Rebranding exercise: 'Quality of life' a better motivator than 'Live longer'

A new University of Michigan study finds that the most convincing exercise message emphasizes immediate benefits that enhance daily quality of life.

30 oct 2011--Health care, business and public health have presumed that promoting health and longevity benefits from exercise will motivate people to exercise. The new findings, however, indicate that these individuals exercised less than those who aimed to enhance the quality of their daily lives.

"The study showed that what an individual espouses as important does not necessarily translate into behavior," said Michelle Segar, research investigator for the U-M Institute for Research on Women and Gender. "While people say they value health and healthy aging, those distant benefits don't make exercise compelling enough to fit into their busy lives."

These findings challenge the current convention of promoting exercise for better health, longevity, or as medicine.

"Promoting exercise for health is logical, but people's daily decisions are more often connected to emotion than logic," Segar said. "A more effective 'hook' is to rebrand exercise to emphasize the immediate benefits that enrich daily living, such as stress reduction and increased vitality."

Individuals may also appreciate the subsequent benefits that make exercise more personally meaningful, such as being a patient parent, enjoying life, being creative and having focus at work, she says.

"By shifting our model from medicine to marketing, we can improve how we 'sell' exercise to the public by using principles like branding," Segar said.

For example, messages about immediate rewards from exercise that make life more enjoyable, such as "move more, get energy," may better motivate busy individuals than promotions focused on achieving distant and abstract benefits, such as "move more, get healthy."

Segar studied responses from 226 women between the ages of 40 to 60 who worked full time. They completed three surveys during a one-year period. Respondents were asked about their exercise goals and participation, how much they valued their goals, body mass index (BMI) and social support. This study supports other research showing that the reasons why individuals initiate exercise influence their motivation and behavioral sustainability.

Segar recommends four steps to rebrand exercise and to improve engagement and participation:

• Assess the specific exercise benefits your organization has been promoting.

• Evaluate the effectiveness of these motives to engage and motivate ongoing participation.

• Ask your target population what values and experiences they most care about achieving in their daily life that exercise benefits would impact, such as reduced stress and improved mood.

• Develop new messaging that addresses these valued end points.

Caroline Richardson, an associate professor of family medicine at U-M and research scientist at the VA Ann Arbor Healthcare System, and Jacquelynne Eccles, a professor of psychology and education, co-authored the study.

More information: The findings appear in the latest issue of The International Journal of Behavioral Nutrition and Physical Activity.

Provided by University of Michigan

Dementia patients face burdensome transitions in last 90 days

A new study in the Sept. 29, 2011, edition of the New England Journal of Medicine reports that nearly one in five nursing home residents with advanced dementia experiences burdensome transitions in the last 90 days of life, such as moving to a different facility in the last three days of life or repeat hospitalizations for expected complications of dementia in the last 90 days of life.

29 sept 2011--"Such patterns of transitions are burdensome, particularly since the overwhelming majority of family members state the main goal of care is comfort," said study co-author Joan Teno, professor of health policy and practice at the Warren Alpert Medical School of Brown University and a palliative care physician. "These transitions reflect the inefficiency of our health care system. Similar outcomes could be achieved by keeping these patients in the nursing home setting."

An important reason for the prevalence of burdensome transitions might be embedded in the way Medicare pays nursing homes, said Brown health economist and lead author Pedro Gozalo. Nursing homes can earn higher payments for patients who have been transferred to a hospital for three days and they may qualify for skilled nursing services paid by Medicare rather than Medicaid upon their return. The current incentives under Medicare and Medicaid encourage nursing homes to send patients to the hospital, he said.

What makes the transitions burdensome, especially for patients with cognitive impairment, Teno said, is that they are often unnecessary, raise the risk of medical errors, and interrupt continuity of care for patients who can experience significant stress and disorientation when they are suddenly removed from familiar surroundings and people. When the patients become upset, their families experience more stress.

Because these financial incentives, market conditions, and the culture of end-of-life care vary by state, so do the rates of burdensome transitions. The authors, who also include researchers from Harvard University and Dartmouth College, found that the overall percentage of patients experiencing at least one burdensome transition was 19 percent. State-level rates varied from 2.1 percent in Alaska to 37.5 percent in Louisiana.

"These burdensome transitions are not only bad for the patient, they also drain the federal treasury, hastening the day when the Medicare trust fund runs out of money," said economist Jonathan Skinner from Dartmouth College, a co-author on the study.

A state-by-state report of the rate of burdensome transitions is available from Brown University at www.LTCFocUS.org.

Blacks and Hispanics were also more likely than whites to experience burdensome transitions, the authors found.

Amiss before dying

To reach these conclusions, the team analyzed federal databases of nursing home and Medicare records accumulated between 2000 and 2007. In all, they found 474,829 patients who were older than 66, had advanced cognitive impairment, and lived in a nursing home 120 days before their death. Of these, 90,228 residents experienced at least one burdensome transition, defined as either a transfer in the last three days of life, returning to a different nursing home than the one they lived in before they went to the hospital, or multiple hospitalizations in the last 90 days of life.

Often these hospitalizations occur even though the condition prompting the hospitalization — pneumonia, urinary tract infection, or dehydration — could easily be treated in a properly equipped and staffed nursing home.

These variations were particularly wide across different geographic areas. In McAllen, Texas, 25.8 percent of patients had multiple hospitalizations for urinary tract infections, pneumonia or dehydration, compared to only 1.1 percent of patients in Grand Junction, Colo.

The regional rate of burdensome transitions also correlates with other indicators of poor end-of-life care, Gozalo noted. Compared to patients living in the health care markets with the lowest rates of burdensome transitions, those who lived in the regions with the highest rates were three times more likely to have a feeding tube inserted, more than twice as likely to be in the intensive care unit in the last 30 days of life, and more than twice as likely to have developed an advanced pressure ulcer.

Ultimately, Teno said, all of these problems are signs of care gone awry. The best care for a patient with advanced cognitive impairment near the end of life is often to maximize comfort. The burdens of hospitalization usually outweigh the benefits.

"Our research calls for efforts to reform health care payment that create incentives to improve advance care planning and care coordination," Gozalo said. "Current reform efforts like accountable care organizations that bundle both the hospital and post-acute care payments could begin to address some of these perverse incentives. We need financial incentives to make sure that people are getting the right care in the right place at the right time."

Provided by Brown University

Women who break a hip at increased risk of dying within a year

Women ages 65-69 who break a hip are five times more likely to die within a year than women of the same age who don't break a hip, according to a Kaiser Permanente Center for Health Research study funded by the National Institutes of Health and published online today in the Archives of Internal Medicine.

27 sept 2011--This paper breaks down death risk by age group. In addition to the finding for women ages 65-69, it finds that for women ages 70-79, a hip fracture doubles the risk of dying within a year. Most women 80 and older have the same risk of dying within a year whether they fracture their hip or not, but for women 80 and older who are in excellent health, a hip fracture nearly triples the risk of dying within a year.

"This study is a wake-up call that the first year after a hip fracture is a critical time for all elderly women, but especially for younger women, ages 65-69, who face a much higher death rate compared to their peers," said Erin S. LeBlanc, MD, MPH, lead author and investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "We need to do more to prevent hip fractures from occurring, and we need to study how best to care for women after fracture to prevent these deaths."

Other studies have found that women who break a hip are at higher risk for earlier death, but most of those studies concluded that the increased risk was not because of the fracture, but because of underlying health conditions such as heart disease, stroke, or diabetes. This study controlled for these underlying health conditions and also matched each woman who broke her hip with four women of the same age who didn't break a hip.

"Our study suggests that it is the hip fracture, and not just poor health, that puts these women at higher risk of dying," said Teresa Hillier, MD, MS, co-author and senior investigator at the Kaiser Permanente Center for Health Research. "We also found women are at the highest risk of dying within the first three months after hip fracture, which leads us to hypothesize that hospitalization, surgery and immobility lead to other complications that ultimately result in their death."

Another reason researchers think that hip fractures, and not other underlying health conditions, put women at higher risk of death is their finding involving women aged 80 and older. These women are often sicker to begin with and most of them face the same risk of dying within a year whether they break their hip or not. But when researchers looked at a subset of women who were 80 and older and were also in excellent health, they found that those who fractured a hip were almost three times more likely to die compared to their counterparts who didn't break a hip.

"This finding suggests that it is the hip fracture itself that ultimately leads to death in these women. Even though they start out in excellent health the hip fracture is so devastating that many of them don't recover," said LeBlanc.

The study is part of the Study of Osteoporotic Fractures that has been ongoing for more than two decades. During 1986-88 SOF enrolled nearly 10,000 community-dwelling, ambulatory women ages 65 and older from Baltimore; Minneapolis; Portland, Ore.; and the Monongahela Valley near Pittsburgh.

