Postponed retirement slows cognitive decline

Participating in the labor market until the age of 67 slows cognitive decline and is protective against cognitive impairment, study indicates

Participating in the labor market until the age of 67 slows cognitive decline and is protective against cognitive impairment, such as that caused by Alzheimer’s. This protective effect appears to hold regardless of gender and educational or occupational attainment. These findings were recently published in the journal SSM Population Health.

The team of researchers with Jo Mhairi Hale, Maarten J. Bijlsma, and Angelo Lorenti, all affiliated with the Max Planck Institute for Demographic Research (MPIDR) in Rostock, Germany, used data from the Health and Retirement Study on more than 20,000 US-Americans ages 55 to 75 who participated in the labor market at some point between 1996 and 2014.

There are modifiable life-course predictors of cognitive function

With population aging there is a growing concern about increasing prevalence in Alzheimer’s disease. As there is no cure for Alzheimer’s, it is important to understand the influences on cognitive function over one’s life span, paying particular attention to modifiable risk factors.

“In this study, we approach retirement and cognitive function from the perspective that they both come near the end of a long path of life”, says Angelo Lorenti. "It begins with one's social origins in ethnicity, gender, and early-life social and economic status, goes on with educational and occupational attainment and health behaviors, and goes all the way up to more proximate factors such as partnership status and mental and physical health. All these kinds of factors accumulate and interact over a lifetime to affect both cognitive function and age at retirement."

What are the health consequences of postponing retirement?

“We investigated how demographic change interacts with social and labor market dynamics”, says Angelo Lorenti. In many countries governments have enacted policies to increase the statutory retirement age. That is why it is relevant to understand if retiring at older ages may have health consequences, particularly on cognitive function. “Our study suggests that there may be a fortuitous unintended consequence of postponed retirement”, so Lorenti.

Moderate-vigorous physical activity is the most efficient at improving fitness

 

Physical fitness is a powerful predictor of health outcomes

In the largest study performed to date to understand the relationship between habitual physical activity and physical fitness, researchers from Boston University School of Medicine (BUSM) have found that higher amount of time spent performing exercise (moderate-vigorous physical activity) and low-moderate level activity (steps) and less time spent sedentary, translated to greater physical fitness

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“By establishing the relationship between different forms of habitual physical activity and detailed fitness measures, we hope that our study will provide important information that can ultimately be used to improve physical fitness and overall health across the life course,” explained corresponding author Matthew Nayor, MD, MPH, assistant professor of medicine at BUSM.

He and his team studied approximately 2,000 participants from the community-based Framingham Heart Study who underwent comprehensive cardiopulmonary exercise tests (CPET) for the “gold standard” measurement of physical fitness. Physical fitness measurements were associated with physical activity data obtained through accelerometers (device that measures frequency and intensity of human movement) that were worn for one week around the time of CPET and approximately eight years earlier.

They found dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

According to the researchers, while the study was focused on the relationship of physical activity and fitness specifically (rather than any health-related outcomes), fitness has a powerful influence on health and is associated with lower risk of cardiovascular disease, diabetes, cancer and premature death. “Therefore, improved understanding of methods to improve fitness would be expected to have broad implications for improved health,” said Nayor, a cardiologist at Boston Medical Center.

Largest real-world study of COVID-19 vaccine safety P

 The Clalit Research Institute, in collaboration with researchers from Harvard University, analyzed one of the world’s largest integrated health record databases to examine the safety of the Pfizer/BioNTech BNT162B2 vaccine against COVID-19. The study provides the largest peer-reviewed evaluation of the safety of a COVID-19 vaccine in a nationwide mass-vaccination setting. The study was conducted in Israel, an early global leader in COVID-19 vaccination rates.

Previous efforts to characterize vaccine safety have relied on voluntary active reporting by vaccinated individuals, which is known to be incomplete. The present study relies on the analysis of millions of anonymized electronic medical records, which are far more comprehensive.

