High-intensity exercise improves memory in seniors

Researchers at McMaster University who examine the impact of exercise on the brain have found that high-intensity workouts improve memory in older adults.
The study, published in the journal Applied Physiology, Nutrition and Metabolism, has widespread implications for treating dementia, a catastrophic disease that affects approximately half a million Canadians and is expected to rise dramatically over the next decade.
Researchers suggest that intensity is critical. Seniors who exercised using short, bursts of activity saw an improvement of up to 30% in memory performance while participants who worked out moderately saw no improvement, on average.
"There is urgent need for interventions that reduce dementia risk in healthy older adults. Only recently have we begun to appreciate the role that lifestyle plays, and the greatest modifying risk factor of all is physical activity," says Jennifer Heisz, an associate professor in the Department of Kinesiology at McMaster University and lead author of the study.
"This work will help to inform the public on exercise prescriptions for brain health so they know exactly what types of exercises boost memory and keep dementia at bay," she says.
For the study, researchers recruited dozens of sedentary but otherwise healthy older adults between the ages of 60 and 88 who were monitored over a 12-week period and participated in three sessions per week. Some performed high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) while a separate control group engaged in stretching only.
The HIIT protocol included four sets of high-intensity exercise on a treadmill for four minutes, followed by a recovery period. The MICT protocol included one set of moderate-intensity aerobic exercise for nearly 50 minutes.
To capture exercise-related improvements in memory, researchers used a specific test that taps into the function of the newborn neurons generated by exercise which are more active than mature ones and are ideal for forming new connections and creating new memories.
They found older adults in the HIIT group had a substantial increase in high-interference memory compared to the MICT or control groups. This form of memory allows us to distinguish one car from another of the same make or model, for example.
Researchers also found that improvements in fitness levels directly correlated with improvement in memory performance.
"It's never too late to get the brain health benefits of being physically active, but if you are starting late and want to see results fast, our research suggests you may need to increase the intensity of your exercise," says Heisz.
She cautions that it is important to tailor exercise to current fitness levels, but adding intensity can be as simple as adding hills to a daily walk or increasing pace between street lamps.
"Exercise is a promising intervention for delaying the onset of dementia. However, guidelines for effective prevention do not exist. Our hope is this research will help form those guidelines."

Study Raises Concerns About Higher Dementia Risk Among Former Soccer Pros

Question Addressed:

• What did an epidemiologic study of former professional soccer players reveal about the potential long-term consequences of playing soccer at the professional level?

Study Synopsis and Perspective:
Two headers reverberated around the world. In 1970, legendary soccer star Pelé leapt over a defender for a head goal that helped Brazil to win its third World Cup title. Abby Wambach's towering header in stoppage time at a 2011 soccer match against Brazil relaunched the U.S. team's efforts to win the Women's World Cup. They are only two of the stars admired and emulated by more than a quarter of a billion people who play this contact sport in over 200 countries. But there may be neurological consequences later in life for heading the ball 6 to 12 times, on average, per game (in addition to heading drills at practice), and thousands of times during a career.

Action Points

• Mortality from neurodegenerative diseases was higher and prescriptions for dementia-related medications were more common among former professional soccer players compared with matched controls in a Scottish retrospective epidemiologic analysis.
• Note that mortality from other common diseases was lower among former soccer players compared with controls, but realize that these data need to be confirmed in prospective matched-cohort studies.

Researchers have now confirmed these concerns for Scottish former professional soccer players who formed part of the retrospective Football's InfluencE on Lifelong health and Dementia risk (FIELD) study. Compared with matched individuals from the general population, the former professional soccer players had an approximately 3.5 times higher rate of death due to neurodegenerative diseases. Neurodegenerative disease listed as the primary cause of death among former players was 1.7% versus 0.5% in controls (subhazard ratio adjusted for competing risks of death from ischemic heart disease and from any cancer 3.45, 95% CI 2.11-5.62, P<0 .001="" a="" and="" chb="" co-authors="" glasgow="" href="https://www.nejm.org/doi/full/10.1056/NEJMoa1908483" in="" mb="" of="" phd="" reported="" stewart="" target="_blank" the="" university="" willie="">New England Journal of Medicine