Over the next 20 years, 1,116 of those women suffered hip fractures. Researchers categorized the women by age and then matched 4,464 women of the same age who didn't break a hip to serve as controls. They followed all of the women, sending out postcards every four months to check on their health status, and asking them to come in for clinic visits every 2 to 3 years. During the visits women were given a medical exam and asked to fill out questionnaires about their health status. Cause of death was determined by death certificates and other supporting documentation where available. The leading causes of death among all women in the study were heart disease, cancer and stroke.

Among women who broke a hip, more than half of the short-term deaths occurred within three months after the fracture and nearly three-quarters occurred within six months. The only women who had a higher long-term risk of death (within 10 years) after hip fracture were the women ages 65-69.

According to the National Osteoporosis Foundation, about half of women over age 50 will break a bone because of osteoporosis, which is a thinning or weakening of the bone that can cause bones to break more easily. The foundation recommends that women 65 and older, and pre-menopausal women with risk factors such as low body weight, smoking or long-term steroid use, should get a bone density scan to determine if they have or are at risk for developing osteoporosis. Once diagnosed, many women start taking medication to strengthen their bones and decrease the risk of fracture.

Other tips to prevent hip fractures include:

• Ensure adequate calcium and vitamin D intake
• Do weight-bearing and balancing exercises
• Avoid cigarette smoking
• Have a home assessment to make sure your home is fall proof

Provided by Kaiser Permanente

Insulin may slow Alzheimer's, study finds

Inhaling a concentrated cloud of insulin through the nose twice a day appears to slow - and in some cases reverse - symptoms of memory loss in people with early signs of Alzheimer's disease, a new pilot study has found.

26 sept 2011--The study involved only 104 people and is considered very preliminary. But it suggests that a safe, simple and cheap measure that boosts flagging metabolism in key areas of the brain could hold off or possibly derail the progression of the devastating neurological disorder in its early stages. The results were published online Monday by the journal Archives of Neurology.

Insulin is a metabolic hormone best known for its role in treating diabetes, a condition in which the hormone is either insufficiently produced or poorly used by the body's organs. But in recent years, studies have found that people with diabetes and prediabetes are at heightened risk of developing Alzheimer's, and autopsies have shown that diabetics whose condition was tightly managed had fewer of the brain tangles and plaques that are the hallmark of disease. Studies involving animals have suggested that insulin deficiency in the brain may be a key factor in the progression of Alzheimer's.

Researchers from the Veterans Affairs' Puget Sound Health Care System in Washington state decided to test insulin on people without diabetes who had been diagnosed with mild to moderate Alzheimer's or amnestic mild cognitive impairment, a disorder characterized by increased forgetfulness that often progresses to dementia. Study participants were divided into three groups: 36 of them inhaled 20 milligrams of insulin twice a day for four months, 38 got 40 mg twice a day, and 30 were given a saline solution.

After two months of treatment, those treated with 20 mg of insulin had improved performance on a memory test. The gains persisted after four months of treatment and were still evident two months after the insulin treatment stopped.

Patients who got the higher dose of insulin had no change in their memory abilities, while those who got the placebo saw a decline. The differences between those on insulin and those on the placebo were "small in absolute terms," the authors wrote. But they were robust enough that by generally accepted research standards, they are unlikely to have been the result of chance.

Subjects taking either dose of insulin were rated by their caregivers as holding steady in their overall social, mental and everyday functioning, while those on the sham medication were rated as having declined. And on physician-administered tests of cognitive function, subjects taking insulin showed less decline than those on the placebo.

In a subset of subjects who underwent additional measurements, researchers found that there were fewer amyloid plaque deposits, protein tangles and other physiological hallmarks of Alzheimer's in those whose memory improved most on the insulin treatment compared with those who had weak responses or were on the placebo.

But the persistence of insulin's effect was a mixed picture. Two months after the insulin treatments stopped, caregivers of subjects in all three groups noted similar declines in their overall daily function.

Dr. Jacobo Mintzer, an Alzheimer's expert at the Medical University of South Carolina in Charleston who was not involved in the study, hailed the research as "a new way of thinking" about treating dementia.

"As a clinician, I would not tell my patients to get their hopes up," he said. "But as a scientist, I always get very encouraged when the paradigm shifts," as he said it has here.

An estimated 5.4 million Americans are believed to have Alzheimer's, according to the Alzheimer's Association. Scientists acknowledge that while they can diagnose the disease earlier and offer medications to temporarily slow the progression of symptoms, they have been stymied in their search for ways to prevent, halt or reverse it.

It will take a larger study involving more patients over a longer time to figure out whether nasally administered insulin merely slows the march of Alzheimer's or thwarts it, said Laurie Ryan, a neuropsychologist who directs clinical trials involving dementia at the National Institute on Aging, which funded the pilot study.

In the meantime, she said, intranasal insulin has two things going for it: Insulin is already in wide use at relatively low cost, and the nasal inhaler allows it to be delivered directly and safely to the brain. That minimizes the risk of the hormone affecting blood sugar levels elsewhere in the body, which could be dangerous to kidneys, eyes and blood vessels.

"A safe, easy delivery system - those are things we'd love to see for any kind of treatment for Alzheimer disease," she said.

Older adults make smarter decisions that lead to long-term gains, study shows

Many people believe getting older means losing a mental edge, leading to poor decision-making, but a new study from psychologists at The University of Texas at Austin and Texas A&M University suggests older adults are far better at making choices that lead to long-term gain.

25 sept 2011--The study, co-authored by University of Texas at Austin psychologist Todd Maddox, found older adults, at least 60 years old, are better at strategizing their decisions than those in their late teens and early 20s, who tend to focus on instant gratification.

Findings from the study, led by Darrell Worthy, professor of psychology at Texas A&M University, will be published in Psychological Science. 
Collaborators on the study include University of Texas psychologists David Schnyer, Jennifer Pacheco and Marissa Gorlick.

Contradicting negative stereotypes of age and reasoning ability, the results show that the wisdom that comes with age can allow people to make better decisions under some conditions. Maddox says the study gives insight into the decision-making process, which will help researchers learn more about the effects of aging in the brain.

"Broadly, these results suggest that younger adults may behave more impulsively, favoring immediate gains, while older adults are better at considering the long-term ramifications of their actions," Maddox says.

As part of the study, 28 older adults and 28 younger counterparts performed decision-making tasks, in which they only needed to consider immediate rewards to earn points. In this experiment, the younger adults were more efficient at selecting the options that yielded the best short-term rewards.

However, in a second experiment, the older participants outperformed the younger group in choosing options that resulted in long-term gains, such as strategically storing the most amount of oxygen in "oxygen accumulators" on an imaginary space mission in Mars. In this portion of the study, 52 older adults (ages 67-82) and 51 younger adults (ages 20-26) performed decision-making tasks in which the choices they made influenced future rewards.

As part of the experiment, the researchers created a test with two oxygen extraction systems on Mars. The rewards depended on the respondents' previous choices. The respondents had to choose from two options: the "increasing option," which increased rewards in future trials, and the "decreasing option," which decreased future rewards but offered a larger immediate reward. In each permutation of the experiment, the older participants outperformed the younger group by figuring out which option led to the most long-term cumulative rewards.

"We found that younger adults performed equivalently in the experiment, but older adults were more adept at adjusting their strategy to fit the goals of the task," Maddox says.

The researchers suggest these results provide insight into how people use their brains as they age. When making choices, younger people use the ventral striatum, a region of the brain associated with habit formation and immediate rewards. As this declines with age, the psychologists theorize that people compensate by using their prefrontal cortex, an area of the brain that controls rational and deliberate thoughts.

To test this theory, Maddox and his team of researchers are conducting a neuroimaging study to determine which parts of the brain respond to immediate gratification and long-term rewards while the participants engage in decision-making tasks. Collaborators on this study include Worthy, Jeannette Mumford, psychology research assistant at The University of Texas at Austin, and Russell Poldrack, professor of psychology and neurobiology and director of the Imaging Research Center at The University of Texas at Austin.

Provided by University of Texas at Austin

Alzheimer's disease: The first prevention study of its kind

Researchers at the Douglas Mental Health University Institute, in Montreal, Quebec, are about to launch the first epidemiological study on the prevention of Alzheimer's disease.

24 sept 2011--"As far as we know, this is the first study of its kind to be carried out anywhere in the world," states John Breitner, the study's lead investigator and Director of the new Centre for Studies on Prevention of Alzheimer's Disease (StoP-Alzheimer). Dr John Breitner and Dr Judes Poirier, the Centre's Associate Director, will be recruiting 250 healthy adults aged 60 or over, who have (or had) a parent, brother or sister with Alzheimer's disease, in order to learn which methods are most effective at preventing this neurodegenerative condition.

