HEALTH & HAPPINESS 4 YOU: Issue 28

Summer 2018

HEALTH & HAPPINESS 4 You

Green spaces may improve mental health Air pollution contributes to diabetes Socialise to strengthen your heart

Feel young and keep your brain healthy

Replace potatoes and rice with pulses to lower blood sugar

HEALTH & HAPPINESS 4 YOU: SERVING COMMUNITY FOR THE LAST SEVEN YEARS

Link between fast food and asthma

CONTENTS Summer 2018, Issue 28

A new Respirology review and analysis of published studies reveals a link between fast food consumption and an increased likelihood of having asthma, wheeze, and several other allergic diseases such as pollen fever, eczema, and rhino-conjunctivitis.

The analysis included 16 studies. In terms of different types of fast food consumption, hamburger intake was most prominently associated with allergic diseases in a dosedependent manner, irrespective of consumers' income.

The authors note that poor quality diet is likely to contribute to the development and progression of asthma and wheeze via multiple mechanisms. "Additional studies are needed to confirm the relationships seen in this analysis, however, and to identify potential causal associations between the consumption of fast food and allergic diseases," said senior author Dr. Gang Wang, of West China Hospital, Sichuan University.

5- Air pollution may contribute to diabetes 7- Feeling young slows down the ageing of brain 8- A fat belly is bad for your heart 9- Create social network to improve heart health 11- When times are tough stop behaving badly 12- Replace potatoes and rice to lower blood glucose 13- Too many babies are overfed 14- Green spaces improve mental health 15- Music can improve your health and mood 16- Sleeping too much or too little may impact your health 17- Mozart, meditation and yoga for breast cancer 18- Better coordination among children improves school performance.

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Disclaimer: The information available in this magazine is for general awareness only. It is NOT a substitute for the knowledge and judgment of qualified medical experts. We make no warranty as to the accuracy, reliability or completeness of this information. Should you have any medical condition, you are strongly advised to consult a qualified health care professional. Views expressed by our contributors are their own and we take no responsibility for their views.

Air pollution contributes significantly to diabetes

New research links outdoor air pollution -- even at levels deemed safe -- to an increased risk of diabetes globally, according to a study from Washington University School of Medicine in St. Louis. The findings raise the possibility that reducing pollution may lead to a drop in diabetes cases in heavily polluted countries such as India and less polluted ones such as the United States.

Diabetes is one of the fastest growing diseases, affecting more than 420 million people worldwide and 30 million Americans. The main drivers of diabetes include eating an unhealthy diet, having a sedentary lifestyle, and obesity, but the new research indicates the extent to which outdoor air pollution plays a role.

"Our research shows a significant link between air pollution and diabetes globally," said Ziyad Al-Aly, MD, the study's senior author and an assistant professor of medicine at Washington University. "We found an increased risk, even at low levels of air pollution currently considered safe by the U.S. Environmental Protection Agency (EPA) and the World Health Organization (WHO)."

The findings are published June 29 in The Lancet

Planetary Health. To evaluate outdoor air pollution, the researchers looked at particulate matter, airborne microscopic pieces of dust, dirt, smoke, soot and liquid droplets. Previous studies have found that such particles can enter the lungs and invade the bloodstream, contributing to major health conditions such as heart disease, stroke, cancer and kidney disease. In diabetes, pollution is thought to reduce insulin production and trigger inflammation, preventing the body from converting blood glucose into energy that the body needs to maintain health.

Overall, the researchers estimated that pollution contributed to 3.2 million new diabetes cases globally in 2016, which represents about 14 percent of all new diabetes cases globally that year. They also estimated that 8.2 million years of healthy life were lost in 2016 due to pollution-linked diabetes, representing about 14 percent of all years of healthy life lost due to diabetes from any cause. In the United States, the study attributed 150,000 new cases of diabetes per year to air pollution and 350,000 years of healthy life lost annually.

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Feeling young slows down the aging of your brain

While everyone gets older, not everyone feels their age.

A recent study finds that such feelings, called subjective age, may reflect brain aging. Using MRI brain scans, researchers found that elderly people who feel younger than their age show fewer signs of brain aging, compared with those who feel their age or older than their age.

