Mindfulness meditation training changes brain structure in 8 weeks

31 jan 2011-- Participating in an 8-week mindfulness meditation program appears to make measurable changes in brain regions associated with memory, sense of self, empathy and stress. In a study that will appear in the January 30 issue of Psychiatry Research: Neuroimaging, a team led by Massachusetts General Hospital (MGH) researchers report the results of their study, the first to document meditation-produced changes over time in the brain's grey matter.

"Although the practice of meditation is associated with a sense of peacefulness and physical relaxation, practitioners have long claimed that meditation also provides cognitive and psychological benefits that persist throughout the day," says Sara Lazar, PhD, of the MGH Psychiatric Neuroimaging Research Program, the study's senior author. "This study demonstrates that changes in brain structure may underlie some of these reported improvements and that people are not just feeling better because they are spending time relaxing."

Previous studies from Lazar's group and others found structural differences between the brains of experienced mediation practitioners and individuals with no history of meditation, observing thickening of the cerebral cortex in areas associated with attention and emotional integration. But those investigations could not document that those differences were actually produced by meditation.

For the current study, MR images were take of the brain structure of 16 study participants two weeks before and after they took part in the 8-week Mindfulness-Based Stress Reduction (MBSR) Program at the University of Massachusetts Center for Mindfulness. In addition to weekly meetings that included practice of mindfulness meditation – which focuses on nonjudgmental awareness of sensations, feelings and state of mind – participants received audio recordings for guided meditation practice and were asked to keep track of how much time they practiced each day. A set of MR brain images were also taken of a control group of non-meditators over a similar time interval.

Meditation group participants reported spending an average of 27 minutes each day practicing mindfulness exercises, and their responses to a mindfulness questionnaire indicated significant improvements compared with pre-participation responses. The analysis of MR images, which focused on areas where meditation-associated differences were seen in earlier studies, found increased grey-matter density in the hippocampus, known to be important for learning and memory, and in structures associated with self-awareness, compassion and introspection. Participant-reported reductions in stress also were correlated with decreased grey-matter density in the amygdala, which is known to play an important role in anxiety and stress. Although no change was seen in a self-awareness-associated structure called the insula, which had been identified in earlier studies, the authors suggest that longer-term meditation practice might be needed to produce changes in that area. None of these changes were seen in the control group, indicating that they had not resulted merely from the passage of time.

"It is fascinating to see the brain's plasticity and that, by practicing meditation, we can play an active role in changing the brain and can increase our well-being and quality of life." says Britta Hölzel, PhD, first author of the paper and a research fellow at MGH and Giessen University in Germany. "Other studies in different patient populations have shown that meditation can make significant improvements in a variety of symptoms, and we are now investigating the underlying mechanisms in the brain that facilitate this change."

Amishi Jha, PhD, a University of Miami neuroscientist who investigates mindfulness-training's effects on individuals in high-stress situations, says, "These results shed light on the mechanisms of action of mindfulness-based training. They demonstrate that the first-person experience of stress can not only be reduced with an 8-week mindfulness training program but that this experiential change corresponds with structural changes in the amydala, a finding that opens doors to many possibilities for further research on MBSR's potential to protect against stress-related disorders, such as post-traumatic stress disorder." Jha was not one of the study investigators.

More information: Psychiatry Research: Neuroimaging

Provided by Massachusetts General Hospital

Hormone therapy begun at menopause may pose risk for breast cancer

Starting hormone therapy at around the time of menopause is associated with a greater risk of breast cancer compared to starting after a longer gap, according to a study published online Jan. 28 in The Journal of the National Cancer Institute.

In this large, prospectively followed cohort of women, those who started hormone therapy five years or more after menopause had little or no increased risk, regardless of the type of hormone therapy used, how long they used it, and whether they were overweight or obese.

30 jan 2011--Many studies have established that breast cancer incidence increases in users of hormonal therapy, in particular among women who use an estrogen-progestin combination as opposed to estrogen-alone. Few studies have looked at the timing of hormone therapy as a risk factor, although two previous studies suggested the interval between menopause and initiating hormone therapy may influence breast cancer risk.

To investigate this question, Valerie Beral, FRS, of Oxford University and colleagues, used data from the Million Women Study (MWS) in the UK. The researchers estimated the adjusted relative risks of breast cancer in hormone therapy users and past users compared to non-users in 1.13 million women in the study. They also compared women on different types of hormone therapy.

They found that women starting hormone therapy at the time of menopause were at greater risk of breast cancer than those starting it later. They write, "A new finding of this study, which has been little investigated previously, is that the interval between menopause and starting hormonal therapy has a substantial effect on breast cancer risk."

Two previous studies have suggested this association but only in certain subgroups. "In this large study, we found greater risks of breast cancer if hormonal therapy use began either before or soon after menopause than after a longer gap; and this pattern of risk was seen across different types of hormonal therapy, among women who used hormonal therapy for either short of long durations, and also in lean and in overweight and obese women."

In an accompanying editorial, Rowan T. Chlebowski, M.D., Ph.D., of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and Garnet Anderson from the Fred Hutchinson Cancer Research Center note the study provides substantial support for similar findings from the Women's Health Initiative (WHI) in the U.S. They add that the similarities between the patterns of breast cancer risk in these two large studies increase the likely validity of the results, especially since the methodologies of the two studies were quite different.

The editorialists also discuss discrepancies in the two studies' findings regarding the risk of estrogen-only hormone therapy; the WHI found little risk associated with estrogen alone while the MWS found a statistically significant increased risk, except in overweight and obese women. They conclude that "the question of the effect of estrogen-only formulation use on breast cancer risk in postmenopausal women, even with longer-term hormone use, still stands unanswered."

Provided by Journal of the National Cancer Institute

Adult ADHD Linked to Lewy Body Dementia

Patients with Lewy body dementia more likely to have history of attention deficit in adulthood

29 jan 2011-- Adults with symptoms of attention-deficit and hyperactivity disorder (ADHD) may be at increased risk of developing dementia with Lewy bodies (DLB), according to a study published in the January issue of the European Journal of Neurology.

Angel Golimstok, M.D., of the Hospital Italiano Buenos Aires in Argentina, and colleagues investigated the link between ADHD symptoms in adults and the subsequent development of DLB. The frequency of ADHD symptoms during adult life was evaluated in 109 patients with DLB, 251 patients with Alzheimer's disease, and 149 controls, between 2000 and 2005.

The researchers found the prevalence of ADHD symptoms to be significantly higher in DLB cases compared to either the control group or the Alzheimer's disease group. The frequency of preceding ADHD symptoms in DLB cases was 47.8 percent, compared with 15.2 percent in those with Alzheimer's disease and 15.1 percent in the control group.

"The association between ADHD symptoms and DLB that we observed may be explained by a common neurotransmitter pathway dysfunction in both entities. We hypothesized that a common process is involved in both illnesses: ADHD in the initial state of that dysfunction that progresses to DLB in senescence," the authors write.

Abstract

Yearly mammograms from age 40 save 71 percent more lives, study shows

A new study questions the controversial U.S. Preventative Service Task Force recommendations for breast cancer screening, with data that shows starting at a younger age and screening more frequently will result in more lives saved.

29 jan 2011--The study analyzed the same data looked at by the task force, which issued its guidelines on mammography screening in November 2009. The study authors compared the task force's recommendations for screening every other year in women 50-74 to American Cancer Society guidelines of screening every year in women 40-84.

The study was conducted by R. Edward Hendrick, Ph.D., clinical professor of radiology at the University of Colorado School of Medicine, and Mark Helvie, M.D., director of breast imaging at the University of Michigan Comprehensive Cancer Center. It appears in the February issue of the American Journal of Roentgenology.

Hendrick and Helvie used six model scenarios of screening mammography created by the Cancer Intervention and Surveillance Modeling Network. This is the same modeling data the task force considered. The authors compared task force guidelines to American Cancer Society guidelines.

They found that if women begin yearly mammograms at age 40, it reduces breast cancer deaths by 40 percent. When screening begins at 50 and occurs every other year, it reduces breast cancer deaths 23 percent.

The difference between these two screening strategies comes down to 71 percent more lives saved with yearly screening beginning at 40.

"Task force guidelines have created confusion among women, leading some to forego mammography altogether. Mammography is one of the few screening tools that has been proven to save lives and our analysis shows that for maximum survival, annual screening beginning at 40 is best. This data gives women more information to make an informed choice about the screening schedule that's best for them," says Helvie, professor of radiology at the U-M Medical School.

