Earth

FOLSOM, Calif., October 27, 2020 - A new study published in the Journal of the American College of Cardiology found that regular consumption of foods rich in omega-3 eicosapentaenoic acid (EPA), found in marine foods like fatty fish, and alpha-linolenic acid (ALA), found in plant foods like walnuts, was associated with improved outcomes in individuals who suffered a heart attack, including decreased risk of death. Additionally, the consumption of both ALA and EPA provided the greatest benefit, suggesting a synergistic effect and unique protective qualities when both types of omega-3 are consumed.

The observational study, supported by the California Walnut Commission and reinforced by an editorial in the same publication entitled "A Revolution in Omega-3 Fatty Acid Research," included 944 participants who experienced a very serious heart attack in which one of the heart's major arteries was blocked. Clinicians refer to this as a ST-segment elevation myocardial infarction (STEMI), but consumers may be more familiar with the term "widow-maker" heart attack.

Heart disease is the leading cause of death in America and every 40 seconds someone experiences a heart attack. Of those older than 45 years of age, 36% of men and 47% of women who have experienced a heart attack will die from their second heart attack if it occurs within five years of the first. A lead researcher in the study, Dr. Aleix Sala-Vila, Research Associate at IMIM (Hospital del Mar Medical Research Institute) and Barcelonaβeta Brain Research Center, explains, "Heart attacks are still very common, and aside from treatments to keep the patient alive, researchers have been exploring approaches to secure the quality of life of the patient after the heart attack. What is novel about this research is that it shows that ALA and EPA appear to be partners in improving the long-term outcomes of heart attack sufferers. Consuming both marine and plant-based omega-3s, from foods like salmon, walnuts, and flaxseed, seems to offer the greatest protection."

The patients in this study, whose mean age was 61 and were made up of 78% men, had their blood taken during hospital admission. The researchers then determined the level of omega-3s in their blood, a reliable way to establish the intake of omega-3s during the weeks leading up to the heart attack. Next, they explored whether those with higher blood levels of omega-3s at the time of the heart attack were at decreased risk of suffering complications during a three-year follow-up period.

Specifically, the researchers found that that those who showed higher blood levels of ALA were at decreased risk of three-year all-cause mortality. Also, those with higher levels of EPA were at decreased risk of death or needing hospital readmission for cardiovascular reasons.

Walnuts have long been recognized as a heart-healthy food1, backed by more than 30 years of research showing positive outcomes related to cardiovascular health such as cholesterol, blood pressure, inflammation, endothelial function, and plaque formation. Walnuts are also the only nut with an excellent source of omega-3 ALA, providing 2.5 grams per one ounce.

While these results are encouraging, they do not prove cause and effect. Additional research is needed to determine whether EPA and ALA intake specifically contributed to the outcomes, or if other factors like socioeconomic status, education, and pharmacologic treatments also had an effect. Docosahexaenoic acid (DHA, another omega-3 supplied by fatty fish) was not part of this study.

Ice loss from the Greenland Ice Sheet has accelerated significantly over the past two decades, transforming the shape of the ice sheet edge and therefore coastal Greenland, according to scientific research led by Twila Moon, deputy lead scientist of the National Snow and Ice Data Center. These changes to the ice sheet could have far-reaching impacts on ecosystems and communities, as the flow of water under the ice sheet as well as nutrient and sediment flow are altered. Results of the research were published on October 27 in the American Geophysical Union's Journal of Geophysical Research: Earth Surface.

"The speed of ice loss in Greenland is stunning," said Moon. "We can now see many signs of a transformed landscape from space. And as the ice sheet edge responds to rapid ice loss, the character and behavior of the system as a whole is changing, with the potential to influence ecosystems and people who depend on them."

The researchers compiled data from NASA, the United States Geological Survey, and other satellites from 1985 to 2015 to compare ice edge position, ice sheet surface elevation, and glacier flow over three decades. Advancements in satellite technology allowed them to observe the changes to the ice sheet in much greater detail than was possible in the past. Much of the data used was from the NASA Inter-mission Time Series of Land Ice Velocity and Elevation (ITS_LIVE) project, which facilitates ice sheet, ice shelf, and glacier research by providing a global record of land ice velocity and elevation derived from nearly three decades of satellite observations.

Using these comparisons, the researchers developed a few key findings. The most consistent trend, found across the entire ice sheet, is widespread ice edge retreat. While there is a range of behavior among glaciers across the ice sheet, there is a noticeable lack of sustained ocean-connected glacier advance. Out of 225 ocean-connected glaciers that were measured, none have substantially advanced while 200 have retreated, particularly since 2000. This is notable even in regions dominated by slower-moving glaciers and cooler ocean water, such as the northern and northeastern regions of the ice sheet. In addition, while the vast majority of glaciers are retreating, ice flow response on those glaciers, such as speeding up or slowing down, is affected in large part by topography and upstream factors. This includes the slope of the landscape and the presence and shape of bedrock and sediments underneath the glacier. Therefore, even glaciers within the same regional or local area can behave differently.

As the researchers examined changes in the Greenland Ice Sheet, they found that zones of fast glacier flow are narrowing, ice is being rerouted, and in some cases, the flow of new ice to glaciers is slowed, stranding glaciers in place. These processes could have a variety of downstream impacts, such as altering how water moves under the ice sheet, which could affect the availability of water to communities and animals, altering where nutrients and sediment enter the ocean, exposing new land areas, opening new fjord waters, and altering ecosystems and physical landscapes.

"As the Arctic ocean and atmosphere warm, we can clearly see the flow of ice into the ocean accelerate and the ice edge retreat," said Alex Gardner, a research scientist at NASA's Jet Propulsion Laboratory and co-author of the study. "When we look more closely, however, we can see the complexity of how individual glaciers respond, owing to differences in the properties of the ocean water that reach the glacier front, the bedrock and till that lie below, and in how meltwater runoff is routed beneath. Understanding the complexity of individual glacier response is critical to improving projections of ice sheet change and the associated sea level rise that will arrive at our shores."

LA JOLLA, CA--Scientists at Scripps Research have uncovered a potential new strategy for treating eye diseases that affect millions of people around the world, often resulting in blindness.

Many serious eye diseases--including age-related macular degeneration, diabetic retinopathy and related disorders of the retina--feature abnormal overgrowth of new retinal blood vessel branches, which can lead to progressive loss of vision. It's a phenomenon called "neovascularization."

For the past decade and a half, eye doctors have been treating these conditions with drugs that block a protein, VEGF, that's responsible for spurring new vessel growth. Such drugs have improved the treatment of these conditions, but don't always work well and have potential safety issues. The Scripps Research scientists, in a study published in the Proceedings of the National Academy of Sciences, showed that a new approach that doesn't target VEGF directly is highly effective in mice and has broader benefits than a standard VEGF-blocking treatment.

