Tag Archives: Amy Norton

Urban living: Add trees for health, happiness

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Trees play a role in bolstering mental and physical health for city dwellers. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


City dwellers who live on tree-lined streets might be happier and healthier for it, a large new study suggests.


The study, of nearly 47,000 urban residents, found that those who lived in areas shaded by tree canopy reported less psychological distress and better general health over six years.


Green grass, on the other hand, didn’t cut it: People in neighborhoods with more grassy areas actually reported poorer health than those largely surrounded by concrete.


The researchers said the findings suggest there might be something particularly health-promoting about trees. Maybe people who have them nearby have more chances for walking and recreation, or enjoy a buffer against noise and traffic pollution, for example.


The bottom line: Trees seem to matter to our well-being, said Kathleen Wolf, a research social scientist at the University of Washington’s College of the Environment, in Seattle.


Wolf, who was not involved in the study, said it adds to a body of research finding a link between “green space” and better health.


A U.K. study published recently is a case in point. It found that people who spent two hours a week outdoors gave higher ratings to their physical and mental health than those who preferred the great indoors.


“If you have one study showing an association,” Wolf said, “it gives you a heads-up—’Hey, this is an interesting finding.’”


When multiple studies show the same pattern, it suggests something is really there, she added.


A strength of the new study is that it followed people over time, Wolf said, rather than measuring well-being only once.


On average, it found, city dwellers who lived near more tree canopy were less likely to develop new symptoms of psychological distress—like nervousness, hopelessness and unexplained fatigue.


The benefit was seen among people living in areas with tree coverage of at least 30% within a mile of home. Compared with residents with few nearby trees, they were about one-third less likely to report distress symptoms on a standard questionnaire.


They were also one-third less likely to downgrade ratings of their general health to “fair” or “poor.”


Of course, there could be many things about living in greener areas that make people happier and healthier. But the researchers tried to account for those differences—weighing factors like household income, education levels and marital status.


Even then, trees still mattered to mental and physical well-being.


Why would that be? Wolf pointed to various possibilities.


Tree-lined streets and parks may give people more opportunities for exercise—which, she noted, is important not only for physical well-being but mental health, too.


There’s also a theory that being out in nature offers a better sense of perspective, which makes our daily stresses seem less significant.


“Human beings tend to ruminate on the bad things that happen, rather than the good,” Wolf said.


Some of that mental playback may fade when you’re outdoors, with things to see, smell and experience, she noted.


Living near grassy surroundings, on the other hand, was linked to higher odds of distress and poor health.


The study cannot reveal why, said Sjerp de Vries, a researcher with Wageningen University and Research in the Netherlands. But, he said, unlike grass, trees can make an area more walkable.


Trees are also more obvious, de Vries said. Tall trees, especially, make their presence known whether people are outside or inside.


Plus, de Vries noted, there is an argument to be made that trees are beneficial because they release chemicals called phytoncides, which may boost human immune function.


He wrote an editorial accompanying the new study, which was published online recently in JAMA Network Open.


The study results were based on 46,786 adults aged 45 and older in three large Australian cities. All remained in the same neighborhood over six years and completed the same health questionnaires at the beginning and end of the study period.


It’s possible, de Vries said, that healthier people chose to live in tree-lined areas.


But other studies have suggested that “green space” has particular benefits for lower-income people, he noted. And they have less choice about where to live than their wealthier counterparts.


Reprinted with permission from Spectrum Health Beat.



A top cardio plan: Get a canine

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Researchers have found that dog owners are more active — and the benefits may extend to diet and blood sugar levels. (For Spectrum Health Beat)

By Amy Norton, HealthDay


Your dog might be your heart’s best friend, if a new study is any indication.


Researchers found that compared with people who had no pets, dog owners tended to have fewer risk factors for heart disease: They got more exercise and had healthier diets and lower blood sugar levels.


Even compared with other pet owners, they were doing better with diet and exercise.


The study of nearly 1,800 Czech adults is not the first to suggest our canine friends can do our hearts good. In fact, in 2013 the American Heart Association issued a scientific statement saying that dog ownership is likely linked to a lower risk of heart disease.


That was largely based on evidence that people with dogs are more physically active. The new findings suggest the benefit might extend to diet and blood sugar levels.


It’s easy to see how having a dog could get people moving, according to senior researcher Dr. Francisco Lopez-Jimenez.


And it’s possible that dog owners’ lower blood sugar levels were related to their exercise habits, said Lopez-Jimenez, a cardiologist at the Mayo Clinic in Rochester, Minn.


It’s less obvious, though, why dog ownership would encourage a healthier diet. One possibility is that the two are not directly related, he said.


On the other hand, past research has shown that dogs do more than demand walks and get us moving: They offer companionship and emotional support, according to Lopez-Jimenez.


“They can decrease your feelings of loneliness and give you a sense of purpose,” he said. “You have someone to look after.”


And that, he speculated, might encourage people to take better care of themselves.


Dr. Glenn Levine, a volunteer medical expert with the AHA, was lead author of its statement on pets and heart health. He said that, overall, there is “reasonably good data” that adopting a dog can increase people’s physical activity levels.


“That’s the strongest and most direct (cardiovascular) benefit,” said Levine, who is also a professor at Baylor College of Medicine in Houston.


He agreed, though, that pets might support heart health in less-direct ways, too.


“There may be other benefits as well—including reduced stress, greater companionship and happiness, and other factors that could lead people to take better care of themselves,” he said.


For the study, the researchers used data from a health survey of 1,769 Czech adults, aged 25 to 64.


Overall, more than two-thirds of dog owners (67%) met the “ideal” AHA recommendations for exercise. That means 150 minutes of moderate aerobic exercise, or 75 minutes of vigorous activity, each week—along with muscle strengthening exercises a couple of days per week.


In contrast, only 48% of people without pets met that ideal, as did 55% of other pet owners, the findings showed.


When it came to diet, few people met the AHA ideal, which includes plenty of fruits, vegetables, beans, fiber-rich grains, fish and lean meat.


But dog owners were doing better than others: Fewer than 7% scored in the “poor” range for diet, versus 16% of people without pets and 13% of other pet owners.


Dog owners did, however, fall short in one heart-health measure: Their smoking rates were highest.


