How to make New Year's resolutions that you'll actually follow

Drop 10 pounds. Quit smoking. Stop cursing.

31 dec 2011--New Year's resolutions come around every 365 days or so, about the time the tree is tossed, the menorah is stored and one year elbows aside the other. Even though it seems people break them before they have finished making them, those resolutions can be good things.

"Resolutions are important because they promote goal-setting, which is critical to getting things done," said Michael Pantalon, assistant clinical professor of psychiatry at the Yale University School of Medicine in New Haven, Conn. via email.

But the reason behind the resolution can be as important as setting goals.

"If [a resolution] is merely an exercise designed to satisfy an external pressure, the importance diminishes and the issue can become moot," wrote Jacqueline Keller, founding director of NutriFit LLC, Los Angeles, and a licensed professional wellness coach, in an email.

Even with the best of intentions, people often break their resolutions.

Pantalon said people fail due to three main reasons: They promote goals that are too big. They proclaim their goal to the wrong people, those who will pressure them too much or chastise them instead of those who will actually help them realize their goal. They often focus on how to accomplish goals versus why they want to accomplish them, ignoring the "reason behind the reason," which could provide "more powerful and lasting motivation," he said.

"Be very, very clear not only on how you will accomplish your resolution but also on why you want to accomplish it," Pantalon said. "If you can't come up with good and meaningful reasons that resonate with you, then it's probably not a good resolution."

Resolutions should be more than mere "wishes."

According to Srinivasan Pillay, assistant clinical professor of psychiatry at Harvard Medical School in Boston, Mass., biology plays a role in resolutions, and the brain is the director. Pillay noted that for resolutions to work, they have to take root in the brain, which requires more than simply saying or writing them.

Pillay suggested several tips to make solid resolutions with high probability of accomplishment. Getting excited about your resolutions makes the brain more likely to cement the goal. Forming resolutions in a quiet place will allow the brain to focus on them. It is also important to think them through and phrase them carefully and specifically. Broad goals such as "I want to lose weight" may be more difficult to implement than statements of action such as "I will change my diet tomorrow in the following ways." Framing the goal as a positive statement and picturing yourself undertaking the actions of the resolution will activate centers in your brain and make you more likely to fulfill it.

"Resolutions are like goals, and we know that the setting of goals helps us to get things done," said Simon A. Rego, assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine and director of psychology training at the Montefiore Medical Center in Bronx, N.Y., in an email.

Rego stressed that goals are more likely to be reached if they are "smart," meaning specific, measurable, attainable, rewarding, and time-limited. He cautioned against, for example, simply making losing weight a goal, but instead suggested being more specific, such as "I'd like to lose five pounds over the first two months of the year and then set a new goal from there," he said.

Even the best of intentions don't always play out well.

Psychotherapist Karen R. Koenig, a Sarasota, Fla.-based author and expert on the psychology of eating, noted some individuals can sabotage themselves by reacting against their resolutions and do not succeed. Those who do succeed exhibit an internal desire and high motivation to "simply keep doing what's good for them every day without even thinking about commitments or resolutions,” she said.

Breaking an initial resolution doesn't mean a person cannot succeed. And, there's no shame in falling short.

"You are definitely allowed to revise your resolution at any point," said Pantalon.

Provided by Inside Science News Service

New clues as to why some older people may be losing their memory

New research links 'silent strokes,' or small spots of dead brain cells, found in about one out of four older adults to memory loss in the elderly. The study is published in the January 3, 2012, print issue of Neurology, the medical journal of the American Academy of Neurology.

30 dec 2011--"The new aspect of this study of memory loss in the elderly is that it examines silent strokes and hippocampal shrinkage simultaneously," said study author Adam M. Brickman, PhD, of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center in New York.

For the study, a group of 658 people ages 65 and older and free of dementia were given MRI brain scans. Participants also underwent tests that measured their memory, language, speed at processing information and visual perception. A total of 174 of the participants had silent strokes.

The study found people with silent strokes scored somewhat worse on memory tests than those without silent strokes. This was true whether or not people had a small hippocampus, which is the memory center of the brain.

"Given that conditions like Alzheimer's disease are defined mainly by memory problems, our results may lead to further insight into what causes symptoms and the development of new interventions for prevention. Since silent strokes and the volume of the hippocampus appeared to be associated with memory loss separately in our study, our results also support stroke prevention as a means for staving off memory problems," said Brickman.

Provided by American Academy of Neurology

Diet, nutrient levels linked to cognitive ability, brain shrinkage

New research has found that elderly people with higher levels of several vitamins and omega 3 fatty acids in their blood had better performance on mental acuity tests and less of the brain shrinkage typical of Alzheimer's disease – while "junk food" diets produced just the opposite result.

29 dec 2011--The study was among the first of its type to specifically measure a wide range of blood nutrient levels instead of basing findings on less precise data such as food questionnaires, and found positive effects of high levels of vitamins B, C, D, E and the healthy oils most commonly found in fish.

The research was done by scientists from the Oregon Health and Science University in Portland, Ore., and the Linus Pauling Institute at Oregon State University. It was published today in Neurology, the medical journal of the American Academy of Neurology.

"This approach clearly shows the biological and neurological activity that's associated with actual nutrient levels, both good and bad," said Maret Traber, a principal investigator with the Linus Pauling Institute and co-author on the study.

"The vitamins and nutrients you get from eating a wide range of fruits, vegetables and fish can be measured in blood biomarkers," Traber said. "I'm a firm believer these nutrients have strong potential to protect your brain and make it work better."

The study was done with 104 people, at an average age of 87, with no special risk factors for memory or mental acuity. It tested 30 different nutrient biomarkers in their blood, and 42 participants also had MRI scans to measure their brain volume.

"These findings are based on average people eating average American diets," Traber said. "If anyone right now is considering a New Year's resolution to improve their diet, this would certainly give them another reason to eat more fruits and vegetables."

Among the findings and observations:

• The most favorable cognitive outcomes and brain size measurements were associated with two dietary patterns – high levels of marine fatty acids, and high levels of vitamins B, C, D and E.
• Consistently worse cognitive performance was associated with a higher intake of the type of trans-fats found in baked and fried foods, margarine, fast food and other less-healthy dietary choices.
• The range of demographic and lifestyle habits examined included age, gender, education, smoking, drinking, blood pressure, body mass index and many others.
• The use of blood analysis helped to eliminate issues such as people's flawed recollection of what they ate, and personal variability in nutrients absorbed.
• Much of the variation in mental performance depended on factors such as age or education, but nutrient status accounted for 17 percent of thinking and memory scores and 37 percent of the variation in brain size.
• Cognitive changes related to different diets may be due both to impacts on brain size and cardiovascular function.

The epidemiology of Alzheimer's disease has suggested a role for nutrition, the researchers said in their study, but previous research using conventional analysis, and looking in isolation at single nutrients or small groups, have been disappointing. The study of 30 different blood nutrient levels done in this research reflects a wider range of nutrients and adds specificity to the findings.

The study needs to be confirmed with further research and other variables tested, the scientists said.

Provided by Oregon State University

Scientists identify an innate function of vitamin E

Dr. Paul McNeil, cell biologist at Georgia Health Sciences University, has discovered one of the innate functions of vitamin E. Credit: Phil Jones/GHSU photographer

It's rubbed on the skin to reduce signs of aging and consumed by athletes to improve endurance but scientists now have the first evidence of one of vitamin E's normal body functions.

28 dec 2011--The powerful antioxidant found in most foods helps repair tears in the plasma membranes that protect cells from outside forces and screen what enters and exits, Georgia Health Sciences University researchers report in the journal Nature Communications.

Everyday activities such as eating and exercise can tear the plasma membrane and the new research shows that vitamin E is essential to repair. Without repair of muscle cells, for example, muscles eventually waste away and die in a process similar to what occurs in muscular dystrophy. Muscle weakness also is a common complaint in diabetes, another condition associated with inadequate plasma membrane repair.

"Without any special effort we consume vitamin E every day and we don't even know what it does in our bodies," said Dr. Paul McNeil, GHSU cell biologist and the study's corresponding author. He now feels confident about at least one of its jobs.

Century-old animal studies linked vitamin E deficiency to muscle problems but how that happens remained a mystery until now, McNeil said. His understanding that a lack of membrane repair caused muscle wasting and death prompted McNeil to look at vitamin E.

