Early menopause linked to higher risk of osteoporosis, fracture and mortality

Women who go through the menopause early are nearly twice as likely to suffer from osteoporosis in later life, suggests new research published today (25 April) in BJOG: An International Journal of Obstetrics and Gynaecology.

30 april 2012--The Swedish study looked at the long-term effects of early menopause on mortality, risk of fragility fracture and osteoporosis.
In 1977, 390 white north European women aged 48 were recruited in the Malmo Perimenopausal Study, an observational study where women were followed from age 48 onwards.
The women were divided into two categories; women who started the menopause before 47 and women who started the menopause at age 47 or later.
The women's bone mineral density (BMD) was measured. At the age of 77, all eligible women were re-measured for BMD. At this point, 298 women were still alive while 92 had died. One hundred out of the 298 women still alive had relocated or declined further participation, leaving 198 women to attend the follow-up measurement.
The study found that at the age of 77, 56% of women with early menopause had osteoporosis, in comparison with 30% of women with late menopause.
Women who started the menopause early were also found to have a higher risk of fragility fracture and of mortality. The mortality rate was 52.4% in the early menopause group compared to 35.2% in the late menopause group. The fracture incidence rate was 44.3% in the early menopause group compared to 30.7% in the late menopause group.
Ola Svejme, orthopaedic surgeon at the Skåne University Hospital, Malmo, Sweden and main author of the paper said:
"The results of this study suggest that early menopause is a significant risk factor for osteoporosis, fragility fracture and mortality in a long-term perspective. To our knowledge, this is the first prospective study with a follow-up period of more than three decades."
BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added:
"The study's strength is the length of time the women were observed.
"The higher mortality rate in women with an early menopause needs to be explored further as many other factors could affect this such as medication, nutrition, smoking and alcohol consumption."

More information: Svejme O, Ahlborg H, Nilsson J, Karlsson M. Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women. BJOG 2012; DOI: 10.1111/j.1471-0528.2012.03324.x
Provided by Wiley

Guidelines say diet, exercise, weight control improve odds after cancer diagnosis

New guidelines from the American Cancer Society say for many cancers, maintaining a healthy weight, getting adequate physical activity, and eating a healthy diet can reduce the chance of recurrence and increase the likelihood of disease-free survival after a diagnosis. The recommendations are included in newly released Nutrition and Physical Activity Guidelines for Cancer Survivors, published early online in CA: A Cancer Journal for Clinicians.

29 april 2012--Increasing evidence shows that for many cancers, excess weight, lack of exercise, and poor nutrition increase the risk of cancer recurrence and reduce the likelihood of disease-free and overall survival for cancer patients. "The data suggests that cancer survivors, just like everyone else, benefit from these important steps," said Colleen Doyle MS RD, American Cancer Society director of nutrition and physical activity and co-author of the guidelines. "While we've published previous reports outlining the evidence on the impact of nutrition and physical activity on cancer recurrence and survival, this is the first time the evidence has been strong enough to release formal guidelines for survivorship, as we've done for cancer prevention. Living a physically active lifestyle and eating a healthy diet should absolutely be top of mind for anyone who's been diagnosed with cancer. "
The report was last updated in 2006, and was first created in 2001. For the update, a group of experts in nutrition, physical activity, and cancer survivorship evaluated the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. Among the review's conclusions:

• Avoiding weight gain throughout treatment may be important not only for survivors who are overweight, but also those of normal weight.
• Intentional weight loss after recovering from cancer treatment among overweight and obese patients may be associated with health-related benefits.
• Evidence strongly suggests that exercise is not only safe and feasible during cancer treatment, but that it can also improve physical functioning, fatigue, multiple aspects of quality of life, and may even increase the rate of completion of chemotherapy.
• Physical activity after cancer diagnosis is associated with a reduced risk of cancer recurrence and improved overall mortality among multiple cancer survivor groups, including breast, colorectal, prostate, and ovarian cancer.
• Among breast cancer survivors, physical activity after diagnosis has consistently been associated with reduced risk of breast cancer recurrence and breast cancer-specific mortality.
• Results from observational studies suggest that diet and food choices may affect cancer progression, risk of recurrence, and overall survival in individuals who have been treated for cancer.
• For example, a dietary pattern high in fruits, vegetables, whole grains, poultry, and fish was found to be associated with reduced mortality compared with a dietary pattern characterized by a high intake of refined grains, processed and red meats, desserts, high-fat dairy products, and French fries in women after breast cancer diagnosis and treatment.
• Compelling evidence exists against the use of select supplements in certain oncology populations; therefore, health care professionals and survivors need to proceed with caution.

"As more people survive cancer, there is increasing interest in finding information about food choices, physical activity, and dietary supplements to improve treatment outcomes, quality of life, and overall survival," said Doyle. "Our report summarizes the findings of this expert panel, and is intended to present health care providers with the best possible information with which to help cancer survivors and their families make informed choices related to nutrition and physical activity." The recommendations also include specific guidance for people diagnosed with breast, colorectal, endometrial, ovarian, lung, prostate, head and neck, and hematologic cancers. It also includes a section with answers to common questions about alcohol, organic foods, sugar, supplements, and several other areas of interest.
Provided by American Cancer Society

Guidelines for prostate screening widely ignored

A surgical team performs a robotic prostatectomey at the University of Chicago Medicine Credit: Bruce Powell for the University of Chicago Medicine

New research confirms that the controversial decision by Warren Buffet – the 81-year-old CEO of Berkshire Hathaway – to undergo a blood test screening for prostate cancer despite his age is hardly unusual. Despite recommendations in 2008 from the United States Preventive Services Task Force against testing for prostate cancer in men aged 75 years or older, almost half of men in that age group continue to get screening tests.

28 april 2012--In 2005, before the recommendations were released, 43 percent of men age 75 and above elected to take the prostate-specific antigen (PSA) test. In August 2008, the Task Force stated it "recommends against the service," arguing "there is moderate or high certainty the service has no net benefit or that the harms outweigh the benefits."
Survey results from 2010, however, published in the April 25, 2012, issue of JAMA, found that two years after the Task Force's recommendations were announced, the screening rate for that group of men had gone up slightly, to 43.9 percent. This is higher than the rates for men in their 40s (12.5 percent) or 50s (33.2 percent), who are more likely to benefit from early diagnosis and treatment. Only men aged 60 to 74 were more likely to get the screening test (51.2 percent).
"PSA screening for more than 40 percent of men 75 or older is inappropriate," said study author Scott Eggener, MD, assistant professor of surgery at the University of Chicago Medicine. "Selective screening is reasonable to consider for the healthiest men over age 75, but for the large majority of men in this age group, early detection can lead to treatment of a disease that will probably never cause a problem. A substantial proportion of men over 75 with an elevated PSA will die from something else before a prostate cancer interferes with the quality or duration of their life."
"Our data are likely an underestimate," the authors note. They worked with information from the 2005 and 2010 Cancer Control Supplements, part of the annual National Health Interview Survey (NHIS), which gathers information through in-person interviews and is a representative sample of the US population. "Self-reported screening rates in the NHIS," they note, "are predominantly lower compared with medical record extraction."
The revised draft recommendations presented in October 2011 by the USPSTF are even more critical of PSA screening than the 2008 version, suggesting there was not enough evidence that PSA screening improves health outcomes to routinely recommend the test for men at any age. "Prostate-specific antigen–based screening results in small or no reduction in prostate cancer–specific mortality," the Task Force concludes. It is associated with "harms related to subsequent evaluation and treatments, some of which may be unnecessary." These draft recommendations are not finalized yet but are expected to be forthcoming soon.
Clinical practice patterns following the 2011 USPSTF recommendations "should be monitored," the study authors conclude. Even if PSA screening is discouraged in the final USPSTF recommendation, "I'm not anticipating a massive change in utilization," Eggener said, based on a general tendency for individuals and physicians to support cancer screening, evidence that fewer men are dying of prostate cancer since the introduction of PSA, subsequent confusion about the recommendation among the general public, and ongoing concern about the disease.
Provided by University of Chicago Medical Center

Eating more berries may reduce cognitive decline in the elderly

Blueberries and strawberries, which are high in flavonoids, appear to reduce cognitive decline in older adults according to a new study published today in Annals of Neurology, a journal of the American Neurological Association and Child Neurology Society. The study results suggest that cognitive aging could be delayed by up to 2.5 years in elderly who consume greater amounts of the flavonoid-rich berries.

