Monthly Archives: November 2015

Effect of pedometer-based walking on depression, anxiety, and insomnia among postmenopausal women.

Climacteric. 2015 Jun 22:1-16. [Epub ahead of print]

Effect of pedometer-based walking on depression, anxiety, and insomnia among postmenopausal women.

Abstract

OBJECTIVE:

Insomnia, anxiety, and depression are some psychological symptoms associated with menopause. The aim of this study was to evaluate the effect of a pedometer-based walking on anxiety, insomnia, and depression among postmenopausal women.

METHODS:

In this randomized controlled trial, 106 postmenopausal women were randomly assigned to two groups (n = 53 in each group). Their anxiety, insomnia, and depression levels were assessed using the GHQ-28 and Beck questionnaires in the 4th, 8th, and 12th week of intervention. The depression level was assessed in the beginning, and in the 12th week of trial. The intervention group received a pedometer, and was asked to increase their steps by 500 per week. Data were analyzed using the independent t-test, chi-square, and repeated measures tests.

RESULTS:

The levels of anxiety and insomnia decreased in the 8th (4.2 ± 2.1 vs. 5.4 ± 2.3, p = 0.007) and 12th week (4.3 ± 2.8 vs. 7.2 ± 2.6, p < 0.001) in the intervention group, compared with the control group. The depression intensity decreased in the intervention group, compared with the control group, after 12 weeks (13.7 ± 5 vs. 19.6 ± 4.79, p < 0.001). The intervention group increased their step count from 76,377 steps per month in the first month, to 106,398 in the third month (p < 0.001).

CONCLUSION:

This study showed the pedometer-based walking had a positive effect on depression, insomnia, and anxiety among postmenopausal women. A walking training program can be considered for postmenopausal women in Iran.

Let’s talk about sex over 60: condoms, casual partners and the ageing body

Let’s talk about sex over 60: condoms, casual partners and the ageing body

July 29, 2015 6.06am AEST

Disclosure statement

Bianca Fileborn receives funding from the Australian Research Council to undertake research on STIs and ageing.

Anthony Lyons receives funding from the Australian Research Council to undertake research on the sexual health of older Australians.

Partners

La Trobe University provides funding as a member of The Conversation AU.

Over the past few years we’ve seen a dramatic rise in the rates of sexually transmitted infections (STIs) among Australians aged 60 years and older. Rates of gonorrhoea more than doubled in this age group between 2007 and 2011. Rates of chlamydia also rose significantly during this time, mirroring similar trends internationally.

STIs can be accompanied by some unpleasant symptoms and health complications, or lead to major chronic conditions, in the case of HIV. It’s therefore important STIs are diagnosed and treated, regardless of age.

To understand why STIs are on the rise, we need to know more about older people’s sexual and romantic relationships, their knowledge of STIs and safe sex, and the safe sex practices that they use. However, older people are routinely excluded from research on sex and relationships. Here’s what we know so far.

Changing sexual and relationship patterns

The Baby Boomer generation is renowned for challenging norms around sex and age and this has continued in recent decades.

Improvements to life expectancy and overall health in later life mean that older people may be more willing and able to engage in varying kinds of sexual activity. In fact, there is some evidence to suggest that remaining sexually active is associated with better health in older age.

Changes in the social acceptability of divorce and dating in later life have also opened up the possibility of entering in to a new sexual relationship. With new sexual partners comes an increased possibility of contracting an STI.

Alongside this, internet dating has increased the opportunities to meet new sexual or romantic partners. And medical advances such as Viagra have made (penetrative) sex in later life more of a possibility for older men than was previously the case.

However, this does not mean that all older people are sexually active, or that they are sexually active in the same ways as younger people. Instead, research suggests that older people engage in a diverse range of sexual practices, and may have to adjust to ageing bodies.

Let’s (not) talk about sex

Despite these changes, and increasing evidence that older people continue to be sexually active, there’s a reluctance to acknowledge this shift. Many in the community continue to cling to outdated and ageist assumptions that older people are asexual.

