Evidence mounting that older adults who volunteer are happier, healthier

Credit: Bill Kuffrey/public domain

Older adults who stay active by volunteering are getting more out of it than just an altruistic feeling – they are receiving a health boost!

31 aug 2014--A new study, led by the Rotman Research Institute at Baycrest Health Sciences and published online this week in Psychological Bulletin, is the first to take a broad-brush look at all the available peer-reviewed evidence regarding the psychosocial health benefits of formal volunteering for older adults.

Lead investigator Dr. Nicole Anderson, together with scientists from Canadian and American academic centres, examined 73 studies published over the last 45 years involving adults aged 50-plus who were in formal volunteering roles.

To be included in the review, studies had to measure psychosocial, physical and/or cognitive outcomes associated with formal volunteering – such as happiness, physical health, depression, cognitive functioning, feelings of social support and life satisfaction.

"Our goal was to obtain a more comprehensive view of the current state of knowledge on the benefits of volunteering among older adults," said Dr. Anderson, a senior scientist with Baycrest's Rotman Research Institute and associate professor, University of Toronto. "We discovered a number of trends in the results that paint a compelling picture of volunteering as an important lifestyle component for maintaining health and wellbeing in later years."

Among the key findings:

• Volunteering is associated with reductions in symptoms of depression, better overall health, fewer functional limitations, and greater longevity.
• Health benefits may depend on a moderate level of volunteering. There appears to be a tipping point after which greater benefits no longer accrue. The "sweet spot" appears to be at about 100 annual hours, or 2-3 hours per week.
• More vulnerable seniors (i.e. those with chronic health conditions) may benefit the most from volunteering.
• Feeling appreciated or needed as a volunteer appears to amplify the relationship between volunteering and psychosocial wellbeing.

"Taken together, these results suggest that volunteering is associated with health improvements and increased physical activity – changes that one would expect to offer protection against a variety of health conditions," said Dr. Anderson. Indeed, a moderate amount of volunteering has been shown to be related to less hypertension and fewer hip fractures among seniors who volunteer compared to their matched non-volunteering peers.

One troubling finding for the research team was that "very few studies" have examined the benefits of volunteering on cognitive functioning in older adults. The report noted that "not a single study" has examined the association between volunteering and risk of dementia, or the association between volunteering and a host of other health conditions that put seniors at higher risk for dementia, such as diabetes and stroke.

With dementia prevalence projected to double over 20 years, from over 30 million people worldwide today to more than 65 million people in 2030 (Alzheimer's Disease International and World Health Organization, 2012), Dr. Anderson called it a "startling omission" that the field of neuroscience research has yet to investigate the capacity of volunteering to mitigate dementia risk or delay onset.

"We encourage investigators to include more objective measures of cognitive functioning in future studies. Particularly interesting would be the inclusion of a more comprehensive battery of neuropsychological tests, so that the association of volunteering with the risks of various forms of dementia and its precursor, mild cognitive impairment, could be ascertained," the report concluded.

Provided by Baycrest Centre for Geriatric Care

'Face time' for the heart diagnoses cardiac disease

To the careful observer, a person's face has long provided insight into what is going on beneath the surface. Now, with the assistance of a web camera and software algorithms, the face can also reveal whether or not an individual is experiencing atrial fibrillation, a treatable but potentially dangerous heart condition.

30 aut 2014--A pilot project, the results of which were published online today in the journal Heart Rhythm, demonstrates that subtle changes in skin color can be used to detect the uneven blood flow caused by atrial fibrillation. The technology was developed in a partnership between the University of Rochester School of Medicine and Dentistry and Xerox.

"This technology holds the potential to identify and diagnosis cardiac disease using contactless video monitoring," Jean-Philippe Couderc, Ph.D., with the University of Rochester's Heart Research Follow-up Program. "This is a very simple concept, but one that could enable more people with atrial fibrillation to get the care the care they need."

Atrial fibrillation is an irregular or sometimes rapid heart rate that commonly causes poor blood flow to the body. This occurs when erratic cardiac electrical activity causes the upper and lower chambers of the heart to beat out of sync. More than three million Americans suffer from the disease.

While, the condition can be readily diagnosed, in many people it goes undetected, either because it comes and goes or because the symptoms – fatigue and weakness – are too general to warrant concern. Consequently, it is estimated that 30 percent of the people with atrial fibrillation do not know they have the condition.

Furthermore, while atrial fibrillation is treatable if detected – both by medication and through a procedure that essentially resets the heart's electrical activity – many individuals with the condition will experience a re-occurrence. If untreated, the condition places individuals at a significantly higher risk for blood clots and stroke.

The technology described in the study employs a software algorithm developed by Xerox that scans the face and can detect changes in skin color that are imperceptible to the naked eye. All this requires is that the subject remain still for 15 seconds.

Sensors in digital cameras are designed to record three colors: red, green, and blue. Hemoglobin – a component of blood – "absorbs" more of the green spectrum of light and this subtle change can be detected by the camera's sensor. In turns out that the face is the ideal place to detect this phenomenon, because the skin is thinner than other parts of the body and blood vessels are closer to the surface.

The study participants were simultaneously hooked up to an electrocardiogram (ECG) so results from the facial scan could be compared to the actual electrical activity of the heart.

The researchers found that the color changes detected by video monitoring corresponded with an individual's heart rate as detected on an ECG. Essentially, the irregular electrical activity of the heart found in people with atrial fibrillation could be identified by "observing" the pulses of blood flowing through the veins on the face as it absorbed or reflected green light with each heartbeat.

The study found that the video monitoring technique – which researchers have dubbed videoplethymography – had an error rate of 20 percent, comparable to the 17 to 29 percent error rate associated with automated ECG measurements.

While the pilot study was only conducted on 11 people and intended to demonstrate that the technology was feasible, the researchers are now in the process of evaluating the technology on a larger study population, including those without atrial fibrillation.

Couderc contends that these new studies – coupled with the application of image stabilizing technology and the ongoing improvement in the resolution of cameras – will lower the error rate. "This study was intended to be a proof of concept and, as is the case with many new technologies, we believe that we can significantly improve its accuracy and the usability," said Couderc.

Like many other personal health technologies that have emerged in recent years, the authors see this as a way to diagnose or monitor people at risk for atrial fibrillation and alert them and/or their physicians when the condition is detected. The contactless nature of the technology and the proliferation of web cameras could even eventually allow the screening to occur without interrupting the user. For example, the program could run in the background while someone is reading their email on their tablet, computer, or smart phone.