It’s not clear why, according to Lopez-Jimenez—and it might not hold true in other countries, such as the United States. In general, smoking is more common in Eastern Europe.


The bottom line, according to Levine, is that people might enjoy health benefits from having a canine companion. But the AHA does not advocate adopting a dog for that purpose.


“The primary purpose of adopting or rescuing a dog should be to give the dog a loving and caring home,” Levine said. “The health benefits that may come from this are a bonus.”


The findings were published recently in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.


Reprinted with permission from Spectrum Health Beat.



The bottom line on blood pressure

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By understanding the implications of both numbers in a blood pressure reading, you may gain more understanding of your risk for heart disease and stroke. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


When it comes to blood pressure readings, the “top” number seems to grab all the attention.


But a large, new study confirms that both numbers are, in fact, critical in determining the risk of heart attack and stroke.


Blood pressure measurements are given as a “top” and “bottom” number. The first reflects systolic blood pressure, the amount of pressure in the arteries as the heart contracts. The second reflects diastolic blood pressure, the pressure in the arteries between heart muscle contractions.


For years, systolic blood pressure has been seen as the one that really matters. That’s based on studies—including the famous Framingham Heart Study—showing that high systolic blood pressure is a stronger predictor of heart disease and stroke.


At the same time, though, doctors measure both systolic and diastolic blood pressure—and treatment guidelines are based on both. So just how important is that diastolic number?


“The idea behind this new study was to address the confusion,” said lead researcher Dr. Alexander Flint, an investigator with Kaiser Permanente Northern California’s division of research.


Using medical records from 1.3 million patients, his team confirmed that, yes, high systolic blood pressure was a stronger risk factor for heart attack and stroke.


But those risks also climbed in tandem with diastolic pressure. And people with normal systolic readings were still at risk if their diastolic pressure was high.


“There’s been a common belief that systolic blood pressure is the only one that matters,” Flint said. “But diastolic definitely matters.”


He and his colleagues reported the findings in a recent issue of the New England Journal of Medicine.


The definition of high blood pressure has gotten a revamp in recent years. Guidelines issued in 2017 by the American College of Cardiology and other heart groups lowered the threshold for diagnosing the condition—from the traditional 140/90 mm Hg to 130/80.


The fact that treatment guidelines include a diastolic pressure threshold implies that it’s important.


And indeed it is, said Dr. Karol Watson, a member of the ACC’s prevention section and leadership council.


In fact, she said, doctors once thought that diastolic blood pressure was the more important one, based on research at the time. Then came the studies showing that systolic pressure was generally a better predictor of people’s risk of heart disease and stroke.


In addition, Watson said, high systolic blood pressure is more prevalent, because of natural changes in blood pressure as people age.


“As we get older, systolic blood pressure keeps marching up,” she explained. Diastolic blood pressure, on the other hand, generally peaks when people are in their 40s to 60s—and then it declines.


But it’s clear, Watson said, that while systolic and diastolic blood pressure are different they both deserve attention.


In the latest study, cardiovascular risks rose with each “unit increase” in systolic pressure above 140, by about 18% on average. Meanwhile, each increase in diastolic blood pressure above 90 was tied to a 6% increase in heart disease and stroke risk.


The researchers saw a similar pattern when they looked at blood pressure increases above the 130/80 threshold. That, Flint said, supports the 2017 guideline shift.


The findings are based on over 1.3 million patients in the Kaiser Permanente health system who had roughly 36.8 million blood pressure readings taken from 2007 through 2016. Over eight years, more than 44,000 patients had a heart attack or stroke.


According to Flint, it’s the largest study of its kind to date.


The bottom line for patients, Watson said, is that they should care about both blood pressure numbers.


In her experience, she noted, patients often point to the number that’s in the normal range and say, “But look how good this is.”


Flint agreed, saying that no one should “ignore” the diastolic number.


“It’s important not only in blood pressure treatment, but on the side of diagnosis, too,” he said.


Reprinted with permission from Spectrum Health Beat.



Deep sleep—cleansing for the brain

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While the biological processes are still a bit murky, researchers suspect a proper night’s rest gives your brain a chance to rid itself of toxic molecules. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


The deep stages of sleep may give the brain a chance to wash itself free of potentially toxic substances, a new study suggests.


Researchers found that during deep sleep, the “slow-wave” activity of nerve cells appears to make room for cerebral spinal fluid to rhythmically move in and out of the brain—a process believed to rinse out metabolic waste products.


Those waste products include beta-amyloid—a protein that clumps abnormally in the brains of people with dementia, said researcher Laura Lewis, an assistant professor of biomedical engineering at Boston University.


Lewis stressed that the findings, reported in a recent issue of Science, do not prove that deep sleep helps ward off dementia or other diseases.


But the ultimate goal of research like this is to understand why poor sleep quality is linked to higher risks of various chronic conditions, from dementia to heart disease to depression, she said.


Researchers have known that cerebral spinal fluid helps clear metabolic byproducts from the brain, so that they do not build up there.


They’ve also known that the process appears to amp up during sleep.


But various “hows” and “whys” remained.


So the investigators recruited 11 healthy adults for a sleep study using noninvasive techniques: advanced MRI to monitor fluid flow in the brain and electroencephalograms to gauge electrical activity in brain cells.


Sleep is marked by REM and non-REM cycles.


During REM sleep, breathing and heart rates are relatively higher and people often have vivid dreams.


Non-REM sleep includes stages of deep—or slow-wave—sleep. During those stages, there’s a slow-down in brain cell activity, heart rate and blood flow, and research has found that deep sleep may aid memory consolidation and allow the brain to recover from the daily grind.


“There are all these fundamental things your brain is taking care of during deep sleep,” Lewis said.


Her team found that housecleaning may be one.


When study participants were in deep sleep, each pulse in slow-wave brain activity was followed by oscillations in blood flow and volume, which allowed cerebral spinal fluid to flow into fluid-filled cavities in the central brain.


The spinal fluid moved in “large, pulsing waves” that were seen only during deep sleep, Lewis explained.


Based on what’s known about the work of cerebral spinal fluid, experts said it’s reasonable to conclude that slow-wave sleep promotes the flushing of waste from the brain.


The study “elegantly” illustrates the importance of deep sleep, according to Dr. Phyllis Zee, a sleep medicine specialist not involved in the work.


