Acupuncture improves gait function in Parkinson's disease
For patients with Parkinson's disease (PD), acupuncture is associated with improvement in gait function, according to a study published in the October issue of the Journal of the American Geriatrics Society.
31 oct 2015--Shimpei Fukuda, Ph.D., from the Meiji University of Integrative Medicine in Kyoto, Japan, and colleagues examined the immediate effects of acupuncture on gait function in 27 outpatients with PD. The acupuncture points used were bilateral legs, bilateral arms, posterior region of neck, and back. Acupuncture needles were inserted perpendicular to the skin surface to a depth of 10 mm. A portable gait rhythmogram was used to measure gait function.
The researchers observed significant increases in gait speed, step length, floor reaction force (all P < 0.001), and cadence (P = 0.007) after acupuncture. No adverse effects related to the therapy were reported.
"Acupuncture can be a safe way to decrease gait disturbances," the authors write. "Further studies on a set period of acupuncture treatment, as well as controlled comparative studies to exclude the placebo effect, are needed."
Prolonged TV viewing linked to eight leading causes of death in US
Credit: Paul Brennan/public domain
On average, 80% of American adults watch 3.5 hours of television per day and multiple observational studies have demonstrated a link between TV viewing and poorer health. In this new study published in the December issue of the American Journal of Preventive Medicine, investigators reported an association between increasing hours of television viewing per day and increasing risk of death from most of the major causes of death in the United States.
30 oct 2015--Virtually all Americans (92%) have a television at home and watching TV consumes more than half of their available leisure time, potentially displacing more physical activities. Previous studies had reported a relationship between TV viewing and elevated risk of death from cancer and cardiovascular disease. In this study, researchers at the National Cancer Institute looked at more than 221,000 individuals aged 50-71 years old who were free of chronic disease at study entry. They confirmed the association for higher mortality risk from cancer and heart disease. In addition, they identified new associations with higher risk of death from most of the leading causes of death in the U.S., such as, diabetes, influenza/pneumonia, Parkinson's disease, and liver disease.
"We know that television viewing is the most prevalent leisure-time sedentary behavior and our working hypothesis is that it is an indicator of overall physical inactivity. In this context, our results fit within a growing body of research indicating that too much sitting can have many different adverse health effects," explained lead investigator Sarah K. Keadle, PhD, MPH, Cancer Prevention Fellow, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute.
Dr. Keadle cautioned that although each of the associations observed have plausible biological mechanisms, several associations are being reported for the first time and additional research is needed to replicate these findings and to understand the associations more completely. "Our study has generated new clues about the role of sedentary behavior and health and we hope that it will spur additional research."
The study found that compared to those who watched less than one hour per day, individuals who reported watching 3-4 hours of television watching per day were 15% more likely to die from any cause; those who watched 7 or more hours were 47% more likely to die over the study period. Risk began to increase at 3-4 hours per day for most causes they examined. The investigators took a number of other factors into consideration that might explain the associations observed, such as caloric and alcohol intake, smoking, and the health status of the population, but when they controlled for these factors in statistical models, the associations remained.
Another important finding of the study is that the detrimental effects of TV viewing extended to both active and inactive individuals, "Although we found that exercise did not fully eliminate risks associated with prolonged television viewing, certainly for those who want to reduce their sedentary television viewing, exercise should be the first choice to replace that previously inactive time," said Dr. Keadle.
Investigators caution that more research is needed to explore connection between TV viewing and mortality and whether these same associations are found when we consider sitting in other contexts, such as driving, working, or doing other sedentary leisure-time activities. "Older adults watch the most TV of any demographic group in the U.S.," concluded Dr. Keadle. "Given the increasing age of the population, the high prevalence of TV viewing in leisure time, and the broad range of mortality outcomes for which risk appears to be increased, prolonged TV viewing may be a more important target for public health intervention than previously recognized."
More information: Sarah K. Keadle et al. Causes of Death Associated With Prolonged TV Viewing, American Journal of Preventive Medicine (2015). DOI: 10.1016/j.amepre.2015.05.023
Provided by Elsevier
Thursday, October 29, 2015
'Virtual Week' brain game has potential to help older adults remain independent longer
Computer screen shot of "Virtual Week" brain game. Credit: Credit: Baycrest Health Sciences
An international team of scientists has demonstrated that just one month of training on a "Virtual Week" computer brain game helps older adults significantly strengthen prospective memory - a type of memory that is crucial for planning, everyday functioning and independent living.
29 oct 2015--Seniors who played the cognitive-training game "more than doubled" the number of prospective memory tasks performed correctly compared to control groups that performed other activities such as music classes.
The promising results are reported by the Rotman Research Institute at Baycrest Health Sciences which led the study, and posted online today in Frontiers in Human Neuroscience, ahead of print publication.
Prospective memory refers to the ability to remember and successfully carry out intentions and planned activities during the day; it also tends to weaken with age. Prospective memory accounts for between 50 - 80% of reported everyday memory problems, yet few studies have attempted to train or rehabilitate prospective memory in older adults.
What makes this study unique is that it's the first to incorporate a "train for transfer" approach - essentially a training intervention designed to have participants practice performing real-world prospective memory tasks in simulated everyday settings and assess whether the cognitive gains transfer to successful performance at home.
"As the world's population ages, it is becoming increasingly important to develop ways to support successful prospective memory functioning so that older adults can continue to live independently at home without the need for assisted care," said Nathan Rose, lead investigator of the study and now a research fellow in the School of Psychology at the Australian Catholic University in Melbourne. Senior author on the paper is Dr. Fergus Craik, an internationally-known memory researcher based at Baycrest.
"While these results are encouraging, they represent a first step in exploring the efficacy of prospective memory training with the Virtual Week training program," said Dr. Craik. "Perhaps the most exciting aspect is that training in the lab resulted in improvements in real-life memory tasks. This lab-to-life transfer has been difficult to achieve in previous studies."
In the study, scientists developed a version of a computerized board game called "Virtual Week" in which players simulate going through the course of a day on a circuit that resembles a Monopoly board. Players roll a virtual die (one of a pair of dice) to move their token through a virtual day. Along the way, players have to remember to perform several prospective memory tasks, such as taking medication or taking their dinner out of the oven at appropriate times.
Fifty-nine healthy adults, aged 60 to 79, took the training, playing 24 levels of the Virtual Week game over a one-month period (three sessions a week, two levels per session). The difficulty of the game increased over the course of training in terms of the number of tasks to be completed per day, the complexity of tasks, and/or interference with prior tasks. The difficulty was titrated to each individual's level of performance on the previous day. Pre and post training prospective memory performance measures were taken and compared to two control groups - one of which received a music-based cognitive training program and the other which received no intervention.
The scientists found large training gains in prospective memory performance in the group that played the Virtual Week game (relative to control groups). Moreover, these gains transferred to significant improvements in real-world prospective memory, including performance on simulated activities of daily living following the training. These activities included counting change and following medication instructions. The researchers also developed a "call-back" task in which participants had to remember to phone the lab from home during their everyday activities.
Brain imaging (EEG) on a subset of the groups showed some evidence of neuroplasticity (i.e., brain changes) which correlated to correct prospective memory performance, particularly with the ability to stop oneself from carrying on with ongoing activities and switch to performing an intended action at the appropriate time.
The early findings are so promising that the researchers have been awarded a grant from the Australian Research Council, in partnership with Villa Maria Catholic Homes, to follow up on the study with a large randomized control trial. The research team was also awarded a grant with colleagues in the Centre for Heart and Mind at the Australian Catholic University's Mary MacKillop Institute for Health Research to implement the game-based cognitive training program in patients with chronic heart failure, a group that demonstrates severe prospective memory problems associated with self-care.
Provided by Baycrest Centre for Geriatric Care
Wednesday, October 28, 2015
Withdrawing dementia drug doubles risk of nursing home placement
Withdrawing a commonly-prescribed Alzheimer's disease drug from people in the advanced stages of the disease doubles their risk of being placed in a nursing home within a year, according to UCL research published today in The Lancet Neurology.
