Exercise Plus Dieting Superior in Older Obese Individuals

The combination results in improved physical function compared with either approach alone

31 mar 2011---- Dieting plus exercise may be better than either alone for improvement in physical function in older adults who are obese, according to research published in the March 31 issue of the New England Journal of Medicine. Dennis T. Villareal, M.D., of the Washington University School of Medicine in St. Louis, and colleagues randomly assigned 107 adults aged 65 years or older and obese to a control group, a diet group, an exercise group, or a diet plus exercise group to assess the effects on Physical Performance Test scores, frailty, body composition, bone mineral density, specific physical functions, and quality of life. In the 93 participants who finished the study, scores on the Physical Performance Test increased more in the diet plus exercise group (21 percent) than in the diet, exercise, or control groups (12, 15, and 1 percent, respectively). Body weight decreased by 10 and 9 percent in the diet and diet plus exercise groups, respectively, but not in the exercise or control groups. The diet plus exercise group experienced improvements in strength, balance, and gait. "These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone," the authors write. Full Text (subscription or payment may be required)

Researchers find many elderly men are undergoing unnecessary PSA screenings

A new study on the use of prostate-specific antigen (PSA)-based prostate cancer screening in the United States found that many elderly men may be undergoing unnecessary prostate cancer screenings. Using data from surveys conducted in 2000 and 2005, researchers report that nearly half of men in their seventies underwent PSA screening in the past year – almost double the screening rate of men in their early fifties, who are more likely to benefit from early prostate cancer diagnosis and treatment. Further, men aged 85 and older were screened just as often as men in their early fifties.

30 mar 2011--Because prostate cancer tends to be slow-growing, data show that many men – particularly those in their seventies and older – will die of other causes before prostate cancer becomes a problem that requires medical attention. The new findings underscore a long-standing concern that overuse of PSA screening and PSA-based treatment decisions may lead to unnecessary treatment of many older men and potential complications such as incontinence, impotence and bowel dysfunction.

"Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer. We're concerned these screenings may prompt cancer treatment among elderly men who ultimately have a very low likelihood of benefitting the patient and paradoxically can cause more harm than good," said senior author Scott Eggener, MD, assistant professor of surgery at the University of Chicago. "We were also surprised to find that nearly three-quarters of men in their fifties were not screened within the past year. These results emphasize the need for greater physician interaction and conversations about the merits and limitations of prostate cancer screening for men of all ages."

While large declines in prostate cancer metastases and death rates in the last 20 years coincide with widespread use of PSA-based screening, questions remain about its use. Data have been unclear about when men should be considered for PSA screening and when screening should stop, and recent studies have provided conflicting evidence on whether routine PSA screening in the general population of men actually reduces the risk of dying from prostate cancer. Based on these concerns, major organizations such as the American Cancer Society now encourage men who expect to live at least 10 years to talk with their doctor about the risks and benefits of screening, starting at age 50 for men with an average risk or at age 45 for men with a higher risk.

In this study, the researchers examined results from health surveys of randomly selected households conducted in 2000 and 2005 as part of the federal government-sponsored National Health Interview Survey. In addition to reviewing survey data, which included information on age, smoking, mass-body index, underlying medical conditions and other factors, the investigators calculated the estimated five-year life expectancy of each man over 40 who had received a PSA test.

They divided survey results of men age 70 and older into five-year age groups (70 to 74, 75 to 79, 80 to 84, and 85 years and older). In all, 2,623 men ages 70 and older were included in the analysis, while nearly 12,000 men between the ages of 40 and 69 served as controls.

The overall PSA screening rate within the past year for men aged 40 and older was 23.7 percent in 2000 and 26.0 percent in 2005. The PSA screening rate was lowest in the 40 to 44 age group (7.5 percent). Researchers found that the PSA screening rate was 24.0 percent in men ages 50 to 54, increasing with age until a peak of 45.5 percent in ages 70 to 74. Screening rates then declined with age, with 24.6 percent of men 85 or older reporting being screened.

Among men who were 70 or older, the investigators did find that PSA screening was more common in men with a greater estimated five-year life expectancy. For example, approximately 47.3 percent of men who were unlikely to die in five years (an estimated chance of 15 percent or less) were screened, 39.2 percent of men with an intermediate chance (16 to 48 percent probability) of dying received screening, and 30.7 percent of those with the highest probability of death (48 percent or greater) in five years were screened.

Eggener offered some possible explanations for the results, noting that screening rates may reflect how frequently men visit primary care physicians. Older men tend to have more health problems that require doctor visits, and this may in turn result in more frequent PSA testing than younger men, who see their doctors less. The authors suggest that physicians should be more selective in recommending PSA testing for older men, particularly those with a limited life expectancy, and consider more routinely screening younger, healthier men who are most likely to benefit from early prostate cancer diagnosis and related treatment. Men are encouraged to talk with their doctor about their individual risk for prostate cancer, and about the risks and benefits of prostate cancer screening.

More information: http://www.cancer. … state+Cancer

Provided by American Society of Clinical Oncology

Almost Two-Thirds of Older Adults Have Hearing Loss

Black race offers significant protection against hearing loss compared to white subjects

29 mar 2011-- Nearly two-thirds of older Americans experience hearing loss, and it is most strongly associated with age, gender, and race, according to a study published online Feb. 27 in The Journals of Gerontology: Series A.

Frank R. Lin, M.D., Ph.D., of the Johns Hopkins School of Medicine in Baltimore, and colleagues investigated the prevalence of hearing loss among 717 adults aged 70 years and older, as well as its associative factors and hearing aid use. They analyzed data from the 2005 to 2006 cycle of the National Health and Nutritional Examination Survey (NHANES). Audiometry results, information on hearing aid use, noise exposure, medical history, and demographics were assessed. Hearing loss was defined as a speech-frequency pure-tone average with 25 dB threshold in the better ear.

The researchers found that the prevalence of hearing loss was 63.1 percent. After adjustment for confounders, the odds of hearing loss were associated with increased age and male gender, whereas black race protected against hearing loss (odds ratio, 0.32). Forty percent of adults with moderate hearing loss used hearing aids; whereas, among those with mild hearing loss, 3.4 percent used hearing aids.

"Hearing loss is prevalent in nearly two-thirds of older adults ≥70 years in the U.S. population. Additional research is needed to determine the epidemiologic and physiologic basis for the protective effect of black race against hearing loss and to determine the role of hearing aids in those with a mild hearing loss," the authors write.

Abstract

Negative attitudes toward fat bodies going global, study finds

Stigma against overweight people is becoming a cultural norm around the world, even in places where larger bodies have traditionally been valued. That's according to a cross-cultural study of attitudes toward obesity to be published in the April issue of Current Anthropology.

29 mar 2011--Researchers from Arizona State University surveyed people in nine diverse locations around the world and found negative attitudes toward fat bodies in every one. The results suggest a rapid "globalization of fat stigma" in which overweight people are increasingly viewed as ugly, undesirable, lazy, or lacking in self control, the researchers say.

In the U.S., slim bodies have been idealized and fat ones stigmatized for several decades. But that has not been true of the rest of the world, says Alexandra Brewis, a biological anthropologist and one of the study's authors.

"Previously, a wide range of ethnographic studies have shown that many human societies preferred larger, plumper bodies," Dr. Brewis said. "Plump bodies represented success, generosity, fertility, wealth, and beauty."

But those fat-positive values are quickly giving way to a more negative Western way of looking at obesity, such as symbolizing personal failing.

The researchers surveyed people in Mexico, Argentina, Paraguay, the U.S., and the U.K. Also included were American Samoa, Puerto Rico, and Tanzania—cultures that have traditionally been thought of as fat-positive. People were asked if they agreed or disagreed with a series of statements about body size. Some statements were fat-negative ("Fat people are lazy"), others were fat-positive ("A big woman is a beautiful woman").

The responses across these diverse cultures were largely congruent with Western attitudes, the researchers found. What's more, the highest fat stigma scores were not in the U.S. or the U.K., "but rather Mexico, Paraguay, and—perhaps most surprisingly—in American Samoa," the researchers write.

The change in attitudes in American Samoa has happened with remarkable speed, says Dr. Brewis. "When I was doing research in the Samoas in the 1990s, we found people starting to take on thinner body ideals, but they didn't yet have discrediting ideas about large bodies," she said. "But that appears to be changing very quickly."

"People from sites that have adopted fat-negative attitudes more recently seem to be more strident," said cultural anthropologist Amber Wutich, another of the study's authors. "The late adopters were more likely to agree with the most judgmental statements like 'fat people are lazy.'"

The study didn't test what is driving this rapid shift in attitude, but the researchers say that "newer forms of educational media, including global public health campaigns" may be playing a role.

Dr. Brewis said the findings reveal another dimension to the global obesity epidemic.

"There are now more overweight than underweight people around the world," she said. "Our results show that this rapid growth in obesity isn't just a concern because it can undermine health. As more people globally gain weight, we also need to be as concerned about the profound emotional suffering that comes with these types of prejudicial ideas about big bodies taking hold."