It “helps to explain how and why sleep is important for keeping neurons healthy—facilitating the removal of toxic molecules,” said Zee, a professor of neurology at Northwestern University Feinberg School of Medicine, in Chicago.


“One can think of sleep as a top way to take care of your brain,” she said.


Another sleep medicine specialist agreed.


“There is growing evidence, with this study and others, that sleep plays a role in clearing toxins from the brain,” said Dr. Raman Malhotra, an associate professor of neurology at Washington University in St. Louis.


Other research has suggested that sleep loss can promote the buildup of “unwanted proteins” in the brain, said Malhotra, who also serves on the board of directors of the American Academy of Sleep Medicine.


A recent government study, for instance, found that one night of sleep deprivation triggered an increase in beta-amyloid in the brains of healthy adults.


“As we learn more about this role of sleep,” Malhotra said, “it may help explain why individuals who don’t get enough sleep, or suffer from sleep disorders, are at higher risk of certain chronic health conditions.”


The latest study involved younger adults with no health problems.


Lewis said that it will be important to find out whether healthy older adults, or people with certain health conditions, show any differences in cerebral spinal fluid dynamics during deep sleep.


A big question for future research, she said, will be whether alterations in those dynamics precede the development of disease.


Reprinted with permission from Spectrum Health Beat.




Study: Focus on lifestyle, then HDL

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An active lifestyle will always be one of the best tools to build a healthy heart. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


A large new study adds to questions about whether your “good” HDL cholesterol levels really affect your risk of heart disease.


The study, of nearly 632,000 Canadian adults, found that those with the lowest HDL levels had higher death rates from heart disease and stroke over five years. But they also had higher death rates from cancer and other causes.


What’s more, there was no evidence that very high HDL levels—above 90 mg/dL—were desirable.


People with HDL that high were more likely to die of noncardiovascular causes, compared to those with HDL levels in the middle, the study found.


The fact that low HDL was linked to higher death rates from all causes is key, said lead researcher Dr. Dennis Ko.


That suggests it’s just a “marker” of other things, such as a less healthy lifestyle or generally poorer health, he said.


That also means it’s unlikely that low HDL directly contributes to heart disease, added Ko, a senior scientist at the Institute for Clinical Evaluative Sciences in Toronto.


“This study is going against the conventional wisdom,” he said.


But the reality is, doctors are already shifting away from the conventional wisdom, said cardiologist Dr. Michael Shapiro.


Shapiro, who was not involved in the study, is a member of the American College of Cardiology’s Prevention of Cardiovascular Disease Section.


“Many people know that HDL is the ‘good’ cholesterol,” he said. “But they may not know that the medical community is moving away from the idea that we’ve got to raise low HDL.”


That’s in part because of the results of several clinical trials that tested the vitamin niacin and certain medications that boost HDL levels.


The studies found that while the treatments do raise HDL, they make no difference in people’s risk of heart trouble.


On top of that, Shapiro said, research has shown that gene variants associated with HDL levels have no connection to the risk of cardiovascular disease.


No one is saying that doctors and patients should ignore low HDL levels. Levels below 40 mg/dL are linked to a heightened risk of heart disease.


“That is a consistent finding,” Shapiro said. “So we can reliably use it as a marker to identify patients at higher risk and see what else is going on with them.”


Causes of low HDL include a sedentary lifestyle, smoking, poor diet and being overweight. And it’s probably those factors—not the HDL level itself—that really matter, Shapiro said.


The current findings are based on medical records and other data from nearly 631,800 Ontario adults ages 40 and up. Over five years, almost 18,000 of them died.


Ko’s team found that men and women with low HDL levels were more likely to die during the study period, versus those with levels between 40 and 60 mg/dL.


But they had increased risks of not only heart disease death, but also death from cancer or other causes.


People with low HDL tended to have lower incomes, and higher rates of smoking, diabetes and high blood pressure. After the researchers accounted for those factors, low HDL was still linked to higher death rates.


“But we couldn’t account for everything,” Ko said. And he believes that factors other than HDL number—such as exercise and other lifestyle habits—are what count.


“When you see that something (low HDL) is associated with deaths from many different causes, it’s probably a ‘generic’ marker of risk, rather than a cause,” Ko said.


At the other end of the spectrum, people with very high HDL—topping 90 mg/dL—faced increased risks of dying from noncardiovascular causes.


Shapiro called the finding “very interesting,” but the reasons for it are unclear.


Alcohol can raise HDL. So that raises the question of whether heavy drinking helps explain the link, said Dr. Robert Eckel, a professor of medicine at the University of Colorado Denver, Anschutz Medical Campus.


Regardless, there is no reason for people to try to send their HDL skyward using niacin or other medications.


“Raising HDL with drugs is not indicated,” Eckel said.


Shapiro stressed the importance of lifestyle: “Don’t smoke, get regular aerobic exercise, lose weight if you need to.”


Those things may, in fact, boost your HDL, Shapiro noted. But it’s not the number that matters, he said, it’s the healthy lifestyle.


The findings were published in the Journal of the American College of Cardiology.


Reprinted with permission from Spectrum Health Beat.


Parkinson’s pandemic looms

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The motor and non-motor symptoms of Parkinson’s. (Wikipedia Commons)

By Amy Norton, HealthDay


The number of people living with Parkinson’s disease worldwide could double in the next two decades, experts project.


In a report warning of a possible Parkinson’s “pandemic,” researchers say the stage is set for cases to surge to 12 million or more by 2040.


What’s to blame? In large part, trends that are generally positive: Older age is a major risk factor for Parkinson’s. With life expectancy rising worldwide, more people will develop the disease. At the same time, Parkinson’s patients are surviving longer, which drives up the number of people living with the disease at any given time.


Then there’s a less expected factor: Declining smoking rates. While the habit has many devastating effects, research suggests it protects against Parkinson’s.


Those are obviously trends that no one wants to reverse, said report author Dr. Ray Dorsey.


There are, however, other ways to slow the projected rise in Parkinson’s, said Dorsey, a professor of neurology at the University of Rochester Medical Center in New York.


“We believe there’s a lot we can do toward prevention,” he said.


At the top of the list is reducing people’s exposure to certain pesticides, solvents and other chemicals that research has linked to Parkinson’s risk.