28 oct 2015--Researchers funded by the Medical Research Council and Alzheimer's Society followed 295 people with moderate to severe Alzheimer's disease to monitor the effects of continuing or discontinuing the drug donepezil - which is typically withdrawn in the later stages of the disease because of a lack of perceived benefit by clinicians. The participants were randomly selected to either continue donepezil or withdraw from the drug by receiving a placebo. These two groups were then each divided to test the effect of receiving another dementia drug, memantine, or a placebo.
The DOMINO trial, conducted by scientists at UCL, found that withdrawing donepezil doubled the risk of nursing home placement after a year. Memantine was not found to have any effect on risk of nursing home placement.
In the UK, 70% of care home residents have dementia or severe memory problems. The costs of residential care vary across the country, but the average cost is estimated to be between £30,732 and £34,424 per year, for people with dementia. By comparison, the cost of donepezil is around £21.59 per year.
Robert Howard, professor of old age psychiatry at UCL, said: "Our previous work showed that, even when patients had progressed to the moderate or severe stages of their dementia, continuing with donezepil treatment provided modest benefits in cognitive function and in how well people could perform their daily activities.
"Our new results show that these benefits translate into a delay in becoming dependant on residential care, a point that many of us dread. We are all impatient for the advent of true disease-modifying drugs that can slow or halt the Alzheimer process, but donepezil is available right now and at modest cost."
Dr Kathryn Adcock, head of neurosciences and mental health at the Medical Research Council, said: "This study provides strong evidence that donepezil can benefit people in the more severe stages of Alzheimer's disease for longer than was expected. The number of people with dementia is at a critical level and it's never been more important to invest in research to help doctors make informed decisions about treatments for their patients.
"We currently have no cure for dementia but we are closing the gap and in the meantime, we are committed to developing effective and safe treatments to improve the quality of life for people with Alzheimer's disease and their care givers."
Dr Doug Brown, director of research and development at the Alzheimer's Society, said: "With no new treatments for Alzheimer's disease in over a decade, it is absolutely crucial that we make the most of the drugs we have available. Residential care can be the best option for someone whose care needs are complex, but it is important that we continue to find better ways to support people with dementia to remain in their own homes for longer.
"These robust findings are of real significance to people with dementia and their families who want to continue living at home for as long as possible. We urge clinicians to consider the implications of this research and adjust their prescribing patterns accordingly."
In 2001, NICE approved the use of three anticholinesterase inhibitors – which included donepezil – in the early and moderate stages of Alzheimer's. The drugs had been found to reduce the symptoms of Alzheimer's and were the first treatments to be approved for the disease.
Previous results published from the DOMINO trial in 2012 were the first to show that continued treatment with donepezil can provide cognitive and functional benefits in people with moderate to severe Alzheimer's disease, such as retaining the ability to eat, dress and go shopping more independently. A later survey found that two-thirds of old age psychiatrists felt that prescribing practice would change based on the results of this trial.
In the UK, it is estimated that 527,000 people are living with Alzheimer's disease, the most common form of dementia. An estimated 58,600 people with mild-to-moderate Alzheimer's disease are currently taking donepezil. More information: Robert Howard et al. Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (DOMINO-AD) trial: secondary and post-hoc analyses,The Lancet Neurology (2015). DOI: 10.1016/S1474-4422(15)00258-6
Provided by University College London
Tuesday, October 27, 2015
Should I stop eating meat? No need, experts say
Credit: Maliz OngThe UN's International Agency for Research on Cancer (IARC) warned Monday that processed meats like sausages and ham cause bowel cancer, and red meat "probably" does too. Does this mean we should stop eating meat?
27 oct 2015--By the IARC's own account, meat has "known health benefits".
And the agency says it does not know what a safe meat quota would be—or even if there is one.
Other specialists insist the report is no reason to drop steak from the menu, though it is probably wise for big eaters of it to cut back.
Meat is a good source of key nutrients like zinc, protein and vitamin B12, they point out, as well as iron, which humans absorb more easily from meat than from plants.
"This decision doesn't mean you need to stop eating any red and processed meat," said Tim Key, an epidemiologist at Cancer Research UK.
"But if you eat lots of it, you may want to think about cutting down. You could try having fish for your dinner rather than sausages, or choosing to have a bean salad for lunch over a BLT (bacon, lettuce and tomato sandwich)."
Nutritionist Elizabeth Lund from Norfolk in England said obesity and lack of exercise were a far bigger cancer risks.
"Overall, I feel that eating meat once a day combined with plenty of fruit, vegetable and cereal fibre plus exercise and weight control, will allow for a low risk of CRC," she said, referring to colo-rectal cancer.
"It should also be noted that some studies have shown that if meat is consumed with vegetables or a high-fibre diet, the risk of CRC is reduced."
Ian Johnson of the UK-based Institute of Food Research, said meat consumption was "probably one of many" factors contributing to relatively high rates of bowel cancer in the United States, Western Europe and Australia—parts of the developed world where more meat has traditionally been eaten.
However, "there is little or no evidence that vegetarians in the UK have lower risk of bowel cancer than meat-eaters," he said.
The specialists point out that the cancer risk posed by a meaty diet was statistically much lower than other factors like tobacco smoking and air pollution.
The IARC report "does not mean... that eating bacon is as bad as smoking," said University of Reading nutrition expert Gunter Kuhnle.
"Processed meat can be part of a healthy lifestyle—smoking can't".
According to the World Health Organization, bowel cancer is the third most common type, with some 900,000 new cases every year, and 500,000 deaths.
Generally, dietary advice is to limit red-meat intake to once or twice a week, said nutrition professor Tom Sanders of King's College London—the equivalent of about two steaks or three hamburgers.
"The problem with this issue is that food is not like tobacco—we have to eat something."
Monday, October 26, 2015
A biomarker for premature death
This schematic summarizes an investigation of the biology of GlycA, a known biomarker for short-term mortality. They reveal GlycA's long-term behavior in apparently healthy patients: it is stable for >10 years and associated with chronic low-grade inflammation. Accordingly, GlycA predicts death from infection up to 14 years in the future. Credit: Ritchie et al./Cell Systems 2015A single blood test could reveal whether an otherwise healthy person is unusually likely to die of pneumonia or sepsis within the next 14 years. Based on an analysis of 10,000 individuals, researchers have identified a molecular byproduct of inflammation, called GlycA, which seems to predict premature death due to infections.
26 oct 2015--The findings, published October 22 in Cell Systems, suggest that high GlycA levels in the blood indicate a state of chronic inflammation that may arise from low-level chronic infection or an overactive immune response. That inflammation damages the body, which likely renders individuals more susceptible to severe infections.
"As biomedical researchers, we want to help people, and there are few more important things I can think of than identifying apparently healthy individuals who might actually be at increased risk of disease and death," said co-senior author Michael Inouye, of the University of Melbourne, in Australia. "We want to short-circuit that risk, and to do that we need to understand what this blood biomarker of disease risk is actually telling us."
Inouye and his colleagues note that additional studies are needed to uncover the mechanisms involved in GlycA's link to inflammation and premature death, and whether testing for GlycA levels in the clinic might someday be warranted.
"We still have a lot of work ahead to understand if we can modify the risk in some way," said co-senior author Johannes Kettunen, of the University of Oulu and the National Institute for Health and Welfare, in Finland. "I personally would not want to know I was at elevated risk of death or disease due to this marker if there was nothing that could be done about it."
For example, to plan a course of treatment, researchers need to know whether high GlycA is the result of a chronic, low-level microbial infection or an aberrant reaction of the body's own inflammatory response.
