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2012-02-01T01:11:00.000Z

Women report feeling pain more intensely than men: study

Women report more-intense pain than men in virtually every disease category, according to Stanford University School of Medicine investigators who mined a huge collection of electronic medical records to establish the broad gender difference to a high level of statistical significance.

01 feb 2012--Their study, to be published online Jan. 23 in the Journal of Pain, suggests that stronger efforts should be made to recruit women subjects in population and clinical studies in order to find out why this gender difference exists.

The study also shows the value of EMR data mining for research purposes. Using a novel database designed especially for research, the Stanford scientists examined more than 160,000 pain scores reported for more than 72,000 adult patients. From these, they extracted cases where disease-associated pain was first reported, and then stratified these findings by disease and gender.

"None of these data were initially collected for research, but this study shows that we can use it in that capacity," said Atul Butte, MD, PhD, the study's senior author.

The medical literature contains numerous reports indicating that women report more pain than men for one or another particular disease, noted Butte, a professor of systems medicine in pediatrics. "We're certainly not the first to find differences in pain among men and women. But we focused on pain intensity, whereas most previous studies have looked at prevalence: the percentage of men vs. women with a particular clinical problem who are in pain. To the best of our knowledge, this is the first-ever systematic use of data from electronic medical records to examine pain on this large a scale, or across such a broad range of diseases."

The study's first authors were Butte's graduate student Linda Liu and postdoctoral scholar David Ruau, PhD, who splits his time between Butte's group and that of co-author Martin Angst, MD, professor of anesthesia. David Clark, MD, PhD, a professor of anesthesia, was another co-author.

Electronic medical records are deployed in about 1-2 percent of hospitals now, but that should approach 100 percent within the next few years as the United States continues to move toward EMRs, Butte said. Thus, large-scale research using clinically collected data will become increasingly feasible.

In this case, the scientists tapped an existing data archive that has been designed specifically for ease of research: the Stanford Translational Research Integrated Database Environment, or STRIDE. Pioneered by the medical school's chief information officer, Henry Lowe, MD (who is also an associate professor of systems medicine in pediatrics and director of Stanford's Center for Clinical Informatics), STRIDE aggregates clinical data on patients cared for at Stanford Hospital & Clinics and Lucile Packard Children's Hospital, making this data searchable for approved research projects.

Butte's team selected only adult records and looked for gender-related differences in pain intensity as reported on 1-to-10 scales, in which a zero stands for "no pain" and 10 for "worst imaginable." Their search algorithm combed through de-identified EMR data for more than 72,000 patients, and came up with more than 160,000 instances, ranging across some 250 different disease categories, in which a pain score had been reported.

"If someone's reporting that they're in pain, they're probably going to be given medication, which might reduce any subsequently measured pain score," said Butte. To get pain estimates that weren't as confounded by subsequent pain-relief medications or procedures, his group analyzed only the first pain-intensity score reported by a patient per encounter with a hospital-associated health professional.

The search identified 47 separate diagnostic categories for which there were more than 40 pain reports for each gender. The sample included more than 11,000 individual adult patients, of which 56 percent were women and 51 percent of them white. The researchers were able to further analyze these 47 categories by condensing them into 16 disease clusters: "musculoskeletal and connective tissue" (in which the biggest gender differences in reported pain intensity were observed), "circulatory" and so forth.

"We saw higher pain scores for female patients practically across the board," said Butte. Those reported differences were not only statistically significant, but also clinically significant. "In many cases, the reported difference approached a full point on the 1-to-10 scale. How big is that? A pain-score improvement of one point is what clinical researchers view as indicating that a pain medication is working."

While the overall results tended to confirm previous clinical findings — for example, that female fibromyalgia or migraine patients report more pain than their male counterparts — the search also unearthed previously unreported gender differences in pain intensity for particular diseases, for example acute sinusitis and "cervical spine disorders," more commonly known as neck pain.

The study's results come with a few caveats. First, the investigators made the assumption that patients' pain hadn't already been treated—for example, that they hadn't already self-medicated with over-the-counter painkillers — by the time they showed up in the emergency room, doctor's office or neighborhood health clinic (or, equivalently, that the men and women were equally likely to have done so).

Other possible confounders include the setting in which pain was reported, Butte said. "Will an 18-year-old male report the same pain intensity with or without his mom present, or in the presence of a male vs. a female nurse? We can't be sure." But the sheer size of the study probably washes these concerns out at least to some extent, he said.

The third caveat is perhaps the most controversial. "It's still not clear if women actually feel more pain than men do," said Butte. "But they're certainly reporting more pain than men do. We don't know why. But it's not just a few diseases here and there, it's a bunch of them — in fact, it may well turn out to be all of them. No matter what the disease, women appear to report more-intense levels of pain than men do."

To get to the bottom of this, Butte's team plans to search EMRs to see if they can find some objective measurement — an already commonly measured blood-test variable, for instance — that correlates highly with reported pain. "We want to find a biomarker for pain," he said.

Provided by Stanford University Medical Center

2012-01-31T00:09:00.000Z

Two-arm blood pressure check indicator for risk from heart disease or death

A systematic review and meta-analysis carried out by researchers at the University of Exeter Peninsula College of Medicine and Dentistry (PCMD) has found that differences in systolic blood pressure between arms could be a useful indicator of the likelihood of vascular risk and death.

31 jan 2012--The findings add support to the calls for both-arm blood pressure checks to be performed as standard.

The review is published in The Lancet online today and the study is supported by the Royal College of General Practitioners, the South West GP Trust and the National Institute for Health Research Peninsula Collaboration for Leadership in Applied Health Research and Care.

The study reviewed 28 papers covering difference in systolic blood pressure between arms. It found significant evidence to suggest that a difference of 15mm Hg or more was associated with increased risk of: peripheral vascular disease (the narrowing and hardening of the arteries that supply blood to the legs and feet); pre-existing cerebrovascular disease (affecting the blood supply to the brain and often associated with cognitive issues such as dementia); and mortality, both as a result of cardiovascular problems and generally.

The risk of peripheral vascular disease was also increased at a difference of 10mm Hg or more.

The findings further support the need for both-arm blood pressure checks to be the norm – not least because most cases are 'clinically silent' and such checks would better identify those at risk.

Dr. Christopher Clark, Clinical Academic Fellow at PCMD and a GP in Witheridge, Devon, led the study. He said: "We set out to investigate whether there was an association between differences in systolic blood pressure between arms and vascular disease and mortality. Our findings indicate a strong association, and that differences of 10mm Hg or 15mm Hg or more might help to identify patients who are at risk and who need further vascular assessment. More research is required in order to transfer our findings to clinical practice, but in the meanwhile we will be flagging the results of our review to the UK Vascular Check programme."

More information: Paper online: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61710-8/abstract

Provided by The Peninsula College of Medicine and Dentistry

2012-01-30T00:03:00.000Z

Study: Men at higher risk for mild memory loss than women

Men may be at higher risk of experiencing mild cognitive impairment (MCI), or the stage of mild memory loss that occurs between normal aging and dementia, than women, according to a study published in the January 25, 2012, online issue of Neurology.

30 jan 2012--"These results are surprising, given that women generally have higher rates of dementia than men," said study author R.O. (Rosebud) Roberts, MB ChB, MS, of the Mayo Clinic in Rochester, Minn., and a member of the American Academy of Neurology. "The risk of MCI in men and women combined was high in this age group of elderly persons. This is disturbing given that people are living longer, and MCI may have a large impact on health care costs if increased efforts at prevention are not used to reduce the risk."

For the study, a group of 1,450 people from Olmsted County, Minn., between the ages of 70 and 89 and free of dementia at enrollment underwent memory testing every 15 months for an average of three years. Participants were also interviewed about their memory by medical professionals. By the end of the study period, 296 people had developed MCI.

The study found that the number of new cases of dementia per year was higher in men, at 72 per 1,000 people compared to 57 per 1,000 people in women and 64 per 1,000 people in men and women combined. MCI with memory loss present was more common at 38 per 1,000 people than MCI where memory loss was not present, which affected 15 per 1,000 people. Those who had less education or were not married also had higher rates of MCI.

"Our study suggests that risk factors for mild cognitive impairment should be studied separately in men and women," said Roberts.

Another finding of interest in the study showed that among people who were newly diagnosed with MCI, 12 percent per year were later diagnosed at least once with no MCI, or reverted back to what was considered "cognitively normal." Roberts said the majority of people with MCI, about 88 percent per year, continue to have MCI or progress to dementia.

Provided by American Academy of Neurology

2012-01-29T02:10:00.000Z

Food fried in olive or sunflower oil is not linked to heart disease

Eating food fried in olive or sunflower oil is not linked to heart disease or premature death, finds a paper published in the British Medical Journal today.

29 jan 2012--The authors stress, however, that their study took place in Spain, a Mediterranean country where olive or sunflower oil is used for frying and their results would probably not be the same in another country where solid and re-used oils were used for frying.

In Western countries, frying is one of the most common methods of cooking. When food is fried it becomes more calorific because the food absorbs the fat of the oils.

While eating lots of fried food can increase some heart disease risk factors such as high blood pressure, high cholesterol and obesity, a link between fried food and heart disease has not been fully investigated.

So the authors, led by Professor Pilar Guallar-Castillón from Autonomous University of Madrid, surveyed the cooking methods of 40,757 adults aged 29 to 69 over an 11-year period. None of the participants had heart disease when the study began.

Trained interviewers asked participants about their diet and cooking methods. Fried food was defined as food for which frying was the only cooking method used. Questions were also asked about whether food was fried, battered, crumbed or sautéed.

The participants' diet was divided into ranges of fried food consumption, the first quartile related to the lowest amount of fried food consumed and the fourth indicated the highest amount.

During the follow-up there were 606 events linked to heart disease and 1,134 deaths.

The authors conclude: "In a Mediterranean country where olive and sunflower oils are the most commonly used fats for frying, and where large amounts of fried foods are consumed both at and away from home, no association was observed between fried food consumption and the risk of coronary heart disease or death."

In an accompanying editorial, Professor Michael Leitzmann from the University of Regensburg in Germany, says the study explodes the myth that "frying food is generally bad for the heart" but stresses that this "does not mean that frequent meals of fish and chips will have no health consequences." He adds that specific aspects of frying food are relevant, such as the type of oil used.

Provided by British Medical Journal

2012-01-28T15:38:00.000Z

Study finds exercise reduces anxiety symptoms in women

Approximately 3 percent of the U.S. population suffers from excessive, uncontrollable worry that reduces their health and quality of life. The condition, known as Generalized Anxiety Disorder, is difficult to overcome and is accompanied by a host of physical symptoms, including fatigue, muscle tension, irritability and poor sleep. However, a new University of Georgia study shows that regular exercise can significantly reduce anxiety symptoms in patients with GAD.

28 jan 2011--In a study published online in the Nov. 22 edition of Psychotherapy and Psychosomatics, researchers randomly assigned 30 sedentary women, ages 18-37 who were diagnosed with GAD, to either a control group or six weeks of strength or aerobic exercise training. Women in the exercise conditions completed two weekly sessions of either weight lifting or leg cycling exercise. Remission of the disorder, determined by psychologists who were unaware of the treatment each client received, was higher among exercisers and best among those who performed weight lifting exercise. Worry symptoms, the primary problem among individuals with GAD, were significantly reduced among the exercisers, and moderate-to-large improvements in other symptoms, such as irritability, feelings of tension, low energy and pain, were found.

Matthew Herring, now a research associate in the department of epidemiology at the University of Alabama, Birmingham, led the study during his dissertation research as a doctoral student in the UGA College of Education's department of kinesiology. The team also included Patrick O'Connor and Rodney Dishman, co-directors of the UGA exercise psychology laboratory, psychology professor Cynthia Suveg and doctoral student Marni Jacob.

"Our findings add to the growing body of evidence of the positive effects of exercise training on anxiety," said Herring. "Our study is the first randomized controlled trial focused on the effects of exercise training among individuals diagnosed with GAD. Given the prevalence of GAD and drawbacks of current treatments, including expense and potential negative side effects, our findings are particularly exciting, because they suggest that exercise training is a feasible, well-tolerated potential adjuvant therapy with low risk that can reduce the severity of signs and symptoms of GAD. Future research should confirm these findings with large trials and explore potential underlying mechanisms of exercise effects among individuals with GAD."

The study also examined potential interactions between exercise and drugs used to treat GAD. Half of the participants in each group were taking a medication to treat GAD during the exercise program. Exercise training lessened anxiety symptoms to the same degree among those taking medication compared to those not taking medication.

"The large improvements found in this small investigation show that regular exercise has the power to help calm women suffering from GAD, even among those who appear to be resistant to treatment using medication," said O'Connor.

"The results of this research are very exciting because exercise is available to everyone, is relatively inexpensive and has beneficial effects beyond the reduction of anxious and depressive symptoms," said Suveg. "For individuals suffering from impairing symptoms, these preliminary findings suggest that exercise may offer another potential treatment option that has few, if any, negative side effects. Future research needs to explore the long-term benefits of exercise as well as the conditions under which exercise may be most beneficial and for whom."

More information: For more information about the study, see http://content.kar … f&doi=327898

Provided by University of Georgia

2012-01-26T19:58:00.001Z

Alzheimer's neurons induced from pluripotent stem cells

Stem-cell-derived neurons, made from patients with Alzheimer's disease, provide a new tool for unraveling the mechanisms underlying the neurodegenerative disease. In this image, DNA is shown in blue, dendrites and cell bodies in red and endosomal markers Rab5 and EEA1 in green and orange, respectively. Credit: UC San Diego School of Medicine

Led by researchers at the University of California, San Diego School of Medicine, scientists have, for the first time, created stem cell-derived, in vitro models of sporadic and hereditary Alzheimer's disease (AD), using induced pluripotent stem cells from patients with the much-dreaded neurodegenerative disorder.

26 jan 2012--"Creating highly purified and functional human Alzheimer's neurons in a dish – this has never been done before," said senior study author Lawrence Goldstein, PhD, professor in the Department of Cellular and Molecular Medicine, Howard Hughes Medical Institute Investigator and director of the UC San Diego Stem Cell Program. "It's a first step. These aren't perfect models. They're proof of concept. But now we know how to make them. It requires extraordinary care and diligence, really rigorous quality controls to induce consistent behavior, but we can do it."

The feat, published in the January 25 online edition of the journal Nature, represents a new and much-needed method for studying the causes of AD, a progressive dementia that afflicts approximately 5.4 million Americans. More importantly, the living cells provide an unprecedented tool for developing and testing drugs to treat the disorder.

"We're dealing with the human brain. You can't just do a biopsy on living patients," said Goldstein. "Instead, researchers have had to work around, mimicking some aspects of the disease in non-neuronal human cells or using limited animal models. Neither approach is really satisfactory."

Goldstein and colleagues extracted primary fibroblasts from skin tissues taken from two patients with familial AD (a rare, early-onset form of the disease associated with a genetic predisposition), two patients with sporadic AD (the common form whose cause is not known) and two persons with no known neurological problems. They reprogrammed the fibroblasts into induced pluripotent stem cells (iPSCs) that then differentiated into working neurons.

The iPSC-derived neurons from the Alzheimer's patients exhibited normal electrophysiological activity, formed functional synaptic contacts and, critically, displayed tell-tale indicators of AD. Specifically, they possessed higher-than-normal levels of proteins associated with the disorder.

With the in vitro Alzheimer's neurons, scientists can more deeply investigate how AD begins and chart the biochemical processes that eventually destroy brain cells associated with elemental cognitive functions like memory. Currently, AD research depends heavily upon studies of post-mortem tissues, long after the damage has been done.

"The differences between a healthy neuron and an Alzheimer's neuron are subtle," said Goldstein. "It basically comes down to low-level mischief accumulating over a very long time, with catastrophic results."

The researchers have already produced some surprising findings. "In this work, we show that one of the early changes in Alzheimer's neurons thought to be an initiating event in the course of the disease turns out not to be that significant," Goldstein said, adding that they discovered a different early event plays a bigger role.

The scientists also found that neurons derived from one of the two patients with sporadic AD exhibited biochemical changes possibly linked to the disease. The discovery suggests that there may be sub-categories of the disorder and that, in the future, potential therapies might be targeted to specific groups of AD patients.

Though just a beginning, Goldstein emphasized the iPSC-derived Alzheimer's neurons present a huge opportunity in a desperate fight. "At the end of the day, we need to use cells like these to better understand Alzheimer's and find drugs to treat it. We need to do everything we can because the cost of this disease is just too heavy and horrible to contemplate. Without solutions, it will bankrupt us – emotionally and financially."

