Monday, June 30, 2014

Achy knees and in your 60s? Or maybe its one of your parents who complains about arthritic knee pain and been told s/he needs a knee replacement. Consider this...one-third of knee replacements performed are inappropriate according to a study published in "Arthritis & Rheumatology" and reported in Medical News Today.

One third of total knee replacements in US are 'inappropriate'

 
Monday 30 June 2014 - 12am PST


One third of total knee replacements in the US are "inappropriate" when applied to a Spanish patient classification system, according to a study published in Arthritis & Rheumatology, a journal of the American College of Rheumatology. 
 
Figures from the Agency for Healthcare Research and Quality show that more than 600,000 knee replacements are performed each year in the US. This surgery has become increasingly more common over the past 15 years, with studies showing a 162% annual volume increase in Medicare-covered knee replacement surgeries during 1991-2010.

Experts are divided on the reasons for this growth, with some maintaining it demonstrates that the procedure is effective, while others argue the surgery is being overused. One concern of the critics who believe total knee arthroplasties (TKA) are being overused is that the procedure "is highly reliant on subjective criteria."

For the new study, researchers from Virginia Commonwealth University in Richmond examined the criteria that is used to determine appropriateness for TKA.

The authors point out that the investigated criteria have not been studied in the US and have been developed in other countries.

"To my knowledge, ours is the first US study to compare validated appropriateness criteria with actual cases of knee replacement surgery," says lead author Dr. Daniel Riddle from the Department of Physical Therapy at Virginia Commonwealth University. 
 
Dr. Riddle examined a modified version of an appropriateness classification system developed in Spain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Physical Function scale.

In the study, Riddle and colleagues note that the Spanish criteria are considered by many experts in the field to be "among the most powerful tools for improving quality of care and controlling costs."

Analysis finds that 44% of TKA surgeries are 'appropriate' and 34% are 'inappropriate'

The classification systems were used to assess participants enrolled in the Osteoarthritis Initiative - a 5-year study of 4,796 people partly funded by the National Institutes of Health.

x ray of osteoarthritis
One concern of critics who believe total knee arthroplasties are being overused is that the procedure "is highly reliant on subjective criteria."
 
Looking at a sub-set of 175 people who underwent TKA surgery, Dr. Riddle's analysis found that 44% of surgeries were classified as "appropriate," 22% were "inconclusive," and 34% were "inappropriate."

The mean age of knee replacement patients in the study was 67 years old, and 60% of them were female.

"Our finding that one third of knee replacements were inappropriate was higher than expected and linked to variation in knee pain [osteoarthritis] severity and functional loss," says Dr. Riddle. "These data highlight the need to develop patient selection criteria in the US."

"I agree with Riddle and colleagues," writes Dr. Jeffery Katz - from the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital in Boston, MA - in a linked editorial.

"We should be concerned about offering total knee replacements to subjects who endorse 'none' or 'mild' on all items of the WOMAC pain and function scales."

The new study also highlights that there are many variables involved in the decision to undergo TKA surgery. Severity of symptoms and the psychological readiness of the patient are two important factors, but in addition to the variables examined in the study, there are a wide range of variables specific to the patient that a surgeon will consider when making the decision for or against TKA surgery.

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Sunday, June 22, 2014

And you thought exercise was just beneficial to building muscle or improving your cardiovascular system? Now a new, albeit small, study shows exercise benefits the gut environment and has a surprisingly good impact on your wellbeing.

Exercise and the ‘Good’ Bugs in Our Gut

 
GettyImages

Being physically active may encourage beneficial germs to thrive in your gut, while inactivity could do the reverse, according to an innovative new study. The findings suggest that, in addition to its other health benefits, frequent exercise may influence our weight and overall health by altering the kinds of organisms that live inside of us. 

In recent years, there has been an explosion of interest in the role that gut microbes play in whole-body health. A multitude of studies have shown that people with large and diverse germ populations in their digestive tracts tend to be less prone to obesity, immune problems and other health disorders than people with low microbial diversity, and that certain germs, in particular, may contribute to improved metabolic and immune health. 