Provided by University of Rochester Medical Center

USPSTF recommends counseling for adults at risk for CVD 

29 aug 2014—The U.S. Preventive Services Task Force (USPSTF) recommends offering or referring overweight and obese adults with cardiovascular disease risk factors to intensive behavioral counseling. These findings are presented in a final recommendation statement published online Aug. 26 in the Annals of Internal Medicine.

Michael L. LeFevre, M.D., M.S.P.H., from the USPSTF in Rockville, Md., and colleagues updated recommendations on dietary counseling for adults with cardiovascular disease risk factors. Data were reviewed from 74 trials relating to the benefits and harms of primary care-relevant counseling interventions for a healthful diet and physical activity.

Based on the current evidence, the researchers recommend offering or referring overweight or obese adults with additional cardiovascular disease risk factors to intensive behavioral counseling interventions (Grade B recommendation). These interventions should promote a healthful diet and physical activity. These findings apply to adults aged 18 years or older in primary care settings who are overweight or obese and have additional cardiovascular disease risk factors, including hypertension, dyslipidemia, impaired fasting glucose, or metabolic syndrome.

"The most effective interventions vary, but typically involve a trained counselor who provides education, helps patients set goals, shares tools to help promote healthy behaviors, and regularly monitors and follows up with patients," Task Force member Su Curry, Ph.D., said in a statement.

More information: Recommendation
Evidence Review

Aspirin cuts risk of clots, DVT by a third, new study finds

 

Coated aspirin tablets. Image: Wikimedia Commons.

Low dose aspirin lowers the occurrence of new venous blood clots – and represents a reasonable treatment option for patients who are not candidates for long-term anticoagulant drugs, such as warfarin, according to a new study published in today's issue of Circulation.

28 aug 2014--"The study provides clear, consistent evidence that low-dose aspirin can help to prevent new venous blood clots and other cardiovascular events among people who are at risk because they have already suffered a blood clot," says the study's lead author, University of Sydney Professor, John Simes.

"The treatment effect of aspirin is less than can be achieved with warfarin or other new generation direct thrombin inhibitors, which can achieve more than an 80 per cent reduction in adverse circulatory and cardiopulmonary events.

"However, aspirin represents a useful treatment option for patients who are not candidates for anticoagulant drugs because of the expense or the increased risk of bleeding associated with anticoagulants."

Key results

Compared to placebo patients, those who took 100mg daily of aspirin had a one-third reduction in the risk of:

• thromboembolism, which is the obstruction of a blood vessel by a clot that has dislodged from another site in the circulation.
• deep vein thrombosis (DVT), which is the formation of a blood clot in a deep vein, predominantly in the legs.
• pulmonary embolism, which is a blood clot affecting the arteries that supply blood to the lungs.
• myocardial infarction (heart attack), stroke or cardiovascular death.

Most people who have had a blood clot in a leg vein (deep-vein thrombosis) or an embolism (where the clot blocks the blood flow) have anticoagulant drug treatment (such as warfarin) for at least 6 months, first to dissolve the clot and then to prevent it happening again.

However, long-term anticoagulant drugs are expensive and inconvenient, requiring frequent regular blood tests and adjustments to the dosage. Further, there is an elevated risk that the treatment could cause bleeding in some patients. For people who are not able to cope with this, the viable alternative of taking regular aspirin will be a great benefit.

"The study provides evidence that after a first venous thrombosis or embolism, daily aspirin reduces the risk of another event, without causing undue bleeding. This treatment is an alternative to long-term anticoagulation and will be especially useful for patients who do not want the inconvenience of close medical monitoring or the risk of bleeding," says Professor Simes.

"Aspirin will be ideal in the many countries where prolonged anticoagulant treatment is too expensive. A major benefit of this treatment is its cost-effectiveness. Aspirin is cheap, but it will save the treatment costs of the many recurrent clots that are prevented. This could mean a saving of millions of healthcare dollars worldwide."

Co-investigator Tim Brighton, a senior haematologist at Sydney's Prince of Wales Hospital, adds: "This important study demonstrates clearly that low-dose aspirin reduces the risks of further blood clot. This is especially important for patients who are not able to take long-term anticoagulant medications for whatever reason, such as personal preference, adverse effects of anticoagulant or cost."

Provided by University of Sydney

Sleep apnea treatment is effective for older people

Illustration of obstruction of ventilation. Credit: Habib M’henni / public domain

Continuous positive airway pressure is effective at treating sleep apnoea in older people, a new study has found.

27 aug 2014--Obstructive sleep apnoea (OSA) is a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing and causing profound sleepiness. For people with moderate or severe OSA, doctors usually recommend using a continuous positive airway pressure (CPAP) device, which consists of a small pump that delivers pressurised air into the nose through a mask, stopping the throat from closing.

Previous studies have established the benefits of CPAP in middle-aged people with OSA, but until now there has been no research on whether the treatment is useful and cost-effective for older patients.

The new research found that CPAP reduces how sleepy patients feel in the daytime and reduces healthcare costs. The researchers say CPAP should be offered routinely to older patients with OSA, and more should be done to raise awareness of the condition.

The study, published today in Lancet Respiratory Medicine, involved 278 patients aged 65 or over at 14 NHS centres in the UK. It was led by researchers at Imperial College London and the Royal Infirmary of Edinburgh in collaboration with the Medical Research Council Clinical Trials Unit at UCL, and the Universities of Oxford and York. It was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme.

Around 20 per cent of the adult population experiences breathing problems during sleep. In four to five per cent of middle-aged people, these problems lead to sleepiness in the daytime, classified as obstructive sleep apnoea syndrome. The condition is thought to be more common in older people, but the true prevalence is unknown, in part because patients and their relatives may attribute their sleepiness to old age, or older people can compensate by napping. The disease is becoming more common because obesity is a major risk factor.

Professor Mary Morrell, co-principal investigator of the study from the National Heart and Lung Institute at Imperial College London, said: "Sleep apnoea can be hugely damaging to patients' quality of life and increase their risk of road accidents, heart disease and other conditions. Lots of older people might benefit from this treatment. Many patients feel rejuvenated after using CPAP because they're able to sleep much better and it may even improve their brain function."