Vitamin E appears to aid repair in several ways. As an antioxidant, it helps eliminate destructive byproducts from the body's use of oxygen that impede repair. Because it's lipid-soluble, vitamin E can actually insert itself into the membrane to prevent free radicals from attacking. It also can help keep phospholipids, a major membrane component, compliant so they can better repair after a tear.

For example, exercise causes the cell powerhouse, the mitochondria, to burn a lot more oxygen than normal. "As an unavoidable consequence you produce reactive oxygen species," McNeil said. The physical force of exercise tears the membrane. Vitamin E enables adequate plasma membrane repair despite the oxidant challenge and keeps the situation in check.

When he mimicked what happens with exercise by using hydrogen peroxide to produce free radicals, he found that tears in skeletal muscle cells would not heal unless pretreated with vitamin E.

Next steps, which will be aided by two recent National Institutes of Health grants, include examining membrane repair in vitamin E-deficient animals.

McNeil also wants to further examine membrane repair failure in diabetes. Former GHSU graduate student Dr. Amber C. Howard showed in a recent paper in the journal Diabetes that cells taken from animal models of types 1 and 2 diabetes have faulty repair mechanisms. Howard found high glucose was a culprit by soaking cells in a high-glucose solution for eight to 12 weeks, during which time they developed a repair defect. It's also well documented that reactive oxygen species levels are elevated in diabetes.

The Nature Communications paper showed that vitamin E treatment in an animal model of diabetes restored some membrane repair ability. Also, an analogue of the most biologically active form of vitamin E significantly reversed membrane repair deficits caused by high glucose and increased cell survival after tearing cells in culture.

Now McNeil wants to know if he can prevent the development of advanced glycation end products – a sugar that high glucose adds to proteins that his lab has shown can also impede membrane repair – in the animal models of diabetes. The researchers have a drug that at least in cultured animal cells, prevents repair defects from advanced glycation end products.

Provided by Georgia Health Sciences University

99-year-old woman regains mobility following spinal procedures

Scans of Elizabeth DiGennaro's spine show the compression fracture, above, and the results, below, after doctors at University of Rochester Medical Center performed kyphoplasty to repair the bone.

27 dec 2011-- A 99-year-old woman has returned to her daily routine after doctors repaired three separate compression fractures in her spine three times in a month. Specialists at the University of Rochester Medical Center repaired the brittle vertebra using bone glue while the patient was under sedation, which is easier for elderly patients.

Elizabeth DiGennaro of Scottsville is the oldest person to undergo the procedure at URMC exemplifying doctors’ commitment to providing comprehensive care for the fast-growing elderly population. She believes the injury occurred during routine chores that may have been too much for her aging, osteoporotic bones.

She will celebrate her 100th birthday Jan. 3.

“Looking at the scans, you can see that bone had crumbled into pieces,” said Per-Lennart Westesson, M.D., D.D.S., Ph.D., a neuroradiologist who collaborated with Orthopedic surgeon Susan V. Bukata, M.D., and Freda B. Hannafon, FNP-C,MSN, of The Center for Bone Health, to care for DiGennaro.

After several weeks of being bedridden with back pain, DiGennaro’s family worried that she would never recover. They sought help from Bukata, who suggested balloon kyphoplasty. The procedure involves injecting bone cement directly into the compression fracture and using balloons to shift the vertebrae back into place to relieve pain and hasten healing.

This procedure has been used for decades by doctors in Orthopedics, Neurosurgery and Interventional Radiology. Bukata recognized that traditional surgery under general anesthesia may not be best for DiGennaro, because it can elevate a risk of stroke in elderly patients. Bukata suggested Westesson perform kyphoplasty using sedation in an interventional radiology suite, rather than an operating room.

“This was a better option for Mrs. DiGennaro and other elderly patients who suffer these types of injuries,” said Westesson, professor of Imaging Sciences.

The near-centenarian has always been an active, strong-willed woman, according to her daughter, Barbara Galbraith. And the spinal fracture was very painful and the medications to control the pain made her confused and exhausted, and as a result, she was bedridden

“We were really worried that she’d never be able to enjoy her life again,” Galbraith said. “That was no way for her to live.”

“The pain went away immediately and she was back to her normal self again. Two days later she was in pain again, and it was a break, but not the same place. And then there was a third one. Each time we went back and had the second and third procedures she did really well.”

DiGennaro had the first surgery on Sept. 30, followed by a second on Oct. 12, and the third on Nov. 23. Each procedure was a success; the pain was gone and she was able to resume her normal life.

URMC doctors perform more than 100 kyphoplasty procedures each year, providing much needed relief for aging adults with compression fractures.

“This is something we’ll do more and more often with sedation as we see the baby boomer generation age further,” Westesson said.

Provided by University of Rochester Medical Center

Diagnosis, treatment of depression among elderly depend on racial, cultural factors

Despite improvements to diagnostic tools and therapies in the two last decades, significant disparities in the diagnosis and treatment of depression remain, according to Rutgers research published online by the American Journal of Public Health; print, February 2012.

26 dec 2011--In the study "Racial and Ethnic Disparities in Depression Care in Community-Dwelling Elderly in the United States," lead author Ayse Akincigil, an assistant professor in Rutgers' School of Social Work, and colleagues found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider than were non-Hispanic whites. In addition, those diagnosed were less likely to be treated for depression.

"Vigorous clinical and public health initiatives are needed to address this persisting disparity in care," she said.

Depression is a significant public health problem for older Americans – about 6.6 percent of elderly Americans experience an episode of major depression each year. "If untreated or undertreated, depression can significantly diminish quality of life," Akincigil said. In addition, depression can complicate such medical conditions commonly found in older populations as congestive heart failure, diabetes and arthritis.

For their study, Rutgers researchers culled data from the U.S. Medicare Current Beneficiary Survey, 2001-2005 obtaining information on health care use and costs, health status, medical and prescription drug insurance coverage, access to care and use of services. Based on a national survey of 33,708 Medicare beneficiaries, depression diagnosis rates were 6.4 percent for non-Hispanic whites, 4.2 percent for African Americans, 7.2 percent for Hispanics and 3.8 percent for others. The heterogeneity of Hispanics makes it difficult to determine why they are undertreated and their treatment preferences, Akincigil said.

"Are there cultural differences or systemic differences regarding health care quality and access for treatment of depression?" Akincigil asked. "If African Americans prefer psychotherapy over drugs, then accessing therapists for treatment in poorer neighborhoods is a lot more difficult than it is for whites, who generally have higher incomes and live in neighborhoods more likely for therapists and doctors to be located.

"Whites use more antidepressants than African Americans. We presume they have better access to doctors and pharmacies, and more money to spend on drugs."

The investigation focused on whether there are racial/ethnic differences in the rate of diagnosis of depression among the elderly, controlling for sociodemographic characteristics and depression symptoms (depressed mood, anhedonia) reported on a two-item screener, and also in treatment provided to those diagnosed with depression by a health care provider. Akincigil said there is evidence that help-seeking patterns differ by race/ethnicity, contributing to the gap in depression diagnosis rates. Stigma, patient attitudes and knowledge also may vary by race and ethnicity.

"African Americans might turn to their pastors or lay counselors in the absence of psychotherapists," she said. "Low-income African Americans who were engaged in psychotherapy reported that stigma, dysfunctional coping behavior, shame and denial could be reasons some African Americans do not seek professional help."

The nature of the patient-physician relationship also might contribute to disparities in depression diagnosis rates. "African Americans reported greater distrust of physicians and poorer patient-physician communication than do white patients," Akincigil explained. "Communication difficulties may contribute to lower rates of clinical detection of depression because the diagnosis of depression depends to a considerable degree on communication of subjective distress."

The researchers also noted that racial and ethnic differences in the clinical presentation of depression may further explain the lower rates of depression detection among African-American patients.

Financial factors may also play a role in the detection rates, according to Akincigil. Among Medicare beneficiaries, African Americans are substantially less likely than non-Hispanic whites to have private supplemental insurance that covers charges larger than standard Medicare-approved amounts. "Differences in provider reimbursement may favor increased clinical detection of depression in white patient groups if higher payment rates result in longer visits," she said.

Akincigil and co-authors Karen A. Zurlo and Stephen Crystal, both from Rutgers' School of Social Work; Mark Olfson, Department of Psychiatry at Columbia University; and Michele Siegel and James T. Walkup from Rutgers' Center for Health Services Research on Pharmacotherapy, Chronic Disease Management and Outcomes, conclude that "efforts are needed to reduce the burden of undetected and untreated depression and to identify the barriers that generate disparities in detection and treatment."