The findings will likely form the foundation for numerous other studies that will investigate the role of GlycA in the body. "The more high-quality genomics data we have, linked health records and long-term follow-up, the better our models and predictions will be," Inouye says. "This study is an example of the progress that can be made when altruistic research volunteers, clinicians, technologists, and data scientists work together, but we have the potential to do much more, and large-scale strategic inter-disciplinary initiatives are vitally needed."
More information:Cell Systems, Ritchie et al.: "The biomarker GlycA is associated with chronic inflammation and predicts long-term risk of severe infection" dx.doi.org/10.1016/j.cels.2015.09.007
Provided by Cell Press
Sunday, October 25, 2015
Alzheimer's disease: Plaques impair memory formation during sleep
Image representing the slow waves in the brain, which spread out normally during sleep (left). This process is severely disrupted by the β -amyloid plaques (center). The disruption is reversed by administering a benzodiazepine (right). Credit: Marc Aurel Busche / TUMAlzheimer's patients frequently suffer from sleep disorders, mostly even before they become forgetful. Furthermore, it is known that sleep plays a very important role in memory formation.
25 oct 2015--Researchers from the Technical University of Munich (TUM) have now been able to show for the first time how the pathological changes in the brain act on the information-storing processes during sleep. Using animal models, they were able to decode the exact mechanism and alleviate the impairment with medicinal agents.
The sleep slow waves, also known as slow oscillations, which our brain generates at night, have a particular role in consolidating what we have learned and in shifting memories into long-term storage. These waves are formed via a network of nerve cells in the brain's cortex, and then spread out into other parts of the brain, such as the hippocampus.
"These waves are a kind of signal through which these areas of the brain send mutual confirmation to say 'I am ready, the exchange of information can go ahead'. Therefore, there is a high degree of coherence between very distant nerve cell networks during sleep", explains Dr. Dr. Marc Aurel Busche, scientist at the Department of Psychiatry and Psychotherapy at TUM University Hospital Klinikum rechts der Isar and TUM Institute of Neuroscience. Together with Prof. Dr. Arthur Konnerth from the Institute of Neuroscience, he headed the study which was published in the journal Nature Neuroscience.
Disrupted spread of sleep waves in Alzheimer models
As the researchers discovered, this coherence process is disrupted in Alzheimer's disease. In their study, they used mouse models with which the defects in the brains of Alzheimer's patients can be simulated. The animals form the same protein deposits, known as β-amyloid plaques, which are also visible in human patients. The scientists were now able to show that these plaques directly impair the slow wave activity. "The slow oscillations do still occur, but they are no longer able to spread properly - as a result, the signal for the information cross-check is absent in the corresponding regions of the brain," is how Marc Aurel Busche summarizes it.
The scientists also succeeded in decoding this defect at the molecular level: correct spread of the waves requires a precise balance to be maintained between the excitation and inhibition of nerve cells. In the Alzheimer models, this balance was disturbed by the protein deposits, so that inhibition was reduced.
Low doses of sleep-inducing drugs as possible therapy
Busche and his team used this knowledge to treat the defect with medication. One group of sleep-inducing drugs, the benzodiazepines, is known to boost inhibitory influences in the brain. If the scientists gave small amounts of this sleep medication to the mice (approximately one-tenth of the standard dose), the sleep slow waves were able to spread out correctly again. In subsequent behavioral experiments, they were able to demonstrate that learning performance had now improved as well.
For the researchers, of course, these results are just a first step on the way to a suitable treatment of Alzheimer's disease. "But, these findings are of great interest for two reasons: firstly, mice and humans have the same sleep oscillations in the brain - the results are thus transferrable. Secondly, these waves can be recorded with a standard EEG monitor, so that any impairment may also be diagnosed at an early stage", concludes the scientist.
More information: Marc Aurel Busche et al. Rescue of long-range circuit dysfunction in Alzheimer's disease models, Nature Neuroscience (2015). DOI: 10.1038/nn.4137
Provided by Technical University Munich
Friday, October 23, 2015
Trial results show that 'health risk assessment' benefits non-disabled elderly people
Implementation of a collaborative care model among community-dwelling older people using a health risk assessment instrument resulted in better health behaviors and increased use of preventative care, according to a study published this week in PLOS Medicine. The trial, conducted by Andreas Stuck from the University Hospital Bern and University of Bern, Switzerland, and colleagues, demonstrated improved 8-year survival among recipients of the intervention.
23 oct 2015--In almost every country, the over-60 age group is growing faster than any other age group. Programs that encourage a healthy lifestyle and the uptake of preventative care among older people are a health policy priority. In this pragmatic trial, Stuck and colleagues found that health risk assessment by self-administered questionnaire combined with two years of personal reinforcement by specially trained counselors was effective in reducing the average participant's number of risk factors and preventative care deficits. For example, at the 2-year follow-up, 70% of the intervention group were physically active compared to 62% of the control group (Odds Ratio 1.43 (95% CI 1.16-1.77, p = 0.001), and 66% of the intervention group had had an influenza vaccination that year compared to 59% of the control group (OR 1.35 (95% CI 1.09-1.66, p = 0.005)). Over the 8-year follow-up, the mortality rate was 3.16 (95% CI 2.74-3.63) per 100 person-years in the intervention group, as compared to 3.97 (95% CI 3.59-4.39) in the control group (Hazard Ratio 0.79 (95% CI 0.66-0.94, p = 0.009). Stuck and colleagues calculated that, to avert one death over eight years, 21 individuals would need to receive the intervention.
Certain aspects of the trial design may limit the interpretation of these findings. Some participants may have given socially desirable answers on questionnaires, the study was undertaken at a single site, and long-term follow-up information was limited to survival. Overall, however, these findings suggest that the use of regionally adapted approaches for health risk assessment combined with individual counseling might be an effective and relatively low-cost way to improve health and survival among non-disabled older people. The authors state, "Our study may also serve as a model for low- and middle-income countries, given the importance of the demographic challenge of rapidly growing populations of older individuals in these countries."
More information: Stuck AE, Moser A, Morf U, Wirz U, Wyser J, Gillmann G, et al. (2015) Effect of Health Risk Assessment and Counselling on Health Behaviour and Survival in Older People: A Pragmatic Randomised Trial. PLoS Med12(10): e1001889. DOI: 10.1371/journal.pmed.1001889
Provided by Public Library of Science
Thursday, October 22, 2015
Growing old can be risky business
Managing money can be difficult at any age. For older adults, changes in physical condition and life circumstances can lead to changes for the worse in financial behavior, putting their well-being in danger. Now those changes have been given a name: age-associated financial vulnerability.
22 oct 2015--Two experts in elder abuse coin the term and explain the concept in an opinion article published in the Oct. 13 issue of the Annals of Internal Medicine. They also call for research to identify and helpolder adults at risk from age-associated financial vulnerability, or AAFV for short.
They define the condition as "a pattern of financial behavior that places an older adult at substantial risk for a considerable loss of resources such that dramatic changes in quality of life would result." To be considered AAFV, this behavior also must be a marked change from the kind of financial decisions a person made in younger years.
"For example, if an older adult gives his or her neighbor $10,000, this many be a sign of AAFV. However, if the older adult has given large sums of money to those in need throughout his or her adult lifetime, then the $10,000 gift in old age may not represent a change in behavior, and thus may not represent AAFV," explains Duke Han, PhD, co-author of the study and associate professor of behavioral sciences at Rush University Medical Center.
Not the same old problem
The authors note that AAFV is a condition different from age-related cognitive impairment, including dementia, which already is recognized as putting older adults at risk of causing themselves financial harm. Since recent studies have indicated that "cognitively intact older adults" may become financially vulnerable, they write, "cognitive impairment is not necessary for AAFV."
Instead, the trouble can lie in the many ordinary changes brought about by aging. "Functional changes such as impaired mobility, vision and hearing loss, and the cost of multiple medications can directly influence vulnerability in older adults," Han says.
