Wednesday, October 18, 2017

Anxiety and depression linked to migraines


In a study of 588 patients who attended an outpatient headache clinic, more frequent migraines were experienced by participants with symptoms of anxiety and depression. In the Headache study, poor sleep quality was also found to be an independent predictor of more severe depression and anxiety symptoms.

The study's investigators noted that factors such as emotional distress and frequency of headache may influence each other through a common pathophysiological mechanism. For example, emotional responses have the potential to alter pain perception and modulation through certain signaling pathways.

"These findings potentially suggest that adequate medical treatment to decrease headache frequency may reduce the risk of depression and anxiety in migraine patients," said Dr. Fu-Chi Yang, corresponding author of the study and an investigator in the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taiwan.


Some older adults don't get to the hospital soon enough when experiencing a heart attack


For individuals experiencing a heart attack, delays in getting to the hospital can have life-threatening consequences. A new study in the Journal of the American Geriatrics Society found that certain factors--non-white race, atypical symptoms, and heart failure--are linked with such delays in older individuals.

The study included 2500 patients aged 75 or older hospitalized for heart attack. Pre-hospital delay (six or more hours before getting to the hospital) was much more common (42%) than in studies of younger heart attack populations, in whom the reported prevalence ranges from 20% to 25%.

"Delays in presentation can have huge consequences for older adults with heart attacks. Based on the results of our study, we need to develop better clinical and public health strategies to ensure timely presentation, especially among non-white communities, those with atypical symptoms, and those with heart failure," said lead author Dr. Gregory Ouellet, of Yale University.

Life in the city: Living nearer nature keeps your amygdala healthier



A study conducted at the Max Planck Institute for Human Development has investigated the relationship between the availability of nature near city dwellers' homes and their brain health. Its findings are relevant for urban planners among others.

Noise, pollution, and many people in a confined space: Life in a city can cause chronic stress. City dwellers are at a higher risk of psychiatric illnesses such as depression, anxiety disorders, and schizophrenia than country dwellers. Comparisons show higher activity levels in city dwellers' than in country dwellers' amygdala -- a central nucleus in the brain that plays an important role in stress processing and reactions to danger.

Which factors can have a protective influence? A research team led by psychologist Simone Kühn has examined which effects nature near people's homes such as forest, urban green, or wasteland has on stress-processing brain regions such as the amygdala.

"Research on brain plasticity supports the assumption that the environment can shape brain structure and function. That is why we are interested in the environmental conditions that may have positive effects on brain development. Studies of people in the countryside have already shown that living close to nature is good for their mental health and well-being. We therefore decided to examine city dwellers," explains first author Simone Kühn, who led the study at the Max Planck Institute for Human Development and now works at the University Medical Center Hamburg-Eppendorf (UKE).

Indeed, the researchers found a relationship between place of residence and brain health: those city dwellers living close to a forest were more likely to show indications of a physiologically healthy amygdala structure und were therefore presumably better able to cope with stress. This effect remained stable when differences in educational qualifications and income levels were controlled for.

However, it was not possible to find an association between the examined brain regions and urban green, water, or wasteland. With these data, it is not possible to distinguish whether living close to a forest really has positive effects on the amygdala or whether people with a healthier amygdala might be more likely to select residential areas close to a forest. Based on present knowledge, however, the researchers regard the first explanation as more probable. Further longitudinal studies are necessary to accumulate evidence.

The participants in the present study are from the Berlin Aging Study II (BASE-II) - a larger longitudinal study examining the physical, psychological, and social conditions for healthy aging. In total, 341 adults aged 61 to 82 years took part in the present study. Apart from carrying out memory and reasoning tests, the structure of stress-processing brain regions, especially the amygdala, was assessed using magnetic resonance imaging (MRI). In order to examine the influence of nature close to peoples' homes on these brain regions, the researchers combined the MRI data with geoinformation about the participants' places of residence. This information stemmed from the European Environment Agency's Urban Atlas, which provides an overview of urban land use in Europe.

"Our study investigates the connection between urban planning features and brain health for the first time," says co-author Ulman Lindenberger, Director of the Center for Lifespan Psychology at the Max Planck Institute for Human Development. By 2050, almost 70 percent of the world population is expected to be living in cities. These results could therefore be very important for urban planning. In the near future, however, the observed association between the brain and closeness to forests would need to be confirmed in further studies and other cities, stated Ulman Lindenberger.

