Avoiding that new year's hangover

Drink in moderation and eat beforehand, doctor says.

31 dec 2013—Hangover headaches are a common problem over the holidays, but there are ways to prevent them, an expert says.

The best way to avoid a hangover headache is to stick to non-alcoholic drinks such as sodas, spritzers and punches, said Dr. Noah Rosen, director of the Headache Center at North Shore-LIJ's Cushing Neuroscience Institute in Manhasset, N.Y.

If you do drink alcohol, do so in moderation, he advised.

"It is also best to eat beforehand as having food in the stomach slows the absorption of alcohol in the body," Rosen noted. "High-fat foods are particularly good in absorbing alcohol. Also, it is a good idea to snack throughout the party to keep blood sugar levels up."

Drink alcohol slowly and make every other drink a non-alcoholic one. Water is the best choice, because caffeinated sodas can boost heart rate and contribute to dehydration, he explained.

"Avoid darker alcohols as they contain more congeners, which are toxic chemicals," Rosen said. "Red wine has high congeners that can contribute to a hangover headache."

If you've been drinking, taking an anti-inflammatory drug—such as aspirin or ibuprofen or naproxen—before going to sleep will help reduce the pain of a hangover headache, Rosen said.

More information: The U.S. National Library of Medicine offers hangover treatment tips.

Tips to jump-start your New Year's resolutions

Expert advice on putting weight-loss, healthy-eating and exercise plans 

30 dec 2013--Healthier eating, losing weight and getting more exercise are among the most common New Year's resolutions, and it's important to make a plan and be patient to achieve these goals, an expert says.

If you decide to start eating healthier, it can be difficult to decide where to start. It's best to focus on specific changes to make your goal more attainable, said Kelly Hogan, a clinical dietitian at Mount Sinai Hospital in New York City.

Here are some examples: Replace fried chicken or fish with baked or broiled versions two or three times a week; eat four or five servings of vegetables every weekday; and cook dinner at home three nights a week instead of ordering carry-out food.

Instead of cutting out all your nightly desserts, plan to have one small dessert one or two nights per week. This will satisfy your sweet tooth and prevent intense cravings, Hogan said.

If you pledge to get more exercise, try to schedule workouts with a friend who has similar goals so you can hold each other accountable. You could also plan exercise in smaller increments throughout the day, Hogan said. For example, divide 30 minutes of daily exercise into three 10-minute sessions.

There are other easy ways to boost your physical-activity levels, Hogan said, such as getting off the subway a few stops early and walking the rest of the way.

If you vow to lose weight, you need to keep reminding yourself to be patient. People who lose weight gradually and steadily (1 or 2 pounds a week) are more successful at keeping the weight off, according to the U.S. Centers for Disease Control and Prevention.

One good way to get started is to keep a food journal for a few days in order to get an idea of your eating habits and levels of food consumption, Hogan said. There are some good mobile apps to help you track calorie intake and exercise, she said. If you can, work with a registered dietitian to develop a plan and help you achieve your weight-loss goals, Hogan said.

More information: The U.S. General Services Administration offers tips for sticking with popular New Year's resolutions.

Study: New Year resolution is your best chance to quit smoking

A New Year resolution to quit smoking is particularly effective if combined with stop smoking medications and support.

January is one of the best times to give up smoking, according to award-winning researchers who say New Year's resolutions can help you quit forever.

29 dec 2013--Data from UK studies into who gives up smoking, and how, indicate that people who quit in January are more likely to be successful than those who quit at other times of the year.

This is because New Year's resolutions can give an added boost to quitters' motivation, a critical element in whether or not people will be successful.

University of Stirling public health scientist Professor Linda Bauld says :"Studies over the last decade show that one of the single biggest factors in predicting whether someone will stop smoking is how motivated they are. A January deadline can give a bit of extra motivation."

A New Year resolution to quit smoking is particularly effective if combined with stop smoking medications and support, she emphasises.

According to Professor Bauld and her team - whose ground-breaking research was recognised with a prestigious Queen's Anniversary Prize in 2013 - a further incentive to successful quitting includes having a "buddy" who stops smoking with you.

"Social support is important. For example, one of the biggest determinants of whether a woman manages to stop during pregnancy is if her partner also stops," says Professor Bauld.

Only four per cent of smokers who try to give up by relying purely on will power are likely to succeed, according to the data.

Add in anti-smoking medication and behavioural support from the National Health Service, and smokers will be four times more likely to give up tobacco for good.

Many smokers are now using e-cigarettes to help quit tobacco, which contains harmful toxins, but the jury is still out on whether these nicotine delivery devices are hazardous to longer-term health.

Don't give up on quitting smoking if you have tried it before and failed, because the research shows that many people have successfully stopped after several dud attempts.

"The more often you try to stop, the more likely you are to be successful eventually," says the University of Stirling scientist.

The data also shows that if you started smoking early, as a child or teenager, you are likely to find it much more difficult to stop. This is because if you start smoking when your brain is still developing, the effects of being exposed to nicotine are particularly harmful.

"If we can delay someone becoming a smoker, that in itself is an achievement," says Professor Bauld.

The work of Professor Bauld and her colleagues at the University of Stirling has been instrumental in shaping policy changes that have seen the UK implement bans on tobacco advertising and smoking in public places over the past decade.

The university's researchers have also led work to help develop laws that restrict the display and promotion of tobacco in shops around the UK and ban cigarette sales to under-18s in Scotland.

One of the key sources of evidence for policy and public health recommendations is the Institute's Youth Tobacco Policy Survey, which has been carried out every two to three years since 1999 and is funded by Cancer Research UK.

It measures smoking attitudes before and after policies are introduced. At least 7,000 young people have participated in the survey.

Smoking is the leading preventable cause of chronic disease and death in the UK.

Provided by University of Stirling

USPSTF supports counseling, BRCA tests for at-risk women 

28 dec 2013—Nine of 10 women do not need and should not receive genetic testing to see if they are at risk for breast or ovarian cancer, an influential panel of health experts announced Monday.

The U.S. Preventive Services Task Force (USPSTF) reaffirmed its previous recommendation from 2005 that only a limited number of women with a family history of breast cancer be tested for mutations in the BRCA1 and BRCA2 genes that can increase their cancer risk.

