Australians should have the right to choose assisted dying, groundbreaking report says

Assisted death should be available to people with incurable and terminal illness who persistently request it. This is a key recommendation of a report from leading academics released today.

27 april 2013--The report by Australia21 (A21), a non-profit body committed to analysis of complex issues affecting Australia's future, calls on state governments to legislate for change and on the Federal Government to return to the territories their right to legalise assisted dying.

The report, "The right to choose an assisted death: Time for legislation?", was prepared after a roundtable discussion by opponents and supporters of assisted dying from the fields of medicine, law, ethics, palliative care and politics that was held in Brisbane in January in conjunction with QUT's Health Law Research Centre (HLRC).

HLRC director Professor Ben White from QUT's School of Law said the report considered reform of the currently illegal practices of voluntary euthanasia and assisted suicide.

"The laws on voluntary euthanasia and assisted suicide lack coherence and there is a body of evidence that shows they are not being followed," Professor White said.

"This area of the law should be reformed to respect choice, in line with community thinking."

The report's lead author Emeritus Professor Bob Douglas AO, founding chair of A21, said views on assisted dying were changing rapidly around the world.

"A number of jurisdictions around the world have decriminalised assisted dying and voluntary euthanasia and national polls in Australia show people want this option as they approach the end of their lives," Professor Douglas said.

The report is being sent to all state and federal parliamentarians and to professional and religious bodies around Australia.

The report can be downloaded here.

Provided by Queensland University of Technology

Study shows how Parkinson's disease protein acts like a virus

A protein known to be a key player in the development of Parkinson's disease is able to enter and harm cells in the same way that viruses do, according to a Loyola University Chicago Stritch School of Medicine study.

26 april 2013--The protein is called alpha-synuclein. The study shows how, once inside a neuron, alpha synuclein breaks out of lysosomes, the digestive compartments of the cell. This is similar to how a cold virus enters a cell during infection. The finding eventually could lead to the development of new therapies to delay the onset of Parkinson's disease or halt or slow its progression, researchers said.

The study by virologist Edward Campbell, PhD, and colleagues, was published April 25, 2013 in the journal PLOS ONE.

Alpha-synuclein plays a role in the normal functioning of healthy neurons. But in Parkinson's disease patients, the protein turns bad, aggregating into clumps that lead to the death of neurons in the area of the brain responsible for motor control. Previous studies have shown that these protein aggregates can enter and harm cells. Campbell and colleagues showed how alpha synuclein can bust out of lysosomes, small structures that collectively serve as the cell's digestive system. The rupture of these bubble-like structures, known as vesicles, releases enzymes that are toxic to the rest of the cell.

"The release of lysosomal enzymes is sensed as a 'danger signal' by cells, since similar ruptures are often induced by invading bacteria or viruses," said Chris Wiethoff, a collaborator on the study. "Lysosomes are often described as 'suicide bags' because when they are ruptured by viruses or bacteria, they induce oxidative stress that often leads to the death of the affected cell."

In a viral or bacterial infection, the deaths of such infected cells may overall be a good thing for the infected individual. But in Parkinson's disease, this same protective mechanism may lead to the death of neurons and enhance the spread of alpha-synuclein between cells in the brain, Campbell said. "This might explain the progressive nature of Parkinson's disease. More affected cells leads to the spread of more toxic alpha-synuclein aggregates in the brain," Campbell said. "This is very similar to what happens in a spreading viral infection."

Campbell stressed that these studies need to be followed up and confirmed in other models of Parkinson's disease. "Using cultured cells, we have made some exciting observations. However, we need to understand how lysosomal rupture is affecting disease progression in animal models of Parkinson's disease and, ultimately, the brains of people affected by Parkinson's disease. Can we interfere with the ability of alpha-synuclein to rupture lysosomes in these settings? And will that have a positive effect on disease progression? These are the questions we are excited to be asking next."

Jeffrey H. Kordower, PhD, professor of neurological sciences, professor of neurosurgery and director of the Research Center for Brain Repair at Rush University Medical Center, said the study "is an important finding by a group of investigators who are beginning to make their impact in the field of Parkinson's disease. This paper adds to the growing concept that alpha-synuclein, a main culprit in the cause of Parkinson's disease, can transfer from cell to cell. This paper elegantly puts a mechanism behind such a transfer. The findings will help shape the direction of Parkinson's disease research for years to come."

More information: dx.plos.org/10.137… pone.0062143

Provided by Loyola University Health System

Nearly half of all deaths from prostate cancer can be predicted before age 50

Focusing prostate cancer testing on men at highest risk of developing the disease is likely to improve the ratio between benefits and the harms of screening, suggests a paper published today in BMJ.

25 april 2013--Prostate specific antigen (PSA) screening is widely used for the early detection of prostate cancer, but remains highly controversial, as it became widespread long before evidence to prove its value. There is now evidence that PSA screening can reduce prostate cancer mortality in men who would not otherwise be screened. However, this can come at considerable harm.

As there is little evidence to support many aspects of screening guidelines, researchers from Sweden and the USA carried out a case-control study taking data from the Malmo Preventative Project (MPP) cohort, in an attempt to develop an evidence-based scheme for prostate cancer testing. A previous study from the MPP, published in the BMJ in 2010, demonstrated that PSA level at age 60 is strongly predictive of the risk of death from prostate cancer by age 85.

The Malmo cohort included 21,277 men aged 27 to 52 who participated in the MPP between 1974 and 1984. All these men gave a blood sample. A smaller group of these men were then invited to provide a second blood sample about six years later: 4922 (72%) of those re-invited complied.

The researchers focused their studies on men close to age 40, mid-to-late forties (45-49) and early-to-mid fifties (51-55).

Within 25 to 30 years, 44% of deaths from prostate cancer occurred in those with the top 10% of PSA levels at age 45-49, a PSA of about 1.5 ng / ml or more. The risk of prostate cancer death was more than 10 times greater in this group compared to men with the lowest 25% of PSA levels.

The researchers questioned whether PSA screening should start at age 40, mid-to-late 40s or early 50s: they found that even for men with PSA in the top decile at age 40, the risk of metastatic prostate cancer was very low at 0.6%, after 15 years of follow-up. The researchers say that due to this, it would be difficult to justify initiating PSA testing at age 40 for men with no other significant risk factor.

