Stress may have only small impact on weight

NEW YORK , 31 oct 2010-- Despite the common belief that stress causes people to pack on the pounds, a new research review finds that, on average, stress has little long-term effect on weight.

The results are surprising, researchers say, given the widespread notion that stress - by causing people to reach for junk food or skimp on exercise, for example -- is an important factor in weight gain.

When the investigators pulled together 32 previously published studies on the question, however, they found the majority showed no association between people's stress levels and their weight gain over several years.

When the researchers combined the studies' results -- in what is known as a meta-analysis -- there was only a modest association overall between stress and weight gain.

"When we started this meta-analysis, we assumed that there would be a substantial association between stress and obesity, since the popular view is that stress contributes to weight gain," co-researcher Dr. Andrew Steptoe, of University College London in the UK, told Reuters Health in an e-mail.

"But when we looked carefully at well-controlled scientific studies," he said, "effects were surprisingly small."

That does not necessarily mean that stress cannot have a significant influence on some people's weight, according to Steptoe. The average effect of stress on weight might be small, but there could be wide variations among individuals, he said.

Citing diet as one example, Steptoe noted that "some people may increase their food consumption under stress, while others may stop eating and lose their appetites."

In addition, he said, different types of stress - whether associated with work, caregiving or specific life events -- might have different effects on weight gain.

Examining those questions was beyond the scope of the data Steptoe and his colleagues had.

For the study, the researchers, led by Dr. Jane Wardle, also of University College London, analyzed 32 international studies conducted mainly in the 1990s and 2000s.

All of the studies assessed participants' stress levels, then followed the subjects over time to see whether there was a relationship between stress and subsequent weight gain. Most followed participants for one to seven years, but a few were longer term projects that followed people for up to 38 years.

Some of the studies focused on participants' levels of work stress, while others gauged "general life stress," which includes anything from major traumas like experiencing a serious illness or a divorce, to feeling overwhelmed by daily hassles.

Overall, the researchers found, 69 percent of the studies uncovered no clear association between stress levels and weight gain. One-quarter linked higher stress levels to greater weight gain, and the remaining 6 percent found that greater stress was related to less weight gain over time.

When Wardle's team pooled the results of all the studies, they found a modest association between higher stress levels and greater weight gain.

In general, the connection was stronger among men than among women -- an interesting finding, Steptoe said, since it is "popular belief" that stress has a greater impact on women's weight.

One of the limitations of this review, according to the researchers, was that it could not examine the role of psychological disorders - the included studies focused on exposure to stress, and not, for example, whether a person developed depression in response to that stressor.

"The general message," Steptoe said, "is that, based on the best current scientific research, stress is not likely to play a major role in increasing body weight or obesity for most people."

"It could be that some people are more affected than others," he added, "but rather little is known about this at present."

He and his colleagues call for more research into the factors that might explain why one person puts on pounds in response to stress and another does not.

Getting older leads to emotional stability, happiness: study

"As people get older, they're more aware of mortality," researcher Laura Carstensen said. "So when they see or experience moments of wonderful things, that often comes with the realization that life is fragile and will come to an end. But that's a good thing. It's a signal of strong emotional health and balance."

30 oct 2010--As people age, they're more emotionally balanced and better able to solve highly emotional problems, says psychology professor and longevity expert Laura Carstensen.

It's a prediction often met with worry: In 20 years, there will be more Americans over 60 than under 15. Some fear that will mean an aging society with an increasing number of decrepit, impaired people and fewer youngsters to care for them while also keeping the country's productivity going.

The concerns are valid, but a new Stanford study shows there's a silver lining to the graying of our nation. As we grow older, we tend to become more emotionally stable. And that translates into longer, more productive lives that offer more benefits than problems, said Laura Carstensen, the study's lead author.

"As people age, they're more emotionally balanced and better able to solve highly emotional problems," said Carstensen, a psychology professor and director of the Stanford Center on Longevity. "We may be seeing a larger group of people who can get along with a greater number of people. They care more and are more compassionate about problems, and that may lead to a more stable world."

Between 1993 and 2005, Carstensen and her colleagues tracked about 180 Americans between the ages of 18 and 94. Over the years, some participants died and others aged out of the younger groups, so additional participants were included.

For one week every five years, the study participants carried pagers and were required to immediately respond to a series of questions whenever the devices buzzed. The periodic quizzes were intended to chart how happy, satisfied and comfortable they were at any given time.

Carstensen's study – which was published online Monday in the journal Psychology and Aging – was coauthored by postdoctoral fellows Bulent Turan and Susanne Scheibe as well as Stanford doctoral students and researchers at Pennsylvania State, Northwestern, the University of Virginia and the University of California's campuses in San Francisco and Los Angeles.

While previous research has established a correlation between aging and happiness, Carstensen's study is the first to track the same people over a long period of time to examine how they changed.

The undertaking was an effort to answer questions asked over and over again by social scientists: Are seniors today who say they're happy simply part of a socioeconomic era that predisposed them to good cheer? Or do most people – whether born and reared in boom times or busts – have it within themselves to reach their golden years with a smile? The answer has important implications for future aging societies.

"Our findings suggest that it doesn't matter when you were born," Carstensen said. "In general, people get happier as they get older."

Over the years, the older subjects reported having fewer negative emotions and more positive ones compared with their younger days. But even with the good outweighing the bad, older people were inclined to report a mix of positive and negative emotions more often than younger test subjects.

"As people get older, they're more aware of mortality," Carstensen said. "So when they see or experience moments of wonderful things, that often comes with the realization that life is fragile and will come to an end. But that's a good thing. It's a signal of strong emotional health and balance."

Carstensen (who is 56 and says she's happier now than she was a few decades ago) attributes the change in older people to her theory of "socio-emotional selectivity" – a scientific way of saying that people invest in what's most important to them when time is limited.

While teenagers and young adults experience more frustration, anxiety and disappointment over things like test scores, career goals and finding a soul mate, older people typically have made their peace with life's accomplishments and failures. In other words, they have less ambiguity to stress about.

"This all suggests that as our society is aging, we will have a greater resource," Carstensen said. "If people become more even-keeled as they age, older societies could be wiser and kinder societies."

So what, then, do we make of the "grumpy old man" stereotype?

"Most of the grumpy old men out there are grumpy young men who grew old," Carstensen said. "Aging isn't going to turn someone grumpy into someone who's happy-go-lucky. But most people will gradually feel better as they grow older."

The perils of taking experimental cancer drugs

NEW YORK 29 oct 2010-- Trying a new, experimental cancer drug may offer a glimpse of hope for very sick patients, but often does more harm than good, a new study shows.

Researchers said cancer doctors regularly resort to drugs still undergoing testing, as long as they have been approved for other diseases or in different combinations or doses.

But because the science is still up in the air, nobody really knows what the consequences of taking such drugs are.

"Many of these drugs end up not being the tremendous improvement that we hoped they would be," said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who was not involved in the new study.

"People need to realize that because the trials have not been completed there is a great deal that is not known about the treatments," he told Reuters Health. "There are people who get these treatments and get hurt."

The new study, published in the Journal of Clinical Oncology, looked at 172 clinical trials published over two years.

Less than a third of the clinical trials showed the experimental drugs improved patient survival, and less than half found the drugs helped other clinical outcomes.

Those numbers could even be too high, researchers say, because negative findings tend not to be published.

On the other hand, two thirds of the trials reported increases in at least one severe or life-threatening side-effect.

Most of the drugs under scrutiny had already been approved in different doses or combinations -- or for different diseases -- and were available on the U.S. market.

It's unclear if doctors were prescribing them for unapproved indications, but it's entirely possible as one-fifth of US drugs are prescribed in such a way -- a legal practice known as off-label prescription.

"We know there is a high demand for new treatments in oncology," said Dr. Jeffrey Peppercorn, a cancer doctor at Duke University Medical Center in Durham, North Carolina, who led the new research.

In an earlier survey, he said, he had found that more than eight in 10 cancer doctors prescribe medications that are being tested.

"This sounds a cautionary note," Peppercorn said about his new findings. "In most cases, we should refrain from using experimental drugs outside of clinical trials."

And it's not only patients taking the experimental drugs that may feel the impact.

Clinical trials done in the US, the researchers found, had trouble recruiting participants and took nearly twice as long to complete when the drug under scrutiny was already on the market.

"The concern is that you have fewer people choosing to enter the trial if the drug is already available," Peppercorn said, cautioning that the trial didn't prove that to be the case.