. FIELD investigators represented a multidisciplinary collaboration of researchers and experts in traumatic brain injury, public health, and sport. Their purview was to investigate a wide range of physical and mental health outcomes, including neurodegenerative diseases, in former soccer players. Stewart and colleagues evaluated cause of death and use of medications for dementia in 7,676 former players and 23,028 matched controls (matched on the basis of age, sex, and degree of social deprivation).
The median follow-up was 18 years from study entry. The mean ages at death for 1,180 former soccer players (15.4%) and 3,807 matched controls (16.5%) were 67.9 years and 64.7 years, respectively.
Compared with controls, all-cause mortality was lower in former players up to age 70, but higher after that. Former pro athletes had lower death rates from ischemic heart disease (HR 0.80, 95% CI 0.66-0.97, P=0.02) and from lung cancer (HR 0.53, 95% CI 0.40-0.70, P<0 .001="" p=""> Neurodegenerative disease listed as a primary or contributory cause of death was highest in former players with Alzheimer's disease (HR 5.07, 95% CI 2.92-8.82, P<0 .001="" 1.17-3.96="" 2.15="" 95="" and="" ci="" disease="" em="" in="" lowest="" parkinson="" s="" those="" with="">P
=0.01), compared with controls. Dementia-related medications were prescribed more frequently to former players than to controls (OR 4.90, 95% CI 3.81-6.31, P<0 .001="" p=""> A specific form of degenerative brain disease linked to traumatic brain injury, known as chronic traumatic encephalopathy (CTE), has been observed in athletes from a wide range of contact sports. However, because no International Classification of Diseases (ICD)-9 or ICD-10 codes exist for CTE or its synonym, dementia pugilistica, these diagnoses were not available from death certificates reviewed for the study. Other study limitations included possible errors in reporting on death certificates and the possible introduction of bias due to the fact that not all former players identified from the master datasets could be matched to Community Health Index numbers. The researchers also stated that the results were not directly applicable to collegiate, recreational, and amateur players.
Source References: New England Journal of Medicine 2019; DOI: 10.1056/NEJMoa1908483
Editorial: New England Journal of Medicine 2019; DOI: 10.1056/NEJMe1912071
Study Highlights and Explanation of Findings:
Good news and bad news emerged from a retrospective epidemiologic study for former professional soccer players. Mortality from non-neurological diseases was lower among former soccer players up to the age of 70 compared with matched controls from the general population. This unsurprising finding is in keeping with the reduced risk of heart disease and all-cause mortality associated with participation in sports.
However, neurodegenerative disease listed as the primary cause of death was higher among the former soccer players versus controls. Competing risks of death from ischemic heart disease or cancer partially attenuated the findings. In addition, prescriptions for dementia-related medications were more common among former players.
"This is the largest study to date looking in this detail at the incidence of neurodegenerative disease in any sport, not just professional footballers," said Stewart in a statement.
"A strength of our study design is that we could look in detail at rates of different neurodegenerative disease subtypes. This analysis revealed that risk ranged from a 5-fold increase in Alzheimer's disease, through an approximately 4-fold increase in motor neuron disease, to a 2-fold [increase in] Parkinson's disease in former professional footballers compared to population controls," he added.
"An important aspect of this work has been the ability to look across a range of health outcomes in former professional footballers. This allows us to build a more complete picture of health in this population," he said. "Our data show that while former footballers had higher dementia rates, they had lower rates of death due to other major diseases. As such, whilst every effort must be made to identify the factors contributing to the increased risk of neurodegenerative disease to allow this risk to be reduced, there are also wider potential health benefits of playing [soccer] to be considered."
Stewart's group also called for confirmation of these findings in prospective matched-cohort studies.
In an accompanying editorial, Robert Stern, PhD, of Boston University, highlighted the growing body of evidence linking repetitive brain trauma suffered in some contact and collision sports to increased risks of cognitive/neuropsychiatric impairments, as well as the risk of neurodegenerative disease and CTE.
These results are similar to those reported in a study of former National Football League (NFL) players that showed all-cause mortality was lower in former players compared with the general population, but neurodegenerative mortality was higher, he observed.
"Another study involving former NFL players included a comparison group of former Major League Baseball players and found that all-cause mortality, cardiovascular mortality, and neurodegenerative mortality were higher among the former NFL players," Stern added. "These results suggest that factors that vary in these two sports, such as body habitus and exposure to repetitive head impacts, rather than common factors such as overall physical activity could be responsible for the differences."
It seems it's "not just the 'big hits' resulting in symptomatic concussions that increase the risk of neurologic disorders later in life," he wrote. "Rather, the total duration of exposure to repetitive head impacts, including 'sub-concussive' injuries without symptoms, has been associated with neuropathology, in vivo markers of neurodegeneration, and cognitive and neuropsychiatric symptoms later in life."
Stern agreed with the authors that there was a need for further study, such as longitudinal assessments to examine possible relationships between heading and neurodegenerative diseases to confirm or refute current findings. "Perhaps, however, there is already adequate evidence that repeated blows to the brain from heading in professional soccer is an occupational risk that needs to be addressed," he concluded.
Britain's Football Association, which helped fund the research, said it plans to set up a task force to examine potential causes of neurodegenerative deaths among soccer players and while more research is needed, "there is not enough evidence at this stage to make other changes to the way the modern-day game is played."
Although next steps remain a hot topic, it is worth noting that the U.S. Soccer Federation banned headers for children age 10 and under and placed a limit on the same practice for children ages 11 to 13.

Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College

Primary Source

New England Journal of Medicine

Source Reference: Mackay DF, et al "Neurodegenerative disease mortality among former professional soccer players" N Engl J Med 2019; DOI: 10.1056/NEJMoa1908483.

Secondary Source

New England Journal of Medicine

Source Reference: Stern RA "Soccer and mortality -- good news and bad news" N Engl J Med 2019; DOI: 10.1056/NEJMe1912071.

Additional Source

MedPage Today

Source Reference: George J "Dementia Deaths High in Former Pro Soccer Players" 2019.

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Acetaminophen in pregnancy linked to higher risk of ADHD, autism

Exposure to acetaminophen (TYLENOL) in the womb may increase a child's risk for attention deficit/hyperactivity disorder and autism spectrum disorder, suggests a study funded by the National Institutes of Health and the Agency for Health Care Research and Quality. The study was conducted by Xiaobing Wang, M.D., of the Johns Hopkins University Bloomberg School of Public Health, Baltimore, and colleagues. It appears in JAMA Psychiatry.
Attention deficit/hyperactivity disorder (ADHD) is marked by a pattern of hyperactivity and impulsive behavior. Autism spectrum disorder (ASD) is a complex developmental disorder that affects how a person behaves, interacts with others and learns.
Researchers analyzed data from the Boston Birth Cohort, a long-term study of factors influencing pregnancy and child development. They collected umbilical cord blood from 996 births and measured the amount of acetaminophen and two of its byproducts in each sample. By the time the children were an average of 8.9 years, 25.8% had been diagnosed with ADHD only, 6.6% with ASD only and 4.2% with ADHD and ASD. The researchers classified the amount of acetaminophen and its byproducts in the samples into thirds, from lowest to highest. Compared to the lowest third, the middle third of exposure was associated with about 2.26 times the risk for ADHD. The highest third of exposure was associated with 2.86 times the risk. Similarly, ASD risk was higher for those in the middle third (2.14 times) and highest third (3.62 times).
The authors conclude that their results support earlier studies linking acetaminophen exposure in the womb with ADHD and ASD and underscore the need for additional research. The U.S. Food and Drug Administration urges careful consideration before using any pain-relieving medication during pregnancy.
NIH funding for the study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute of Allergy and Infectious Diseases and the National Institute of Environmental Health Sciences.