Using a combined diagnostic approach of brain imaging and cerebrospinal fluid analysis, the researchers will observe their subjects' biomarkers for a period of ten years to find out which preventative agents can stop the disease from developing, long before symptoms appear. The preventative agents involved—five in all—have already shown promising results in previous studies. They are anti-inflammatory medications, insulin, physical activity, the Mediterranean diet, and drugs stimulating the production of a protein connected to the apoE gene.

The future of Alzheimer's research

For more than a decade, research into the treatment of Alzheimer's disease, whether pharmacological or other, has not produced the desired results. To date, only some symptoms relating to cognitive decline or memory loss can be treated. Observations by scientists suggest that the focus should shift to prevention and that money should be invested in major studies into this aspect of the disease. "Alzheimer's is a public health crisis that could take on catastrophic proportions in the coming years. It is imperative that we find the prevention strategies that are most likely to succeed," stresses Dr Poirier.

Centre for Studies on Prevention of Alzheimer's Disease

Supported financially by McGill University and the professorial chair funded by pharmaceutical giant Pfizer, the Centre for Studies on Prevention of Alzheimer's Disease, based at the Douglas Institute, is committed to finding ways to stop the disease's progress long before any symptoms are noticed. The Centre will be able to draw on the findings of more than twenty scientists already studying brain aging. This new study by Dr Breitner and Dr Poirier is the first in a series that will be developed at the Centre.

"What we will be doing is similar to the work done on preventing heart disease, that is, to intervene before the damage is done," explains Dr Poirier.

The impact of disease prevention

Preventing the disease from manifesting itself, even if only for a few years, would have a huge impact on future generations, on families, on society, and on the health care system as a whole.

• Postponing the disease's symptoms for two years represents 30% fewer cases for the current generation.

• Push the symptoms back by five years, and the number of cases is cut by half within one generation. It's a crisis situation. Every year, the costs attributable to Alzheimer's disease are estimated to be between $6 billion and $8 billion in Canada alone.

• Half a million Canadians suffer from Alzheimer's or a related dementia—71,000 of those are under 75 years of age (Alzheimer's Society of Montreal).

• A person who has a parent with Alzheimer's is two to three times more likely to develop the disease.

Provided by Douglas Mental Health University Institute

Opioids linked to higher risk of pneumonia in older adults

Opioids -- a class of medicines commonly given for pain -- were associated with a higher risk of pneumonia in a study of 3,061 adults, aged 65 to 94, e-published in advance of publication in the Journal of the American Geriatrics Society. The study from researchers at Group Health Research Institute and the University of Washington (UW) also found that benzodiazepines, which are drugs generally given for insomnia and anxiety, did not affect pneumonia risk.

23 sept 2011--"Pneumonia is a common infection that can have serious consequences in older adults," said study leader Sascha Dublin, MD, Ph.D, a Group Health Research Institute assistant investigator and Group Health primary care physician.

"Opioids and benzodiazepines work in different ways, but both can decrease the breathing rate. Both are also sedatives, which can increase the risk of aspiration." Aspiration is inhaling material (including saliva or food particles) from the mouth into the lungs, which can lead to pneumonia.

A 2009 study estimated that two million Americans age 65 and older received long-term opioid treatment for non-cancer pain. Prescription opioid use has been on the rise in the United States. In earlier Group Health research, the use of chronic opioid therapy for chronic non-cancer pain doubled in the prior decade. And a 1998 report found that one in 10 older Americans used benzodiazepines.

"In animal studies, some opioids -- including morphine, codeine, and fentanyl -- harm the immune system, which also might contribute to pneumonia," said Dr. Dublin. She and her research team hypothesized that risk of pneumonia would be higher in people using opioids or benzodiazepines than in people not using these medications, and would be highest for opioids that suppress the immune system. Study subjects were members of Group Health Cooperative, a nonprofit health care system with extensive computerized pharmacy, laboratory, and medical records that were used in the analysis.

Dublin and colleagues conducted a "case-control study," matching patients who had pneumonia during the study period of 2000 to 2003 ("cases") with similar patients who did not have pneumonia ("controls"). All were living in the community, not hospitalized or in nursing homes, and the researchers excluded people whose immune systems were suppressed.

The researchers measured whether people with pneumonia were more likely than controls to have taken opioids or benzodiazepines before the start of their illness. Among pneumonia cases, 13.9 percent were using opioids and 8.4 percent were using benzodiazepines. In subjects without pneumonia, 8.0 percent were using opioids and 4.6 percent were using benzodiazepines.

Statistical analysis by the researchers showed that:

• Patients taking long-acting opioids such as sustained-release morphine were more than three times as likely to get pneumonia as were those not taking opioids.
• Recently starting use was a risk factor: During their first 14 days of use, patients who took opioids were more than three times as likely to get pneumonia as were those not taking opioids.
• Patients using immunosuppressing opioids were nearly 1.9 times as likely to get pneumonia as were those not using opioids.
• Use of opioids for a longer time period, defined as three months or more before getting pneumonia, was not associated with infection.
• Taking benzodiazepines did not affect the risk of getting pneumonia.

This was the first large epidemiological study to look at how opioid use affects the risk of getting pneumonia in a general population. It lays the foundation for research on additional questions about the safety of opioid drugs in older Americans.

"Benzodiazepines don't seem to be associated with increased risk of pneumonia," said Dr. Dublin. "But our results mean that it is crucial to look more closely at opioid prescriptions and infections."

Provided by Group Health Research Institute

YouTube videos can inaccurately depict Parkinson's disease and other movement disorders

Looking online for medical information? Viewers beware, doctors caution. After reviewing the most frequently watched YouTube videos about movement disorders, a group of neurologists found that the people in the videos often do not have a movement disorder. As described in a Letter to the Editor in this week's New England Journal of Medicine, such medical misinformation may confuse patients suffering from devastating neurological disorders and seeking health information and advice online.

22 sept 2011--Many people use the Internet as a primary resource for medical information, and YouTube, the third most visited website on the Internet, is a popular platform for patients to share personal medical stories and experiences on video.

Dozens of YouTube videos show people who believe they have movement disorders such as Parkinson's disease demonstrating and talking about their symptoms. In January 2011, neurologists at University College London began a study when patients alerted them that online videos often proposed a diagnosis and suggested therapies.

Seven neurologists from different countries and medical institutions searched YouTube using six keywords: "dystonia," "Parkinsonism," "chorea," "myoclonus," "tics" and "tremor", and found videos allegedly depicting various movement disorders. They then independently reviewed the top three percent most-watched videos that were of sufficient quality to review patient symptoms. Out of 29 videos, the majority (66 percent) were identified as showing "psychogenic" movement disorders, meaning that the abnormal movement originates from a psychological condition or mental state rather than a disease with a physical cause, such as Parkinson's. Of these videos, more than half contained advice about specific therapies to treat the movement disorder. Furthermore, the doctors reviewing the videos did so independently, yet their diagnoses agreed in 87 to 100 percent of all cases.

"Patients and doctors have to be very thoughtful and careful when looking for information on YouTube, as well as the Internet in general," commented Mark Hallett, M.D., senior investigator at the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health. "There is a great deal of good information on the Internet, but one has to be careful."

More information: "Movement Disorders on YouTube — Caveat Spectator." New England Journal of Medicine, published online September 22, 2011, Volume 365, No. 12, pages 1160-1161

Accurate information on movement disorders can be found at http://www.ninds.n … _disease.htm

Provided by National Institutes of Health

Diabetes may significantly increase your risk of dementia

People with diabetes appear to be at a significantly increased risk of developing dementia, according to a study published in the September 20, 2011, print issue of Neurology, the medical journal of the American Academy of Neurology.

21 sept 2011--"Our findings emphasize the need to consider diabetes as a potential risk factor for dementia," said study author Yutaka Kiyohara, MD, PhD, of Kyushu University in Fukuoka, Japan. "Diabetes is a common disorder, and the number of people with it has been growing in recent years all over the world. Controlling diabetes is now more important than ever."

People with diabetes were more likely to develop Alzheimer's disease and other types of dementia, such as vascular dementia, which occurs when there is damage to blood vessels that eventually deprive the brain of oxygen.

For the study, a total of 1,017 people who were age 60 and older were given a glucose (sugar) tolerance test after an overnight fast to determine if they had diabetes. Study participants were monitored for an average of 11 years and then tested for dementia. During the study, 232 people developed dementia.