Trials are designed to compare new drugs with existing ones that have been deemed safe and effective by the US Food and Drug Administration.

Signing a patient up for a trial therefore often means only a 50-50 chance that he or she will get the new drug. So doctors may choose to prescribe it off label instead, and insurance companies often pay for it.

"Most of the doctors who do this are thinking that they are doing something in the best interest of the patients," said Brawley. But in reality, he added, they end up slowing down the development of new drugs.

Dr. Steven Joffe, an ethicist at Dana-Farber Cancer Institute in Boston who has worked with Peppercorn on earlier studies, agreed.

"I perfectly understand why a patient with a poor prognosis might want to have access to these drugs and why doctors would give them the drugs," he told Reuters Health.

"They may think they know that it works," he said. "But the fact is, somebody is running a study to find out if it does. Almost by definition it hasn't been proved safe and effective."

As an example of how doctors and patients can be fooled, Joffe mentioned that scores of women were treated for breast cancer with stem cells in the 1990s, when the treatment was still in clinical trials.

"It took about ten years to do the trial because it was so hard to get women to enroll," said Joffe. And when the results finally came, the treatment turned out to be a dud -- a toxic and expensive one, too.

Joffe said prescribing drugs when they are still in clinical trials might not only slow the development of good medical evidence, but could even halt it.

"We know that many studies fail to ever get completed," he explained. "These data suggest that the use of drugs outside of trial protocols could contribute to the failure of studies ever to get completed."

Sometimes, of course, new drugs do work, and no one argues that doctors shouldn't be allowed to prescribe medications they think will help patients.

But doctors should be very clear about the high risks involved. One way to do that, said Peppercorn, would be to require that cancer doctors get informed consent from patients before they start them on experimental drugs.

In the end, Brawley said, the decision to use such treatment should be left to the patient and his or her doctor.

"There are times when it can be justified," he noted, "but it is done far more often than it should be."

Glucosamine causes the death of pancreatic cells

Quebec City, 28 oct 2010—High doses or prolonged use of glucosamine causes the death of pancreatic cells and could increase the risk of developing diabetes, according to a team of researchers at Université Laval's Faculty of Pharmacy. Details of this discovery were recently published on the website of the Journal of Endocrinology.

In vitro tests conducted by Professor Frédéric Picard and his team revealed that glucosamine exposure causes a significant increase in mortality in insulin-producing pancreatic cells, a phenomenon tied to the development of diabetes. Cell death rate increases with glucosamine dose and exposure time. "In our experiments, we used doses five to ten times higher than that recommended by most manufacturers, or 1,500 mg/day," stressed Professor Picard. "Previous studies showed that a significant proportion of glucosamine users up the dose hoping to increase the effects," he explained.

Picard and his team have shown that glucosamine triggers a mechanism intended to lower very high blood sugar levels. However, this reaction negatively affects SIRT1, a protein critical to cell survival. A high concentration of glucosamine diminishes the level of SIRT1, leading to cell death in the tissues where this protein is abundant, such as the pancreas.

Individuals who use large amounts of glucosamine, those who consume it for long periods, and those with little SIRT1 in their cells are therefore believed to be at greater risk of developing diabetes. In a number of mammal species, SIRT1 level diminishes with age. This phenomenon has not been shown in humans but if it were the case, the elderly—who constitute the target market for glucosamine—would be even more vulnerable.

"The key point of our work is that glucosamine can have effects that are far from harmless and should be used with great caution," concluded Professor Picard.

The results obtained by Picard and his team coincide with recent studies that cast serious doubt on the effectiveness of glucosamine in treating joint problems.

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This study was co-authored by Mathieu Lafontaine-Lacasse and Geneviève Doré.

Information:
Frédéric Picard
Faculty of Pharmacy
Université Laval
418-656-8711 ext. 3737

New guideline from ASH and ASCO recommends caution regarding ESA use in cancer patients

WASHINGTON, 27 oct 2010– An updated joint guideline by the American Society of Hematology (ASH) and the American Society of Clinical Oncology (ASCO) advises physicians about the appropriate use of erythropoiesis-stimulating agents (ESAs), a class of drugs that stimulate the bone marrow to produce more red blood cells, to treat cancer patients with chemotherapy-induced anemia. While the guideline cautions that ESAs are associated with shorter survival and increased risk of thromboembolism — blood clots — and tumor progression, it also recognizes their major benefit of reducing the need for red blood cell transfusions, which can potentially cause serious infections and adverse reactions in the immune system.

"This updated guideline offers clinicians the latest synthesis of the medical evidence surrounding use of ESAs in patients with cancer, including appropriate cautions where evidence is lacking or where risks may outweigh the use of ESAs," said J. Douglas Rizzo, MD, MS, Co-Chair of the guideline panel and Professor of Medicine at the Medical College of Wisconsin.

Those risks may include thromboembolism or even death, according to new data cited in the guideline, which suggests that physicians avoid the use of ESAs in cancer patients who are not receiving chemotherapy, except for those with myelodysplastic syndrome (MDS). At the same time, the guideline confirms the effectiveness of ESAs in sparing patients the need for transfusions, which can substantially impact quality of life. By recommending that physicians discuss individual risks and benefits of ESAs and blood transfusion with patients prior to therapy, the guideline recognizes the critical role of shared decision-making between the patient and the physician.

In addition to outlining the clotting risks of ESAs, the guideline makes specific recommendations on usage and provides insights into disease progression and patient survival. The guideline also details new thresholds for initiation and modification of ESAs, which are consistent with current FDA labeling.

Originally published in 2002 and last updated in 2007, the guideline was derived from analysis of individual patient data, various medical literature, and systematic reviews of published clinical trials. In developing the update, panel members considered all relevant literature published between January 2007 and January 2010. Additional evidence was considered when it was considered pertinent to each section of the updated guideline.

"These guidelines touch on almost all aspects of the use of ESAs in patients with cancer and MDS, as well as secondary issues, such as the role of iron supplementation," said Samuel Silver, MD, a member of ASH's Committee on Practice and Professor of Internal Medicine at the University of Michigan. "These are issues that confront practicing hematologists and oncologists on a daily basis, and we hope that these evidence-based recommendations will influence practice standards and result in better care for patients."

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The guideline will be published ahead of print on the websites of Blood (bloodjournal.org), ASH's scientific journal, and ASCO's Journal of Clinical Oncology (jco.org) at 4:00 p.m. on October 25. The guideline will be published in print in Blood on November 18 and in the Journal of Clinical Oncology on November 20.

Heavy Smoking Linked to Alzheimer's in Study

26 oct 2010-- Heavy smoking in middle age seems to increase the risk for developing Alzheimer's disease or another dementia, a large new study suggests.

"We found that people who reported heavy smoking in midlife had more than a 100 percent increase in risk of Alzheimer's disease and vascular dementia," said lead researcher Rachel A. Whitmer, a research scientist in Kaiser Permanente's Division of Research in Oakland, Calif.

"We have known that smoking is a risk factor for cancer, stroke and cardiovascular disease," she said. "This adds to the evidence that what is bad for the heart is bad for the brain."

The report is published in the Oct. 25 online edition of the Archives of Internal Medicine.

For the study, Whitmer's group collected data on 21,123 ethnically diverse people in the Kaiser Permanente health care system who were surveyed between 1978 and 1985, when they were 50 to 60 years old.

During an average follow-up of 23 years, the researchers found that 25.4 percent were diagnosed with dementia, including Alzheimer's (1,136 people) or vascular dementia (416 people), which is the second most common form of dementia after Alzheimer's disease. Vascular dementia is caused by damage to the arteries in the brain.

Compared with non-smokers, those who smoked more than two packs of cigarettes a day in midlife had a "dramatic increase" in the incidence of dementia -- more than a 157 percent increased risk of developing Alzheimer's disease and a 172 percent increased risk of developing vascular dementia, Whitmer's team found.

Former smokers and people who smoked less than half a pack a day did not appear to be at increased risk of Alzheimer's or vascular dementia, the researchers note.

The associations between smoking and dementia did not change even after adjusting for race or gender, high blood pressure, high cholesterol or heart attack, stroke or weight, they add.

A link between Alzheimer's and smoking has been shown before, but this new study pinpoints the specific risk for middle-age smokers for developing both Alzheimer's and vascular dementia, the researchers say.

Smoking, an established risk factor for stroke, may contribute to the likelihood of vascular dementia by causing small clots in the brain. Smoking also contributes to oxidative stress and inflammation, which may be linked to the risk of developing Alzheimer's disease, the researchers say.

