Radical treatment and examination combined can halve mortality from prostate cancer

Men with very high-risk prostate cancer, who are treated at hospitals with a high proportion of administered radical local treatment (radiotherapy or prostatectomy), only have half of the mortality risk of men who are treated at hospitals with the lowest proportion. This is according to a new study conducted by researchers at Umeå University in Sweden and published in European Urology.

"The results suggest that the combination of thorough examination and subsequent radical local therapy can prolong life for men with very high-risk prostate cancer," says Pär Stattin, a researcher at the Department of Surgical and Perioperative Sciences who led the study.

Using patient data from the National Prostate Cancer Register (NPCR) of Sweden, the researchers investigated the link between prostatectomy or full-dose radiotherapy and mortality in men with deadly high-risk prostate cancer. Differences in treatment selection were analysed on a group basis whereas mortality from prostate cancer and other causes was analysed on an individual basis.

Results show that men with a very high-risk prostate cancer, who were treated at hospitals with the highest proportion of radical treatment, were only half as likely (mortality rate ratio; MRR 0.51) to die from prostate cancer compared to men treated at hospitals where radical local therapy was administered the least. However, since this was an observational study, the potential effects of high-intensity in diagnostic activity and work-up cannot be isolated from therapeutic activity.

"Our data suggests that there are benefits of radical local therapy for men with very advanced forms of prostate cancer. However, these men most often only receive hormonal treatment. To confirm our findings and hopefully to improve treatment praxis, there is a need for a randomized study of the effects of local radical therapy on patients with very high-risk prostate cancer," says Pär Stattin.

Working and volunteering could reduce disablement in seniors

Working or volunteering can reduce the chances of chronic health conditions leading to physical disability in older Americans, according to researchers at Georgia State University and Florida State University.

The study found people ages 50 to 64 who worked full-time or part-time or volunteered up to 100 hours per year experienced a reduction in the extent to which chronic conditions were associated with subsequent functional limitations, such as the ability to walk a block or climb a flight of stairs. The findings are published in The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences.

Previous studies have not examined how working or volunteering affects functional limitations, said Ben Lennox Kail, lead author and assistant professor in the Department of Sociology at Georgia State.

"If we can find interventions that slow down early-stage disability, we might be able to help people live healthier and ultimately longer because decreased physical functioning is associated with excess risk of mortality," Kail said. "What we're arguing is that it's important to have programs that incentivize people who are healthy enough to continue working and volunteering to do so because it can intervene in health processes."

Maintaining high levels of physical functioning is one of the keys to successful aging. In the United States, nearly 20 percent of men and 30 percent of women older than 65 years old experience some form of functional limitation. Limiting disability is important to help reduce mortality in the U.S., as well as individual and public health expenditures.

"A lot of our programs are about labor force withdrawal," Kail said. "Social Security and Medicare provide incentives to leave the labor force. For lots of people, these are great and important. At the same time, if we want people to age healthier than normal, we need incentives for them to continue working or begin volunteering."

The researchers used Health and Retirement Survey data from 1998 to 2012. The data were collected from 13,268 people older than 50 and younger than 62, who were re-interviewed every two years.

The data include measurements of subsequent functional limitations: walking one block, climbing one flight of stairs, stooping or kneeling, lifting or carrying 10 pounds, picking a dime up off the ground and pushing or pulling a large object. Participants indicated whether they had ever been diagnosed with any of the following chronic conditions: high blood pressure, diabetes, cancer, lung disease, heart problems, stroke or arthritis.

In addition, they reported whether they were engaged in full-time or part-time work over the past year, as well as the number of hours they volunteered during the same period.

The study found working full-time and part-time or volunteering less than 100 hours per year played a significant role in lessening the link between chronic conditions and functional limitations. Workers and volunteers had fewer current physical limitations than their non-active counterparts. On average, they also had fewer chronic conditions.

Volunteering 100 hours or more didn't reduce the association between chronic conditions and subsequent functional limitations, but it was important in limiting functional limitations.

"Some older people are leaving the labor force and not replacing it with anything," Kail said. "If you're not replacing work with a work-like activity, your retirement is radically different than how you spent most of your life and not necessarily radically better."

Dawn Carr of Florida State was a co-author of the study.

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Read the study at http://psychsocgerontology.oxfordjournals.org/content/early/2016/05/25/geronb.gbw060.full?sid=defa9f1e-feaa-4484-bf4f-07f4b2bc6f0d

Chondroitin + glucosamine sulfate may provide no benefits for patients with knee osteoarthritis

Chondroitin sulfate (CS) plus glucosamine sulfate (GS) was no better than placebo for reducing pain and function impairment in a multicenter, randomized, double-blinded, placebo-controlled study of 164 patients with knee osteoarthritis.

