Aspirin may slow the decline in mental capacity among elderly patients

A daily dose of acetylsalicylic acid equivalent to a fourth of an aspirin may slow the decline in intellectual capacity among elderly individuals with high cardiovascular risk. This is shown in a study by Sahlgrenska Academy, University of Gothenburg, Sweden.

31 oct 2012--Researchers at Sahlgrenska Academy, University of Gothenburg, over a five year period studied how intellectual capacity changes among 681 elderly women (70 to 92 years) with heightened risk of suffering from a heart attack, vascular spasm or stroke.

Of the 681 women, 129 received a low daily dose of acetylsalicylic acid, equivalent to a fourth of an aspirin, to prevent heart disease. The Gothenburg study shows that acetylsalicylic acid also slowed decline in brain capacity among the elderly women.

In the study, published in British Medical Journal Open, the women underwent various tests to measure their physical health and intellectual capacity, such as language and memory tests.

"At the end of the five year examination period mental capacity had declined among all the women and the portion that suffered from dementia was equally large in the entire group. However, the decline in brain capacity was significantly less and occurred at a slower pace among the women who received acetylsalicylic acid," says Silke Kern, researcher at Sahlgrenska Academy.

The effect remained even when age, genetic factors and use of anti-inflammatory drugs were taken into account.

In addition to preventing heart disease, acetylsalicylic acid has been shown to be effective against cancer according to several scientific studies. It is common practice in many countries to treat women at risk for heart disease with a small dose of acetylsalicylic acid – but not in Sweden.

Silke Kern emphasizes that the study is an observational study and that more research is necessary before any definitive conclusions can be made.

"Our results indicate that acetylsalicylic acid may protect the brain, at least among women at high risk for a heart attack or stroke. However, we do not know the long term effects of routine treatment. We certainly do not want to encourage the elderly to self-medicate with aspirin to avoid dementia," she states.

The research group in Gothenburg has now started a follow-up study that will follow the older women for an additional five years.

More information: The study Does low-dose acetylsalicylic acid prevent cognitive decline in women with high cardiovascular risk? A 5-year follow-up of a non-demented population-based cohort of Swedish elderly women was published in BJM Open on October 3, 2012.bmjopen.bmj.com/co… e001288.long

Provided by University of Gothenburg

Women smokers who quit before 40 gain nine years in lifespan

Women can add nine years to their lives by quitting smoking before the age of 40 but still face a 20-percent higher death rate than those who never smoked, a study said Saturday.

30 oct 2012--Published in The Lancet, a survey of nearly 1.2 million women in Britain showed that smoking throughout adulthood chopped on average 11 years off lifespan.

These results echoed the findings of earlier research conducted on men.

Among women who kicked the habit before the age of 40, the researchers measured an average lifespan gain of more than nine years compared with those who never stopped.

For those who quit before 30 the gains were even bigger—about 10 years.

"Whether they are men or women, smokers who stop before reaching middle age will on average gain about an extra 10 years of life," study co-author Richard Peto of the University of Oxford said.

But the paper warned this did not mean that it was safe to continue smoking until 40 before quitting.

"Women who do so have throughout the next few decades [of their lives] a mortality rate 1.2 times that of never-smokers. This is a substantial excess risk, causing one in six of the deaths among these ex-smokers."

In Europe and the United States, the popularity of smoking reached its peak among women in the 1960s, decades later than for men.

The Lancet study is one of the most extensive probes into the impacts of smoking on this generation of women, the first likely to have smoked substantially throughout their adult lives.

The research is part of a vast survey that enrolled 1.2 million women in the UK between 1996 and 2001. The volunteers were asked to detail their smoking history, and were followed for an average of 12 years.

The women were on average 55 years old when they signed up. Twenty percent of them were smokers, 28 percent ex-smokers, while 52 percent had never smoked.

The researchers found that the group of women who continued smoking had three times the overall mortality rate of never-smokers.

While the risks increased with the amount smoked, "Even those smoking fewer than 10 cigarettes per day... had double the overall mortality rate than never-smokers," warned the study.

It also cautioned against so-called "light" cigarettes, smoked by most of the women in the study.

"Low-tar cigarettes are not low-risk cigarettes and... more than half of those who smoke them will eventually be killed by them," the authors warned.

The key causes of death among smokers were chronic lung disease, lung cancer, stroke and heart disease.

First ever objective analysis of elderly falls could lead to improvements in fall prevention

Researchers have completed the first ever objective, real-life analysis of the causes and circumstances of falls in elderly people, which could lead to improvements in the understanding and prevention and of falls in this group.

29 oct 2012--The Article, published Online First in The Lancet, reveals that previous studies – generally based on interviews, incident reports, or artificial laboratory simulations – might have missed some of the most important features of falls in elderly people.

Scientists analysed videos of 227 falls from 130 individuals, taken from CCTV systems in public areas of two facilities providing long-term care for the elderly, in British Columbia, Canada. They assessed the cause of the fall and what the person was doing when they fell, finding that the most frequent cause of falling (41%) was incorrect weight shifting, where the person shifted their bodyweight causing their centre of gravity to move outside their base of support.

Trips or stumbles (21%), hits or bumps (11%), loss of support (11%), and collapse (11%) were also common causes of falls in the study. 25% of recorded trips were due to the foot being caught on a table or chair, suggesting that awareness of this type of hazard needs to be improved among care home staff. Slipping accounted for just 3% of falls, yet as the researchers point out, falls caused by slipping have been the focus of most laboratory-based studies of the dynamics of falling.

Falls are the most frequent cause of unintentional injuries in elderly people (at least 65 years old), accounting for 90% of hip and wrist fractures and 60% of head injuries. Around 30% of elderly people who live independently and 50% of those who live in long-term care fall at least once each year.

According to Professor Stephen Robinovitch, at Simon Fraser University in Burnaby, Canada, "Prevention of falls in elderly people needs to be a public health priority. However, up to now, the general scarcity of reliable information on falls in elderly people has hindered the development of safer environments for older people and fall prevention programmes. Our study provides long-missing objective evidence of the causes and circumstances of falls in elderly people, and should open up new avenues for the prevention of fall injury in long-term care."