The study found that people with diabetes were twice as likely to develop dementia as people with normal blood sugar levels. Of the 150 people with diabetes, 41 developed dementia, compared to 115 of the 559 people without diabetes who developed dementia.

The results remained the same after the researchers accounted for factors such as high blood pressure, high cholesterol and smoking. The risk of dementia was also higher in people who did not have diabetes, but had impaired glucose tolerance, or were "pre-diabetes."

In addition, the study found the risk of developing dementia significantly increased when blood sugar was still high two hours after a meal.

Provided by American Academy of Neurology

Chronic disease to cost $47 trillion by 2030: WEF

LONDON, 20 sept 2011- The global economic impact of the five leading chronic diseases - cancer, diabetes, mental illness, heart disease, and respiratory disease - could reach $47 trillion over the next 20 years, according to a study by the World Economic Forum (WEF).

The estimated cumulative output loss caused by the illnesses, which together already kill more than 36 million people a year and are predicted to kill tens of millions more in future, represents around 4% of annual global GDP over the coming two decades, the study said.

"This is not a health issue, this is an economic issue - it touches on all sectors of society," Eva Jane-Llopis, WEF's head of chronic disease and wellness, said in a telephone interview.

The research was published on Sunday, the eve of a two-day United Nations meeting on chronic, or non-communicable diseases (NCDs), which aims to draw up global action plans to tackle growing levels of death and illness from these costly diseases often linked to diet, tobacco, alcohol and exercise.

According to the World Health Organization (WHO), the worldwide NCD epidemic is expected to accelerate so that by 2030 the number of deaths from NCDs could reach 52 million a year.

While often thought of as diseases of the rich world - often linked to living on fatty, sugary foods, little exercise and too much alcohol and tobacco - NCDs now disproportionately affect those in poorer nations. More than 80% of NCD deaths are among people in low and middle income countries.

The WEF study, which was conducted with Harvard School of Public Health, found the cumulative costs of heart diseases, chronic respiratory diseases, cancer and diabetes in these poorer countries are expected to top $7 trillion in 2011-2025, an average of nearly $500 billion a year.

Mental health, which is typically left off lists of leading NCDs, will account for $16 trillion - a third of the overall $47 trillion anticipated costs.

BANKRUPT HEALTH SYSTEMS

Olivier Raynaud, the WEF's senior director of health, said the study showed how families, countries and economies are losing people in their most productive years.

"Until now, we've been unable to put a figure on what the World Health Organization calls the 'world's biggest killers'," he said in a statement. But these numbers suggest NCDs "have the potential to not only bankrupt health systems but to also put a brake on the global economy," he added.

The U.N. meeting is the only second-ever such high-level meeting to be held on a threat to global health and has been billed as a "once in a generation" opportunity to tackle the predicted wave of these diseases.

But health organizations fear big consumer firms selling processed foods, alcohol and cigarettes could hijack the meeting to protect their own interests and persuade governments away from setting targets or making firm commitments.

The WEF study used three modeling methods to calculate the costs of NCDs - the WHO's EPIC model, the Value of Statistical Life (VSL) approach and the Cost-Of-Illness (COI) approach.

It found mental illness and heart diseases alone account for almost 70% of lost output.

In 2010, the global direct and indirect cost of heart diseases - which currently kill more than 17 million people a year - was around $863 billion and is estimated to rise 22% to $1,044 billion by 2030.

Overall, the cost for heart diseases could be as high as $20 trillion over the 20 year period, it said.

"Think of what could be achieved if these resources were productively invested in an area like education," WEF's executive chairman Klaus Schwab said. "The need for immediate action is critical to the future of the global economy."

SOURCE: http://bit.ly/ra9ZZA World Economic Forum report

The prevention of lifestyle diseases has finally reached the top table of the United Nations

The European Society of Cardiology, through the European Chronic Disease Alliance (ECDA), has urged European heads of chronic non-communicable diseases state "to show leadership" and long-term commitment to the prevention of at today's "high level meeting" of the UN General Assembly in New York.

19 sept 2011--This will be the first time ever that the UN has sought "action-orientated" commitments from governments and international organisations on the prevention and control of lifestyle-related diseases, and only the second time - following its declaration on HIV/AIDS in 2001 - that a health issue has attracted such high governmental attention. Measures to prevent non-communicable diseases, says the UN, have the potential to save "millions of lives" and "untold suffering".

The draft declaration on which the General Assembly will begin discussion today was made public on 9th September. It will make concrete commitments on access to effective medicines, the control of tobacco, the elimination of industrially produced trans-fats in foods, and the implementation of measures to reduce consumption of dietary salt, sugars and saturated fats and increase levels of physical activity in all populations.

Agreement on all of these measures, says ESC spokesman Simon Capewell, Professor of Clinical Epidemiology at the University of Liverpool, UK, would be a major step forward in the prevention of cardiovascular and other non-communicable diseases. "Indeed," he notes, "the fact that they are even being discussed by the UN and endorsed by heads of state will give the whole question of prevention the importance it deserves. So far, although there has been great progress in some countries and in some areas of prevention, the global burden imposed by non-communicable diseases is still overwhelming. This is unacceptable and totally unnecessary."

Even within Europe, where anti-smoking and heart-healthy lifestyle campaigns have been introduced with some degree of success, the present facts underline the challenge:

• Non-communicable diseases, such as heart disease, stroke, diabetes, common cancers and chronic diseases of the liver, kidney and respiratory system together cause 86% of all deaths in Europe
• Up to 40% of European adults suffer some long-standing health problem related to chronic non-communicable diseases
• Up to 80% of all healthcare expenditure in Europe is allocated to chronic diseases; cardiovascular diseases alone are estimated to cost the EU economy over 192 billion euro every year

Moreover, only 3% of all current healthcare spending is directed at prevention. The rest is consumed by treatment. While all these non-communicable diseases are "treatable", rarely are they curable - although the majority of them are indisputably preventable. "Prevention," says Capewell, "is much more effective and more cost efficient than treatment."

Indeed, as recent research performed by Capewell and colleagues indicates, legislation or other measures to reduce salt or trans-fat consumption by just a small percentage would yield substantial personal health benefits and reductions in healthcare costs. [BMJ 2011; 343: d4044. doi: 10.1136/bmj.d4044]

Thus, the ESC welcomes the acknowledgement of trans-fats in the draft UN declaration and the specific recognition that "price and tax measures are an effective and important means of reducing tobacco consumption". In the past anti-tobacco campaigners have found tobacco interests lobbying ferociously against any fiscal measures on tobacco. This has frustrated national policies designed to protect citizens.

The ESC and associate organisations therefore welcomes the draft declaration's:

• Agreement for countries to establish their own chronic disease policies by 2013
• Recognition of non-communicable diseases (and their prevention) in all development and planning agendas
• Commitment to accelerate implementation of the WHO Framework Convention on Tobacco Control (FCTC), which details price and tax (and non-price) measures to reduce the demand for tobacco.

There is also provision in the declaration for a follow-up meeting in 2014 to assess the impact of the measures agreed in New York. However, the ESC along with other organisations is disappointed that no targets have been set for this assessment. For example, says Capewell, the deletion of a 5 mg target on salt intake per person per day which was in earlier drafts has now been removed. In its place are the promotion and initiation of "appropriate" cost-effective interventions to reduce salt, sugar and saturated fat. "There are many references to 'as appropriate' placed against health measures," he says. "This lets governments off the hook."

The ESC and ECDA were also hoping that the draft would set an overall target for global mortality attributed to non-communicable disease based on the WHO recommendation to cut preventable deaths by 25% by 2025. But no defining target has been included in the present draft, so the impact will not be easily measured - and the impetus for countries to try harder less pronounced.

However, despite the disappointing nature of some items of the draft, the ESC welcomes the strong overall message of the Declaration and the new focus on chronic diseases at the highest governmental level. "Two years ago," says Capewell, "such a focus would have been unthinkable. Now, the whole summit process has moved preventable diseases right up to the top table. There is now a clear recognition of the scale of the problem and of the need to take action."

In Europe ESC President Professor Michel Komajda along with other leaders of the ECDA has already written to José Manuel Barroso, President of the European Commission, to advise him of the importance of today's meeting. Since then, the Commission has pledged to make clear its commitments to the prevention and control of non-communicable diseases with a new resolution.

More information: The draft Declaration is accessible at here (PDF) http://www.un.org/ … r%202011.pdf

Provided by European Society of Cardiology

Xanthelasmata Predict Death, Ischemic Vascular Disease

Xanthelasmata either alone or combined with arcus corneae predict risk in general population

17 sept 2011-- Xanthelasmata either individually or in combination with arcus corneae, but not arcus corneae alone, predict the risk of ischemic vascular disease and death in the general population, according to a study published online Sept. 15 in BMJ.