As part of their recommendation, the task force emphasized the potential harms mammography can cause – including pain during the screening exam and anxiety from false-positives, which can lead to additional imaging or biopsy.

The study authors found that on average women ages 40-49 who are screened annually will have a false-positive mammogram once every 10 years. They will get asked back for more tests once every 12 years and will undergo a false-positive biopsy once every 149 years.

"The task force overemphasized potential harms of screening mammography, while ignoring the proven statistically significant benefit of annual screening mammography starting at age 40," Hendrick says. "In addition, the panel ignored more recent data from screening programs in Sweden and Canada showing that 40 percent of breast cancer deaths are averted in women who get regular screening mammography. Our modeling results agree completely with these screening program results in terms of the large number of women lives saved by regular screening mammography."

More information: American Journal of Roentgenology, Vol. 196, W112-W116, February 2011

Provided by University of Michigan Health System

Diabetes Prevalence Reaches 26 Million in United States

8.3 percent of U.S. population now affected, and 35 percent of adults have prediabetes

28 jan 2011 -- Nearly 26 million people in the United States have diabetes, and 79 million U.S. adults are estimated to have prediabetes, according to new estimates released by the U.S. Centers for Disease Control and Prevention.

Members of the CDC collected data from their own surveys, the Indian Health Service's National Patient Information Reporting System, the U.S. Renal Data System of the National Institutes of Health, the U.S. Census Bureau, and published studies to compile a fact sheet representing the current status of diabetes in the United States.

The researchers note that, in 2011, diabetes affects 8.3 percent of all Americans, or almost 26 million people, and that prediabetes affects 35 percent (79 million) of adults aged 20 and older. The CDC estimates that 27 percent of individuals with diabetes, or 7 million people, do not know they have it. In 2008, the agency estimated that 23.6 million Americans -- 7.8 percent of the population -- had diabetes and that 57 million adults had prediabetes. The CDC notes that the 2011 estimates have increased because more people are developing diabetes, more people are living longer with the disease, and hemoglobin A1c is now used as a diagnostic test and was incorporated into national prevalence calculations for the first time.

"These distressing numbers show how important it is to prevent type 2 diabetes and to help those who have diabetes manage the disease to prevent serious complications such as kidney failure and blindness," Ann Albright, Ph.D., R.D., director of CDC's Division of Diabetes Translation, said in a statement. "We know that a structured lifestyle program that includes losing weight and increasing physical activity can prevent or delay type 2 diabetes."

Little-known growth factor enhances memory, prevents forgetting in rats

A naturally occurring growth factor significantly boosted retention and prevented forgetting of a fear memory when injected into rats' memory circuitry during time-limited windows when memories become fragile and changeable. In the study funded by the National Institutes of Health, animals treated with insulin-like growth factor (IGF-II) excelled at remembering to avoid a location where they had previously experienced a mild shock.

28 jan 2011--"To our knowledge, this is the first demonstration of potent memory enhancement via a naturally occurring factor that readily passes through the blood-brain barrier – and thus may hold promise for treatment development," explained Cristina Alberini, Ph.D., of Mount Sinai School of Medicine, New York, a grantee of the NIH's National Institute of Mental Health (NIMH).

Alberini and colleagues say IGF-II could become a potential drug target for boosting memory. They report on their discovery in the Jan. 27, 2011 issue of Nature.

"As we learn more about such mechanisms of fear memory formation and extinction, we hope to apply this knowledge to address clinical problems, including post-traumatic stress disorder," said NIMH Director Thomas R. Insel, M.D.

The staying power of a memory depends on the synthesis of new proteins and structural changes in the connections between brain cells. These memory-strengthening changes occur within time-limited windows right after learning, when memories undergo consolidation, and also right after a memory is retrieved, a process called reconsolidation.

Hints from other studies led the researchers to suspect that IGF-II plays a role in these processes within the brain's memory center, the hippocampus, where it is relatively highly concentrated. The little-known growth factor is part of the brain's machinery for tissue repair and regeneration; it is important during development and declines with age.

To find out how it might work in memory, Alberini's team employed a standard test of fear memory called inhibitory avoidance training. They tracked the movement of rats in an environment where the animals learned to associate a dark area with mild foot shocks. The more an animal avoided the dark area, the better its fear memory.

This kind of learning boosted the expression of naturally occurring IGF-II in the hippocampus. So the researchers injected synthetic IGF-II directly into the hippocampus during windows of consolidation or reconsolidation, when memories are malleable. Remarkably, the rats' memory markedly improved – with the effects lasting at least a few weeks. An examination of the animals' brains revealed that IGF-II had strengthened the cellular connections and mechanisms underlying long-term memory – a process called long-term potentiation.

So IGF-II both strengthened a memory and delayed its normal decay – forgetting, noted Alberini.

The researchers had previously discovered that the fragility induced by memory retrieval requires new protein synthesis in the brain's fear area, the amygdala – but only if the memory is less than two weeks old. In the new study, they found that memory enhancement triggered by IGF-II during this reconsolidation window depended on new protein synthesis in the hippocampus during the same time period. They suggest that these time-limited effects might be explained by a gradual shift in the site where a memory is stored as it grows older, from the hippocampus to the brain's outer mantle, or cortex.

The study showed that the growth factor works through its own – also little known – IGF-II receptor and depends on activation of an enzyme (GSK3 beta), and AMPA receptors for the chemical messenger glutamate, both of which are implicated in memory. Evidence suggests that rather than activating new neurons, it appears to work through already activated connections between cells – or synapses – that are regulated by the enzyme and receptor.

Among future directions, researchers could explore whether IGF-II might enhance other types of memory, such as extinction learning, in which a fear memory is replaced by a memory of safety, said Alberini. If so, it might provide clues to new treatments for anxiety disorders like PTSD.

Provided by National Institutes of Health

Cost to treat heart disease in United States will triple by 2030

The cost to treat heart disease in the United States will triple by 2030, according to a policy statement published in Circulation: Journal of the American Heart Association.

27 jan 2011--"Despite the successes in reducing and treating heart disease over the last half century, even if we just maintain our current rates, we will have an enormous financial burden on top of the disease itself," said Paul Heidenreich, M.D., chair of the American Heart Association expert panel issuing the statement.

The panel estimated future medical costs based on the current rates of disease and used Census data to adjust for anticipated population shifts in age and race. The rigorous methods they devised didn't double count costs for patients with multiple heart conditions.

"These estimates don't assume that we will continue to make new discoveries to reduce heart disease," Heidenreich said. "If our ability to prevent and treat heart disease stays where we are right now, costs will triple in 20 years just through demographic changes in the population."

The panel said effective prevention strategies are needed to limit the growing burden of cardiovascular disease — the leading cause of death in the United States that accounts for 17 percent of overall national health expenditures.

"Unhealthy behaviors and unhealthy environments have contributed to a tidal wave of risk factors among many Americans," said Nancy Brown, American Heart Association CEO. "Early intervention and evidence-based public policies are absolute musts to significantly reduce alarming rates of obesity, hypertension, tobacco use and cholesterol levels."

Currently, 1 in 3 Americans (36.9 percent) have some form of heart disease, including high blood pressure, coronary heart disease, heart failure, stroke and other conditions. By 2030, approximately 116 million people in the United States (40.5 percent) will have some form of cardiovascular disease, the panel said. The largest increases are anticipated in stroke (up 24.9 percent) and heart failure (up 25 percent).

Between 2010-30, the cost of medical care for heart disease (in 2008 dollar values) will rise from $273 billion to $818 billion, the authors predicted. "We were all surprised at the remarkable increase in costs that are expected in the next two decades," Heidenreich said. "We need to continue to invest resources in the prevention of disease, the treatment of risk factors and early treatment of existing disease to reduce that burden."

Provided by American Heart Association

Why older people are less astute drivers and how the answer could help us understand depression

A test subject has the medial temporal visual area (MT) of her brain temporarily weakened so that researchers can study how it affects her ability to detect motion. University of Rochester Professor Duje Tadin has found that the MT area is responsible for allowing humans to ignore background motion in their environments and instead focus in on more important motion of smaller objects in the foreground. Credit: University of Rochester

26 jan 2011--When elderly drivers get behind the wheel, they often confront the harrowing reality that they cannot easily see other cars, pedestrians, or cyclists moving around them. This frightening effect of aging, it turns out, is not necessarily a result of a reduced ability to perceive moving objects, as one might suspect, but a heightened awareness of the backdrop against which these objects move.

