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Press releases Monday 7 July - Friday 11 July 2008
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(1) Sex really does get better with age (2) Is paying people to look after their health money well spent? (3) Slowing down the ageing process—the future of disease prevention? (4) Malaria on the increase in the UK (5) Screening for heart disorders in competitive athletes would save lives
(1) Sex really does get better with age (Secular trends in self reported sexual activity and satisfaction in Swedish 70 year olds: cross sectional survey of four populations, 1971-2001) http://www.bmj.com/cgi/content/full/337/jul08_3/a279 (Editorial: Sexuality and older people) http://www.bmj.com/cgi/content/short/337/jul08_3/a239
An increasing number of 70 year olds are having good sex and more often, and women in this age group are particularly satisfied with their sex lives, according to a study published today on BMJ.com.
Knowledge about sexual behaviour in older people (70 year olds) is limited and mainly focuses on sexual problems, less is known about "normal" sexual behaviour in this age group.
Nils Beckman and colleagues from the University of Gothenburg in Sweden, studied attitudes to sex in later life among four representative population samples of 70 year olds in Sweden, who they interviewed in 1971-2, 1976-7, 1992-3, and 2000-1. In total, over 1 500 people aged 70 years were interviewed about different aspects of their sex lives including sexual dysfunctions, marital satisfaction and sexual activity.
The authors found that over the thirty year period the number of 70 year olds of both sexes reporting sexual intercourse increased: married men from 52% to 98%, married women from 38% to 56%, unmarried men from 30% to 54%, and unmarried women from 0.8% to 12%.
In addition, the number of women reporting high sexual satisfaction increased, more women reported having an orgasm during sex and fewer reported never having had an orgasm.
While the proportion of women reporting low satisfaction with their sex lives decreased, the proportion of men reporting low satisfaction increased. The authors suggest that this might be because it is now more acceptable for men to admit "failure" in sexual matters.
They also note that the number of men reporting erectile dysfunction deceased, whereas the proportion reporting ejaculation dysfunction increased, but the proportion reporting premature ejaculation did not change.
Interestingly, both men and women blame men when sexual intercourse stops between them. This finding replicates the results of other studies in the 1950s and 2005-06.
"Our study...shows that most elderly people consider sexual activity and associated feelings a natural part of later life", they conclude.
These findings emphasise the important and positive part sex plays in the lives of 70 year olds and is a welcome contribution to the limited literature about sexual behaviour in older people, writes Professor Peggy Kleinplatz from the University of Ottawa in Canada.
It will hopefully highlight the need for doctors to be trained to ask all patients, regardless of age, about their sexual concerns, she adds.
Contacts: Nils Beckman, Institute of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden Email: nils.beckman@neuro.gu.se Peggy J. Kleinplatz, Department of Family Medicine, University of Ottawa, Ottawa, Canada Email: kleinpla@uottawa.ca
(2) Is paying people to look after their health money well spent? (Head to Head: Should disadvantaged people be paid to take care of their health?)Yes: http://www.bmj.com/cgi/content/extract/337/jul08_3/a589 No: http://www.bmj.com/cgi/content/extract/337/jul08_3/a594 (Feature: New York’s road to health)http://www.bmj.com/cgi/content/extract/337/jul08_3/a673
Many countries increasingly use cash incentives to encourage disadvantaged people to look after their health, but is this money well spent, or just a temporary fix?
Two experts debate the issue on BMJ.com today.
Conditional cash payments to disadvantaged people to take care of their health have the potential to improve population health, reduce health inequality and save the taxpayer money, writes Richard Cookson from the University of York.
Over the past decade, behavioural conditions attached to receipt of state funded welfare, such as ensuring that people receiving unemployment benefit are actively seeking work or attending health check-ups, have become increasingly common. For example, US Medicaid focuses on screening and chronic disease and Solidario in Chile focuses on maternal and child healthcare.
Unhealthy behaviours impose huge costs on society as well as harming the individual, says Cookson, and are particularly common among disadvantaged people who are less responsive to health promotion messages such as taking folic acid before pregnancy, and less likely to take up free public health services such as screening and child health programmes.
Evidence is growing, he says, that well designed conditional cash transfer programmes are effective in increasing the use of preventive services and can improve health status, although more research is needed on cost effectiveness.
According to Cookson, disadvantaged people are more responsive to cash incentives and can be easily identified through the benefit system. This is not the nanny state "gone mad" or "excessive paternalism" it is "only fair that welfare recipients make simple changes in their behaviour to avoid burdening their fellow citizens", he concludes.
But Jennie Popay from Lancaster University, argues that such payments separate people off from society, labelling them as irresponsible and unwilling to behave in ways "defined as appropriate by people with little understanding of how to survive poverty."
According to Popay the evidence for these programmes is limited and the results mixed. Overall, she says, the programmes are stigmatising, difficult to target, administratively costly, and although they seem successful in changing simple behaviours such as uptake of services, they do not have a lasting impact on complex behaviours such as smoking and diet.
