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Effect of different #nap opportunity durations on short-term maximal performance, attention, feelings, muscle soreness, fatigue, #stress and sleep.

The aim of the present study was to determine the effect of different nap opportunity durations on short-term maximal performance, attention, feelings, muscle soreness, fatigue, stress and sleep. Twenty physically active men (age: 21.1 ± 3.6 years, height: 176.4 ± 5.7 cm, body-mass: 72 ± 10.8 kg) performed the 5-jump and the digit-cancellation (i.e., attention) tests after four randomized nap opportunity conditions: no-nap opportunity (N0), 25 min of nap opportunity (N25), 35 min of nap opportunity (N35) and 45 min of nap opportunity (N45).

Subjective measurement of feelings, muscle soreness, fatigue, stress and sleep were performed during each test session. Compared to N0, there was a significant improvement of the 5-jump performance during N35 (Δ = +3.5%, p < .01) and N45 (Δ = +3.7%, p < .01). Attention was also better after N45 compared to N0 (Δ = +7.5%, p < .05). Fatigue, sleep and stress scores were significantly lower after N25, N35 and N45 compared to N0 (p < .05). However, no-significant effect of naps durations on feelings and fatigue scores was observed.

A nap opportunity has a beneficial effect on physical performance and attention with better results observed for naps ≥35 min.

https://www.ncbi.nlm.nih.gov/pubmed/31491444

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A Randomized Controlled Trial of #Metacognitive Therapy for #Depression: Analysis of 1-Year Follow-Up

..low mood and depression is prolonged by perseverative thinking styles, such as depressive rumination, worry, and other unhelpful self-regulation strategies. This thinking style, called the cognitive attentional syndrome (CAS; Wells and Matthews, 1994) is influenced by positive and negative metacognitive beliefs about uncontrollability and danger of rumination and worry as well as maladaptive executive control of attentional processes.

..Within-group effect sizes were large for reductions in symptoms of depression (d = 2.09) and anxiety (d = 1.16) at 1-year. Treatment response was associated with reductions in rumination, worry, and metacognitive beliefs as predicted by the metacognitive model, but reductions in metacognitions independently predicted reductions in depression scores from pre-treatment to 1-year follow-up. The results suggest that treatment gains are stable at 1-year follow-up. The study sets the stage for future research, which should evaluate MCT over a longer term and compare it with active treatments using suitably powered RCTs.

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01842/full

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Intact global #cognitive and #olfactory ability predicts lack of transition to #dementia

Odor identification deficits characterize Alzheimer's disease and other dementias

..Smell Identification Test, which includes the 12-item Brief Smell Identification Test (B-SIT)

..In covariate-adjusted survival analyses, impairment on the Blessed Orientation Memory Concentration Test and B-SIT each predicted dementia (n = 109), primarily Alzheimer's disease (n = 101). Among participants with intact olfactory (B-SIT ≥ 11/12 correct) and cognitive (Blessed Orientation Memory Concentration Test ≤ 5/28 incorrect) ability, 3.4% (4/117) transitioned to dementia during follow-up with no transitions in the 70–75 and 81–83 years age group quartiles.

Discussion
Odor identification testing adds value to global cognitive testing, and together can identify individuals who rarely transition to dementia, thereby avoiding unnecessary diagnostic investigation.

Highlights
•Olfactory and cognitive impairment each predict dementia.
•Impaired odor identification predicts cognitive decline.
•Intact olfaction and global cognition indicates lack of transition to dementia.

https://www.alzheimersanddementia.com/article/S1552-5260(19)35374-9/fulltext

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How the #weather affects the #pain of citizen scientists using a smartphone app

Weather has been thought to affect symptoms in patients with chronic disease since the time of Hippocrates over 2000 years ago.1 Around three-quarters of people living with arthritis believe their pain is affected by the weather..

..Precipitation was not associated with an increased odds of a pain event (OR 0.996 (0.989–1.003) per 1 mm daily rainfall amount)..

..This study has demonstrated that higher relative humidity and wind speed, and lower atmospheric pressure, were associated with increased pain severity in people with long-term pain conditions. The most significant contribution was from relative humidity. The effect of weather on pain was not fully explained by its day-to-day effect on mood or physical activity.

The overall effect sizes, while statistically significant, were modest. For example, the ‘worst’ combination of weather variables would increase the odds of a pain event by just over 20% compared to an average day. Nonetheless, such an increased risk may be meaningful to people living with chronic pain..

https://www.nature.com/articles/s41746-019-0180-3

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Relationship between #obesity indices and #hypertension among middle-aged and elderly populations in Taiwan: A community-based, cross-sectional study

..The obesity indices included body mass index (BMI), body fat (BF) percentage and waist circumference (WC).

