Doctors’ beliefs about treatment affect patients’ experience of pain


New research finds that the placebo effect may be socially contagious. In other words, a doctor’s beliefs about whether or not a pain treatment will work can exert a subtle influence on how much pain the patient will actually experience. 

A doctor’s display of confidence in a treatment may make it more effective.

The power of placebo may extend beyond what researchers previously believed.

At first, they only used placebos as controls in drug experiments.

With time, however, placebos proved to have value as potential treatments in their own right.

Pain, depression, anxiety, irritable bowel syndrome, Parkinson’s disease, and epilepsy are only some of the conditions that placebos have shown promise in treating.

A new study has looked into another fascinating aspect of the placebo: Does it transmit socially, from one person to another? If so, how? More specifically, how does a doctor’s belief about the effects of a medication affect their patient’s experience of pain?

Laboratory at Dartmouth College in Hanover, NH — is the corresponding author of the new study.

Chang and colleagues have published their findings in the journal Nature Human Behaviour

Testing placebo power in 3 experiments

To study the phenomenon of socially transmitted placebo, the researchers devised three experiments. All three involved two different creams that were meant to relieve heat-induced pain by targeting pain receptors on the participants’ skin.

One of the creams was called thermedol, and the other was a control cream. Although different in appearance, both creams were actually placebos — namely, petroleum jelly with no pain relieving properties at all.

The researchers asked undergraduate students to play the roles of “doctors” and “patients.” They informed the “doctors” of the creams’ benefits and conditioned them to believe that thermedol was better at relieving pain than the control cream.

The first experiment consisted of 24 “doctor-patient” pairs. In each pair, the “patient” did not know which cream was thermedol and which was the control. Only the “doctor” knew which was the “effective” cream.

The researchers then applied the creams to the participants’ arms, followed by pain-inducing heat, in order to evaluate the effects of the cream. All participants received the same amount of heat.

During the experiment, all participants wore cameras that recorded their facial expressions in the doctor-patient interactions.

Using a machine-learning algorithm trained on facial signals of pain, the researchers were able to examine the effect of cues such as raised eyebrows, raised upper lips, or nose wrinkling on the perceived effectiveness of the treatments.

In this experiment, the participants reported experiencing less pain with thermedol, and skin conductance tests suggested that they actually did experience less discomfort. Their facial expressions also reflected less pain with thermedol.

In the other two experiments, the researchers applied the creams in different orders, and they led the doctors to believe that they were using thermedol when they were using the control creams, and vice versa.

The experimenters themselves were also blind to the study, not knowing which cream was which. In these experiments, the results were the same.

How doctors’ beliefs affect clinical results

Overall, across all three experiments, the results revealed that when the “doctors” believed that a treatment was effective, the “patients” reported feeling less pain. Their facial expressions and skin conductance tests also revealed fewer signs of pain.

The reasons for this remain unclear. However, the researchers believe that social contagion via facial cues is the most likely explanation.

“When the doctor thought that the treatment was going to work, the patient reported feeling that the doctor was more empathetic,” says Chang.

“The doctor may have come across as warmer or more attentive. Yet, we don’t know exactly what the doctor was doing differently to convey these beliefs that a treatment works. That’s the next thing that we’re going to explore,” he adds.

“What we do know though is that these expectations are not being conveyed verbally but through subtle social cues,” explains Chang.

“These findings demonstrate how subtle social interactions can impact clinical outcomes. You can imagine that in a real clinical context, if the healthcare providers seemed competent, empathetic, and confident that a treatment may work, the impact on patient outcomes could be even stronger.”

Balancing work and family life puts a strain on women’s heart health.


Researchers believe that stress and cardiovascular health are linked in some way, but the association is not yet fully clear. A large-scale new study has recently delved into the effects of a unique kind of stress.

According to the American Heart Association (AHA), stress may affect factors that increase the risk of heart disease, including blood pressure and cholesterol level.

One major source of stress is the workplace.

In fact, a 2015 review of 27 studies that appeared in the journal Current Cardiology Reports

found an association between work stress and a “moderately elevated risk of incident coronary heart disease and stroke.”

However, one type of stress that researchers often leave out of studies is that felt by a person who needs to simultaneously balance the demands of work and family life.

Examining this in more depth may eventually help health professionals better identify and treat cardiovascular issues. This is according to the authors of the new study, which now appears in the Journal of the American Heart Association.

What is work-family conflict?

Cardiovascular diseases are currently the leading cause of death worldwide, say the World Health Organization (WHO).

Health professionals can determine people’s cardiovascular health score. Based on seven metrics including diet, blood pressure, and physical activity levels, the researchers who conducted the new study used this score to investigate how work and family stress can impact heart health.

According to the study paper, work-family conflict refers to “a form of inter-role conflict in which the role pressures from the work and family domains are mutually incompatible in some respect.”

More than 11,000 workers ages 35–74, from six state capitals in Brazil, made up the study’s sample. The participants came from a variety of educational and work backgrounds, and the study included a slightly higher number of women.

Each participant filled out a questionnaire to determine how their job affected their family life, and how their family life impacted their work.

The researchers calculated the participants’ cardiovascular health scores using a combination of clinical examinations, laboratory test results, and self-reported questionnaires.

An unequal impact

The analysis showed a distinct sex difference. Men reported less work interference with family and more time for personal care and leisure. Both sexes reported a similar amount of family interference with work.

However, women appeared to be worse off. Those who reported a number of frequent work-family conflicts had lower cardiovascular health scores.

“This was interesting because in our previous study, job stress alone affected men and women almost equally,” says senior study author Dr. Itamar Santos, a professor at the University of São Paulo in Brazil.

There could be a simple explanation as to why this is the case, and it has to do with traditional gender roles. “You feel the stress to fulfill the gender roles, and I think women still feel more of a need to have that nurturing home life,” says Dr. Gina Price Lundberg, clinical director of the Emory Women’s Heart Center in Atlanta, GA.

