stimulation (TMS).

But, the researchers warn, the jury is still out on whether many brain-training exercises improve the overall functioning of the dorsolateral prefrontal cortex, or only hone its ability to complete the specific task being trained. Additional studies on more diverse populations are also needed to confirm their findings.

"We are hoping to help improve current mental health treatments by first predicting who is most at-risk so that we can intervene earlier, and second, by using these types of approaches to determine who might benefit from a given therapy," Scult said.

For moms and daughters, a walk in the park is best


Spending time together with family may help strengthen the family bond, but new research from the University of Illinois shows that specifically spending time outside in nature -- even just a 20-minute walk -- together can help family members get along even better.

The research is based on the attention restoration theory which describes how interaction with natural environments can reduce mental fatigue and restore attentional functioning. Many studies have supported the theory, but most, if not all, previous studies have only looked at the benefits of spending time in nature on an individual's attention.

U of I family studies researchers Dina Izenstark and Aaron Ebata believed that if this theory worked for individuals it might also work for families and help to facilitate more positive family interactions and family cohesion. So last year they developed a new theoretical approach to studying the benefits of family-based nature activities.

"Past research shows that in nature individuals' attention is restored but we wanted to know, what does that mean for family relationships? In our theoretical model we made the case that when an individual's attention is restored, they are less irritable, have more self-control, and are able to pick up on social cues more easily. Because of all of those dynamics, we believe they should get along better with other family members," Izenstark explains.

In a new study, Izenstark, now an assistant professor at San José State University, and Ebata, an associate professor and Extension specialist in the Department of Human Development and Family Studies at U of I, test their theory by looking at sets of moms and daughters (ages 10-12 years) who were asked to take a walk together in nature and a walk in a mall. The researchers then tested both the mothers' and daughters' attention and observed their family interactions after each walk.

The results were clear; a walk in nature increased positive interactions, helping the mothers and daughters get along better. It also restored attention, a significant effect for mothers in the study.

"We know that both moms and daughters experience mental or attentional fatigue. It's common especially after a full day of concentrating at work or at school," Izenstark says. "If you think about our everyday environments, not only are you at work, but maybe your cell phone is constantly buzzing, and you're getting emails. With all the stimuli in our everyday environments, our attention is taxed more than we realize."

Izenstark adds that in order to relieve some of that mental fatigue, people need to restore their directed attention. "In nature, you can relax and restore your attention which is needed to help you concentrate better. It helps your working memory."

To test the mothers' and daughters' cohesiveness and whether attention was restored, 27 mom/daughter dyads met at a homelike research lab on campus before each walk. For 10 minutes they engaged in attention-fatiguing activities (i.e. solving math problems, word searches) while a recording of loud construction music played in the background. The researchers gave them a "pre-attention" test, and then set them out on a walk -- one day to a nature arboretum, and then on another day to a local indoor mall. Each walk was 20 minutes long.

After returning from each walk, the moms and daughters were interviewed separately. They were given a "post-attention" test, and were surveyed about which location they found the most fun, boring, or interesting. They were then videotaped playing a game that required them to work together.

For moms, attention was restored significantly after the nature walk. Interestingly, for daughters, attention was restored after both walks, which Izenstark says may be a result of spending family leisure time with their mother.

"It was unique that for the daughters walking with moms improved their attention. But for the moms, they benefitted from being in a nature setting. It was interesting to find that difference between the family members. But when we looked at their subjective reports of what they felt about the two settings, there was no question, moms and daughters both said the nature setting was more fun, relaxing, and interesting."

The last aspect of the findings was in regards to improved cohesion or togetherness in the mom/daughter pairs. After analyzing the videotaped interactions during the game, the researchers only found an effect for nature; after the nature walk, moms and daughters displayed greater dyadic cohesion, a sense of unity, closeness, and the ability to get along, compared to the indoor walk.
Although the study only focused on mothers and daughters, Izenstark says that the overall aim of the research is to examine different ways in which nature affects family relationships in general.

"First and foremost I hope it encourages families to find ways to get outside together, and to not feel intimidated, thinking, 'oh, I have to go outside for an hour or make it a big trip.' Just a 20-minute walk around the neighborhood before or after eating dinner or finding pockets of time to set aside, to reconnect, not only can benefit families in the moment but a little bit after the activity as well."
 
 
 

Monday, November 27, 2017

Arthritis prevalence is much higher than current estimates especially over 65 years old

 

New research indicates that the prevalence of arthritis in the United States has been substantially underestimated, especially among adults over 65 years old. The Arthritis & Rheumatology findings indicate that research is needed to better monitor arthritis prevalence in the US population and to develop better prevention strategies.

Current national estimates of arthritis rely on a single survey question, asking participants whether they remember being ever told by a health professional that they have arthritis, without using information on patients' joint symptoms that are available in the survey. Because many cases of arthritis may be missed, S. Reza Jafarzadeh, DVM, MPVM, PhD and David T. Felson, MD, MPH, of Boston University School of Medicine, developed a method for arthritis surveillance based on doctor-diagnosed arthritis, chronic joint symptoms, and whether symptom duration exceeded three months.