Although the use of CS and GS has been recognized since the 1970s, there has been limited data concerning their efficacy for treating knee osteoarthritis. Additional research may provide valuable insights on what role CS+GS therapy might play in the management of osteoarthritis.

"This is the first randomized controlled trial sponsored by a pharmaceutical company to evaluate the efficacy of a combination of CS and GS and that included a Data and Safety Monitoring Board, or DSMB, composed of independent experts charged with ensuring participant safety and accurate, bias-free data. This committee was blinded to treatment assignment and not involved in the trial procedures, and it had no financial ties or conflicts of interest with the sponsor or other trial organizers," said Prof. Gabriel Herrero-Beaumont, senior author of the Arthritis & Rheumatology study.

Cardiac complications from energy drinks

The high levels of caffeine in energy drinks may lead to cardiac complications, suggests a case report in the July/August Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM). The journal is published by Wolters Kluwer.

The case adds to previous reports of adverse cardiovascular events related to consuming energy drinks, including abnormal heart rhythms (arrhythmias). The lead author is Dr. Maryam Sattari of University of Florida, Gainesville.

Arrhythmia Sends Energy Drink User to the Emergency Room

The patient was a 28-year-old man seen in the emergency department after developing vomiting with blood. On examination, the only abnormality (other than obesity) was a very fast heart rate--about 130 beats per minute.

An electrocardiogram revealed an abnormal heart rhythm called atrial fibrillation: a common type of arrhythmia that can lead to serious complications if sustained. Further tests showed no other heart problems.

The patient said he routinely drank two Monster energy drinks per day--for a total caffeine content of 320 milligrams--along with two or three beers. No other common causes of his heart rhythm abnormality were apparent.

With medications, the atrial fibrillation resolved over 48 hours. Endoscopy showed a tear of the stomach and esophagus, probably caused by forceful vomiting. The patient was sent home in stable condition; at one year's follow-up, he had no further symptoms of arrhythmia.

Although several factors might have contributed to the patient's atrial fibrillation, Dr. Sattari and colleagues write, "We believe that energy drink consumption played a key role." They point out the 160 mg caffeine content of a Monster energy drink is about four times higher than in a caffeinated soft drink (The caffeine content of coffee drinks varies widely, but may be even higher).

A review of the medical research identified at least eight cases of cardiovascular events linked to energy drinks, such as Monster or Red Bull. The researchers discuss several mechanisms by which the high caffeine content of these products might lead to cardiovascular events. These include other ingredients, such as taurine, that might heighten the effects of caffeine; using energy drinks along with alcohol or illicit drugs; or high stress levels.

Energy drinks have become increasingly popular in recent years, especially among adolescents and young adults. Marketed as "nutritional supplements," these beverages are not subject to the caffeine limits on soft drinks, or to the safety testing and labeling required for medications.

This and previous reports are "suggestive but not conclusive" that the caffeine in energy drinks may cause abnormal heart rhythms and other cardiac complications. "We suggest that arrhythmia could be a complication of energy drink consumption," Dr. Sattari and coauthors write. They encourage health care providers to ask about energy drink intake in otherwise healthy young patients with unexplained arrhythmias.

Regular physical activity for older adults: higher brain volumes and a reduced risk for developing dementia

Using the landmark Framingham Heart Study to assess how physical activity affects the size of the brain and one's risk for developing dementia, UCLA researchers found an association between low physical activity and a higher risk for dementia in older individuals. This suggests that regular physical activity for older adults could lead to higher brain volumes and a reduced risk for developing dementia.

The researchers found that physical activity particularly affected the size of the hippocampus, which is the part of the brain controlling short-term memory. Also, the protective effect of regular physical activity against dementia was strongest in people age 75 and older.

Though some previous studies have found an inverse relationship between levels of physical activity and cognitive decline, dementia and Alzheimer's disease, others have failed to find such an association. The Framingham study was begun in 1948 primarily as a way to trace factors and characteristics leading to cardiovascular disease, but also examining dementia and other physiological conditions. For this study, the UCLA researchers followed an older, community-based cohort from the Framingham study for more than a decade to examine the association between physical activity and the risk for incident dementia and subclinical brain MRI markers of dementia.

The researchers assessed the physical activity indices for both the original Framingham cohort and their offspring who were age 60 and older. They examined the association between physical activity and risk of any form of dementia (regardless of the cause) and Alzheimer's disease for 3,700 participants from both cohorts who were cognitively intact. They also examined the association between physical activity and brain MRI in about 2,000 participants from the offspring cohort.

What this all means: one is never too old to exercise for brain health and to stave off the risk for developing dementia.