More information: Alexandra Brewis, Amber Wutich, Ashlan Falletta-Cowden, and Isa Rodriguez-Soto, "Body Norms and Fat Stigma in Global Perspective." Current Anthropology 52:2 (April 2011).

Provided by University of Chicago Press Journals

Walnuts are top nut for heart-healthy antioxidants

A new scientific study positions walnuts in the No. 1 slot among a family of foods that lay claim to being among Mother Nature's most nearly perfect packaged foods: Tree and ground nuts. In a report here today at the 241st National Meeting & Exposition of the American Chemical Society, scientists presented an analysis showing that walnuts have a combination of more healthful antioxidants and higher quality antioxidants than any other nut.

28 mar 2011--"Walnuts rank above peanuts, almonds, pecans, pistachios and other nuts," said Joe Vinson, Ph.D., who did the analysis. "A handful of walnuts contains almost twice as much antioxidants as an equivalent amount of any other commonly consumed nut. But unfortunately, people don't eat a lot of them. This study suggests that consumers should eat more walnuts as part of a healthy diet."

Vinson noted that nuts in general have an unusual combination of nutritional benefits — in addition those antioxidants — wrapped into a convenient and inexpensive package. Nuts, for instance, contain plenty of high-quality protein that can substitute for meat; vitamins and minerals; dietary fiber; and are dairy- and gluten-free. Years of research by scientists around the world link regular consumption of small amounts of nuts or peanut butter with decreased risk of heart disease, certain kinds of cancer, gallstones, Type 2 diabetes, and other health problems.

Despite all the previous research, scientists until now had not compared both the amount and quality of antioxidants found in different nuts, Vinson said. He filled that knowledge gap by analyzing antioxidants in nine different types of nuts: walnuts, almonds, peanuts, pistachios, hazelnuts, Brazil nuts, cashews, macadamias, and pecans. Walnuts had the highest levels of antioxidants.

Vinson also found that the quality, or potency, of antioxidants present in walnuts was highest among the nuts. Antioxidants in walnuts were 2-15 times as potent as vitamin E, renowned for its powerful antioxidant effects that protect the body against damaging natural chemicals involved in causing disease.

"There's another advantage in choosing walnuts as a source of antioxidants," said Vinson, who is with the University of Scranton in Pennsylvania. "The heat from roasting nuts generally reduces the quality of the antioxidants. People usually eat walnuts raw or unroasted, and get the full effectiveness of those antioxidants."

If nuts are so healthful and nutritious, why don't people eat more? Vinson's research shows, for instance, that nuts account for barely 8 percent of the daily antioxidants in the average person's diet. Many people, he said, may not be aware that nuts are such a healthful food. Others may be concerned about gaining weight from a food so high in fat and calories. But he points out that nuts contain healthful polyunsaturated and monosaturated fats rather than artery-clogging saturated fat. As for the calories, eating nuts does not appear to cause weight gain and even makes people feel full and less likely to overeat. In a 2009 U. S. study, nut consumption was associated with a significantly lower risk of weight gain and obesity. Still, consumers should keep the portion size small. Vinson said it takes only about 7 walnuts a day, for instance, to get the potential health benefits uncovered in previous studies.

Provided by American Chemical Society

Even mild stress is linked to long-term disability

Even relatively mild stress can lead to long term disability and an inability to work, reveals a large population based study published online in the Journal of Epidemiology and Community Health.

27 mar 2011--It is well known that mental health problems are associated with long term disability, but the impact of milder forms of psychological stress is likely to have been underestimated, say the authors.

Between 2002 and 2007, the authors tracked the health of more than 17,000 working adults up to the age of 64, who had been randomly selected from the population in the Stockholm area.

All participants completed a validated questionnaire (GHQ-12) at the start of the study to measure their mental health and stress levels, as well as other aspects of health and wellbeing.

During the monitoring period, 649 people started receiving disability benefit - 203 for a mental health problem and the remainder for physical ill health.

Higher levels of stress at the start of the study were associated with a significantly greater likelihood of subsequently being awarded long term disability benefits.

But even those with mild stress were up to 70% more likely to receive disability benefits, after taking account of other factors likely to influence the results, such as lifestyle and alcohol intake.

One in four of these benefits awarded for a physical illness, such as high blood pressure, angina, and stroke, and almost two thirds awarded for a mental illness, were attributable to stress.

The authors say that it is important to consider their findings in the context of modern working life, which places greater demands on employees, and social factors, such as fewer close personal relationships and supportive networks.

These factors lead them to ask: "Are the strains and demands of modern society commonly exceeding human ability?" And they conclude that while mild stress should not be over-medicalised, their findings suggest that it should be taken more seriously than it is.

Provided by British Medical Journal

Researchers uncover novel immune therapy for pancreatic cancer

Researchers at the University of Pennsylvania's Abramson Cancer Center have discovered a novel way of treating pancreatic cancer by activating the immune system to destroy the cancer's scaffolding. The strategy was tested in a small cohort of patients with advanced pancreatic cancer, several of whose tumors shrank substantially. The team believes their findings – and the novel way in which they uncovered them -- could lead to quicker, less expensive cancer drug development.

26 mar 2011--The authors call the results, published in the March 25 issue of Science, a big surprise. "Until this research, we thought the immune system needed to attack the cancer directly in order to be effective," said senior author Robert H. Vonderheide, MD, DPhil, an associate professor of Medicine in the division of Hematology/Oncology and the Abramson Family Cancer Research Institute. "Now we know that isn't necessarily so. Attacking the dense tissues surrounding the cancer is another approach, similar to attacking a brick wall by dissolving the mortar in the wall. Ultimately, the immune system was able to eat away at this tissue surrounding the cancer, and the tumors fell apart as a result of that assault. These results provide fresh insight to build new immune therapies for cancer."

The current study is part of a unique research model designed to move back and forth between the bench and the bedside, with the investigative team consisting of researchers based in both the laboratory and in the clinic. In the clinical trial led at Penn by Peter O'Dwyer, MD, professor of Hematology/Oncology, and Gregory L. Beatty, MD, PhD, instructor of Hematology/Oncology, pancreatic cancer patients received standard gemcitabine chemotherapy with an experimental antibody manufactured by Pfizer Corporation. The antibody binds and stimulates a cell surface receptor called CD40, which is a key regulator of T-cell activation. The team initially hypothesized that the CD40 antibodies would turn on the T cells and allow them to attack the tumor.

The treatment appeared to work, with some patients' tumors shrinking substantially and the vast majority of tumors losing metabolic activity after therapy, although all of the responding patients eventually relapsed. When the researchers looked at post-treatment tumor samples, obtained via biopsy or surgical removal, there were no T cells to be seen. Instead, they saw an abundance of another white blood cell known as macrophages.

To understand what was happening in the tissues of these patients, Vonderheide and Beatty and colleagues turned to a mouse model of pancreatic cancer developed several years ago at Penn. Unlike older mouse models that were simplistic models of human disease, new genetically engineered mice develop spontaneous cancers that are very close reproductions of human tumors. "We can perform preclinical trials in these mice with the same principles we use in our patients," Vonderheide says, noting that the team even used a randomization protocol to assign individual mice to different arms of the study.

When the investigators treated mice that developed pancreatic cancer with gemcitabine in combination with CD40 antibodies, the results looked like those of the human trial. Some mouse tumors shrank and were found to be loaded with macrophages but contained few or no T cells. Closer inspection showed that the macrophages were attacking what is known as the tumor stroma, the supporting tissue around the tumor. Pancreatic tumors secrete chemical signals that draw macrophages to the tumor site, but if left to their own devices, these macrophages would protect the tumor. However, treating the mice (or patients) with CD40 antibodies seemed to flip that system on its head. "It is something of a Trojan horse approach," Vonderheide says. "The tumor is still calling in macrophages, but now we've used the CD40 receptor to re-educate those macrophages to attack – not promote – the tumor."

The researchers believe that the CD40 antibodies also activated T cells in the mice, but the T cells couldn't get into the tumor or its surrounding tissue. "We learned that T cells have a major problem with migration into tumors, and this may be a particular problem for pancreatic cancer," Vonderheide says. "The area surrounding pancreatic cancers is very dense, fibrotic, and hostile. This is one of the main reasons standard therapies for this disease often work so poorly."

The researchers are now working on ways to capitalize on their novel information, testing ways to super-charge the macrophage response and to get the T cells into the tumor microenvironment. Vonderheide thinks his team can speed up clinical research by running pilot trials in the mice to test potential therapeutics. Once they understand responses in the mice, then they can use that information to design better human trials.

"Beyond our specific findings, we think these findings point to a new approach for drug development in cancer -- one where we use state-of-the-art mouse models for preclinical trials to guide which trials we should do next in patients," Vonderheide says. "It should be faster, cheaper and give us a head start in the clinical trials."

