New research suggests that psychological resilience, ie having attitudes and behaviours that help people bounce back after stressful challenges, may help older individuals with type 2 diabetes to experience fewer hospitalisations and have better physical functioning, lower disability, better mental quality of life, and a lower likelihood of becoming frail.
The study, published in published in theJournal of the American Geriatrics Society, recruited 3199 participants, average age 72.2 years, 61% female, 61% white, and followed them for 14 years. The association of resilience with some metrics (grip strength and self-reported disability) varied based on recent hospitalisation history, and results suggested that some associations may differ based on race/ethnicity.
“This study suggests that individuals who report being psychologically resilient also report fewer aging-related concerns,” said lead author KayLoni L. Olson, PhD, of the Warren Alpert Medical School of Brown University. “This study is preliminary but points to the potential role of psychological resilience in helping individuals feel better mentally and physically, which can ultimately enhance their later years of life.”
For certain patients with vomiting and nausea in the emergency department (ED), haloperidol may be a better alternative to the usual ondansetron, according to a small study presented at the American College of Emergency Physicians annual meeting.
“[Haloperidol] is definitely a drug that’s going to help young patients with benign abdomens who come in with vomiting and generalised abdominal pain,” study presenter Jessica McCoy, MD, told MedPage Today.
Dr McCoy presented data showing that, at 90 minutes, median abdominal pain Visual Analogue Scale (VAS) score fell from 5 to 0 in the patients who received haloperidol compared with a VAS score drop from 6 to 3.5 in the ondansetron group.
Also at 90 minutes, median nausea VAS score fell from 7 to 0.5 in the haloperidol group versus 6 to 3.5 in the ondansetron group.
Of 48 patients (ages 18-55) who were included and completed the study, 22 were randomised to receive 2.5mg of intravenous haloperidol (half the usual dose) and 26 to receive 4mg of IV ondansetron.
Dr McCoy said despite concern over haloperidol prolonging the QT interval, no sign of a difference between the drugs was found. Among the 29 cannabis users in the study, haloperidol was not found to be superior at 90 minutes post-treatment, she said.
Halving the dose of haloperidol seemed to prevent common side effects of anxiety, sedation, and restlessness, Dr McCoy noted.
Adverse effects, which resolved by the time of discharge from the ED, included three cases of anxiety/restlessness and one case of tongue swelling in the haloperidol group and single cases of restlessness, sleepiness, and irritated throat in the ondansetron group.
Nausea and vomiting is commonly reported by ED patients, one of the top five complaints in the ED, and a diagnosis may be elusive if urgent treatment is not needed, she explained. “There’s this whole list of things it could be that make you feel lousy for a little bit but get better on their own.”
Increased chronic cannabis use, meanwhile, has caused more cases of nausea and vomiting, she said.
ED physicians often use ondansetron, developed for nausea in chemotherapy patients, Dr McCoy said. However, ondansetron “doesn’t work great. And it really wasn’t developed for people who were actively vomiting.”
The new study follows on from Dr McCoy’s previous research demonstrating the benefit of haloperidol for severe benign headache. She noted that the new study is small and was halted at the interim analysis due to COVID. At that time, ED waits were six or seven hours long, she said, and some patients with nausea and vomiting gave up and went home.
Dr McCoy noted that the ED physicians at her institution continue to turn to alternatives to ondansetron such as haloperidol in appropriate cases, especially in patients with anxiety. Haloperidol, however, is not appropriate, she cautioned, for more complex cases such as patients with rigid abdomens, possible dissections, or who have a need for surgery.
Like ondansetron, haloperidol is inexpensive, she added. “I hope [the new research] spurs more interest in studying this drug and its pain-relieving properties.”
A study published in the Journal of Orthopaedic Research showed that physical activity levels may impact adolescents’ and young adults’ leg alignment during development, as measured by magnetic resonance imaging (MRI) scans.