27 april 2012--Flavonoids are compounds found in plants that generally have powerful antioxidant and anti-inflammatory properties. Experts believe that stress and inflammation contribute to cognitive impairment and that increasing consumption of flavonoids could mitigate the harmful effects. Previous studies of the positive effects of flavonoids, particularly anthocyanidins, are limited to animal models or very small trials in older persons, but have shown greater consumption of foods with these compounds improve cognitive function.
According to the 2010 U.S. Census, elderly Americans—those 65 years of age and older—increased by 15% between 2000 and 2010, faster than the total U.S. population, which saw a 9.7% increase during the same time period. "As the U.S. population ages, understanding the health issues facing this group becomes increasingly important," said Dr. Elizabeth Devore with Brigham and Women's Hospital and Harvard Medical School in Boston, Mass. "Our study examined whether greater intake of berries could slow rates of cognitive decline."
The research team used data from the Nurses' Health Study—a cohort of 121,700 female, registered nurses between the ages of 30 and 55 who completed health and lifestyle questionnaires beginning in 1976. Since 1980 participants were surveyed every four years regarding their frequency of food consumption. Between 1995 and 2001, cognitive function was measured in 16,010 subjects over the age of 70 years, at 2-year intervals. Women included in the present study had a mean age of 74 and mean body mass index of 26.
Findings show that increased consumption of blueberries and strawberries appear to slow cognitive decline in older women. A greater intake of anthocyanidins and total flavonoids was also associated with reduce cognitive degeneration. Researchers observed that women who had higher berry intake delayed cognitive aging by up to 2.5 years. The authors caution that while they did control for other health factors in the modeling, they cannot rule out the possibility that the preserved cognition in those who eat more berries may be also influenced by other lifestyle choices, such as exercising more.
"We provide the first epidemiologic evidence that berries may slow progression of cognitive decline in elderly women," notes Dr. Devore. "Our findings have significant public health implications as increasing berry intake is a fairly simple dietary modification to test cognition protection in older adults."

More information: "Dietary Intake of Berries and Flavonoids in Relation to Cognitive Decline." Elizabeth E. Devore, Jae Hee Kang, Monique M.B. Breteler and Francine Grodstein. Annals of Neurology; Published Online: April 26, 2012 (DOI:10.1002/ana.23594).
Provided by Wiley

Guidelines for prostate screening widely ignored

New research confirms that the controversial decision by Warren Buffet – the 81-year-old CEO of Berkshire Hathaway – to undergo a blood test screening for prostate cancer despite his age is hardly unusual. Despite recommendations in 2008 from the United States Preventive Services Task Force against testing for prostate cancer in men aged 75 years or older, almost half of men in that age group continue to get screening tests.

26 april 2012--In 2005, before the recommendations were released, 43 percent of men age 75 and above elected to take the prostate-specific antigen (PSA) test. In August 2008, the Task Force stated it "recommends against the service," arguing "there is moderate or high certainty the service has no net benefit or that the harms outweigh the benefits."
Survey results from 2010, however, published in the April 25, 2012, issue of JAMA, found that two years after the Task Force's recommendations were announced, the screening rate for that group of men had gone up slightly, to 43.9 percent. This is higher than the rates for men in their 40s (12.5 percent) or 50s (33.2 percent), who are more likely to benefit from early diagnosis and treatment. Only men aged 60 to 74 were more likely to get the screening test (51.2 percent).
"PSA screening for more than 40 percent of men 75 or older is inappropriate," said study author Scott Eggener, MD, assistant professor of surgery at the University of Chicago Medicine. "Selective screening is reasonable to consider for the healthiest men over age 75, but for the large majority of men in this age group, early detection can lead to treatment of a disease that will probably never cause a problem. A substantial proportion of men over 75 with an elevated PSA will die from something else before a prostate cancer interferes with the quality or duration of their life."
"Our data are likely an underestimate," the authors note. They worked with information from the 2005 and 2010 Cancer Control Supplements, part of the annual National Health Interview Survey (NHIS), which gathers information through in-person interviews and is a representative sample of the US population. "Self-reported screening rates in the NHIS," they note, "are predominantly lower compared with medical record extraction."
The revised draft recommendations presented in October 2011 by the USPSTF are even more critical of PSA screening than the 2008 version, suggesting there was not enough evidence that PSA screening improves health outcomes to routinely recommend the test for men at any age. "Prostate-specific antigen–based screening results in small or no reduction in prostate cancer–specific mortality," the Task Force concludes. It is associated with "harms related to subsequent evaluation and treatments, some of which may be unnecessary." These draft recommendations are not finalized yet but are expected to be forthcoming soon.
Clinical practice patterns following the 2011 USPSTF recommendations "should be monitored," the study authors conclude. Even if PSA screening is discouraged in the final USPSTF recommendation, "I'm not anticipating a massive change in utilization," Eggener said, based on a general tendency for individuals and physicians to support cancer screening, evidence that fewer men are dying of prostate cancer since the introduction of PSA, subsequent confusion about the recommendation among the general public, and ongoing concern about the disease.

Provided by University of Chicago Medical Center

New research shows the trajectory of cognitive decline can be altered in seniors at risk for dementia

Cognitive decline is a pressing global health care issue. Worldwide, one case of dementia is detected every seven seconds. Mild cognitive impairment is a well recognized risk factor for dementia, and represents a critical window of opportunity for intervening and altering the trajectory of cognitive decline in seniors.
25 april 2012--A new study by researchers at the Centre for Hip Health and Mobility at Vancouver Coastal Health and the University of British Columbia shows that implementing a seniors' exercise program, specifically one using resistance-training, can alter the trajectory of decline. Perhaps most importantly, the program improved the executive cognitive process of selective attention and conflict resolution as well as associative memory, which are robust predictors of conversion from mild cognitive impairment to dementia.
The research led by Teresa Liu-Ambrose, principal investigator with the Centre for Hip Health and Mobility and the Brain Research Centre at VCH and UBC, and co-investigators from the Department of Psychology and Division of Geriatric Medicine at UBC, and Department of Psychology, University of Iowa, was published today in the Archives of Internal Medicine.
Over the course of six months, the study team followed 86 senior women with probable mild cognitive impairment. The randomized controlled trial is the first to compare the efficacy of both resistance and aerobic training to improve executive cognitive functions - such as attention, memory, problem solving and decision making - necessary for independent living. The trial also assessed the effect of both types of exercise on associative memory performance and corresponding functional brain plasticity.
Both types of exercise were performed twice weekly for six months. Participants were measured with a series of cognitive tests and brain plasticity was assessed using functional MRI. The results showed resistance-training significantly improved executive cognitive functions, associative memory performance, and functional brain plasticity. In contrast to previous studies in healthy older adults, aerobic training did not demonstrate any significant effect for cognitive and brain plasticity.
"There is much debate as to whether cognitive function can be improved once there is noticeable impairment," says Liu-Ambrose, "What our results show is that resistance training can indeed improve both your cognitive performance and your brain function. What is key is that it will improve two processes that are highly sensitive to the effects of aging and neurodegeneration: executive function and associative memory -- often impaired in early stages of Alzheimer's disease."
This work builds on the same researcher team's Brain Power Study, published in the January 2010 issue of Archives of Internal Medicine and July 2011 issue of Neurobiology of Aging, which demonstrated that 12 months of once-weekly or twice-weekly progressive strength training improved executive cognitive function and functional brain plasticity in healthy women aged 65- to 75- years- old and provided lasting benefits.
Coinciding with the study, the team has developed and launched an informative video of the resistance training exercises used in the study.

"Exercise is attractive as an prevention strategy for dementia as it is universally accessible and cost-effective," says Liu-Ambrose, who is who is also an assistant professor, in the Department of Physical Therapy at UBC and a Michael Smith Foundation for Health Research and CIHR New Investigator scholar. "By developing this YouTube video we can help translate our findings directly to the senior population and fitness instructors who are working with them." Cognitive decline among seniors is a pressing health care issue for this province. The number of seniors in B.C. is expected to increase by 220 per cent by 2031, representing 23.5 per cent of B.C. population. Effective strategies to prevent cognitive decline are essential to improving quality of life for older British Columbians and to save the healthcare system millions in associated costs.
Provided by University of British Columbia

How Parkinson's disease starts and spreads

Injection of a small amount of clumped protein triggers a cascade of events leading to a Parkinson's-like disease in mice, according to an article published online this week in the Journal of Experimental Medicine.