"The brain is not immune to long-term damage from smoking," Whitmer said.

Two smaller studies of predominantly white participants also suggested that mid-life smoking raised the risk of developing Alzheimer's, researchers noted.

Commenting on the new study, William Thies, chief medical and scientific officer at the Alzheimer's Association, said "this is a sound confirmation of something that's been known for a while."

Another expert, Dr. Samuel E. Gandy, the Mount Sinai Professor of Alzheimer's Disease Research at Mount Sinai School of Medicine in New York City, said the findings are promising.

"Environmental factors in Alzheimer's disease have been long sought, and, until now, only head injury has emerged," Gandy said. "Unlike head injury, a tobacco smoking association is especially important because that is a risk that can be modified."

Yoga alleviates pain and improves function in fibromyalgia patients

According to new study published in Pain

Philadelphia, PA, 25 oct 2010– Fibromyalgia (FM) is a debilitating condition affecting 11 million individuals in the US alone. FM carries an annual direct cost for care of more than $20 billion and drug therapies are generally only 30% effective in relieving symptoms and 20% effective in improving function. Standard care currently includes medications accompanied by exercise and coping skills approaches. In a study published in the November issue of PAIN, researchers report patients participating in a "Yoga of Awareness" program showed significantly greater improvement in FM symptoms and functioning compared to patients on a standard FM care program.

"Although yoga has been practiced for millennia, only recently have researchers begun to demonstrate yoga's effects on persons suffering from persistent pain," commented lead investigator James W. Carson, PhD, Oregon Health & Science University. "The Yoga of Awareness program stands in contrast to previous multimodal interventions with FM patients in that it integrates a wide spectrum of yoga-based techniques – postures, mindfulness meditation, breathing exercises, application of yogic principles to optimal coping, and group discussions.…the findings of this pilot study provide promising preliminary support for the beneficial effects of yoga in patients with FM."

Given the much higher prevalence of FM in females (80%), researchers chose to include only women in this study. 53 women at least 21 years of age participated. To be eligible, patients had to meet the following criteria: be diagnosed with FM by American College of Rheumatology (ACR) criteria for at least 1 year and be on a stable regimen of pharmacologic and/or non-pharmacologic treatment for FM for at least 3 months. The patients were randomized; 25 participated in the Yoga of Awareness program, while 28 received standard care.

Yoga of Awareness is an innovative, comprehensive yoga program, which for the purposes of this study was tailored to address pain, fatigue, sleep disturbance, and emotional distress in FM. Each Yoga of Awareness class included approximately 40 minutes of gentle stretching poses, 25 minutes of mindfulness meditation (e.g., awareness of breath, awareness of awareness itself), 10 minutes of breathing techniques (e.g., full yogic breath, breathing into sensation), 20 minutes of didactic presentations on the application of yogic principles to optimal coping, and 25 minutes of group discussions (e.g., experiences while practicing yoga at home).

After the yoga program was completed, both groups were assessed for fibromyalgia symptoms and functional deficits, overall improvement in fibromyalgia symptoms, physical tests of fibromyalgia symptoms and functional deficits such as tender points, strength and balance deficits, and a number of pain coping strategies.

Following treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue, and mood, and in pain catastrophizing, acceptance, and other coping strategies.

Dr. Carson and colleagues observed, "In addition, the results suggested the yoga intervention led to a beneficial shift in how patients cope with pain, including greater use of adaptive pain coping strategies (i.e., problem solving, positive reappraisal, use of religion, activity engagement despite pain, acceptance, relaxation) and less use of maladaptive strategies (i.e., catastrophizing, self-isolation, disengagement, confrontation)."

One-Third of U.S. Adults Could Have Diabetes by 2050: CDC

24 oct 2010-- The number of American adults with diabetes could double or triple by 2050 if current trends continue, warns a federal government study released Friday.

The number of new diabetes cases a year will increase from 8 per 1,000 in 2008 to 15 per 1,000 in 2050, predicts the U.S. Centers for Disease Control and Prevention. By 2050, between one-fifth and one-third of all adults could have diabetes -- with virtually all the increase attributed to type 2 diabetes, which is largely preventable.

An aging population, an increase in minority groups at higher risk for diabetes, and the fact that diabetes patients are living longer are among the reasons for the steep projected rise.

"These are alarming numbers that show how critical it is to change the course of type 2 diabetes," Ann Albright, director of CDC's Division of Diabetes Translation, said in an agency news release. "Successful programs to improve lifestyle choices on healthy eating and physical activity must be made more widely available, because the stakes are too high and the personal toll too devastating to fail."

Another expert agreed.

"These data are accurate and reflect reality," said Dr. Mary Ann Banerji, professor of medicine and director of the Diabetes Treatment Center at SUNY Downstate Medical Center, New York City. "Taking into consideration minorities and longer life expectancy, the real burden of diabetes is much greater than many people thought."

Banerji believes that "we need to act now. Immediate changes in diet, physical activity, stress and sleep are known to decrease diabetes and obesity. We can make changes in our physical environment to promote greater physical activity and we should consider changes in national food policy."

Diabetes remains the leading cause of new cases of blindness under age 75, kidney failure, and preventable leg and foot amputation among adults in the United States, according to the CDC.

In addition, people diagnosed with diabetes have medical costs that are more than twice that of those without the disease, the agency reports. The total costs of diabetes in the United States are an estimated $174 billion annually, including $116 billion in direct medical costs.

The study appears in the journal Population Health Metrics.

The projected increase in U.S. diabetes numbers reflects the global growth of the disease. About 285 million people worldwide had diabetes in 2010, and the number could swell to as many as 438 million by 2030, according to the International Diabetes Federation.

About 24 million Americans have diabetes, but one-quarter of them don't know it. Older age, obesity, a sedentary lifestyle, family history, developing diabetes while pregnant, and race/ethnicity are risk factors for type 2 diabetes. Racial/ethnic groups at increased risk are African Americans, Hispanics, American Indians/Alaska Natives, and some Asian-Americans and Pacific Islanders.

"The incidence of diabetes over the last few decades has progressively increased," notes diabetes expert Dr. Jacob Warman, chief of endocrinology at The Brooklyn Hospital Center, New York City. "It is not surprising that with a flourishing of fast food chains and use of Internet and cable television, the population has become more sedentary and overweight."

However, regular physical activity and proper nutrition can reduce the risk of type 2 diabetes and help control the disease. To that end, the CDC has launched a campaign to reduce such risks in overweight and obese people, stressing dietary changes, coping skills and group support to help participants lose 5 percent to 7 percent of their body weight and get at least 150 minutes per week of moderate physical activity.

Prevention programs that target at-risk groups can help reduce -- but not eliminate -- future increases in type 2 diabetes prevalence, the study said.

Studies: Pneumonia is misdiagnosed on patient readmissions

DETROIT23 oct 2010 – Patients were misdiagnosed with pneumonia at an alarming rate when they were readmitted to the hospital shortly after a previous hospitalization for the same illness, according to two Henry Ford Hospital companion studies.

Researchers say the misdiagnoses led to overuse of antibiotics and increased health care costs. Pneumonia ranks second to congestive heart failure as the reason for readmission within 30 days of a previous hospitalization.

Led by Henry Ford Infectious Diseases physicians Hiren Pokharna, M.D., and Norman Markowitz, M.D., researchers found that:

• 72 percent of patients were misdiagnosed with pneumonia upon readmission to the same hospital.
• African-Americans were twice more likely than Caucasians to be misdiagnosed with pneumonia.
• Patients who smoke or have lung disease were likely to be misdiagnosed with pneumonia.
• 72 percent of the misdiagnoses occurred in the Emergency Department.
• Fewer than 33 percent of patients had any outpatient follow-up care prior to their readmission.

Results of the two companion studies will be presented Friday at the 48th annual meeting of the Infectious Diseases Society of America Oct. 21-24 in Vancouver.

"These studies show that we need to increase awareness among physicians about using the diagnostic standards and criteria set forth in the Centers for Disease Control and Prevention's National Healthcare Safety Network for diagnosing pneumonia at the time of readmission," says Dr. Pokharna, a fellow at Henry Ford and the lead author of the companion studies.

"This also points to the importance of using X-ray for ruling out pneumonia. And once pneumonia is ruled out, the antibiotics can be discontinued."