The study included 57 elite male soccer players compared with 34 male and 34 female controls aged 11–21 years. Outcome measures were the hip knee angle (HKA), medial proximal tibial physeal angle (MPTPhyA), lateral distal femoral physeal angle (LDFPhyA) on full leg length MRI scans, and a physical activity questionnaire score.
Using magnetic resonance imaging scans, physical activity levels were associated with the development of varsus or ‘knock knees’, an abnormal leg alignment, which may represent a physiological adaptation to load where the shin bone meets the knee.
“Our study suggests that abnormal leg alignment, a risk factor for future injury and osteoarthritis, develops in early adolescence due to high activity levels,” said corresponding author Scott Fernquest, DPhil, of the University of Oxford. “Modifying activity levels during this critical period of growth may prevent the development of abnormal leg alignment. We hope our findings lead to further research investigating this possibility.”
Scientists have developed a variety of games designed to boost older adults’ cognitive capacity. Co-creator Professor Adam Gazzaley, MD, PhD, said the games can be an “experiential medicine”. The games adapt to the players’ skill on the fly, and were shown to confer benefits on many important cognitive processes such as short-term memory, attention and long-term memory.
Each game uses adaptive closed-loop algorithms that Dr Gazzaley’s lab pioneered in the widely cited 2013 Neuroracer study published in Nature, which first demonstrated it was possible to restore diminished mental faculties in older people with just four weeks of training on a specially designed video game. The most recent game, which uses drumming, is described in in PNAS.
Watch a short video showing how the games Neuroracer and Body Brain Trainer, developed by the Neuroscape Center, improve cognitive function for multitasking and working memory, and can even be beneficial for conditions like ADHD, Parkinson’s, and multiple sclerosis.
These algorithms get better results than commercial games by automatically adjusting in difficulty according to the players’ skills. The games using these algorithms recreate common activities, such as driving, exercising and playing a drum, and use the skills each can engender to retrain cognitive processes that decline with age.
“All of these are taking experiences and delivering them in a very personalised, fun manner, and our brains respond through a process called plasticity,” said Prof Gazzaley at the UCSF Weill Institute for Neurosciences and who is founder and executive director of Neuroscape. “Experiences are a powerful way of changing our brain, and this form of experience allows us to deliver it in a manner that’s very accessible.”
The lab’s most recent invention is a musical rhythm game, developed in consultation with drummer Mickey Hart, that not only taught the 60 to 79-year-old participants how to drum, but also improved their ability to remember faces.
The eight-week program used visual cues to train people how to play a rhythm on an electronic tablet, with an algorithm matching difficulty to the player’s ability. The cues disappeared over time, forcing the players to memorise the rhythmic pattern.
When the participants were tested at the end to see how well they could recognise unfamiliar faces, electroencephalography (EEG) data showed increased activity in a part of the brain on the right side (the superior parietal lobule) that is involved both in sight reading music and in short-term visual memory for other tasks. The researchers said the data indicate that the training improved how people bring something into memory and then take it back out again when they need it.
A second game, the Body Brain Trainer, published recently in NPJ Aging, improved blood pressure, balance and attention in a group of healthy older adults with eight weeks of training, as well as a key signature of attention that declines with age. The game also included a feedback mechanism.
“We had people wearing a heart rate monitor, and we were getting that heart rate data and feeding it into the game,” said Joaquin A. Anguera, PhD, associate professor of neurology at UCSF and director of the Clinical Division at Neuroscape. “If they weren’t working hard enough, the game got harder.”
Neuroscape published the results of a third study last year in Scientific Reports on a virtual reality spatial navigation game called Labyrinth that improved long-term memory in older adults after four weeks of training.
“These are all targeting cognitive control, an ability that is deficient in older adults and that is critical for their quality of life,” Prof Gazzaley said. “These games all have the same underlying adaptive algorithms and approach, but they are using very, very different types of activity. And in all of them we show that you can improve cognitive abilities in this population.”
A world-first study published in the journal Diabetes, Obesity and Metabolism, has uncovered an association between metabolism and dementia-related brain measures, providing valuable insights about the disease.