In contrast, the risk of developing metastatic prostate cancer within 15 years is close to three-fold higher for men in the top level PSA at age 45-49 (1.7%) and close to ten-fold higher at age 51-55 (5.2%). This suggests that initiating PSA screening after age 50 would leave a significant proportion of men at elevated risk of later being diagnosed with an incurable cancer.

The researchers also looked at screening intervals: results showed that the absolute risk of metastatic cancer remains very low within 15 years follow-up for men with PSA in the low deciles and as such, a screening interval less than five years for these men is unnecessary.

The researchers conclude that PSA levels are informative of the current risk of cancer as well as being "predictive of the future risk of prostate cancer" and any cancer-specific death. They say that screening programmes can be designed so as to "reduce the risk of over-diagnosis whilst still enabling early cancer detection for men at highest risk of death from prostate cancer". As it turns out, the best way to determine risk is a single PSA before the age of 50.

More information: Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study, BMJ, 2013.

Provided by British Medical Journal

Researchers chart new path for study of ageism

Researchers say stereotypes of what older people should be, known as prescriptive stereotypes, center on three key issues. Select the thought bubbles in the illustration below to learn more about each of these issues.

24 april 2013--Michael North, a fifth-year graduate student in psychology at Princeton University, knew he was lucky to land a summer research position at the University of Michigan after he finished his bachelor's degree there in 2006.

His task: Sit in a lab for two hours at a time and interview local residents—young and old—for a study on wisdom.

"When the professor told me this, I nodded and said OK, but as a 22-year-old kid I wasn't really excited about sitting in a basement interviewing old people, as I saw them," North said. "I thought they would be really boring. I thought they would smell. I thought they would make me feel weird. These were the thoughts I had, honestly."

But the reality was different. North found that he enjoyed interacting with the older group more than the younger people. "The older people were the ones who showed more interest in the project, they showed more interest in me personally and asked more interesting questions," North said.

The realization opened his eyes to a field ripe for exploration.

A focus on ageism research

North came to Princeton in 2008 and joined the lab of Susan Fiske, the Eugene Higgins Professor of Psychology and a professor of psychology and public affairs. Together, they have put a new emphasis on ageism, or age-based prejudice, focusing on the challenges society faces to adjust to a growing older population and the intergenerational tensions that can result.

The older population in the United States is expected to double in the next 20 years, and the number of older people is likely to reach more than a quarter of the population by 2050, outnumbering children for the first time in history, North and Fiske noted last year in the journalPsychological Bulletin.

"In other words, the people society now considers older and irrelevant are about to become far more common and visible—perhaps more so than ever in modern society," the researchers wrote.

Those factors make this an ideal time to put a spotlight on the social perceptions of ageism, a generally understudied area in academia, North said.

"It's not hard to read The New York Times or The Wall Street Journal and see that as the baby boomers are getting older, age-discrimination cases are on the rise and worries are growing about the long-term sustainability of Social Security and Medicare," North said. "The academic literature hasn't really spoken to these questions."

The research by North and Fiske homes in on the idea that understanding intergenerational tension is key to understanding ageism. Ageism is the one kind of discrimination, North noted, in which those who are generally doing the discriminating—younger generations—will eventually become part of the targeted demographic.

North and Fiske are making important contributions to ageism research, said Susan Krauss Whitbourne, a psychology professor at the University of Massachusetts-Amherst who studies aging and adult development.

"Ageism is a topic that touches on many sensitive areas, including older adults themselves, family members, policymakers and the media," she said. "North and Fiske unpack the stereotypes toward older adults and show how these stereotypes vary in their causes and effects."

Fiske, a social psychologist, joined the Princeton faculty in 2000. Her most recent book is "Envy Up, Scorn Down: How Status Divides Us" (2012). The research she and North have conducted expands her far-reaching work on stereotypes.

"We have found a variety of evidence, over the past dozen years, that people make sense of each other along two primary and apparently universal dimensions," Fiske said. "The first is warmth—does the other have good intentions, is that person trustworthy and sociable. The second dimension is competence—can the other enact those intentions. Stereotypically, the middle class are both warm and competent, rich people are cold but competent, homeless people are neither. The default stereotype for older people is well-intentioned (warm) but incompetent."

What older people 'should be'

The researchers focus on ageism that is based on what psychologists call prescriptive prejudice. "Instead of describing what old people supposedly are in reality, it 'prescribes' what others think old people should be," Fiske said. "Older people who 'violate' these 'prescriptions' are punished by those who discriminate against them; older people who adhere to them are rewarded with sympathy and pity."

The researchers say prescriptive stereotypes center on three key issues: 

• Succession, the idea that older people should move aside from high-paying jobs and prominent social roles to make way for younger people;
• Identity, the idea that older people shouldn't attempt to act younger than they are; and
• Consumption, the idea that older people shouldn't consume so many scarce resources such as health care.

In studies detailed in an article for the journal Personality and Social Psychology Bulletin, the researchers found that younger people were more resentful of older people who went against these prescriptive stereotypes, compared with the feelings of middle-aged and older study participants. The article was published online in March.

In a January article in Social Issues and Policy Review, Fiske and North focused on the dangers of lumping together all older people, starting as young as ages 50 or 55. Instead, North and Fiske argue that the "young-old"—generally those still working and in relatively good health—should be considered separately from the "old-old"—generally older people who no longer work and are in poor health.

"Though numerical age is a useful indicator, it is an imprecise one when it comes to distribution of societal resources," the researchers wrote. "Age-related characteristics are evolving all the time, but social policies seem stuck in the past, uncertain how to accommodate shifting age dynamics (as evidenced by impending Social Security and Medicare crises)."

Further advancing their work, North and Fiske have conducted experiments that helped shape a scale for measuring ageism that is described in a paper accepted for publication in the journal Psychological Assessment. The Succession, Identity and Consumption scale "is a promising tool for cutting-edge ageism research, as the population grays and generational equity concerns grow more salient," the researchers wrote.

North, who is finishing his dissertation on the issue, said he hopes to continue to work on ageism throughout his career, identifying interventions that could lessen or prevent ageism, such as shifting views of the younger about what it means to be older.