In seeking to explain the difficulty of diagnosing pneumonia and high prevalence of misdiagnoses, Henry Ford researchers examined medical records of 127 patients diagnosed with pneumonia between December 2008 and December 2009 and readmitted within 30 days of a previous hospitalization.

Researchers found that 92 of the 127 patients were misdiagnosed with health care associated pneumonia using CDC/National Healthcare Safety Network criteria. Health care associated pneumonia is a newly recognized form of pneumonia in patients who had recent close contact with a health care system, either through a hospital, outpatient dialysis center, nursing home or long-term care facility. The classification was added with the shift from hospital-based care to home-based care.

Researchers cited several reasons for the misdiagnoses, including pre-existing lung disease and abnormalities on chest X-rays.

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The studies were funded by Henry Ford Hospital.

Hormone therapy linked to increased cancer risk

WASHINGTON, 22 oct 2010 – Menopausal women taking combined hormone therapy have an elevated risk of being diagnosed with a more advanced stage of breast cancer and dying from it, according to a new US study.

Researchers conducted a new analysis of a landmark, federally funded clinical trial known as the Women's Health Initiative (WHI), which was halted in 2002 after data suggested women who took a combination of estrogen and progestin hormones faced a higher risk of breast cancer.

The study, published in this week's edition of the Journal of the American Medical Association, also found that women who previously used hormone therapy and discontinued it after the WHI was terminated still faced a slightly higher breast cancer mortality rate than women not taking hormones.

For their analysis, Rowan Chlebowski of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and colleagues observed 16,608 postmenopausal women ages 50 to 79 years with no prior hysterectomy from 40 US clinical centers.

Their follow-up of about 11 years of WHI participants found that 385 women receiving hormones for an average of 5.6 years, or 0.42 percent, developed invasive breast cancer, compared with 293 women who received a placebo, or 0.34 percent.

A significantly larger fraction of the women in the hormone therapy group -- 81, or 23.7 percent -- were diagnosed after their breast cancer had spread to lymph nodes. In the placebo group, only 43 women, or 16.2 percent, were diagnosed at that stages.

Twenty-five of the women who received the hormone therapy died from breast cancer, compared to 12 deaths among those who received a placebo. That translated to one to two extra deaths from breast cancer each year for every 10,000 women who used hormone therapy rather than a placebo.

Researchers noted that in the WHI trial, unlike most observational studies, combined hormone therapy both increased the risk of breast cancer and interfered with breast cancer detection, hindering the detection of breast cancer and thus leading to diagnoses at more advanced stages.

"Now, with longer follow-up results available, there remains a cumulative, statistically significant increase in breast cancers in the combined hormone therapy group, and the cancers more commonly had lymph node involvement," the researchers said.

"The observed adverse influence on breast cancer mortality of combined hormone therapy can reasonably be explained by the influence on breast cancer incidence and stage."

They noted that the incidence of breast cancer substantially decreased in the United States after the WHI trial's results were initially reported eight years ago, which was attributed to a marked decrease in postmenopausal hormone therapy use.

"The adverse influence of estrogen plus progestin on breast cancer mortality suggests that a future reduction in breast cancer mortality in the United States may be anticipated as well," the researchers added.

In an accompanying editorial, Peter Bach of Memorial Sloan-Kettering Cancer Center in New York said "the available data dictate caution in the current approach to use of hormone therapy," namely because physicians are "ill-equipped" to anticipate its effects on long-term health.

"Clinicians who prescribe brief courses of hormone therapy for relief of menopausal symptoms should be aware that this approach has not been proven in rigorous clinical trials and that the downstream negative consequences for their patients are of uncertain magnitude," Bach added.

Devastating impact of spinal osteoporotic fractures revealed on World Osteoporosis Day

A new report issued by the International Osteoporosis Foundation (IOF) for World Osteoporosis Day puts the spotlight on the severe impact of spinal fractures and calls on health professionals to recognize the signs of these fractures in their patients.

21 oct 2010--"The widespread under–diagnosis and lack of treatment of spinal fractures, leaves millions of people around the world with chronic pain, deformity, disability and at high risk of future fractures," says Professor John Kanis, President of the IOF.

As many as two-thirds of spinal osteoporotic fractures are not recognized by doctors. Untreated, as many as one in five women with a spinal fracture will sustain another within twelve months.

'The Breaking Spine', authored by Professor Harry K. Genant of the University of California and Dr. Mary Bouxsein of Harvard Medical School, reveals the serious impact of these fractures and calls on health professionals to take action to diagnose patients and refer them for treatment. "Doctors must look out for evidence of spinal fractures, especially in their patients over 50 – stooped back, loss of height, and sudden, severe back pain are the three tell-tale signs, says Professor Genant. "It is essential that doctors refer these patients for further testing and that radiology reports clearly identify spinal fractures as 'FRACTURED' to avoid ambiguity." Currently, only about 40% of older women with spinal fractures visible on X-ray are tested for osteoporosis. The figure is even lower in men (less than 20%).

The IOF urges health professionals and the public to recognize the signs of spinal fractures. The repercussions of these common fractures can be severe, resulting in stooped back, acute and chronic back pain, loss of height, immobility, depression, increased number of bed days, reduced pulmonary function and even premature death.

Globally, spinal fractures represent a huge socio-economic burden. It is estimated that one spinal fracture occurs every 22 seconds worldwide. Studies have shown that as many as 20-25% of Caucasian women and men over 50 years of age have a current spinal fracture. Costs associated with all osteoporotic fractures are predicted to rise markedly over the next few decades as the population ages.

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The new IOF report, The Breaking Spine, can be downloaded on http://www.iofbonehealth.org/publications/the-breaking-spine.html

Survey Reveals Alzheimer's Caregivers' Top Concerns

20 oct 2010-- Family caregivers' greatest concerns about the progression of a loved one's Alzheimer's disease are memory loss (41 percent), personal safety (33 percent) and confusion (27 percent), finds a new survey.

The poll of 524 caregivers also found that 67 percent named at least one cognitive (or thinking skills') change in their loved one as a main concern; 55 percent said caring for a loved one with Alzheimer's has taken a toll on their own health; and 60 percent said they felt overwhelmed.

Male caregivers were more concerned about memory loss than women -- 50 percent versus 37 percent.

The survey was conducted by Harris Interactive in September for drug makers Eisai Inc. and Pfizer Inc., in partnership with the Alzheimer's Foundation of America (AFA).

Among the other findings about issues caregivers face:

• Women were more likely than men to "worry all the time" (13 percent versus 3 percent) and less likely than men to feel that they have enough support to take care of themselves and their own needs (60 percent versus 76 percent).
• Women were more likely than men to find it challenging to maintain relationships with family or friends -- 47 percent versus 31 percent.
• People looking after loved ones with severe Alzheimer's disease were more likely (84 percent) to say that caregiving frequently prevents them from doing activities they enjoy, compared to caregivers of loved ones with moderate (68 percent) or mild (67 percent) Alzheimer's disease.
• Men were more likely than women to be satisfied with communication with their loved one's health care professional (84 percent versus 70 percent) and more likely to regularly discuss options for support or information (26 percent versus 14 percent).
• Dissatisfaction with a loved one's treatment was expressed by 53 percent of caregivers who had little or no involvement in discussions with health care providers, compared with 31 percent of caregivers who were involved.

"These survey results reveal that changes in cognition as the disease progresses were an important concern among caregivers. We encourage caregivers and health care professionals to discuss these changes and any others during regular visits," Eric J. Hall, president and CEO of the AFA, said in a Harris Interactive news release.

More information

The U.S. National Institute on Aging has more about Alzheimer's disease.

Coronary Artery Calcium Aids Risk Classification in Elderly

Adding CAC to risk classification model most appropriate for those at intermediate risk

19 oct 2010-- Coronary artery calcium (CAC) levels can be used to fine-tune coronary heart disease (CHD) risk assessment in elderly people with no disease symptoms, according to a study in the Oct. 19 issue of the Journal of the American College of Cardiology.

Suzette E. Elias-Smale, M.D., of Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues followed 2,028 elderly subjects without CHD symptoms for a median 9.2 years, during which 135 nonfatal myocardial infarctions and CHD deaths occurred. First the subjects were classified into low-, intermediate-, and high-risk categories in accordance with a Framingham risk model, and then the researchers added CAC levels (measured in Agatston units) to the risk model, assessed the impact of CAC on risk recalculation, and computed CAC cutoff values for risk reclassification.