Published in open-access journal Frontiers in Aging Neuroscience, this study is the first to find a link between subjective age and brain aging. The results suggest that elderly people who feel older than their age should consider caring for their brain health.

We tend to think of aging as a fixed process, where our bodies and minds change steadily. However, the passing years affect everyone differently. How old we feel, which is called our subjective age, also varies between people -with many feeling older or younger than their actual age.

But is subjective age just a feeling or attitude, or does it reflect how our bodies are actually aging? This question intrigued Dr Jeanyung Chey of Seoul National University in Korea.

People frequently experience some cognitive impairment as they age. In fact, the brain shows a variety of age-related changes that are reflective of declining neural health, including reductions in gray matter volumes. Recently developed techniques can help researchers to identify brain features associated with aging, to provide an estimated brain age.

Chey and her colleagues applied these techniques to investigate the link between subjective age and brain aging. They performed MRI brain scans in 68 healthy people whose ages ranged from 59-84 years and looked at gray matter volumes in various brain regions. The participants also completed a survey, which included questions on whether they felt older or younger than their age and questions assessing their cognitive abilities and perceptions of their overall health.

People who felt younger than their age were more likely to score higher on a memory test, considered their health to be better and were less likely to report depressive symptoms. Critically, those who felt younger than their age showed increased gray matter volume in key brain regions. The researchers used the MRI data to calculate estimated brain ages for the participants.

The researchers hypothesize that those who feel older may be able to sense the aging process in their brain, as their loss of gray matter may make cognitive tasks more challenging.

One intriguing possibility is that those who feel younger are more likely to lead a more physically and mentally active life, which could cause improvements in brain health. However, for those who feel older, the opposite could be true.

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A fat belly is bad for your heart Doctors should measure central obesity to assess cardiovascular risk – even in patients with normal BMI Belly fat, even in people who are not otherwise overweight, is bad for the heart, according to results from the Mayo Clinic presented today at EuroPrevent 2018, a European Society of Cardiology congress.

“See your doctor if your waist is bigger than your hips,” said study author Dr Jose Medina-Inojosa, from the division of Preventive Cardiology at the Mayo Clinic, Rochester, Minnesota, and The International Clinical Research Centre of St. Anne's University Hospital (FNUSA-ICRC), Brno, Czech Republic.

Body mass index (BMI), which is weight relative to height in kg/m2, is used to categorise adults as underweight, normal weight, overweight or obese.

However, BMI does not account for the amount and distribution of fat and muscle.

Central obesity is a store of excess fat around the middle of the body and is a marker of abnormal fat distribution. This study tested the hypothesis that people with normal weight and central obesity would have more heart problems than people with normal weight and normal fat distribution.

In 1997 to 2000 the study enrolled 1,692 residents of Olmsted County, Minnesota, aged 45 years or older. The sample was representative of the county population for age and sex. Participants underwent a clinical examination and measurements were taken of weight, height, waist circumference and hip circumference.

Central obesity was defined as a ratio dividing the waist circumference by the hip circumference of 0.90 or above for men and 0.85 or above for women.

Patients were followed-up from 2000 to 2016 for the occurrence of major adverse cardiovascular events (MACE) using linked medical records from the Rochester Epidemiology Project. MACE was defined as heart attack, surgical or percutaneous coronary revascularisation to open blocked arteries, stroke, or death from cardiovascular causes.

Participants with a normal BMI (18.5–24.9 kg/m2) and central obesity had an approximately two-fold higher

long-term risk of MACE compared to participants without central obesity, regardless of their BMI. Dr Medina-Inojosa said: “People with a normal weight but a fat belly have more chance of heart problems than people without a fat belly, even if they are obese according to BMI. This body shape indicates a sedentary lifestyle, low muscle mass, and eating too many refined carbohydrates.”

“The belly is usually the first place we deposit fat, so people classified as overweight BMI but without a fat belly probably have more muscle which is good for health,” he continued. “Muscle is like a metabolic storehouse and helps decrease lipid and sugar levels in the blood.”

Participants with a normal BMI and central obesity also had a higher risk of MACE than overweight and obese participants with central obesity. Dr Medina-Inojosa said that overweight and obese people with central obesity might also have more muscle mass which could be protective.