As an example, Dorsey pointed to the weed-killer paraquat.


“It’s been strongly linked to an increased risk of Parkinson’s and it’s banned in 32 countries,” he said.


It’s still used in the United States, however. And, Dorsey noted, some countries that have banned it—such as England—continue to make and export it to other countries, including the United States


Then there is trichloroethylene, or TCE—an industrial solvent that is a known human carcinogen and can contaminate groundwater, according to the U.S. Department of Health.


TCE is also toxic to nerve cells and studies have tied it to Parkinson’s, Dorsey said.


Parkinson’s disease currently affects nearly 1 million people in the United States alone, according to the nonprofit Parkinson’s Foundation.


The cause is unclear, but as the disease progresses, the brain loses cells that produce dopamine—a chemical that regulates movement. As a result, people suffer symptoms like tremors, stiff limbs and balance and coordination problems. All gradually worsen over time.


Medications and other treatments can lessen those effects, but there is no cure.


The new report—co-authored by representatives of the Parkinson’s Foundation and Michael J. Fox Foundation—paints a potentially bleak picture.


Between 1990 and 2015, the number of people diagnosed with Parkinson’s worldwide doubled, to just over 6 million. And based on the aging population, Dorsey and his colleagues project that the number will double again by 2040, to about 12 million.


But that figure, they say, could actually be higher—up to 17 million—with declining smoking rates and growing industrialization factored into the mix.


“There is an urgent and pressing need for the world to wake up and recognize there is a coming wave of Parkinson’s disease,” said Dr. Michael Okun, medical director of the Parkinson’s Foundation and an author of the report.


In addition to broader bans on paraquat and TCE, Dorsey said other measures could help stem the tide.


For example, people with a history of head injury face a relatively higher risk of Parkinson’s. So preventing head injuries in the workplace, sports or recreation—by wearing helmets, for instance—could help, Dorsey said.


There’s also some evidence that certain healthy lifestyle habits are protective—namely, vigorous exercise and eating a Mediterranean diet.


But beyond prevention, health care systems have to prepare for a surge in Parkinson’s, according to Okun.


“The numbers of patients with Parkinson’s disease are growing a rates that will overwhelm the world’s health care systems,” he said.


One key step, Dorsey said, will be to find ways to bring health care to patients at home.


“If I’m an elderly person with Parkinson’s who can no longer drive,” he said, “I need the care to come to me.”


Of course, many patients will have family members who can help out. But that brings up another huge issue—the burden on family caregivers.


Already in the United States, more than 30 million people provide care to an adult aged 50 or older, Dorsey pointed out.


“The main reason,” he said, “is neurological conditions, like Alzheimer’s and Parkinson’s.”


The report was published recently in a supplement to the Journal of Parkinson’s Disease.


Reprinted with permission from Spectrum Health Beat.


Gene therapy targets prostate cancer

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Researchers say new drug therapies can target certain genes that play a role in the growth and spread of prostate cancer. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


A drug that targets faulty gene repair may buy more time for some men with advanced prostate cancer, a new clinical trial finds.


Experts called the study “landmark,” because it zeroed in on men with particular gene mutations that can be targeted with newer drug therapies.


It’s an approach that is already used in treating breast, ovarian and lung cancers.


Specifically, the trial tested a drug called Lynparza (olaparib), which is currently approved to treat certain patients with breast or ovarian cancers linked to mutations in the BRCA genes.


When BRCA is working properly, it helps repair damaged DNA in body cells that can lead to cancer. When the gene is altered, those repair mechanisms go awry.


BRCA mutations do not only lead to breast and ovarian cancers, though. They also help drive some cases of prostate cancer.


In the new trial, researchers recruited men with advanced prostate cancer who had alterations in BRCA or certain other genes involved in DNA repair.


The investigators found that, compared with standard hormonal therapy, Lynparza delayed patients’ cancer progression for a median of about three months. That means half the patients saw a longer delay and half a shorter one.


Along with that delay, the drug slowed down patients’ pain progression.


“Delaying the cancer from growing is meaningful,” said Dr. Maha Hussain, who led the trial, which was funded by drug makers Astra Zeneca and Merck.


“At the end of the day, patients want to live longer—and also better,” added Hussain, a professor at Northwestern University Feinberg School of Medicine, in Chicago.


She was to present the findings at the annual meeting of the European Society for Medical Oncology, in Barcelona. Studies reported at meetings are generally considered preliminary until they are published in a peer-reviewed journal.


Lynparza is one of a newer class of drugs called PARP inhibitors, which block a protein that cancer cells need to keep their DNA healthy. Without it, those cells may die. Cancer cells with defects in DNA-repair genes are especially vulnerable to PARP inhibitors.


The drug class is part of a wider trend in cancer treatment, toward “targeted therapies”—where medications are tailored to target certain molecules in cancer cells that help them grow and spread.


A range of targeted drugs are available for common cancers, such as breast and lung, but prostate cancer has “lagged behind,” Hussain said.


Dr. Eleni Efstathiou, of MD Anderson Cancer Center in Houston, described the new trial as landmark.


“Overall, these data show that, like breast and lung cancers, prostate cancer is not one but many different diseases,” Efstathiou said. “We need to start identifying different groups of patients and treating them with targeted therapy.”


She noted that only a fairly small percentage of prostate cancer patients would have alterations in DNA-repair genes—which can be inherited or arise as the cancer progresses.


And doctors do not routinely screen cancers for all those gene flaws.


Screening for inherited mutations is “becoming part of guidelines,” Efstathiou noted, but screening for non-inherited alternations is not yet done.


For the latest trial, the researchers screened 4,425 men with advanced prostate cancer that had spread to distant sites in the body and was not responding to standard hormonal therapy.


The investigators ended up with 245 patients with alterations in either BRCA or another gene called ATM. A second group of 142 patients had alterations in any of 12 other genes tied to flawed DNA repair.


Patients in both groups were randomly assigned to either take Lynparza tablets or start one of two newer hormonal therapies.


Overall, Lynparza patients saw their cancer advance more slowly, with the difference being clearer in the group with BRCA or ATM defects.


For those men, cancer progression was delayed by a median of 7.4 months, versus 3.5 months among patients on hormonal therapy. A preliminary analysis suggested their overall survival was also better—a median of 18.5 months, versus 15 months.