Patients with sleep apnoea sometimes stop breathing for 30 seconds or longer at night before they wake up and start breathing again. In these pauses, their blood oxygen levels fall.We think low oxygen levels at night might accelerate cognitive decline in old people, and studies have found that sleep apnoea causes changes in the grey matter in the brain. We're currently researching whether treatment can prevent or reverse those changes," said Professor Morrell.

Co-principal investigator Dr.Renata Riha, Consultant and Honorary Reader at the Royal Infirmary of Edinburgh, added that sleep medicine spans many disciplines and comprises an important area of research which deserves support and greater recognition by funding bodies, universities and public policy makers. "Sleep disorders, such as sleep apnoea, impact on a wide variety of chronic conditions, potentially leading to their development or worsening them, including diabetes, heart attacks, strokes and possibly even cancer. Successful treatment diminishes this risk but we still have a great deal of work to do in the area," she said.

More information: A. McMillan et al. 'Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial.' Lancet Respiratory Medicine, Published Online 25 August 2014. dx.doi.org/10.1016/S2213-2600(14)70172-9

Provided by Imperial College London

New term will banish stigma, educate providers on postmenopausal problems

Talking about genital, sexual, and urinary problems can be uncomfortable for postmenopausal women and their doctors. Having a term that doesn't carry stigma, isn't embarrassing to say, and is medically accurate could go a long way in helping women get the help they need and allowing them to make smarter healthcare decisions. That term is "genitourinary syndrome of menopause" or GSM, developed and endorsed by The North American Menopause Society (NAMS) and the International Society for the Study of Women's Sexual Health (ISSWSH). The article about the term's development is published online today in the NAMS journal Menopause.

26 aug 2014--Various terms have been used to refer to the genital problems women can have when estrogen drops after menopause, including "atrophic vaginitis" and "vulvovaginal atrophy." The first implies infection or inflammation, which isn't the main problem. The second uses "vaginal," which is embarrassing for many to say. And "atrophy" implies that something is wasting away from disuse,—a misperception that doesn't account for the many women who want to continue their sex lives free of pain after menopause. What's more, the terms ignore the urinary symptoms that come along with these genital changes, including urgency (that "gotta go" problem), painful urination, and recurring urinary tract infections.

The vagina; the area around it (the "vestibule"), which includes the urethra; and the lower end of the bladder (the "trigone") all have the same embryologic origin and are rich in estrogen receptors. The vestibule is also rich in androgen receptors. In these areas, the low hormone levels after menopause result in thinning tissue, loss of elasticity, fewer blood vessels, dryness, and physical changes that can make intercourse painful and the urethra easily irritated.

A panel of NAMS and ISSWSH menopause experts met at a consensus conference to scrutinize all that's known about the changes in these tissues after menopause and to hash out a term that fits that knowledge, doesn't stigmatize women who face these changes, and isn't embarrassing to say publicly. The panel decided the term should include both genital and urinary changes ("genitourinary"), show that it is a whole group of signs and symptoms ("syndrome"), and link the changes to their principal cause ("menopause"). With members' support, both the NAMS and ISSWSH boards endorsed the term.

Although GSM affects about half of all postmenopausal women, many don't know that it is hormonal and that treatments are available, such as vaginal moisturizers, vaginal estrogen, and an oral medication that acts like estrogen in the vagina. In addition, because women are so uncomfortable talking about these problems, only a small percentage bring them up with their healthcare providers, and only about 1 in 10 providers brings up the symptoms with patients, surveys show.

"The term 'GSM' will make discussing the problems so much easier, similar to the way 'ED' changed our ability to talk about impotence,'" says NAMS Executive Director Margery Gass, MD, a member of the consensus conference panel of NAMS and ISSWSH menopause experts.

The panelists have also begun to develop a tool to help standardize a physical examination to look for these changes. That means not only will patients and healthcare providers be able to talk about these problems more easily, but also that providers will be able to make the diagnosis swiftly and accurately to get women the treatment they need.

More information: The article "Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society" will be published in the October 2014 print edition of Menopause.

Provided by The North American Menopause Society

Depression often untreated in Parkinson's disease

Depression is known to be a common symptom of Parkinson's disease, but remains untreated for many patients, according to a new study by Northwestern Medicine investigators in collaboration with the National Parkinson's Foundation (NPF).

25 aug 2014--In fact, depression is the most prevalent non-motor symptom of Parkinson's, a chronic neurodegenerative disorder typically associated with movement dysfunction.

"We confirmed suspicion that depression is a very common symptom in Parkinson's disease. Nearly a quarter of the people in the study reported symptoms consistent with depression," said Danny Bega, MD, '14 GME, instructor in the Ken and Ruth Davee Department of Neurology and first author of the study. "This is important because previous research has determined that depression is a major determinant of overall quality of life."

Using the NPS's patient database, the investigators looked at records of more than 7,000 people with Parkinson's disease. Among those with high levels of depressive symptoms, only one-third had been prescribed antidepressants before the study began, and even fewer saw social workers or mental health professionals for counseling.

The investigators then focused their analysis on the remaining two-thirds of patients with depressive symptoms who were not receiving treatment at the start of the study. Throughout a year of observation, less than 10 percent of them received prescriptions for antidepressants or referrals to counseling. Physicians were most likely to identify depression and advocate treatment for patients with the severest depression scores.

The findings were published in the Journal of Parkinson's Disease.

"The majority of these patients remained untreated," said Dr. Bega. "Still, the physician recognition of depression in this population was actually better than previous reports had suggested."

However, recognition may be lower for the general population of patients with Parkinson's disease – the patients in this study visited medical centers deemed "Centers of Excellence" by the NPF.

"Physicians must be more vigilant about screening patients for depression as part of a routine assessment of Parkinson's disease, and the effectiveness of different treatments for depression in this population need to be assessed," said Dr. Bega.

More information: Recognition and Treatment of Depressive Symptoms in Parkinson's Disease: The NPF Dataset, iospress.metapress.com/content/92617284j0410402/

Provided by Northwestern University

Targeted exercise benefits Parkinson's patients

Can exercise help people with Parkinson's disease? Maureen Gartner, MSN, a nurse practitioner with the University of Cincinnati (UC) Neuroscience Institute's Gardner Family Center for Parkinson's Disease and Movement Disorders, answers with an emphatic "Yes!"

24 auug 2014--"Everyone with Parkinson's disease is encouraged to exercise," Gartner says. "Research strongly suggests that exercise holds significant quality-of-life benefits for people with Parkinson's. Studies show that patients' motor and non-motor scores improve after only three months of targeted exercise." (Motor scores involve muscle strength, mobility, flexibility, balance, walking, swallowing and speaking. Non-motor scores involve depression, apathy, fatigue and constipation.)