Mette Christoffersen, from the Rigshospitalet in Denmark, and colleagues investigated whether xanthelasmata (563 cases) and arcus corneae (3,159 cases), either individually or in combination, predict the risk of ischemic vascular disease and death in the general population. A total of 12,745 individuals (aged 20 to 93 years), who were free from vascular disease at baseline, were followed up from 1976-1978 to May 2009. Odds ratios (ORs) were estimated for severe atherosclerosis, and hazard ratios (HR) for 1,872 cases of myocardial infarction (MI), 3,699 ischemic heart disease (IHD), 1,498 ischemic strokes, 1,815 ischemic cerebrovascular disease (CVD), and 8,507 deaths.

The investigators found that the multifactorially adjusted HRs/ORs for individuals with xanthelasmata versus those without, and for individuals with combined xanthelasmata and arcus corneae versus those without were 1.48 and 1.47 (MI), 1.39 and 1.56 (IHD), 0.94 and 0.87 (ischemic stroke), 0.91 and 0.86 (ischemic CVD), 1.69 and 2.75 (severe atherosclerosis), and 1.14 and 1.09 (death), respectively. The ratios for arcus corneae were not significant. The presence of xanthelasmata increased the absolute 10-year risk of MI, IHD, and death in all age-groups and genders. The highest absolute 10-year risks of IHD in individuals aged 70 to 79 years with and without xanthelasmata were 53 and 41 percent, respectively, for men, and 35 and 27 percent, respectively, for women.

"Xanthelasmata predict risk of MI, IHD, severe atherosclerosis, and death in the general population," the authors write.

Abstract
Full Text

Psychologists discover a gene's link to optimism, self-esteem

16 sept 2011-- UCLA life scientists have identified for the first time a particlular gene's link to optimism, self-esteem and "mastery," the belief that one has control over one's own life -- three critical psychological resources for coping well with stress and depression.

"I have been looking for this gene for a few years, and it is not the gene I expected," said Shelley E. Taylor, a distinguished professor of psychology at UCLA and senior author of the new research. "I knew there had to be a gene for these psychological resources."

The research is currently available in the online edition of the journal Proceedings of the National Academy of Sciences (PNAS) and will appear in a forthcoming print edition.

The gene Taylor and her colleagues identified is the oxytocin receptor gene (OXTR). Oxytocin is a hormone that increases in response to stress and is associated with good social skills such as empathy and enjoying the company of others.

"This study is, to the best of our knowledge, the first to report a gene associated with psychological resources," said lead study author Shimon Saphire-Bernstein, a doctoral student in psychology in Taylor's laboratory. "However, we wanted to go further and see if psychological resources explain why the OXTR gene is tied to depressive symptoms. We found that the effect of OXTR on depressive symptoms was fully explained by psychological resources."

At a particular location, the oxytocin receptor gene has two versions: an "A" (adenine) variant and a "G" (guanine) variant. Several studies have suggested that people with at least one "A" variant have an increased sensitivity to stress, poorer social skills and worse mental health outcomes.

The researchers found that people who have either two "A" nucleotides or one "A" and one "G" at this specific location on the oxytocin receptor gene have substantially lower levels of optimism, self-esteem and mastery and significantly higher levels of depressive symptoms than people with two "G" nucleotides.

The findings are "very strong, highly significant," Taylor said. The study has important implications.

"Sometimes people are skeptical that genes predict any kind of behavior or psychological state. I think we show conclusively that they do," said Taylor, who is a member of the National Academy of Sciences and directs UCLA's Social Neuroscience Laboratory.

She stresses, however, that while genes may predict behavior, the do not determine it.

Genes are not destiny

"Some people think genes are destiny, that if you have a specific gene, then you will have a particular outcome. That is definitely not the case," Taylor said. "This gene is one factor that influences psychological resources and depression, but there is plenty of room for environmental factors as well. A supportive childhood, good relationships, friends and even other genes also play a role in the development of psychological resources, and these factors also play a very substantial role in whether people become depressed.

"There is a genetic basis for these resources, but no — the OXTR gene does not explain most of these resources. The more you study genes, the more you realize that many factors influence their expression."

"The expression of genes is not always stable," Saphire-Bernstein noted. "For physical features like eye color, it is stable. Your eye color is not going to change this week, but your depression might change this week. Genes are only one set of contributing factors to behavior, to illness and to psychological disorders such as depression."

The researchers brought 326 people into a UCLA laboratory and had them complete self-assessments of optimism, self-esteem and mastery. To measure self-esteem, questionnaires included such statements as "I feel I am a person of worth, at least as much as other people" and asked subjects whether they agreed or disagreed, using a four-point scale. To measure optimism, the researchers included statements such as "In uncertain times, I usually expect the best" and "I hardly ever expect things to go my way."

The researchers obtained DNA from participants' saliva and used UCLA's Genotyping Center to analyze the DNA for the variants in the OXTR gene. Participants also completed an assessment of depression, using a tool that is often employed by clinical psychologists to identify people at risk for mental health problems.

"People with the 'A' variant scored substantially higher on depression. The question is whether that association between the gene and depression is explained by psychological resources," said Taylor, a founder of the field of health psychology who was honored last year with the American Psychological Association's Lifetime Achievement Award. "We found the answer is yes. The relation of the gene to depression is explained entirely by these psychological resources."

Even people with the "A" variant can overcome depression and manage stress, according to Taylor. "We found nothing that interferes with learning coping skills," she said.

The research implies that people would benefit if they could train themselves to be more optimistic, to have higher self-esteem and a higher sense of mastery to improve their ability to cope with stressful events.

The research was federally funded by the National Science Foundation and by the National Institutes of Health's National Institute on Aging.

Other co-authors of the study were Baldwin Way, an assistant professor of psychology at Ohio State University who conducted the research as a UCLA postdoctoral scholar in Taylor’s lab, and Heejung Kim and David Sherman, associate professors of psychology at UC Santa Barbara, who are also former members of Taylor's lab.

An increase in oxytocin tends to lead to more social behavior, especially under stress and especially in females, earlier research has indicated.

OXTR likely interacts with other genes. Taylor and her colleagues plan to continue to search for additional genes that predict behavioral responses to stress and to study how they interact.

"I originally assumed that biology largely determines behavior, and so it was a tantalizing surprise to see how clearly social relationships forge our underlying biology, even at the level of gene expression," Taylor wrote in her 2002 book "The Tending Instinct: How Nurturing Is Essential to Who We Are and How We Live." "Chief among these social forces are the ways in which people take care of one another and tend to one another's needs. An early warm and nurturant relationship, such as mothers often enjoy with their children, is as vital to development as calcium is to bones.

"The benefits that tending provides to children, especially those with genetic risks, are substantial. From life in the womb to the surprisingly resilient brain of old age, the social environment molds and shapes the expression of our genetic heritage until the genetic contribution is sometimes barely evident. A mother's tending can completely eliminate the potential effects of a gene; a risk for a disease can fail to materialize with nurturing, and a genetic propensity may lead to one outcome for one person and the opposite for another, based on the tending they received."

Provided by University of California Los Angeles

World Alzheimer's Report 2011: The benefits of early diagnosis and intervention

The World Alzheimer's Report 2011 'The Benefits of Early Diagnosis and Intervention', released today by Alzheimer's Disease International (ADI), shows that there are interventions that are effective in the early stages of Alzheimer's disease, some of which may be more effective when started earlier, and that there is a strong economic argument in favour of earlier diagnosis and timely intervention.

14 sept 2011--ADI commissioned a team of researchers led by Professor Martin Prince from King's College London Institute of Psychiatry, to undertake the first-ever, comprehensive, systematic review of all evidence on early diagnosis and early intervention for dementia.

Currently, the majority of people with dementia receive a diagnosis late in the course of the disease, if at all, resulting in a substantial 'treatment gap'. This greatly limits their access to valuable information, treatment, care, and support and compounds problems for all involved - patients, families, carers, communities and health professionals.

Lead author Prof Prince said: 'There is no single way to close the treatment gap worldwide. What is clear is that every country needs a national dementia strategy that promotes early diagnosis and a continuum of care thereafter. Primary care services, specialist diagnostic and treatment centres and community-based services all have a part to play, but to differing degrees depending upon resources.'

'Failure to diagnose Alzheimer's in a timely manner represents a tragic missed opportunity to improve the quality of life for millions of people,' said Dr. Daisy Acosta, Chairman of ADI. 'It only adds to an already massive global health, social, and fiscal challenge - one we hope to see in the spotlight at next week's United Nations Summit on Non-Communicable Diseases.'