Lynparza does have side effects, including anemia and nausea, Efstathiou pointed out, which can make it difficult to stick with the drug. Just over 16% of Lynparza patients in the trial stopped treatment due to side effects.


The drug is not yet approved for prostate cancer, though some doctors use it “off-label” for certain patients, Hussain noted.


At this point, Efstathiou said, doctors may want to screen for DNA-repair mutations in the tumors of men with advanced prostate cancer, since “we now have evidence it can be successfully targeted.”


Like other targeted drugs, Lynparza carries a hefty price tag: Researchers have estimated that it costs more than $234,000 to extend a patient’s life by one year.


Reprinted with permission from Spectrum Health Beat.



Rethink those sleepy Saturdays

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By Amy Norton, HealthDay

Sleeping in on Saturday and Sunday mornings may feel like a reboot from a harried week, but it’s unlikely to compensate for what your body really needs: consistently good sleep. (Courtesy Spectrum Health Beat)


People who are sleep-deprived during the week often try to make up for it on weekends. But a new study suggests the tactic may backfire.


Researchers found that weekday sleep loss had negative effects on people’s metabolism—and “catch-up” sleep on the weekend did not reverse it.


In fact, there were signs that the extra weekend shut-eye could make matters worse, said senior study author Kenneth Wright, a professor at the University of Colorado, Boulder.


The bottom line, according to Wright, is that people need to consistently get sufficient sleep.


“If you want to lead a healthy lifestyle,” he said, “that has to include good sleep habits.”


The study, published online recently in the journal Current Biology, included 36 healthy young adults. They were randomly assigned to one of three groups that all spent nine nights in the sleep lab.


One group was allowed to sleep for up to nine hours each night. A second could sleep only five hours. The third group was allowed five hours of sleep for five days, then a weekend “recovery” period where they could sleep in as late as they wanted. After that, they returned to five hours of sleep for two nights.


Wright’s team found that in both sleep-deprived groups, people lost some of their sensitivity to insulin, a hormone that regulates blood sugar. They also began to eat more at night and gained some weight, on average.


The group that was allowed to sleep in on the weekend saw one benefit: There was less late-night eating on those days.


However, they went right back to post-dinner munching once they returned to five-hour nights. And their insulin sensitivity remained impaired.


In addition, Wright said, they showed decreased insulin sensitivity in the liver and muscles, specifically—which was not seen in the group that got no catch-up sleep over the weekend.


Over time, decreased insulin sensitivity can be a precursor to Type 2 diabetes. And a number of studies have linked chronic sleep loss to heightened risks of diabetes and obesity, Wright noted.


In general, experts recommend that adults get seven or more hours of sleep each night for the sake of their overall health. Yet, studies show that more than one-third of U.S. adults fall short of that goal.


Dr. Phyllis Zee, a sleep specialist and professor at Northwestern University School of Medicine, in Chicago, said, “We tend to buy into the myth that by ‘catching up’ on sleep on weekends, we’ll (reverse) the adverse effects of repeated sleep loss.”


But, according to Zee, who was not involved in the new research, “the results of this study support that it is indeed a myth. In fact, even the muscle and liver ‘remember’ the adverse and persistent effects of sleep loss.”


It’s true, Wright said, that real life can get in the way of optimal sleep. But he added that people should take an honest look at their habits and see if they can make time for a good night’s sleep.


“What are the ‘sleep stealers’ in your life?” Wright said. “Are you up late watching TV or on your computer?”


Late-night “screen” use is a problem not only because it takes time away from sleep, he pointed out. Staring at a blue light before bedtime can actually disrupt your ability to fall asleep.


Sleep is vital for a range of body processes, not only metabolism. And Zee said there’s evidence that other effects of chronic sleep loss—including dampened alertness and mental performance—cannot be erased with a couple of nights of catch-up sleep.


“Regularity in both timing and duration of sleep is key to brain and body health” she said.


Reprinted with permission from Spectrum Health Beat.


Stroke rate keeps falling

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Taking medication for high blood pressure or high cholesterol can reduce the odds of stroke. Researchers also suspect improvements in diet, exercise and lifestyle are contributing to better outcomes. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


Starting in the late 1980s, stroke rates among older Americans began to fall—and the decline shows no signs of stopping, a new study finds.


The researchers found that between 1987 and 2017, the rate of stroke incidence among Americans aged 65 and older dropped by one-third per decade.


The pattern has been steady, with no leveling off in recent years.


It’s not completely clear why, according to researcher Dr. Josef Coresh, a professor at Johns Hopkins School of Public Health, in Baltimore.


Over time, fewer older adults in the study were smokers, which is a major risk factor for stroke. On the other hand, some other risk factors—such as high blood pressure and Type 2 diabetes—became more common.


Of course, those conditions can be treated. And it’s known that for any one person, getting high blood pressure, high cholesterol and diabetes under control can cut the risk of stroke, Coresh said.


“However,” he added, “at the population level, we found that the decline (in strokes) was larger than what would be predicted from risk factor control alone.”


That suggests something else is going on, Coresh said.


The findings are based on data from a long-running heart health study that began in 1987. At the outset, it recruited almost 15,800 adults aged 45 to 64 from communities in four U.S. states.


A previous study found that the stroke rate among the participants fell between 1987 and 2011—a decline seen only among people aged 65 and older.


The new analysis, published online recently in JAMA Neurology, shows that the trend continued between 2011 and 2017.


Over 30 years, Coresh’s team found, there were 1,028 strokes among participants aged 65 and older. The incidence dropped by 32% over time.


In more recent years, many more older adults were on medication for high blood pressure or high cholesterol, versus the late 1980s. But risk factor control did not fully explain why the stroke rate dropped so much, according to Coresh.


He said that other factors not measured in the study—including exercise, salt intake and overall diet—might be involved.


Dr. Larry Goldstein, a spokesperson for the American Heart Association/American Stroke Association, made another point: The study could not account for exactly how well-controlled people’s blood pressure and other risk factors were.


That could go a long way toward explaining the decline in stroke incidence, according to Goldstein, who is also a professor of neurology at the University of Kentucky.


But while the latest findings are good news, there are also more sobering stroke statistics, Goldstein said. Although strokes are most common among people aged 65 and older, they strike younger adults, too, and the incidence of stroke among younger people has been inching up in recent years.