Tuesday, October 17, 2017

High blood pressure boosts risk of common heart valve disorder

                     


Elevated blood pressure is a risk factor for mitral regurgitation, a leakage of one of the heart valves, according to a paper published this week in PLOS Medicine by Kazem Rahimi of The George Institute for Global Health at the University of Oxford, UK and colleagues. The research suggests that this valve disorder, which is increasingly diagnosed wordwide, particularly among older people, is not an inevitable consequence of ageing, as previously assumed, but may be preventable.
In mitral regurgitation, the valve between the two chambers on the left side of the heart doesn't close tightly, allowing blood to leak backwards when the heart muscle contracts. 

 Mitral regurgitation may be associated with palpitations, and in severe cases can cause shortness of breath, fatigue, and swelling of the legs and feet. In the new study, researchers used electronic health records from the UK Clinical Practice Research Datalink (CPRD) between 1990 and 2015 to examine the relationship between systolic blood pressure (BP) and mitral regurgitation. The study included 5.5 million patients with no known cardiovascular disease at the start of the study.

During the 10-year follow-up period, 28,655 patients (0.52%) were diagnosed with mitral regurgitation based on hospital discharge reports or primary care records. Systolic blood pressure (BP) was found to be continuously related to the risk of mitral regurgitation, with each 20 mmHg increase in systolic BP associated with a 26% higher risk of the heart disorder (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 1.23 to 1.29). Only a small portion of this excess risk could be explained by other conditions that are known to cause mitral regurgitation, such as myocardial infarction or ischaemic heart disease (mediator-adjusted HR 1.22; CI 1.20 to 1.25).

"These findings suggest that BP control may be of importance in the prevention of mitral regurgitation," the authors say.

Friday, October 13, 2017

Learning and staying in shape key to longer lifespan


People who are overweight cut their life expectancy by two months for every extra kilogramme of weight they carry, research suggests.

A major study of the genes that underpin longevity has also found that education leads to a longer life, with almost a year added for each year spent studying beyond school.

Other key findings are that people who give up smoking, study for longer and are open to new experiences might expect to live longer.

Scientists at the University of Edinburgh analysed genetic information from more than 600,000 people alongside records of their parents' lifespan.

Because people share half of their genetic information with each of their parents, the team were able to calculate the impact of various genes on life expectancy.

Lifestyle choices are influenced to a certain extent by our DNA - genes, for example, have been linked to increased alcohol consumption and addiction. The researchers were therefore able to work out which have the greatest influence on lifespan.

Their method was designed to rule out the chances that any observed associations could be caused by a separate, linked factor. This enabled them to pinpoint exactly which lifestyle factors cause people to live longer, or shorter, lives.

They found that cigarette smoking and traits associated with lung cancer had the greatest impact on shortening lifespan.

For example, smoking a packet of cigarettes per day over a lifetime knocks an average of seven years off life expectancy, they calculated. But smokers who give up can eventually expect to live as long as somebody who has never smoked.

Body fat and other factors linked to diabetes also have a negative influence on life expectancy.
The study also identified two new DNA differences that affect lifespan. The first - in a gene that affects blood cholesterol levels - reduces lifespan by around eight months. The second - in a gene linked to the immune system - adds around half a year to life expectancy.

The research, published in Nature Communications, was funded by the Medical Research Council.
Data was drawn from 25 separate population studies from Europe, Australia and North America, including the UK Biobank - a major study into the role of genetics and lifestyle in health and disease.
Professor Jim Wilson, of the University of Edinburgh's Usher Institute, said: "The power of big data and genetics allow us to compare the effect of different behaviours and diseases in terms of months and years of life lost or gained, and to distinguish between mere association and causal effect."

Dr Peter Joshi, Chancellor's Fellow at the University of Edinburgh's Usher Institute, said: "Our study has estimated the causal effect of lifestyle choices. We found that, on average, smoking a pack a day reduces lifespan by seven years, whilst losing one kilogram of weight will increase your lifespan by two months."

Wednesday, October 11, 2017

Experts call for more rigor, less hype, for mindfulness and meditation


 Dependable scientific evidence has lagged worrisomely behind the rapid and widespread adoption of mindfulness and meditation for pursuing an array of mental and physical wellness goals, wrote a group of 15 experts in a new article in Perspectives on Psychological Science. The article offers a "critical evaluation and prescriptive agenda" to help the burgeoning mindfulness industry replace ambiguous hype with rigor in its research and clinical implementations.
Recent years have seen a huge surge not only in media and scientific articles about mindfulness and meditation, the authors wrote, but also in the implementation of medical interventions for everything from depression to addiction, pain and stress. The widespread adoption of therapies has put the field at a critical crossroads, the authors argued, where appropriate checks and balances must be implemented.

"Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled and disappointed," they wrote.