The new ADI report reveals the following:

• As many as three-quarters of the estimated 36 million people worldwide living with dementia have not been diagnosed and hence cannot benefit from treatment, information and care. In high-income countries, only 20-50% of dementia cases are recognized and documented in primary care. In low- and middle-income countries, this proportion could be as low as 10%.
• Failure to diagnose often results from the false belief that dementia is a normal part of aging, and that nothing can be done to help. On the contrary, the new report finds that interventions can make a difference, even in the early stages of the illness.
• Drugs and psychological interventions for people with early-stage dementia can improve cognition, independence, and quality of life. Support and counselling for caregivers can improve mood, reduce strain and delay institutionalization of people with dementia.
• Governments, concerned about the rising costs of long-term care linked to dementia, should spend now to save later. Based on a review of economic analyses, the report estimates that earlier diagnosis could yield net savings of over US$10,000 per patient in high-income countries.

'Over the past year, the research team has reviewed thousands of scientific studies detailing the impact of early diagnosis and treatment, and we have found evidence to suggest real benefits for patients and caregivers,' said Marc Wortmann, Executive Director of ADI.

'Earlier diagnosis can also transform the design and execution of clinical trials to test new treatments. But first we need to ensure that people have access to the effective interventions that are already proven and available, which means that health systems need to be prepared, trained and skilled to provide timely and accurate diagnoses, communicated sensitively, with appropriate support.'

To that end, ADI recommends that every country have a national Alzheimer's/dementia strategy that promotes early diagnosis and intervention. More specifically, governments must:

• Promote basic competency among physicians and other health care professionals in early detection of dementia in primary care services.
• Where feasible, create networks of specialist diagnostic centres to confirm early-stage dementia diagnosis and formulate care management plans.
• In resource-poor settings, apply the World Health Organization's recently developed guidelines for diagnosis and initial management by non-specialist health workers.
• Publicize the availability of evidence-based interventions that are effective in improving cognitive function, treating depression, improving caregiver mood and delaying institutionalization.
• Increase investment in research—especially randomized control trials to test drugs earlier and over longer periods of time, and to test the efficacy of interventions with particular relevance to early-stage dementia.

More information: http://www.alz.co. … ldreport2011

Provided by King's College London

About One in Four Adults at Risk of Physician-Diagnosed COPD

Chronic obstructive pulmonary disease risk tied to male gender, rural living, socioeconomic status

12 sept 2011-- Lifetime risk of physician-diagnosed chronic obstructive pulmonary disease (COPD) is 27.6 percent, and is higher among men, rural inhabitants, and those with a lower socioeconomic status, according to a study published Sept. 10 in the special European Respiratory Society issue of The Lancet.

Andrea S Gershon, M.D., from the Institute for Clinical Evaluative Sciences in Toronto, and colleagues estimated the lifetime risk of physician-diagnosed COPD in a multiethnic North American population of about 13 million. Data were collected from health administrative databases. Individuals who did not have COPD in 1996 were followed up for up to 14 years for incidence of three possible outcomes: physician-diagnosed COPD, reaching 80 years of age, or death. Cumulative incidence of physician-diagnosed COPD over a lifetime was determined by modified survival analysis technique, after adjusting for competing risk of death. Results were stratified by gender, socioeconomic status, and rural or urban living environment.

The investigators found that 579,466 individuals had physician-diagnosed COPD over the study period, with a 27.6 percent overall lifetime risk at 80 years of age. COPD lifetime risk was higher in men than in women (29.7 versus 25.6 percent), in those living in a rural versus urban environment (32.4 versus 26.7 percent), and in those in the lowest versus the highest socioeconomic status quintile (32.1 versus 23 percent).

"About one in four individuals are likely to be diagnosed and receive medical attention for COPD during their lifetime," the authors write.

Abstract

Fewer screening colonoscopies OK for some: study

NEW YORK , 11 sept 2011- People who've had a colonoscopy with no signs of cancer may be able to delay the next one or not have it at all, German researchers suggest. Guidelines from the U.S. Preventive Services Task Force, a federally supported expert panel, currently recommend that people at average risk of colon cancer start screening for the disease at age 50, using one of a number of tests that have all been found to cut the risk of dying from colon cancer. The advantage of colonoscopy, which costs around $3,000, is that it only has to be repeated once every ten years, as opposed to every year for the much cheaper stool test. Although the German study isn't definitive, it does suggest that doing even fewer colonoscopies might be reasonable in some cases. Dr. Hermann Brenner at the German Cancer Research Center in Heidelberg and colleagues asked nearly 2,000 colon cancer patients and 2,400 healthy people whether and when they'd had colonoscopies. Compared with people who'd never undergone the procedure, those whose test came back negative had five times lower odds of developing cancer down the road. Writing in the Journal of Clinical Oncology, the German researchers say their results challenge current guidelines. "The finding of sustained low risk for 20 years and beyond after a negative colonoscopy suggests that a screening colonoscopy might not need to be repeated after 10 years as was previously recommended," they note. For those who light up, however, that might not be the case. Ten years from a negative test, current smokers had the same colon cancer risk as non-smokers who'd never had a colonoscopy. Longer screening intervals could have a significant impact on the overall cost-effectiveness of colonoscopy as well as lower the rate of colonoscopy-related complications, according to the German team. Dr. John Inadomi of the University of Washington in Seattle said the new findings are not surprising, because a negative colonoscopy sorts people at low risk of colon cancer from those at higher risk. He added that the first intervention to prevent a disease is always the most effective because of diminishing returns on any subsequent interventions that cost the same. Still, he told Reuters Health, "perhaps lengthening the interval between screening colonoscopies is a reasonable proposal" for patients with a negative colonoscopy. SOURCE: http://bit.ly/mTdu4R J Clin Oncol, 2011.

Vitamin D in foods may reduce risk of depression in older women

Results of a large study among older women suggest that those who ate more of the "sunshine vitamin" were less likely to experience depression symptoms than women who consumed less of the vitamin, according to findings published this week by Elizabeth Bertone-Johnson at the University of Massachusetts Amherst School of Public Health and Health Sciences, with colleagues from several other U.S. academic centers.

10 sept 2011--Overall, a diverse population of postmenopausal women who consumed 800 international units (IU) per day of the vitamin was 20 percent less likely to have depressive symptoms than those who consumed less than 100 IU daily. Among women who had no depression at baseline, those who took in 400 IU or more of vitamin D per day from food sources also had a 20 percent lower risk of depressive symptoms three years later compared to those in the group taking in the lowest amount of vitamin D.

In terms of absolute risk for depressive symptoms and vitamin D intake, the prevalence of depressive symptoms was 10.0 percent in women reporting total vitamin D intake greater than or equal to 800 IU per day compared to 12.7 percent in those reporting less than 100 IU per day, the authors report. Their results are in the current issue of the American Journal of Clinical Nutrition.

These findings need to be confirmed in clinical trials of vitamin D and depression, say Bertone-Johnson and colleagues at institutions across the nation, but the results are provocative. "Dietary vitamin D intake and supplement use are easy for women to modify and, if shown to be effective in clinical trials, could provide new avenues for the prevention and perhaps the treatment of depression," she points out.

In addition to sunlight, fat-soluble vitamin D comes largely from eating fatty fish and fortified milk, dairy products and orange juice.

The association observed between dietary vitamin D intake and depressive symptoms was found among nearly 82,000 postmenopausal women (50 to 79 years old) recruited for the Women’s Health Initiative Observational Study, part of a larger study of older women funded by the National Heart, Lung and Blood Institute at 40 clinical centers throughout the United States from 1993 to 1998.

Participants’ vitamin D intake at baseline was measured by questionnaire and supplement use was assessed by trained interviewers. Among other questions, participants were asked to report their usual intake of 122 foods or food groups in the three previous months. The study also estimated and controlled for the average amount of sunlight residents could receive in various parts of the country.

Bertone-Johnson and colleagues examined depressive symptoms at baseline and after three years using an established eight-item scale plus information on current antidepressant use.

The analyses controlled for age, physical activity and other factors and evaluated how mean total vitamin D intake, vitamin D from food sources and vitamin D intake from supplements were associated with the prevalence of depressive symptoms at baseline and with depressive symptoms after 3 years.

Women with the highest intake of total vitamin D, greater than 800 IU daily, and vitamin D from food sources greater than 400 IU daily, each had a significantly lower prevalence of depressive symptoms compared to those reporting consuming less than 100 IU per day. Also, among women without evidence of depression at baseline, higher vitamin D intake from food sources was associated with a lower risk of depressive symptoms in the third year of follow-up.

A strength of this large study included the diversity of subjects which allowed the researchers to explore whether the association between vitamin D and depression may vary by race/ethnicity, age or other factors such as education, body mass index, smoking, alcohol use, possible sunlight exposure and physical activity.