Of the 396 people recruited, 200 had HTN. The age-adjusted Pearson’s coefficients of BMI, BF percentage and WC were 0.23 (p<0.001), 0.14 (p=0.01) and 0.26 (p<0.001), respectively. Multiple logistic regression of the HTN-related obesity indices showed that the ORs of BMI, BF percentage and WC were 1.15 (95% CI 1.08 to 1.23, p<0.001), 1.07 (95% CI 1.03 to 1.11, p<0.001) and 1.06 (95% CI 1.03 to 1.08, p<0.001), respectively. The AUCs of BMI, BF percentage and WC were 0.626 (95% CI 0.572 to 0.681, p<0.001), 0.556 (95% CI 0.500 to 0.613, p=0.052) and 0.640 (95% CI 0.586 to 0.694, p<0.001), respectively.

Conclusions WC is a more reliable predictor of HTN than BMI or BF percentage. The effect of abdominal fat distribution on blood pressure is greater than that of total BF amount

https://bmjopen.bmj.com/content/9/10/e031660

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Does chronic high-intensity #endurance training have an effect on cardiovascular markers of active populations and athletes? Systematic review and meta-analysis

There was significant improvement in high-density lipoprotein with weighted standardised mean difference and effect size=−1.06 (−1.83 to −0.30), p=0.006. We have also observed a significant reduction in low-density lipoprotein and total cholesterol with weighted standardised mean difference and effect size=−0.97 (−1.58 to −0.36), p=0.002, and = −0.78 (−1.34 to −0.22), p=0.007, respectively. There was a significant reduction in interleukin 6 (IL-6) using a fixed effect model with weighted standardised mean difference and effect size=−0.87 (−1.33 to −0.40), p=0.0003 and C reactive protein (CRP) with weighted standardised mean differences and effect size=−0.41 (−0.73 to −0.09), p=0.01.

Conclusion Chronic high-intensity endurance training improves healthy lipid profiles (increase high-density lipoprotein, decreased low-density lipoprotein and total cholesterol). And decreased inflammatory markers (IL-6 and CRP) independent of age and sex and cannot be associated with an increased risk of developing cardiovascular disease

https://bmjopen.bmj.com/content/9/10/e032832

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Is #running associated with a lower risk of all-cause, #cardiovascular and cancer #mortality, and is the more the better? A systematic review and meta-analysis

Fourteen studies from six prospective cohorts with a pooled sample of 232 149 participants were included. In total, 25 951 deaths were recorded during 5.5–35 year follow-ups. Our meta-analysis showed that running participation is associated with 27%, 30% and 23% lower risk of all-cause (pooled adjusted hazard ratio (HR)=0.73; 95% confidence interval (CI) 0.68 to 0.79), cardiovascular (HR=0.70; 95% CI 0.49 to 0.98) and cancer (HR=0.77; 95% CI 0.68 to 0.87) mortality, respectively, compared with no running. A meta-regression analysis showed no significant dose–response trends for weekly frequency, weekly duration, pace and the total volume of running.

Conclusion Increased rates of participation in running, regardless of its dose, would probably lead to substantial improvements in population health and longevity. Any amount of running, even just once a week, is better than no running, but higher doses of running may not necessarily be associated with greater mortality benefits.

https://bjsm.bmj.com/content/early/2019/09/25/bjsports-2018-100493

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Association Between #Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical #Hypothyroidism

..The hypothyroid symptoms score decreased from 21.7 at baseline to 19.3 at 12 months in the levothyroxine group vs from 19.8 at baseline to 17.4 at 12 months in the placebo group (adjusted between-group difference, 1.3 [95% CI, −2.7 to 5.2]; P = .53). The tiredness score increased from 25.5 at baseline to 28.2 at 12 months in the levothyroxine group vs from 25.1 at baseline to 28.7 at 12 months in the placebo group (adjusted between-group difference, −0.1 [95% CI, −4.5 to 4.3]; P = .96). At least 1 adverse event occurred in 33 participants (29.5%) in the levothyroxine group (the most common adverse event was cerebrovascular accident, which occurred in 3 participants [2.2%]) and 40 participants (28.8%) in the placebo group (the most common adverse event was pneumonia, which occurred in 4 [3.6%] participants).

Conclusions and Relevance In this prospectively planned analysis of data from 2 clinical trials involving adults aged 80 years and older with subclinical hypothyroidism, treatment with levothyroxine, compared with placebo, was not significantly associated with improvement in hypothyroid symptoms or fatigue. These findings do not support routine use of levothyroxine for treatment of subclinical hypothyroidism in adults aged 80 years and older.

https://jamanetwork.com/journals/jama/article-abstract/2753909

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Evidence-based clinical practice guideline on #antibiotic use for the urgent management of pulpal- and periapical-related #dental pain and intraoral swelling

..systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical #periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults.