Traffic exhaust at residential address increases the risk of stroke

High levels of traffic exhaust at one's residence increases the risk of stroke even in low-pollution environments, according to a study by researchers at Karolinska Institutet and other universities in Sweden. The study, published in the journal Environmental Health Perspectives, suggests that it is mainly black carbon from traffic exhaust that increases the risk for stroke, and not particulate matter from other sources.
Black carbon is the sooty black material emitted from gas and diesel engines, coal-fired power plants and other fuels. In city environments, the emissions come mainly from road traffic. These particles have previously been linked to negative health effects, especially in studies of heavily polluted environments. Now researchers at Karolinska Institutet, University of Gothenburg, Umeå University, the Swedish Meteorological and Hydrological Institute and SLB analysis-Environmental unit in Stockholm have shown that long-term exposure to traffic exhaust at the residential address increases the risk of stroke in Swedish towns.
"This study identifies local traffic exhaust as a risk factor for stroke, a common disease with great human suffering, high mortality and significant costs to society," says Petter Ljungman, researcher at the Institute of Environmental Medicine at Karolinska Institutet and the study's main author. "We see that these emissions have consequences even in low-pollution environments like Swedish cities."
The researchers followed almost 115,000 middle-aged healthy individuals living in Gothenburg, Stockholm and Umeå over a period of 20 years. During this time, some 3,100 of the people suffered a stroke. With the help of dispersion models and Swedish emission inventories, the researchers were able to estimate how much different local emission sources, including from traffic exhaust, road wear and residential heating, contributed to particulate matter and black carbon at specific addresses in these cities.
The researchers found that for every 0.3 micrograms per cubic meter (μg/m3) of black carbon from traffic exhaust, the risk of stroke increased by 4 percent. Similar associations were not seen for black carbon emitted from residential heating or for particulate matter in general, neither from inhalable particles with a diameter of 10 micrometers or less (PM10) or from particles with a diameter of 2.5 micrometers or less (PM2.5). In the studied cities, the annual averages of PM2.5 ranged from 5.8 to 9.2 μg/m3, considerably lower than current European Union standard of 25 μg/m3. There is currently no specific metric for black carbon in EU, which includes it as part of its broader regulation of particulate matter.
"Black carbon from traffic exhaust could be an important measure to consider when assessing air quality and health consequences," says Petter Ljungman.

Avocados may help manage obesity, prevent diabetes

Your guacamole may hold the key to managing obesity and helping delay or prevent diabetes, according to a new study by a University of Guelph research team.
For the first time, researchers led by Prof. Paul Spagnuolo have shown how a compound found only in avocados can inhibit cellular processes that normally lead to diabetes. In safety testing in humans, the team also found that the substance was absorbed into the blood with no adverse effects in the kidney, liver or muscle.
The study was recently published in the journal Molecular Nutrition and Food Research.
About one in four Canadians is obese, a chronic condition that is a leading cause of Type 2 diabetes. Insulin resistance in diabetic patients means their bodies are unable to properly remove glucose from the blood.
Those complications can arise when mitochondria, or the energy powerhouses in the body's cells, are unable to burn fatty acids completely.
Normally, fatty acid oxidation allows the body to burn fats. Obesity or diabetes hinders that process, leading to incomplete oxidation.
The U of G researchers discovered that avocatin B (AvoB), a fat molecule found only in avocados, counters incomplete oxidation in skeletal muscle and the pancreas to reduce insulin resistance.
In their study, the team fed mice high-fat diets for eight weeks to induce obesity and insulin resistance. For the next five weeks, they added AvoB to the high-fat diets of half of the mice.
The treated mice weighed significantly less than those in the control group, showing slower weight gain. More important, said Spagnuolo, the treated mice showed greater insulin sensitivity, meaning that their bodies were able to absorb and burn blood glucose and improve their response to insulin.
In a human clinical study, AvoB given as a dietary supplement to participants eating a typical western diet was absorbed safely into their blood without affecting the kidney, liver or skeletal muscle. The team also saw reductions in weight in human subjects, although Spagnuolo said the result was not statistically significant.
Having demonstrated its safety in humans, they plan to conduct clinical trials to test AvoB's efficacy in treating metabolic ailments in people.
Spagnuolo said the safety trial helped the team to determine just how much AvoB to include in the supplement formulation.
Having received Health Canada approval for the compound as a human supplement, he will begin selling it in powder and pill forms as soon as 2020 through SP Nutraceuticals Inc., a Burlington, Ont.-based natural health products company.
He said eating avocados alone would likely be ineffective, as the amount of natural avocatin B varies widely in the fruit and we still do not fully understand exactly how it is digested and absorbed when we consume a whole avocado.
Although avocados have been touted as a weight-loss food, Spagnuolo said more study is needed. He said a healthy diet and exercise are recommended to prevent metabolic disorders leading to obesity or diabetes.
PhD student Nawaz Ahmed, lead author of the paper, said, "We advocate healthy eating and exercise as solutions to the problem, but that's difficult for some people. We've known this for decades, and obesity and diabetes are still a significant health problem."
In earlier work funded by the Ontario Institute for Cancer Research, Spagnuolo has studied the potential use of avocatin B for treating acute myeloid leukemia.