He said: “If you have fat around your belly and it’s greater than the size of your hips, visit your doctor to assess your cardiovascular health and fat distribution. If you have central obesity the target will be waist loss rather than weight loss. Exercise more, decrease sedentary time by taking the stairs or getting off the train one stop early and walking, increase your muscle mass with strength and resistance training, and cut out refined carbohydrates.”

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Feeling lonely? Create social network to improve your heart health

Loneliness is bad for the heart, according to a study presented today at Euro Heart Care 2018, the European Society of Cardiology’s annual nursing congress. The study found that feeling lonely was a stronger predictor of poor outcomes than living alone, in both men and women.

“Loneliness is more common today than ever before, and more people live alone,” said Anne Vinggaard Christensen, study author and PhD student, The Heart Centre, Copenhagen University Hospital, Denmark. “Previous research has shown that loneliness and social isolation are linked with coronary heart disease and stroke, but this has not been investigated in patients with different types of cardiovascular disease."

The study investigated whether poor social network was associated with worse outcomes in 13,463 patients with ischaemic heart disease, arrhythmia (abnormal heart rhythm), heart failure, or heart valve disease. Data from national registers was linked with the Den Heart survey, which asked all patients discharged from April 2013 to April 2014 from five heart centres in Denmark to answer a questionnaire about their physical and mental health, lifestyle factors such as smoking, and social support.

Feeling lonely was associated with poor outcomes in

all patients regardless of their type of heart disease, and even after adjusting for age, level of education, other diseases, body mass index, smoking, and alcohol intake.

Loneliness was associated with a doubled mortality risk in women and nearly doubled risk in men. Both men and women who felt lonely were three times more likely to report symptoms of anxiety and depression, and had a significantly lower quality of life than those who did not feel lonely.

Ms Vinggaard Christensen noted that people with poor social support may have worse health outcomes because they have unhealthier lifestyles, are less compliant with treatment, and are more affected by stressful events. But she said: “We adjusted for lifestyle behaviours and many other factors in our analysis, and still found that loneliness is bad for health.”

European guidelines on cardiovascular prevention state that people who are isolated or disconnected from others are at increased risk of developing and dying prematurely from coronary artery disease. The guidelines recommend assessment of psychosocial risk factors in patients with established cardiovascular disease and those at high risk of developing cardiovascular disease.

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When times are tough stop behaving badly to your partner Refraining from bad behaviour toward a significant other during stressful life events is more important than showing positive behaviour, according to a Baylor University study.

Compared with positive gestures, negative ones tend to trigger more intense and immediate responses, according to the study.

And how a couple works together during trying times is associated with individual well-being as well as satisfaction with the relationship.

"When people face stressful life events, they are especially sensitive to negative behaviour in their relationships, such as when a partner seems to be argumentative, overly emotional, withdrawn or fails to do something that was expected," said researcher Keith Sanford, Ph.D., professor of psychology and neuroscience in Baylor's College of Arts & Sciences.

"In contrast, they're less sensitive to positive behaviour -- such as giving each other comfort," he said.

The study also found that low doses of a behaviour are most important, and over time, more extreme levels have less impact.

"Because people are especially sensitive to negative relationship behaviour, a moderate dose may be sufficient to produce a nearly maximum effect on increasing life stress," Sanford said. "After negative behaviour reaches a certain saturation point, it appears that stress is only minimally affected by further increases in the dose of relationship problems."The study -- "Negative Relationship Behaviour Is More Important Than Positive: Correlates of Outcomes During Stressful Life Events" -is published in Journal of Family Psychology. Sanford and co-researcher Alannah Shelby Rivers, doctoral candidate in psychology and neuroscience, surveyed couples experiencing stressful life events to measure their behaviour, relationship satisfaction, personal well-being and quality of life.

The research consisted of two studies done using data from Internet samples. In the first study, 325 couples who were married or living with a partner all reported experiences of at least one of six possible stressful events within the past month, including: losing a job, becoming a

primary caregiver of an older relative, experiencing a parent's death, experiencing a child's death, not having enough resources to afford basic necessities, and experiencing bankruptcy, foreclosure or repossession of a house or car.