“Men are helping more than ever, but I think working women still feel the stress of trying to do it all.” She goes on to describe the study as “well-designed,” due to its large sample size, the diverse background of the participants, and the balance of men and women.

However, certain elements of the study relied on the participants’ own thoughts and feelings, which may have biased the results.

How to live with stress

What this study has dipped into is the need for a good work-life balance. However, this is easier said than done in many cases.

Dr. Santos hopes that the new findings will encourage workplaces to introduce stress reducing initiatives and encourage doctors to look for signs of stress when examining people.

“We’re not going to eliminate stress,” Dr. Santos says. “But we should learn how to live with it to not have so many bad consequences.”

Whether that would be through measures such as at-home meditation or employer-led strategies is yet to be determined.

Dr. Santos and team are now planning to follow the same participants for up to a decade to gain further insight.

A simple blood test could make a great difference for those with brain cancer.

New blood test detects brain tumors with 87% accuracy

Dr. Matthew J. Baker, a reader in the Department of Pure and Applied Chemistry at the University of Strathclyde in Glasgow, United Kingdom, is the lead author of the new research.

He and his colleagues have now published their findings in the journal Nature Communications.

Of the study, Dr. Baker says, “This is the first publication of data from our clinical feasibility study, and it is the first demonstration that our blood test works in the clinic.”

Although it is quite rare, brain cancer often has a poor outlook.

According to the National Cancer Institute, around 0.6% of people will develop brain cancer or another cancer of the nervous system in their lifetime.

However, the 5 year survival rate for those who do receive such a diagnosis is less than 33%.

Largely, the poor outlook is due to the fact that brain tumors have very nonspecific symptoms, which makes them more difficult to distinguish from other conditions.

Study co-author Dr. Paul Brennan — a senior clinical lecturer and consultant neurosurgeon at the University of Edinburgh in the U.K. — explains, “Diagnosing brain tumors is difficult, leading to delays and frustration for lots of people.”

“The problem is that symptoms of brain tumor are quite nonspecific, such as headache, or memory problems. It can be difficult for doctors to tell which people are most likely to have a brain tumor,” he adds.

The lack of cost effective tests that can help doctors triage people with brain tumors in primary care also means that it takes longer to accurately diagnose brain cancer. This ultimately results in a poorer outlook.

The team’s new blood test brings much needed hope in this regard. Dr. Baker and colleagues used infrared light to create a “bio-signature” of people’s blood samples and applied artificial intelligence to scan for signs of cancer.

The test correctly identified brain cancer in a cohort of 104 people 87% of the time.

A more rapid means of diagnosis

As the researchers explain in their paper, they used a technique called attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy and coupled it with machine learning technology to detect brain cancer.

The authors explain that the technique is “a simple, label free, noninvasive, nondestructive” way of analyzing the biochemical profile of a blood sample without requiring extensive preparation of the sample.

The ATR-FTIR technique allowed the researchers to work out a biochemical “fingerprint” of brain cancer.

Dr. Baker and team trained a machine learning algorithm to use these biochemical fingerprints to diagnose brain cancer in a retrospective cohort of 724 people. This cohort included people with primary and secondary cancers as well as control participants without cancer.

They then used the algorithm to predict brain cancer cases in a sample of 104 participants. Of these, 12 people had cancer, including four cases of glioblastoma. This is one of the most aggressive forms of brain tumor.

The findings revealed a sensitivity of 83.3% and a specificity of 87% for the blood test. “With this new test, we have shown that we can help doctors quickly identify which [people] with these nonspecific symptoms should be prioritized for urgent brain imaging,” says Dr. Brennan.

“This,” he adds, “means a more rapid diagnosis for people with a brain tumor, and quicker access to treatment.”

Hayley Smith — an ambassador for the Brain Tumor Charity in Hampshire, U.K. — adds that it is “very encouraging to hear that this blood test can lead to a quicker diagnosis for brain cancer.”

“This kind of test will be vital to patients, helping people to get the correct diagnosis quicker, which ultimately will help people to get the urgent medical care that they need.”

What to know about spotting in early pregnancy

Spotting in early pregnancy is common for many women and usually not a cause for concern. However, in some instances, it may occur as a symptom of a pregnancy complication.

About a quarter of pregnant women experience bleeding during the first trimester. Although bleeding is a possible sign of early pregnancy loss, it does not mean that this will happen. Several other conditions and factors, including normal hormonal shifts, may cause spotting in early pregnancy.

Causes

The most common causes of spotting in early pregnancy include:

Subchorionic hematoma

A subchorionic hematoma is sometimes called subchorionic hemorrhage. This happens when blood builds up near the chorion, which is the fetal membrane next to the placenta. The bleeding may also appear between the uterus and the placenta.

Subchorionic hematoma is a common pregnancy complication with various studies estimating the prevalence between 1.3% and 62% among different groups of pregnant women.

A subchorionic hematoma is not a pregnancy loss. Many pregnant women with this type of bleeding have no further complications during their pregnancy.

A 2012 meta-analysis of nine research studies concluded that there was a link between subchorionic hemorrhage and higher risk of pregnancy loss and preterm labor.

However, a 2013 observational study of 1,115 women that included 142 with a subchorionic hematoma found no significant increase in the risk of pregnancy complications.

Ectopic pregnancy

In an ectopic pregnancy, a fertilized egg implants outside of the uterus, often in the fallopian tubes. A woman may still have pregnancy symptoms or get a positive pregnancy test. The pregnancy, however, cannot survive. If it continues to grow, it can rupture and cause life threatening bleeding or a dangerous infection.

An ectopic pregnancy can cause spotting as the pregnancy grows. If the pregnancy ruptures, it can cause life threatening internal bleeding that may get progressively heavier over several hours.

Cervical irritation

The cervix, the doughnut-shaped entry to the uterus, increases its blood supply during pregnancy. This means it is more likely to bleed from irritation, such as after sex or a pelvic exam. Light spotting after any form of vaginal penetration is a possible sign of cervical bleeding.

Cervical bleeding is not dangerous and usually stops on its own within a few hours. The blood is typically red or brown, and the bleeding minimal.

