Friday, February 23, 2007


Playing Video Games May Contribute To Keyhole Surgery Skills

A small US study suggests that surgeons who played video games have better keyhole surgery skills than those that did not. The study was performed by US scientists at Beth Israel Medical Centre in New York and is published in this month's issue of the Archives of Surgery. The researchers did the study because although anecdotal observations suggest that young surgeons who played video games were better at performing laparoscopies (keyhole surgery) than those who do not, this had not been empirically investigated.

Laparoscopy is a type of surgery where the surgeon has to handle small instruments and go into the patient's body via a small hole or incision, hence the term "keyhole surgery". The surgeon does the operation using a television screen to see where to move the instruments; her or she cannot look straight at the place they are operating on because it is inside the body and the keyhole is too small. The researchers found a strong link between ability to play video games and performing well in keyhole surgery.

The researchers studied 33 surgeons based at New York's Beth Israel Medical Centre. The participants had to play three different video games for up to 25 minutes to assess their current skill, and also answer questions on their past experience of playing video games.

Their surgical skill were measured during a course that took one and a half days to complete. On the course the participants carried out a range of simulated laparoscopic and suturing procedures where their completion time and error rates were measured. The researchers also took note of the participants' level of surgical training, number of cases of laparoscopy performed, and the years they had been in medical practice.

They then ran a cross-sectional analysis to compare participants' laparoscopic and suturing skills against video game experience and video game scores. The results showed that 9 young surgeons who had played video games for at least 3 hours a week made 37 per cent fewer mistakes and worked 27 per cent faster than 15 surgeons who had never played video games. The 9 surgeons with past experience of video game playing also scored 42 per cent higher overall on the range of surgical skill tests. Also, the correlation between video gaming skill and surgical skill as measured by the simulation, was stronger than either the surgeon's training or experience measured in duration. The researchers concluded that video games could help train surgeons who perform keyhole surgery.

In an invited critique that accompanies the same issue of the journal, Doctor Myriam Curet re-iterates the warning that the researchers made in their article ""indiscriminate video game play is not a panacea," and invites the media not to distort the message in this study. She said parents still need to keep a check on their children's video gaming hours and the types of games they are playing.

And looking at the robustness of the article, she points out that it has limitations such as the small sample size. She also draws attention to the jump from the results to the conclusion. The results showed that it was past experience of video gaming that correlated to present level of surgical skill.

Perhaps the most useful contribution that this study makes is that it has opened a door that invites further investigation. One of the authors of the study, Dr Douglas Gentile did a survey in 2004 on video game playing by American teenagers and found that over 90 per cent of them are playing for an average of 9 hours a week. Excessive game playing takes the place of physical exercise, and has been linked to poorer performance at school and aggressive behaviour. Dr Gentile advises that parents should not view this study as supporting the notion that it is OK for children to play video games for more than 1 hour a day. That will not help them get into medical school, he said.


Journal abstract follows:

The Impact of Video Games on Training Surgeons in the 21st Century

By: James C. Rosser et al.

Background: Video games have become extensively integrated into popular culture. Anecdotal observations of young surgeons suggest that video game play contributes to performance excellence in laparoscopic surgery. Training benefits for surgeons who play video games should be quantifiable.

Hypothesis: There is a potential link between video game play and laparoscopic surgical skill and suturing.

Design: Cross-sectional analysis of the performance of surgical residents and attending physicians participating in the Rosser Top Gun Laparoscopic Skills and Suturing Program (Top Gun). Three different video game exercises were performed, and surveys were completed to assess past experience with video games and current level of play, and each subject's level of surgical training, number of laparoscopic cases performed, and number of years in medical practice.

Setting: Academic medical center and surgical training program.

Participants: Thirty-three residents and attending physicians participating in Top Gun from May 10 to August 24, 2002.

Main Outcome Measures: The primary outcome measures were compared between participants' laparoscopic skills and suturing capability, video game scores, and video game experience.

Results: Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P<.02) and 27% faster completion (P<.03). Overall Top Gun score (time and errors) was 33% better (P<.005) for video game players and 42% better (P<.01) if they played more than 3 h/wk. Current video game players made 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005) than their nonplaying colleagues. When comparing demonstrated video gaming skills, those in the top tertile made 47% fewer errors, performed 39% faster, and scored 41% better (P<.001 for all) on the overall Top Gun score. Regression analysis also indicated that video game skill and past video game experience are significant predictors of demonstrated laparoscopic skills.

Conclusions: Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.


It seems so -- but you need both together

Folate and vitamin B12, two important nutrients for the development of healthy nerves and blood cells, may work together to protect cognitive function among seniors, reports a new epidemiological study from the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (USDA HNRCA). According to Martha Savaria Morris, PhD, epidemiologist at the USDA HNRCA, "we found a strong relationship between high folate status and good cognitive function among people 60 and older who also had adequate levels of vitamin B12." The study, published the American Journal of Clinical Nutrition, also determined that low vitamin B12 status was associated with increased cognitive impairment.