Plus, Goldstein said, the death rate from stroke—which had been declining—has recently “stalled” and is starting to reverse course.


“It might be because folks are now having more severe strokes,” Goldstein noted.


It’s critical, he added, that people be aware of the signs of stroke and get help quickly if they think they, or a family member, is having one.


Some of the warning signs include a drooping or numbness on one side of the face; arm weakness or numbness; slurred speech; sudden confusion or difficulty seeing or walking; or, as Goldstein described it, “the worst headache of your life.”


His advice: “Don’t delay getting help. Time saved is brain saved.”


Reprinted with permission from Spectrum Health Beat.



The ever-growing scourge

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Pressed for time, parents are increasingly turning to TV and electronics as fast and easy forms of babysitting. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


The electronic babysitter is alive and thriving in the new digital age.


A new study says it all: Children under the age of 2 spend twice the amount of time in front of a screen each day—almost three hours, to be exact—as they did 20 years ago.


Kids are being exposed to far more screen time than recommended by pediatric experts, the researchers added.


That screen was most often a TV set, with the television viewing of toddlers rising fivefold between 1997 and 2014, the study findings showed.


Children aged 3 to 5 actually spent less time on screens than younger kids, around two-and-a-half hours per day, with no significant change between 1997 and 2014, according to the report.


The American Academy of Pediatrics discourages all media use for kids younger than 2 and recommends limiting screen time for children aged 2 to 5 to just one hour a day of high-quality programming.


The researchers found it “surprising” that television still served as the screen of choice for young children, even four years after the debut of the iPad in 2010, said lead researcher Weiwei Chen, an assistant professor with the Florida International University College of Public Health and Social Work, in Miami.


Kids aged 2 and younger spent an average of 2.6 hours a day watching TV in 2014 and children 2 to 5 watched an average of 2.1 hours a day. On average, both groups spent a half-hour daily on mobile devices, Chen said.


“It’s possible they are using it in good ways, like for educational purposes,” Chen said. “But also remember that looking at this young age, it’s before they are attending school, so I would think these are not children that are using that for homework.”


For their study, the researchers used data from the Panel Study of Income Dynamics, the world’s longest-running household survey. The study has been tracking U.S. family trends since 1968.


The findings were published online recently in the journal JAMA Pediatrics.


TV might have become an easier option by 2014 because streaming services and on-demand programming had largely replaced video tapes and DVDs, said Pamela Rutledge, director of the Media Psychology Research Center.


“By 2014, there were many more choices in children’s television programming following in Sesame Street’s example and with lots of cable channels to fill,” Rutledge said.


“Some shows intentionally build in interactivity that reinforces learning, such as ‘Dora the Explorer’ and ‘Blue’s Clues.’ However, not all programming is suitable for children and not all children’s programming is truly educational,” she added.


It’s likely parents still are using the time-honored strategy of using TV as a babysitter, said Sarah Domoff, director of the Family Health Lab at Central Michigan University.


“Research my collaborators and I have conducted indicates that TV may be used to help manage children’s behaviors and allow parents to accomplish tasks at the home,” Domoff said. “Some households frequently leave TV on in the background throughout the day, which may also increase a child’s screen time.”


Domoff recommends limiting screen time for young children to educational content alone, with active parental involvement at all times.


“We know that having a TV in a child’s bedroom increases a child’s risk for sleep issues and obesity,” Domoff said. “Additionally, research has also indicated children hear fewer words from caregivers and have fewer conversations when TV or other electronic media is on, compared to when it is not on. Therefore, excessive screen time may interfere with important activities or routines essential for a child’s development.”


Chen also pointed out that it’s very likely that tablets and mobile devices have become more used among kids 5 and younger since 2014.


“In 2014, it was still a relatively early stage for those products. It’s understandable at that time, they weren’t as common as today,” Chen said. “Now you see we have many more tablets and devices and all kinds of things.”


Reprinted with permission from Spectrum Health Beat.

Subtract the additive

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Propionate is a preservative commonly found in breads and other manufactured foods. Researchers are trying to pin down the effects on humans, but in animal trials the ingredient led to weight gain. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


If you’re watching your weight, you probably know to avoid sugary and fatty foods.


But what about preservatives?


Eating a preservative widely used in breads, baked goods and cheese may trigger metabolic responses that are linked to obesity and diabetes, an early study suggests.


The additive, called propionate, is actually a naturally occurring fatty acid produced in the gut. When it’s used as an additive in processed foods, it helps prevent mold.


But in the new study, researchers found that feeding mice low doses of propionate gradually caused weight gain and resistance to the hormone insulin—which, in humans, is a precursor to type 2 diabetes.


And when the researchers gave healthy adults a single propionate dose, it spurred a release of blood sugar-raising hormones—and a subsequent surge in insulin.


None of that proves propionate-containing foods raise the odds of weight gain and diabetes, said senior researcher Dr. Gokhan Hotamisligil, a professor at the Harvard School of Public Health.


“The point is not to say this additive is ‘bad,’” he stressed.


Instead, Hotamisligil said, his team is interested in understanding the effects—good or bad—of the various “molecules” humans consume in their diets.


“There’s a scarcity of scientific evidence on a lot of the things we put in our bodies through food,” he said. “Propionate is just one example.”


Still, Hotamisligil said, the findings do raise an important question: “Could long-time consumption of propionate in humans be a contributing factor to obesity and diabetes?”


When it comes to processed foods, the concern is usually directed toward ingredients like added sugar, sodium and trans fats. But there’s also a host of additives that, according to the U.S. Food and Drug Administration, are “generally recognized as safe.”


Despite that “GRAS” status, though, there is typically little known about how those food additives might affect metabolism, according to Hotamisligil.


Dr. Emily Gallagher is an assistant professor of endocrinology at Mount Sinai Icahn School of Medicine in New York City.


She agreed it’s important to dig into the potential metabolic effects of food additives.


“People may look at food labels and think they are making healthy choices,” said Gallagher, who had no part in the study. “But without our knowledge, very small amounts of certain additives in food may be causing detrimental metabolic effects.”


That said, it’s too soon to point the finger at propionate, according to Gallagher.


She called these early findings “thought-provoking,” but said longer-term studies are needed to better understand any health effects from the additive.


