Sunday, March 29, 2020

Regular consumption of fish oil is likely associated with decreased all-cause and cardiovascular disease risk


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Consumption of fish oil was associated with decreased incidence of cardiovascular events with effects being most pronounced in patients with hypertension.

Lifestyle modification and dietary supplementation have long been recognized as potential avenues of additional therapeutic options to manage and prevent cardiovascular disease (CVD).  Fish oil and omega 3 fatty acid supplementation have previously been recognized as products that could potentially prevent CVD and have widespread usage globally despite follow-up investigations providing inconclusive results. 

To better characterize its suitability for usage in the general population, researchers conducted a large-scale cohort study published in the BMJ consisting of 427,678 participants aged 40 to 69 in the UK investigating the associations between fish oil supplementation with all-cause mortality, CVD mortality, and CVD events, consisting of strokes and myocardial infarction. Median follow up times were 9 years for mortality outcomes and 8.1 years for CVD events. 

Compared to controls, the cohort of 133,438 participants self-reporting habitual use of fish oil supplements had lower hazard ratios for all-cause mortality (0.87; 95% CI 0.83 – 0.90), CVD mortality (0.84; 95% CI, 0.78 – 0.91), and CVD events (0.93; 95% CI, 0.90 – 0.96). The effect of CVD event mitigation was most pronounced with patients with hypertension. Results were independent of possible confounding risk factors such as sex, BMI, physical activity, and diet. 

Findings from the study provide further evidence to suggest a role for fish oil supplementation in providing a marginal benefit for CVD management and the prevention of mortality from all causes and CVD.



Thursday, March 26, 2020

Study shows legal marijuana products too strong for pain relief


More than 90% of the legal marijuana products offered in medical dispensaries are much stronger than what clinical studies have shown that doctors recommend for chronic pain relief, according to a study published in the March 26 online edition of the journal PLOS ONE.
To many that may seem like a good thing, but just the opposite is true.
"We know that high-potency products should not have a place in the medical realm because of the high risk of developing cannabis-use disorders, which are related to exposure to high THC-content products," said the study's lead author, Alfonso Edgar Romero-Sandoval, M.D., Ph.D., associate professor of anesthesiology at Wake Forest School of Medicine, part of Wake Forest Baptist Health.
"Several earlier studies showed that levels of up to 5% tetrahydrocannabinol (THC) - the main psychoactive compound in marijuana that provides pain relief as well as intoxication - were sufficient to reduce chronic pain with minimal side effects."
The goal of this study was to evaluate the advertised THC and CBD content of legal cannabis products to determine their suitability for medicinal use, and to compare the potency of the products offered in medical and recreational programs.
The researchers recorded the concentrations of THC and cannabidiol (CBD) - the non-euphoric compound in marijuana - in all plant cannabis products provided by legal dispensary websites and compared them between or within the states in the study: California, Colorado, Maine, Massachusetts, New Hampshire, New Mexico, Rhode Island, Vermont and Washington. A total of 8,505 cannabis products across 653 dispensaries were sampled.
Romero-Sandoval's team found that most of the products offered in the medical dispensaries in the study had more than 10% THC and that many had 15% or more, the same as what is available in products at recreational dispensaries.
This is problematic because between 60% and 80% of people who use medical marijuana use it for pain relief, Romero-Sandoval said. The higher the concentration of THC the greater risk, not only for developing dependency, but also for developing tolerance more quickly, which means higher and higher concentrations might be needed to get the same level of pain relief.
"It can become a vicious cycle," Romero-Sandoval said.
"Better regulation of the potency of medical marijuana products is critical. The FDA regulates the level of over-the-counter pain medications such as ibuprofen that have dose-specific side effects, so why don't we have policies and regulations for cannabis, something that is far more dangerous?"
This study provides the scientific evidence to help policy makers correct mistakes and to create a better framework to protect patients, he said.