The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high.

Conclusion and Practical Implications
Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.

https://jada.ada.org/article/S0002-8177(19)30617-8/fulltext

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#Insomnia symptoms and risk of cardiovascular diseases among 0.5 million adults. A 10-year cohort

..Three insomnia symptoms were assessed with self-reported difficulties in initiating or maintaining sleep, early morning awakening, and daytime dysfunction for at least 3 d/wk at baseline

Cox regressions showed that 3 insomnia symptoms were associated with increased risk of total #CVD, with respective adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.09 (95% CI 1.07–1.11), 1.07 (95% CI 1.05–1.09), and 1.13 (95% CI 1.09–1.18). Participants with individual symptoms also had higher risks of ischemic heart disease (IHD; HR 1.13, 1.09, and 1.17) and ischemic stroke but not hemorrhagic stroke. Participants with all 3 symptoms were at an 18%, 22%, or 10% higher risk of CVD, IHD, or ischemic stroke compared to nonsymptomatic adults. Associations between 3 symptoms and CVD incidence were consistently stronger in younger adults or those without baseline hypertension (p for interaction <0.05).

Conclusions Individual and coexisting insomnia symptoms are independent risk factors for CVD incidence, especially among young adults or adults who have not developed hypertension.

https://n.neurology.org/content/early/2019/11/06/WNL.0000000000008581

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American Academy of #Pediatrics – Section on #Surgery
Five Things Physicians and Patients Should Question

. Avoid the routine use of whole-body computed tomography (CT) scanning (pan-scanning) in pediatric trauma patients.

. Avoid using computed tomography (CT scan) as the first-line imaging modality in the evaluation of suspected appendicitis in children. Ultrasound should be done first with a CT scan or magnetic resonance imaging (MRI) considered in equivocal cases.

. Avoid performing antireflux operations (fundoplications) during gastrostomy insertion in most children who are otherwise growing and thriving with gastric feedings.

 . Avoid referring most children with umbilical hernias to a pediatric surgeon until around age 4-5 years.

. Reduce post-operative opioid requirements in pediatric patients by administering acetaminophen and/or non-steroidal anti-inflammatory medications in the perioperative period.

 http://www.choosingwisely.org/societies/american-academy-of-pediatrics-section-on-surgery/

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Activity of Hospital #Disinfectants against Vegetative Cells and Spores of #Clostridioides difficile Embedded in Biofilms

Clostridioides difficile spores can survive in the environment either in mono- or mixed-species biofilms. However, no previous studies have investigated chemical disinfection of C. difficile spores embedded in biofilms..

C. difficile vegetative cells and spores were recovered from biofilms regardless the type of biofilm growth or biofilm growth time. No disinfectant was able to completely eliminate C. difficile from the biofilms. Overall, Clorox, OPA, and Virex were most effective at killing C. difficile spores regardless of biofilm age, ribotype, or wash conditions (p= 0.001, each).

Clorox and OPA were also effective at killing total vegetative cell growth (P=0.001, each) but Virex was found to be ineffective against vegetative cell growth in biofilms (p=0.77). Clorox and Virex were most effective in reducing biomass followed by Nixall, OPA and Vital oxide.

Conclusion. No disinfectant was able to completely eliminate C. difficile embedded within biofilms although differences among disinfectants were noted. Future research will be required to determine methods to eradicate this persister reservoir.

https://aac.asm.org/content/early/2019/10/08/AAC.01031-19

#Antihypertensive medications and risk for incident #dementia and #Alzheimer's disease: a meta-analysis of individual participant data from prospective cohort studies

..We assessed the association of incident dementia and clinical Alzheimer's disease with use of five AHM classes, within strata of baseline high (systolic blood pressure [SBP] ≥140 mm Hg or diastolic blood pressure [DBP] ≥90 mm Hg) and normal (SBP <140 mm Hg and DBP <90 mm Hg) blood pressure.

..There were 3728 incident cases of dementia and 1741 incident Alzheimer's disease diagnoses. In the high blood pressure stratum (n=15 537), those using any AHM had a reduced risk for developing dementia (hazard ratio [HR] 0·88, 95% CI 0·79–0·98; p=0·019) and Alzheimer's disease (HR 0·84, 0·73–0·97; p=0·021) compared with those not using AHM. We did not find any significant differences between one drug class versus all others on risk of dementia. In the normal blood pressure stratum (n=15 553), there was no association between AHM use and incident dementia or Alzheimer's disease.

