Get off the golf cart if you have knee osteoarthritis

From presidents to retirees, more than 17 million people over the age of 50 golf regularly. Knee osteoarthritis, which causes swelling, pain and difficulty moving the joint, is one of the leading causes of disability in this age group.
It may seem intuitive that golfers with knee osteoarthritis should stay off their feet and ride in a golf cart. But new research from the Shirley Ryan AbilityLab and Northwestern Medicine has found, for the first time, that walking the course provides significantly higher health benefits and is not associated with increased pain, cartilage breakdown or inflammation.
This study is the first comparing the health benefits of walking the golf course versus using a cart, as well as the first to use a blood-based biomarker analysis in knee osteoarthritis during a prolonged sporting event. The findings will be presented April 28 at the Osteoarthritis Research Society International Annual Meeting in Liverpool, England.
The health benefits of golf have decreased as the number of people who ride the course has increased over the past 20 years. In the late 1980s, 45 percent of all rounds of golf were played with a golf cart. By 2006, 69 percent of rounds were played with a cart. During this same time period, activity has decreased among Americans, while obesity has increased.
"Individuals with knee osteoarthritis are often concerned about pain and may be more likely to use a golf cart," said lead study author Dr. Prakash Jayabalan, a physician scientist at the Shirley Ryan AbilityLab and an assistant professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine.
"However, through sophisticated blood-based biomarker analysis, this study has shown that golfers with knee osteoarthritis do not need to be concerned about worsening their disease through walking the course. In fact, walking provides the best health benefit," Jayabalan said.
The study, completed in partnership with the Glenview Park District Golf Course in Glenview, Illinois, involved 15 participants -- 10 who had knee osteoarthritis and five who were of similar age but did not have the disease. Participants played 18 holes (one round of golf) walking the course and, on a separate day, the same individuals played a round riding a golf cart. The research team compared their heart rates to determine the intensity of exercise performed and took blood samples during each round to measure markers of cartilage stress and inflammation.
The researchers found that, prior to starting either round, the golfers with knee osteoarthritis had an average pain score of 1.3 (on a scale of 0-10). When they played the round walking the course, they had an average 2.1-point increase in pain score. When they played the round using the golf cart, they experienced on average a 1.5-point increase, a difference that is not clinically significant.
The research team also measured blood-based biomarkers of cartilage stress and inflammation. Although both methods of transportation caused an increase in these markers (as would be expected with regular walking), there was no difference between the rounds.
When walking the course, golfers with knee osteoarthritis spent more than 60 percent of the round with heart rates in the moderate intensity heart rate zone. When driving on a cart, golfers spent 30 percent of the round in this range. While this figure is lower, it still fulfills daily exercise recommendations.
Although walking the course offers the most significant health benefits, the study found that riding the course with a golf cart during a round -- and the requisite moderate walking that comes with it -- still offers cardiovascular benefits and helps fulfill daily exercise guidelines.

"Bottom line: walking the course is significantly better than using a golf cart, but using a golf cart is still better than not exercising at all," said Jayabalan.

Higher aerobic fitness levels are associated with better word production skills in healthy older adults

Healthy older people who exercise regularly are less inclined to struggle to find words to express themselves, research led by the University of Birmingham has discovered.

Researchers found that older adults' aerobic fitness levels are directly related to the incidence of age-related language failures such as 'tip-of-the-tongue' states.

The research, published today in Scientific Reports, is the first of its kind to investigate the relationship between aerobic fitness levels and temporary cognitive lapses, such as not having a word come to mind when speaking - known as a 'tip-of-the-tongue' state.

People in a tip-of-the-tongue state have a strong conviction that they know a word, but are unable to produce it, and this phenomena occurs more frequently as we grow older.

The University of Birmingham study - carried out in collaboration with the University of Agder in Norway, the University of Leuven in Belgium and King's College London - measured the occurrence of tip-of-the-tongue states in a psycholinguistic experiment.

The study saw a group of 28 healthy adults (20 women with the average age of 70 and 8 men with the average age of 67), being compared in a 'tip-of-the-tongue' language test to 27 young people (19 women with the average age of 23 and 8 men with the average age of 22).

The test involved a 'definition filling task', done on a computer. They were asked to name famous people in the UK, such as authors, politicians and actors, based on 20 questions about them. They were also given the definitions of 20 'low frequency' and 20 'easy' words and asked whether they knew the word relating to the definition.

The participants' underwent a static bike cycling test - a gold standard test which quantified their ability to use oxygen during exercise and their resulting individual aerobic fitness levels.

Lead author Dr Katrien Segaert, of the University of Birmingham's School of Psychology, said:

"Older adults free from medical diseases still experience age-related cognitive decline.
"Significantly, what we found was that the degree of decline is related to one's aerobic fitness.
"In our study, the higher the older adults' aerobic fitness level, the lower the probability of experiencing a tip-of-the-tongue state. 

"Importantly, our results also showed that the relationship between the frequency of tip-of-the-tongue occurrences and aerobic fitness levels exists over and above the influence of a person's age and vocabulary size."

Dr Segaert said that tip-of-the-tongue states are uniquely a problem with language functioning.

"Older adults sometimes worry that tip-of-the-tongue states indicate serious memory problems but this is a misconception: tip-of-the-tongue states are not associated with memory loss," she added. "In fact, older adults usually have a much larger vocabulary than young adults. Instead, tip-of-the-tongue states occur when the meaning of a word is available in our memory, but the sound form of the word can temporarily not be accessed."

"Accessing the sound forms of words is essential for successful and fluent language production, and its disruption has very noticeable negative consequences for older adults."

She said she hoped the study would add gravitas to the public health message that regular exercise is important to ensure healthy ageing.

She added: "There are a lot of findings already on the benefits of aerobic fitness and regular exercise, and our research demonstrates another side of the benefits, namely a relationship between fitness and language skills. We were able to show, for the first time, that the benefits of aerobic fitness extend to the domain of language."

"Maintaining good language skills is extremely important for older adults. Older adults frequently have word finding difficulties and they experience these as particularly irritating and embarrassing."
"Speaking is a skill we all rely on every day. Communication with others helps us maintain social relationships and independence into old age."

In future research, the University of Birmingham plans to undertake exercise intervention studies to determine whether regular exercise can successfully increase language abilities.

Following five healthy lifestyle habits may increase life expectancy by decade or more

Maintaining five healthy habits--eating a healthy diet, exercising regularly, keeping a healthy body weight, not drinking too much alcohol, and not smoking--during adulthood may add more than a decade to life expectancy, according to a new study led by Harvard T.H. Chan School of Public Health.

Researchers also found that U.S. women and men who maintained the healthiest lifestyles were 82% less likely to die from cardiovascular disease and 65% less likely to die from cancer when compared with those with the least healthy lifestyles over the course of the roughly 30-year study period.
The study is the first comprehensive analysis of the impact of adopting low-risk lifestyle factors on life expectancy in the U.S. It will be published online April 30, 2018 in Circulation.

Americans have a shorter average life expectancy--79.3 years--than almost all other high-income countries. The U.S. ranked 31st in the world for life expectancy in 2015.

The new study aimed to quantify how much healthy lifestyle factors might be able to boost longevity in the U.S.

Harvard Chan researchers and colleagues looked at 34 years of data from 78,865 women and 27 years of data from 44,354 men participating in, respectively, the Nurses' Health Study and the Health Professionals Follow-up Study.

The researchers looked at how five low-risk lifestyle factors--not smoking, low body mass index (18.5-24.9 kg/m2), at least 30 minutes or more per day of moderate to vigorous physical activity, moderate alcohol intake (for example, up to about one 5-ounce glass of wine per day for women, or up to two glasses for men), and a healthy diet--might impact mortality.

For study participants who didn't adopt any of the low-risk lifestyle factors, the researchers estimated that life expectancy at age 50 was 29 years for women and 25.5 years for men. But for those who adopted all five low-risk factors, life expectancy at age 50 was projected to be 43.1 years for women and 37.6 years for men. In other words, women who maintained all five healthy habits gained, on average, 14 years of life, and men who did so gained 12 years, compared with those who didn't maintain healthy habits.

Compared with those who didn't follow any of the healthy lifestyle habits, those who followed all five were 74% less likely to die during the study period. The researchers also found that there was a dose-response relationship between each individual healthy lifestyle behavior and a reduced risk of early death, and that the combination of all five healthy behaviors was linked with the most additional years of life.