Why life can get better as we age -- study


Mindfulness helps wellbeing at all ages

People say life gets better with age. Now research suggests this may be because older people have the wisdom and time to use mindfulness as a means to improve wellbeing.
Healthy ageing researchers at Flinders University say certain characteristics of mindfulness seem more strongly evident in older people compared to younger people - and suggest ways for all ages to benefit.
"This suggests that mindfulness may naturally develop with time and life experience," says behavioural scientist Associate Professor Tim Windsor, who co-authored a recent study based on an online community survey of 623 participants aged between 18 and 86?years.
"The significance of mindfulness for wellbeing may also increase as we get older, in particular the ability to focus on the present moment and to approach experiences in a non-judgmental way.
"These characteristics are helpful in adapting to age-related challenges and in generating positive emotions."
Mindfulness refers to the natural human ability to be aware of one's experiences and to pay attention to the present moment in a purposeful, receptive, and non-judgmental way. Using mindful techniques can be instrumental in reducing stress and promoting positive psychological outcomes.
From middle age to old age, the Flinders University survey highlights the tendency to focus on the present-moment and adopt a non-judgmental orientation may become especially important for well-being with advancing age.
In one of the first age-related studies of its kind, the researchers assessed participants' mindful qualities such as present-moment attention, acceptance, non-attachment and examined the relationships of these qualities with wellbeing more generally.
"The ability to appreciate the temporary nature of personal experiences may be particularly important for the way people manage their day-to-day goals across the second half of life," says study lead author Leeann Mahlo, who is investigating mindfulness in older adulthood as part of her PhD research.
"We found that positive relationships between aspects of mindfulness and wellbeing became stronger from middle age onwards," she says.
"Our findings suggest that if mindfulness has particular benefits in later life, this could be translated into tailored training approaches to enhanced wellbeing in older populations."
Mindfulness skills can help build wellbeing at any age, adds clinical psychology PhD candidate Ms Mahlo.
Tips to develop mindful techniques include:
  • Becoming aware of our thoughts and surroundings and paying attention to the present moment in an open and nonjudgmental way. This can prevent us from focusing on the past or worrying about the future in unhelpful ways.
  • Understanding that our thoughts, feelings and situations exist in the moment and will not last. This can help us to respond in flexible, more optimistic ways to challenging circumstances, including those that we are facing with concerns related to the COVID-19 disease.
  • Finding out more about mindfulness via app-based programs such as Calm, Headspace, Insight Timer, Smiling Mind, and Stop, Breathe & Think. These are available for use on computers or smartphones and offer flexible ways of learning and practising mindfulness - including for people now spending more time at home.

Wednesday, March 25, 2020

Low risk of coronavirus spreading through tears


While researchers are certain that coronavirus spreads through mucus and droplets expelled by coughing or sneezing, it is unclear if the virus is spread through other bodily fluids, such as tears. Today's just-published study offers evidence that it is unlikely that infected patients are shedding virus through their tears, with one important caveat. None of the patients in the study had conjunctivitis, also known as pink eye. However, health officials believe pink eye develops in just 1 percent to 3 percent of people with coronavirus. The study's authors conclude that their findings, coupled with the low incidence of pink eye among infected patients, suggests that the risk of virus transmission through tears is low. Their study was published online today in Ophthalmology, the journal of the American Academy of Ophthalmology.
To conduct the study, Ivan Seah, MBBS, and his colleagues at the National University Hospital in Singapore collected tear samples from 17 patients with COVID-19 from the time they showed symptoms until they recovered about 20 days later. Neither viral culture nor reverse transcription polymerase chain reaction (RT-PCR) detected the virus in their tears throughout the two-week course of the disease.
Dr. Seah also took samples from the back of the nose and throat during the same time period. While the patients' tears were clear of virus, their noses and throats were teeming with COVID-19. Dr. Seah said he hopes their work helps to guide more research into preventing virus transmission through more significant routes, such as droplets and fecal-oral spread.
Despite this reassuring news, it's important for people to understand that guarding your eyes -- as well as your hands and mouth -- can slow the spread of respiratory viruses like the coronavirus.
Here's why:
  • When a sick person coughs or talks, virus particles can spray from their mouth or nose into another person's face. You're most likely to inhale these droplets through your mouth or nose, but they can also enter through your eyes.
  • You can also become infected by touching something that has the virus on it -- like a table or doorknob -- and then touching your eyes.