A team of scientists led by University of Rochester Professor Duje Tadin has isolated the cause of this phenomenon, and the surprising results could not only help train elderly people to be better drivers, but they could also help psychiatrists better understand abnormal brain processes in psychological conditions like depression and schizophrenia. Their research, conducted at the Berenson-Allen Center for Noninvasive Brain Stimulation at the Harvard Medical School, will be published in the Journal of Neuroscience on January 25.

In a healthy, young person, a brain region called the middle temporal visual area, or MT, actively suppresses often irrelevant background motion so that he or she can concentrate on the more important motions of smaller objects in the foreground. Previous studies have found that elderly people, as well as those with psychological conditions such as schizophrenia and depression, are better at perceiving motion in the background. But this above average motion perception is not something to look forward to as we age. Because the brain is spending its limited resources constantly paying attention to the unimportant motions of background objects, it has a harder time noticing the motions of smaller objects.

“The amount of visual information around us is huge, and we don’t have the brain power to process it all,” Tadin said. “Evolutionarily speaking, moving objects are the most important visual features to detect quickly, because they could be your lunch or they could want to eat you for lunch. It just makes sense that our vision prioritizes processing them.”

Tadin and his colleagues discovered that the MT was responsible for this effect by using a technique called Transcranial Magnetic Stimulation (TMS). By precisely placing magnetic coils on the back of a subject’s head, the scientists stimulated the MT with electrical signals for 15 minutes to temporarily inhibit its functioning. Then, while the MT was less active, they tested how well subjects identified motions of smaller and larger objects. They found that when the MT was inhibited, subjects had an easier time identifying the motion of large, background-like objects. These results indicate that an improperly functioning MT may be the cause behind better than normal perception of background motion in older adults.

This knowledge could be useful to psychiatrists trying to better diagnose schizophrenia and depression, Tadin says. Current diagnostic techniques for these conditions can involve subjective and qualitative information like a history of hallucinations or feelings of apathy. But if a person also exhibits better than normal detection of background motion, it could be a quantitative confirmation that he or she has one of these afflictions.

Provided by University of Rochester

Weight loss plus walking essential for older, obese adults

Walking more and losing weight can improve mobility as much as 20 percent in older, obese adults with poor cardiovascular health, according to a new Wake Forest University study.

25 jan 2010--The results from the five-year study of 288 participants appear online Jan. 24 in the Archives of Internal Medicine.

The combination of weight loss and physical activity is what works best. These findings run counter to the commonly held belief that it is unhealthy for older adults to lose weight.

"To improve mobility, physical activity has to be coupled with weight loss," said Jack Rejeski, Thurman D. Kitchin Professor of Health and Exercise Science. "This is one of the first large studies to show that weight loss improves the functional health of older people with cardiovascular disease."

The study addresses what to do to help seniors with poor mobility, but it also proves existing community agencies can be used effectively to get seniors the help they need.

"With 60 percent of adults over age 65 walking less than one mile per week and a rapidly growing population of older adults, the need for cost-effective community-based intervention programs to improve the mobility of seniors is critical," said Rejeski, principal investigator for the Cooperative Lifestyle Intervention Program (CLIP). Key co-investigators included Dr. David C. Goff and Walter T. Ambrosius from Wake Forest University School of Medicine, Peter Brubaker, professor of health and exercise science at Wake Forest, Lucille Bearon and Jacquelyn McClelland from North Carolina State University, and Michael Perri from the University of Florida.

"Community-based preventative programs are extremely important," Rejeski said.

The researchers partnered with the North Carolina Cooperative Extension and trained health care professionals at centers in three counties (Davidson, Forsyth and Guilford) to lead the programs along with an intervention team from Wake Forest. The participants, ranging in age from 60 to 79, were tracked over an 18-month period. The study divided participants into three groups: a control group who received education on successful aging, a physical activity only group, and a physical activity and weight loss group.

The physical activity group did well, but the most dramatic effect was found in the participants who combined an increase in physical activity with weight loss.

On average, they improved their mobility by 5 percent as measured by the time it took them to walk 400 meters. Those with the most limited mobility improved by as much as 20 percent.

The 400-meter walk is a widely used measure of mobility disability in older adults because for those who cannot walk this distance the likelihood of losing their independence increases dramatically.

Rejeski uses this analogy for the loss of mobility in seniors who often don't realize its seriousness. "It is like being in a canoe paddling down a river and being completely unaware that a waterfall is only a short distance away. Once your canoe starts down the waterfall of disability, the consequences are severe."

The waterfall is the cascade of adverse outcomes including hospitalizations, worsening disability, institutionalization, and death that are more likely when seniors lose the basic ability to get around. Seniors with limited mobility require significantly more high-cost medical care.

"Clearly the ability to walk without assistance is a critical factor in an older person's capacity to function independently in the community," he said. "The next step is to develop a model that can be replicated at similar sites across the state and the country and we look forward to working with our colleagues from North Carolina to achieve this goal."

Provided by Wake Forest University

Youth adapt faster than seniors to unexpected events

Does experience give seniors an edge in reacting to sudden change or are younger people quicker to respond? A new study from Concordia University shows that when a routine task is interrupted by an unexpected event, younger adults are faster at responding. Published in the Journal of Gerontology, the findings have implications for educators and for older adults in situations where performance is crucial.

24 jan 2011--"When we frequently perform a task, our reactions become automatic," says Kevin Trewartha, first author and a PhD student in Concordia's Department of Psychology and a researcher at the Centre for Research in Human Development. "For example, experienced drivers are often 'on autopilot' when they're behind the wheel, but they do just fine, unless something unexpected happens. We're interested in reaction speeds in different age groups when something unexpected does occur while someone is performing a routine task."

Some 40 participants took part in the study: half were 19 to 36 years old, while the other half were 60 to 75 years old. Each participant was asked to follow visual cues on a computer screen and press corresponding keys on a piano keyboard. Some sequences were repeated frequently so that participants learned to expect them, while other sequences were randomly added at intervals to create unexpected sequences.

Reaction in older adults

"Older adults were less able to overcome their habitual responses when unexpected sequences arose," says Trewartha. "They were also slower in learning to adapt. They didn't improve as much as younger adults when they were asked to vary their learned routine on multiple occasions."

The study is one of the first to use 3D motion capture technology, the same tool used in film and animation, to link age-related cognitive changes to motor control. In short, the research sought to break down the reaction time of participants before they undertook a movement and the time they required to complete that movement. This breakdown produced unexpected results.

The research team found older adults tended to take less time to plan movements but more time to execute them – perhaps because they felt uncertain about their reactions. Trewartha and colleagues are already planning follow-up research to study the brain activity linked with the performance of learned and new movement patterns.

These results suggest that focus is even more important for older adults than for younger individuals. "When they really need to perform well at a given task, older adults should probably seek out an environment where they can focus on the task at hand without distractions," says senior author Karen Z.H. Li, a professor in Concordia's Department of Psychology and a researcher at the Centre for Research in Human Development.

More information: The study, "Movement Kinematics of Prepotent Response Suppression in Aging During Conflict Adaptation," published in the Journal of Gerontology, was authored by Kevin M. Trewartha, Virginia B. Penhune and Karen Z.H. Li from Concordia University. http://psychsocger … .gbq090.full

Provided by Concordia University

CT scanning aids rapid diagnosis, treatment planning for abdominal pain

The use of CT scanning to evaluate abdominal pain in emergency departments can help physicians arrive at a diagnosis quickly and decisively. A study conducted at Massachusetts General Hospital (MGH) and appearing in the February issue of the American Journal of Roentgenology also finds that information provided by CT scans changed treatment plans for almost half the patients studied and significantly reduced probable hospital admissions.

23 jan 2011--"Our report addresses an important question with substantial policy relevance – what is the value of CT scanning in the emergency department setting?" says Scott Gazelle, MD, MPH, PhD, an MGH radiologist and director of the Institute for Technology Assessment, senior author of the study. "We specifically looked at how the use of CT for patients with abdominal pain affects physicians' thinking about their patients' diagnosis, their confidence in the diagnosis and the treatment plan; and we found that it significantly affected all three."

Gazelle explains that imaging has become a target for efforts to reduce health care costs. "We've strongly believed that the use of CT in the emergency department can improve efficiency in the workup for many conditions, but we haven't had the evidence we would like to back up that assertion. We chose abdominal pain for our study because it's a common presenting symptom that doesn't have the clearly defined diagnostic guidelines available for other common symptoms that can lead to CT, like headache."