"This study underscores the importance of following healthy lifestyle habits for improving longevity in the U.S. population," said Frank Hu, chair of the Department of Nutrition at Harvard Chan School and senior author of the study. "However, adherence to healthy lifestyle habits is very low. Therefore, public policies should put more emphasis on creating healthy food, built, and social environments to support and promote healthy diet and lifestyles.

Taking a photo each day improves wellbeing

Taking a photo each day and posting it online has complex benefits say researchers who say it supports improved wellbeing.

This is a popular social phenomenon, with Instagram having over 1.5million photos tagged #365 for each day of the year while there are thousands of members of Blipfoto, a key photo-a-day site.
A study co-authored by Dr Liz Brewster of Lancaster University and Dr Andrew Cox of the University of Sheffield recorded what photos people took, what text they added and how they interacted with others on the photo-a-day site for two months.

They found that taking a daily photo improved wellbeing through:

• Self-care
• Community interaction
• The potential for reminiscence

Taking a moment to be mindful, and looking for something different or unusual in the day were seen as positive well-being benefits of the practice.
One participant said: "My job was a very highly stressful role... There were some days when I'd almost not stopped to breathe, you know what I mean... And just the thought: oh wait a moment, no, I'll stop and take a photograph of this insect sitting on my computer or something. Just taking a moment is very salutary I think."
It also led to more exercise and gave a sense of purpose, competence and achievement.
Another participant said: "It encourages me out of the house sometimes when I could just sit on my backside with a cup of tea. I'll think maybe I'll take a walk down on to the seafront and before I know it I'm two miles along the coast. "
The online contact helped people to manage loneliness and grief as well as meeting new people with shared interests. Several participants had taken early retirement and found that the contact established via photo-a-day replaced some of the daily office chatter that they missed.
"There's the banter in the workshop or the office or the place where you work. And perhaps [photo-a-day] offers that... Because I'm having conversations with people that I would perhaps have had in the workplace.
The online interactions created a community based on the photos and accompanying text.
"It could be a rubbish photograph but if somebody commented on it, it made it worthwhile."
The online text was used to provide personal narratives, reminiscences, and explanations of repeated images.
"I'm ever feeling down or something it's nice to be able to scroll back and see good memories. You know, the photos I've taken will have a positive memory attached to it even if it's something as simple as I had a really lovely half an hour for lunch sitting outside and was feeling really relaxed."
The researchers said the practice is "an active process of meaning making, in which a new conceptualisation of wellbeing emerges."

Eating garlic can reduce the risk of developing certain kinds of cancers, cardiovascular disease, and type 2 diabetes

Researchers today generally agree that eating garlic, used for thousands of years to treat human disease, can reduce the risk of developing certain kinds of cancers, cardiovascular disease, and type 2 diabetes. Nevertheless, in a review published April 26 in the journal Trends in Pharmacological Sciences, researchers in the UK argue that explaining exactly how garlic affects human health -- and getting consistent results during clinical trials -- is more complex, because of the vast array of compounds garlic produces.

Garlic's unique flavor comes from sulfur compounds. Like other members of the allium family, the plant absorbs sulfate from the soil and incorporates it into amino acids and sulfur storage molecules. These sulfur storage molecules can then be broken down into approximately 50 different sulfur-containing compounds when the garlic is prepared and eaten. "These molecules give the plants an ecological advantage when they're growing out in the wild. As it happens, they're also biologically active within mammalian cells and tissues," says senior author Peter Rose, a biochemist at the University of Nottingham.

These compounds are well studied in garlic, and there is research to suggest that they are important in producing the health effects for which garlic is renowned. Understanding how they produce those effects is less clear, however, in part because how we prepare garlic affects which sulfur compounds we end up consuming. Chopping fresh garlic, fermenting garlic in alcohol, and pressing garlic for oil, for example, all yield different sulfur compounds.

"Each of these preparative forms could have a different effect within mammalian systems. And that's what makes this research so complex, because we don't really understand how these compounds are metabolized in humans and it's very difficult to identify common mechanisms of action for these molecules," he says.

While there's no right or wrong way to prepare your garlic, this quirk of garlic's biochemistry could explain why studies of the plant's effects on humans have had such mixed results. "When it comes to human intervention studies, there's been quite a lot of disparity. Sometimes the consumption of and exposure to these compounds has biological effects, and other times, it does nothing. I think it needs reinvestigating, just because of the sheer complexity of the diversity of these sorts of compounds and the different distribution of them between different garlic products," he says.

Rose and his colleagues are particularly interested in how these sulfur compounds might affect gaseous signaling molecules like nitric oxide and hydrogen sulfide, which are naturally produced by our bodies. Gaseous signaling molecules play an important role in cell communication and maintaining homeostasis, and altered levels of them are present in many diseases. Recent research in vitro has linked the kinds of sulfur compounds we get from garlic to increased production of these molecules, suggesting that this might be the common mechanism by which the different sulfur compounds affect the human body.

There's still a lot of research to be done, but Rose believes that someday we might be able to identify other plants that stimulate the production of these gases or modify garlic, onions, and other alliums to be more efficient at producing them once ingested.

"There is a lot of possibility within this area for finding approaches that could reduce the risk of diseases and improve human health, but it all comes back to those fundamental questions of what actually happens to these compounds when we metabolize them. There's a whole spectrum of human work that still needs to be done to further explore some of these weird and wonderful sulfur compounds that we find within our diets," he says.

He also believes that it's important to remember that garlic isn't some kind of magic bullet. "I don't think there is one individual plant species that is a cure-all, but there are certainly plant species that are strongly associated with reducing disease risk within humans. Variety is the spice of life, but understanding the chemistry of some of your spices is probably a very advantageous thing to do."

Wines and beers labelled as lower in alcohol may increase the total amount of alcohol consumed

Wines and beers labelled as lower in alcohol strength may increase the total amount of alcoholic drink consumed, according to a study published in the journal Health Psychology. The study was carried out by the Behaviour and Health Research Unit at the University of Cambridge in collaboration with the Centre for Addictive Behaviours Research at London South Bank University.

Alcohol is the fifth leading cause of disease and premature death both in the UK and globally. Reducing consumption of alcohol is a public health priority in many countries. In the UK, as part of a range of steps to reduce overall alcohol consumption, policymakers are currently interested in allowing industry to label a wider range of alcohol products as lower in alcohol.

Proposed legislative changes include extending the variety of terms that could be used to denote lower alcohol content, and extending the strength limit to include products lower than the current average on the market (12.9% ABV for wine and 4.2% ABV for beer*).

"For lower strength alcohol products to reduce consumption, consumers will need to select them in place of equal volumes of higher strength products," says Dr Milica Vasiljevic from the University of Cambridge. "But what if the lower strength products enable people to feel they can consume more?"

In this study, two-hundred and sixty-four weekly wine and beer drinkers -- sampled from a representative panel of the general population of England -- were randomised to one of three groups to taste test drinks in a laboratory designed to mimic a bar environment. The drinks varied only in the label displayed. In one group participants taste-tested drinks labelled 'Super Low' and '4%ABV' for wine or '1%ABV' for beer. In another group the drinks were labelled 'Low' and '8%ABV' for wine or '3%ABV' for beer. In the final group participants taste-tested drinks labelled with no verbal descriptors of strength, but displaying the average strength on the market -- wine ('12.9%ABV') or beer ('4.2%ABV').

The results showed the total amount of drink consumed increased as the label on the drink denoted successively lower alcohol strength. The mean consumption of drinks labelled 'Super Low' was 214ml, compared with 177ml for regular (unlabelled) drinks. Individual differences in drinking patterns and socio-demographic indicators did not affect these results.

"Labelling lower strength alcohol may sound like a good idea if it encourages people to switch drinks, but our study suggests it may paradoxically encourage people to drink more," says Professor Theresa Marteau, senior author and Director of the Behaviour and Health Research Unit.

While this study shows that people may drink more if drinks are labelled as lower in strength, the researchers do not yet know if this effect is sufficient to result in the consumption of more units of alcohol overall from lower strength alcohol drinks. Furthermore, participants in this study were tested in a bar-laboratory setting. To learn more about the impact of lower strength alcohol labelling, research in real-world settings is needed.

*ABV denotes alcohol by volume, the standard measure of how much alcohol is contained in a given volume of an alcoholic drink.