For the animal portion of the study, the researchers gave mice propionate in their water. The immediate effects included an increase in three hormones that spur the liver to produce glucose (sugar). Over time, chronic exposure to the additive caused the mice to gain weight and become resistant to the hormone insulin, which helps lower blood sugar levels.


The human portion of the study included 14 healthy people given a dose of either propionate or a placebo with a meal. Compared with the placebo meal, the additive caused the same hormonal response seen in mice, plus a surge in insulin in the blood.


Whether those effects over time could harm people’s health is unknown.


Many factors, including overall diet and exercise, affect the risks of obesity and diabetes, Gallagher pointed out.


For now, she said, the findings support the general advice that we should be limiting processed foods in favor of healthier, whole foods.


Hotamisligil agreed. “I’m not saying, if you don’t eat propionate, you’ll live forever,” he said. “But these are the types of foods we should limit anyway.”


The findings were published online recently in Science Translational Medicine.


Reprinted with permission from Spectrum Health Beat.


Gross alert: Your dishwasher is not as sterile as you think

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Keep microbes contained by not opening the dishwasher before it has cooled down following a wash cycle. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay

 

Your dishwasher may get those plates spotless, but it is also probably teeming with bacteria and fungus, a new study suggests.

 

Microbes—from bacteria to viruses to fungi—are everywhere, including within and on the human body. So it’s no surprise, the researchers said, that a kitchen appliance would be hosting them.

 

So do people need to worry about getting sick from their dishwashers? No, said Erica Hartmann, an assistant professor at Northwestern University who was not involved with the study.

 

“The risk is probably in the realm of a shark attack,” she said. That is, most people face little to no risk, but there are select groups who may be at higher risk—in this case, people with conditions that weaken their immune defenses.

 

Dishwashers are an interesting case when it comes to microbes because they are actually an “extreme” habitat, Hartmann explained.

 

“People don’t think of them that way. It’s just your dishwasher. But it really is an extreme environment,” said Hartmann, who studies the microbiology of the indoor environment.

 

Dishwashers create constantly fluctuating conditions—wet to dry, high heat to cooler temperatures, low to high acidity. They also harbor mixtures of detergents and dinner scraps. So, only certain microbes will thrive.

 

The new study looked at which bacteria and fungi are actually dwelling there, and what factors seem to influence that microbial makeup.

 

Specifically, the European researchers took samples from the rubber seals of 24 household dishwashers.

 

Overall, they found, the most common bacteria included Pseudomonas, Escherichia and Acinetobacter—all of which have strains that are “opportunistic pathogens.” That means they are normally harmless, but can cause infections in people with a compromised immune system.

 

The most common types of fungus were Candida, Cryptococcus and Rhodotorula—which also include opportunistic pathogens.

 

Nina Gunde-Cimerman, a professor of microbiology at the University of Ljubljana, in Slovenia, worked on the study.

 

She said dishwashers and other microbe-hosting appliances are “generally safe” for healthy people. It’s “sensitive groups,” she said, who may need to be more cautious.

 

Gunde-Cimerman said she and her colleagues suspect dishwashers might play a role in fungal infections called mycoses in certain immune-compromised patients. A fungus commonly found in those patients, she said, is known as Exophiala dermatitidis, or black yeast.

 

And while that fungus is “hardly known in nature,” she said, it’s easy to find in dishwashers.

 

However, Gunde-Cimerman stressed, that’s speculation. No one has yet proven a connection between dishwasher microbes and mycoses infections.

 

How do fungus and bacteria get into dishwashers? The “main entry point” for fungi is the tap water that supplies the appliance, Gunde-Cimerman said. But food, people and pets are other potential sources, she added.

 

As for the bacteria, the source isn’t clear, according to Gunde-Cimerman. “But we speculate that contaminated food is the main entry route,” she said.

 

It is possible for dishwasher microbes to break free from their home: They can get out via waste water, or through the hot air produced at the end of the dishwasher cycle, Gunde-Cimerman said.

 

So one way to keep the microbes contained is to avoid opening the dishwasher before it has cooled down, according to Gunde-Cimerman.

 

“Do not open the dishwasher when it is still hot and humid,” she said, “to prevent the release of aerosols in the kitchen.”

 

Wiping the rubber seal with a dry cloth at the end of a cycle can also limit microbe buildup, Gunde-Cimerman said.

 

Hartmann agreed that people who are concerned can wipe down the dishwasher seal.

 

But she also emphasized the positive aspects of the microbial communities living in all our homes: Scientists have made great discoveries by studying microorganisms.

 

Hartmann pointed to the example of a bacterial enzyme discovered in the hot springs of Yellowstone National Park. It was instrumental in developing a breakthrough technique called polymerase chain reaction, which is now used to study DNA in research and clinical labs everywhere.

 

“Your kitchen might not be Yellowstone,” Hartmann noted. But, she added, it may host some “pretty amazing” microbes.

 

So if you are ever presented with the opportunity to have researchers swab your kitchen, Hartmann said, consider it.

 

The study was published in the journal Applied and Environmental Microbiology.

 

Reprinted with permission from Spectrum HealthBeat.

Many Americans face pain, depression in their final year

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By Amy Norton, HealthDay

 

For a growing number of Americans, the final year of life is marked by pain, depression and other distressing symptoms, a study has found.

 

Experts said the study, published in Annals of Internal Medicine, highlights disturbing shortcomings in the U.S. health care system.

 

Researchers found that between 1998 and 2010, the number of Americans who suffered pain in their last year of life rose from 54 percent to 61 percent.

 

Meanwhile, the prevalence of depression rose from 45 percent to 57 percent, while other symptoms — such as breathlessness, confusion, severe fatigue and incontinence — either increased or did not improve.

 

“These findings are troubling,” said senior researcher Dr. Karl Lorenz, of the Pardee RAND Graduate School and the University of California, Los Angeles.

 

The increase in end-of-life symptoms, Lorenz said, has occurred despite national efforts to improve end-of-life care, dating back to the 1990s.

 

Those efforts have made a difference. The number of Americans in hospice care doubled between 2000 and 2009, the study noted. Hospice care focuses on easing symptoms and improving quality of life for people with a terminal illness.