Interpretation
Over a long period of observation, no evidence was found that a specific AHM drug class was more effective than others in lowering risk of dementia. Among people with hypertensive levels of blood pressure, use of any AHM with efficacy to lower blood pressure might reduce the risk for dementia. These findings suggest future clinical guidelines for hypertension management should also consider the beneficial effect of AHM on the risk for dementia.

https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30393-X/fulltext

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Vitamin #D-VDR signaling inhibits Wnt/beta-catenin-mediated #melanoma progression and promotes anti-tumor immunity

..1α,25-dihydroxyvitamin D3 signals via the Vitamin D Receptor (VDR). Higher serum vitamin D is associated with thinner primary melanoma and better outcome, although a causal mechanism has not been established. As melanoma patients commonly avoid sun exposure, and consequent vitamin D deficiency might worsen outcomes, we interrogated 703 primary melanoma transcriptomes to understand the role of vitamin D-VDR signalling and replicated the findings in TCGA metastases. VDR expression was independently protective for melanoma death in both primary and metastatic disease.

..Vitamin D deficiency (< 25 nmol/l ~ 10 ng/ml) shortened survival in primary melanoma in a VDR-dependent manner.

.. In summary, vitamin D-VDR signaling contributes to controlling pro-proliferative/immunosuppresive Wnt/beta-catenin signaling in melanoma and this is associated with less metastatic disease and stronger host immune responses. This is evidence of the causal relationship between vitamin D-VDR signaling and melanoma survival which should be explored as a therapeutic target in primary resistance to checkpoint blockade.

https://cancerres.aacrjournals.org/content/early/2019/11/05/0008-5472.CAN-18-3927

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The Predictive Performance of Objective Measures of #physical Activity Derived From Accelerometry Data for 5-Year All-Cause Mortality in #Older Adults: National Health and Nutritional Examination Survey 2003–2006

Declining physical activity (PA) is a hallmark of aging. Wearable technology provides reliable measures of the frequency, duration, intensity, and timing of PA..

In univariate logistic regression, the total activity count was the best predictor of 5-year mortality (Area under the Curve (AUC) = 0.771) followed by age (AUC = 0.758). Overall, 9 of the top 10 predictors were objective PA measures (AUC from 0.771 to 0.692). In multivariate regression, the 10-fold cross-validated AUC was 0.798 for the model without objective PA variables (9 predictors) and 0.838 for the forward selection model with objective PA variables (13 predictors). The Net Reclassification Index was substantially improved by adding objective PA variables (p < .001).

Conclusions
Objective accelerometry-derived PA measures outperform traditional predictors of 5-year mortality, including age. This highlights the importance of wearable technology for providing reproducible, unbiased, and prognostic biomarkers of health.

https://academic.oup.com/biomedgerontology/advance-article-abstract/doi/10.1093/gerona/glz193/5555985

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Associations Between #vascular Risk Across Adulthood and #Brain Pathology in Late Life
Evidence From a British Birth Cohort

Office-based Framingham Heart study–cardiovascular risk scores (FHS-CVS) were derived at ages 36, 53, and 69 years using systolic blood pressure, antihypertensive medication usage, smoking, diabetic status, and body mass index. Analysis models adjusted for age at imaging, sex, APOE genotype, socioeconomic position, and, where appropriate, total intracranial volume.

..At all points, these scores were associated with smaller whole-brain volumes (36 years: β coefficient per 1% increase, −3.6 [95% CI, −7.0 to −0.3]; 53 years: −0.8 [95% CI, −1.5 to −0.08]; 69 years: −0.6 [95% CI, −1.1 to −0.2]) and higher white matter–hyperintensity volume (exponentiated coefficient: 36 years, 1.09 [95% CI, 1.01-1.18]; 53 years, 1.02 [95% CI, 1.00-1.04]; 69 years, 1.01 [95% CI, 1.00-1.02]), with largest effect sizes at age 36 years. At no point were FHS-CVS results associated with β-amyloid status.

Conclusions and Relevance Higher vascular risk is associated with smaller whole-brain volume and greater white matter–hyperintensity volume at age 69 to 71 years, with the strongest association seen with early adulthood vascular risk. There was no evidence that higher vascular risk influences amyloid deposition, at least up to age 71 years. Reducing vascular risk with appropriate interventions should be considered from early adulthood to maximize late-life brain health.

https://jamanetwork.com/journals/jamaneurology/fullarticle/2753445

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#Nanoparticle-induced #neutrophil apoptosis increases survival in #sepsis and alleviates neurological damage in #stroke

Human neutrophils are the most abundant circulating leukocytes and contribute to acute and chronic inflammatory disorders. Neutrophil apoptosis is programed cell death to maintain immune homeostasis, but inflammatory responses to infections or tissue injury disrupt neutrophil death program, leading to many diseases.

