ASCO: Burnout reported by most palliative care clinicians
31 oct 2014—More than 60 percent of palliative care clinicians report burnout, according to a study presented at the American Society of Clinical Oncology's inaugural Palliative Care in Oncology Symposium, held from Oct. 24 to 25 in Boston.
Arif Kamal, M.D., from the Duke University Medical Center in Durham, N.C., and colleagues examined the prevalence and predictors of burnout among palliative care providers. Data were collected from surveys from 1,241 clinicians who were members of the American Academy of Hospital and Palliative Medicine who had completed the Maslach Burnout Inventory. Burnout severity was assessed across two domains: emotional exhaustion (EE) and depersonalization (DP).
The researchers found that 68 percent of the respondents were physicians, 57 percent were older than 50 years, and 65 percent were females. Forty-two percent reported regularly receiving overnight calls and 30 percent reported working at least 50 hours per week. Of the respondents, 24, 59, and 62 percent, respectively, reported high DP, high EE, and high burnout symptoms on either EE or DP scales. The greatest risk of burnout was reported for younger colleagues, those working more than 50 hours per week, and those with fewer colleagues within their practice (P < 0.02).
"Further studies on how burnout affects sustainability of the palliative care workforce are needed, especially since this workforce is so critical to the provision of high-quality cancer care," the authors write.
New frailty test predicts risk of poor outcomes in elderly patients
A simplified frailty index created by surgeons at Wayne State University School of Medicine in Detroit, Mich., is a reliable tool for assessing risk of mortality and serious complications in older patients considering total hip and knee replacement procedures, according to new study findings presented today at the 2014 Clinical Congress of the American College of Surgeons.
30 oct 2014--As more seniors stay healthier longer, elective operations such as hip and knee replace-ments are becoming more common. Traditionally, a person's eligibility for surgery has been based largely upon biological age. In recent years, however, a person's level of frailty (under-stood as a general decline in functional status) has come to be recognized as an independent risk factor for adverse health outcomes.
"We felt that age and general impression of the patient wasn't adequate for predicting outcomes, so we created a simplified frailty index to stratify risk of mortality and morbidity in surgical patients," said study coauthor Peter Adams, MD, a resident in general surgery at Henry Ford Hospital, Detroit, Mich. "We started our analysis in elderly emergent patients, and then moved on to vascular patients, and with this research, we have narrowed it down to two specific procedures."
While a number of different indices exist for measuring age-related frailty, the index used in this study is the only one directly mapped to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.
"The advantage is that NSQIP provides a very large sample size and better quality data than our typical retrospective chart reviews," Dr. Adams said. "And the fact that we can get a large sample size for specific types of surgeries allows us to narrow down our data and be more precise in our understanding of individual patient populations and procedures in terms of risk."
The simplified frailty index takes into account 11 data points collected by the ACS NSQIP database. Since most of these variables are considered co-morbidities, such as history of heart attack, stent and hypertension, health care providers can easily calculate a patient's frailty score by taking a simple medical history. No laboratory values are included.
For the study, Dr. Adams and his colleagues used the ACS NSQIP database to identify total joint replacements between 2006 and 2012. Overall, frailty scores were calculated for 40,469 patients. Frailty scores ranged from 0 (no positive frailty values) to 0.64 (four positive frailty values) with a mean score of .10. Mean age was 66, and 61 percent of the patients underwent total knee replacement surgery and 39 percent had hip replacement surgery.
Since the majority of patients in this study had four or less positive frailty values, the maximum assigned score was 4/11, rather than 11/11.
Using the index, study authors found a significant mortality rate for the 462 patients with high frailty scores. Patients with no frailty associated values (a frailty score of 0) had a mortality rate of 0.08 percent, but those with four values (a frailty score of 0.36), had a mortality rate of 2 percent.
The research also found that risk of serious postoperative complications increased from .67 percent (with no frailty associated values) to 6.24 percent (with four frailty values). Furthermore, this frailty test was shown to be a more reliable predictor of death and serious complications than patient age.
"I think using our frailty index can kind of enlighten surgeons into recognizing that even if they are doing an elective case, such as total knee or hip replacement, sicker patients who have significant medical histories may have a high risk of wound infections and even mortality," Dr. Adams said. "This frailty score will allow surgeons to have accurate and meaningful conversations with patients about their risk."
Importantly, Dr. Adams points out that this frailty score could also be used to show that elderly patients should not be denied an option for surgical treatment. Patients who have low frailty scores will probably do well and should be considered on the merits of their health, and not solely on age.
Provided by American College of Surgeons
Wednesday, October 29, 2014
High milk intake linked with higher fractures and mortality
A high milk intake in women and men is not accompanied by a lower risk of fracture and instead may be associated with a higher rate of death, suggests observational research published in The BMJ this week.
29 oct 2014--This may be explained by the high levels of lactose and galactose (types of sugar) in milk, that have been shown to increase oxidative stress and chronic inflammation in animal studies, say the researchers.
However, they point out that their study can only show an association and cannot prove cause and effect. They say the results "should be interpreted cautiously" and further studies are needed before any firm conclusions or dietary recommendations can be made.
A diet rich in milk products is promoted to reduce the likelihood of osteoporotic fractures, but previous research looking at the importance of milk for the prevention of fractures and the influence on mortality rates show conflicting results.
So a research team in Sweden, led by Professor Karl Michaëlsson, set out to examine whether high milk intake may increase oxidative stress, which, in turn, affects the risk of mortality and fracture.
Two large groups of 61,433 women (aged 39-74 years in 1987-1990) and 45,339 men (aged 45-79 years in 1997) in Sweden completed food frequency questionnaires for 96 common foods including milk, yoghurt and cheese.
Lifestyle information, weight and height were collated and factors such as education level and marital status were also taken into account. National registers were used to track fracture and mortality rates.
Women were tracked for an average of 20 years, during which time 15,541 died and 17,252 had a fracture, of whom 4,259 had a hip fracture.
In women, no reduction in fracture risk with higher milk consumption was observed. Furthermore, women who drank more than three glasses of milk a day (average 680 ml) had a higher risk of death than women who drank less than one glass of milk a day (average 60 ml).
Men were tracked for an average of 11 years, during which time 10,112 died and 5,066 had a fracture, with 1,166 hip fracture cases. Men also had a higher risk of death with higher milk consumption, although this was less pronounced than in women.
Further analysis showed a positive association between milk intake and biomarkers of oxidative stress and inflammation.