Even then, these women should discuss the test with both their family doctor and a genetic counselor before proceeding with the BRCA genetic test, the panel said.

"Not all people who have positive family histories should be tested. It's not at all simple or straightforward," said Dr. Virginia Moyer, the task force's chair.

Interest among women in genetic testing for breast cancer has greatly increased, partially due to Hollywood film star Angelina Jolie's announcement in May that she underwent a double mastectomy because she carried the BRCA1 mutation.

A Harris Interactive/HealthDay poll conducted a few months after Jolie's announcement found as many as 6 million women in the United States planned to get medical advice about having a preventive mastectomy or ovary removal because of the actress' personal decision.

On average, mutations of the BRCA genes can increase breast cancer risk between 45 percent to 65 percent, according to the American Cancer Society.

The problem is that there are myriad mutations of the BRCA gene. Doctors have identified some mutations that increase breast cancer risk, but there are many more BRCA mutations where the increased risk is either low or as yet unknown.

"The test is not something that comes back positive or negative. The test comes back a whole lot of different ways, and that has to be interpreted," Moyer said. "There are a variety of mutations. Often you get what appears to be a negative test but we call it an 'uninformative' negative because it just doesn't tell you anything. A woman would walk away from that with no idea, but worried, and that's not helpful."

Earlier this month, the genetic testing company 23andMe announced it's no longer offering health information with its home-based kit service after the U.S. Food and Drug Administration warned that the test is a medical device that requires government approval.

The new task force recommendations will be published online Dec. 23 in the Annals of Internal Medicine.

The task force's judgment carries heavy weight within the health care industry. For instance, the federal government's list of preventive health care measures that insurers must provide free of charge under the Affordable Care Act is based on USPSTF recommendations.

According to the task force, about 90 percent of American women do not have a family history associated with an increased risk for BRCA mutations, and even fewer will have a mutation that could lead to breast cancer.

"Only two or three women in a thousand have these mutations. Doing this is not going to prevent most breast cancers," Moyer said.

Medical experts are concerned that many women will undergo unnecessary surgery following an unclear genetic test, having their breasts or ovaries needlessly removed to prevent a cancer risk they never had.

"All of us have a copy of the BRCA gene, and some of us have a mutation," said Dr. Otis Brawley, chief medical officer of the American Cancer Society. "Some mutations increase the risk of breast cancer by up to 85 percent, others by 40 percent, others by 10 percent."

"But the woman who now knows she has a mutation is very frightened and very upset, and no amount of explaining that it's of little to no significance will help," Brawley continued.

Both Brawley and Moyer emphasized that any woman interested in BRCA screening should meet with a certified genetic counselor before proceeding. The counselor will take a very detailed clinical history of the patient and assess whether they would benefit from the test.

"The key here is that women who think they might want the test should talk to a genetic counselor, and that genetic counselor should explain the risks and benefits of the test and help them make the decision," Brawley said. "A physician shouldn't necessarily be the person doing it. It should be a certified genetic counselor. Most doctors are not skilled at doing this."

The task force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. It routinely issues recommendations about clinical preventive services such as screenings, counseling services and preventive medications.

More information: Full Text - Evidence Review
Full Text - Recommendation Statement

Angelina Jolie's preventive mastectomy raised awareness, but not knowledge of breast cancer risk

Angelina Jolie heightened awareness about breast cancer when she announced in a New York Times op-ed that she had undergone a preventive double mastectomy. But a new study led by researchers in the University of Maryland School of Public Health and the Johns Hopkins School of Public Health reveals that widespread awareness of Jolie's story did not unfortunately translate into increased understanding of breast cancer risk.

27 dec 2013--The survey of more than 2,500 Americans found that three out of four were aware of Jolie's story, but fewer than 10% of those could correctly answer questions about the BRCA gene mutation that Jolie carries and the typical person's risk of developing breast cancer. Though very rare, women with harmful mutations in either of two genes, BRCA1 and BRCA2, have a risk of breast cancer that is about five times the normal risk, and a risk of ovarian cancer that is about ten to thirty times normal. The study is published today in Genetics in Medicine.

"Ms. Jolie's health story was prominently featured throughout the media and was a chance to mobilize health communicators and educators to teach about the nuanced issues around genetic testing, risk, and prophylactic surgery," explained lead author Dina Borzekowski, who is a research professor in the University of Maryland School of Public Health's Department of Behavior and Community Health. "It feels like it was a missed opportunity to educate the public about a complex but rare health situation."

Among survey respondents who were aware of Jolie's story, nearly half could recall her estimated risk of breast cancer before the surgery, but fewer than 10 percent of those had the necessary information to interpret the risk of an average woman without a BRCA gene mutation relative to Jolie's risk. Additionally, exposure to Jolie's story was associated with greater confusion, rather than clarity, about the relationship between a family history of cancer and increased cancer risk. About half incorrectly thought that a lack of family history of cancer was associated with a lower than average personal risk of cancer, and among respondents who had at least one close relative affected by cancer, those who were aware of Jolie's story were less likely than those who were unaware of her story to estimate their own cancer risk as higher than average (39 vs. 59 percent).

"Since many more women without a family history develop breast cancer each year than those with, it is important that women don't feel falsely reassured by a negative family history," said Dr. Debra Roter, co-author of the study and Director of the Center for Genomic Literacy and Communication at the Johns Hopkins Bloomberg School of Public Health.

Breast cancer cases linked to a BRCA gene mutation are extremely rare, and the average woman's risk of getting breast cancer over her lifetime if she does not have a BRCA mutation is between five and 15 percent.

Other survey findings included that more than half of the women (57%) who had heard the story said they would undergo similar surgery if they carried the faulty BRCA gene, and a majority (72%) of men and women surveyed felt Ms. Jolie did the right thing by publically announcing her situation.

The study concluded that despite the ability of celebrities to raise awareness of health issues by sharing personal stories, these messages need to be accompanied by a more purposeful communication effort to assist the public in understanding and using the complex diagnostic and treatment information that these stories convey.

Provided by University of Maryland

An apple a day keeps the doctor away: 150 year old proverb stands the test of time, say researchers

Prescribing an apple a day to all adults aged 50 and over would prevent or delay around 8,500 vascular deaths such as heart attacks and strokes every year in the UK – similar to giving statins to everyone over 50 years who is not already taking them - according to a study in the Christmas edition of the BMJ.