"In short, exercise is a win-win for people with Parkinson's," Gartner says. Exercise also reduces the risk of other diseases that may develop, including cardiovascular disease, osteoporosis, cognitive impairment and Alzheimer's disease."

Gartner will be a panelist at the Parkinson's Disease Symposium and Expo Sept. 6 at the Oasis Conference Center in Loveland, Ohio, part of the 2014 Sunflower Revolution. The Sunflower Revolution Fitness Festival, featuring a 5-kilometer run/walk and 25K, 40K and 100K bike rides, will be held Sept. 7 at Yeatman's Cove on the Ohio River at downtown Cincinnati.

Also appearing at the symposium will be Becky Farley, PT, PhD, founder and chief executive officer of Parkinson's Wellness Recovery, a nonprofit organization based in Tucson, Arizona. Her topic will be "Exercise as Medicine: Essentials for Parkinson's."

With exercise high on the priority list for people who have Parkinson's disease and their families and caregivers, Gartner answered some questions about it:

What is "targeted" exercise?

Targeted exercise for people with Parkinson's is different from simply getting on a treadmill three days a week. Getting on a treadmill will help your fitness, but by itself it will not help your Parkinson's. The goal of "targeted" exercise is to challenge your brain to develop or strengthen a variety of neural connections. You can do this by performing different movements rather than a single, repetitive movement. Exercising in a variety of ways will yield the greatest benefits.

How often should I exercise, and for how long?

Your doctor can recommend a program that is appropriate for you based on your symptoms, fitness level and overall health. Your doctor can recommend how many times a week you should exercise and how long and how intensely you should exercise. Stop exercising if at any time you begin to feel pain or feel sick.

What types of exercise are best?

An ideal exercise program for people with Parkinson's is a "targeted" exercise program that includes stretching, strengthening, walking, balance training and aerobic activities that get your heart pumping. It could include time spent on a treadmill or stationary bike. Water aerobics and swimming are other good options. In addition, there are forms of exercise that we don't always think of as exercise, such as yoga, tai chi and just getting out on the dance floor. You can also exercise your hand muscles and reflexes with the Nintendo Wii, whose games include tennis, bowling, baseball and a balance board. It's important to stick with your exercise program. Keep in mind that exercise is a way to take control of your Parkinson's. You cannot always control your disease, but exercise is part of your health that you can control.

Who can help create an exercise program that's right for me?

There are a growing number of personal trainers who are knowledgeable about Parkinson's disease. The local chapter of the American Parkinson's Disease Association also sponsors multiple exercise classes. These classes are led by personal trainers whose passion is helping people with Parkinson's disease.

Is it safe for me to exercise by myself?

To exercise safely is to exercise with a partner or caregiver. Someone should always be with you in case you fall or freeze in place. Wherever you exercise, you should avoid slippery floors, rooms with poor lighting and throw rugs. If you have balance problems, you should exercise in an environment where you can grab onto something if you begin to fall. Nevertheless, there are a few exercises that you might prefer to do alone in the comfort of your home. These include exercises for your facial muscles. You can smile, yawn, shout, sing, make faces in the mirror and make chewing movements to help keep your facial muscles as strong as possible.

What are cues and what role do they play in exercise?

Cues are hints given by another person, a sound, an image or an object to help you stay balanced or in the right position so that you do not hurt yourself. Cues can be verbal, musical, written (on reminder cards) or visual. For example, if you have freezing of gait, a trainer might put blocks on the floor for you to walk around. The trainer also might also give you verbal cues by saying "BIG STEP" or "BIG STRIDE" to help your brain send that message to your legs.

What should I wear when I exercise?

Wear loose, comfortable clothing and comfortable shoes.

When is the best time to exercise?

Exercise when your medicines are working well, not when they are wearing off.

I have always been a couch potato. How do I begin?

First, be realistic. Check with your doctor and then start slowly. Perhaps you can begin by walking around the block or doing a few crunches while watching TV. Soup cans or soda bottles can be used as simple weights. Next, find an exercise buddy, perhaps your spouse or someone from your support group, neighborhood or church. Be on the lookout for ways to incorporate more activity into your day. Make exercise more enjoyable by listening to music. Remember that exercisecan help you live better with Parkinson's.

Provided by University of Cincinnati

Living forever may never be possible, study says

An elderly man rests on a seat in Weijian village, in China's Henan province on July 30, 2014

Is there a limit to how old humans could one day become?

23 aug 2014--French researchers trying to answer the age-old question said they found evidence in two categories of people who lived long lives of a "biological barrier" to living forever.

The team used the recorded deaths of 1,205 "supercentenarians" who died between 1899 and 2013 aged 110 or older, and of 19,012 athletes who had competed in the Olympics from 1896 to 2012.

The athletes are considered among the longest-living people.

For the supercentenarians, the researchers found longevity had steadily increased until 1997, when the rate levelled out. A similar ceiling was observed among the athlete group.

These trends "provide no signs of a recent increased longevity pattern among the longest-lived," which is not good news for people with average life expectancies, the authors wrote in the Journal of Gerontology.

Had there been a non-stop upward trend, they would have expected to find evidence of more people living ever longer, the team said.

Instead, their results support theories of an "invisible barrier" to a non-stop increase in longevity.

The team conceded the number of people they studied was "relatively small" and the observation period restricted, meaning the trend they observed could be merely a temporary anomaly.

Coronary calcium predicts heart disease risk in patients with chronic kidney disease 

Calcium buildup in the coronary arteries may be a better indicator of kidney disease patients' risk of heart disease than traditional risk factors used in the general population, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings provide valuable new information that could help safeguard the heart health of patients with kidney disease.

22 aug 2014--Heart disease is the leading cause of death in individuals with chronic kidney disease (CKD). Some studies have found that conventional risk factors for predicting an individual's likelihood of developing heart disease aren't as useful in CKD patients as they are in the general population.

Kunihiro Matsushita, MD, PhD (Johns Hopkins Bloomberg School of Public Health) and his colleagues looked to see if calcium measurements within blood vessel walls might be helpful. Because the kidney helps regulate the body's calcium levels, individuals with chronic kidney disease often have altered calcium metabolism, which may influence the usefulness of calcium in the coronary artery walls as an indicator of heart disease.