In contrast, a high intake of fermented milk products with a low lactose content (including yoghurt and cheese) was associated with reduced rates of mortality and fracture, particularly in women.
They conclude that a higher consumption of milk in women and men is not accompanied by a lower risk of fracture and instead may be associated with a higher rate of death. Consequently, there may be a link between the lactose and galactose content of milk and risk, although causality needs be tested.
"Our results may question the validity of recommendations to consume high amounts of milk to prevent fragility fractures," they write. "The results should, however, be interpreted cautiously given the observational design of our study. The findings merit independent replication before they can be used for dietary recommendations."
Michaëlsson and colleagues raise a fascinating possibility about the potential harms of milk, says Professor Mary Schooling at City University of New York in an accompanying editorial. However, she stresses that diet is difficult to assess precisely and she reinforces the message that these findings should be interpreted cautiously.
"As milk consumption may rise globally with economic development and increasing consumption of animal source foods, the role of milk and mortality needs to be established definitively now," she concludes.
Dietary cocoa flavanols reverse age-related memory decline, study shows
Dietary cocoa flavanols -- naturally occurring bioactives found in cocoa -- reversed age-related memory decline in healthy older adults, according to a study led by Columbia University Medical Center scientists. A cocoa flavanol-containing test drink prepared specifically for research purposes was produced by the food company Mars, Incorporated, which also supported the research, using a proprietary process to extract flavanols from cocoa beans. Most methods of processing cocoa remove many of the flavanols found in the raw plant. Credit: Mars, Incorporated
28 oct 2014--Dietary cocoa flavanols—naturally occurring bioactives found in cocoa—reversed age-related memory decline in healthy older adults, according to a study led by Columbia University Medical Center (CUMC) scientists. The study, published today in the advance online issue of Nature Neuroscience, provides the first direct evidence that one component of age-related memory decline in humans is caused by changes in a specific region of the brain and that this form of memory decline can be improved by a dietary intervention.
As people age, they typically show some decline in cognitive abilities, including learning and remembering such things as the names of new acquaintances or where one parked the car or placed one's keys. This normal age-related memory decline starts in early adulthood but usually does not have any noticeable impact on quality of life until people reach their fifties or sixties. Age-related memory decline is different from the often-devastating memory impairment that occurs with Alzheimer's, in which a disease process damages and destroys neurons in various parts of the brain, including the memory circuits.
Previous work, including by the laboratory of senior author Scott A. Small, MD, had shown that changes in a specific part of the brain—the dentate gyrus—are associated with age-related memory decline. Until now, however, the evidence in humans showed only a correlational link, not a causal one. To see if the dentate gyrus is the source of age-related memory decline in humans, Dr. Small and his colleagues tested whether compounds called cocoa flavanols can improve the function of this brain region and improve memory. Flavanols extracted from cocoa beans had previously been found to improve neuronal connections in the dentate gyrus of mice.
Dr. Small is the Boris and Rose Katz Professor of Neurology (in the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, the Sergievsky Center, and the Departments of Radiology and Psychiatry) and director of the Alzheimer's Disease Research Center in the Taub Institute at CUMC.
A cocoa flavanol-containing test drink prepared specifically for research purposes was produced by the food company Mars, Incorporated, which also partly supported the research, using a proprietary process to extract flavanols from cocoa beans. Most methods of processing cocoa remove many of the flavanols found in the raw plant.
The brain area outlined in yellow is the hippocampus; the dentate gyrus is shown in green and the entorhinal cortex in purple. Previous work, including by the laboratory of senior author Scott A. Small, M.D., had shown that changes in a specific part of the brain's hippocampus -- the dentate gyrus -- are associated with normal age-related memory decline in humans and other mammals. The dentate gyrus is distinct from the entorhinal cortex, the hippocampal region affected in early-stage Alzheimer's disease. Credit: Lab of Scott A. Small, M.D.
In the CUMC study, 37 healthy volunteers, ages 50 to 69, were randomized to receive either a high-flavanol diet (900 mg of flavanols a day) or a low-flavanol diet (10 mg of flavanols a day) for three months. Brain imaging and memory tests were administered to each participant before and after the study. The brain imaging measured blood volume in the dentate gyrus, a measure of metabolism, and the memory test involved a 20-minute pattern-recognition exercise designed to evaluate a type of memory controlled by the dentate gyrus.
"When we imaged our research subjects' brains, we found noticeable improvements in the function of the dentate gyrus in those who consumed the high-cocoa-flavanol drink," said lead author Adam M. Brickman, PhD, associate professor of neuropsychology at the Taub Institute.
The high-flavanol group also performed significantly better on the memory test. "If a participant had the memory of a typical 60-year-old at the beginning of the study, after three months that person on average had the memory of a typical 30- or 40-year-old," said Dr. Small. He cautioned, however, that the findings need to be replicated in a larger study—which he and his team plan to do.
Flavanols are also found naturally in tea leaves and in certain fruits and vegetables, but the overall amounts, as well as the specific forms and mixtures, vary widely.
The dentate gyrus is distinct from the entorhinal cortex, the hippocampal region affected in early-stage Alzheimer's disease. Previous work, including by the laboratory of senior author Scott A. Small, M.D., had shown that changes in a specific part of the brain's hippocampus -- the dentate gyrus -- are associated with normal age-related memory decline in humans and other mammals. Credit: Lab of Scott A. Small
The precise formulation used in the CUMC study has also been shown to improve cardiovascular health. Brigham and Women's Hospital in Boston recently launched an NIH-funded study of 18,000 men and women to see whether flavanols can help prevent heart attacks and strokes.
The researchers point out that the product used in the study is not the same as chocolate, and they caution against an increase in chocolate consumption in an attempt to gain this effect.
Two innovations by the investigators made the study possible. One was a new information-processing tool that allows the imaging data to be presented in a single, three-dimensional snapshot, rather than in numerous individual slices. The tool was developed in Dr. Small's lab by Usman A. Khan, an MD-PhD student in the lab, and Frank A. Provenzano, a biomedical engineering graduate student at Columbia. The other innovation was a modification to a classic neuropsychological test, allowing the researchers to evaluate memory function specifically localized to the dentate gyrus. The revised test was developed by Drs. Brickman and Small.
Besides flavanols, exercise has been shown in previous studies, including those of Dr. Small, to improve memory and dentate gyrus function in younger people. In the current study, the researchers were unable to assess whether exercise had an effect on memory or on dentate gyrus activity. "Since we didn't reach the intended VO2max (maximal oxygen uptake) target," said Dr. Small, "we couldn't evaluate whether exercise was beneficial in this context. This is not to saythat exercise is not beneficial for cognition. It may be that older people need more intense exercise to reach VO2max levels that have therapeutic effects."