Eating dark chocolate improves vision

Bottom Line: A small study found slight improvement in vision after eating dark chocolate.
Why The Research Is Interesting: Eating dark chocolate has been associated with better blood flow, mood and cognition in the short term but little is known about its possible effects on vision.
Who and When: 30 participants; testing was conducted from June to August 2017
What (Study Interventions and Outcomes): Eating a dark or milk chocolate bar (intervention); visual acuity and the ability to read letters of different sizes and contrast (lighter vs. darker letters) were measured about two hours after eating chocolate (outcomes)
How (Study Design): This was a randomized clinical trial (RCT). RCTs allow for the strongest inferences to be made about the true effect of an intervention such as a medication or a procedure. However, not all RCT results can be replicated in real-world settings because patient characteristics or other variables may differ from those that were studied in the RCT

Seniors stick to fitness routines when they work out together

Older adults are more likely to stick with a group exercise program if they can do it with people their own age, a new University of British Columbia study has found.
Working out with peers of the same gender doesn't seem to make a difference - it's the age that counts.
"This study points to the importance of age-targeting, but perhaps not gender-targeting, when developing these programs," says UBC kinesiology professor Mark Beauchamp, the study's lead author.
Older adults worldwide are less active than they should be, with activity levels lowest in the Americas. In Canada, fewer than 15 per cent of people past age 59 meet international physical activity guidelines. Beauchamp and his international team of researchers have been looking for ways to keep people active into old age, because inactivity has been shown to increase risk of cardiovascular disease, obesity and arthritis. It can also lead to physical limitations that affect overall quality of life.
The researchers knew from earlier studies that older adults prefer to exercise within their own age group. They wanted to find out whether preferences expressed by older adults in surveys would actually lead to greater adherence in practice.
The study recruited 627 adults, averaging 72 years in age, for 12-week exercise classes at YMCA locations in Metro Vancouver. Participants had the option to extend participation for another 12 weeks afterward. Researchers divided participants into three workout groups. One group was consistent in age and gender, while another was consistent in age but not gender. Those groups were led by older adult instructors recruited and trained for the study. The third group worked out in a typical YMCA class that was open to all ages and genders, led by a YMCA instructor.
Over the 24-week period, participants who worked out with people their own age attended an average of 9.5 more classes than counterparts in the mixed-age group. Participants in the mixed-age group averaged 24.3 classes. Participants in the same-age, mixed-gender group averaged 33.8 classes, and participants in the same-age, same-gender group averaged 30.7 classes.
The researchers' prediction that same-gender classes would lead to even greater adherence wasn't borne out by the results. This is significant, as it could free facilitators from the cost of providing separate classes for each gender unnecessarily.
Age and gender groupings weren't the only strategies researchers used to try to strengthen participants' commitment. Participants also received custom T-shirts that identified them as members of a group, and were given opportunities to socialize over coffee following class.
"All of this together points to the power of social connections," Beauchamp said. "If you set the environment up so participants feel a sense of connection or belonging with these other people, then they're more likely to stick with it."
Such strategies would be easy to employ in a variety of physical activity settings such as community centres, fitness clubs and retirement communities, the researchers noted.
In this case, study participants didn't want the classes to end. Rather than continue their workouts in regular classes, they successfully lobbied the YMCA to continue age-specific sessions after the experiment was over.
The study appears in the May issue of Health Psychology and was funded by a grant from the Canadian Institutes of Health Research.

Consuming protein supplements with meals may work better for weight control

A new systematic review of available evidence appearing in Nutrition Reviews indicates that consuming protein supplements with meals may be more effective at promoting weight control than consuming supplements between meals in adults following a resistance training regimen.

It is well established that consuming dietary protein proximate to resistance-type exercise sessions promotes a positive net protein balance during post-exercise recovery. Protein supplements are available in ready-to-drink, powdered, and solid form and are marketed for different outcomes such as weight gain, weight loss, and weight management. However, for each outcome, the promoted timing of protein intake varies. Protein supplements designed to augment weight gain or support weight stability are promoted for consumption between meals. Protein supplements either with meals or as meal replacements are often recommended for ingestion to promote weight loss.

Consuming protein supplements between meals may decrease compensatory eating behaviors, thereby increasing energy intakes and body weight. Conversely, adults undergoing a resistance training program and consuming protein supplements twice daily with meals may compensate for the protein supplement by decreasing their self-chosen diet. Consequently, the timing of protein supplementation may be of particular importance, depending on the desired body weight and body composition outcome.

The impact of timing the consumption of protein supplements relative to meals has not previously been evaluated systematically. In the newly published review of the literature, the researchers investigated whether the existing research studies support consuming protein supplements between meals, vs. with meals, to differentially change body composition in adults who initiate resistance training regimens.

Researchers here assessed 34 randomized controlled trials with 59 intervention groups. Of the intervention groups designated as consuming protein supplements with meals vs. between meals, 56% vs. 72% increased their body mass, 94% vs. 90% increased their lean mass, 87% vs. 59% reduced their fat mass, and 100% vs. 84% increased the ratio of lean to fat mass over time, respectively.

With-meal ingestion of protein was defined as consumption of a dietary protein-rich supplement immediately after a meal, with a meal, or as a high-protein meal replacement. Between-meal ingestion of protein was defined as consumption of a dietary protein supplement predominantly either very near a workout or during another non mealtime.

The results from this systematic review provide novel information for people who choose to consume protein supplements as part of their dietary pattern to promote body mass gain or improve body composition through fat mass reduction. However, consuming protein supplements with meals, rather than between meals, may be a more effective dietary strategy to improve resistance training-induced changes in body composition by reducing fat mass, which may be relevant for adults looking to improve their health status. Consuming protein supplements between meals may be more effective at increasing overall body mass.

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The systematic review "Effects of protein supplements consumed with meals, versus between meals, on resistance training-induced body composition changes in adults: a systematic review" is available at: https://doi.org/10.1093/nutrit/nuy012

Study links night exposure to blue light with breast and prostate cancer

Researchers used images taken by astronauts to evaluate outdoor lighting in Madrid and Barcelona

Barcelona Institute for Global Health (ISGlobal)

IMAGE: Aerial image of the city of Barcelona (Spain) taken by astronauts of the International Space Station. view more 

Credit: Image courtesy of the Earth Science and Remote Sensing Unit, NASA Johnson Space Center. http://eol.jsc.nasa.gov

A study performed by an international team led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, reports a link between exposure to blue light at night and higher risk of developing breast and prostate cancer. Blue light is a range of the visible light spectrum emitted by most white LEDs and many tablet and phone screens. The results have been published in Environmental Health Perspectives.
"WHO's International Agency for Research on Cancer (IARC) has classified night shift work as probably carcinogenic to humans. There is evidence pointing to an association between exposure to artificial light at night, disruption of the circadian rhythm, and breast and prostate cancers. With this study we sought to determine whether night exposure to light in cities can affect the development of these two types of cancer", explains Manolis Kogevinas, ISGlobal researcher and coordinator of the study. "We know that depending on its intensity and wave length, artificial light, particularly in the blue spectrum, can decrease melatonin production and secretion", says Martin Aubé, physics professor at CÉGEP in Sherbrooke, Canada and study co-author.
The study was conducted within the framework of the MCC-Spain project cofunded by the 'Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública' (CIBERESP), and includes medical and epidemiological data of more than 4,000 people between 20 and 85 years of age in 11 Spanish regions. Indoor exposure to artificial light was determined through personal questionnaires, while outdoor levels of artificial light were evaluated for Madrid and Barcelona, based on nocturnal images taken by astronauts aboard the International Space Station.
Results obtained for both cities show that participants exposed to higher levels of blue light had a 1.5 and 2-fold higher risk of developing breast and prostate cancer, respectively, as compared to the less-exposed population.
Ariadna García, ISGlobal researcher and first author of the study, says: "Given the ubiquity of artificial light at night, determining whether it increases or not the risk of cancer is a public health issue". At this point, further studies should include more individual data using for instance light sensors that allow measuring indoor light levels. It would also be important to do this kind of research in young people that extensively use blue light emitting screens".
"Currently, the images taken by the astronauts on the Space Station are our only way of determining the colour of outdoor lighting at a large scale, and the spread of blue light-emitting white LEDs in our cities", comments Alejandro Sánchez de Miguel, scientist at the Astrophysics Institute in Andalucía-CSIC and Exeter University.

When do problems with memory and decision-making affect older adults' ability to drive?

For older adults, driving can mean living a more independent, satisfying life. Therefore, it's no surprise that about 86 percent of adults age 65 and older hold active driver's licenses, and many of us expect to drive for longer as we age.

Car crashes can be devastating or even deadly for anyone, including older adults and other road users. However, the fatal crash rate based on the distance someone travels in a vehicle begins to rise at age 65. At the same time, when older adults stop driving due to health issues or other concerns, they may experience isolation and depression. They also may be more likely to enter long-term care facilities earlier than they otherwise would.