As a result, medical professionals can be reluctant to talk to their older patients about sex. Research in the United Kingdom shows GPs assume the topic of sexual health is not relevant to older people, and fail to proactively raise this issue with their older patients. This is often based on an incorrect assumption that older people are no longer sexual.

How do you negotiate condom use and an ageing body? Studio KIWI/Shutterstock

This reluctance can have direct and negative implications for the sexual health of older people. It becomes less likely that older patients will be offered routine sexual health screenings , or have the opportunity to ask their GP questions about sexual health.

Learning about safe sex is a life-long endeavour

When we talk about safe sex and STIs, our focus tends to be on younger people. In some ways this makes sense: many younger people are entering their first sexual relationships and need to learn how to have sex safely.

There is also an assumption that older people already know about safe sex. Yet, many older people grew up in a time when comprehensive sex education wasn’t provided in school. For those who have been in long-term, monogamous relationships, using condoms may have seemed irrelevant.

Older Australians need different types of information at different stages in the life course. Those reentering the dating or casual sex scenes, for instance, might benefit from a refresher on safe sex.

Older people might also have unique or different safe sex needs to their younger counterparts. For example, how does one negotiate condom use and an ageing body? How can issues around increased friction and pain that can be associated with condom use (particularly for postmenopausal women) be managed?

We need age-specific education and resources.

Don’t delay treatment

STIs can be costly to treat, and the economic burden of STIs increases with delayed diagnosis and treatment. Delayed treatment can result in more severe symptoms and complications. Ignoring older people as sexual beings may contribute towards poorer overall health and deny their sexual agency.

We need to be more proactive in engaging older Australians around their sexual health. This could start with providing education, access to testing, and opportunities for discussions about sex, relationships, and sexual health.

We also need to know more about sex and relationships among older Australians and what they already know or don’t know about STIs and safe sex. This week we launched SexAge&Me, the first national study of older Australians’ sexual and romantic relationships, to help answer these questions and inform future approaches to sexual health policy and health care responses.

If you’re an Australian resident aged over 60 and want to take part in the survey, click here.

How viruses can fool the immune system

  How viruses can fool the immune system

July 31, 2015 2.51pm AEST

But the immune system can sometimes misbehave. It can start attacking its own proteins, rather than the infection, causing autoimmunity. Or, it can effectively respond to one variant of a virus, but then is unable to stop another variant of the virus. This is termed the original antigenic sin (OAS).

OAS occurs when the initial successful immune response blocks an effective response when the person is next exposed to the virus. This can have potentially devastating consequences for illnesses such as the mosquito-borne dengue.

There are around 400 million dengue infections worldwide each year and no vaccine is available. Reinfection of someone who has been exposed to dengue previously can result in life-threatening hemorrhagic fever.

OAS is also thought to limit our immune responses to the highly variable influenza virus, increasing the chance of pandemics.

To understand why OAS occurs, we need to go back to basics about how immunity is formed.

The race begins

When a virus enters the body, a race begins between responding immune cells and the infecting pathogen. The pathogen replicates and finds a target cell or organ that will allow it to thrive.

So, the effectiveness of a response depends on the immune system winning the race to clear the pathogen before it causes irreversible damage to the body.

Immune cells called “B cells” make antibodies. A pathogen such as a virus is a large molecule with different components, called antigens. When a B cell recognises an antigen, it is activated and interacts with other immune cells to receive directions.

Quality control

B cells then set out on two main paths. Some of the cells begin to make an antibody early in the response. But this antibody is often not of sufficient quality to rid the body of the infection.

The B cells that choose the alternate pathway go through a process that improves the quality of the antibody. This strengthens the binding between antibody and antigen. Antibodies are also grouped depending on the way they help eliminate the pathogen.

Some groups are better at clearing viruses and other pathogens. So, the antibody group that is tailored to be most effective at clearing the type of infection comes to dominate the response over this period.

Although the increase in quality of antibody can take weeks, there are two critical benefits. It means the pathogen is cleared. And high-quality “memory” cells remain to provide us with immunity to future infections.

Memory cells

Immune memory cells consist of long-lived plasma cells and memory B cells. Long-lived plasma cells live in the bone marrow and can continuously pump out high-quality antibody, providing a first wave of protection when we’re reinfected with a virus.