More information: Enhancing dentate gyrus function with dietary flavanols improves cognition in older adults, Nature Neuroscience, DOI: 10.1038/nn.3850
Provided by Columbia University Medical Center
Monday, October 27, 2014
Changing lifestyle may improve cognitive function in the elderly
A randomized controlled trial published in the current issue of Psychotherapy and Psychosomatics indicates that modifications in lifestyle may improve cognitive function in the elderly. Since a healthy lifestyle may protect against cognitive decline, the authors examined outcomes in elderly individuals after 18 months of a five-group intervention program consisting of various modalities: physical activity, antismoking, social activity, cognitive activity, alcohol drinking in moderation, and leaning about body mass and a healthy diet.
27 oct 2014--Between 2008 and 2010, a cluster randomized controlled trial assessing 460 community-dwelling individuals aged 60 years and older, was conducted in a geriatric community mental health center in Suwon, Republic of Korea. The intervention program based on the principles of contingency management was developed in a way that could be delivered by ordinary primary health workers. According to the research design, group A (n = 81) received standard care services, group B (n = 80) received bimonthly (once every 2 months) telephonic care management, group C (n = 111) received monthly telephonic care management and educational materials similar to those in group B, group D (n = 93) received bimonthly health worker-initiated visits and counseling and group E (n = 94) received bimonthly health worker-initiated visits, counseling, and rewards for adherence to the program.
The primary outcome was the change in Mini-Mental State Examination (MMSE) scores from baseline to the final follow-up visit at 18 months. Group E showed superior cognitive function to group A (adjusted coefficient β = 0.99, p = 0.044), with participation in cognitive activities being the most important determining factor among several health behaviors (adjusted coefficient β = 1.04, p < 0.01). The study showed that engaging in cognitive activities, in combination with positive health behaviors, may be most beneficial in preserving cognitive abilities in community-dwelling older adults.
More information: Lee K.S., Lee Y., Back J.H., Son S.J., Choi S.H., Chung Y.-K., Lim K.-Y., Noh J.S., Koh S.H., Oh B.H., Hong C.H. "Effects of a Multidomain Lifestyle Modification on Cognitive Function in Older Adults: An Eighteen-Month Community-Based Cluster Randomized Controlled Trial." Psychother Psychosom2014;83:270-278.
Provided by Journal of Psychotherapy and Psychosomatics
Sunday, October 26, 2014
New insight on why people with Down syndrome invariably develop Alzheimer's disease
Amyloid plaques are found in the brains of people with Down syndrome and Alzheimer's disease. Credit: Juan Gartner
26 oct 2014--A new study by researchers at Sanford-Burnham Medical Research Institute reveals the process that leads to changes in the brains of individuals with Down syndrome—the same changes that cause dementia in Alzheimer's patients. The findings, published in Cell Reports, have important implications for the development of treatments that can prevent damage in neuronal connectivity and brain function in Down syndrome and other neurodevelopmental and neurodegenerative conditions, including Alzheimer's disease.
Down syndrome is characterized by an extra copy of chromosome 21 and is the most common chromosome abnormality in humans. It occurs in about one per 700 babies in the United States, and is associated with a mild to moderate intellectual disability. Down syndrome is also associated with an increased risk of developing Alzheimer's disease. By the age of 40, nearly 100 percent of all individuals with Down syndrome develop the changes in the brain associated with Alzheimer's disease, and approximately 25 percent of people with Down syndrome show signs of Alzheimer's-type dementia by the age of 35, and 75 percent by age 65. As the life expectancy for people with Down syndrome has increased dramatically in recent years—from 25 in 1983 to 60 today—research aimed to understand the cause of conditions that affect their quality of life are essential.
"Our goal is to understand how the extra copy of chromosome 21 and its genes cause individuals with Down syndrome to have a greatly increased risk of developing dementia," said Huaxi Hu, Ph.D., professor in the Degenerative Diseases Program at Sanford-Burnham and senior author of the paper. "Our new study reveals how a protein called sorting nexin 27 (SNX27) regulates the generation of beta-amyloid—the main component of the detrimental amyloid plaques found in the brains of people with Down syndrome and Alzheimer's. The findings are important because they explain how beta-amyloid levels are managed in these individuals."
Beta-Amyloid, Plaques and Dementia
Xu's team found that SNX27 regulates beta-amyloid generation. Beta-amyloid is a sticky protein that's toxic to neurons. The combination of beta-amyloid and dead neurons form clumps in the brain called plaques. Brain plaques are a pathological hallmark of Alzheimer's disease and are implicated in the cause of the symptoms of dementia.
"We found that SNX27 reduces beta-amyloid generation through interactions with gamma-secretase—an enzyme that cleaves the beta-amyloid precursor protein to produce beta-amyloid," said Xin Wang, Ph.D., a postdoctoral fellow in Xu's lab and first author of the publication. "When SNX27 interacts with gamma-secretase, the enzyme becomes disabled and cannot produce beta-amyloid. Lower levels of SNX27 lead to increased levels of functional gamma-secretase that in turn lead to increased levels of beta-amyloid."
SNX27's Role in Brain Function
Previously, Xu and colleagues found that SNX27 deficient mice shared some characteristics with Down syndrome, and that humans with Down syndrome have significantly lower levels of SNX27. In the brain, SNX27 maintains certain receptors on the cell surface—receptors that are necessary for neurons to fire properly. When levels of SNX27 are reduced, neuron activity is impaired, causing problems with learning and memory. Importantly, the research team found that by adding new copies of the SNX27 gene to the brains of Down syndrome mice, they could repair the memory deficit in the mice.
The researchers went on to reveal how lower levels of SNX27 in Down syndrome are the result of an extra copy of an RNA molecule encoded by chromosome 21 called miRNA-155. miRNA-155 is a small piece of genetic material that doesn't code for protein, but instead influences the production of SNX27.
With the current study, researchers can piece the entire process together—the extra copy of chromosome 21 causes elevated levels of miRNA-155 that in turn lead to reduced levels of SNX27. Reduced levels of SNX27 lead to an increase in the amount of active gamma-secretase causing an increase in the production of beta-amyloid and the plaques observed in affected individuals.
"We have defined a rather complex mechanism that explains how SNX27 levels indirectly lead to beta-amyloid," said Xu. "While there may be many factors that contribute to Alzheimer's characteristics in Down syndrome, our study supports an approach of inhibiting gamma-secretase as a means to prevent the amyloid plaques in the brain found in Down syndrome and Alzheimer's."