Researchers have a history of studying driver safety in older adults after they've been diagnosed with dementia, a decline in memory and other mental abilities that make daily living difficult. However, we have limited knowledge about the effects on older drivers whose problems with mental abilities are less severe than those associated with dementia.

Recently, a team of researchers designed a study to learn more about cognitive health and older drivers' crash risks. The study was published in the Journal of the American Geriatrics Society. In this study, the researchers focused on links between levels of cognitive function and crash risk among older drivers without dementia over a 14-year study period. They also assessed the link between changes in cognitive function over time and later risks of crashes.

The researchers used information from the Adult Changes in Thought (ACT) study, an ongoing study of adults aged 65 and older. The researchers linked ACT data from 2002 to 2015 to the Washington State crash database and to information from the Washington State Department of Licensing.

ACT participants were tested for their ability to think and make decisions. Researchers followed 2,615 participants for an average of 6.7 years or until they dropped out of ACT, died, were diagnosed with dementia, or failed to renew their license. The researchers then looked at motor vehicle crashes involving ACT participants. They included all crashes resulting in injury, death, or property damage totaling at least $1,000.

For older licensed drivers without dementia, lower levels of cognitive function were linked to a higher risk of motor vehicle crashes. Depression also was linked to a higher risk for crashes in older licensed drivers without dementia.

The researchers noted that, unfortunately, there is not yet a widely accepted specific clinical exam, procedure, or lab test that can evaluate driving and crash risk related to cognitive function. The researchers concluded that older drivers with lower levels of cognitive function were somewhat more likely to be involved in a crash. These older drivers, their family members, and their healthcare providers must balance the benefits of independence, mobility, and social engagement with the potential for car crashes as they make decisions about whether an older person should continue to drive.

Adults who eat breakfast gain less weight

Although studies have shown an association between eating breakfast and healthy body weight in children and teenagers, less research has focused on this relationship in adults. In an analysis involving 347 healthy adults, researchers from the Mayo Clinic found that study participants who skipped breakfast were more likely to be obese than those who ate it frequently, defined as five to seven times a week.

Participants who skipped breakfast also had larger waists than those who ate breakfast frequently or infrequently (one to four times a week). The link between skipping breakfast and weight gain remained even after the researchers took into account age, gender and body mass index. People who did not eat breakfast reported the most weight gain over the past year, and those who consumed breakfast on most days reported the lowest weight gain.

The researchers conclude that regularly consuming breakfast is important for maintaining a healthy weight at all ages.

Drinking water may help exercising seniors stay mentally sharp

Older people should drink more water to reap the full cognitive benefits of exercise, new research suggests. The study, to be presented today at the American Physiological Society (APS) annual meeting at Experimental Biology 2018 in San Diego, explores the association between hydration status before exercising and exercise-enhanced cognition in older adults.Dehydration has been shown to impair exercise performance and brain function in young people, but less is known about its impact on older populations.

"Middle-age and older adults often display a blunted thirst perception, which places them at risk for dehydration and subsequently may reduce the cognitive health-related benefits of exercise," a team of New England-based researchers wrote.

The researchers recruited recreational cyclists (average age 55) who participated in a large cycling event on a warm day (78-86 degrees F). The cyclists performed a "trail-making" executive function test--quickly and accurately connecting numbered dots using paper and pencil--before and after the event. Executive function includes the skills needed to plan, focus, remember and multitask. Exercise has been shown to improve intellectual health, including executive function.

The research team tested the volunteers' urine before they exercised and divided them into two groups--normal hydration and dehydrated--based on their hydration status. The normal hydration group showed noticeable improvement in the completion time of the trail-making test after cycling when compared to their pre-cycling test. The dehydration group also completed their post-cycling test more quickly, but the time reduction was not significant.

"This suggests that older adults should adopt adequate drinking behaviors to reduce cognitive fatigue and potentially enhance the cognitive benefits of regular exercise participation," the researchers wrote.

Even a single mindfulness meditation session can reduce anxiety

Mindfulness meditation programs have shown promise for the treatment of anxiety, one of the most common mental health disorders in the U.S. New research suggests people can begin to derive psychological and physiological benefits from the practice after a single introductory session.

"Our results show a clear reduction in anxiety in the first hour after the meditation session, and our preliminary results suggest that anxiety was significantly lower one week after the meditation session," said lead study author John J. Durocher, PhD, an assistant professor of physiology in the department of biological sciences at Michigan Technological University. "Participants also had reduced mechanical stress on their arteries an hour after the session. This could help to reduce stress on organs like the brain and kidneys and help prevent conditions such as high blood pressure."

Understanding the effects of mindfulness meditation on the body can help improve the design of anti-anxiety therapies, according to Durocher. He will present the research at the American Physiological Society annual meeting during the 2018 Experimental Biology meeting, held April 21-25 in San Diego.

Anxiety can be a risk factor for cardiovascular disease. Previous studies have indicated that arterial stiffness (a predictor of cardiovascular disease) can be increased by traumatic life events, job strain, depression, temporary anxiety and long-term proneness to anxiety. Cardiovascular changes associated with anxiety can also lead to high blood pressure and long-term damage to various organs.

Researchers recruited 14 participants who had normal blood pressure but high levels of anxiety. They measured factors related to cardiovascular functioning--including heart rate, blood pressure, aortic blood pressure (blood pressure in the aorta, specifically) and arterial stiffness--before and after a 60-minute guided introductory session of mindfulness meditation. This type of meditation emphasizes focusing on breathing and awareness of one's thoughts.

The results demonstrate that even a single, brief intervention can yield measurable improvements in people with anxiety. Researchers said most participants reported continuing to use mindfulness after the initial session and anxiety scores were reduced even further one week later.

"This study is different because we examined the effect of a single mindfulness meditation session on anxiety and cardiovascular outcomes, while other studies have examined the effect of several days or weeks of mindfulness meditation," Durocher said. "The results suggest that a single mindfulness meditation session may help to reduce cardiovascular risk in those with moderate anxiety."

Durocher and colleagues recently started a new study to assess the effects of mindfulness-based stress reduction in people with moderately elevated blood pressure.

Opioid use linked to increased risk of falls, death in older adults\

 Recent opioid use is associated with an increased risk of falls in older adults and an increased risk of death, found new research in CMAJ (Canadian Medical Association Journal).

Falls are a leading cause of injury and death in older adults. However, evidence for a link between opioid use and falls is inconsistent.

The study included data on 67 929 patients aged 65 and older who were admitted for injury to one of 57 trauma centres in the province of Quebec. The mean age of patients was 81 years, and the majority -- 69% -- were women. Falls were the most common cause of injury (92% of patients), and more than half (59%) had surgery for their injuries, with lengthy hospital stays (median stay of 12 days).

Researchers looked at opioid prescriptions in the preceding 2 weeks before injury and found that the patients who had filled an opioid prescription during this period were 2.4 times more likely to have had a fall causing injury. Patients whose falls were linked to opioid use were also more likely to die during their hospital stay.

"This study confirms an association between recent opioid use and fall-related injury in a large trauma population of older adults," writes Dr. Raoul Daoust, Hôpital du Sacré-Cœur de Montréal and the Université de Montréal, Montreal, Quebec, with coauthors. "Physicians should be aware that prescribing opioids to older patients is not only associated with an increased risk of falls, but also, if these patients do fall, a higher in-hospital mortality rate," conclude the authors.

"Recent opioid use and fall-related injury among older patients with trauma" is published April 23, 2018.

Statins save lives of people with high levels of LDL cholesterol

Cholesterol-lowering drugs are more likely to save thousands of additional lives when used in people with higher levels of LDL cholesterol, or "bad" cholesterol, according to a new study from the University of Iowa, published in the Journal of the American Medical Association (JAMA).

Jennifer Robinson, a physician, professor of epidemiology in the UI College of Public Health, and study coauthor, says the findings show that doctors should more aggressively treat patients who have high levels of LDL cholesterol with statins, and patients should feel safe using them.

"Statins are the safest drugs we have to reduce the risk of heart attacks, strokes, and death in a wide range of patients," says Robinson. "Patients with higher LDL cholesterol levels are likely to experience even greater health benefits from taking statins and some of the newer cholesterol drugs."

The study analyzed 34 previous studies that involved more than 270,000 participants. The analysis found that statins were more likely to reduce the risk of death when LDL cholesterol levels were 100 milligrams per deciliter (mg/dl) or greater, whether or not they were used with other LDL-lowering drugs.