But little science had examined the interplay between physical activity and gut bugs in people. So, for a study published this month in Gut, researchers at University College Cork, part of the National University of Ireland, and other institutions, set out to learn more by turning to a group of people who exercise a lot: the national rugby team of Ireland. 

“We chose professional athletes as a study group, because we wanted to be sure not to miss any effect of exercise and needed a group who were safely performing at the extremes of human endeavor,” said Dr. Fergus Shanahan, an author of the study who is a professor of gastroenterology and director of the Alimentary Pharmabiotic Center at University College Cork.

Forty of the players agreed to participate. At the time of the study, the men’s national team was in preseason training and the players were exercising strenuously for several hours every day. 

For the sake of comparison, the researchers also recruited two groups of healthy adult men, none of them athletes. One group consisted of men with a normal body mass index. Most of the men in this group exercised occasionally but lightly.

The men in the final group were generally sedentary and had a body mass index that would qualify them as overweight or obese. This group was included, Dr. Shanahan said, because the rugby players, although supremely fit, were physically huge, with body masses well above normal. The researchers wanted to compare their gut microbes to those of men whose weight was similar, if not their musculature. 

The scientists drew blood and collected stool samples from all of the men, rugby players and non-athletes alike. The volunteers also completed lengthy questionnaires about their exercise routines and diet, and spoke with a nutritionist about their typical daily food intake. 

Then the scientists analyzed the men’s blood for markers of muscle damage and inflammation, which would indicate how much each volunteer had — or had not — been moving and exercising recently. The scientists also used sophisticated genetic sequencing techniques to identify and enumerate the particular microbes living in each man’s gut.

As it turned out, the internal world of the athletes was quite different from that of the men in either of the control groups. The rugby players had considerably more diversity in the make-up of their gut microbiomes, meaning that their intestinal tracts hosted a greater variety of germs than did those of the other men, especially the men in the group with the highest B.M.I. 

The rugby players’ guts also harbored larger numbers of a particular bacterium, uneuphoniously named Akkermansiaceae, that has been linked in past studies with a decreased risk for obesity and systemic inflammation. 

Interestingly, the rugby players’ blood showed low levels of markers for inflammation, even though the men were exercising intensely. Their muscles were being pummeled but, in physiological terms, recovering well. 

The men in both of the control groups, on the other hand, especially those with the highest B.M.I.s and who rarely exercised, had relatively low numbers of Akkermansiaceae in their guts and elevated markers for inflammation in their bloodstreams.

These findings “draw attention to the possibility that exercise may have a beneficial effect on the microbiota,” Dr. Shanahan said, in ways that improve bodily health. 

However, the results are still preliminary, he said. This study was small and, because of its methodology, the researchers can’t determine how exercise alters gut germs or tease out the effects of intense exercise from those of diet. The rugby players consumed far more calories than did the other men, with a much larger percentage of their diet consisting of protein. Such nutritional differences can affect which microbes thrive in the gut. The athletes also were training at a level that few of us would be able or willing to emulate.

Dr. Shanahan and his colleagues have begun a follow-up study examining whether and how moderate exercise changes the gut environment in both men and women. The results should be available later this year. 

But even in advance of those findings, he said, it seems likely that any amount of exercise should make your gut more welcoming to the bacteria that you want residing there.

Monday, June 16, 2014

Outside of the spine, the joints used most in the body belong to those gompher joints - your teeth. Dental care, at times, seems not to have changed much over time. But now new technology being explored by researchers at King's College London may finally keep us in the dentist chair without the need to drill those nasty cavities.


The Washington Post: To Your Health

This new technology may put an end to drilling at the dentist’s office

June 16 at 3:01 PM
 

It’s fair to say that no one would miss this. (Photo by John Moore/Getty Images)
 
 
There may be a time in the near future when fillings for minor cavities are a thing of the past.
Researchers at King’s College London are developing a procedure that uses low frequency electrical currents to help teeth “self heal” lesions (sometimes referred to as cavities) without drilling.