Fifty-one percent of men and 53 percent of women initially classified as intermediate-risk were reclassified as a result of the inclusion of CAC levels. Among men, 30 percent of those initially at intermediate risk were moved to the low-risk category, and 21 percent were moved to the high-risk category. Among women, 29 percent of those initially at intermediate risk were moved to a lower-risk category and 24 percent were moved to a higher-risk category.

"In a general population of elderly patients at intermediate CHD risk, CAC scoring is a powerful method to reclassify persons into more appropriate risk categories. Empirically derived CAC cut-off values at which persons at intermediate risk reclassified to either high or low risk were 615 and 50 Agatston units, respectively," the authors write.

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TTF and chemotherapy increase survival for patients with advanced non-small cell lung cancer

Novocure reported that patients with advanced non-small cell lung cancer (NSCLC) achieved a significant increase in survival time when tumor treating fields (TTF) therapy was added to chemotherapy, as compared to previously reported outcomes for patients receiving chemotherapy alone. Dr. Miklos Pless, head of medical oncology at the Winterthur Hospital Cancer center in Switzerland, presented the data at the European Society for Medical Oncology Congress (ESMO).

18 oct 2010--Physicians delivered TTF Therapy to patients in the study using the NovoTTF-100L—a portable, non-invasive medical device. Investigators conducted this single arm, phase II study at four centers in Switzerland, enrolling 42 patients with locally advanced and metastatic NSCLC (stage IIIb-IV) who had failed prior treatments with chemotherapy. Patients in the study received TTF Therapy for 12 hours a day in combination with pemetrexed (Alimta; Eli Lilly) until disease progression.

Advanced NSCLC is the second cancer in which TTF Therapy has shown clinical efficacy in human trials. Novocure reported a successful phase III clinical trial of TTF monotherapy in patients with recurrent glioblastoma, an aggressive form of brain cancer, at the American Society for Clinical Oncology Conference (ASCO) earlier this year. Results of this phase III trial have been filed with the U.S. Food and Drug Administration (FDA).

"We were pleased to report on the results of this multi-center trial of TTF Therapy in a non-brain tumor indication," said Dr. Pless. "We believe this study has shown TTF Therapy to be completely non-toxic and to have the potential to act as a significant adjunct to chemotherapy in the treatment of NSCLC and other solid tumor indications."

Patients treated with TTF Therapy in combination with pemetrexed had a median overall survival time of 13.8 months compared with the 8.3 months reported for pemetrexed alone. The one-year survival rate for the combination was 57 percent compared with the 30 percent reported for pemetrexed alone. Progression-free survival more than doubled when TTF Therapy was added to pemetrexed, to 22-28 weeks versus the 12 weeks previously reported for pemetrexed alone1. The only reported adverse event for TTF Therapy was mild to moderate skin irritation at the treatment site.

"These NSCLC data further validate TTF Therapy as a viable approach to treating deadly cancers," said Asaf Danziger, chief executive officer of Novocure. "We have seen positive clinical success in both phase II and phase III studies, alone and in combination with chemotherapy, and believe TTF Therapy has the potential to be effective in a range of solid tumors."

TTF Therapy slows and reverses tumor cell proliferation by inhibiting mitosis, the process by which cells divide and replicate themselves. The NovoTTF-100L device, which weighs about six pounds (three kilograms), creates a low-intensity, alternating electric field within the tumor that exerts physical forces on electrically charged cellular components, preventing the normal mitotic process and causing cancer cell death prior to division.

Novocure’s NovoTTF-100A device has received its CE Mark and is approved for sale in six European countries as a treatment for glioblastoma brain tumors. The NovoTTF-100L device has received its CE Mark as a treatment for NSCLC and will be launched in Europe in the near future. Novocure is also planning to file an investigational device application with the FDA for a phase III study of TTF Therapy in early stage NSCLC in the near future.

More information: Nasser Hanna et al; "Randomized Phase III Trial of Pemetrexed versus Docetaxel in Patients with Non-Small-Cell Lung Cancer Previously TreatedWith Chemotherapy," Journal of Clinical Oncology 22.9 (2004): pp 1589-1597

Walking 6 to 9 Miles a Week May Help Save Memory

17 oct 2010-- Walking about six miles a week appears to protect against brain shrinkage in old age, which in turn helps stem the onset of memory problems and cognitive decline, new research reveals.

"We have always been in search of the drug or the magic pill to help treat brain disorders," noted Kirk I. Erickson, an assistant professor of psychology at the University of Pittsburgh and the study's lead author. "But really what we are after may be, at least partially, even simpler than that. Just by walking regularly, and so maintaining a little bit of moderate physical activity, you can reduce your likelihood of developing Alzheimer's disease and [can] spare brain tissue."

A report on the research, which was supported by the U.S. National Institute on Aging, is published online Oct. 13 in Neurology.

Erickson and his colleagues began tracking the physical activity and cognitive (or thinking) patterns of nearly 300 adults in 1989. At the start, all participants were in good cognitive health, they averaged 78 years old and about two-thirds were women. The researchers charted how many blocks each person walked in a week.

Nine years later, they were given a high-resolution MRI scan to measure brain size. All were deemed to be "cognitively normal."

But four years after that, testing showed that a little more than one-third of the participants had developed mild cognitive impairment or dementia.

By correlating cognitive health, brain scans and walking patterns, the research team found that being more physically active appeared to marginally lower the risk for developing cognitive impairment.

But more specifically, they concluded that the more someone walks, the more gray matter tissue the person will have a decade or more down the road in regions of the brain -- namely the hippocampus, the inferior frontal gyrus and the supplementary motor area -- that are central to cognition.

And among the more physically active participants who had retained more gray matter a decade out, the chances of developing cognitive impairment were cut in half, the study found.

However, the researchers stressed that the relationship between walking and gray matter volume appears to apply only to people who regularly walk relatively long distances that equal about six to nine miles a week.

Walking more than the six- to nine-mile range, however, did not have cognitive benefit, the study found.

"That's because the size of our brain regions can only be so large," Erickson said, adding that the opposite isn't true. "So with no exercise, there can be significant deterioration and decay with age."

However, he added, "what we often tend to think of as an inevitable component or characteristic of aging -- memory decline and brain decay -- is clearly not inevitable. There's plenty of evidence now, and this study is part of that, that shows that we can retain our brain tissue and retain our memories well into late adulthood by maintaining an active and engaged lifestyle."

Dr. Steven V. Pacia, chief of neurology at Lenox Hill Hospital in New York City, described the study's finding as both "intriguing" and an "undoubtedly positive message to send to the public."

"My first reaction to studies like this is that only in America do we have to prove to people that it's good to walk," he said with a chuckle.

"But it stands to reason that being active as we age is going to have a beneficial effect on the brain, just as being inactive is going to have a negative impact," Pacia noted. "Because the brain lives in the environment of the body."

But there may be a catch. "This is just an observational study," Pacia noted. "And while we may assume that the relationship between the brain and activity is a prevention-of-atrophy issue -- just like it is with muscle and bone -- this study doesn't actually prove that. We don't yet know enough about the use-it-or-lose-it notion with respect to brain and exercise. So we do need more research to look at that."

Chest-Compression-Only CPR Should Be Recommended

Emergency medical services shouldn't advise bystanders to perform CPR with mouth-to-mouth

16 oct 2010-- Chest-compression-only cardiopulmonary resuscitation (CPR) should be recommended by emergency medical services to bystanders caring for individuals experiencing out-of-hospital cardiac arrest rather than standard CPR with mouth-to-mouth, according to research published online Oct. 15 in The Lancet.

Michael Hupfl, M.D., of Medical University of Vienna in Austria, and colleagues systematically reviewed studies in which chest-compression-only bystander CPR was compared with standard bystander CPR for adult patients with out-of-hospital cardiac arrest. The investigators completed a primary meta-analysis in which patients were randomized to receive one of the two CPR techniques, as well as a secondary meta-analysis of observational cohort studies.

In the primary meta-analysis, using pooled data from three randomized trials, the investigators found that chest-compression-only CPR was associated with an improved chance of survival as compared with standard CPR (14 percent versus 12 percent). The data also revealed that the absolute increase in survival was 2.4 percent and the number needed to treat was 41. No difference was found between chest-compression-only CPR and standard CPR in the secondary meta-analysis of seven observational cohort studies.

"Our findings support the idea that emergency medical services dispatch should instruct bystanders to focus on chest-compression-only CPR in adults with out-of-hospital cardiac arrest," the authors write. "However, whether chest-compression-only CPR should be recommended for unassisted lay bystander CPR is unclear."