Furthermore, in order to provide the necessary context for interpreting vaccine safety findings, this study is the first to examine a wide range of adverse events both among vaccinated individuals and among unvaccinated individuals who were infected with the coronavirus. Thus, two separate analyses were conducted:

1. Vaccination Outcomes Analysis: 884,828 vaccinated individuals aged 16 and over were carefully matched with 884,828 unvaccinated individuals based on an extensive set of sociodemographic, geographic and health-related attributes. Individuals were assigned to each group dynamically based on their changing vaccination status (235,541 individuals moved from the unvaccinated cohort into the vaccinated cohort during the study). Rates of the 25 potential adverse events within three weeks following either vaccine dose were compared between the two groups. This analysis took place from December 20, 2020, the launch of Israel’s national vaccination campaign, through May 24, 2021.
2. Infection Outcomes Analysis: To provide context for the vaccine safety findings above, a separate analysis was conducted that estimated the rates of the same 25 potential adverse events among 173,106 unvaccinated individuals who were infected with the coronavirus, compared to 173,106 carefully matched controls who were not infected with the coronavirus. This analysis took place from March 1, 2020 (the beginning of the COVID-19 pandemic in Israel) through May 24, 2021.

The vaccine was found to be safe: Out of 25 potential side effects examined, 4 were found to have a strong association with the vaccine.

Myocarditis was found to be associated with the vaccine, but rarely – 2.7 excess cases per 100,000 vaccinated individuals. (The myocarditis events observed after vaccination were concentrated in males between 20 and 34.) In contrast, coronavirus infection in unvaccinated individuals was associated with 11 excess cases of myocarditis per 100,000 infected individuals.

Other adverse events moderately associated with vaccination were swelling of the lymph nodes, a mild side effect that is part of a standard immune response to vaccination, with 78 excess cases per 100,000, appendicitis with 5 excess cases per 100,000 (potentially as a result of swelling of lymph nodes around the appendix), and herpes zoster with 16 excess cases per 100,000.

In contrast to the relatively small number of adverse effects associated with the vaccine, high rates of multiple serious adverse events were associated with coronavirus infection among unvaccinated patients, including: Cardiac arrhythmias (a 3.8-fold increase to an increase of 166 cases per 100,000 infected patients), kidney damage (14.8-fold increase; 125 excess cases per 100,000), pericarditis (5.4-fold increase; 11 excess cases per 100,000), pulmonary embolism (12.1-fold increase; 62 excess cases per 100,000), deep vein thrombosis (3.8-fold increase; 43 excess cases per 100,000), myocardial infarction (4.5-fold increase; 25 excess cases per 100,000), and stroke (2.1-fold increase; 14 excess cases per 100,000).

The research was conducted by Dr. Noam Barda, Dr. Noa Dagan, Yair Ben-Shlomo, Dr. Eldad Kepten, Dr. Jacob Waxman, Reut Ohana and Prof. Ran Balicer from the Clalit Research Institute, Dr. Doron Netzer of Clalit Health Services, as well as Prof. Miguel Hernán and Prof. Marc Lipsitch of the Harvard T.H. Chan School of Public Health, Prof. Isaac Kohane of the Department of Biomedical Informatics at Harvard Medical School, and Prof. Ben Reis of Boston Children’s Hospital and Harvard Medical School.

This study focused on adverse events that may develop in the short to medium term after vaccination, and those with clinical significance. The study did not focus on common immediate symptoms such as redness and discomfort at the injection site or fever. Symptoms that occurred within 6 weeks of the vaccine (three weeks after each vaccine dose) were defined as an adverse event of the vaccine if they occurred more frequently among the vaccinated group compared to the control group.

The results of this study validate and complement the previously reported findings of the Pfizer/BioNTech Phase-III randomized clinical trial, which, with 21,720 vaccinated individuals, could not precisely and comprehensively assess vaccine safety. The present study’s large size allows a more detailed assessment of the vaccine’s safety across a wider range of adverse events.