Very rarely, a serious injury to the cervix, such as from an assault or trauma, might cause more severe cervical bleeding. These injuries can cause infections and other serious complications. It is important to see a doctor following any traumatic injury to the cervix or vagina.

Pregnancy loss

For many pregnant women, bleeding triggers fears of pregnancy loss. A 2010 study of 4,539 pregnant women found that 26.7% experienced bleeding at some point during their pregnancies, but only 12% had a pregnancy loss. These figures suggest that less than half of people who bleed during pregnancy have a pregnancy loss.

About two-thirds of people who do have a pregnancy loss report bleeding. As such, bleeding is a symptom that a pregnant person should not ignore. Any pregnant woman who has concerns about their pregnancy should speak to a doctor about risk factors and how to minimize them.

Hormonal shifts

Around the 7th week of pregnancy, a luteal-placental shift happens. This is when the placenta develops enough to begin producing hormones that sustain the pregnancy. Before this change, the corpus luteum — a group of cells that forms during ovulation — produces pregnancy hormones.

This hormonal change sometimes triggers a temporary drop in the hormone progesterone. This shift may cause spotting, or even bleeding as heavy as a period. As long as the placenta begins producing enough progesterone, the pregnancy can safely continue, and a woman will not have a pregnancy loss.

Diagnosis

A doctor or other healthcare provider may do numerous tests to diagnose bleeding. These may include:

Ultrasound

A doctor may order an ultrasound to help diagnose a subchorionic hematoma.

An ultrasound can diagnose a subchorionic hematoma. It can also tell a healthcare provider the location of the pregnancy, helping in the detection of an ectopic pregnancy.

After about the 6th week of pregnancy, an ultrasound can measure the viability of the pregnancy. If the embryo is growing correctly, and there is a sufficiently strong heartbeat, this suggests that the pregnancy will continue and the risk of pregnancy loss is low.

An ultrasound can also examine other pelvic organs to check for causes of bleeding. For example, an ovarian cyst may cause bleeding.

Blood tests

Blood tests can measure levels of the pregnancy hormone hCG. Low hCG may suggest that a pregnancy is not developing correctly or is in its early stages.

Some healthcare providers also check progesterone levels. Low progesterone may cause temporary bleeding, while very low progesterone may be a sign of an abnormal pregnancy.

Is it normal?

While many women who experience bleeding have healthy pregnancies, it is important never to treat bleeding as usual. Bleeding can be a critical symptom of several pregnancy-related symptoms, and prompt treatment for conditions such as ectopic pregnancy can save lives.

Implantation bleeding

Implantation happens when a fertilized egg embeds in the lining of the uterus. This marks the beginning of pregnancy. Some women notice spotting shortly after implantation. However, the body does not begin producing hCG until after implantation.

A woman is not pregnant until after implantation, and a pregnancy test cannot usually detect pregnancy until several days after implantation. So, bleeding that appears after a woman already knows she is pregnant is not implantation bleeding.

Implantation bleeding is usually brown. Some women may mistake the bleeding for their monthly period because it usually occurs around the time a woman expects her period.

The flow of implantation bleeding is often lighter and shorter than a period, so women who experience unusual bleeding after having sex should consider the possibility of pregnancy.

When to see a doctor

Speak to a doctor about any bleeding early in pregnancy. While the bleeding may be harmless, it is impossible to diagnose its cause without blood work, an ultrasound, or other diagnostic tests.

Bleeding from a ruptured ectopic pregnancy can endanger the life of the mother. While many pregnancy losses pass on their own, some require treatment to prevent excessive bleeding and infection.

Prompt medical care can be lifesaving. Even when there is no serious problem, the right care can offer peace of mind.

If a pregnant woman experiencing spotting has Rh-negative blood, a doctor may prescribe RhoGAM. This treatment can help prevent a condition known as erythroblastosis fetalis.

If a woman experiences light bleeding at any time, they should contact a midwife, doctor, or another healthcare provider.

A woman should visit an emergency room if:

  • they develop a fever
  • bleeding gets heavier over several hours
  • bleeding is heavy, similar to a period
  • there are large clots in the blood
  • they have cramps
  • there is severe pain in the abdomen
  • they feel dizzy or light-headed

Summary

Many women panic when they bleed during pregnancy, especially if they have a previous history of miscarriage. Seeking prompt care is the fastest way to ease anxiety and get clear answers.

It is not advisable for people to try to self-diagnose bleeding or assume that bleeding means a pregnancy loss. A few quick tests can usually diagnose the cause, and prompt treatment can prevent possible complications.

A new study suggests that even 100% natural fruit juices may increase the risk of diabetes.

While researchers already knew that drinks with added sugar could increase a person’s risk of type 2 diabetes, a new study suggests that the same may be true for naturally sweet drinks, such as 100% fruit juices, as well as artificially sweetened beverages, such as “diet” soft drinks.

Research has shown that drinking soft drinks with added sugar can increase a person’s risk of developing type 2 diabetes by affecting subtle metabolic mechanisms.

But are “diet” soda and 100% fruit juices that contain a natural level of fructose but no added sugar any healthier?

The evidence surrounding diet soda and its effect on diabetes risk has been conflicting. Some studies suggest that it might have an impact, while others report that there is no association between the two.

Most people believe that naturally sweet drinks are healthful. However, recent research has shown that they are not nearly as good for us as we think. One study that we covered on Medical News Today in July this year, for instance, indicated that they could increase a person’s risk of cancer.

Now, research from an international team of investigators from Harvard T. H. Chan School of Public Health in Boston, MA and Fudan University in Shanghai, China, suggests that all sugary drinks, including natural fruit juices and artificially sweetened beverages, could increase diabetes risk.

However, the study, which appears in the journal Diabetes Care, also offers some hope. It notes that people can decrease this risk by replacing sugary drinks of any kind with non-sweetened beverages, such as water, tea, and coffee.

“The study provides further evidence demonstrating the health benefits associated with decreasing sugary beverage consumption and replacing these drinks with healthier alternatives like water, coffee, or tea.”