Other potential contributing factors may include cognitive changes, such as a lessened ability to discern a person's trustworthiness, and psychosocial problems, including loneliness or depression. In addition, the finance industry has identified older adults as an untapped market, which can lead to them being overwhelmed by the "dizzying array of financial products and services," according to Han and co-author Mark Lachs, MD, MPH, professor of medicine and co-chief of geriatrics and gerontology at Weill Medical College in New York.
"In my discussions with Dr. Lachs about our experiences with the heart-breaking effects of financial vulnerability among our older patients, we decided that naming the problem may be a useful first step to addressing the issue," Han says.
Protecting the vulnerable from the villainous
Han and Lachs believe it's important to understand AAFV as a condition in order to protect older adults who exhibit signs of it, distinct from behavior brought on by cognitive impairment or problems with financial judgement that preceded older age. In particular, AAFV can put a person at risk for financial exploitation: Han notes that financial abuse is one of the most common forms of elder abuse, and is the most frequent form of perpetrator-related elder abuse in Illinois.
"This is a growing problem since we have a large aging population with no ways to determine who is at risk and why," Han warns. "We need more screening, and more interventional programs and strategies to address this issue. We also need to determine what the role and responsibility is of physicians in protecting their patients."
Research study validates neuroreader for accurate and fast measurement of brain volumes
Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.A new neuroimaging software, Neuroreader, was shown to be as accurate as traditional methods for detecting the slightest changes in brain volume, and does so in a fraction of the time, according to a research study published in the Journal of Alzheimer's Disease this month. The research validates the software program that can be used for measuring hippocampal volume, a biomarker for detecting Alzheimer's Disease.
21 OCT 2015--The study, which was conducted earlier this year by a team of 10 researchers, neurologists, radiologists and other healthcare professionals, representing six different organizations, sought to test the accuracy and speed of the Neuroreader software in detecting changes in brain volume on MRIs. Neuroreader, a product of Denmark-based medical technology company Brainreader, is a U.S. Food and Drug Administration-cleared software program for assessment of clinical volume on brain MRIs.
Titled, "Quantitative Neuroimaging Software for Clinical Assessment of Hippocampal Volumes on MR Imaging," the research was performed independently in Denmark and at the Medical College of Wisconsin, with both studies producing similar results. One of the study's lead authors and the inventor of Neuroreader, Dr. Jamila Ahdidan, conducted a study at her Brainreader labs, while Edgar A. DeYoe, PhD, a professor in the Department of Radiology at the Medical College of Wisconsin, replicated the study independently in his facility.
Research compared the results of 1.5 T and 3.0 T MRI scans processed by Neuroreader with those which were traced manually by expert anatomists and radiologists. Prior to the onset of neuroimaging software, manual tracing has been the "gold standard"—the most accurate method—used among healthcare professionals.
Measuring the level of spatial overlap between Neuroreader and "gold standard" manual segmentation, Neuroreader was on average more than 87% accurate in its agreement with the gold standard method, but could accomplish this task in a fraction of the time - in about 5 minutes per scan compared to 30 minutes for manual segmentation.
The study's results indicate that neuroimaging software, because it allows radiologists to quickly detect subtle changes in brain volumes, can be a vital tool in the early diagnosis of Alzheimer's and other degenerative brain diseases.
"For more than 30 years, since the development of the Magnetic Resonance Imaging scanner, the MRI has been the go-to test equipment to find abnormalities in brain volume, which provides strong indication of brain trauma or disease," said Dr. Oscar Lopez, of the University of Pittsburgh's Department of Neurology. "Neuroreader adds value to any MRI scanner by providing fast and accurate measurements of brain structure."
David Merrill, a geriatric psychiatrist at UCLA said, "In applying Neuroreader to my patients with memory loss what I find it most useful for is helping me understand which patients do not have Alzheimer's. Many persons with psychiatric disorders but not Alzheimer's have cognitive problems."
Dr. Dale E. Bredesen, Professor of Neurology at UCLA and founding President and CEO of the Buck Institute for Research on Aging, said, "Regional brain volumes are critical, not only for identifying and differentiating neurodegenerative processes such as Alzheimer's disease, but also for documenting successful therapeutic approaches."
According to John L. Ulmer, MD, Director of Neuroradiology at the Medical College of Wisconsin, "People at risk for Alzheimer's dementia need to know their hippocampal volumes as an important number - just as someone at risk for a heart attack would need to know their cholesterol count."
Provided by IOS Press
Tuesday, October 20, 2015
More than 11 moles on your arm could indicate higher risk of melanoma
Researchers at King's College London have investigated a new method that could be used by GPs to quickly determine the number of moles on the entire body by counting the number found on a smaller 'proxy' body area, such as an arm.
20 oct 2015--Naevus (mole) count is one of the most important markers of risk for skin cancer despite only 20 to 40 per cent of melanoma arising from pre-existing moles. The risk is thought to increase by two to four per cent per additional mole on the body, but counting the total number on the entire body can be time consuming in a primary care setting.
Previous studies on a smaller scale have attempted to identify mole count on certain body sites as a proxy to accurately estimate the number on the body as a whole and found that the arm was the most predictive.
This study, funded by the Wellcome Trust, used a much larger sample of participants to identify the most useful 'proxy' site for a full body mole count as well as the 'cut off' number of moles that can be used to predict those at the highest risk of developing skin cancer.
The researchers used data from 3594 female Caucasian twins between January 1995 and December 2003 as part of the TwinsUK study protocol. Twins underwent a skin examination including recording skin type, hair and eye colour and freckles as well as mole count on 17 body sites performed by trained nurses. This was then replicated in a wider sample of male and female participants from a UK melanoma case control study published previously.
Scientists found that the count of moles on the right arm was most predictive of the total number on the whole body. Females with more than seven moles on their right arm had nine times the risk of having more than 50 on the whole body and those with more than 11 on their right arm were more likely to have over 100 on their body in total, meaning they were at a higher risk of developing a melanoma.
These findings could help GPs to more easily identify those at the highest risk of developing a melanoma (skin cancer).
Scientists also found that the area above the right elbow was particularly predictive of the total body count of moles. The legs were also strongly associated with the total count as well as the back area in males.
Lead author, Simone Ribero of the Department of Twin Research & Genetic Epidemiology said: "This study follows on from previous work to identify the best proxy site for measuring the number of moles on the body as a whole. The difference here is that it has been done on a much larger scale in a healthy Caucasian population without any selection bias and subsequently replicated in a case control study from a similar healthy UK population, making the results more useful and relevant for GPs.
"The findings could have a significant impact for primary care, allowing GPs to more accurately estimate the total number of moles in a patient extremely quickly via an easily accessible body part. This would mean that more patients at risk of melanoma can be identified and monitored."
The study is being published in the British Journal of Dermatology.
Provided by King's College London
Monday, October 19, 2015
8 fresh ways fruits and vegetables are getting into your diet
Half of Americans are determined to eat more fruits and vegetables this year according to Innova Market Insights. Because fruits and vegetables are now in just about every food and beverage category, consumers shouldn't have a problem doing so.
19 oct 2015-- In the October issue of Food Technology magazine published by the Institute of Food Technologists (IFT), senior associate editor Karen Nachay looks at eight different ways fruits and vegetables are turning up in unexpected places.
Cauliflower: From 2013 to 2014 Innova Market Insights found a 22 percent increase in global product launches containing cauliflower. It can be roasted, mashed, pureed and included in everything from pizza to ice cream.
Exotic Fruits and Vegetables: Consumers are becoming more willing to try more than just apples and oranges these days and fruits and vegetables like kohlrabi, rhubarb, dragon fruit, passion fruit, sour cherry, prickly pear, and celeriac are easier to find in your local grocery store.
Cruciferous Vegetables: Now that consumers are realizing that these types of vegetables can taste good when properly prepared (CCD Innovation Culinary Trend Mapping Report, 2014), chefs are turning to unique preparations of parsnips, turnips, rutabagas, dinosaur kale and sea vegetables.