More information: A patent application has been filed on this technology by the University of California, San Diego. For more information, go to: http://techtransfe … D/22199.html

Provided by University of California - San Diego

2012-01-25T01:47:00.002Z

Researchers find negative social interactions can lead to increased amounts of internal inflammation

25 jan 2012--Researchers from the University of California have found that negative social interactions can cause internal inflammation that may over time lead to possible health consequences. In the study, the results of which the team has published in the Proceedings of the National Academy of Sciences, the team writes that stressful events can lead to increased production of cytokines, molecules that are produced when inflammation occurs.

To find out if cytokines are produced from everyday stressful events, the team recruited 122 young adults (69 women and 53 men) as volunteers to take part in a study. Each participant was asked to keep a very detailed diary describing the events of their day, for eight consecutive days, focusing most specifically on personal or social conflicts. Each volunteer also had a saliva sample taken each day, followed by a stress test followed by another saliva test to check for cytokine levels.

Following the completion of the study, the research team compared cytokine levels against diary entries and found that cytokine levels rose predictably during those periods when the volunteers were reporting negatively stressful events, such as arguing with a roommate. Interestingly, they found that positive stress factors, such as participating in team sports did not cause any increase.

Inflammation occurs, the authors explain, in response to stressful situations. It is believed it happens as our immune systems prepare to deal with the possibility of injury or disease, which is of course a good thing. Problems creep in however, when inflammation and the increased production of cytokines occurs over long periods of time. Prior research has shown it can lead to hypertension, cardiovascular disease, cancer, diabetes and mental disorders.

The team also notes that it is unlikely that short term negatively stressful events such as those experienced by the volunteer group would cause health problems, it’s only when such conditions persist for many years that people begin showing symptoms of stress induced diseases.

The authors suggest that their findings indicate that people would be wise to remove themselves from long term relationships that continually cause negative stresses and instead pursue supportive relationships that foster harmony and good will.

More information: Negative and competitive social interactions are related to heightened proinflammatory cytokine activity, PNAS, Published online before print January 23, 2012, doi: 10.1073/pnas.1120972109

Abstract
Research has consistently documented that social relationships influence physical health, a link that may implicate systemic inflammation. We examined whether daily social interactions predict levels of proinflammatory cytokines IL-6 and the soluble receptor for tumor necrosis factor-α (sTNFαRII) and their reactivity to a social stressor. One-hundred twenty-two healthy young adults completed daily diaries for 8 d that assessed positive, negative, and competitive social interactions. Participants then engaged in laboratory stress challenges, and IL-6 and sTNFαRII were collected at baseline and at 25- and 80-min poststressor, from oral mucosal transudate. Negative social interactions predicted elevated sTNFαRII at baseline, and IL-6 and sTNFαRII 25-min poststressor, as well as total output of sTNFαRII. Competitive social interactions predicted elevated baseline levels of IL-6 and sTNFαRII and total output of both cytokines. These findings suggest that daily social interactions that are negative and competitive are associated prospectively with heightened proinflammatory cytokine activity.

2012-01-24T00:30:00.000Z

Lifelong brain-stimulating habits linked to lower Alzheimer's protein level

A new study led by researchers at the University of California, Berkeley, provides even more reason for people to read a book or do a puzzle, and to make such activities a lifetime habit.

24 jan 2012--Brain scans revealed that people with no symptoms of Alzheimer's who engaged in cognitively stimulating activities throughout their lives had fewer deposits of beta-amyloid, a destructive protein that is the hallmark of the disease.

While previous research has suggested that engaging in mentally stimulating activities – such as reading, writing and playing games – may help stave off Alzheimer's later in life, this new study identifies the biological target at play. This discovery could guide future research into effective prevention strategies.

"These findings point to a new way of thinking about how cognitive engagement throughout life affects the brain," said study principal investigator Dr. William Jagust, a professor with joint appointments at UC Berkeley's Helen Wills Neuroscience Institute, the School of Public Health and Lawrence Berkeley National Laboratory. "Rather than simply providing resistance to Alzheimer's, brain-stimulating activities may affect a primary pathological process in the disease. This suggests that cognitive therapies could have significant disease-modifying treatment benefits if applied early enough, before symptoms appear."

An estimated 5.4 million Americans live with Alzheimer's disease, but the numbers are growing as baby boomers age. Between 2000 and 2008, deaths from Alzheimer's increased 66 percent, making it the sixth-leading killer in the country. There is currently no cure, but a draft of the first-ever National Alzheimer's Plan, released this week, revealed that the U.S. government is aiming for effective Alzheimer's treatments by 2025.

The new study, to be published Monday, Jan. 23, in the Archives of Neurology, puts the spotlight on amyloid – protein fibers folded into tangled plaques that accumulate in the brain. Beta-amyloid is considered the top suspect in the pathology of Alzheimer's disease, so finding a way to reduce its development has become a major new direction of research.

The researchers note that the buildup of amyloid can also be influenced by genes and aging – one-third of people age 60 and over have some amyloid deposits in their brain – but how much reading and writing one does is under each individual's control.

"This is the first time cognitive activity level has been related to amyloid buildup in the brain," said study lead author Susan Landau, research scientist at the Helen Wills Neuroscience Institute and the Berkeley Lab. "Amyloid probably starts accumulating many years before symptoms appear. So it's possible that by the time you have symptoms of Alzheimer's, like memory problems, there is little that can be done to stop disease progression. The time for intervention may be much sooner, which is why we're trying to identify whether lifestyle factors might be related to the earliest possible changes."

The researchers asked 65 healthy, cognitively normal adults aged 60 and over (average age was 76) to rate how frequently they participated in such mentally engaging activities as going to the library, reading books or newspapers, and writing letters or email. The questions focused on various points in life from age 6 to the present.

The participants took part in extensive neuropsychological testing to assess memory and other cognitive functions, and received positron emission tomography (PET) scans at the Berkeley Lab using a new tracer called Pittsburgh Compound B that was developed to visualize amyloid. The results of the brain scans of healthy older individuals with various levels of lifetime cognitive activity were compared with those of 10 patients diagnosed with Alzheimer's disease and 11 healthy people in their 20s.

The researchers found a significant association between higher levels of cognitive activity over a lifetime and lower levels of beta-amyloid in the PET scans. They analyzed the impact of other factors such as memory function, physical activity, self-rated memory ability, level of education and gender, and found that lifelong cognitive engagement was independently linked to amyloid deposition.

Notably, the researchers did not find a strong connection between amyloid deposition and levels of current cognitive activity alone.

"What our data suggests is that a whole lifetime of engaging in these activities has a bigger effect than being cognitively active just in older age," said Landau.

The researchers are careful to point out that the study does not negate the benefits of kicking up brain activity in the later years.

"There is no downside to cognitive activity. It can only be beneficial, even if for reasons other than reducing amyloid in the brain, including social stimulation and empowerment," said Jagust. "And actually, cognitive activity late in life may well turn out to be beneficial for reducing amyloid. We just haven't found that connection yet."

More information: Arch Neurol. Published online January 23, 2012. doi:10.1001/archneurol.2011.2748

Provided by University of California - Berkeley

2012-01-23T01:14:00.000Z

Is it the alcohol or polyphenols in red wine that decreases cardiovascular disease?

Observational epidemiologic studies relating wine and alcohol to health all suffer from the fact that they, of necessity, compare people who prefer certain beverages, but not the beverages themselves. While there have been many intervention trials in animals, randomized trials in humans are less common. Randomized crossover trials, in which each subject receives all interventions in sequence, can be especially important as they tend to avoid baseline differences among subjects and can detect effects of different interventions with smaller numbers of subjects.

23 jan 2012--This study by Chiva-Blanch G et al, just published in the American Journal of Clinical Nutrition, included 67 male volunteers in Spain who were considered to be at "high-risk" of cardiovascular disease on the basis of increased BMI, smoking, diabetes, hypertension, or other risk factors. About one half of the individuals were taking ACE inhibitors, statins, aspirin, and/or oral hypoglycemic drugs, so the results of this study may be especially relevant for patients in the real world.

The subjects agreed to not consume any alcohol for a baseline period, then for three one-month periods consumed 30 g/day of alcohol as red wine or as gin, or an equivalent amount of phenolics from dealcoholized red wine. The polyphenol contents of the RW and the DRW interventions were the same. A very high degree of compliance of the subjects with the assigned interventions is evidenced by results of counting numbers of empty bottles of the intervention beverage returned, dietary records, urinary metabolites, etc. Further, there is good evidence that there were no important changes between periods in diet or exercise habits. The effects of each intervention on a large number of adhesion molecules and chemokines that affect inflammation and relate to the development of vascular disease were evaluated.

Specific comments on the study: Most reviewers considered this to be a well-done, comprehensive study. As one reviewer commented: "This is an excellent paper. The results strongly indicate an effect of wine polyphenols on inflammation (in broad and modern terms) and this is just what we expect from the biochemistry and nutritional effects of fruits and vegetables. The effect of ethanol, on the other hand, likely fits a hormetic mechanism, where low doses regularly supplied are protective while high doses in a single shot are worsening the progression of disease." Another reviewer added: "We need more information on separating the effects of beer, wine, and various types of spirits. Some spirits like brandy and whisky can have useful antioxidant effects, so distinguishing effects among different types of beverages may be informative."

Another Forum reviewer commented: "This is a very interesting paper that goes a way towards answering the question whether it is the alcohol or polyphenols in red wine that confer the health benefits. The trial was well conducted and controlled, with very detailed analyses. It would have been interesting to analyse any changes in conventional risk factors after the interventions. It would also have been interesting in the study to determine the effects on vascular function by, for example, brachial artery activity (flow mediated dilatation)."

Given that the effects of both alcohol and polyphenols on physiologic factors (e.g., platelet function, fibrinolysis) are transient, generally lasting for no more than 24 hours, it was appropriate that the subjects in this study were instructed to consume the intervention substance (RW, gin, DRW) on a daily basis. When drinking is moderate, there is no evidence that having "alcohol-free days" is beneficial to health. Indeed, most epidemiologic studies show better health effects from daily consumption rather than from drinking on a few days per week.

Concerns about the present study: One Forum reviewer stated: "This appears to be a carefully designed and well executed study, but I have four concerns: (1) The study has been undertaken in high-risk individuals, more than half of whom are hypertensive, a quarter dyslipidaemic, and a quarter diabetic. It is not described what happened to the conventional risk factors during the interventions. (For example, any improvement in inflammatory markers may have come at the cost of higher blood pressure with the alcohol interventions.) (2) Was there any weight change that could have confounded any of the outcomes? (3) Both polyphenol and alcohol biomarkers were measured – did the change in these biomarkers correlate with the changes in any of the inflammatory markers; i.e., any suggestion of a dose response relationship? (4) Even though at least 30 outcome variables were assessed, the authors do not describe any correction for multiple comparisons."

Another Forum reviewer: "This is a well conducted study, and adds to our understanding of the potential cardiovascular benefits of alcohol and the non-alcoholic compounds of alcoholic beverages. However, in this study more than one-half of the high-risk subjects consumed drugs with known anti-inflammatory effects, which could be a confounding factor. The anti-inflammatory effects of these pharmaceuticals may be responsible for the beneficial results, and may not be related to the RW, DRW and gin interventions." However, others think that this concern is unlikely to be important since this was a crossover study, and there were no changes in lifestyle or medication use between the intervention periods.

The key results of the study were that both ethanol and nonalcoholic compounds in red wine have potentially protective effects that may reduce the risk of vascular disease. Specifically, the authors conclude that "the phenolic content of red wine may modulate leukocyte adhesion molecules, whereas both ethanol and polyphenols of red wine may modulate soluble inflammatory mediators in patients at high risk of cardiovascular disease." Thus, this study provides important new mechanistic evidence that the reduced risk of cardiovascular disease among red wine drinkers observed in most epidemiologic studies may result from a combination of both the alcohol and the polyphenols in the wine.

More information: Chiva-Blanch G, Urpi-Sarda M, Llorach R, Rotches-Ribalta M, Guillèn M, Casas R, Arranz S, Valderas-Martinez P, Portoles O, Corella D, Tinahones F, Lamuela-Raventos RM, Andres-Lacueva C, Estruch R. Differential effects of polyphenols and alcohol of red wine on the expression of adhesion molecules and inflammatory cytokines related to atherosclerosis: a randomized clinical trial. Am J Clin Nutr 2012. doi: 10.3945/ajcn.111.022889

Provided by Boston University Medical Center

2012-01-22T02:46:00.000Z

Older women with normal T-scores may not need bone mineral density screening for 15 years

The U.S. Preventive Services Task Force and other organizations have recommended that women ages 65 and older be routinely screened for osteoporosis using bone mineral density (BMD) screening. However, how often women should be screened is a topic that remains controversial and undecided, with no definitive scientific evidence to provide guidance.

22 jan 2012--Now a new study led by Margaret L. Gourlay, MD, MPH of the University of North Carolina at Chapel Hill School of Medicine finds that women aged 67 years and older with normal bone mineral density scores may not need screening again for 15 years.

"If a woman's bone density at age 67 is very good, then she doesn't need to be re-screened in two years or three years, because we're not likely to see much change," Gourlay said. "Our study found it would take about 15 years for 10 percent of women in the highest bone density ranges to develop osteoporosis."

"That was longer than we expected, and it's great news for this group of women," Gourlay said.

Gourlay, an assistant professor in UNC's Department of Family Medicine, presented these results in a study published in the Jan. 19, 2012 issue of The New England Journal of Medicine.

In the study, Gourlay and study co-authors analyzed data from 4,957 women aged 67 years and older that were collected as part of the longest-running osteoporosis study in the U.S., the Study of Osteoporotic Fractures. These women were enrolled in the study from 1986 to 1988 when they were 65 years or older, and had bone mineral density (BMD) testing starting about two years later. All had bone mineral density testing at least twice during the study period; some were tested up to five times over a period of 15 years.

For the analysis, women were categorized by BMD T-scores, which compare a person's bone mineral density to the expected bone density of a healthy young adult (about age 30). Women with osteoporosis (those with a T-score of -2.5 or lower) or past hip or clinical vertebral (spine) fractures were excluded because current guidelines recommend treatment for all women in those groups. Women who had already received treatment for osteoporosis were also excluded. The remaining women were placed in three groups according to their baseline BMD T-scores at the hip. The high risk group was women with T-scores ranging from -2.49 to -2.00, while the moderate risk group had T-scores from -1.99 to -1.50. The low risk group included two T-score ranges: T-scores -1.49 to -1.01, and normal BMD (those with T-scores of -1.00 or higher).

The researchers calculated estimated times for 10 percent of the women in each T-score group to transition to osteoporosis. For the high risk group, the estimated time was 1.1 years, while it was about 5 years for the moderate risk group and slightly over 15 years for the low risk group. They found that in those same time periods, only 2 percent or less of women had hip or clinical vertebral fractures, which are the most important fractures doctors try to prevent by screening for osteoporosis.

The study concluded that baseline BMD is the most important factor for doctors to consider in determining how often a patient should be screened. It also suggests that older postmenopausal women with a T-score -2.0 and below will transition to osteoporosis more rapidly, while women with T-scores higher than -2.0 may not need screening again for 5 to 15 years, Gourlay said. "Doctors may adjust these time intervals for a number of reasons, but our results offer an evidence-based starting point for this clinical decision."

Provided by University of North Carolina School of Medicine

2012-01-21T14:45:00.000Z

Sexual activity is safe for most heart, stroke patients

If you have stable cardiovascular disease, it is more than likely that you can safely engage in sexual activity, according to an American Heart Association scientific statement.

21 jan 2012--The statement, published online in Circulation: Journal of the American Heart Association, contains recommendations by experts from various fields, including heart disease, exercise physiology and sexual counseling.

"Sexual activity is a major quality of life issue for men and women with cardiovascular disease and their partners," said Glenn N. Levine, M.D., lead author of the statement and a professor of medicine at Baylor College of Medicine in Houston, Texas. "Unfortunately, discussions about sexual activity rarely take place in the clinical context."