"We were thrilled to see how well this worked in the animal model," says Rebecca Berlow, PhD, co-senior author of the study. "There really is a need for another way to treat patients who do not respond well to anti-VEGF treatments."

Berlow is a staff scientist in the laboratory of Peter Wright, PhD, professor and Cecil H. and Ida M. Green Investigator in the Department of Integrative Structural and Computational Biology. The co-senior author on the study was Martin Friedlander, MD, PhD, professor in the Department of Molecular Medicine at Scripps Research, retina specialist and ophthalmologist in the Division of Ophthalmology at Scripps Clinic and President of the Lowy Medical Research Institute.

Ayumi Usui-Ouchi, MD, PhD, a post-doctoral fellow in Friedlander's laboratory and visiting assistant professor from the Department of Ophthalmology at Juntendo University in Tokyo, Japan, led the laboratory effort.

"Our findings have important implications for treating these retinal diseases," Friedlander says.

New alternative to an imperfect solution

Vision-impairing neovascularization in the retina typically represents the body's faulty attempt to restore a blood supply that has been impaired by aging, diabetes, high blood cholesterol or other factors.

As the small vessels supplying the retina narrow or fail, oxygen levels in the retina decline. This low-oxygen condition, called hypoxia, is sensed by a protein called HIF-1α, which then triggers a complex "hypoxic response." This response includes boosting production of the VEGF protein to bring more blood to areas in need. In principle, this is an adaptive, beneficial response. But chronic hypoxia leads to chronic and harmful--blindness-causing--overgrowth of abnormal, often leaky, new vessels.

Although anti-VEGF drugs stabilize or improve vision quality in most patients, about 40 percent are not significantly helped by these drugs. Moreover, researchers are concerned that the long-term blocking of VEGF, a growth factor needed for the health of many tissues including the retina, may do harm along with good. Many cases of retinal neovascularization are accompanied by the loss of tiny blood vessels elsewhere in the retina, and blocking VEGF inhibits or prevents the re-growth of these vessels.

In a 2017 paper in Nature, Berlow and colleagues described the workings of a different protein that naturally dials down the hypoxic response and thus might be the basis for an alternative treatment strategy. The protein, CITED2, is produced by HIF-1α as part of the hypoxic response, and apparently functions as a "negative feedback" regulator that blocks HIF-1α's ability to switch on hypoxic response genes--keeping the response from becoming too strong or staying on too long.

A winning combination

For the new study, the team of researchers conducted tests in a mouse model of retinal hypoxia and neovascularization, using a fragment of CITED2 that contains its functional, hypoxic-response-blocking elements.

They showed that when a solution of the CITED2 fragment was injected into the eye, it lowered the activity of genes that are normally switched on by HIF-1α in retinal cells, and significantly reduced neovascularization. Moreover, it did so while preserving, or allowing to re-grow, the healthy capillaries in the retina that would otherwise have been destroyed--researchers call it "vaso-obliteration"--in this model of retinal disease.

In the same mouse model, the researchers tested a drug called aflibercept, a standard anti-VEGF treatment. It helped reduce neovascularization, but did not prevent the destruction of retinal capillaries. However, reducing the dose of aflibercept and combining it with the CITED2 fragment yielded better results than either alone, strongly reducing neovascularization while preserving and restoring retinal capillaries.

CITED2's ability to combine these two benefits appears to represent a key advance, the researchers conclude.

"Most hypoxia-related retinal disorders, such as diabetic retinopathy, have extensive capillary loss in late stages of disease, leading to neuronal cell death and vision loss," Friedlander says. "No current treatment has any therapeutic benefit for this aspect of the disorder."

The researchers now hope to develop the CITED2-based treatment further, with the ultimate goal of testing it in human clinical trials.

Durham, NC - A study released today in STEM CELLS may point to a new treatment for myelin-related disorders including Charcot-Marie-Tooth (CMT) disease. The study demonstrates that fibulin 5, a protein secreted by human Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs), plays an important role in the development of Schwann cells in the peripheral nervous system (PNS).

"This information suggests that WJ-MSCs can be a potent treatment for myelin-related diseases, including CMTs," said Ji Eun Lee, Ph.D., of the Samsung Advanced Institute for Health Sciences & Technology at Sungkyunkwan University (SKKU). She and Jong Wook Chang, Ph.D., of the Stem Cell & Regenerative Medicine Institute, Samsung Medical Center (SMC), were co-authors of the study. Other research team members included SKKU and SMC colleagues along with scientists from Kongju National University. Their work was focused on finding a treatment for CMT.

Affecting one in every 2,500 people worldwide, CMT comprises a group of inherited genetic disorders leading to nerve damage and smaller, weaker muscles. It results when the myelin sheaths of axons in the PNS - important for the fast and proper transmission of nerve impulses - ¬¬¬are impaired. While the most severe cases are typically manifested in foot abnormalities and difficulty walking, patients might also experience trouble with breathing, swallowing or speaking if the muscles that control these functions are impacted.

"No effective treatments for CMTs have been developed to date," Dr. Lee said. "These factors led us to investigate mesenchymal stem cells-based therapies."

Although mesenchymal stem cells (MSCs) have limitations such as difficulty in transplantation and a possibility of becoming cancer cells, they are gaining attention as an alternative treatment because of their ability to differentiate into various types of cells and to suppress inflammation-induced immune response. MSCs are effective in repairing damaged cells by promoting cell proliferation or preventing cell death in various types of cells.

"Indeed, previous clinical trials have reported that human-derived MSCs can be applied safely and efficiently to treat neurological diseases," Dr. Lee said.

The therapeutic effects of MSCs are mainly due to paracrine factors acting on disease-related targets or adjacent cells. Recent studies have identified significant proteins among paracrine factors and demonstrated that recombinant proteins have therapeutic effects comparable to MSCs in several disease model systems. Other studies have reported that a protein called fibulin 5 (FBLN5) is associated with the proliferation of several types of cells, such as smooth muscle cells.

"This all led us to surmise that uncovering key paracrine factors affecting Schwann cells may offer an alternative approach to developing targeted treatment of myelin-related diseases," Dr. Chang said. Schwann cells are vital to a healthy PNS as they produce the myelin sheath surrounding neuronal axons. Their main role is to insulate (myelinate) and supply nutrients to individual nerve fibers (axons) of the PNS neurons.

During the course of their study, conducted on zebrafish, the team able to identify FBLN5 as a key paracrine factor and demonstrate that it is important for the proliferation of Schwann cells, too.