The second study included 154 people who were either married or living with a partner and experiencing a serious medical issue meeting one or more of these criteria: a condition requiring hospitalization or a trip to the emergency room, a serious chronic condition and a life-threatening condition. All participants reported that they had visited a medical practitioner within the past year for treatment of their conditions.

Researchers used a scale that included 18 items -- nine for negative and nine for positive behaviour. Participants were asked to remember the past month, then write a few words describing different memories of interactions occurring in their relationships and indicate how often specific types of interactions occurred in their relationships.

All participants also were asked questions about how rewarding their relationships were, their general wellbeing (such as being active and vigorous) and their quality of life (such as health). Those in the first study also were asked about stress, their coping strategies in general and their coping style in the relationship.

The second study, examining couple's behaviour during stressful medical events, showed lower levels of negative behaviour than the first study dealing with other types of stressful issues.

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Replace potatoes and rice with pulses to lower your blood glucose

Replacing potatoes or rice with pulses and lentils can lower your blood glucose levels by more than 20 per cent, according to a first-ever University of Guelph study. Prof.

Alison Duncan, Department of Human Health and Nutritional Sciences, and Dan Ramdath of Agriculture and Agri-Food Canada, found that swapping out half of a portion of these starchy side dishes for lentils can significantly improve your body's response to the carbohydrates.

Replacing half a serving of rice with lentils caused blood glucose to drop by up to 20 per cent. Replacing potatoes with lentils led to a 35-per-cent drop."Pulses are extremely nutrient-dense food that has the potential to reduce chronic diseases associated with mismanaged glucose levels," said Duncan.

Yet very few Canadians eat lentils, she added."Canada has a huge production of lentils, but we export most of it and only 13 percent of Canadians eat them on any given day," said Duncan. "We are hoping this research will make people more aware of the health benefits of eating pulses."

Published and specially featured in the Journal of Nutrition, the study involved 24 healthy adults fed four dishes -- white rice only, half white rice and half large green lentils, half white rice and half small green lentils, and half white rice and half split red lentils.

Researchers measured glucose levels in the participants' blood before they ate and during two hours afterward.

They repeated the process for white potatoes alone and the same combinations of potatoes and lentils. "We mixed the lentils in with the potatoes and rice because people don't typically eat pulses on their own, but rather consume them in combination with other starches as part of a larger meal, so we wanted the results to reflect that."

Blood glucose fell by similar amounts when half of the starch was replaced with each of the three types of lentils.

Blood glucose comprises sugar found in the blood during digestion in the upper digestive tract and depends on the starch content of foods consumed. Pulses, such as lentils, can slow digestion and the release of sugars found in starch into the bloodstream, ultimately reducing blood glucose levels, said Duncan.

"This slower absorption means you don't experience a spike in glucose. Having high levels over a period of time can lead to mismanagement of blood glucose, which is the hallmark of Type 2 diabetes. Essentially, eating lentils can lower that risk." Pulses contain components that inhibit enzymes involved in absorption of glucose, and fibre contained in these foods can encourage the production of short-chain fatty acids, which can also help to reduce blood glucose levels, added Duncan.

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Too many babies are overfed A report published by Public Health England suggests three-quarters of UK babies and toddlers may be eating more calories than they should. The report has come at time when government advisers published new guidance - the first in more than 20 years - on feeding babies.

The data comes from the Infant Feeding Survey and the Diet and Nutrition Survey of Infants and Young Children carried out in 2010 and 2011. Public Health England says more up-to-date statistics are needed and is recommending the Department of Health and Social Care considers this.

Experts know that people who are overweight as children are more likely to be overweight as adults. A link with diet in early infancy is increase the risk of food allergy (but seek advice if less clear. Nearly a quarter of children in England are there is a strong family history of food allergy) obese or overweight at four to five years old.

Part of the next phase of the government's plan to tackle Prof Mary Fewtrell, from the Royal College of childhood obesity includes examining whether baby food Paediatrics and Child Health, said they noted the concerns is healthy enough and whether it contains too much sugar. raised and said the prevalence of overfeeding and overweight infants should be monitored and addressed.