Writing in a linked Comment, Dr Clemens Becker, at Robert Bosch Hospital in Stuttgart, Germany, highlights the problems caused by the lack of objective research in this area, writing that: "Many assumptions and decisions about falls are still based on subjective and often biased information. This absence of understanding is one of the reasons why efforts to prevent falls have had little success, although some progress has been achieved."

However, Dr Becker adds that limitations of the study – particularly the fact that only falls in public areas were studied, which are thought to only account for half of all falls that take place in long-term care homes – should spur on further objective research in this area, using innovative technology: "To study falls in the community, we will need a technological shift. Evidence provided by Robinovitch and colleagues of the movement patterns that lead to falls is helpful in guiding the design of sensor-based fall monitoring systems. The next step will require coordinated action and possibly an open-access database that would allow real-world fall data, obtained through different sensors, to be shared."

Professor Robinovitch also hopes that the results of this study will aid any future technological developments in the field, adding that, "Our results also inform the design of wearable sensor systems for provision of information about movement quality during daily activities, and for automatic detection of falls in elderly people—a rapidly developing discipline. In particular, our results identify the most common sequence of events, including activities leading to falls, and subsequent causes of imbalance, that should be considered in designing and testing of fall detection algorithms appropriate for the long-term care population."

More information: www.thelancet.com/… 3-X/abstract

Provided by Lancet

Resveratrol falls short in health benefits

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Studying healthy, middle-aged women, researchers found that supplementation with resveratrol, an ingredient in red wine, does not offer the medical benefits previously thought.

Resveratrol, an ingredient in red wine thought to improve insulin sensitivity, reduce risk of heart disease and increase longevity, does not appear to offer these benefits in healthy women, new research at Washington University School of Medicine in St. Louis indicates.

28 oct 2012--The study, reported online Oct. 25 in Cell Metabolism, involved 29 post-menopausal women who did not have type 2 diabetes and who were reasonably healthy. For 12 weeks, half took an over-the-counter resveratrol supplement, and the rest got a placebo, or sugar pill.

"Resveratrol supplements have become popular because studies in cell systems and rodents show that resveratrol can improve metabolic function and prevent or reverse certain health problems like diabetes, heart disease and even cancer," says senior investigator Samuel Klein, MD, director of Washington University's Center for Human Nutrition. "But our data demonstrate that resveratrol supplementation does not have metabolic benefits in relatively healthy, middle-aged women."

The results were somewhat surprising because earlier studies suggested that drinking red wine lowers the risk of health problems.

"Few studies have evaluated the effects of resveratrol in people," Klein explains. "Those studies were conducted in people with diabetes, older adults with impaired glucose tolerance or obese people who had more metabolic problems than the women we studied. So it is possible that resveratrol could have beneficial effects in people who are more metabolically abnormal than the subjects who participated in the study."

Klein, the Danforth Professor of Medicine and Nutritional Science, directs the Division of Geriatrics and Nutritional Science and the Center for Applied Research Sciences. He says many people who have heard about red wine's health benefits want to take resveratrol supplements to get the benefits of red wine without consuming large amounts of alcohol. In recent years, annual U.S. sales of resveratrol supplements have risen to $30 million.

As part of the study, Klein and his colleagues gave 15 post-menopausal women 75 milligrams of resveratrol daily, the same amount they'd get from drinking 8 liters of red wine, and compared their insulin sensitivity to 14 others who took a placebo.

The team measured the women's sensitivity to insulin and the rate of glucose uptake in their muscles, infusing insulin into their bodies and measuring their metabolic response to different doses.

"It's the most sensitive approach we have for evaluating insulin action in people," he says. "And we were unable to detect any effect of resveratrol. In addition, we took small samples of muscle and fat tissue from these women to look for possible effects of resveratrol in the body's cells, and again, we could not find any changes in the signaling pathways involved in metabolism."

But if resveratrol doesn't have a health benefit, then why are red wine drinkers less likely to develop heart disease and diabetes? Klein says there may be something else in red wine that provides the benefit.

"The purpose of our study was not to identify the active ingredient in red wine that improves health but to determine whether supplementation with resveratrol has independent, metabolic effects in relatively healthy people," he says. "We were unable to detect a metabolic benefit of resveratrol supplementation in our study population, but this does not preclude the possibility that resveratrol could have a synergistic effect when combined with other compounds in red wine."

Provided by Washington University School of Medicine

Smoking takes 10 years off life expectancy in Japan, not 4 as previously thought, experts warn

Smoking reduces life expectancy by ten years in Japan, but much of the risk can be avoided by giving up smoking, a paper published on bmj.com today shows.

27 oct 2012--Previous studies in Japan suggested smoking reduced life expectancy by only a few years compared with about ten years in Britain and the USA. This new report, from researchers in Oxford and Japan, investigates the impact of smoking on mortality in a large group of Japanese people who were living in Hiroshima or Nagasaki in 1950. The findings are, however, nothing to do with radiation exposure from the bombs.

The Life Span Study (LSS) was initiated in 1950 to investigate the effects of radiation, tracking over 100,000 people. However, most received minimal radiation exposure, and can therefore provide useful information about other risk factors. Surveys carried out later obtained smoking information for 68,000 men and women, who have now been followed for an average of 23 years to relate smoking habits to survival.

The younger a person was when they started smoking the higher the risk in later life. Older generations did not usually start to smoke until well into adult life, and usually smoked only a few cigarettes per day. In contrast, Japanese born more recently (1920-45) usually started to smoke in early adult life, much as smokers in Britain and the USA.

These differences in smoking habits are reflected in the mortality patterns. Smokers born before 1920 lost just a few years. In contrast, men born later (1920-45) who started to smoke before age 20 lost nearly a decade of life expectancy, and had more than double the death rate of lifelong non-smokers, suggesting that more than half of these smokers will eventually die from their habit. Results on the few women who had smoked since before age 20 were similar.

Previous studies of the effects of smoking in Japan had been mainly of individuals born in the first few decades of the twentieth century who probably didn't start to smoke until well into adult life and smoked only a few cigarettes per day. This explains why the risks of smoking seemed low. Nowadays, however, young Japanese smokers tend to smoke more cigarettes per day and to start at a younger age, so their risks will be higher.

