Too much sitting around may kill you. Period.

Paleo-epidemiology. We were simply not designed to sit around a lot.

Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis

Aviroop Biswas, BSc; Paul I. Oh, MD, MSc; Guy E. Faulkner, PhD; Ravi R. Bajaj, MD; Michael A. Silver, BSc; Marc S. Mitchell, MSc; and David A. Alter, MD, PhD
Ann Intern Med. 2015;162(2):123-132. doi:10.7326/M14-1651

Background: The magnitude, consistency, and manner of association between sedentary time and outcomes independent of physical activity remain unclear.

Purpose: To quantify the association between sedentary time and hospitalizations, all-cause mortality, cardiovascular disease, diabetes, and cancer in adults independent of physical activity.

Data Sources: English-language studies in MEDLINE, PubMed, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and Google Scholar databases were searched through August 2014 with hand-searching of in-text citations and no publication date limitations.

Study Selection: Studies assessing sedentary behavior in adults, adjusted for physical activity and correlated to at least 1 outcome.

Data Extraction: Two independent reviewers performed data abstraction and quality assessment, and a third reviewer resolved inconsistencies.

Data Synthesis: Forty-seven articles met our eligibility criteria. Meta-analyses were performed on outcomes for cardiovascular disease and diabetes (14 studies), cancer (14 studies), and all-cause mortality (13 studies). Prospective cohort designs were used in all but 3 studies; sedentary times were quantified using self-report in all but 1 study. Significant hazard ratio (HR) associations were found with all-cause mortality (HR, 1.240 [95% CI, 1.090 to 1.410]), cardiovascular disease mortality (HR, 1.179 [CI, 1.106 to 1.257]), cardiovascular disease incidence (HR, 1.143 [CI, 1.002 to 1.729]), cancer mortality (HR, 1.173 [CI, 1.108 to 1.242]), cancer incidence (HR, 1.130 [CI, 1.053 to 1.213]), and type 2 diabetes incidence (HR, 1.910 [CI, 1.642 to 2.222]). Hazard ratios associated with sedentary time and outcomes were generally more pronounced at lower levels of physical activity than at higher levels.

Limitation: There was marked heterogeneity in research designs and the assessment of sedentary time and physical activity.

Conclusion: Prolonged sedentary time was independently associated with deleterious health outcomes regardless of physical activity.

Primary Funding Source: None.

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Treatment of vitamin D deficiency in asymptomatic persons might reduce mortality risk

Reviews | 20 January 2015

Screening for Vitamin D Deficiency: A Systematic Review for the U.S. Preventive Services Task Force

Erin S. LeBlanc, MD, MPH; Bernadette Zakher, MBBS; Monica Daeges, BA; Miranda Pappas, MA; and Roger Chou, MD
Ann Intern Med. 2015;162(2):109-122. doi:10.7326/M14-1659

Abstract

Background: Vitamin D deficiency has been associated with adverse health outcomes.

Purpose: To systematically review benefits and harms of vitamin D screening in asymptomatic adults.

Data Sources: Ovid MEDLINE (through the third week of August 2014), Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews.

Study Selection: Randomized trials of screening for and treatment of vitamin D deficiency and case–control studies nested within the Women’s Health Initiative.

Data Extraction: One investigator abstracted data, a second reviewed data for accuracy, and 2 investigators independently assessed study quality using predefined criteria.

Data Synthesis: No study examined the effects of vitamin D screening versus no screening on clinical outcomes. Vitamin D treatment was associated with decreased mortality versus placebo or no treatment (11 studies; risk ratio [RR], 0.83 [95% CI, 0.70 to 0.99]), although benefits were no longer seen after trials of institutionalized persons were excluded (8 studies; RR, 0.93 [CI, 0.73 to 1.18]). Vitamin D treatment was associated with possible decreased risk for having at least 1 fall (5 studies; RR, 0.84 [CI, 0.69 to 1.02]) and falls per person (5 studies; incidence rate ratio, 0.66 [CI, 0.50 to 0.88]) but not fractures (5 studies; RR, 0.98 [CI, 0.82 to 1.16]). Vitamin D treatment was not associated with a statistically significant increased risk for serious adverse events (RR, 1.17 [CI, 0.74 to 1.84]).

Limitation: Variability across studies in 25-hydroxyvitamin D assays and baseline levels, treatment doses, use of calcium, and duration of follow-up.

Conclusion: Treatment of vitamin D deficiency in asymptomatic persons might reduce mortality risk in institutionalized elderly persons and risk for falls but not fractures.

Primary Funding Source: Agency for Healthcare Research and Quality.


