Cycling to Work - Research

Cycling to work, cuts the risk of developing heart disease and cancer by almost half, research suggests.

Walking to work is also good for you, although it does not offer the same benefits as taking a bike, experts from the University of Glasgow found.
The new study on 264,337 people, 52% of whom were women, found cycling to work is linked to a 45% lower risk of developing cancer and a 46% lower risk of cardiovascular disease, compared to driving to work or taking public transport.
Overall, cyclists had a 41% lower risk of premature death from any cause.

The study also found some health benefits,

if people cycled part of their journey

Walking to work was also associated with a 27% lower risk of developing cardiovascular disease and a 36% lower risk of dying from it.
But there was no link with a lower risk of cancer or dying early from any cause in walkers, the study found.
People who preferred to stroll to work also had to walk for two hours a week in total to see health benefits, at an average speed of three miles per hour.
Experts behind the study, published in the British Medical Journal (BMJ), said the lower benefits seen for walking compared to cycling could be down to several factors.
These include the fact cyclists covered longer distances in their commutes than the walkers, cycling is a higher intensity exercise and cyclists were generally more fit.


Dr Carlos Celis-Morales, from the University of Glasgow, said: "Walking to work was associated with lower risk of heart disease, but unlike cycling was not associated with a significantly lower risk of cancer or overall death.
"This may be because walkers commuted shorter distances than cyclists, typically six miles per week, compared with 30 miles per week, and walking is generally a lower intensity of exercise than cycling."
The study also found some health benefits if people cycled part of their journey and took public transport or drove the rest of the way.
The people taking part in the research were aged 52 on average at the start of the study and were followed for five years.
About 2,430 people died during the study period, with 496 deaths related to cardiovascular disease, which covers all diseases of the heart and circulation, and 1,126 deaths from cancer.
Overall, 3,748 people developed cancer over the five years, and 1,110 had an event related to cardiovascular disease, such as a heart attack or stroke.

Vitamin (D) - Further Research

Vitamin D supplements could spare more than three million people from colds or flu in the UK each year, researchers claim.
The sunshine vitamin is vital for healthy bones, but also has a role in the immune system.
The analysis, published in the British Medical Journal, argues food should be fortified with the vitamin.

But Public Health England (PHE) says the infections data is not conclusive, although it does recommend supplements. These, it says, should be taken for improved bone and muscle health.  

The immune system uses vitamin D to make antimicrobial weapons that puncture holes in bacteria and viruses. But as vitamin D is made in the skin while out in the sun, many people have low levels during winter.

Trials on using supplements to prevent infections have given mixed results, so the researchers pooled data on 11,321 people from 25 separate trials to try to get a definitive answer.
The team at Queen Mary University of London (QMUL) looked at respiratory tract infections - which covers a wide range of illnesses from a sniffle to flu to pneumonia.

Overall, the study said one person would be spared infection for every 33 taking vitamin D supplements.
That is more effective than flu vaccination, which needs to treat 40 to prevent one case, although flu is far more serious than the common cold.
There were greater benefits for those taking pills daily or weekly - rather than in monthly super-doses - and in people who were deficient in the first place.

                           

               

Its main function is to regulate the amount of calcium and phosphate in the body, which are vital for the growth and maintenance of healthy bones, teeth and muscles.
In extreme cases, low levels can lead to rickets in children - where the bones become soft and weak and misshapen as they continue to grow.
In adults, vitamin D deficiency can lead to osteomalacia - causing severe bone pain and muscle aches. But there is a balance - too much vitamin D can lead to high levels of calcium in the blood which can cause heart and kidney problems.
Anyone with a chronic condition or taking medication should seek advice from their doctor.

One of the researchers, Prof Adrian Martineau, said: "Assuming a UK population of 65 million, and that 70% have at least one acute respiratory infection each year, then daily or weekly vitamin D supplements will mean 3.25 million fewer people would get at least one acute respiratory infection a year."
PHE already advises everyone to take vitamin D supplements in autumn and winter for the sake of healthy bones and muscles.
They are recommended all year round for some people who get little sunlight on their skin, including people in care homes or those who cover up.

