Healthy Sex Life Can Extend Into 80s

By Serena Gordon

14 aug 2008 -- A satisfying sex life is possible as you age into your 70s and 80s, new research suggests.
Many older Americans are apparently taking advantage of that fact, because 68 percent of men between 57 and 85 reported having sex last year, as did 42 percent of women, according to the study's lead author, Edward Laumann, the George Herbert Mead Distinguished Service Professor of Sociology at the University of Chicago. And, Laumann added, more older women might have wanted to have sex, but there just aren't as many available older men for them to partner with.
"Healthy people can have reasonably satisfying sexual health for most of their lives," said Laumann. "There are challenges that arise, but it's not aging, per se, that's the issue. A decline in sexuality may be the canary in the mineshaft. Sexual problems may manifest before diabetes and high blood pressure."
The study findings were published in the current issue of The Journal of Sexual Medicine.
"It's definitely whether you're elderly or "wellderly" that makes a difference," said Dr. Virginia Sadock, director of the program of human sexuality at New York University Langone Medical Center in New York City. "Illness and medications make a difference in sex lives."
Other factors that can get in the way of a satisfying sex life later in life include having had a sexually transmitted disease, and having physical problems, mental health issues or relationship difficulties, the study found.
The study included information from 1,550 women and 1,455 men between the ages of 57 and 85. All participated in the National Social Life, Health and Aging Project.
Some highlights of the study include:
Having had a sexually transmitted disease (STD) in the past nearly quadrupled a woman's odds of having sexual pain, and it tripled the odds a woman would have lubrication problems.
In men, a history of STD was associated with five times the risk of finding sex unpleasant.
In both older men and women, a common factor in sexual dysfunction and a decreased interest in sex was urinary tract syndrome.
Both older men and older women reported that mental health issues affected their interest in sex.
For men, relationship troubles also contributed to a lack of interest in sex and the inability to achieve orgasm.
Drinking alcohol daily improved a women interest in and pleasure from sex. Alcohol didn't have that effect on men.
Hispanic women were twice as likely to report pain during intercourse.
Black men were twice as likely to say they weren't interested in sex and were more likely to report climaxing early.
"Sexual health is a harbinger of physical and mental health, and it plays an important role in the quality of life," Laumann said. "Older people don't just drop out of the picture. In general, if you're healthy, you can be sexually active."
Sadock added: "Don't assume that because you're older, your sex life has to be gone. If you're healthy and connected to someone, and you've had a pretty good sex life when you're younger, then you can have a pretty good sex life in old age."

Physical Frailty Could Predict Alzheimer's Disease

By Alan MozesHealth
WEDNESDAY, 14 aug 2008-- Physical frailty among the elderly may be linked to early Alzheimer's disease, regardless of whether or not patients develop dementia, new research reveals.
The finding, based on brain autopsies of deceased elderly patients, raises the notion that motor impairment in the elderly is an early symptom of Alzheimer's -- one that appears before mental decline.
It could also turn out to be that frailty and Alzheimer's are not directly linked but stem from a common origin, researchers say.
"What we know is that if you see a very frail person next to somebody not so frail, the very frail person is more likely to have Alzheimer's pathology in their brain when they die," said study lead author Dr. Aron S. Buchman, an associate professor in the department of neurological sciences at Rush University Medical Center in Chicago.
"This is important as we try to wrap our heads around the biology of aging," he added. "Because it turns out that as you get older Alzheimer's pathology, signs of its development are really ubiquitous, even if that doesn't mean that you actually have dementia. So, this finding could alter the way most medical and non-medical people conceptualize Alzheimer's -- as a disease simply of impaired memory and cognition -- while expanding our view of what it actually means to become frail."
Buchman and his colleagues were expected to publish their findings in the Aug. 12 issue of Neurology.
Prior studies have indicated that about 7 percent of men and women over the age of 65 are frail, meaning they display a significant loss of strength, energy, and agility. That figure rises to 45 percent among people over the age of 85, the researchers said.
In the new study, the Chicago group looked for the presence of the microscopic protein "plaques and tangles" typically associated with Alzheimer's disease in the autopsied brains of 165 male and female study participants.
The autopsies were conducted on Rush patients who had participated in a larger aging and chronic disease study, launched with support from the U.S. National Institute on Aging in 1997. At the time of their deaths, the participants were an average of 88 years old.
While alive, all of the participants had been subject to annual clinical evaluations to assess four markers of frailty: grip strength, time it took to walk eight feet, body mass index (a measure of obesity), and fatigue.
According to the team, patients whose brains showed high levels of Alzheimer's development had been about twice as physically frail as those with low levels of Alzheimer's progression. This was true regardless of whether the patient had experienced dementia or not.
A little more than one-third of the patients had displayed signs of dementia or memory loss prior to their death, the authors noted.
The findings also held up regardless of a patient's physical activity level or disease history.
According to Buchman's group, one previous study that focused on the same group of patients while they were still alive revealed that among those with no cognitive impairment, frailer patients had a higher risk for developing Alzheimer's than those who were less frail.
"So now, we put all this together, and it raises the possibility that Alzheimer's is much more of a public health issue than previously thought, if it turns out that being weak is a sign of its onset," said Buchman. "But, if so, we also now have a clue as to how we can possibly intervene, perhaps by treating motor dysfunction years before people develop dementia, so that they won't develop dementia as early."
Dr. Laurel Coleman, an Augusta, Maine-based geriatrician and member of the Alzheimer's Association's National Board, described the study as "well-done" and "incredibly provocative."
"This study really ties together two very common syndromes in aging --cognitive processes and motor skills -- in ways I have not seen them connected before," she noted. "So, I think this is very important and relevant, because it raises the question of whether frailty could be an early manifestation of Alzheimer's disease. The study doesn't necessarily answer the question, and this is something they now have to go about proving. But already, for me, that idea is a whole new thought that will push me to look at my patients with new eyes."