Coconut Water: New blends of coconut water with other fruit and vegetable juices highlight tropical fruits like mango and even spinach, red beet, and carrot juices.
Yogurt: Yogurt is taking on a savory twist with the addition of new flavors like sweet potato, beet, butternut squash, tomato, kimchi, coconut lemongrass, fig and parsnip.
Chilled Soups: While most people think of gazpacho as tomato-based cold soup, the addition of new fruits and vegetables like papaya, watermelon, cucumber, and lemon coriander give this classic soup a new appeal.
Sweet Potatoes: Sweet potatoes are no longer just ingredients in pies and side dishes; companies are using sweet potatoes as ingredients in juices, muffins, cheesecake, sauces, and even beer.
Natural Food Coloring: As consumers are scrutinizing food labels with synthetic ingredients, manufacturers are turning to fruits and vegetables for naturally derived coloring options. Fruits and vegetables can be minimally processed into purees or juice concentrates to extract the pigments that give them their color.
The size of your hippocampi could indicate your risk of cognitive impairment
Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.17 oct 201--A larger brain volume could indicate a reduced risk of memory decline according to research published in the open access journal Alzheimer's Research and Therapy.
The preliminary study of 226 people indicates that an association between brain volume, in particular the size of one's hippocampi, and one's memory, could predict one's likelihood of cognitive impairment, such as dementia. Further research is needed to confirm what exact role the hippocampi play in the onset of cognitive impairment.
Our hippocampi, a pair of seahorse looking structures located in the left and right sides of the brain, are responsible for forming new memories. When these are impaired, as in Alzheimer's disease, it becomes difficult to remember recent acts or events. Previous studies have suggested that their size could be used as a standard assessment, indicating those at increased risk for the development of Alzheimer's disease.
The left hippocampus is associated with verbal retention, while the right is associated with spatial memory, for example, the geographical layout of your hometown.
The researchers examined a total of 226 memory clinic patients to see if there was any indication of those who may be at higher risk of developing dementia. This was a large group of patients, for this type of study, with various forms of neurodegenerative disorders; 34 were diagnosed with Alzheimer's disease and 82 have amnestic Mild Cognitive Impairment, which can be a precursor to Alzheimer's disease.
The patients performed memory tests. The first test assessed their verbal memory by analyzing their ability to recall lists of words read out to them. The subjects then performed spatial tests to see how well they could remember geometric shapes and patterns. Following on from this, the researchers analyzed brain scans recorded from magnetic resonance imaging. Individuals with 'normal memory' had larger hippocampi and performed better in memory tasks than those with cognitive impairment.
Aaron Bonner-Jackson, the lead author of the study, from Center for Brain Health at the Cleveland Clinic, USA, says, "We found that a large left or right hippocampus could indicate a better verbal or spatial memory. We suggest that performance on the spatial memory task is a more sensitive measure of hippocampal volumes than performance on the verbal memory task. This challenges earlier studies and clinical trials which focused on verbal memory alone, as we're now finding that spatial memory is a bigger player in assessment of those at risk for Alzheimer's disease."
Bonner-Jackson adds: "We want to detect the earliest signs of dementia and this link between the performance on standard clinical measures of memory and changes in the hippocampus could be another hallmark sign of Alzheimer's disease."
"We restricted our analysis only to the hippocampus, but the relationship between other brain structures, such as thalamus and amygdala, and Alzheimer's disease should also be examined. Although this is one of the largest studies looking at the role hippocampi play in the onset of dementia, further investigation is needed to confirm the relationship. Clinical trials of Alzheimer's disease therapies should then consider these findings in designing new medications."
This study was observational, so it can increase our understanding of possible links between hippocampal volume and memory decline, but it cannot show cause and effect because other factors may play a role. More information: Aaron Bonner-Jackson et al. Verbal and non-verbal memory and hippocampal volumes in a memory clinic population, Alzheimer's Research & Therapy (2015). DOI: 10.1186/s13195-015-0147-9
Provided by BioMed Central
Friday, October 16, 2015
Pros and cons of annual physical discussed
16 oct 2015—The pros and cons of the annual physical are discussed in two perspective pieces published online Oct. 14 in the New England Journal of Medicine.
Allan H. Goroll, M.D., from Massachusetts General Hospital in Boston, discussed the appeal of the annual physical, which is supported by patients and physicians despite a lack of hard evidence of its benefits. The author suggests that the appeal lies in people's desire to maintain a close and trusting relationship with their personal physician. Benefits of a therapeutic relationship include enhancements in functional status, patient satisfaction, and adherence to medication regimens. The annual physical should be improved, perhaps by transitioning to a team effort, and could function as an annual health review, the author writes.
Ateev Mehrotra, M.D., M.P.H., from Harvard Medical School in Boston, and Allan Prochazka, M.D., from the University of Colorado Health Sciences Center in Denver, discussed the case for elimination of the annual physical. They note that two systematic reviews concluded that annual physicals do not reduce morbidity or mortality, although they may reduce patient worry and increase preventive careuse. Evidence has suggested potential harms of annual visits. The authors recommended a three-step approach that includes creating a new type of visit whose role is to establish relationships, ensuring that patients' preventive care is up to date, and eliminating reimbursement for annual physicals.
"We believe it's time to act on this evidence and stop wasting precious primary care time by having a third of the adult population come in for such visits," Mehrotra and Prochazka write.
Despite the stereotype that older adults often ramble or talk off topic, seniors who enjoy socializing are able to adapt their conversations to a listener's age, says a University of Michigan researcher.
15 oct 2015--Knowing what the listener will find relevant helps position a speaker as an attentive and sensitive conversational partner, says Deborah Keller-Cohen, professor of education, linguistics and women's studies.
This is an important skill in many "life" situations, she says. For example, a senior who gives incomplete information or off-topic details to a doctor, rather than provide a succinct narrative about their health, may not receive the level of care needed.
Keller-Cohen analyzed whether older adults could modify their speech when speaking to a child or another adult. She also sought to address how seniors' social network and living arrangements affect the way they speak to listeners of different ages.
A sample of 34 adults, whose ages ranged from 75 to 90, rated their social interactions, such as the frequency, satisfaction and number of people with whom they interacted. Study participants were asked to describe how to make a grilled cheese or egg salad sandwich to two fictive listeners: a 10-year-old boy and a 30-year-old adult. Their words and phrases were then analyzed.
Older adults provided more information and a more restricted range of words when talking to a child. In contrast, when an adult was the listener, older adults often used a variety of different words in their explanations.
"This indicates they were sensitive to the diversity of vocabulary their listener was likely to possess," Keller-Cohen said.
Older adults with more frequent social interactions also provided more information to the child, the study indicated.
The findings appear in the current issue of Research on Aging.
More information: D. Keller-Cohen. "Audience Design and Social Relations in Aging," Research on Aging (2014). DOI: 10.1177/0164027514557039
Provided by University of Michigan
Wednesday, October 14, 2015
Confirm high blood pressure outside doctor's office, US task force says
Expert group advises ambulatory or home monitoring before starting treatment.14 oct 2015—High blood pressure levels should generally be confirmed with home or ambulatory blood pressure monitoring before starting treatment for hypertension, a new U.S. Preventive Services Task Force (USPSTF) recommendation says.
Many factors can affect blood pressure readings, such as stress, physical activity and caffeine or nicotine, the USPSTF said. And, some people experience "white-coat hypertension"—an increase in blood pressure at the doctor's office from stress—when having their blood pressure taken.
All of these factors can make it hard to tell if someone really has high blood pressure, the researchers said.
That's why the Task Force recommends confirming a diagnosis of high blood pressure, or hypertension, before starting treatment, unless someone has very high blood pressure that needs to be treated right away.
"For most patients, elevated blood pressure readings in the doctor's office should be confirmed outside the doctor's office before starting treatment," said Task Force vice-chair Dr. Kirsten Bibbins-Domingo.