However, there is considerable debate about the importance of the latest study.
Prof Louis Levy, the head of nutrition science at PHE, said: "The evidence on vitamin D and infection is inconsistent and this study does not provide sufficient evidence to support recommending vitamin D for reducing the risk of respiratory tract infections."
But Prof Martin Hewison, from the University of Birmingham and the Society for Endocrinology, said the findings were "striking".
"I agree with the authors that this study supports a new indication for vitamin D beyond its established benefits for bone health," he added.
And the research wing of the NHS, the National Institute for Health Research which funded the study, said the findings were "worthy of serious further debate".
Ultimately, the researcher team at QMUL want vitamin D to be added to food like in the US where milk is fortified.
Prof Martineau said: "Vitamin D fortification of foods provides a steady, low-level intake of vitamin D that has virtually eliminated profound vitamin D deficiency in several countries.
"By demonstrating this new benefit of vitamin D, our study strengthens the case for introducing food fortification to improve vitamin D levels in countries such as the UK where profound vitamin D deficiency is common."

Sports Concussion - Health Implications

While Ireland beat the New Zealand rugby team for the first time in 111 years, last Saturday evening at Soldier Field, Chicago. The famous All Blacks team was without one of their star players, Brodie Retallick due to the impacts of concussion, received during a previous game.

'Former World Player of the Year, Brodie Retallick has returned to the New Zealand squad as the specialist lock replacement, after he missed last week's match in Chicago, USA with concussion.'

 

The BMJ journal provides an article on Concussion in Sport, taken from their issue of 25th September 2013 -

http://www.bmj.com/content/347/bmj.f5748

 Players with symptoms and signs of concussion, should not continue or return to play, until these resolve.

 

The diagnosis of concussion and some aspects of its management remain contentious, particularly in the context of continuing to play sport and return to play after concussion. The latest Zurich consensus statement on concussion in sport addresses some of these problems and variations in the definition, clinical assessment, and management of concussion.

Definitions of concussion vary and include mechanistic, pathophysiological, and clinical features. These complex definitions are necessary for research but have little practical use for most clinicians, including those “pitch or track side.” A more pragmatic definition of a “traumatically induced, usually transient, disturbance of brain function that involves complex pathophysiological processes” is a diagnosis made in retrospect and provides little help with early clinical decision making.

International Travel Hazards

Travel Hazards - Travellers' Diarrhoea


The BMJ journal has published a Clinical Review on the hazards of international travel:
             
Travellers' Diarrhoea  -   http://www.bmj.com/content/353/bmj.i1937

Jessica Barrett and Mike Brown review the current epidemiology of travellers’ diarrhoea, evidence for different management strategies, and the investigation and treatment of persistent diarrhoea, following travel.

Related article

• Clinical Review
  

  Irritable bowel syndrome: new and emerging treatments

  Published: 18 June 2015; BMJ 350 doi:10.1136/bmj.h1622 http://www.bmj.com/content/350/bmj.h1622  

Linking Alcohol to Cancer - Recent Survey

People lack awareness of link between alcohol and cancer, BMJ Survey 2016; 

  

Lustrous Wooden Cabinet with Health..

#10872771

 http://alcoholireland.ie/facts/alcohol-and-costs/

Lustrous Wooden Cabinet with Health..

#10872771

Anne Gulland - Author affiliations

1. London

Most people do not link the consumption of alcohol with an increased risk of cancer, a report by Cancer Research UK has found.1

In a survey of 2100 adults in England, just 13% of respondents identified cancer when asked, “Which, if any health conditions, do you think can result from drinking too much alcohol?”

The survey also highlighted a lack of understanding of the link between drinking alcohol and the risk of developing certain types of cancer. When asked about seven different cancer types, 80% of respondents said that they thought that alcohol caused liver cancer, but only 18% were aware of alcohol’s link with breast cancer.

The study showed that only one in five people could correctly identify the previous recommended maximum number of units that should not be exceeded in a day, as recommended at the time the survey was carried out, in 2015.

Among drinkers, just one in 10 men (10.8%) and one in seven women (15.2%) correctly identified these recommended limits and used them to track their drinking habits.