In addition, she says, research shows that far from being simple as Cookson argues, unhealthy behaviours are coping mechanisms that help people survive poverty and its "multiple humiliations".
"Cash might coerce some people into changing behaviour but if their lives do not change we should not be surprised if they lapse or substitute other (perhaps equally) unhealthy behaviours", Popay warns.
In an accompanying feature, Karen McColl examines how New York City is taking a pioneering approach to public health by introducing a programme of conditional cash transfers to break the poverty cycle. 'Opportunity NYC' gives cash rewards to families for investing in their own health, education and welfare.
Contacts: Richard Cookson, Department of Social Policy and Social Work, University of York, UK Email: rc503@york.ac.uk Jennie Popay, Professor of Sociology and Public Health, Lancaster University, UK Email: j.popay@lancaster.ac.uk Karen McColl, freelance writer, Savoie, France Email: karen@karenmccoll.co.uk
(3) Slowing down the ageing process - the future of disease prevention? (Analysis: New model of health promotion and disease prevention for the 21st century) http://www.bmj.com/cgi/content/extract/337/jul08_3/a399 (Analysis: Has the time come to take on time itself?)http://www.bmj.com/cgi/content/extract/337/jul08_3/a414
Slowing the ageing process would have a much greater benefit for people's health than traditional medical approaches that target individual disease, say experts on BMJ.com today.
Most medical research focuses on preventing and curing individual diseases as if they were independent of one another, but as people in developed nations are living longer they are increasingly experiencing more than one age related disease - comorbidity is now the norm rather than the exception.
Professor S Jay Olshansky and colleagues believe that the effectiveness of the disease-specific approach will become increasingly limited and that even if a "cure" was found for any of the major fatal diseases, it would have only a marginal effect on life expectancy.
They argue that because our susceptibility to disease increases as we grow older, the most efficient approach to combating disease and disability is a "systematic attack on ageing itself."
They suggest that recent advances in understanding the biological mechanisms responsible for ageing, which give rise to most diseases and other age related health problems, means that the time has arrived for this new model of health promotion and disease prevention.
Evidence suggests that all living things, including humans, possess biochemical mechanisms that influence how quickly we age and these are modifiable, say the authors. For example, dietary restriction and genetic alteration have been shown to extend the lifespan of many laboratory organisms including mice, flies and worms, and postpone age related diseases such as cancer, cataracts and cognitive decline.
They call for increased funding to investigate how diseases such as type 2 diabetes, Parkinson's disease and most cancers interact with ageing and for more research into the "fundamental cellular and physiological changes that drive ageing itself", alongside continued research into individual diseases.
Staying healthier for longer has benefits for society as well as individuals, writes Professor Colin Farrelly from the University of Waterloo in Canada, in an accompanying Analysis.
Success in increasing longevity in laboratory organisms has demonstrated that aging is not an irreversible process. If human ageing was slowed by seven years, the age specific risk of death, frailty and disability would be reduced by about half that at every age, claims Farrelly.
The rapid rise in older people over the next few decades will be accompanied by an increase in the number of people with disease and chronic illness and costs are set to rise dramatically. In 2007, cancer cost the US alone an estimated $219bn, including $130bn for lost productivity and $89bn in direct medical costs.
Can we really afford not to tackle ageing, he asks. By extending the healthy lifespan, people would remain in the workforce longer, personal income and savings would flourish, age entitlement programmes would face less pressure and national economies would flourish.
Farrelly concludes that the greatest obstacle will be convincing the general public that slowing ageing is feasible and deserving of a larger share of the funds available for scientific research.
Contacts: S Jay Olshansky, University of Illinois at Chicago, Chicago, USA Email: sjayo@uic.edu Colin Farrelly, Department of Political Science, University of Waterloo, Canada Email: farrelly@uwaterloo.ca
(4) Malaria on the increase in the UK (Imported malaria and high risk groups: an observational study using UK surveillance data 1987-2006) http://www.bmj.com/cgi/content/abstract/337/jul03_2/a120 (Editorial: Imported malaria in the UK)http://www.bmj.com/cgi/content/extract/337/jul03_2/a135
A huge rise in the numbers of UK residents travelling to malaria endemic areas, combined with a failure to use prevention measures, has significantly increased cases of imported falciparum malaria in the UK over the past 20 years, according to a study published on BMJ.com.
Between 1987-91 there were 5120 reported cases of the potentially fatal faliciparum malaria, increasing to 6753 in 2002-6. These findings highlight the urgent need for health messages and services targeted at travellers from migrant groups visiting friends and family abroad, say the authors.
Malaria acquired in one of the 150 countries where it is endemic and then imported into non-endemic countries accounts for a significant proportion of largely preventable disease and death in Europe every year.
Dr Adrian Smith and colleagues from the Health Protection Agency's Malaria Reference Laboratory, present the latest trends in malaria in the UK between 1987 and 2006, using data from the Malaria Reference Laboratory, involving 39 300 confirmed cases of malaria.