"We were able to show that co-culture with WJ-MSCs or treatment of recombinant FBLN5 promotes the proliferation of Schwann cells through ERK activation, whereas FBLN5-depleted WJ-MSCs do not. We further revealed that during myelination of Schwann cells, FBLN5 binds to Integrin and modulates actin remodeling. At the same time, we discovered that FBLN5 effectively restores the myelination defects of Schwann cells," Dr. Lee said.

"Overall, our data propose human WJ-MSCs or FBLN5 protein as a potential treatment for myelin-related diseases. Accordingly, based on this research, SMC and Korean biotechnology company ENCell Co., Ltd., plan to start a phase 1 clinical trial of CMT cell therapy using WJ-MSCs in 2021," Dr. Chang added.

"Our next goal is to uncover the mechanism by which FBLN5 regulates ERK activation, and particularly to explore role of FBLN5 in the ERK-dependent recovery of impaired Schwann cells," Dr. Lee said.

Dr. Jan Nolta, Editor-in-Chief of STEM CELLS, said, "this study conducted in zebrafish is extremely exciting because it shows the mechanism by which MSCs can enhance and potentially heal the myelin sheath surrounding neuronal axons. This has promise for future investigations to treat not only CMT, but other demyelinating disorders as well."

Big tidal ranges some 400 million years ago may have initiated the evolution of bony fish and land vertebrates. This theory is now supported by researchers in the UK and at Uppsala University who, for the first time, have used established mathematical models to simulate tides on Earth during this period. The study has been published in Proceedings of the Royal Society A.

"During long periods of the Earth's history, we've had small tidal ranges. But in the Late Silurian and Early Devonian, they seem to have been large in some parts of the world. These results appear highly robust, because even if we changed model variables such as ocean depth, we got the same patterns," says Per Ahlberg, professor of evolutionary organismal biology at Uppsala University.

Between 420 and 380 million years ago (Ma) - that is, during the end of one geological period, the Silurian, and beginning of the next, the Devonian - Earth was a completely different world from now. Instead of today's well-known continents there were other land masses, clustered in the Southern Hemisphere. Stretching across the South Pole was the huge continent of Gondwana. North of it was another big one known as Laurussia, and squeezed between the two were a few small continents. Other salient differences compared with now were that Earth's day lasted only 21 hours, since our planet revolved faster on its own axis, and the Moon looked much larger because its orbit was closer to Earth.

Life on land had gradually begun to get established. But the vertebrates, then consisting only of various kinds of fish, were still to be found only in the oceans. Then, during the Devonian, immense diversification of fish took place. One group to emerge was the bony fish, which make up more than 95 per cent of all fish today but were also the ancestors of terrestrial vertebrates. The earliest bony fish were the first animals to evolve lungs. What set off the evolution of bony fish, and how some of them started to adapt to a life on land, has not been clarified. One theory is that it happened in tidal environments where, in some periods, fish had been isolated in pools as a result of particularly large tides. This challenging habitat may have driven the evolution of lungs and, later on, the transformation of fins into front and hind legs.

To test this tidal theory, researchers at Uppsala University, in collaboration with colleagues from the Universities of Oxford and (in Wales) Bangor, used an established mathematical model of the tidal system for the first time to simulate, in detail, the tides in the Late Silurian and Early Devonian. Data on the positions of the continents, the distance of the Moon, the duration of Earth's day, our planet's gravity and the physical properties of seawater were fed into the model. These simulations showed unequivocally that the period, just like that of the present day, was one when large tides occurred in some places. The small continent of South China on the Equator showed a difference of more than four metres in sea level between high and low tide. The existence of tides at the time has previously been verified through studies of geological strata, but determining the extent of the difference between low and high tide has not been feasible. To researchers this news has been interesting, since fossil finds indicate that it was specifically around South China that bony fish originated.

"Our results open the door to further and even more detailed tidal analyses of key episodes in Earth's past. The method can be used to explore the possible role of tides in other evolutionary processes of vertebrate development. And perhaps, conversely, whether tides, with their influence on ocean dynamics, played a part in the big marine extinctions that have taken place again and again in Earth's history," Ahlberg says.

PHILADELPHIA - Police shootings of unarmed Black people in the United States were three times higher than that of white people between 2015 and the beginning of 2020, according to a new report from researchers at the University of Pennsylvania's Perelman School of Medicine, Yale University, and Drexel University. The study shows that, despite a more widespread use of body cameras and increased media attention of police brutality over the past five years, violent encounters with police continue to represent significant causes of injury and death in the United States, particularly for Black, Indigenous, and People of Color (BIPOC).

The study, published in the Journal of Epidemiology and Community Health today examines data provided by the Washington Post on fatal police shootings in the United States from 2015 to the first quarter of 2020. The database draws its data from local news reports, independent databases, and its own reporting. It includes the race, age, and sex of every person killed by on-duty police officers, as well as details about whether the victims were armed or unarmed.

Using these data, the research team measured changes in fatal police shootings based on race and also calculated the death rate and total years of life lost (YLL) from these encounters, which is estimated based on the difference between the life expectancy for U.S. citizens in the victim's birth year and their age of death. While the data is publicly available, the researchers said they wanted to enter it into the scientific literature and present it using methods that are rigorous and robust.

Overall, the report found 5,367 fatal police shootings in the five-year span, of which 4,653 were eligible for analysis because both race and age were identified. The researchers calculated that this represented an annual average of 31,960 years of life lost among all races. Over that period, researchers found a small but statistically significant decline in white deaths (about 1 percent) but no significant change in deaths for BIPOC. The rate of fatal police shootings of unarmed Black and Native American people in the U.S. was more than three times as high as it was among white people during this time period, prompting the researchers to describe U.S. police brutality as a "public health emergency."

"Fatal police shootings are a public health crisis and it can be compared to other conditions that we consider to be important and high priority," said lead author Elle Lett, an MD-PhD student in the Perelman School of Medicine at the University of Pennsylvania. "We want to address this issue of police violence and the ways that it is disproportionately experienced by marginalized groups."

Half of the victims of the shooting fatalities were white (51 percent), followed by Black (27 percent), Hispanic (19 percent), Asian (2 percent) and Native American (nearly 2 percent). Black Americans make up only 14 percent of the U.S., showing the disproportionate impact of police killings on this population.

Lett said that the findings underscore the role that medical professionals play in broader conversations about racial and social justice, but there is further work to be done to understand how police brutality affects BIPOC as individuals.

"We're just beginning to scratch the surface of how fatal police shootings are a collective trauma, how this affects individuals, and what it does to their health," Lett said.