"If there's one take away from this research, it's that it's important to focus on the facts of these demographic changes rather than misguided perceptions," he said. "Talking about these issues helps you find constructive ways to address them."

Provided by Princeton University

Exercise may help people with Alzheimer's avoid nursing homes

Study finds regular activity delays physical decline, reduces falls.

21 april 2013—Regular exercise slows disability and prevents falls in patients with Alzheimer's disease without increasing overall costs, a new study from Finland says.

The findings suggest that exercise, particularly when tailored to an individual's needs and performed at home, may help Alzheimer's patients maintain their independence and delay the move to a nursing home.

"This is an important study," said Dr. Kostos Lyketsos, director of the Johns Hopkins Memory and Alzheimer's Treatment Center, in Baltimore. "If we could ever deliver exercise for people with dementia in their homes, I think we could accomplish very substantial benefits for patients and reduce costs, which is a very big deal ... in health care these days." Lyketsos was not involved in the new research.

Mental changes are the first wrenching signs of Alzheimer's disease, and they often are the symptoms that get the most attention. But physical declines are also a part the disease. Over time, muscles become stiff and uncoordinated, or may start to tremor. Alzheimer's patients may lose the ability to brush their teeth, climb stairs, and dress, feed and bathe themselves.

"These people are at very high risk of disability. That's one of the reasons they end up in institutional care," said study author Dr. Kaisu Pitkala, a general practitioner at the University of Helsinki. "They need so much help that their caregivers often get very tired, and after a few years they will end up in institutional care, which is very expensive and often not the wish of the patients nor the caregivers."

For the study, published online April 15 in the journal JAMA Internal Medicine, the researchers chose more than 200 patients with moderate to severe Alzheimer's disease who were living at home with a caregiver and showing signs of physical decline. The patients were randomly assigned to one of three groups: home exercise, group exercise at a day care center, or a control group that got usual care through the Finnish national health care system.

Those in the home-exercise group got visits from a physical therapist for one hour twice a week. The physical therapists specialized in dementia care, and they tailored these sessions to each patient's problems with function and mobility.

Patients in the group-exercise classes traveled to an adult care center twice a week, where two physical therapists guided them through exercises to improve endurance, balance, strength and mental function.

The patients in the usual-care group were followed by the study nurses and were given advice on nutrition and exercise.

After one year, all the groups saw declines in physical function, but the groups that exercised regularly fared better than those who got usual care. Those in the home-exercise group did the best. Their physical function declined about half as much as that of the control group. Importantly, they also had half as many falls as those who got usual care.

Group exercisers showed some signs of better health—their strength improved over the course of the year—but those results were not statistically significant. And although the study found an association between exercise and better health among Alzheimer's patients, it didn't prove a cause-and-effect relationship.

The researchers think one reason the group exercisers didn't see bigger benefits was because they were more likely to skip their sessions than those who exercised at home.

"When the taxi came to the person's home to take them to the group-based exercise, they could say often, 'Today I'm tired; I'm not coming,'" Pitkala said. "When there's a person coming to your home and telling you, 'Let's do a little bit today,' it's much easier to say yes than it is to go outside your home."

During the year they exercised, patients in the home group had fewer hospital admissions and about half as many falls as those in the control group. The money they saved on medical bills more than offset the cost of regular private sessions with a physical therapist. The average annual cost of caring for a patient in the home-exercise group was about $25,000, but it was about $34,000 for patients who received only usual care. The annual cost for group-exercise patients was even lower, at about $22,000.

Another expert who was not involved in the study praised the research and said it offered a practical blueprint to improve the lives of patients and families affected by Alzheimer's disease.

"If you can do something that can improve their physical functioning and mobility and help them stay home and not actually cost anything—or be cost neutral—I think you can make a huge potential impact on a family's quality of life," said Dr. James Galvin, a professor of neurology and psychiatry at NYU Langone School of Medicine, in New York City.

More information: For more on the progression of Alzheimer's disease, visit the Alzheimer's Association.

Parkinson's discovery could lead to earlier diagnosis

20 april 2013—A new study could help earlier diagnosis of Parkinson's disease, after a Malaysian researcher working for Newcastle University in the UK identified that even early in the disease people experience symptoms.

While movement - motor - problems are the main symptom of Parkinson's disease, non-motor problems such as drooling, anxiety and bowel problems affect a large number of patients and begin sooner than previously thought. Earlier diagnosis could lead to earlier treatment and therefore allow patients to have a better quality of life.

In the study, published in the journal Neurology, the medical journal of the American Academy of Neurology, researchers from Newcastle University compared 159 people with newly-diagnosed Parkinson's disease to 99 people of similar ages who did not have the disease. Participants were asked whether they experienced any of the 30 non-motor symptoms screened for, including sexual problems, sleep problems and gastrointestinal problems.

Study author Dr Tien K. Khoo, said: "Often people don't even mention these symptoms to their doctors, and doctors don't ask about them, yet many times they can be treated effectively."

The people with Parkinson's disease had an average of eight of the non-motor problems, compared to three non-motor symptoms for the people who did not have the disease. Among the most common symptoms for those with Parkinson's disease included drooling, urinary urgency, constipation, anxiety and a reduced sense of smell. These were all significantly more common in people with Parkinson's disease than in those without the disease.

For example, 56 percent of the people with Parkinson's had problems with excess saliva or drooling, compared to 6 percent of those without the disease. A total of 42 percent of those with Parkinson's had constipation, compared to 7 percent of the control group. For anxiety, it was 43 percent compared to 10 percent.

Dr Khoo said: "These results show that Parkinson's affects many systems in the body, even in its earliest stages. Often these symptoms affect people's quality of life just as much if not more than the movement problems that come with the disease. Both doctors and patients need to bring these symptoms up and consider available treatments."

Newcastle University's Professor David Burn, Chief Investigator of the ICICLE-PD project, which this study is part of, said: "Hopefully clinicians can use these findings to improve the treatment of the thousands of people worldwide who suffer with Parkinson's disease. The earlier we can get a diagnosis the quicker treatment can start and patient's quality of life will improve.

"This is one part of a much bigger study, which we are hoping will lead to better treatments for this devastating disease. "

Provided by Newcastle University

Preventing cognitive decline in healthy seniors

Cognitive training exercises—or mental exercise—may help prevent cognitive decline in healthy older adults, while evidence for the benefits of pharmacologic substances and exercise is weak, outlines a review published in CMAJ (Canadian Medical Association Journal).