The recommendations include:

After a diagnosis of cardiovascular disease, it is reasonable for patients to be evaluated by their physician or healthcare provider before resuming sexual activity.
Cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications related to sexual activity in people who have had heart failure or a heart attack.
Women with cardiovascular disease should be counseled on the safety and advisability of contraceptive methods and pregnancy based on their patient profile.
Patients with severe heart disease who have symptoms with minimal activity or while at rest should not be sexually active until their cardiovascular disease symptoms are stabilized with appropriate treatment.
Patients should be assessed to see if their sexual dysfunction is related to underlying vascular or cardiac disease, anxiety, depression or other factors.
Drugs that can improve cardiovascular symptoms or survival should not be withheld due to concerns that such drugs may impact sexual function.
Drugs to treat erectile dysfunction are generally safe for men who have stable cardiovascular disease. These drugs should not be used in patients receiving nitrate therapy for chest pains due to coronary artery disease (blockages in the arteries that supply the heart with blood), and nitrates should not be administered to patients within 24-48 hours of using an erectile dysfunction drug (depending on the drug used).
It is reasonable for post-menopausal women with cardiovascular disease to use estrogen that's topically or vaginally inserted for the treatment of painful intercourse.

Decreased sexual activity and function — common in men and women with cardiovascular diseases — is often related to anxiety and depression.

The absolute rate of cardiovascular events during sexual activity, such as heart attacks or chest pain caused by heart disease, is miniscule because sexual activity is usually for a short time.

"Some patients will postpone sexual activity when it is actually relatively safe for them to engage in it," said Levine, who is also director of the Cardiac Care Unit at the Michael E. DeBakey Medical Center in Houston. "On the other hand, there are some patients for whom it may be reasonable to defer sexual activity until they're assessed and stabilized."

Provided by American Heart Association

2012-01-20T00:02:00.000Z

Cell senescence does not stop tumor growth

Since cancer cells grow indefinitely, it is commonly believed that senescence could act as a barrier against tumor growth and potentially be used as a way to treat cancer. A collaboration between a cancer biologist from the University of Milano, Italy, and two physicists, from the National Research Council of Italy and from Cornell University, has shown that cell senescence occurs spontaneously in melanoma cells, but does not stop their growth, which is sustained by a small population of cancer stem cells. The results, published in the open-access journal PLoS Computational Biology on January 19 explain why it is difficult to treat cancer cells by inducing senescence alone.

20 jan 2011--The work explores the relationship between melanoma and senescence, the normal process where cells decline and eventually stop duplicating after reaching maturity. The investigators followed the long-term evolution of melanoma cell populations, monitoring the number of senescent cells. After three months, growth slowed and most of the cells turned senescent, however growth did not stop and eventually resumed its initial rate until the senescent cells had almost disappeared.

The authors mathematically modeled the experimental data using the cancer stem cell hypothesis, where a sub-group of cancer cells replicate indefinitely, and are thus unaffected by senescence. These cancer stem cells give rise to a larger population of cancer cells that can duplicate only a finite number of times. The model yielded an indirect confirmation of the presence of cancer stem cells in melanoma, an issue that is still controversial in the cancer research community.

Although a large fraction of cancer cells are susceptible to senescence, the researchers conclude that inducing senescence is unlikely to provide a successful therapeutic strategy because these cells are irrelevant for tumor growth. However, the indirect evidence of cancer stem cells in melanoma may enable the development of new methods to treat specific kinds of cancer. The challenge will be in the strong resistance to drug induced senescence that would be found in the cancer stem cells. Along this line of research, treatment of tumors would focus on targeting only these cancer stem cells, rather than every single cancerous cell.

More information: La Porta CAM, Zapperi S, Sethna JP (2012) Senescent Cells in Growing Tumors: Population Dynamics and Cancer Stem Cells. PLoS Comput Biol 8(1): e1002316. doi:10.1371/journal.pcbi.1002316

Provided by Public Library of Science

2012-01-19T20:06:00.002Z

Metastasis of pancreatic cancer in action

Pancreatic cells spread by blending in. The left panel shows an inflammed pancreatic duct surrounded by what appear to be fibroblasts (blue arrow). Lineage tagging allowed the researchers to see that some of these fibroblast-like cells are actually invading pancreatic epithelial cells in disguise (left panel, white arrow). Such cells have undergone a process of epithelial-to-mesenchymal transition and are able to enter the bloodstream. Credit: Andrew Rhim, PhD, Perelman School of Medicine, University of Pennsylvania; Cell Press

Ben Stanger, MD, PhD, assistant professor of Medicine in the Division of Gastroenterology at the Perelman School of Medicine, University of Pennsylvania, and Andrew Rhim, MD, a Gastroenterology Fellow in the Stanger lab, discovered that pancreatic cancer cells in an animal model begin to spread before clinically obvious tumor tissue is detected. What's more, they showed that inflammation enhances cancer progression in part by facilitating a cellular transformation that leads to entry of cancer cells into the circulation. They report their findings this week in Cell.

19 jan 2012--Metastasis has been difficult to study because it involves a series of unpredictable events. To capture these events, the team developed a sensitive method to tag and track pancreatic epithelial cells in a mouse model of pancreatic cancer. Tagged cells invaded and entered the bloodstream unexpectedly early, before overt malignancy could be detected by rigorous analysis of tissue slides.

Pancreatic cancer is among the most lethal of cancers, with no real treatments, and at the time of diagnosis up to three-quarters of patients have metastatic disease, says Stanger. Little is known about how pancreatic cancer cells spread, "What leads to this are rare events that are hard to catch in tissues. Small numbers of cells break off tumors and move, but how can we find them?"

These wandering cells are associated with a phenomenon called the epithelial-to-mesenchymal transition (EMT). This change in cell motility is an important process during the development of embryos. But when the transition is aberrantly reactivated in adults it can have dire physiological consequences, leading to cancer metastasis as well as other disease processes. Epithelial cells form a covering or lining of a body surface and are the type of cell from which most solid tumors arise. However, when a molecular switch is turned off or absent, epithelial cells acquire characteristics of another cell type, called mesenchymal cells, and gain the ability to migrate and move away from the primary tumor site.

Using a mouse model of pancreatic cancer developed at Penn in 2005, the team delivered mutations in an oncogene and a tumor suppressor protein, K-ras and p53 respectively, in the pancreas. A green marker was also induced in the embryos' still-forming pancreas. At about one to two months, the juvenile mice developed pre-malignant lesions, and at about four to five months full blown pancreatic cancer.

During this time, the mouse pancreatic epithelial cells lost their epithelial characteristics and became more like mesenchymal cells, blending in and making their way to the bloodstream. True epithelial cells are sticky, keeping linings tightly connected, but these imposter epithelial cells changed identity, becoming less sticky.

With the green stain, the researchers were able to detect the transition from epithelial cell to mesenchymal cell in a tissue slide, showing many green cells that had undergone EMT. "We are now able to see what was before before unseeable – the pancreas cells that have taken on a disguise," says Stanger.

What spurs the EMT in first place? The team surmised that it was inflammation, so they blocked inflammation with an immunosuppressant, and at about eight to ten weeks, the green cells undergoing EMT disappeared. Conversely, when they induced pancreatitis- associated inflammation, the EMT green cells increased.

In trying to relate these findings to metastasis, they looked for green EMT cells outside of the pancreas and found them in the blood and distinct tissues such as the liver at eight to ten weeks of age, long before a pathologist would recognize it as cancer.

"These results provide new insight into the earliest events of cellular invasion and suggest that inflammation enhances cancer progression by giving cells increased access to the bloodstream," says Stanger.

The team plans to use the methodology used in this study to enhance the detection of spreading cells in human patients at an early timepoint, when therapy could have a greater impact.

Both the development of the pancreatic cancer mouse model and Dr. Stanger's current work were partially funded by research grants from the Pancreatic Cancer Action Network. "We are highly encouraged by Dr. Stanger's recent results," said Lynn Matrisian, PhD, vice president of Scientific and Medical Affairs at the Pancreatic Cancer Action Network. "A deeper understanding of the disease biology, and in particular metastasis, will move us closer to our goal of doubling the survival rate of pancreatic cancer by the year 2020."

Provided by University of Pennsylvania School of Medicine

2012-01-19T02:05:00.000Z

Exercise triggers beneficial cellular recycling: study

The cross-sections of tibialis anterior muscle shown above are from transgenic mice expressing GFP-LC3, a fluorescent green indicator of autophagy. Muscle from a resting animal is shown at left. The muscle on the right shows the increase in autophagy after 80 minutes of running on a treadmill.

Everyone knows exercise is good for you. We’re told time spent on the treadmill can reduce our risk of diabetes, cancer, and cardiovascular disorders. But exactly how exercise provides this protection is a bit of a mystery. A new study finds that exercise prompts cells to break down unwanted proteins and other cellular junk to produce more energy. The process, called autophagy, may explain how exercise fends off metabolic disorders like diabetes and protects against other diseases.

19 jan 2012--Autophagy is like a “cellular garbage disposal,” says Howard Hughes Medical Institute investigator Beth Levine, a physician at the University of Texas Southwestern Medical School in Dallas who has been studying the process for more than a decade. The process works like this: First, a double membrane forms around the unwanted cargo inside the cell, enveloping it. This membrane then fuses with an organelle called a lysosome, which contains enzymes that rush in and break down the contents. The bits and pieces created by this process get recycled, providing raw materials for new structures or a burst of energy.

Autophagy keeps cells healthy by “getting rid of all of the obsolete and abnormal structures,” Levine explains. It also helps cells survive lean times. By cannibalizing unwanted proteins and other junk, the cells can get nutrients.

Scientists have long known that starvation can trigger a boost in autophagy. Levine and her colleagues suspected that exercise, because it increases cells’ energy demands, might have a similar effect. To test the idea, she and her colleagues used transgenic mice whose cells produce a glowing green protein whenever autophagy occurs. Then they placed these mice on treadmills. After 30 minutes of running, the rodents’ muscle and heart cells were speckled with green dots, evidence of increased autophagy. “That was a brand new finding,” she says. In a paper published January 18, 2012, in the journal Nature, the researchers report that exercise also sparked an increase in autophagy in cells in the liver and pancreas, organs involved in the metabolism of glucose.

Next, Levine and her colleagues set out to determine what purpose the autophagy serves. The team engineered mice that could undergo normal autophagy, but due to a mutation in a gene called B-cell lymphoma 2 (Bcl-2), lacked the ability to ramp up autophagy during exercise or starvation. Bcl-2 is known to inhibit cell death and plays a key role in regulating autophagy.

When the researchers placed these mutant mice on the treadmill, they found that they couldn’t run as long as normal mice. A closer look revealed that the mice weren’t metabolizing sugar properly. When a normal mouse runs on a treadmill, its muscle cells kick into overdrive, increasing their uptake of sugar. Consequently, the amount of sugar in the blood plummets. But this didn’t happen in the mutant mice. The enzyme that helps cells take in more sugar, called AMP kinase, did not get activated. As a result, the blood sugar levels of the mice stayed unnaturally high and the mice showed less endurance.

Levine thought that these mutant mice might not derive any long-term benefit from exercise either. To test the hypothesis, the researchers fed both mutant and normal mice a high-fat diet for four weeks. Not surprisingly, the mice gained weight and developed a disorder akin to type 2 diabetes, a disease in which sugar doesn’t move efficiently from the blood into cells.

Next, they put the mice on a stringent exercise regimen for eight weeks while still feeding them a high fat diet. The normal mice lost weight and their diabetes disappeared. Their muscle cells regained the ability to take up sugar. The mutant mice that exercised on the treadmill also lost weight, but they didn’t get any of the metabolic benefits; their blood sugar levels stayed high. The data suggest that, to get the benefits, “autophagy really was necessary,” Levine says.

The findings suggest that increased autophagy may be the reason why exercise protects against type 2 diabetes and other metabolic disorders. Several oral drugs used to treat type 2 diabetes work by activating AMP kinase. Autophagy induced by exercise appears to do the same thing.

The team’s next step will be to investigate whether autophagy could also explain why regular exercise protects against cancer, neurodegenerative disorders, and aging. For cancer, the mechanism may be similar, Levine speculates. Studies have shown that diabetics who take AMP kinase activators have a lower incidence of cancer than diabetics with similar blood sugar levels who don’t take the drugs.

In the meantime, Levine plans to get more exercise herself. She recently invested in a treadmill. “If it’s good enough for my mice,” she says, “it’s good enough for me.”

More information: Study: DOI:10.1038/nature10758

Provided by Howard Hughes Medical Institute

2012-01-19T01:38:00.000Z

Researchers identify genetic signatures of exceptional longevity in re-published study

While environment and family history are factors in healthy aging, genetic variants play a critical and complex role in conferring exceptional longevity, according to researchers from the Boston University Schools of Public Health and Medicine, Boston Medical Center, IRCCS Multimedica in Milan, Italy, and Yale University.

19 jan 2012--Published in PLoS ONE, after peer review, the research findings are the corrected version of work originally published in Science in July 2010. The revised publication includes additional authors who independently assessed and helped to produce a valid genotype data set, for which the same analysis as in the original paper was performed. It also contains an additional replication data set of subjects with an average age of 107.

Centenarians are a model of healthy aging, as the onset of disability in these individuals is generally delayed until they are well into their mid-90s. Because exceptional longevity can run strongly in families, and numerous animal studies have suggested a strong genetic influence on life span, the researchers set out to determine which genetic variants play roles in human survival beyond 100 years of age. They used a well-established Bayesian statistical method for determining which single nucleotide polymorphisms (SNPs, or genetic variants) could, as a group, be used to categorize subjects as centenarians versus controls, based solely upon the genetic information. The predictive sensitivity of the model they developed, which contains 281 SNPs, increased with the age of the subject, supporting the hypothesis that genes play an increasingly strong role in survival in centenarians. The model was able to predict exceptional longevity with 60 to 85 percent accuracy, depending on the average age of the replication sample that was used. The older the sample, the stronger the sensitivity. Many of the 130 known genes associated with the SNPs in the prediction model have been shown by other gerontologists to play roles in age-related diseases and aging, said the study's lead researchers, Paola Sebastiani, PhD, professor of biostatistics at the BU School of Public Health, and Thomas Perls, MD, MPH, associate professor of medicine at the BU School of Medicine.

"This is a useful step towards meaningful predictive medicine and personal genomics," said Dr. Perls, a geriatrician at Boston Medical Center. "When people can do this kind of analysis on whole genome sequences for traits that have important genetic components, the predictive value should be even better."

The new study differs from the earlier study, voluntarily retracted by the authors, in several ways: A select group of faulty SNPs was eliminated from this study ;an additional sample of extremely old study subjects was added; and researchers from Yale University were called in to independently validate the data and methodology. The corrected study, as did the original, found that subjects who shared the same profile of variations for genetic markers in the model appeared to share similar levels of risk for various traits or diseases associated with exceptional longevity -- most notably, in their ages of survival. "Further study of these genetic characteristics may yield a better understanding of the genetic and biological bases of delaying or escaping age-related diseases and achieving longer survival," Dr. Perls said."The novel approach to genetic data that is described here is likely applicable to other complex inherited traits, and we look forward to other research groups applying these methods to their data."

More information: The full study is available here: http://dx.plos.org … pone.0029848

Provided by Boston University Medical Center

2012-01-18T02:36:00.000Z

US wants effective Alzheimer's treatment by 2025

The government is setting what it calls an ambitious goal for Alzheimer's disease: Development of effective ways to treat and prevent the mind-destroying illness by 2025.

18 jan 2012--The Obama administration is developing the first National Alzheimer's Plan to find better treatments for the disease and offer better day-to-day care for those afflicted.

A newly released draft of the overall goals sets the 2025 deadline, but doesn't provide details of how to fund the necessary research to meet that target date. Today's treatments only temporarily ease some dementia symptoms, and work to find better ones has been frustratingly slow.

A committee of Alzheimer's experts begins a two-day meeting Tuesday to help advise the government on how to finalize the plan.

An estimated 5.4 million Americans have Alzheimer's or similar dementias. It's the sixth-leading killer, and is steadily growing as the population rapidly ages. By 2050, 13 million to 16 million Americans are projected to have Alzheimer's, costing $1 trillion in medical and nursing home expenditures.

The national plan is supposed to tackle both the medical and social aspects of dementia, and advocacy groups had urged that it set a deadline for progress.

Among the draft's other goals:

-Improve timely diagnosis. A recent report found as many as half of today's Alzheimer's sufferers haven't been formally diagnosed, in part because of stigma and the belief that nothing can be done. Symptomatic treatment aside, a diagnosis lets families plan, and catching the disease earlier would be crucial if scientists ever find ways to slow the disease's progress.

-Improve support and training for families so they know what resources are available for patients and what to expect as dementia worsens.

Alzheimer's sufferers gradually lose the ability to do the simplest activities of daily life and can survive that way for a decade or more. In meetings around the country last summer and fall, families urged federal health officials to make sure the national plan addresses how to help patients live their last years at home without ruining their caregivers' own health and finances.