First author Jean-Philippe Drouin-Chartier, Ph.D.

Sugary drinks linked to 16% increase in risk

Drouin-Chartier and colleagues analyzed data collected over 22–26 years from 76,531 women enrolled in the Nurses’ Health Study between 1986–2012, 81,597 women enrolled in the Nurses’ Health Study II between 1991–2013, and 34,224 men from the Health Professionals’ Follow-up Study, enrolled between 1986–2012.

The researchers gave the participants questionnaires that asked them how often they consumed certain foods and beverages. By analyzing the results, the study authors found out how often participants drank certain sugary drinks and were able to calculate any changes in their drink consumption patterns.

The researchers found that people who increased their total intake of soft drinks with added sugars and naturally sweet fruit drinks by over 4 ounces (oz) per day over 4 years saw an associated diabetes risk increase of 16% over the following 4 years.

However, those who increased their total intake of artificially sweetened beverages — such as diet soda — by the same quantity over the same period saw an associated 18% increase in the risk of developing type 2 diabetes.

These associations remained in place even after the researchers adjusted for confounding variables, including body mass index (BMI), different dietary changes, and relevant lifestyle habits.

The investigators caution, however, that the finding regarding artificially sweetened beverages may be unreliable because it remains unclear which way the association runs. They explain that people who know that they are already at high risk of developing diabetes may switch from sugary drinks to diet sodas to try and mitigate that risk.

Moreover, the study authors also point out the risk of surveillance bias in their research. This refers to the fact that people who are at high risk of developing diabetes are more likely to undergo screenings for diabetes, therefore receiving a diagnosis sooner than other individuals.

Overall, the research suggests that people might want to consider caution about their intake of sweet drinks of all kinds. It also found that switching to unsweetened drinks could help reduce diabetes risk.

More specifically, replacing one daily serving of a sweet drink with water or unsweetened coffee or tea was associated with a 2–10% lower risk of type 2 diabetes.

“The study results are in line with current recommendations to replace sugary beverages with noncaloric beverages free of artificial sweeteners,” notes senior author Prof. Frank Hu, from Harvard T.H. Chan School of Public Health.

Nor should people overestimate the benefits of natural juices. “Although fruit juices contain some nutrients, their consumption should be moderated,” he stresses.

Freshly blended fruit smoothies of various colors and tastes in glass jars. Yellow, red, green. Turquoise blue background

How plant based diets can help people with rheumatoid arthritis

Many recent studies have highlighted the health benefits that a plant based diet can bring. Now, a new review explains just why it can be helpful for people living with rheumatoid arthritis.

Rheumatoid arthritis — a chronic autoimmune condition that causes pain and stiffness in the joints — has a prevalence of between 0.3% and 1% among the world’s population, according to the World Health Organization (WHO).

The condition can become so debilitating as to stop people from continuing in full time work. As the WHO also note, within only 10 years from disease onset, at least 50% of individuals with rheumatoid arthritis in high income countries become “unable to hold down a full time job.”

Doctors usually prescribe a range of drugs and lifestyle adjustments to help people manage their rheumatoid arthritis and make disability less likely. Management strategies that healthcare providers might advise include increased physical activity and weight loss.

Now, a new review appearing in the journal Frontiers in Nutrition shows that following a plant based diet can be a useful intervention when it comes to coping with this condition, as it triggers some helpful biological changes.

‘Symptoms may improve or even disappear’

The review — conducted by specialists from the Physicians Committee for Responsible Medicine in Washington, DC — looked at recent studies that observed the impact of diet on biological mechanisms that are important in rheumatoid arthritis.

It concluded that plant based diets lead to specific changes that can help relieve the symptoms of this condition.

One key way in which plant based diets can be helpful is by reducing levels of inflammation. The review authors cite a study from 2015 that showed participants who ate a plant based diet for 2 months had lower inflammation than those who ate a diet that was high in fat and featured more animal products.

The team also notes that additional research has found an association between adherence to diets high in fat and processed meat and a rise in markers of inflammation. One of these markers is C-reactive protein, a protein present in the blood, and one which reacts to inflammation.

On the other hand, following plant based diets or diets that have a high content of fiber has an association with lower levels of C-reactive protein.

Another study that the review looked at was a randomized clinical trial showing that, after following a low fat vegan diet for 4 weeks, individuals with moderate-to-severe rheumatoid arthritis saw significant improvements in symptoms, including joint pain and stiffness, tenderness, and swelling.

People with rheumatoid arthritis can also benefit from losing extra weight. According to evidence from a 2018 study, overweight individuals with rheumatoid arthritis who shed in excess of 5 kilograms were three times more likely to have improvements in their symptoms compared to those who lost less weight.

The review authors explain that vegetarian and vegan diets appear to help people lose weight, more so than any other diet types.

Finally, the researchers explain that plant based diets also seem to promote a healthy gut environment, since many of these diets are high in fiber, which, as studies have shown, influences the composition of the gut microbiome.

Specifically, plant based diets seem to increase bacterial diversity in the gut, which could help people with rheumatoid arthritis, precisely because they tend to lack bacterial diversity.

The investigators who conducted the review suggest there is a need for further research into the benefits that plant based diets may afford to people with inflammatory autoimmune conditions, as well as their underlying mechanisms.

However, they note that, so far, the emerging evidence suggests that eating more fruits, vegetables, whole grains, and legumes could make a real difference for people with rheumatoid arthritis.

“A plant based diet comprised of fruits, vegetables, grains, and legumes may be tremendously helpful for those with rheumatoid arthritis. This study offers hope that with a simple menu change, joint pain, swelling, and other painful symptoms may improve or even disappear.”

Study co-author Dr. Hana Kahleova

A complex relationship between Alcohol & Dementia

Although alcohol has been popular for millennia, and dementia is increasingly prevalent, scientists are yet to understand the relationship between the two. A recent study sets out for answers.

With dementia predicted to affect 13.9 million adults in the United States by 2060, understanding why these conditions develop is more urgent than ever.