"Promising approaches include providing universal depression screening and ensuring access to care in low-income and minority neighborhoods," they write. "An increase in the reimbursement of case management services for the treatment of depression also may be effective."

Provided by Rutgers University

More reasons to keep this New Year's weight loss resolution uncovered

Long-term healthy dietary interventions frequently induce a rapid weight decline, mainly in the first four to six months, followed by weight stabilization or regain, despite continued dieting. The partial regain may discourage people from adhering to healthier habits, but research now shows that improvements to health remain even if weight is regained.

25 dec 2011--The study recently released online in Diabetes Care (Print: February 2012) identified two distinct biomarker patterns that correspond to weight change, one of which continues to improve with time.

The study was conducted among 322 participants during the two-year Dietary Intervention Randomized Controlled Trial (DIRECT) performed by Ben-Gurion University of the Negev at the Nuclear Research Center Negev, Israel (New England Journal of Medicine). The population was randomized to three different, but healthy interventions: low-fat, Mediterranean or low-carbohydrate diets, and unprecedented adherence rates were maintained throughout the entire two-year period.

According to BGU Faculty of Health Sciences Prof. Assaf Rudich, "This study tells us that we may all have tunnel vision on weight when it comes to healthy dieting. Although maintaining ideal body weight is linked to better health, when it comes to adopting healthier dietary habits in mild to moderately obese people, there are benefits beyond weight loss, such as decreasing inflammatory tone and elevating the 'good cholesterol' HDL."

Rudich explains that switching to healthier dieting extends benefits beyond the single outcome of weight loss. In fact, important improvements that likely signify decreased risk for cardiovascular disease occur even despite weight regain, as long as dieting continues.

The researchers identified two distinct patterns:

"Pattern-A" includes biomarkers [insulin, triglycerides, leptin, chemerin, monocyte-chemotactic-protein-1(MCP-1), and retinol-binding-protein-4(RBP4)] whose dynamics tightly corresponded to changes in body weight. They significantly improved during the first six months of the "rapid weight loss phase." Then, unfortunately, they significantly trended in the opposite direction once participants started to regain weight during months 7-24 (the "weight maintenance/regain phase").

"Pattern B" that includes high-molecular-weight (HMW) [adiponectin, HDL-cholesterol, high-sensitive C-reactive protein (hsCRP), fetuin-A, progranulin, and vaspin], which displayed a continued, cumulative improvement throughout the intervention, despite the partial weight regain observed during months 7-24 of continued dieting, a totally different pattern of biomarkers.

These patterns were similar, although of different magnitude, across the low-carb, Mediterranean and low-fat diets.

Along the same line of continued benefit of adopting healthier dietary habits, the research team published an article last year in Circulation (a journal of the American Heart Association) that participants in DIRECT showed regression of the atherosclerotic plaque in their carotid artery, a process underlying a large percentage of the cases of stroke. Regression of atherosclerosis was previously only demonstrated with medications or with rather extreme dietary regimens.

According to Prof. Iris Shai, principal investigator of DIRECT, these findings contain a strong message for the public. A researcher at BGU's S. Daniel Abraham International Center for Health and Nutrition in the Department of Epidemiology, Shai says that, "Switching to a healthy lifestyle is a long-term strategy that should be done moderately but persistently. There are no magic shortcuts," she says.

"There is no doubt that moderate weight loss is an important goal for specific populations, and losing weight will indeed improve several markers that are rather tightly related to fat mass, such as triglycerides, insulin and leptin. These, however, will tend to change similarly to weight dynamics.

"Yet, it is encouraging that adhering to a healthy diet per-se will continue to improve other blood biomarkers, some of which quite strongly associate with improved cardio-metabolic health, likely because they reflect adipose tissue and other organ function, such as HDL-c, adiponectin and CRP. Such markers may signify long-term effects of the initial weight loss, or, maybe even more promisingly, reveal to us the capacity of healthier dietary habits to reverse obesity-associated adipose tissue and liver dysfunction."

Provided by American Associates, Ben-Gurion University of the Negev

Supersized market economy, supersized belly: Wealthier nations have more fast food and more obesity

New research from the University of Michigan suggests obesity can be seen as one of the unintended side effects of free market policies.

24 dec 2011--A study of 26 wealthy nations shows that countries with a higher density of fast food restaurants per capita had much higher obesity rates compared to countries with a lower density of fast food restaurants per capita.

"It's not by chance that countries with the highest obesity rates and fast food restaurants are those in the forefront of market liberalization, such as the United States, the United Kingdom, Australia, New Zealand and Canada, versus countries like Japan and Norway, with more regulated and restrictive trade policies," said Roberto De Vogli, associate professor in the U-M School of Public Health, and lead researcher of the study.

For example, in the United States, researchers reported 7.52 fast food restaurants per 100,000 people, and in Canada they reported 7.43 fast food restaurants per 100,000 people. The paper reported the obesity rates among US men and women were 31.3 percent and 33.2 percent, respectively. The obesity rates for Canadian men and women were 23.2 percent and 22.9 percent, respectively.

Compare that to Japan, with 0.13 fast food restaurants per 100,000 people, and Norway, with 0.19 restaurants per capita. Obesity rates for men and women in Japan were 2.9 percent and 3.3 percent, respectively. In Norway, obesity rates for men and women were 6.4 percent and 5.9 percent, respectively. The relationships remain consistent even when researchers controlled for variables such as income, income inequality, urban areas, motor vehicles and internet use per capita.

Obesity research largely overlooks the global market forces behind the epidemic, De Vogli said.

"In my opinion the public debate is too much focused on individual genetics and other individual factors, and overlooks the global forces in society that are shaping behaviors worldwide. If you look at trends overtime for obesity, it's shocking," De Vogli said.

"Since the 1980s, since the advent of trade liberalization policies that have indirectly…promoted transnational food companies…we see rates that have tripled or quadrupled. There is no biological, genetic, psychological or community level factor that can explain this. Only a global type of change can explain this."

Researchers chose one fast food restaurant to use as a proxy measure for how many fast food restaurants were present per 100,000. The study is in no way an indictment of that restaurant, De Vogli said, but rather an indicator of fast food density in a particular area.

Fast food refers to food sold in restaurants or stores with preheated or precooked ingredients, and served to the customer in a packaged form. A typical fast food meal includes a hamburger, fries and a soft drink, the paper said. Fast food is usually high in fat and calories, and several studies have found associations between fast food intake and increased body mass index, weight gain and obesity. Obesity accounts for approximately 400,000 deaths each year in the United States alone. Fast food consumption is also related to insulin resistance and type II diabetes, another major worldwide public health threat.

More information: The paper, "Globesization: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies," will be published in the December print issue of Critical Public Health.

Provided by University of Michigan

Most patients need several sequential treatment steps for remission of major depression

Major depressive disorder is a major public health problem that affects 7% of the population during any 12-month period and affects around 1 in 6 people throughout their lifetime. A Seminar published Online First by the Lancet reviews recent developments relating to this seriously disabling condition, and concludes that most patients need several sequential treatment steps for remission of their major depression. The Seminar also explains why deep brain stimulation is a treatment that holds promise for the future. It is written by Professors David J Kupfer, Ellen Frank, and Mary L Phillips, all of University of Pittsburgh Medical Center, PA, USA.

23 dec 2011--Depression has a similar negative impact on health equivalent to other chronic diseases, such as arthritis and diabetes, but this is not always recognised. Furthermore, it can combine with any other chronic disease to result in substantially worse patient outcomes. The authors say: "A crucial implication is that primary care providers should not ignore the presence of depression when patients have a chronic physical disorder." They add that some of the risk factors for obesity might also increase the risk of depression and, in turn, depression increases the risk of becoming obese. Such two-way relationships might be the reason for increased association between depression and coronary artery disease. Studies have also led to the conclusion that clinical depression is associated with a 65% increased risk of diabetes in elderly people.

The evidence continues to suggest that drug treatments and depression-specific psychotherapy are both effective treatments for depression, either alone or in combination. Cognitive behavioural therapy and interpersonal psychotherapy are also backed by several large studies in the USA and Europe, and cognitive therapy can be delivered using non-traditional means such as telephone or internet, which can lead to large cost savings. The authors also point out antidepressants are the most commonly prescribed type of medication in both general practice and hospital outpatient-based practice, but not all sectors of the population are accessing them equally, with low rates of use persisting in racial and ethnic minorities.