Judges' decisions are an integral part of combat sports, from boxing and wrestling to mixed martial arts (MMA). However, a new study suggests the rate at which competitors fight is more likely to result in judges awarding victory than the skill with which they attack their opponents.

The research was conducted by experts in animal behaviour from the University of Plymouth's School of Biological and Marine Sciences.

They analysed almost 550 men's and women's mixed martial arts contests, taking place between February 2019 and March 2020, using data collated for the Ultimate Fighting Championship (UFC).

That data included the percentage of significant strikes landed that land firmly on the target (a measure of skill), the number of strikes attempted per second (a measure of vigour), the outcome of the fight and whether it was determined by knockout or judges' decision.

The results showed that in all fights, winners fought more vigorously than losers but this performance trait was more important for fights resolved via judges' decisions compared with those ending as a result of a knockout or technical knockout.

Fighting skilfully (landing more significant strikes) also increased their chance of winning - with skilful fighting even enhancing the effect of vigour on success - but despite this, the rate of attack was consistently the dominant factor determining success in fights evaluated by judges.

Dr Sarah Lane, Post-doctoral Research Fellow and the study's lead author, said: "MMA is a fast paced sport and one of the suggestions from our research would be that judges may find vigour easier to assess than skill. That, in turn, leads them to overvalue it when making their decisions especially in longer fights where one fighter tires more quickly and the disparity in vigour is easier to spot. The advance of technology such as instant replays could potentially counter this, but until they are employed more regularly rate of attack is likely to remain the most important performance trait for victory by decision."

The study, published in Biology Letters, was funded by the Biotechnology and Biological Sciences Research Council as part of ongoing research into the role of skill in animal contests.

That research is predominantly focused on the behaviour of hermit crabs, who fight over the ownership of the empty snail shells that they rely on for protection.

However, the current study's authors - who have previously analysed fighting behaviours in a number of other marine species - say their observations of human contests could potentially have implications across the animal kingdom.

Mark Briffa, Professor of Animal Behaviour and co-author of the study, added: "Human combat sports provide a unique scenario in which to explore how performance traits such as skill and vigour are perceived, both by participants and observers. However, because of the obvious communication issues, very little is known about the accuracy with which fighting animals more widely judge the abilities of their rivals.

"What we do know is that bystanders often observe and evaluate fighters' performances in order to choose future mating partners or learn which rivals to avoid. That would suggest the human use of performance traits to evaluate fighting ability as seen in this study is being replicated elsewhere in the animal kingdom, and this is something we are continuing to explore through our work."

Peer-reviewed / Observational study / People

New study of older adults (aged 70 or over) in Stockholm, Sweden, suggests older people living in care homes had higher COVID-19 mortality risk than those living in single houses or apartment buildings.

Those living in multigenerational homes had higher COVID-19 mortality risk, compared to those who live only with other older individuals, according to the study.

The study investigated the impact of living arrangements on COVID-19 mortality among the elderly in a context where lockdown was never formally implemented, and the strategy relied on shielding of the vulnerable and social distancing recommendations.

Given the higher risk of death for the elderly in close contact with younger people within the home, the researchers conclude that measures designed to protect older adults must consider community spread as well as individual points of transmission, such as family members, as well care as home visitors and employees.

Older people living with or in close contact with people of working age may be at higher risk of COVID-19 mortality in Stockholm, Sweden, according to an observational study published today in The Lancet Healthy Longevity journal.

The researchers highlight that the study focuses on Sweden, where only the frailest older people tend to live in care homes and where lockdown was never formally implemented but which relied on people adhering to social distancing recommendations, and therefore the findings may not apply other countries. However, experts commenting on the study warn that it provides a clear example of the impact on elderly people when community transmission is not part of a control strategy. [1]

Maria Brande?n, of Linko?ping University, Sweden, and lead author of the study, said: "Our findings confirm that in areas of the community where there are high numbers of COVID-19 infections, there are high mortality rates among the elderly and that elderly people are more at risk of dying from COVID-19 if they live in a care home or with family members who are working age." [2]

She adds: "Controlling community transmission is key in protecting everyone in this pandemic. Neighbourhood transmission is an important consideration for COVID-19 even if older people can and do self-isolate, because many of them will come into contact with working age people at some point. Close exposure to working age-individuals in the form of care workers or other household members puts older people at risk, so strategies to protect these people must be explored, with particular attention to densely populated areas." [2]

Living arrangements, the type of home, and neighbourhood characteristics are considered to be important aspects in understanding the spread of COVID-19 among older adults, but previous research has relied on aggregated data and not considered individual risk factors. In this first of its kind study, individual patient data was used to evaluate how residential context was related to COVID-19 mortality among older adults in Stockholm, Sweden.

In the observational study, researchers used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify COVID-19 mortality, and mortality from other causes among people aged 70 years and over in Stockholm between 12 March and 8 May 2020.

During the study period, there were 3,386 deaths, 1,301 were reported as COVID-19 related. They linked five variables to find out how many COVID-19 deaths were associated with each. The variables included how crowded the housing was (m2 per individual), the household age structure (living alone, living with at least one individual aged 66 years or over, and living with at least one individual younger than 66 years), house type (single-family detached house, multi-family housing such as apartment buildings and care homes), neighbourhood population density, and confirmed cases in the area.

The researchers then adjusted these numbers for other factors that could influence COVID-19 mortality (age, sex, education, income, and country of birth) and created a model to calculate the difference in risk of dying from COVID-19 associated with the five variables. They also compared these figures to mortality from other causes of death to see which factors were exclusively associated with COVID-19. This comparison allowed the researchers to highlight which residential conditions were particularly relevant risk factors for COVID-19, rather than being general risk factors for the elderly.

When looking at living arrangements, those in care homes had the highest mortality (233 deaths per 1,000 people per year), followed by those living in apartment blocks (26 deaths per 1,000 people per year), and those living in a detached house (16 deaths per 1,000 people per year). After adjusting for age, sex, education, income, and country of birth, individuals living in care homes were four times as likely to die of COVID-19 compared to those living in independent housing.

In terms of household age structure, the lowest COVID-19 mortality was found among older people who lived with someone aged 66 or older (19 deaths per 1,000 people per year), while the highest mortality was found in homes with at least one person older the 66 years of age and one child younger than 16 years of age (38 deaths per 1,000 people per year in homes). After adjustment, living with someone who is working age (younger than 66 years old) was associated with a 60% increase in COVID-19 mortality, compared with living in a household with individuals aged 66 years or older.

Living in the most densely populated neighborhoods (more than 5,000 individuals per km2) had the highest mortality (39 deaths per 1,000 people per year), compared to neighbourhoods of less than 150 individuals per km2 (11 deaths per 1,000 people per year). After adjustment, older people living in the most densely populated neighborhoods (more than 5,000 individuals per km2) were at a 70% higher risk of dying from COVID-19 than the least populated areas.