26 dec 2013--The researchers conclude that the 150 year old public health message: "An apple a day keeps the doctor away" is able to match more widespread use of modern medicine, and is likely to have fewer side effects. The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, although by all means eat more apples.

In the United Kingdom, lifestyle changes are the recommended first step to prevent heart disease. However, trial data suggest that statins can reduce the risk of vascular events, irrespective of a person's underlying risk of cardiovascular disease. As such, calls are being made for greater use of statins at a population level, particularly for people aged 50 years and over.

Using mathematical models a team of researchers at the University of Oxford set out to test how a 150 year old proverb might compare with the more widespread use of statins in the UK population. They analysed the effect on the most common causes of vascular mortality of prescribing either a statin a day to those not already taking one or an apple a day to everyone aged over 50 years in the UK.

The researchers assumed a 70% compliance rate and that overall calorie intake remained constant.

They estimate that 5.2 million people are currently eligible for statin treatment in the UK and that 17.6 million people who are not currently taking statins would be offered them if they became recommended as a primary prevention measure for everyone over 50.

They calculate that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70% of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.

However, side-effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes.

Additional modelling showed a further 3% reduction in the annual number of vascular deaths when either apples or statins were prescribed to everybody aged over 30. However the number of adverse events is predicted to double.

"This study shows that small dietary changes as well as increased use of statins at a population level may significantly reduce vascular mortality in the UK," say the authors.

"This research adds weight to calls for the increased use of drugs for primary prevention of cardiovascular disease, as well as for persevering with policies aimed at improving the nutritional quality of UK diets," they conclude.

Dr Adam Briggs of the BHF Health Promotion Research Group at Oxford University said: "The Victorians had it about right when they came up with their brilliantly clear and simple public health advice: "Anapple a day keeps the doctor away". It just shows how effective small changes in diet can be, and that both drugs and healthier living can make a real difference in preventing heart disease and stroke.

While no-one currently prescribed statins should replace them for apples, we could all benefit from simply eating more fruit."

Provided by British Medical Journal

During the holidays, keep an eye on the elderly for symptoms of Alzheimer's

When Deborah Bell's father was diagnosed with gallbladder cancer seven years ago, she knew something was off about her mother, Rosa.

25 dec 2013--She was mean, combative, detached and accusing Bell of being the "other woman" in her father's life. And when Bell's father was placed in hospice care and died in their home, Rosa had no idea what had happened to her husband.

But the biggest red flag came when Rosa went to let out the dog, turned the house alarm on, then forgot the alarm was on and couldn't remember how to turn it off.

After neighbors called Bell to tell her about the incident, rescuers were called and she was evaluated at the hospital.

Testing revealed her diagnosis: middle-stage Alzheimer's disease.

"My dad would always say to me 'your mom is crazy as hell,' but I thought it was just normal parents fighting kind of stuff," said Bell, of Dania Beach, Fla. "I would say to him, 'No Dad. Come on. I'm sure you are a little crazy too.' But looking back at it, she was going through Alzheimer's and we didn't know."

Alzheimer's is a slowly progressive brain disease - and the most common form of dementia - that destroys memory and cognitive skills and leads to behavioral changes. Although there are treatments available to delay the worsening of symptoms, there is no cure. Treatments include oral medications for symptoms of the disease, clinical trials, music and art therapy, creative writing and retention therapy, mentally stimulating activities and physical fitness.

The disease, which takes an average of eight to 12 years to fully progress, ultimately leaves individuals in a vegetative state in which they are unable to talk, walk or swallow.

According to the U.S. Department of Health and Human Services National Institute on Aging, symptoms of Alzheimer's usually appear after age 60, and it is estimated that as many as 5.1 million Americans have the disease.

Dr. Elizabeth Crocco, chief of Geriatric Psychiatry at the University of Miami Miller School of Medicine, says the behavioral changes are the most difficult part to manage and it is important to keep individuals with Alzheimer's stable and well for as long as possible.

"A steady routine is essential, and it is important to take care of physical health," she said. "People can live many years with this disease. The bottom line is that we can all go at any time. We want individuals with Alzheimer's to be able to live life to the fullest."

Bell moved into her mother's house to take care of her full-time while continuing her "second full-time job" as a middle-school teacher. She says her mother, now 85, can no longer carry out a conversation or complete daily tasks such as showering or dressing herself. She also doesn't recognize her daughter.

"At this point, she thinks I am her mom," Bell said. "She answers to me with, 'Yes ma'am,' but other days she'll have these lucid moments where she will look at me and say 'I love you.' That makes it all worthwhile."

Age is the primary risk factor for Alzheimer's disease followed by family history, genetics, major head trauma, repeated head trauma, diabetes and stroke.

As families prepare to get together for the holiday season, some individuals may notice changes in a family member's physical or cognitive health - especially elderly relatives - that can be the first sign of Alzheimer's disease.

According to the Alzheimer's Association, family members should be on the lookout for 10 important warning signs during the holiday season: Memory loss that disrupts daily life; challenges in planning or solving problems; difficulty completing familiar tasks; confusion with time or place; trouble understanding visual images and special relationships; new problems with words in speaking or writing; misplacing things and losing the ability to retrace steps; decreased or poor judgment; withdrawal from work or social activities and changes in mood or personality.

Jamie Brodarick, the program services manager for the Alzheimer's Association, says one in eight people with Alzheimer's live alone.

It is important for family members to be proactive.

"There are some normal age-related changes, but anytime these changes are interfering with a person's ability to have a normal daily routine then it is a problem," she said. "There are things you can do to make sure you are not dealing with a crisis situation."

Dr. Marc Agronin, a geriatric psychiatrist and the director of mental health and clinical research at Miami Jewish Health Systems, says early diagnosis is critical when it comes to Alzheimer's disease.

"The earlier you diagnose the memory changes, the more you can do," he said. "The sooner you identify, the more damage you can prevent."

The current theory for Alzheimer's disease is that by the time symptoms begin to appear, the process has been going on for several years. Although other forms of dementia are reversible, Alzheimer's is not.