This is the same type of antibody that is transferred from mother to a breastfed baby, providing passive immunity against pathogens the mother has previously been infected with. But this level of antibody may not be enough to clear the infection.

This is where memory cells step in. Because memory cells have already undergone quality improvement, they can respond quickly after reinfection to produce a large number of plasma cells secreting high-quality antibody.

Therefore, memory cells can clear the infection much more rapidly than the initial infection. This means the pathogen doesn’t have time to damage the body.

When the quality improvement process fails

The quality improvement process that allows B cells to bind and clear the pathogen more effectively is highly selective to the dominating antigen.

In most responses to infection, this is critical to clear the infection. But in the case of some pathogens, such as dengue, the virus may have variant strains that can fool the immune memory response.

Dengue virus has four major variant serotypes. Within each major variant, one antigen dominates and is targeted by the immune system.

Infection by variant A results in extremely selective targeting towards antigen A. If the body is reinfected with the same variant (A), it can effectively clear the virus.

However, after reinfection by a second variant (in which antigen B dominates), immune memory cells recognise the virus, but they make antibody specific for antigen A, rather than the second variant, in which antigen B is now dominating.

So, antibody is being made but is unable to bind and eliminate the virus. To make matter worse, it appears that any new immune response to antigen B is inhibited by the memory response, although the reasons why this occurs are unclear.

Influenza is a highly variable virus, and these variations each season are why we require yearly vaccinations.

But the role of OAS in limiting our ability to respond to different variants of influenza is still highly controversial. Almost 60 years after OAS was proposed to describe the response to influenza infections, it is still a source of much current research.

How can we avoid OAS?

We need to train our immune system to be more flexible and produce antibodies that can adapt when viruses try to evade the immune system.

To this end, researchers are designing vaccines to respond to multiple variants of pathogens. This has shown promising results and may be the way forward to overcome OAS for potentially life-threatening viruses such as dengue

Many Older Women Don’t Need Vitamin D Supplements


Many Older Women Don’t Need Vitamin D Supplements

 

Vitamin D supplements may be ineffective in improving bone density or bone strength in postmenopausal women, a clinical trial has found.

Researchers randomized 230 women to one of three groups: a low-dose group who took 800 units of vitamin D daily; a high-dose group who took 50,000 units twice a month; and a group that received placebo pills.

All had similar vitamin D blood levels at the start of the study, about 20 milligrams per deciliter. By the end of one year, the average vitamin D levels were 42 in the high-dose group, 27 in the low-dose group, and 18 in the placebo group.

Calcium absorption increased about 1 percent in the high-dose group, while decreasing 2 percent in the low-dose group and 1.3 percent in the placebo takers. But there was no difference among groups in changes in bone mineral density or trabecular bone score, a measure of osteoporosis risk. Nor was there any difference in the number of falls or the ability to exercise. The study is in JAMA Internal Medicine.

“Right now, our patients are getting mixed messages from ‘don’t bother taking D at all’ to ‘take 2,000 too 4,000 units a day,’ so what are we to do?” said the lead author, Dr. Karen E. Hansen, an associate professor of medicine at the University of Wisconsin. “This study supports a middle-of-the-road approach. If your D level is 20 or higher, that’s enough, and if you’re low, you can achieve that with 600 to 800 units a day.”

See also:

Doctors slam calcium and Vitamin D conflict of interest

No evidence of vitamin D health benefits

Labels Like ‘Alternative Medicine’ Don’t Matter. The Science Does.

The University of Toronto recently stirred up a bit of controversy by offering an uncritical class on “Alternative Medicine.” A variety of bloggersand journalists brought up many valid concerns about the curriculum, but there is a much larger problem: No one is sure how best to teach that subject.

The dichotomy, however, between alternative and traditional medicine, or between Eastern and Western medicine, is a false one. We would be much better off if we could reframe the issue.

People often think of Eastern or alternative medicine as more “natural.” Many feel that Western medicine is built around technology and products produced in a lab. They’re not entirely wrong. Many of the gains that have been made in traditional medicine have been the result of innovation in laboratories.