Progressive accumulation of clumps of the protein alpha-synuclein in the brains of patients with Parkinson's disease coincides with the onset of motor dysfunction. However, whether these clumps are sufficient to trigger neurodegeneration, and how these clumps spread throughout the brain, remained unclear.
To answer these questions, a team led by Virginia M.Y. Lee at the University of Pennsylvania School of Medicine studied mice expressing a mutated form of alpha-synuclein found in patients with Parkinson's disease. These mice show symptoms of disease around one year of age but not earlier.
Lee and colleagues found that injecting preformed clumps of human alpha-synuclein into the brains of young mice accelerated disease onset and severity. These clumps seemed to act as "seeds" that recruited even the mouse version of alpha-synuclein into new clumps, which then spread throughout the brain. The pattern of spreading from neuron to neuron suggests that the clumps may hijack the highway traveled by normal brain signals.
These findings suggest that Parkinson's disease, like other neurodegenerative diseases including Alzheimer's, may start and progress due to abnormal aggregation and accumulation of proteins within the brain. What gets these clumps going in the first place remains unclear.
More information: Hung, L.W., et al. 2012. J. Exp. Med. doi:10.1084/jem.20112285
Provided by Rockefeller University

Diabetes groups issue new guidelines on blood sugar

Type 2 diabetes is a complex metabolic disorder, and treating the disease often requires a personalized, multi-pronged approach, say new expert guidelines on treating high blood sugar levels, issued Thursday.

23 april 2012--The recommendations are a joint effort by the American Diabetes Association and the European Association for the Study of Diabetes.
"We're making a lot of progress in managing type 2 diabetes," said Dr. Vivian Fonseca, president of medicine and science for the American Diabetes Association. "The new guidelines are more patient-centered. The message is to choose an appropriate [blood sugar] goal based on the patient's current health status, motivation level, resources and complications."
"It is very possible to manage type 2 diabetes well and keep blood sugar under good control," he noted. "It's important that patients have a discussion with their doctor about what their [blood sugar] goals should be, and what is the best treatment or treatments to get them to that goal."
The new guidelines are scheduled to be published in the June issue of Diabetes Care, but were released online ahead of publication on April 19.
Fonseca said the new guidelines were necessary because the management of type 2 diabetes is becoming increasingly complex; there is a widening array of medications available to treat the disease, and new research studies are constantly being released highlighting both the benefits and the risks of current treatments.
The biggest change in the new guidelines is an emphasis on a patient-centered approach to treatment. For example, the blood sugar goal for someone who's young, healthy and motivated to manage type 2 diabetes will be lower than it is for someone who's elderly and has additional health problems.
Blood sugar goals are usually expressed in terms of hemoglobin A1C levels (HbA1C). HbA1C, often just referred to as A1C, is a measure of long-term blood sugar control. It gives an estimate of what the average blood sugar level has been for the past two to three months. A1C is expressed as a percentage, and in general, the goal for people with type 2 diabetes is to lower their A1C levels below 7 percent. Someone without diabetes generally has levels below 5.6 percent, according to the American Diabetes Association.
In the past, the below-7-percent goal was applied to most people with type 2 diabetes. But, the new guidelines note that more stringent goals, such as keeping A1C between 6 and 6.5 percent, might be appropriate for someone who has a long life expectancy, no history of heart disease and who hasn't experienced significant low blood sugar levels (hypoglycemia). Low blood sugar levels can be a potentially dangerous side effect of many diabetes treatments.
The new guidelines suggest that blood sugar targets should be looser (A1C between 7.5 and 8 percent) for people who are older than 65 or 70, because they're more at risk of having complications from hypoglycemia, as well as being more at risk of side effects from taking multiple medications.
Lifestyle changes remain an important part of any type 2 diabetes management plan in the new guidelines. The recommendations are to lose 5 percent to 10 percent of body weight, and to participate in modest exercise for at least two-and-a-half hours each week.
The medication metformin is also recommended as a first-line treatment for people with type 2 diabetes. Metformin works by making the body more receptive to the hormone insulin. Metformin therapy should begin as soon as someone is diagnosed with type 2 diabetes, unless they have a near-normal A1C and are highly motivated to make lifestyle changes, according to the guidelines. In such a case, doctors may choose to follow up with the patient in three to six months to see if the lifestyle changes have been effective. If not, metformin should be started.
The guidelines also recommend adding another drug to metformin therapy if blood sugar levels aren't under control after three months on metformin alone. Again, this is an area where the patient needs to be considered and consulted. Each additional treatment option has its own risks and benefits. Talk to your doctor about which might be right for you.
"The new guidelines take a patient-centered view: Treat the patient and not the blood sugar. The type of medication should be tailored to the pathophysiology of the patient," explained Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City.
"I feel that we need to have combination therapy much earlier in the disease, but the issue is that we don't have research data on combination therapy, and we need studies to know what are the best combinations. But, I believe it's important to be aggressive early in the disease to prevent complications," Zonszein said.
And, he added, although the current guidelines only cover the treatment of high blood sugar, it's also important to remember to control cholesterol and high blood pressure in people with type 2 diabetes.

Daily physical activity may reduce Alzheimer's disease risk at any age

Daily physical activity may reduce the risk of Alzheimer's disease and cognitive decline, even in people over the age of 80, according to a new study by neurological researchers from Rush University Medical Center that will be published in the online issue of Neurology, the medical journal of the American Academy of Neurology on April 18.

22 april 2012--"The results of our study indicate that all physical activities including exercise as well as other activities such as cooking, washing the dishes, and cleaning are associated with a reduced risk of Alzheimer's disease," said Dr. Aron S. Buchman, lead author of the study and associate professor of neurological sciences at Rush. "These results provide support for efforts to encourage all types of physical activity even in very old adults who might not be able to participate in formal exercise, but can still benefit from a more active lifestyle."
"This is the first study to use an objective measurement of physical activity in addition to self-reporting," said Dr. Aron S. Buchman, lead author of the study and associate professor of neurological sciences at Rush. "This is important because people may not be able to remember the details correctly."
To measure total daily exercise and non-exercise physical activity, researchers from Rush asked 716 older individuals without dementia with an average age of 82 to wear a device called an actigraph, which monitors activity, on their non-dominant wrist continuously for 10 days.
All exercise and non-exercise physical activity was recorded. Study participants also were given annual cognitive tests during this ongoing study to measure memory and thinking abilities. Participants also self-reported their physical and social activities.
Study participants were individuals from the Rush Memory and Aging Project, an ongoing, longitudinal community study of common chronic conditions of old age.
Over a mean of 3.5 years of follow-up, 71 participants developed Alzheimer's disease.
The research found that people in the bottom 10 percent of daily physical activity were more than twice as likely (2.3 times) to develop Alzheimer's disease as people in the top 10 percent of daily activity.
The study also showed that those individuals in the bottom 10 percent of intensity of physical activity were almost three times (2.8 times) as likely to develop Alzheimer's disease as people in the top percent of the intensity of physical activity.
"Since the actigraph was attached to the wrist, activities like cooking, washing the dishes, playing cards and even moving a wheelchair with a person's arms were beneficial," said Buchman. "These are low-cost, easily accessible and side-effect free activities people can do at any age, including very old age, to possibly prevent Alzheimer's."
The number of Americans older than 65 years of age will double to 80 million by 2030.
"Our study shows that physical activity, which is an easily modifiable risk factor, is associated with cognitive decline and Alzheimer's disease. This has important public health consequences," said Buchman.
Provided by Rush University Medical Center

Largest-ever risk factor study in India identifies cardiovascular disease epidemic causes

21 april 2012-- The Indian Heart Watch (IHW) study has revealed the truth behind the prevalence, awareness, treatment and control of key risk factors that are driving the country's growing cardiovascular disease (CVD) epidemic, in a first-of-a-kind presentation of data at the World Congress of Cardiology today.


The study assessed the prevalence of different "lifestyle" and biological CVD risk factors across the country – and results show that these risk factors are now at higher levels in India than in developed countries and regions such as the USA and Western Europe.

Seventy-nine per cent of men and 83 per cent of women were found to be physically inactive, while 51 per cent of men and 48 per cent of women were found to have high fat diets. Some 60 per cent of men and 57 per cent of women were found to have a low intake of fruit and vegetables, while 12 per cent of men and 0.5 per cent of women smoke.

Moreover, the prevalence of biological and metabolic risk factors was also found to be high. Overweight and obesity was reported in 41 per cent of men and 45 per cent of women. High blood pressure was reported in 33 per cent of men and 30 per cent of women, while high cholesterol was found in one-quarter of all men and women. Diabetes (and or metabolic syndrome) was also reported in 34 per cent of men and 37 per cent of women.

"India has the dubious distinction of being known as the coronary and diabetes capital of the world," said Prof. Prakash Deedwania, University of California, San Francisco, USA. "These results show why - and must prompt the government to develop public health strategies that will change lifestyles, if these risk factors are to be controlled."

According to the IHW, urban social development is also playing a role in the development of CVD risk factors. Risk factors such as smoking, high fat intake and low fruit/vegetable intake were shown to be more common in less developed cities, while physical inactivity was seen to be more prevalent in highly-developed cities. Accordingly, metabolic risk factors such as obesity, high blood pressure and high cholesterol were seen to be more prevalent in more highly developed cities.