The study appears in the Journals of Gerontology Series A: Biological Sciences and Medical Sciences.

Eating more plant protein associated with lower risk of death

Eating more protein from plant sources was associated with a lower risk of death and eating more protein from animals was associated with a higher risk of death, especially among adults with at least one unhealthy behavior such as smoking, drinking and being overweight or sedentary, according to an article published online by JAMA Internal Medicine.

The consideration of food sources is critical to better understanding the health effects of eating protein and fine-tuning dietary recommendations.

Mingyang Song, M.D., Sc.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and coauthors used data from two large U.S. studies that had repeated measures of diet through food questionnaires and up to 32 years of follow-up. They examined hazard ratios (risk) for all-cause and cause-specific mortality in relation to eating animal protein vs. plant protein.

Among 131,342 study participants, 85,013 (64.7 percent) were women and the average age of participants was 49. Median protein intake, measured as a percentage of calories, was 14 percent for animal protein and 4 percent for plant protein.

The authors report:

• After adjusting for major lifestyle and dietary risk factors, every 10 percent increment of animal protein from total calories was associated with a 2 percent higher risk of death from all causes and an 8 percent increased risk of death from cardiovascular disease death.
• In contrast, eating more plant protein was associated with a 10 percent lower risk of death from all causes for every 3 percent increment of total calories and a 12 percent lower risk of cardiovascular death.
• Increased mortality associated with eating more animal protein was more pronounced among study participants who were obese and those who drank alcohol heavily.
• The association between eating more plant protein and lower mortality was stronger among study participants who smoked, drank at least 14 grams of alcohol a day, were overweight or obese, were physically inactive or were younger than 65 or older than 80.
• Substituting 3 percent of calories from animal protein with plant protein was associated with a lower risk of death from all causes: 34 percent for replacing processed red meat, 12 percent for replacing unprocessed red meat and 19 percent for replacing eggs.
• Limitations include the study's observational design, so residual confounding (other mitigating factors) cannot be excluded.

"Substitution of plant protein for animal protein, especially from processed red meat, may confer substantial health benefit. Therefore, public health recommendations should focus on improvement of protein sources," the study concludes.

Higher BMI not associated with increased risk of heart attack or death

A study of 4,046 genetically identical twin pairs with different amounts of body fat shows that twin siblings with a higher Body Mass Index, as a measure of obesity, do not have an increased risk of heart attack or mortality. The study, conducted by researchers at Umeå University in Sweden, also shows that a higher BMI is associated with an increased risk of type 2 diabetes. The study is published today in JAMA Internal Medicine.

"The results suggest that lifestyle changes that reduce levels of obesity do not have an effect on the risk of death and heart attack, which contradicts conventional understandings of obesity-related health risks," says Peter Nordström, researcher at the Department of Community Medicine and Rehabilitation at Umeå University.

"What the study does show is that there's a strong association between obesity and diabetes, which leads us to conclude that weight reduction interventions can be more effective against diabetes than when it comes to reducing the risk of heart attack and mortality."

In the cohort study, Peter Nordström and research colleagues at Umeå University compared health data from 4,046 monozygotic twin pairs. All twins in the study had different levels of body fat, as measured in BMI. Genetically identical siblings with different BMI provide researchers with a unique opportunity to evaluate obesity-related health risks that are independent of genetic factors.

During a follow-up period of on average 12.4 years, differences between the twins were compared when it comes to incidents of mortality, heart attack and type 2 diabetes. The results clearly showed that twin siblings with a higher BMI did not have an increased risk of mortality or heart attack compared to their thinner counterparts. However, twins with a higher BMI did have an increased risk of developing type 2 diabetes.

The results showed that:

• among twin siblings with a higher BMI (mean value 25.1), there were 203 heart attacks (5 %) and 550 deaths (13.6 %) during the follow-up period.
• among twin siblings with a lower BMI (mean value 23.9), there were 209 heart attacks (5.2 %) and 633 deaths (15.6 %) during the same period.
• among the 65 twin pairs in the study who had a BMI difference of 7 or higher, and where the larger twin siblings had a BMI of 30 or higher, there were still no noticeably increased risk of mortality or heart attack associated with a higher BMI.
• The study, described in the article Risks of Myocardinal Infarction, Death, and Diabetes in Identical Twin Pairs With Different Body Mass Index, is based on the Swedish Twin Registry, the largest of its kind in the world. The median age of the twins in the study was 57.5 and participants' ages ranged from 42-92. The cohort study was conducted between 1998 and 2003, with follow-ups regarding incident of mortality, heart attack and diabetes during a 10 year period until 2013. One study limitation was that weight and length (used to calculate BMI) was self-reported.