"For individuals who have very high blood pressure or other health problems, such as heart or kidney damage, that might make it critical to lower blood pressure, this recommendation doesn't really apply to them. This recommendation is really for individuals where one wants to confirm high blood pressure," Bibbins-Domingo said.
Blood pressure levels can be confirmed with ambulatory blood pressure monitoring. Your doctor will provide a small, portable device that automatically measures your blood pressure every 20 to 30 minutes over 12 to 48 hours. If this method isn't available, people can take their blood pressure at different times throughout the day using home blood pressure monitoring, the USPSTF said.
The Task Force recommendations were published online Oct. 12 in the Annals of Internal Medicine.
Ambulatory blood pressure monitoring is the first choice for confirming a diagnosis of high blood pressure, the Task Force said. But, when not available, home monitors are an acceptable alternative.
Home blood pressure monitoring devices can cost from less than $20 to $100 or more, according to Consumers Union. Devices that use upper arm readings—rather than finger or wrist—are considered more accurate, the American Heart Association (AHA) says. But, it's important that the cuff that wraps around your arm fits properly, the AHA advises.
The dangers of sustained high blood pressure include an increased risk for heart attack, stroke, kidney disease and heart failure, the USPSTF said. High blood pressure is a leading cause of death in the United States, particularly among older Americans, Bibbins-Domingo said.
Dr. Gregg Fonarow is a spokesman for the AHA and a professor of cardiology at the University of California, Los Angeles. He said, "Nearly one in three adult men and women in the United States have high blood pressure. However, way too many adults do not have their elevated blood pressure adequately detected and treated, and as a result are at risk for heart attacks and strokes that could have been prevented."
The Task Force's recommendations reinforce that it's essential for all adults to have their blood pressure checked at least once a year, he said. The latest guidelines also emphasize the need to take action to achieve and maintain a healthy blood pressure level in consultation with their doctor, Fonarow said.
"It is well established that systolic blood pressure above 120 mm Hg results in a greater risk of heart disease and stroke," he said. Systolic blood pressure is the top number in a reading.
"New trial results demonstrate that treating systolic blood pressure to achieve a goal of 120 mm Hg lowers the risk of death from any cause, compared with treating to a conventional goal of 140 mm Hg," Fonarow said, adding that the USPSTF's treatment section needs to be updated to reflect this new information.
More information: For advice on selecting a home blood pressure monitor, go to the American Heart Association.
Tuesday, October 13, 2015
Red wine with dinner can improve cardiovascular health of people with type 2 diabetes
A glass of red wine every night may help people with type 2 diabetes manage their cholesterol and cardiac health, according to new findings from a two-year randomized controlled trial (RCT) led by researchers at Ben-Gurion University of the Negev (BGU). Additionally, both red and white wine can improve sugar control, depending on alcohol metabolism genetic profiling.
13 oct 2015--In this first long-term alcohol study, just published in the prestigious Annals of Internal Medicine, the researchers aimed to assess the effects and safety of initiating moderate alcohol consumption in diabetics, and sought to determine whether the type of wine matters.
People with diabetes are more susceptible to developing cardiovascular diseases than the general population and have lower levels of "good" cholesterol. Despite the enormous contribution of observational studies, clinical recommendations for moderate alcohol consumption remain controversial, particularly for people with diabetes, due to lack of long-term, randomized controlled trials, which are the "holy grail" of evidence-based medicine.
"Red wine was found to be superior in improving overall metabolic profiles, mainly by modestly improving the lipid profile, by increasing good (HDL) cholesterol and apolipoprotein A1 (one of the major constituents of HDL cholesterol), while decreasing the ratio between total cholesterol and HDL cholesterol," the researchers explain.
The researchers concluded that "initiating moderate wine intake, especially red wine, among well-controlled diabetics, as part of a healthy diet, is apparently safe, and modestly decreases cardio-metabolic risk. The differential genetic effects that were found may assist in identifying diabetic patients in whom moderate wine consumption may induce greater clinical benefit."
The researchers also found that only the slow alcohol-metabolizers who drank wine achieved an improvement in blood sugar control, while fast alcohol-metabolizers (with much faster blood alcohol clearance) did not benefit from the ethanol's glucose control effect. Approximately one in five participants was found to be a fast alcohol-metabolizer, identified through ADH enzyme genetic variants tests.
Wine of either type (red or white) did not effect change in blood pressure, liver function tests, adiposity, or adverse events/symptoms. However, sleep quality was significantly improved in both wine groups, compared with the water control group. All comparisons were adjusted for changes in clinical, medical and drug therapy parameters occurring among patients during the years of the study.
The two-year CArdiovaSCulAr Diabetes and Ethanol (CASCADE) randomized controlled intervention trial was performed on 224 controlled diabetes patients (aged 45 to 75), who generally abstained from alcohol. They gradually initiated moderate wine consumption, as part of a healthy diet platform, and not before driving. The trial completed with an unprecedented adherence rate of 87 percent after two years.
According to BGU's Prof. Iris Shai, principal investigator of the CASCADE trial, and a member of the Department of Public Health in the Faculty of Health Sciences, "The differences found between red and white wine were opposed to our original hypothesis that the beneficial effects of wine are mediated predominantly by the alcohol. Approximately 150ml of the dry red or white tested wines contained ~17g ethanol and ~120kCal, but the red wine had sevenfold higher levels of total phenols and 4 to 13-fold higher levels of the specific resveratrol group compounds than the white wine. The genetic interactions suggest that ethanol plays an important role in glucose metabolism, while red wine's effects additionally involve non-alcoholic constituents. Yet, any clinical implication of the CASCADE findings should be taken with caution with careful medical follow-up."
The study was performed in collaboration with Prof. Meir Stampfer from Harvard University, USA, and with colleagues from University of Leipzig, Germany and Karolinska Institute, Sweden.
In the new study that followed the research group's three-month alcohol pilot RCT findings (Shai I, et al., Diabetes Care 2007), the patients were randomized into three equal groups according to whether they consumed a five-ounce serving (150ml) of mineral water, white wine or red wine with dinner every night for two years. Wine and mineral water were provided free of charge for the purposes of the study. Compliance with alcohol intake was tightly monitored, with patients returning their empty wine bottles and receiving their new supplies. All groups followed a non-calorie-restricted Mediterranean diet (following the group's previous two-year dietary RCT findings; Shai I, et al., NEJM 2008). Adherence was monitored using several validated assessment tools.
During the study, subjects underwent an array of comprehensive medical tests, including continuous monitoring of changes in blood pressure, heart rate and blood glucose levels, and follow-up for the dynamic of atherosclerosis and fat by ultrasound and MRI tests.
Provided by American Associates, Ben-Gurion University of the Negev
Monday, October 12, 2015
Pain is in the brain
Chronic pain results from disease or trauma to the nervous system. Damaged nerve fibres with heightened responses to normal stimuli send incorrect messages to pain centres in the brain. This phenomenon, called "peripheral and central sensitization" is one of the key mechanisms involved in the condition which touches people with diabetes, cancer, and those suffering from multiple sclerosis, among others.
More information: Peripheral Neuropathy Induces HCN Channel Dysfunction in Pyramidal Neurons of the Medial Prefrontal Cortex, The Journal of Neuroscience, 23 September 2015, 35(38): 13244-13256; DOI: 10.1523/JNEUROSCI.0799-15.2015
11 oct 2015—Inclusion of the coronary artery calcium (CAC) score improves coronary heart disease (CHD) risk prediction, while the absence of CAC reclassifies many patients as not eligible for statins, according to two studies published in the Oct. 13 issue of the Journal of the American College of Cardiology.
