Context Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates. Objective To evaluate the relationship between gait speed and survival. Design, Setting, and Participants Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34 485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s. Main Outcome Measures Survival rates and life expectancy. Results There were 17 528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%-88.8%) and 10-year survival rate was 59.7% (95% CI, 46.5%-70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; P  Conclusion In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.

https://jamanetwork.com/journals/jama/articlepdf/644554/joc05171_50_58.pdf

Gait speed and survival in older adults.

The prevalence of obesity is rapidly increasing globally. Epidemiological studies have associated obesity with a range of cancer types, although the mechanisms by which obesity induces or promotes tumorigenesis vary by cancer site. These include insulin resistance and resultant chronic hyperinsulinaemia, increased bioavailability of steroid hormones and localized inflammation. Gaining a better understanding of the relationship between obesity and cancer can provide new insight into mechanisms of cancer pathogenesis.

/pdf/overweight-obesity-and-cancer-epidemiological-evidence-and-3aap682afc.pdf

Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms

Harmon S. Jordan, ScD, Karima A. Kendall, PhD, Linda J. Lux, Roycelynn Mentor-Marcel, PhD, MPH, Laura C. Morgan, MA, Michael G. Trisolini, PhD, MBA, Janusz Wnek, PhD

Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN,

2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society

There has been much effort recently to probe the long-recognized relationship between the pathological processes of infection, inflammation and cancer. For example, epidemiological studies have shown that approximately 15% of human deaths from cancer are associated with chronic viral or bacterial infections. This Review focuses on the molecular mechanisms that connect infection, inflammation and cancer, and it puts forward the hypothesis that activation of nuclear factor-kappaB (NF-kappaB) by the classical, IKK-beta (inhibitor-of-NF-kappaB kinase-beta)-dependent pathway is a crucial mediator of inflammation-induced tumour growth and progression, as well as an important modulator of tumour surveillance and rejection.

NF-kappaB: linking inflammation and immunity to cancer development and progression.

The Physical Activity Scale for the Elderly (PASE): development and evaluation.

Medically treated injuries have been shown to increase with increasing body mass index (BMI). Information is lacking on the frequency and type of injuries and illnesses among overweight and obese adults who engage in regular physical activities as part of weight loss or weight gain prevention programs. Sedentary adults with BMIs between 25 and 40 kg/m2 (n = 397) enrolled in one of two randomized clinical trials that emphasized exercise as part of a weight loss or weight gain prevention program. Interventions differed by duration of the exercise goal (150, 200, or 300 minutes/week or control group). Walking was prescribed as the primary mode of exercise. At six month intervals, participants were asked, "During the past six months, did you have any injury or illness that affected your ability to exercise?" Longitudinal models were used to assess the effects of exercise and BMI on the pattern of injuries/illnesses attributed to exercise over time; censored linear regression was used to identify predictors of time to first injury/illness attributed to exercise. During the 18-month study, 46% reported at least one injury/illness, and 32% reported at least one injury that was attributed to exercise. Lower-body musculoskeletal injuries (21%) were the most commonly reported injury followed by cold/flu/respiratory infections (18%) and back pain/injury (10%). Knee injuries comprised one-third of the lower-body musculoskeletal injuries. Only 7% of the injuries were attributed to exercise alone, and 59% of the injuries did not involve exercise. BMI (p ≤ 0.01) but not exercise (p ≥ 0.41) was significantly associated with time to first injury and injuries over time. Participants with higher BMIs were injured earlier or had increased odds of injury over time than participants with lower BMIs. Due to the linear dose-response relationship between BMI and injury/illness, any weight loss and reduction in BMI was associated with a decrease risk of injury/illness and delay in time to injury/illness. Overweight and obese adults who were prescribed exercise as part of weight loss or weight gain prevention intervention were not at increased risk of injury compared to overweight adults randomized not to participate in prescribed exercise. Since onset of injury/illness and pattern of injuries over time in overweight and obese individuals were attributed to BMI, weight reduction may be an avenue to reduce the risk of injury/illness in sedentary and previously sedentary overweight and obese adults. Clinicaltrials.gov NCT00177502 and NCT00177476