The researchers studied 6553 adults aged 45 to 84 years who did not have prior cardiovascular disease and who were participating in the Multi-Ethnic Study of Atherosclerosis. Among the participants, 1284 had CKD.

During a median follow-up of 8.4 years, 650 cardiovascular events (coronary heart disease, stroke, heart failure, and peripheral artery disease) occurred, with 236 of the events occurring in participants with CKD. The investigators found that calcium build-up in the coronary artery walls was more useful for correctly determining CKD patients' risk of cardiovascular disease (particularly coronary heart disease and heart failure) than other measures of atherosclerosis such as thickness of the carotid artery walls and narrowing of the arteries in the legs.

"Our research is important since it assures the usefulness of coronary artery calcium for better cardiovascular disease prediction in persons with CKD, a population at high risk for cardiovascular disease but with potential caveats for the use of traditional risk factors," said Dr. Matsushita.

More information: The article, entitled "Subclinical Atherosclerosis Measures for Cardiovascular Prediction in CKD," will appear online at jasn.asnjournals.org/ on August 21, 2014.

Provided by American Society of Nephrology

Researchers find that coronary arteries hold heart-regenerating cells

Endothelial cells residing in the coronary arteries can function as cardiac stem cells to produce new heart muscle tissue, Vanderbilt University investigators have discovered.

21 aug 2014--The findings, published recently in Cell Reports, offer insights into how the heart maintains itself and could lead to new strategies for repairing the heart when it fails after a heart attack.

The heart has long been considered to be an organ without regenerative potential, said Antonis Hatzopoulos, Ph.D., associate professor of Medicine and Cell and Developmental Biology.

"People thought that the same heart you had as a young child, you had as an old man or woman as well," he said.

Recent findings, however, have demonstrated that new heart muscle cells are generated at a low rate, suggesting the presence of cardiac stem cells. The source of these cells was unknown.

Hatzopoulos and colleagues postulated that the endothelial cells that line blood vessels might have the potential to generate new heart cells. They knew that endothelial cells give rise to other cell types, including blood cells, during development.

Now, using sophisticated technologies to "track" cells in a mouse model, they have demonstrated that endothelial cells in the coronary arteries generate new cardiac muscle cells in healthy hearts. They found two populations of cardiac stem cells in the coronary arteries – a quiescent population in the media layer and a proliferative population in the adventitia (outer) layer.

The finding that coronary arteries house a cardiac stem cell "niche" has interesting implications, Hatzopoulos said. Coronary artery disease – the No. 1 killer in the United States – would impact this niche.

"Our study suggests that coronary artery disease could lead to heart failure not only by blocking the arteries and causing heart attacks, but also by affecting the way the heart is maintained and regenerated," he said.

The current research follows a previous study in which Hatzopoulos and colleagues demonstrated that after a heart attack, endothelial cells give rise to the fibroblasts that generate scar tissue.

"It looks like the same endothelial system generates myocytes (muscle cells) during homeostasis and then switches to generate scar tissue after a myocardial infarction. After injury, regeneration turns to fibrosis," he said.

Understanding this switch could lead to new strategies for restoring regeneration and producing new heart muscle after a heart attack, during aging or in disease conditions such as diabetes and high blood pressure, he said.

"If we can understand the molecular mechanisms that regulate the fate switch that happens after injury, perhaps we can use some sort of chemical or drug to restore regeneration and make muscle instead of scar," Hatzopoulos said. "We think there is an opportunity here to improve the way we treat people who come into the clinic after myocardial infarction."

Provided by Vanderbilt University Medical Center

Atypical antipsychotics up renal injury risk in seniors

20 aug 2014—Use of atypical antipsychotic drugs is associated with increased risk of acute kidney injury (AKI) in older adults, according to research published in the Aug. 19 issue of the Annals of Internal Medicine.

Y. Joseph Hwang, from the Case Western Reserve University School of Medicine in Cleveland, and colleagues analyzed data for 97,777 adults aged 65 years or older who received a new outpatient prescription for an oral atypical antipsychoticdrug. These patients were matched 1:1 with a group of individuals who did not receive such a prescription. The authors sought to assess the risk of AKI and other adverse outcomes with the use of these agents.

The researchers found that risk of hospitalization for AKI was higher among older adults who used atypical antipsychotic agents compared with those who did not use these agents (relative risk [RR], 1.73; 95 percent confidence interval [CI], 1.55 to 1.92). When data were analyzed for a subpopulation of patients for whom information on serum creatinine levels was available, this association was consistently observed (5.46 versus 3.34 percent; RR, 1.70 [95 percent CI, 1.22 to 2.38]; absolute risk increase, 2.12 percent [95 percent CI, 0.80 to 3.43 percent]). Use of atypical antipsychotic drugs in older adults was also associated with increased risk of hypotension (RR, 1.91; 95 percent CI, 1.60 to 2.28), acute urinary retention (RR, 1.98; 95 percent CI, 1.63 to 2.40), and all-cause mortality (RR, 2.39; 95 percent CI, 2.28 to 2.50).

"The findings support current safety concerns about the use of these drugs in older adults," the authors write.

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

Resistant hypertension: A review for physicians

An infographic on resistant hypertension. Credit: Canadian Medical Association Journal

19 aug 2014--A new review article on resistant hypertension, which affects about 1 in 10 people with high blood pressure, is aimed at helping physicians assess and manage patients with the condition. The review, published in CMAJ(Canadian Medical Association Journal) includes information on emerging therapies for the condition.

The authors note that high-quality evidence is lacking. "We found few randomized controlled trials (RCTs) and no systematic reviews to guide decision-making. Thus, we have made management recommendations based primarily on expert consensus unless otherwise specified," writes Dr. Raj Padwal, Department of Medicine, University of Alberta, with coauthors.

About 20% of Canadian adults have hypertension (high blood pressure.) Resistant hypertension is defined as blood pressure levels that exceed the target level despite treatment with three or more hypertension drugs. Obesity, especially a large waist circumference, and sleep apnea are the top contributing factors to resistant hypertension. Patients with resistant hypertension are at higher risk of heart disease and death.

Before treating patients for resistant hypertension, physicians must rule out "pseudoresistance." Elevated blood pressure during physician visits ("white coat effect"), not taking recommended medications and inaccurate blood pressuremeasurements can contribute to apparently resistant hypertension.