"Our next step is to develop and implement a screening test to identify molecules that can reduce the levels of miRNA-155 and hence restore the level of SNX27, and find molecules that can enhance the interaction between SNX27 and gamma-secretase. We are working with the Conrad Prebys Center for Chemical Genomics at Sanford-Burnham to achieve this," added Xu.
Provided by Sanford-Burnham Medical Research Institute
Saturday, October 25, 2014
Oestrogen possible treatment in menopause also at increased risk of cardiovascular disease
A new population study from Karolinska Institutet shows that women with an increased risk of cardiovascular disease may benefit from oestrogen treatment for menopausal problems, something that has so far been advised against. Researchers have studied 41,000 Swedish women who were treated with cholesterol-lowering drugs, and the results are being published in the journal Menopause.
25 oct 2014--"The proportion of women treated with oestrogens during menopause has decreased in recent years, for several reasons", says first study-author Dr. Ingegärd Anveden Berglind. "At the same time, many women going through menopause have explicit problems with hot flashes, sleeping, osteoporosis, and mild depression, which often can be treated successfully with oestrogens. The results of this study could be of value for evaluating risk and benefit of oestrogen treatment for menopause related conditions."
According to current treatment recommendations, women who are at an increased risk of cardiovascular disease should be treated with oestrogenes for menopausal problems with caution. These recommendations were designed based on the results from two major studies conducted in the beginning of the 2000s, which showed that women treated with oestrogens were at an increased risk of falling ill from cardiovascular disease. In the current study, researcher at the Centre for Pharmacoepidemiology at Karolinska Institutet studied oestrogen treatment and the risk of cardiovascular disease and mortality among women treated with so-called statins.
Simultaneously treated
Statins are a commonly used as cholesterol-lowering treatment to prevent cardiovascular disease in patients with an increased risk of such disease; in all 10 percent of the Swedish adult population are being treated with these drugs. The current study included 41,000 women, ages 40 to 75, treated with statins. A little more than 2,800 (7%) of these women were simultaneously treated with oestrogens. Risk of disease and mortality were studied by comparing women with our without oestrogen treatment.
The results show that the risk of death was almost halved in women treated with oestrogen, and that there were no increased risk of cardiovascular disease during the four years of follow-up. Researchers therefor draw the conclusion that oestrogens do not increase the risk of cardiovascular disease and death in women treated with statins.
More information: "Hormone therapy and risk of cardiovascular outcomes and mortality in women treated with statins." Menopause, online 22 Oct 2014, publishing in the April 2015 print issue. journals.lww.com/menopausejour… ovascular.98288.aspx
Provided by Karolinska Institutet
Friday, October 24, 2014
Gait and dementia link confirmed
Researchers at Newcastle University have found a definitive link between gait - the way someone walks - and early changes in cognitive function in people with Parkinson's disease.
24 oct 2014--And the findings, published today in the journal Frontiers in Aging Neuroscience could mean that gait may be used as an early warning sign to help predict the development of cognitive impairment and dementia in Parkinson's. It has been known for several years that there is a link between gait disturbance and dementia in older adults, but until now the relationship has not been clear in Parkinson's.
The Newcastle findings indicate that subtle changes in walking patterns – some of which are undetectable to the eye - could be an early warning sign of cognitive decline and could be a guide to alert medical practitioners that treatment is needed. Although there is no cure, early treatment can help manage symptoms.
Parkinson's disease
Over 120 people with Parkinson's disease were tested making this the biggest study to date in early Parkinson's Disease and they were compared to over 180 older adults. Volunteers were asked to walk for two minutes in the lab and their stride pattern was then analysed. Factors such as the length of stride, and sideways sway were looked at in a specially designed gait laboratory at the Clinical Ageing Research Unit, a clinical research facility jointly managed by Newcastle University and the Newcastle upon Tyne NHS Hospitals Foundation Trust.
Lynn Rochester, Professor of Human Movement Science at Newcastle University and lead author of the paper, said: "The relationship between gait and cognition has never been established this early on and in such a large group of Parkinson's before. In the future walking patterns may be a useful early warning system to help identify dementia risk in Parkinson's.
"Subtle changes in someone's walking pattern, for example slowing down of steps, and increased sway from side to side are related to cognitive function even before changes are seen in cognitive tests.
"Ongoing work will confirm if it is possible to predict future cognitive decline and dementia risk. However this early work shows great promise.
"If we can use this and test people who may at risk, then we could pick up the early signs and begin treatment and advice."
Provided by Newcastle University
Thursday, October 23, 2014
Loss of Y chromosome associated with higher mortality and cancer in men
Age-related loss of the Y chromosome (LOY) from blood cells, a frequent occurrence among elderly men, is associated with elevated risk of various cancers and earlier death, according to research presented at the American Society of Human Genetics (ASHG) 2014 Annual Meeting in San Diego.
23 oct 2014--This finding could help explain why men tend to have a shorter life span and higher rates of sex-unspecific cancers than women, who do not have a Y chromosome, said Lars Forsberg, PhD, lead author of the study and a geneticist at Uppsala University in Sweden.
LOY, which occurs occasionally as a given man's blood cells replicate – and thus takes place inconsistently throughout the body – was first reported nearly 50 years ago and remains largely unexplained in both its causes and effects. Recent advances in genetic technology have allowed researchers to use a blood test to detect when only a small fraction of a man's blood cells have undergone LOY.
Dr. Forsberg and colleagues studied blood samples from 1,153 elderly men aged 70 to 84 years, who were followed clinically for up to 40 years. They found that men whose samples showed LOY in a significant fraction of their blood cells lived an average of 5.5 years less than men whose blood was not affected by LOY. In addition, having undergone LOY significantly increased the men's risk of dying from cancer during the course of the study. These associations remained statistically significant when results were adjusted for men's age and other health conditions.
"Many people think the Y chromosome only contains genes involved in sex determination and sperm production," said Jan Dumanski, MD, PhD, co-author on the study and a professor at Uppsala University. "In fact, these genes have other important functions, such as possibly playing a role in preventing tumors." When LOY takes place, Y chromosome genes are not expressed, and this tumor prevention would be reduced.
Interestingly, LOY in blood cells is associated with many different cancers, including those outside of the blood system. This may be because Y chromosome genes enable blood cells to assist with immunosurveillance, the process by which the immune system detects and kills tumor cells to prevent cancer.