Robinson says the study found the lives of an additional 4.3 in 1,000 people were saved every year when treated with LDL cholesterol lowering therapy. The greatest benefit--and the greatest reduction in death rates--came to those with the highest levels of LDL cholesterol, she says.

LDL cholesterol causes fat and plaque to build up in arteries, increasing the risk for heart attacks and strokes. Levels below 100 mg/dl are considered optimal, as people with that reading are less likely to develop cholesterol plaques as they age. Readings above 100 mg/dl are considered unhealthy.

Given that 12.4 percent of American adults--or about 30 million people--have LDL levels above 160 mg/dl, Robinson says the findings show statins save tens of thousands of lives annually.

"Unfortunately, most Americans with higher cholesterol levels are not treated, and lives are unnecessarily being lost," she says.

Those with excess LDL can reduce their levels through an improved diet, increased exercise, and by taking medications such as statins. People who already have cardiovascular disease or genetic causes of high cholesterol also may benefit from adding other LDL-lowering drugs to statin therapy.

The study shows that LDL-lowering drugs can be effective for preventing heart attacks and stroke in people with risk factors even when LDL cholesterol levels are low, but even more heart attacks and death are prevented when people have LDL levels above 100 mg/dl.

The study, "Lipid lowering and mortality and cardiovascular outcomes," was published in the April 3, 2018, issue of JAMA

Eating more fish could prevent Parkinson's disease A study from Chalmers University of Technology, Sweden, shines more light on the link between consumption of fish and better long-term neurological health

A new study from Chalmers University of Technology, Sweden, shines more light on the link between consumption of fish and better long-term neurological health. Parvalbumin, a protein found in great quantities in several different fish species, has been shown to help prevent the formation of certain protein structures closely associated with Parkinson's disease.

Fish has long been considered a healthy food, linked to improved long-term cognitive health, but the reasons for this have been unclear. Omega-3 and -6, fatty acids commonly found in fish, are often assumed to be responsible, and are commonly marketed in this fashion. However, the scientific research regarding this topic has drawn mixed conclusions. Now, new research from Chalmers has shown that the protein parvalbumin, which is very common in many fish species, may be contributing to this effect.

One of the hallmarks of Parkinson's disease is amyloid formation of a particular human protein, called alpha-synuclein. Alpha-synuclein is even sometimes referred to as the 'Parkinson's protein'.
What the Chalmers researchers have now discovered, is that parvalbumin can form amyloid structures that bind together with the alpha-synuclein protein. Parvalbumin effectively 'scavenges' the alpha-synuclein proteins, using them for its own purposes, thus preventing them from forming their own potentially harmful amyloids later on.

"Parvalbumin collects up the 'Parkinson's protein' and actually prevents it from aggregating, simply by aggregating itself first," explains Pernilla Wittung-Stafshede, Professor and Head of the Chemical Biology division at Chalmers, and lead author on the study.

With the parvalbumin protein so highly abundant in certain fish species, increasing the amount of fish in our diet might be a simple way to fight off Parkinson's disease. Herring, cod, carp, and redfish, including sockeye salmon and red snapper, have particularly high levels of parvalbumin, but it is common in many other fish species too. The levels of parvalbumin can also vary greatly throughout the year.
"Fish is normally a lot more nutritious at the end of the summer, because of increased metabolic activity. Levels of parvalbumin are much higher in fish after they have had a lot of sun, so it could be worthwhile increasing consumption during autumn," says Nathalie Scheers, Assistant Professor in the Department of Biology and Biological Engineering, and researcher on the study. It was Nathalie who first had the inspiration to investigate parvalbumin more closely, after a previous study she did looking at biomarkers for fish consumption.

Other neurodegenerative diseases, including Alzheimer's, ALS and Huntington's disease, are also caused by certain amyloid structures interfering in the brain. The team is therefore keen to research this topic further, to see if the discovery relating to Parkinson's disease could have implications for other neurodegenerative disorders as well. Pernilla Wittung-Stafshede stresses the importance of finding ways to combat these neurological conditions in the future:

"These diseases come with age, and people are living longer and longer. There's going to be an explosion of these diseases in the future - and the scary part is that we currently have no cures. So we need to follow up on anything that looks promising."

A follow up study, looking at parvalbumin from another angle, is indeed planned for this autumn. Nathalie Scheers, together with Professor Ingrid Undeland, also of Chalmers, will investigate parvalbumin from herring, and its transport in human tissues.

"It will be very interesting to study how parvalbumin distributes within human tissues in more depth. There could be some really exciting results."

More About: Fish and Better Neurological Health

The link between higher consumption of fish and better long-term health for the brain has been long established. There is correlation between certain diets and decreased rates of Parkinson's disease - as well as other neurodegenerative conditions.
"Among those who follow a Mediterranean diet, with more fish, one sees lower rates of Parkinson's and Alzheimer's," says Tony Werner, a PhD student in the Department of Biology and Biological Engineering, and lead researcher on the study. This has also been observed in Japan, where seafood forms a central part of the diet. The team is careful to note that no definite links can be established at this point, however.

More About: Amyloids and Aggregation

Proteins are long chains of amino acids that fold into specific structures to carry out their function. But sometimes, proteins can fold incorrectly, and get tangled up with other proteins, a process known as aggregation. As these misfolded proteins aggregate together, they create long fibrous structures known as amyloids. Amyloids are not necessarily a bad thing, but can be responsible for various diseases. Some of them can interfere with neurons in the brain, killing those cells, and causing a variety of neurodegenerative conditions.

More About: The Study 

Nathalie Scheers had looked at parvalbumin before in another context.
"I was on a previous study where we looked at possible compliance markers for fish intake. Parvalbumin is a cause of fish allergies, so we knew that it passed over to the blood, and that this form of parvalbumin is specific for fish"
She joined forces with Pernilla Wittung-Stafshede, and together they took the idea forward.
"Because Nathalie had previously shown that parvalbumin passes into the body of the person eating fish, it made sense to study its interaction with human proteins. We already knew that they can meet in the gut, the blood, or the brain," explains Pernilla Wittung-Stafshede.

Fetal exposure to moderate/high caffeine levels linked to excess childhood weight gain

Exposure to moderate to high caffeine levels while in the womb is linked to excess weight gain in early childhood, suggests a large observational study published in the online journal BMJ Open.
The findings, which back general advice to limit caffeine intake while pregnant, prompt the researchers to query whether mums-to-be should cut out the world's most widely consumed central nervous system stimulant altogether.
Caffeine passes rapidly through tissues, including the placenta, and takes the body longer to get rid of during pregnancy. It has been linked to a heightened risk of miscarriage and restricted fetal growth.
The researchers wanted to try and find out if caffeine intake during pregnancy might also be associated with excess weight gain in the child's early years.
They therefore drew on just under 51,000 mother and infant pairs, all of whom were part of the Norwegian Mother and Child Cohort Study between 2002 and 2008.
At 22 weeks of pregnancy, the mums-to-be were asked to quantify their food and drink intake from among 255 items, including caffeine, using a specially adapted Food Frequency Questionnaire.
Sources of caffeine included coffee, black tea, caffeinated soft/energy drinks, chocolate, chocolate milk, sandwich spreads; and desserts, cakes, and sweets. Daily intake was grouped into: 0-49 mg (low); 50-199 mg (average); 200-299 mg (high); and 300 + mg (very high).
Their children's weight, height, and body length were subsequently measured at 11 time points: when they were 6 weeks old; at 3, 6, 8, and 12 months; and then at 1.5, 2, 3, 5, 7, and 8 years of age.
Excess weight gain was assessed using World Health Organization criteria, while overweight and obesity were assessed according to International Obesity Task Force criteria. Growth trajectories for weight and length/height were calculated from the age of 1 month to 8 years using a validated approach (Jenss-Bayley growth curve).
Just under half of the mums-to-be (46%) were classified as low caffeine intake; 44 percent as average intake; 7 percent as high; and 3 percent as very high.
The higher the intake, the greater was the likelihood that the mother was older than 30, had had more than one child, consumed more daily calories, and smoked during her pregnancy. And women with a very high caffeine intake during their pregnancy were more likely to be poorly educated, and to have been obese before they got pregnant.
Average, high, and very high caffeine intake during pregnancy were associated with a heightened risk--15, 30, and 66 percent, respectively--of faster excess growth during their child's infancy than low intake, after taking account of potentially influential factors.
And exposure to any caffeine level while in the womb was associated with a heightened risk of overweight at the ages of 3 and 5 years, although this persisted only for those 8 year olds whose mums had had a very high caffeine intake during their pregnancy.
Children exposed to very high levels of caffeine before birth weighed 67-83 g more in infancy (3-12 months); 110-136 g more as toddlers; 213-320 g more as pre-schoolers (3-5 years); and 480 g more at the age of 8 than children who had been exposed to low levels.
This is an observational study, so it can't confirm causality, while questionnaires can only provide a snapshot in time of dietary behaviour.
Nevertheless, the researchers point to the large sample size, the consistency of their findings, and a plausible biological explanation--fetal programming.
"Maternal caffeine intake may modify the overall weight growth trajectory of the child from birth to 8 years," the write.
"The results add supporting evidence for the current advice to reduce caffeine intake during pregnancy and indicate that complete avoidance might actually be advisable," they add.