The review recommends structured approaches to managing this condition:

• optimizing current medication regimen and strategies to improve adherence
• counselling patients to reduce salt intake, limit alcohol, exercise and strive for a healthy weight
• treating obstructive sleep apnea with continuous positive airway pressure
• adding drugs when current drugs are not effective—spironolactone, a-blockers, b-blockers and others
• referring patients to clinics with hypertension specialists

The authors close by emphasizing the need for more rigorous studies in the field to address knowledge gaps and clarify uncertainties.

More information: Canadian Medical Association Journal, www.cmaj.ca/lookup/doi/10.1503/cmaj.130764

Provided by Canadian Medical Association Journal

Epigenetic breakthrough bolsters understanding of Alzheimer's disease

Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.

18 aug 2014--A team led by researchers at the University of Exeter Medical School and King's College London has uncovered some of the strongest evidence yet that epigenetic changes in the brain play a role in Alzheimer's disease.

Epigenetic changes affect the expression or activity of genes without changing the underlying DNA sequence and are believed to be one mechanism by which the environment can interact with the genome. Importantly, epigenetic changes are potentially reversible and may therefore provide targets for the development of new therapies.

Globally, more than 26 million people are currently affected by Alzheimer's Disease. As this number grows in line with an increasingly aging population, the need to identify new disease mechanisms is more important than ever. Post-mortem examinations have revealed much about how Alzheimer's damages the brain, with some regions, such as the entorhinal cortex, being particularly susceptible, while others, such as the cerebellum, remain virtually unscathed. However, little is yet known about how and why the disease develops in specific brain regions.

The current study found that chemical modifications to DNA within the ANK1 gene are strongly associated with measures of neuropathology in the brain. The study, published in Nature Neuroscience, found that people with more Alzheimer's disease-related neuropathology in their brains had higher levels of DNA modifications within the ANK1 gene. The finding was particularly strong in the entorhinal cortex, and also detected in other cortical regions affected by the disease. In contrast, no significant changes were observed in less affected brain regions or blood.

Professor Jonathan Mill, of the University of Exeter Medical School and King's College London, who headed the study, said: "This is the strongest evidence yet to suggest that epigenetic changes in the brain occur in Alzheimer's disease, and offers potential hope for understanding the mechanisms involved in the onset of dementia. We don't yet know why these changes occur – it's possible that they are involved in disease onset, but they may also reflect changes induced by the disease itself."

Dr Katie Lunnon, first author on the study, from the University of Exeter Medical School, added: "It's intriguing that we find changes specifically in the regions of the brain involved in Alzheimer's disease. Future studies will focus on isolating different cell-types from the brain to see whether these changes are neuron-specific."

Dr Simon Ridley, Head of Research at Alzheimer's Research UK, the UK's leading dementia research charity, who also provided funding for the study said:

"We know that changes to the DNA code of certain genes are associated with an increased risk of developing Alzheimer's disease. Investigating how epigenetic changes influence genes in Alzheimer's is still a relatively new area of study. The importance of understanding this area of research is highlighted by the fact that epigenetic changes have been associated with development of other diseases, including cancer.

"This innovative research has discovered a potential new mechanism involved in Alzheimer's by linking the ANK1 gene to the disease. We will be interested to see further research into the role of ANK1 in Alzheimer's and whether other epigenetic changes may be involved in the disease."

"Alzheimer's affects millions of people worldwide and we need pioneering research to understand exactly why the disease occurs. Alzheimer's Research UK is helping to fund research which will take us a step closer to understanding and defeating this devastating disease."

More information: Paper: dx.doi.org/10.1038/nn.3782
Related paper: dx.doi.org/10.1038/nn.3786

Provided by University of Exeter

Low vitamin D levels linked to increased risks after noncardiac surgery

Patients with low blood levels of vitamin D are at increased risk of death and serious complications after noncardiac surgery, suggests a study in Anesthesia & Analgesia.

17 aug 2014--"Vitamin D concentrations were associated with a composite of in-hospital death, serious infections, and serious cardiovascular events," according to the new research by Dr Alparslan Turan and colleagues of the Cleveland Clinic. They believe their results warrant further study to see if giving vitamin D supplementation before surgery can reduce the risk of these adverse outcomes.

Lower Vitamin D Levels Linked to Higher Surgical Risk

The researchers analyzed the relationship between vitamin D level and surgical outcomes in approximately 3,500 patients who underwent operations other than heart surgery between 2005 and 2011. Only patients who had available data on vitamin D levels around the time of surgery—from three months before to one month afterward—were included in the study.

The concentration of vitamin D (specifically, 25-hydroxyvitamin D) in blood samples was analyzed as a risk factor for death, cardiovascular events, or serious infections while in the hospital. The analysis included adjustment for other factors such as demographic characteristics, medical conditions, and type and duration of surgery.

Most patients did not meet the recommended 25-hydroxyvitamin D concentration of greater than 30 nanograms per milliliter (ng/mL). The median vitamin D level was 23.5 ng/mL—more than 60 percent of patients were in the range of vitamin D insufficiency (10 to 30 ng/mL). Nearly 20 percent had vitamin D deficiency (less than 10 ng/mL).

"Higher vitamin D concentrations were associated with decreased odds of in-hospital mortality/morbidity," the researchers write. For each 5 ng/mL increase in 25-hydroxyvitamin D level, the combined risk of death, cardiovascular events, or serious infections decreased by seven percent.

Patients at the lowest level of 25-hydroxyvitamin D (less than 13 ng/mL) were at highest risk of death or serious complications. Those with higher vitamin D levels (up to 44 ng/mL) had about half the risk as those in the lowest group. The association with low vitamin D was statistically significant only for cardiovascular complications, although there were "strong trends" for mortality and infections.

Further Study Needed to Determine Cause and Effect

"Vitamin D deficiency is a global health problem," according to Dr Turan and coauthors. In addition to protective cardiovascular and neurological effects, vitamin D plays an important role in the immune system.

The high rates of vitamin D insufficiency and deficiency in the surgical patients studied are consistent with previous findings in the general population. In recent years, studies have suggested that vitamin D levels may affect a wide range of health outcomes.

Patients undergoing surgery are at risk of cardiovascular and infectious complications, both of which may be aggravated by vitamin D deficiency. Previous studies found no increased risk of adverse outcomes related to vitamin D levels in patients undergoing cardiac surgery. It may be that the tissue injury and inflammation associated with heart surgery overwhelms any potential protective effect of vitamin D.

However, Dr Turan and colleagues note that their study had some important limitations of their study—especially the fact that it included only patients who had recent measurements of vitamin D levels. They may represent a less-healthy group, introducing a potential source of selection bias.