Robyn L. McClelland, Ph.D., from the University of Washington in Seattle, and colleagues derived and validated a novel risk score to estimate 10-year CHD risk using CAC and other traditional risk factors. The algorithm was developed in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort involving 6,814 participants. The researchers observed significant improvement in risk prediction with inclusion of CAC in the MESA risk score (C-statistic, 0.80 versus 0.75; P < 0.0001). Evidence of very good discrimination and calibration was seen in external validation in two studies.
Khurram Nasir, M.D., M.P.H., from Baptist Health South Florida in Miami, and colleagues examined the implications of the absence of CAC in reclassifying patients from a risk stratum in which statins are recommended to one in which they are not. Data were included from 4,758 participants from the MESA cohort. The researchers found that for most of the 50 percent of participants eligible for statins, eligibility was due to having a 10-year estimated atherosclerotic cardiovascular disease risk of ≥7.5 percent. Forty-one percent of those recommended statins had CAC = 0. Of the participants eligible (recommended or considered) for statins, 44 percent had CAC = 0 at baseline.
"The absence of CAC reclassifies approximately one-half of candidates as not eligible for statin therapy," the authors write.
One author from the McClelland study disclosed financial ties to General Electric. Several authors from the Nasir study disclosed financial ties to the pharmaceutical, biotechnology, and technology industries.
Study compares traditional and modern views of aging
Participants from traditional and modern societies were asked to point at an older (right) or younger face in response to a set of questions intended to gauge perceptions about aging. The older and younger faces were of the same person, with the younger face digitally altered to appear older.A new study tests the idea that traditional societies see aging in a more positive light than modern societies, a presumption supported by anecdotes and personal narratives but lacking systematic cross-cultural research.
More information: Piotr Sorokowski et al. "Aging Perceptions in Tsimane' Amazonian Forager–Farmers Compared With Two Industrialized Societies," The Journals of Gerontology Series B: Psychological Sciences and Social Sciences (2015). DOI: 10.1093/geronb/gbv080
Provided by Cornell University
Friday, October 09, 2015
Dying at home leads to more peace and less grief, but requires wider support
Dying at home could be beneficial for terminally ill cancer patients and their relatives, according to research published in the open access journal BMC Medicine.
09 oct 2015--The study shows that, according to questionnaires completed by their relatives, those who die at home experience more peace and a similar amount of pain compared to those who die in hospital, and their relatives also experience less grief. However, this requires discussion of preferences, access to a comprehensive home care package and facilitation of family caregiving.
Previous studies have shown that most people would prefer to die at home. In the UK, US and Canada, slightly more appear to be realising this wish, while in Japan, Germany, Greece and Portugal, a trend towards institutionalised dying persists.
Despite differing trends, the most frequent location of death for cancer patients remains hospital. Evidence regarding whether dying at home is better or worse than in hospital has, however, been inconsistent.
The new study took place in four health districts in London covering 1.3 million residents. 352 bereaved relatives of cancer patients completed questionnaires after their death - 177 patients died in hospital and 175 died at home. The questionnaires included validated measures of the patient's pain and peace in the last week of life and the relative's own grief intensity.
Lead author Barbara Gomes from the Cicely Saunders Institute at King's College London, UK, said: "This is the most comprehensive population-based study to date of factors and outcomes associated with dying at home compared to hospital. We know that many patients fear being at home believing they place an awful burden on their family. However, we found that grief was actually less intense for relatives of people who died at home.
"Many people with cancer justifiably fear pain. So it is encouraging that we observed patients dying at home did not experience greater pain than those in hospitals where access to pain relieving drugs may be more plentiful. They were also reported to have experienced a more peaceful death than those dying in hospital."
The study found that over 91% of home deaths could be explained by four factors: patient's preference; relative's preference; receipt of home palliative care in the last three months of life and receipt of district/community nursing in the last their months of life. When Marie Curie nurses (which provide additional home support) were involved, the patient rarely died in hospital. The number of general practitioner home visits also increases the odds of dying at home.
Three additional factors were also identified that had been previously overlooked - length of family's awareness of that the condition could not be cured, discussion of patient's preference with family, and the days taken off work by relatives in the three months before death. The authors say this challenges current thinking about the influence of patient's functional status, social conditions, and living arrangements, which showed no association once other factors are considered.
Barbara Gomes said: "Our findings prompt policymakers and clinicians to improve access to comprehensive home care packages including specialist palliative care services and 24/7 community nursing. This is important because, in some regions, the workforce providing essential elements of this care package is being reduced."
The researchers also highlight the crucial role of families in caring for patients at home and in decision-making processes, and the need to facilitate family caregiving.
Barbara Gomes added: "Many relatives see dedicated care as something they would naturally do for their loved one, but it still represents out-of-pocket money or days off their annual leave. Some governments, for example, in Canada, the Netherlands, Norway and Sweden, have set up social programmes or employment insurance benefits, similar to maternity leave, aimed at supporting families to provide care for their dying relatives.
"We urge consideration of similar schemes where they do not exist, with the necessary caution associated with complex public health interventions - careful development, piloting and testing, prior to implementation."
Limitations of the study include its retrospective and observational nature, showing associations which do not necessarily indicate causality. The transferability of findings to regions outside of London, where home care services are less available, is uncertain. Subjective factors, pain and peace are also vulnerable to recall and observer bias from respondents.
More information: Barbara Gomes et al. Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study, BMC Medicine (2015). DOI: 10.1186/s12916-015-0466-5
Provided by BioMed Central
Thursday, October 08, 2015
USPSTF recommends CRC screening for 50- to 75-year-olds
08 oct 2015—The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer (CRC) screening starting at age 50 years and continuing through age 75 years. These findings form the basis of a draft recommendation statement, published Oct. 5 by the USPSTF.
Researchers from the USPSTF conducted a systematic review of the evidence relating to screening for CRC. They examined the effectiveness or comparative effectiveness of screening tests on CRC incidence and mortality; diagnostic accuracy of screening tests; and harms of screening.
The USPSTF recommends CRC screening for adults aged 50 to 75 years; variation was seen in the risks and benefits of different screening methods (grade A recommendation). For adults aged 76 to 85 years, the decision to screen for CRC should be an individual one based on patient health and prior screening history (grade C recommendation). The draft recommendation statement is available for public comment from Oct. 6 through Nov. 2.
"Colorectal cancer screening is a very effective, but underused, health promotion strategy in the United States," USPSTF member, Douglas K. Owens, M.D., said in a statement. "The evidence is clear that adults ages 50 to 75 years will substantially benefit from getting screened, but about one-third of these people have never done so."
Britain topped an 80-country "quality of death" study released Tuesday, which warned that ageing and booming populations would make palliative care a growing worldwide issue. The 2015 Quality of Death Index, compiled by the London-based Economist Intelligence Unit, found Britain to be the best at palliative care.
07 oct 2015--"Its ranking is due to comprehensive national policies, the extensive integration of palliative care into the National Health Service, a strong hospice movement, and deep community engagement on the issue," the EIU said.
Britain was followed by Australia, New Zealand, Ireland, Belgium and Taiwan.
Palliative care provision was found to be worst in Iraq among the 80 countries studied, with Bangladesh, the Philippines, Nigeria and Myanmar rounding out the bottom five.
The report praised progress made by less wealthy states.
"Many developing countries are still unable to provide basic pain management due to limitations in staff and basic infrastructure," it said.
"Yet some countries with lower income levels demonstrate the power of innovation and individual initiative."
It said Panama (31st) was building palliative care into its primary care services, Mongolia (28th) had seen rapid growth in hospice facilities, while Uganda (35th) had made impressive advances in the availability of opioid painkillers.
China (71st) was found to be among the most vulnerable from population ageing and rising incidences of conditions such as cardiovascular disease.
"The adoption of palliative care in China has been slow, with a curative approach dominating healthcare strategies," the study found.
"Many other developing countries will also need to work hard to meet rising future need as the incidence of non-communicable disease increases and their populations grow older," the report said.
The study found that income levels correlated strongly with success in delivering palliative care, though some, such as Singapore (12th), Hong Kong (22nd) and Saudi Arabia (60th), were lagging.