Six in 7 women at high risk of breast cancer shun tamoxifen as a preventive measure

Six in seven women with a family history of breast cancer opt out of taking tamoxifen as a preventive measure, according to a study funded by Cancer Research UK and published in Breast Cancer Research and Treatment today (Tuesday)*.
Researchers asked 258 healthy women across England who had been identified as having an increased risk of the disease whether they had agreed to take the drug to help prevent breast cancer developing, and interviewed 16 women to identify what influenced their decision to take it.
Women chose not to start taking the drug because they thought cancer was down to fate, they distrusted medication in general or they feared side effects would interfere with looking after their family.
But overall the team, based at the University of Leeds, Northwestern University, University College London and Queen Mary University of London, found women with children were more likely to take up the offer of tamoxifen.
The research, which is the first of its kind since the drug was approved to be used for prevention, also suggested that social class, educational attainment and ethnicity had no effect on uptake.
Tamoxifen is most commonly given to women who have been treated for breast cancer to lower the risk of it recurring.
But in 2013 the National Institute for Health and Care Excellence (NICE) also approved it for cancer prevention in women at increased risk of the disease due to a family history of breast or ovarian cancer, following research which showed it could lower risk by around a third**.
Dr Samuel Smith, study author from the University of Leeds, said: "While it's reassuring a woman's background doesn't seem to be a barrier to taking tamoxifen, only one in seven of those at increased risk of breast cancer are taking up the option. Therefore it's important doctors can discuss women's concerns and provide information to help them while they are considering their options.
"Further research is needed to understand if all women eligible to take tamoxifen for prevention are getting the help and support they need."
Dr Richard Roope, Cancer Research UK's senior clinical adviser and GP expert, said: "When an established drug like tamoxifen is found to work not only as a treatment for breast cancer, but is also shown to reduce the risk of the disease, it seems we're making real progress.
"It's valuable to understand why women might reject tamoxifen, and this research highlights there are a range of complex reasons behind the decision.
"It's vital more work is done to understand these barriers, improve treatments and ensure doctors are getting the support they need to help women decide whether preventative medication is right for them.
"Whatever a woman's risk of developing breast cancer, keeping a healthy weight and cutting back on alcohol are also ways of reducing it."

Strength training in older women needed to ward off effects of aging

Regular physical activity may help older women increase their mobility, but muscle strength and endurance are likely to succumb to the effects of frailty if they haven't also been doing resistance training.

That is according to the findings of a cross-sectional study led by the University at Buffalo and published in the journal Physical & Occupational Therapy in Geriatrics.

The study underscores the need for older women to build up muscle strength early in the aging process to help ward off the effects of aging, say the study's lead authors Machiko Tomita, clinical professor, and Nadine Fisher, clinical associate professor, both in the Department of Rehabilitation Science in UB's School of Public Health and Health Professions.

"Frailty progresses with aging, but older women who engage in a high level of daily physical activity can reverse certain characteristics related to aging, such as slow walking and decreased function," says Tomita.

"But for women over the age of 75, muscle strength and endurance declines. Starting resistance exercise when they are young and continuing it is important so that when they reach a very advanced age they have already built up their strength and endurance reserves," Fisher added.

The study looked at 46 women across two different age ranges, 60-74 and 75-90, to learn how physical activity affects frailty differently in the two groups. Researchers found that there was a larger difference between the two groups in terms of muscle strength and endurance among those who were very physically active.

"The younger group's strength and endurance were much better than the older group's. This change was attributed to the younger group's significant gain in them because of the age," Tomita said.
With mobility -- as measured by the length of a person's step -- and basic functional ability, there was a gap between the two age groups among women who engaged in minimal physical activity. However, that gap disappeared if they did a high level of physical activities.

"Two indicators of frailty, muscle strength and endurance vs. walking speed and function, showed an opposite pattern when we examined age and physical activity levels," Tomita said.

Tomita says she was surprised to find that women in the 60-74 age group were not engaging in enough physical activity.

"Their main physical activities consisted of light gardening, light housework and stretching. Is this because they are still working and don't have time for exercise, or do they think they are healthy and don't need to?" she said. "It appears that committing to regular exercise is not yet a standard part of older women's lifestyles and is instead a reactive behavior to, for example, falls or illness."

Tomita suggests that older women should walk more, but 10,000 steps per day are excessive. She also recommends talking to a physical therapist or trainer to learn about exercises that can build muscle strength and endurance.

In follow-up studies, Tomita and Fisher hope to track older adults who engage in high and low levels of physical activity for a period of several years. "This will tell us real lifestyle differences that impact frailty," Tomita says.

Prenatal cannabis use associated with low birth weights

With marijuana use during pregnancy on the rise, a new study led by the Colorado School of Public Health shows that prenatal cannabis use was associated with a 50 percent increased likelihood of low birth weight, setting the stage for serious future health problems including infection and time spent in Neonatal Intensive Care Units. "Our findings underscore the importance of screening for cannabis use during prenatal care and the need for provider counselling about the adverse health consequences of continued use during pregnancy," said the study's lead author Tessa Crume, PhD, MSPH, assistant professor of epidemiology at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.
The study was published last month in The Journal of Pediatrics.
Crume and her colleagues utilized survey data from 3,207 women who participated in the Colorado Pregnancy Risk Assessment Monitoring System in 2014 and 15. They found the prevalence of marijuana use in the state of Colorado was 5.7 percent during pregnancy and 5 percent among women who were breastfeeding.
They also discovered that prenatal marijuana use was associated with a 50 percent increased chance of low birth weight regardless of tobacco use during pregnancy. Prenatal marijuana use was three to four times higher among women who were younger, less educated, received Medicaid or WIC, were white, unmarried and lived in poverty.
Crume said the numbers are surprising but also reflect changing attitudes toward marijuana, especially in a state like Colorado where it is legal.
"There is increased availability, increased potency and a vocal pro-cannabis advocacy movement that may be creating a perception that marijuana is safe to use during pregnancy," Crume said.
The National Survey on Drug Use and Health suggests that cannabis use among pregnant women has increased as much as 62 percent between 2002 and 2014. At the same time, the potency of the drug has increased six or seven fold since the 1970s along with the ways it is consumed - eating, vaping, lotions etc.
"Growing evidence suggests prenatal cannabis exposure has a detrimental impact on offspring brain function starting in the toddler years, specifically issues related to attention deficit disorder," Crume said. "But much of the research on the effects of prenatal cannabis on neonatal outcomes was based on marijuana exposures in the 1980s and 1990s which may not reflect the potency of today's cannabis or the many ways it is used."
The study found that 88.6 percent of women who used cannabis during pregnancy also breastfed. The risk of cannabis to the infant through breastmilk remains unknown. Various studies have found that cannabinoids are passed to the baby in this way. One of the study's co-authors, Dr. Erica Wymore, MD, MPH, from Children's Hospital Colorado and the CU School of Medicine, is currently conducting a study to evaluate this issue.
The researchers recommend that health care providers ask pregnant women about their cannabis use and advise them to stop during pregnancy and lactation.
"Obstetric providers should refrain from prescribing or recommending cannabis for medical purposes during preconception, pregnancy and lactation," Crume said. "Guidance and messaging about this should be incorporated into prenatal care. And screening of pregnant women at risk for cannabis dependency should be linked to treatment options."

Prolonged Tylenol use during pregnancy linked to increased ASD and ADHD risk Res

A study from the Hebrew University of Jerusalem sheds new light on the possible relationship between prolonged use of acetaminophen (Tylenol/paracetamol) during pregnancy and the risk of neurodevelopmental disorders in childhood.