Investigational Tibolone Lowers Fracture Rate but Increases Stroke Risk

By Michael Smith
SAN FRANCISCO, 14 aug 2008--The relative risk of vertebral fracture was reduced by 45% by the use of the selective tissue estrogenic activity regulator tibolone, an investigational agent to ease menopause symptoms or prevent osteoporosis, researchers here said.
Tibolone also reduced the risk of non-vertebral fracture and invasive breast cancer in a randomized, double-blind, placebo-controlled study, according to Steven Cummings, M.D., of the California Pacific Medical Center, and colleagues.
But tibolone also was associated with an increased risk of stroke, which led in part to the study being stopped in February 2006, Dr. Cummings and colleagues reported in the Aug. 14 issue of the New England Journal of Medicine.
Tibolone is not approved in the U.S., although it is marketed under the name Livial in 90 other countries. The trial -- Long-Term Intervention on Fractures with Tibolone, or LIFT -- was sponsored by Organon, now part of Schering-Plough, which manufactures the drug.
The study enrolled 4,538 women between ages 60 and 85, who had a bone mineral density T score of no more than minus 2.5 at the hip or spine or a T score of minus 2.0 or less and radiologic evidence of a vertebral fracture.
They were randomized to placebo or once-daily tibolone at a dose of 1.25 milligrams. All patients were also given up to 630 to 1,260 milligrams of calcium citrate and 400 to 800 IU of vitamin D3 daily.
The trial's data safety monitoring board halted the study after a median of 34 months of treatment because the risk of stroke in the tibolone arm was more than twice as high as in the placebo arm, and because the study had met a predetermined stopping point for efficacy, the researchers said.
Analysis of the data found:
A vertebral fracture rate of 70 per 1,000 person-years in the tibolone arm versus 126 among those getting placebo. The relative hazard was 0.55 with a 95% confidence interval from 0.41 to 0.74, which was significant at P<0.001.
A non-vertebral fracture rate of 122 cases per 1,000 person-years for tibolone, compared with 166 cases for placebo. The relative hazard was 0.74 with a 95% confidence interval from 0.58 to 0.93, which was significant at P=0.01.
A decreased risk of invasive breast cancer in the tibolone group. The relative hazard was 0.32 with a 95% confidence interval from 0.13 to 0.80, which was significant at P=0.02.
A lower risk of colon cancer for the tibolone group. The relative hazard was 0.31 with a 95% confidence interval from 0.10 to 0.96, which was significant at P=0.04.
However, the tibolone group had an increased risk of stroke. The relative hazard was 2.19 with a 95% confidence interval from 1.14 to 4.23, which was significant at P=0.02.
The excess risk of stroke was mainly seen in the first year of treatment and in older women, the researchers said.
Overall, the difference in absolute risk of stroke for women in the tibolone group was an increase of 2.3 per 1,000 person-years compared with placebo.
However, for participants 70 or older, the difference in absolute risk was 3.1 per 1,000 person-years, while for those younger than 70, the difference in absolute risk was 1.8 per 1,000 person-years, Dr. Cummings and colleagues found.
The study had limited power to analyze outcomes such as coronary heart disease and endometrial cancer, the researchers noted. Also, longer treatment might change the risk-benefit profile, they said.
The efficacy of the drug in treating menopausal symptoms and preventing bone loss has led to its widespread approval, although its effects on major health outcomes has been "unclear," said Ghada El-Hajj Fuleihan, M.D., of the American University of Beirut Medical Center, in Beirut, Lebanon.
Writing in an accompanying editorial, Dr. El-Hajj Fuleihan said the LIFT study begins to clarify that picture, with clear evidence that the drug should not be used in older women or in those with strong risk factors for stroke (hypertension, smoking, diabetes, and atrial fibrillation).
But the long-term effects of the drug are still unknown, Dr. El-Hajj Fuleihan said.
The study confirms that tibolone reduces both the risk of fractures and the incidence of invasive breast cancer, said David Sturdee, M.D., of Solihull Hospital, in Solihull, England, and the president of the International Menopause Society.
But, he cautioned in a statement, no form of hormone replacement therapy is a "one-size-fits-all solution."
"In older women, or women with an increased risk of stroke, alternative treatments should be considered," Dr. Sturdee said. "For every woman, therapy needs to be individualized in consultation with her medical adviser, depending on her age and the indications."
The study was supported by Organon. Dr. Cummings reported financial links with Amgen, Eli Lilly, Procter & Gamble, GlaxoSmithKline, and Organon.
Dr. El-Hajj Fuleihan reported financial links with Eli Lilly, Novartis, Merck, and sanofi-aventis.
Primary source: New England Journal of MedicineSource reference:Cummings SR, et al "The Effects of Tibolone in Older Postmenopausal Women" N Engl J Med 2008; 359: 697-708. Additional source: New England Journal of MedicineSource reference: El-Hajj Fuleihan G "Tibolone and the Promise of Ideal Hormone-Replacement Therapy" N Engl J Med 2008; 359: 753-55.