"Our hypothesis is that LOY disrupts the immunosurveillance normally conducted by blood cells, allowing tumors to grow unchecked and develop into cancer," Dr. Forsberg said.
These findings suggest a new approach to early detection of cancer risk in men: a blood test to assess LOY. "LOY is not very dangerous in a small fraction of blood cells, but becomes increasingly predictive of cancer as more cells lose their Y chromosome," Dr. Forsberg explained. "This takes years, so you'd have a window of time to do something to reduce your risk."
The researchers are currently exploring LOY in more detail, including the effects of various lifestyle factors and other health conditions. They are also examining the frequency and consequences of LOY in different types of cells and throughout the life course.
More information: Forsberg L et al. (2014 Oct 21). Abstract: Mosaic loss of chromosome Y (LOY) in blood cells is associated with shorter survival and higher risk of cancer in men. Presented at American Society of Human Genetics 2014 Annual Meeting. San Diego, Calif.
Provided by American Society of Human Genetics
Wednesday, October 22, 2014
Ebola: Five questions about the killer virus
22 oct 2014--The highly contagious Ebola virus, which has killed more than 4,500 people in west Africa since December and has fueled global alarm, is among the most dangerous ever identified.
Where did it come from?
Like AIDS, which began in Kinshasa in the 1920s before spreading worldwide, according to a recent study, Ebola was first identified in central Africa.
The tropical virus was named after a river in the Democratic Republic of Congo, where it came to light in 1976.
Five species have been identified to date (Zaire, Sudan, Bundibugyo, Reston and Tai Forest), the first being the most dangerous with death rates that have reached 90 percent among humans.
The death rate in the current epidemic of haemorrhagic fever is around 70 percent according to the World Health Organization (WHO).
How is it transmitted?
The virus' natural reservoir animal is probably the bat, which does not contract the disease itself.
Chimpanzees, gorillas, monkeys, forest antelope and porcupines have also been found to transmit Ebola to humans.
Only one certified contact with an animal has been recorded in the current outbreak, however, early on in Guinea, following which it has been passed on among humans.
Although it is highly contagious, Ebola is transmitted less easily than some other diseases. An average of two people have been infected by each person who has contracted the disease since December.
This is because Ebola is transmitted by contact with the blood, body fluids, secretions or organs of an infected person, but not by air.
Those infected do not become contagious until the symptoms appear. They then become more and more contagious until just after their death, which poses great risks during funerals.
Following an incubation period of between two and 21 days, five being the average according to a Swiss study, Ebola develops into a high fever, weakness, intense muscle and joint pain, headaches and sore throats.
That is often followed by vomiting and diarrhoea, skin eruptions, kidney and liver failure, and internal and external bleeding.
How can it be treated?
Because there is no approved drug treatment at present, patients are essentially re-hydrated.
A series of experimental treatments have nonetheless resulted in positive results among several patients.
The best known is ZMapp, a cocktail of three monoclonal (single cell) antibiotics developed through a Canadian/US partnership, of which several hundred doses are expected to become available by the end of this year.
Avignan, an anti-flu treatment developed by the Japanese firm Toyama Chemical, could be available rapidly but it has not yet been proven sufficiently effective against the Ebola virus.
Toyama Chemical says it has enough Avignan in stock for more than 20,000 people.
Two vaccines have been deemed promising by the WHO and their development has been speeded up. They are the Canadian drug VSV-EBOV, of which 1,000 doses were sent to the WHO this week, and cAd3-ZEBOV, made by the British pharmaceutical group GlaxoSmithKline, which is not expected to be ready before 2016.
How can you protect yourself?
Ebola is best treated preventively, notably through hand-washing and using gel- or alcohol-based disinfectants. The required procedure is simple but must be done rigorously, and anyone suspected of exposure must check carefully for symptoms, especially fever.
It is recommended to keep a distance of several metres (yards) from infected people or bodies, and health-care providers must wear disposable protection clothing that includes masks and gloves.
Sites that have been contaminated must be disinfected.
How to defeat Ebola?
Patients must first be identified through laboratory tests because the symptoms resemble those of other diseases such as malaria. Those infected must be isolated.
Ebola treatment centres require substantial means: WHO estimates that it takes between 200-250 medical personnel to safely staff a centre of 70 beds.
All people in contact with an infected person must be closely watched for 21 days to ensure they have not contracted the disease.
The United Nations has estimated it will take around $1.0 billion (780 million euros) to fight Ebola over the next six months, but less than 40 percent of that amount has been received so far.
The money is needed to increase the number of available beds to 7,000 from 4,300 at present by December 1 and to provide the required number of personnel.
doc-burs-sst/wai/jmy/gd
Tuesday, October 21, 2014
Three-minute assessment successfully identifies delirium in hospitalized elders
Delirium is a state of confusion that develops suddenly, often following an acute medical illness, a surgical procedure or a hospitalization. Although delirium is estimated to complicate hospital stays for over 2.5 million elderly individuals in the U.S. each year, this common condition often goes undetected. The end result can be serious complications with sometimes devastating consequences for vulnerable hospitalized elders.
21 oct 2014--Now, investigators at Beth Israel Deaconess Medical Center (BIDMC) have developed a three-minute diagnostic assessment for delirium and demonstrated that it is extremely accurate in identifying the condition in a group of older hospital patients.
In a study that appears in the October 21 issue of the Annals of Internal Medicine, the authors report that the assessment, the 3-Minute Diagnostic Interview for CAM-Defined Delirium (3D-CAM), detected delirium with greater-than-90-percent specificity and sensitivity when compared with a reference standard. Of particular note, the 3D-CAM was shown to be highly accurate in identifying delirium in patients with dementia, a group for whom diagnosis can be particularly challenging.
"Prompt recognition of delirium is the first step to timely evaluation and treatment, preventing complications and keeping older patients safe while in the hospital," says lead author Edward Marcantonio, MD, SM, Director of the Aging Research Program in the Division of General Medicine and Primary Care at BIDMC and Professor of Medicine at Harvard Medical School. "As growing numbers of older adults are being hospitalized, it's critically important that doctors, nurses and other hospital care providers be able to recognize delirium. We wanted to develop a brief and simple method to make this easier to accomplish, and we are extremely happy with the 3D-CAM results. It appears that this easy-to-administer interview could significantly improve detection of this common and morbid condition in vulnerable older hospital patients. "
Delirium affects 30 to 40 percent of older medical patients and between 15 and 50 percent of older surgical patients. The condition remains distressingly under-recognized, with average detection rates of only 12 to 35 percent in most clinical settings. Moreover, the cases of delirium that are identified tend to be agitated patients who are disruptive to patient care, while the patients with hypoactive delirium, who are quiet and lethargic, often are undiagnosed.