Precise control of neutrophil apoptosis may resolve inflammation to return immune homeostasis. Here, we report a method in which doxorubicin (DOX)–conjugated protein nanoparticles (NPs) can in situ selectively target inflammatory neutrophils for intracellular delivery of DOX that induces neutrophil apoptosis. We showed that neutrophil uptake of NPs required their activation and was highly selective. DOX release was triggered by acidic environments in neutrophils, subsequently inhibiting neutrophil transmigration and inflammatory responses.

In two disease models, DOX-conjugated NPs notably increased mouse survival in sepsis and prevented brain damage in cerebral ischemia/reperfusion, but the NPs did not suppress systemic immunity. Our studies offer a promising strategy to treat inflammatory diseases.

https://advances.sciencemag.org/content/5/11/eaax7964

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#Cleveland Clinic Unveils Top 10 Medical #Innovations for 2020

1. Dual-Acting Osteoporosis Drug

2. Expanded Use of Minimally Invasive Mitral Valve Surgery

3. Inaugural Treatment for Transthyretin Amyloid Cardiomyopathy

4. Therapy for Peanut Allergies

5. Closed-Loop Spinal Cord Stimulation

6. Biologics in Orthopaedic Repair

7. Antibiotic Envelope for Cardiac Implantable Device Infection Prevention

8. Bempedoic Acid for Cholesterol Lowering in Statin Intolerant Patients

9. PARP Inhibitors for Maintenance Therapy in Ovarian Cancer

10. Drugs for Heart Failure with Preserved Ejection Fraction

..Currently, recommendations for this treatment are directed at accompanying conditions and mere symptom relief. But SGLT2 inhibitors, a class of medications used in the treatment of type 2 diabetes, is now being explored in HFpEF – alluding to a potential new treatment option..

https://newsroom.clevelandclinic.org/2019/10/23/cleveland-clinic-unveils-top-10-medical-innovations-for-2020/

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Association of #Testosterone Therapy With Risk of Venous #Thromboembolism Among Men With and Without #Hypogonadism

..A total of 39 622 men (mean [SD] age, 57.4 [14.2] years) were enrolled in the study, and 3110 men (7.8%) had evidence of hypogonadism. In age-adjusted models, testosterone therapy use in all case periods was associated with a higher risk of VTE in men with (odds ratio [OR], 2.32; 95% CI, 1.97-2.74) and without (OR, 2.02; 95% CI, 1.47-2.77) hypogonadism. Among men without hypogonadism, the point estimate for testosterone therapy and VTE risk in the 3-month case period was higher for men younger than 65 years (OR, 2.99; 95% CI, 1.91-4.68) than for older men (OR, 1.68; 95% CI, 0.90-3.14), although this interaction was not statistically significant (P = .14).

Conclusions and Relevance Testosterone therapy was associated with an increase in short-term risk for VTE among men with and without hypogonadism, with some evidence that the association was more pronounced among younger men. These findings suggest that caution should be used when prescribing testosterone therapy.

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754091

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#Temperature and #mental health: Evidence from the spectrum of mental health outcomes

This paper characterizes the link between ambient temperatures and a broad set of mental health outcomes. We find that higher temperatures increase emergency department visits for mental illness, suicides, and self-reported days of poor mental health. Specifically, cold temperatures reduce negative mental health outcomes while hot temperatures increase them. Our estimates reveal no evidence of adaptation, instead the temperature relationship is stable across time, baseline climate, air conditioning penetration rates, accessibility of mental health services, and other factors.

The character of the results suggests that temperature affects mental health very differently than physical health, and more similarly to other psychological and behavioral outcomes. We provide suggestive evidence for sleep disruption as an active mechanism behind our results and discuss the implications of our findings for the allocation of mental health services and in light of climate change.

https://www.sciencedirect.com/science/article/abs/pii/S016762961830105X

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Skeletal #muscle mass in relation to 10 year #cardiovascular disease incidence among middle aged and older adults: the ATTICA study

Skeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old.

The 10 year CVD incidence increased significantly across the baseline SMI tertiles (p<0.001). Baseline SMM showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81% (95% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile.

Conclusions The presented findings support the importance of SMM evaluation in the prediction of long-term CVD risk among adults 45+ years old without pre-existing CVD. Preservation of SMM may contribute to CVD health.

https://jech.bmj.com/content/early/2019/10/16/jech-2019-212268