The authors refer to the STAR*D study that examined up to four successive treatment steps, starting with citalopram, and included a switch to and augmentation with additional drug or cognitive therapy in the subsequent steps. Remission rates in steps 1 to 4 were disappointing at 37%, 31%, 14%, and 13%, with a cumulative remission rate of 67%, lower than suggested by efficacy studies of the various antidepressants. The authors say this "suggests that, in actual practice, most patients need several sequential treatment steps to achieve remission." They also mention new strategies that have been used, such as ademetionine for major depression and intravenous ketamine for the acute treatment of treatment-resistant depression.

The safety of selective serotonin reuptake inhibitors (SSRIs) has been much discussed, but the authors say the evidence is conflicting in relation to suicide risk and use of these drugs, with some studies showing an increased risk and others showing reduced risk of suicide after starting SSRI treatment, especially with sertraline, and in men. They also discuss risk of SSRI use during pregnancy, with data showing that paroexetine might cause major malformations, especially cardiac defects. Presence of persistent pulmonary hypertension in newborns can be associated with SSRI use in late pregnancy, and infants with continuous exposure to mother's depression and continuous exposure to SSRIs throughout gestation were more likely to be born preterm than were infants with partial or no exposure. The authors say: "Guidelines suggest that SSRIs should be used with caution during pregnancy and that paroxetine be avoided."

An exciting prospect for future treatment for major depression is use of deep brain stimulation, yet to be approved by the US Food and Drug Agency (FDA) or the European Medicines Agency, but showing promising results. Electrodes are implanted bilaterally in the brain and are connected to an internal pulse generator, that can be adjusted to the patient's needs. Transcranial magnetic stimulation (TMS) already has FDA approval, but repetitive TMS might not be as effective as deep brain stimulation.

However, the authors conclude that, despite the recent clinical, neurobiological, and treatment advances made in the past five years, "no fully satisfactory treatments for major depression are available".

More information: Online: http://www.thelanc … 0140-6736(11)60602-8/abstract

Provided by Lancet

Can proteins in the blood predict an early death?

Certain measures of kidney health may predict who is likely to die prematurely, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The findings suggest that some markers of kidney function are better than others at predicting an individual's prognosis.

22 dec 2011--A person's level of kidney function often indicates how likely they are to develop kidney failure and other conditions. Kidney function is most accurately represented by the kidneys' filtration rate, but this is difficult to measure. Therefore, blood levels of a protein called creatinine are commonly used to assess kidney function, but levels of two other blood components—cystatin C and beta trace protein—are newly proposed markers that may be better predictors of individuals' future health. It's thought that these markers may go beyond indicating kidney health to include other aspects of an individual's well being.

To see how well these markers predict people's future health, Navdeep Tangri, MD, Mark Sarnak, MD MS (Tufts Medical Center), and their colleagues analyzed data from the Modification of Diet in Renal Disease Study, which provided levels of these markers for 816 kidney disease patients who were then followed for an average of 16.6 years.

The researchers found that, independent of the kidneys' filtration rate, participants with higher creatinine had a higher risk of developing kidney failure, but a lower risk of dying. Those with higher cystatin C and beta trace protein had a higher risk of both kidney failure and death.

These results suggest that creatinine, beta trace protein, and cystatin C may be predictive of aspects of health that go beyond the kidneys. Beta trace protein and cystatin C appear to provide more consistent prognostic information than creatinine.

Future studies should investigate whether a panel of markers of kidney function would provide a better prediction of an individual's prognosis than any one marker alone.

More information: The article, entitled "Filtration Markers Have Prognostic Value Independent of Glomerular Filtration Rate" will appear online on December 15, 2011, doi: 10.1681/ASN.2011070663

Provided by American Society of Nephrology

Mediterranean diet gives longer life

A Mediterranean diet with large amounts of vegetables and fish gives a longer life. This is the unanimous result of four studies to be published by the Sahlgrenska Academy at the University of Gothenburg. Research studies ever since the 1950s have shown that a Mediterranean diet, based on a high consumption of fish and vegetables and a low consumption of animal-based products such as meat and milk, leads to better health.

21 dec 2011--Scientists at the Sahlgrenska Academy have now studied the effects of a Mediterranean diet on older people in Sweden. They have used a unique study known as the "H70 study" to compare 70-year-olds who eat a Mediterranean diet with others who have eaten more meat and animal products. The H70 study has studied thousands of 70-year-olds in the Gothenburg region for more than 40 years.

The results show that those who eat a Mediterranean diet have a 20% higher chance of living longer. "This means in practice that older people who eat a Mediterranean diet live an estimated 2 3 years longer than those who don't", says Gianluca Tognon, scientist at the Sahlgrenska Academy, University of Gothenburg.

These results are supported by three further as yet unpublished studies into Mediterranean diets and their health effects: one carried out on people in Denmark, the second on people in northern Sweden, and the third on children.

"The conclusion we can draw from these studies is that there is no doubt that a Mediterranean diet is linked to better health, not only for the elderly but also for youngsters", says Gianluca Tognon.

Provided by University of Gothenburg

Polyphenol-rich diet could reduce cardiovascular risk

19 dec 2011-- A diet high in polyphenols could help reduce the risk of cardiovascular disease and associated health risks, according to a new study by the University of Glasgow.

Researchers in the Institute of Cardiovascular and Medical Sciences (ICAMS) and Mosaique Diagnostics recruited 39 overweight volunteers, with a body mass index greater than 25, and gave half of them a fruit drink rich in polyphenols – naturally-occurring chemicals found in many plants – and the other half a placebo.

The drink used in the study was specially developed by the scientists and The Coca-Cola Company to contain polyphenolic compounds from a range of sources, including: green tea, grape seed, lemons and apples.

After two weeks, scientists took urine samples from the participants and subjected them to proteomic analysis.

Proteomics is a developing field of medicine which seeks to identify a range of proteins produced in the body which can be monitored to identify the development of particular disease states, long before symptoms are evident.

By knowing which proteins – or biomarkers – change when a disease is in its early stages of development, doctors might be able to prevent or reverse the disease’s progress, or to begin therapeutic treatment earlier.

The research found a total of 27 proteins that were significantly different between the two groups, including five that are associated with reduced risk cardiovascular disease.

Professor Harald Mischak, Professor of Proteomics and founder of Mosaique Diagnostics, said: “While the epidemiological data supports the idea that a diet rich in fruit and vegetables is beneficial to health, clinical studies have generally not adequately confirmed this. Our data indicates that proteomic analysis can be a powerful tool to assess potential positive effects of dietary products.

“Our pilot study suggests that as far as polyphenol-containing fruit drinks go, there are possible benefits for cardiovascular health, which deserve further consideration in longer term trials.

“Given the recommended daily intake of five 80g portions of fruit and vegetables a day is taken by around just a quarter of Britons and less than half of Americans, fruit juices and juice drinks fortified with polyphenols represent a potential way for some consumers to meaningfully increase their intake of such potentially beneficial compounds, although the long term effects remain to be elaborated.”

Dr William Mullen, Director of Biomarker Research at the University of Glasgow, said: “The long-term goal of clinical proteomics is to identify biomarkers for a range of diseases that would allow early detection and treatment.

“However, finding a single ‘ideal’ compound that can do this is an unlikely prospect, but by using a ‘fingerprint’ of a number of proteins we can identify pre-symptomatic development of a range of diseases, from coronary artery disease to chronic kidney disease and diabetes. We have developed a range of biomarkers from urine samples for clinical diagnostics that are highly sensitive and selective for a range of diseases. These biomarkers are in effect ‘urinary fingerprints’ of diseases.

“This technology and approach also has potential for use in nutrition and health research, as our study has demonstrated.

“This study was small and did not allow the testing of all proteomics data so we need larger, more in-depth studies to develop this potential further, and we need longer term studies to link patterns to disease outcomes.

“The technology of this method has been found to be acceptable for use in clinical studies by the US Food & Drug Administration and many diseases can be analysed with just one urine sample.”

The research, published in the Journal of Agricultural and Food Chemistry, was led by Professor Naveed Sattar and funded by The Coca-Cola Company.

Provided by University of Glasgow

Doctors should tell patients the realities of aging

Dr. Alexander K. Smith hopes to provoke a national discussion about being frank with the very elderly about their individual medical prognosis.

18 dec 2011--In his recent paper on the issue published by the New England Journal of Medicine, he makes a strong case for outlining the future in frank terms - provided the elder wants to hear it.

"Studies show patients want to discuss the realities of aging but they may be waiting for the physician to bring it up," says Smith, who is an assistant professor of medicine at the University of California San Francisco and an associate of the San Francisco Veterans Affairs Medical Center.