Alison Cox, Cancer Research UK’s director of cancer prevention, said, “The link between alcohol and cancer is now well established, and it’s not just heavy drinkers who are at risk. This is reflected in the new guidelines issued by the UK’s chief medical officers that stated that the risk of developing a range of illnesses, including cancer, increased with any amount of alcohol you drink.”

In January this year the United Kingdom’s chief medical officers introduced new drinking guidelines,2 which recommended that men and women should drink no more than 14 units of alcohol a week, spread evenly over three days or more. They also recommended that people abstain from alcohol for several days a week.

Ian Gilmore, chair of the Alcohol Health Alliance UK, said that the public’s lack of awareness of the link between alcohol consumption and cancer was “extremely concerning.”

Gilmore said, “The chief medical officers have been clear in their new alcohol guideline that there is no level of drinking which can be considered ‘safe’ from these risks. As the CMOs emphasise, the public have a right to know about the link between alcohol and cancer and other health risks, so that they can make an informed choice about their drinking habits.”

View Abstract

Recommended Articles:

1. Effect of policy, economics, and the changing alcohol marketplace on alcohol related deaths in England and Wales.
   Nick Sheron et al., The BMJ, 2016
2. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits.
   E B Rimm et al., The BMJ, 1996
3. Estimating the population at risk
   Philip Sedgwick et al., The BMJ, 2012
4. Science commentary: Why wine might be less harmful than beer and spirits
   Abi Berger et al., The BMJ, 1998
5. Alcohol and blood pressure: the INTERSALT study.
   M G Marmot et al., The BMJ, 1994

 

1. Alcohol Plays A Huge Role In Cancer Deaths In The U.S.
   Medical News Today, 2013
2. Reduce alcohol consumption, say new guidelines
   Yvette Brazier, Medical News Today
3. Coffee Linked To Reduced Liver Cancer Risk
   Catharine Paddock PhD, Medical News Today, 2007
4. Alcohol and the Brain: Healthy or Harmful?
   Bret S. Stetka, MD, Medscape, 2015
5. Just one or two drinks a day could increase risk for certain cancers
   Honor Whiteman, Medical News Today, 2015

  

 

 

New research to guide GP management for patients with multiple chronic illnesses

The new research recommends providing continuity of care with one named GP where possible, prioritising the aspects of care that matter most to patients (such as difficulties in physical functioning), and providing regular reviews of prescriptions. The study, recently published in the British Journal of Medicine, was led by researchers at the HRB Centre for Primary Care Research in the Royal College of Surgeons in Ireland.

The paper entitled, ‘Managing patients with multimorbidity in primary care' can be viewed online on the BMJ website at http://www.bmj.com/content/350/bmj.h176

Current clinical guidelines, which recommend best practice for GPs, tend to focus on single conditions which make decision making more challenging for those patients with several co-existing conditions.

Commenting on this publication, Graham Love, Chief Executive at the Health Research Board said,

‘It is very important that care for people with multimorbidity is organised and delivered based on best research evidence in order to improve the outcomes that really matter to patients. This review offers guidance for GPs to help support this process.’

More information is available from the press release on the RCSI website.

E-Cigarettes - BMJ Research

How should we view e-cigarettes? As a safe and effective way to quit tobacco? Or as a grave risk to public health because of their potential to renormalise and glamourise smoking, especially among young people?

To help you decide, read a selection of the dozens of articles published in The BMJ on e-cigarettes. These date back to January 2010, when Andreas Flouris and Dimitris Oikonomou asked if they were a miracle or a menace?

In September 2011 editorialists Ron Borland and Nigel Gray concluded that allowing e-cigarettes to be sold was the approach with the greatest potential public health benefit, creating incentives to conduct research and to consider more appropriate regulation

But should they be classified as medicine? In October 2013 the European Parliament backed moves to make smoking less attractive to young people but rejected the health commissioner’s call to have electronic cigarettes classified as medicines.

In a head to head debate published four months earlier, Simon Chapman, professor of public health at the University of Sydney, supported regulation, seeing e-cigarettes as another way for big tobacco to try to make nicotine addiction socially acceptable again.