“The extensive nationwide rollout of Israel’s COVID-19 vaccination campaign provided the Clalit Research Institute with a unique opportunity to assess, through its rich and comprehensive digital datasets, the safety of the vaccine in a real-world setting, without needing to rely on individual-driven active reporting of side-effects” said Prof. Ran Balicer, senior author of the study, Director of the Clalit Research Institute and Chief Innovation Officer for Clalit. “These results show convincingly that this mRNA vaccine is very safe and that the alternative of ‘natural’ morbidity caused by the coronavirus puts a person at significant, higher and much more common risk of serious adverse events. These data should facilitate informed individual risk-benefit decision-making, and, in our view, make a strong argument in favor of opting-in to get vaccinated, especially in countries where the virus is currently widespread,” added Prof. Balicer, who also serves as Chairman of Israel's National Expert Advisory Team on COVID-19 response.

“This study sheds light for the first time on the significant side effects of the coronavirus vaccine. Since this is a more comprehensive analysis based on electronic medical records, these are more reliable assessments than those published to date which have relied on voluntary active reporting systems,” explains Doron Netzer, Chief Medical Officer of Clalit’s Community Health Division.

Prof. Ben Reis, Director of the Predictive Medicine Group at the Boston Children’s Hospital Computational Health Informatics Program and Harvard Medical School, said, “To date, one of the main drivers of vaccine hesitancy has been a lack of information regarding potential side effects of the vaccine. This careful epidemiological study provides reliable information on vaccine safety, which we hope will be helpful to those who have not yet decided about vaccination.” He continued, “Those who have hesitated until now to get vaccinated due to concerns about very rare side effects - such as myocarditis – should be aware that the risks for this very same side effect are actually higher among unvaccinated infected individuals."

Prof. Miguel Hernán, Director of the CAUSALab and Professor at the Harvard T.H. Chan School of Public Health, said, “This research is a perfect example of how randomized trials and observational healthcare databases complement each other. The original trial of the Pfizer/BioNTech vaccine provided evidence of its safety, but the estimates were too imprecise given the small sample size. This analysis of Clalit’s high-quality database emulates the design of the original trial, uses its findings as a benchmark, and expands upon them to confirm the vaccine’s safety on a wide range of adverse events. This combination of evidence from randomized trials and observational studies is a model for efficient medical research, something which is especially important in COVID times.”

Prof. Marc Lipsitch, Director of the Center for Communicable Disease Dynamics and Professor at the Harvard T.H. Chan School of Public Health, said, “In all studies of vaccine safety, a major challenge is to ensure that those we are comparing to identify the vaccine’s side effects are similar in the other characteristics that may predict whether they will experience these side effects. This is especially hard in the context of a rapidly growing, age-targeted vaccine campaign. Clalit’s extraordinary database made it possible to design a study that addressed these challenges in a way that provides tremendous confidence in the inferences that come out of the study.”

The research was funded in part by the newly announced Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute. “The strengthening of the scientific collaboration between Harvard and Clalit made possible by the Berkowitz Living Laboratory Collaboration is already bearing fruit and giving us a foretaste of the value of healthcare systems instrumented for research,” said Prof. Isaac Kohane, Chair of the Department of Biomedical Informatics at Harvard Medical School and co-Director of the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration along with Professor Balicer. “Israel offers a unique environment in which to study the vaccine and its effects, and this study is an excellent example of what can be accomplished through such close scientific collaborations.”

How saturated fat from various foods relates to cardiovascular disease.

  A study in more than 100,000 individuals has found a potential link between eating saturated fat from meat and developing heart disease. The preliminary research is presented at ESC Congress 2021.1

Study author Dr. Rebecca Kelly of the Nuffield Department of Population Health, University of Oxford, UK said: “The association seen between saturated fat and cardiovascular disease risk in observational studies has previously been unclear; our findings are important because they provide a possible explanation — that the relationship may vary depending on the food source. We found that saturated fat from meat may be associated with a higher risk than other food sources – in part because those consuming large amounts of meat also had a higher body mass index (BMI) than low consumers.”