Agronin says studies are working on using a new type of brain scan that uses dye to help identify the beta amyloid protein in the brain. People who have a certain amount of this protein are considered to have a higher risk for Alzheimer's disease, and then become involved in clinical trials.

Susan, whose husband Jim has moderate Alzheimer's disease, was involved in an immunotherapy clinical trial and is currently part of the Girsh Memory Enrichment Institute at Miami Jewish Health Systems - a program for individuals with cognitive impairment and their caregivers.

"It is difficult for a single caregiver to stimulate their loved one to keep things going," said Susan, who asked that her last name not be used for security reasons. "It's stimulation, which makes all the difference."

Agronin says caregivers need to remain hyper vigilant because disaster can be right around the corner. Depression, anxiety, behavioral changes, sleep disturbances and sexual dysfunction are all things that go with Alzheimer's.

"We are making gains in terms of understanding this disease, but we need help," he said. "Don't hesitate. And, don't give up hope. It is never too late to make changes to improve the situation. Even though we can't cure it, there are lots of different ways to care for the person."

©2013 The Miami Herald
Distributed by MCT Information Services

Experts lay out options for menopause symptoms

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Evidence grows that antidepressants can help, new guidelines say.

24 dec 2013—Women bothered by hot flashes or other effects of menopause have a number of treatment options—hormonal or not, according to updated guidelines from the American College of Obstetricians and Gynecologists.

It's estimated that anywhere from 50 percent to 82 percent of women going through menopause have hot flashes—sudden feelings of extreme heat in the upper body—and night sweats. For many, the symptoms are frequent and severe enough to cause sleep problems and disrupt their daily lives. And the duration of the misery can last from a couple years to more than a decade, says the college, the nation's leading group of ob/gyns.

"Menopausal symptoms are common, and can be very bothersome to women," said Dr. Clarisa Gracia, who helped write the new guidelines. "Women should know that effective treatments are available to address these symptoms."

The guidelines, published in the January issue of Obstetrics & Gynecology, reinforce some longstanding advice: Hormone therapy, with estrogen alone or estrogen plus progestin, is the most effective way to cool hot flashes.

But they also lay out the growing evidence that some antidepressants can help, said Gracia, an associate professor of obstetrics and gynecology at the University of Pennsylvania in Philadelphia.

In studies, low doses of antidepressants such as venlafaxine (Effexor) and fluoxetine (Prozac) have helped relieve hot flashes in some women. And two other drugs—the anti-seizure drug gabapentin and the blood pressure medication clonidine—can be effective, according to the guidelines.

So far, though, only one non-hormonal drug is actually approved by the U.S. Food and Drug Administration for treating hot flashes: a low-dose version of the antidepressant paroxetine (Paxil).

And experts said that while there is evidence some hormone alternatives ease hot flashes, none works as well as estrogen and estrogen-progestin.

"Unfortunately, many providers are afraid to prescribe hormones. And a lot of the time, women are fearful," said Dr. Patricia Sulak, an ob/gyn at Scott & White Hospital in Temple, Texas, who was not involved in writing the new guidelines.

Years ago, doctors routinely prescribed hormone replacement therapy after menopause to lower women's risk of heart disease, among other things. But in 2002, a large U.S. trial called the Women's Health Initiative found that women given estrogen-progestin pills actually had slightly increased risks of blood clots, heart attack and breast cancer.

"Use of hormones plummeted" after that, Sulak noted.

But research since then has suggested that hormone therapy is safer for relatively younger women who start using it soon after menopause, the report notes. Women in that landmark study were in their early 60s, on average—whereas U.S. women typically hit menopause at around age 51.

Experts now say that women should not take hormones to prevent any chronic ills. But when it comes to hot flashes, hormone therapy remains the most effective option.

Another ob/gyn agreed that doctors and women alike are often reluctant to consider hormones. "Since the [Women's Health Initiative], we've been like little fishes swimming upstream," said Dr. Jill Rabin, of Long Island Jewish Medical Center in New Hyde Park, N.Y.

To help minimize any risks, she said, it's important to keep the hormone dose at the lowest level needed to relieve a woman's symptoms.

Sulak agreed. "I'm an estrogen minimalist," she said. "I'm going to start you at a low dose, and that's enough for most women."

Women who should not try hormones, she noted, include those who've ever had breast cancer or a blood clot.

Hot flashes and night sweats are the most common menopause complaint. But vaginal dryness and pain during sex are also issues for many women.

The guidelines say that estrogen applied directly to the vagina—in the form of creams, tablets or rings—is effective. "Very little" of that estrogen gets into the bloodstream, Sulak said, so the risk of side effects is considered small.

And just this year, the FDA approved a new option for treating painful sex in postmenopausal women. It's a pill called ospemifene (Osphena), and it has estrogen-like effects on the lining of the vagina.

As for "natural" remedies, such as soy and black cohosh, studies have failed to prove they're effective for hot flashes and night sweats, the guidelines say.

However, Rabin said that some women who try supplements do feel better—even if it's by a "placebo effect."

There are some "common sense" tactics any woman can use to help ease hot flashes, the guidelines say. Those include dressing in layers, keeping the thermostat lower at home and drinking cool beverages.

But for women who need more than that, Gracia advised talking to your doctor about the benefits and risks of all your options. "Therapy should be individualized, since one therapy may not be optimal for allwomen."

More information: The U.S. National Institute on Aging has more on menopause.

Study shows where Alzheimer's starts and how it spreads

Alzheimer's disease starts in the entorhinal cortex (yellow). Using fMRI in mouse (left) and human (right) brains, the researchers provide evidence that the disease spreads from the entohrinal cortex (yellow) to other cortical regions (red) -- the perirhinal cortex and posterior parietal cortex. Credit: Usman Khan/lab of Scott A. Small, MD, Columbia University Medical Center.

23 dec 2013--Using high-resolution functional MRI (fMRI) imaging in patients with Alzheimer's disease and in mouse models of the disease, Columbia University Medical Center (CUMC) researchers have clarified three fundamental issues about Alzheimer's: where it starts, why it starts there, and how it spreads. In addition to advancing understanding of Alzheimer's, the findings could improve early detection of the disease, when drugs may be most effective. The study was published today in the online edition of the journal Nature Neuroscience.