"Often it's the doctor who doesn't want to talk about it," he says.

Here Smith discusses the issue:

Q: You admit not all patients want to know the details of their future, medically. For those who are interested, what's the problem?

A: As I write in this paper, co-authored by Dr. Brie A. Williams and Dr. Bernard Lo, despite knowing that life expectancy inexorably decreases with advancing age, we tend to avoid discussing overall prognosis with elderly patients, particularly those with no dominant terminal illness. By avoiding such discussions, however, we may undercut the ability of patients and their caregivers to make informed choices for their future.

Q: You say discussing these individual issues with elderly patients should be the norm. Seems this should already be routine and not the topic of such serious debate.

A: Well, the idea of patient activism is relatively new. There has been, in the past, strong pressure to deny the realities of aging. We know a substantial number of patients want to talk about this now. But we have to respect those who don't. It depends on the person. I have patients who are 100 who won't admit their time is limited.

Q: Is this a way to reduce overall health costs? I mean, if I know that the cancer I have is going to kill me eventually, why bother to spend the money to treat it in the end days of life? By denying treatment to those it will not substantially benefit with many more years of good health, we could reduce Medicare costs significantly.

A: When patients are aware of the options, they often make choices themselves that reduce the cost of care. But it is our job to support the patient's goals and aspirations. I absolutely am not suggesting we tell people that the eventual outcome of this treatment will not benefit them so we aren't going to do it because of the expense.

Right now, we are doing a study to find out why patients will talk about a short-term prognosis but generally aren't willing to talk about five or 10 years ahead.

We need to set a balance but we also must give hope. So many are living longer comfortably with disabilities that once were painful.

Q: In your paper you suggest that clinicians should routinely offer to discuss the overall prognosis for elderly patients with a life expectancy of less than 10 years Â- or at least by the time a patient reaches 85 - and that the older and frail should be encouraged to talk about reducing the pill burden and engaging in advanced care planning.

A: Most of the very elderly patients place great emphasis on the harms as well as the benefits of medications (but) clinicians may fear talking about or even raising the topic of overall prognosis because it may seem threatening to patients and family members....

Whereas clinicians consider overall prognosis in order to inform medial decision-making, in our experience, many very elderly patients are interested in it because it affects personal life choices Â- motivating them, for instance, to arrange finances for long-term care or to prioritize spending time with grandchildren and other family members while they are active.

Q: Some of the common medical decisions and life choices that you say offer opportunities to discuss overall prognosis with the elderly are assessing the appropriateness of high-risk surgery or initiating renal dialysis in an elderly patient.

A: Not withstanding large current gaps in evidence, we believe we should start talking about overall prognosis now, even as we carry out more research on patient preferences and ways of improving such discussions. To make our care more patient-centered, we need to start helping our very elderly patients set goals of care that take their overall prognosis into account. We should do so in the ordinary course of clinical practice, letting our patients be our guides.

Biochemical signature predicts progression to Alzheimer's disease

A study led by Research Professor Matej Orešič from VTT Technical Research Centre of Finland suggests that Alzheimer's disease is preceded by a molecular signature indicative of hypoxia and up-regulated pentose phosphate pathway. This indicator can be analysed as a simple biochemical assay from a serum sample months or even years before the first symptoms of the disease occur. In a healthcare setting, the application of such an assay could therefore complement the neurocognitive assessment by the medical doctor and could be applied to identify the at-risk patients in need of further comprehensive follow-up.

16 dec 2011--Alzheimer's disease (AD) is a growing challenge to the health care systems and economies of developed countries with millions of patients suffering from this disease and increasing numbers of new cases diagnosed annually with the increasing ageing of populations.

The progression of Alzheimer's disease (AD) is gradual, with the subclinical stage of illness believed to span several decades. The pre-dementia stage, also termed mild cognitive impairment (MCI), is characterised by subtle symptoms that may affect complex daily activities. MCI is considered as a transition phase between normal aging and AD. MCI confers an increased risk of developing AD, although the state is heterogeneous with several possible outcomes, including even improvement back to normal cognition.

What are the molecular changes and processes which define those MCI patients who are at high risk of developing AD? The teams led by Matej Orešič from VTT and Hilkka Soininen from the University of Eastern Finland set out to address this question, and the results were published on 13th Dec. 2011 in Translational Psychiatry.

The team used metabolomics, a high-throughput method for detecting small metabolites, to produce profiles of the serum metabolites associated with progression to AD. Serum samples were collected at baseline when the patients were diagnosed with AD, MCI, or identified as healthy controls. 52 out of 143 MCI patients progressed to AD during the follow-up period of 27 months on average. A molecular signature comprising three metabolites measured at baseline was derived which was predictive of progression to AD. Furthermore, analysis of data in the context of metabolic pathways revealed that pentose phosphate pathway was associated with progression to AD, also implicating the role of hypoxia and oxidative stress as early disease processes.

The unique study setting allowed the researchers to identify the patients diagnosed with MCI at baseline who later progressed to AD and to derive the molecular signature which can identify such patients at baseline.

Though there is no current therapy to prevent AD, early disease detection is vital both for delaying the onset of the disease through pharmacological treatment and/or lifestyle changes and for assessing the efficacy of potential AD therapeutic agents. The elucidation of early metabolic pathways associated with progression to Alzheimer's disease may also help in identifying new therapeutic avenues.

More information: M. Orešič, T. Hyötyläinen, S.-K. Herukka, M. Sysi-Aho, I. Mattila, T. Seppänan-Laakso, V. Julkunen, P. V. Gopalacharyulu, M. Hallikainen, J. Koikkalainen, M. Kivipelto, S. Helisalmi, J. Lötjönen, H. Soininen, Metabolome in progression to Alzheimer's disease, Translational Psychiatry, 13th December 2011.

Provided by VTT Technical Research Centre of Finland

Despite guidelines, elderly receiving too many cancer screenings

14 dec2011-- Despite guidelines from a major medical group recommending limited – or no – screenings for four types of cancer for people in their 60s, 70s, and 80s, a UConn researcher has found that more than half of elderly adults continue to receive the screenings.

Keith Bellizzi, an assistant professor in the Department of Human Development and Family Studies in the College of Liberal Arts and Sciences, says that despite the U.S. Preventive Services Task Force guidelines against routine screening for breast, colorectal, cervical, and prostate cancer at the age of 75 years (65 for cervical cancer), more than 50 percent of physicians continue to recommend the tests. High rates continue for people in their 80s.

Bellizzi found that elderly Hispanics and African Americans were screened less often than Caucasians, differences accounted for by lower educational attainment in these two groups compared to Caucasians.

The USPSTF guidelines recommend against routine cervical cancer screenings in women older than 65; ending routine screening for mammography and colorectal cancer in adults 75 or older; and against screening for prostate cancer in men 75 and older. Other agencies and organizations also recommend fewer screenings for the elderly.

“These findings reinforce the need to examine factors that physicians consider in deciding to screen their patients, and underscores the critical role for health care providers to make informed screening decisions for their patients,” says Bellizzi.

The study will be published later this month in the Archives of Internal Medicine, a publication of the American Medical Association. Joining Bellizzi in the work was Erica Breslau and Allison Burness of the National Cancer Institute.

Bellizzi analyzed data from the CDC’s National Health Interview Survey, an annual in-person nationwide survey used to track health trends in American citizens, to estimate the prevalence of cancer screening among older adults in different racial groups. The study population of 49,575 individuals included 1,697 who were 75 to 79 years of age and 2,376 who were 80 years of age and older.

“In the United States, the number of adults 65 years or older, currently estimated at 36.8 million, is expected to double by the year 2030. Providing high-quality care to this growing population while attempting to contain costs will pose a significant challenge,” Bellizzi says. “While a great deal is known about cancer screening behaviors and trends in young and middle-aged adults, less is known about screening behaviors in older adults from different racial backgrounds.”

Historically, older adults have been excluded from cancer screening trials, so screening efficacy data on this population is limited, Bellizzi says. Research also is needed to determine the value of continued screening in elderly Americans, and whether the benefits – potentially longer lives – outweigh the negatives: complications from tests, false positives putting unneeded stress on the patient and their families, treatment of clinically unimportant cancers, distress, and anxiety.

“Older adults are becoming increasingly heterogeneous with respect to health status because of earlier lifestyle behaviors and health trajectories,” Bellizzi says. “As such it is quite likely that continued screening for certain segments of the older adult population is warranted.

“At the same time, there are segments of the older adult population with limited life expectancy, poor health status, and concomitant health conditions that would likely not benefit from screening. The challenge is how do we make this determination,” he says.