19 april 2013--Mild cognitive impairment (cognitive decline that is more than normal for someone of a specific age) affects 10%-25% of people over age 70. The annual rate of decline to dementia (which is cognitive decline in several areas along with some functional ability) is about 10%. With anaging population, it is estimated that the prevalence of dementia will double to more than 1 million Canadians over the next 25 years.

The authors reviewed 32 randomized controlled trials to provide the latest evidence for physicians and their patients to help manage cognitive decline.

There is no strong evidence for pharmacologic treatments such as ginkgo, dehydroepiandrosterone (DHEA), vitamins and other substances. Most studies on efficacy show no effect whereas estrogen therapy showed an increase in cognitive decline and dementia. Evidence for the benefits of physical exercise is also weak.

Mental exercise, however, showed benefits in the three clinical trials included in the review. This involved computerized training programs or intensive one-on-one personal cognitive training in memory, reasoning or speed of processing. In one trial, participants had significantly improved memory during 5-year follow-up periods. Another study showed an improvement in auditory memory and attention in a group of seniors who participated in a computerized cognitive training program.

"This review provides some evidence to help clinicians and their patients address what strategies might prevent cognitive decline," writes Dr. Raza Naqvi, Division of Geriatric Medicine, University of Toronto, with coauthors. "Future studies should address the impact of cognitive training on the prevention of cognitive decline, and we encourage researchers to consider easily accessible tools such as crossword puzzles and sudoku that have not been rigorously studied. The studies in this review that assessed cognitive exercises used exercises that were both labour- and resource-intensive, and thus may not be applicable to most patients."

More information: www.cmaj.ca/lookup… /cmaj.121448

Provided by Canadian Medical Association Journal

Green cities mean healthier people

18 april 2013—Australians will be happier, safer and healthier if they look after the nature spots in their cities, according to new research led by The University of Queensland.

The research was led by Dr Richard Fuller from UQ's School of Biological Sciences and the National Environmental Research Program's (NERP) Environmental Decisions Hub, an Australian Government research hub hosted by UQ.

Dr Fuller said the research showed that having nature nearby can boost people's health, improve their ability to think, and help lower violence and aggression in the community.

"Conserving nature in cities, such as restoring habitats or setting up reserves can be expensive relative to conservation actions outside cities," Dr Fuller said.

"This often raises the question of whether we should invest in keeping biodiversity within our urban areas.

"The answer is yes, as scientific studies around the world now show that experiences of nature provide important benefits to many aspects of our lives, including our mental and physical health, social relationships and even our spiritual wellbeing."

One study that compared the effects of exercising in a green space and an urban environment revealed that stress was reduced after exercise in forest or parks but not in built-up areas. Another study showed that children who participated in gardening or who visited parks had improved self-esteem and mental wellbeing.

Spending time in nature can also help sick people recover faster, Dr Fuller said.

"Patients in rooms with a view of trees spend less time in hospitals, require fewer strong painkillers and have fewer postsurgical complications than those whose rooms overlook a brick wall.

"Nature can also lower death rates. Various studies in the UK and Netherlands show that people living near green spaces have lower disease loads and mortality rates."

As well as physical and mental health benefits, the restorative properties of nature can improve a person's ability to tackle mentally challenging tasks, the studies showed.

"We constantly direct our attention towards avoiding hazards and coping with noise and sights in busy urban environments," Dr Fuller said.

"This requires sustained effort and can lead to mental fatigue, resulting in reduced ability to concentrate.

"A study shows that when asked to repeat a sequence of numbers in reverse order, students who previously walked through a busy city street performed poorly compared to those who had walked through a tree-lined arboretum."

Another study that tested people's ability to proofread reveals that those who spent their vacation in the wilderness made few mistakes, whereas the performance of those who spent their holidays elsewhere was poorer.

The benefits of living close to nature also extend to wider society. In Chicago, violence and aggression were significantly lower in buildings with more surrounding vegetation, Dr Fuller said.

In addition, having shared green spaces in urban areas encouraged social interaction and fostered empowerment. People who participated in community conservation projects often benefited from the social support they encounter there, he said.

"While we aren't sure which aspects of nature deliver these benefits – whether it's particular types of garden, trees or animals – there is mounting evidence that having green spaces close to us has a positive impact on our lives," Dr Fuller said.

"This is a win-win situation for conservation and society - so we should hold on to our green spaces instead of clearing them for development."

Dr Fuller says Australians could plant more trees and shrubs in their backyards to encourage biodiversity.

"It's important to have lots of vegetation where possible, including denser thickets, tall trees, low-growing shrubs and scraggly grass where birds and insects abound," he said.

"In the meantime, spend more time outdoors, especially with your children. A nationwide survey in US shows that growing up in natural environments has a strong influence on positive environmental attitudes in adult life, and they are more likely to appreciate and support conservation in adulthood."

More information: Keniger, L. et al. What are the benefits of interacting with nature? International Journal of Environmental Research and Public Health. www.mdpi.com/1660-… 10/3/913/pdf

Provided by University of Queensland

No evidence drugs, vitamins, supplements help prevent cognitive decline in healthy older adults

A review of published research has found no evidence that drugs, herbal products or vitamin supplements help prevent cognitive decline in healthy older adults.

17 april 2013--The review, conducted at St. Michael's Hospital, found some evidence that mental exercises, such as computerized memory training programs, might help.

"This review provides some evidence to help clinicians and their patients address what strategies might prevent cognitive decline," said Dr. Raza Naqvi, a University of Toronto resident and lead author of the review.

The issue is of particular importance given that mild cognitive impairment affects 10 to 25 per cent of people over age 70. Mild cognitive impairment is characterized by reduced memory, judgment, and decision-making skills compared to someone of a similar age, but not enough to interfere with daily activities.

The annual rate of decline into dementia, such as Alzheimer's disease, is about 10 per cent. Given that rate and the aging population, it's estimated the number of Canadians with dementia will double to more than 1 million in the next 25 years.

Researchers including Dr. Sharon Straus, head of the Knowledge Translation Program at St. Michael's, reviewed 32 randomized clinical trials involving about 25,000 patients.