Prof Louis Levy, head of nutrition science at PHE, said The new infant feeding guidelines "exclusive breastfeeding until six months of age and not Published by the Scientific Advisory Committee on introducing solid foods until around this time" would help Nutrition (SACN) the new guidelines recommend: avoid infants becoming "too heavy". "Further consideration is needed on ways to monitor overfeeding  Babies should be exclusively breastfed for around the and overweight prevalence in infants, to help give them first six months of life the best start in life," Dr Levy said.

A Department of Health and Social Care spokesperson  Solid foods can be introduced at around six months said: "Children aged up to 2.5 years are assessed for healthy weight and nutrition during universal visits  Cows' milk should not be given until 12 months delivered locally by health visitors - who are responsible for measuring and recording weight where there may be a  Avoid high sugar or high salt foods concern. "While there are currently no plans to reinstate the Infant Feeding Survey, we will consider the SACN  Foods containing peanut and hens' eggs can be report's findings." introduced at six months because delaying this might 13 HEALTH & HAPPINESS 4 YOU

Turning vacant land into green space improves mental health

Researchers have long touted the mood-boosting effects of green space and spending time outdoors — and a new study emphasizes just how much of an impact your environment can have on your mental health. The paper, published Friday in JAMA Network Open, found an association between urban restoration efforts in Philadelphia and the mental health of city residents. “Cleaning and greening” urban lots in Philadelphia was linked to a drop in neighborhood residents feeling depressed or worthless, and a slight uptick in overall resident mental health, the study says.

For the study, a team of researchers identified 541 vacant lots in Philadelphia and divided them into clusters: groups of lots within a quarter-mile radius that all showed signs of urban blight, like illegal dumping, abandoned cars and overgrown vegetation.

Next, they interviewed 442 adults living within one of these clusters. People were told they had been chosen for a study focused on “improving our understanding of urban health,” and answered questions about mental health.

After the initial surveys were completed, the researchers randomly selected 37 lot clusters for a greening intervention that involved removing trash and debris, planting grass and trees, installing a fence and performing routine maintenance. Another

36 clusters had trash removed and minor maintenance, but little in the way of increasing green space. The final 37 were left untouched.

Within 18 months of completing the restoration efforts, the researchers re-interviewed 342 of the original study participants, about a third of whom lived near one of the clusters assigned to the greening intervention. Compared to people who lived near lots with no improvements, these people experienced a 41% drop in depressive feelings and an almost 51% drop in feelings of worthlessness.

Overall improvements to mental health didn’t quite reach statistical significance, but South says the researchers are “pretty confident that people are experiencing better mental health.”

Greening was particularly impactful for people living in neighbourhoods falling below the poverty line. Taken together, the results suggest that urban greening could offer a real opportunity for cities looking to improve population mental health, especially since it only cost about $1,600 to transform an abandoned lot, and $180 per year to maintain it, says study co-author Dr. Eugenia South, an assistant professor of emergency medicine at the University of Pennsylvania’s Perelman School of Medicine.

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Music can improve your mood and also your health When the Executive Editor of Harvard Heart Letter asked some of her long time friends what was their “cheer up” song, it spurred a list of songs from the ‘70s and ‘80s, back when we were in high school and college.

But did you know that music may actually help boost your health as well as your mood?

Music engages not only your auditory system but many other parts of your brain as well, including areas responsible for movement, language, attention, memory, and emotion. “There is no other stimulus on earth that simultaneously engages our brains as widely as music does,” says Brian Harris, certified neurologic music therapist at Harvardaffiliated Spaulding Rehabilitation Hospital. This global activation happens whether you listen to music, play an instrument, or sing — even informally in the car or the shower, he says.

Make my heart sing Music can also alter your brain chemistry, and these changes may produce cardiovascular benefits, as evidenced by a number of different studies. For example, studies have found that listening to music may • • • • •

enable people to exercise longer during cardiac stress testing done on a treadmill or stationary bike improve blood vessel function by relaxing arteries help heart rate and blood pressure levels to return to baseline more quickly after physical exertion ease anxiety in heart attack survivors help people recovering from heart surgery to feel less pain and anxiety.

Notable effects Like other pleasurable sensations, listening to or creating music triggers the release of dopamine, a brain chemical that makes people feel engaged and motivated.

As Harris points out, “An exercise class without music is unimaginable.” Sound processing begins in the brainstem, which also controls the rate of your heartbeat

and respiration. This connection could explain why relaxing music may lower heart rate, breathing rate, and blood pressure — and also seems to ease pain, stress, and anxiety.