The technology, called “electrically accelerated and enhanced remineralization,” could put an end to fillings for early-stage lesions and moderate tooth decay. And eventually it could lead to new treatments for more advanced decay.

Sounds good, right? There’s even better news: This technology could make it to dentists’ offices within three years.

By the time a dentist looks at an X-ray and diagnoses a patient with a cavity, he or she is seeing a tooth after it has lost minerals in the enamel and has started to decay.

Teeth can repair themselves by replacing those minerals with ones found in saliva or fluoride through a natural “remineralization” process. Researchers have been trying to figure out how to enhance that process by making it faster and allowing it to work more deeply in the tooth.

“We in the dental research field have known about remineralization for some time,” King’s College London Professor Nigel Pitts, a dentist, said in an interview. “People were talking about remineralization in the 1980s, but it’s been hard to achieve a viable way that will remineralize established, large lesions in depth.”

Pitts said his team’s “Eureka” moment came when they began focusing on preparing the tooth by removing barriers to the remineralization process, including saliva and tissue. Step two involves using electrical currents to help drive minerals into the tooth.

In theory, a dentist would be able to place what Pitts calls a “healing hand piece” on the surface of the tooth for the duration of the relatively quick procedure. It emits an imperceptible electric current that drives minerals back into the tooth.

The process would be painless and would cost about as much as, or less than, a traditional filling, and would take about as much time, Pitts said.

“Using the electrical method, we can achieve remineralization that would have taken weeks and we can do it an order of magnitude faster and better,” he said.



These 3D images show a tooth decay lesion inside the tooth decreasing in size and volume (Left to Right) after treatment with the Electrically Accelerated and Enhanced Remineralization procedure. (courtesy Nigel Pitts/Kings College London)


The World Health Organization estimates that 60-90 percent of schoolchildren and nearly 100 percent of adults worldwide have dental cavities.

Now it appears that technology might be close to meeting the growing demand for pain-free, effective solutions to cavities that don’t discourage people from coming back to the dentist’s office for other serious problems such as gum disease.

“The procedure that’s involved in cutting a cavity and giving an injection is in some ways really uncomfortable. For some patients it’s a real phobia,” Pitts. “When patients are more relaxed, they’ll come for monitoring.”

“Dentistry is changing and quite a lot of what we’re doing is about health and well-being, and we need to control the dental decay as much as we can,” he added,

Pitts and his partner, dentist Christopher Longbottom, formed a company called Reminova to raise money and run patient trials of the technology in partnership with King’s College. Academic research supporting the validity of the remineralization technology is expected to be published in industry journals in coming months.

The pair is aiming to have the devices in dentists’ offices—beginning in Britain — within three years, which Pitts calls “conservative.”

As for the prognosis for American dental offices, Pitts acknowledged that the regulatory environment for medical treatments in the U.S. is a little different. But he and his team have been working with international dentistry organizations throughout the process of developing the technology.

“The U.S. environment has its own characteristics, it has the [Food and Drug Administration] and others protecting what’s done,” Pitts said. “But the type of dentistry that’s being done and the move toward prevention are very similar.”

Monday, June 9, 2014

Eat your vegetables! They're good for you! Words that don't really work on most kids growing up. But new research reported in the New York Times might help you to get your kids to eat their lima beans.


Credit Michael Waraksa

One of the fiercest marketing battles in the world takes place in kitchens and at dining room tables across the world. The sellers are parents, trying everything to persuade their children to eat their vegetables.

Now, new research shows why parents — and food marketers — might be doing themselves no favors. The problem is the pitch: It is too aggressive, even at its most well-meaning and heartfelt. The best way to pitch food to children, the research finds, is to present it with no marketing message whatsoever.

Don’t tell them it’s healthy or it will make them smart or strong. Telling them it’s yummy is O.K., but even that message doesn’t seem to help the cause. “You just need to give them the food. You mess them up by giving all kinds of messages,” said the paper’s co-author, Ayelet Fishbach, a professor of behavioral science and marketing at the University of Chicago Booth School of Business. When giving food to children, “nothing helps beyond no message whatsoever.”