One author disclosed financial ties to Roche Diagnostics and Gerson Lehrman Group, and another disclosed financial ties to St John's Ambulance Service in Vienna and Novo Nordisk.

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The Hispanic Mortality Paradox: Why Do Latinos Outlive Other Americans?

For the first time, the U.S. Department of Health and Human Services has collected national life expectancy data for the Hispanic population, and backed up the surprising findings of past studies: the average life expectancy of a Hispanic baby born in 2006 was 80.6 years. That's 2.5 years longer than the life expectancy for whites, 7.7 years longer than for blacks and nearly three years higher than the national average.

15 oct 2010--The results are interesting because the Hispanic population, which makes up 15% of the American public, has several characteristics that are traditionally associated with shorter life: more obesity, less education and more poverty; 18.9% of Latinos are poor, compared with 6.1% of whites. (One exception to the paradox: Hispanics' median income is higher than blacks', and fewer Hispanics than blacks are poor, making it unsurprising that average Hispanic life expectancy is higher.)

Trying to understand why Hispanics live longer is difficult because the Hispanic community as a whole is so diverse. But their diversity may well explain the mortality data. One statistical advantage may be the large number of Hispanic immigrants: 69% of the non-Mexican Latino population is foreign-born (49% of Mexican-Americans are foreign-born); it may be that healthier and longer-lived people tend to emigrate to other countries. Cubans immigrants, for example - who had their major migration to the U.S. in the 1950s - have a larger percentage of elderly individuals than American-born white or black communities.

Also, while the Hispanic population on average is poorer and less educated, income and education vary greatly between specific Hispanic communities. For instance, 25% of Dominicans fall below the poverty line and 15% have a college degree; by comparison, 25% of Cubans have graduated from college, while TK% of those of Spanish descent are poor.

Statisticians are scrambling to explain the Hispanic paradox, and as USA Today reports, the research is just beginning:

"I don't think anyone has a great idea," says Carl Haub, a demographer at the Population Reference Bureau. "We might want to see what Hispanics are doing and try to emulate them."

Solving the puzzle may help the nation deal with health care issues because Hispanics use health services less - they make fewer doctors visits and spend less time in hospitals, [David] Hayes-Baustista, [director of the Center for the Study of Latino Health and Culture at UCLA's David Geffen School of Medicine] says.

"It's clearly something in the Latino culture," he says. "If this was the 'healthy migrant effect,' we would see it in all immigrant groups. It seems to be something in what Latinos do."

The report acknowledged that misidentification of age and ethnicity on death certificates may have contributed some error to the data.

View this article on Time.com

Consensus reached on use of Parkinson's treatment

Since the late 1990s, deep brain stimulation (DBS) has proven to be a lifeline for some patients suffering from Parkinson's disease, a cruel neurological disorder that can cause lack of control over movement, poor balance and coordination, and rigidity, among other symptoms.

14 oct 2010--The procedure is used only for patients whose symptoms cannot be adequately controlled with medications. A neurosurgeon uses magnetic resonance imaging or computed tomography to identify the exact target within the brain where abnormal electrical nerve signals generate the disease's tremors and other symptoms, and a neurostimulator is then surgically implanted to deliver electrical stimulation to that area to block the signals.

The goal, ultimately, is to improve the patient's quality of life.

Yet despite its effectiveness, there has been no consensus on several aspects of the use DBS, including which patients make the best candidates, where the optimal location for the placement of electrodes is, and the role that still exists for surgical removal of the damaged areas of the brain.

To address these concerns, a more than 50 DBS experts — including world-renowned neurologists, clinicians and surgeons — pooled their experience with the procedure and reached a consensus. The goal of this "meeting of the minds" was to better inform Parkinson's patients and their families about the potential of DBS treatment and to better inform the medical community in suggesting the procedure.

The results of their April 2009 meeting are presented in the current online edition of the journal Archives of Neurology.

"We know that very little accessible information is out there to help a Parkinson's patient make an informed decision as to whether he or she would be a good candidate for deep brain stimulation," said Jeff Bronstein, a UCLA professor of neurology and lead author of the report.

Surgical trials take a long time, he said, and what information is available on DBS appears in academic journals, is focused and limited, and is usually written by one group reflecting their biases.

Bronstein, who directs the UCLA Movement Disorder Program and is a member of the UCLA Brain Research Institute, said the results of the group's meeting will help clarify some of the issues about DBS treatment. Among their findings:

• The best candidates for DBS are those who can't tolerate the side effects of medications, who don't suffer from significant active cognitive or psychiatric problems, and who do suffer from tremors and/or motor fluctuations.


• DBS surgery is best performed by an experienced team and neurosurgeon with expertise in stereotactic neurosurgery — microsurgery deep within the brain that is based on a three-dimensional coordinate system using advanced neuroimaging.


• DBS, when used in the two most commonly treated areas of the brain — the subthalamic nuclei and the globus pallidus pars interna — is effective in addressing the motor symptoms of Parkinson's, but treatment in the subthalamic nuclei may cause increased depression and other symptoms in some patients.


• Surgical removal of the area of the brain causing Parkinson's disease is still an effective alternative and should be considered in patients.


• Surgical complication rates vary widely, with infection being the most commonly reported complication of DBS.

Multiple authors were involved in the report; Bronstein, the lead author, reports no conflict of interest.

Experts Propose New Lexicon for Alzheimer's Disease

AD redefined as a clinical-biological syndrome, allowing earlier diagnosis and targeted treatment

13 oct 2010-- The International Working Group for New Research Criteria for the Diagnosis of AD (Alzheimer's disease) has proposed a new lexicon as a point of reference for earlier diagnosis of AD patients in a position paper published online Oct. 11 in The Lancet Neurology.

Bruno Dubois, M.D., of the Institute for Memory and Alzheimer's Disease in Paris, and colleagues provide a broader diagnostic definition of AD as a clinical-biological syndrome. The definition aims to enable earlier diagnosis of AD by using biomarkers to diagnose patients with the condition instead of requiring a post-mortem examination.

According to the proposed lexicon, patients must present with episodic memory impairment and at least one positive biomarker shown on magnetic resonance imaging, neuroimaging with positron emission tomography, or cerebrospinal fluid analysis to meet the criteria for the diagnosis of AD. The authors write that the new definition could aid in selecting patients for trials of disease-modifying drugs and help in diagnosing patients at an earlier stage of disease to target treatment more effectively.

"The value of these definitions is their potential application in clinical trials of disease-modifying drugs," the authors write. "Individuals identified as 'asymptomatic at risk for AD' or 'presymptomatic AD' might be enrolled in trials aimed at delaying the onset of clinical signs. Patients with prodromal AD could be included in trials of drugs targeting progression to more severe stages of AD (AD dementia)."

Multiple authors disclosed financial relationships with medical device and pharmaceutical companies, including companies developing drugs for Alzheimer's disease.

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Physical symptoms prevalent no matter what stage of cancer including remission

INDIANAPOLIS,12 oct 2010 – Twenty-two physical symptoms associated with cancer – symptoms often unrecognized and undertreated – are prevalent in all types of cancers regardless of whether the patient is newly diagnosed, undergoing treatment or is a cancer survivor, according to researchers from the Regenstrief Institute and the Indiana University schools of medicine and nursing.

Common symptoms include fatigue, pain, weakness, appetite loss, dry mouth, constipation, insomnia and nausea. These physical symptoms are associated with substantial functional impairment, disability and diminished quality of life.

The study of 405 patients was reported in the Oct. 11, 2010, issue of the Archives of Internal Medicine. Numerous physical symptoms, rather than just a few, were prevalent in patients with cancer and this prevalence did not diminish after completion of therapy.

"We found that regardless of where they are in the course of their diseases, many individuals with cancer have a high symptom burden," said Kurt Kroenke, M.D., the study's principal investigator and first author. Dr. Kroenke is a Regenstrief Institute investigator and a Chancellor's Professor of Medicine in the IU School of Medicine.

"These symptoms impact them at home and at work throughout their lives," he said.

Study participants, all of whom had pain, depression or both, experienced substantial disability, reporting on average 17 of the past 28 days as either bed days or days in which they had to cut down on activities by at least 50%. Almost all patients reported feeling tired (97.5%) and most (78.8%) were bothered "a lot" by this symptom. Of the 22 symptoms studied, 15 were reported by more than half of the study participants.