Analysing UK Biobank data from 26 239 people, University of South Australia researchers found that those with obesity related to liver stress, or to inflammation and kidney stress, had the most adverse brain findings.
The study measured associations of six diverse metabolic profiles and 39 cardiometabolic markers, using MRI brain scan measures of brain volume, brain lesions, and iron accumulation, to identify early risk factors for dementia.
Participants with metabolic profiles associated with obesity were more likely to have adverse MRI profiles showing lower hippocampal and grey matter volumes, greater burden of brain lesions, and higher accumulation of iron.
UniSA researcher, Dr Amanda Lumsden, says the research adds a new layer of understanding to brain health.
“Dementia is a debilitating disease that affects more than 55 million people worldwide,” Dr Lumsden said.
“Understanding metabolic factors and profiles associated with dementia-related brain changes can help identify early risk factors for dementia.
“In this research, we found that adverse neuroimaging patterns were more prevalent among people who had metabolic types related to obesity.
“These people also had the highest Basal Metabolic Rate (BMR) -how much energy your body requires when resting in order to support its basic functions — but curiously, BMR seemed to contribute to adverse brain markers over and above the effects of obesity.”
Senior investigator Professor Elina Hyppönen said that the finding presents a new avenue for understanding brain health.
“This study indicates that metabolic profiles are associated with aspects of brain health. We also found associations with many individual biomarkers which may provide clues into the processes leading to dementia,” said Prof Hyppönen.
“The human body is complex, and more work is now needed to find out exactly why and how these associations arise.”
A 3D map of the islets in the human pancreas. Source: Wikimedia
A meta-analysis of molecular studies found a strong link between enterovirus infection and type 1 diabetes. Across 48 abstracts on the topic, people with type 1 diabetes were nearly eight times more likely to have an enterovirus infection than those with normal pancreatic function, according to a presentation at the European Association for the Study of Diabetes (EASD) meeting.
For this review, researchers examined 56 studies using molecular methods to identify enterovirus infection by looking for viral nucleic acid or protein in a human clinical sample.
People with islet autoimmunity were twice as likely to have had an enterovirus infection at any point in time, based on data from 18 studies.
Subgroup analysis of people who were diagnosed with the enterovirus within the past month found 16.22-fold higher odds of recent-onset type 1 diabetes, based upon 28 studies.
“This is very recent onset type 1 diabetes, and that was the highest risk group that we detected,” reported Sonia Isaacs, PhD candidate, of University of New South Wales in Australia, during a press conference.
Looking more closely at other subgroup criteria revealed associations.
First, those who had any islet autoimmunity and eventually progressed to full-blown type 1 diabetes were over five times more likely to have an enterovirus infection than controls; this was a higher risk than those who had islet autoimmunity and never progressed to type 1 diabetes. When it came to timing, only infections at the time of or after islet autoimmunity seroconversion carried higher risk (OR 5.1), whereas the increased risk wasn’t significant for infections prior to seroconversion.
Isaacs noted that those with a familial risk of type 1 diabetes (ie in a first-degree relative) also had a much higher risk for an enterovirus infection (OR 9.8), higher than the subgroup recruited for having a high-risk HLA gene. Those who had the high-risk HLA gene and a familiar risk of type 1 diabetes had 141.1-times higher odds of prior enterovirus infection.
Having several enterovirus infections was also linked with a doubled chance of islet autoimmunity.
Specific type of enterovirus linked to risk of type 1 diabetes included:
Enterovirus A: OR 3.7
Enterovirus B: OR 12.7
Enterovirus C: OR 13.8
“This is where the coxsackieviruses come from,” Isaacs pointed out. “Coxsackievirus B1 and B4 stood out.”
Isaacs suggested the possibility of enterovirus vaccinations and antivirals as a prevention strategy for type 1 diabetes.