2012-01-17T00:10:00.001Z

No walk in the park: Factors that predict walking difficulty in elderly

Yale School of Medicine researchers have found that the likelihood of becoming disabled with age increases with the following factors: having a chronic condition or cognitive impairment; low physical activity; slower gross motor coordination; having poor lower-extremity function; and being hospitalized. Women are also more likely than men to become disabled in their later years.

17 jan 2012--Based on 12 years of data, the findings are published in the Jan.17 issue of Annals of Internal Medicine by a research team led by Thomas Gill, M.D., the Humana Foundation Professor of Geriatric Medicine and professor of medicine, epidemiology, and public health at Yale School of Medicine.

With age, many people can no longer walk short distances or drive a car, and those with long-term loss of mobility have difficulty regaining independence.

"Losing the ability to walk independently not only leads to a poorer overall quality of life, but prolonged disability leads to higher rates of illness, death, depression and social isolation," said Gill, who followed a group of 641 people aged 70 or older who could walk a quarter mile unassisted or who were active drivers at the start of the study. All participants could perform essential activities of daily living, such as bathing and dressing.

Gill and his team assessed the participants for changes in potential disability risk factors every 18 months between 1998 and 2008. They also assessed the participants' mobility each month. Those who said they needed help from another person to walk a quarter mile were considered to be walking disabled. Those who said that they had not driven a car during the past month were considered driving disabled.

On a monthly basis, the research team also assessed the participants' exposure to potential causes of disability, including illnesses or injuries leading to hospitalization and restricted activity, which increased the likelihood of long-term disability by 6-fold.

The team found that multiple risk factors, together with subsequent illness and injury leading to hospitalization and restricted activity, are associated with an increased likelihood of developing long-term walking and driving disability. The team considered a disability to be long term if it persisted for at least six months.

"We've learned that targeted strategies are needed to prevent disability among older people living independently in the community," said Gill.

More information: Annals of Internal Medicine, Vol. 156, No. 2: 131-140 (January 17, 2012)

Provided by Yale University

2012-01-16T19:21:00.000Z

Active lifestyle associated with less Alzheimer disease-related brain change among persons with APOE epsilon4 genotype

A sedentary lifestyle is associated with greater cerebral amyloid deposition, which is characteristic of Alzheimer’s disease (AD), among cognitively normal individuals with the ε4 allele of the apolipoprotein E (APOE) gene, according to a report published Online First by Archives of Neurology, one of the JAMA/Archives journals.

16 jan 2012--“The presence of an APOE ε4 allele is the most established genetic risk factor for Alzheimer disease (AD), with a higher percentage of individuals with AD having an ε4 allele in comparison with the general population,” the authors write as background information in the article. “It has been suggested that APOE status may modify associations between lifestyle factors such as exercise engagement and risk of cognitive decline and dementia.”

More information: Exercise Engagement as a Moderator of the Effects of APOE Genotype on Amyloid Deposition, Arch Neurol. Published online January 9, 2012. doi:10.1001/archneurol.2011.845

ABSTRACT

Objective. APOE 4 status has been associated with greater cortical amyloid deposition, whereas exercise has been associated with less in cognitively normal adults. The primary objective here was to examine whether physical exercise moderates the association between APOE genotype and amyloid deposition in cognitively normal adults.
Design APOE genotyping data and answers to a questionnaire on physical exercise engagement over the last decade were obtained in conjunction with cerebrospinal fluid (CSF) samples and amyloid imaging with carbon 11–labeled Pittsburgh Compound B ([11C]PiB) positron emission tomography. Participants were classified as either low or high exercisers based on exercise guidelines of the American Heart Association.
Setting. Knight Alzheimer's Disease Research Center at Washington University, St Louis, Missouri.
Participants. A total of 201 cognitively normal adults (135 of whom were women) aged 45 to 88 years were recruited from the Knight Alzheimer’s Disease Research Center. Samples of CSF were collected from 165 participants. Amyloid imaging was performed for 163 participants.
Results. APOE 4 carriers evidenced higher [11C]PiB binding (P < .001) and lower CSF Aβ42 levels (P < .001) than did noncarriers. Our previous findings of higher [11C]PiB binding (P = .005) and lower CSF Aβ42 levels (P = .009) in more sedentary individuals were replicated. Most importantly, we observed a novel interaction between APOE status and exercise engagement for [11C]PiB binding (P = .008) such that a more sedentary lifestyle was significantly associated with higher [11C]PiB binding for 4 carriers (P = .013) but not for noncarriers (P = .20). All findings remained significant after controlling for age; sex; educational level; body mass index; the presence or history of hypertension, diabetes mellitus, heart problems, or depression; and the interval between assessments.
Conclusion. Collectively, these results suggest that cognitively normal sedentary APOE 4–positive individuals may be at augmented risk for cerebral amyloid deposition.

Provided by Washington University in St. Louis

2012-01-14T10:43:00.000Z

Over-65s are frequent binge drinkers: US study

Binge drinking is more common in the United States than previously thought, particularly among young adults, though the most frequent offenders are over 65, said a US government study on Tuesday.

14 jan 2011--One in six Americans, or 17.1 percent of the population, binge drinks, defined as consuming five or more alcoholic beverages in a sitting for men and four or more among women, said the Centers for Disease Control and Prevention.

The latest data for 2010 is an increase over the CDC's report on the same topic for 2009, which said about 15 percent of US adults, or 33 million Americans, binge drink, a rate that had stayed the same for more than 15 years.

While the most common age group among the 38 million American who binge drink was 18-34, those who reported doing it most often were over 65, said the CDC's Vital Signs report, which also warned of the health and safety risks of high alcohol use.

Seniors who binge drink reported doing so 5.5 times per month, compared to an average of four times a month among the rest of the binge-drinking population.

The 18-24 age group had the highest amount of binge drinkers (28.2 percent) in their ranks and tended to drink the most -- 9.3 drinks -- in each setting. The age group 25-34 was a close second (27.9 percent).

"Binge drinking by adults has a huge public health impact, and influences the drinking behavior of underage youth by the example it sets," said CDC substance abuse and mental health services administrator Pamela Hyde.

"We need to reduce binge drinking by adults to prevent the immediate and long-term effects it has on the health of adults and youth."

The data was collected by a randomized phone survey in 48 states and the US capital region. This year, it also included cell phones, which likely resulted in a higher number of young people's participation.

The survey found that binge drinking was most common among people who earned $75,000 or more a year in household income, but those who earned less than $25,000 a year went on binges more frequently.

Low-income binge drinkers tended to consume excessive alcohol five times per month and 8.5 drinks each time.

Whites and Hispanics were more likely to binge drink than blacks. Also, men were more likely to binge drink than women.

"Binge drinking causes more than half of the 80,000 deaths and three quarters of the $223.5 billion in economic costs caused by excessive drinking," said the report.

"Drinking too much contributes to over 54 different injuries and diseases, including car crashes, violence, and sexually-transmitted diseases."

The CDC said that raising the price of alcohol, limiting the days and hours when it can be sold, and restricting the number of liquor licenses offered in a given geographic area could help cut down on binge drinking.

More information: CDC report: http://www.cdc.gov/vitalsigns

2012-01-13T01:34:00.000Z

Hip fracture guidelines tackle 'considerable variations' in UK and Irish hospital care

All patients with hip fractures should be fast-tracked through hospital emergency departments and operated on within 48 hours of admission, according to new consensus guidelines developed by UK experts in anaesthesia, orthopaedics, geriatrics and emergency medicine and published in the January issue of Anaesthesia.

13 jan 2012--However, patients in one in five hospitals in England and Wales currently wait longer than two days, risking lengthier inpatient stays, increased health problems - such as pressure sores, pneumonia and blood clots - and even an increased chance of death if the delay is prolonged.

The Association of Anaesthetists of Great Britain and Ireland teamed up with a number of other organisations, including the Age Anaesthesia Association and British Orthopaedic Association, to develop the new ten-point plan for the Management of Proximal Femoral Fractures.

"Unlike existing guidelines, they review the current clinical evidence and also recommend best practice in numerous circumstances where evidence is controversial or incomplete, based on expert consensus" says consultant anaesthetist Dr Richard Griffiths, who chaired the working party.

"These are the first guidelines to cover some of the difficult clinical problems faced by anaesthetists on a daily basis.

"For example, we recommend that if any investigations need to be carried out on patients with systolic heart murmurs, this should be done as a matter of urgency to avoid delaying their operations.

"The management of patients on antiplatelet drugs to avoid blood clots forming is another controversial area. Evidence is incomplete, but the expert consensus is to proceed with surgery without stopping the drugs, as operating delays pose a greater risk to the patient."

Hip fractures present unique challenges for anaesthetists as they often occur in elderly patients with significant health problems, stresses Dr Griffiths.

"Despite the fact that guidance has been in place since the early 1990s concerning best practice management for these vulnerable patients, there remain considerable variations in models of post-operative care, rehabilitation and orthogeriatric input" he says.

"Bringing together experts in anaesthesia, orthopaedics, geriatrics and emergency medicine has enabled us to look at the journey of the hip fracture patients from admission to discharge and recommend how their care can be maximised by everyone involved."

Approximately 77,000 patients break their hips in the UK every year, spending an average of 16 days in hospital and costing the National Health Service £785 million. The majority (95 per cent) occur in people over 60 years of age and 75 per cent occur in females.

More than eight per cent of patients will die within 30 days of a hip fracture, especially if they are older, sicker or male, and this figure rises to up to 30 per cent within a year. It has been suggested that half of postoperative deaths are potentially preventable.

Only 44 per cent of UK patients admitted from home are discharged back to their home within 30 days of surgery. A further 22 per cent are discharged to a residential or nursing home and they can often spend a long time in hospital waiting for admission to these facilities, blocking much needed beds.

The ten-point action plan advises that:

There should be protocol-driven, fast-track admission of patients with hip fractures through the emergency department.
Patients with hip fractures require multidisciplinary care, led by orthogeriatricians.
Surgery is the best analgesic for hip fractures.
Surgical repair of hip fractures should occur within 48 hours of hospital admission.
Surgery and anaesthesia must be undertaken by appropriately experienced surgeons and anaesthetists.
There must be high-quality communication between clinicians and allied health professionals.
Early mobilisation is a key part of the management of patients with hip fractures.
Pre-operative management should take into consideration plans for the patient's discharge from hospital.
Measures should be taken to prevent secondary falls.
Continuous audit and targeted research is required in order to inform and improve the management of patients with hip fracture.

"We hope that our guidelines will address current variations in clinical practice so that patients can all benefit from a more consistent approach" concludes Dr Griffiths, who is also lead clinician for the National Health Service Hip Fracture Perioperative Group, an initiative started by anaesthetists, but with increasing membership from orthogeriatricians.

More information: Management of proximal femoral fractures 2011. Griffiths et al. Anaesthesia. 67, pp85-98. (2012). doi:10.1111/j.1365-2044.2011.06957.x

Provided by Wiley

2012-01-12T01:29:00.000Z

New study supports view that Lewy bodies are not the primary cause of cell death in Parkinson's Disease

The pathology of Parkinson's disease is characterized by a loss of dopamine-producing neurons in the pars compacta of the substantia nigra (SN), an area of the brain associated with motor control, along with the development of α-synuclein (αS) protein in the form of Lewy bodies (LB) in the neurons that survive. The spread of LB pathology is thought to progress along with the clinical course of Parkinson's disease, although recent studies suggest that they are not the toxic cause of cell death. A new study published in The Journal of Parkinson's Disease finds no support for a primary pathogenic role of LBs, as neither their distribution nor density was associated with the severity of nigral cell loss.

12 jan 2011--"We investigated the relationship between nigral dopaminergic cell loss, distribution and density of α-synuclein immunoreactive LBs, and the duration of motor symptoms in 97 patients with Parkinson's disease," explains lead investigator Andrew J. Lees, MD, of Queen Square Brain Bank for Neurological Disorders and the Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK. "Despite the reasonably close correlation between neuronal density in SN and severity of bradykinesia and rigidity in Parkinson's disease, our results suggest that nigral cell loss is gradual and there is considerable variability, which may explain the clinical heterogeneity."

Researchers confirmed that both neuronal number and density in SN in Parkinson's disease decrease over time. The density of nigral neurons was estimated to decrease by 2% each year after confirmation of the clinical diagnosis of Parkinson's disease, but showed marked heterogeneity across patients. Some patients with longer duration of illness still had a significant number of preserved nigral neurons at the time of death. An average of 15% of surviving nigral neurons contained LBs and the age-adjusted proportion of LB-bearing neurons appeared relatively stable through the disease duration. "This could be explained by a passive 'one-pass' phenomenon where the LBs appear at the beginning of the disease and then decrease at the same rate as nigral neurons are lost, or alternatively that a dynamic 'turnover' occurs with some LBs continuously produced and destroyed at the same rate," explains Dr. Lees.

Nigral neuron density was unrelated to the Braak PD stage of the disease (i.e. distribution of LBs in the brain) or to cortical LB densities. "In our view, the fact that neither the widespread regional distribution of LBs nor increased cortical LB densities were found directly linked with pars compacta nigral cell loss lends support to the view that they are not the primary cause of the pathological process leading to cell death in vulnerable regions in the brain in Parkinson's disease," concludes Dr. Lees.

More information: The article is "Disentangling the Relationship between Lewy Bodies and Nigral Neuronal Loss in Parkinson's Disease" by Laura Parkkinen, Sean S O'Sullivan, Catherine Collins, Aviva Petrie, Janice L. Holton, Tamas Revesz, and Andrew J. Lees. Journal of Parkinson's Disease. 1(2011) 277-286. DOI 10.3233/JPD-2011-11046

Provided by IOS Press

2012-01-11T17:39:00.000Z

Study finds nicotine patches may help improve memory loss in older adults

Wearing a nicotine patch may help improve memory loss in older adults with mild cognitive impairment, according to a study published today in Neurology, the medical journal of the American Academy of Neurology.

11 jan 2012--The study looked at individuals with mild cognitive impairment (MCI), the stage between normal aging and dementia when others begin to notice that an individual is developing mild memory or thinking problems. Many older adults with MCI go on to develop Alzheimer's disease.

The study looked at 74 non-smokers with MCI and an average age of 76. Half of the patients were given a nicotine patch of 15 mg a day for six months and half received a placebo. The study was designed so neither the participants nor the investigators knew which group received the nicotine patch.

Paul Newhouse, M.D., professor of Psychiatry and director of the Center for Cognitive Medicine at Vanderbilt University Medical Center, who authored the study, said the results of the study should not be viewed as an endorsement of smoking or of nicotine for normal individuals. "What we and others have shown is that nicotine doesn't do much for memory and attention in the normal population, but it does do something for those whose cognitive function is already impaired."

"People with memory loss should not start smoking or using nicotine patches by themselves because there are harmful effects of smoking and a medication such as nicotine should only be used with a doctor's supervision," Newhouse said. "But this study provides strong justification for further research into the use of nicotine for people with early signs of memory loss which may help us determine whether benefits persist over long periods of time and provide meaningful improvement."

Newhouse said nicotine is a "fascinating drug with interesting properties." The effects of nicotine are dependent on the initial state of a person's cognitive functioning, he said. "If you're already functioning fine, but slip down the hill, nicotine will push you back up toward the top. A little bit of the drug makes poor performers better. Too much, and it makes them worse again, so there's a range. The key issue is to find the sweet spot where it helps."

The study showed evidence of improvement across multiple cognitive tests for attention memory, speed of processing and consistency of processing. For example, after 6 months of treatment, the nicotine-treated group regained 46 percent of normal performance for age on long-term memory, whereas the placebo group worsened by 26 percent over the same time period. One area that didn't show significant improvement was that of "global impression," which means a health care provider didn't observe the patient was any better or any worse.

Newhouse said that future study is needed. "We need to do a much longer and larger study, to see if we can make a significant impact on the process of change. "

Nicotine stimulates receptors in the brain that are important for thinking and memory and may have neuroprotective effects. People with Alzheimer's disease lose some of those receptors.

Newhouse said the future of nicotinic treatment is to try to identify earlier stages at which treatment can be applied, to see if it changes the trajectory of those who already have evidence of memory loss. "I don't think it's going to become a treatment for Alzheimer's disease by itself. That would be like trying to rebuild a house after a fire when the fire's still going. You need to prevent the fire. The holy grail would be changing the deterioration curve."