"It has been known for years that Alzheimer's starts in a brain region known as the entorhinal cortex," said co-senior author Scott A. Small, MD, Boris and Rose Katz Professor of Neurology, professor of radiology, and director of the Alzheimer's Disease Research Center. "But this study is the first to show in living patients that it begins specifically in the lateral entorhinal cortex, or LEC. The LEC is considered to be a gateway to the hippocampus, which plays a key role in the consolidation of long-term memory, among other functions. If the LEC is affected, other aspects of the hippocampus will also be affected."

The study also shows that, over time, Alzheimer's spreads from the LEC directly to other areas of the cerebral cortex, in particular, the parietal cortex, a brain region involved in various functions, including spatial orientation and navigation. The researchers suspect that Alzheimer's spreads "functionally," that is, by compromising the function of neurons in the LEC, which then compromises the integrity of neurons in adjoining areas.

A third major finding of the study is that LEC dysfunction occurs when changes in tau and amyloid precursor protein (APP) co-exist. "The LEC is especially vulnerable to Alzheimer's because it normally accumulates tau, which sensitizes the LEC to the accumulation of APP. Together, these two proteins damage neurons in the LEC, setting the stage for Alzheimer's," said co-senior author Karen E. Duff, PhD, professor of pathology and cell biology (in psychiatry and in the Taub Institute for Research on Alzheimer's Disease and the Aging Brain) at CUMC and at the New York State Psychiatric Institute.

In the study, the researchers used a high-resolution variant of fMRI to map metabolic defects in the brains of 96 adults enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP). All of the adults were free of dementia at the time of enrollment.

Patterns of cortical spread in mouse models overlap with those observed in preclinical Alzheimer’s disease. Dysfunction in the entorhinal cortex, shown in yellow, was found to spread to the perirhinal cortex, as well as to the posterior parietal cortex (mice) and precuneus (humans), shown in red. Credit: Usman Khan

"Dr. Richard Mayeux's WHICAP study enables us to follow a large group of healthy elderly individuals, some of whom have gone on to develop Alzheimer's disease," said Dr. Small. "This study has given us a unique opportunity to image and characterize patients with Alzheimer's in its earliest, preclinical stage."

The 96 adults were followed for an average of 3.5 years, at which time 12 individuals were found to have progressed to mild Alzheimer's disease. An analysis of the baseline fMRI images of those 12 individuals found significant decreases in cerebral blood volume (CBV)—a measure of metabolic activity—in the LEC compared with that of the 84 adults who were free of dementia.

A second part of the study addressed the role of tau and APP in LEC dysfunction. While previous studies have suggested that entorhinal cortex dysfunction is associated with both tau and APP abnormalities, it was not known how these proteins interact to drive this dysfunction, particularly in preclinical Alzheimer's.

To answer this question, explained first author Usman Khan, an MD-PhD student based in Dr. Small's lab, the team created three mouse models, one with elevated levels of tau in the LEC, one with elevated levels of APP, and one with elevated levels of both proteins. The researchers found that the LEC dysfunction occurred only in the mice with both tau and APP.

The study has implications for both research and treatment. "Now that we've pinpointed where Alzheimer's starts, and shown that those changes are observable using fMRI, we may be able to detect Alzheimer's at its earliest preclinical stage, when the disease might be more treatable and before it spreads to other brain regions," said Dr. Small. In addition, say the researchers, the new imaging method could be used to assess the efficacy of promising Alzheimer's drugs during the disease's early stages.

More information: Molecular drivers and cortical spread of lateral entorhinal cortex dysfunction in preclinical Alzheimer's disease, dx.doi.org/10.1038/nn.3606

Provided by Columbia University Medical Center

Patient 'progressing' after first artificial heart implant in France

A 75-year-old man who this week became the first person to receive an artificial heart developed by French biomedical firm Carmat was progressing well, doctors said Saturday.

22 dec 2013--The patient was "progressing and recuperating", said surgeon Christian Latremouille, who was among the 16-strong team of doctors who performed the operation at the Georges Pompidou Hospital in Paris on Wednesday.

Artificial hearts have already been in use for many years as a temporary fix for patients with chronic heart problems.

The Carmat product aims at providing a longer-term solution to bridge the wait for a donor heart and enable hospitalised patients to return home and maybe even resume work.

"He was nearing the end of his life," Latremouille told a press conference, adding that the surgery had gone according to plan. "The intervention took place in good conditions... There were no complications linked to the innovative nature of the implant operation," he said.

"He is not walking yet, but we will try to get him sitting and then standing soon enough. The objective is for him to have a normal life."

The artificial heart, a self-contained unit implanted in the patient's chest, uses soft "biomaterials" and an array of sensors to mimic the contractions of the heart.

The goal is to lessen the risk of blood clots and rejection by the immune system.

The patient will have to wear a belt of lithium batteries to power the heart.

Cardiac surgeon Alain Carpentier, who led the operation and who has spent 25 years working on the development of the artificial heart, said he was grateful to the patient for taking part in the trial. "He has a lot of humour. He's a very good patient," he told reporters.

More volunteers could soon benefit from the 900-gramme (31-ounce) device, according to Philippe Pouletty, who co-founded Carmat with Carpentier.

"A number of patients are being selected. It is likely that other implantations will take place in the coming weeks," he told Europe 1 radio.

The first phase of the trial, on a small group of volunteers in terminal condition, will assess survival one month after the operation, or earlier if the patient receives a natural heart.

"France can be proud of this exceptional effort in the service of human progress," French President Francois Hollande said in a congratulatory letter to the medical team.

Prime Minister Jean-Marc Ayrault turned to Twitter to praise the achievement. "Thank you for the hope and prospects that this feat brings," he wrote.

Nearly 100,000 people in Europe and the United States are in need of a heart transplant, according to Carmat.

A US rival to Carmat, an artificial heart called AbioCor, is authorised in the United States for patients with end-stage heart failure or life expectancy of less than 30 days, who are not eligible for a natural heart plant and have no other viable treatment options.

© 2013 AFP

French firm starts human trials of artificial heart

French biomedical firm Carmat said on Friday it had begun the first human trial of its prototype artificial heart, which aims at overcoming shortages of organs available for transplant.

22 dec 2013--The implant operation, which took place on Wednesday at the Georges Pompidou Hospital in Paris, "went satisfactorily," it said in a statement.