"These results show that improving urban planning and overall living conditions are critical to the curb the CVD epidemic in India," said Dr. Rajeev Gupta, Fortis Escorts Hospital, Jaipur, India. "But, this can not be the extent of government efforts which have to include improvements in basic amenities, healthcare facilities and, perhaps most importantly, education that will enable people to take responsibility for their own actions."

Indeed, the results of the IHW study showed that even among literate middle-class urban Indians there is a low awareness and control rates of these risk factors. Of the approximately one-third of study participants found to have hypertension, only about half (57 per cent) were aware of their high blood pressure, only 40 per cent were on treatment and only 25 per cent had adequate control. This is in contrast to more than 75 per cent awareness in most high and middle-income countries, where more than 50 per cent of people with high blood pressure are controlled.

The study took place over a five-year period (2006-2010) and involved 6,000 men and women from 11 cities across various regions of India was conducted under the chairmanship of Professors Prakash Deedwania (University of California San Francisco, Fresno, USA) and Rajeev Gupta (Fortis Escorts Hospital, Jaipur, India).

Provided by World Heart Federation

Scientists find new breast cancer genes, rewrite rulebook

Scientists at the BC Cancer Agency and University of British Columbia have identified new breast cancer genes that could change the way the disease is diagnosed and form the basis of next-generation treatments.

20 april 2012--Researchers have reclassified the disease into 10 completely new categories based on the genetic fingerprint of a tumour. Many of these genes could offer much-needed insight into breast cancer biology, allowing doctors to predict whether a tumour will respond to a particular treatment. Whether the tumour is likely to spread to other parts of the body or if it is likely to return following treatment.

The study, published online today in the international journal Nature, is the largest global study of breast cancer tissue ever performed and the culmination of decades of research into the disease.

In the future, this information could be used by doctors to better tailor treatment to the individual patient.

"This is a major step forward in building the genetic encyclopedia of breast cancer and in the process we've learned there are many more subtypes of breast cancer than we imagined. The new molecular map of breast cancer points us to new drug targets for treating breast cancer and also defines the groups of patients who would benefit most." said Dr. Sam Aparicio, study co-lead author. "The size of this study is unprecedented and provides insights into the disease such as the role of immune response, which will stimulate other avenues of research.

The team at the BC Cancer Agency, in collaboration with Cancer Research UK's Cambridge Research Institute and Manitoba Institute of Cell Biology at University of Manitoba, analyzed the DNA and RNA of 2,000 tumour samples taken from women diagnosed with breast cancer between five and 10 years ago. The sheer number of tumours mapped allowed researchers to spot new patterns in the data.

Study milestones include:

• Classified breast cancer into 10 subtypes grouped by common genetic features, which correlate with survival. This new classification could change the way drugs are tailored to treat women with breast cancer.
• Discovered several completely new genes that had never before been linked to breast cancer. These genes that drive the disease are all targets for new drugs that may be developed. This information will be available to scientists worldwide to boost drug discovery and development.
• Revealed the relationship between these genes and known cell signaling pathways – networks that control cell growth and division. This could pinpoint how these gene faults cause cancer, by disrupting important cell processes.

This is the second major breakthrough announced by BC Cancer Agency scientists in as many weeks. On April 4, a team led by Dr. Sam Aparicio celebrated the decoding of the genetic makeup of the most-deadly of breast cancers, triple-negative breast cancer, which until then was defined by what it was missing, not what it was. Similar to that announcement, today's new discovery identifies genes that were previously unknown to be linked to breast cancer and makes it clear that breast cancer is an umbrella term for what really is a number of unique diseases.

While the research is unlikely to benefit women who currently have breast cancer, it substantially advances how scientists approach further research and clinical trials by providing them with a springboard to develop new treatment options and drugs targeted to specific genes.

More information: "The integrative genomic and transcriptomic architecture of 2000 breast tumours." Curtis et al. Nature. DOI: 10.1038/nature10983

Provided by University of British Columbia

Positive feelings may help protect cardiovascular health

Over the last few decades numerous studies have shown negative states, such as depression, anger, anxiety, and hostility, to be detrimental to cardiovascular health. Less is known about how positive psychological characteristics are related to heart health. In the first and largest systematic review on this topic to date, Harvard School of Public Health (HSPH) researchers found that positive psychological well-being appears to reduce the risk of heart attacks, strokes and other cardiovascular events.

19 april 2012--The study was published online April 17, 2012 in Psychological Bulletin.

The American Heart Association reports more than 2,200 Americans die of cardiovascular disease (CVD) each day, an average of one death every 39 seconds. Stroke accounts for about one of every 18 U.S. deaths.

"The absence of the negative is not the same thing as the presence of the positive. We found that factors such as optimism, life satisfaction, and happiness are associated with reduced risk of CVD regardless of such factors as a person's age, socioeconomic status, smoking status, or body weight," said lead author Julia Boehm, research fellow in the Department of Society, Human Development, and Health at HSPH. "For example, the most optimistic individuals had an approximately 50% reduced risk of experiencing an initial cardiovascular event compared to their less optimistic peers," she said.

In a review of more than 200 studies published in two major scientific databases, Boehm and senior author Laura Kubzansky, associate professor of society, human development, and health at HSPH, found there are psychological assets, like optimism and positive emotion, that afford protection against cardiovascular disease. It also appears that these factors slow the progression of disease.

To further understand how psychological well-being and CVD might be related, Boehm and Kubzansky also investigated well-being's association with cardiovascular-related health behaviors and biological markers. They found that individuals with a sense of well-being engaged in healthier behaviors such as exercising, eating a balanced diet, and getting sufficient sleep. In addition, greater well-being was related to better biological function, such as lower blood pressure, healthier lipid (blood fat) profiles, and normal body weight.

If future research continues to indicate that higher levels of satisfaction, optimism, and happiness come before cardiovascular health, this has strong implications for the design of prevention and intervention strategies. "These findings suggest that an emphasis on bolstering psychological strengths rather than simply mitigating psychological deficits may improve cardiovascular health," Kuzbansky said.

More information: "The Heart's Content: The Association between Positive Psychological Well-Being and Cardiovascular Health," Julia K. Boehm and Laura D. Kubzansky, Psychological Bulletin, online April 17, 2012

Provided by Harvard School of Public Health

Nutrition, mobility predict early death in elderly cancer patients

Low nutritional assessment scores, poor mobility, and advanced disease predict early death after chemotherapy initiation among elderly patients with cancer, according to a study published online April 16 in the Journal of Clinical Oncology.

18 april 2012-- Low nutritional assessment scores, poor mobility, and advanced disease predict early death after chemotherapy initiation among elderly patients with cancer, according to a study published online April 16 in the Journal of Clinical Oncology.

To investigate factors that predict death within six months of chemotherapy initiation, Pierre Soubeyran, M.D., Ph.D., of the Bordeaux Segalen University in France, and colleagues studied 348 elderly cancer patients (median age, 77.45 years) who had not had previous cancer treatment. Participants were evaluated at baseline using the abbreviated comprehensive geriatric assessment (aCGA), including the Mini-Mental State Exam, Timed Get Up and Go (GUG), Activities of Daily Living (ADL), Instrumental Activities in Daily Living (IADL), Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS15), and comorbidities index (Cumulative Index Rating Scale-Geriatric).

The researchers found that 18.1 percent of participants had abnormal aCGA scores on the ADL, as did 73.0 percent on the IADL, 24.1 percent on the GUG, 19.0 percent on the MMS, 44.0 percent on the GDS15, and 64.9 percent on the MNA. Higher risk of early death was associated with advanced disease (odds ratio [OR], 3.9), a low MNA score (OR, 2.77), male gender (OR, 2.40), and long GUG (OR, 2.55).

"We recommend that the MNA and GUG, performed by a trained nurse, be maintained as part of routine pretreatment work-up in these patients to identify at-risk patients and to inform the decision-making process for chemotherapy," the authors write.

Several authors disclosed financial relationships with pharmaceutical companies, many of which funded the study.

More information: Abstract

New findings, imaging may aid diagnosis of concomitant AD in patients with Parkinson's disease dementia

Dementia is a frequent complication of Parkinson's disease (PD), but it is clinically impossible to distinguish PD dementia (PDD), which develops from the progression of the Lewy body pathology that underlies PD, from PD with coexistent Alzheimer's disease (PDAD). Both have similar characteristics. A team of scientists has found that PDAD patients have much denser accumulations of amyloid plaques in the striatal area of the brain than PDD patients. The results suggest that recently developed imaging techniques may be able to identify striatal amyloid plaques in the living brain and could be useful for distinguishing PDD from PDAD. Their results are published in the April issue of the Journal of Parkinson's Disease.