Cardiovascular disease is a leading cause of death and disability worldwide.2 Eating higher amounts of saturated fat is linked to elevated low-density lipoprotein (LDL) or “bad” cholesterol,3,4 which increases risk of cardiovascular disease.5 There is some evidence that different types of foods rich in saturated fat, particularly meat and dairy, may have differing associations with cardiovascular disease. Therefore, this study examined how saturated fat from various foods relates to ischaemic heart disease, stroke, and total cardiovascular disease (heart disease and stroke combined).

The study included 114,285 UK Biobank participants who were free of cardiovascular disease at the start of the study. Participants completed dietary assessments asking what they ate the day before to estimate their usual intake of total saturated fat and saturated fat from different foods (e.g. dairy and meat). They also completed a detailed lifestyle questionnaire and had blood samples and body measurements taken.

The researchers tracked participants for around 8.5 years using information from linked hospital and death records to find out whether they developed cardiovascular disease. During the follow-up period, total cardiovascular disease, heart disease, and stroke occurred in 4,365, 3,394 and 1,041 participants, respectively.

The data were analysed to assess if there were any links between intake of total saturated fat and saturated fat from different foods and cardiovascular disease outcomes. The analyses accounted for multiple lifestyle, socioeconomic and medical factors.  

There were no clear associations between total saturated fat and cardiovascular disease outcomes. However, consuming 5% higher total energy from saturated fat from meat was associated with 19% and 21% elevated risks of total cardiovascular disease and heart disease, respectively – but the associations did not remain significant after accounting for BMI. Researchers also found that associations of SFA from dairy with heart disease went in the opposite direction, but this association was not clear after accounting for BMI.

Dr. Kelly said: “Our results suggest that differences in BMI may be responsible, in part, for the association between cardiovascular disease and saturated fat from meat. It is not possible to determine whether this is because of a specific impact of saturated fat from meat on BMI or because those with a higher BMI consume more meat. In addition, it is difficult to fully disentangle whether part of the effect of saturated fat on cardiovascular disease may be through higher LDL cholesterol in this cohort because cholesterol-lowering medication use is high in UK adults.” 

Dr. Kelly concluded: “We recommend following the dietary guidelines advice to consume less than 10% of daily energy from saturated fat. Our findings emphasise the importance of studying the different food sources of saturated fat when examining risk of cardiovascular disease. Further research is needed to ensure that these observations were not influenced by dietary or non-dietary factors that were not measured in this study.”

Mediterranean diet shows promise in men with erectile dysfunction

A Mediterranean diet is associated with improvements in erectile dysfunction, according to research presented at ESC Congress 2021.1

Men with hypertension are twice as likely to have erectile dysfunction as their peers with normal blood pressure.2 Erectile dysfunction is primarily considered a disorder of the small arteries, which lose the ability to dilate and augment flow. Declining testosterone levels in middle age contribute to its onset. Previous research has shown that fitness is linked with improved survival in men with hypertension,3 while the Mediterranean diet lowers blood pressure4 and prevents heart attacks and strokes5 in individuals at high cardiovascular risk.

This study assessed adherence to the Mediterranean diet in middle aged men with high blood pressure and erectile dysfunction. This dietary pattern emphasises fruit, vegetables, whole grains and olive oil, modest consumption of dairy products, and limiting red meat. The researchers then examined whether dietary habits were linked with fitness, testosterone levels, blood flow, arterial stiffness, and erectile performance.

The study included 250 men with high blood pressure and erectile dysfunction. The average age was 56 years. Mediterranean diet consumption was assessed by questionnaire and participants received a score of 0 to 55, with higher values indicating greater adherence.6Exercise capacity was assessed with a treadmill test and testosterone was measured in blood samples taken before 09:00 am.