Using data collected from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2002, Morris and colleagues found that people with normal vitamin B12 status and high serum folate, which is a measure of folate in the blood, had higher scores on a test of cognitive function. Blood tests were used to determine folate and vitamin B12 levels, and the cognitive function test assessed aptitudes such as response speed, sustained attention, visual spatial skills, associative learning, and memory. Cognitive impairment was identified when a subject fell into the bottom 20th percentile of the distribution on the test.

"People with normal vitamin B12 status performed better if their serum folate was high," explains Morris, corresponding author of the study. "But for people with low vitamin B12 status, high serum folate was associated with poor performance on the cognitive test." Seniors with low vitamin B12 status and high serum folate were also significantly more likely than seniors in other categories to have anemia, a condition caused by reduced amounts of hemoglobin in oxygen-carrying red blood cells, or by a deficiency in the number or volume of such cells.

"For seniors, low vitamin B12 status and high serum folate was the worst combination," says Morris. "Specifically, anemia and cognitive impairment were observed nearly five times as often for people with this combination than among people with normal vitamin B12 and normal folate." Vitamin B12 deficiency, which affects many seniors due to age-related decreases in absorption, can impact the production of DNA needed for new cells, as well as neurological function.

Vitamin B12 is normally consumed in meat, fish, poultry, eggs, and dairy products, and folate is found in leafy green vegetables, citrus fruits, and beans. Although folate occurs naturally in many foods, the U.S. Food and Drug Administration in 1998 required that all enriched cereal-grain products be fortified with folic acid, the synthetic form of folate, in order to help prevent birth defects in infants.

Morris notes that the study's results are inconsistent with the idea that high folate status delays detection of vitamin B12 by masking one of its key signs: anemia. "When folate fortification was considered, opponents raised the possibility that because more folate might mask anemia, many cases of vitamin B12 deficiency would go undetected, causing people with the condition to suffer neuropsychiatric consequences. But in our study, the people with low vitamin B12 who also had high serum folate were more likely to exhibit anemia and cognitive impairment than subjects with low vitamin B12 status and normal serum folate. So although having high serum folate had an impact on cognitive function in our study, it did not cure anemia, as opponents of food fortification have suggested."

Senior author Jacob Selhub, PhD, director of the Vitamin Metabolism Laboratory at the USDA HNRCA and professor at the Friedman School, says, "Our findings support the often-expressed idea that many seniors would benefit from more folate, but the research shows that we must look at the effects this would have on seniors with age-related vitamin B12 deficiency, who may be more numerous than once realized. There are also indications that too much folic acid and too little B12 is a general phenomenon that affects other systems in the body, and might be a factor in some other diseases."

As with any epidemiological study, Morris cautions that the results show association and not causation. She also notes that because the study only measured levels of total folate in the blood, it is uncertain whether the results were due to unmetabolized folic acid in the body. "We encourage further studies of these relationships and their underlying mechanisms," write Morris and her colleagues at Tufts. "We hope our findings both inform the continuing debate about folic acid fortification and influence future efforts to detect and treat low vitamin B12 status among seniors."


Journal abstract follows:

Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification

By: Martha Savaria Morris et al.

Background:Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical.

Objective:We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score <34) in senior participants in the 1999-2002 US National Health and Nutrition Examination Survey.

Design:The subjects had normal serum creatinine concentrations and reported no history of stroke, alcoholism, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries (n = 1459). We defined low vitamin B-12 status as a serum vitamin B-12 concentration <148 pmol/L or a serum methylmalonic acid concentration >210 nmol/L-the maximum of the reference range for serum vitamin B-12-replete participants with normal creatinine.

Results:After control for demographic characteristics, cancer, smoking, alcohol intake, serum ferritin, and serum creatinine, low versus normal vitamin B-12 status was associated with anemia [odds ratio (OR): 2.7; 95% CI: 1.7, 4.2], macrocytosis (OR: 1.8; 95% CI: 1.01, 3.3), and cognitive impairment (OR: 2.5; 95% CI: 1.6, 3.8). In the group with a low vitamin B-12 status, serum folate >59 nmol/L (80th percentile), as opposed to ~ 59 nmol/L, was associated with anemia (OR: 3.1; 95% CI: 1.5, 6.6) and cognitive impairment (OR: 2.6; 95% CI: 1.1, 6.1). In the normal vitamin B-12 group, ORs relating high versus normal serum folate to these outcomes were <1.0 (Pinteraction < 0.05), but significantly <1.0 only for cognitive impairment (0.4; 95% CI: 0.2, 0.9).

Conclusion:In seniors with low vitamin B-12 status, high serum folate was associated with anemia and cognitive impairment. When vitamin B-12 status was normal, however, high serum folate was associated with protection against cognitive impairment.


Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.