Co-author Willoughby Britton, an assistant professor of psychiatry and behavior at the Warren Alpert Medical School of Brown University said: "We are sometimes overselling the benefits of mindfulness to pretty much any person who has any condition, without much caution, nuance or condition-specific modifications, instructor training criteria, and basic science around mechanism of action. The possibility of unsafe or adverse effects has been largely ignored. This situation is not unique to mindfulness, but because of mindfulness's widespread use in mental health, schools and apps, it is not ideal from a public health perspective."

Lead author Nicholas Van Dam, a clinical psychologist and research fellow in psychological sciences at the University of Melbourne in Australia, said that the point of the article is not to disparage mindfulness and meditation practice or research, but to ensure that their applications for enhancing mental and physical health become more reflective of scientific evidence. So far, such applications have largely been unsupported, according to major reviews of available evidence in 2007 and again in 2014.

"The authors think there can be something beneficial about mindfulness and meditation," Van Dam said. "We think these practices might help people. But the rigor that should go along with developing and applying them just isn't there yet. Results from the few large-scale studies that have been conducted so far have proven equivocal at best."

Added co-author David E. Meyer, a professor of psychology at the University of Michigan, "Sometimes, truly promising fields of endeavor get outstripped by efforts to harvest them before they're really ripe; then workers there must step back, pause to take stock, and get a better plan before moving onward."

Future efforts to improve the quality of mindfulness and meditation research will be bolstered by a new research center at Brown University, led by Eric Loucks, an associate professor in the university's School of Public Health.

"The center's mission will be to perform high-quality, methodologically rigorous research about impacts of mindfulness on health, and to offer collaborative, evidence-based resources for hospitals, schools and businesses that are interested in offering mindfulness-based interventions," Loucks said.

A young, undefined field
Among the biggest problems facing the field is that mindfulness is poorly and inconsistently defined both in popular media and the scientific literature. According to the authors, there "is neither one universally accepted technical definition of 'mindfulness' nor any broad agreement about detailed aspects of the underlying concept to which it refers." As a result, research papers have varied widely in what they actually examine, and often, their focus can be hard to discern.

"Any study that uses the term 'mindfulness' must be scrutinized carefully, ascertaining exactly what type of 'mindfulness' was involved, what sorts of explicit instruction were actually given to participants for directing practice," the authors wrote. "When formal meditation was used in a study, one ought to consider whether a specifically defined type of mindfulness or other meditation was the target practice."

"Without specific, well-defined terms to describe not only practices but also their effects, studies of interventions such as mindfulness-based stress reduction (MBSR) cannot provide valid and comparable measurements to produce reliable evidence." As part of its proposed remedy, the new article offers a "non-exhaustive list of defining features for characterizing contemplative and medication practices.
"
Greater rigor
Along with specific, precise and standardized definitions, similar improvements in research methodology must also come, the authors wrote.

"Many intervention studies lack or have inactive control groups," Van Dam said.

The field also has struggled to achieve consistency in what it is being measured and how to measure those things perceived to be of greatest importance to mindfulness.

Van Dam said the situation is akin to earlier psychological research on intelligence. This concept proved to be too broad and too vague to measure directly. Ultimately, however, psychologists have made progress by studying the "particular cognitive capacities that, in combination, may make people functionally more or less intelligent," he and his co-authors wrote.

Thus, the authors wrote, "We recommend that future research on mindfulness aim to produce a body of work for describing and explaining what biological, emotional, cognitive, behavioral and social, as well as other such mental and physical functions, change with mindfulness training."

Clinical care
A wide variety of contemplative practices have been studied for an even larger variety of purposes, yet in both basic and clinical studies of mindfulness and meditation, researchers have rarely advanced to the stage where they can confidently conclude whether particular effects or specific benefits resulted directly from the practice. Measured by the National Institutes of Health's stage model for clinical research, only 30 percent of mindfulness-based interventions (MBIs) have moved past the first stage, and only 9 percent have tested efficacy in a research clinic against an active control.
"Given the absence of scientific rigor in much clinical mindfulness research, evidence for use of MBIs in clinical contexts should be considered preliminary.," the authors wrote.

The proposed agenda for future research is rigorous and extensive, Van Dam said.

"Replication of earlier studies with appropriately randomized designs and proper active control groups will be absolutely critical," the authors continued. "In conducting this work, we recommend that researchers provide explicit detail of mindfulness measures, primary outcome measures, mindfulness/meditation practices and intervention protocol."

Researchers and care providers involved with delivering MBIs have begun to become more vigilant about possible adverse effects, the authors wrote, but more needs to be done. As of 2015, fewer than 25 percent of meditation trials actively monitored for negative or challenging experiences.

Contemplating contemplative neuroscience
Van Dam said recent efforts to assess the neural correlates of mindfulness and meditation with technologies, such as magnetic resonance imaging (MRI) and magnetoencephalography, may perhaps have the potential to bring new rigor to the field. Nonetheless, he and his co-authors also express concern in the article that these technologies so far have not fulfilled this potential.