Acetaminophen is one of the most common medications used for treatment of pain and fever reduction during pregnancy and is considered safe in humans. However, evidence of neuro-disruptive properties is accumulating: past studies have shown that long-term administration of low doses of acetaminophen may affect the development of the fetal nervous system, and that this effect is often seen years after exposure during childhood.

Now, researchers led by Dr. Ilan Matok at the Institute for Drug Research in the School of Pharmacy at the Hebrew University's Faculty of Medicine, together with doctoral student Reem Masarwa, have conducted a systematic review and meta-analysis to assess the possible association between prolonged exposure to acetaminophen during pregnancy and the risk for attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD).

The analysis, which appears in the American Journal of Epidemiology, shows that prolonged exposure to acetaminophen during pregnancy is associated with a 30% increase in relative risk for ADHD (compared to those who did not take acetaminophen during pregnancy) and a 20% increase in relative risk for ASD.

This is the first meta-analysis and the most comprehensive study ever conducted on the possible association between prolonged use of acetaminophen during pregnancy and risk of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). The research data covered 132,738 mother and child pairs with a follow-up period of 3-11 years.
Given the significant limitations of existing studies, the researchers believe the results should be interpreted with caution, as they may cause unnecessary anxiety among pregnant women. It is important to understand that pain and fever during pregnancy can have a detrimental effect on the developing fetus and that acetaminophen is still considered a safe drug for use during pregnancy. Therefore, if a pregnant woman has fever and/or pain, acetaminophen can be taken for a short period, and if the fever or pain continue beyond that, she should consult her physician regarding further treatment
Dr. Amichai Perlman and Dr. Hagai Levine of the Hebrew University of Jerusalem and Hadassah Medical Center participated in the research.
"Our study provides the first comprehensive overview of developmental outcomes following prolonged acetaminophen use during pregnancy," said Dr. Ilan Matok, Head of the Pharmacoepidemiology Research Lab, Institute for Drug Research, School of Pharmacy, Hebrew University Faculty of Medicine. "Our findings suggest an association between prolonged acetaminophen use and an increase in the risk of autism and ADHD. However, the observed increase in risk was small, and the existing studies have significant limitations. While unnecessary use of any medication should be avoided in pregnancy, we believe our findings should not alter current practice and women should not avoid use of short term acetaminophen when clinically needed."

Mental, not physical, fatigue affects seniors' walking ability Experimental

Low "mental energy" may affect walking patterns in older adults more than physical fatigue. New research about the relationship between walking ability and self-reported mood will be presented today at the American Physiological Society (APS) annual meeting at Experimental Biology 2018 in San Diego.

Researchers from Clarkson University in New York observed a group of older adults (average age 75) while they performed physically and mentally tiring tasks. The volunteers performed the physical task--a timed walking test at normal speed for six minutes--before and after the cognitive components. LED sensors embedded in the five-meter walking track captured gait speed and stride length.

The cognitive portion of the test consisted of several math subtraction activities and visually identifying specific numbers and sequences on a computer screen. The volunteers reported their mood, motivation and energy levels after both the physical and cognitive tests. Vocabulary used to capture the participants' mood included "a list of mood components such as tense, worn out, energetic, confused [and] lively," explained Abigail Avolio, first author of the study.

The research team used a well-known correlation formula (Pearson correlation coefficient) to determine the relationship between self-reported mood and physical performance. There was no change in gait in relation to mental fatigue in the first 30 seconds of the follow-up walking test.

However, walking speed and stride length later in the test period decreased significantly in people who reported more cognitive fatigue, but not in response to lagging physical energy levels.
More study is needed "to further evaluate why feelings of physical energy and fatigue are not related to gait," the researchers wrote.

Abigail Avolio, an undergraduate student at Clarkson University, will present "Impact of mood after cognitive fatigue on gait in older adults" on Tuesday, April 24, in the Exhibit Hall of the San Diego Convention Center.

Soccer heading -- not collisions -- cognitively impairs players

Worse cognitive function in soccer players stems mainly from frequent ball heading rather than unintentional head impacts due to collisions, researchers at Albert Einstein College of Medicine have found. The findings suggest that efforts to reduce long-term brain injuries may be focusing too narrowly on preventing accidental head collisions. The study published online today in the Frontiers in Neurology.
"Unintentional head impacts are generally considered the most common cause of diagnosed concussions in soccer, so it's understandable that current prevention efforts aim at minimizing those collisions," said study leader, Michael Lipton, M.D., Ph.D., F.A.C.R., professor of radiology and of psychiatry and behavioral sciences at Einstein and medical director of MRI Services at Montefiore. "But intentional head impacts--that is, soccer ball heading--are not benign. We showed in a previous study that frequent heading is an underappreciated cause of concussion symptoms. And now we've found that heading appears to alter cognitive function as well, at least temporarily."
While heading has previously been associated with transient cognitive problems, the Einstein study is the first to compare the cognitive effects of heading to unintentional head impacts such as collisions. Three hundred and eight amateur soccer players in New York City filled out questionnaires detailing their recent (previous two weeks) soccer activity, including heading and unintentional head impacts. Participants also completed neuropsychological tests of verbal learning, verbal memory, psychomotor speed, attention and working memory. The players ranged in age from 18 to 55, and 78 percent were male.
Players headed soccer balls an average of 45 times during the two weeks covered by the questionnaire. During that time, about one-third of the players suffered at least one unintentional head impact (e.g., kicks to the head or head-to head, head-to-ground, or head-to-goalpost collisions).
Players who reported the most headings had the poorest performance on psychomotor speed and attention tasks, which are areas of functioning known to be affected by brain injury. Heading frequency also correlated with poorer performance on the working memory task, although the association was of borderline significance. In contrast, unintentional head impacts were not related to any aspect of cognitive performance.
The changes in cognitive function did not cause overt clinical impairment, the Einstein team reported. "However, we're concerned that subtle, even transient reductions in neuropsychological function from heading could translate to microstructural changes in the brain that then lead to persistently impaired function. We need a much longer-term follow-up study of more soccer players to fully address this question," said Dr. Lipton.
In the meantime, soccer players should consider reducing heading during practice and soccer games, Dr. Lipton advises. "Heading is a potential cause of brain injury," he says, "and since it's under control of the player, its consequences can be prevented."

Dark chocolate consumption reduces stress and inflammation

New research shows there might be health benefits to eating certain types of dark chocolate. Findings from two studies being presented today at the Experimental Biology 2018 annual meeting in San Diego show that consuming dark chocolate that has a high concentration of cacao (minimally 70% cacao, 30% organic cane sugar) has positive effects on stress levels, inflammation, mood, memory and immunity. While it is well known that cacao is a major source of flavonoids, this is the first time the effect has been studied in human subjects to determine how it can support cognitive, endocrine and cardiovascular health.

Lee S. Berk, DrPH, associate dean of research affairs, School of Allied Health Professions and a researcher in psychoneuroimmunology and food science from Loma Linda University, served as principal investigator on both studies.

"For years, we have looked at the influence of dark chocolate on neurological functions from the standpoint of sugar content - the more sugar, the happier we are," Berk said. "This is the first time that we have looked at the impact of large amounts of cacao in doses as small as a regular-sized chocolate bar in humans over short or long periods of time, and are encouraged by the findings. These studies show us that the higher the concentration of cacao, the more positive the impact on cognition, memory, mood, immunity and other beneficial effects."

The flavonoids found in cacao are extremely potent antioxidants and anti-inflammatory agents, with known mechanisms beneficial for brain and cardiovascular health. The following results will be presented in live poster sessions during the Experimental Biology 2018 meeting:
on.
Dark Chocolate (70% Cacao) Effects Human Gene Expression: Cacao Regulates Cellular Immune Response, Neural Signaling, and Sensory Perception (Monday, April 23, 10:00 a.m. - 12:00 p.m., San Diego Convention Center, Exhibit Halls A - D)

• This pilot feasibility experimental trial examined the impact of 70 percent cacao chocolate consumption on human immune and dendritic cell gene expression, with focus on pro- and anti-inflammatory cytokines. Study findings show cacao consumption up-regulates multiple intracellular signaling pathways involved in T-cell activation, cellular immune response and genes involved in neural signaling and sensory perception - the latter potentially associated with the phenomena of brain hyperplasticity.