Bicycle-related injuries have increased significantly among older riders

The rise in popularity of bike riding has led to an increase in more serious injuries, particularly among cyclists aged 55 to 64. They were treated at hospital emergency departments nationwide for traumatic brain injuries and broken bones in the face more than 86,439 times from 2008 to 2017.

The incidence of these craniofacial injuries varied significantly among age groups. While patients aged 18 to 24 were injured more frequently, likely due to the popularity of bicycling in younger adults, patients aged 55 to 64 had the most significant increase in injuries, with a 54 percent growth over the ten-year study period.

Traumatic brain injury was the most commonly diagnosed injury, accounting for nearly 50 percent of emergency department visits. Those aged 45 to 54 were the most likely to be hospitalized with facial fractures, the most common to nasal bones, followed by jawbone fractures.

Researchers say older adults need to practice additional safety precautions when bicycling to help reduce injuries. Preventative behaviors such as avoiding alcohol before cycling, wearing brightly colored or reflective clothing, using lights or reflectors at night, and wearing helmets are simple maneuvers that can be taken to prevent hospitalizations and decrease cycling-related morbidity.

Living in a noisy area increases the risk of suffering a more serious stroke

The high levels of environmental noise we are subjected to in large cities can increase both the severity and consequences of an ischaemic stroke. More precisely, researchers from the Hospital del Mar Medical Research Institute (IMIM) and doctors from Hospital del Mar, together with researchers from the Barcelona Institute for Global Health (ISGlobal), CIBER in Epidemiology and Public Health (CIBERESP), and Brown University, in the United States, put the increased risk at 30% for people living in noisier areas. In contrast, living close to green areas brings down this risk by up to 25%. This is the first time that these factors have been analysed in relation to stroke severity. The study has been published in the journal Environmental Research.
The researchers looked at the influence of noise levels, air pollution (particularly suspended particles smaller than 2.5 microns; PM2.5), and exposure to green areas on nearly 3,000 ischaemic stroke patients treated at Hospital del Mar between 2005 and 2014. To do this, they used data from the Cartographic Institute of Catalonia, as well as models to analyse atmospheric pollutant levels, the noise map of Barcelona, and satellite images to define areas with vegetation. Also taken into account was the socioeconomic level of the place the patients lived.
Dr. Rosa María Vivanco, from the IMIM's Neurovascular Research Group and first author of the study, points out that the study gives us initial insight into how noise levels and exposure to green spaces influences the severity of ischaemic stroke. "We have observed a gradient: the more green spaces, the less serious the stroke. And the more noise, the more serious it is. This suggests that factors other than those traditionally associated with stroke may play an independent role in the condition", she explains. At the same time, Dr. Xavier Basagaña, one of the authors of the study and a researcher at ISGlobal, a centre supported by "la Caixa", stresses that "exposure to green spaces can benefit human health through various mechanisms. For example, it can reduce stress, encourage social interaction, and increase levels of physical activity." However, in this study no link was seen with atmospheric pollution. The researchers warn that one of the limitations of the work was the lack of variability in pollutant concentrations to which the study population is exposed. This made it difficult to draw conclusions, and they point out that more studies are needed in this field.
More noise, greater stroke severity
"Previous studies have demonstrated that living in places with high levels of air pollution or noise, or with fewer green areas, exposes the population to a higher risk of suffering an ischaemic stroke. This work broadens our knowledge in this field, showing that the place where we live affects not only the risk of suffering a stroke, but also its severity if it occurs", explains Dr Gregory A. Wellenius, from the Epidemiology Department at Brown University and final author of the study. In this sense, the results indicate that patients living in noisier areas presented more severe strokes on arrival at hospital.
The researchers have analysed the effects of stroke on neurological deficits, such as speech impairment and mobility, using the NIHSS (National Institute of Health Stroke Scale). "The severity of a stroke depends on various factors, including the extent of the brain injury, the specific area of brain affected, the subtype of stroke, the existence of associated risk factors (diabetes, atrial fibrillation, atherosclerotic load), and so on. The fact that we have demonstrated, in addition to all these factors, that environmental aspects like green spaces and urban noise levels affect the severity of a stroke and therefore our health, shows that this information must be taken into account by political and health planners", emphasises Dr. Jaume Roquer, head of the Neurology Service at Hospital del Mar, coordinator of the IMIM's Neurovascular Research Group, and one of the main authors of the work.
The researchers did not aim to determine which noise levels lead to increased risk, but rather to detect a gradient by comparing patients living in noisier areas with those living in quieter areas. Indeed, the World Health Organisation (WHO) recommends traffic noise limits of a maximum of 53 decibels during the day and 45 decibels at night. "The average noise level to which patients have been exposed, as well as the general population of the study area, requires reflection, as it is considerably above the WHO recommendations", points out Carla Avellaneda, an IMIM researcher and author of the work. The same researchers have already revealed that high levels of air pollution from diesel engines increase the risk of suffering atherothrombotic stroke by 20%.
Stroke
In Spain, stroke is the leading cause of death in women and the third ranked in men, and is estimated to affect 1 in 6 people throughout their lives (in 2012, it caused the death of 6.7 million people around the world, according to WHO data). In Catalonia there are 13,000 cases and 3,800 deaths from stroke each year. The two main types of stroke are haemorrhagic and ischaemic.
Ischaemic stroke is due to the obstruction of a blood vessel in the brain and accounts for 80-85% of all cases. This lack of blood flow in the affected area of the brain can lead to permanent damage. The risk of having a stroke is closely related to factors including age, smoking, high blood pressure, diabetes, obesity, a sedentary lifestyle and, as recently demonstrated, other factors like air pollution.