But Jean-François Etter, a professor at the Institute of Social and Preventive Medicine at the University of Geneva, said restrictions would result in more harm to smokers.
Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, warned that any debate over regulation may favour the interests of the industry.
You can browse all articles published so far about e-cigarettes at this link. Alternatively, here is a selection of the key articles published so far:

• Views and Reviews: Electronic cigarettes: miracle or menace?
• Editorial: Electronic cigarettes as a method of tobacco control
• Feature: Electronic cigarettes: medical device or consumer product?
• Analysis: Tobacco harm reduction: the devil is in the deployment
• Observations: Big Tobacco lights up e-cigarettes
• Observations: E-cigarettes and the marketing push that surprised everyone
• Editorial: Journal policy on research funded by the tobacco industry
• Editorial: Regulation of electronic cigarettes
• Analysis: E-cigarettes: the best and the worst case scenarios for public health—an essay by Simon Chapman
• Feature: E-cigarettes latest: users on the up but rules tighten
• News: First TV advertisement for e-cigarettes prompts complaints

BMJ Study: High milk diet 'may not cut risk of bone fractures'

Drinking lots of milk may not lower the risk of fracturing bones, a study in the British Medical Journal suggests.

The research, conducted in Sweden, showed women who drank more than three glasses a day were actually more likely to break bones than those who had less.

View Reserach article here: Milk intake and risk of mortality and fractures in women and men: cohort studies

The researchers cautioned that their work only suggested a trend and should not be interpreted as proof that high milk consumption caused fractures.  Factors such as alcohol and weight were likely to play a role, they said.

A team of scientists in Sweden examined the dietary habits of 61,400 women in 1987-1990 and 45,300 men in 1997 and then monitored their health for years afterwards.  Participants were asked to complete questionnaires on how frequently they consumed common foods such as milk, yoghurt and cheese over a one-year period.

Researchers then tracked how many developed fractures and how many participants died in the years afterwards.

In the 20-year follow-up period in which the women were monitored, those who drank more than three glasses, or 680ml, of milk a day were more likely to develop fractures than those who had consumed less.  The high-intake group had a higher risk of death too.

Prof Karl Michaelsson, lead researcher at Uppsala University, said: "Women who drank three or more glasses a day had twice the chance of dying at the end of the study than those who drank less than one glass a day. And those who had a high milk intake also had a 50% higher risk of hip fracture."

Men were monitored for an average of 11 years after the initial survey and the results showed a similar but less pronounced trend

.

When fermented milk products such as yoghurt were considered, the opposite pattern was observed - people who consumed more had a lower risk of fractures.

Prof Michaelsson says the findings could be due to sugars in milk, which have been shown to accelerate ageing in some early animal studies

"The results should, however, be interpreted cautiously given the observational design of our study."

Dietary advice should not be changed until more research had been conducted, he said.  British experts said the research should be treated with caution because the milk in Sweden is fortified with vitamin A which could have an impact on the findings.

View more here

Addressing Obesity Levels - BMJ

British Medical Journal Editorial:

Getting Serious About Obesity            

Reports from UK medical bodies are a start, but doctors can’t do it alone

Obesity continues to be one of the biggest health threats to the UK population. We therefore welcome the fact that two of the United Kingdom’s most important medical organisations—the Royal College of Physicians (RCP) and the Academy of Medical Royal Colleges—have launched major reports this year setting out concrete steps for responding to this crisis.

According to the BMA’s consensus statement on the role of the doctor,1 doctors have to act in “the best interests of their patients and of the population served.” In helping serve the best interests of patients, the RCP report takes several important steps to help bring UK clinical practices in line with those in the United States, which also has an obesity crisis.2 These include developing bariatric medicine as a clinical subspecialty, along with better education for general practitioners, a patient charter, introducing a cross governmental obesity chief, and research into better pharmaceutical and surgical interventions to treat obesity as a medical condition.

1. ↵ 
   BMA. The consensus statement on the role of the doctor. 2008. www.medschools.ac.uk/Publications/Pages/Role-of-the-Doctor-Consensus-Statement.aspx.

   
   
2. ↵ 
   Royal College of Physicians. Action on obesity: comprehensive care for all. 2013. www.rcplondon.ac.uk/sites/default/files/action-on-obesity.pdf.

click on highlighted text to see full editorial:
Getting Serious About Obesity