The CAM algorithm was originally developed in 1990 by the study's senior author Sharon K. Inouye, MD, MPH, Director of the Aging Brain Center in the Institute for Aging Research at Hebrew Senior Life and HMS Professor of Medicine in the Division of Gerontology at BIDMC. To date, the CAM has been used in over 4,000 original studies and has been translated into more than 14 languages. The CAM diagnostic algorithm requires that the assessor determine the presence or absence of four key features of delirium: 1) acute change and fluctuating course; 2) inattention; 3) disorganized thinking; and 4) altered level of consciousness. To be diagnosed with delirium, a patient must have features 1 and 2 and either 3 or 4.
"We have found that there are many different cognitive tests that the person rating the CAM can use to assess for these four features, and we've shown that the quality of the assessment makes a big difference in the accuracy of identification of delirium," explains Inouye. "The 3D-CAM is a major advance since it provides a brief, easy-to-administer approach that operationalizes the CAM algorithm in three minutes, and provides highly accurate results compared to a gold standard clinical assessment."
To develop the 3D-CAM assessment tool, the investigators reduced an original list of 160 questions and observations down to 20 items. To do this, each item was evaluated using a modern measurement approach called Item Response Theory, which is also used to create educational tests such as the Scholastic Aptitude Test (SAT). Only the most informative items for delirium diagnosis were selected for inclusion in the final 3D-CAM assessment. Examples included patient questions about symptoms ("Have you been feeling confused?"), structured observations ("Did the patient fall asleep during the interview?") and cognitive testing of attention and orientation.
After selecting the 20 best items and assembling the 3D-CAM interview, the authors embarked on a prospective validation study by enrolling 201 patients over age 75 who were hospitalized in BIDMC's General Medicine Service between 2010 and 2012.
The authors first conducted a "gold standard" clinical assessment for delirium and dementia, in which an experienced clinician conducted a full patient evaluation including a cognitive exam, a review of the patient's medical records and conversations with the patient's nurse and family caregiver. This assessment took between 60 and 90 minutes and resulted in data similar to a doctor's initial evaluation.
An expert panel then reviewed all of the data and made a judgment as to the presence or absence of delirium and dementia. The "gold standard" assessment, determined that 42 of 201 participants (21 percent) had delirium, 88 percent of which was hypoactive or "quiet." They also found that 56 patients (28 percent) had dementia prior to being admitted to the hospital. In some cases, patients had both delirium and dementia. Research assistants subsequently administered the 3D-CAM assessment without knowledge of the gold-standard results.
"First, we timed the test, and found that, on average, it did indeed take only three minutes to administer," says Marcantonio. The researchers then compared the results of the 3D-CAM with the gold standard assessment and found that the 3D-CAM correctly identified 95 percent of the patients with delirium (95 percent sensitivity) while correctly identifying 94 percent of patients without delirium (94 percent specificity). When a second research assistant went back and administered the 3D-CAM without knowledge of the first test results, the answer was the same 95 percent of the time (95 percent reproducibility.) Importantly, the 3D-CAM performed nearly as well in patients with dementia, which is a particularly challenging group in which to diagnose delirium.
"Given its brevity, ease of use, and excellent accuracy and reproducibility, the 3D-CAM could be an important component of a program to improve recognition and management of delirium in older hospitalized adults," says Marcantonio. Adds Inouye, "Hospitals throughout the world are increasingly recognizing the importance of delirium as a major preventable adverse event. The 3D-CAM holds great promise as an important advance for delirium care specifically, and for acute care of elders more generally."
Study shows inpatient palliative care reduces hospital costs and readmissions
Palliative care provided in the hospital offers known clinical benefits, and a new study shows that inpatient palliative care can also significantly lower the cost of hospitalization and the rate of readmissions. Further, the study shows the hospital can get the expertise it needs through a collaborative relationship with a community hospice. The results of a comparative study are published in Journal of Palliative Medicine, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Palliative Medicine website until November 15, 2014.
20 oct 2014--the article "A Hospice-Hospital Partnership: Reducing Hospitalization Costs and 30-Day Readmissions among Seriously Ill Adults," John Tangeman, MD, Christopher Kerr, MD, PhD, and Pei Grant, PhD, Center for Hospice and Palliative Care (Cheektowaga, NY), and Carole Rudra, PhD, MPH, Rudra Research (Buffalo, NY), compared cost per hospital admission and readmission rates among patients who received inpatient palliative care to those who did not at two hospitals in western New York.
"Palliative care has been proven to deliver on the value equation," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine and Clinical Professor of Medicine, Ohio University. "To be successful, every health system will want to maximize its investment in palliative care to deliver the highest quality of care at the lowest cost."
More information: "Hospice-Hospital Partnership: Reducing Hospitalization Costs and 30-Day Readmissions among Seriously Ill Adults." Tangeman John C., Rudra Carole B., Kerr Christopher W., and Grant Pei C.. Journal of Palliative Medicine. September 2014, 17(9): 1005-1010. DOI: 10.1089/jpm.2013.0612.
Provided by Mary Ann Liebert, Inc
Saturday, October 18, 2014
Positive subliminal messages on aging improve physical functioning in elderly
Credit: Shutterstock
19 oct 2014--Older individuals who are subliminally exposed to positive stereotypes about aging showed improved physical functioning that can last for several weeks, a new study led by the Yale School of Public Health has found.
Researchers used a novel intervention method to examine for the first time whether exposure to positive age stereotypes could weaken negative age stereotypes and their effects over time, and lead to healthier outcomes.
The study, to be published in an upcoming online issue of the journal Psychological Science, consisted of 100 older individuals (average age 81 years) who live in the greater New Haven, Connecticut area. Some of the participants were subjected to positive age stereotypes on a computer screen that flashed words such as "spry" and "creative" at speeds that were too fast to allow for conscious awareness.
Individuals exposed to the positive messaging exhibited a range of psychological and physical improvements that were not found in control subjects. They benefited from improved physical function, such as physical balance, which continued for three weeks after the intervention ended. Also, during the same period, positive age stereotypes and positive self-perceptions of aging were strengthened, and negative age stereotypes and negative self-perceptions of aging were weakened.
"The challenge we had in this study was to enable the participants to overcome the negative age stereotypes which they acquire from society, as in everyday conversations and television comedies," said lead researcher Becca Levy, associate professor and director of the Social and Behavioral Science Division. "The study's successful outcome suggests the potential of directing subliminal processes toward the enhancement of physical function."