17 april 2012--"We sought to determine if the presence, density, or type of striatal plaques were predictive of the presence of a clinicopathological diagnosis of Alzheimer's disease in subjects with PD and dementia," say lead investigators Thomas G. Beach, MD, PhD, of Banner Sun Health Research Institute, and Charles H. Adler, MD, PhD, of the Mayo Clinic. Dr. Brittany Dugger, first author, notes the ability to determine the cause of dementia in patients with PD is a crucial objective if effective treatments are to be developed.

Researchers performed autopsies on the brains of elderly subjects who had volunteered to be part of the Arizona Parkinson's Disease Consortium and Banner Sun Health Research Institute Brain and Body Donation Program, a longitudinal clinicopathological study of normal aging, dementia, and parkinsonism. They evaluated the brains of patients with a diagnosis of PD without dementia (PDND), PDD without pathological AD, and PDAD. For comparative purposes, subjects from a previously published study of patients with AD without PD (AD), as well as non-demented normal control subjects without parkinsonism (NC), were also included. Amyloid plaque densities were graded at several sites in the brain and scored by the researchers as none, sparse, moderate, or frequent. Scores were derived by considering all types of plaques together – cored, neuritic, and diffuse – as well as separately for cored and neuritic plaques, without diffuse plaques.

Investigators found that the AD and PDAD cases had significantly higher cerebral cortex total and neuritic plaque density scores when compared to PDD, PDND, and NC. In patients with PD, the presence of any type of striatal plaques predicted the clinicopathological diagnosis of AD with 80% sensitivity and 80% specificity. In comparison, the presence of cerebral cortex plaques was 100% sensitive but only 48% specific when PDND, PDAD, and PDD were included; and only 55% specific when only the PDAD and PDD groups were included.

"The results suggest that, with the use of amyloid imaging, the presence of striatal plaques could help clinically distinguish PDD from PDAD," notes Dr. Beach. "Large antemortem-postmortem correlative studies are needed to determine whether a positive striatal amyloid imaging signal would be a sensitive and specific marker of concurrent PD and AD and their clinical severities."

More information: “Presence of Striatal Amyloid Plaques in Parkinson’s Disease Dementia Predicts Concomitant Alzheimer’s Disease: Usefulness for Amyloid Imaging,” by B.N. Dugger, G.E. Serrano, L.I. Sue, et al. Journal of Parkinson’s Disease, 2(2012) 57-65. DOI: 10.3233/JPD-2012-11073

Provided by IOS Press

U.S. panel rejects ovarian cancer screening

Renewing prior recommendations, experts say current tests may do more harm than good.

16 april 2012-- A leading U.S. government panel has renewed its 2004 recommendation that women at average risk for ovarian cancer not get screened for the disease.

The currently used blood test and transvaginal ultrasound may cause more harm than benefit for those patients, according to draft recommendations issued Tuesday by the U.S. Preventive Services Task Force.

"Currently, the task force does not recommend screening for ovarian cancer," said Dr. David Grossman, a member of the task force and senior investigator with Group Health Research Institute in Seattle. "The tests that we have, unfortunately, just aren't very accurate and, with a lot of false positives, a lot of women get harmed with unnecessary biopsies and surgeries."

Women with a family history of ovarian cancer should be referred for genetic testing and counseling, the recommendations also state.

Two methods are currently used to test for ovarian cancer, a blood test which looks for the tumor marker CA-125 and a transvaginal ultrasound, Grossman explained.

However, a large study published last year found no difference in mortality between women who were randomly assigned to receive a blood test plus the ultrasound compared to those who had "usual care."

What's more, some 10 percent of women who underwent screening received a false-positive result and one-third of these had an ovary removed unnecessarily.

Another study estimated that 33 surgeries were needed to diagnose one case of ovarian cancer using the blood test/ultrasound screening.

Preliminary data from yet another trial, ongoing in the United Kingdom, also turned up false-positive results in about 10 percent of women undergoing screening. Half of those women had surgery and about 4 percent of these experienced a major complication from the surgery.

Like many screening tests, the blood test plus ultrasound for ovarian cancer "doesn't work, is potentially dangerous and also costs a lot of money," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.. "You're giving people a false sense of security, and it creates a lot of false positives which ultimately results in a lot of unnecessary surgeries."

Yet, many doctors still perform the tests because women demand it, Brooks noted.

With no new data affirming the benefit of CA-125 screening plus ultrasound, the new draft recommendations essentially reaffirm 2004 recommendations.

They are also in line with recommendations from the American Cancer Society and the American Congress of Obstetricians and Gynecologists (ACOG), Grossman said.

This leaves women with no good test to screen for ovarian cancer, considered a "silent killer" because symptoms are often noticed too late to be treatable.

"At the present, we do not have a good screening test for ovarian cancer," Brooks said.

And there are no other techniques on the horizon, Grossman added.

The draft recommendations will be posted on the task force website, and physicians and members of the public and of professional societies are invited to comment.

Final recommendations may be out in as soon as two months, Grossman said.

Alzheimer's precursor protein controls its own fate, study finds

This is a microscopic image showing co-localization of a fragment of the amyloid precursor protein, known as sAPP-α, with BACE1, an enzyme involved in the development of characteristic Alzheimer's amyloid deposits. This merging suggests sAPP-α may serve as a mechanism to inhibit BACE1 activity and thus lower production of toxic amyloid beta associated with Alzheimer's disease.

A research team led by the University of South Florida Department of Psychiatry & Behavioral Neurosciences has found that a fragment of the amyloid precursor protein (APP) -- known as sAPP-α and associated with Alzheimer's disease -- appears to regulate its own production. The finding may lead to ways to prevent or treat Alzheimer's disease by controlling the regulation of APP.

14 april 2012--Their study is published online today in Nature Communications.

"The purpose of this study was to help better understand why, in most cases of Alzheimer's disease, the processing of APP becomes deregulated, which leads to the formation of protein deposits and neuron loss," said study senior author Dr. Jun Tan, professor of psychiatry and the Robert A. Silver Chair, Rashid Laboratory for Developmental Neurobiology at the USF Silver Child Development Center. "The many risk factors for Alzheimer's disease can change the way APP is processed, and these changes appear to promote plaque formation and neuron loss."

An estimated 30 million people worldwide and 5 million in the U.S. have Alzheimer's. With the aging of the "Baby Boom" generation, the prevalence of the debilitating disease is expected to increase dramatically in the U.S. in the coming years. Currently, there are no disease-modifying treatments to prevent, reverse or halt the progression of Alzheimer's disease, only medications that may improve symptoms for a short time.

"For the first time, we have direct evidence that a secreted portion of APP itself, so called 'sAPP-α,' acts as an essential stop-gap mechanism," said the study's lead author Dr. Demian Obregon, a resident specializing in research in the Department of Psychiatry & Behavioral Neurosciences at USF Health. "Risk factors associated with Alzheimer's disease lead to a decline in sAPP-α levels, which results in excessive activity of a key enzyme in Aβ formation,"

In initial studies using cells, and in follow-up studies using mice genetically engineered to mimic Alzheimer's disease, the investigators found that the neutralization of sAPP-α leads to enhanced Aβ formation. This activity depended on sAPP-α's ability to associate with the APP-converting enzyme, BACE1. When this interaction was blocked, Aβ formation was restored.

The authors suggest that through monitoring and correcting low saPP-α levels, or through enhancing its association with BACE, Alzheimer's disease may be prevented or treated.

Provided by University of South Florida

Drugs ease depression in Parkinson's patients without worsening other symptoms


Today's anti-depressant medications can ease depression in Parkinson's patients without worsening other symptoms of the disease, according to a study published online in Neurology, the medical journal of the American Academy of Neurology.

13 april2012--"Depression is the number-one factor negatively affecting the quality of life for people with Parkinson's disease," said Irene Hegeman Richard, M.D., who led the study. "It causes a great deal of suffering among patients. The great news here is that it's treatable. And when the depression is treated adequately, many of the other symptoms become much more manageable for patients," added Richard, a neurologist at the University of Rochester Medical Center.

The findings are good news for patients with Parkinson's disease, a chronic neurologic disorder best known for causing slow movement, stiffness, balance problems and other motor difficulties. However, about half of Parkinson's patients also struggle with depression.

"It's very important to note that these patients are not depressed simply because they are dealing with a chronic neurological condition," said Richard. "Rather, the depression is caused by the underlying disease process, which also causes problems with movement and balance."

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While older medications known as tricyclics help treat depression in such patients, those drugs have hefty side effects. That led physicians to try newer medications in Parkinson's patients. But recent smaller studies with these medications had mixed results, leaving some physicians to question whether these drugs were actually of any benefit. In addition, there was some concern that they might worsen patient's motor symptoms.