Scientists have uncovered certain factors that increase the risk of developing dementia. Some, such as advancing age, cannot be prevented. However, it is possible to avoid other potential risk factors, such as smoking tobacco.

It is essential to identify modifiable risk factors as understanding these could help prevent or delay the onset of dementia.

Recently, researchers designed a study to look for links between dementia and alcohol consumption in older adults. They published their findings in JAMA Network Open.

What do we already know?

Perhaps surprisingly, as the authors explain, “we know little about the independent associations of quantity and frequency of alcohol consumption with dementia risk.”

Although some studies have investigated alcohol and dementia more broadly, there are still substantial gaps in our understanding. For instance, in an earlier study, researchers calculated alcohol consumption as a daily average across each year.

Using a daily average in this way misses the nuances of alcohol quantity and frequency.

This is an important point. For example, drinking 7 glasses of beer on 1 day each week is likely to have a different impact than drinking 1 glass of beer each night, every day of the week; although the quantity consumed is the same.

The authors of another study concluded that binge drinking in midlife increases the risk of dementia. However, it is still not clear whether regularly drinking smaller amounts of alcohol has the same effect.

Other studies muddy the water further by looking at the links between alcohol, dementia risk, and the presence of apolipoprotein E4 (APOE E4). This gene variant has associations with an increased risk of developing Alzheimer’s.

An earlier study concluded that alcohol consumption increases the risk of dementia and that people with the APOE E4 variant have a higher chance of developing dementia.

Another unknown is how alcohol influences dementia risk for individuals with mild cognitive impairment (MCI). Scientists consider MCI to be the stage between normal age-related cognitive decline and dementia.

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Alcohol and dementia data

To investigate, the scientists delved into an existing dataset, extracting the information from 3,021 participants, with an average age of 72.

The Ginkgo Evaluation of Memory Study from 2000–2008 supplied the data.

At the beginning of the study, participants provided information about the amount of alcohol they consumed, how often they drank, and what types of drinks they consumed — beer, wine, or liquor.

According to the authors, at the start of the study, each participant went through “a comprehensive neuropsychological battery of 10 tests.” These assessed a range of cognitive functions, and participants completed the tests every 6 months.

Scientists isolated DNA from blood samples to identify carriers of the APOE E4 variant.

Alongside genetic data and details about alcohol use, the scientists also collated information about blood pressure, body weight, height, history of heart disease, and smoking status. They also asked questions to estimate how regularly each participant was involved in social interactions.

Many gaps remain

Of the 3,021 participants, 2,548 did not have MCI, and 473 did have MCI. Over approximately 6 years of follow-up, 512 participants received a diagnosis of dementia.

The authors found that, among those without MCI, no amount of alcohol consumption increased dementia risk compared with those who drank less than one drink per week.

When they analyzed the group of individuals with MCI, it was a similar story; there was no statistically significant difference.

However, dementia risk appeared to be highest for the individuals with MCI who drank 14 drinks per week compared with those who drank less than one drink each week — a relative risk increase of 72%.

The authors also note some differences associated with drinking patterns:

“Daily low-quantity drinking was associated with lower dementia risk than infrequent higher-quantity drinking among participants without MCI at baseline.”

Although the authors are keen to underline the negative impacts of excessive drinking on brain health and health in general, they also note that:

“Our findings provide some reassurance that alcohol consumed within recommended limits was not associated with an increased risk of dementia among older adults with normal baseline cognition.”

When the researchers investigated the potential impact of APOE E4, they found no significant effect, which mirrors several previous studies. The authors theorize that the lack of effect might be because the association is more pronounced in younger populations; they call for further investigation.

In conclusion, the current study provides few solid answers. It confirms, however, that the relationship between alcohol and dementia is complex and likely to require a great deal more research.

Memory impairment in ARD correlates best with lesions of the thalamus. Atrophy of the mamillary bodies is specific for Wernicke’s Encephalopathy (WE) Diagnosis is clinical, not radiological.

Link found between chronic headache and back pain

A review of 14 studies found that people with persistent headache or back pain were twice as likely to experience the other disorder as well.

Chronic headaches and persistent back pain are both debilitating conditions. New findings suggest a link between the two, potentially charting a new course for more effective treatment.

Chronic headaches and back pain both appear in the top five causes of years lived with disability. Healthcare professionals often treat the conditions separately, but there is a theory that in some people, they appear together. Therefore, treating both as one disorder may provide better results.

Up to 4% of individuals in the global adult population have headaches on 15 or more days of every month, according to the World Health Organization (WHO).

Meanwhile, about 80% of adults experience low back pain at least once in their lifetime, according to the National Institute of Neurological Disorders and Stroke, and approximately 20% of these people go on to develop chronic low back pain.

In 2013, a German study found a link between low back pain and both chronic migraine and chronic tension-type headaches.

Now, researchers from the University of Warwick, United Kingdom, appear to have found an even stronger association.

Double the odds

Appearing in the Journal of Headache and Pain, their review involved 14 studies with a range of sample sizes. The smallest study included 88 participants, while the largest involved 404,206 individuals.

One type of headache and a particular back pain disorder were the focus: chronic headaches and persistent low back pain. The team notes the definitions of these conditions, describing the former as headaches that occur on the majority of days for a minimum of 3 months and the latter as pain “between the bottom of the rib cage and the buttock creases” for the same period.

The review found that all the studies shared a similar positive association between the two conditions. However, the odds of experiencing both conditions varied widely between the studies from less than twice as likely to eight times as likely.

This meant that the researchers were unable to pool the data in a combined statistical analysis. However, Prof. Martin Underwood notes, “[i]n most of the studies, we found that the odds were about double — either way, you’re about twice as likely to have headaches or chronic low back pain in the presence of the other.”

For people experiencing migraine ⁠— the third most prevalent illness in the world ⁠— the link was even stronger.

A few limitations exist, namely that inconsistent study designs and populations and varying definitions of the disorders may have weakened the quality of the results.