The findings, to be published in October in Journal of Consumer Research, offer insight not only into children’s decision-making around food, but also, more broadly, into the powerful and counterintuitive ways that overzealous marketing can misfire — with adults and children alike.

The idea for the study came from Michal Maimaran, a visiting assistant marketing professor at the Kellogg School of Management at Northwestern and co-author of the paper. She wondered why her tactics could backfire when she tried to sell healthy food to her children, ages 7, 4 and 2.

To be scientific about it, the two scholars devised a series of experiments that they ran with the cooperation of a Y.M.C.A. outside Chicago. In the first experiment, children ages 4 and 5 were read a story about a little girl named Tara who ate some Wheat Thins before she went out to play.

But not all the children heard the same story. In one version, Tara ate the Wheat Thins and “felt strong and healthy.” The children who heard this version were reminded that the crackers are good for their health. Another group of children heard that “Tara thought the crackers were yummy, and she was happy.” A third group heard that Tara ate Wheat Thins but without any description of whether the crackers were healthy or yummy.

Then each child got a moment alone to snack from a bowl of Wheat Thins. The number of crackers the children ate varied sharply depending on which version of the story they heard.

If children heard that Wheat Thins were healthy, they ate, on average, three crackers. If they heard that the crackers were yummy, they ate 7.2.

But most noteworthy, the researchers said, was the choice made by children who got no information at all about the character of Wheat Thins: They ate nine. In subsequent studies, the researchers discovered the same phenomenon in younger children, and with carrots.

Why was no message the best message? One possible explanation has to do with the “dilution effect” — the watering down of a marketing message that makes too many claims.

For instance, a video game system that is marketed as a movie player/video game console/Internet device might fare less well among consumers than if it is pitched as an “entertainment system.” Too many claims devalue each one.

Similarly, the researchers hypothesize, if children think food is good for them, it can’t also taste good.
So what to do? Let children make their own decision with a major caveat: Choose what food to put in front of them. Don’t pitch, but also: “Don’t let them do the shopping,” Professor Fishbach said.

Monday, June 2, 2014

Ahhh, nuts! Once again, a new study demonstrates positive outcomes - this time for pistachios and almonds as being beneficial to the prevention of Type 2 diabetes. Taste good, good for the heart, and now with added benefit!

Medscape Medical News from the

Eating Nuts May Help Pause Path to Type 2 Diabetes


May 30, 2014


SOFIA, Bulgaria — Eating nuts could help protect against the development of type 2 diabetes in individuals who are already at high risk for the disease, 2 new studies suggest.

Researchers from Spain and the United States reported on the potential benefits of pistachio nuts and almonds, so-called "tree nuts," here at the 2014 European Congress on Obesity.

Mònica Bulló, MD, of the human nutrition unit at Virgili University, Reus, Spain, and senior author on the pistachio study, told Medscape Medical News: "I would advise people to eat a handful of nuts whenever they can."

Her study, conducted in 49 overweight or obese prediabetic subjects, showed that 57 g of pistachios daily for 4 months significantly reduced fasting glucose, insulin, and insulin resistance. Importantly, there was no change in body weight after eating the nuts.

The other trial, presented in a poster by Sze Yen Tan, PhD, of department of nutrition science, Purdue University, West Lafayette, Indiana, reported on 137 adults at elevated risk for diabetes who were randomized to consume 43 g of almonds per day — either with meals or as a snack — or to no almonds, for 4 weeks.

Those who ate the nuts felt less hungry and fuller than those who didn't, and they had lower postprandial blood glucose levels, without experiencing any weight gain.

Dr. Bulló added that nuts in general have been found to be associated with a reduced risk for coronary heart disease through moderation of LDL cholesterol, triglycerides, and circulating glucose concentrations. And in studies in type 2 diabetes, they have been shown to reduce postmeal glucose and insulin levels, although she admitted findings have been "mixed" in this patient population.