 

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“Noncognitive” symptoms of early Alzheimer disease

Neurology.org:
“Noncognitive” symptoms of early Alzheimer disease

A longitudinal analysis

  1. Mary Clare Masters, MD,
  2. John C. Morris, MD and
  3. Catherine M. Roe, PhD

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  1. Correspondence to Dr. Roe: cathyr@wustl.edu
  1. Published online before print January 14, 2015, doi: 10.1212/WNL.0000000000001238Neurology 10.1212/WNL.0000000000001238

ABSTRACT

Objectives: To observe the natural time course of noncognitive symptoms before the onset of symptomatic Alzheimer disease dementia.

Methods: Using the National Alzheimer’s Coordinating Center Uniform Data Set from September 2005 to March 2013, data from cognitively normal individuals who were aged 50 years or older at first visit and had subsequent follow-up were analyzed. Survival analyses were used to examine the development of particular symptoms relative to each other on the Neuropsychiatric Inventory Questionnaire (NPI-Q), Functional Activities Questionnaire, and Geriatric Depression Scale, and to compare the development of individual symptoms for persons who did and did not receive a Clinical Dementia Rating (CDR) >0 (indicating abnormal cognition) during the follow-up period.

Results: The order of symptom occurrence on the NPI-Q was similar for participants who remained at CDR 0 and for those who received a CDR >0 over the follow-up period, although the time to most NPI-Q symptoms was faster for participants who received a CDR >0 (p < 0.001). With the exception of memory, Geriatric Depression Scale symptoms reported by both CDR groups were similar.

Conclusions: We found a significantly earlier presence of positive symptoms on the NPI-Q in cognitively normal patients who subsequently developed CDR >0. Among participants with no depression symptoms at baseline, results suggest that depressive symptoms may increase with aging regardless of incipient dementia. Such findings begin to delineate the noncognitive course of Alzheimer disease dementia in the preclinical stages. Future research must further elucidate the correlation between noncognitive changes and distinct dementia subtypes.

  • Received June 16, 2014.
  • Accepted in final form October 10, 2014.

For more, please visit: psychiatryneurology.net

 

 

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More Chinese travel abroad for medical treatment

WantChinaTimes.com

Knowing China through Taiwan

  • Sunday, January 11, 2015
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More Chinese travel abroad for medical treatment

 

  • Staff Reporter
  • 2014-12-08
  • 16:07 (GMT+8)
A Saint Lucia Consulting advert. (Photo/Saint Lucia Consulting)A Saint Lucia Consulting advert. (Photo/Saint Lucia Consulting)

More and more Chinese nationals have become wealthy enough to afford medical treatment abroad, bolstering the growth of businesses catering to this emerging trend, reports Nanjing’s Yangcheng Evening News.

In China, six people are diagnosed with cancer every minute, with new cancer cases touching an annual 3.12 million, according to government data.

The five-year survival rate for cancer patients in China is around 25%, according to government data released in January, compared with 68% between 2003 and 2009 in the United States. A growing number of Chinese patients are travelling overseas in search of these higher odds, and around 70% of them are cancer patients, said the newspaper.

Massachusetts General Hospital, affiliated with Harvard Medical School, saw the number of Chinese patients jump from around 40 in 2012 to around 100 in 2013, said the report.

Along with the growing number of patients traveling abroad, several domestic businesses have sprung up to cater to the demand and help people arrange for their international medical trips, according to the newspaper.

Beijing-based Saint Lucia Consulting, established in 2011, is the first of such businesses in China. Up to 10 similar services have emerged across the country since its establishment, excluding those making arrangements for overseas cosmetic surgery, said the report.

Zhang Xiang, president of Vanta Consulting Service, the first Guangzhou company to offer arrangements for overseas medical treatment, estimates that the sector has already reached US$100 billion in scale, and is projected to grow by 20% a year.

According to Zhang, treatment abroad is not as expensive as people think. The average spending of his company’s 30+ clients so far has been around US$150,000.

Medical fees are the highest in the United States, which are usually three to four times the charges in China, while fees in Germany and the United Kingdom are just 30% higher, Zhang said.

Apart from the better quality of medical services abroad, Chinese patients also opt for overseas treatments for newer drugs that usually hit the Chinese market much later. “There are new drug trials beginning in top hospitals abroad every day. Chinese patients can see their medical bills cut by 15% to 20% if they take part in clinical trials,” Zhang said.

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China Daily USA: US hospital looks to China for more medical tourists

China Daily USA

US hospital looks to China for more medical tourists

Updated: 2014-12-05 14:27

By Zheng Xin in Beijing(China Daily USA)

Ten years ago, Children’s Hospital Los Angeles received its first patient from the Chinese mainland, with that child patient who had traveled thousands of miles seeking more advanced medical treatment, gaining celebrity status of sorts. Today, such travel is commonplace.