The study can't determine whether there is any cause-and-effect relationship between vitamin D levels and the risk of adverse outcomes. Dr Turan and colleagues suggest a formal randomized trial to evaluate whether preoperative vitamin D supplementation can reduce the risk of serious complications and death after surgery.

More information: Anesthesia & Analgesia. journals.lww.com/anesthesia-an… entration.98423.aspx

Provided by Wolters Kluwer Health

Decline in daily functioning related to decreased brain activity in Alzheimer's

Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.

16 aug 2014--Decline in daily functioning associated with Alzheimer's disease is related to alterations in activity in certain regions of the brain, according to a study published in the August 2014 issue of the Journal of Alzheimer's Disease.

Impairment in instrumental activities of daily living—or an inability to perform high-level daily activities such as calculating finances, remembering appointments and medications, and driving—is first seen when a person has mild cognitive impairment, which can later progress to dementia due to Alzheimer's disease. Deterioration in the ability to carry out daily activities has been associated with changes in brain activity measured as use of energy (or metabolism of sugar) with a nuclear medicine scan called 18F-Flourodeoxy glucose (FDG) positron emission tomography (PET).

To further investigate the relationship between instrumental activities of daily living and brain activity (FDG metabolism), a team led by researchers from Brigham and Women's Hospital (BWH) analyzed data from the Alzheimer's Disease Neuroimaging Initiative database, a multi-center study that BWH has been a part of for nearly 10 years.

They looked at data from 104 clinically normal elderly participants, 203 participants with mild cognitive impairment, and 95 participants with mild dementia due to Alzheimer's disease. The participants had a baseline PET scan to determine brain activity and underwent clinical assessments every 6 to 12 months for up to three years. The participants' study partners (family members or friends who knew them well) also completed questionnaires about the participants' daily living activities.

The researchers found that decreased activity in frontal areas of the brain, which are responsible for cognitive processing and decision making, and deep temporal and parietal (back) areas of the brain, which are associated with memory, were associated with greater impairment of instrumental activities of daily living initially and over time.

"Impairment in activities of daily living is a major source of burden for Alzheimer's disease patients and caregivers alike," said Gad Marshall, MD, BWH Center for Alzheimer Research and Treatment, assistant professor of Neurology at Harvard Medical School, senior study author. "Therefore, detecting these important deficits early on prior to the dementia stage, along with a better understanding of how they relate to changes in the brain, can lead to more effective design of clinical trials that focus on vital patient-centered outcomes. This in turn will ultimately lead to better treatments prescribed to patients at the early stages of Alzheimer's disease before they are robbed of their faculties and autonomy."

According to the National Institute on Aging, National Institutes of Health, as many as five million people age 65 and older in the United States have dementia due to Alzheimer's disease. As the rapid growth of the aging population continues, the number of those developing the disease is expected to increase significantly, with the number of people with dementia due to Alzheimer's disease doubling for every five-year interval beyond age 65.

Provided by Brigham and Women's Hospital

Global public health objectives need to address substance abuse in developing countries

Substance addiction is a large and growing problem for developing societies. A new study that surveyed reports on modalities for treating addiction and their effectiveness in the developing world calls on policymakers to use this information to support the design of programs that meet known population needs. The study also encourages looking at ways to adapt the Alcoholics Anonymous (AA) model to fit different cultural norms. The findings are published in the Annals of Global Health.

15 aug 2014--The World Health Organization has indicated that alcohol and illicit drugs pose multifaceted dangers to millions of people, from the psychological damage of addiction to a range of physical health problems. A recent report highlights the need to address a broad spectrum of mental health issues, including substance use disorder (SUD), in order to achieve global public health objectives. This led to a call by policymakers to improve access to treatment for SUD in developing nations. Resources to address SUD in the developing world are severely limited, however, and some 34% of low- and middle-income nations have not yet developed a substance use policy.

"It is difficult to assess the extent of SUD. This is, in part, because of the limited capacity of these countries' governments to conduct national surveys, but it is also due to underinvestment in mental health care in these countries and to underutilization of mental health services in resource-poor settings," says Craig L. Katz, MD, of the Departments of Psychiatry and Medical Education, Icahn School of Medicine at Mount Sinai, New York. "The poorest nations allocate the smallest portion of their already strained public budgets to mental health."

These challenges provided the impetus for a review of the current literature on SUD treatment in the developing world, with the aim of informing future program development and research. Investigator Jasleen Salwan, MD-MPH Candidate, Icahn School of Medicine at Mount Sinai, identified 30 relevant studies published in 1994 or later. The treatment methods included pharmacological approaches, intervention studies to prevent, detect, and reduce harm, the AA-style or Minnesota/Therapeutic Community Model, and multimodal approaches. Two studies compared treatment approaches between two different countries: China with Germany, and El Salvador with Puerto Rico. Other studies looked at access to treatment and resources for providers.

"An important finding is that what works well in one setting may not work well in another," notes Salwan. "Existing research highlights the need to provide secular alternatives to the dominant faith-based treatment approach in El Salvador, to improve access to harm reduction programs for crack cocaine users in Brazil, and to ensure the availability of safe havens for recovering addicts in China to avoid being treated as criminals."

Although comprehensive overviews of treatment models were markedly absent from the literature surveyed, the studies highlight specific areas of need within developing countries, building on existing awareness of general barriers to treatment in those countries. "Policymakers can use this information to design programs that meet known population needs and avoid providing extraneous services," adds Katz.

The investigators recommend that future research should blend inquiry with practice. "Although further investigation is clearly needed in order to better understand the specific needs of developing world populations, assisting those populations should be a primary goal of all endeavors. Conversely, service-oriented planning for addressing SUD in the developing world should be done with a mandate to study the effect of interventions in order to establish program efficacy," comments Katz.

Finally, the authors suggest further evaluation of the AA model. There were mixed results in the literature regarding implementation of the AA model in developing countries that invite further exploration, ideally in more systematic and comprehensive ways.

"Although there is reason to question whether a model that relies so heavily on self-revelation and sharing will work in all places due to cultural and privacy concerns, the AA model has great appeal for developing countries that lack financial resources to create more comprehensive substance use treatment programs. Finding successful ways to adapt the AA model in different settings therefore may not only be a cost-effective way to scale up services, but also help foster a culture of awareness of substance use issues that can in turn spark greater investment in medicalized resources beyond what AA can offer," Katz concludes.