Early retirement can accelerate cognitive decline

Early retirement can accelerate cognitive decline among the elderly, according to research conducted by faculty at Binghamton University, State University of New York.
Plamen Nikolov, assistant professor of economics, and Alan Adelman, a doctoral student in economics, examined China's New Rural Pension Scheme (NRPS) and the Chinese Health and Retirement Longitudinal Survey (CHARLS) to determine the effects of pension benefits on individual cognition of those ages 60 or above. CHARLS, a nationally representative survey of people ages 45 and above within the Chinese population, is a sister survey of the U.S. Health and Retirement Survey and directly tests cognition with a focus on episodic memory and components of intact mental status.
With a higher life expectancy and decline in fertility in developing countries, the elderly population has become the largest demographic source in Asia and Latin America, generating an urgent need for new, sustainable pension systems. However, research suggests that these retirement plans can be detrimental, as retirement plays a significant role in explaining cognitive decline at older ages.
"Because of this large demographic boom, China introduced a formal pension program (called NRPS) in rural parts of the country. The program was introduced on the basis of an economy's needs and capacity, in particular to alleviate poverty in old age," said Nikolov. "In rural parts of the country, traditional family-based care for the elderly had largely broken down, without adequate formal mechanisms to take its place. For the elderly, inadequate transfers from either informal family and community transfers could severely reduce their ability to cope with illness or poor nutrition."
The researchers discovered that there were significant negative effects of pension benefits on cognition functioning among the elderly. The largest indicator of cognitive decline was delayed recall, a measure that is widely implicated in neurobiological research as an important predictor of dementia. The pension program had more negative effects among females, and Nikolov said the results support the mental retirement hypothesis that decreased mental activity results in the worsening of cognitive skills.
"Individuals in the areas that implement the NRPS score considerably lower than individuals who live in areas that do not offer the NRPS program," Nikolov said. "Over the almost 10 years since its implementation, the program led to a decline in cognitive performance by as high as almost a fifth of a standard deviation on the memory measures we examine."
Surprisingly, the estimated program impacts were similar to the negative findings in higher income countries such as America, England and the European Union, which Nikolov said demonstrates the global issues of retirement.
"We were surprised to find that pension benefits and retirement actually resulted in reduced cognitive performance. In a different study we found a very robust finding that the introduction of pension benefits and retirement led to positive health benefits via improvements in sleep and the reduction of alcohol consumption and smoking," he said. "The fact that retirement led to reduced cognitive performance in and of itself is a stark finding about an unsuspected, puzzling issue, but a finding with extremely important welfare implications for one's quality of life in old age."
While pension benefits and retirement were found to lead to improved health, these programs also induced a stark and much more negative influence on other dimensions: social activities, activities associated with mental fitness and social engagement, more broadly.
"For cognition among the elderly, it looks like the negative effect on social engagement far outweighed the positive effect of the program on nutrition and sleep," said Nikolov. "Or alternatively, the kinds of things that matter and determine better health might simply be very different than the kinds of things that matter for better cognition among the elderly. Social engagement and connectedness may simply be the single most powerful factors for cognitive performance in old age."
Nikolov said he hopes this research will help create new policies to improve the cognitive functioning of older generations during retirement.
"We hope our findings will influence retirees themselves but perhaps, more importantly, it will influence policymakers in developing countries," Nikolov said. "We show robust evidence that retirement has important benefits. But it also has considerable costs. Cognitive impairments among the elderly, even if not severely debilitating, bring about a loss of quality of life and can have negative welfare consequences. Policymakers can introduce policies aimed at buffering the reduction of social engagement and mental activities. In this sense, retirement programs can generate positive spillovers for health status of retirees without the associated negative effect on their cognition."
Nikolov plans to continue research on this topic and examine how the introduction of pension benefits led to responses of labor force participation among the elderly in rural China.
The paper, "Do Pension Benefits Accelerate Cognitive Decline? Evidence from Rural China," was published in the IZA Institute of Labor Economics.