They found no strong evidence for pharmacologic treatments such as cholinesterase inhibitors that were developed to improve the effectiveness of acetylcholine, a chemical messenger that assists memory, thought and judgment.

Nor was there strong evidence that herbal supplements such as gingko improved cognitive functions or vitamins and fatty acids such as vitamin B6 or omega-3 fatty acids.

Some studies on estrogen actually indicated an increase in cognitive decline and dementia.

Evidence on the value of physical exercise, such as strength-training, was weak.

The strongest evidence was for the value of mental exercises such as computerized training programs or intensive one-on-one personal cognitive training in memory, reasoning, or speed of processing.

Dr. Naqvi said future studies should address the impact of cognitive training on the prevention of cognitive decline.

"We encourage researchers to consider easily accessible tools such as crossword puzzles and sudoko that have not been rigorously studied," he said. "The studies in this review that assessed cognitive exercises used exercises that were both labour- and resource-intensive, and thus may not be applicable to most of our patients."

Provided by St. Michael's Hospital

Where does coffee stand in your health?

We are often asked whether coffee is good or bad for the health. The answer is both good and bad.

15 april 2013--Many studies have been done that show no overall adverse outcome on health associated with caffeine from coffee. However, there are certain aspects of coffee drinking that may be deleterious to health.

THE GOOD

-The Nurses' Health Study and Health Professions Follow-up study done on 130,000 people tracked caffeine consumption for approximately 20 years and found that coffee does not increase mortality.

There was no relationship found between coffee consumption and increased risk of death from any cause including cancer or heart disease.

-Studies around the world consistently show high consumption of caffeinated or decaffeinated coffee is associated with low risk of type 2 diabetes, so scientists hypothesize there may be a long-term benefit from caffeine on diabetes.

-Other preliminary research has shown that coffee may protect against Parkinson's disease, liver cancer and liver cirrhosis, as well as a reduced risk of cardiovascular disease.

-A study led by Harvard School of Public Health researchers published in the Sept. 26, 2011, issue of the Archives of Internal Medicine, found that, among women, drinking coffee may reduce the risk of depression. The study found the risk of depression to be 20 percent lower among women who drank four or more cups of caffeinated coffee than those who drank little or none. Those who drank decaf, tea, soft drinks, chocolate and other beverages containing less caffeine did not appear to be protected against depression.

-Caffeine has been shown to increase alertness and test performance.

THE BAD

-Coffee contains cafestol, which increases LDL cholesterol levels. Usually, this is resolved by using a paper filter. However, if you drink your coffee boiled and unfiltered, via French press, or Turkish style, you will ingest large levels of cafestol. Unfiltered coffee has been shown in some studies to increase LDL by 8 percent.

-There may be a short-term negative effect on diabetes with coffee. In studies that give people caffeine or caffeinated coffee, followed by something rich in glucose, it was found that the subjects' sensitivity to insulin dropped and their blood-glucose levels were higher than expected.

-Coffee prepared black, or with a small amount of milk and sugar may be healthy. However, most coffee drinks contain large amounts of processed sugar, syrups, cream and whipped cream - which can increase blood sugars and cholesterol levels. Further, many coffee drinks have upward of 500 calories - 25 percent of the total calories that are needed for a 2,000-calorie-per-day diet. Thus, the calories alone in these drinks can lead to weight gain.

-Coffee drinking as a lifestyle behavior appears to be linked to other negative lifestyle behaviors, such as exercising less, a less-healthy diet and increased smoking. Thus, whereas coffee may be neutral on the health, other associated behaviors may cause adverse health outcomes.

(c)2013 The Sacramento Bee (Sacramento, Calif.) 
Distributed by MCT Information Services

Older people may be at greater risk for alcohol impairment than teens, study says

An acute dose of alcohol may cause greater impairment in coordination, learning and memory in the elderly than in young people, according to a study by Baylor University.

15 april 2013--Researchers said the findings have profound significance for older people —a population that is aging worldwide at an unprecedented rate and that includes Baby Boomers as they become seniors.

"Health implications such as falls, accidents and poor medicine-taking are pretty easy to conclude," said Douglas B. Matthews, Ph.D., senior author of the paper, published online in the journal Alcoholism: Clinical and Experimental Research.

In the United States, as many as 13 percent of men and 8 percent of women over age 65 engage in risky drinking behavior, with an estimated 1 to 3 percent of those afflicted with an alcohol use disorder, according to prior research. Because of improvements in medicine and public health, nutrition and education, people 65 and older will account for nearly 20 percent of the U.S. population by the year 2030, according to U.S. Census Bureau estimates.

While previous data have indicated that aged people show significantly greater impairments than younger adults when alcohol is consumed, understanding the neurobiology underlying that increased sensitivity in the aged has been hampered by the lack of an adequate animal model, said Matthews, a research scientist in psychology and neuroscience in Baylor's College of Arts & Sciences and head of psychology at Nanyang Technological University in Singapore.

The Baylor research, the first of its kind, established a baseline of the acute effects of alcohol in aged populations, which can aid future research into neurobiology and in determining the effect of prolonged alcohol abuse.

The experiment included adult and aged rats (at least 18 months old), Matthews said. It showed a dramatic increase in ethanol-induced ataxia.

"We know a lot of neurobiological changes occur during aging which underlie age-related cognitive and behavioral deficits. It's reasonable to suspect a significant interaction exists between age-related and alcohol-induced effects in the brain," said Jim Diaz-Granados, Ph.D., a study co-author, chair of Baylor's department of psychology and neuroscience, and chair of the Council of Graduate Departments of Psychology, a national organization.

"Our hope would be that further findings in this area will serve as a basis to educate the public regarding the risks and provide insights in the clinic," Diaz-Granados said.

Provided by Baylor University

Mobile phones could carry end-of-life care wishes

Storing and creating advanced care directives on mobile phones would give doctors easier access to end-of-life care wishes. Credit: shutterstock.com

Mobile phones should be used to express and store our end-of-life medical care preferences, experts say.

14 april 2013--Advance care directives (ACDs) are legal documents that allow people to detail the quality of life they are prepared to accept when in a coma, terminally ill, or no longer able to speak for themselves.

