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Tuesday, 15 December 2015

There's an app for that: An easy, fast and reliable way to record causes of death

Researchers have developed a revolutionary new app to capture accurate global cause of death data on tablets and mobile phones.
Worldwide, two in three deaths - 35 million each year - are unregistered. Around 180 countries that are home to 80 per cent of the world's population do not collect reliable cause of death statistics.
IMAGEThe app is the result of a decade-long global collaboration, led by the University of Melbourne and researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
A new paper, published today in BMC Medicine, explains the process behind the app. The research team redesigned a short 'verbal autopsy' questionnaire and tested it in India, the Philippines, Mexico, and Tanzania. The app was then field-tested in China, Sri Lanka and Papua New Guinea.
Family members of the deceased were given surveys in hand-held devices. A computer then analysed the data to make a diagnosis, bypassing the need to rely on doctors to do this work.
University of Melbourne Laureate Professor Alan Lopez led the study.
Prof Lopez said in the age of big data, we still know next to nothing about what kills people in poor countries.
"Without accurate cause of death information, we can't monitor disease and injury trends, we can't keep track of emerging health problems and we don't have any markers to show us whether programs and policies are actually working.
"So if you live in a country where no-one is dying from malaria, then why are you pouring money into malaria-prevention programs? And conversely, if people are dying from lung cancer, why aren't you investing in tobacco control?
"Up-to-date, reliable information on what people are dying from and at what age, is really important for policies to prevent premature death. Our app provides a way to do this, quickly, simply, cheaply and effectively, in real time, with the power of technology."
IHME Director Dr Christopher Murray added: "Verbal autopsy research has shown that computer models are just as accurate as physicians in making diagnoses based on verbal autopsy data, at a fraction of the cost.
"In countries with scarce data on causes of death, policymakers need this information to better understand local disease burden and effectively allocate resources."
The problem in many regions around the world is that only registered doctors are qualified to determine a cause of death, but the process is expensive, time-consuming and can be unreliable.
Computers can reliably provide a diagnosis by linking symptoms with a specific cause of death in real-time. The instant provision of information overcomes what can be a 10-year lag between the death and the doctor's report.
"Relying on doctors to collect information about causes of death in rural populations is not helpful," Prof Lopez said.
"Our method involves data collection by health workers, registrars and village officials, who use the app to administer the surveys.
"The data is fed into a computer, which makes a diagnosis. It requires very minimal training. This way doctors are free to do what they do best, which is providing essential medical care to their communities.
"Governments now have a way to gather data to inform their health policies, that costs nothing and can be provided in real time. Even if you're sitting out in the remote bush in Africa and you can do this. Anywhere you've got power, it's possible."

Can natural remedies jeopardize cardiovascular health?

Chinese physicians report on the case of a woman who presented with aconitine-induced cardiovascular symptoms. Their report, published in theCanadian Journal of Cardiology, warns that the use of this natural ingredient may lead to severe poisoning.
A 45-year-old Chinese woman was diagnosed with a severe heart-rhythm disorder, bidirectional ventricular tachycardia (BVT), associated with aconitine poisoning. BVT is a rare form of tachycardia (characterized by a resting heart rate over 100 beats per minute) and a distinct pattern of ECG waves on presentation.
The patient's husband reported that she had drunk about 50 milliliters of a medicinal liquid about 30 minutes before she developed a sudden drop in blood pressure and then lost consciousness. The woman had no history of previous heart-rhythm problems and there was no family history of unexpected sudden death or fatal accidents. On examination she had a heart rate of 150 beats per minute and her blood pressure was 50/30. Her skin was cool, moist, and cyanotic. Treatment with the antiarrhythmic agents amiodarone, metoprolol, lidocaine, and potassium chloride was ineffective. An abdominal ultrasound showed marked gastric retention. A gastric tube was used to suction out the contents of her stomach. After two hours, the patient's BVT ceased and her circulation improved.
Investigation revealed that the patient's blood was positive for aconitine, a substance produced by the Aconitum plant, also known as devil's helmet or monkshood. Although well-known for its highly toxic properties, aconitine is the primary ingredient of the traditional Chinese medicine known as Fuzi, a remedy made from the processed lateral roots ofAconitum carmichaeli Debx. It is widely distributed in the southwest provinces of China and is used in small doses for its anti-inflammatory and pain-relieving effects.
"Management of potentially lethal ventricular tachyarrhythmia associated with aconitine poisoning presents a therapeutic challenge. In a previously published case, amiodarone was effective in suppressing the BVT. However, in our patient, both lidocaine and amiodarone were ineffective," explained lead author Zhong Yi, MD, PhD, of the Aerospace Center Hospital, Beijing, People's Republic of China.
"The public should be warned of the risk of severe poisoning that can accompany traditional Chinese medicinal usage of Fuzi," Dr. Yi concluded.
Commenting on the report, P. Timothy Pollak, MD, PhD, FRCPC, of the Department of Medicine at the University of Calgary, Alberta, cautioned that "not all products of Mother Nature are free of harm. This case report reminds us that aconitine is not the only naturally derived substance that can cause potentially lethal ventricular tachyarrhythmias, including BVT. The report also demonstrates the human tendency to think that if a little is good, more must be better."
Dr. Pollak advises clinicians to be aware of what their patients are taking and be prepared to discuss alternative remedies, at least at a basic level. "Dodging the discussion can only lend credibility to any patient suspicions that as a practitioner of Western medicine, you have been denied the secrets of alternative remedies or are hiding them for ulterior motives. This report serves as a timely illustration that alternative remedies do have implications for the practice of cardiology that cannot be ignored."