Provided by University of Pennsylvania School of Medicine

Subjects at risk of Alzheimer's may now be able to delay the onset of their first symptoms

For elderly subjects at risk of developing Alzheimer's disease, research shows that hope may lie in brain plasticity.

25 mar 2011--The human brain loses 5 to 10% of its weight between the ages of 20 and 90 years old. While some cells are lost, the brain is equipped with two compensatory mechanisms: plasticity and redundancy. Based on the results of her most recent clinical study published today in the online version of Brain: A Journal of Neurology, Dr. Sylvie Belleville, PhD in neuropsychology, the principal author of this study and Director of Research at the Institut universitaire de gériatrie de Montréal (IUGM), which is affiliated with the Université de Montréal, has found that for elderly subjects at risk of developing Alzheimer's disease, hope may lie in brain plasticity.

"Brain plasticity refers to the brain's remarkable ability to change and reorganize itself. It was long thought that brain plasticity declined with age, however, our study demonstrates that this is not the case, even in the early stages of Alzheimer's disease", declares Sylvie Belleville.

These findings open countless new avenues of research including the possibility of improving the plasticity of affected areas of the brain, and slowing the decline in plasticity through pharmacological means or lifestyle changes, thereby allowing subjects with Alzheimer's disease to enjoy several more symptom-free years.

The hypothesis behind this research was that certain cells traditionally involved in other brain processes could, through a simple memory training program, temporarily take over since they themselves are not yet affected. According to Dr. Belleville: "Our research has validated our hypothesis. Not only were we able to use functional imaging to observe this diversification, but we also noted a 33% increase in the number of correct answers given during a post-training memory task by subjects with mild cognitive impairment (MCI) who, incidentally, are ten times more likely to develop Alzheimer's disease".

The training program that was used was designed to help elderly subjects with MCI develop strategies, such as the use of mnemonics, for example, and promote encoding and retrieval, such as word lists, for example, using alternative areas of the brain. "The hypothesis had already been raised, but our team was the first to provide scientific support, using a functional neuroimaging protocol", added Sylvie Belleville.

Researchers worked with thirty elderly subjects: 15 healthy adults and 15 with MCI. Magnetic resonance imaging was used to analyse brain activity in the two groups 6 weeks prior to memory training, one week prior to training and one week after training. Before the memory training, magnetic resonance imaging in both the healthy elderly subjects and those with MCI showed activation in areas of the brain traditionally associated with memory. As expected, decreased activation was observed in subjects with MCI. After training, brain areas in elderly subjects with MCI showed increased activation in areas typically associated with memory, but also in new areas of the brain usually associated with language processing, spatial and object memory and skill learning.

According to Dr. Belleville: "Analysis of brain activity during encoding as measured before and after the training program, indicates that increased post-training activation in the right inferior parietal gyrus is associated with post-intervention improvement. The healthy area of the brain has taken over for the area that is compromised."

Provided by University of Montreal

Time lived with obesity linked with mortalityMonash University researchers have found the number of years individuals live with obesity is directly associated with the risk of mortality.

24 mar 2011--The research shows that the duration of obesity is a strong predictor of mortality, independent of the actual level of Body Mass Index (BMI). As the onset of obesity occurs earlier and the number of years lived with obesity increases, the risk of mortality associated with adult obesity in contemporary populations is expected to increase compared with previous decades.

Using data from the Framingham Heart Study, 5209 participants were followed up for 48 years from 1948. The current study however only included participants who were free from pre-existing diseases of diabetes, cardiovascular diseases and cancer.

The research showed that for those who had a medium number of years lived with obesity (between five years and 14.9 years), the risk of mortality more than doubled than for those who had never been obese. The risk of mortality almost tripled for those with the longest duration of obesity (more than 15 years).

Furthermore, the research showed for every additional two years lived with obesity, the risk of mortality increased by between six and seven per cent.

"Before now, we did not know whether being obese for longer was any worse for you health than simply being obese. However, this research shows for the first time that being obese for longer increases your risk of mortality, no matter how heavy you actually are," Monash University researcher, Dr Anna Peeters said.

"This research provides added support for all the current policy trying to prevent obesity in general. It also indicates that we should try extra hard to prevent obesity at younger ages," said Dr Peeters.

Provided by Monash University

Elderly victims of abuse often use alcohol or drugs, study says

Victims of severe traumatic elder abuse are more likely to be female, suffer from a neurological or mental disorder, and to abuse drugs or alcohol, according to research published in the March issue of the Journal of the American Geriatrics Society.

23 mar 2011--"Past studies have shown that alcohol abuse by the perpetrator plays a substantial role and is strongly associated with physical abuse," says Lee Friedman, assistant professor of environmental and occupational health sciences at the University of Illinois at Chicago and lead author of the study. "Our findings indicate that alcohol abuse among the victims may be an important contributing factor as well."

Twenty-nine percent of abuse victims in the study tested positive for alcohol, compared to 13 percent of controls.

Local researchers examined medical record data at two Chicago-area Level I trauma units from 41 cases of elder abuse and compared them to a random set of other over-60 patients between 1999 and 2006.

The researchers found that elderly victims of physical abuse suffered more severe injuries than their non-abused counterparts. They also suffered disproportionately from pre-existing medical conditions such as heart disease, dementia and Alzheimer's disease, mental illness and alcohol abuse.

All the key measures of injury severity -- length of hospital stay, treatment in an intensive care unit, assisted breathing, injury severity scores, in-hospital case fatality rates -- were higher in the abuse cases, according to the researchers, and are associated with long-term adverse outcomes.

In the study, 20 victims of abuse returned to the environment in which the abuse occurred. In the majority of cases, the perpetrator had been arrested, but 17 percent of the victims expressed a desire to return to the perpetrator and not to press charges.

Eighty-five percent of the perpetrators were family members or intimate partners. In most cases, the abuse was not identified until after the admission process or several days into hospitalization.

The failure of medical staff to properly identify abuse victims and contact adult protective services in the majority of cases shows that clinicians need to better understand elder abuse, Friedman said.

Provided by University of Illinois at Chicago

Study shows polypill to be safe and accepted by physicians and patients in developing countries

For a patient at high risk of cardiovascular disease (CVD), keeping up with what pills to take at different times of the day can be tedious. Window sills lined with prescription bottles – a pill for cholesterol, another for blood pressure, and an aspirin to keep blood thin and flowing – the list can get quite long and, as a result, many people, especially the elderly, often forget doses or take the wrong pill at the wrong time.

22 mar 2011--But what if there was a single pill that had all the benefits of multiple medications in one dose? Would people take it? Would doctors prescribe it? And would it be effective?

A new study done by researchers at Wake Forest Baptist Medical Center provides evidence that, in fact, such a pill may be a viable option for developing countries, where CVD is strongly emerging and the demand for cost-effective, low maintenance treatment is high.

"The idea behind the polypill is that it offers a simpler way to give medications to people so that they will have better adherence to their pills," said Elsayed Z. Soliman, M.D., M.Sc., M.S., director of the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist and lead author on the study. "It's not always easy for people to consistently take multiple pills, even if they are needed to treat a serious condition, like CVD. This is especially true in developing countries, where cost of CVD medications is another major challenge. This one pill has the potential to improve adherence while being less costly to the population in developing countries."

To adopt the polypill approach in developing countries, a large scale clinical trial is needed, Soliman added. However, before conducting such a trial, research was needed to see if it was even possible to conduct a clinical trial in a developing country.

Going into this study, there were many perceived barriers to doing research in a developing country, Soliman said. Among them, would the country have investigators capable and willing to participate in a study and the necessary follow-up? Would patients sign up to participate? And if the pill was proven to work, would doctors even feel comfortable prescribing it?

So Soliman and colleagues brought the study to Sri Lanka, where they enrolled 216 participants without diagnosed CVD, in the hope of answering some of these questions. Half of the participants received "standard' treatment for CVD risk prevention, and the other half received the polypill. Patients were recruited as planned. Two hundred three patients (94.0%) completed the treatment program and returned for their follow-up visits. No safety concerns were reported.

These findings suggest a high rate of patient acceptability, a finding that is bolstered by the fact that the majority of patients who completed the trial – 90 percent – indicated that they would take the polypill "for life" if proven to be effective in reducing CVD risk. Approximately 86 percent of the physicians surveyed agreed with and supported use of the polypill for primary prevention and 93 percent for secondary prevention of CVD. In terms of reduction in CVD risk, both the polypill and "standard treatment" resulted in marked reductions in systolic blood pressure, total cholesterol and 10-year estimated risk of CVD.

"Our trial has fulfilled its purposes," Soliman said. "We wanted to check the feasibility of doing a large-scale clinical trial with a polypill in a developing country and to examine the acceptability of the polypill by patients and physicians, and we now know that it's feasible and acceptable."

He added that the "standard" treatment in this trial was administered by highly specialized physicians in tertiary-care centers, making it a tough competitor, yet the simple polypill held its own.