Over a 15-month period from November 2006 through February 2008, physicians in the MGH Emergency Department (ED) who ordered CT scans for patients with abdominal pain not associated with a traumatic injury were asked to complete a questionnaire both before the scan was conducted and again after receiving the results. The questionnaire included the physicians' current diagnosis of the probable cause of symptoms, their level of confidence in the diagnosis and their expected treatment recommendations.

Complete sets of questionnaires on the care of 584 patients were available for analysis. The CT scan results changed the diagnosis for 49 percent of patients and the management plan for 42 percent. The number of patients who would have been held for observation – possibly including additional diagnostic procedures – decreased 44 percent, and the number of planned hospital admissions was reduced almost 20 percent. The use of CT scanning significantly increased physicians' confidence in their diagnosis – both when the scan changed and when it did not change the prescan diagnosis – and that improvement was more pronounced in resident physicians than in staff physicians.

"Poor diagnostic certainty can lead to poor decision making," explains lead author Hani Abujudeh, MD, MBA, of MGH Radiology. "Increased certainty improves treatment planning and can reduce inappropriate utilization of hospital resources. Overall, the CT scan is an important tool for providing our patients with appropriate and timely care."

Gazelle adds, "While we didn't include a cost analysis in our study, it is fair to say that our results suggest the CT scan might reduce the use of other tests and procedures and therefore lower overall costs. Another benefit is that CT provides rapid results, which makes the workup process more efficient and can reduce both monetary costs and the time required to move patients through the ED."

Provided by Massachusetts General Hospital

Study of nutrition, Alzheimer's links hampered by research approach

Research is trying to determine whether Alzheimer's disease might be slowed or prevented with nutritional approaches, but a new study suggests those efforts could be improved by use of nutrient "biomarkers" to objectively assess the nutrient status of elderly people at risk for dementia.

22 jan 2011--The traditional approach, which primarily relies on self-reported dietary surveys, asks people to remember what they have eaten. Such surveys don't consider two common problems in elderly populations – the effect that memory impairment has on recall of their diet, or digestive issues that could affect the absorption of nutrients.

This issue is of particular concern, experts say, because age is the primary risk factor for Alzheimer's disease, and the upcoming wave of baby boomers and people 85 years and older will soon place many more people at risk for dementia.

"Dietary and nutritional studies have yielded some intriguing results, but they are inconsistent," said Emily Ho, an associate professor of nutrition at Oregon State University, co-author of the study, and principal investigator with OSU's Linus Pauling Institute.

"If we are going to determine with scientific accuracy whether one or another nutritional approach to preventing dementia may have value, we must have methods that accurately reflect the nutritional status of patients," Ho said. "The gold standard to assess nutritional status should be biomarkers based on blood tests."

The research was just published in Alzheimer's Disease and Associated Disorders, in work supported by the National Institutes of Health. The study was led by Dr. Gene Bowman, a nutrition and aging researcher at Oregon Health and Science University, in collaboration with OSU researchers.

Prevention strategies for Alzehimer's disease are "becoming more feasible," researchers said, because scientists are beginning to understand what populations are at high risk for developing the disease.

"One of the issues in doing a good study is understanding the nutritional status of your participants when you start and how the nutrient treatment changes it," Ho said. "Giving supplements or foods to a person who already has a normal nutritional status of that nutrient may be very different than if the person is deficient."

Complicating the issue, she said, is that elderly people in general may not absorb or process many nutrients as well as younger adults, and because of genetic differences they many have different biological responses to the same level of a nutrient. Knowing what they ate gives, at best, only a partial picture of what their nutritional status actually is. And it also assumes that people, including those with beginning dementia, will always remember with accuracy what their diet actually has been when questioned about 124 food items in an interview that can last up to two hours.

In this study, the scientists recruited 38 elderly participants, half with documented memory deficit and the other half cognitively intact. They compared the reliability of the nutrient biomarkers to food questionnaires administered twice over one month.

The questionnaire was able to determine some nutrient levels, but only in the group with good memory. The reliability of the nutrient biomarkers depended on the nutrient of interest, but overall performed very well.

"Now that we have a reliable blood test for assessing nutritional status, we can begin to study nutrient biomarkers in combination, their interactive features, and how they collectively may influence chronic diseases, including risk for Alzheimer's disease and dementia," Bowman said.

Such approaches could lead to more effective nutritional therapies in the future to promote cognitive health, he said.

Are positive emotions good for your health in old age?

The notion that feeling good may be good for your health is not new, but is it really true? A new article published in Current Directions in Psychological Science, a journal of the Association for Psychological Science, reviews the existing research on how positive emotions can influence health outcomes in later adulthood.

21 jan 2011--"We all age. It is how we age, however, that determines the quality of our lives," said Anthony Ong of Cornell University, author of the review article. The data he reviews suggest that positive emotions may be a powerful antidote to stress, pain, and illness.

There are several pathways through which a positive attitude can protect against poor health later in life. For example, happier people might take a proactive approach to aging by regularly exercising and budgeting time for a good night's sleep. Alternately, these people may avoid unhealthy behaviors, such as smoking and risky sex. The benefits of these healthy lifestyle choices may become more important in older adults, as their bodies become more susceptible to disease.

An optimistic outlook has also been shown to combat stress—a known risk factor for a lot of disease. Studies have found that people with stronger positive emotions have lower levels of chemicals associated with inflammation related to stress. Also, by adopting a positive attitude people may even be able to undo some of the physical damage caused by stress.

Ong, a developmental psychologist, became interested in the study of positive emotion during graduate school when he learned about what researchers call the paradox of aging: Despite the notable loss of physical function throughout the body, a person's emotional capacity seemed to stay consistent with age. Ong speculates that if positive emotions are indeed good for our health then, "one direct, measureable consequence of this should be the extended years of quality living."

Provided by Association for Psychological Science

Evidence Limited on Statins for Primary Prevention

Statins found to reduce death, cardiac events, but selective and potentially biased reporting occurred

20 jan 2011-- There is not enough evidence to support the widespread use of statins in individuals with no history of cardiovascular disease (CVD), according to a review published in The Cochrane Library.

Fiona Taylor, of the London School of Hygiene and Tropical Medicine, and colleagues reviewed data from 14 trials involving 34,272 patients to assess the effects of statins among individuals with no history of CVD. Outcomes in patients prescribed statins were compared to outcomes in patients given placebos or usual care.

Using combined data from eight trials involving 28,161 patients that provided data on deaths from all causes, the investigators found that statins reduced the risk of dying from nine to eight deaths for every 1,000 people treated with statins each year. In addition, statins reduced fatal and non-fatal CVD events, stroke and revascularization surgery, and blood cholesterol levels. However, the researchers write that their conclusions are limited by unclear, selective, and possibly biased reporting and that patients' individual risk profiles should be carefully considered before statins are prescribed.

"Although reductions in all-cause mortality, composite end points, and revascularisations were found with no excess of adverse events, there was evidence of selective reporting of outcomes, failure to report adverse events, and inclusion of people with CVD. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk," the authors write.

Abstract

ASCO: Gene Test May Predict Colorectal Cancer Recurrence

ColoPrint predicts recurrence risk in patients with localized, stage II disease

20 jan 2011-- A novel microarray-based genetic test, ColoPrint, appears to effectively determine the risk of colorectal cancer recurrence among patients with localized, stage II disease, according to a study presented at the American Society of Clinical Oncology's annual Gastrointestinal Cancers Symposium, held from Jan. 20 to 22 in San Francisco.

Robert Rosenberg, M.D., of the University Hospital of the Technical University in Munich, Germany, and colleagues evaluated tumor tissue excised from 233 patients who underwent surgical resection for stage II or stage III colorectal cancer between 1987 and 2003. The investigators used ColoPrint to analyze tumors for the expression of 18 colon cancer recurrence-specific genes.

In 135 stage II patients, the investigators found that ColoPrint identified 73 percent of patients as being at low risk of recurrence, with just 5 percent of them experiencing recurrence within five or more years. ColoPrint identified 27 percent of stage II patients as high-risk, with 20 percent of these patients experiencing a recurrence over a median follow-up of 97 months. The five-year distant-metastasis-free survival was 95 percent for low-risk patients and 80 percent for high-risk patients. The genetic test is currently being prospectively compared to clinical risk factors in an international, multi-center, clinical study of stage II colon cancer patients (Prospective Analysis of Risk Stratification using ColoPrint). The genetic test is also being evaluated among stage III colorectal cancer patients.