In addition to studying the risk of smoking, the researchers were able to examine the benefits of stopping. As elsewhere, those who stopped smoking before age 35 avoided almost all the excess risk among continuing smokers, and even those who stopped around age 40 avoided most of it.

The researchers conclude that the future health risks to young smokers are likely to be just as big in Japan as in other countries although much of the risk can be avoided by stopping.

Provided by British Medical Journal

Cochrane Review finds no benefit from routine health checks

Carrying out general health checks does not reduce deaths overall or from serious diseases like cancer and heart disease, according to Cochrane researchers. The researchers, who carried out a systematic review on the subject for The Cochrane Library, warn against offering general health checks as part of a public health program.

25 oct 2012--In some countries, general health checks are offered as part of standard practice. General health checks are intended to reduce deaths and ill health by enabling early detection and treatment of disease. However, there are potential negative implications, for example diagnosis and treatment of conditions that might never have led to any symptoms of disease or shortened life.

The researchers based their findings on 14 trials involving 182,880 people. All trials divided participants into at least two groups: one where participants were invited to general health checks and another where they were not. The number of new diagnoses was generally poorly studied, but in one trial, health checks led to more diagnoses of all kinds. In another trial, people in the group invited to general health checks were more likely to be diagnosed with high blood pressure or high cholesterol, as might be expected. In three trials, large numbers of abnormalities were identified in the screened groups.

However, based on nine trials with a total of 11,940 deaths, the researchers found no difference between the number of deaths in the two groups in the long term, either overall or specifically due to cancer or heart disease. Other outcomes were poorly studied, but suggested that offering general health checks has no impact on hospital admissions, disability, worry, specialist referrals, additional visits to doctors or time off work.

"From the evidence we've seen, inviting patients to general health checks is unlikely to be beneficial," said lead researcher Lasse Krogsbøll of The Nordic Cochrane Centre in Copenhagen, Denmark. "One reason for this might be that doctors identify additional problems and take action when they see patients for other reasons."

"What we're not saying is that doctors should stop carrying out tests or offering treatment when they suspect there may be a problem. But we do think that public healthcare initiatives that are systematically offering general health checks should be resisted."

According to the review, new studies should be focused on the individual components of health checks and better targeting of conditions such as kidney disease and diabetes. They should be designed to further explore the harmful effects of general health checks, which are often ignored, producing misleading conclusions about the balance of benefits and harm. Another problem is that those people who attend health checks when invited may be different to those who do not. People who are at a high risk of serious illness may be less likely to attend.

More information: Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing mor- bidity and mortality from disease. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD009009. DOI: 10.1002/14651858.CD009009.pub2

Provided by Wiley

Panel rules against HRT for preventing chronic disease

23 oct 2012—Postmenopausal women should not use hormone replacement therapy to prevent chronic medical conditions such as heart disease, according to updated recommendations from the U.S. Preventive Services Task Force.

For the update, published online Oct. 23 in the Annals of Internal Medicine, the independent panel of experts reviewed more than 50 articles published since 2002 about estrogen-progestin therapy and estrogen alone for prevention of heart disease, dementia, osteoporosis and other chronic conditions. It recommends against their use for all because of the increased risk of other conditions including stroke.

However, the statement does not address use of hormone replacement therapy, or HRT, for short-term relief of menopausal symptoms such as hot flashes and vaginal dryness.

"The task force does not address treatment, so we do not make recommendations about menopausal symptoms," said Dr. Virginia Moyer, chair of the task force.

The report essentially echoes the task force's 2005 guidelines, while taking into account the more recent research. "It was updated as part of our routine to make sure the data were current," Moyer said.

The debate about the risks and harms of hormone therapy is ongoing. Years ago, hormone therapy was often prescribed to prevent chronic conditions such as osteoporosis and cardiovascular disease. But initial results of the Women's Health Initiative study, published in 2002, found harmful effects for estrogen-plus-progestin therapy. These included increased risk of heart disease and multiple other problems.

Two years later, serious concerns about estrogen-only therapy—often used after a hysterectomy— were also raised.

Here are highlights of the current report:

• Although hormone therapy is of moderate benefit in reducing the risk of osteoporosis-related fractures, that benefit is outweighed by the harms, including an increased risk for stroke, gallbladder disease and urinary incontinence.
• Convincing evidence connects hormone therapy with a small increased risk of breast cancer, and blood clots in the limbs and lungs.
• Estrogen and progestin combined increased risk for probable dementia.
• Hormone therapy appears to have no protective effect against heart disease and likely increases the risk, the task force said.

The updated recommendations are in line with those of many major health organizations, including the American Heart Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Family Physicians.

One expert said the updated recommendations reflect current practice and won't change how he counsels patients.

"We currently aren't using it for chronic disease," said Dr. Michael Nimaroff, vice chair of obstetrics and gynecology at North Shore University Hospital of the LIJ Health System in Great Neck, N.Y., who was not involved with the report.

For certain chronic conditions, he said, hormone therapy may do more harm than good.

For women seeking short-term hormone therapy to relieve symptoms, he said, "we try the lowest dose possible to treat the symptom."

Nimaroff said he and many doctors believe taking hormone therapy for short-term symptom relief for less than five years is reasonable. "But we can't say that it is without risk," he added.

"We really try to discourage women from taking it for long periods of time," he said. "There is clearly a dose response."

Moyer said other experts are researching effective management of menopausal symptoms. That information is expected out in the near future. 

More information: To learn more about the recommendations, visit the U.S. Preventive Services Task Force.

Medication beliefs strongly affect individuals' management of chronic diseases, expert says

18 oct 2012—Nearly half of patients taking medications for chronic conditions do not strictly follow their prescribed medication regimens. Failure to use medications as directed increases patients' risk for side effects, hospitalizations, reduced quality of life and shortened lifespans. Now, a University of Missouri gerontological nursing expert says patients' poor adherence to prescribed medication regimens is connected to their beliefs about the necessity of prescriptions and concerns about long-term effects and dependency.

MU Assistant Professor Todd Ruppar found that patients' beliefs about the causes of high blood pressure and the effectiveness of treatment alternatives significantly affected their likelihood of faithfully following prescribed medication regimens. In his pilot study, Ruppar focused on older patients' adherence to medication treatments that control high blood pressure, a condition that affects nearly 70 million adults in the U.S. and can lead to heart disease and stroke.