Those in the study group receiving the nicotine patch experienced only minor side effects like nausea and dizziness, similar to what a person would experience when smoking a cigarette for the first time, Newhouse said. Those on the nicotine patch also experienced mild weight loss, not surprising since nicotine is an appetite suppressant. There were also no withdrawal symptoms reported when the study participants stopped using the nicotine patch.

Provided by Vanderbilt University Medical Center

2012-01-10T01:28:00.000Z

Mass prostate cancer screening doesn't reduce deaths: study

There's new evidence that annual prostate cancer screening does not reduce deaths from the disease, even among men in their 50s and 60s and those with underlying health conditions, according to new research led by Washington University School of Medicine in St. Louis.

10 jan 2012--A longer follow-up of more than 76,000 men in a major U.S. study shows that six years of aggressive, annual screening for prostate cancer led to more diagnoses of tumors but not to fewer deaths from the disease.

The updated results of the Prostate, Lung, Cancer, Colorectal and Ovarian (PLCO) Cancer Screening Trial will be published online Jan. 6 in the Journal of the National Cancer Institute.

"The data confirm that for most men, it is not necessary to be screened annually for prostate cancer," says the study's lead author and principal investigator Gerald Andriole, MD, chief urologic surgeon at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. "A large majority of the cancers we found are slow-growing tumors that are unlikely to be deadly."

The PLCO study involved men ages 55 to 74, who were randomly assigned to receive either annual PSA tests for six years and digital rectal exams for four years or "routine care," meaning they had the screening tests only if their physicians recommended them.

The new research updates an earlier report of the data published in 2009 in the New England Journal of Medicine. At that time, when nearly all men had been followed for seven years, Andriole and his colleagues did not find a mortality benefit from prostate cancer screening.

But because so few men in the study had died from any causes, the researchers said then that it would be premature to make broad generalizations about whether men should continue to be screened. However, they did recommend against prostate cancer screening for men with a life expectancy of seven to 10 years or less.

"Now, based on our updated results with nearly all men followed for 10 years and more than half for 13 years, we are learning that only the youngest men — those with the longest life expectancy — are apt to benefit from screening. We need to modify our current practices and stop screening elderly men and those with a limited life expectancy," says Andriole, who also is the Robert K. Royce Distinguished Professor. "Instead, we need to take a more targeted approach and selectively screen men who are young and healthy and particularly those at high risk for prostate cancer, including African-Americans and those with a family history of the disease."

Andriole recommends that men get a baseline PSA test in their early 40s because recent studies have indicated that elevated levels at that age can predict the risk of prostate cancer in later years. Men in their 40s with low PSA levels are very unlikely to develop lethal prostate cancer and could potentially avoid additional testing.

The researchers detected 12 percent more prostate tumors among men screened annually compared to those who received routine care (4,250 tumors in the screening arm vs. 3,815 tumors in the control arm).

But deaths from prostate cancer did not differ significantly between the groups. There were 158 deaths from prostate cancer in the screening group and 145 deaths in the routine-care group.

Annual screening tests also did not reduce deaths from prostate cancer among men in their 50s and 60s, as the researchers had hoped.

In addition, men diagnosed with prostate cancer who also had a history of heart attacks, strokes, diabetes, cancer or lung and liver disease were far more likely to die from causes other than prostate cancer – a finding that suggests that screening often finds tumors that are not likely to cause harm.

"Mass screening of all men on the basis of age alone is not the way to go, but screening can still be useful in select men," says Andriole, who acknowledges that widespread testing has lead many men with slow-growing tumors to be over-diagnosed and over-treated with surgery or radiation therapy, the possible side effects of which include incontinence and impotence. "We have to take a more nuanced approach to determine which men should be screened with PSA in the first place, how frequently they should be tested, the PSA level at which they should be biopsied and whether their cancer warrants aggressive therapy."

The study comes just months after a draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older because of concerns that the test does not save lives and, when positive, often leads to invasive biopsies and aggressive treatments.

The researchers will continue to follow patients in the PLCO study for up to 15 years after they enrolled and evaluate the effects of prostate cancer screening on mortality.

More information: Andriole GL, Crawford ED, Grubb RL, Prorok PC et al. Prostate cancer screening in the randomized prostate, lung, colorectal and ovarian cancer screening trial: mortality results after 13 years of follow-up. Journal of the National Cancer Institute, published online Jan. 6, 2012.

Provided by Washington University School of Medicine

2012-01-09T00:03:00.002Z

Low vitamin D levels linked to depression, psychiatrists report

Low levels of vitamin D have been linked to depression, according to UT Southwestern Medical Center psychiatrists working with the Cooper Center Longitudinal Study. It is believed to be the largest such investigation ever undertaken.

09 jan 2012--Low levels of vitamin D already are associated with a cavalcade of health woes from cardiovascular diseases to neurological ailments. This new study – published in Mayo Clinic Proceedings – helps clarify a debate that erupted after smaller studies produced conflicting results about the relationship between vitamin D and depression. Major depressive disorder affects nearly one in 10 adults in the U.S.

"Our findings suggest that screening for vitamin D levels in depressed patients – and perhaps screening for depression in people with low vitamin D levels – might be useful," said Dr. E. Sherwood Brown, professor of psychiatry and senior author of the study, done in conjunction with The Cooper Institute in Dallas. "But we don't have enough information yet to recommend going out and taking supplements."

UT Southwestern researchers examined the results of almost 12,600 participants from late 2006 to late 2010. Dr. Brown and colleagues from The Cooper Institute found that higher vitamin D levels were associated with a significantly decreased risk of current depression, particularly among people with a prior history of depression. Low vitamin D levels were associated with depressive symptoms, particularly those with a history of depression, so primary care patients with a history of depression may be an important target for assessing vitamin D levels. The study did not address whether increasing vitamin D levels reduced depressive symptoms.

The scientists have not determined the exact relationship – whether low vitamin D contributes to symptoms of depression, whether depression itself contributes to lower vitamin D levels, or chemically how that happens. But vitamin D may affect neurotransmitters, inflammatory markers and other factors, which could help explain the relationship with depression, said Dr. Brown, who leads the psychoneuroendocrine research program at UT Southwestern.

Vitamin D levels are now commonly tested during routine physical exams, and they already are accepted as risk factors for a number of other medical problems: autoimmune diseases; heart and vascular disease; infectious diseases; osteoporosis; obesity; diabetes; certain cancers; and neurological disorders such as Alzheimer's and Parkinson's diseases, multiple sclerosis, and general cognitive decline.

Investigators used information gathered by the institute, which has 40 years of data on runners and other fit volunteers. UT Southwestern has a partnership with the institute, a preventive medicine research and educational nonprofit located at the Cooper Aerobics Center, to develop a joint scientific medical research program aimed at improving health and preventing a wide range of chronic diseases. The institute maintains one of the world's most extensive databases – known as the Cooper Center Longitudinal Study – that includes detailed information from more than 250,000 clinic visits that has been collected since Dr. Kenneth Cooper founded the institute and clinic in 1970.

Provided by UT Southwestern Medical Center

2012-01-08T01:59:00.000Z

Sexual satisfaction in women increases with age

A new study of sexually active older women has found that sexual satisfaction in women increases with age and those not engaging in sex are satisfied with their sex lives. A majority of study participants report frequent arousal and orgasm that continue into old age, despite low sexual desire. The study appears in the January issue of the American Journal of Medicine.

08 jan 2012--Researchers from the University of California, San Diego School of Medicine and the Veterans Affairs San Diego Healthcare System evaluated sexual activity and satisfaction as reported by 806 older women who are part of the Rancho Bernardo Study (RBS) cohort, a group of women who live in a planned community near San Diego and whose health has been tracked for medical research for 40 years. The study measured the prevalence of current sexual activity; the characteristics associated with sexual activity including demographics, health, and hormone use; frequency of arousal, lubrication, orgasm, and pain during sexual intercourse; and sexual desire and satisfaction in older women.

The median age in the study was 67 years and 63% were postmenopausal. Half the respondents who reported having a partner had been sexually active in the last 4 weeks. The likelihood of sexual activity declined with increasing age. The majority of the sexually active women, 67.1%, achieved orgasm most of the time or always. The youngest and oldest women in the study reported the highest frequency of orgasm satisfaction.

40% of all women stated that they never or almost never felt sexual desire, and one third of the sexually active women reported low sexual desire. Lead investigator Elizabeth Barrett-Connor, MD, Distinguished Professor and Chief, Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, comments, "Despite a correlation between sexual desire and other sexual function domains, only 1 in 5 sexually active women reported high sexual desire. Approximately half of the women aged 80 years or more reported arousal, lubrication, and orgasm most of the time, but rarely reported sexual desire. In contrast with traditional linear model in which desire precedes sex, these results suggest that women engage in sexual activity for multiple reasons, which may include affirmation or sustenance of a relationship."

Regardless of partner status or sexual activity, 61% of all women in this cohort were satisfied with their overall sex life. Although older age has been described as a significant predictor of low sexual satisfaction, the percentage of RBS sexually satisfied women actually increased with age, with approximately half of the women over 80 years old reporting sexual satisfaction almost always or always. Not only were the oldest women in this study the most satisfied overall, those who were recently sexually active experienced orgasm satisfaction rates similar to the youngest participants. "In this study, sexual activity was not always necessary for sexual satisfaction. Those who were not sexually active may have achieved sexual satisfaction through touching, caressing, or other intimacies developed over the course of a long relationship," says first author Susan Trompeter, MD, Associate Clinical Professor of Medicine. Division of General Internal Medicine, Department of Medicine at the University of California, San Diego School of Medicine and Staff Physician at the VA San Diego Healthcare System.

"Emotional and physical closeness to the partner may be more important than experiencing orgasm. A more positive approach to female sexual health focusing on sexual satisfaction may be more beneficial to women than a focus limited to female sexual activity or dysfunction," Trompeter concludes.

More information: The article is "Sexual Activity and Satisfaction in Healthy Community-Dwelling Older Women," by Susan E. Trompeter, MD, Ricki Bettencourt, MS, and Elizabeth Barrett-Connor, MD. It appears in the American Journal of Medicine, Volume 125, Issue 1 (January 2012)

Provided by Elsevier

2012-01-07T03:08:00.000Z

A decade of research proves PET effectively detects dementia

In a new review of imaging studies spanning more than ten years, scientists find that a method of positron emission tomography (PET) safely and accurately detects dementia, including the most common and devastating form among the elderly, Alzheimer's disease. This research is featured in the January issue of the Journal of Nuclear Medicine.

07 jan 2012--Researchers reviewed numerous PET studies to evaluate a molecular imaging technique that combines PET, which provides functional images of biological processes, with an injected biomarker called 18F-FDG to pinpoint key areas of metabolic decline in the brain indicating dementia. Having physiological evidence of neurodegenerative disease by imaging patients with PET could give clinicians the information they need to make more accurate diagnoses earlier than ever before.

"The new data support the role of 18F-FDG PET as an effective addition to other diagnostic methods used to assess patients with symptoms of dementia," says Nicolaas Bohnen, MD, PhD, lead author of the study and professor of radiology and neurology at the University of Michigan, Ann Arbor, Mich. "The review also identified new literature showing the benefit of this imaging technique for not only helping to diagnose dementia but also for improving physician confidence when diagnosing a patient with dementia. This process can be difficult for physicians, especially when evaluating younger patients or those who have subtle signs of disease."

Dementia is not a specific illness but a pattern of symptoms characterized by a loss of cognitive ability. These disorders can be caused by injury or progressive disease affecting areas of the brain that control attention, memory, language and mobility. While Alzheimer's is most commonly associated with progressive memory impairment, dementia with Lewy bodies, another form of the disease, can be associated with symptoms of Parkinson's and prominent hallucinations, while another disorder, called frontotemporal dementia, can be seen in patients showing uncharacteristic personality changes and difficulties in relating and communicating. Physicians can use FDG-PET with high accuracy to not only help diagnose dementia but also differentiate between the individual disorders. The role molecular imaging plays in the diagnosis of dementia has expanded enough that the official criteria physicians use to diagnose patients now includes evidence from molecular imaging studies.

"For the first time, imaging biomarkers of Alzheimer's disease are included in the newly revised clinical diagnostic criteria for the disease," says Bohnen. "This is a major shift in disease definition, as previously an Alzheimer's diagnosis was based mainly on a process of evaluating patients to exclude possible trauma, hemorrhage, tumor or metabolic disorder. Now it is becoming a process of inclusion based on biomarker evidence from molecular imaging."

The PET biomarker 18F-FDG comprises a radionuclide combined with fluorodeoxyglucose (FDG), which mimics glucose in the body. Cells metabolize FDG as fuel, and the variation in this uptake by cells throughout the body can then be imaged to detect a range of abnormalities. In the case of dementia, marked reductions in the metabolism of different lobes of the cerebral cortex can confirm a patient's disorder. Physicians can tell Alzheimer's disease apart from other dementias, depending on the specific cortices affected.

This review presents the most up-to-date and salient evidence of FDG-PET's usefulness for the evaluation of patients with suspected dementia. The objective of the study was to replace prior retrospective reviews that were performed as the technique was just emerging and that suggested methodological improvements. The new review includes studies with better methodology, including confirmation of diagnoses with autopsy, more expansive recruitment of subjects and use of multi-center studies. After reviewing 11 studies that occurred since the year 2000 and that met more stringent study review standards, researchers conclude that 18F-FDG is highly effective for detecting the presence and type of dementia.

"Using 18F-FDG PET in the evaluation of patients with dementia can improve diagnostic accuracy and lead to earlier treatment and better patient care," says Bohnen. "The earlier we make a diagnosis, the more we can alleviate uncertainty and suffering for patients and their families."

The biomarker 18F-FDG is among a variety of imaging agents being investigated for its efficacy in Alzheimer's imaging. As treatments for dementia become available for clinical use, PET will no doubt play an important role in not only the diagnosis of these diseases, but also the assessment and monitoring of future therapies.

According to the World Health Organization, an estimated 18 million people worldwide are currently living with Alzheimer disease. That number is projected to almost double by 2025.

More information: "Effectiveness and safety of FDG-PET in the evaluation of dementia: a review of the recent literature" Journal of Nuclear Medicine. http://jnm.snmjournals.org/

Provided by Society of Nuclear Medicine

2012-01-06T17:21:00.000Z

Cognitive decline can begin as early as age 45: study

The brain's capacity for memory, reasoning and comprehension skills (cognitive function) can start to deteriorate from age 45, finds research published in the British Medical Journal today.

06 jan 2012--Previous research suggests that cognitive decline does not begin before the age of 60, but this view is not universally accepted.

Researchers, led by Archana Singh-Manoux from the Centre for Research in Epidemiology and Population Health in France and University College London in the UK, argue that "understanding cognitive ageing will be one of the challenges of this century," especially as life expectancy continues to rise.

They add that it is important to investigate the age at which cognitive decline begins because medical interventions are more likely to work when individuals first start to experience mental impairment.

Therefore the authors observed 5,198 men and 2,192 women over a 10-year period from 1997. They were all civil servants aged between 45 and 70 and were part of the Whitehall II cohort study established in 1985.

Participants' cognitive functions were assessed three times over the study period. Individuals were tested for memory, vocabulary and aural and visual comprehension skills. The latter include recalling in writing as many words beginning with "S" (phonemic fluency) and as many animal names (semantic fluency) as possible.

Differences in education level were taken into account.

The results show that cognitive scores declined in all categories (memory, reasoning, phonemic and semantic fluency) except vocabulary and there was faster decline in older people.

The findings also reveal that over the 10-year study period there was a 3.6% decline in mental reasoning in men aged 45-49 and a 9.6% decline in those aged 65-70. The corresponding figures for women were 3.6% and 7.4%.

The authors argue that robust evidence showing cognitive decline before the age of 60 has important ramifications because it demonstrates the importance of promoting healthy lifestyles, particularly cardiovascular health, as there is emerging evidence that "what is good for our hearts is also good for our heads."

They add that targeting patients who suffer from one or more risk factors for heart disease (obesity, high blood pressure and high cholesterol levels) could not only protect their hearts but also safeguard them from dementia in later life.

In an accompanying editorial, Francine Grodstein, Associate Professor of Medicine at Brigham and Women's Hospital in Boston, says the study "has profound implications for prevention of dementia and public health."

She adds that more creative research, perhaps using telephone and computer cognitive assessments, needs to be undertaken.

Provided by British Medical Journal

2012-01-05T01:50:00.001Z

Another potential risk factor for developing dementia and Alzheimer's disease women

A hormone derived from visceral fat called adiponectin may play a role as a risk factor for development of all-cause dementia and Alzheimer disease (AD) in women, according to a study published Online First by the Archives of Neurology.