Besides Bertone-Johnson and colleagues at the University of Massachusetts Amherst, other researchers taking part in this study were from Group Health Research Institute in Seattle, the University of Nevada School of Medicine in Reno, Drexel University School of Public Health in Philadelphia, Fred Hutchinson Cancer Research Center in Seattle, the University of Buffalo, Brigham and Women’s Hospital and Harvard Medical School in Boston; the UMass Medical School in Worcester, the University of California at Los Angeles School of Public Health, the Albert Einstein College of Medicine and Yeshiva University in Bronx, New York.

The Women’s Health Initiative is funded by the National Heart, Lung and Blood Institute at the National Institutes of Health.

More information: http://www.ajcn.or … early/recent

Provided by University of Massachusetts Amherst

One drink a day may be related to good overall health in women when older

Women who drink 15 grams or less of alcohol a day (the equivalent of one drink of any alcoholic beverage) at midlife may be healthier when older than women who do not drink at all, who consume more than two drinks a day, or who consume four drinks or more at the one time.

09 sept 2011--A study led by Qi Sun from the Harvard School of Public Health and the Brigham and Women's Hospital in Boston, USA, and published in this week's PLoS Medicine suggests that in women, regular, moderate alcohol consumption during middle age (average age 58 years) is related to good overall health—that is, having no major chronic diseases, such as heart disease or diabetes, and no major cognitive and physical impairment, or mental health limitations—in those who live to 70 years and beyond. The authors define this good overall health as "successful ageing."

The authors used information from periodic food frequency questionnaires given to the 121,700 female nurses enrolled in the US Nurses' Health Study (which began in 1976) to assess the alcohol consumption of the nurses during middle age. The authors then included in their analysis the vast majority (98.1%) of participants who were not heavier drinkers (45 g/d) when middle-aged and examined the health status in the 13,984 women who lived to 70 years and over.

After discounting other factors, such as smoking, that might affect their health status, the authors found that women who drank 5 g of alcohol per day (between a 1/3 and 1 drink per day) had about a 20% higher chance of good overall health when older compared to non-drinkers. Furthermore, women who drank alcohol regularly had a better chance of good overall health when older than occasional drinkers: compared to women who didn't drink, women who drank five to seven days a week had almost 50% greater chance of good overall health when older.

The authors conclude: "These data suggest that regular, moderate consumption of alcohol at midlife may be related to a modest increase in overall health status among women who survive to older ages."

They add: "The 2010 US Department of Agriculture dietary guidelines note that moderate alcohol consumption of up to one drink per day for women and up to two drinks per day for men may provide health benefits in some people. Our data support this recommendation and provide novel evidence suggesting that light-to-moderate alcohol consumption at the levels of one to two drinks/day or slightly less at midlife may benefit overall health at older ages in US women."

More information: Sun Q, Townsend MK, Okereke OI, Rimm EB, Hu FB, et al. (2011) Alcohol Consumption at Midlife and Successful Ageing in Women: A Prospective Cohort Analysis in the Nurses' Health Study. PLoS Med 8(9): e1001090. doi:10.1371/journal.pmed.1001090

Provided by Public Library of Science

Cerebrovascular Pathologies Tied to Mild Parkinsonian Signs

Macroscopic infarcts, microinfarcts, arteriolosclerosis tied to parkinsonian signs in old age

08 sept 2011-- Cerebrovascular pathologies, such as macroscopic infarcts, microinfarcts, and arteriolosclerosis, are associated with mild parkinsonian signs in old age, particularly parkinsonian gait, according to a study published online Sept. 1 in Stroke.

Aron S. Buchman, M.D., from the Rush University Medical Center in Chicago, and colleagues investigated whether cerebrovascular pathologies are related to parkinsonian signs. Samples from brain autopsies were assessed from 418 deceased patients who underwent evaluation of parkinsonian signs with a modified version of the motor section of the Unified Parkinson's Disease Rating Scale.

The investigators identified macroscopic infarcts in 149 cases (more than 35 percent). Pathologies not detected by conventional brain imaging were revealed in nearly 30 percent of cases without macroscopic infarcts: 33 microinfarcts (7.9 percent), 62 cases of arteriolosclerosis (14.8 percent), and 24 cases of both (5.7 percent). Higher global parkinsonian scores were correlated with macroscopic infarcts, specifically multiple cortical and one or more subcortical macroscopic infarcts. The presence of multiple and cortical microinfarcts was correlated with the global parkinsonian score. An association was found between arteriolosclerosis and the global parkinsonian score, but this effect was reduced and was no longer significant after accounting for infarcts. Each of the pathologies was significantly correlated with parkinsonian gait, with subcortical macroscopic and microinfarcts specifically correlating with the severity of parkinsonian gait.

"Cerebrovascular pathologies, including macroscopic infarcts, microinfarcts, and arteriolosclerosis, are common in older persons and may be unrecognized common etiologies of mild parkinsonian signs, especially parkinsonian gait, in old age," the authors write.

Abstract

Volunteering to help others could lead to better health

People who volunteer may live longer than those who don't, as long as their reasons for volunteering are to help others rather than themselves, suggests new research published by the American Psychological Association.

07 sept 2011--This was the first time research has shown volunteers' motives can have a significant impact on life span. Volunteers lived longer than people who didn't volunteer if they reported altruistic values or a desire for social connections as the main reasons for wanting to volunteer, according to the study, published online in the APA journal Health Psychology. People who said they volunteered for their own personal satisfaction had the same mortality rate four years later as people who did not volunteer at all, according to the study.

"This could mean that people who volunteer with other people as their main motivation may be buffered from potential stressors associated with volunteering, such as time constraints and lack of pay," said the study's lead author, Sara Konrath, PhD, of the University of Michigan.

Researchers examined data from the Wisconsin Longitudinal Study, which has followed a random sample of 10,317 Wisconsin high school students from their graduation in 1957 until the present. The sample is 51.6 percent female, with an average age of 69.16 years in 2008.

In 2004, respondents reported whether they had volunteered within the past 10 years and how regularly. They reported their reasons for volunteering (or the reasons they would volunteer, for those who had not done so) by answering 10 questions. Some motives were more oriented toward others (e.g., "I feel it is important to help others," or "Volunteering is an important activity to the people I know best") and some that were more self-oriented (e.g., "Volunteering is a good escape from my own troubles," or "Volunteering makes me feel better about myself").

The researchers also considered the respondents' physical health, socioeconomic status, marital status, health risk factors (i.e., smoking, body mass index and alcohol use), mental health and social support. Much of this information was collected in 1992, 12 years before the respondents were asked about their volunteering experience. The researchers then determined how many of the respondents were still alive in 2008.

Overall, 4.3 percent of 2,384 non-volunteers were deceased four years later, which was similar to the proportion of deceased volunteers who reported more self-oriented motives for volunteering (4 percent). However, only 1.6 percent of those volunteers whose motivations were more focused on others were dead four years later. This effect remained significant even when controlling for all the variables. Additionally, respondents who listed social connection or altruistic values as their predominant motive were more likely to be alive compared with non-volunteers.

"It is reasonable for people to volunteer in part because of benefits to the self; however, our research implies that, ironically, should these benefits to the self become the main motive for volunteering, they may not see those benefits," said the paper's co-author, Andrea Fuhrel-Forbis, MA.

Provided by American Psychological Association

Even mild cognitive impairment appears to substantially increase risk for death

Cognitive impairment, even when detected at an early, mild stage, is a significant predictor of decreased life expectancy.

06 sept 2011--According to a new, long-term study from Regenstrief Institute and Indiana University researchers, cognitive impairment, especially at the moderate to severe stages has an impact on life expectancy similar to chronic conditions such as diabetes or chronic heart failure. Their findings, "Cognitive Impairment: An Independent Predictor of Excess Mortality. A Cohort Study" appears in the Sept. 6, 2011 issue of Annals of Internal Medicine.

Nearly 4,000 people between the ages of 60 to 102 years, initially seen from 1991 to 1993 by primary care physicians at Wishard Health Services, a large public hospital with community health centers in Indianapolis, participated in the study. The patients were followed for 13 years.

"Previous studies have associated cognitive impairment with an increased risk for death, but most of this work focused on patients with Alzheimer disease and subjects in research centers. The patients in our study better reflect the general public, displaying no indications of disease or mild, moderate or severe cognitive impairment," said Regenstrief investigator Greg A. Sachs, M.D., professor of medicine at the Indiana University School of Medicine, where he is the division chief of general internal medicine and geriatrics. "We found that even mild cognitive impairment, as determined by a simple screening tool in a primary care physician's office, has a strong impact on how long individuals survive on the same order as other chronic diseases."