64.5% of 20 488 malaria cases amongst UK travellers had visited friends and relatives in malaria endemic countries. This is reflected by the huge increase in the number of UK residents travelling to malaria endemic areas - from 593 000 visits in 1987 to 2.6 million visits in 2004.
Imported malaria cases were heavily concentrated in communities with frequent travel to see friends and relatives in West Africa.
The researchers also note a worrying trend in cases of the potentially fatal falciparum malaria which have increased steady over the past 20 years in the UK. Of all malaria imported to the UK, 96% of falciparum malaria occurred after travel to Africa. Travellers to Nigeria and Ghana, neither common tourist destinations, account for half of all imported falciparum cases.
Importantly, say the authors, only 42% of UK travellers reported taking any form of malaria prophylaxis during their travels. In particular, people visiting friends and relatives in their country of origin were less likely to report using prevention measures than other travellers. For example, amongst malaria cases in travellers to sub-Saharan Africa between 1999-2006, only 7% of people with malaria visiting friends and relatives reported using recommended drugs, compared to 24% of other travellers with malaria.
These findings highlight that health messages are not getting through to ethnic minority groups, particularly those visiting West Africa, warn the authors. "Targeting messages tailored to these groups is essential in primary care and public health…and this would have a substantial impact on UK malaria", they add.
Increasing the use of effective antimalarial prophylactic drugs by travellers visiting sub-Saharan Africa should be a priority, they conclude.
Research into cultural beliefs, knowledge, and attitude towards malaria prevention in people visiting friends and relatives in malaria endemic countries, would help identify how best to target health education campaigns and innovative techniques, says Jane Zuckerman, Director of WHO collaborating centre for reference, research, and training in travel medicine, in an accompanying editorial.
Contacts: Press office, Health Protection Agency, London, UK Tel: +44 (0)208 327 7080 Jane Zuckerman, Director of WHO collaborating centre for reference, research, and training in travel medicine, Royal Free and University College Medical School, London, UK Email: j.zuckerman@medsch.ucl.ac.uk
(5) Screening for heart disorders in competitive athletes would save lives (Cardiovascular evaluation, including resting and exercise electrocardiography, before participation in competitive sports: cross sectional study ) http://www.bmj.com/cgi/content/abstract/337/jul03_2/a346 (Editorial: Sudden cardiac death in young athletes)http://www.bmj.com/cgi/content/extract/337/jul03_2/a309
Athletes who take part in competitive sport should be screened for potentially fatal heart problems before they compete, according to a study published on BMJ.com today.
The findings show that a pre-participation screening programme, which involves checking the activity of the heart during exercise, would detect more athletes at risk of sudden cardiac death and save lives, say the authors.
One young competitive athlete dies every three days from an unrecognised cardiovascular disorder in the United States alone.
In the majority of cases the athletes appear healthy and there is no previous clinical sign of heart problems. The clinical usefulness of pre-screening programmes to identify people at high risk has been hotly debated. Whether or not to include an electrocardiogram (ECG) as part of pre-screening has been particularly controversial because of concerns over cost-effectiveness and the number of false-positive test results.
In America and Europe authorities have recommended a pre-participation evaluation which includes taking a detailed patient and family history as well as a physical examination.
However, in Italy for the past 25 years, athletes wishing to enter competitive sport have also had to have two ECGs (a test to measure the electrical activity of the heart), one at rest and one while exercising. Researchers from the University of Florence set out to evaluate the clinical usefulness of this programme.
Dr Francesco Sofi and colleagues analysed data from 30 065 athletes who underwent a complete pre-participation cardiovascular evaluation at the Institute of Sports Medicine in Florence during a five year period (2002-6).
During the resting ECG they found that 1.2% (348) of participants had distinctly abnormal test results. However, the results from the ECGs taken during exercise found that 4.9% of participants (1459) had some form of heart abnormality. So a significant number of heart problems were only evident during exercise.
The age of people with problems found only during the exercise ECG, was also significantly higher (30.9 years old compared to 24.9 years old) than those who had normal test results.
Importantly, of the 159 people disqualified from sport for identified heart problems, only six would have been picked up through history and physical examination alone, meaning nineteen in twenty would have been missed. Eight in ten (79.2%) would have been missed if they had only had a resting ECG.
In an accompanying editorial Professor Jonathan Drezner from the University of Washington says "adding electrocardiography to the screening process will detect more athletes with silent cardiovascular disorders at risk of sudden death."
Both Drezner and Sofi call for ECGs to be added to screening programmes for all people taking part in competitive sports, and emphasise that it is particularly important for people who are middle aged or older.
Contacts: Francesco Sofi, Institute of Sports Medicine, University of Florence, Italy Email: francescosofi@gmail.com Editorial: Jonathan Drezner, Department of Family Medicine, University of Washington, USA Email: jdrezner@fammed.washington.edu
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