In spite of high symptom prevalence, the researchers did not uncover greater use of the health care system. There may be several explanations for this including patients' inclinations to focus on cancer treatment while with their physicians or to accept the symptoms as an inevitable result of the disease or its treatment. Alternatively, the explanation may lie with the fact that those in the study, as cancer patients or former patients, were already frequently interacting with many parts of the health care system.

"Patients and their families should be encouraged to bring up symptoms like pain or insomnia with physicians. But because oncologists are necessarily focused on treatment of the cancer itself, they often have insufficient time to optimally evaluate and manage symptoms and other factors impacting quality of life. We have shown in an earlier study that one effective solution might be a partnership between a telephone-based symptom management team and community-based oncology practices,," said Dr. Kroenke, who is a research scientist with the Center for Implementing Evidence-Based Practice at the Richard Roudebush VA Medical Center and an Indiana University Melvin and Bren Simon Cancer Center member.

The previous study, published earlier in 2010 in the Journal of the American Medical Association, reported that an economical, centralized approach is feasible to conduct and significantly improved symptoms of pain and depression in patients in any phase of cancer. That approach gave patients, many of whom lived in underserved rural areas, one-stop assistance they probably wouldn't have had access to unless they went to a major cancer center, Kroenke said.

Recognizing and managing physical symptoms such as fatigue, pain, nausea, and insomnia may make a significant difference regardless of type or phase of cancer. The researchers plan to investigate medical and behavioral strategies and combinations of both approaches to control these symptoms.

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In addition to Dr. Kroenke, co-authors of "Somatic Symptoms in Patients with Cancer Experiencing Pain or Depression" are "Xin Zhong, R.N. and Janet Carpenter, Ph.D., R.N., of the IU School of Nursing; Dale Theobald, M.D., Ph.D. of Community Home Health Hospice and Symptom Management Group; Jingwei Wu, M.S., of the IU School of Medicine; and Wanzhu Tu, Ph.D., of the Regenstrief Institute and the IU School of Medicine.

The study was supported by a grant from the National Cancer Institute.

MRI may predict continued decline in patients with mild cognitive impairment

OAK BROOK, Ill.,11 oct 2010 – Using advanced MRI and an artificial intelligence technique, researchers in Geneva, Switzerland, have identified a method that may help identify which individuals with mild cognitive impairment (MCI) will continue to decline, according to a study published online and in the December issue of Radiology.

"We know that about half of all individuals with early-stage mild cognitive impairment will progress to Alzheimer's disease," said lead researcher Sven Haller, M.D, M.Sc., a radiologist at University Hospitals of Geneva. "But not knowing which patients will continue to decline makes it difficult to treat Alzheimer's early in the disease process."

Haller and a team of researchers used two novel techniques to image the brains of 35 control participants (mean age 63.7) and 69 patients with MCI (mean age 65 years), including 38 women and 31 men. Patients were diagnosed with MCI based on a battery of neuropsychological tests, which were repeated on 67 of the patients one year later to determine whether their disease was stable (40 patients) or progressive (27 patients).

Using an advanced technique called susceptibility-weighted MRI, the researchers were able to generate scans with greater detail of the many blood vessels in the brain, including the presence of tiny leaks called microhemorrhages or microbleeds.

"The number of cerebral microbleeds was significantly higher in the individuals with mild cognitive impairment than those in the control group," Dr. Haller said.

The MRI scans revealed microbleeds in 33 percent of individuals with stable MCI and 54 percent of those with progressive MCI. Only 14 percent of the control participants had microbleeds.

The susceptibility-weighted MRI also revealed that compared to the control participants, individuals with MCI had significantly increased iron concentration in certain areas deep within the structure of the brain and reduced levels of iron in others.

"Altered iron distribution in the subcortical nuclei was another distinguishing feature between the healthy control individuals and patients with mild cognitive impairment," Dr. Haller said.

Haller's team also analyzed the MRI data with support vector machines (SVM), an artificial intelligence technique that uses algorithms to identify patterns within a group and create classifications. SVM analysis of baseline MRI data acquired at the initial exam distinguished patients with progressive MCI from those with stable MCI with 85 percent accuracy.

"The goal of my work is to identify biomarkers of mild cognitive impairment that will help us diagnose individual patients at risk for further decline," Dr. Haller said. "Using SVM to analyze iron deposits in the brain may be such a biomarker."

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"Cerebral Microhemorrhage and Iron Deposition in Mild Cognitive Impairment: Susceptibility-weighted MR Imaging Assessment." Collaborating with Dr. Haller were Andreas Bartsch, M.D., Duy Nguyen, M.D., Cristelle Rodriguez, M.R.Psychol., Joan Emch, M.R.Psychol., Gabriel Gold, M.D., Karl O. Lovblad, M.D., and Panteleimon Giannakopoulos, M.D.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.rsna.org/)

Americans' life expectancy continues to fall behind other countries'

Obesity, smoking, traffic fatalities and homicide ruled out as causes of failure of US to keep up with gains in life expectancy in other countries

10 oct 2010—The United States continues to lag behind other nations when it comes to gains in life expectancy, and commonly cited causes for our poor performance—obesity, smoking, traffic fatalities, and homicide—are not to blame, according to a Commonwealth Fund-supported study published today as a Health Affairs Web First. The study, by Peter Muennig and Sherry Glied at Columbia University, looked at health spending; behavioral risk factors like obesity and smoking; and 15-year survival rates for men and women ages 45 and 65 in the U.S. and 12 other nations (Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom).

While the U.S. has achieved gains in 15-year survival rates decade by decade between 1975 and 2005, the researchers discovered that other countries have experienced even greater gains, leading the U.S. to slip in country ranking, even as per capita health care spending in the U.S. increased at more than twice the rate of the comparison countries. Fifteen-year survival rates for men and women ages 45 and 65 in the US have fallen relative to the other 12 countries over the past 30 years. Forty-five year old U.S. white women fared the worst—by 2005 their 15-year survival rates were lower than that of all the other countries. Moreover, the survival rates of this group in 2005 had not even surpassed the 1975 15-year survival rates for Swiss, Swedish, Dutch or Japanese women. The U.S. ranking for 15-year life expectancy for 45-year-old men also declined, falling from 3rd in 1975 to 12th in 2005, according to the study, "What Changes in Survival Rates Tell Us About U.S. Health Care."

When the researchers compared risk factors among the 13 countries, they found very little difference in smoking habits between the U.S. and the comparison countries—in fact, the U.S. had faster declines in smoking between 1975 and 2005 than almost all of the other countries. In terms of obesity, the researchers found that, while people in the U.S. are more likely to be obese, this was also the case in 1975, when the U.S. was not so far behind in life expectancy. In fact, even as the comparison countries pulled ahead of the US in terms of survival, the percentage of obese men and women actually grew faster in most of those countries between 1975 and 2005. Finally, examining homicide and traffic fatalities, the researchers found that they have accounted for a stable share of U.S. deaths over time, and would not account for the significant change in 15-year life expectancy the study identified.

The researchers say that the failure of the U.S. to make greater gains in survival rates with its greater spending on health care may be attributable to flaws in the overall health care system. They point to the role of unregulated fee-for-service payments and our reliance on specialty care as possible drivers of high spending without commensurate gains in life expectancy.

"It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them," said lead author Peter Muennig, assistant professor at Columbia University's Mailman School of Public Health. "But what really surprised us was that all of the usual suspects—smoking, obesity, traffic accidents, and homicides—are not the culprits. The U.S. doesn't stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy."

"This study provides stark evidence that the U.S. health care system has been failing Americans for years," said Commonwealth Fund President Karen Davis. "It is unacceptable that the U.S. obtains so much less than should be expected from its unusually high spending on health care relative to other countries." The good news is that the Affordable Care Act will take significant steps to improve our health care system and the health of Americans by expanding health insurance, improving primary care, and holding health care organizations accountable for their patients' overall health and ensuring the coordination of primary care and specialty care to eliminate errors, waste of patients' time, and wasteful duplication of tests and services."

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The article is available on the Health Affairs Web site at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2010.0073.

Informant-Based Tool Is Good Screen for Alzheimer's

AD8 screen correlates strongly with Alzheimer's disease biomarkers

09 oct 2010 -- A brief informant-based dementia assessment can identify Alzheimer's disease better than more traditional methods and may be a lower-cost alternative for Alzheimer's screening, according to a report published online Sept. 7 in Brain.