"Often, patients with chronic diseases are prescribed medications but they already have underlying beliefs about the causes of high blood pressure and how it can be treated, which leads them to underuse their medications," Ruppar said. "For example, some individuals might be able to reduce their blood pressure by walking or cutting down on salt consumption; however, most people need medication to reduce their risk of adverse health outcomes."

Rather than relying on education approaches, Ruppar says practitioners should aim to amend patients' behaviors using tactics such as electronic pill bottle caps that alert patients to take medications at specific times or more frequent monitoring of their blood pressure levels so they associate medication adherence with health benefits and non-adherence with negative side effects.

"Patients benefit from objective feedback to see what led them to miss doses, such as varying sleep patterns or weekend schedules. Then, they can change their routines to make taking doses as habitual as brushing their teeth," Ruppar said. "Self-management is important because encounters with health care providers are fairly short, so as patients, we tend to have better outcomes if we work with our providers to manage our chronic conditions."

More information: The study, "Medication Beliefs and Antihypertensive Adherence Among Older Adults: A Pilot Study," was published in Geriatric Nursing.

Provided by University of Missouri-Columbia

Nearly 170 million years of healthy life lost due to cancer in 2008

The first detailed study to estimate the global impact of cancer on the number of healthy years of life lost by patients has revealed that nearly 170 million years of healthy life were lost because of cancer in 2008, according to an article published Online First in the Lancet.

17 oct 2012--The study used a measure known as disability-adjusted life-years (DALYs) to take account of not only the effects of fatal cancer, but also the effects of disabling non-fatal disease outcomes (e.g. mastectomy for breast cancer or infertility for cervical cancer). The researchers analysed data from the cancer registries worldwide to estimate that globally, 169.3 million years of healthy life were lost due to cancer in 2008.

According to lead author Dr Isabelle Soerjomataram, at the International Agency for Research on Cancer (IARC) in Lyon, France, "While overall DALYs are remarkably similar across different levels of human development*, they reflect a higher average premature mortality in lower income countries and a higher average disability and impairment in higher income countries. Our study represents an important first step towards establishing an evidence base for fatal and non-fatal cancer-related outcomes that is urgently needed to set priorities in cancer control."

Dr Freddie Bray, one of the paper's co-authors and Deputy Head of the IARC's Section of Cancer Information, adds "Our findings illustrate quite starkly how cancer is already a barrier to sustainable development in many of the poorest countries across the world and this will only be exacerbated in the coming years if cancer control is neglected."

Asia and Europe were the main contributors to the global burden of years of healthy life lost due to cancer, with men in eastern Europe facing the largest cancer burden worldwide (3146 age-adjusted DALYs lost per 100 000 men). For women, the highest burden was found in sub-Saharan Africa (2749 age-adjusted DALYs lost per 100 000 women).

Colorectal, lung, breast, and prostate cancers were the main contributors to total DALYs rates in most regions, accounting for 18 – 50% of the total cancer burden. The contribution of infection-related cancers to the overall DALYs (primarily liver, stomach, and cervical cancer) was high in Sub-Saharan Africa (25% of all cancers) and eastern Asia (27% of all cancers), compared to other regions.

The study also highlights the fact that improved access to high-quality treatment has not greatly improved survival for a number of common cancers associated with poor prognoses (especially lung, stomach, liver, and pancreatic cancers), emphasising the crucial role that primary prevention will need to play if the global cancer burden is to be reduced.

Writing in a linked Comment, Dr Ahmedin Jemal, at the American Cancer Society in Atlanta, USA, outlines the difference between the measure used in this study and other commonly used measures: "By contrast with mortality rates and counts, which emphasise deaths occurring at old ages, DALY give more weight to deaths occurring at young ages at which people are more likely to be working, raising children, and supporting other family members."

However, Dr Jemal points out that addressing the challenges highlighted by the new study will require a major effort, adding that, "Implementation of comprehensive and sustainable interventions to challenge the growing cancer burden in low-income and middle-income countries will require the coordinated efforts of many stakeholders from the public and private sectors, including national and international public health agencies, health industries, philanthropic and government donors, and local and regional policy makers."

More information: * The researchers grouped estimates of DALYs into four categories, based on countries' Human Development Index (HDI). HDI combines indicators of life expectancy, educational attainment and income, allowing human development to be compared between countries.

Paper online: www.thelancet.com/… 9-2/abstract

Provided by Lancet

New guide helps providers make effective connection with senior patients

"Communicating With Older Adults: An Evidence-Based Review of What Really Works," the latest report from The Gerontological Society of America (GSA), provides 40 pages of recommended guidelines for health care providers interacting with the fastest growing age segment of America's population.

16 oct 2012--This publication is intended for physicians, nurses, pharmacists, biologists, psychologists, social workers, caregivers, economists, and health policy experts—anyone who seeks to have the best possible interactions with older patients. It was developed by GSA and supported byMcNeil Consumer Healthcare.

"The report is based in the scientific literature, yet the contributors created something extremely accessible," said Jake Harwood, PhD, head of the Advisory Board that crafted the report. "It covers the full range of communication issues experienced by older adults and health care providers, and gives concrete suggestions for dealing with problems when they arise."

The U.S. Administration on Aging forecasts that nearly one in five Americans will be 65 or older by 2030. At present, those age 65 and above make nearly twice as many physician office visits per year as do adults 45 to 65. According to the U.S. Centers for Disease Control and Prevention, two-thirds of older people are unable to understand the information given to them about their prescription medications.

The report provides 29 specific recommendations in four categories: general tips for improving interactions with older adults, general tips for improving face-to-face communication with older adults, tips for optimizing interactions between health care professionals and older patients, and tips for communicating with older adults with dementia.

The recommendations were contributed by experts in the fields of gerontology and communications. Each is accompanied by a brief explanation of the rationale, tips for implementing the recommendation in busy health care settings, and selected references for further reading. The objective is to encourage behaviors that consider the unique abilities and challenges of older adult patients and produce positive, effective interactions among everyone involved.

"The report distills a large body of empirical research findings and scholarship from several disciplines into a set of concrete recommendations for effective communication with older adults," said Advisory Board member Daniel G. Morrow, PhD. "The recommendations include nonverbal and verbal strategies that are often grounded in compelling examples that involve common communication challenges."