Although feasibility has been demonstrated, Soliman explained that there are other important questions about the polypill that still need answers, such as: Which patient population should a polypill target: those who have not yet been diagnosed with CVD (primary prevention) or those who have a CVD diagnosis in their medical history (secondary prevention)? Also, what components should make up the pill and in what doses will they be most effective?

"There are many questions, but a single trial will never answer all of them," Soliman said. "At least now we know that it is possible to begin looking for the answers."

More information: The study was published in Trials.

Provided by Wake Forest University Baptist Medical Center

Gardening linked to increased vegetable consumption in older adults

New research from Texas A&M University and Texas State University found that older adults who participate in gardening may be more likely to eat their veggies. The report, published in HortTechnology, presents the results of an online survey of adults aged 50+ and includes recommendations for promoting gardening "intervention" programs to older adults.

21 mar 2011--According to researchers Aime Sommerfeld, Amy McFarland, Tina Waliczek, and Jayne Zajicek, studies have shown that poor nutrition is one of several factors responsible for mortality and morbidity in the elderly and is comparable to deaths caused from cigarette smoking. "Although older adults tend to report a higher intake of fruit and vegetables than other age groups, over half of the U.S. older population does not meet the recommendation of five daily servings of fruit and vegetables." They added that several previous research studies confirmed that gardening is one way to increase individuals' fruit and vegetable intake.

The objectives of the study were to examine and compare fruit and vegetable consumption of gardeners and nongardeners, and to investigate differences in fruit and vegetable consumption of long-term gardeners compared with newer gardeners. To collect the information, an online survey was posted on a web site for one month; 261 questionnaires were completed by adults aged 50 years and older.

"Our results support previous studies that indicated gardeners were more likely to consume vegetables when compared with nongardeners. Interestingly, these results were not found with regard to fruit consumption", stated Waliczek, corresponding author of the study. The responses also showed that the length of time an individual reported having participated in gardening activities seemed to have no relationship to the number of vegetables and fruits they reportedly consumed. "This suggests that gardening intervention programs late in life would be an effective method of boosting vegetable and fruit consumption in older adults."

The number of hours per week individuals spent gardening did not appear to be a factor in vegetable and fruit consumption; the researchers observed that this indicates that even older adults with limited time or abilities—those who spend less time gardening—may consume greater quantities of vegetables and fruits than their nongardening counterparts.

Finally, the survey results showed that a person's reason for gardening had no relationship with the quantity of vegetables and fruit consumed, implying that programs designed to encourage older adults to participate in gardening need not exclusively promote the health benefits derived from gardening, but may appeal to a range of personal motives.

More information: The complete study and abstract are available on the ASHS HortTechnology electronic journal web site: http://horttech.as … act/20/4/711

Provided by American Society for Horticultural Science

Tai chi beats back depression in the elderly, study shows

The numbers are, well, depressing: More than 2 million people age 65 and older suffer from depression, including 50 percent of those living in nursing homes. The suicide rate among white men over 85 is the highest in the country — six times the national rate.

20 mar 2011--And we're not getting any younger. In the next 35 years, the number of Americans over 65 will double and the number of those over 85 will triple.

So the question becomes, how to help elderly depressed individuals?

Researchers at UCLA turned to a gentle, Westernized version of tai chi chih, a 2,000-year-old Chinese martial art. When they combined a weekly tai chi exercise class with a standard depression treatment for a group of depressed elderly adults, they found greater improvement in the level of depression — along with improved quality of life, better memory and cognition, and more overall energy — than among a different group in which the standard treatment was paired with a weekly health education class.

The results of the study appear in the current online edition of the American Journal of Geriatric Psychiatry.

"This is the first study to demonstrate the benefits of tai chi in the management of late-life depression, and we were encouraged by the results," said first author Dr. Helen Lavretsky, a UCLA professor-in-residence of psychiatry. "We know that nearly two-thirds of elderly patients who seek treatment for their depression fail to achieve relief with a prescribed medication."

In the study, 112 adults age 60 or older with major depression were treated with the drug escitalopram, a standard antidepressant, for approximately four weeks. From among those participants, 73 who showed only partial improvement continued to receive the medication
daily but were also randomly assigned to 10 weeks of either a tai chi class for two hours per week or a health education class for two hours per week.

All the participants were evaluated for their levels of depression, anxiety, resilience, health-related quality of life, cognition and immune system inflammation at the beginning of the study and again four months later.

The level of depression among each participant was assessed using a common diagnostic tool known as the Hamilton Rating Scale for Depression, which involves interviewing the individual. The questions are designed to gauge the severity of depression. A cut-off score of 10/11 is generally regarded as appropriate for the diagnosis of depression.

The researchers found that among the tai chi participants, 94 percent achieved a score of less than 10, with 65 percent achieving remission (a score of 6 or less). By comparison, among participants who received health education, 77 percent achieved scores of 10 or less, with 51 percent achieving remission.

While both groups showed improvement in the severity of depression, said Lavretsky, who directs UCLA's Late-Life Depression, Stress and Wellness Research Program, greater reductions were seen among those taking escitalopram and participating in tai chi, a form of exercise that is gentle enough for the elderly.

"Depression can lead to serious consequences, including greater morbidity, disability, mortality and increased cost of care," Lavretsky said. "This study shows that adding a mind-body exercise like tai chi that is widely available in the community can improve the outcomes of treating depression in older adults, who may also have other, co-existing medical conditions, or cognitive impairment.

"With tai chi," she said, "we may be able to treat these conditions without exposing them to additional medications."

Provided by University of California - Los Angeles

Study: Multi-tasking on the street not a good idea for older people

Older adults may put themselves at risk by talking on cell phones while crossing the street, researchers report in a new study. The researchers found that adults aged 59 to 81 took significantly longer than college students to cross a simulated street while talking on a mobile phone, and their heightened cautiousness in initiating crossing did nothing to improve their safety. Older adults on cell phones also were more likely to fail to cross in the time allotted for the task.

19 mar 2011--The findings, from researchers at the University of Illinois, appear in the journal Psychology and Aging.

In the study, 18 undergraduate students (aged 18 to 26 years) and 18 older adults crossed simulated streets of varying difficulty while either undistracted, listening to music or conversing on a hands-free cell phone. The older adults were significantly impaired on the most challenging street-crossing tasks while also engaged in a second activity, with the most pronounced impairment occurring during cell phone conversations. The younger adults showed no impairment on dual-task performance, the researchers found.

"It should be noted that we have previously found that younger adults show similar performance decrements, but under much more challenging crossing conditions," said lead author Mark Neider, a postdoctoral researcher who conducted the study with Illinois psychology professor and Beckman Institute director Art Kramer<.

"Combined with our previous work, the current findings suggest that while all pedestrians should exercise caution when attempting to cross a street while conversing on a cell phone, older adults should be particularly careful," Neider said.

More information: "Walking and Talking: Dual-Task Effects on Street Crossing Behavior in Older Adults,"


Provided by University of Illinois at Urbana-Champaign

Guided care reduces the use of health services by chronically ill older adults

A new report shows that older people who receive Guided Care, a new form of primary care, use fewer expensive health services compared to older people who receive regular primary care. Research published in the March 2011 edition of Archives of Internal Medicine found that after 20 months of a randomized controlled trial, Guided Care patients experienced, on average, 30 percent fewer home health care episodes, 21 percent fewer hospital readmissions, 16 percent fewer skilled nursing facility days, and 8 percent fewer skilled nursing facility admissions. Only the reduction in home health care episodes was statistically significant.

18 mar 2011--According to the study, Guided Care produced even larger reductions in a subset of patients who received their primary care from one well managed health system. Guided Care patients in Kaiser Permanente of the Mid Atlantic States experienced, on average, 52 percent fewer skilled nursing facility days, 47 percent fewer skilled nursing facility admissions, 49 percent fewer hospital readmissions, and 17 percent fewer emergency department visits; the differences for skilled nursing facility days and admissions were statistically significant.

"These data suggest that Guided Care can reduce avoidable health service use and costs in well managed systems," said lead author Chad Boult, MD, MPH, MBA. "Because they are part of a delivery system in which their health professionals already work as a team, Kaiser Permanente and similarly coordinated systems may be better able to achieve cost savings with a comprehensive, team-based care model such as Guided Care," said Boult. "We would like to further explore which elements of the Kaiser-Permanente culture may have helped Guided Care reduce the use of costly health services."

This multi-site, randomized controlled trial of Guided Care involving 49 physicians, 904 older patients and 319 family members recently concluded in 8 locations in the Baltimore-Washington, D.C. area. The three-year study was funded by a private-public partnership of the John A. Hartford Foundation, the Jacob and Valeria Langeloth Foundation, the Agency for Healthcare Research and Quality, and the National Institute on Aging.