Done properly, he adds, “we would improve the quality of care in the older population, while containing health care costs.”

Provided by University of Connecticut

Study: No decline in running economy for older runners

Runners over the age of 60 are the fastest-growing group in the sport. A new study from the University of New Hampshire suggests that their running can remain fast as they age, too.

13 dec 2011--The study, published in the Journal of Strength and Conditioning Research, found that the running economy – how efficiently the body uses oxygen at a certain pace – of older runners was no different than that of younger runners. "That really jumped off the page. It was surprising, but in a good way," says lead author Timothy Quinn, who is an associate professor of exercise science at UNH.

Yet in general older runners are slower than younger ones, which is why races segment competitors by age. Moderating the good news about running economy, Quinn and his colleagues found that maintaining this running economy came at a higher "cost" to senior runners. Their VO2 max, which measures the body's capacity to transport and use oxygen during exercise, was significantly lower than their younger peers, as were their maximal heart rates.

"For the runners over age 60, it's physiologically more difficult to run at that speed, even though the absolute oxygen uptake value is the same as a younger runner," says Quinn. In other words, it will feel harder.

Working with competitive male and female distance runners who had all finished first, second or third place in their age categories in large local road races, the researchers grouped their subjects as young (18-39 years), master (40-59 years) and older (60 years and over). In addition to running economy, Quinn and co-authors, who include former UNH exercise science graduate student and instructor Michelle Manley and former clinical assistant professor Allison MacKenzie (now at the University of Buffalo), looked at other factors – strength, power, and flexibility -- that might explain how running performance declines with age.

The older runners fared significantly worse than younger ones on all three measures, helping pinpoint the sources of age-related performance declines. Strength, in particular upper-body strength, is necessary to propel runners uphill and to hasten leg turnover, says Quinn. Muscle power – how fast that strength is generated – governs the speed at which runners can change speed or direction or run up hills. And flexibility, measured in this study with a sit-and-reach test to assess hamstring and lower back flexibility, correlates with stride length and step frequency.

These findings should by no means suggest that older runners should hang up their sneakers, the researchers say. "Strength declines with age, but you can minimize that if you do strength training. It doesn't take a lot to maintain strength," says Quinn. "We need to set up programs that enhance strength, especially upper-body strength, and power. They'll be better runners for it."

Quinn, who has done research on running, cardiovascular function, and fitness throughout his two-decade career at UNH, hopes to measure this same group of runners over time, launching a longitudinal study that will shed new light on the performance of runners as they age.

More information: An abstract of the study, "Aging and Factors Related to Running Economy," is available to download here: http://journals.lw … nomy.5.aspx.

Provided by University of New Hampshire

Socially active older adults have slower rates of health declines

Staying connected to other people through a wide variety of social activities can yield important health consequences as you age.

12 dec 2011--That’s the message from a new study that found that older adults who maintain high levels of social activity or ramp up their social life as they age might be protected from increases in physical and cognitive issues over time.

“People have some control over their social lives, so it is encouraging to find that something many people find enjoyable—socializing with others—can benefit their cognitive and physical health,” said study author Patricia A. Thomas, Ph.D., of the Population Research Center at University of Texas at Austin.

While earlier research had established a link between health and social relations, this study sought to examine how changing social connections over time influenced health. While the elderly are vulnerable to losing formal social roles through retirement or the death of a spouse, they could still seek out social activities in other arenas.

In the study, which appears online in the December issue of the Journal of Health and Social Behavior, the researchers analyzed data from a sample of 1,667 adults older than 60 years. Data collection from participants occurred in 1986, 1989, 1994 and 2002. Participants were asked about their frequency of social activities, such as visiting with friends and family members; attending meetings, programs or clubs; and volunteering in the community over the previous 12 months. They also answered questions about cognitive and physical limitations.

Older adults who had high initial levels of social engagement that only slightly decreased over time and those who had high or medium levels of engagement that increased over time developed cognitive and physical limitations more slowly than did those with low levels of engagement that decreased over time.

Thomas pointed out, “Even if older adults weren’t socially active when they were younger, when they increase social activity later in life, it can still reduce physical and cognitive health issues.”

Asenath La Rue, Ph.D., a neuropsychologist with the Wisconsin Alzheimer's Institute at the University of Wisconsin School of Medicine and Public Health, agreed with the study’s main finding. La Rue said there has not been much reporting about the benefits gained from social interaction if a person was not socially connected when younger. “However, it’s like the chicken and egg question about which comes first,” she explained, noting that while the research was observational, epidemiology supports the fact that social interaction is beneficial for cognitive health and physical performance in older adults.

More information: Thomas, P.A. (2011) Trajectories of Social Engagement and Limitations in Late Life. Journal of Health and Social Behavior, 52(4), 430-443.

Provided by Health Behavior News Service

Aging stem cells may explain higher prevalence of leukemia, infections among elderly

Human stem cells aren't immune to the aging process, according to scientists at the Stanford University School of Medicine. The researchers studied hematopoietic stem cells, which create the cells that comprise the blood and immune system. Understanding when and how these stem cells begin to falter as the years pass may explain why some diseases, such as acute myeloid leukemia, increase in prevalence with age, and also why elderly people tend to be more vulnerable to infections such as colds and the flu.

11 dec 2011--"We know that immune system function seems to decline with increasing age," said Wendy Pang, MD. "This is the first study comparing the function and gene expression profiles of young and old purified, human hematopoietic stem cells, and it tells us that these clinical changes can be traced back to stem cell function."

Specifically, the researchers found that hematopoietic stem cells from healthy people over age 65 make fewer lymphocytes — cells responsible for mounting an immune response to viruses and bacteria — than stem cells from healthy people between ages 20 and 35. (The cells were isolated from bone marrow samples.) Instead, elderly hematopoietic stem cells, or HSCs, have a tendency to be biased in their production of another type of white blood cell called a myeloid cell. This bias may explain why older people are more likely than younger people to develop myeloid malignancies.

The study will be published online Nov. 28 in the Proceedings of the National Academy of Sciences. Pang, who is in the Medical Science Training Program at Stanford, is the first author of the research; professor of pathology Irving Weissman, MD, is the senior author. Weissman is also the director of Stanford's Institute for Stem Cell Biology and Regenerative Medicine.

Pang began the study to understand whether human HSCs aged like mouse HSCs. Previous studies had shown that mouse HSCs change in number and function as a laboratory mouse grows older. She obtained HSCs from 15 healthy elderly people and 28 healthy young people and compared their prevalence, distribution and cell cycle profile.

She found that HSCs comprised a greater proportion of bone marrow cells in older people than in younger people. They were also more likely to be actively dividing than younger HSCs. But their greater numbers and increased proliferation didn't translate into greater efficiency; like a top wobbling out of control as its rotation slows, the aging HSCs instead appear to be unsuccessfully trying to keep up with the demands of everyday life.

When Pang purified the HSCs and grew them in laboratory dishes, she found that HSCs from older people were less able to differentiate into B lymphocytes and more likely to become myeloid cells. Furthermore, immune-deficient laboratory mice given transplants of older, human HSCs exhibited a higher proportion of myeloid to lymphoid cells in their bone marrow in the weeks to months after the transplant.

Finally, Pang examined the gene expression profile of the two sets of human HSCs, as well as five samples of HSCs from people ages 42 to 61. She found that HSCs from elderly donors express comparatively higher levels of several age-related genes associated with the cell cycle, proliferation and development, as well as genes associated with DNA repair and cell death. The higher levels of these genes suggests the cells are less likely to wait quietly on the sidelines until new blood or immune cells are needed and are instead entering the cell cycle inappropriately.

Overall, the results mirror those seen in studies of HSCs from laboratory mice of varying ages. They suggest that human HSCs struggle as a person ages, and that this struggle can sometimes lead not only to inadequate immune responses, but also to inappropriate growth and specific types of blood cancers, such as acute myeloid leukemia. They also contribute valuable information for the study of many other conditions.

"In both mice and humans, the puzzle has been how the system ages," said Weissman, who is also the Virginia & D.K. Ludwig Professor for Clinical Investigation in Cancer Research and a member of Stanford's Cancer Institute. "Because HSCs in old mice and humans are derived from the HSCs they had in their youth, there are two possibilities to describe how these differences occur. Either individual, young HSCs change their gene expression patterns as they age, undergoing heritable adaptations that favor the myeloid lineage, or each young HSC already has a specific lineage bias and is battling for precious niches through the natural selection of aging, which favors those biased toward myeloid cells." Understanding which possibility is true could help clinicians of the future encourage the survival of HSCs with more-appropriate properties in patients with age-related diseases, Weissman believes.