With funding from the National Institute of Neurological Disorders and Stroke, Richard launched the Study of Antidepressants in Parkinson's Disease or SAD-PD. The effort included 115 people with Parkinson's disease at 20 sites in the United States, Canada, and Puerto Rico. All the participants had Parkinson's disease and met the criteria for depression.

About one-third of the participants received paroxetine (brand name Paxil), a selective serotonin reuptake inhibitors (SSRIs); one-third received venlafaxine extended release (brand name Effexor), a serotonin and norepinephrine reuptake inhibitor (SNRI); and one-third received a placebo.

On average, the people receiving paroxetine had a 59 percent improvement and those receiving venlafaxine had a 52 percent improvement in their scores, according to the Hamilton Rating Scale for Depression. People who received the placebo had a 32 percent improvement. Three other depression rating scales showed similar results. The drugs were generally well tolerated and did not lead to any worsening in motor functioning.

Publication of the results marks the culmination of a decade-long effort by Richard to study the problem in depth in a quest to better treat not only her patients but similar patients around the globe. She compiled preliminary data to attract funding, then pulled together a team of dozens of clinicians and researchers spanning North America to do painstaking study and analysis of an issue that has often been unrecognized among both patients and physicians.

Today, people are becoming more knowledgeable that depression is oftentimes part of the disease, said Richard, who has witnessed striking improvement in many patients after effective treatment.

"After treatment for depression, patients and their families often see a dramatic difference in how they're feeling, within a few weeks or months. They have more interest in things. They have more energy; they're sleeping better. And oftentimes there is a great sense of relief, and a huge burden has been lifted," said Richard, associate professor of Neurology and Psychiatry.

She added that sometimes it can be difficult to spot depression in patients, because some symptoms overlap with other symptoms of Parkinson's. For instance, Parkinson's patients will be less animated, their voice will be less expressive, and many will have sleep difficulties – but they may not be depressed. Careful diagnosis is crucial.

Provided by University of Rochester Medical Center

Dementia cases to double by 2030: WHO

The number of people with dementia is expected to almost double to 65.7 million by 2030 as the world population ages, according to a World Health Organisation report published Wednesday.

12 april 2012--And by 2050 the number of sufferers could be more than three times the current figure of 35.6 million, the UN body said.

The report released by WHO and Alzheimer's Disease International estimates the current cost of treating and caring for those with the condition at $604 billion (461 billion euros) a year.

Dementia is caused by a variety of brain illnesses that affect memory, thinking, behaviour and the ability to perform everyday activities.

Alzheimer's disease is the most common cause of dementia and accounts for about 70 percent of cases.

More than half of sufferers (58%) live in low and middle income countries but this could rise to 70 percent by 2050.

The report said far more effective diagnosis was needed, as even in high income countries only 20 to 50 percent of dementia cases are routinely recognised.

"Since we know the prevelence of the disease will explode in this century as we all live longer -- the risk of dementia is 1 in 8 for those over 65 and a shocking 1 in 2.5 for those over 85 -- its impact will become greater as the decades go by," according to Shekhar Saxena, head of the mental health department at WHO.

"We need to increase our capacity to detect dementia early and to provide the necessary health and social care," said Oleg Chestnov, assistant director general of Noncommunicable Diseases and Mental Health at WHO.

"Much can be done to decrease the burden of dementia. Health-care workers are often not adequately trained to recognise dementia."

Only eight countries worldwide -- Australia, Britain, Denmark, France, Japan, South Korea, the Netherlands and Norway -- currently have national programmes in place to address dementia, according to the report "Dementia: a public health priority".

Germany and Sweden have set out lists of recommendations.

The study also highlights a general lack of information and understanding about the disease, fuelling stigma with the result that people sometimes delay seeking support.

"It is now vital to tackle the poor levels of public awareness and understanding, and to drastically reduce the stigma associated with dementia," said Marc Wortmann, executive director of Alzheimer's Disease International.

"We need to act, we need to stop this epidemic."

In its report, the WHO recommends that authorities seek to reduce the stigma that has long been associated with dementia, and improve general care for victims, along with support for caregivers.

It is currently not possible to treat dementia, but progress of the disease can in some cases be slowed down.

Brazil alarmed over rising obesity rate

In Brazil, a country known for girls in mini-bikinis and where body-consciousness borders on obsession, nearly half the population is overweight, a study by the Ministry of Health released Tuesday found.

11 april 2012--"There is a tendency toward increased weight and obesity in the country. It's time to reverse the trend to avoid becoming a country like the United States," said Health Minister Alexandre Padilha.

According to the study, the percentage of overweight people increased from 42.7% in 2006 to 48.5% in 2011 while the obesity rate increased from 11.4% to 15.8% in the same period.

The highest rates for overweight were found among men 35 years old to 45 years old (63%) and women 45 years old to 54 years old (55.9%).

The youngest group in the study were 18-to-24-year olds, where 30% of the men and 25% of the women were overweight.

"Adopting public policies for children and adolescents is essential to prevent people from becoming obese," the health minister said.

He said a third of Brazilians consume either high fat foods or sugared soft drinks at least five times a week.

The study showed nearly 40% of men and 22% of women exercise regularly.

The study was based on 54,000 interviews of adults across Brazil from January to December 2011.

The highest obesity rate was reported in Macapa at 21.4%, followed by Porto Alegre at 19.6%. Sao Paulo reported a 15.5% obesity rate while Rio de Janeiro came in at 16.5%.

Older subjects who regularly practice Tai Chi found to have better arterial compliance


Exercise which can achieve both cardiovascular function and muscle strength "would be a preferred mode of training for older persons", say investigators

09 april 2012--Experienced practitioners of Tai Chi, the traditional Chinese mind-body exercise now enjoyed worldwide, have been shown in a study of older subjects to have improved expansion and contraction of arteries according to cardiac pulsation (arterial compliance) and improved knee muscle strength.

The findings, say the investigators, of better muscle strength without jeopardising arterial compliance suggest that Tai Chi may well be a suitable exercise for older people to improve both cardiovascular function and body strength. A number of studies, they explain, have shown that strength training to improve muscle function and offset the effects of ageing have also been accompanied by a decline in arterial compliance. "Evidence that strength training could change arterial compliance in middle-aged and older subjects is still elusive," they note.

As background to their report, the investigators explain that arterial stiffness - when an artery fails to distend or rebound in response to pressure changes - is closely associated with cardiovascular diseases, possibly through elevated blood and pulse pressure and atherosclerosis. Arterial compliance, therefore, has been identified as an important predictor of cardiovascular health in the elderly and a therapeutic target for physical exercise in the prevention of cardiovascular disease.

The study, published online today in the European Journal of Preventive Cardiology, involved 65 elderly subjects from Hong Kong, 29 recruited from local Tai Chi clubs who had each practised Tai Chi for at least 1.5 hours a week for three years, and 36 controls with no Tai Chi experience. All subjects' physical activity levels were defined according to metabolic index units as light, moderate and heavy - but there were no differences between the two groups.

Initial results showed that the Tai Chi subjects were better in almost all haemodynamic observations - including blood pressure, vascular resistance, and pulse pressure. Measurements also showed that both large and small artery compliance was significantly higher in the Tai Chi group (by 40-44%). Additional analysis showed that the Tai Chi subjects had greater average muscle strength in both their knee extensors and flexors.

Tai Chi is well known for its aerobic affects. Significant improvement in cardiopulmonary function has been found in Tai Chi practitioners when compared with sedentary controls, and Tai Chi training has been shown to improve cardiopulmonary function in patients with chronic heart failure and myocardial infarction. The effect of Tai Chi training in lowering blood pressure has also been extensively reviewed.

"However," said principal investigator Dr William Tsang from the The Hong Kong Polytechnic University in Hong Kong, "this is the first study to investigate the possible effects of Tai Chi on arterial compliance by comparing older Tai Chi practitioners with non-practitioners similar in age and activity level. The improvement in arterial compliance could have resulted from a combination of aerobic training, stretching, mental concentration and calm meditation during Tai Chi movement."

The study findings showed that older Tai Chi practitioners have better arterial compliance and knee muscle strength than their healthy counterparts. And, because Tai Chi can be practised at any time, anywhere, and without the constraints of equipment or a gymnasium, Dr Tsang added that this traditional Chinese exercise could be a good exercise strategy for older adults, both for vascular health and for muscle strengthening.