Still, the findings are “very interesting,” notes Prof. Martin Underwood, from Warwick Medical School, “because typically these have been looked at as separate disorders and then managed by different people.”

“But this makes you think that there might be, at least for some people, some commonality in what is causing the problem.”

Combining treatments

The researchers are not yet sure of the potential shared cause, but they have some theories. One, explains Prof. Underwood, is that there may be “an underpinning biological relationship” in some people with headaches and back pain.

“There may be something in the relationship between how people react to the pain,” he says, “making some people more sensitive to both the physical causes of the headache, particularly migraine, and the physical causes in the back, and how the body reacts to that and how you become disabled by it.”

Such a cause could be a target for treatment. In fact, the team thinks that a joint approach may be best.

Right now, drugs are available to treat chronic headaches. Some people try a range of holistic remedies too. Back pain, meanwhile, may require a combination of exercise and psychological therapy.

Ensuring that people with both disorders receive appropriate support and management techniques could well help their quality of life. A combined treatment method could also provide a financial benefit by reducing the number of medication prescriptions.

“There is a need for doctors and other healthcare professionals to think that when treating one issue, [they should] ask about the other and tailor the treatment accordingly.”

Prof. Martin Underwood

“For future research, there’s probably work that needs to be done to understand what the underlying mechanisms behind this relationship are,” he adds.

Man having a back pain over gray background

Onion & Garlic Vs Greasy Cancer

Onions and garlic may protect against breast cancer

New research examines the consumption of onion and garlic among women in Puerto Rico and suggests that the vegetables can significantly reduce the risk of breast cancer.

Onions and garlic are part of the allium genus, along with leeks, chives, and hundreds of other species.

Rich in flavor, with a strong, pungent kick, these “feisty” vegetables may also be able to fight off diseases, such as diabetes, heart disease, and cancer, according to emerging evidence.

In regards to cancer, several studies have specifically explored the links between onion and garlic consumption and the risk of colorectal, stomach, and prostate cancers.

Overall, these studies have found that the more of these vegetables that people consume, the lower their risk of developing these cancers.

However, less extensive research has gone into the link with breast cancer, say researchers led by Gauri Desai, a doctoral candidate in epidemiology at the University at Buffalo (UB), part of The State University of New York.

So, Desai and the team set out to investigate this topic further, looking at a population of women in Puerto Rico. The reasons for choosing this population were twofold. Firstly, “Puerto Rico has lower breast cancer rates, compared to the mainland [United States], which makes it an important population to study,” explains Desai.

Secondly, a condiment called “sofrito,” which consists largely of garlic and onion, is a traditional Puerto Rican sauce that is widely consumed across the island.

The researchers published the results of their findings in the journal Nutrition and Cancer.

Studying onions, garlic, and cancer risk

Desai and the team used hospital and clinic records to identify 314 women aged between 30 and 79 who had breast cancer between 2008 and 2014. The researchers also included 346 control participants who were matched based on age and residential area.

nonmelanoma skin cancer. The researchers used a food frequency questionnaire to enquire about dietary patterns and total onion and garlic intake, which included sofrito consumption.

The team employed unconditional logistic regression to examine the association between onion and garlic intake and breast cancer occurrence, adjusting for factors such as age, education, family history, body mass index, smoking status, and others.

Sofrito linked to 67% lower breast cancer risk

The researchers found an inverse association between moderate and high total onion and garlic consumption and breast cancer cases, compared with low consumption of these vegetables.

Their findings were consistent after the researchers had stratified the results according to menopausal status, suggesting that “High onion and garlic consumption is protective against breast cancer in [the studied] population.”

Specifically, the authors write, “Sofrito intake, when examined alone, was inversely associated with breast cancer; for those consuming sofrito more than once/day, there was a 67% decrease in risk, compared to never consumers.”

“We found that among Puerto Rican women, the combined intake of onion and garlic, as well as sofrito, was associated with a reduced risk of breast cancer.”

Gauri Desai

“Studying Puerto Rican women who consume a lot of onions and garlic as sofrito was unique,” Desai adds, referring to one strength of the research.

Why might onions, garlic lower cancer risk?

Study co-author Jo Freudenheim, Ph.D., chair of epidemiology and environmental health at UB, also comments on the uniqueness of the study, saying, “There is very little research on breast cancer in Puerto Rico.”

“This study was a collaboration between my colleagues here at UB and at the University of Puerto Rico to help us understand why rates there are lower than in the rest of the U.S., and why rates there are continuing to increase, while they are decreasing in the rest of the [U.S.].”

Although the study was observational and cannot explain the mechanisms behind the findings, the researchers suspect that the flavonols and organosulfur compounds abundant in onions and garlic may be responsible for the anticancer effects.

In particular, the S-allylcysteine, diallyl disulfide, and diallyl sulfide in garlic and the alk(en)yl cysteine sulphoxides in onions have shown “anticarcinogenic properties in humans, as well as in experimental animal studies,” says Dr. Lina Mu, an associate professor of epidemiology and environmental health at UB and the study’s senior author.

Some study limitations

However, the authors also recognize some limitations to their research. For instance, they write, “The size of the study was small, particularly for analyses stratified on menopausal status.”

Secondly, the number of people who had never consumed garlic or onion was too small to use as a reference group. Therefore, the low exposure group still consumed some onion and garlic.

For this reason, say the researchers, the results “may have underestimated the true association between garlic and onion intake and breast cancer.”

“Furthermore, there is not a standardized recipe for sofrito, a condiment which is frequently homemade and therefore varies at least somewhat in recipe from person to person,” add the authors. “Hence, we were also not able to estimate the amount of onion and garlic in sofrito.”

“Although the recipe for sofrito varies to some extent, other ingredients, such as bell peppers, tomatoes, cilantro, and black pepper are usually added. Since we did not adjust our models for these ingredients, we cannot be sure that our results were due to the sole effect of onions and garlic.”

