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Soldiers exposed to bomb blasts may be at higher risk of Alzheimer’s

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Soldiers exposed to the shock waves from military explosives may be at an increased risk of developing Alzheimer’s in later life.

A study supported by the Leonard Wood Institute in Missouri in cooperation with the US Army Research Laboratory (ARL), has found that the brains of otherwise healthy military personnel who are exposed to explosions show an abnormal accumulation of amyloid-beta protein.

The build-up of certain forms of this toxic protein is known to cause brain cells to become sick and die, leading to cognitive decline and neurodegenerative diseases, such as Alzheimer’s.

Research conducted over several decades has suggested there may be a relationship between repetitive or severe traumatic brain injury (TBI) caused by contact sports like rugby and football, assaults, falls, and traffic accidents, and abnormal amyloid-beta accumulation.

TBI can also result from indirect forces, however, such as shock waves from battlefield explosions, that shake the brain violently in the skull.

Previous autopsy studies have shown the presence of amyloid plaques as early as hours after severe brain injury.

For this latest study published in Radiology, a journal of the Radiological Society of North America, researchers recruited nine military grenade or breacher instructors at Fort Leonard Wood Military Base in Fort Leonard, Missouri, from January 2020 to December 2021.

Grenade and breacher instructors are military officers who train recruits in the use of hand grenades and explosives or other mechanical methods to force open doors.

An additional nine civilians were included in the study as a healthy control group. All participants had no previous history of concussion, and they were all males in their early 30s, an age at which amyloid accumulation is not expected.

The 18 participants were evaluated twice. The first evaluation was to establish a baseline and the second occurred after blast exposure, approximately five months after the baseline examination.

The military instructors filled out a digital log with the number of exposures to explosions, including the firing of weapons. The control participants were evaluated at similar time points.

All participants underwent a PET scan of the head to evaluate and quantify amyloid changes. Analysis software was used to segment six brain regions that are usually associated with Alzheimer’s disease and TBI.

Abnormal amyloid accumulation was seen in six of the nine participants who were exposed to explosions. Three of the participants had one region of the brain with increased amyloid accumulation, two had two areas, and one had three zones with abnormal accumulation.

None of the healthy control participants showed any abnormal amyloid build-up.

Study author Carlos Leiva-Salinas, associate professor of radiology at the University of Missouri School of Medicine in Columbia, Missouri, said: “Amyloid-beta is a molecule not normally found in the brains of young patients. Amyloid-beta accumulation in the brain is proposed to be an early event in the pathogenesis of Alzheimer’s disease, the most common type of dementia worldwide, impacting millions of people.

“Further research needs to be done to establish the relationship between the frequency and the severity of traumatic brain injury and the degree of amyloid changes in the brain, the natural course of the observed accumulation, and other potential biologic risk factors for amyloid plaque deposition and the development of cognitive decline.”

He suggested that non-invasive positron emission tomography, or PET, imaging could be used to identify early-stage amyloid-beta accumulation in individuals or professions exposed to traumatic brain injury such as military personnel, police officers, firefighters, and sports people, like football players.

This is not the first study to make a link between soldiers exposed to explosions and a higher risk of Alzheimer’s.

Analysis published in February 2021 conducted by researchers at the University of North Carolina in collaboration with the US Army Combat Capabilities Development Command, the ARL, and the National Institutes of Health, that tested the impact of controlled military blast waves on rats, identified selective reductions in components of brain connections that are required for memory.

The researchers also observed a sharp drop in electrical activity from those neuronal connections. They stated that blast-induced effects were evident among healthy neurons, which could explain the increased risk of Alzheimer’s disease among soldiers without any apparent brain damage.

At the time the ARL’s Army Research Office programme manager, Dr Frederick Gregory, said: “Blasts can lead to debilitating neurological and psychological damage but the underlying injury mechanisms are not well understood.

“Understanding the molecular pathophysiology of blast-induced brain injury and potential impacts on long-term brain health is extremely important to understand in order to protect the lifelong health and wellbeing of our service members.”

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Air pollution linked to increased hospital admission for heart and lung diseases

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Exposure to fine particulate matter (PM2.5) air pollution is linked to an increased risk of hospital admission for major heart and lung diseases, find two large US studies, published by The BMJ.

Together, the results suggest that no safe threshold exists for heart and lung health.

According to the Global Burden of Disease study, exposure to PM2.5 accounts for an estimated 7.6% of total global mortality and 4.2% of global disability adjusted life years (a measure of years lived in good health).

In light of this extensive evidence, the World Health Organization (WHO) updated the air quality guidelines in 2021, recommending that an annual average PM2.5 levels should not exceed 5 μg/m3 and 24 hour average PM2.5 levels should not exceed 15 μg/m3 on more than 3-4 days each year.

In the first study, researchers linked average daily PM2.5 levels to residential zip codes for nearly 60 million US adults (84 per cent white, 55 per cent women) aged 65 and over from 2000 to 2016. They then used Medicare insurance data to track hospital admissions over an average of eight years.

After accounting for a range of economic, health and social factors, average PM2.5 exposure over three years was associated with increased risks of first hospital admissions for seven major types of cardiovascular disease – ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy, arrhythmia, valvular heart disease, and thoracic and abdominal aortic aneurysms.

Compared with exposures of 5 μg/m3 or less (the WHO air quality guideline for annual PM2.5), exposures between 9 and 10 μg/m3, which encompassed the US national average of 9.7 μg/m3 during the study period, were associated with a 29% increased risk of hospital admission for cardiovascular disease.