All factors were exclusively associated with COVID-19 except when it came to living in the most crowded homes, which was also associated with an increase of mortality of other causes of death. Living in the most crowded homes (0m2 to

The researchers say the higher associated risk of COVID-19 mortality when living with a younger person suggests that multigenerational living could contribute to COVID-19 mortality in countries where it is common and community transmission remains high. They warn that measures to protect the elderly must also focus on reducing community transmission, as well as individual points of transmission. For example, individuals of working age or younger who live with or are in frequent contact (i.e., care home workers) with the elderly must have access to adequate PPE or resources allowing them to mitigate the spread of the virus.

Additionally, self-isolating and making use of services such as online shopping and doctors' appointments, both common practices in Stockholm, may have allowed older people to successfully shield, reflected in the lower rates of mortality when living with someone aged 66 years and older. There was a lack of PPE equipment in care homes at the beginning of the pandemic, which could have contributed to the higher risk of mortality when living in a care home, the researchers suggest.

The authors note some limitations to their study. The findings might not be applicable to other contexts, as older people in Sweden seem to live in the community more than in other countries, so they say that only the frailest would have been in care homes. They add that the data could have underestimated the amount of people living in care homes because the frailest sometimes die before their move into the care home has been registered. Additionally, the data did not capture people living independently but receiving in-home care, the researchers said.

The researchers suggest that gathering data in finer detail on symptoms and spatial resolution is needed to more accurately assess how neighbourhood transmission is associated with COVID-19.

Writing in a linked Comment, Dr Alison Roxby of the University of Washington School of Medicine, USA, says: "Brandén et al's work offers insight into the devastating impact of COVID-19 among older adults living in settings with close intergenerational contact. The passive stance taken in Sweden to avoid a generalized lockdown resulted in increased deaths not only in care homes, but also among community-dwelling older adults. Today, older adults are experiencing crisis levels of isolation that will likely lead to long-term loneliness and poorer health. COVID-19 testing is more accessible, active contact tracing is occurring, and face coverings are important measures in reducing infection and spread, but these practices may do little to prevent transmission within households. Household-level preventive measures will be needed to protect older adults as the pandemic continues. Vaccines and monoclonal antibodies are promising tools that may reduce the risk of infection and spread; older adults and their support networks should be among the earliest recipients once available. The Swedish experience reveals that COVID-19 mortality will continue to place its heaviest burden on older adults without a comprehensive public health strategy going forward."

University of Calgary scientists and members of the Clark H. Smith Brain Tumour Centre at the Arnie Charbonneau Cancer Institute at the Cumming School of Medicine (CSM) have discovered a way to stop the growth of glioblastoma, the deadliest form of brain cancer. The finding, published in Nature Communications, provides a new tactic in the war against cancer that involves reprogramming the immune system to do what it does best - fight the tumour instead of fueling it.

For some time, scientists have observed a tumour's ability to recruit cells from the immune system. Until now, they did not understand how the tumour was able to do that.

"We discovered that glioblastoma cells secrete a specific factor, called interleukin 33," says Stephen Robbins, PhD, co-principal investigator on the study, and professor at the CSM. "It's this substance that draws immune cells to the tumour and helps to create an environment that changes the function of the immune cells. Instead of fighting the tumour, the immune cells go to work for it, contributing to the tumour's rapid growth."

Interleukin 33 (IL-33) is not new to researchers. It is referred to as an alarmin. Just like it sounds, alarmin raises an alarm in the body that signals the immune system. The research, conducted in mice, shows that when the tumour cells release IL-33 it signals the immune cells to the tumour. However, its job does not stop there, IL-33 also works in the nucleus of the tumour cell, which is critical, as it is this change that triggers the transformation in the immune cells. Altering their function from fighting tumour growth to promoting it.

Current treatment for glioblastoma includes surgery, radiation, and chemotherapy, which can be effective, but is not curative. This type of tumour is very resilient, however, the researchers found that there is a way to stop the tumour's growth.

"We found that by stopping IL-33 from reaching the nucleus of the tumour cell, it crippled the entire process," says Dr. Donna Senger, PhD, co-principal investigator on the study, and research associate professor at the CSM. "When we interrupt this step, the immune cells come into the tumour and can do the job they were meant to do. Attack the cancer."

When the IL-33 process was disrupted, survival rates increased to over a year, from two months or less. While this study was in mice, glioblastomas in people behave similarly. The researchers say this discovery provides an additional strategy for the medical community to consider to contain and possibly destroy this fatal cancer.

"New findings like this one advances our fundamental understanding of how we can potentially re-program our immune system precisely to attack and destroy glioblastoma and other cancers," says Dr. Victor Ling, Terry Fox Research Institute (TFRI) president and scientific director. "Our congratulations to this pan-Canadian team, led from the University of Calgary, for demonstrating how translational cancer research built on collaboration, and open and transparent data sharing, can have profound results."

Robbins and Senger add this finding can help shift the conversation and approach to fighting cancer to move beyond targeting the cancer cell to now include the host immune system as part of the artillery.

Marginalised young people in Brazilian cities can play an important role in responding to the threat of climate change, but youth engagement needs to be both 'playful' and take youth 'seriously' to support them in expressing their full potential in bringing about local change according to a new study.

Researchers working with young people in Sao Paulo, aged 12 to 18, discovered a mismatch between what matters to youth and the processes of communication around environmental issues by different adult groups.

They found that young citizens living in Sao Paulo's urban peripheries - the densely-populated and precarious spaces between the core city and outer suburbs - felt disconnected from discussions by academics, and policy-makers on issues around climate change whether local, national or international.

Young people's emotional relationships to their environment might sometimes seem unconventional and possibly even contradictory, yet they reflected the youngsters' own experiences, stories, and emotions.

Publishing their findings in Children's Geographies, researchers at the Universities of Birmingham and Sao Paulo found that COVID-19 threw into sharp relief existing inequalities and mechanisms of socio-economic exclusion in the urban periphery in Brazil.

They found that, although structural inequalities were found in some central neighbourhoods of Sao Paulo, peripheral communities are more marginalised as poor public transport and long distances widened the gap access to education, the labour market and leisure.

Report co-author Dr. Susanne Börner, Marie Curie Fellow at the University of Birmingham, commented: "Overcoming this rupture requires us to work with young people to identify and connect with their views, experiences, and emotions related to their local environment and global climate change - moving beyond just listening to them."