"If the results from the ongoing studies validate our findings, we will be able to use ColoPrint in routine clinical practice as a commercially available assay," Rosenberg said in a statement. "Further goals are to combine results of the gene signature test with clinical parameters to further improve patient stratification and to offer individualized therapy options to our patients."

Two authors disclosed financial relationships with Agendia, maker of ColoPrint.

Abstract

Imaging procedure can identify biomarker associated with Alzheimer's disease

Preliminary research suggests that use of a type of molecular imaging procedure may have the ability to detect the presence of beta-amyloid in the brains of individuals during life, a biomarker that is identified during autopsy to confirm a diagnosis of Alzheimer disease, according to a study in the January 19 issue of JAMA.

20 jan 2011--"Both diagnosis and treatment of Alzheimer disease (AD) are hampered by the lack of noninvasive biomarkers of the underlying pathology. Between 10 percent and 20 percent of patients clinically diagnosed with AD lack AD pathology at autopsy, and community physicians may not diagnose AD in 33 percent of patients with mild signs and symptoms," according to background information in the article. "The ability to identify and quantify brain beta-amyloid could increase the accuracy of a clinical diagnosis of Alzheimer disease." Several types of positron emission tomographic (PET) imaging tests are under study, with florbetapir F 18 (a diagnostic chemical that binds with beta-amyloid) PET showing promise. "However, the definitive relationship between the florbetapir-PET image and beta-amyloid deposition has not been established."

Christopher M. Clark, M.D., of Avid Radiopharmaceuticals, Philadelphia, and colleagues conducted a study to determine if florbetapir F 18 PET imaging performed during life accurately predicts the presence of beta-amyloid in the brain at autopsy. Florbetapir-PET imaging was performed on 35 patients from hospice, long-term care, and community health care facilities near the end of their lives (6 patients to establish the protocol and 29 to validate), which was compared with measures of brain beta-amyloid that was determined by autopsy after their death. PET images were also obtained in 74 young individuals (18-50 years) presumed free of brain amyloid to better understand the frequency of a false-positive interpretation of a florbetapir-PET image.

Florbetapir-PET imaging was performed an average of 99 days before death for the 29 individuals in the primary analysis group. Fifteen of the 29 individuals (51.7 percent) met pathological criteria for AD. Analysis of images and other data indicated a correlation between florbetapir-PET images and presence and quantity of beta-amyloid pathology at autopsy. "Florbetapir-PET images and postmortem results rated as positive or negative for beta-amyloid agreed in 96 percent of the 29 individuals in the primary analysis cohort. The florbetapir-PET image was rated as amyloid negative in the 74 younger individuals in the nonautopsy cohort," the researchers write.

They add that while amyloid pathology is an essential element for an AD diagnosis, "clinically impaired function may depend, in part, on the ability of the individual's brain to tolerate aggregated amyloid. Genetic risk factors, lifestyle choices, environmental factors, and neuropathological comorbidities may alter the threshold for the onset of cognitive impairment associated with beta-amyloid aggregation."

"This prospective imaging to autopsy study provides evidence that a molecular imaging procedure can identify beta-amyloid pathology in the brains of individuals during life. Understanding the appropriate use of florbetapir-PET imaging in the clinical diagnosis of AD or in the prediction of progression to dementia will require additional studies," the authors conclude.

More information: JAMA. 2011;305[3]:275-283.

Provided by JAMA and Archives Journals

Use of antidepressant associated with reduction in menopausal hot flashes

Women who were either in the transition to menopause or postmenopausal experienced a reduction in the frequency and severity of menopausal hot flashes with the use of the antidepressant medication escitalopram, compared to women who received placebo, according to a study in the January 19 issue of JAMA.

19 jan 2011--"Hormonal agents have been the predominant therapy for menopausal hot flashes, but their use decreased substantially following the shifts in risk-benefit ratios that were identified in the Women's Health Initiative Estrogen plus Progestin randomized controlled trial. However, no other treatments have U.S. Food and Drug Administration approval for menopausal hot flashes, and the efficacy of alternative pharmacologic and nonpharmacologic agents is inconclusive," according to background information in the article. Selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs) have been investigated for hot flash treatment with mixed results. The SSRI escitalopram reduced hot flashes with minimal toxicities in 2 pilot investigations, but conclusions were limited by the small samples and unblinded treatment.

Ellen W. Freeman, Ph.D., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues evaluated the efficacy of escitalopram vs. placebo to reduce the frequency and severity of hot flashes in healthy women, and examined whether race, menopausal status, depressed mood, and anxiety were important modifiers of any observed effect. The multicenter, 8-week, randomized trial enrolled 205 women (95 African American; 102 white; 8 other) between July 2009 and June 2010. Women received 10 to 20 mg/d of escitalopram or a matching placebo for 8 weeks. The primary outcomes measured included frequency and severity of hot flashes assessed by prospective daily diaries at weeks 4 and 8.

The average frequency of hot flashes at the beginning of the study was 9.8 per day. Escitalopram was associated with a significant reduction in the frequency of hot flashes relative to placebo, adjusted for race, site, and baseline hot flash frequency. In the escitalopram group, average hot flash frequency at week 8 decreased to 5.26 hot flashes per day (47 percent decrease or an average of 4.6 fewer hot flashes per day than at the beginning of the study). In the placebo group, hot flash frequency decreased to 6.43 hot flashes per day (33 percent decrease or an average of 3.2 fewer hot flashes per day).

Clinical improvement at week 8 (decrease of 50 percent or more from baseline in hot flash frequency) was significantly greater in the escitalopram group than in the placebo group (55 percent vs. 36 percent). Also, use of escitalopram significantly reduced hot flash severity compared with placebo, adjusted for race, site, and baseline severity.

Race did not significantly modify the treatment effect. Overall discontinuation due to adverse events was 4 percent (7 in the active group, 2 in the placebo group).

"The 3-week postintervention follow-up demonstrated that hot flashes increased after cessation of escitalopram but not after cessation of placebo, providing further evidence of escitalopram's effects," the authors write.

The researchers note that although the decreases in hot flash frequency and severity appear modest, the study participants perceived these improvements as meaningful, as indicated by their reported satisfaction with treatment and desire to continue the treatment.

"Our findings suggest that among healthy women, 10 to 20 mg/d of escitalopram provides a nonhormonal, off-label option that is effective and well-tolerated in the management of menopausal hot flashes. Further studies are needed to directly compare the relative efficacy of SSRIs and SNRIs with hormone therapy in the treatment of menopause-related hot flashes."

More information: JAMA. 2011;305[3]:267-274.

Provided by JAMA and Archives Journals

Lower biomarker levels, less education associated with greater cognitive decline

Older adults without dementia and with lower levels in plasma of the biomarkers beta-amyloid 42/40 (protein fragments) had an increased rate of cognitive decline over a period of 9 years, according to a study in the January 19 issue of JAMA. The researchers also found that this relationship was stronger among individuals with less education and lower levels of literacy.

19 jan 2011--An estimated 36 million people currently have dementia, with the prevalence expected to double every 20 years, according to background information in the article. "Thus, biomarkers to identify elderly persons at risk of developing dementia could be useful for early prevention, if and when such interventions are available, and treatment," the authors write. "Lower plasma beta-amyloid 42 and 42/40 levels have been associated with incident dementia, but results are conflicting and few have investigated cognitive decline among elders without dementia."

Kristine Yaffe, M.D., of the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, and colleagues conducted a study to investigate the association between plasma beta-amyloid 42 and 42/40 levels and cognitive decline in a large group of community-dwelling older adults without dementia, and also examined whether measures of cognitive reserve, as indicated by levels of education and literacy attained, modified the association of plasma beta-amyloid level with cognitive decline. The analysis included 997 black and white community-dwelling older adults who were enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998 with 10-year follow-up in 2006-2007. Participant average age was 74 years; 55.2 percent (n = 550) were female; and 54 percent (n = 538) were black. Measures of beta-amyloid 42 and 42/40 and cognitive function (via Modified Mini-Mental State Examination) were obtained.

The researchers found that low beta-amyloid 42/40 level was associated with greater cognitive decline over 9 years. After adjustment for several factors, the results remained statistically significant. There was also a significant association between plasma beta-amyloid 42 levels and cognitive decline. There was no association between plasma beta-amyloid 40 levels and baseline cognitive function or decline.