On an absolute scale, the risk of hospital admission for cardiovascular disease increased from 2.59% with exposures of 5 μg/m3 or less to 3.35% at exposures between 9 and 10 μg/m3.

“This means that if we were able to manage to reduce annual PM2.5 below 5 µg/m3, we could avoid 23% in hospital admissions for cardiovascular disease,” say the researchers.*

These cardiovascular effects persisted for at least three years after exposure to PM2.5, and susceptibility varied by age, education, access to healthcare services, and area deprivation level.

The researchers say their findings suggest that no safe threshold exists for the chronic effect of PM2.5 on overall cardiovascular health, and that substantial benefits could be attained through adherence to the WHO air quality guideline.

“On February 7, 2024, the US Environmental Protection Agency (EPA) updated the national air quality standard for annual PM2.5 level, setting a stricter limit at no more than 9 µg/m3. This is the first update since 2012. However, it is still considerably higher than the 5 µg/m3 set by WHO. Obviously, the newly published national standard was not sufficient for the protection of public health,” they add.*

In the second study, researchers used county-level daily PM2.5 concentrations and medical claims data to track hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease for 50 million US adults aged 18 and over from 2010 to 2016.

During the study period, more than 10 million hospital admissions and 24 million emergency department visits were recorded.

They found that short term exposure to PM2.5, even at concentrations below the new WHO air quality guideline limit, was statistically significantly associated with higher rates of hospital admissions for natural causes, cardiovascular disease and respiratory disease, as well as emergency department visits for respiratory disease.

For example, on days when daily PM2.5 levels were below the new WHO air quality guideline limit of 15 μg/m3, an increase of 10 μg/m3 in PM2.5 was associated with 1.87 extra hospital admissions per million adults aged 18 and over per day.

The researchers say their findings constitute an important contribution to the debate about the revision of air quality limits, guidelines, and standards.

Both research teams acknowledge several limitations such as possible misclassification of exposure and point out that other unmeasured factors may have affected their results. What’s more, the findings may not apply to individuals without medical insurance, children and adolescents, and those living outside the US.

However, taken together, these new results provide valuable reference for future national air pollution standards.

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Home health care linked to increased hospice use at end-of-life – study

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Patients who had previously received home health care had a higher likelihood of accessing hospice care at the end of their life, according to a new study.

Researchers, whose findings are published in the Journal of Palliative Medicine, examined the home health care and hospice care experiences of more than two million people.

Using Medicare data, researchers found when individuals received home health care before the last year of their life, they had higher odds of using hospice care than those who had never received home health care.

Researchers said this association underscores the potential benefits of receiving end-of-life care in the comfort of one’s home.

As the aged population increases, the findings also show the need for more resources in the health care sector and staff training in end-of-life care.

Home health care services including skilled nursing, therapy, social work and aide services are used to maintain functioning or slow decline in health. Hospice care provides similar services but is intended for those with life expectancies of six months or less and is focused on pain relief, minimising hospital visits and providing comfort and support. Both services provide patients the opportunity to receive more personalised care in their home.

Researchers say home-based care also encourages greater involvement of family caregivers in the caregiving process.

Olga Jarrín, senior author of the study, the Hunterdon Professor of Nursing Research at the Rutgers School of Nursing and director of the Community Health and Aging Outcomes Laboratory within the Rutgers Institute for Health, Health Care Policy and Aging Research, commented: “In addition to benefits for the patient, hospice care also provides resources and support to help family caregivers cope with the physical, emotional and practical challenges of caring for a loved one at the end of life.”

Hyosin (Dawn) Kim, research assistant professor at Oregon State University and first author of the study, added: “By providing personalised care, reducing hospitalisations, fostering family involvement and support, and improving symptom management, home-based care can enhance the quality of end-of-life experiences for patients with terminal illnesses and their families.”

 

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Sleep programme shows promise in those with memory problems – study

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A new study has shown promising results in improving sleep and quality of life in individuals living with memory problems.

A group of researchers from Penn Nursing, Penn Medicine, Rutgers School of Nursing, and Drexel University’s College of Nursing and Health Professions, have delved into the efficacy of a non-pharmacological approach in a trial known as the Healthy Patterns Sleep Program.

The study involved 209 pairings of community-residing individuals with memory problems and their care partners. Participants were assigned to either the Healthy Patterns Sleep Program, which consisted of one-hour home activity sessions administered over four weeks, or a control group that received sleep hygiene training, plus education on home safety and health promotion.

The Healthy Patterns Sleep Program trained care partners in timed daily activities such as reminiscence in the morning, exercise in the afternoon and sensory activities in the evening that can decrease daytime sleepiness and improve nighttime sleep quality.

Nancy Hodgson, PhD, RN, FAAN, the Claire M. Fagin Leadership Professor in Nursing and Chair of Department of Biobehavioral Health Sciences, who led the study, said: “The results from this study provide fundamental new knowledge regarding the effects of timing activity participation and can lead to structured, replicable treatment protocols to address sleep disturbances. Overall, the Healthy Patterns program resulted in improved QOL compared to an attention-control group.”

The findings also indicate that, compared to a control group, the four-week Healthy Patterns program improved sleep quality among persons living with memory issues who had depressive symptoms or poor sleep quality.  The study indicates the Healthy Patterns Intervention might need a longer dose to induce improvements in other sleep-wake activity metrics.

The study’s significance lies in its confirmation of the effectiveness of behavioural interventions in not only improving quality of life and addressing sleep quality issues in this population, but also potentially reducing care partner burden and overall care costs for persons living at home with memory problems.

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