 

But often hospice care isn’t offered until the last few weeks or days of life, Lorenz said.

 

“It’s often ‘tacked on’ to more-intensive care,” he said.

 

However, another expert said the findings are not actually about the typical American’s final year of life — because many people with chronic diseases are suffering these symptoms long-term.

 

“I think the findings are very valid, but the conclusions about what they mean are not,” said Dr. Sean Morrison, who directs the Hertzberg Palliative Care Institute at Mount Sinai Icahn School of Medicine in New York City.

 

“I think you’d see a high prevalence of these symptoms if you looked at older adults’ last two years of life, or last three, or last five,” Morrison said.

 

The issue, he said, is that more and more Americans are living longer with chronic ills — from heart and lung disease, to painful arthritis, to Alzheimer’s disease. At the same time, the health care system has grown increasingly specialized and “organ-specific,” with less focus on primary care.

 

“We’re doing a very poor job addressing the multiple health conditions so many older Americans have,” Morrison said. “We’re focusing on treating organs, and not on improving people’s quality of life.”

 

Morrison said the health care system — including medical schools — needs to pay much more attention to palliative care.

 

Palliative care refers to therapy that focuses on easing physical or psychological symptoms, rather than curing a disease. Hospice care, which is intended for people with a limited time to live, is one form of palliative care.

 

Other forms, though, can start as soon as a serious medical condition is diagnosed, and given along with treatments aimed at battling the disease. Usually, a team of providers, including nurses, nutritionists and social workers, is involved.

 

But Morrison said that to many people, including doctors, “palliative” is synonymous with dying. So it’s often not offered, even if it’s locally available.

 

“Other research shows that the overwhelming majority of Americans do not have access to high-quality palliative care,” Morrison said.

 

The current findings are based on a periodic health survey of older Americans. Between 1998 and 2010, slightly more than 7,200 study participants died, and their family members were asked about symptoms their loved one had suffered in the last year of life.

 

Over time, problems like pain, depression, periodic confusion and incontinence grew more common. Other symptoms, such as fatigue and severe weight loss, held fairly stable.

 

Lorenz said part of the increase could be due to awareness. More doctors may be asking family members about those symptoms — which would be a good thing, he said.

 

But the fact that pain and other distressing symptoms are so common is disturbing, he said.

 

Morrison agreed. “This really is an indictment of the health care system,” he said. “And the public should be outraged.”

 

He and Lorenz suggested that older adults ask their doctors about any palliative services available for their symptoms — at any point in the course of a disease.

 

Medicare covers hospice care, and many Medicare Advantage plans pay for other palliative services, Morrison noted.

 

But relatively few research dollars, he added, go into palliative care. “We invest so much in finding disease cures,” Morrison said. “We should also be investing in making life better for the people living with these diseases right now.”

 

Reprinted with permission from Spectrum Health Beat.

Study: Women less likely to receive CPR

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Study: Women less likely to receive CPR (Courtesy Spectrum HealthBeat)

By Amy Norton, HealthDay

 

Some bystanders may avoid performing CPR on women because they fear hurting them or even being accused of sexual assault, preliminary research suggests.

 

In two new studies, researchers tried to dig deeper into a puzzling pattern that has been seen in past research: Women are less likely than men to receive bystander CPR if they go into cardiac arrest in a public place.

 

One study confirmed that real-world phenomenon in a controlled setting: It found that even in “virtual reality” simulations, participants were less likely to perform CPR when the virtual victim was female, versus male.

 

People performed CPR on 65 percent of male victims, but only 54 percent of females.

 

A separate study, which surveyed 54 adults, turned up some possible explanations.

 

Respondents said bystanders may worry about hurting a woman while doing CPR chest compressions—or fear being accused of sexual assault. Some said people also might believe women’s breasts get in the way of CPR.

 

The respondents also cited a long-standing misconception: Women are less likely to have heart problems than men.

 

But the reality is that heart disease is the leading killer of U.S. women and men alike, according to government figures.

 

And when cardiac arrest strikes, CPR can be lifesaving, regardless of sex, said Dr. Sarah Perman, who led the survey.

 

People in cardiac arrest need immediate chest compressions, said Perman, an assistant professor at the University of Colorado School of Medicine in Denver.

 

“Providing this lifesaving procedure for women should be normalized and not sexualized,” she said.

 

In the United States, more than 356,000 people suffer cardiac arrest outside a hospital each year. Only about 11 percent survive, according to the American Heart Association.

 

Survival is dismal because without emergency treatment, cardiac arrest is fatal within minutes. But quick CPR can double or triple survival odds, the American Heart Association says.

 

Cardiac arrest occurs when the heart suddenly stops beating and cannot pump blood and oxygen to the body. If a bystander performs CPR, that keeps the victim’s blood circulating, buying time until paramedics arrive. Cardiac arrest is not a heart attack, which is caused by an artery blockage that diminishes blood flow to the heart.

 

“There is still a lot of misunderstanding about cardiac arrest and CPR,” said Dr. Aaron Donoghue, of the American Heart Association and the University of Pennsylvania.

 

Men and women benefit equally from CPR chest compressions, Donoghue said, adding that the notion that it could injure women is “false.”

 

As for fears of being accused of sexual assault, Donoghue noted that chest compressions are performed on the breastbone—also called the sternum, it’s the long flat bone in the center of the chest—not the breasts.

 

“It would be terrible for that fear to deter a would-be rescuer from performing CPR,” said Donoghue, who was not involved in the new studies.

 

“Doing nothing is always worse than doing something,” he added.

 

For its pilot study, Perman’s team surveyed 54 U.S. adults. Participants were asked: “Do you have any ideas on why women may be less likely to receive CPR than men when they collapse in public?”

 

Their answers reflect their personal perceptions, Donoghue pointed out. So, he said, it’s hard to know whether witnesses to cardiac arrest really do act on such beliefs in the real world.

 

Perman agreed, saying more research is needed to understand why women are less likely to receive CPR. She and her colleagues have already conducted a larger survey, she said, but the results have not been published yet.

 

For now, Donoghue suggested people educate themselves about cardiac arrest and CPR. The American Heart Association website is one place to start, he said.

 

Both studies are scheduled for presentation at the upcoming American Heart Association meeting in Chicago. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

 

Reprinted with permission from Spectrum HealthBeat.