Also, cognitive reserve measures modified the association between beta-amyloid 42/40 level and cognitive decline. Older adults with low reserve (as measured by less than a high school diploma or sixth-grade or lower literacy) had an even greater association with beta-amyloid 42/40 level, whereas those with high reserve had less association.

"These results are important, as the prevalence of cognitive impairment is increasing exponentially and prevention will be crucial. To identify those at risk of dementia, biomarkers like plasma beta-amyloid level that are relatively easy to obtain and minimally invasive could be useful. In addition, our finding of an interaction of cognitive reserve with the association of plasma beta-amyloid level and cognitive decline could have public health importance because it may suggest pathways for modifying beta-amyloid effects on cognition," such as with cognitive activity or ongoing education, the authors write.

"Future studies should further explore the use of plasma beta-amyloid as a biomarker, assess the mechanisms by which cognitive reserve modifies this association, and determine whether increasing cognitive reserve through interventions can reduce the risk of Alzheimer disease."

More information: JAMA. 2011;305[3]:261-266.

Provided by JAMA and Archives Journals

Common antibiotics and blood pressure medication may result in hospitalization

Mixing commonly used antibiotics with common blood pressure medications may cause hypotension (abnormally low blood pressure) and induce shock in older patients, requiring hospitalization, according to a study published in CMAJ.

18 jan 2011--"Macrolide antibiotics (erythromycin, clarithromycin and azithromycin) are among the most widely prescribed antibiotics, with millions of prescriptions dispensed in Canada each year." writes Dr. David Juurlink, Scientist at the Sunnybrook Research Institute and the Institute for Clinical Evaluative Sciences with coauthors. "The drugs are generally well-tolerated, but they can cause several important drug interactions."

This study was conducted among Ontarians 66 years and older who were treated with a calcium-channel blocker (drugs often used to treat high blood pressure) between 1994 and 2009. The researchers then identified those who were hospitalized for low blood pressure and, in that group, whether or not a macrolide antibiotic had been prescribed shortly beforehand.

The researchers identified 7100 patients hospitalized for low blood pressure or shock while taking a calcium channel blocker. Treatment with erythromycin was found to increase the risk of low blood pressure almost 6-fold, while clarithromycin increased the risk almost 4-fold. In contrast, azithromycin did not increase the risk of hypotension.

"In older patients receiving calcium channel blockers, the two macrolide antibiotics erythromycin and clarithromycin are associated with a major increase in the risk of hospitalization for hypotension," conclude the authors. "However, the related drug azithromycin appears safe. When clinically appropriate, it should be used preferentially in patients receiving a calcium channel blocker."

Provided by Canadian Medical Association Journal

Popular sleep medicine puts older adults at risk for falls, cognitive impairment

A new study led by CU-Boulder Associate Professor Kenneth Wright, above, indicates a common sleep medication puts adults more at risk for nighttime falls and potential injuries. Credit: Photo by Patrick Campbell/University of Colorado

Adults who take one of the world's most commonly prescribed sleep medications are significantly more at risk for nighttime falls and potential injury, according to a new study by the University of Colorado at Boulder.

18 jan 2011--The study, which involved 25 healthy adults, showed 58 percent of the older adults and 27 percent of the young adults who took a hypnotic, sleep-inducing drug called zolpidem showed a significant loss of balance when awakened two hours after sleep. The findings are important because falls are the leading cause of injury in older adults, and 30 percent of adults 65 and older who fall require hospitalization each year, said CU-Boulder Associate Professor Kenneth Wright, lead study author.

To measure balance, the research team used a technique known as a "tandem walk" in which subjects place one foot in front of the other with a normal step length on a 16-foot-long, six-inch-wide beam on the floor. In 10 previous practice trials with no medication, none of the 25 participants stepped off the beam, indicating no loss of balance. All participants were provided with stabilizing assistance to prevent falls during the trials, he said.

"The balance impairments of older adults taking zolpidem were clinically significant and the cognitive impairments were more than twice as large compared to the same older adults taking placebos," said Wright, a faculty member in the integrative physiology department. "This suggests to us that sleep medication produces significant safety risks."

The new CU-Boulder study is the first to measure both the walking stability and cognition of subjects taking hypnotic sleep medicines or placebos. In addition to the balance problems caused by zolpidem, the study also showed that waking up after two hours of sleep after taking zolpidem enhances sleep inertia, or grogginess, a state that temporarily impairs working memory. The study participants were given computerized performance tests that involved adding randomly generated numbers.

A paper on the subject was published Jan. 13 in the Journal of the American Geriatric Society. Co-authors included CU-Boulder's Daniel Frey, Justus Ortega, Courtney Wiseman and Claire Farley. The study was funded primarily by the National Institutes of Health.

The effects of sleep inertia even without sleep medication has previously been shown to cause cognitive impairment, said Wright. But when the CU-Boulder study subjects took zolpidem rather than a placebo, the cognitive impairments essentially doubled.

One unexpected study finding was that young people taking placebos appear to be more cognitively impacted by sleep inertia than older adults taking placebos, he said.

A 2006 study led by Wright showed that study subjects who took no sleep medicine and were awakened after eight hours of sleep were more cognitively impaired, for a short period of time, than a totally sleep deprived person.

Several billion doses of zolpidem have been prescribed worldwide, said Wright, who also directs CU-Boulder's Sleep and Chronobiology Laboratory. Zolpidem is a generic drug that is marketed under a number of different brand names, including Ambien, Zolpimist, Edluar, Hypogen, Somidem and Ivedal.

The CU-Boulder team also measured balance and cognition in older adults who took no sleep medication and were kept awake for two hours past their normal bedtime. They found that 25 percent of these older adults failed the tandem walking balance test, which is consistent with what is seen in people who have insomnia. "Just having insomnia itself increases your risk of falls, even without sleep medication," he said.

The finding that zolpidem affected older adults more than younger adults in balance tests may be explained in part by the fact that both groups were given five milligram doses on study nights. While the normal dose for older adults is five milligrams, the standard dosage for younger adults being treated for insomnia is 10 milligrams. "This is an area that needs more study," he said.

The study results showing that both hypnotic sleep medications and sleep inertia cause significant impairment have important public health implications, said Wright. In older adults, falls have caused millions of nonfatal injuries annually and more than 300,000 fatalities worldwide. "Falls can be very debilitating, especially when older people break their hips and require hospitalization, causing their quality of life to go down," said Wright.

In addition, the cognitive impairments caused by both zolpidem and sleep inertia may impact decision-making, including responding to situations like fire alarms and medical emergencies as well as caring for sick children or driving to a clinic or hospital, said Wright.

"One of the goals of this study was to understand the risk of this sleep medication and of sleep inertia on human safety and cognition and to educate adults and health care workers about potential problems," said Wright. "We are not suggesting that sleep medications should not be used, because they have their place in terms of the treatment of insomnia."

One possible solution to reducing falls of older people due to zolpidem, other sleep medications or sleep inertia would be to install bedside commodes for those who frequently wake up in the night to void themselves, said Wright. Additional research is needed on this important public health and safety topic, he said.

Provided by University of Colorado at Boulder

'Thirdhand smoke' may be bigger health hazard than previously believed

Scientists are reporting that so-called "thirdhand smoke" — the invisible remains of cigarette smoke that deposits on carpeting, clothing, furniture and other surfaces — may be even more of a health hazard than previously believed. The study, published in ACS' journal, Environmental Science & Technology, extends the known health risks of tobacco among people who do not smoke but encounter the smoke exhaled by smokers or released by smoldering cigarette butts.

17 jan 2011--Yael Dubowski and colleagues note that thirdhand smoke is a newly recognized contributor to the health risks of tobacco and indoor air pollution. Studies show that that nicotine in thirdhand smoke can react with the ozone in indoor air and surfaces like clothing and furniture, to form other pollutants. Exposure to them can occur to babies crawling on the carpet, people napping on the sofa, or people eating food tainted by thirdhand smoke.

In an effort to learn more about thirdhand smoke, the scientists studied interactions between nicotine and indoor air on a variety of different materials, including cellulose (a component of wood furniture), cotton, and paper to simulate typical indoor surfaces. They found that nicotine interacts with ozone, in indoor air, to form potentially toxic pollutants on these surfaces. "Given the toxicity of some of the identified products and that small particles may contribute to adverse health effects, the present study indicates that exposure to [thirdhand smoke] may pose additional health risks," the article notes.