"Young people, with no space in institutional and adult arenas, don't see themselves as part of the solution and perceive few opportunities for improving the neighbourhood. Caught in a daily struggle to make ends meet, some cannot think beyond their immediate necessities."

Dr. Börner added that a sense of belonging and connection was fundamental for young people to start perceiving themselves as part of the solution. Confidence and trust were important factors with young people not necessarily believing that they have a valuable point of view.

This made building and maintaining trust especially relevant during the current context of COVID-19, which amplifies current and future conditions of vulnerability and exacerbates systemic shortcomings in opportunities for virtual learning and engagement - increasing the risk that those young people already marginalised will be left behind even further.

"We perceive important opportunities for youth to develop a changing, more sustainable relationship with their environment - experiencing an increase in self-esteem and being better able to communicate matters of concern with both peers and adults," said Dr. Börner.

"Stimulating youth leadership is strongly connected to emotions such as fun and humour - youth engagement must be both 'playful' and take young people seriously in order to incentivise their participation and create better relations between young people and adults."

ARLINGTON, Va., October 26, 2020 -- Adding the advanced PET radiotracer fluciclovine to conventional imaging to help guide radiation treatments for recurrent prostate cancer can improve disease-free survival rates, a new study finds. Among patients whose prostate cancer had returned after surgical removal of their prostate, 75.5% whose treatment integrated the PET molecular imaging were disease-free after three years, compared to 63% for whom only conventional imaging techniques were used to plan treatment. The increased survival rate persisted for up to four years. Findings from the randomized phase II/III EMPIRE-1 trial (NCT01666808) will be presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

"The decision to offer post-prostatectomy radiation therapy is complex, because conventional imaging can leave unanswered questions on the best approach to treatment planning," said co-principal investigator Ashesh B. Jani, MD, FASTRO, a professor of radiation oncology at the Winship Cancer Institute of Emory University in Atlanta. "What this research has found is that integrating advanced molecular imaging into the treatment planning process allows us to do a better job of selecting patients for radiation therapy, guiding radiation treatment decisions and planning and ultimately, keeping patients' cancer under control."

"This is the first study of its kind to look at the role of PET in influencing a cancer control endpoint," added David M. Schuster, MD, a nuclear radiology specialist and professor at Emory University who collaborated with Dr. Jani on the study as co-principal investigator. "That's a very high bar for an imaging study."

Prostate cancer is one of the most common types of cancer, and a leading cause of cancer death, among men in the United States. An estimated one in nine men will be diagnosed with prostate cancer in his lifetime. Removing all or part of the prostate is a common treatment, but for 20-40% of men, prostate specific antigen (PSA) levels may nonetheless rise after surgery, signaling a return of cancer cells. Furthermore, failure rates for post-surgical radiation treatments remain high. "This is prostate cancer that, by virtue of being recurrent, has demonstrated its capacity to be aggressive," explained Dr. Jani.

Conventional imaging techniques, such as bone scans, computerized tomography (CT) or magnetic resonance imaging (MRI), are typically used to guide radiation therapy decisions and treatment plans for these recurrent cancers by identifying if tumors are present in the body. Molecular imaging with positron emission tomography (PET) scans, which look instead for higher levels of injected radiotracer activity within cancer cells, has been effectively used to guide treatment of many cancers by more accurately detecting the presence and location of developing tumors. Though previous PET studies have led to changes in how prostate cancer is managed, an ensuing improvement in patient outcomes had not been demonstrated until this point.

This study used a type of PET known as [fluorine-18, or 18F] fluciclovine (brand name Axumin). For this scan, patients are given radioactive tracers containing a synthetic amino acid. Because cancer cells use more amino acids than other cells, the cancer is more easily detected when it accumulates more of this type of radiotracer.

"This is a jump ahead of the traditional way of looking at things," said Dr. Jani. "It helps us to pinpoint the location of the prostate cancer recurrence." Research by the team previously established a role for fluciclovine in guiding post-prostatectomy radiation therapy treatment decisions and target volumes.

The Emory Molecular Prostate Imaging for Radiotherapy Enhancement, or EMPIRE-1 trial (NCT01666808), enrolled 165 patients who had undergone prostatectomies, but who later showed abnormal PSA blood test scores, indicating their cancer was returning. All patients underwent conventional imaging (bone scans, CT or MRI) for initial treatment planning. Patients were then randomized into two groups. The first group received radiation therapy based on these initial treatment plans. The other group was given fluciclovine PET scans and treated based on the additional findings.

After three years, the study showed patients who were treated based on the more advanced imaging results had a higher disease-free survival rate (p=0.003), which persisted for four years (51% for those in the conventional arm, versus 75.5% in the advanced imaging arm, pResearchers attributed the improved outcomes to better patient selection, by excluding patients with extra-pelvic disease who are more susceptible to failure, as well as better definition of the tumor and treatment field.

"The reason we did this research was because we were frustrated that we could not get better cure rates for patients with this type of cancer," said Dr. Schuster. "We thought one of the factors involved may be the sensitivity of the imaging tests used for planning radiation therapy. We thought this new PET test, with its greater sensitivity for detecting prostate cancer, would translate into a better cure rate, as well. We believed there would be some effect but were pleasantly surprised by the strength of the findings."

Fluciclovine was approved for use by the U.S. Food and Drug Administration (FDA) about halfway through the study in 2016, and it is now widely accepted for the restaging of recurrent prostate cancer with inclusion in the NCCN guidelines. It has not yet been widely adopted as the standard for planning treatment in this patient population, however.

"Before a patient is considered for radiation therapy to treat prostate cancer that has returned after surgery, the doctor should not rely on traditional imaging alone, but should also use advanced molecular imaging. Doing so will help determine if radiation therapy is appropriate for that patient and, if so, more precisely plan how to target his disease," said Dr. Jani.

The collaborative team led by Drs. Jani and Schuster is already investigating whether a newer type of PET scan, which uses a radiotracer to target a receptor on the surface of prostate cancer cells, could be even more effective than fluciclovine in improving cancer control. The newer scan, PSMA, is not yet FDA approved.

"Fluciclovine PET has become the best available test," said Dr. Schuster. "But now there's an even newer kid on the block. In EMPIRE-2, we're building on the results of EMPIRE-1 by comparing PSMA with fluciclovine to see which one of these radiotracers improves cancer control better."

During the last 2.6 million years of Earth's climate has altered between glacial and interglacial states. As such, there have been times in which the transition between the two climate states appeared with either regular or irregular periodicity. AWI researcher Peter Köhler has now discovered that the irregular appearance of interglacials has been more frequent than previously thought. His study makes a significant contribution to our understanding of Earth's fundamental climate changes.