The study said that, overall, palliative care was rising up the agenda as "seismic demographic shifts" force governments to confront the reality of providing for ageing populations.
Wealthy nations will have to shift from curative care to managing long-term conditions.
Meanwhile developing countries would have to deal with booming populations and increasingly unhealthy lifestyles that will force healthcare systems to adapt to chronic condition like diabetes.
Women with Alzheimer's-related gene lose weight more sharply after age 70
Researchers led by Deborah Gustafson, PhD, MS, professor of neurology at SUNY Downstate Medical Center, have shown that women with a gene variant (APOEe4 allele) associated with Alzheimer's disease experience a steeper decline in body mass index (BMI) after age 70 than those women without the version of the gene, whether they go on to develop dementia or not. The finding adds to a body of evidence suggesting that body weight change may aid in the diagnosis and management of Alzheimer's disease.
06 oct 2015--The results of the study are published online in the Journal of Alzheimer's Disease 48(4). The article is entitled, "37 Years of Body Mass Index and Dementia: Effect Modification by the APOE Genotype: Observations from the Prospective Population Study of Women in Gothenburg, Sweden." Dr. Gustafson is also docent and affiliate researcher, University of Gothenburg, Sahlgrenska Academy, Neuropsychiatric Epidemiology Research Unit, in Sweden.
Dr. Gustafson notes that women tend to evidence a U-shaped relationship between age and body weight or body mass index (BMI), a common marker of overweight and obesity. From middle age to approximately 70 years of age, adults gain weight on average. After age 70, weight tends to decrease on average. This weight change over the life course may be due to aging, changes in body composition, energy metabolism, sensory changes, and changes in the brain related to regulation of basic body processes.
Among adults who develop dementia, however, the life course of BMI differs. Studies have shown that being more overweight or obese in mid-life may increase risk for dementia. Studies have also shown that after age 70 years, adults who develop dementia may lose weight more rapidly compared to those who do not develop dementia and that if one is a bit more overweight in later life, it is protective for both dementia and death.
Dr. Gustafson explains, "In this study, we followed Swedish women for almost 40 years from mid-life ages of 38-60 years. We tracked their BMI in relation to dementia onset, and considered the potential role of the APOEe4 allele, a known risk factor for late-onset dementia." She adds, "In a previous publication, we showed that development of dementia is associated with specific pattern of BMI change over the life course. Women who developed dementia after age 65 tended to gain BMI at a slower rate during middle age."
Dr. Gustafson concludes, "Now, we show that those with the APOEe4 allele experience greater or steeper decline in BMI after age 70 years, whether they develop dementia or not. Body weight change and BMI are easily measured, noninvasive potential prognostic indicators for dementia. Better understanding of a relatively common risk allele such as APOEe4 and how it modifies risk may aid in our understanding of how we can better intervene among those at highest risk for dementia."
More information: Bäckman, EJ, Waern, M, Östling, S, Guo,X, Blennow, K, Skoog, I, Gustafson, DR, 37 Years of Body Mass Index and Dementia: Effect Modification by the APOE Genotype: Observations from the Prospective Population Study of Women in Gothenburg, Sweden, Journal of Alzheimer's Disease (2015), DOI: 10.3233/JAD-150326
Provided by SUNY Downstate Medical Center
Saturday, October 03, 2015
Five things women should know about breast cancer
UC San Francisco's Dr. Laura Esserman leads the Athena Breast Health Network. Credit: Susan Merrell/UC San FranciscoDr. Laura Esserman is filled with hope this Breast Cancer Awareness Month. The UC San Francisco surgeon is gearing up for a five-year study that will tap into technology to improve breast cancer screening and patient outcomes.
03 oct 2015--Esserman leads the Athena Breast Health Network, a collaboration of the five University of California medical centers and partners that will soon launch the WISDOM study. The study—Women Informed to Screen Depending on Measures of Risk—with $14.1 million from the Patient-Centered Outcomes Research Institute, will investigate whether a personalized approach to breast cancer screening is as safe and effective as annual mammograms.
Breast cancer is the most common kind of cancer among American women, except for skin cancer, and the second leading cause of cancer death in women, exceeded only by lung cancer.
But emerging knowledge offers reason for optimism. Here are five things women should know about breast cancer, according to Esserman.
1. Breast cancer isn't one disease.
"Breast cancer is, in fact, many diseases," Esserman said. "Some can be indolent (unlikely to cause patients harm) and some can be very aggressive. We don't want to treat them the same. Two people might walk into my office, both age 50, have the same size tumor, but it might be appropriate to have different treatments. A patient may have a condition that doesn't make radiation possible. You have to make sure patients understand all of their options and are comfortable with their decisions because there's more than one choice."
2. Not all breast cancer is life threatening.
More than 1 in 5 new cases of breast cancer diagnosed in U.S. women are ductal carcinoma in situ (DCIS or "stage zero" cancer), according to the American Cancer Society. While this often is treated aggressively, evidence suggests that may be unnecessary for some patients, Esserman said.
"Low-grade DCIS, I think, should not be called cancer at all," she said. "These conditions can be watched and not treated as aggressively. One size does not fit all. We've got lots of data. It's time to take what we've learned and change practice. We can continue to refine screening so low-grade DCIS doesn't have to be a target for screening. It's not just about finding every abnormality in the breast; it's about finding people at high risk, finding consequential cancers and changing outcomes with interventions early on."
3. Not everyone needs the same approach to screening.
The annual mammogram recommendation is based on 30-year-old evidence, Esserman said.
"It's high time to have a modern trial where we try to figure out who is at risk for different types of breast cancer. That's what the WISDOM study is all about: Set up a framework where we can learn much more quickly. We are going to test what many people still consider to be the gold standard: one mammogram a year for women 40 and over.
"We're working with a next-generation sequencing company, Color Genomics. We're trying to define from the genetics side what influences risk and then we're going to test it to see if it improves screening. We'll integrate the data on a Salesforce platform. We're going to generate a risk for women and that will trigger when to start screening, when to stop screening and how often to screen.
"Over time we'll learn who is at risk for breast cancer and who is at risk for different interventions. If this works, this could be a good paradigm to approach any disease."
4. Consider participating in a clinical trial.
Improvements in clinical care depend on scientific research. Currently only 3 to 5 percent of women participate in clinical trials. The goal is to get consideration of clinical trials to be the norm rather than the exception.
Esserman encourages women to join the WISDOM study.
"We're trying to recruit 100,000 women for the WISDOM study," Esserman said. "We're asking women to share their stories and their wisdom. The only way to know better is to study the alternatives. In screening, the only way to know better is to be part of the WISDOM study.
"We're asking providers to be open. We hope at the end of this trial, we'll have a better model for risk assessment.
"We're asking payers and insurers to step up to the plate and implement coverage for risk-based screening, just as they currently do for annual screening. UC Health is supporting this program for all the people who get benefits from UC Care. Blue Shield has stepped up, too. We're in conversation with a number of companies and insurers to participate as well."
5. Precision medicine shows promise.
"The essence of precision medicine is being able to tailor treatment to biology, patient preference and clinical performance," Esserman said.
"The WISDOM study is precision screening. We want to be smarter. We want to do it just right. It's 'Moneyball' for medicine. The story of the Oakland A's is how people discovered that statistics tell a story that can actually affect strategies and improve outcomes. Think about the data on every player that you have at your fingertips – data that can help to make better decisions. We need that same kind of data at our fingertips in medicine, so that we can keep improving the field. That's what our partnership with Salesforce is all about: How do we take advantage of technology to make medicine better?
"This is not a study that any one institution could accomplish on its own. UC is really interested in population health, and we have the power to collect and address these big issues that matter to the public. I think that we're going to find this is a much more efficient way to screen. It will help us figure out how best to prevent breast cancer," Esserman said.
Provided by University of California, San Francisco