Additional authors of "The Effect of Guided Care Teams of the Use of Health Services: Results from a Cluster-Randomized Controlled Trial" include Lisa Reider, MHS; Bruce Leff, MD; Kevin D. Frick, PhD; Cynthia M. Boyd, MD, MPH; Jennifer Wolff, PhD; Katherine Frey, MPH, RN, MS; Lya Karm, MD; Stephen T. Wegener, PhD; Tracy Mroz, MS, OTR/L; and Daniel O. Scharfstein, ScD.

Previous articles have reported that Guided Care patients and their family caregivers rate the quality of their health care more highly than other patients -- and that Guided Care improves physicians' satisfaction with the chronic care they provide.

Guided Care is a model of proactive, comprehensive health care provided by physician-nurse teams for people with several chronic health conditions. Primary care practices can adopt Guided Care to help become patient-centered medical homes or accountable care organizations. The model is designed to improve quality of care and quality of life, while improving the efficiency of treating the sickest and most complex patients. Guided Care teams consist of a registered nurse, two to five physicians, and the other members of the primary care office staff who work together for the benefit of each patient to:

• Assess the patient and family caregiver at home
  
• Create an evidence-based 'Care Guide' (care plan) and patient-friendly 'Action Plan'
  
• Monitor the patient's conditions monthly
  
• Promote patient self-management
  
• Coordinate the efforts of all the patient's healthcare providers
  
• Smooth the patient's transition between sites of care
  
• Inform and support family caregivers
  
• Facilitate access to community resources

More information: For more information about Guided Care, please visit http://www.GuidedCare.org

Provided by Johns Hopkins University Bloomberg School of Public Health

First successful double-blind trial of gene therapy for advanced Parkinson's disease

A multi-center gene therapy trial for patients with advanced Parkinson’s disease demonstrated reduced symptoms of the progressive movement disorder, according to a new study published in Lancet Neurology.

17 mar 2011--The study was designed to deliver the gene for glumatic acid decarboxylase (GAD) packaged in inert viral vectors into an area of the brain called the subthalamic nucleus. GAD makes an important inhibitory chemical called GABA. The subthalamic nucleus is abnormally activated in Parkinson’s disease and this activity leads to the debilitating movement problems. The idea of the gene therapy is that the billions of AAV-2 GAD viral vectors delivered into the subthalamic nucleus will increase GABA, thereby quieting this brain region.

The lead investigator of the study was Andrew Feigin, MD, associate professor of neurology and molecular medicine at The Feinstein Institute for Medical Research in Manhasset, NY, and the trial was funded by Neurologix, Inc. Early development of the therapy was done Michael Kaplitt, MD, and Matthew During, MD, co-authors of the current study. The study was conducted at seven US medical centers.

A total of 45 patients were enrolled in the study. Roughly half of the patients (23) were randomized into the sham surgery arm of the study, which meant that they had a surgical procedure that did not penetrate the brain, and received infusions of saline under the skin rather than the active GAD-containing viral vectors. A dose-escalation safety study of the gene therapy technique was published in 2007 and paved the way to this expanded double-blind placebo study to test its effectiveness in reducing motor symptoms.

Everyone in the study had a positron emission tomography (PET) brain scan before the surgery to confirm the diagnosis of Parkinson’s disease. Dr. Feigin and his colleagues found that 11 of 56 patients did not actually have Parkinson’s and they were excluded from the study. Everyone was assessed at one month, three months and six months after the genes were infused. Each patient in the active treatment received about a billion viral vectors. It is not clear how long the genes will pump out GAD to make GABA.

The scientists only included patients who got bilateral infusions delivered to the correct area of the brain, the subthalamic nucleus. There were also a few cases where the pumps delivering the treatment (the real and the placebo) malfunctioned during surgery and those cases were taken out of the analysis as well. The final analysis included 16 patients who received active (AAV2-GAD) treatment and 21 who received the sham surgery.

The main outcome measure was a change on a rating scale that assesses motor symptoms. The treated group showed a 23 percent improvement on the United Parkinson’s Disease Rating Scale, compared to a 12 percent improvement in those who received sham surgery. Normally over a six-month period patient scores remain stable or worsen. The 12 percent improvement among the sham treated group suggests a placebo response.

“This is a completely novel treatment for advanced Parkinson’s disease,” said Dr. Feigin. “The treatment was remarkably well tolerated, with mostly only mild adverse events in the AAV2-GAD treated group that were felt to be unrelated to the treatment, and completely resolved,” said Dr. Feigin. He added that other secondary clinical assessments also provided evidence for improvements from the gene therapy.

Provided by North Shore-Long Island Jewish (LIJ) Health System

Factfile: Health risks from radiation

Following is a primer on the health consequences of exposure to radiation:

RADIATION RISK

16 mar 2011--Three things, say experts, determine whether a blast of radiation will be harmless, debilitating or lethal: the intensity of exposure, its duration and access to treatment.

Radioactive fallout includes caesium 137, a long-term element, and iodine, which is a short-term element. Intensity of exposure is measured in a unit called millisieverts (mSv), while the absorbed dose in the body is measured in milligrays.

EXPOSURE

Small, controlled doses of exposure for medical applications cause no ill effects, doctors say. A brain scan, for example, generates 25 mSv, while a whole body scan puts out 150 mSv. A single dose of 1,000 mSv, though, can cause temporary radiation sickness, including nausea and vomiting.

About half of people exposed to a 5,000 mSv dose across the entire body would probably die, while 6,000 mSv would be fatal without immediate treatment.

Exposure to 10,000 mSv in a single dose would lead to death "within a few weeks," according to the World Nuclear Association (WNA), an industry group.

Japanese officials said radiation levels as of 10:20 a.m. (0122 GMT) Tuesday were 30 mSv between the No. 2 and No. 3 reactors, and 400 mSv near No. 3, and 100 mSv near No. 4.

During a severe nuclear accident, exposure can reach several thousand mSv near the reactor core.

RADIATION ILLNESS

The main health danger is cancer, especially leukaemia, along with lung, thyroid and colon cancer.

"The risk is proportional to the dose received," said Patrick Gourmelon, a top researcher at the French Institute for Radioprotection and Nuclear Safety (IRSN).

"Even for relatively small doses, the risk of developing cancers rises."

In cases of extreme irradiation, the body's bone marrow stops making red and white blood vessels, resulting in death. Cells inside the digestive tract are also especially vulnerable.

Over the long term, radiation can also damage DNA, leading to potential birth defects.

TREATMENT OPTIONS

Potassium iodine pills taken beforehand can help prevent radioactive iodine in the air from settling in the thyroid and causing cancer, especially in infants and children.

The tablets are preferably taken an hour before a known fallout incident.

Japanese guidelines say the pills should be distributed when the likely absorbed dose of radioactivity is 100 milligray, a unit named after a British physicist.

Once exposed, the best first step is to throw away contaminated clothes and wash one's hair and body.

Some drugs help boost white-blood cell production inside bone marrow, and build up the body's compromised immunity.

Vitamin D insufficiency high among patients with early Parkinson disease

Patients with a recent onset of Parkinson disease have a high prevalence of vitamin D insufficiency, but vitamin D concentrations do not appear to decline during the progression of the disease, according to a report in the March issue of Archives of Neurology, one of the JAMA/Archives journals.

15 mar 2011--Vitamin D is now considered a hormone that regulates a number of physiological processes. "Vitamin D insufficiency has been associated with a variety of clinical disorders and chronic diseases, including impaired balance, decreased muscle strength, mood and cognitive dysfunction, autoimmune disorders such as multiple sclerosis and diabetes (types 1 and 2), and certain forms of cancer," the authors write as background information in the article. "Vitamin D insufficiency has been reported to be more common in patients with Parkinson disease (PD) than in healthy control subjects, but it is not clear whether having a chronic disease causing reduced mobility contributes to this relatively high prevalence."

Marian L. Evatt, M.D., M.S., of Emory University School of Medicine and the Atlanta Veterans Affairs Medical Center, and colleagues examined the prevalence of vitamin D insufficiency in untreated patients with early PD, diagnosed within five years of entry into the study. They conducted a survey study of vitamin D status in stored blood samples from patients with PD who were enrolled in the placebo group of the Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism (DATATOP) trial.

The authors found a high prevalence of vitamin D insufficiency and deficiency in 157 study participants with early, untreated PD. At the baseline visit, most study participants (69.4 percent) had vitamin D insufficiency and more than a quarter (26.1 percent) had vitamin D deficiency. "At the end point/final visit, these percentages fell to 51.6 percent and 7 percent, respectively."

"Contrary to our expectation that vitamin D levels might decrease over time because of disease-related inactivity and reduced sun exposure, vitamin D levels increased over the study period," the authors write. "These findings are consistent with the possibility that long-term insufficiency is present before the clinical manifestations of PD and may play a role in the pathogenesis of PD."

Vitamin D insufficiency in patients with early PD was similar or higher than the prevalence reported in previous studies.