KNOW YOUR HEART. 10 Facts about the Cardiovascular system…

The cardiovascular system carries blood and nutrients to the cells of the body. The function of this system has effects on other parts of the body. A nursing student has many facts to learn about the cardiovascular system. Therefore, this article below will start you off with a list of 10 facts about the cardiovascular system that every nursing student should know.

The cardiovascular system or circulatory system consists of the heart, blood and blood vessels. The heart is the pump of the system and sits in the thoracic cavity. The heart sits predominately on the left side. Therefore, approximately two-thirds of the heart is to the left side of the sternum. The blood is a connective tissue. It is the fluid component of the system. The blood is transported to the cells via a network of passageways call the blood vessels.

There are 3 major layers of the heart. The layers are the endocardium, myocardium and the pericardium. The endocardium lines the inner chambers of the heart and the valves. The myocardium makes up the heart wall. The pericardium is the container of the heart. This triple-walled layer protects the heart. Also, the pericardium contains a fibrous layer and a serous layer. The serous layer has two separate layers. These layers are the parietal and visceral layers.

Below is a list of 10 facts about the cardiovascular system that every nursing student should know to help build a foundation of knowledge of the cardiovascular system.

Fact #1: The Cardiovascular System Is A Closed System.

The cardiovascular system is a closed system and also a system which is under pressure. This means if there is a leak in a large vessel it does not drip it sprays, especially a leak on the arterial side.

Therefore, when small leaks occur the system has a method of stopping these leaks. Hemostasis is the system within the blood that stops these leaks. Hemostasis is defined as the stoppage of blood. This system is constantly in action sealing small insults to the system.

Substances contained in the blood assist the process of hemostasis. The blood contains calcium ions and plasma proteins that cause coagulation or clotting within seconds of an injury. These plasma proteins are your clotting factors. (e.g. prothrombin and vitamin K)

Fact #2: The Heart Has Four Chambers.

The heart has four chambers: the right and left atria and the right and left ventricles. The right atrium and right ventricle receive deoxygenated blood from the body. The left atrium and left ventricle receive oxygenated blood from the lungs.

The atria of the heart are mostly reservoirs. The atria only contribute “atrial kick” to the cardiac cycle. Atrial kick or atrial contraction contributes approximately 20% of the volume to ventricular filling.

The ventricles make up the majority of the heart. The ventricles of the heart receive blood from the atrium. They eject blood into the pulmonary system (lungs) and to the systemic circulation (body).

The right side of the heart (ventricle) pumps against a low-pressure system (pulmonary circulation) and the left side of the heart (ventricle) pumps against a high-pressure system (systemic circulation). The left ventricle works harder than all the other chambers because it has to pump against the high pressure of the systemic circulation.

Fact #3: The Heart Has Four Valves.

The right side of the heart contains the tricuspid and pulmonary valves. The left side of the heart contains the bicuspid (mitral) and aortic valves.

The tricuspid and bicuspid (mitral) valves separate the atrium and ventricles.  These valves are also called the atrioventricular or AV valves.  As you would guess the tricuspid valve had three cusps or leaflets and the bicuspid valve has two cusps or leaflets.

The pulmonary valve opens to the pulmonary circulation and the lungs. The aortic valve opens to the systemic circulation. These valves are also called the semilunar valves because of their shape. The pulmonary and aortic valve each has three cusps or leaflets that are shaped like a half moon.

The “Lub-Dub” sound you hear with your stethoscope is the closing of the heart valves. The heart sound S1 is the closure of the tricuspid and bicuspid (mitral) valves. The heart sound S2 is the closure of the pulmonary and aortic valves.

Fact #4: The Heart Valves Operate Due To A Pressure System.

The valves of the heart open and close due to pressure within the system. During the cardiac cycle, the atria fill with blood. As the atria fill, the pressure in the atria eventually exceeds the pressure in the ventricles. When this happens the tricuspid and bicuspid (mitral) valves open and blood flows into the ventricles.

As blood flows into the ventricles the pressure begins to rise. Eventually, the pressure in the ventricles exceeds the pressure in the atria. This pressure that builds up in the ventricles is attributed to filling volumes of the ventricles. At this time the pulmonary valve and aortic valves close.

Following the isovolumetric contraction of the ventricles, the pulmonary and aortic valves open. Then, blood is ejected into the pulmonary circulation and systemic circulation.

Both the left and right atria fill at the same time and both the left and right ventricles fill at the same time.

Fact #5: Blood Vessels Are The Vascular Portion Of The Cardiovascular System.

Blood vessels include arteries and veins. When the blood leaves the heart it flows into the arteries. Arteries carry oxygenated blood from the heart to systemic circulation. The arteries divide into the smaller arterioles. Next, the arterioles divide into the even smaller capillary network on the arterial side. This arterial capillary network feeds the cells.

The veins divide into smaller venules. The venules divide into the smaller capillary network of the veins. Starting at the capillary network, the capillaries on the vein side pick up carbon dioxide and waste products which travel to the venules and then to the veins and back to the heart.

Blood flows from the heart to the arteries to the arterioles to the arterial capillary network. Then blood moves from the vein capillary network to the venules to the veins and back to the heart.

Fact #6: Blood Vessels Can Constrict And Dilate Having An Effect On Blood Pressure.

The sympathetic nervous system controls the blood vessels. Blood vessels have the ability to constrict or dilate with signals from the sympathetic nervous system.

Vasoconstriction and vasodilation occur when the blood vessels dilate and constrict. Vasoconstriction causes a decrease in the inner diameter of the blood vessel. Vasodilation causes an increase in the inner diameter of the blood vessel.

Blood vessels have an effect on blood pressure.

Remember, blood pressure is the measure of the pressure exerted on the walls of the blood vessel. The greater the pressure within the blood vessel the higher the blood pressure measurement. The lower the pressure within the blood vessel the lower the blood pressure measurement. The systolic pressure is the maximum pressure against the wall of the blood vessel and the diastolic pressure is the recoil.