In their analysis of the 2015 National Health Interview Survey (NHIS), the researchers found that arthritis affects a much higher percentage of the US adult population and at a younger age than previously thought. Of 33,672 participants, 19.3 percent of men and 16.7 percent of women age18-64 years reported joint symptoms without a concurrent report of a doctor-diagnosed arthritis. For participants 65 years of age and older, the respective proportions were 15.7 percent and 13.5 percent.

The prevalence of arthritis was 29.9 percent in men aged 18-64 years, 31.2 percent in women aged 18-64 years, 55.8 percent in men aged 65 years and older, and 68.7 percent in women aged 65 years and older. Arthritis affected 91.2 million US adults (36.8 percent of the population) in 2015, which included 61.1 million persons between 18-64 years (31.6 percent of the population).

The investigators' prevalence estimate is 68 percent higher than previously reported arthritis national estimates that did not correct for measurement errors in the current surveillance methods.

"Our findings are important because of underestimated, yet enormous, economic and public health impacts of arthritis including healthcare costs and costs from loss of productivity and disability, including in adults younger than 65 years of age," said Dr. Jafarzadeh. "Studies have reported a rising rate of surgeries such as total knee replacement that outpaced obesity rates in recent years, especially among younger adults affected by arthritis." He noted that current arthritis surveillance methods, which have been used since 2002, should be revised to correct for inherent limitations of the survey methods and to increase accuracy.

Moderate exercise + a Mediterranean/low carb diet = reduced fat deposits even if no weight


A new, long-term diet study published in the high impact American Heart Association journal, Circulation, used MRI imaging technology for the first time to plot the diverse changes in an array of body organ fat storage pools during 18 months of Mediterranean/low-carb (Med/LC) and low-fat diets, with and without moderate physical exercise.

The CENTRAL MRI is a randomized, controlled trial conducted at Ben-Gurion University of the Negev (BGU), in collaboration with the Dimona Nuclear Research Center and Soroka University Medical Center in Israel, as well as Harvard University and Leipzig University in Germany. The research group, led by Drs. Iris Shai, Yftach Gepner, Ilan Shelef and Dan Schwarzfuchs from BGU and Dr. Meir Stampfer from Harvard University, sought to assess how distinct lifestyle strategies would impact specific body (adipose) fat deposits.

To map these deposits, they collected an unprecedented quantity of whole body MRI data in benchmark six-month and 18-month scans, each with 300 data points, from moderately overweight to obese men and women.

"Weighing patients or using blood tests to detect changes, hasn't, until now, given us accurate pictures, literally, of how different fat deposits are impacted disproportionately by diet and exercise," says Prof. Iris Shai, the primary investigator of the CENTRAL MRI trial. "These findings suggest that moderate exercise combined with a Mediterranean/low carb diet may help reduce the amount of some fat deposits even if you don't lose significant weight as part of the effort."

In the study, even with only moderate weight loss, the Med/LC diet was found to be significantly superior to a low-fat diet in decreasing some of the fat storage pools, including visceral (abdominal deep), intra-hepatic (liver), intra-pericardial (heart), and pancreatic fats. However, fat deposits in renal-sinus (kidney), femoral-intermuscular or the cervical (neck) were only altered by weight loss and not by specific lifestyle strategies.

The various fat deposits exhibited highly diverse responsiveness to the interventions, along with moderate, long-term weight loss. In general, the greatest fat deposit decreases were hepatic (-29 percent), visceral (-22 percent) and intra-pericardial (-11 percent). Pancreatic and femur intermuscular fat deposits were only reduced one to two percent.

"We learned in this trial that moderate, but persistent, weight loss may have dramatic beneficial effects on fat deposits related to diabetes and cardiovascular diseases," Prof. Shai explains. A Mediterranean diet, rich in unsaturated fats and low in carbohydrates, was a more effective strategy than an iso-caloric low-fat diet to dramatically reverse morbid fat storage sites.

The 18-month trial included 278 sedentary adults in an isolated workplace, the Nuclear Research Center, with a monitored lunch provided. The participants were randomized to iso-caloric low-fat or Med/LC diet+28gr walnuts per day with or without an added moderate workout at least three times weekly and a supervised, free gym membership.

The CENTRAL MRI trial followed the groundbreaking DIRECT two-year trial (NEJM 2008) and its four-year follow-up (NEJM 2012). These found that Med/LC diets were effective in improving the cardio-metabolic state and in reversing carotid atherosclerosis (Circulation 2010). Based on those findings, the researchers asked whether internal body fat redistribution, rather than mild weight loss differences between the diets, may underline the significant health benefits attributed to Med/LC diets.

The researchers also found that the decline in hepatic fat and each one of the abdominal fat deposits had specific related health outcomes. After controlling for several parameters, losing visceral fat or hepatic fat were independently associated with improved lipid profile. Losing deep subcutaneous fat was associated with improved insulin sensitivity, and losing superficial subcutaneous fat remained neutral, except for association with decreased leptin hormone.