Regarding vascular health, echocardiography was performed to assess coronary flow reserve, which indicates the ability to increase blood flow when needed. Values of 2 or higher are considered normal and point to better vascular function. The researchers examined arterial stiffness using two measures: augmentation index and central pulse pressure. Higher values indicate stiffer arteries, which are associated with a higher risk of adverse heart events in men with erectile dysfunction.7

Severity of erectile dysfunction was assessed using the Sexual Health Inventory for Men (SHIM) which uses five questions about erectile ability to allocate a score of 0 to 25, with higher values correlating to better erectile performance.8

The researchers found that men with a higher Mediterranean diet score (above 29) also had higher coronary flow reserve and testosterone, better erectile performance (SHIM score above 14), and lower arterial stiffness.

When the relationships were analysed according to fitness, the researchers found that patients with greater exercise capacity (above 10 METs)9 had higher coronary flow reserve, testosterone, Mediterranean diet score (above 25) and SHIM score (above 12), and lower arterial stiffness.

Study author Dr. Athanasios Angelis of the University of Athens, Greece said: “In our study, consuming a Mediterranean diet was linked with better exercise capacity, healthier arteries and blood flow, higher testosterone levels, and better erectile performance. While we did not examine mechanisms, it seems plausible that this dietary pattern may improve fitness and erectile performance by enhancing function of the blood vessels and limiting the fall in testosterone that occurs in midlife.”

He concluded: “The findings suggest that the Mediterranean diet could play a role in maintaining several parameters of vascular health and quality of life and in middle aged men with hypertension and erectile dysfunction.”

Sunlight makes you fall in love

Researchers at Tel Aviv University have found that exposure to ultraviolet radiation from sunlight enhances romantic passion in humans. In the study both men and women were exposed to UVB (ultraviolet radiation type B) under controlled conditions, and the findings were unequivocal: increased levels of romantic passion in both genders. The study revealed that exposure to sunlight affects the regulation of the endocrine system responsible for the release of sexual hormones in humans.

 

The study was led by PhD student Roma Parikh and Ashchar Sorek from the laboratory of Prof. Carmit Levy at the Department of Human Molecular Genetics and Biochemistry at the Sackler Faculty of Medicine. UVB phototherapy was administered to the subjects at the Tel Aviv Sourasky (Ichilov) and Assuta Medical Centers. The groundbreaking discovery was published as a cover story in the prestigious scientific journal Cell Reports.

 

Prof. Levy explains: "It has been known for many years now that ultraviolet radiation from sunlight increases testosterone levels in males, and we also know that sunlight plays a major role in both the behavioral and hormonal regulation of sexuality. However, the mechanism responsible for this regulation remained unknown. Our study enabled a better understanding of this mechanism."

 

The study began in an animal model, exposing the animals to UVB - sunrays at wavelengths of 320-400 nanometers. The effect was dramatic: females' hormone levels rose significantly, enlarging their ovaries and prolonging their rut season; the attraction between males and females increased; and both were more willing to engage in sexual intercourse.

 

In the second stage, the researchers repeated the experiment in the animal model, this time removing from the skin a protein called p53, which identifies DNA damage and activates pigmentation during exposure to sunlight, as protection against its adverse effects. The removal of p53 eliminated the effect of UVB exposure on the animals' sexual behavior, convincing Prof. Levy and her colleagues that exposure to radiation through the skin was the cause of the observed hormonal, physiological and behavioral changes, and that the protective system is also responsible for the regulation of sexuality.

 

The last stage of the study included 32 human subjects, who filled out validated questionnaires on behaviors of romantic passion and aggression. Treated with UVB phototherapy at the Tel Aviv Sourasky (Ichilov) and Assuta Medical Centers, both genders exhibited a rise in romantic passion, and males also noted an increase in levels of aggression.

 

Similar results were found when the subjects were asked to avoid sunlight for two days, and then tan themselves for approximately 25 minutes. Blood tests revealed that exposure to sunlight resulted in a higher release of hormones like testosterone compared to one day before exposure. A rise in testosterone in males during the summer was also found in analyses of data from the Clalit and Maccabi Health Services.