More information: "Thirdhand Smoke: Heterogeneous Oxidation of Nicotine and Secondary Aerosol Formation in the Indoor Environment", Environmental Science & Technology.

Provided by American Chemical Society

'A stark warning:' Smoking causes genetic damage within minutes after inhaling

In research described as "a stark warning" to those tempted to start smoking, scientists are reporting that cigarette smoke begins to cause genetic damage within minutes -- not years -- after inhalation into the lungs.

17 jan 2011--Their report, the first human study to detail the way certain substances in tobacco cause DNA damage linked to cancer, appears in Chemical Research in Toxicology, one of 38 peer-reviewed scientific journals published by the American Chemical Society.

Stephen S. Hecht, Ph.D., and colleagues point out in the report that lung cancer claims a global toll of 3,000 lives each day, largely as a result of cigarette smoking. Smoking also is linked to at least 18 other types of cancer. Evidence indicates that harmful substances in tobacco smoke termed polycyclic aromatic hydrocarbons, or PAHs, are one of the culprits in causing lung cancer. Until now, however, scientists had not detailed the specific way in which the PAHs in cigarette smoke cause DNA damage in humans.

The scientists added a labeled PAH, phenanthrene, to cigarettes and tracked its fate in 12 volunteers who smoked the cigarettes. They found that phenanthrene quickly forms a toxic substance in the blood known to trash DNA, causing mutations that can cause cancer. The smokers developed maximum levels of the substance in a time frame that surprised even the researchers: Just 15-30 minutes after the volunteers finished smoking. Researchers said the effect is so fast that it's equivalent to injecting the substance directly into the bloodstream.

"This study is unique," writes Hecht, an internationally recognized expert on cancer-causing substances found in cigarette smoke and smokeless tobacco. "It is the first to investigate human metabolism of a PAH specifically delivered by inhalation in cigarette smoke, without interference by other sources of exposure such as air pollution or the diet. The results reported here should serve as a stark warning to those who are considering starting to smoke cigarettes," the article notes.

Provided by American Chemical Society

New guidelines for preventing falls in the elderly include: Start tai chi, cut-back on meds

In the first update of the American Geriatrics Society and the British Geriatric Society's guidelines on preventing falls in older persons since 2001, they now recommend that all interventions for preventing falls should include an exercise component and that a number of new assessments should be used, including; feet and footwear, fear of falling, and ability to carry out daily living activities. The guidelines, a summary of which are published today in the Journal of the American Geriatrics Society, also state that fall screening and prevention should be a part of all healthcare practices for older adults.

16 jan 2011--The guidelines were compiled by a panel comprising members from the previous panels and new members with substantial knowledge, experience, and publications in fall prevention and care of older patients, and are based on a systematic review of the randomized controlled trials of fall prevention interventions. The literature search included meta-analyses, systematic literature reviews, randomized controlled trials, controlled before-and-after studies, and cohort studies published between May 2001 and April 2008. The panel also reviewed the RCTs published between April 2008 and July 2009 and concluded that the additional evidence did not change the ranking of the evidence or the guideline recommendations.

"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence," said Dr. Mary Tinetti of Yale University School of Medicine, USA, and one of the panel chairs. "Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes."

The guidelines now state that doctors and other health professionals should determine whether their older patients are at risk of falling by asking if they have fallen recently or if they are unsteady walking. If so, health providers should look for the presence of known problems such as muscle weakness, poor balance or blood pressure that drops too much on standing. If they have these problems, then older adults should receive the interventions described in the guidelines, but if there is no evidence of gait problems or recurrent falls, they do not require a risk assessment.

The new recommendations for interventions focus on:

• Multifactorial interventions which include exercise for balance, gait and strength training, such as Tai Chi or physical therapy
  
• Environmental adaptation to reduce fall risk factors in the home and in daily activities
  
• Cataract surgery where needed, but they recommend against vision intervention as an individual approach
  
• Medication reduction, regardless of the number of medications prescribed (in 2001 this was only recommended for those on at least four) with particular attention to medications that affect the brain such as sleeping medications and antidepressants
  
• Focus on raising low blood pressure and managing heart rate and rhythm abnormalities

"We found that the most effective trials for preventing falls in older people looked at multiple interventions rather than just one; previous studies have indicated that it is more effective to focus on one intervention, but because we looked at not only what recommendations were given, but also which carried out, we're confident that multifactorial interventions is the best course of action," said Tinetti.

"There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice. By making fall prevention part of the clinical care of older adults this trend can continue."

FDA Limits Acetaminophen in Combo Prescription Products

Sets 325 mg maximum in order to lower risk of liver toxicity; also requesting boxed warning

15 jan 2011-- The U.S. Food and Drug Administration is requesting that manufacturers of prescription combination products containing acetaminophen limit the amount of acetaminophen to a maximum of 325 mg in each tablet or capsule to reduce the risk of liver toxicity. In addition, the agency is directing manufacturers to update labels of all prescription combination products to warn consumers of the possible risk for severe liver injury.

Combination prescription products that contain acetaminophen may also contain codeine (Tylenol with Codeine), oxycodone (Percocet), and hydrocodone (Vicodin). According to the FDA, the risk of severe liver injury appears to be highest among those who take more than the prescribed dose of an acetaminophen-containing product in a 24-hour period, take more than one acetaminophen-containing product at the same time, or consume alcohol while taking acetaminophen products. The current maximum dose is 4,000 mg within 24 hours.

Over the next three years, higher dose prescription products containing acetaminophen will be phased out, but this poses no threat of a shortage of pain medication, according to the FDA. The FDA is also proposing a boxed warning to be added to the label of acetaminophen prescription products. Acetaminophen is also available over-the-counter (OTC) alone or in combination with other OTC ingredients, such as cough and cold ingredients. The FDA action regarding prescription acetaminophen products is not intended to impact the use of OTC acetaminophen products.

"There is no immediate danger to patients who take these combination pain medications and they should continue to take them as directed by their health care provider," Sandra Kweder, M.D., deputy director of the Office of New Drugs in FDA's Center for Drug Evaluation and Research, said in a statement.

Online tool can help seniors quickly determine risk for dementia

15 jan 2011 -- A quick online assessment tool developed by Johns Hopkins researchers can help worried seniors find out if they are at risk of developing dementia and determine whether they should seek a comprehensive, face-to-face diagnosis from a physician, according to a new study.

The tool, which is being refined and validated, is not meant to replace a full evaluation from a doctor that includes a physical exam, blood work, imaging studies and more. Instead, this assessment provides a scientific way to help a person educate herself about a disease that doctors now believe is best managed if caught early.

“As the population ages and dementia becomes more prevalent, it’s important to get people diagnosed early,” says Jason Brandt, Ph.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the leader of the study appearing online in the journal Alzheimer’s & Dementia. “Alzheimer’s disease and other types of dementia don’t just creep up on you. They’re incubating for decades in the brain. This tool is potentially very useful in determining who is at risk.”

Among the questions asked on the Dementia Risk Assessment are about whether a person has a history of high blood pressure, depression, diabetes, high cholesterol or head injury, all of which are considered well-documented risk factors for dementia. The assessment also includes a simple memory test that could point to a subtle cognitive decline, Brandt says.

The study analyzed responses from 357 people over the age of 50 who took the assessment at alzcast.org. Those who scored lowest on the memory test were significantly older, and were more likely to be men, have hypertension and report severe memory problems. And while only 9 percent of respondents reported they had severe memory problems, more than one-third said they had a first-degree relative with dementia or severe memory loss — a major risk factor for the condition.

The assessment takes just five to 10 minutes to complete online, and the questions have been borrowed from other scientifically valid assessments.

Brandt says the assessment may be helpful in weeding out those who have signs of dementia from those who are simply experiencing the memory loss that comes with aging or a busy lifestyle. Not being able to find your keys or remembering where you parked is rarely a failsafe sign that a person is suffering from dementia.

“Our goal is really to educate people about what some of the risk factors are and, often, to put people’s minds at ease,” he says. “We somehow expect our memories to be as good at 50 as they were at 30. We can’t run as fast as we could 20 years ago. Why should our memory be as good?”

Alzheimer’s disease still has no cure, but early interventions are being used to slow cognitive decline, Brandt says. Brandt says he hopes this assessment will get patients with several risk factors or symptoms to consult a physician.