Dark Chocolate (70% Organic Cacao) Increases Acute and Chronic EEG Power Spectral Density (μv2) Response of Gamma Frequency (25-40Hz) for Brain Health: Enhancement of Neuroplasticity, Neural Synchrony, Cognitive Processing, Learning, Memory, Recall, and Mindfulness Meditation (Tuesday, April 24, 10:00 a.m. - 12:00 p.m., San Diego Convention Center, Exhibit Halls A - D)

• This study assessed the electroencephalography (EEG) response to consuming 48 g of dark chocolate (70% cacao) after an acute period of time (30 mins) and after a chronic period of time (120 mins), on modulating brain frequencies 0-40Hz, specifically beneficial gamma frequency (25-40Hz). Findings show that this superfood of 70 percent cacao enhances neuroplasticity for behavioral and brain health benefits.

Berk said the studies require further investigation, specifically to determine the significance of these effects for immune cells and the brain in larger study populations. Further research is in progress to elaborate on the mechanisms that may be involved in the cause-and-effect brain-behavior relationship with cacao at this high concentrati

A link between pneumonia in older people and Proton-pump inhibitors

A study published in the Journal of the American Geriatrics Society has found a link between pneumonia in older people and Proton-pump inhibitors (PPIs) , a group of medicines commonly used to neutralize stomach acid in people with heartburn or stomach ulcers.   

Approximately 40 percent of older adults receive PPIs, although according to some experts, up to 85 percent of people who receive PPI prescriptions may not need them.   

Once thought to be relatively harmless, PPIs have more recently been linked to increased rates for certain health concerns like fractures, cardiovascular disease, and some bacterial infections. 

The association between PPI use and pneumonia was studied because stomach acid is a barrier to infections spreading from the gut in people with stomach reflux.

Millennials aren't getting the message about sun safety and the dangers of tanning

IMAGE: Many millennials lack knowledge about the importance of sunscreen and continue to tan outdoors in part because of low self-esteem and high rates of narcissism that fuel addictive tanning behavior,... view more 

Credit: Oliver Day, Oregon State University

BEND, Ore. - Many millennials lack knowledge about the importance of sunscreen and continue to tan outdoors in part because of low self-esteem and high rates of narcissism that fuel addictive tanning behavior, a new study from Oregon State University-Cascades has found.
Lead author Amy Watson and her colleagues found that those with higher levels of self-esteem were less likely to tan, while those with lower self-esteem and higher levels of narcissism were more likely to present addictive tanning behavior. The motivation for the addictive tanning behavior was the perception of improved appearance.
"This study gives us a clearer understanding of actual consumer behavior," said Watson, an assistant professor of marketing at OSU-Cascades. "The number of people still deliberately exposing their skin to the sun for tanning purposes is alarming. We need to find new ways to entice people to protect their skin, including challenging the ideal of tan skin as a standard of beauty."
The findings were published recently in the Journal of Consumer Affairs. Co-authors are Gail Zank and Anna M. Turri of Texas State University.
Skin cancer is the most common type of cancer worldwide, with more than 3.5 million cases diagnosed annually. Melanoma cases among women rose sharply between 1970 and 2009, with an 800 percent increase among women 18 to 39.
In an effort to improve consumer education about the role of sunscreen in the prevention of skin cancer, the Centers for Disease Control and the Food and Drug Administration developed a new "Drug Facts" panel of information now required on all sunscreen bottles. The panel includes directions for sunscreen use and advice on other sun protection measures, among other information.
The researchers' goal with the study was to gauge whether the information on this new label is effective at curbing tanning behavior and if new information is helping to increase consumer knowledge about how and when to use sunscreen and how much to use.
The study of 250 college students, most between 18 and 23 years old, measured their sun safety knowledge and included: questions about their beliefs regarding sunscreen effectiveness and ultraviolet light exposure danger; questions about tanning motivation and behavior; an assessment of tanning addiction; and personality questions relating to self-esteem, narcissism, appearance and addictive behavior.
The study participants, 47 percent male and 53 percent female, scored an average of 54 percent on an 11-question sun safety knowledge test, which included true/false statements such as: "On a daily basis I should use at least one ounce of sunscreen on exposed skin" (true); and "When applied correctly, SPF 100 is twice as effective as SPF 50" (false).
About 70 percent of the study participants reported purposefully exposing their skin to the sun to achieve a tan. About a third of the participants reported that having a tan is important to them, while about 37 percent said they feel better with a tan, and 41 percent indicated that having a tan makes them more confident in their appearance.
The participants' levels of tanning addiction were measured through questions such as "I get annoyed when people tell me not to tan," and "I continue to tan knowing that it is bad for me," and "I feel unattractive or anxious to tan if I do not maintain my tan."
The researchers found that those with lower self-esteem and higher narcissism rates were also more likely to exhibit addictive tanning behavior. They found no evidence that increased knowledge about sun safety leads to lower levels of addictive tanning.
"What we found is that this knowledge doesn't matter to the consumers," Watson said. "That tactic to require sunscreen manufacturers to include this information is not effective."
Sun safety and sunscreen messaging from the CDC is all statistics-based, emphasizing the likelihood of a skin cancer occurrence or diagnosis, Watson said. But that type of message isn't resonating with millennials. The next step for Watson and her colleagues is to begin testing other types of messages to identify ways millennials would respond more positively to sun safety measures.
"People are starting to get the message about the dangers of using tanning beds, but a large number of people are still tanning outdoors, deliberately exposing their skin to the sun, because they think it's attractive," she said.
"We need to move away from the narrative where tan skin is associated with health and youth. That's the opposite of reality. Because reality is tan skin is damaged skin."

Low total testosterone in men widespread, linked to chronic disease

A male's total testosterone level may be linked to more than just sexual health and muscle mass preservation, a new study finds. Low amounts of the hormone could also be associated with chronic disease, even among men 40 years of age and younger.
"If we look at data for men from a population level, it has become evident over time that chronic disease is on the rise in older males," says Mark Peterson, Ph.D., M.S., FACSM, lead author of the study and assistant professor of physical medicine and rehabilitation at Michigan Medicine. "But we're also finding that a consequence of being obese and physically inactive is that men are seeing declines in testosterone even at younger ages."
Published in Scientific Reports, Peterson and colleagues studied this relationship among testosterone, age and chronic disease.
"Previous research in the field has shown that total testosterone deficiency in men increases with age, and studies have shown that testosterone deficiency is also associated with obesity-related chronic diseases," Peterson says. "But it hasn't been previously understood what the optimal levels of total testosterone should be in men at varying ages, and to what effect those varying levels of the hormone have on disease risk across the life span."
The study's basis came from previous work from other researchers that appeared to define normal ranges of testosterone but didn't use population-representative cohorts, he says.
"Previous studies used clinical cohorts that were not reflective of the current male population in the United States," Peterson says. "The cohorts they used enforced strict guidelines for patients that were accepted into the cohort. Therefore, those patients tended to be much healthier."
Peterson and colleagues, then, leveraged a population sample that was much more representative of males in the United States today.
Multimorbidity across age groups
Using data from the National Health and Nutrition Examination Survey, the research team examined the extent to which hypogonadism is prevalent among men of all ages.
Of the 2,399 men in the survey who were at least 20 years old, 2,161 had complete information on demographics (e.g., age, ethnicity and household income), chronic disease diagnoses, blood samples obtained for total testosterone, grip strength and lab results for cardiometabolic disease risk factors.
Peterson and team then examined prevalence of nine chronic conditions, including type 2 diabetes, arthritis, cardiovascular disease, stroke, pulmonary disease, high triglycerides, hypercholesterolemia, hypertension and clinical depression.
The researchers studied the prevalence of multimorbidity, or when two or more of the chronic conditions were present, among three age groups (young, middle-aged and older men) with and without testosterone deficiency. They found that low total testosterone was associated with multimorbidity in all age groups -- but it was more prevalent among young and older men with testosterone deficiency.
"We also found a large dose-response relationship between the age-specific low total testosterone and moderate total testosterone levels and multimorbidity, even after adjusting for obesity and muscle strength capacity," Peterson says. "Which means that men should be concerned about declining total testosterone, even if it has not reached a level to warrant a clinical diagnosis (<300 dl="" ng="" nmol="" p=""> Co-author Aleksandr Belakovskiy, M.D., a resident in family medicine at Michigan Medicine, who helped to design and carry out the study, notes that the results show the need for further testing and research.
"This study showed a robust association between testosterone and multiple medical morbidities that could influence the way we think about testosterone in general practice," Belakovskiy says. "While these findings cannot prove causation, it does spark the need for better clinical awareness and more research."
The team hopes the study and its results can serve as a public service announcement for men.

"A lot of men may not be aware of the risk factors for testosterone deficiency because of their current lifestyle," Peterson says. "And more importantly, that declining levels could be contributing to a silent decline in overall health and increased risk for chronic disease."