The study followed 3,957 patients. At screening, 3,157 had no cognitive impairment, 533 had mild impairment, and 267 had moderate to severe impairment. During follow-up, 57 percent of patients with no impairment died, compared with 68 percent of those with mild impairment and 79 percent of those with moderate to severe impairment. Median survival time was 138 months for patients with no impairment, 106 months for those with mild impairment, and 63 months for those with moderate to severe impairment.

Study participants were screened for cognitive impairment using an easy-to-administer 10-question mental status questionnaire. On the basis of the number of errors patients made on this test, they were categorized as having no, mild, or moderate to severe cognitive impairment. The Regenstrief Medical Record System was used to obtain data on the patients' medical conditions, results of lab tests and other relevant information.

Cognitive impairment affects memory and thinking. Approximately 4 million to 5 million people in the United States have dementia, and the number of individuals affected is significantly higher if individuals with milder forms of cognitive impairment are included. The prevalence of cognitive impairment at all stages is expected to increase as the population ages.

The study findings have important clinical and prognostic implications beyond dementia detection, treatment and support for affected patients and their families. Reduced life expectancy in patients with cognitive impairment should be factored into medical decisions, such as advance care planning, cancer screening and prescribing of medications, especially in patients with severe impairment, the authors state.

Given that the magnitude of the risk of mild and moderate to severe cognitive impairment is similar to that of many life-limiting diseases, as well as the ease of indentifying cognitive impairment by using a short screening tool, recognition of cognitive impairment in primary care practices should be given a higher priority, the study concludes.

Provided by Indiana University School of Medicine

Diastolic dysfunction appears to worsen over time; associated with increased risk of heart failure

A follow-up of participants in a heart function study finds that the prevalence of left ventricular diastolic dysfunction (left ventricular filling [with blood] is abnormal and is accompanied by elevated filling pressures) had increased; that diastolic function had worsened in a nearly a quarter of patients; and that participants who had diastolic dysfunction were more likely to develop heart failure, according to a study in the August 24/31 issue of JAMA.

05 sept 2011--"There is an emerging emphasis on understanding the progression from heart failure risk factors to asymptomatic ventricular dysfunction and eventually to symptomatic heart failure and death. Therefore, it is important to have population-based information on changes in cardiac function over time," according to background information in the article. "… little is known about time-dependent changes in diastolic function or their relationship to clinical heart failure."

Garvan C. Kane, M.D., Ph.D., of the Mayo Clinic and Medical School, Rochester, Minn., and colleagues conducted a study to measure changes in diastolic function over time and to determine the relationship between diastolic dysfunction and the risk of subsequent heart failure. The study included participants enrolled in the Olmsted County Heart Function Study (OCHFS). Randomly selected participants 45 years or older (n = 2,042) underwent clinical evaluation, medical record abstraction, and echocardiography (examination 1 [1997-2000]). Diastolic left ventricular function was graded as normal, mild, moderate, or severe via testing. After 4 years, participants were invited to return for examination 2 (2001-2004). The group of participants returning for examination 2 (n = 1,402 of 1,960 surviving [72 percent]) then underwent follow-up testing for determination of new-onset heart failure (2004-2010).

The researchers found that from examination 1 to examination 2, the prevalence of diastolic dysfunction of any degree increased from 23.8 percent to 39.2 percent. Moderate or severe diastolic dysfunction increased from 6.4 percent to 16.0 percent. Over 4 years, 23.4 percent of participants experienced worsening of diastolic function, 67.8 percent remained unchanged, and 8.8 percent experienced improved diastolic function. Age was predictive of the development of diastolic dysfunction, especially ages 65 years or older.

In the analysis of the diastolic function of healthy participants (without hypertension, diabetes, coronary artery disease, heart failure, or use of cardiovascular medications), incidence of diastolic dysfunction of any degree increased from 11.3 percent at examination 1 to 29.8 percent at examination 2. Among 423 healthy participants, 19.9 percent showed worsening diastolic function, 75.2 percent remained the same, and 5.0 percent improved.

During 6.3 years of additional follow-up, 81 participants developed heart failure. Age 65 years or older was the strongest predictor of heart failure. The authors found that persistent or worsening diastolic dysfunction was associated with heart failure. "Cumulative heart failure incidence was 2.6 percent in participants whose diastolic function remained normal or normalized between examinations; 7.8 percent in those with persistent, or progression to mild diastolic dysfunction; and 12.2 percent in those with persistent, or progression to moderate or severe diastolic dysfunction."

"Longitudinal evaluation of participants in the population-based OCHFS cohort reveals that left ventricular diastolic dysfunction is highly prevalent, tends to worsen over time, and is associated with advancing age. Worsening diastolic function can be detected even in apparently healthy persons. Although confirmation in other studies would be helpful, our data suggest that persistence or progression of diastolic dysfunction is a risk factor for heart failure in elderly persons," the researchers conclude.

More information: JAMA. 2011;306[8]:856-863.

Eating chocolate cuts risk of heart disease

04 sept 2011-- The researchers compiled a systematic review of seven studies using data from 114,000 patients and found that people who consumed the most chocolate had a 37 per cent lower risk of developing heart disease and a 29 per cent lower risk of suffering a stroke than those who consumed less chocolate.

The studies looked at the consumption of dark chocolate as well as milk chocolate, chocolate drinks and other chocolate confectionaries.

Although the analysis suggests a certain benefit to eating higher quantities of chocolate, the findings still need to be interpreted with caution, in particular because commercially available chocolate is very calorific and eating too much of it could in itself lead to weight gain, which increases various health risks.

Lead author, Dr. Oscar Franco, from the Department of Public Health and Primary Care, said: “Chocolate may be beneficial, but it should be eaten in a moderate way, not in large quantities and not in binges,” he said. “If it is consumed in large quantities, any beneficial effect is going to disappear.”

However, they conclude that, given the health benefits of eating chocolate, initiatives to reduce the current fat and sugar content in most chocolate products should be explored.

The World Health Organisation predicts that by 2030, nearly 23.6 million people will die from heart disease. Furthermore, about a fifth of the world’s adult population are thought to have metabolic syndrome, a cluster of factors associated with an increased risk of type 2 diabetes and cardiovascular disease.

Provided by University of Cambridge

European women live longer than men, but not better

European women live longer than men, because of both biological and behavioural advantages, but women's longer lives are not necessarily healthy lives. Studies commented on by Dr Vannuzzo at the ESC Congress 2011, show that due to increase in tobacco and alcohol consumption in women, the gender gap is decreasing.

03 sept 2011--In the European Union (27 countries) the total number of deaths is roughly similar in men and women (in 2009: 2 416 786 men and 2 418 048 women), and trends are also similar, but women die older than men and an interesting way to evaluate the difference is Life Expectancy.

Life Expectancy is the average number of years a person can expect to live, if in the future they experience the current age-specific mortality rates in the population. In 2008 the EU Life Expectancy at birth was 82.4 years in women and 76.4 years in men, a gap of 6 years! There were marked differences among countries, with a Life Expectancy at birth ranging in women from 77.0 years in Bulgaria to 84.8 in France, and in men from 66.3 years in Lithuania to 80.0 in Iceland. A gender gap in Life Expectancy was present in each of the 27 countries, always favouring women, with a minimum of 3.3 years in Iceland and a maximum of 11.3 years in Lithuania.

Considering "Healthy life years at birth" by gender, that is, the number of years that a person at birth is still expected to live in a healthy condition, the average proportion is 85% of healthy years in men and 80% in women.

The difference between Life Expectancy and Healthy Life Years at Birth is called Life Expectancy with Disability. In proportion, Life Expectancy with Disability is worse in women but in absolute terms, life is longer compared to men. Disability cumulates in later life and is due to cardiovascular diseases for about 1/4. The main reasons for the gender gap in Life Expectancy are tobacco and alcohol. In a recently published study (Tobacco Control 2011;20:166-168. doi:10.1136/tc.2010.037929), smoking-related deaths accounted for around 40% of the gender gap in all-cause mortality, while alcohol-related mortality typically accounted for 20% of the gender gap in Eastern Europe and 10% elsewhere in Europe.

Unfortunately, more and more women smoke and therefore the gender gap is decreasing, like in Italy. Smoking is particularly harmful in women, and its predictive power is higher in women: about 25% in excess, as demonstrated in the Italian Progetto CUORE (Am J Epid 2006; 163(10): 893-902; Europ J Cardiov Prev 2006; 13: 562-570) and in a Lancet Meta-analysis just published (Published Online August 11, 2011 DOI:10.1016/S0140-6736(11)60781-2).

Provided by European Society of Cardiology