Newly discovered biological changes in mothers who suffer postpartum depression may help explain the condition, yield long-sought treatments and let doctors identify those at risk even before their babies are born. The findings were published in Molecular Psychiatry.
Postpartum depression strikes up to 20% of new mothers, and roughly 20% of maternal deaths after childbirth are from suicide. Postpartum depression can cause anxiety and irritability, feelings of self-doubt and difficulty bonding with the baby, cognitive impairment, and interfering with sleeping and eating. For the child, maternal postpartum depression can lead to cognitive, emotional and social development problems.
Risk factors for postpartum depression are thought to include the mother’s age at childbirth, diabetes and prior history of mental health issues. But the new discovery suggests a previously unknown biological contributor: an impairment of the body’s ability to clean up old genetic material and other cellular debris.
“The finding that cells aren’t cleaning out old proteins and cellular debris, called autophagy, occurs before women develop depression symptoms, indicating that it could be part of the disease process,” explained Jennifer L. Payne, MD, director of the Reproductive Psychiatry Research Program at the University of Virginia School of Medicine. “There are several medications that promote autophagy in cells, so this finding might open the door to new treatments and to identification of women at risk of postpartum depression before they become ill.”
Understanding Postpartum Depression
Dr Payne and colleagues wanted to determine if ‘extracellular RNA communication’, a newly discovered form of communication among cells, might contribute to postpartum depression. Extracellular RNA communication is heightened during pregnancy and is critical in embryo implantation and in the body’s inflammatory response afterward.
The researchers analysed blood plasma samples from 14 research participants with and without postpartum depression, collected during and after their pregnancies. The researchers found that extracellular RNA communication in immune cells was altered extensively in women who suffered postpartum depression. Further, they determined that this “large and consistent” change significantly limited the women’s bodies’ ability to perform important cellular cleanup – suggesting a potential biological cause for their depression.
“Deficits in autophagy are thought to cause toxicity that may lead to the changes in the brain and body associated with depression,” Dr Payne said. “We have never fully understood the biological basis for postpartum depression, and this finding gets us closer to an understanding.”
Psychostimulants are commonly used as treatments of psychiatric disorders or to improve cognition, but the benefits of these drugs are not the same for everyone, as their effects vary greatly both across individuals and within the same patient. This variability hinders treatment strategies in psychiatry, and the reasons behind it are still not clear. Now, a study published in PNAS, researchers reported advances in understanding why this is.
One such psychostimulant is methylphenidate (Ritalin), which is used to treat attention deficit hyperactivity disorder (ADHD), and has significant variability in efficacy. In addition to treating ADHD, methylphenidate is widely used by healthy people for its cognition-improving effects. Methylphenidate acts in part by increasing levels of dopamine, a neurotransmitter involved in the brain’s reward system.
The researchers tested the hypothesis that the effects of methylphenidate on learning based on reward or punishment depend on the baseline levels of dopamine in a person’s brain. To test this, one hundred young healthy adults received (in different sessions) methylphenidate, sulpiride (a medication used to treat symptoms of schizophrenia that acts more selectively on dopamine receptors), or a placebo, and were later scanned with functional magnetic resonance imaging (fMRI) during a reward/punishment reversal learning task. In this task, participants learned to predict whether a picture (of a face or a landscape) that is selected by the computer is followed by reward or punishment. A reward outcome consisted of a green smiley and a + €100 sign. A punishment consisted of a red sad smiley and a – €100 sign. Whether the face or the landscape was associated with reward or punishment changed frequently in the task, so to perform well people had to continue to pay attention and flexibly update their behaviour based on prediction errors.
The researchers observed that the degree to which both methylphenidate and sulpiride improved reward compared with punishment learning depends on baseline dopamine synthesis capacity. These learning effects were also were accompanied by increased activity in the striatum, a dopamine-rich region deep inside the brain, and also by increased specificity of the activity in regions of the cortex near the back of the brain that are specialised for processing faces and landscapes.