What music resonates for you?

But preference matters. Research suggests that patientselected music shows more beneficial effects than music chosen by someone else, which makes sense. According to the American Music Therapy Association, music “provokes responses due to the familiarity, predictability, and feelings of security associated with it.”

In the cardiac stress test study (done at a Texas university), most of the participants were Hispanic, so the researchers chose up-tempo, Latin-inspired music. In the artery relaxation study, which tested both classical and rock music, improvements were greater when classical aficionados listened to classical music than when they listened to rock, and vice versa. Someone who loves opera might find a soaring aria immensely calming. “But quite frankly, if you don’t care for opera, it could have the opposite effect!” says Harris.

There’s no downside to using music either to relax or to invigorate your exercise routine, provided you keep the decibel level in a safe range. You might even consider using your heart health as an excuse to splurge on a new sound system.

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Sleeping too much or not enough may have bad effects on health Fewer than six and more than ten hours of sleep per day are associated with metabolic syndrome and its individual components, according to a study published in the open access journal BMC Public Health that involved 133,608 Korean men and women aged 40-69 years.

Researchers at Seoul National University College of Medicine found that compared to individuals who slept six to seven hours per day, men who slept fewer than six hours were more likely to have metabolic syndrome and higher waist circumference. Women who slept fewer than six hours were more likely to have higher waist circumference.

Sleeping more than ten hours per day was associated with metabolic syndrome and increased levels of triglycerides in men, and with metabolic syndrome, higher waist circumference, higher levels of triglycerides and blood sugar, as well as low levels of 'good' cholesterol (HDL-C) in women. The authors found that nearly 11% of men and 13% of women slept less than six hours, while 1.5% of men and 1.7% of women slept more than ten hours.

Claire E. Kim, lead author of the study said: "This is the largest study examining a dose-response association between sleep duration and metabolic syndrome and its components separately for men and women. Because we were able to expand the sample of our previous study, we were able to detect associations between sleep and metabolic syndrome that were unnoticed before. We observed a potential gender difference between sleep duration and metabolic syndrome, with an association between metabolic syndrome and long sleep in women and metabolic syndrome and short sleep in men."

Based on common definitions, participants were considered to have metabolic syndrome if they showed at least three of the following: elevated waist circumference, high triglyceride levels, low levels of 'good' cholesterol, hypertension, and high fasting blood sugar. The prevalence of metabolic syndrome was just over 29% in men and 24.5% in women. The authors suggest that as the prevalence of metabolic syndrome in Korea is high, it is critical to identify modifiable risk factors such as sleep duration.

The authors used data from the HEXA study, a large-scale community-based study conducted in Korea during the years 2004-2013, which included information on sociodemographic characteristics, medical history, medication use, family history, lifestyle factors, diet, physical activity, and reproductive factors for women. As part of the HEXA study, samples of plasma, serum, buffy coat, blood cells, genomic DNA, and urine were collected, and participants underwent physical examinations by medical professionals. Sleep duration was assessed by asking the question: "In the past year, on average, how many hours/minutes of sleep (including daytime naps) did you take per day?"

Although the biological mechanisms that underlie the association between sleep duration and metabolic syndrome remain unclear, several potential processes have been reported. These include elevated levels of hormones which increase appetite and caloric intake or reduce energy expenditure in people who sleep less than seven hours per day, which may lead to increased waist circumference and development of obesity.

The authors caution that the cross-sectional, observational nature of this study does not allow for conclusions about cause and effect. Estimates of sleep duration were based on self-report data rather than objective measures and may reflect 'time in bed', actual time spent asleep or time people believed they slept. Also, as the study did not distinguish between daytime naps and nighttime sleep, their impact on health could not be assessed separately.

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Mozart, meditation and yoga:

Integrative therapies for breast cancer A breast cancer patient dealing with anxiety, depression or mood swings could soon be encouraged by her oncologist to learn meditation techniques, join a yoga class or put music to therapeutic use. Today, The American Society of Clinical Oncology (ASCO), published its endorsement of integrative therapy guidelines recently established by the Society for Integrative Oncology (SIO).