Tuesday, March 24, 2020

Commonly used mouthwash could make saliva significantly more acidic


The first study looking at the effect of chlorhexidine mouthwash on the entire oral microbiome has found its use significantly increases the abundance of lactate-producing bacteria that lower saliva pH, and may increase the risk of tooth damage.
A team led by Dr Raul Bescos from the University of Plymouth's Faculty of Health gave a placebo mouthwash to subjects for seven days, followed by seven days of a chlorhexidine mouthwash.
At the end of each period, the researchers carried out an analysis of the abundance and diversity of the bacteria in the mouth - the oral microbiome - as well as measuring pH, saliva buffering capacity (the ability to neutralise acids in the mouth), lactate, glucose, nitrate and nitrite concentrations.
The research, published in Scientific Reports today, found using chlorhexidine mouthwash over the seven days led to a greater abundance of species within the families of Firmicutes and Proteobacteria, and fewer Bacteroidetes, TM7 and Fusobacteria. This change was associated with an increase in acidity, seen in lower salivary pH and buffering capacity.
Overall, chlorhexidine was found to reduce microbial diversity in the mouth, although the authors cautioned more research was needed to determine if this reduction in diversity itself increased the risk of oral disease.
One of the primary roles of saliva is to maintain a neutral pH in the mouth, as acidity levels fluctuate as a result of eating and drinking. If saliva pH gets too low, damage can occur to the teeth and mucosa - tissue surrounding the teeth and on the inside of the mouth.
The research also confirmed findings from previous studies indicating that chlorhexidine disrupted the ability of oral bacteria to turn nitrate into nitrite, a key molecule for reducing blood pressure. Lower saliva and blood plasma nitrite concentrations were found after using chlorhexidine mouthwash, followed by a trend of increased systolic blood pressure. The findings supported earlier research led by the University that showed the blood pressure-lowering effect of exercise is significantly reduced when people rinse their mouths with antibacterial mouthwash rather than water.
Dr Bescos said: "There is a surprising lack of knowledge and literature behind the use of these products. Chlorhexidine mouthwash is widely used but research has been limited to its effect on a small number of bacteria linked to particular oral diseases, and most has been carried out in vitro.
"We believe this is the first study to look at the impact of 7-day use on the whole oral microbiome in human subjects."
Dr Zoe Brookes and Dr Louise Belfield, Lecturers in the Peninsula Dental School at the University of Plymouth, are co-authors of the study.
Dr Belfield said: "We have significantly underestimated the complexity of the oral microbiome and the importance of oral bacteria in the past. Traditionally the view has been that bacteria are bad and cause diseases. But we now know that the majority of bacteria - whether in the mouth or the gut - are essential for sustaining human health."
Dr Brookes added: "As dental clinicians, we need more information on how mouthwashes alter the balance of oral bacteria, so we can prescribe them correctly. This paper is an important first step in achieving this.
"In the face of the recent COVID-19 outbreak many dentists are now using chlorhexidine as a pre-rinse before doing dental procedures. We urgently need more information on how it works on viruses"