In order to understand human beings' role in the development of our current climate, we have to look back a long way, since there has always been climate change - albeit over vastly different timescales than the anthropogenic climate change, which is mainly due to the use of fossil fuels over the past 200 years. Without humans, for millions of years, climate altered between glacial and interglacial states over periods of many thousands of years, mainly because of the Earth's tilt which changes by a few degrees with a periodicity of 41,000 years. This in turn changes the angle at which the sun's rays strike Earth - and as such the energy that reaches the planet, especially at high latitudes in summer. However, there is strong evidence that during the course of the last 2.6 million years, interglacials have repeatedly been 'skipped'. The Northern Hemisphere - particularly North America - remained frozen for long periods, despite the angle of the axial tilt changing to such an extent that more solar energy once again reached Earth during the summer, which should have melted the inland ice masses. This means Earth's tilt can't be the sole reason for Earth's climate to alter between glacial and interglacial states.

In order to solve the puzzle, climate researchers are investigating more closely at what points in Earth's history irregularities occurred. Together with colleagues at Utrecht University, physicist Peter Köhler from the Alfred Wegener Institute (AWI) has now made a significant contribution towards providing a clearer picture of the sequence of glacial and interglacial periods over the last 2.6 million years. Until now, experts thought that, especially over the past 1.0 million years, glacial and interglacial periods deviated from their 41,000- year cycle, and that interglacial periods were skipped, as a result of which some glacial periods lasted for 80,0000 or even 120,000 years. "For the period between 2.6 and 1.0 million years ago, it was assumed that the rhythm was 41,000 years," says Peter Köhler. But as his study, which has now been published in the scientific journal Nature Communications, shows, there were also repeated irregularities during the period between 2.6 and 1.0 million years ago.

Köhler's study is particularly interesting because he re-evaluated a well-known dataset that researchers have been using for several years - the LR04 climate dataset - yet arrived at completely different conclusions. This dataset consists of a global evaluation of core samples from deep-sea sediments that are millions of years old, and includes measurements from the ancient shells of microscopic, single-celled marine organisms - foraminifera - that were deposited on the ocean floor. Foraminifera incorporate oxygen from the seawater into their calcium shells. But over millennia, the level of specific oxygen isotopes - oxygen atoms that have differing numbers of neutrons and therefore different masses - varies in seawater.

18O reveals what the world was like in the past

The LR04 dataset contains measurements of the ratio of the heavy oxygen isotope 18O to the lighter 16O. The ratio of 18O/16O stored in the foraminifera's shells depends on the water temperature. But there is also another effect that leads to relatively large amounts of 18O being found in the foraminifera's shells in glacial periods: when, during the course of a glacial period, there is heavy snowfall on land, which leads to the formation of thick ice sheets, the sea level falls - in the period studied, by as much as 120 m. Since 18O is heavier than 16O, water molecules containing this heavy isotope evaporate less readily than molecules containing the lighter isotope. As such, comparatively more 18O remains in the ocean and the 18O content of the foraminifera shells increases. "If you take the LR04 dataset at face value, it means you blur two effects - the influence of ocean temperature and that of land ice, or rather that of sea level change," says Peter Köhler. "This makes statements regarding the alternation of the glacial periods uncertain." And there is an additional factor: climate researchers mainly determine the sequence of glacial periods on the basis of glaciation in the Northern Hemisphere. But using 18O values doesn't allow us to say whether prehistoric glaciation chiefly occurred in the Northern Hemisphere or in Antarctica.

Computer model separates the influencing parameters

In an attempt to solve this problem, Köhler and his team evaluated the LR04 dataset in a completely different way. The data was fed into a computer model that simulates the growth and melting of the large continental ice sheets. What sets it apart: the model is capable of separating the influence of temperature and that of sea level change on the 18O concentration. Furthermore, it can accurately analyse where and when snow falls and the ice increases - more in the Northern Hemisphere or in Antarctica. "Mathematicians call this separation a deconvolution," Köhler explains, "which our model is capable of delivering." The results show that the sequence of glacials and interglacials was irregular even in the period 2.6 to 1.0 million years ago - a finding that could be crucial in the coming years. As part of the ongoing major EU project 'BE-OIC (Beyond EPICA Oldest Ice Core)', researchers are drilling deeper than ever before into the Antarctic ice. With the oldest ice core recovered to date, 'EPICA', they have 'only' travelled back roughly 800,000 years into the past. The ancient ice provides, among other things, information on how much carbon dioxide Earth's atmosphere contained at that time. With 'Beyond EPICA' they will delve circa 1.5 million years into the past. By combining the carbon dioxide measurements with Köhler's analyses, valuable insights can be gained into the relation between these two factors - the fluctuations in the sequence of glacials and the carbon dioxide content of the atmosphere. And this can help us understand the fundamental relationship between greenhouse gases and climate changes in Earth's glacial history.

Ecosystem services are crucial for human well-being and they depend on a well-functioning ecosystem and complex interactions among many organisms. However, human activities are resulting in biodiversity loss and changes to ecosystems, which threatens the supply of key services. An international team of 32 scientists, from 22 institutions, led by Dr Maria Felipe-Lucia (UFZ, iDiv) and Prof Eric Allan (University of Bern) now present the very first assessment of the simultaneous effects of land-use intensity on biodiversity, ecosystem functions, and services.

A new approach to investigate shifts in the ecosystem

The researchers investigated how these interactions vary with land-use intensity. They analysed data from 300 German grasslands and forests, varying in land-use intensity, and borrowed approaches from network analysis to characterize the overall relationships between biodiversity, ecosystem functions and services.

"We already knew that land use affects biodiversity and ecosystem functioning," says the lead author of the paper Dr Felipe-Lucia, senior scientist at UFZ and iDiv. "But we knew very little about how land-use intensity simultaneously alters the relationships between diversities, functions and services. By understanding these relationships, we can anticipate how future changes in land use will affect ecosystems and human wellbeing."

We cannot intensify without limits: varied landscapes are the key

The study demonstrates that low intensity farming and forestry can provide material benefits (fodder, timber), while preserving biodiversity. In contrast, high intensity practices increase material benefits but reduce biodiversity and the benefits people derive from it.

"With increasing land-use intensity we are losing specialized relationships," Felipe-Lucia concludes. "This is comparable to shopping either in a low-quality mega-store or in a specialized boutique." Similar to specialized boutiques, where it is necessary to visit many different of them to get the best items, low land-use intensity grasslands and forests are specialized in a particular set of biodiversity, functions and associated services. High land-use intensity landscapes are comparable to mega-stores where all kinds of goods can be found at one place, but of lower quality.