Their findings provide strong support for two hypotheses related to methylphenidate: First, that dopamine enhances task-relevant cortical signals by acting on the striatum. Second, that differences between individuals in dopamine synthesis capacity in the striatum explain the variability in the drug’s cognitive effects.
A small study has shown that young adults sleeping using weighted blankets had increased levels of the hormone melatonin, which increases in response to darkness, and which some research suggests promotes sleep. The findings are published in the Journal of Sleep Research.
Weighted blankets have been suggested to ease insomnia in humans in previous research but underlying mechanisms are not fully understood. To address this, Uppsala University researchers recruited 26 young men and women to examine if the bedtime use of a weighted blanket increases the production of sleep-promoting and anti-stress hormones like melatonin and oxytocin. They also investigated whether the bedtime use of a weighted blanket (12% of participants’ body weight) reduced the activity of stress systems in the body. Saliva samples were collected from participants while they were covered with either a weighted or a light blanket to measure melatonin, oxytocin, cortisol, and sympathetic nervous system activity.
“Using a weighted blanket increased melatonin concentrations in saliva by about 30%. However, no differences in oxytocin, cortisol, and the activity of the sympathetic nervous system were observed between the weighted and light blanket conditions,” reported Elisa Meth, first author and PhD student.
“Our study may offer a mechanism explaining why weighted blankets may exert some therapeutic benefits, such as improved sleep. However, our findings rely on a small sample and investigated only the acute effects of a weighted blanket. Thus, larger trials are needed, including an investigation of whether the observed effects of a weighted blanket on melatonin are sustained over longer periods,” said senior author Christian Benedict, Associate Professor at Uppsala University.
In a clinical trial, researchers found that, after a course of vancomycin, faecal microbiota transplantation (FMT) resolved Clostridioides difficile infections significantly more effectively than standard care alone. The treatment was so effective that further participant recruitment was halted. The findings were published in The Lancet Gastroenterology and Hepatology.
The results of the randomised, double-blind, placebo-controlled trial are extremely encouraging, said Simon Mark Dahl Baunwall, a PhD student at the Department of Clinical Medicine and a doctor at Aarhus University Hospital.
“Our new study shows that we can effectively cure the infection through the early use of faecal microbiota transplantation (FMT) after completing the standard treatment, to prevent relapses,” he said.
Few treatment options are available for the urgent threat of C. diff infections. Microbiota restoration with faecal microbiota transplantation is an effective treatment option for patients with multiple recurring episodes of C. diff. The researchers compared the efficacy and safety of faecal microbiota transplantation compared with placebo after vancomycin for first or second C. diff infection.
At a Danish hospital, 42 eligible patients with first or second C. difficile infection were randomly assigned to either faecal microbiota transplantation or placebo administered on day 1 and between day 3 and 7, after they had received 125mg oral vancomycin four times daily for 10 days. The primary endpoint was resolution of C difficile-associated diarrhoea (CDAD) eight weeks after treatment, with patients followed for eight weeks or until recurrence.
Due to the efficacy The primary outcome and safety outcomes were analysed in the intention-to-treat population, which included all randomly assigned patients.
Findings
The trial was stopped after the interim analysis done on April 7, 2022 for ethical reasons because the placebo group had a much lower rate of resolution at week 8 (33%) than the treatment group (90%). The absolute risk reduction was 57%.
“In rare cases, it can happen that you discover that the treatment you are investigating is so effective that it is ethically indefensible to continue,” said Baunwall.
“Our study is one example, in that the new FMT treatment is so much better than the standard treatment with antibiotics that it would be unethical to continue, because the patients in the control group would risk not receiving the FMT treatment.”
Overall, 204 adverse events occurred, with one or more adverse events being reported in 20 of 21 patients in the FMT group and all 21 patients in the placebo group, with the most common being diarrhoea and abdominal pain.
Interpretation
The study authors concluded that FMT in patients with first or second C. diff infection, is highly effective and superior to the standard of care vancomycin alone in achieving sustained resolution from C. diff.