More information: Lu X, Hui-Chan CWY, Tsang WWN. Tai Chi, arterial compliance, and muscle strength in older adults. Eur J Prevent Cardiol 2012; DOI: 10.1177/2047487312443483

Provided by European Society of Cardiology

Soy may alleviate hot flashes in menopause, large-scale study finds

In the most comprehensive study to date to examine the effects of soy on menopause, researchers have found that two daily servings of soy can reduce the frequency and severity of hot flashes by up to 26 percent, compared to a placebo.

7 april 2012--The findings, published in Menopause: The Journal of the North American Menopause Association, reviewed 19 previous studies that examined more than 1,200 women.

Although the effectiveness of soy in alleviating hot flashes has been inconclusive, with some studies suggesting soy to be beneficial and others suggesting otherwise, much of the discrepancy is due to small sample sizes and inconsistent methodology, according to the authors.

"When you combine them all, we've found the overall effect is still positive," said Melissa Melby, a medical anthropology professor at the University of Delaware and co-author of the study.

Examining the impact of soy isoflavones, chemicals found in soy that exert a mild estrogen-like effect, Melby and her colleagues found:

• Ingesting at least 54 milligrams of soy isoflavones daily for six weeks to a year reduces menopause hot flash frequency by 20.6 percent and severity by 26 percent, compared to a placebo.
• The total reduction in frequency and severity might be even greater due to the placebo effect.
• In longer duration studies (where women consumed soy isoflavones for 12 weeks or more), the decrease in hot flash frequency was approximately threefold greater than in shorter-duration trials.
• Isoflavone supplements with higher levels (at least 19 milligrams) of genistein, one of the two main types of isoflavones, were more than twice as effective at reducing hot flash frequency than lower amounts.

Melby called the genistein result particularly notable because the compound is the primary isoflavone in soybeans and soy foods, suggesting that, "Eating soy foods, or using supplements derived from whole soybeans, may work better for women."

Each gram of soy protein in soybeans and traditional soyfoods provides approximately 3.5 mg of isoflavones. Two glasses (16 oz) of soymilk or seven ounces of tofu provide approximately 50 mg of isoflavones.

The interest in soy and menopause stems from observational evidence in Japan, where researchers have found the low frequency of hot flashes in Japanese women might be attributed to the high soy consumption that often begins in utero and continues throughout their lifespan.

"Soy is probably more effective in these women," Melby said. "But if you're 50 and you've never touched soy, it's not too late. We've found that it still helps."

Provided by University of Delaware

62 percent of men and 37 percent of women over the age of 65 are sexually active: Spanish study

There are gender differences among those older than 65, with less sexual activity in women compared to men. Credit: Jose Javier

A study based on the National Health and Sexuality Survey, involving nearly 2000 people, describes the sexual practices of senior citizens in Spain. The most common are kisses, caresses and vaginal penetration. The main causes of sexual inactivity are physical illness and widowerhood.

06 april 2012--A new study published in one of the world's biggest sexuality journals the Journal of Sexual Medicine analyses the factors that influence sexual activity amongst elderly people in Spain.

"This research lets us know the reality of a social phenomenon which is not tackled enough in Spain: sexuality and the elderly", Domingo Palacios, a researcher at the Rey Juan Carlos University in Madrid and main author of this study, explained to SINC.

The results, based on the National Health and Sexuality Survey, in which 1,939 heterosexual elderly people participated in 2009, show that 62.3% of men and 37.4% of women are sexually active. The most common practices are kisses, caressing and vaginal penetration. On the other hand, the least practised are masturbation and oral sex.

Furthermore, there are other factors that limit sexual activity in both sexes: being older than 75, not having a partner, having a low level of education, a poor perception of their own health and sexuality, suffering from two or more chronic illnesses and taking two or more types of medication.

"This can be applied to preventing illnesses and promoting health and healthy sexual practices", Palacios states. He highlights widowerhood and physical illness amongst reasons why the older Spanish population do not have sexual intercourse.

The authors note gender differences among those older than 65, with less sexual activity in women compared to men. They also note age differences, with better results for those aged between 65 and 74 than those older than 75.

The results support previous studies

This is not the first time that sexual health amongst the elderly has been measured. In 2006, a study published during the XXVI Spanish Family and Community Medicine Society (SEMFYC) Conference showed that 60% of people over the age of 65 said they had sex on average four times a month.

In that project, which was carried out with over 100 people by family doctors in Catalonia, the majority said that although their sexual intercourse had changed as a result of age, they were not "less satisfying".

Furthermore, new data backs up a survey carried out in the USA and published in 'New England Journal of Medicine' in 2008, in which 73% of Americans between 57 and 64 years of age had sex. The number dropped to 53% for those aged between 65 and 75, and dropped to 26% for those aged 85.

More information: Domingo Palacios-Ceña; Pilar Carrasco-Garrido; Valentín Hernández-Barrera; Cristina Alonso-Blanco; César Fernández-de-las-Peñas; Rodrigo Jiménez-García. "Sexual Behaviors among Older Adults in Spain: Results from a Population-Based National Sexual Health Survey". J Sex Med; 9:121-129, Jan 2012.

Provided by FECYT - Spanish Foundation for Science and Technology

Studies: Memory declines faster in years closest to death

Two new studies published in the April 4 online issue of Neurology, the medical journal of the American Academy of Neurology, suggest that a person's memory declines at a faster rate in the last two-and-a-half years of life than at any other time after memory problems first begin. The second study shows that keeping mentally fit through board games or reading may be the best way to preserve memory during late life. Both studies were conducted by researchers at Rush University Medical Center.

05 april 2012--"In our first study, we used the end of life as a reference point for research on memory decline rather than birth or the start of the study," said study author Robert S. Wilson, PhD, study author and neuropsychologist at Rush University Medical Center in Chicago.

For the study, 174 Catholic priests, nuns and monks without memory problems had their memory tested yearly for six to 15 years before death. After death, scientists examined their brains for hallmarks of Alzheimer's disease called plaques and tangles.

The study found that at an average of about two-and-a-half years before death, different memory and thinking abilities tended to decline together at rates that were 8 to 17 times faster than before this terminal period. Higher levels of plaques and tangles were linked to an earlier onset of this terminal period but not to rate of memory decline during it.

The second study, also conducted by Wilson, showed that keeping mentally fit through board games or reading may be the best way to preserve memory during late life.

The study, which focused on mental activities, involved 1,076 people with an average age of 80 who were free of dementia. Participants underwent yearly memory exams for about five years. They reported how often they read the newspaper, wrote letters, visited a library and played board games such as chess or checkers. Frequency of these mental activities was rated on a scale of one to five, one meaning once a year or less and five representing every day or almost every day.

"The results suggest a cause and effect relationship: that being mentally active leads to better cognitive health in old age," said Wilson.

The results showed that people's participation in mentally stimulating activities and their mental functioning declined at similar rates over the years. The researchers also found that they could predict participants' level of cognitive functioning by looking at their level of mental activity the year before but that level of cognitive functioning did not predict later mental activity.

Provided by Rush University Medical Center

Changing old attitudes to aging and making aging well a global priority

This year's WHO World Health Day will be on healthy ageing, with the official launch on April 4 ahead of the actual World Health Day on April 7. Correspondence published Online First by The Lancet shows that not only must old attitudes to ageing be transformed, but attention must be shifted to dealing with non-communicable diseases in the elderly, which represent by far the largest burden of disease in this age group. The letter is by Dr Peter Lloyd-Sherlock, School of International Development, University of East Anglia (UEA), Norwich, UK, and colleagues.

04 april 2012--The authors say: "Depictions of older people remain stereotyped and generalised, distorting public opinion and skewing policy debates. For example, the use of economic dependency ratios, one of the commonest measures of ageing, assumes that anyone aged 65 years or older is unproductive. Similarly, the use of disability-adjusted life years to capture the health of a population explicitly views older people as a social and economic burden. Yet many older people continue to make substantial social, economic, and cultural contributions, which can be enhanced by measures that improve their health and functional status." Furthermore, they point out that health spending and health-service use are more closely associated with how close one is to death than with chronological age. They add: "Indeed, it is often the case that less is spent on older people than on younger people with similar conditions."

Noting the variations in functional status of older people both between and within countries, the authors say substantial improvements in status can be achieved with relatively cheap and simple interventions such as the effective management of hypertension, diabetes, and high cholesterol, and the promotion of healthy lifestyles, in particular regular physical activity. The authors say: "Yet in most countries these interventions are not available to large sections of adult populations. The failure of national governments and international agencies to prioritise these cheap and effective treatments represents a missed opportunity to reduce mortality, illness, and disability on an unprecedented scale. Although the non-communicable disease (NCD) agenda has gathered some momentum in recent years, international health spending in low-income and middle-income countries remains heavily focused on infectious diseases and mother and child health."