But few Australians have ACDs and those who do rarely carry them, meaning clinicians are unable to access the patient's wishes in life threatening medical situations.

Ms Margaret Brown, research fellow at the University of South Australia's Hawke Research Institute, said mobile phones may provide an answer.

"The key benefit would be, that it is something you have on you or close to you, and its not stored in a shoe box under the bed where nobody knows its there," Ms Brown said.

A further potential benefit of using mobile phones in the creation of these ACDs is that it may allow the documents to be more readily altered.

"The important thing about any sort of electronic record, is that it must be on the person rather than on the computer because if the person decides they want to make a change to their direction, to their wishes, reappoint somebody because there has been a conflict in the family, they have to be able to change it," Ms Brown said.

Professor Kenneth Hillman, Professor of Intensive Care, University of New South Wales said storing and creating ACDs on mobile phones made a lot of sense.

"It is not just having your wishes recorded, it is making sure that your wishes are conveyed to everyone. It is important that the app or information is available to your general practitioner and family," Professor Hillman said

"For younger people it might even be able to be tied up with, and financially supported by, the big move to make Australians aware of the possibilities of their organs being donated, so the two things could go hand in hand."

But the idea is still in early stages, with many potential hurdles to overcome.

"Many of the people we are talking about are in their 70s, 80s, and 90s now, and they may not have ready access to mobile phone technologies," Professor Hillman said.

Professor Colleen Cartwright, Foundation Professor of Aged Services and Director of the ASLaRC Aged Services Unit, Southern Cross University, echoed this view and said a lack of uniformity in state laws, the need for the documents to be witnessed, and the potential privacy considerations would all need to be addressed before the technology could be put to use.

"How do you make sure it is not the [person's] children who alter it rather than the person themselves; how are you going to provide the security?" Professor Cartwright said.

Ms Brown also acknowledged these hurdles but said the idea warranted further investigation.

Source: The Conversation

Scientists map elusive 3-D structure of telomerase enzyme, key actor in cancer, aging

Entire telomerase enzyme .

13 april 2013—Like finally seeing all the gears of a watch and how they work together, researchers from UCLA and UC Berkeley have, for the first time ever, solved the puzzle of how the various components of an entire telomerase enzyme complex fit together and function in a three-dimensional structure.

The creation of the first complete visual map of the telomerase enzyme, which is known to play a significant role in aging and most cancers, represents a breakthrough that could open up a host of new approaches to fighting disease, the researchers said.

"Everyone in the field wants to know what telomerase looks like, and there it was. I was so excited, I could hardly breathe," said Juli Feigon, a UCLA professor of chemistry and biochemistry and a senior author of the study. "We were the first to see it."

The scientists report the positions of each component of the enzyme relative to one another and the complete organization of the enzyme's active site. In addition, they demonstrate how the different components contribute to the enzyme's activity, uniquely correlating structure withbiochemical function.

The research appears April 11 in the print edition of the journal Nature and is available online.

"We combined every single possible method we could get our hands on to solve this structure and used cutting-edge technological advances," said co-first author Jiansen Jiang, a researcher who works with Feigon and the study's co-senior author, Z. Hong Zhou, director of the Electron Imaging Center for Nanomachines at the California NanoSystems Institute at UCLA and a professor of microbiology, immunology and molecular genetics. "This breakthrough would not have been possible five years ago."

"We really had to figure out how everything fit together, like a puzzle," said co-first author Edward Miracco, a National Institutes of Health postdoctoral fellow in Feigon's laboratory. "When we started fitting in the high-resolution structures to the blob that emerged from electron microscopy, we realized that everything was fitting in and made sense with decades of past biochemistry research. The project just blossomed, and the blob became a masterpiece."

The telomerase enzyme is a mixture of components that unite inside our cells to maintain the protective regions at the ends of our chromosomes, which are called telomeres. Telomeres act like the plastic tips at the end of shoelaces, safeguarding important genetic information. But each time a cell divides, these telomeres shorten, like the slow-burning fuse of a time bomb. Eventually, the telomeres erode to a point that is no longer tolerable for cells, triggering the cell death that is a normal part of the aging process.

While most cells have relatively low levels of telomerase, 80 percent to 90 percent of cancer cells have abnormally high telomerase activity. This prevents telomeres from shortening and extends the life of these tumorigenic cells—a significant contributor to cancer progression.

The new discovery creates tremendous potential for pharmaceutical development that takes into account the way a drug and target molecule might interact, given the shape and chemistry of each component. Until now, designing a cancer-fighting drug that targeted telomerase was much like shooting an arrow to hit a bulls-eye while wearing a blindfold. With this complete visual map, the researchers are starting to remove that blindfold.

"Inhibiting telomerase won't hurt most healthy cells but is predicted to slow down the progression of a broad range of cancers," said Miracco. "Our structure can be used to guide targeted drug development to inhibit telomerase, and the model system we used may also be useful to screen candidate drugs for cancer therapy."

The researchers solved the structure of telomerase in Tetrahymena thermophila, the single-celled eukaryotic organism in which scientists first identified telomerase and telomeres, leading to the 2009 Nobel Prize in medicine or physiology. Research on Tetrahymena telomerase in the lab of co-senior author Kathleen Collins, a professor of molecular and cell biology at UC Berkeley, laid the genetic and biochemical groundwork for the structure to be solved.

"The success of this project was absolutely dependent on the collaboration among our research groups," said Feigon.

"At every step of this project, there were difficulties," she added. "We had so many technical hurdles to overcome, both in the electron microscopy and the biochemistry. Pretty much every problem we could have, we had, and yet at each stage these hurdles were overcome in an innovative way."

One of the biggest surprises, the researchers said, was the role of the protein p50, which acts as a hinge in Tetrahymena telomerase to allow dynamic movement within the complex; p50 was found to be an essential player in the enzyme's activity and in the recruitment of other proteins to join the complex.

"The beauty of this structure is that it opens up a whole new world of questions for us to answer," Feigon said. "The exact mechanism of how this complex interacts with the telomere is an active area of future research."

"The atmosphere and collaboration at UCLA really amazes me, and that is combined with some of the most advanced facilities around," Zhou said. "We have a highly advanced electron microscopy facility here at UCLA that even researchers without a strong background in electron microscopy can learn how to use and benefit from. This will be really useful as we move forward."