Among the specific steps outlined in the report, care providers are encouraged to avoid speech that might be seen as patronizing to an older person, verify listener comprehension during a conversation, and pay close attention to sentence structure when conveying critical information.

"This resource will be of great benefit to health care providers, and would also make good reading for older adults. Increasing awareness of some of these issues among the older population could help them seek more appropriate accommodation when needed," Harwood said.

GSA will distribute the report to its own members, as well as members of the American Geriatrics Society, the American Academy of Physical Medicine and Rehabilitation, the American Medical Association, the American Public Health Association, the American Society of Consultant Pharmacists, and the National Association of Professional Geriatric Care Managers.

"While focused on older adults, the recommendations are relevant to communication across the lifespan," Morrow said.

Provided by Gerontological Society of America

Focused ultrasound for treating Parkinson's disease to be tested

Dr. Jeff Elias, left,is the principal investigator of a a new study to investigate the scalpel-free technology’s safety and effectiveness in reducing tremor related to Parkinson’s disease. 

15 oct 2012—After a promising clinical trial of focused ultrasound as a potential treatment for essential tremor, the University of Virginia Health System is launching a new study to investigate the scalpel-free technology's safety and effectiveness in reducing tremor related to Parkinson's disease.

The phase 1 clinical trial has been approved by the U.S. Food and Drug Administration and is expected to enroll 30 subjects with medication-resistant Parkinson's disease. The subjects will undergo an investigational procedure using focused sound waves delivered within a magnetic resonance scanner to target a small area deep in the brain. Unlike traditional brain surgery, there is no need to cut into the skull.

"We are very encouraged by our initial experience with MRI-guided focused ultrasound. There is a tremendous amount of enthusiasm from our patients and the public for treatments without incisions," Dr. Jeff Elias, the trial's principal investigator, said. "Parkinson's disease is the next logical step on our roadmap of investigation."

Elias previously conducted the first focused ultrasound trial for treatment of essential tremor. All 15 trial participants were discharged the day after their procedures, and tremor improvement has been seen throughout follow-up.

"The technology allowed us to safely perform the procedure in all 15 of the patients, and none of them received any anesthesia," Elias said. "They got a similar degree of tremor control that we see with other surgical procedures like deep brain stimulation."

Elias is preparing the full findings of the essential tremor trial, and he expects to proceed to a larger, multicenter and international trial. Because the trial was the first of its kind, more work needs to be done to determine the long-term effectiveness of the procedure in treating essential tremor. As such, it remains investigational and is not yet available as a treatment outside a clinical trial.

The new Parkinson's trial will test focused ultrasound's safety and efficacy in treating tremor related to Parkinson's disease, an incurable, neurodegenerative condition characterized by tremor and uncontrollable movements. Surgery can, in some cases, alleviate symptoms when medications have become ineffective. The current frontline surgical option is deep brain stimulation, which involves drilling holes in the skull and implanting a pacemaker system in the brain.

U.Va.'s new Parkinson's trial is sponsored jointly by the Focused Ultrasound Foundation, the Heller Foundation, the Commonwealth of Virginia and InSightec, the maker of the ultrasound device. Trial participants must have Parkinson's disease with tremor that is resistant to standard medical therapy.

More information: To learn more about focused ultrasound at U.Va., visit uvahealth.com/focusedultrasound. The site includes a link to a database where those interested in being considered for the Parkinson's trial should submit their information.

Provided by University of Virginia

New report calls for global efforts to prevent fragility fractures due to osteoporosis

Today, the International Osteoporosis Foundation (IOF) released a new report, revealing approximately 80 percent of patients treated in clinics or hospitals following a fracture are not screened for osteoporosis or risk of future falls. Left untreated, these patients are at high risk of suffering secondary fractures and facing a future of pain, disfigurement, long-term disability and even early death.

14 oct 2012--The report 'Capture the Fracture – A global campaign to break the fragility fracture cycle' calls for concerted worldwide efforts to stop secondary fractures due to osteoporosis by implementing proven models of care.

Prof. Bess Dawson-Hughes, Professor of Medicine at Tufts University School of Medicine and General Secretary of IOF, warned, "Half of all individuals who go on to suffer a hip fracture have already come to clinical attention because of a prior fragility fracture. It is obvious that health professionals are missing a clear warning signal. All too often the broken bone is simply 'repaired' and the patient is sent home without proper diagnosis and management of the underlying cause of the fracture."

She added, "This care gap results in countless avoidable fragility fractures at a cost of many billions of dollars worldwide. With the launch of the IOF Capture the Fracture campaign and this report, we are urging health care professionals and health authorities to implement proven cost-effective measures that will ensure that these high-risk individuals receive the necessary assessment and care to prevent further fractures.

IOF's report was issued today at a joint media event with the National Osteoporosis Foundation (NOF) and Osteoporosis Canada in anticipation of World Osteoporosis Day, observed annually on October 20. World Osteoporosis Day, led by IOF with participation in more than 90 countries, launches a year-long campaign dedicated to raising global awareness of the prevention, diagnosis and treatment of osteoporosis and related musculoskeletal diseases.

Representatives from IOF, NOF, National Bone Health Alliance (NBHA), Osteoporosis Canada and a patient will be present to speak about IOF's report findings and the importance of raising global awareness of osteoporosis as part of World Osteoporosis Day and subsequent year-long campaign.

"Today's press conference has three major bone groups coming together around the urgency of fracture prevention. We have the evidence, we know what systems work and we know it is cost-effective to implement coordinated models of care for secondary fracture prevention – now is the time to do it," said Judy Stenmark, CEO, IOF.

Osteoporosis sufferer and speaker at the event, Jeannie Joas, was diagnosed two years ago and has had one wrist fracture as a result. An avid exerciser and healthy eater, Jeannie is one of the many men and women surprised by their diagnosis.

"Two years ago when my bone density test showed significant bone loss since the last test, the doctor thought it was a mistake and ordered it be repeated, only to learn it was true," Joas said. "I'm active, fit, exercise regularly and have always taken care of my health, including being a 'milkoholic' throughout my life. How could I be told I have osteoporosis?"