They conclude: "If we do not challenge existing policy paradigms and the social attitudes that underpin them, population ageing might indeed lead to a crisis in the provision of health and welfare services. Instead, we should see it as a welcome opportunity to challenge outdated public perceptions, political priorities, and policy models."

A linked Lancet Editorial says that 5 years from now, for the first time in history, the number of people aged 65 years and older will outnumber children younger than 5 years.

The Editorial concludes: "This World Health Day, WHO is championing a life-course approach to healthy and active ageing, which includes: promoting good health for all ages to prevent the development of chronic disease; early detection of chronic diseases to minimise their impact; creating physical and social environments that foster the health and participation of older people; and changing social attitudes to ageing. Later this year, The Lancet will publish a Series on ageing. We hope that this Series, together with WHO's renewed commitments, will help create a new movement for healthy ageing for all."

More information: http://www.thelanc … 0140-6736(12)60519-4/abstract

Provided by Lancet

Gene mapping for everyone? Study says not so fast

Gene scans for everyone? Not so fast. New research suggests that for the average person, decoding your own DNA may not turn out to be a really useful crystal ball for future health.

3 april 2012--Today, scientists map entire genomes mostly for research, as they study which genetic mutations play a role in different diseases. Or they use it to try to diagnose mystery illnesses that plague families. It's different from getting a genetic test to see if you carry, say, a particular cancer-causing gene.

But as genome mapping gets faster and cheaper, scientists and consumers have wondered about possible broader use: Would finding all the glitches hidden in your DNA predict which diseases you'll face decades later?

Johns Hopkins University developed a model using registries of thousands of identical twins, who despite their shared genes can develop different diseases. They examined 24 ailments, including different types of cancer, heart disease, diabetes and Alzheimer's.

Under best-case scenarios, most people would be told they had a somewhat increased risk of at least one disease, said Dr. Bert Vogelstein, a Hopkins cancer geneticist and the study's senior author.

But a negative test for most of the rest of the diseases doesn't mean you won't get them. It just means that you're at no more risk than the general population. Those are the findings Vogelstein's team reported Monday in the journal Science Translational Medicine. Why? Cancer, for example, typically doesn't result from inherited genes but from mutations that can form anytime, Vogelstein explained. Many other common diseases are influenced by lifestyle and environment - so you'd still have to eat well, exercise and take the other usual precautions.

The study examined just one possible future use of genome mapping. It doesn't mean there aren't other benefits from the effort.

Make no mistake: This technology does have huge promise for customizing care for certain people, especially children with otherwise undiagnosed illnesses, said Dr. James Lupski of Baylor College of Medicine, who wasn't involved in Monday's study.

Last year, Baylor researchers reported one of the first examples of genome mapping directly benefiting a patient. It found a mutation that pointed to the right treatment for a 14-year-old girl's baffling trouble breathing.

But even if finding a genetic explanation doesn't lead to treatment, knowing whether it was inherited can help parents decide whether to chance having another baby, Lupski added.

"There are families where this can be transformative," said Lupski. He had his own genome mapped to identify the cause of a rare nerve disorder.

Treating cancer as a chronic disease

New research from the Technion-Israel Institute of Technology Rappaport Faculty of Medicine and Research Institute and the Rambam Medical Center may lead to the development of new methods for controlling the growth of cancer, and perhaps lead to treatments that will transform cancer from a lethal disease to a chronic, manageable one, similar to AIDS.

02 april 2012--By placing cancer cells in and near a growth developed from a population of human stem cells, scientists have demonstrated that the cancer cells grow and proliferate more robustly when exposed to human cells than they do in a typical petri dish or mouse model. The cancer cell population is also more diverse than had previously been understood. The research was published in the current advanced online issue of the journal Stem Cells. Maty Tzukerman, Rambam senior research scientist and the project leader and senior co-author on the report, says that this model will facilitate targeted drug discovery aimed at blocking the cancer cell self-renewal process.

Previous studies have determined that some tumor cells appear to be differentiated, while others retain the self-renewal property that makes cancer so deadly. According to Technion Professor Karl Skorecki, director of Medical Research and Development at Rambam Health Care Campus and senior co-author on the report, this new research attempts to understand how cancer grows, and to find ways to halt the runaway replication.

In order to mimic the human cancer environment as closely as possible, the research team developed a teratoma - a tumor made of a heterogenous mix of cells and tissues - by enabling the differentiation of human embryonic stem cells into a variety of normally occuring human cell lines on a carrier mouse. The human cellular teratoma constitutes a new platform of healthy human cells for monitoring the behavior and proliferation of human cancer cells.

For this study, the team took cells from one woman's ovarian clear cell carcinoma and injected them either into or alongside the human stem cell-derived environment. "We noticed very early on, rather strikingly, that the human cancer cells grow more robustly when they are in the teratoma environment compared to any other means in which we grew them, such as in a mouse muscle or under the skin of a mouse," says Skorecki.

The scientists were able to tease out six different kinds of self-renewing cells, based on behavior - how quickly they grow, how aggressive they are, how they differentiate - and on their molecular profile. This was a previously unknown finding, that one tumor might have such a diversity of cells with crucial fundamental growth properties. Tzukerman explains that the growth of the cancer cell subpopulations can now be explained by their proximity to the human cell environment.

The researchers cloned and expanded the six distinct cell populations and injected them into the human stem cell teratomas. One key observation is that some cells, which were not self-replicating in any other model, became self-replicating when exposed to the human cells.

Skorecki said that while he wasn't surprised that the human environment affected the growth, he was in fact surprised by the magnitude of the effect: "We've known for years now that cancers are complex organs, but I didn't think the power of the human stem cell environment would be so robust, that it would make such a big difference in how the cells were grown."

The researchers point out that they do not yet know the cues that particularly enhance the cancer's proliferation, and the team is now working on isolating the factors from human cells that promote such plasticity and self-renewing properties. The scientists explain that this may eventually allow physicians to manage cancer as a chronic disease: instead of one therapy against the entire tumor, researchers may develop a method to tease out the variety of self-renewing cell lines of a particular tumor and determine what allows each to thrive, then attack that mechanism.

Skorecki and Tzukerman say that an important next step in this line of cancer research will be to identify and develop ways of blocking the factor or factors that promote this essential self-renewing property of cancer, thus relegating many forms of cancer to controllable, chronic diseases.

This research was supported with grants from the Daniel M. Soref Charitable Trust, the Skirball Foundation, the Richard D. Satell Foundation, the Sohnis and For man families, and the Israel Science Foundation.

Provided by American Technion Society

MRI and neuropsychological tests best predict Alzheimer's disease in old patients

Investigators from the University of Amsterdam, Netherlands, have shown that in most elderly patients invasive and expensive techniques, i.e. lumbar puncture and PET scan, are not useful to establish the diagnosis of Alzheimer's disease. They arrived at this conclusion after analysis of data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), a large collaborative research project of medical centers in the USA and Canada.

01 april 2012--The Dutch researchers divided the ADNI sample into two halves, a younger (<75 y) and an older half (>74 y). They showed that the CSF biomarkers (amyloid and tau), and FDG- PET, are informative in the younger but not in the older patients.

In the older patients MRI scans and neuropsychological tests appeared to convey useful information, but CSF biomarkers and FDG-PET did not. The latter two techniques are informative only in younger patients. MRI scans and cognitive tests are not only helpful in distinguishing patients who are already demented from those who are not, but also in predicting who among older MCI patients will progress to dementia within a few years. Predictions based on CSF biomarkers may turn out to be right on the longer term, say five or ten years, in patients who live that long and become demented.

"But this long-term prediction is not what doctors, patients and families really need", says Willem A. van Gool, professor of neurology at the University of Amsterdam. "They want to know the causes of the symptoms, which made them seek help at a memory clinic, and they want to know what the prognosis is in a shorter time frame."

From a theoretical point of view these results underscore that dementia in the older elderly is not exactly the same as Alzheimer's disease in younger patients. It is probably a mix of disease mechanisms. At older ages vascular brain damage and degenerative processes other than amyloid accumulation, such as sclerosis of the hippocampus, are probably important contributors to the dementia syndrome. "At any rate", according to Van Gool, "research findings stemming from relatively young patient samples cannot readily be extrapolated to the vast majority of older dementia patients. In older persons with dementia the causes are more complex than mere amyloid-beta accumulation, and researchers have to address this complexity."

Ben Schmand, professor of clinical neuropsychology at the University of Amsterdam, stresses a practical implication for clinicians. "In MCI patients", he says, "particularly in older patients, it is not sufficient to base a diagnosis solely on a brief memory test, a MRI scan, and a lumbar puncture. Generally, a more thorough clinical evaluation will be necessary Cerebrospinal fluid biomarkers and PET scanning remain informative in relatively young patients."

Provided by IOS Press