But nuts are, she noted, "a rich, dense food with a healthy lipid profile," and pistachios in particular are rich in antioxidant carotenoids, she added.

However, Dr. Richard Elliott, research communications officer at Diabetes UK, told Medscape Medical News that until full reports of these studies have been published, "We would not be able to make a definitive judgement….We are not aware of any strong evidence that eating nuts reduces the risk of type 2 diabetes."

Potential Protective Role of Pistachios 
 
Despite the prior work on nuts, no previous study has evaluated the effect of nuts in prediabetes, which Dr. Bulló told a press briefing here is "a silent disease," indicating blood glucose levels in the range of 100 to 125 mg/dL, associated comorbidities, and an increased mortality risk.

In the study, reported at the meeting by her colleague Pablo Hernández-Alonso, MD, also of Virgili University, 54 overweight or obese prediabetic people were randomly assigned to a control diet or a pistachios diet (57 g daily, around a "handful" of nuts, said Dr. Bulló) for 4 months. They then had a 2-week washout period before crossing over to the alternative diet for another 4 months, so the individuals effectively acted as their own controls.

The diets were designed to be isocaloric and modified according to each individual's weight: the amount of calories varied from 1900 to 2500 per day, depending on the weight of the person.

Both diets were Mediterranean in nature, and the control diet used olive oil in place of pistachios — the diets did not differ in the amount of saturated fatty acids and cholesterol content. At baseline and then monthly, anthropometric measurements were taken, blood pressure was measured, and physical activity was assessed. Blood samples were also collected at the beginning and end of each intervention period to look at hemostatic, inflammatory, oxidative, and related metabolic risk markers.

There were no statistically significant changes in body mass index (BMI) between intervention periods, but fasting glucose, insulin, and insulin-resistance markers decreased significantly after the pistachio diet compared with the control diet (P < .001).

There were nonsignificant decreases in HbA1c and serum-LDL cholesterol levels; the latter became significant when 5 participants who dropped out for personal reasons were excluded from the analysis.

Other metabolic risk markers such as fibrinogen, glucagonlike peptide-1 (GLP-1), oxidized LDL, and platelet factor-4 all showed a statistically significant decrease after the pistachio diet compared with control diet (P < .05).

"Regular consumption of pistachios could decrease insulin resistance, thus suggesting a potential protective role for pistachio consumption against development of type 2 diabetes," Dr. Bulló concluded.

Almonds Get in on the Action Too, but Are Best as a Snack 
 
Meanwhile, in the almond study, 137 adults at elevated risk of diabetes (BMI 27–35 or normal weight with a family history of diabetes) were randomized to 1 of 3 groups: 43 g per day of almonds (approximately 250 calories) with breakfast or lunch; 43 g of almonds alone as a morning or afternoon snack; or no almonds; for 4 weeks.

Those who ate the almonds felt less hungry and fuller than those who did not consume them; these effects were most noticeable when the almonds were eaten as a snack. Similarly, although almond consumption led to lower blood glucose, this reduction was significant only among those who ate the nuts as a snack.

Adding almonds to the usual diet for 4 weeks did not alter body weight or any other anthropometric measures compared with the control group. The lipid profile of those who consumed the nuts did not improve, however, "possibly because participants were generally healthy and normal-cholesterolemic," said Dr. Tan.

Dr. Tan noted that the US Department of Agriculture recommends the inclusion of about 43 g of nuts per day as part of a healthy diet.

"Overall," he concluded, "inclusion of 43 g of almonds into a daily diet, especially as snacks, may help to moderate glycemia without promoting weight gain."

Dr. Bulló's study was funded by the Western Pistachios Association (United States) and Paramount Farms, but none of the funding sources played a role in the design, collection, analysis, or interpretation of the data, and she said neither she nor her colleagues receive any honoraria from these sources. Dr. Tan's study was funded by the Almond Board of California. 
 
2014 European Congress on Obesity. Abstract T5:OS2.3, presented May 31, 2014.