But that doesn’t mean that everything doctors are taught in medical school involves a drug or device. I talk to patients all the time about diet and exercise. I don’t do this because there’s a company making money off it. I do it because both of these things have been proven to be important for health.

Photo

CreditEdel Rodriguez

Nor do all medications get cooked up in a lab. We recommend folic acid, which is a B Vitamin, for pregnant women because research has shown that it reduces the risk of major birth defects in newborns. We all know that adequate intake of vitamin C prevents scurvy and that vitamin D preventsrickets.

None of these things are controversial to physicians. We recommend them all the time. That’s not because they were developed in the Western Hemisphere. It’s because they have been subjected to the rigor of scientific investigation — and found to have merit.

There are many other forms of nontechnological medicine that have the weight of scrutiny behind them. In a meta-analysis published just a few years ago, researchers looked at all the accumulated randomized controlled trials examining how acupuncture fared in treating people with chronic pain. They found that not only did acupuncture work better than no-acupuncture control groups, but there were also significant differences between acupuncture and sham acupuncture. This suggests that not all of the benefits are placebo effects.

People have been treating many mental health problems with therapy for years. Full disclosure: I’m one who has been treated. I’ve never taken any of the long-term psychotropic drugs, and many patients prefer not to if possible. Austin Frakt, my Upshot co-contributor, wrote recently about the evidence supporting cognitive behavioral therapy for insomnia, as well as for a host of other health problems. Even mindfulness, or meditation, has been studied extensively, and found to be pretty effective in treating anxiety and mood problems. I’ve been convinced enough by this evidence to try meditation myself.

I would argue that all the therapies I mention here aren’t considered complementary therapies — they’re often just considered therapies. That’s because they’ve been studied, and they’ve proved to work. Too often, though, those who consider themselves supporters of alternative medicinedisdain the idea that any of their treatments need to be studied. They make an appeal to the fact that their medicine is more natural; has been used for long periods of time; or has the support of many people in other cultures.

Of course, not long ago, all therapies could be described in this way. The application of modern science allowed us to devise and conduct trials that could prove or disprove a treatment’s efficacy or harm. Many of the drugs we use today had natural origins. Digitalis comes from foxglove, quinine from cinchona bark, penicillin from bread mold and aspirin from willow tree bark. Conventional medicine may have improved our ability to purify these substances, but it acknowledges that many natural therapies hold value.

Yet science rejects many forms of complementary medicine as ineffective. Just a few months ago, the National Health and Medical Research Council of Australia released a report in which it fully reviewed 225 studies of homeopathy, the practice of treating sick people with small amounts of substances that cause similar symptoms in healthy people. They found no well-designed studies that found it to outperform a placebo or function as well as any conventionally approved therapies. Their conclusions echoed aprevious report from Britain, and those found in many Cochrane systematic reviews.

In 1998, The Journal of the American Medical Association published a theme issue on alternative medicine for common chronic medical conditions. The randomized controlled trials within it offered evidence thatspinal manipulation did not improve tension-type headaches, thatacupuncture and acupressure didn’t reduce pain caused by H.I.V.-related peripheral neuropathy and that the supplement Garcinia cambogia did not help with weight loss. However, the same issue contained studies that showed that yoga-based interventions improved carpal tunnel syndrome more than wrist splinting, that the Chinese practice of moxibustion significantly increased fetal activity and fixed breech presentations before delivery, and that Chinese herbal medicine appeared to improve symptoms in some patients with irritable bowel syndrome. Although some of this research has been continued, to my knowledge neither side of medicine has changed practices or beliefs much based on this work.

In an accompanying editorial, Phil Fontanarosa and George Lundberg, two of JAMA’s editors, wrote: “There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.”

I’d change this only by adding, “There is no conventional medicine.”

Correction: August 10, 2015 
An earlier version of this article misstated the surname of an editor at JAMA. He is George Lundberg, not Lungberg.

Hormone Conference

I will be giving a presentation on “The latest evidence regarding HRT” at a conference on Dec 7th.  More information is available for anyone interested at : https://www.ausmed.com.au/course/hormone-conference