The SIO guidelines were reviewed by an ASCO expert panel co-chaired by Dr. Gary H. Lyman, an oncologist with Fred Hutchinson Cancer Research Center in Seattle, and Dr. Lorenzo Cohen of the University of Texas MD Anderson Cancer Center in Houston.

The full guidelines appear online in the Journal of Clinical Oncology. Some of the key recommendations include: •

•

• •

• •

•

Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction.

Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders.

Meditation and yoga are recommended to improve quality of life.

Acupressure and acupuncture in addition to antinausea medications are recommended for reducing chemotherapy-induced nausea and vomiting.

Glutamine is not recommended for improving nausea and vomiting during chemotherapy.

Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy because of a possibility of harm.

No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related adverse effects.

"Patients undergoing and surviving breast cancer treatment naturally want to use every tool available to them to enhance the effectiveness of treatment and improve their quality of life," Lyman said. "Our goal is to help cancer care specialists and their patients make appropriate individualized treatment decisions -evaluating the current medical literature on complementary therapies to determine what works, what doesn't work and what might actually be harmful instead of helpful. The guidelines should be seen only as that -guidelines -- because each patient's case is unique, and there's nothing more important than the judgment of an independent, caring professional. There is a considerable lack of information on the benefits and harms of many integrative therapies in oncology and further rigorous research of such methods is greatly needed."

ASCO's expert panel said recommendations may be subject to change as additional scientific evidence is compiled, and although ASCO generally endorsed the SIO recommendations, the panel brought attention to several areas of discussion, including safety concerns about mistletoe, sometimes taken to improve quality of life, and ginseng, sometimes taken to counter fatigue.

Certain forms of ginseng could have estrogenic properties, but more research is needed to evaluate risk in patients with estrogen receptor-positive breast cancer.

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Children with better coordination more likely to achieve at school Young children with better eye-to-hand co-ordination were more likely to achieve higher scores for reading, writing and maths according to new research -- raising the possibility schools could provide extra support to children who are clumsy.

Just over 300 children aged four to 11 took part in computer tasks to measure their co-ordination and interceptive timing -- their ability to interact with a moving object. The study, led by researchers at the University of Leeds, is published in the peer-review journal Psychological Science.

The tasks designed to measure eye-tohand coordination involved steering, taking aim and tracking objects on a computer screen. In the 'interceptive timing' task, the children had to hit a moving object with an on-screen bat.

This task taps into a fundamental cognitive ability -- how the brain predicts the movement of objects through time and space. The researchers suggest that this skill may have provided the evolutionary foundations for the emergence of cognitive abilities related to mathematics, a theory first proposed by the famous Swiss psychologist Jean Piaget in the 1950s.

After controlling for age, the results revealed that the children who did better at the eye-to-hand coordination tasks tended to have higher academic attainment in reading, writing and maths.

Those with the best performance at the 'steering task' in particular were on average nine months ahead of classmates who struggled.

However, the researchers found that while the children's interceptive timing skills tended to predict their attainment in mathematics, it did not influence reading and writing development.

This was an observational study, identifying statistically significant associations between the ability to process what is happening in the physical world and educational attainment. It does not demonstrate direct cause and effect.

Mark Mon-Williams, Professor of Cognitive Psychology at the University of Leeds who supervised the research, said: "The results show that eye-to-hand coordination and interceptive timing are robust predictors of how well young children will perform at school."

This research builds on recent findings from other studies which suggested that the ability of babies aged between six and 13 months to understand the world around them had an impact on their ability to manipulate numbers when they reached the age of four.

The University of Leeds' study was conducted at Lilycroft Primary School in Bradford, West Yorkshire, where Headteacher Nicola Roth is applying the findings of the research. The school has remodelled its reception, indoor and outdoor areas to include a space where children can develop their motor skills and the ability to call on large muscle groups to coordinate movement.

She said: "As a school, we decided to harness the research findings. We have decided that our pupils should be encouraged to develop motor skill and eye to hand coordination throughout their time at the school.

"Playing with construction equipment toys used to stop when children reached the ages of five or six but we have decided to continue with that until they are nine years old.

This is one of the ways we have implemented the findings, It is a simple step that can have significant benefits for the children's wider education."

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