Half of 65+ adults lack dental insurance


Oral care coverage acts as a strong draw for enrolling in Medicare Advantage plans
MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN
Nearly all older Americans support adding a dental benefit to the Medicare program that covers most people over age 65, according to a new national poll that also reveals how often costs get in the way of oral health for older adults.
Ninety-three percent of people between the ages of 65 and 80 favor including dental coverage in traditional Medicare, though the percentage dropped to 59% when they were asked if they'd favor it even if they had to pay more for their Medicare benefits.
Just over half of the older adults polled (53%) said they currently have dental coverage. Half of this group are covered as employees or retirees, or spouses of employees.
Another quarter said they have dental coverage because they've chosen to get their Medicare coverage through a Medicare Advantage plan offered by a commercial insurance company. In fact, 72% of those with Medicare Advantage coverage said they'd chosen their plan in part because it covered dental care.
Whether they had insurance or not, cost plays a role in dental decisions, the poll finds. One in five of the older adults polled said they had delayed getting dental care, or gone without it, in the past two years.
The majority of these respondents said cost, or insurance problems, played a role in this decision. Those without dental insurance, and those with lower incomes, were more likely to say they'd delayed or gone without oral care.
The new results come from the National Poll on Healthy Aging, carried out by the University of Michigan Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine, U-M's academic medical center. It involved a national sample of more than 1,030 adults aged 65 to 80 who answered a range of questions about their own oral health and dental health policy.
"These results suggest that health care providers and policymakers should seek solutions to better identify and address how cost and other factors act as barriers to dental care among older adults," says Domenica Sweier, Ph.D., D.D.S.
Sweier, a clinical associate professor at the U-M School of Dentistry, helped develop the poll questions and analyze the results. She adds that as providers and policy makers continue to seek solutions, "This will be important to preventing health and social consequences of unmet oral health needs in this population."
Differences across the over-50 age range
A previous National Poll on Healthy Aging report looked at dental health, including insurance and cost factors, among people in their 50s and early 60s. Only one in four of those polled said they lacked dental insurance, but half said they did not know how they would get dental coverage after they retired and some assumed that traditional Medicare would cover their dental care needs.
"Across the spectrum of ages, dental care and coverage vary, and cost plays a major role," says Preeti Malani, M.D., director of the poll and a professor of internal medicine at U-M with special training in the care of older adults. "We know that poor oral health can affect everything from social interactions to eligibility for surgery, so it's important for health professionals as well as policymakers to understand what older adults are experiencing."
One in four of the adults over 65 polled (27%) said they were embarassed by the condition of the teeth, and about the same percentage rated their overall dental health as fair or poor.
The role of dental care costs
One in three hadn't been to the dentist for preventive care such as a cleaning in at least a year. When the research team cross-referenced this with household income, they found that those with incomes over $60,000 were nearly twice as likely as those with incomes less than $30,000 to have gone to the dentist in the past year.
Nearly half of the poll sample (46%) said they were missing teeth but didn't have a denture or implant to fill the gap.
"Coverage of dental care, as well as vision and hearing care, is critical for the long-term health of our population" says Alison Bryant, Ph.D., senior vice president of research for AARP. "Even simple teeth cleanings may not be affordable to seniors living on fixed incomes, so having coverage for dental benefits may help address that problem."
The poll also shines additional light on the growing body of evidence linking oral health and overall health and wellbeing.
Those who said their overall physical or mental health were fair or poor also visited the dentist's office less often, and were more likely to say their oral health was poor. Problems with dry mouth related to medication use, and challenges eating a healthy diet because of untreated dental problems, could make these issue worse, says Malani.
The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 1,039 adults aged 65 to 80 who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have them.
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A full report of the findings and methodology is available at http://www.healthyagingpoll.org, along with past National Poll on Healthy Aging reports.

Past your bedtime? Inconsistency may increase risk to cardiovascular health


Despite increasing awareness of how critical sleep is to our health, getting a good night's rest remains increasingly difficult in a world that's always "on" -- responding to emails at all hours, news cycles that change with every tweet and staring endlessly into the blue light of cell phone, tablet and computers screens.
Scientists have stressed the importance of healthy sleep habits, recommending at least seven hours each night, and have linked lack of sleep to an increased risk in numerous health conditions, including diabetes, stroke and cardiovascular disease.
Now a new study shows whether or not you go to bed on time could also have an effect on your health. Researchers at the University of Notre Dame studied the correlation between bedtime regularity and resting heart rate (RHR) and found that individuals going to bed even 30 minutes later than their usual bedtime presented a significantly higher resting heart rate that lasted into the following day.
"We already know an increase in resting heart rate means an increased risk to cardiovascular health," said Nitesh Chawla, the Frank M. Freimann professor of Computer Science and Engineering at Notre Dame, director of the Center for Network and Data Science and a lead author of the study. "Through our study, we found that even if you get seven hours of sleep a night, if you're not going to bed at the same time each night, not only does your resting heart rate increase while you sleep, it carries over into the next day."
Chawla and his team analyzed data collected via Fitbit from 557 college students over the course of four years. They recorded 255,736 sleep sessions -- measuring bedtimes, sleep and resting heart rate. Significant increases in RHR were observed when individuals went to bed anywhere between one and 30 minutes later than their normal bedtime. Normal bedtime was defined as the one-hour interval surrounding a person's median bedtime. The later they went to bed, the higher the increase in RHR. Rates remained elevated into the following day.
Surprisingly, going to bed earlier than one's standard bedtime also showed signs of increasing RHR, though it depended on just how early. Going to bed 30 minutes earlier than usual appeared to have little effect, while going to bed more than a half hour earlier significantly increased RHR. In cases of earlier bedtimes, however, RHR leveled out during the sleep session. Circadian rhythms, medications and lifestyle factors all come into play when it comes to healthy sleep habits, but Chawla said it's vital to consider consistency as well.
"For some, it may be a matter of maintaining their regular 'work week' bedtime through the weekend," said Chawla. "For shift workers and those who travel frequently, getting to bed at the same time each night is a challenge. Establishing a healthy bedtime routine -- as best you can -- is obviously step number one. But sticking to it is just as important."