Provided by University of California, Los Angeles

Healthy doctors make healthy patients, study finds

Patients are more likely to follow preventive health practices like getting a flu shot or mammography if their doctors do likewise, researchers at the University of British Columbia and in Israel have discovered.

12 april 2013--"We found that patients whose physicians adhered to the recommended screening or vaccination practices were significantly more likely to also undergo screening or vaccination compared with patients of non-compliant physicians," said Dr. Erica Frank of UBC's School of Population and Public Health.

Dr. Frank worked with three Israeli researchers and their findings are published in the April 8 edition of the Canadian Medical Association Journal.

Researchers looked at the screening and vaccination practices of 1,488 physicians and their almost 1.9 million adult patients in Israel's largest health care organization, Clalit Health Services (CHS). Practices included mammography, blood pressure measurement, colorectal screening, annual influenza vaccinations and others.

Dr. Frank noted that 49 per cent of patients of physicians who received a flu shot also received the vaccine compared with 43 per cent of patients whose physicians did not receive the vaccine.

The study also highlighted that doctors could improve their personal screening and vaccination practices.

"While physicians' health habits are generally exemplary, doctors could improve some of their personal screening and vaccination practices, which should improve the health practices of their patients." Dr. Frank said.

The researchers recommended that hospitals and medical schools develop programs for physician health promotion in order to encourage a healthy doctor-healthy patient relationship.

More information: www.cmaj.ca/lookup… /cmaj.121028

Provided by University of British Columbia

ACP unveils tools to improve care for patients with prediabetes, gout, obesity, and Alzheimer's

The American College of Physicians (ACP) today unveiled a series of interventions to help patients and physicians manage prediabetes, gout, obesity and weight loss, and Alzheimer's disease.

"Prediabetes: Your guide to reducing your risk for the development of diabetes"

11 april 2013--Patients with prediabetes and undiagnosed type 2 diabetes face serious health issues. Prediabetes increases the risk of cardiovascular disease and death compared with normal patients. Untreated diabetes can lead to blindness, kidney disease, amputation, and other serious conditions.

This patient booklet, funded by a grant from Novo Nordisk, is designed to encourage conversation between patients and their physicians. It provides important information about prediabetes and risks for diabetes that should trigger action by the patient. Offered in English and Spanish, the booklet is written in a conversational tone at a fifth-grade reading level and includes photographs of real patients with their families. It gives practical tips and concrete examples of how to reduce the risk for developing diabetes.

Three patient videos are also available: "Prediabetes: An Overview"," Prediabetes and Proper Diet," and "Prediabetes and Increasing Activity."

"Relief from Gout: A Guide for Patients"

Gout is a type of arthritis that causes sudden severe pain, swelling, and tenderness. Left untreated, gout attacks can become more frequent and severe. Approximately 8 million people in the U.S. cope with gout, but it is still often not recognized or treated.

The guidebook and accompanying DVD explain the basics of gout and how it can be successfully managed. Patients will learn what causes gout, how to relieve gout pain, and ways to reduce the risk of future gout attacks.

"Excess Weight and Your Health: A Guide to Effective, Healthy Weight Loss"

Obesity is an increasingly urgent public health issue. Produced in partnership with the Obesity Action Coalition and funded by VIVUS, Inc., this guidebook and accompanying DVD profiles "success stories" of four formerly obese patients and explains why some people gain excess weight, the risks of having excess weight, and what patients can do about it. Patients

will learn nutrition and fitness tips that will show how to make better food choices and incorporate physical activity. Patients also will learn about medicines and surgical techniques that may be options for those with significant excess weight.

"Make It Happen!: Helpful Ways to Lose Weight"

Designed with input from experts and people who have either lost weight or are trying to lose weight, this guidebook provides valuable information to help patients with the struggle of losing weight and with helpful tips for making healthier choices. Patients will learn how to eat better, move more, sleep well, and stress less.

Like other ACP patient guides, "Make It Happen" includes clear language and photos so that patients will not be intimidated by complex information and impersonal graphics. The guide suggests small steps patients can take as well as helping patients develop their own achievable action plans.

Alzheimer's Disease

Alzheimer's disease is a form of dementia that gradually gets worse over time, affecting memory, thinking, and behavior. According to the Alzheimer's Association, more than five million Americans—one in eight older Americans—have Alzheimer's disease.

ACP has produced three videos, funded by a grant from Pfizer Inc., to help clinicians assess Alzheimer's disease, the sixth-leading cause of death in the United States: "Alzheimer's Disease Visit 1: Assessing Cognition and Recommending Follow-up," "Alzheimer's Disease Visit 2: Disclosing an Alzheimer's Diagnosis," and "Peer-to-Peer Discussion of Important Aspects of Assessing Cognition and Disclosing Alzheimer's Disease during Primary Care Visits."

ACP's patient education materials can be ordered at http://www.acponline.org/patient_tools or by calling ACP Customer Service at 800-523-1546, extension 2600. "Prediabetes," "Relief from Gout,", "Excess Weight and Your Health," and "Alzheimer's Disease" are available for all physicians to order for free. "Make It Happen" is available for all physicians to order for their patients but is free to ACP members.

Provided by American College of Physicians

New evidence that egg white protein may help high blood pressure

Scientists reported new evidence today that a component of egg whites—already popular as a substitute for whole eggs among health-conscious consumers concerned about cholesterol in the yolk—may have another beneficial effect in reducing blood pressure. Their study was part of the 245th National Meeting & Exposition of the American Chemical Society (ACS).

10 april 2013--"Our research suggests that there may be another reason to call it 'the incredible, edible egg,'" said study leader Zhipeng Yu, Ph.D., of Jilin University. "We have evidence from the laboratory that a substance in egg white—it's a peptide, one of the building blocks of proteins—reducesblood pressure about as much as a low dose of Captopril, a high-blood-pressure drug."

Yu and colleagues, who are with Clemson University, used a peptide called RVPSL. Scientists previously discovered that the substance, like the family of medications that includes Captopril, Vasotec and Monopril, was an angiotensin-converting-enzyme (ACE) inhibitor. It has a powerful ability to inhibit or block the action of ACE, a substance produced in the body that raises blood pressure.