While it has been previously shown by Levy that negative age stereotypes can weaken an older individual's physical functioning, this is the first time that subliminal activation of positive age stereotypes was found to improve outcomes over time.
The study found that the intervention influenced physical function through a cascade of positive effects: It first strengthened the subjects' positive age stereotypes, which then strengthened their positive self-perceptions, which then improved their physical function.
The study's effect on physical function surpassed a previous study by others that involved a six-month-exercise intervention's effect with participants of similar ages.
Why men are the weaker sex when it comes to bone health
Alarming new data published today by the International Osteoporosis Foundation (IOF), shows that one-third of all hip fractures worldwide occur in men, with mortality rates as high as 37% in the first year following fracture. This makes men twice as likely as women to die after a hip fracture. Osteoporosis experts warn that as men often remain undiagnosed and untreated, millions are left vulnerable to early death and disability, irrespective of fracture type.
18 oct 2014--The report entitled 'Osteoporosis in men: why change needs to happen' is released ahead of World Osteoporosis Day on October 20, and highlights that the ability of men to live independent pain-free lives into old age is being seriously compromised. Continued inaction will lead to millions of men being dependent on long-term care with health and social care systems tested to the limit.
Often mistakenly considered a woman's disease, osteoporotic fractures affect one in five men aged over 50 years. However, this number is predicted to rise dramatically as the world's men are ageing fast. From 1950–2050 there will have been a 10-fold increase in the number of men aged 60 years or more – rising from 90 million to 900 million – the age group most at risk of osteoporosis.
Men are the 'weaker sex' in terms of death and disability caused by osteoporosis as their bone health is simply being ignored by health-care systems. A study from the USA has shown that men were 50% less likely to receive treatment than women. As governments and health-care systems focus on diseases such as cancer and heart disease, this 'silent killer' is not being recognized as a threat and affecting an increasing number of victims.
Professor John A. Kanis, President, IOF said "It is estimated that the lifetime risk of experiencing an osteoporotic fracture in men over the age of 50 years is up to 27%, higher than that of developing prostate cancer. Yet, an inadequate amount of health-care resources are being invested in bone, muscle and joint diseases. We have proven cost-effective solutions available, such as Fracture Liaison Services that can help identify those at risk and avoid a continuous cascade of broken bones. People should not have to live with the pain and suffering caused by osteoporosis as we can help prevent and control the disease".
Osteoporosis is a disease that affects the bones, causing them to become weak and fragile and more likely to break/fracture. All types of fractures, e.g. spine and hip, lead to higher death rates in men when compared to women. If health-care professionals identified osteoporotic men after their first bone break this would dramatically reduce their risk of future fractures and early death. Yet fewer than 20% of these men are being assessed and treated.
Lead author of the report, Professor Peter Ebeling (IOF board member and Head, Department of Medicine, Monash University, Victoria, Australia) said, "In the EU, projections suggest that by 2025 the total number of fractures in men will increase by 34%, to almost 1.6 million cases per year. In the USA the number of hip fractures among men is expected to increase by 51.8% from the year 2010 to 2030, and in contrast the number among women is expected to decrease 3.5%. A battle is set to rage between the quantity and quality of life. We must act now to ensure men not only live longer but also have a future free of the pain and suffering caused by osteoporotic fractures".
Older adults satisfied with aging more likely to seek health screenings
Adults over 50 who feel comfortable about aging are more proactive in getting preventive health care services, a new University of Michigan study found.
17 oct 2014--Sometimes, the older population does not visit their doctor because they believe that physical and mental declines typify old age, says Eric Kim, a U-M doctoral student in clinical psychology. They think that lifestyle changes will not make a difference, making them less likely to seek preventive care. This is not true and also not a healthy mindset, he says.
Studies show that older adults can go down several different trajectories of health as they age: some decline, some maintain and some even get healthier. Different mindsets influence which health trajectories people follow because mindsets influence health behaviors, says Kim, the study's lead author.
If people are satisfied with their aging process, which includes feeling useful and having high energy, they sought health screenings.
The study's 6,177 participants were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. Each respondent answered questions about use of preventive health services over time.
Individuals who reported higher satisfaction with aging were more likely to obtain a cholesterol test and colonoscopy over time. For women, they received a mammogram/X-ray or pap smear with greater frequency. Men made medical appointments more often to get a prostate exam, the study showed. These associations remained even after adjusting for potential confounding factors.
One area that did not improve based on aging satisfaction: getting a flu shot.
16 oct 2014--American nurse Nina Pham is the second health worker to contract Ebola outside of West Africa while caring for patients with the virus, despite using personal protective equipment. Authorities were quick to attribute lapses in protocol for Pham's and Madrid nurse Teresa Romero Ramos' infection. But inadequate guidelines for personal protective equipment (PPE) may equally be to blame.
The World Health Organization (WHO), United States Centers for Disease Control (CDC), Australia and many countries recommend health workers treating Ebola wear surgical masks for protection, along with other personal protective equipment such gowns, gloves and goggles.
A glaring inconsistency of these guidelines is that lab scientists working with Ebola are recommended to use respirators, which offer more protection than surgical masks, while masks are deemed adequate for doctors and nurses at the front line. The hospital ward, however, is a far more contaminated and volatile environment than the sterile, highly controlled lab.
Nurses have the closest contact with patients, and deserve all available protection for their occupational health and safety. This means higher personal protective equipment, including respirators.
The CDC's most recent guideline update for putting on and removing protective wear suggest the second glove can be removed by hooking a bare finger under the glove (risking contact with the outside of the glove which could be contaminated), and does not mention protective boots at all.
Non-government organisations such as Medecins Sans Frontieres (MSF), however, have more comprehensive Ebola-specific protocols on glove removal, footwear and the use of respirators.
Ebola kills 50% to 90% of people who become infected, which is much higher than any other infection we are used to dealing with. The 2009 influenza pandemic killed less than 0.01% of those infected, and SARS killed 15%.
The price of getting it wrong with flu guidelines might be a week in bed, but for Ebola it is far more likely to be death. The risk analysis equation we need to use must consider not only the probability of Ebola turning up on our shores, but also the consequences.
Unprecedented epidemic
The current West African Ebola outbreak has caused more than 8000 cases and more than 4000 deaths, with the epicentre being Guinea, Sierra Leone and Liberia. Official figures are underestimated because many cases are not reaching health-care facilities or being reported.