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Higher daily step count linked with lower all-cause mortality

In a new study, higher daily step counts were associated with lower mortality risk from all causes. The research team, which included investigators from the National Cancer Institute (NCI) and the National Institute on Aging (NIA), both parts of the National Institutes of Health, as well as from the Centers for Disease Control and Prevention, also found that the number of steps a person takes each day, but not the intensity of stepping, had a strong association with mortality.
The findings were published March 24, 2020, in the Journal of the American Medical Association.
“While we knew physical activity is good for you, we didn’t know how many steps per day you need to take to lower your mortality risk or whether stepping at a higher intensity makes a difference,” said Pedro Saint-Maurice, Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics, first author of the study. “We wanted to investigate this question to provide new insights that could help people better understand the health implications of the step counts they get from fitness trackers and phone apps.”
Previous studies have been done on step counts and mortality. However, they were conducted primarily with older adults or among people with debilitating chronic conditions. This study tracked a representative sample of U.S. adults aged 40 and over; approximately 4,800 participants wore accelerometers for up to seven days between 2003 and 2006. The participants were then followed for mortality through 2015 via the National Death Index. The researchers calculated associations between mortality and step number and intensity after adjustment for demographic and behavioral risk factors, body mass index, and health status at the start of the study.
They found that, compared with taking 4,000 steps per day, a number considered to be low for adults, taking 8,000 steps per day was associated with a 51% lower risk for all-cause mortality (or death from all causes). Taking 12,000 steps per day was associated with a 65% lower risk compared with taking 4,000 steps. In contrast, the authors saw no association between step intensity and risk of death after accounting for the total number of steps taken per day.
“At NIA, we’ve long studied how exercise is important for older adults, and it’s good to see further evidence from a large study with a broad sample that the main thing is to get moving for better overall health as we age,” said Eric Shiroma, Ph.D., a co-author and NIA Intramural Research Program scientist.
In analyses by subgroups of participants, the authors found that higher step counts were associated with lower all-cause death rates among both men and women; among both younger and older adults; and among white, black, and Mexican-American adults. In secondary outcomes of the study, higher step counts were also associated with lower rates of death from cardiovascular disease and cancer.
Data collection was conducted through the CDC’s National Health and Nutrition Examination Survey (NHANES), a program of studies designed to assess a nationally representative sample of the health and nutritional status of adults and children in the United States.
The researchers were surprised they didn’t find an association between higher stepping intensity and all-cause mortality after adjusting for the total number of steps per day. Because few studies have investigated an association between mortality and intensity among adults going about their daily lives, the study authors wrote that future studies of walking intensity and mortality are warranted.
Although the study authors controlled for factors that could have affected the results, the study is observational and cannot prove causality. Nevertheless, their findings are consistent with current recommendations that adults should move more and sit less throughout the day. Adults who do any amount of physical activity gain some health benefits. For even greater health benefits, adults are recommended to get at least 150 minutes of moderate-intensity physical activity per week.
“Being physically active has many benefits, including reducing a person’s risk of obesity, heart disease, type 2 diabetes, and some cancers. And on a daily basis, it can help people feel better and sleep better,” said Janet Fulton, Ph.D., of CDC’s Division of Nutrition, Physical Activity, and Obesity. “CDC is working with communities and partners across the country, as part of the Active People, Healthy Nation initiative, to make it easier, safer, and more convenient for people to be active in their own communities." 