The patient, whom it did not name, is in intensive care, "is conscious and speaking to relatives," Carmat said, adding that it was too early to draw wider conclusions about the operation.

Artificial hearts have been in use for many years as a temporary fix for patients with chronic heart problems.

Tens of thousands of people with hearts damaged by disease or a heart attack die each year because of a lack of a donor.

The Carmat product aims at providing a longer-term solution to bridge the wait and enable hospitalised patients to return home and maybe even resume work.

A self-contained unit implanted in the patient's chest, it uses soft "biomaterials" and an array of sensors, rather than a pump, to mimic the contractions of the heart.

The goal is to lessen the risk of blood clots and rejection by the immune system.

Power comes from an external source or wearable lithium batteries.

The company was authorised in September by French health watchdogs to carry out four trials in three hospitals after tests on animals.

The 900-gramme (31-ounce) device is the outcome of a years-long collaboration between cardiac surgeon Alain Carpentier and the European aerospace giant EADS.

Nearly 100,000 people in Europe and the United States are in need of a heart transplant, according to Carmat.

The price of the heart is estimated at between 140,000 and 180,000 euros ($190,000 and $244,000).

Phase I of the trial, on the small group of volunteers in terminal condition, will assess survival one month after the operation, or earlier if the patient receives a natural heart.

If all goes well, a second phase, conducted among a group of about 20 patients, will look at efficacy—quality of life, comfort and side effects—as well as safety.

A US rival to Carmat, an artificial heart called AbioCor made the biotech firm Abiomed, is authorised in the United States for patients with end-stage heart-failure or life expectancy of less than 30 days, who are not eligible for a natural heart plant and have no other viable treatment options.

© 2013 AFP

Luggage-lifting tips for safe travels

Pack like a pro to help avoid injury.

21 dec 2013—Carrying and lifting heavy luggage during the holidays can lead to neck, wrist, back and shoulder pain and injuries unless you take proper safety precautions, an orthopedic surgeon says.

In 2012, nearly 54,000 luggage-related injuries occurred in the United States, according to the U.S. Consumer Product Safety Commission.

"Holiday travel can be uniquely stressful and physically taxing, especially when transporting heavy and cumbersome luggage," said Dr. Warner Pinchback, a spokesman for the American Academy of Orthopaedic Surgeons.

"To ensure that you arrive at your holiday destination free from pain, it's important to know how to optimally choose, pack, carry and lift your luggage," he added in an academy news release.

The academy offers the following luggage safety tips:

• When buying new luggage, select a sturdy, lightweight piece with wheels and a handle.
• Don't overpack. Try to carry items in a few smaller bags instead of one large suitcase. Keep in mind that many airlines restrict the size and weight of carry-on luggage.
• Bend your knees when lifting. The safe way to hoist a heavy item such as luggage is to stand alongside of it, bend at the knees—not the waist—and use your leg muscles as you grab the handle and straighten up. Be sure to hold the bag close to your body when lifting.
• Take care when storing luggage in overhead compartments. The first step is to lift the piece to the top of the seat. Then, with one hand on each side of the piece, lift the suitcase up. Place the wheel-side in the compartment first, then push the bag to the back of the compartment.
• Keep your back straight. When lifting and carrying luggage, point your toes in the direction you are headed, and then turn your entire body in that direction. Don't twist your back.
• Take it slow. Don't try to rush when lifting or carrying a suitcase. It's a good idea to ask for help if you are having trouble with a bag that is too heavy or an awkward shape.
• Check your bags. Don't attempt to carry heavy luggage for long periods of time or for long distances, such as through a large airport terminal.
• Carry your luggage when climbing stairs, don't drag it behind you.
• Even backpacks can be too heavy. Make sure if you wear a backpack that both shoulder straps are padded and adjusted properly. Use all the compartments to help distribute the weight of your items evenly. Don't sling the bag over one shoulder because this can cause muscle strain.

More information: The U.S. Centers for Disease Control and Prevention offers holiday health and safety tips.

Tips to survive the holiday season without packing on the pounds

Special family meals, holiday buffets and free drinks can be open invitations for disaster for the more than 50 percent of Americans who are struggling with their weight and dieting.

20 dez 2013-- Navigating the holidays can be stressful, said Jeffrey Gersten, PsyD, Gottlieb Memorial Hospital.  "Close family situations, the ready availability of trigger foods, such as cookies, kugels and candies, unhappy memories of past holidays – all add stress to make keeping your waistline in check a challenge."

Dr. Gersten counsels weight-conscious patients at Gottlieb Memorial Hospital, where dozens have successfully lost, and are keeping off, as much as 100 pounds or more.

Frosted cookies are an important part of enjoying the holidays for Suzy Krueckeberg, 49, who lives in a Chicago suburb. "I eat my favorite foods but change the portion size," said the graduate of a weight-loss program at Gottlieb.

"At a party, I will scope out the offerings and make my choices. I'll eat half of a frosted cookie and one-third of a dessert slice – enough so that I have a true taste of the foods I like."

Krueckeberg dropped more than 24 pounds in 12 weeks with Gottlieb's help and has lost more than 30 pounds total, despite the challenges of the holiday season. "I still go to out to dinners and restaurants, but I'll modify the meal so that I eat an open-face sandwich, or if I really want potato chips I'll eat half and throw the other half away. I am aware of the calories and also of what I really want to eat," she said. "I do eat more salads and vegetables, but if I want to eat something, I pay attention to those feelings and I eat it, but in a smaller quantity."

Here are Dr. Gersten's top five tips to keep you from going overboard:

The Roadmap. You need more than just directions to the party, you need a plan for the entire occasion. "You don't plan to fail, you just fail to plan" is an old chestnut worth picking up this season. "Identify your trigger foods – those that you know you will be unable to eat in a moderate portion" and avoid them. Completely. "I know that one of my trigger foods is pizza," said Dr. Gersten, who as a young man struggled with his weight. "I know that I cannot stop after just one slice, so I stay away from it altogether and remove myself from the challenge." Provide yourself healthy options, such as bringing your own low-fat snacks to get-togethers. "Don't starve yourself either," Dr. Gersten said. "Your blood sugar level will drop, creating a hunger that is unstoppable, which will lead to overeating, usually of high-calorie foods." Stick to eating three balanced meals.