Transcendental Meditation and lifestyle modification increase telomerase, new study finds

A new study published in PLOS ONE found that the Transcendental Meditation technique and lifestyle changes both appear to stimulate genes that produce telomerase, an enzyme that's associated with reduced blood pressure, cardiovascular disease, and mortality.
Specifically, these approaches were found to activate two genes that code for telomerase, which adds molecules to the ends of chromosomes, or telomeres, protecting them from deteriorating.
May explain mechanism for known health benefits
"The finding that telomerase gene expression is increased, and that this is associated with a reduction in blood pressure in a high-risk population, suggests that this may be a mechanism by which stress reduction improves cardiovascular health," said Robert Schneider, MD, FACC, coauthor of the study.
Earlier research on the Transcendental Meditation technique found lower rates of high blood pressure, heart attack, stroke, and death, as well as slowing of biological aging. The new study examined what was happening at the level of DNA, showing that the Transcendental Meditation technique increases telomerase gene expression and suggesting that this may contribute to the cardiovascular and aging benefits.
Both groups show improvement after 16 weeks
For this pilot trial, the subjects included 48 men and women with high blood pressure who were recruited and studied at Howard University Medical Center. Half were assigned to a group that learned the Transcendental Meditation technique and received a basic health education course. The other half were assigned to a group that focused on achieving significant lifestyle modifications such as weight reduction, reducing salt intake, engaging in regular physical activity, and moderating alcohol. They also participated in support groups and group exercises.
After 16 weeks, both groups showed significant increases in telomerase gene expression and reductions in blood pressure. There was no significant difference between the changes in the two groups. The results also showed that the lifestyle modification group made a larger number of changes in their lifestyle behaviors.
"These findings are very encouraging for prevention," said Dr. Schneider, director of the Institute for Natural Medicine and Prevention at MUM. "They show that both the Transcendental Meditation technique and active lifestyle modification can contribute to heart health."
Coauthor Otelio Randall, MD at Howard University College of Medicine concluded, "This pilot study in African Americans suggests stress reduction and lifestyle modifications may reduce blood pressure with an increase in telomerase."
Encouraging findings for heart health

"The result is valuable new information, relevant both to cardiovascular disease and to the molecular mechanisms involved in Transcendental Meditation," said John Fagan, professor of molecular biology at Maharishi University of Management and senior author on the study.
Source:Plos one

Suffering With Arthritis? Do Yoga to Soothe Your Aching Joints and Get Instant Relief

Suffering With Arthritis? Do Yoga to Soothe Your Aching Joints and Get Instant ReliefThe randomized trial of people with two common forms of arthritis has found that yoga can be safe and effective for people with arthritis. Johns Hopkins researchers report that 8 weeks of yoga classes improved the physical and mental well-being of people with two common forms of arthritis, knee osteoarthritis and rheumatoid arthritis.

There's a real surge of interest in yoga as a complementary therapy, with 1 in 10 people in the U.S. now practicing yoga to improve their health and fitness, says researcher Susan J. Bartlett, adding that yoga may be especially well suited to people with arthritis because it combines physical activity with potent stress management and relaxation techniques and focuses on respecting limitations that can change from day to day.

Arthritis, the leading cause of disability, affects 1 in 5 adults, most of whom are under 65 years of age. Without proper management, arthritis affects not only mobility, but also overall health and well-being, participation in valued activities, and quality of life. There is no cure for arthritis, but one important way to manage arthritis is to remain active.

Yet up to 90 percent of people with arthritis are less active than public health guidelines suggest, perhaps due to arthritis symptoms such as pain and stiffness, but also because they are unsure of how best to remain active.