05 jan 2012--The number of people affected by dementia worldwide is estimated to double over the next 20 years from the current number of about 36 million people, the authors provide as background information in the article. AD is the most common form of dementia. The authors write that data suggest an association between insulin resistance and inflammation, hallmarks for type 2 diabetes, and development of dementia. "An additional potential factor that may contribute to the onset of AD and all-cause dementia is adiponectin. Adiponectin is a hormone derived from visceral fat, which sensitizes the body to insulin, has anti-inflammatory properties, and plays a role in the metabolism of glucose and lipids."

Thomas M. van Himbergen, Ph.D., from the Lipid Metabolism Laboratory, Human Nutrition Research Center on Aging, Tufts University, Boston, and colleagues measured levels of glucose, insulin, and glycated albumin, as well as C reactive protein, lipoprotein associated phospholipase A2, and adiponectin in the plasma of patients at the 19th biennial examination (1985 – 1988) of the Framingham Heart Study.

The 840 patients (541 women, median age of 76 years) were followed-up for an average of 13 years and evaluated for signs of the development of AD and all-cause dementia. During that time, 159 patients developed dementia, including 125 cases of AD. After adjustment for other dementia risk factors (age, apoE genotype, low plasma docosahexaenoic acid, weight change) only adiponectin in women was associated with an increased risk of all-cause dementia and AD.

"It is well established that insulin signaling is dysfunctional in the brains of patients with AD, and since adiponectin enhances insulin sensitivity, one would also expect beneficial actions protecting against cognitive decline," the authors write. "Our data, however, indicate that elevated adiponectin level was associated with an increased risk of dementia and AD in women."

"One of the main features of adiponectin is that it has been shown to play a role in the sensitization of insulin and therefore may become a therapeutic target for the treatment of T2D (type 2 diabetes). Surprisingly, a higher adiponectin level was found to be a predictor of all-cause and vascular mortality. In concurrence with the mortality findings, the current investigation shows that an elevated adiponectin level is also an independent predictor for all-cause dementia and AD in women," the authors conclude.

More information: Arch Neurol. Published online January 2, 2012. doi:10.1001/archneurol.2011.670

Provided by JAMA and Archives Journals

2012-01-04T14:12:00.001Z

Genetic predisposition to disease common in two supercentenarians: study

The first-ever published whole-genome sequences of not just one, but two supercentenarians, aged more than 114 years, reveal that both unusual and common genetic phenomena contribute to the genetic background of extreme human longevity.

04 jan 2012--Data from the study led by researchers from the Boston University Schools of Public Health and Medicine and Boston Medical Center -- will be available to researchers around the world at the NIH data repository.

In the study, published Jan. 3 in the open-access journal Frontiers in Genetics, researchers at BU, the University of Florida, Gainesville, and The Scripps Research Institute report a comprehensive analysis of the whole genome sequences of a man and a woman, both of whom lived past the age of 114. Supercentenarians (age 110+ years) are very rare, occurring at a rate of one person per five million in developed countries, and there is growing evidence supporting a strong genetic influence in survival to such ages.

The study, led by Paola Sebastiani, professor of biostatistics at the BU School of Public Health, shows that the overall genomic architecture of these two subjects is comparable to that of other published full genomes, in terms of rates of novel variants, functional variants, and variants that predispose to common age-related diseases and common cancers. But while the two carried as many disease-associated genes as the general population, their longevity suggests other protective mechanisms at work.

For example, the male subject had 37 genetic mutations associated with increased risk for colon cancer -- indicating that he was in no way immune to that age-related disease. "In fact, he had presented with an obstructing colon cancer earlier in his life that had not metastasized and was cured with surgery. He was in phenomenal cognitive and physical shape near the time of his death," said Dr. Thomas Perls, director of the New England Centenarian Study and senior author of the article.

The female supercentenarian also had numerous genetic variations associated with age-related diseases, including those related to increased risks for Alzheimer's, cancer and heart disease. She did have congestive heart failure and mild cognitive impairment, but these diseases did not become evident until after the age of 108 years.

"The presence of these disease-associated variants is consistent with our and other researchers' findings that centenarians carry as many disease-associated genes as the general population," Perls said. "The difference may be that the centenarians likely have longevity-associated variants that cancel out the disease genes. That effect may extend to the point that the diseases don't occur -- or, if they do, are much less pathogenic or markedly delayed towards the end of life, in these individuals who are practically living to the limit of the human lifespan."

In support of this conjecture, Sebastiani and colleagues identified more than 50 putative longevity-associated variants in genes that determine two forms of progeria (an accelerated aging disease), and genes linked to cardiovascular disease and Alzheimer's disease. The authors highlighted the importance of performing follow-up studies to determine the impact and function of these genetic variants and their role in regulating health span, as well as life span.

The findings of the study suggest that unusual genetic phenomena and a combination of rare and common genetic variants contribute to the genetic background of extreme human longevity, the authors said.

"The study of these two supercentenarians is just the beginning, and genetic study of many more such subjects needs to be performed," said Perls. A number of such endeavors are underway, on a larger scale, including the Archon Genomics X Prize and a collaboration between Complete Genomics, Inc., The Scripps Translational Science Institute, and other institutions.

More information: http://www.frontie … 090/abstract

Provided by Boston University Medical Center

2012-01-03T02:31:00.002Z

Changes seen in cerebrospinal fluid levels before onset of Alzheimer dementia

Cerebrospinal fluid levels of Aβ42 appear to be decreased at least five to 10 years before some patients with mild cognitive impairment develop Alzheimer disease (AD) dementia whereas other spinal fluid levels seem to be later markers of disease, according to a report in the January issue of Archives of General Psychiatry.

03 jan 2012--Hopefully, new therapies that can retard or even halt progression of the disease will soon be available. Together with an early and accurate diagnosis, such therapies could be initiated before neuronal degeneration is too widespread and patients are already demented," the authors conclude.

The researchers note as background in the study that disease-modifying therapies, such as immunotherapy, are more likely to be successful if started in the early stages of the disease so there is a need to identify patients with Alzheimer disease before neurodegeneration is not too severe.

Peder Buchhave, M.D., Ph.D, who is affiliated with Lund University and Skane University, Sweden, and colleagues conducted an extended follow-up of the cohort from a previous study of 137 patients with mild cognitive impairment (MCI) at baseline. The median follow-up was 9.2 years.

During the follow-up, 72 patients (53.7 percent) developed AD and 21 (15.7 percent) progressed to other forms of dementia. At the baseline, cerebrospinal fluid Aβ42 levels were reduced and other biomarkers T-tau and P-tau levels were elevated in patients who converted to AD during follow-up compared with levels in patients who did not develop AD.

The study indicates baseline CSF Aβ42 levels were equally reduced in patients with MCI who converted to AD within five years (the early converters) compared to those who converted later between five and 10 years. However, T-tau and P-tau levels were significantly higher in early converters compared to later ones.

Researchers suggest that "approximately 90 percent of patients with MCI and pathologic CSF biomarkers at baseline will develop AD within 9.2 years."

"Therefore, these markers can identify individuals at high risk for future AD least five to 10 years before conversion to dement

Provided by JAMA and Archives Journals

2012-01-01T22:08:00.003Z

How to prevent, treat a New Year's hangover

01 jan 2012-- New Year’s Eve is fast approaching and many plan on ringing in the new year with a few drinks.

Dr. Aaron Michelfelder, a Loyola University Health System family physician, offers these tips on how to avoid the misery of a New Year's hangover:

Before the party:

• Plan to drink moderately -- a maximum of five drinks for men and three drinks for women during a minimum three-hour periode.

During the party:

• Eat first, and then drink, not the other way around. Food slows the absorption of alcohol.

• Drink slowly.

• To prevent dehydration, drink a glass of water after each alcoholic drink.

• Take a B vitamin supplement.

After the party:

• Do not drink and drive.

• Get as much sleep as possible.

• The morning after:

• Take another B vitamin.

• Drink lots of water.

• Exercise (if you can stand it). During vigorous exercise, blood circulates three times as fast as it does when you are sitting on the couch. And the faster you circulate blood through your liver and kidneys, the faster your body will remove the toxins.

What doesn't work:

• Coffee will make you more alert, but it won't prevent or help a hangover.

• Forget "hair of the dog" -- the notion that having a drink can relieve a hangover. It will only make you feel worse.

Provided by Loyola University Health System

2011-12-31T00:09:00.001Z

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

Drop 10 pounds. Quit smoking. Stop cursing.

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

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

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

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

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

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

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

Resolutions should be more than mere "wishes."

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

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

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

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

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

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

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

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

Provided by Inside Science News Service

2011-12-30T14:29:00.001Z

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

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

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

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

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

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

Provided by American Academy of Neurology

2011-12-29T13:45:00.001Z

Diet, nutrient levels linked to cognitive ability, brain shrinkage

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

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

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

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

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

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

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

Among the findings and observations:

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

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

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

Provided by Oregon State University

2011-12-28T02:06:00.000Z

Scientists identify an innate function of vitamin E

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

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

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

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

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

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

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

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

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

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

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

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

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

Provided by Georgia Health Sciences University

2011-12-27T01:02:00.000Z

99-year-old woman regains mobility following spinal procedures

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

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

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

She will celebrate her 100th birthday Jan. 3.

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

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

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

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

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

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

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

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

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

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

Provided by University of Rochester Medical Center

2011-12-26T14:33:00.001Z

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Provided by Rutgers University

2011-12-25T15:00:00.001Z

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

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

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

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

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

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

The researchers identified two distinct patterns:

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

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

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

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

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

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

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

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

2011-12-24T13:51:00.000Z

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

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

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

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

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

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

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

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

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

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

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

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

Provided by University of Michigan

2011-12-23T17:06:00.001Z

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

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

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

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

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

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

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

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

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

Provided by Lancet

2011-12-22T02:10:00.002Z

Can proteins in the blood predict an early death?

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

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

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

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

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

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

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

Provided by American Society of Nephrology

2011-12-21T01:43:00.001Z

Mediterranean diet gives longer life

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

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

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

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

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

Provided by University of Gothenburg

2011-12-19T20:57:00.001Z

Polyphenol-rich diet could reduce cardiovascular risk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Provided by University of Glasgow

2011-12-17T23:45:00.001Z

Doctors should tell patients the realities of aging

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

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

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

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

Here Smith discusses the issue:

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-12-16T00:44:00.000Z

Biochemical signature predicts progression to Alzheimer's disease

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

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

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

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

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

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

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

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

Provided by VTT Technical Research Centre of Finland

2011-12-14T02:14:00.001Z

Despite guidelines, elderly receiving too many cancer screenings

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

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

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

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

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

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

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

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

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

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

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

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

Provided by University of Connecticut

2011-12-13T01:28:00.000Z

Study: No decline in running economy for older runners

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

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

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

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

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

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

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

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

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

Provided by University of New Hampshire

2011-12-12T00:14:00.000Z

Socially active older adults have slower rates of health declines

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

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

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

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

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

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

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

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

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

Provided by Health Behavior News Service

2011-12-11T01:48:00.001Z

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

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

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

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

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

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

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

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

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

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

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

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

Provided by Stanford University Medical Center

2011-12-10T00:22:00.001Z

Alzheimer's vaccine cures memory of mice

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

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

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

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

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

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

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

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

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

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

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

Provided by University of Sydney

2011-12-09T13:18:00.001Z

Pharmacogenomics study finds rare gene variants critical for personalized drug treatment

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

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

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

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

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

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

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

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

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

Provided by Cold Spring Harbor Laboratory

2011-12-08T00:19:00.001Z

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Provided by Queen Mary, University of London

2011-12-07T01:43:00.000Z

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

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

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

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

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

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

Provided by Federation of American Societies for Experimental Biology

2011-12-03T02:49:00.001Z

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

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

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

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

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

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

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

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

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

Provided by Georgia Health Sciences University

2011-12-02T12:01:00.001Z

Socially active older adults have slower rates of health declines

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

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

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

Provided by Health Behavior News Service

2011-11-29T14:08:00.000Z

Depression can lead to heart disease

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

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

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

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

Heart rate recovery is a powerful diagnostic tool

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

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

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

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

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

2011-11-28T02:10:00.000Z

Fruit fight: Kiwi tops apple in blood pressure study

ORLANDO,28 nov 2011-- An apple a day may keep the doctor away, but three kiwis could lower your blood pressure.

A study presented at the American Heart Association scientific meeting in Orlando on Tuesday found that eating the fuzzy-skinned fruit with the tart green flesh three times a day lowered blood pressure more than an apple.

The eight-week study, led by Mette Svendsen, a registered dietitian at Oslo University Hospital in Norway, involved 118 subjects with an average age of 55 and mildly high blood pressure.

One group added three kiwis to their daily diet, while the other half added the proverbial apple a day. Kiwis contain lutein, which has antioxidant properties.

After eight weeks, researchers found the kiwi group's 24-hour systolic blood pressure was 3.6 mm Hg lower than that of the apple eaters, on average.

The diastolic blood pressure was also lower in the kiwi group, but that association to the fruit was not as clear, researchers said. They recommended that the findings be confirmed with a larger study.

Perhaps the most surprising thing about the kiwi fruit study was that it was conducted in Norway and not in New Zealand.

2011-11-27T01:18:00.000Z

Drugs ID'd in Most Older Adult Emergency Hospitalizations

Warfarin, insulin, oral antiplatelets, hypoglycemics implicated in most emergency hospitalizations

27 nov 2011-- Adverse drug events from commonly used medications, including warfarin, insulin, oral antiplatelet agents, and oral hypoglycemic agents, account for the majority of emergency hospitalizations in older adults in the United States, according to a study published in the Nov. 24 issue of the New England Journal of Medicine.

Daniel S. Budnitz, M.D., M.P.H., from the Division of Healthcare Quality Promotion at the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues estimated the frequency and rates of emergency hospitalization after emergency department visits for adverse drug events in adults aged 65 years or older. Adverse event data were collected for 5,077 cases identified from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project from 2007 to 2009, and were used to assess the contribution of specific medications to hospitalizations.

The investigators identified approximately 99,628 emergency hospitalizations for adverse drug events in older adults each year. Adults aged 80 years or older accounted for 48.1 percent of these hospitalizations, and almost two-thirds of the hospitalizations (65.7 percent) resulted from unintentional overdoses. Sixty-seven percent of the hospitalizations involved four medications or medication classes, alone or in combination: warfarin (33.3 percent), insulin (13.9 percent), oral antiplatelet agents (13.3 percent), and oral hypoglycemic agents (10.7 percent). In 1.2 percent of hospitalizations, high-risk medications were implicated.

"Most emergency hospitalizations for recognized adverse drug events in older adults resulted from a few commonly used medications, and relatively few resulted from medications typically designated as high-risk or inappropriate," the authors write.

2011-11-26T03:11:00.000Z

How cancer cells get by on a starvation diet

MIT researchers have found that when deprived of oxygen, cancer cells can engage an alternate metabolic pathway that allows them to use glutamine (seen above) as the starting material for synthesizing lipids.

Cancer cells usually live in an environment with limited supplies of the nutrients they need to proliferate — most notably, oxygen and glucose. However, they are still able to divide uncontrollably, producing new cancer cells.

26 nov 2011--A new study from researchers at MIT and the Massachusetts General Hospital (MGH) Cancer Center helps to explain how this is possible. The researchers found that when deprived of oxygen, cancer cells (and many other mammalian cells) can engage an alternate metabolic pathway that allows them to use glutamine, a plentiful amino acid, as the starting material for synthesizing fatty molecules known as lipids. These lipids are essential components of many cell structures, including cell membranes.

The finding, reported in the Nov. 20 online edition of Nature, challenges the long-held belief that cells synthesize most of their lipids from glucose, and raises the possibility of developing drugs that starve tumor cells by cutting off this alternate pathway.

Lead author of the paper is Christian Metallo, a former postdoc in the lab of Gregory Stephanopoulos, the William Henry Dow Professor of Chemical Engineering and Biotechnology at MIT and a corresponding author of the paper. Othon Iliopoulos, an assistant professor of medicine at Harvard Medical School and MGH, is the paper’s other corresponding author.

Alternate pathways

Much of the body’s supply of oxygen and glucose is carried in the bloodstream, but blood vessels often do not penetrate far into the body of tumors, so most cancer cells are deficient in those nutrients. This means they can’t produce fatty acids using the normal lipid-synthesis pathway that depends mostly on glucose.