A change in the diameter of the blood vessels causes changes in the blood pressure. When the blood vessels constrict (vasoconstriction), the blood pressure is higher. This is because the decrease in the diameter of the blood vessel increases the pressure exerted on the lumen. When the blood vessels dilate (vasodilation), the blood pressure is lower. This is because the increase in the diameter of the blood vessel decreases the pressure exerted on the lumen.

Fact #7: The Ventricles Contract Due To Electrical Pathways.

The ventricles contract due to the cardiac conduction system (electrical pathways). The cardiac conduction system consists of the SA or sinoatrial node, the AV or atrioventricular node, the bundle of HIS, the right bundle branch, the left bundle branch and the Purkinje fibers.

The SA node is known as the pacemaker of the heart. It is located on the wall of the right atrium near the entrance to the superior vena cava. The AV node receives electrical impulses from the SA node and transfers them to the bundle of HIS. The bundle of HIS divides into the left and right bundle branch. Impulses travel to each bundle branch down the septum to the Purkinje fibers. The Purkinje fibers innervate the ventricles. The atria of the heart contract before the ventricles.

Fact #8: The Cardiac Cycle Consist of Diastole and Systole.

First of all, the cardiac cycle consists of phases called diastole and systole. These terms should not be confused with the terms diastolic and systolic which refer to blood pressure. These terms are related but not the same. Also, when we talk about diastole and systole we are referring to the ventricles. (e.g. ventricular diastole, ventricular systole)

During systole, when the heart contracts, blood is ejected from the ventricles.  The right ventricle ejects blood into the pulmonary circulation (lung) and left ventricle ejects blood into the systemic circulation (body).

During diastole, the heart is at rest and the ventricles are filling. When you think of diastole think of Die, Done, Doing nothing (but filling-ventricular filling) and systole is the opposite.

Fact #9: The Cardiac Cycle Moves Blood Through The Heart.

The phases of the cardiac cycle are diastole and systole. Diastole is divided into early, mid, and late diastole. Systole is divided into early and late systole. Remember, when you think of diastole and systole, think of ventricular diastole and systole. Let’s take a quick walk through diastole and systole. It is easier to begin at diastole.

Early Diastole

Early diastole begins following the closure of the pulmonary and aortic. The tricuspid and bicuspid (mitral) valves are open. During early diastole, the ventricles are rapidly filling. The pressure in the ventricles is beginning to increase.

Mid Diastole

During mid-diastole, the ventricles continue filling but slower. The pressure in the ventricles continues to rise but they still have not exceeded the pressure in the atria. The tricuspid and bicuspid (mitral) valves are still open. The pulmonary and aortic valves close.

Late Diastole

During late diastole, the atrium contract to finish emptying. The atrial contraction is the “atrial kick”. This accounts for approximately 20% of ventricular filling.

Early Systole

At the beginning of early systole, the pressure in the ventricles is greater than the pressure in the atrium. At this time you have an isovolumetric contraction. The ventricular filling and the isovolumetric contraction causes the tricuspid and bicuspid (mitral) to close. This causes the “Lub” sound. The “Lub” is the S1 heart sound.

Late Systole

During late systole, you have ventricular ejection.  The blood is ejected into the pulmonary circulation and systemic circulation when the pulmonary and aortic valves are opened. The blood is ejected by the ventricles fast at first then the blood flow slows.

This puts us back to the beginning of early diastole in which the pulmonary and aortic valves close and the tricuspid and mitral valves are open. When the pulmonary and aortic valves close they make the “Dub” sound. The “Dub” is the S2 heart sound. The ventricles are filling during this period.

So, between S1 and S2 you have systole. Between the S2 and the next S1, you have diastole.

Fact #10: There Is A Relationship Between The Cardiac Cycle And Blood Flow.

First of all, the cardiac cycle and blood flow through the heart are very similar. If you understand one you will understand the other. With the cardiac cycle, we move from the top to the bottom (atria to ventricles). With blood flow through the heart, we will move from the right to the left.

Right Atrium

On the venous or return side, deoxygenated blood travel from the venous capillary beds to the venule. Blood continues to travel to the large veins called the superior vena cava and the inferior vena cava. These veins transport blood from the top and bottom of the body. They return blood to the right side of the heart into the right atrium. Then, the right atrium fills causing increased pressure that is eventually greater than the pressure in the right ventricle. This places pressure on the tricuspid valve.

Right Ventricle

The pressure continues to rise until it is greater in the right atrium and causes the tricuspid valve to open. The right ventricle begins to fill. The right atrium contracts causing the final filling of the right ventricle.

As a result of electrical stimulation, the right ventricle contracts. The tricuspid valve closes. The right ventricle ejects blood causing the pulmonary valve to open. Blood enters the pulmonary circulation and moves to the lungs via the pulmonary artery. The blood travels through the capillary bed of the lung. After the blood is oxygenated it returns to the left side of the heart.

Left Atrium

On the left side of the heart, blood travels from the lung to the left atrium via the pulmonary vein. The left atrium begins to fill causing the pressure to increase in the left atrium. The increased pressure is eventually greater in the left atrium producing pressure on the bicuspid (mitral) valve.

Note: If you note above, the pulmonary artery carries deoxygenated blood to the lungs and the pulmonary veins carry oxygenated blood to the left atrium. The pulmonary artery is the only artery in the body that carries deoxygenated blood and the pulmonary vein is the only vein in the body that carries oxygenated blood.

Left Ventricle

The pressure continues to rise until it is greater in the left atrium than the left ventricle and causes the bicuspid (mitral) valve to open. The left ventricle begins to fill. The left atrium contracts causing the final filling of the left ventricle.

Again due to the electrical stimulation, the left ventricle contracts. The bicuspid (mitral) valve closes and the aortic valve opens ejecting blood into the systemic circulation via the aorta. The blood travels throughout the body via the arteries, arterioles to the capillary bed where the process continues.

In conclusion, the list of 10 facts about the cardiovascular system above is by no means all-inclusive. Hopefully, this list will help build a foundation useful in studying the cardiovascular system. Hence, these simple facts will give you a greater understanding of not only how the system works but how it can affect other parts of the body.