"These findings will also serve as an important baseline for future studies of age-related diseases, such as myeloid dysplastic syndrome, anemia and leukemia," said Pang. "Now that we know how HSCs change and function in elderly individuals who are not ill, we should be able to tease out disease-associated changes from normal age-associated phenomena."

Provided by Stanford University Medical Center

Alzheimer's vaccine cures memory of mice

Associate Professor Lars Ittner: "Although we have a long way to go before the vaccine might be available for human use, these early results are very promising."

10 dec 2011-- A vaccine that slows the progression of Alzheimer's disease and other types of dementia has been developed by researchers at the University of Sydney's Brain and Mind Research Institute (BMRI).

The vaccine, which targets a protein known as tau, prevents the ongoing formation of neurofibrillary tangles in the brain of a mouse with Alzheimer's disease.

This progressive neurodegenerative disease affects more than 35 million people worldwide. The tau protein is also involved in front temporal dementia, the second most common form of dementia in people younger than 65 years.

The results of the study which led to the production of the vaccine have been published today in the scientific journal PLoS ONE.

Lead author on the study, Associate Professor Lars Ittner, from the Alzheimer's and Parkinson's Disease Laboratory says: "Our study is the first to show that a vaccine targeting the tau protein can be effective once the disease has already set in.

"The vaccine appears to have a preventative effect: slowing the development of further tangles, rather than clearing existing ones, but the exact mechanism involved is not yet understood," he said.

According to Associate Professor Ittner, scientists have been working on vaccines targeting the amyloid plaques seen in Alzheimer's for many years with a few currently in clinical trials.

"Most of the other vaccines targeting tau were tested only before or around the onset of the disease in animal models, but the vast majority of people with Alzheimer's disease are only diagnosed after the symptoms have appeared.

"We are already collaborating with the US pharmaceutical industry to develop this new vaccine for humans.

"Although we have a long way to go before the vaccine might be available for human use, these early results are very promising and a great reward for the countless hours spent in the lab by me and my team!"

Provided by University of Sydney

Pharmacogenomics study finds rare gene variants critical for personalized drug treatment

The use of genetic tests to predict a patient's response to drugs is increasingly important in the development of personalized medicine. But genetic tests often only look for the most common gene variants. In a pharmacogenomics study published online today in Genome Research (www.genome.org), researchers have characterized rare genetic variants in a specific gene that can have a significant influence in disposition of a drug used to treat cancer and autoimmune disease, a finding that will help improve the effectiveness of personalized care.

09 dec 2011--The drug methotrexate is used to treat cancers such as acute lymphoblastic leukemia, and autoimmune diseases including rheumatoid arthritis. Common genetic variants in the SLCO1B1 gene, which encodes a transporter in the liver important for clearance of medication from the body, are present in 10-15% of the population and affect the efficiency of methotrexate clearance from the body.

Low clearance of methotrexate results in high levels in the blood and increased side effects. Rare variants could also significantly affect drug clearance, but the influence of rare versus common SLCO1B1 variants in methotrexate clearance had not yet been explored.

In this report, an international team of researchers sequenced the exons of SLCO1B1, the gene regions that code for protein, in a cohort of pediatric patients receiving methotrexate, finding rare genetic variants that have an effect on the efficiency of clearance of the drug from the body. "We showed that rare inherited genomic variants, present in as few as 1 in 699 people, account for a significant percentage of variability in blood levels of methotrexate," said Dr. Mary Relling of St. Jude Children's Research Hospital, senior author of the study. "This means that the high blood levels present in 2% of people are due to very rare genetic variants."

The research group then utilized computational algorithms to predict the potential negative impact of genomic variants identified in this study on function of the SLCO1B1 protein in the transport of methotrexate. They then tested these predictions in laboratory cell lines, confirming that these genetic variants conferred lower transport of the drug.

"Our discovery of important but rare coding variants in SLCO1B1 not only has implications for methotrexate, but also possibly for other drugs," explained Dr. Laura Ramsey of St. Jude Children's Research Hospital, primary author of the study. Ramsey noted that SLCO1B1 variants are tested to inform choice of the appropriate dosage of statins, commonly used to treat or prevent high cholesterol.

Ramsey added that clinical genetic tests are currently limited, generally only testing for the most common SLCO1B1 variants. "Our findings that there are additional rare functional coding variants in this gene suggest that genotyping tests would need to expand to include rare variants in order to avoid false negative test results."

Scientists from St. Jude Children's Research Hospital (Memphis, TN), Aarhus University (Aarhus, Denmark), MD Anderson Cancer Center (Houston, TX), the University of Tennessee Health Science Center (Memphis, TN), the Sidney Kimmel Comprehensive Cancer Center (Baltimore, MD), and the University of California, San Francisco (San Francisco, CA) contributed to this study.

More information: The manuscript will be published online ahead of print on December 6, 2011. Its full citation is as follows: Ramsey LB, Bruun GH, Yang W, Trevino LR, Vattathil S, Scheet P, Cheng C, Rosner GL, Giacomini KM, Fan Y, Sparreboom A, Mikkelsen TS, Corydon TJ, Pui C, Evans WE, Relling MV. Rare versus common variants in pharmacogenetics: SLCO1B1 variation and methotrexate disposition. Genome Res doi: 10.1101/gr.129668.111

Provided by Cold Spring Harbor Laboratory

Cigarettes, diet, alcohol and obesity behind more than 100,000 cancers

08 dec 2011-- More than 100,000 cancers – equivalent to one third of all those diagnosed in the UK each year – are being caused by smoking, unhealthy diets, alcohol and excess weight, according to new research from Queen Mary, University of London.

This figure further increases to around 134,000 when taking into account all 14 lifestyle and environmental risk factors analysed in this study.

This new review of cancer and lifestyle in the UK is the most comprehensive undertaken to date and is published in a supplement to the British Journal of Cancer.

Smoking is far and away the most important lifestyle factor causing 23 per cent of cancers in men and 15.6 per cent in women (nearly one in five cancers).

Overall the review shows that 45 per cent of all cancers in men could be prevented – compared with 40 per cent of all cancers in women.

Professor Max Parkin, a Cancer Research UK epidemiologist based at Queen Mary, University of London, and study author, said “Many people believe cancer is down to fate or ‘in the genes’ and that it is the luck of the draw whether they get it.

“Looking at all the evidence, it’s clear that around 40 per cent of all cancers are caused by things we mostly have the power to change.

“We didn’t expect to find that eating fruit and vegetables would prove to be so important in protecting men against cancer. And among women we didn’t expect being overweight to have a greater effect than alcohol.

“In most cases cancers have multiple causes – for example a cervical cancer can be linked to both HPV infection and smoking. This means it isn’t possible to add up the effects of different lifestyle factors – you’d get more than 100 per cent.”

In this study, the top six risk factors were calculated as follows (the number of cases has been rounded to the nearest hundred).

Overall, one in 25 cancers is linked to occupation and one in 33 to infections.

It is estimated that tobacco smoking, dietary factors, drinking alcohol and bodyweight account for 106,845 or 34 per cent of cancers occurring in 2010. This is based on predicted numbers of cancer cases in 2010, using UK incidence figures for the 15-year period from 1993 to 2007.

Sara Hiom, director of information at Cancer Research UK, said: “We know, especially during the Christmas party season, that it is hard to watch what you eat and limit alcohol and we don’t want people to feel guilty about having a drink or indulging a bit more than usual. But it’s very important for people to understand that long term changes to their lifestyles can really reduce their cancer risk.”

Dr. Harpal Kumar, Cancer Research UK’s chief executive, said: “Leading a healthy life doesn’t guarantee that a person won’t get cancer but this study shows that healthy habits can significantly stack the odds in our favour.

“While we have made tremendous progress in improving the chance of surviving cancer during the last 40 years, we need to make sure people are made aware of the risks of getting the disease in the first place so they can make the healthiest possible lifestyle choices.

“We know that cancer risk can be affected by family history and getting older, but these figures show that we can take positive steps to help reduce our risk of the disease. Stopping smoking, eating a balanced diet, cutting down on alcohol and maintaining a healthy weight could be New Year’s resolutions that help save more lives in future.”