Fractures: a socio-economic burden:

Around the world up to 1 in 2 women and 1 in 5 men over 50 years of age will suffer a fragility fracture. Fractures are a tremendous burden on older people and healthcare budgets, with costs exceeding that of many other age-related diseases, including stroke, MS and Parkinson's disease.

Vertebral and hip fractures in particular can result in substantial pain and suffering, disability and loss of quality of life. Around 20 percent of hip fracture sufferers die in the year following the fracture while 33 percent of seniors who suffer a hip fracture become physically impaired and lose their ability to live independently.

One study showed that during year 2000, there were an estimated 9 million new fragility fractures worldwide, of which 1.6 million were at the hip, 1.7 million at the wrist, 0.7 million at the humerus and 1.4 million symptomatic vertebral fractures. In 2002, all osteoporotic fractures in the United States alone cost $20 billion per year.

International efforts to 'capture' and treat high risk patients:

As outlined in the 'Capture the Fracture' report, a systematic literature review found the majority of successful systems for secondary fracture prevention throughout the world have employed a dedicated coordinator. The coordinator acts as the link between the orthopaedic team, the osteoporosis and falls services, the patient and the primary care physician. Giving examples of successful and cost-effective service models from many countries, the report outlines the solid evidence in favor of these systems of care.

All over the world health authorities and patient organizations are increasingly recognizing the importance of secondary fracture prevention. In the U.S., NBHA launched 2Million2Many, a national campaign that aims to break the fracture cycle by calling on the public and healthcare professionals to request an osteoporosis test when someone 50 years or older breaks a bone. As part of this initiative, NBHA created a visual representation of the 5,500 bone breaks that occur every day called Cast Mountain.

"In the U.S., we know there are two million bone breaks that occur each year due to osteoporosis. The sad reality is only two in 10 patients with initial bone breaks get a follow-up test or treatment for osteoporosis," said Professor Robert Lindsay, chief of Internal Medicine, Helen Hayes Hospital, Columbia University and chair, NBHA 2Million2Many Project Team. "The number of annual fractures is expected to swell to around three million and cost the healthcare system $25 billion per year by 2025, hence NBHA's '20/20' vision to reduce the incidence of bone breaks by 20 percent by 2020."

More information: The IOF report 'Capture the Fracture - A global campaign to break the fragility fracture cycle' is available on www.worldosteoporosisday.org in multiple languages.

Provided by International Osteoporosis Foundation

Smoking may lead to cataracts in aging population

Cigarette smoking is a well-known risk factor for a wide-range of diseases. Now, scientists have evidence that smoking may also increase the risk of age-related cataract, the leading cause of blindness and vision loss in the world.

13 oct 2012--Reported in Investigative Ophthalmology & Visual Science (Smoking and Risk of Age-related Cataract: A Meta-analysis), the new findings are the result of a meta-analysis conducted by a team of researchers from China.

"Although cataracts can be removed surgically to restore sight, many people remain blind from cataracts due to inadequate surgical services and high surgery expenses," said author Juan Ye, MD, PhD, of the Institute of Ophthalmology, Zhejiang University in China. "Identifying modifiable risk factors for cataracts may help establish preventive measures and reduce the financial as well as clinical burden caused by the disease."

The team performed the analysis using 12 cohorts and eight case-control studies from Africa, Asia, Australia, Europe and North America, to compare the prevalence of age-related cataract in individuals who ever smoked cigarettes to those who have never smoked. Further subgroup analyses were performed based on the subjects' status as a past or current smoker and the three subtypes of age-related cataract.

The results showed that every individual that ever smoked cigarettes was associated with an increased risk of age-related cataract, with a higher risk of incidence in current smokers. In the subgroup analysis, former and current smokers showed a positive association with two of the subtypes: nuclear cataract, when the clouding is in the central nucleus of the eye, and subscapular cataract, when the clouding is in the rear of the lens capsule. The analysis found no association between smoking and cortical cataract, in which the cloudiness affects the cortex of the lens.

While the overall analysis suggests that smoking cigarettes may increase the risk of age-related cataracts, the researchers point out that further effort should be made to clarify the underlying mechanisms.

"We think our analysis may inspire more high-quality epidemiological studies" said Ye. "Our analysis shows that association between smoking and the risk of age-related cataract differ by subtypes, suggesting that pathophysiologic processes may differ in the different cataract types."

Provided by Association for Research in Vision and Ophthalmology

Study identifies biological mechanism that plays key role in early-onset dementia

Using animal models, scientists at the Gladstone Institutes have discovered how a protein deficiency may be linked to frontotemporal dementia (FTD)—a form of early-onset dementia that is similar to Alzheimer's disease. These results lay the foundation for therapies that one day may benefit those who suffer from this and related diseases that wreak havoc on the brain.

12 oct 2012--As its name implies, FTD is a fatal disease that destroys cells, or neurons, that comprise the frontal and temporal lobes of the brain—as opposed to Alzheimer's which mainly affects brain's memory centers in the hippocampus. Early symptoms of FTD include personality changes, such as increased erratic or compulsive behavior. Patients later experience difficulties speaking and reading, and often suffer from long-term memory loss. FTD is usually diagnosed between the ages of 40 and 65, with death occurring within 2 to 10 years after diagnosis. No drug exists to slow, halt or reverse the progression of FTD.

A new study led by Gladstone Senior Investigator Robert V. Farese, Jr., MD, offers new hope in the fight against this and other related conditions. In the latest issue of the Journal of Clinical Investigation, available today online, Dr. Farese and his team show how a protein called progranulin prevents a class of cells called microglia from becoming "hyperactive." Without adequate progranulin to keep microglia in check, this hyperactivity becomes toxic, causing abnormally prolonged inflammation that destroys neurons over time—and leads to debilitating symptoms.

"We have known that a lack of progranulin is linked to neurodegenerative conditions such as FTD, but the exact mechanism behind that link remained unclear," said Dr. Farese, who is also a professor at the University of California, San Francisco (UCSF), with which Gladstone is affiliated. "Understanding the inflammatory process in the brain is critical if we are to develop better treatments not only for FTD, but for other forms of brain injury such as Parkinson's disease, Huntington's disease and multiple sclerosis (MS)—which are likely also linked to abnormal microglial activity."