They set out to further document RVPSL's effects, using laboratory rats that develop high blood pressure and are stand-ins for humans in such early research on hypertension. The results of feeding the substance were positive, showing that RVPSL did not have apparent toxic effects and lowered blood pressure by amounts comparable to low doses of Captopril.

"Our results support and enhance previous findings on this topic," Yu said. "They were promising enough to move ahead with further research on the effects of the egg white peptide on human health."

Yu noted that the research was done with a version of the peptide that was heated to almost 200 degrees Fahrenheit during preparation—less than the temperatures typically used to cook eggs. He cited evidence from other research, however, that egg whites may retain their beneficial effects on blood pressure after cooking.

One, for instance, published in the ACS' Journal of Agricultural and Food Chemistry, showed that fried egg protein, cooked at high temperatures, actually showed greater ability to reduce blood pressure than eggs boiled at 212 degrees F.

Yu believes that egg white peptides, either in eggs or as a supplement, could become useful as an adjunct to high-blood-pressure medication. For now, he said people with high blood pressure should consult their health care provider before making any changes.

And he noted that findings about egg white and high blood pressure add to the emerging nutritional image of eggs. Once regarded as a food to avoid in a healthy diet, studies in recent years have concluded that many people can eat eggs without raising their blood cholesterol levels, benefiting from an inexpensive food low in calories and rich in protein, vitamins and other nutrients.

More information: Abstract

The purpose of the work was to evaluate cell viability of egg white protein peptide RVPSL (Arg-Val-Pro-Ser-Leu), which had been characterized previously in vitro as a potent inhibitor of angiotensin-converting enzyme (ACE), and to investigate antihypertensive effect in spontaneously hypertensive rats. In the current work, cell viability of RVPSL was measured by MTT method. Subsequently, in vivo antihypertensive effect of RVPSL orally administered was evaluated by the tail-cuff method. The systolic blood pressure and the diastolic blood pressure of rats were measured before administration and also 5, 10, 15, and 20 h post-administration. The results showed that RVPSL at 6 mg/ml was not toxic to HepG2 cells. Our founding also indicated that short-term antihypertensive effect of RVPSL administration at a dose of 50 mg/kg b w was comparable to Captopril at 10 mg/kg b w dose. Therefore, egg white protein peptide may be useful to prevent or treat hypertension.

Provided by American Chemical Society

Researchers discover new link between heart disease and red meat

An uncooked rib roast. Credit: Michael C. Berch/Wikipedia

A compound abundant in red meat and added as a supplement to popular energy drinks has been found to promote atherosclerosis – or the hardening or clogging of the arteries – according to Cleveland Clinic research published online this week in the journal Nature Medicine.

09 april 2013--The study shows that bacteria living in the human digestive tract metabolize the compound carnitine, turning it into trimethylamine-N-oxide (TMAO), a metabolite the researchers previously linked in a 2011 study to the promotion of atherosclerosis in humans. Further, the research finds that a diet high in carnitine promotes the growth of the bacteria that metabolize carnitine, compounding the problem by producing even more of the artery-clogging TMAO.

The research team was led by Stanley Hazen, M.D., Ph.D., Vice Chair of Translational Research for the Lerner Research Institute and section head of Preventive Cardiology & Rehabilitation in the Miller Family Heart and Vascular Institute at Cleveland Clinic, and Robert Koeth, a medical student at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

The study tested the carnitine and TMAO levels of omnivores, vegans and vegetarians, and examined the clinical data of 2,595 patients undergoing elective cardiac evaluations. They also examined the cardiac effects of a carnitine-enhanced diet in normal mice compared to mice with suppressed levels of gut microbes, and discovered that TMAO alters cholesterol metabolism at multiple levels, explaining how it enhances atherosclerosis.

The researchers found that increased carnitine levels in patients predicted increased risks for cardiovascular disease and major cardiac events like heart attack, stroke and death, but only in subjects with concurrently high TMAO levels. Additionally, they found specific gut microbe types in subjects associated with both plasma TMAO levels and dietary patterns, and that baseline TMAO levels were significantly lower among vegans and vegetarians than omnivores. Remarkably, vegans and vegetarians, even after consuming a large amount of carnitine, did not produce significant levels of the microbe product TMAO, whereas omnivores consuming the same amount of carnitine did.

"The bacteria living in our digestive tracts are dictated by our long-term dietary patterns," Hazen said. "A diet high in carnitine actually shifts our gut microbe composition to those that like carnitine, making meat eaters even more susceptible to forming TMAO and its artery-clogging effects. Meanwhile, vegans and vegetarians have a significantly reduced capacity to synthesize TMAO from carnitine, which may explain the cardiovascular health benefits of these diets."

Prior research has shown that a diet with frequent red meat consumption is associated with increased cardiovascular disease risk, but that the cholesterol and saturated fat content in red meat does not appear to be enough to explain the increased cardiovascular risks. This discrepancy has been attributed to genetic differences, a high salt diet that is often associated with red meat consumption, and even possibly the cooking process, among other explanations. But Hazen says this new research suggests a new connection between red meat and cardiovascular disease.

"This process is different in everyone, depending on the gut microbe metabolism of the individual," he says. "Carnitine metabolism suggests a new way to help explain why a diet rich in red meat promotes atherosclerosis."

While carnitine is naturally occurring in red meats, including beef, venison, lamb, mutton, duck, and pork, it's also a dietary supplement available in pill form and a common ingredient in energy drinks. With this new research in mind, Hazen cautions that more research needs to be done to examine the safety of chronic carnitine supplementation.

"Carnitine is not an essential nutrient; our body naturally produces all we need," he says. "We need to examine the safety of chronically consuming carnitine supplements as we've shown that, under some conditions, it can foster the growth of bacteria that produce TMAO and potentially clog arteries."

This study is the latest in a line of research by Hazen and his colleagues exploring how gut microbes can contribute to atherosclerosis, uncovering new and unexpected pathways involved in heart disease. In a 2011 Nature study, they first discovered that people are not predisposed to cardiovascular disease solely because of their genetic make-up, but also based on how the micro-organisms in their digestive tracts metabolize lecithin, a compound with a structure similar to carnitine.

More information: Paper: dx.doi.org/10.1038/nm.3145

Provided by Cleveland Clinic