James E. Galvin, M.D., of Washington University in St. Louis, and colleagues developed and tested a new, brief dementia screening test -- the Ascertain Dementia 8 (AD8) questionnaire, which is administered to friends or family members who know the patient very well -- to ascertain observed changes in memory and behavior in 257 patients. The purpose of the study was to validate the AD8 against traditional biomarkers, such as those found in spinal fluid assays and brain plaque scans, as well as cognitive testing methods for Alzheimer's disease screening.

The researchers found that patients who had positive AD8 scores had abnormal Pittsburgh compound B binding and cerebrospinal fluid biomarkers compared with individuals who had negative AD8 scores. The AD8 was also better at detecting early stages of dementia than the Mini Mental State Examination.

"We found a strong relationship between the AD8, a brief, informant-based dementia screening tool, and biomarkers of Alzheimer's disease. Individuals with AD8 scores of greater than or equal to two had a biomarker phenotype (positive PiB binding, low CSF Aβ42, high tau, high tau phosphorylated at threonine 181) consistent with Alzheimer's disease," the authors write. "A positive AD8 screening test corresponded to lower performance on tests of episodic memory, supporting a clinical phenotype of Alzheimer's disease."

Two of the authors hold the copyright for the AD8; another author is a consultant for Avid Radiopharmaceuticals.

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Tinnitus in the elderly is prevalent and impacts quality of life

Alexandria, VA, 08 oct 2010 — Tinnitus is common among elderly Nigerians and associated with treatable health conditions like otitis media, rhinosinusitis, head injury and hypertension, according to new research published in the October 2010 issue of Otolaryngology – Head and Neck Surgery.

Nearly 36 million Americans, however, suffer from tinnitus or head noises. It may be an intermittent sound or an annoying continuous sound in one or both ears. In Nigeria, tinnitus affects between 10.1% and 33% of the population, with about 3 to 4% consulting a doctor on at least one occasion in their lifetime. Its effect makes it a significant contributor to morbidity in the elderly.

The study included face-to-face interviews of 1,302 elderly people aged 65 years and over; age, sex, economic status or residence were not associated with the occurrence of tinnitus. The researchers found a significant difference between the prevalence of tinnitus among "young elderly" subjects aged 65-69 (6.5%), and the older (80+ years) group (41.9 %). Also in this study, a non-significant trend was observed for the prevalence of tinnitus to increase with decreasing socioeconomic and educational level.

"Our results are of potential value in the overall consideration of the health consequence of aging in this setting, especially given the projections of a rapid increase in the proportion of the elderly in developing countries," said study author Akeem Olawale Lasisi, MBChB, FWACS, FMCORL.

In spite of its public health significance, tinnitus among the elderly has received poor research attention in Sub-Saharan Africa where, with relatively poor access to health service, etiologically important medical conditions that would otherwise be readily treated could become chronic and increase vulnerability to tinnitus. In this study, the authors focused on subjective tinnitus; in selecting risk factors to study, they speculated that the presence of chronic recurrent rhinosinusitis may lead to eustachian tube dysfunction, hence middle ear pressure dysregulation and tinnitus. In addition, chronic medical conditions predisposing to arteriosclerosis have been considered as correlates because when untreated or complicated (as often found in this area), they might lead to hypoperfusion of the cochlear and dysregulation of inner ear fluid dynamics, which could then cause tinnitus. Furthermore, control of these risk factors may help in ameliorating tinnitus and improving quality of life, which would be a significant benefit to the majority of the elderly.

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Otolaryngology – Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF). The study's authors are Akeem Olawale Lasisi, MBChB, FWACS, FMCORL; Taiwo Abiona, MSc; Oye Gureje, MBBS, PhD,

AACR: Memory Problems May Plague Cancer Survivors

40 percent more likely to report memory problems severe enough to affect daily functioning

07 oct 2010-- Cancer survivors are more likely than those with no cancer history to experience memory problems that thwart daily activities, according to research presented at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities, held from Sept. 30 to Oct. 3 in Miami.

Michael Antoni, Ph.D., of the University of Miami Miller School of Medicine, and colleagues analyzed data from a sample of 9,819 respondents to the National Health and Nutrition Examination Survey to determine the prevalence of memory impairment in cancer and non-cancer populations.

The researchers found that memory problems were reported more often by the 1,305 respondents who had cancer or a history of cancer than by those who did not, at 14 and 8 percent, respectively. Cancer history was also independently associated with memory impairment (odds ratio, 1.5). Those with cancer were 40 percent more likely to have memory problems severe enough to interfere with daily functioning.

"These memory issues can be related to treatment, such as chemotherapy, radiation, and hormone therapies, or to the tumor biology itself, which could change brain chemistry and neurobehavioral function," a co-author of the research said in a statement.

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Mortality Predictors for Parkinson's Disease Identified

Dementia, psychosis, motor severity, and age at onset among independent predictors

06 oct 2010-- Age at onset (AAO), chronological age, presence of dementia, motor severity, and psychosis are among the independent factors predictive of mortality in Parkinson's disease (PD) patients, according to research published in the Oct. 5 issue of Neurology.

Elin Bjelland Forsaa, M.D., of the Stavanger University Hospital in Norway, and colleagues analyzed assessments of motor and non-motor symptoms from 1993 to 2005 in 230 patients with PD to identify risk factors for mortality during a long-term follow-up.

The researchers found AAO, chronological age, male sex, Unified Parkinson's Disease Rating Scale motor score, psychotic symptoms, and dementia to be independent predictors of mortality; 211 patients (92 percent) died during the study period, and the median survival time from onset of motor symptoms was 15.8 years, ranging from 2.2 to 36.6 years.

"This population-based long-term study demonstrates that in addition to AAO, chronological age, motor severity, and dementia, psychotic symptoms independently predict increased mortality in PD. In contrast, no significant impact of antipsychotic or antiparkinsonian drugs on survival was observed in our PD cohort. Early prevention of motor progression and development of psychosis and dementia may be the most promising strategies to increase life expectancy in PD," the authors write.

Two authors disclosed financial relationships with pharmaceutical companies.

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Informatics = essential M.D. competency

JAMA article recommends biomedical informatics in education of physicians

		IMAGE: Dr. Edward H. Shortliffe is the president and CEO of AMIA, a professional association for informatics professionals; an emerging field in health care that supports clinical decision-making and...

05 oct 2010--In an article published in the Sept. 15 edition of the Journal of the American Medical Association, (JAMA), author Edward H. Shortliffe, MD, PhD, points out that although information underlies all clinical work, and despite the growing role that information management and access play in healthcare delivery and clinical support, there is a dearth of informatics competency being developed in America's future corps of physicians. Formalized education in the application of informatics and the use and methodologies of health information technology and exchange, Dr. Shortliffe observes, is not typically a specific part of medical education.

In his article, "Biomedical Informatics in the Education of Physicians," Dr. Shortliffe writes that knowledge management is key to clinical decision-making and yet "a coherent approach to information and knowledge management and their application has generally not been part of medical education." He identifies and defines the formal discipline missing from medical school curricula: biomedical and health informatics, defined as "the interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem-solving and decision-making, motivated by efforts to improve human health."

Biomedical informatics has four major areas of applications, Dr. Shortliffe writes: bioinformatics, encompassing molecular and cellular processes; imaging informatics (of tissues and organ systems); clinical informatics, which relates to individuals and patients; and public health informatics, which focuses on populations and society (e.g., disease control, epidemic surveillance, vaccine development). More specific subareas also contribute to the major applications: nursing informatics, pharmacogenomics, and consumer health informatics, to name a few.

Dr. Shortliffe observes that medical students need to learn both the practical applied side of informatics and the core concepts that will remain valuable throughout careers practicing medicine or conducting research in the computer age. To function successfully as physicians, medical students also need to learn about the value and role of online bibliographic databases, the role of order-entry systems, electronic health records, regional data exchanges, telemedicine and other current informatics applications in health and medicine, says Shortliffe.

"Biomedical informatics is not a topic that is optimally taught in a single course during the preclinical years," says Dr. Shortliffe, "but rather should be blended into the four-year curriculum. . ..with the use of clinical examples and challenges to motivate and direct the grasp of informatics concepts."

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Dr. Shortliffe is a professor in the School of Biomedical Informatics at UTHealth, Houston, and editor-in-chief of the Journal of Biomedical Informatics. He is also President and CEO of the American Medical Informatics Association (AMIA), the leading professional association of informatics professionals and an important player in medicine, health care, and science, that serves as the voice of the nation's top biomedical and health informatics professionals.