Microglia—which are a type of immune cells that reside in the CNS—normally secrete progranulin. Early studies on traumatic CNS injury found that progranulin accumulates at the injury site alongside microglia, suggesting that both play a role in injury response. So, Dr. Farese and his team designed a series of experiments to decipher the nature of the relationship between progranulin and microglia. First, the team generated genetically modified mice that lack progranulin. They then monitored how the brains of these mice responded to toxins, comparing this reaction to a control group.

"As expected, the toxin destroys neurons in both sets of mice—but the progranulin-deficient mice lost twice as many neurons as the control group," said Lauren Herl Martens, a Gladstone and UCSF graduate student and the study's lead author. "This showed us that progranulin is crucial for neuron survival. We then wanted to see whether a lack of progranulin itself would injure these cells—even in the absence of toxins."

In a petri dish, the researchers artificially prevented microglia from secreting progranulin and monitored how these modified microglia interacted with neurons. They observed that a significantly greater number of neurons died in the presence of the progranulin-deficient microglia when compared to unmodified microglia. Other experiments revealed the process' underlying mechanism. Microglia are the CNS's first line of defense. When the microglia sense toxins or injury, they trigger protective inflammation—which can become toxic to neurons if left unchecked. Dr. Farese's team discovered that progranulin works by tempering the microglia's response, thereby minimizing inflammation. Without progranulin, the microglia are unrestricted—and induce prolonged and excessive inflammation that leads to neuron damage—and can contribute to the vast array of symptoms that afflict sufferers FTD and other fatal forms of brain disease.

"However, we found that boosting progranulin levels in microglia reduced inflammation—keeping neurons alive and healthy in cell culture," explained Dr. Farese. "Our next step is to determine if this method could also work in live animals. We believe this to be a therapeutic strategy that could, for example, halt the progression of FTD. More broadly, our findings about progranulin and inflammation could have therapeutic implications for devastating neurodegenerative diseases such as Alzheimer's, Parkinson's and MS."

Provided by Gladstone Institutes

The paradox of BMI and life expectancy

11 oct 2012—Although the medical cost to the community rises as more and more people become obese, there is little adverse association between being overweight and life expectancy, new research has confirmed.

The increasing rates of obesity and associated disability and illness mean greater financial costs for the community. This expenditure is partly why obesity may have little effect on life expectancy in the aged.

The Monash University-led collaborative study of over 110,000 people examined the effect of BMI (Body Mass Index, regarded as a measure of obesity) on life expectancy and the repercussions for health-care systems. The 12-year study included men and women across all age groups. 

The results of the research were recently published in the Asia Pacific Journal of Clinical Nutrition. The study also included researchers from the National Health Research Institutes, Taiwan and the National Defense Medical Centre, Taiwan.

Co-author, Emeritus Professor Mark Wahlqvist from Monash University's Department of Epidemiology and Preventive Medicine and the Monash Asia Institute, said the study drew attention to the growing need to recognise paradoxes with weight disorders in health care systems, both clinical and public health.

"We found that especially in the elderly, medical expenditure continues to rise with increasing BMI, but there was little relationship with how long a person lived," Professor Wahlqvist said.

One reason for this greater expenditure is that, with age, excess weight is increasingly accompanied by loss of muscle (sarcopenia) and bone (osteopenia or osteoporosis), with their own health consequences.

"The study showed that to maintain a favourable life expectancy for those who fall outside the desirable BMI range, more money is being spent," Professor Wahlqvist said.

BMI indicates a relationship between weight and height. The findings show that, if medical expenditure is to be reduced, people must maintain their BMI in the lower end of the desirable range between 18.5 and 24.

"To reduce the health burden, and the associated medical expenditure by both individuals and governments, it is important that people are encouraged to maintain a desirable BMI - and to do so by inexpensive exercise as well as diet," Professor Wahlqvist said.

"It also means greater government effort for the well-being of ageing communities is needed."

Professor Wahlqvist said that the economic impact for both individuals and society was a consequence not only of the health costs of obesity but also of the effects it had on independent living, workforce participation and livelihoods.

"Another difficulty to be actively addressed is that the socio-economically disadvantaged are at greater risk of obesity in the first place," Professor Wahlqvist said.

"In times of international financial crisis, vulnerability in the health system becomes more apparent. This can be seen in those countries in the euro-zone with demanding terms for debt alleviation, including cut-backs to health system funding."

More information: apjcn.nhri.org.tw/… _577_587.pdf

Provided by Monash University

Better guidelines needed for multimorbidity

New clinical guidelines need to be developed to help doctors provide better care for people with more than one chronic illness, according to a research team led by the University of Dundee.

10 oct 2012--In an article published in the British Medical Journal, the research team - which includes the Universities of Dundee, Glasgow and Manchester and the National Institute for Health and Clinical Excellence (NICE) - say that existing guidelines which concentrate on individual diseases are not best serving clinicians or patients where a number of chronic conditions have to be treated.

"Doctors and other professionals often use guidelines to inform their clinical decision making, and clinical guidelines have played an important part in making healthcare more consistent, efficient, and systematic," said Professor Bruce Guthrie, of the Medical Research Institute at the University of Dundee.

"Through the National Institute for Health and Clinical Excellence and the Scottish Intercollegiate Guidelines Network (SIGN), the UK is a world leader in guideline methodology, and guideline development and implementation.

"Despite their success, clinical guidelines are almost always focused on making recommendations about the treatment of individual diseases, which can make their use in clinical practice problematic. This is because most people with long term conditions have more than onechronic illness, particularly older people in whom multiple chronic illnesses (multimorbidity) are the norm.

"For example, 93% of people with coronary heart disease (heart attacks or angina) have at least one other chronic condition, and a fifth have five or more other conditions.

"This creates a paradox - every individual guideline recommendation may be rational and strongly evidence based, but the cumulative effect of recommendations for multiple chronic conditions may not be appropriate as recommendations are contradictory or treatments recommended interact, or because the burden imposed on patients in terms of numbers of drugs, non-drug therapies (diet, exercise, physiotherapy and so on), and attendance for investigation or follow-up may be overwhelming and not feasible for some people with multiple conditions.

"There will of course be many situations where all guideline recommendations are non-contradictory and appropriate, but previous studies in the USA have shown that guidelines there only occasionally address multiple conditions and recommendations are frequently inconsistent or would produce undesirable drug interactions if implemented.