The authors note that technologies such as MRI depend on subjects remaining physically still while being tested, and image quality can be affected by subjects' rate of breathing. Experienced meditators may be better suited to maintaining ideal physiological states for MRI studies than are inexperienced individuals or non-meditators. Due to such problematic factors, between-group differences in brain scans might have little to do with the mental state researchers are attempting to measure and much to do with head motion and/or breathing differences.

"Contemplative neuroscience has often led to overly simplistic interpretations of nuanced neurocognitive and affective phenomena," the authors wrote. "As a result of such oversimplifications, meditative benefits may be exaggerated and undue societal urgency to undertake mindfulness practices may be encouraged."

Ultimately that's the authors' shared concern: Insufficient research may mislead people to think that the vague brands of "mindfulness" and "meditation" are broad-based panaceas when in fact refined interventions may only be helpful for particular people in specific circumstances. More, and much better, scientific studies are needed to clarify these matters. Otherwise people may waste time and money, or worse, suffer needless adverse effects.

"This paper is a coordinated effort among concerned mindfulness researchers and meditation scholars to rectify this gap to maximize benefit and minimize harm from MBIs," Britton said.

Older adults with insomnia may fall even more when on prescription sleep meds



Taking physician-recommended sleep medications to treat insomnia may actually increase the risk of falling for older adults, according to a team of sleep researchers.

The problem may stem from older people continuing to take sleep medications long after they should, said Orfeu Buxton, associate professor of biobehavioral health, Penn State.

"The importance for me -- personally and professionally -- is that this matches what I've heard from gerontologists and physicians treating older patients at assisted-living and nursing homes," said Buxton. "So many older adults come into the care of a physician late in life with a huge medication burden. They've been taking sleeping medications for years, or decades, and it's the physician's problem to get them off of medications that are no longer appropriate at that age."

The medications, which include sleeping pills -- some of which are sedative hypnotics -- often have side effects that cause problems with balance, memory and situational awareness, according to Buxton and his colleagues, Soomi Lee, assistant research professor in biobehavioral health, Penn State, and Tuo-Yu Chen, visiting assistant professor, Duke-NUS Graduate Medical School and an international faculty affiliate at Penn State Center for Healthy Aging, who report their findings in the current issue of Sleep.

The more likely a person has difficulty sleeping, the more likely they are going to be up and walking around in the dark at night," said Buxton. "You might think that if they have a physician-prescribed sleep medication that risk of falling might go down because they would stay in bed, but it doesn't. It worsens."

Falls are a major health concern for older adults and a costly strain on the American health system, according to the researchers. More than 30 percent of adults aged 60 who live on their own -- community dwelling -- fall each year. The costs for falls in the older adult population is estimated at $23.3 billion.

Buxton suggests that non-drug-related approaches to treating sleep disorders may be more effective for older adults and not put them at risk for increased falls.

"If you have difficulty sleeping the most effective treatment is cognitive behavioral therapy for insomnia -- CBTi -- which teaches patients how to learn to sleep well again," said Buxton. "In contrast, medications have many unintended consequences that worsen with later age and with the duration of taking them. Almost all the sleeping medications are meant only for short-term use and even the long-term use indications are supposed to be on the order of weeks, not decades."

The researchers also found a link between the number of insomnia symptoms and fall risk. The four symptoms of insomnia -- trouble falling asleep, waking up during the night, waking up too early and not feeling rested -- all increased the risks of falls for older adults, according to the researchers.

The probability of a fall goes steadily upward from 28 percent for older adults with no symptoms of insomnia, to 40 percent for older adults reporting four different symptoms of insomnia, according to the researchers. However, the risk of falls for those taking physician-prescribed insomnia medicine was always higher for older adults with insomnia, even those who had all four symptoms of insomnia. Buxton said that future research should be aimed at studying ways to improve the sleep of older adults without sleeping pills.

"We have an urgent need to get older adults with insomnia off of hypnotic medications, they are often contraindicated in older adults," said Buxton. "We think the most important next studies to do are how to manage that titration process with cognitive behavioral therapy to assist older adults sleeping well without the side effects of hypnotic drugs."

The researchers used data from the Health and Retirement Study, a longitudinal study featuring a representative sample of 6,882 Americans from the National Institute on Aging.

"The HRS data is publicly available data set and the data collected was about older adults' lifestyles and their health status, so these older adults were well-functioning, community-dwelling older adults aged 65 and older in the U.S.," said Lee. "I think it's fair to say that it's nationally representative of this group. Also, this is one of the first studies that reveal the longitudinal associations of insomnia burden and sleep medications with falls."