The Telltale Crumbs. So you polished off the entire carton of French onion dip and the bag of chips, or gobbled the plate of cookies you received as a gift. Take control of the situation immediately. "Don't tell yourself that because you've overindulged, all bets are off and everything is now fair game," Dr. Gersten said. "Every moment is a chance to begin again. Don't wait for New Year's to make resolutions. Make them now – keep them."

Give Yourself a Timeout. A walk in the neighborhood to enjoy the decorations, playing a favorite seasonal CD or even just taking a deep breath are all ways to relax and shake off stress. "When you are calm, you are in control," Dr. Gersten said. "Don't let the hectic pace of the holidays run you roughshod."

Friends, through Thick and Thin. Talk to a friend, or fellow party goer, about your desire to eat healthy. "You can do it, they can help," Dr. Gersten said. Enlist their aid so they won't encourage you to "just try this" or guilt you into eating "my famous cake I slaved over for days."

Maintain Utter Consciousness. "I grabbed a handful of chocolate chips the other day and ate them," Dr. Gersten said. "I then grabbed another handful and chowed down, and realized I was just mindlessly eating." Think about what you eat. "Give yourself the five-minute rule. Stop eating for five minutes to see if you are really hungry or just bored."

Provided by Loyola University Health System

New hypertension guidelines offer practical, clinical information for doctors and patients around the globe

18 dec 2013--High blood pressure affects approximately one in three adults in the Americas, Europe, some Asian countries and Australia, and one billion people worldwide. Because of this epidemic, The American Society of Hypertension, Inc. (ASH) and the International Society of Hypertension (ISH) are pleased to announce the creation of first-of-their-kind guidelines for the diagnosis and treatment of Hypertension: "Clinical Practice Guidelines for the Management of Hypertension in the Community." These are the first guidelines to be usable for medical practitioners in any socioeconomic environment around the globe, from those countries with state-of-the-art equipment to those that lack basic resources. And, most importantly, they are designed with guidance that is easy to implement for doctors and healthcare professionals in even the most impoverished areas.

The guidelines were first published on December 17 by the Journal of Clinical Hypertension in the U.S. and the Journal of Hypertension in Europe. They will also appear in medical journals across Latin America and have been endorsed by the Asian Pacific Society of Hypertension. The guidelines have already been translated to French, Spanish and Creole, and there are plans to continue translations for populations across the globe.

"These guidelines have been written to provide a straightforward approach to managing hypertension in the community. We are so proud to have created a set of guidelines that can help not only doctors but also patients understand their disease and the care they receive," says Dr. Michael A. Weber, Editor-in-Chief of the Journal of Clinical Hypertension, former ASH President and current ISH Council member.

"Within the International Society of Hypertension we wanted to create Guidelines for management of hypertension for practitioners, which would provide easy to follow recommendations that were evidence-based and could be carried out in countries that have healthcare systems with either limited or with abundant resources, and above all, that were simple and user-friendly, contributing thus to the control of this highly prevalent condition. Indeed, hypertension is the number one cause of burden of disease worldwide," says Dr. Ernesto L. Schiffrin, President of ISH.

Hypertension is the most common chronic condition dealt with by primary care physicians and other healthcare practitioners. There is also a close relationship between blood pressure levels and the risk of cardiovascular events, strokes and kidney disease.

"With the development and dissemination of treatment guidelines that are designed to educate medical practitioners, doctors in training and other health care providers, ASH is furthering its commitment to our mission through initiatives that aim to improve the clinical management of hypertension and its complications," says Dr. William B. White, professor of medicine and current President of ASH.

The guidelines' 25 authors include top hypertension specialists and pharmacists from around the world, including past and present officers of the American Society of Hypertension and the International Society of Hypertension.

Provided by American Society of Hypertension

Do vitamins block disease? Some disappointing news

There's more disappointing news about multivitamins: Two major studies found popping the pills did not protect aging men's brains or help heart attack survivors.

17 dec 2013--Millions of people spend billions of dollars on vitamin combinations, presumably to boost their health and fill gaps in their diets. But while people who don't eat enough of certain nutrients may be urged to get them in pill form, the government doesn't recommend routine vitamin supplementation as a way to prevent chronic diseases.

The studies released Monday are the latest to test if multivitamins might go that extra step and concluded they don't.

"Evidence is sufficient to advise against routine supplementation," said a sharply worded editorial that accompanied Monday's findings in the journal Annals of Internal Medicine.

After all, most people who buy multivitamins and other supplements are generally healthy, said journal deputy editor Dr. Cynthia Mulrow. Even junk foods often are fortified with vitamins, while the main nutrition problem in the U.S. is too much fat and calories, she added.

But other researchers say the jury's still out, especially for the most commonly used dietary supplement—multivitamins that are taken by about a third of U.S. adults, and even more people over the age of 50.

Indeed, the U.S. Preventive Services Task Force is deliberating whether vitamin supplements make any difference in the average person's risk of heart disease or cancer. In a draft proposal last month, the government advisory group said for standard multivitamins and certain other nutrients, there's not enough evidence to tell. (It did caution that two single supplements, beta-carotene and vitamin E, didn't work). A final decision is expected next year.

"For better or for worse, supplementation's not going to go away," said Dr. Howard Sesso of Brigham and Women's Hospital in Boston. He helps leads a large multivitamin study that has had mixed results—suggesting small benefits for some health conditions but not others—and says more research is needed, especially among the less healthy.

Still, "there's no substitute for preaching a healthy diet and good behaviors" such as exercise, Sesso cautioned.

As scientists debate, here are some questions and answers to consider in the vitamin aisle:

Q: Why the new focus on multivitamins?

A: Multivitamins have grown more popular in recent years as research showed that taking high doses of single supplements could be risky, such as beta-carotene.

Multivitamins typically contain no more than 100 percent of the daily recommended amount of various nutrients. They're marketed as sort of a safety net for nutrition gaps; the industry's Council for Responsible Nutrition says they're taken largely for general wellness.

Q: What are the latest findings?

A: With Alzheimer's on the rise as the population ages, Harvard researchers wondered if long-term multivitamin use might help keep older brains agile. They examined a subset of nearly 6,000 male doctors, age 65 or older, who were part of a larger study. The men were given either multivitamins or dummy pills, without knowing which they were taking.