As the epidemic increases exponentially in West Africa there is a risk of imported cases occurring around the world. The first of these was in Dallas, Texas, but countries everywhere are on the alert for suspected cases. Experts have estimated that the risk of a travel-related case being imported into Europe is up to 75% by the end of October.
This epidemic is unprecedented because:
It is the largest and longest in history;
It is the first time Ebola has occurred in more than one country simultaneously;
It is the first time Ebola has affected urban areas and capital cities; and
It is the first time Ebola has been transmitted from person to person outside of Africa.
Health authorities such as the US CDC are conveying certainty that Ebola cannot be transmitted by any means other than direct contact. But it's a very poorly studied infection compared with other diseases and the sum of the evidence shows significant uncertainty around transmission.
The prevailing view is that infections can only be transmitted by one of three mutually exclusive routes – contact, droplet or airborne. But this is based on experiments from the 1940s and 50s using blunt instruments. There is plenty of evidence that pathogen transmission is far more complex than this, and that most pathogens can be transmitted by several modes. Take influenza, for example.
While the predominant mode of transmission of Ebola is contact, some scientists believe it could also be spread by aerosols. Studies in monkeys and pigs have demonstrated non-contact transmission of Ebola, which could be airborne or aerosol.
There is little research in humans, but in a 1995 outbreak in the Democratic Republic of Congo, five people contracted Ebola without reporting any direct contact with the index patient.
Health worker infections
The estimated infectious potential of Ebola in West Africa is similar to influenza. Each person with Ebola infects, on average, two other people, which is similar to estimates for the last pandemic of flu. It is a mystery why an infection that is supposedly only transmitted by contact has such a high infection rate.
Around 400 health-care workers have contracted Ebola during this outbreak, many of whom are unsure how they were infected. Dr Kent Brantley, for instance, is certain he did not get infected in the Ebola ward, as he used strict personal protective equipment. He guesses he might have been infected elsewhere, such as the emergency room.
Dr Sheikh Hummar Khan was the leading viral haemorrhagic fever expert of Sierra Leone, who had already treated over 100 Ebola patients using full personal protective equipment when he died from Ebola.
Why then are so many health workers contracting Ebola when it is supposedly so "hard to catch"? There are three possible explanations:
Lapses in infection control protocols, such as mistakes when putting protective equipment on or taking it off.
Inadequate guidelines that are failing to protect against other (non-contact) modes of transmission.
Health workers are becoming infected somewhere other than where they're in direct patient contact (where they do not expect to be at risk). This is possible in West Africa with such a large scale epidemic, but is unlikely in the United States and Spain.
There is no scientific evidence to explain why health workers using personal protective equipment are becoming infected, and nor has there been a reasoned approach to trying to explain it.
Instead, the blame has been placed on the health workers for lapsing in personal protective equipment protocols. It was reported Ramos might have touched her face with a glove as she removed her personal protective equipment.
In epidemiology, we are concerned about recall bias: the tendency of people with an illness to recall perceived risks more than well people, when prompted with a leading question. It is not hard to imagine that this nurse, perplexed about how she might have been infected, would have been susceptible to such a leading question.
Rather than guesses, we need a reasoned, scientific approach to establishing which of these explanations – and it may be a combination – are responsible.
Personal protective equipment guidelines should not be based on presumed mode of transmission alone, but also on uncertainty around transmission, on the severity of the disease, on health worker factors, and on other available treatments or preventions. If MSF has more comprehensive protocols on protective wear, it is hard to understand why Western countries are not heeding them.
Protecting health workers
Many dedicated health workers around the world are assisting with the response to Ebola. Some responders are non-clinicians, and that some clinician responders do not have extensive infectious diseases training. There is a clear occupational health and safety risk to health workers from this deadly disease, which is concerning.
To better protect health workers from Ebola, the ARM network, a group of Australian epidemiologists with skills in infectious diseases, is offering a free workshop on Ebola infection control to supplement routine training provided by deploying non-government agencies.
The workshop is for people intending to deploy to West Africa for the Ebola response. But due to expressions of interest, we have opened the workshop to domestic first-line responders (GPs, nurses, paramedics, police, defence, emergency workers) in Australia who may be faced with a local case.
In most responses, lack of knowledge about infection control may not be critical, but in the case of Ebola it may cost lives. If even one person learns something at this workshop which enhances their occupational health and safety, then we would have provided something useful for Australians involved in the response.
Provided by The Conversation
Wednesday, October 15, 2014
Impact of mental stress on heart varies between men, women
This graphic shows the effects of mental stress on psychophysiological domains, myocardial ischemia, and outcomes in men and women. Credit: Zainab Samad et al. Sex Differences in Platelet Reactivity and Cardiovascular and Psychological Response to Mental Stress in Patients With Stable Ischemic Heart Disease: Insights From the REMIT Study. J Am Coll Cardiol. 2014;64(16):1669-1678.
Men and women have different cardiovascular and psychological reactions to mental stress, according to a study of men and women who were already being treated for heart disease. The study, published today in the Journal of the American College of Cardiology, looked at 56 women and 254 men diagnosed with heart disease enrolled in a larger REMIT study of the impact of the medication escitalopram on heart disease induced by mental stress.
After undergoing baseline testing, participants carried out three mentally stressful tasks—a mental arithmetic test, a mirror tracing test, and an anger recall test—followed by a treadmill exercise test. During mental stress tasks and rest periods between tests, researchers conducted echocardiography to study changes in the heart, took blood samples, and measured blood pressure and heart rate.
Researchers from the Duke Heart Center found that while men had more changes in blood pressure and heart rate in response to the mental stress, more women experienced myocardial ischemia, decreased blood flow to the heart. Women also experienced increased platelet aggregation, which is the start of the formation of blood clots, more than men. The women compared with men also expressed a greater increase in negative emotions and a greater decrease in positive emotions during the mental stress tests.
"The relationship between mental stress and cardiovascular disease is well known," said the study lead author Zainab Samad, M.D., M.H.S., assistant professor of medicine at Duke University Medical Center, Durham, North Carolina. "This study revealed that mental stress affects the cardiovascular health of men and women differently. We need to recognize this difference when evaluating and treating patients for cardiovascular disease."
"At this point, further studies are needed to test the association of sex differences in the heart's responses to mental stress and long term outcomes," Samad said. "This study also underscores the inadequacy of available risk prediction tools, which currently fail to measure an entire facet of risk, i.e. the impact of negative physiological responses to psychological stress in both sexes, and especially so among women."