Provided by Queen Mary, University of London

Simple blood test diagnoses Parkinson's disease long before symptoms appear

A new research report appearing in the December issue of the FASEB Journal shows how scientists from the United Kingdom have developed a simple blood test to detect Parkinson's disease even at the earliest stages. The test is possible because scientists found a substance in the blood, called "phosphorylated alpha-synuclein," which is common in people with Parkinson's disease, and then developed a way to identify its presence in our blood.

06 dec 2011--"A blood test for Parkinson's disease would mean you could find out if a person was in danger of getting the disease, before the symptoms started," said David Allsop, Ph.D., a researcher involved in the work from the Division of Biomedical and Life Sciences and the School of Health and Medicine at the University of Lancaster, in Lancaster, UK. "This would help the development of medicines that could protect the brain, which would be better for the quality of life and future health of older people."

To develop the blood test for Parkinson's disease, Allsop and colleagues studied a group of people diagnosed with the disease and a second group of healthy people of a similar age. Blood samples from each group were analyzed to determine the levels of phosphorylated alpha-synuclein present. They found those with Parkinson's disease had increased levels of the substance. Based upon these findings, researchers developed a blood test that detects the presence of phosphorylated alpha-synuclein, which could allow for diagnosis of the disease well before symptoms appear but when brain damage has already begun to occur.

"When most people think of Parkinson's disease, they think of the outward symptoms, such as involuntary movements," said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal, "but many people with Parkinson's also develop neurological problems that may be more difficult to detect right away. Having a blood test not only helps doctors rule out other possible causes of the outward symptoms, but it also allows for early detection which can help patients and their caregivers prepare for the possibility of the mental, emotional, and behavioral problems that the disease can cause."

More information: Penelope G. Foulds, J. Douglas Mitchell, Angela Parker, Roisin Turner, Gerwyn Green, Peter Diggle, Masato Hasegawa, Mark Taylor, David Mann, and David Allsop. Phosphorylated α-synuclein can be detected in blood plasma and is potentially a useful biomarker for Parkinson's disease. FASEB J. December 2011 25:4127-4137; doi:10.1096/fj.10-179192

Provided by Federation of American Societies for Experimental Biology

Diametric shift in 2 protein levels spurs Alzheimer's plaque accumulation

A diametric shift in the levels of two proteins involved in folding, moving and cutting other proteins enables accumulation of the destructive brain plaque found in Alzheimer's disease, researchers report.

03 dec 2011--VPS35 is a protein that folds others into specific positions to unleash their functions. When levels are reduced as they are in aging, it unleashes the normally dormant BACE1, a protein responsible for beta amyloid plaque production, Georgia Health Sciences University researchers report in The Journal of Cell Biology.

When researchers modified a mouse model of Alzheimer's so that VPS35 production was essentially cut in half, BACE1 activity was increased, accelerating aging and development of related problems such as memory deficits and poor communication between brain cells as well as beta amyloid accumulation, said Dr. Wen-Cheng Xiong, developmental neurobiologist and Weiss Research Professor at GHSU and the study's corresponding author.

It was known that expression of VPS35 was down and BACE1 was up in Alzheimer's but the direct relationship was unknown, Xiong said. "We believe impaired function of VPS35 could be a risk factor for Alzheimer's and Parkinson's diseases," Xiong said. Discovering the relationship makes VPS35 a potential biomarker for the diseases as well as a target for new therapies to keep VPS35 elevated. The accelerated aging model Xiong developed and patented will enable these future drug studies.

This unhealthy balance causes cells to accumulate more waste than their recycling systems can handle. Additionally misfolded proteins end up in the wrong cell compartment where they form aggregates that eventually kill the cell. Being in the wrong place is what enables BACE1 activity to increase: it ends up stuck in a cell compartment called the endosome where high acidity levels activate the protein. As BACE1 becomes more numerous and active, it chops up more potentially productive proteins, turning them into garbage.

"Each protein knows its destination, lifespan and when it should be degraded; everything is controlled. With aging, their trafficking, their control system is disrupted," Xiong said.

Future questions include what reduces VPS35 levels, such as increased levels of reactive oxygen species that come with age, and whether exercise can help keep them up. 'We think VPS35 will be a new, hot and hopefully productive area for Alzheimer's and Parkinson's research," Xiong said.

The protein is classified a retromer. Retromers are important to recycling inside cells. While silent in healthy adults, BACE1 plays an important role in brain development.

Provided by Georgia Health Sciences University

Socially active older adults have slower rates of health declines

Staying connected to other people through a wide variety of social activities can yield important health consequences as you age.

02 dec 2011--That’s the message from a new study that found that older adults who maintain high levels of social activity or ramp up their social life as they age might be protected from increases in physical and cognitive issues over time.

“People have some control over their social lives, so it is encouraging to find that something many people find enjoyable—socializing with others—can benefit their cognitive and physical health,” said study author Patricia A. Thomas, Ph.D., of the Population Research Center at University of Texas at Austin.

While earlier research had established a link between health and social relations, this study sought to examine how changing social connections over time influenced health. While the elderly are vulnerable to losing formal social roles through retirement or the death of a spouse, they could still seek out social activities in other arenas.

In the study, which appears online in the December issue of the Journal of Health and Social Behavior, the researchers analyzed data from a sample of 1,667 adults older than 60 years. Data collection from participants occurred in 1986, 1989, 1994 and 2002. Participants were asked about their frequency of social activities, such as visiting with friends and family members; attending meetings, programs or clubs; and volunteering in the community over the previous 12 months. They also answered questions about cognitive and physical limitations.

Older adults who had high initial levels of social engagement that only slightly decreased over time and those who had high or medium levels of engagement that increased over time developed cognitive and physical limitations more slowly than did those with low levels of engagement that decreased over time.

Thomas pointed out, “Even if older adults weren’t socially active when they were younger, when they increase social activity later in life, it can still reduce physical and cognitive health issues.”

Asenath La Rue, Ph.D., a neuropsychologist with the Wisconsin Alzheimer's Institute at the University of Wisconsin School of Medicine and Public Health, agreed with the study’s main finding. La Rue said there has not been much reporting about the benefits gained from social interaction if a person was not socially connected when younger. “However, it’s like the chicken and egg question about which comes first,” she explained, noting that while the research was observational, epidemiology supports the fact that social interaction is beneficial for cognitive health and physical performance in older adults.

More information: Thomas, P.A. (2011) Trajectories of Social Engagement and Limitations in Late Life. Journal of Health and Social Behavior, 52(4), 430-443.

Provided by Health Behavior News Service

Depression can lead to heart disease

Depression may have more far-reaching consequences than previously believed. Recent data suggests that individuals who suffer from a mood disorder could be twice as likely to have a heart attack compared to individuals who are not depressed.

29 nov 2011--This process has been poorly understood — until now. A new study led by Concordia University has found that depressed individuals have a slower recovery time after exercise compared to those who are non-depressed.

These findings suggest that a dysfunctional biological stress system is at play among depressed individuals. Published in the journal Psychophysiology, the research warns of the importance of testing for cardiovascular disease among people suffering from major depression.

"There have been two competing theories as to why depression is linked to cardiovascular disease," says first author Jennifer Gordon, who is a PhD candidate at McGill University. "Depressed people may have poorer health behaviors, which may in turn lead to heart problems. The other possibility is physiological: a problem with the stress system known as the fight or flight response. Our study was the first to examine the role of a dysfunctional fight or flight response in depression in a large population."

Heart rate recovery is a powerful diagnostic tool

A total of 886 participants, who were on average 60 years old, took part in the study conducted by Concordia in association with the Montreal Heart Institute, McGill University, the Hôpital Sacré-Coeur de Montréal, the Université du Québec à Montréal and the University of Calgary.

Approximately 5 per cent of participants were diagnosed with a major depressive disorder. All individuals were asked to undergo a stress test after which their heart rate and blood pressure were recorded. Recovery heart rates and blood pressure levels were compared between depressed and non-depressed individuals.

"We found that it took longer for the heart rate of depressed individuals to return to normal," says senior author, Simon Bacon, a professor in the Concordia University Department of Exercise Science and a researcher at the Montreal Heart Institute. "Heart rate recovery from exercise is one way to measure the fight or flight stress response. The delayed ability to establish a normal heart rate in the depressed individuals indicates a dysfunctional stress response. We believe that this dysfunction, can contribute to their increased risk for heart disease."

"The take-home message of this study is that health care professionals should not only address the mental disorder, but also the potential for heart disease in patients who are suffering from major depression," adds Bacon. "Both of these health issues should be treated to minimize risk of severe consequences."

More information: http://onlinelibra … .01232.x/pdf