"As in any city, it is ok to have a couple of mega-stores, but we cannot neglect the smaller high-quality boutiques either. In our landscapes, we need to maintain pockets of low land-use intensity to provide these specialized gifts," explains Allan, senior athour of the paper.

From ecosystem functioning to human-dependent landscapes

In healthy ecosystems, more species usually means higher levels of ecosystem services for people and therefore better human wellbeing. "Intensification tends to homogenize biodiversity-functioning-service relationships and lead to a less integrated system with fewer positive relations between services," points out Allan. "Diverse low intensity systems can provide different sets of services and a varied landscape could therefore be the key to solve conflicting land uses and provide a wider range of services while preserving biodiversity."

"We also identified the level of management intensity that disrupts the normal functioning of the landscape, that is, when the ecosystem becomes more dependent on human inputs (such as fertilizer) for its functioning," says Felipe-Lucia.

The new analyses can help to detect the loss of correlations between biodiversity and ecosystem services, which could be taken as an early warning signal of ecosystem change. "Our approach provides a new and comprehensive view of ecosystem functioning and can identify the key ecosystem attributes to monitor in order to prevent critical shifts in ecosystems," says Allan. "It can also be applied to analyze the effects of other global changes such as climate change."

The Himalaya are among the youngest and highest mountains in the world, but the exact timing of their uplift and origins of their biodiversity are still in debate. Generally, there are two hypotheses about the uplift process of the Himalaya. The "Stepwise Hypothesis" states that the Himalaya rose slowly from 1000-2500 m during 56-23 million years ago (Ma), before an additional rapid uplift to 4000 m during 23-19 Ma, and a final rise to the current average elevations (~5000 m) at around 15 Ma. Alternatively, recent hydrological and thermal evidences support that this region was probably not elevated to current elevation till mid-Pliocene ("Late Orogeny Hypothesis").

Time-based records of biological processes can be informative about montane histories and environmental changes. Various hypotheses about Himalayan origins can be tested using phylogenetic information and estimates of the timing of biological speciation events. To address the question about the timing of the Himalaya uplift, we carried out field work across the Himalaya to collect samples of amphibians and reptiles. The Himalayan region encompasses multiple countries and has many access challenges, so sampling across the entire region is difficult, which has inhibited integrative studies of the origin of the Himalayan biota.

Combining 14 time-calibrated phylogenies of Himalayan-associated amphibian and reptile families involving 85 genera and 1628 species, we estimated times of divergence among 183 species that occur in the Himalaya. We identified 230 biogeographic events related to the Himalayan species. The dynamics of in situ diversification and dispersal rates remained essentially parallel across the Cenozoic. Both the in situ diversification rate, as well as the dispersal rate into the Himalaya, fit the Stepwise Hypothesis for the origin of this mountain range. In contrast, our estimates of origination and peak diversification are not consistent with the late-uplift hypothesis.

The rapid Himalayan uplift and associated intensified South Asia Monsoon not only promoted a pulse of uplift-driven in situ diversification, but also affected the rates of biotic interchange. Biotic interchange was restricted by the lack of a moist environment that is required by many reptiles and amphibians. In contrast, an expanded tropical forest belt is thought to have persisted between the Himalaya and Southeast Asia since the middle Miocene, which likely accounts for the high dispersal rates between these two regions.

This work has important implications about the assembly process of Himalayan herpetofauna and its conservation. Our analyses show a deep-rooted origin of Himalayan herpetofauna originating in the Paleocene, but with rapid diversification in the Miocene.

The muscles and joints are not the only parts of the body to be worn down by physical work. The brain and heart suffer too. A new study from the University of Copenhagen shows that people doing hard physical work have a 55-per cent higher risk of developing dementia than those doing sedentary work. The figures have been adjusted for lifestyle factors and lifetime, among other things.

The general view has been that physical activity normally reduces the risk of dementia, just as another study from the University of Copenhagen recently showed that a healthy lifestyle can reduce the risk of developing dementia conditions by half.

Here the form of physical activity is vital, though, says associate professor Kirsten Nabe-Nielsen from the Department of Public Health at the University of Copenhagen.

"Before the study we assumed that hard physical work was associated with a higher risk of dementia. It is something other studies have tried to prove, but ours is the first to connect the two things convincingly," says Kirsten Nabe-Nielsen, who has headed the study together with the National Research Centre for the Working Environment with help from Bispebjerg-Frederiksberg Hospital.

"For example, the WHO guide to preventing dementia and disease on the whole mentions physical activity as an important factor. But our study suggests that it must be a 'good' form of physical activity, which hard physical work is not. Guides from the health authorities should therefore differentiate between physical activity in your spare time and physical activity at work, as there is reason to believe that the two forms of physical activity have opposite effects," Kirsten Nabe-Nielsen says and explains that even when you take smoking, blood pressure, overweight, alcohol intake and physical activity in one's spare time into account, hard physical work is associated with an increased occurrence of dementia.

One of the study's co-authors is Professor MSO Andreas Holtermann from the National Research Centre for the Working Environment. He hopes the dementia study from the University of Copenhagen will contribute to shine a spotlight on the importance of prevention, as changes in the brain begin long before the person leaves the labour market.

"A lot of workplaces have already taken steps to improve the health of their staff. The problem is that it is the most well-educated and resourceful part of the population that uses these initiatives. Those with a shorter education often struggle with overweight, pain and poor physical fitness, even though they take more steps during the day and to a larger extent use their body as a tool. For workmen, it is not enough for example to avoid heavy lifts if they wish to remain in the profession until age 70. People with a shorter education doing manual labour also need to take preventive steps by strengthening the body's capacity via for example exercise and strength training," he says.

The study is based on data from the Copenhagen Male Study (CMS), which included 4,721 Danish men, who back in the 1970s reported data on the type of work they did on a daily basis. The study included 14 large Copenhagen-based companies, the largest being DSB, the Danish Defence, KTAS, the Postal Services and the City of Copenhagen.

Through the years, the researchers have compiled health data on these men, including data on the development of dementia conditions.

According to Kirsten Nabe-Nielsen, previous studies have suggested that hard physical work may have a negative effect on the heart blood circulation and thus also on the blood supply to the brain. This may for example lead to the development of cardiovascular diseases like high blood pressure, blood clots in the heart, heart cramps and heart failure.

The National Research Centre for the Working Environment continues to work on the results with a view to identifying healthier ways of doing hard physical work. They have therefore begun to collect data from social and healthcare assistants, child care workers and packing operatives, among others, in order to produce interventions meant to organise hard physical work in such a way that it has an 'exercise effect'.

They thus hope to see companies successfully change work procedures, ensuring for example that heavy lifts will have a positive effect rather than wear down the workers. The results will be published on an ongoing basis.