/pdf/the-influence-of-exercise-and-bmi-on-injuries-and-illnesses-3zsxbkirkr.pdf

The influence of exercise and BMI on injuries and illnesses in overweight and obese individuals: a randomized control trial

A randomized, double-blind, placebo-controlled, parallel-group study was conducted to evaluate the efficacy and safety of gabapentin in relieving the symptoms of social phobia. Sixty-nine patients were randomly assigned to receive double-blind treatment with either gabapentin (dosed flexibly between 900 and 3,600 mg daily in three divided doses) or placebo for 14 weeks. A significant reduction (p < 0.05) in the symptoms of social phobia was observed among patients on gabapentin compared with those on placebo as evaluated by clinician- and patient-rated scales. Results were similar for the intent-to-treat and week-2 completer populations. Adverse events were consistent with the known side effect profile of gabapentin. Dizziness (p = 0.05), dry mouth (p = 0.05), somnolence, nausea, flatulence, and decreased libido occurred at a higher frequency among patients receiving gabapentin than among those receiving placebo. No serious adverse events or deaths were reported. On the basis of these limited data, it seems that gabapentin offers a favorable risk-benefit ratio for the treatment of patients with social phobia. Further studies are required to confirm this effect and to determine whether a dose-response relationship exists.

Treatment of social phobia with gabapentin: a placebo-controlled study.

Results: Weight loss did not differ among the randomized groups at 6 months’ (8%-10% of initial body weight) or 24 months’ (5% of initial body weight) follow-up. Posthoc analysis showed that individuals sustaining a loss of 10% or more of initial body weight at 24 months reported performing more physical activity (1835 kcal/wk or 275 min/wk) compared with those sustaining a weight loss of less than 10% of initial body weight (P.001). Conclusions: The addition of 275 mins/wk of physical activity, in combination with a reduction in energy intake, is important in allowing overweight women to sustain a weight loss of more than 10%. Interventions to facilitate this level of physical activity are needed. Trial Registration: clinicaltrials.gov Identifier: NCT00006315.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/414385/ioi80037_1550_1559.pdf

Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women

BACKGROUND

Primary central nervous system lymphoma (PCNSL) is an extranodal form of non-Hodgkin lymphoma arising in the craniospinal axis. The incidence of PCNSL appears to be increasing.



METHODS

PCNSL incidence data from 1973–1997 were obtained from the nine Surveillance, Epidemiology and End Results (SEER) registries. To limit the influence of the human immunodeficiency virus on incidence rates, data of never–married males and females and persons of unknown marital status were excluded. As a surrogate for new technology, SEER data were reviewed by dates of diagnosis (surrogate for imaging) and compared with glioma incidence (surrogate for stereotactic neurosurgery and improved diagnostic neuropathology). Age-adjusted incidence rates were estimated and compared for the period prior to computed tomography (CT) (1973–1984) and the magnetic resonance imaging (MRI) period (1985–1997). The estimated annual percent change was calculated based on linear regression analyses using SEER*STAT.



RESULTS

The incidence of PCNSL appears to be increasing in all SEER registries examined. All age groups demonstrated an increase over time. This increase was observed both in the CT era as well as in the MRI era. PCNSL age-adjusted incidence (0.15 to 0.48, a 3-fold increase) outpaced that of systemic lymphoma (14.1 to 18.5, a 33% increase) for the same registries over the same time periods. The rate of increase has begun to slow since 1985; the estimated annual percent change for PCNSL was three-fold higher during the period 1973–1985 compared with 1986–1997.



CONCLUSION

The incidence rate of PCNSL continues to rise. The increase is evident in all age groups and in both genders. Data from the current study suggest that improved diagnostic tools, such as CT or MRI, cannot explain this increase. Cancer 2002;95:1504–10. © 2002 American Cancer Society.



DOI 10.1002/cncr.10851

The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: a surveillance, epidemiology, and end results analysis.

Carol A. Janney

Papers

The Physical Activity Scale for the Elderly (PASE): development and evaluation.

The influence of exercise and BMI on injuries and illnesses in overweight and obese individuals: a randomized control trial

Treatment of social phobia with gabapentin: a placebo-controlled study.

Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women

The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: a surveillance, epidemiology, and end results analysis.