"We confirm a high prevalence of vitamin D insufficiency in patients with recent onset of PD, during the early clinical stages in which patients do not require symptomatic therapy," the authors conclude. "Furthermore, vitamin D concentrations did not decrease but instead increased slightly over the course of follow-up. This provides evidence that during early PD, vitamin D concentrations do not decrease with disease progression."

More information: Arch Neurol, 2011;68[3]:314-319.

CDC Study Shows Growing Number of Cancer Survivors

If it feels like you know more cancer survivors lately, don't worry about an increase in the dreaded disease. Blame it on a higher survival rate.

14 mar 2011--According to the Centers for Disease Control and Prevention, the number of cancer survivors is rapidly increasing as technology for early detection, public awareness and treatment options improve. The CDCP released a report Friday indicating that a mere 3 million Americans were cancer survivors in 1971; in 2007, the last year for which data is available, that number had increased to 11.7 million. That means there are almost as many cancer survivors in the United States as there are people in Illinois.

Increasing public awareness of cancer symptoms and the campaign to increase cancer screenings has helped to increase the number of survivors as have advances in cancer treatment. The majority of the cancer survivors alive when these numbers were developed had been treated for breast, prostate or colorectal cancers. Those three types of cancers accounted for more than half the survivors.

The report also pointed out that nearly two-thirds of patients diagnosed with cancer had lived at least five years after their diagnosis. The CDCP advised in the report that physicians and other medical professionals should become accustomed to treating cancer survivors and should learn to recognize the special health needs of those patients.

"Public health and health-care professionals should understand the potential long-term needs of cancer survivors, engage in health promotion (e.g., urging cancer screening and smoking cessation), and ensure coordination of follow-up care for this growing population," the report said.

This study excluded patients with in situ cancer and non-melanoma skin cancer in the developing of the statistics. Various types of cancer are considered more treatable than others and several, including breast cancer, are more often screened for, but the study indicates that on the whole, cancer is becoming more survivable.

Elderly Tend to Drive Slower to Make Up for Reaction Time

13 mar 2011-- One reason that elderly people tend to be slower drivers than younger people is because they have a narrower field of vision and have more difficulty seeing pedestrians, according to a new study.

Israeli researchers tested experienced elderly and non-elderly drivers, and compared the differences between them in reaction times and when pedestrians were perceived as hazards.

Driving simulator tests showed that the elderly drivers noticed pedestrians half as often as younger drivers and also took longer to respond to hazardous situations involving pedestrians.

The elderly drivers reduced their driving speed by almost 20 percent in order to give themselves more time to respond to hazards and dangers, said the team at Ben-Gurion University of the Negev.

The study was released online in advance of publication in an upcoming print issue of the journal Accident Analysis and Prevention.

"These findings strengthen the notion that elderly drivers, shown to have a narrower useful field of view, may also be limited in their ability to detect hazards, particularly when outside the center of their view," Tal Oron-Gilad, of the department of industrial engineering, said in a university news release.

She added that "authorities should be aware of these limitations and increase elderly drivers' awareness of pedestrians by posting traffic signs or dedicated lane marks that inform them of potential upcoming hazards."

More information

The U.S. Centers for Disease Control and Prevention

Keys to long life: Longevity study unearths surprising answers

Cheer up. Stop worrying. Don't work so hard. Good advice for a long life? As it turns out, no. In a groundbreaking study of personality as a predictor of longevity, University of California, Riverside researchers found just the opposite.

12 mar 2011--"It's surprising just how often common assumptions – by both scientists and the media – are wrong," said Howard S. Friedman, distinguished professor of psychology who led the 20-year study.

Friedman and Leslie R. Martin , a 1996 UCR alumna (Ph.D.) and staff researchers, have published those findings in "The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study" (Hudson Street Press, March 2011).

Friedman and Martin examined, refined and supplemented data gathered by the late Stanford University psychologist Louis Terman and subsequent researchers on more than 1,500 bright children who were about 10 years old when they were first studied in 1921. "Probably our most amazing finding was that personality characteristics and social relations from childhood can predict one's risk of dying decades later," Friedman concluded.

The Longevity Project, as the study became known, followed the children through their lives, collecting information that included family histories and relationships, teacher and parent ratings of personality, hobbies, pet ownership, job success, education levels, military service and numerous other details.

"When we started, we were frustrated with the state of research about individual differences, stress, health and longevity," Friedman recalled. "It was clear that some people were more prone to disease, took longer to recover, or died sooner, while others of the same age were able to thrive. All sorts of explanations were being proposed – anxiety, lack of exercise, nerve-racking careers, risk-taking, lack of religion, unsociability, disintegrating social groups, pessimism, poor access to medical care, and Type A behavior patterns." But none were well-studied over the long term. That is, none followed people step-by-step throughout their lives.

When Friedman and Martin began their research in 1991, they planned to spend six months examining predictors of health and longevity among the Terman participants.

But the project continued over the next two decades – funded in part by the National Institute on Aging – and the team eventually involved more than 100 graduate and undergraduate students who tracked down death certificates, evaluated interviews, and analyzed tens of thousands of pages of information about the Terman participants through the years.

"We came to a new understanding about happiness and health," said Martin, now a psychology professor at La Sierra University in Riverside. "One of the findings that really astounds people, including us, is that the Longevity Project participants who were the most cheerful and had the best sense of humor as kids lived shorter lives, on average, than those who were less cheerful and joking. It was the most prudent and persistent individuals who stayed healthiest and lived the longest."

Part of the explanation lies in health behaviors – the cheerful, happy-go-lucky kids tended to take more risks with their health across the years, Friedman noted. While an optimistic approach can be helpful in a crisis, "we found that as a general life-orientation, too much of a sense that 'everything will be just fine' can be dangerous because it can lead one to be careless about things that are important to health and long life. Prudence and persistence, however, led to a lot of important benefits for many years. It turns out that happiness is not a root cause of good health. Instead, happiness and health go together because they have common roots."

Many of the UCR findings fly in the face of conventional wisdom. For example:

* Marriage may be good for men's health, but doesn't really matter for women. Steadily married men – those who remained in long-term marriages – were likely to live to age 70 and beyond; fewer than one-third of divorced men were likely to live to 70; and men who never married outlived those who remarried and significantly outlived those who divorced – but they did not live as long as married men.
* Being divorced is much less harmful to women's health. Women who divorced and did not remarry lived nearly as long as those who were steadily married.
* "Don't work too hard, don't stress," doesn't work as advice for good health and long life. Terman subjects who were the most involved and committed to their jobs did the best. Continually productive men and women lived much longer than their more laid-back comrades.
* Starting formal schooling too early – being in first grade before age 6 – is a risk factor for earlier mortality. Having sufficient playtime and being able to relate to classmates is very important for children.
* Playing with pets is not associated with longer life. Pets may sometimes improve well-being, but they are not a substitute for friends.
* Combat veterans are less likely to live long lives, but surprisingly the psychological stress of war itself is not necessarily a major health threat. Rather, it is a cascade of unhealthy patterns that sometimes follows. Those who find meaning in a traumatic experience and are able to reestablish a sense of security about the world are usually the ones who return to a healthy pathway.
* People who feel loved and cared for report a better sense of well-being, but it doesn't help them live longer. The clearest health benefit of social relationships comes from being involved with and helping others. The groups you associate with often determine the type of person you become – healthy or unhealthy.

It's never too late to choose a healthier path, Friedman and Martin said. The first step is to throw away the lists and stop worrying about worrying.

"Some of the minutiae of what people think will help us lead long, healthy lives, such as worrying about the ratio of omega-6 to omega-3 fatty acids in the foods we eat, actually are red herrings, distracting us from the major pathways," Friedman said. "When we recognize the long-term healthy and unhealthy patterns in ourselves, we can begin to maximize the healthy patterns."

"Thinking of making changes as taking 'steps' is a great strategy," Martin advised. "You can't change major things about yourself overnight. But making small changes, and repeating those steps, can eventually create that path to longer life."

Provided by University of California - Riverside

Aging with grace: In-home assessments lead to better care, lower health costs

The March 2011 issue of the journal Heath Affairs highlights an evidence-based model of geriatric care management developed, implemented and tested by researchers and clinicians from Indiana University, the Regenstrief Institute and Wishard Health Services.

11 mar 2011--Geriatric Resources for Assessment and Care of Elders (GRACE) optimizes the health and functional status of community dwelling lower income, older adults. GRACE is now in use by Wishard Health Services, the third-largest safety-net health organization in the United States; by HealthCare Partners Medical Group, a large managed care organization in Southern California and by a growing number of other organizations.

A previous clinical trial found that GRACE improves health and quality of life, decreases emergency department visits and lowers hospital admission rates in lower income older adults at high risk for hospital admission. The care delivery model focuses on the many issues faced by older adults -- access to needed services, medications, mobility, depression, transportation, nutrition, as well as other health issues of aging.