"In conclusion, the CENTRAL study demonstrates that improving nutritional quality and being physically active can improve cardio-metabolic risk markers through changes in visceral/ectopic fat deposits that are not reflected by changes in body weight alone," Prof. Shai says.

Wednesday, November 22, 2017

Risk factors for cancer in the United States


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IMAGE: Population attributable fraction of cancer deaths by risk factor; men, women, and combined. view more 
Credit: American Cancer Society
A new American Cancer Society study calculates the contribution of several modifiable risk factors to cancer occurrence, expanding and clarifying the role of known risk factors, from smoking to low consumption of fruits and vegetables. The study finds more than four in ten cancer cases and deaths in the United States are associated with these major modifiable risk factors, many of which can be mitigated with prevention strategies. The study appears early online in CA: A Cancer Journal for Clinicians.

In this new analysis, investigators led by Farhad Islami, M.D., Ph.D., of the American Cancer Society used the prevalence of known risk factors and their relative risk (the extent to which they increase cancer risk) to estimate the proportion of cancers due to those factors. They then applied those proportions to actual cancer data to estimate the number of associated cases and deaths overall and for 26 cancer types. The risk factors included in the analysis were: cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet light; and six cancer-associated infections.

They found that in the U.S., an estimated 42.0% of all cancer cases (659,640 of 1,570,975 cancers) and 45.1% of cancer deaths (265,150 of 587,521 deaths) in 2014 were attributable to these modifiable risk factors.

Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% of cases; 6.5% of deaths), alcohol intake (5.6% of cases; 4.0% of deaths), UV radiation (4.7% of cancers; 1.5% of deaths) and physical inactivity (2.9% of cases and 2.2% of deaths). Low fruit and vegetable intake accounted for 1.9% of cases and 2.7% of deaths, while HPV infection accounted for 1.8% of cases and 1.1% of deaths.

Lung cancer had the highest number of cancer cases (184,970) and deaths (132,960) attributable to evaluated risk factors, followed by colorectal cancer (76,910 cases and 28,290 deaths). Several major cancers had a high proportion of cases attributable to evaluated risk factors, including 85.8% of lung cancers, 71% of liver cancers, 54.6% of colorectal cancers, and 28.7% of breast cancers.

Other selected findings from the report:
  • Smoking accounted for 81.7% of lung cancers, 73.8% of larynx cancers, 50% of esophageal cancers, and 46.9% of bladder cancers.
  • Excess body weight was associated with 60.3% of uterine cancers, about one-third of liver cancers (33.9%), 11.3% of breast cancers in women, and 5.2% of colorectal cancers.
  • Alcohol intake was associated with almost one-half of oral cavity and pharyngeal cancers in men (46.3%) and about one-fourth (27.4%) in women, 24.8% of liver cancers in men and 11.9% in women, 17.1% of colorectal cancers in men and 8.1% in women, and 16.4% of breast cancers in women.
  • UV radiation was associated with 96.0% of melanomas of the skin in men and 93.7% in women.
  • Physical inactivity accounted for 26.7% of uterine cancers, 16.3% of colorectal cancers, and 3.9% of female breast cancers.
  • Low fruit and vegetable consumption was associated with 17.6% of oral cavity/pharyngeal cancers, 17.4% of laryngeal cancers, and 8.9% of lung cancers.
  • Red and processed meat consumption accounted for 5.4% and 8.2% of colorectal cancers, respectively. Low dietary fiber accounted for 10.3% of colorectal cancer cases, while low dietary calcium accounted for 4.9% of cases.
The authors also measured the combined contribution of excess body weight, alcohol intake, poor diet, and physical inactivity to the cancer burden. These four factors accounted for 13.9% and 22.4% of all cancer cases in men and women, respectively. The corresponding proportions for cancer deaths were 14.9% and 16.9%, respectively. Studies have shown that following the American Cancer Society's cancer prevention guidelines for maintaining a healthy body weight, limiting alcohol intake (for those who drink), consuming a healthy diet, and being physically active is associated with a reduced risk of developing and dying from cancer.

The authors say their results may underestimate the overall proportion of cancers attributable to modifiable factors because several other potentially modifiable risk factors could not be evaluated due to lack of exposure data. Also, a number of cancer types with likely, but as-yet unestablished associations with modifiable risk factors were not considered.

"Our findings emphasize the continued need for widespread implementation of known preventive measures in the country to reduce the morbidity and premature mortality from cancers associated with potentially modifiable risk factors," write the authors. "Increasing access to preventive health care and awareness about preventive measures should be part of any comprehensive strategy for broad and equitable implementation of known interventions to accelerate progress against cancer."

"In 1981, Doll and Peto published what has become a classic paper on the causes of cancer," said Otis W. Brawley, M.D., American Cancer Society chief medical officer and study co-author. "Since then, volumes of data have been published that have clarified the association between several important risk factors and cancer. In this new report, ACS scientists provide a 21st century calculation that will guide us in the years ahead."