After a decade of pill use, the vitamin-takers fared no better on memory or other cognitive tests, Sesso's team reported Monday in the journal Annals of Internal Medicine.

Q: Did that Harvard study find any other benefit from multivitamins?

A: The results of the Physicians Health Study II have been mixed. Overall it enrolled about 15,000 health male doctors age 50 and older, and the vitamin-takers had a slightly lower risk of cancer—8 percent. Diet and exercise are more protective. They also had a similarly lower risk of developing cataracts, common to aging eyes. But the vitamins had no effect the risk for heart disease or another eye condition, Sesso said.

Q: Might vitamins have a different effect on people who already have heart disease?

A: As part of a broader treatment study, a separate research team asked that question. They examined 1,700 heart attack survivors, mostly men, who were given either a special multivitamin containing higher-than-usual doses of 28 ingredients or dummy pills. But the vitamins didn't reduce the chances of another heart attack, other cardiovascular problems, or death.

Q: What about women?

A: Research involving postmenopausal women a few years ago also concluded multivitamins did not prevent cancer or heart disease. But it was not nearly as rigorous a study as Monday's research, relying on women to recall what vitamins they used.

Q: What's the safety advice for multivitamin users?

A: The preventive services task force cited no safety issues with standard multivitamins. But specialists say to always tell your doctor what over-the-counter supplements you use. Some vitamins interact with some medications, and Sesso said anyone worried about nutrition should be discussing their diet with their doctor anyway.

More information: Full Text (subscription or payment may be required)

World's smallest Medtronic Micra pacemaker: Cardiac pacing game change?

 

15 dec 2013--Device maker Medtronic has accomplished a feat in device miniaturization, this time in the form of an implantable cardiac device the size of a large vitamin. Earlier this month, Minneapolis-based Medtronic said the first in-human implant of the world's smallest pacemaker, without surgery, has taken place in Linz, Austria, as part of a global clinical trial.

The pacemaker's size and the fact that it can be implanted without surgery are the key features. The device is called the Micra Transcatheter Pacing System (Micra TPS). The implant does not require a surgical incision in the chest. Pat Mackin, senior vice president for Medtronic and president of the company's cardiac rhythm disease management business, compared it to a traditional pacemaker. "There's no more generator. There's no more lead," he said. Rather, it can be directly introduced into the heart in a minimally invasive procedure, to eliminate a potential source of device-related complications. The device is 24 millimeters long and 0.75 cubic centimeters in volume, far smaller than the traditional size of a conventional pacemaker.

The device is delivered directly into the heart through a catheter inserted in the femoral vein, sent up through the femoral vein with a catheter, and placed right inside the heart. The little device will perform the same function as the traditional system.

"It's just a phenomenal development" said Dr. Bill Katsiyiannis with the Minneapolis Heart Institute Foundation. He said that eliminating the lead and pocket for the device.represents a huge advance. In Austria, the head of cardiology at Linz General Hospital also spoke about the advantages in Micra TPS. " Because of its small size and unique design, the Micra TPS can be introduced directly into the heart via a minimally invasive procedure, without the need for leads," said Clemens Steinwender, M.D., head of cardiology at the Linz General Hospital in Linz. "The combination of this novel technology with a transcatheter procedure can benefit patients by potentially reducing pocket or lead complications and recovery times observed with traditional surgical pacemaker implants."

The pacemaker delivers electrical impulses that pace the heart through an electrode at the end of the device. Once positioned, the pacemaker is securely attached to the heart wall and can be repositioned if needed.

The Micra TPS is an investigational device worldwide. A clinical trial will enroll up to 780 patients at approximately 50 centers. Initial results from the first 60 patients, followed up to three months, are anticipated in the second half of 2014.

Significant minority think doctors should help 'tired of living' elderly to die if that's their wish

One in five people believes that doctors should be allowed to help the elderly who are not seriously ill, but who are tired of living, to die, if that is their stated wish, reveals research published online in the Journal of Medical Ethics.

14 dec 2013--And one in three thinks that the oldest old should be allowed to take a pill to end their life if that's what they want to do, the study shows.

The findings are based on the survey responses of just under 2000 members of the general public in The Netherlands, where physician assisted suicide has been legal since 2002.

Doctors in The Netherlands can only legally help patients to die if the request is voluntary and has been well thought out, and if the patient is suffering unbearably with no prospect of improvement.

But the issue of whether it should be permissible for doctors to help elderly people who are not seriously ill, but who are simply tired of living, to die, has risen to the fore recently and is the subject of lively debate in Dutch society, say the authors, who wanted to gauge the level of public support for it.

They therefore canvassed a random sample of Dutch adults, aged 18 to 95, in 2009-10 about their attitudes to assisted dying for this group of people, using four statements and two vignettes - one of a healthy old person who is tired of living and the other of a younger person who is terminally ill.

Among the 1960 eligible respondents, over half (57%) agreed that everyone should have a right to euthanasia, and a similar proportion (53%) agreed that everyone has the right to determine their own life and death.

One in four (26%) agreed with the vignette in which a doctor helps an elderly person who is tired of living, to die. And a similar proportion (19%) said they would request this option themselves if they were in the same situation.

This compares with almost half of respondents who would ask a doctor to help them die if they were terminally ill.

And one in five (21%) agreed with the statement: 'In my opinion euthanasia should be allowed for persons who are tired of living without having a serious disease.' Just over half disagreed (52%), while one in four (25%) neither agreed nor disagreed.

A third (36%) also agreed that the oldest old should be able to get hold of pills that would enable them to die, if they so wished. And a further 30% were neutral.

Age and state of health had no bearing on acceptance of the right of elderly people tired of living to choose to die. But those who backed the option tended to be more highly educated, have no religious faith, and to consider it important to make their own end of life decisions. They also had less trust in doctors to comply with their wishes.

The authors say that the level of support for assisted dying among the elderly who are tired of living, as evidenced by the survey responses, is lower than that for people who are seriously ill.

But the responses nevertheless point to a "significant minority" in favour of the option, which suggests "that this topic should be taken seriously in the debate about end of life care and decision making," they conclude.

Provided by British Medical Journal