Think you're allergic to penicillin? You are probably wrong

More than 30 million people in the United States wrongly believe they are allergic to penicillin - resulting in millions of dollars in added health care costs, adverse side effects from the use of more powerful antibiotics and a risk in the rise of dangerous antibiotic resistant infections.
This misconception and public health threat could be corrected, said Christopher M. Bland, clinical associate professor at the University of Georgia College of Pharmacy, by asking those who say they are allergic to penicillin to answer a simple one-page questionnaire and, if necessary, take a penicillin allergy skin test, or PAST.
"In many instances we don't have to go past the questionnaire," Bland said. "We're finding out that what most of these patients think is an allergic reaction is really only a side effect that may have happened once and might never happen again. Patients tell us that they became dizzy or nauseated after taking penicillin years ago or that their father was allergic to penicillin, so they thought they were allergic as well."
Bland said penicillin often gets blamed when it may not be the culprit. Even those who may have once been allergic to penicillin are no longer allergic today, he said. After five years, studies show that half of the individuals who had an allergic reaction - like hives, wheezing, shortness of breath or anaphylaxis - to penicillin were no longer allergic. At 10 years, that number jumps to 80 percent, he said.
In research presented recently at IDWeek, the international infectious diseases meeting in Washington, D.C., Bland and colleagues demonstrated how many penicillin allergies were removed from patient records after patients were interviewed by UGA pharmacy students.
"We are able to reduce the number of those who think they have penicillin allergy by 20 percent right away, just by talking to them through our questionnaire," said Bland. "Our pharmacy students were able to debunk the allergy claim by many patients just by getting a detailed history."
While the Infectious Diseases Society of America has recommended that penicillin allergy assessment be promoted as a way to erase this label on medical records for those who are not allergic, most of the studies that have included PAST as a way to accomplish this have been done at academic medical centers by trained allergists.
Bland and Bruce Jones, an infectious diseases clinical pharmacy specialist at St. Joseph's/Candler Health System and adjunct UGA College of Pharmacy assistant professor in Savannah, said this isn't necessary and can be done in hospitals that do not have dedicated trained allergists on staff. They are working with more than 50 hospitals throughout the country, sharing best practices that will allow PAST to be performed and medical records updated.
In a grant-funded study, Bland and Jones found that PAST done on patients who believed that they were allergic to penicillin - the most effective antibiotic available with the least side effects - demonstrated no real allergy.
These research findings were published in Open Forum Infectious Diseases. The duo worked with nurses at Candler Hospital and found that skin testing can be done safely in a community hospital setting. When skin testing was performed at the hospital by trained nurses, 98 out of 100 patients in the study who had a penicillin allergy on their medical record were deemed not be allergic to the antibiotic.
This allowed for an immediate change to a penicillin type antibiotic for most patients, which is often safer and cheaper, improves outcomes and reduces adverse effects, the goal of the federal antimicrobial stewardship program requiring hospitals to ensure that antibiotics are used only when necessary.
In addition to the public health benefit, Bland estimated that health care savings would be in the tens of millions of dollars annually if patients could be switched back to penicillin from more costly antibiotic treatments. The study at Candler Hospital found an average cost savings of $350 a patient, which includes the cost of the skin test.
"Our team is on a mission right now," said Bland. "Our goal is that every penicillin allergy is questioned and reconciled, with most coming off medical records and allowing patients to get the best antibiotic for their particular infection, which is often a penicillin."

Soft drinks found to be the crucial link between obesity and tooth wear

A new study published today in the journal Clinical Oral Investigations, has found that sugar-sweetened acidic drinks, such as soft drinks, is the common factor between obesity and tooth wear among adults.
Scientists from King's College London found that being overweight or obese was undoubtedly associated with having tooth wear. Significantly, they also found that the increased consumption of sugary soft drinks may be a leading cause of the erosion of tooth enamel and dentine in obese patients.
Drawing on data from the National Health and Nutrition Examination Survey 2003-2004, they analysed a representative sample of survey participants of 3,541 patients in the United States. Patient BMI and the level of tooth wear were the exposure and outcome measurements in the analysis. The intake of sugar-sweetened acidic drinks was recorded through two non-consecutive 24-hour recall interviews where the patients were asked to provide details of diet intake across these two days.
"It is the acidic nature of some drinks such as carbonated drinks and acidic fruit juices that leads to tooth wear," said lead author Dr Saoirse O'Toole from King's College London.
Tooth wear is ranked as the third most important dental condition, after cavities and gum disease and the consumption of acidic food and drink is a leading cause of this. Obese patients also have other risk factors such as increased likelihood of gastric reflux disease (heartburn) which was controlled for in this study.
"This is an important message for obese patients who are consuming calories through acidic sugar sweetened drinks. These drinks may be doing damage to their body and their teeth. There is also an important message for dentists. We should be asking our patients who are obese and have tooth wear what calories they are drinking as this may be having an effect on their full bodies - not just their teeth," Dr O'Toole added.
Previous research from King's has found that tooth wear affects up to 30% of European adults. It is the premature wearing of teeth due to the softening of the dental enamel from dietary or gastric acids, combined with wear and tear. It occurs when the outer layer (enamel) of the tooth slowly dissolves. This can lead to changes in the shape or appearance of teeth, and they can become sensitive when eating or drinking cold food and drinks. At its worst, the tooth structure can gradually wear away. Severe Erosive Tooth Wear reduces quality of life and can mean complex and costly procedures, costing up to £30,000 per patient. Tooth wear is preventable and changes to consumption habits can help stop people from getting it or making it worse.

American Academy of Pediatrics looks at use of nonnutritive sweeteners by children