Some forms of dementia, he says, may not be permanent, and getting to a doctor could help to restore brain function.

Sometimes, Brandt says, seniors are afraid to mention they are having memory or other cognitive issues. The new tool, he says, lets them learn more about themselves and their individualized risk factors in the privacy of their homes.

The aging population means that many more people will be diagnosed with dementia in the coming decades.

“Screening procedures that have demonstrated validity and predictive value and are noninvasive, brief and do not require any special expertise to administer may have the greatest potential to be accepted and actually used by the greatest number of people,” Brandt says. “This tool, which this study preliminarily validates, is the first step toward developing such a procedure.”

Brandt and colleagues are currently conducting research that compares a patient’s results from the online Dementia Risk Assessment with an in-person, comprehensive evaluation by a physician at one of two Johns Hopkins clinics.

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

Population-wide reduction in salt consumption recommended

The American Heart Association today issued a call to action for the public, health professionals, the food industry and the government to intensify efforts to reduce the amount of sodium (salt) Americans consume daily.

14 jan 2011--In an advisory, published in Circulation: Journal of the American Heart Association, the association sets out the science behind the American Heart Association's recommendation for the general population, which is to consume no more than 1500 milligrams (mg) of sodium a day because of the harmful effects of sodium – elevated blood pressure and increased risk of stroke, heart attacks and kidney disease. Elevated blood pressure (hypertension) is a major public health problem – approximately 90 percent of all Americans will develop hypertension over their lifetime.

Sodium consumption is currently more than two times higher than the recommended upper limit of 1,500 mg daily, with 77 percent of that consumption coming from packaged, processed and restaurant foods. "Even a modest decline in intake – say 400 mg per day –would produce benefits that are substantial and warrant implementation," say the advisory authors. The 2005 United States Dietary Guidelines for Americans recommended a sodium intake limit of 2,300 mg per day, which many health experts say is too much for most Americans. Earlier this year, the Dietary Guidelines Advisory Committee recommended to the secretaries of the United States Departments of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) that the goal should be modified to 1,500 mg per day for the general population. The advisory committee consists of leading scientists who reviewed the most recent scientific studies and created a set of recommendations that are being reviewed by the secretaries.

Recently, the American Heart Association lowered their recommendation to no more than 1500 mg of sodium daily for the general public, after a report from the Centers for Disease Control found that a majority of the American population either have high blood pressure or are at high risk for developing it.

According to the advisory:

• As sodium intake rises, so does blood pressure and the risk of negative health outcomes.
  
• Independent of its effects on blood pressure, excess sodium intake adversely affects the heart, kidneys, and blood vessels.
  
• The potential public health benefits of sodium reduction are enormous and extend to all Americans.
  
• Scientific evidence on the adverse effects of excess sodium is strong and compelling
  
• The American Heart Association's 2020 impact goals – to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent – include a population-wide reduction of sodium consumption to less than 1,500 mg daily as one of the ways the association will measure the nation's cardiovascular health. Furthermore, a normal range blood pressure is another key factor the association will use to measure the nation's cardiovascular health status.
  
• The American Heart Association is part of the National Salt Reduction Initiative, which is working with the food industry to reduce sodium content in packaged and restaurant food.

Inherent to the negative health effects are rising healthcare costs, the authors add. They point to one recent study that suggests a national effort that reduces sodium intake by 1,200 mg per day should reduce the health burdens related to heart disease in addition to reducing costs by up to $24 billion per year.

"Americans deserve the opportunity to choose how much sodium is in the food they eat. By supporting measures that will reduce sodium in the overall food supply, we are giving consumers freedom to select foods that could allow them to meet sodium recommendations and improve their ideal cardiovascular health," said Ralph Sacco, M.D., president of the American Heart Association.

The American Heart Association advocates for more robust sodium criteria within school nutrition standards, foods advertised and marketed to children and foods purchased by employers or government feeding programs, and for the Secretaries of HHS and USDA to adopt the Dietary Guidelines Advisory Committee recommendations.

The association also supports improved food labeling that helps consumers understand how much sodium is in their diet and consumer education in restaurants to help consumers choose lower-sodium options.

Provided by American Heart Association

Cancer costs projected to reach at least $158 billion in 2020

Medical expenditures for cancer in the year 2020 are expected to reach at least $158 billion (in 2010 dollars), based on the growth and aging of the US population. If medical advances continue to become more expensive, cancer spending could reach as high as $207 billion. Credit: National Cancer Institute/National Institutes of Health

13 jan 2011--Based on growth and aging of the U.S. population, medical expenditures for cancer in the year 2020 are projected to reach at least $158 billion (in 2010 dollars) – an increase of 27 percent over 2010, according to a National Institutes of Health analysis. If newly developed tools for cancer diagnosis, treatment, and follow-up continue to be more expensive, medical expenditures for cancer could reach as high as $207 billion, said the researchers from the National Cancer Institute (NCI), part of the NIH. The analysis appears online, Jan. 12, 2011, in the Journal of the National Cancer Institute.

The projections were based on the most recent data available on cancer incidence, survival, and costs of care. In 2010, medical costs associated with cancer were projected to reach $127.6 billion, with the highest costs associated with breast cancer ($16.5 billion), followed by colorectal cancer ($14 billion), lymphoma ($12 billion), lung cancer ($12 billion) and prostate cancer ($12 billion).

If cancer incidence and survival rates and costs remain stable and the U.S. population ages at the rate predicted by the U.S. Census Bureau, direct cancer care expenditures would reach $158 billion in 2020, the report said.

However, the researchers also did additional analyses to account for changes in cancer incidence and survival rates and for the likelihood that cancer care costs will increase as new technologies and treatments are developed. Assuming a 2 percent annual increase in medical costs in the initial and final phases of care – which would mirror recent trends – the projected 2020 costs increased to $173 billion. Estimating a 5 percent annual increase in these costs raised the projection to $207 billion. These figures do not include other types of costs, such as lost productivity, which add to the overall financial burden of cancer.

"Rising health care costs pose a challenge for policy makers charged with allocating future resources on cancer research, treatment, and prevention," said study author Angela Mariotto, Ph.D., from NCI's Surveillance Research Program. "Because it is difficult to anticipate future developments of cancer control technologies and their impact on the burden of cancer, we evaluated a variety of possible scenarios."

To project national cancer expenditures, the researchers combined cancer prevalence, which is the current number of people living with cancer, with average annual costs of care by age (less than 65 or 65 and older). According to their prevalence estimates, there were 13.8 million cancer survivors alive in 2010, 58 percent of whom were age 65 or older. If cancer incidence and survival rates remain stable, the number of cancer survivors in 2020 will increase by 31 percent, to about 18.1 million. Because of the aging of the U.S. population, the researchers expect the largest increase in cancer survivors over the next 10 years to be among Americans age 65 and older.

"The rising costs of cancer care illustrate how important it is for us to advance the science of cancer prevention and treatment to ensure that we're using the most effective approaches," said Robert Croyle, Ph.D., director, Division of Cancer Control and Population Sciences, NCI. "This is especially important for elderly cancer patients with other complex health problems."

To develop their cost projections, the authors used average medical costs for the different phases of cancer care: the first year after diagnosis, the last year of life, and the time in between. For all types of cancer, per-person costs of care were highest in the final year of life. Per-person costs associated with the first year after a cancer diagnosis were more varied, with cancers of the brain, pancreas, ovaries, esophagus and stomach having the highest initial costs and melanoma, prostate and breast cancers having the lowest initial-year costs.

These new projections are higher than previously published estimates of direct cancer expenditures, largely because the researchers used the most recent data available – including Medicare claims data through 2006, which include payments for newer, more expensive, targeted therapies which attack specific cancer cells and often have fewer side effects than other types of cancer treatments. In addition, by analyzing costs according to phase of care, which revealed the higher costs of care associated with the first year of treatment and last year of life (for those who die from their disease), the researchers were able to generate more precise estimates of the cost of care.

The researchers used 2005 incidence and mortality data from NCI's Surveillance, Epidemiology and End Results (SEER) program to estimate cancer prevalence for 2010 and 2020. Population estimates for the United States was obtained from the U.S. Census Bureau's National Interim Projections for 2006 to 2020. Medical cost estimates were obtained using the SEER-Medicare database which links SEER data to Medicare claims data from the Center for Medicare and Medicaid Services.

More information: More information about these cost projections is available at: http://costproject … s.cancer.gov

Provided by National Institutes of Health