Monday, March 23, 2020

Isoflavones, in tofu and plant proteins, associated with lower heart disease risk


Eating tofu and foods that contain higher amounts of isoflavones was associated with a moderately lower risk of heart disease, especially for younger women and postmenopausal women not taking hormones, according to observational research published today in Circulation, the flagship journal of the American Heart Association.
Researchers at Harvard Medical School and Brigham and Women's Hospital analyzed data from more than 200,000 people who participated in three prospective health and nutrition studies; all participants were free of cancer and heart disease when the studies began. After eliminating a number of other factors known to increase heart risk, investigators found:
Consuming tofu, which is high in isoflavones, more than once a week was associated with a 18% lower risk of heart disease, compared to a 12% lower risk for those who ate tofu less than once a month; and
The favorable association with eating tofu regularly was found primarily in young women before menopause or postmenopausal women who were not taking hormones.
"Despite these findings, I don't think tofu is by any means a magic bullet," said lead study author Qi Sun, M.D., Sc.D., a researcher at Harvard's T.H. Chan School of Public Health in Boston. "Overall diet quality is still critical to consider, and tofu can be a very healthy component."
Sun noted that populations that traditionally consume isoflavone-rich diets including tofu, such as in China and Japan, have lower heart disease risk compared to populations that follow a largely meat-rich and vegetable-poor diet. However, the potential benefits of tofu and isoflavones as they relate to heart disease needs more research.
Tofu, which is soybean curd, and whole soybeans such as edamame are rich sources of isoflavones. Chickpeas, fava beans, pistachios, peanuts and other fruits and nuts are also high in isoflavones. Soymilk, on the other hand, tends to be highly processed and is often sweetened with sugar, Sun noted. This study found no significant association between soymilk consumption and lower heart disease risk.
"Other human trials and animal studies of isoflavones, tofu and cardiovascular risk markers have also indicated positive effects, so people with an elevated risk of developing heart disease should evaluate their diets," he said. "If their diet is packed with unhealthy foods, such as red meat, sugary beverages and refined carbohydrates, they should switch to healthier alternatives. Tofu and other isoflavone-rich, plant-based foods are excellent protein sources and alternatives to animal proteins."
In the study, researchers analyzed health data of more than 74,000 women from the Nurses' Health Study (NHS) from 1984 to 2012; approximately 94,000 women in the NHSII study between 1991 and 2013; and more than 42,000 men who participated in the Health Professionals Follow-Up Study from 1986 to 2012. All participants were free of cardiovascular disease and cancer at the beginning of each study. Dietary data was updated using patient surveys, conducted every two to four years. Data on heart disease was collected from medical records and other documents, while heart disease fatalities were identified from death certificates.
A total of 8,359 cases of heart disease were identified during 4,826,122 person-years of follow-up, which is the total number of years that study participants were free of heart disease and helps to measure how fast it occurs in a population.
Sun emphasized that the study should be interpreted with caution because their observations found a relationship but did not prove causality. Many other factors can influence the development of heart disease, including physical exercise, family history and a person's lifestyle habits. "For example, younger women who are more physically active and get more exercise tend to follow healthier, plant-based diets that may include more isoflavone-rich foods like tofu. Although we have controlled for these factors, caution is recommended when interpreting these results," said Sun.
In 2000, the U.S. Food and Drug Administration approved health claims that soy edibles protect against cardiovascular disease. However, since then, clinical trials and epidemiological studies have been inconclusive, and the agency is reconsidering its now twenty-year-old decision. The American Heart Association's 2006 Diet and Lifestyle Recommendations and a 2006 science advisory on soy protein, isoflavones and cardiovascular health
found minimal evidence that isoflavones convey any cardiovascular benefits and any protections provided by higher soy intake was likely due to higher levels of polyunsaturated fats, fiber, vitamins and minerals, and lower levels of saturated fat.