"Healthcare reform is calling out for ways to improve health and lower costs. We have found a strategy to do that for a very vulnerable growing population in a way that shows cost savings over time and has the added benefit of providing services that these seniors desperately need but can't get elsewhere," said Steven R. Counsell, M.D., Mary Elizabeth Mitchell Professor of Geriatrics at the IU School of Medicine, an IU Center for Aging Research center scientist, a geriatrician at Wishard, and an affiliated scientist of the Regenstrief Institute, the principal investigator of the GRACE clinical trial. He is currently leading GRACE dissemination initiatives while working to influence health policy to improve integration of medical and social care for vulnerable elders.

The key to GRACE is two teams. The support team, consisting of a nurse practitioner and a social worker, meet with each patient in the home to conduct an initial comprehensive geriatric assessment from the medicine cabinet to the kitchen cabinet. Based on the support team's findings, a larger interdisciplinary team (including a geriatrician, pharmacist, mental health social worker, and community-based services liaison) helps develop an individualized care plan.

Then the ball is back in the support team's court. The nurse practitioner and the social worker meet with the patient's primary care doctor to come up with a healthcare plan consistent with the patient's goals, such as maintaining the ability to participate in social and religious activities. The support team then works with the patient to implement the plan which contains strategies for medical issues of concern as well as elements related to maintaining quality of life. With the assistance of an electronic medical record and web-based tracking system, the GRACE support team provides ongoing comprehensive care management.

Because it improves health and quality of life, GRACE is cost effective. By the second year GRACE even saves money for the sickest (those with three to four chronic diseases). Results of the GRACE trial were published in the Dec. 12, 2007, issue of the Journal of American Medical Association (JAMA). The cost analysis of the GRACE model was published in the August 2009 issue of the Journal of the American Geriatrics Society.

"The GRACE model improves health and reduces healthcare costs by lowering hospitalization rates in high risk seniors. The GRACE intervention can be financed by a health plan under managed care Medicare using the savings from fewer hospitalizations to offset GRACE program expenses. Most seniors, however, are not enrolled in managed care Medicare plans, and most services provided by the GRACE program are not currently reimbursed by traditional fee-for-service Medicare. Thus, payment reform is needed for broad dissemination of the GRACE model to benefit seniors under traditional Medicare. We are pleased that the newly created U.S. government Center for Medicare and Medicaid Innovation is looking at GRACE and other novel ways of delivering medical care and paying healthcare providers that can improve health and also save money for Medicare and Medicaid," said Dr. Counsell.

Provided by Indiana University School of Medicine

Fast, accurate test for Alzheimer's

Scientists at the National Institute for Health Research’s (NIHR) Biomedical Research Centre for Mental Health at the King’s College London Institute of Psychiatry (IoP) and South London and Maudsley NHS Foundation Trust (SLaM) are the first to use an advanced computer program to accurately detect the early signs of Alzheimer's disease from a routine clinical brain scan. The new scan can return 85 per cent accurate diagnostic results in under 24 hours.

10 mar 2011--The 'Automated MRI' software automatically compares or benchmarks someone’s brain scan image against 1200 others, each showing varying stages of Alzheimer’s disease. This collection of images is thought to be the largest of its kind in the world.

Normally in routine clinical practice, brain scans are used to simply exclude diseases that can mimic Alzheimer’s disease, but here automated MRI software is being used for the first time in a NHS setting (Memory Clinics) to make an early and accurate diagnosis of the illness.

Early diagnosis

Early diagnosis of Alzheimer's is clinically difficult and patients with the early signs are frequently not treated until their symptoms become stronger. The new scan however can return 85 per cent accurate diagnostic results in under 24 hours.

An early diagnosis allows someone to plan their care before the condition worsens - helping to prevent institutionalisation, dramatically improving their quality of life. It is also a cost effective and efficient way to manage and organise treatment of the disease.

The scan has been developed by scientists at the IoP, together with colleagues from the Karolinska Hospital in Stockholm.

The system is being 'field tested' over the next 12 months with patients attending SLaM memory services in Croydon, Lambeth and Southwark. The ‘field test’ will also provide a supply of research grade images, which has important implications for the development of the next generation of drugs for dementia and individualised treatments.

There are 750,000 people with dementia in the UK. The financial cost of dementia to the UK is over £20 billion a year. According to the Alzheimer’s Society, in just 15 years a million people will be living with dementia. This will soar to 1.7 million people by 2051.

Provided by King's College London

Mediterranean diet: A heart-healthy plan for life

The Mediterranean diet has proven beneficial effects not only regarding metabolic syndrome, but also on its individual components including waist circumference, HDL-cholesterol levels, triglycerides levels, blood pressure levels and glucose metabolism, according to a new study published in the March 15, 2011, issue of the Journal of the American College of Cardiology. The study is a meta-analysis, including results of 50 studies on the Mediterranean diet, with an overall studied population of about half a million subjects.

09 mar 2011--"The prevalence of the metabolic syndrome is increasing rapidly throughout the world, in parallel with the increasing incidence of diabetes and obesity, and is now considered a major public health problem," said lead investigator Demosthenes Panagiotakos, Ph.D., associate professor in Biostatistics-Epidemiology of Nutrition, Department of Science of Dietetics - Nutrition, Harokopio University of Athens. "Additionally, the metabolic syndrome is one of the main causes of cardiovascular disease (directly or indirectly), associated with personal and socio-economic burdens. As a result, prevention of this condition is of considerable importance."

The Mediterranean diet is a dietary pattern characterized by high consumption of monounsaturated fatty acids, primarily from olives and olive oils; daily consumption of fruits, vegetables, whole grain cereals, and low-fat dairy products; weekly consumption of fish, poultry, tree nuts, and legumes; a relatively low consumption of red meat; and a moderate daily consumption of alcohol, normally with meals.

The Mediterranean diet, according to Dr. Panagiotakos and Christina-Maria Kastorini, MSc, Ph.D. cand., is one of the best-known and well-studied dietary patterns, which has been shown to be associated with decreased mortality from all causes, lower risk for cardiovascular disease, type 2 diabetes, obesity and some types of cancer. Additionally, it has a beneficial effect on abdominal obesity, lipids levels, glucose metabolism and blood pressure levels, which are also risk factors for the development of cardiovascular disease and diabetes. The antioxidant and anti-inflammatory effects of the Mediterranean diet as a whole, as well as the effects of the individual components of the diet, and especially olive oil, fruits and vegetables, whole grains and fish, also confer to the beneficial role of this pattern.

"To the best of our knowledge, our study is the first work that has systematically assessed, through a large meta-analysis, the role of the Mediterranean diet on metabolic syndrome and its components," he said. "Our results add to the existing knowledge, and further demonstrate the protective role and the significance that lifestyle factors, and mainly dietary habits, have when it comes to the development and progression of the metabolic syndrome."

Encouraging adherence to a healthy dietary pattern like the Mediterranean diet, as well as the adoption of an active lifestyle, seems to be a cornerstone in developing public health strategies for the prevention of the metabolic syndrome, Dr. Panagiotakos suggested. Taking into account the limited financial resources many countries face in the 21st century, better eating seems to be an effective and affordable means for preventing cardiovascular diseases, at the population level, he suggested. In addition to its various health benefits, this dietary pattern can be easily adopted by all populations and various cultures.

Provided by American College of Cardiology

Better than a BMI? New obesity scale proposed

Scientists have developed a new way to measure whether a person is too fat without having people step on the scale.

08 mar 2011--The new measure, called the Body Adiposity Index, or BAI, relies on height and hip measurements, and it is meant to offer a more flexible alternative to body mass index, or BMI, a ratio of height and weight, U.S. researchers said on Thursday.

BMI has been used to measure body fat for the past 200 years, but it is not without flaws, Richard Bergman of the University of Southern California, Los Angeles, and colleagues wrote in the journal Obesity.

While there are other, more complex ways to measure body fat beyond simply stepping on a scale, BMI is widely used both by researchers and doctors.

It is calculated by dividing weight in kilograms by height in meters squared. A person who is 5 feet 5 inches tall is classified as overweight at 150 pounds (68 kg) and obese at 180 pounds (82 kg).

But there is a lot of wiggle room in that calculation.

For example, women and men with the same BMI might have very different levels of extra flab. BMI numbers cannot be generalized across different ethnic groups or used with athletes, who have extra lean body mass.

The team made the index using data from a Mexican-American population study. They confirmed the scale's accuracy using an advanced device called a dual-energy X-ray absorption or DEXA scanner. Tests in a study of African Americans showed similar findings, suggesting BAI can be used across different racial groups.

BAI is a complex ratio of hip circumference to height that can be calculated by doctors or nurses with a computer or calculator.

The team says BAI still needs some fine tuning, and they still need to test it among whites and other ethnic groups, but they think it has promise as new tool, especially in remote settings with limited access to reliable scales.

"After further validation, this measure can be proposed as a useful measure of percent fat, which is very easy to obtain. However, it remains to be seen if the BAI is a more useful predictor of health outcome, in both males and females, than other indexes of body adiposity, including the BMI itself," the team wrote.