Nonnutritive or artificial sweeteners are a growing part of U.S. diets, now consumed by at least one in four children. A new American Academy of Pediatrics (AAP) policy statement offers a summary of the existing data around nonnutritive sweeteners and recommends future research into how they affect children's weight, taste preferences, the risk for diabetes, and long-term safety.
The AAP policy statement "The Use of Nonnutritive Sweeteners in Children" published in the November 2019 Pediatrics (published online Oct. 28), recommends that the amount of these no- or low-calorie sweeteners be listed on product labels so families and researchers can better understand how much children are consuming and any possible health effects.
"Looking at the evidence, we found there's still a lot to learn about the impact of nonnutritive sweeteners on children's health," said Carissa Baker-Smith, MD, MPH, FAAP, lead author of the AAP policy statement and an associate professor of pediatrics at the University of Maryland School of Medicine. "We need more research into the use of nonnutritive sweeteners and the risk for obesity and Type 2 diabetes, especially in children. Considering how many children are regularly consuming these products - which have become ubiquitous -- we should have a better understanding of how they impact children's long-term health."
Nonnutritive sweeteners were introduced into the food supply more than 60 years ago to mimic the taste of sucrose (table sugar) without adding calories. Eight nonnutritive sweeteners are approved by the U.S. Food and Drug Administration (FDA). Saccharin, aspartame, acesulfame-potassium, sucralose, neotame and advantame were approved as food additives, while stevia and luo han guo (monk fruit) are approved under the "generally recognized as safe" (GRAS) designation. These products are 180 to 20,000 times sweeter than sugar.
When nonnutritive sweeteners were first introduced, health concerns focused on a potential risk of cancer, which was not borne out in subsequent research. Health concerns around these products now has shifted. As the obesity epidemic has driven increased use of these products, attention is directed at conflicting evidence over whether nonnutritive sweeteners actually help control weight. The majority of short-term studies suggest that substituting a nonnutritive sweetener for sugar may reduce weight gain and promote small amounts of weight loss in children, according to the AAP. However, data is limited. There is also research suggesting possible links between nonnutritive sweetener use and weight gain. In addition, some studies suggest links between nonnutritive sweetener use and changes in appetite and taste preferences, as well as in the gut microbiome, which may affect blood sugar levels and lead to metabolic syndrome, insulin resistance, diabetes and weight gain. But findings remain inconsistent.
The AAP recommends that food and beverage manufacturers report nonnutritive sweetener content on food and beverage labels, rather than just listing them among ingredients, since they are now so widely available and consumed. The National Health and Nutrition Examination Survey 2009-2012 showed that more than one-quarter of U.S. children reported consumption of non-nutritive sweeteners, with 80 percent of these children reporting daily use.
"It is currently hard to know how much nonnutritive sweetener is in a product since manufacturers aren't required to specify," Dr. Baker-Smith said. "Listing the amount of nonnutritive sweetener a product contains would help families and researchers understand how much is actually being consumed by individuals and populations and further evaluate potentially related health effects," Dr. Baker-Smith said.
Research suggests many parents aren't aware their child is consuming these products. One study found that only 23% of parents can correctly identify food products that contain nonnutritive sweeteners. In addition, 53% of parents said they seek items labeled "reduced sugar," but most did not recognize that the sweet taste was instead being provided by a nonnutritive sweetener.
Knowing the amounts of nonnutritive sweeteners in products would also help ensure children's consumption remains below acceptable daily intake levels, Dr. Baker-Smith said. Research suggests that most children's nonnutritive sweetener intake is within the acceptable level, but some has found, based on estimated consumption from 24-hour dietary recall, that intake of nonnutritive sweeteners may exceed the acceptable daily intake.

33% of people on anticoagulants take OTC supplements with potentially serious interactions

Nearly 98% percent of people prescribed direct-acting oral anticoagulants such as apixaban used over-the-counter products. Of those, 33% took at least one such product that, in combination with the anticoagulants, could cause dangerous internal bleeding. People on these medications largely lacked knowledge of some potentially serious interactions.
BACKGROUND
Direct-acting oral anticoagulants are the drug of choice for stroke prevention in patients with atrial fibrillation, which occurs most frequently in older patients. Apixaban is one of the most frequently prescribed. However, most people prescribed apixaban or other direct-acting oral anticoagulants are not followed in specialized anticoagulation clinics or monthly by health care professionals. As a result, these people may not be aware of potential drug interactions.
METHOD
The researchers surveyed 791 English- and Spanish-speaking patients from April to October 2018 who had been prescribed apixaban about their knowledge of potential interactions between the drug and over-the-counter supplements. They were asked about how often they took aspirin, ibuprofen/naproxen, and acetaminophen, and 13 common dietary supplements, including Chinese herbs, various fish oils, ginger and herbal teas, while also taking apixaban.
Limitations to the study included a low response rate (33%), self-reported data, which can be unreliable due to faulty memories, and the researchers focused on a limited number of dietary supplements.
IMPACT
Because such a large number of people lack knowledge of these interactions, there is a need to educate patients and healthcare providers about the dangers that these combinations may pose. In addition, data are needed on outcomes in people combining apixaban and over-the-counter products.

One avocado a day helps lower 'bad' cholesterol for heart healthy benefits

Move over, apples -- new research from Penn State suggests that eating one avocado a day may help keep "bad cholesterol" at bay.
According to the researchers, bad cholesterol can refer to both oxidized low-density lipoprotein (LDL) and small, dense LDL particles.
In a randomized, controlled feeding study, the researchers found that eating one avocado a day was associated with lower levels of LDL (specifically small, dense LDL particles) and oxidized LDL in adults with overweight or obesity.
"We were able to show that when people incorporated one avocado a day into their diet, they had fewer small, dense LDL particles than before the diet," said Penny Kris-Etherton, distinguished professor of nutrition, who added that small, dense LDL particles are particularly harmful for promoting plaque buildup in the arteries. "Consequently, people should consider adding avocados to their diet in a healthy way, like on whole-wheat toast or as a veggie dip."
Specifically, the study found that avocados helped reduce LDL particles that had been oxidized. Similar to the way oxygen can damage food -- like a cut apple turning brown -- the researchers said oxidation is also bad for the human body.
"A lot of research points to oxidation being the basis for conditions like cancer and heart disease," Kris-Etherton said. "We know that when LDL particles become oxidized, that starts a chain reaction that can promote atherosclerosis, which is the build-up of plaque in the artery wall. Oxidation is not good, so if you can help protect the body through the foods that you eat, that could be very beneficial."
While previous research demonstrated that avocados could help lower LDL cholesterol, Kris-Etherton and her colleagues were curious about whether avocados could also help lower oxidized LDL particles.
The researchers recruited 45 adult participants with overweight or obesity for the study. All participants followed a two-week "run-in" diet at the beginning of the study. This diet mimicked an average American diet and allowed all participants to begin the study on similar nutritional "footing."
Next, each participant completed five weeks of three different treatment diets in a randomized order. Diets included a low-fat diet, a moderate-fat diet, and a moderate-fat diet that included one avocado a day. The moderate-fat diet without avocados were supplemented with extra healthy fats to match the amount of monounsaturated fatty acids that would be obtained from the avocados.
After five weeks on the avocado diet, participants had significantly lower levels of oxidized LDL cholesterol than before the study began or after completing the low- and moderate-fat diets. Participants also had higher levels of lutein, an antioxidant, after the avocado diet.
Kris-Etherton said there was specifically a reduction in small, dense LDL cholesterol particles that had become oxidized.
"When you think about bad cholesterol, it comes packaged in LDL particles, which vary in size," Kris-Etherton said. "All LDL is bad, but small, dense LDL is particularly bad. A key finding was that people on the avocado diet had fewer oxidized LDL particles. They also had more lutein, which may be the bioactive that's protecting the LDL from being oxidized."
The researchers added that because the moderate-fat diet without avocados included the same monounsaturated fatty acids found in avocados, it is likely that the fruit has additional bioactives that contributed to the benefits of the avocado diet.
Kris-Etherton said that while the results of the study -- published in the Journal of Nutrition -- are promising, there is still more research to be done.
"Nutrition research on avocados is a relatively new area of study, so I think we're at the tip of the iceberg for learning about their health benefits," Kris-Etherton said. "Avocados are really high in healthy fats, carotenoids -- which are important for eye health -- and other nutrients. They are such a nutrient-dense package, and I think we're just beginning to learn about how they can improve health."