In prior work, Stephanopoulos’ lab identified a metabolic pathway that uses glutamine instead of glucose to produce lipids; the new paper shows that this alternate pathway is much more commonly used than originally thought. The researchers found that in both normal and cancerous cells, lack of oxygen — a state known as hypoxia — provokes a switch to the alternate pathway.

In a normal oxygen environment, 80 percent of a cell’s new lipids come from glucose, and 20 percent from glutamine. That ratio is reversed in a hypoxic environment, Stephanopoulos says.

“We saw, for the first time, cancer cells using substrates other than glucose to produce lipids, which they need very much for their rapid growth,” Iliopoulos explains. “This is the first step to answering the question of how new cell mass is synthesized during hypoxia, which is a hallmark of human malignancies.”

The glutamine may come from within the cell or from neighboring cells, or the extracellular fluid that surrounds cells.

“There’s protein everywhere,” says Matthew Vander Heiden, the Howard S. and Linda B. Stern Career Development Assistant Professor of Biology at MIT and a co-author of the Nature paper. “The new pathway allows cells to conserve what glucose they do have, perhaps to make RNA and DNA, and then co-opt the new pathway to make lipids so they can grow under low oxygen.”

The switch from glucose to glutamine is triggered by low oxygen and allows cancer cells to thrive and proliferate in an environment with minimal glucose, though it is not clear how this is done. “Elucidating the molecular mechanism regulating this switch would be important in understanding regulation of cancer metabolism,” Stephanopoulos says. “This could be important not only for cancer cells but also other cells growing in hypoxic environments, such as stem cells, placenta and during embryonic development.”

New insights into old models

The researchers are now looking into what other unexpected sources might be diverted into lipid-synthesis pathways under low oxygen. “We had to revise models of metabolism that had been established over the past 50 years. This opens up the possibility for more exciting discoveries in this field that may impact strategies of therapy,” Metallo says.

A better understanding of metabolic pathways and their regulation raises the possibility of developing new drugs that could selectively disrupt key metabolic pathways for cancer cell survival and growth. One possible target is the enzyme isocitrate dehydrogenase, which performs a critical step in the transformation of glutamine to acetyl CoA, a lipid precursor.

“While this target is not new, our findings point to a new function and, hence, generate new ideas for drug development,” Iliopoulos says. “The better we understand the molecular basis of these phenomena, the more optimistic we can be about efforts to translate these basic results into effective treatments of cancer.”

“We’ve been looking, as a field, for almost 90 years for a metabolic pathway that could truly be used to differentiate malignant tumors from normal tissues,” says Ralph DeBerardinis, an assistant professor of pediatrics and genetics at the University of Texas Southwestern Medical Center, who was not involved in this research. He adds that more study is needed, but “if this could be exploited, that could have significant therapeutic potential.”

This story is republished courtesy of MIT News (http://web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.

Provided by Massachusetts Institute of Technology

2011-11-25T02:06:00.001Z

Doctors could learn from Shakespeare's deep understanding of mind-body connection

Shakespeare was a master at portraying profound emotional upset in the physical symptoms of his characters, and many modern day doctors would do well to study the Bard to better understand the mind-body connection, concludes an analysis of his works, published in Medical Humanities.

25 nov 2011--Kenneth Heaton, a medical doctor and extensively published author on William Shakespeare's oeuvre, systematically analysed 42 of the author's major works and 46 of those of his contemporaries, looking for evidence of psychosomatic symptoms.

He focused on sensory symptoms other than those relating to sight, taste, the heart, and the gut.

He found that Shakespeare's portrayal of symptoms such as dizziness/faintness, and blunted or heightened sensitivity to touch and pain in characters expressing profound emotions was significantly more common than in works by other authors of the time.

Vertigo/giddiness/dizziness is expressed by five male characters in "Taming of the Shrew", "Romeo and Juliet", "Henry VI" part 1, "Cymbeline" and "Troilus and Cressida". The nearest approximation in contemporaries' works was one incident in John Marston's "The Malcontent".

There are at least 11 instances of breathlessness associated with extreme emotion in "Two Gentlemen of Verona", "The Rape of Lucrece", "Venus and Adonis", and "Troilus and Cressida", compared with just two in the works of other writers.

Fatigue/weariness as a result of grief or distress is a familiar sensation among Shakespeare's characters, most notably in "Hamlet", "The Merchant of Venice", "As You Like It", "Richard II" and "Henry IV" part 2. This crops up twice as frequently as in other contemporaries' works, argues Dr Heaton.

Disturbed hearing at a time of high emotion occurs in "King Lear", "Richard II" and "King John" while blunted/exaggerated senses are portrayed in "Much Ado about Nothing", "Venus and Adonis", "King Lear", "Love's Labour's Lost" and "Coriolanus".

"Shakespeare's perception that numbness and enhanced sensation can have a psychological origin seems not to have been shared by his contemporaries, none of whom included such phenomena in the works examined," writes Dr Heaton.

The Bard also uses coldness - for example, "Romeo and Juliet" - and faintness to convey shock, including in "Titus Andronicus", "Julius Caesar", "Love's Labour's Lost", and "Richard III", significantly more frequently than other writers of the period.

Dr Heaton concludes that his data show that Shakespeare "was an exceptionally body-conscious writer," suggesting that the technique was used to make his characters seem more human and engender greater empathy or raise the emotional temperature of his plays and poems.

And his findings should encourage doctors to remember that physical symptoms can have psychological causes, he suggests.

"Many doctors are reluctant to attribute physical symptoms to emotional disturbance, and this results in delayed diagnosis, overinvestigation, and inappropriate treatment," he writes.

"They could learn to be better doctors by studying Shakespeare. This is important because the so-called functional symptoms are the leading cause of general practitioner visits and of referrals to specialists," he says.

Provided by British Medical Journal

2011-11-24T14:30:00.000Z

People with early Alzheimer's disease may be more likely to have lower BMI

Studies have shown that people who are overweight in middle age are more likely to develop Alzheimer's disease decades later than people at normal weight, yet researchers have also found that people in the earliest stages of Alzheimer's disease are more likely to have a lower body mass index (BMI). A current study examines this relationship between Alzheimer's disease and BMI.

24 nov 2011--The study, published in the November 22, 2011, print issue of Neurology, the medical journal of the American Academy of Neurology, examined 506 people with advanced brain imaging techniques and analyses of cerebrospinal fluid to look for biomarkers for Alzheimer's disease, which can be present years before the first symptoms begin. The participants, who were part of the Alzheimer's Disease. Neuroimaging Initiative, included people with no memory problems, people with mild cognitive impairment, or mild memory problems, and people with Alzheimer's disease.

The study found that in people with no memory or thinking problems and in people with mild cognitive impairment, those who had the Alzheimer's biomarkers were also more likely to have a lower BMI than those who did not have the biomarkers.

For example, 85 percent of the people with mild cognitive impairment who had a BMI below 25 had signs of the beta-amyloid plaques in their brains that are a hallmark of the disease, compared to 48 percent of those with mild cognitive impairment who were overweight. The relationship was also found in people with no memory or thinking problems.

"These results suggest Alzheimer's disease brain changes are associated with systemic metabolic changes in the very earliest phases of the disease," said study author Jeffrey M. Burns, MD, MS, of the University of Kansas School of Medicine in Kansas City and a member of the American Academy of Neurology. "This might be due to damage in the area of the brain called the hypothalamus that plays a role in regulating energy metabolism and food intake. Further studies should investigate whether this relationship reflects a systemic response to an unrecognized disease or a long-standing trait that predisposes a person to developing the disease."

Provided by American Academy of Neurology

2011-11-23T19:51:00.000Z

A study looks at the nature of change in our aging, changing brains

23 nov 2011 -- As we get older, our cognitive abilities change, improving when we’re younger and declining as we age. Scientists posit a hierarchical structure within which these abilities are organized. There’s the “lowest” level— measured by specific tests, such as story memory or word memory; the second level, which groups various skills involved in a category of cognitive ability, such as memory, perceptual speed, or reasoning; and finally, the “general,” or G, factor, a sort of statistical aggregate of all the thinking abilities.

What happens to this structure as we age? That was the question Timothy A. Salthouse, Brown-Forman professor of psychology at the University of Virginia, investigated in a new study appearing in an upcoming issue of Psychological Science, a journal published by the Association for Psychological Science. His findings advance psychologists’ understanding of the complexities of the aging brain.

“There are three hypotheses about how this works,” says Salthouse. “One is that abilities become more strongly integrated with one another as we age.” That theory suggests the general factor influences cognitive aging the most. The second—based on the idea that connectivity among different brain regions lessens with age—“is almost the opposite: that the changes in cognitive abilities become more rather than less independent with age.” The third was Salthouse’s hypothesis: The structure remains constant throughout the aging process.

Using a sample of 1,490 healthy adults ages 18 to 89, Salthouse performed analyses of the scores on 16 tests of five cognitive abilities—vocabulary, reasoning, spatial relations, memory, and perceptual speed. The primary analyses were on the changes in the test scores across an interval of about two and a half years.

The findings confirmed Salthouse’s hunch: “The effects of aging on memory, on reasoning, on spatial relations, and so on are not necessarily constant. But the structure within which these changes are occurring does not seem to change as a function of age.” In normal, healthy people, “the direction and magnitude of change may be different” when we’re 18 or 88, he says. “But it appears that the qualitative nature of cognitive change remains the same throughout adulthood.”

The study could inform other research investigating “what allows some people to age more gracefully than others,” says Salthouse. That is, do people who stay mentally sharper maintain their ability structures better than those who become more forgetful or less agile at reasoning? And in the future, applying what we know about the structures of change could enhance “interventions that we think will improve cognitive functioning” at any age or stage of life.

Provided by Association for Psychological Science

2011-11-22T13:53:00.001Z

Older adults in home health care at elevated risk for unsafe meds

Older adults receiving home health care may be taking a drug that is unsafe or ineffective for someone their age. In fact, nearly 40 percent of seniors receiving medical care from a home health agency are taking at least one prescription medication that is considered potentially inappropriate to seniors, a new study in the Journal of General Internal Medicine has revealed.

22 nov 2011--The study's researchers, led by Dr. Yuhua Bao, assistant professor of public health at Weill Cornell Medical College, found that home health care patients aged 65 and over are prescribed Potentially Inappropriate Medications, or PIMs, at rates three times higher than patients who visit a medical office. The researchers' data shows that home health care patients are taking 11 medications on average, and that the concurrent use of multiple medications is a strong indicator of the presence of PIMs.

"Elderly patients receiving home health care are usually prescribed medications by a variety of physicians, and it's a great challenge for home health care nurses to deal with prescriptions from many sources," says Dr. Bao.

Still, she sees the home health care model offering potential for improving this situation. "Having a medical professional enter an elderly patient's home is an opportunity to do a proper medication review and reconciliation," Dr. Bao explains.

The study used data from the National Home and Hospice Care Survey, conducted in 2007 by the Centers for Disease Control and Prevention (CDC), which is the most recent nationally representative epidemiological survey of home health patients. The 2002 Beers Criteria, an expert-panel-generated list that itemizes 77 medications or groups of medications considered inappropriate for elderly people, was the basis for the PIMs chosen.

In a review of data of 3,124 home health patients 65 years of age or older, the researchers found 38 percent were taking at least one PIM. Senior patients taking 15 or more medications were five to six times as likely to be prescribed PIMs as patients taking seven or fewer medications. Of those seniors taking at least one PIM, 21 percent were taking 15 or more medications.

According to Dr. Bao, the study, if anything, underestimates the prevalence of PIMs taken by home health patients: The researchers were not able to look at potentially problematic drug-to-drug interactions or drug-and-disease interactions because data were not available.

There is no one reason why PIMs are prevalent in home health care settings. "Anecdotal evidence shows that many physicians are not aware of what is on the PIM list," says Dr. Bao. "In our fragmented health care system, we generally don't have an electronic reference for a patient that lists all medications from different physicians, and there isn't a readily available means for professionals to share essential information. Enhanced physician communication with home health care nurses may help to address the problem, as well as better communication among physicians."

Dr. Bao sees incentives for improvement in communication and care coordination in the implementation of the Patient Protection and Affordable Care Act passed by the U.S. Congress in 2010. "The current payment system doesn't provide incentives to optimize coordination of care," says Dr. Bao. "But when providers in different settings as a group are held responsible for outcomes and costs of care through, for example, an accountable care organization -- a concept promoted in the Affordable Care Act -- this could create an impetus to break the communication barriers that currently exist."

Provided by New York- Presbyterian Hospital

2011-11-21T13:44:00.000Z

Study finds sex a significant predictor of happiness among married seniors

The more often older married individuals engage in sexual activity, the more likely they are to be happy with both their lives and marriages, according to new research presented in Boston at The Gerontological Society of America's (GSA) 64th Annual Scientific Meeting.

21 nov 2011--This finding is based on the 2004-2006 General Social Surveys, a public opinion poll conducted on a nationally representative sample of non-institutionalized English and Spanish-speaking person 18 years of age or older living in the U.S. The data analysis was conducted by Adrienne Jackson, PT, PhD, MPA, an assistant professor at Florida Agricultural and Mechanical University.

"This study will help open the lines of communication and spark interest in developing 'outside the box' approaches to dealing with resolvable issues that limit or prevent older adults from participating in sexual activity," said Jackson. "Highlighting the relationship between sex and happiness will help us in developing and organizing specific sexual health interventions for this growing segment of our population."

Based on the survey responses of 238 arried individuals age 65 years or older, Jackson discovered that frequency of sexual activity was a significant predictor of both general and marital happiness. The association even remained after accounting for factors such as age, gender, health status, and satisfaction with financial situation.

Whereas only 40 percent of individuals who reported no sexual activity in the last 12 months said they were very happy with life in general, almost 60 percent who engaged in sexual activity more than once a month said they were very happy. Similarly, while about 59 percent of individuals who reported no sexual activity in the last 12 months said they were very happy with their marriage, almost 80 percent who had sex more than once a month said they were very happy. To assess frequency of sexual activity, respondents were asked the following question: "About how many times did you have sex during the last 12 months? By 'sex' we mean vaginal, oral, or anal sex." To assess general happiness, respondents were asked the following question: "Taken all together, how would you say things are these days — would you say that you are very happy, pretty happy, or not too happy?" To assess marital happiness, respondents were asked the following question: "Taking things all together, how would you describe your marriage? Would you say that your marriage is very happy, pretty happy, or not too happy?"

GSA's meeting — the country's largest interdisciplinary conference in the field of aging — is taking place at the John B. Hynes Veterans Memorial Convention Center and Sheraton Boston Hotel from November 18 to 22.

Provided by The Gerontological Society of America

2011-11-20T02:19:00.000Z

Elderly hospital patients with delirium more likely to die within a year

Hospital patients over 65 who are referred for a psychiatric consultation and found to have delirium are more likely than those without delirium to die within one year following diagnosis, according to a new study published in the journal General Hospital Psychiatry.

20 nov 2011--“Clinical physicians should pay close attention to delirious patients,” says lead author Jian-An Su, M.D., a psychiatrist at Chang Gung Memorial Hospital in Taiwan. “Early psychiatric consultation could decrease mortality.”

Delirium is a sudden change in mental status associated with physical illness and related medications. A delirious patient may experience bouts of confusion, lethargy, agitation, or hallucinations alternating with periods of lucidity.

The new study is based on records for more than 600 patients over 65 years of age examined by psychiatrists in a Taiwanese hospital between 2002 and 2006. Of these, 172 were diagnosed with delirium. The researchers later reviewed state records to find out how many of the patients had subsequently died. The findings were compared to those for a similar group of patients who had not experienced delirium.

Elderly inpatients who were diagnosed with delirium had significantly higher death rates than other patients in the first year after delirium onset, found the authors. The results held regardless of patients’ gender, physical illnesses, or treatment with antipsychotic medications.

In the elderly, delirium is often characterized by “quiet” symptoms, such as confusion and lethargy. “These patients are frequently overlooked, under-diagnosed, or misdiagnosed as having depression, dementia, or severe illness,” note the authors.

“Primary physicians -- whether intensivists, hospitalists, surgical teams, or others -- must first be attuned to a patient’s behavior and cognitions in order to request a psychiatric consultation for a complete evaluation,” says Ian Cook, M.D., of the Resnick Neuropsychiatric Hospital at the University of California, Los Angeles.