Obesity has become a global epidemic, with more than half a billion people, or one in 10 adults worldwide, considered to be obese -- more than double the number in 1980. Obesity-related diseases account for nearly 10 percent of U.S. medical spending, or an estimated $147 billion a year.

Social Activity in Older Adults May Prevent Disability

More socially active elderly are less likely to develop disabilities in basic activities

07 mar 2011-- The more socially active older people are, the less likely they are to become disabled, according to a study published online Feb. 7 in The Journals of Gerontology: Series A.

Bryan D. James, Ph.D., of Rush University Medical Center in Chicago, and colleagues investigated the association of incident disability and social activity among community-dwelling older adults. A total of 954 participants (mean age of 82 years) without clinical dementia, who reported independence in the functional areas assessed, were followed up for an average of 5.1 years. The participants' social activity was evaluated at baseline. An annual evaluation of disability in basic activities of daily living, mobility, and instrumental activities of daily living was carried out. The researchers adjusted for confounders, including depression, vascular disease and risk factors, body mass index, social networks, and self-reported physical activity.

The researchers found that social activity was associated with a decreased risk of incident disability. Each additional unit of social activity was correlated with a 43 percent reduction in the risk of developing a disability in activities of daily living. More socially active individuals were also significantly less likely to develop a disability in mobility (hazard ratio [HR], 0.69) and in instrumental activities of daily living (HR, 0.71).

"This study suggests that more socially active older persons are less likely to become disabled. Future research is needed to determine whether interventions aimed at increasing late-life social activity can play a part in delaying or preventing disability," the authors write.

Human stem cells transformed into key neurons lost in Alzheimer's

Northwestern Medicine researchers for the first time have transformed a human embryonic stem cell into a critical type of neuron that dies early in alzheimer's disease and is a major cause of memory loss.

06 mar 2011--This new ability to reprogram stem cells and grow a limitless supply of the human neurons will enable a rapid wave of drug testing for Alzheimer's disease, allow researchers to study why the neurons die and could potentially lead to transplanting the new neurons into people with Alzheimer's.

The paper is published March 4 in the journal Stem Cells.

These critical neurons, called basal forebrain cholinergic neurons, help the hippocampus retrieve memories in the brain. In early Alzheimer's, the ability to retrieve memories is lost, not the memories themselves. There is a relatively small population of these neurons in the brain, and their loss has a swift and devastating effect on the ability to remember.

"Now that we have learned how to make these cells, we can study them in a tissue culture dish and figure out what we can do to prevent them from dying," said senior study author Jack Kessler, M.D., chair of neurology and the Davee Professor of Stem Cell Biology at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital.

The lead author of the paper is Christopher Bissonnette, a former doctoral student in neurology who labored for six years in Kessler's lab to crack the genetic code of the stem cells to produce the neurons. His research was motivated by his grandfather's death from Alzheimer's.

"This technique to produce the neurons allows for an almost infinite number of these cells to be grown in labs, allowing other scientists the ability to study why this one population of cells selectively dies in Alzheimer's disease," Bissonnette said.

The ability to make the cells also means researchers can quickly test thousands of different drugs to see which ones may keep the cells alive when they are in a challenging environment. This rapid testing technique is called high-throughput screening.

Kessler and Bissonnette demonstrated the newly produced neurons work just like the originals. They transplanted the new neurons into the hippocampus of mice and showed the neurons functioned normally. The neurons produced axons, or connecting fibers, to the hippocampus and pumped out acetylcholine, a chemical needed by the hippocampus to retrieve memories from other parts of the brain.

In new, unpublished research, Northwestern Medicine scientists also have discovered a second novel way to make the neurons. They made human embryonic stem cells (called induced pluripotent stem cells) from human skin cells and then transformed these into the neurons.

Scientists made these stem cells and neurons from skin cells of three groups of people: Alzheimer's patients, healthy patients with no family history of Alzheimer's, and healthy patients with an increased likelihood of developing the disease due to a family history of Alzheimer's because of genetic mutations or unknown reasons.

"This gives us a new way to study diseased human Alzheimer's cells," Kessler said. "These are real people with real disease. That's why it's exciting."

Researcher motivated by his grandfather's Alzheimer's disease

Bissonnette's persistence in the face of often frustrating research was fueled by the childhood memory of watching his grandfather die from Alzheimer's.

"I watched the disease slowly and relentlessly destroy his memory and individuality, and I was powerless to help him," Bissonnette recalled. "That drove me to become a scientist. I wanted to discover new treatments to reverse the damage caused by Alzheimer's disease."

"My goal was to make human stem cells become new healthy replacement cells so that they could one day be transplanted into a patient's brain, helping their memory function again," he said.

Bissonnette had to grow and test millions of cells to figure out how to turn on the exact sequence of genes to transform the stem cell into the cholinergic neuron.

"A stem cell has the potential to become virtually any cell in the body, from a heart cell to a layer of skin," he explained. "Its development is caused by a cascade of things that slowly bump it into a final cell type."

But it wasn't enough just to develop the neurons. Bissonnette then had to learn how to stabilize them so they lived for at least 20 days in order to prove they were the correct cells.

"Since this was brand new research, people didn't know what kind of tissue culture mature human neurons would like to live in," he said. "Once we figured it out, they could live indefinitely."

Provided by Northwestern University

Study: 50-year-old with diabetes dies 6 yrs sooner


A 50-year-old with diabetes dies six years sooner than someone without the disease, and not just from a heart attack or a stroke, new research suggests.

05 mar 2011--The large international effort to measure diabetes' toll found the disease also raises the risk of dying prematurely from a host of other ailments, even breast cancer and pneumonia.

"It's quite a wide sweep of conditions," said Dr. John Danesh of Cambridge University in Britain, who led the team of researchers. While most people think of heart problems, diabetes surprisingly "appears to be associated with a much broader range of health implications than previously suspected."

Putting the six years lost in context, he said, long-term smoking shortens life by 10 years.

The analysis used pooled medical information for 820,900 people from nearly 100 studies done mostly in Europe and North America. The results are published in Thursday's New England Journal of Medicine.

Diabetes, the seventh leading cause of death in the U.S., affects about 26 million Americans, or 8 percent, including 7 million who haven't been diagnosed. Most in the study were thought to have the most common kind - Type 2 - which occurs when the body makes too little insulin or cannot use what it does make to regulate blood sugar.

High blood sugar can damage nerves and blood vessels, and is a major cause of heart disease.

The new research didn't include those who had heart disease when they were first enrolled. Participants were followed on average for 13 1/2 years, and there more than 123,000 deaths. Overall, death rates from various causes were higher for those with diabetes than those without.

The researchers took into account other risk factors that could influence the results: age, gender, smoking and weight. Type 2 diabetes is tied to obesity. They found that those with diabetes had double the risk of dying from a heart attack or stroke, compared to those without the disorder. But they also found that diabetics had a 25 percent higher risk of dying from cancer and were more likely to die from a variety of illnesses including infections, lung and kidney disease as well as falls.


Exactly how diabetes raises those risks isn't clear, but in the case of infections, it could be that diabetes weakens the immune system, the researchers said. Diabetes can cause vision problems and loss of feeling in the legs, which may be the reason for falls, they said.

Danesh said one intriguing finding was a higher risk of suicide in those with diabetes. Other research has linked diabetes with depression, he noted.

The results are "another reason to try to normalize blood glucose in people who have diabetes," through diet, exercise and medication, said Dr. Alvin Powers, a diabetes specialist at Vanderbilt University. "There have been smaller studies that hinted at this but nothing where a study of this size looked at so many different outcomes."

Danesh and his colleagues also estimated diabetes' effect on life expectancy. They calculated that a 50-year-old diabetic without heart disease dies about six years earlier than someone without the disease, with 40 percent of the difference due to cancer and conditions other than heart disease.

"It underscores the need to prevent diabetes," Danesh said.

Previous studies have shown a possible link between diabetes and cancer. The new paper tied some, but not all, cancers; the increased risk ranged from 25 percent for breast cancer to double for liver cancer. Danesh said people with diabetes should get age-appropriate cancer screenings.

Last year, a joint report from the American Diabetes Association and the American Cancer Society looked at the issue and said that it wasn't clear whether any connection was direct, indirect or perhaps because the two disorders share common risk factors, like obesity.

The new research squares with that report's conclusion that "there's a lot more we need to understand about diabetes and the link to cancer," said one of the authors, Dr. Richard Bergenstal of the International Diabetes Center at Park Nicollet in Minneapolis. He a former president of the diabetes group.

While adding to the evidence, the study doesn't answer the question of why, he said.

"Diabetes is a serious condition. We often don't quite think about it quite that way," Bergenstal said.

More information:
Diabetes information: http://www.diabetes.org and http://diabetes.niddk.nih.gov/

New England Journal of Medicine: http://www.nejm.org