“It was not a common practice for Chinese patients back then, as the cost of medical treatment was beyond the capacity of most of them,” said Richard D. Cordova, president and chief executive officer of Children’s Hospital Los Angeles, one of the top five children’s hospitals in the United States.

As the middle class in China has rapidly expanded and its purchasing power has greatly surged, many sectors overseas, including hospitals, have turned an eye to that burgeoning middle class. Children’s Hospital Los Angeles is one such hospital.

Since that first patient from the Chinese mainland landed at the hospital a decade ago, the hospital has steadily seen an increase in the number of patients from China, and believes that growth will continue at a rapid rate among, the growth driven by the emerging middle class more focused than ever on health and well-being.

“It will be no more a rare and unusual practice for Chinese to seek medical advice and treatment from abroad in the future,” said Cordova.

From 2011 to 2013, the hospital received some 44 patients from the Chinese mainland, and 18 of them in 2014, from among a total of 84 international patients.

“The Chinese patients occupy some 20 percent of the overseas patients we received this year, which accounts for a significant proportion,” he said.

The hospital expects the growth rate of the Chinese patients to reach 20 percent in the following year.

“Children’s Hospital Los Angeles is trying to provide better care for more patients at a lower cost, while remaining true to our mission of creating hope and building healthier futures for infants, children and young adults,” said Cordova, in an interview with China Daily.

The hospital has formed a cooperative alliance with several local Chinese hospitals, under which the Chinese hospitals will under certain circumstances recommend patients for treatment abroad.

“We are looking for strategic partnerships that will ensure our future, while revising care models to help patients maintain their health more efficiently,” said Cordova.

Last year, the hospital opened outpatient centers in South Bay and Santa Monica, adding to their existing satellite locations in Arcadia and Valencia, to meet the increasing demand from overseas patients.

As part of a 12-day visit to China, South Korea and Japan earlier this month, Los Angeles Mayor Eric Garcetti signed a memorandum of understanding in Guangzhou to attract more Chinese medical tourists to the Western United States, by promoting tourism and investment in his city.

Nine Chinese and US signatories, including China Southern Airlines; the City of Los Angeles; the Los Angeles Tourism and Convention Board; the Los Angeles Economic Development Corporation; Cedar Sinai Medical Center; City of Hope Hospital; Children’s Hospital Los Angeles; UCLA, and USC, have agreed to promote health tourism from China to Los Angeles.

According to the Los Angeles mayor’s office, trade last year between Los Angeles and China reached $164.38 billion, compared to Japan at $43.5 billion, and South Korea at $23.5 billion.

Some 570,000 Chinese tourists visited Los Angeles and spent $655 million, according tothe mayor’s office.

Children’s Hospital Los Angeles said it is also seeking partnerships with local insurance companies in China, including People’s Insurance Company of China and Ping An Insurance, to see if there’s interest in providing high-end medical insurance.

The departments of orthopedics, ophthalmology, hematology and tumor, for which the hospital is most highly regarded nationwide, receives the most young Chinese patients.

“While many of the patients are recommended through local Chinese hospitals, a lot of them heard of our hospitals through their friends in China,” said Larry Wang, associate director of the Center for Global Health with the hospital.

To better cater to the demands of the Chinese patients and minimize language barriers or cultural shock, the hospital has established an on-site translation team made up of 25 round-the-clock translators proficient in 42 languages, including Chinese. It is also working on a Chinese-language website to attract more Chinese patients.

“We need to make sure the patients are comfortable while seeing doctors in a foreign land, together with the finest medical facilities and services,” said Cordova. “Many patients travel across the continent to us for medical care of better quality and more considerate service. The medicine and pharmaceutical therapy in the hospital also promise the patients a pleasant body care.”

Cordova added that more advanced medicine, medical apparatus and instruments in the United States are reasons given for more overseas patients.

Considering the lack of a medical visa for Chinese individuals who want to travel to the United States for medical treatment, the hospital maintains it will use its good relationship with the U.S. government to make sure Chinese patients coming to their hospital receive tourist visas without too many barriers.

“It is also our obligation to make sure the Chinese patients get here and get back home safely within the permitted stay, issued under the doctor’s judgment,” said Wang.

“Most people used to come to Los Angeles to visit the amusement parks and the beautiful beaches, but now they can also travel two miles from Hollywood to Los Angeles Children’s Hospital for a better body treatment,” said Cordova.

“We want to encourage more people from China to visit our city, not just as tourists to go to places like Disneyland,” said Garcetti, in Guangzhou. “We have the finest hospitals in the world and we want to promote health travel, which can help with the health sector here in China,” he said.

zhengxin@chinadaily.com.cn

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