Cook suggests that a brief series of questions such as, “Can you tell me the name of where we are? What day is it? Why are you here in the hospital?” could help attending physicians recognize patients with delirium more consistently, along with observing behaviors such as agitation or excessive sleepiness. Many resources on delirium also advise family members to alert providers immediately if their loved one displays sudden changes in mental status while in the hospital.

More information: Tsai, M-C. et al. Three-year mortality of delirium among elderly inpatients in consultation–liaison service. General Hospital Psychiatry In Press.

Provided by Health Behavior News Service

2011-11-19T01:02:00.000Z

Study affirms 'mediterranean diet' improves heart health

19 nov 2011-- A team of Johns Hopkins researchers has uncovered further evidence of the benefits of a balanced diet that replaces white bread and pasta carbohydrates with unsaturated fat from avocados, olive oil and nuts — foods typical of the so-called “Mediterranean diet.”

In a report prepared for the American Heart Association’s scientific sessions in Orlando next week, the Johns Hopkins investigators say swapping out certain foods can improve heart health in those at risk for cardiovascular disease, even if the dietary changes aren’t coupled with weight loss.

“The introduction of the right kind of fat into a healthy diet is another tool to reduce the risk of future heart disease,” says Meghana Gadgil, M.D., M.P.H., a postdoctoral fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine who will be presenting the research.

Gadgil and her colleagues analyzed data from the OmniHeart Trial, which studied the cardiovascular effects of three different balanced diets on 164 people with mild hypertension but no diabetes. The researchers compared the body’s ability to regulate blood sugar and maintain healthy insulin levels while on a carbohydrate-rich diet, a protein-rich diet and a diet rich in unsaturated fats. People whose bodies fail to effectively use insulin usually develop type 2 diabetes, which is a major risk factor for heart disease.

The researchers found that a generally balanced diet higher in unsaturated fats such as those in avocados, olive oil and nuts improves insulin use significantly more than a diet high in carbohydrates, particularly such refined carbs as white bread and pasta. The preferred diet is very similar to the Mediterranean diet, inspired by the foods of southern Italy and Greece and emphasizing healthy fats, fruits and vegetables.

Each participant in the study was fed each of the three diets for six weeks in a row, with two to four weeks off in between. Blood samples were collected after fasting periods in weeks four and six of each diet, and used to monitor insulin and glucose levels. The study was designed to keep participants at their starting weights. “A lot of studies have looked at how the body becomes better at using insulin when you lose weight,” Gadgil says. “We kept the weight stable so we could isolate the effects of the macronutrients. What we found is that you can begin to see a beneficial impact on heart health even before weight loss.”

Provided by Johns Hopkins University

2011-11-18T12:39:00.000Z

Protecting our brains: Tackling delirium

A new national plan of action provides a roadmap for improving the care of patients with delirium, a poorly understood and often unrecognized brain condition that affects approximately seven million hospitalized Americans each year.

18 nov 2011--"Delirium: A Strategic Plan to Bring an Ancient Disease into the 21st Century," written on behalf of the American Delirium Society, appears in the supplement to the Nov. 2011 issue of the Journal of the American Geriatrics Society. Publication of the supplement, "Advancing Delirium Science: Systems, Mechanisms and Management" was supported by the John A. Hartford Foundation.

Delirium is a sudden alteration in mental status -- brain failure in a vulnerable individual, often an older adult with multiple health issues, caused by something else such as medications, urinary tract infection, lack of sleep, excessive light or noise or pain. In the United States, an estimated 80 percent of patients in intensive care units experience delirium during their hospital stay, however delirium is unrecognized in 60 percent of patients who experience it.

"Having delirium prolongs the length of a hospital stay, increases the risk of post-hospitalization transfer to a nursing home, doubles the risk of death, and may lead to permanent brain damage," said Regenstrief Institute investigator Malaz Boustani, M.D., M.P.H., associate professor of medicine at the Indiana University School of Medicine and director of the Healthy Aging Brain Center at Wishard Health Services. Dr. Boustani is an IU Center for Aging Research center scientist and president-elect of the American Delirium Society.

"Statistically having delirium is as serious as having a heart attack. Once delirium occurs, the same percentage of individuals die from it as die from a heart attack," said James Rudolph, M.D., president of the American Delirium Society.

Delirium, which occurs suddenly, is not the same as dementia, although individuals with dementia are more susceptible to developing delirium during hospitalization than individuals without dementia.

Delirium has plagued the ill and vulnerable with increased risk of death for centuries, at least since Hippocrates described the condition in the fourth century B.C. Today, as much as $152 billion is spent annually in the U.S. on delirium related costs such as hospitalization, rehabilitation services, or nursing homes residency.

The new framework outlines four broad goals and details steps to achieve them:

Goal 1: Improve clinical care related to delirium including screening patients for delirium risk and developing non-toxic treatments for delirium.

Goal 2: Improve delirium education especially improving public understanding that a change in mental status in an older patient is a medical emergency and correcting the misconception among health care providers that delirium is a 'normal' feature of hospitalization in older patients.

Goal 3: Invest in delirium science by funding research at levels comparable to diseases with similar outcomes. In 2009, NIH funding for delirium was only $12 million compared to $392 for pneumonia/influenza.

Goal 4: Develop a network of delirium professionals to advance the first three goals.

"Delirium may be averted or resolved but we are missing it because we are not focused on preventing, diagnosing or managing it. We need to improve inputs into the brain, create healing environments that do not overload their brains, and cautiously use medications tha act in the brain. Most importantly, we need to make sure we are alert to signs of delirium and address it as soon as possible," said Dr. Rudolph.

Ultimately the patient and his or her caregivers bear the burdens of delirium and the consequences thereafter. The focus of this call to action puts the patient at the forefront.

"Patients, family members, doctors, nurses, pharmacists and everyone involved in delivery of care need to be told about the short term and the long term impact of delirium in our society so we can have a delirium-free century," said Dr. Boustani.

More information: Delirium: A Strategic Plan to Bring an Ancient Disease into the 21st Century. James L. Rudolph, Malaz Boustani, Barbara Kamholz, Marianne Shaughnessey, and Kenneth Shay, on behalf of the American Delirium Society. J Am Geriatr Soc 2011;59(Suppl. 2):S237-S240.

Provided by Indiana University School of Medicine

2011-11-17T01:53:00.000Z

New study links excessive amounts of vitamin D to onset of atrial fibrillation

While previous studies have linked vitamin D deficiency to an increased risk for cardiovascular disease, new research at the Intermountain Medical Center Heart Institute shows that too much vitamin D can lead to the onset of a dangerous heart condition known as atrial fibrillation.

17 nov 2011--Researchers at Intermountain Medical Center, the flagship facility for the Intermountain Healthcare system, studied more than 132,000 patients and found the risk of developing atrial fibrillation was two and a half times greater in those with excess levels of vitamin D compared to patients with normal levels.

Results of the study will be presented on Wednesday, Nov. 16, at the American Heart Association Scientific Sessions in Orlando, Fla.

Atrial fibrillation is a condition in which the heart's upper chambers quiver instead of beating rhythmically, which can cause blood to pool and clot. Atrial fibrillation has been linked to an increased risk of stroke, heart failure, heart attack, dementia and even Alzheimer's disease.

T. Jared Bunch, MD, a heart rhythm specialist at the Intermountain Medical Center Heart Institute and lead investigator on the study, says the findings are significant because so many Americans use vitamin supplements to promote their health.

"There are both benefits and harm to taking vitamin supplements of all kinds," says Dr. Bunch. "Our goal is to determine a safe dose and usage range so patients can understand what amount is healthy, and what amount may be toxic."

To determine if there is a correlation between too much vitamin D and increased heart risk, Dr. Bunch and his colleagues examined blood tests from 132,000 patients in the Intermountain Healthcare database at Intermountain Medical Center.

Patients did not have any known history of atrial fibrillation, and all had previously received a vitamin D assessment as part of their routine care. Patients were then placed into categories to compare levels of vitamin D: low (less than 20 nanograms per decilter), low/normal (21-40 ng/dl), normal (41-80 ng/dl), high/normal (81-100 ng/dl), and excess (more than 100).

Patients with vitamin D levels in the normal range were compared with other groups to assess their risk of developing atrial fibrillation. In patients with low, low-normal, normal and high-normal levels of vitamin D there was no increased risk of atrial fibrillation. However, in those with excess levels of vitamin D there was a significant increased risk of atrial fibrillation. Atrial fibrillation risk was two and a half times greater in patients with excess levels of vitamin D compared to those with normal levels.

The Institute of Medicine currently advises that healthy adults should be able to take as much as 4000 IU (international units) of vitamin D daily. But the reality is that doctors don't yet know how much vitamin D causes toxicity, which is why Dr. Bunch says communication between a patient and their healthcare provider is critical.

Vitamin D, which is synthesized by the body with exposure to sun, is used to regulate calcium and phosphate concentrations in the blood and is essential for growth and development, cellular health, and bone remodeling, a process where mature bone tissue is removed from the skeleton and new bone tissue is formed.

In regions where sun exposure may be limited, supplemental vitamin D may be required to maintain normal blood levels. The exact amount of vitamin D to achieve normal levels is unknown and usage varies in different regions and communities, which can cause problems, say the researchers.

Dr. Bunch stresses that patients need to tell their doctors about all of the vitamins and supplements they take, as well as all medications, in order to ensure they get the best care possible. He says this research also suggests that checking blood levels of vitamin D in patients that develop atrial fibrillation may help uncover the cause of the abnormal heart rhythm disorder.

"Patients don't think of vitamins and supplements as drugs," says Dr. Bunch. "But any vitamin or supplement that is touted as 'healing' or 'natural' is a drug and will have effects that are both beneficial and harmful. Just like any therapy, vitamins need to be taken for the right reasons and at the right doses."

More than two millions Americans suffer from atrial fibrillation. The risk of developing atrial fibrillation increases as people age. About five percent of people over the age of 80 will develop the heart disorder during their lifetime.

Provided by Intermountain Medical Center

2011-11-16T00:01:00.000Z

1 in 10 adults could have diabetes by 2030

16 nov 2011-- The International Diabetes Federation predicts that at least one in 10 adults could have diabetes by 2030, according to its latest statistics.

In a report issued on Monday, the advocacy group estimated that 552 million people could have diabetes in two decades' time based on factors like aging and demographic changes. Currently, the group says that about one adult in 13 has diabetes.

The figure includes both types of diabetes as well as cases that are undiagnosed. The group expects the number of cases to jump by 90 percent even in Africa, where infectious diseases have previously been the top killer. Without including the impact of increasing obesity, the International Diabetes Federation said its figures were conservative.

According to the World Health Organization, there are about 346 million people worldwide with diabetes, with more than 80 percent of deaths occurring in developing countries. The agency projects diabetes deaths will double by 2030 and said the International Diabetes Federation's prediction was possible.

"It's a credible figure," said Gojka Roglic, head of WHO's diabetes unit. "But whether or not it's correct, we can't say."

Roglic said the projected future rise in diabetes cases was because of aging rather than the obesity epidemic. Most cases of diabetes are Type 2, the kind that mainly hits people in middle age, and is linked to weight gain and a sedentary lifestyle.

Roglic said a substantial number of future diabetes cases were preventable. "It's worrying because these people will have an illness which is serious, debilitating, and shortens their lives," she said. "But it doesn't have to happen if we take the right interventions."

More information: http://www.idf.org

http://www.who.int

2011-11-15T14:32:00.000Z

Medical researchers decoding the aging process

Scientists are beginning to decode the complex biology of aging and are optimistic that recent advances in research may lead to treatments that can slow or even reverse degeneration and disease.

15 nov 2011--"We are seeing a major change, very important developments and real therapeutic efforts to try to treat age-related illnesses," said Norman Sharpless, professor of medicine and genetics at the University of North Carolina.

"It's a very exciting time in aging research," said Sharpless, of the Lineberger Comprehensive Cancer Center in the university's school of medicine, citing recent studies in France and the United States.

The French research, led by Jean-Marc Lemaitre at the Functional Genomics Institute, published in October, shows cells from elderly donors can be rejuvenated as stem cells, erasing the ravages of age and proving that aging is reversible.

"It's a major advance," Sharpless said, noting that if many age-related diseases such as cancer, cardiovascular problems or Alzheimer's are to be defeated, regenerative medicine will be required.

But he stressed that "cellular therapy is very difficult to develop," and expectations must be kept in check.

"The way trials work, it is going to be a couple of years before that research is translated into human aging research because of the risk of cancer frankly," Sharpless warned.

"The worry is while those cells are great, there are some risks for the recipients."

At the end of 2010 an American study in Boston showed that aging could be reversed in mice that were treated with telomerase, a naturally occurring enzyme in the body that protects DNA sequences (telomeres) at the end of chromosomes and which shorten cellular aging.

A second US study conducted on genetically-modified mice, published in early November in the British journal Nature, showed that the removal of senescent cells, which cease to renew themselves and increase with age -- they represent 10-15 percent of an elderly person's cells -- would prevent or defer aging.

"By attacking these cells and what they produce, one day we may be able to break the link between aging mechanisms and predisposition to diseases like heart disease, stroke, cancers and dementia," said James Kirkland, head of the Mayo Clinic's Robert and Arlene Kogod Center on Aging.

"There is potential for a fundamental change in the way we provide treatment for chronic diseases in older people," he said.

The mice were treated with a substance that caused their senescent cells to self-destruct, causing a major improvement in their health which saw them not suffering the usual ills of aging such as a decrease in muscle mass or reductions in a layer of fat that can prompt the onset of wrinkles.

Judith Campisi, of the Buck Institute for Age Research at the University of California at Berkeley, said the recent research carried out in France and the United States bodes well for the future.

"Of course we are not there yet, there is still a long way to go," she said, noting the French study showed "aging is not as irreversible as we thought," but the Nature paper highlighted that "we also know that there is something about the aging organisms that will make stem cells not behave very well."

Dan Perry, president of the Alliance For Aging Research in Washington, said there was a lot of excitement within the scientific community at how research may lead to the development of therapies to combat aging and major diseases.

"But it will take more money and effort to bring these across the line into treatment," he noted.

"The hope here is not to extend life span but to extend the health span... in order to reduce the impact of diabetes, cardiovascular disease and cancer," allowing people in their 70s and 80s to enjoy better final years.

"The demographic moment of truth is upon us," he concluded.

2011-11-14T14:07:00.001Z

Sugar-sweetened beverages may increase cardiovascular risk in women

Drinking two or more sugar-sweetened beverages a day may expand a woman's waistline and increase her risk of heart disease and diabetes, according to research presented at the American Heart Association's Scientific Sessions 2011.

14 nov 2011--In this study, researchers compared middle-aged and older women who drank two or more sugar-sweetened beverages a day, such as carbonated sodas or flavored waters with added sugar, to women who drank one or less daily. Women consuming two or more beverages per day were nearly four times as likely to develop high triglycerides, and were significantly more likely to increase their waist sizes and to develop impaired fasting glucose levels. The same associations were not observed in men.

"Women who drank more than two sugar-sweetened drinks a day had increasing waist sizes, but weren't necessarily gaining weight," said Christina Shay, Ph.D., lead author of the study and assistant professor at the University of Oklahoma Health Sciences Center in Oklahoma City. "These women also developed high triglycerides and women with normal blood glucose levels more frequently went from having a low risk to a high risk of developing diabetes over time."

The Multi-Ethnic Study of Atherosclerosis (MESA) included food frequency surveys in 4,166 African-American, Caucasian, Chinese-Americans and Hispanic adults 45 to 84 years old. At the beginning of the study the participants didn't have cardiovascular disease.

Researchers assessed risk factors in three follow-up exams spanning five years starting in 2002. Participants were monitored for weight gain, increases in waist circumference, low levels of high density lipoproteins (HDL "good" cholesterol), high levels of low density lipoproteins (LDL "bad" cholesterol), high triglycerides, impaired fasting glucose levels, and type 2 diabetes.

"Most people assume that individuals who consume a lot of sugar-sweetened drinks have an increase in obesity, which in turn, increases their risk for heart disease and diabetes," said Shay, formerly of Northwestern University's Department of Preventive Medicine in Chicago, where the study was conducted. "Although this does occur, this study showed that risk factors for heart disease and stroke developed even when the women didn't gain weight."

Women may have a greater chance for developing cardiovascular disease risk factors from sugar-sweetened drinks because they require fewer calories than men which makes each calorie count more towards cardiovascular risk in women, Shay said.

Researchers have yet to determine exactly how sugar-sweetened beverages influence cardiovascular risk factors such as high triglycerides in individuals who do not gain weight, Shay said, but further work is planned to try and figure that out.

Provided by American Heart Association