The researchers have developed a checklist to make it easier for doctors to safely recommend yoga to their patients, says researcher Clifton O. Bingham, suggesting that people with arthritis who are considering yoga should talk with their doctors about which specific joints are of concern, and about modifications to poses. The study is published in the Journal of Rheumatology.

Source: ANI

Practicing Yoga can Improve a Man's Parenting Skills

New research suggests that practicing yoga, which can improve physical and mental health, may also help men become better fathers.

The three-year study with 14 different groups of male inmates took place at Chelan County Regional Jail in Wenatchee, Washington. The program was advertised among the jail population. Volunteers, who had to be parents of young children and pass a security screening, were recruited. 

"We would have a class on a specific topic, like child development or setting limits," said researcher Jennifer Crawford from Washington State University. "That would last about an hour, then a yoga instructor would come in and give a guided yoga class," Crawford noted. 

The results showed that inmates demonstrated being more aware and accepting of their vulnerability and responsiveness to children, among other benefits. The instructor started every class with a centering exercise, then taught simple sequences that focused on standing poses; more complicated poses were not used due to potential health issues among the inmates. 

Outside of the class setting, the inmates did journaling exercises such as writing about their own upbringing or ways they communicate with their children. "Yoga can be physically demanding, and the initial responses we got from the participants confirmed that," Crawford said. 

"I believe the yoga practice helped participants become ready to learn and increased their willingness to try new ideas, absorb new information and begin to apply these in their lives," Crawford noted. The study was published in the California Journal of Health Promotion.

Source: IANS

Low Levels of Vitamin D may Increase Stress Fracture Risk

 Low Levels of Vitamin D may Increase Stress Fracture RiskActive individuals who enjoy participating in higher impact activities may need to maintain higher vitamin D levels to reduce their risk of stress fractures, report investigators in The Journal of Foot & Ankle Surgery, as vitamin D plays a crucial role in ensuring appropriate bone density.
The role of vitamin D in the body has recently become a subject of increasing interest owing to its many physiologic effects throughout multiple organ systems. Vitamin D is an essential nutrient that can behave as a hormone. It is obtained through diet and through the skin when exposed to the sun's rays. It is essential for bone development and remodelling to ensure appropriate bone mass density. Low levels of vitamin D can lead to osteoporosis, osteomalacia, decreased bone mineral density, and risk of acute fracture.
 Investigators tested the serum concentration of 25(OH)D, which is used to determine vitamin D status, in patients with confirmed stress fractures. "By assessing the average serum vitamin D concentrations of people with stress fractures and comparing these with the current guidelines, we wanted to encourage a discussion regarding whether a higher concentration of serum vitamin D should be recommended for active individuals," explained lead investigator Jason R. Miller, DPM, FACFAS, Fellowship Director of the Pennsylvania Intensive Lower Extremity Fellowship, foot and ankle surgeon from Premier Orthopedics and Sports Medicine, in Malvern, Pennsylvania, and Fellow Member of the American College of Foot and Ankle Surgeons.

The investigators reviewed the medical records of patients who experienced lower extremity pain, with a suspected stress fracture, over a three-year period from August 2011 to July 2014. All patients had x-rays of the affected extremity and were then sent for magnetic resonance imaging (MRI) if no acute fracture had been seen, yet concern for the presence of a stress fracture remained based on the physical examination findings. Musculoskeletal radiologists independently reviewed all the MRI scans, and the investigators then confirmed the diagnosis of a stress fracture after a review of the images. 

The serum vitamin D level was recorded within three months of diagnosis for 53 (42.74%) of these patients. Using the standards recommended by the Vitamin D Council (sufficient range 40 to 80 ng/mL), more than 80% of these patients would have been classified as having insufficient or deficient vitamin D levels. According to the standards set by the Endocrine Society (sufficient range 30 to 100 ng/mL), over 50% had insufficient levels. 

"Based on these findings, we recommend a serum vitamin D level of at least 40 ng/mL to protect against stress fractures, especially for active individuals who enjoy participating in higher impact activities," explained Dr. Miller. "This correlates with an earlier study of 600 female Navy recruits who were found to have a twofold greater risk of stress fractures of the tibia and fibula with a vitamin D level of less than 20 ng/mL compared with females with concentrations above 40 ng/mL 

"However, vitamin D is not the sole predictor of a stress fracture and we recommend that individuals who regularly exercise or enjoy participating in higher impact activities should be advised on proper and gradual training regimens to reduce the risk of developing a stress fracture," he concluded. 

Source: Eurekalert

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