Another possible correlation between sleep and overall good health

New study shows that your gut microbiome and quality sleep are interconnected

As if you didn't already have enough to worry about to keep you up at night, a new study indicates that poor sleep can negatively affect your gut microbiome, which can, in turn, lead to additional health issues.
Great.
That's at the heart - or gut - of the study just published in PLoS ONE that involved several researchers from Nova Southeastern University (NSU.) They wanted to see just how much of a connection there is between what is going on in our insides and how that may impact the quality of sleep we experience.
"Given the strong gut-brain bidirectional communication they likely influence each other," said Jaime Tartar, Ph.D., a professor and research director in NSU's College of Psychology who was part of the research team. "Based on previous reports, we think that poor sleep probably exerts a strong negative effect on gut health/microbiome diversity."
What you may be asking yourself right now is: "what in the world is a gut microbiome?" Simply put - it's all the microorganisms (bacteria, viruses, protozoa and fungi) and their genetic material found in your gastrointestinal (GI) tract. And yes, we all have these in our GI tract, but not all at the same levels (diversity.) As it turns out, it's this diversity that could be the key.
For this study, subjects wore what Tartar called an "Apple Watch on steroids" to bed, which monitored all sorts of vitals. This way the researchers could determine just how well a night's sleep the subjects got, and then they tested the subjects' gut microbiome. What they found was those who slept well had a more diverse - or "better" - gut microbiome.
Tartar said that gut microbiome diversity, or lack thereof, is associated with other health issues, such as Parkinson's disease and autoimmune diseases, as well as psychological health (anxiety and depression.) The more diverse someone's gut microbiome is, the likelihood is they will have better overall health.
"We know that sleep is pretty much the 'Swiss Army Knife of health," Tartar said. "Getting a good night's sleep can lead to improved health, and a lack of sleep can have detrimental effects. We've all seen the reports that show not getting proper sleep can lead to short term (stress, psychosocial issues) and long-term (cardiovascular disease, cancer) health problems. We know that the deepest stages of sleep is when the brain 'takes out the trash' since the brain and gut communicate with each other. Quality sleep impacts so many other facets of human health."
Tartar's area of research focuses on the mechanisms and consequences of acute and chronic stress in humans and the impact of normal sleep and sleep deprivation on emotion processing and physiological functioning.
So what determines someone's gut microbiome? According to Robert Smith, Ph.D., an associate professor and research scientist at Nova Southeastern University (NSU) Halmos College of Natural Sciences and Oceanography, who is also a member of the research team, there are a couple of factors that come into play.
One is genetics - some people are predisposed at a genetic level to have a more diverse gut microbiome than their friends and neighbors. Another factor is drugs - certain medications, including antibiotics, can have an impact on the diversity of your gut microbiome. He also said that your diet plays a factor as well.
Smith said that their team, which included colleagues from Middle Tennessee State University, examined the association between sleep, the immune system and measures of cognition and emotion. He said understanding how these parts of human physiology work may lead to a better understanding of the "two-way communication" between the person and their gut microbiome, and could lead to novel sleep intervention strategies.
"The preliminary results are promising, but there's still more to learn," Smith said. "But eventually people may be able to take steps to manipulate their gut microbiome in order to help them get a good night's sleep."

Latest Health Research

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General Health

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Diet
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Dairy products associated with higher risk of prostate cancer
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Latest Health Research - Diet

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Medicine  and Supplements
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Statins linked to higher risk of diabetes and skin infections, lower risk of prostate cancer
Health News Report - 2 weeks ago
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Dietary supplement from tomatoes boosts sperm quality
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Latest Health Research - Medicines and supplements
Health News Report - 2 weeks ago
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Exercise
Increase health benefits of exercise by working out before breakfast
Health News Report - 1 week ago
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Health News Report - 2 weeks ago
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Aging
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Health News Report - 1 week ago
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Health News Report - 2 weeks ago
Regular exercise is highly beneficial for all patients with cardiovascular disease regardless of age, report investigators in the *Canadian Journal of Cardiology*, published by Elsevier. Their results showed that the patients who benefited most from cardiac rehabilitation were those who started out with the greatest physical impairment. Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event, yet older patients are largely underrepresented in rehabilitation programs. Studies have shown that this might be due to a l... more »
Mindfulness
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Health News Report - 1 week ago
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Health News Report - 1 week ago
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