More information: "A Review of Substance Use Disorder Treatment in Developing World Communities," by Jasleen Salwan, MD-MPH Candidate, and Craig L. Katz, MD, DOI: dx.doi.org/10.1016/j.aogh.2014.04.010, Annals of Global Health, Volume 80, Issue 2 (2014)

Provided by Elsevier

Verbal abuse of older adults: A disturbing influence on quality of life

Newly published research from Journal of Elder Abuse & Neglect (Routledge) has determined that verbal mistreatment is a highly prevalent concern among older adults in primary care clinics because of its relation to negative mental health outcomes including poor social functioning and major depression. Verbal Mistreatment of the Elderly, conducted by a research team from Northeastern University, is now available online with Free Access.

14 aug 2014--"Our work demonstrates that words can hurt and older adults who suffer from verbal mistreatment have serious sequela," said Terry Fulmer, a member of the research team. "All of us have a responsibility to better understand verbal mistreatment and develop interventions to help stop these unwanted behaviors. Further, we need to develop strategies that help older adults cope with verbal mistreatment."

A diverse sample of 142 older adults aged 65 and older were surveyed regarding verbal mistreatment, quality of life, and depressive symptoms. 38 percent of the sample reported having experienced at least one instance of verbal mistreatment from their primary caregiver. No significant differences were found among factors like age, gender, ethnicity, or marital status. Verbal mistreatment was not strongly associated with physical health, but showed significant detrimental effects on social functioning and mental health. In addition, respondents subjected to verbal mistreatment were three times more likely to report role limitations due to emotional problems.

The research team does offer future directions to alleviate this issue. "Future research should be directed at determining the best methods of intervening for patients who have reported verbal mistreatment. Sensitive and valid screening methods should also be developed to identify the patients who may be at risk for verbal mistreatment and identify patients that are currently experiencing some form of verbal mistreatment," as explained in the conclusion. "Screening methods are important in light of research that has suggested elder mistreatment is grossly under-reported."

More information: www.tandfonline.com/doi/full/1… 08946566.2013.801817

Provided by Taylor & Francis

Digital literacy reduces cognitive decline in older adults, experts finds

Researchers have found a link between digital literacy and a reduction in cognitive decline, according to a study published in The Journals of Gerontology, Series A: Medical Sciences on July 8th.

13 aug 2014--Led by Andre Junqueira Xavier at the Universidade do Sul de Santa Catarina, this is the first major study to show that digital literacy, or the ability to engage, plan and execute digital actions such as web browsing and exchanging emails, can improve memory. Drawn from the English Longitudinal Study of Ageing, the study followed 6442 participants in the UK between the ages of 50 and 89 for 8 years.

The data measures delayed recall from a 10-word-list learning task across 5 separate measurement points. Higher wealth, education and digital literacy improved delayed recall, while people with functional impairment, diabetes, cardiovascular diseases, depressive symptoms or no digital literacy showed decline.

The researchers' findings suggest that "digital literacy increases brain and cognitive reserve or leads to the employment of more efficient cognitive networks to delay cognitive decline." The authors write, "countries where policy interventions regarding improvement in DL are implemented may expect lower incidence rates for dementia over the coming decades."

More information: The paper, "English Longitidunal Study of Ageing (ELSA): Can internet/email use reduce cognitive decline?," can be accessed here: www.oxfordjournals.org/page/5759/14

Provided by Oxford University Press

Bisphosphonates for osteoporosis not associated with reduced breast cancer risk

An analysis of data from two randomized clinical trials finds that three to four years of treatment with bisphosphonates to improve bone density is not linked to reduced risk of invasive postmenopausal breast cancer.

12 aug 2014--The authors are Trisha F. Hue, Ph.D., M.P.H., of the University of California, San Francisco, and colleagues.

Some studies have suggested that bisphosphonates, which are commonly used to treat osteoporosis, may have antitumor and antimetastatic properties. Some observational studies have suggested bisphosphonates may protect women from breast cancer.

The authors analyzed the relationship of postmenopausal breast cancer and bisphosphonate use by examining data from two randomized, double-blind, placebo-controlled trials. The Fracture Intervention Trial (FIT) randomly assigned 6,459 women (ages 55 to 81 years) to alendronate or placebo with an average follow-up of 3.8 years. The Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly-Pivotal Fracture Trial (HORIZON-PFT) randomly assigned 7,765 women (ages 65 to 89 years) to annual intravenous zoledronic acid or placebo with an average follow-up of 2.8 years. The authors compared rates of breast cancer in the bisphosphonate treatment groups to the placebo groups.

There was no significant difference in breast cancer rates between the bisphosphonate and placebo groups. In FIT, the breast cancer rate was 1.5 percent in the placebo group and 1.8 percent in the alendronate group. In HORIZON-PFT the rate was 0.8 percent in the placebo group and 0.9 percent in the zoledronic acid group. There also was no significant difference when data from the two trials were combined.

"These data provide evidence that three to four years of treatment with bisphosphonate, alendronate or zoledronic acid, therapy does not reduce the risk of incident breast cancer in postmenopausal women. The discrepancy between our results and the reports of associations in observational studies may be an example of indication bias and illustrates the limitation and hazard of drawing conclusions about treatment effects from observational studies (even those that are very well done) and emphasizes the value of confirming such associations in randomized trials. The effect of bisphosphonate treatment on breast cancer risk in nonosteoporotic populations should be investigated in other randomized trials."

In a related editor's note, Joseph S. Ross, M.D., M.H.S., a JAMA Internal Medicine associate editor, writes: "Whereas these findings highlight why it is so important for new therapies to be evaluated using RCTs (randomized clinical trials), they also reinforce the importance of assessing the methodological rigor of observational studies before interpreting real-world effects."

"Just as we closely scrutinize RCT design, so must we understand the quality and statistical power of the data used for observational studies, how participants were identified, the duration of follow-up, the end points examined, and the analytical strategy used. Observational studies are particularly valuable for clinical situations unlikely to be tested using RCTs, and many provide valid and reliable real-world evidence," Ross continues.

"Thus, whereas we all can remember examples of when RCTs and observational studies differed, less memorable are the even more numerous examples in which results were consistent. In the end, we should be open to all types of evidence and rely on rigorous clinical science to guide practice," Ross concludes.

More information: JAMA Intern Med. Published online August 11, 2014. DOI: 10.1001/jamainternmed.2014.3634

Provided by The JAMA Network Journals