"Decision making in this situation is complex for both clinicians and patients, but existing guidelines are not ideal for supporting either in deciding the best course of action because they are disease based."

Working with colleagues at the Universities of Manchester and Glasgow, and NICE, Professor Guthrie is leading a research project to implement a new approach to guideline development to help address these problems, and examine its methodological feasibility.

Professors Katherine Payne and Matt Sutton, from the Centre of Health Economics at The University of Manchester, are leading the economic component of the study.

Professor Payne said: "Economic evidence is often used to inform the development of clinical guidelines to provide decision-makers with information on the relative cost effectiveness of the individual interventions included in the guidelines. This study aims to explore if, and how, it is feasible to generate economic evidence to support the development of clinical guidelines involving multiple interventions for people with multiple chronic conditions."

Professor Guthrie added: "This work is exploratory, but if successful will make guideline recommendations more relevant for people with multimorbidity."

The project follows on from previous research published in The Lancet earlier this year by Professor Guthrie and colleagues which showed that having two or more co-existing conditions is the norm for most people with chronic disease, and although the prevalence increases with age, more than half of all people with multimorbidity are under 65.

That paper claimed that health systems in the UK and other developed countries were not devised to deal with this scenario and must be radically changed to cope.

Provided by University of Dundee

Scientists identify genetic signatures for aggressive form of prostate cancer

Scientists have discovered two separate genetic 'signatures' for prostate cancer that appear to be able to predict the severity of the disease, leading to hopes that in future, accuracy of prognosis and treatment of the disease could be greatly improved. Two Articles published in The Lancet Oncology reveal distinctive patterns of RNA—the genetic material that helps turn DNA into proteins—which appear to be able to predict whether patients have an aggressive prostate cancer, or whether they have a milder form of the disease.

09 oct 2012--Prostate cancer shows enormous variation between patients, with some people never showing symptoms, some responding well to treatment, and others developing resistance and progressing. Clinicians refer to the form of the disease which does not respond to standardandrogen deprivation therapy as castration-resistant prostate cancer. Castration-resistant prostate cancer also shows wide variation in patient survival times, though the reasons for this are unclear.

Although tests to determine whether a patient has a more aggressive form of prostate cancer do currently exist, they are only moderately accurate. A more accurate way of determining whether a patient has a more dangerous form of prostate cancer would not only allow doctors to offer more accurate prognoses, but also enable better clinical trials for potential new treatments, as patients could be more effectively stratified into groups with aggressive or less aggressive disease.

The authors of one Article, led by Professor Johann de Bono at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust in the UK, identified a set of genes which were able to predict whether patients had castration-resistant prostate cancer. Further, the signature stratified patients with castration-resistant prostate cancer: patients who were identified as having a distinctive nine-gene pattern characteristic of aggressive prostate cancer survived for an average of 9.2 months after referral for treatment, as opposed to 21.6 months in the group who did not test positive for the RNA signature under study.

In the other Article, researchers led by Professor William Oh at the Tisch Cancer Institute of Mount Sinai School of Medicine in the USA, identified a different set of genes with similar predictive properties to those identified by de Bono and colleagues. In this case, the researchers identified a set of six genes characteristic of a more aggressive form of prostate cancer, in a group of 62 patients at the Dana-Farber Cancer Institute in Boston. The signature divided patients into two groups: one with a median survival time of 7.8 months (the high-risk group), the other with a median survival of at least 34.9 months (the low-risk group). A validation cohort of 140 patients confirmed these findings.

Genetic signatures for different forms of cancer have been identified previously, but they have only been used for classification purposes – these studies are the first to show that they might have potential prognostic use. Previously, genetic tests like this were based on obtaininggenetic material from the tumour itself, but these can be difficult to obtain and may not show the complete picture as there is evidence that patient prognosis may depend not only on the disease biology but also the individual's response to the disease. Furthermore, the genetic signatures identified from normal blood cells in these papers can be detected via a simple blood test, which could eventually lead to huge improvements in providing patients with prostate cancer with an accurate prognosis.

In a linked Comment, Dr Karina Dalsgaard Sørensen at Aarhus University Hospital in Denmark welcomes the findings, writing that, "Scarcity of prognostic markers presents a major challenge for the clinical management of castration-resistant prostate cancer. These results suggest that a few selected genes in blood samples from patients with castration-resistant prostate cancer can significantly improve the prediction of outcomes. However, the biological relevance of these prognostic signatures, which are the first of their kind, is largely unknown and further investigation into the underlying biological mechanisms at work here could greatly advance our understanding."

More information:
de Bono et al: www.thelancet.com/… 2-8/abstract
Oh et al: www.thelancet.com/… 3-2/abstract

Provided by Lancet

Larger study confirms statins' role in preventing cardiac events

A large and unselected community-based study has confirmed the results of randomized controlled trials that have found persistent statin use to be beneficial for the primary prevention of acute cardiac events; the study was published online Sept. 27 in The American Journal of Cardiology.

08 oct 2012—A large and unselected community-based study has confirmed the results of randomized controlled trials that have found persistent statin use to be beneficial for the primary prevention of acute cardiac events; the study was published online Sept. 27 in The American Journal of Cardiology.

Varda Shalev, M.D., from Tel Aviv University in Israel, and colleagues examined the effectiveness of statins in primary prevention of acute nonfatal cardiac events in the community setting. Data were analyzed from a cohort of 171,535 adults aged 45 to 75 years, without cardiovascular disease, who were given statins between 1998 to 2009 in a large health maintenance organization in Israel.

The researchers found that the incidence of acute cardiovascular events during the 993,519 person-years of follow-up was 10.22 per 1,000 person-years. Persistence with statins correlated with significantly reduced risk of incident cardiac events. There was a hazard ratio of 0.58 for the most persistent users (covered with statins for 80 percent or more of their follow-up time) compared with non-persistent users (less than 20 percent of days covered). When the analyses were limited to patients with more than five years of follow-up, the results were similar. Treatment with high efficacy statins correlated with a reduced risk of cardiac events.

"In conclusion, our large and unselected community-based study supports the results of randomized controlled trials regarding the beneficial effect of statins in the primary prevention of acute cardiac events," the authors write.

More information: Abstract 
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