 

Prof. Levy: "The skin contains various mechanisms for dealing with radiation from sunlight, and one of these is the p53 protein. We must remember that exposure to UV is dangerous, and can damage the DNA, as in the case of skin cancer. At the same time, two built-in programs in the skin, activated following exposure to sunlight, are in place to protect against DNA damage: the DNA repair system and pigmentation, namely the suntan, based on degree of exposure. By activating both systems, the p53 protein regulates the level of DNA damage. In our study we found that the same system also activates the endocrine system of sexuality and potentially breeding. "

 

In the future this new discovery from TAU may lead to practical applications, such as UVB treatments for sexual hormone disorders. However, more research is still required before this can be achieved. According to Prof. Levy, the breakthrough will also lead to further discoveries in basic science. "Our findings open many scientific and philosophical questions. As humans, we have no fur, and our skin is thus directly exposed to sunlight. We are only beginning to understand what this exposure does to us, and the key roles it might play in various physiological and behavioral processes. It's only the tip of the iceberg."

 

Link to the article:

https://doi.org/10.1016/j.celrep.2021.109579

Stress busting techniques lead to healthier behaviors

Learning new ways to manage stress can naturally lead to a healthier lifestyle and greater wellbeing, new research suggests.

People who developed and practised strategies for coping with worry and rumination were found to sleep better, drink less alcohol and eat healthier food, analysis of several studies from around the world has shown.

Worry is often concerned with feared future events, while rumination is continuously thinking about stressors encountered in the past. Both are common coping responses to stress.

The research team were aiming to establish whether reducing these responses could improve physical health and health behaviours - actions people take that affect their health in both positive and negative ways, like exercising and healthy eating, or smoking and excessive alcohol intake.

Lead researcher Dane McCarrick, a postgraduate researcher in Psychology at the University of Leeds, said: “This new research provides the first synthesis of experimental evidence testing the most effective methods at reducing worry and rumination within the context of health.

“The review provides fresh evidence for the link between stress and adverse health outcomes and highlights the importance of finding time to switch off and manage worry.”

Stress is known to impact physical health, and can increase blood pressure, heart rate and cardiovascular activity, lower the immune system, affect hormone levels and produce physical symptoms, including pain and nausea.

The research team used data from 5,000 participants across 36 different studies to examine how psychological interventions for worry and rumination impacted mental and physical health and health behaviours over a period of time.

The results were compared with control groups who received no intervention.

Interventions included:

· Psychological detachment - switching off from situations that trigger stress

· Action plans, such as postponing worry until an allocated time

· Stress management

· Mindfulness and relaxation

· Talking therapies: cognitive behavioural therapy (CBT) and acceptance and commitment therapy.

· Pain management

The results showed that all intervention types had a significant, positive effect on health behaviours, with the exception of pain management strategies.

Delivery methods and settings, such as professionally-led or group therapy were also assessed.

The team found that levels of worry and rumination were lower in the intervention group compared with the control group, with larger effects produced when interventions were administered by a healthcare professional. Action planning, psychological detachment and CBT produced significant effects on worry, while mindfulness, psychological detachment, CBT and pain management produced significant results for rumination.

The research, jointly conducted by Mr McCarrick, Dr Andrew Prestwich, Dr. Arianna Prudenzi and Professor Daryl O’Connor, appears in Health effects of psychological interventions for worry and rumination: A meta-analysis. The paper is published in Health Psychology.

The researchers also noted a correlation between lower levels of worry and rumination, and improved health behaviours.

And they found no difference in effect among any sub-groups, suggesting that these techniques are likely to work for most people.

Mr McCarrick said: “Our data suggest that there are ways in which we can look after our mental health – by reducing worry and rumination – that can also have lasting consequences for a range of health behaviours, such as sleep hygiene and alcohol dependency.”

“This is particularly pertinent given other studies have recently shown that both worry and rumination can be exacerbated by the circumstances surrounding the COVID-19 pandemic, so the evidence-based psychological techniques highlighted by this research are especially timely.”