Perceived level of intimacy within a relationship predicts relational uncertainty

University Park, PA – 14 aug 2008– Relational Uncertainty refers to people's lack of confidence in their perceptions of relationship involvement. A new study in the journal Personal Relationships evaluated associations between intimacy and relational uncertainty and found that fluctuations in perceptions of relationships are meaningful aspects of non-marital romantic relationships.
Denise Haunani Solomon of Pennsylvania State University and Jennifer A. Theiss of Rutgers University administered a web-based survey to 315 unmarried college students about their relationship weekly for six weeks.
Researchers found that the level of intimacy people perceived within a relationship in any given week significantly predicted perceptions of relational uncertainty and interference from a partner. The data revealed the highest levels of relational uncertainty when intimacy was low.
"Our results suggest that when intimacy ebbs, doubts about the relationship emerge," the authors conclude. "Making emerging adults aware of how romantic associations inevitably pose a threat to a person's subjective well-being might help them to form more realistic romantic relationship goals."
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This study is published in the September 2008 issue of Personal Relationships. Media wishing to receive a PDF of this article may contact journalnews@bos.blackwellpublishing.net.
Denise Haunani Solomon is affiliated with Pennsylvania State University and can be reached for questions at dhs12@psu.edu.
Personal Relationships, first published in 1994, is an international, interdisciplinary journal that promotes scholarship in the field of personal relationships using a wide variety of methodologies and throughout a broad range of disciplines, including psychology, sociology, communication studies, anthropology, family studies, child development, social work, and gerontology.

Long-term care workers struggle with elderly population boom

13 aug 2008--As America's aging population increases, so does its need for long-term care. And the workers who provide these services often lack the support they need — particularly in the area of pay and work relationships, according to "Better Jobs Better Care: New Research on the Long-Term Care Workforce," the latest special issue of The Gerontologist (Volume 48, Special Issue 1).
Those aged 65 and older are projected to represent at least 20 percent of the total U.S. population by 2030, with the number of those 85-and-older increasing the most. The growth of this demographic will have a major effect on the demand for and supply of long-term care services.
Better Jobs Better Care (BJBC) was the nation's largest single initiative created to reduce the high vacancy and turnover rates of direct care workers and improve workforce quality through both policy and practice changes.
With funding from the Robert Wood Johnson Foundation and the Atlantic Philanthropies, this four-year program was directed and managed by the Institute for the Future of Aging Services at the American Association of Homes and Services for the Aging, with technical assistance from PHI (formerly the Paraprofessional Healthcare Institute).
"The effort was to see what ideas are out there for improving direct care work — to make sure people have what they need to stay in their homes and communities," said special issue editor Susan C. Reinhard, RN, PhD, FAAN.
Through two-types of grants — state-based demonstration projects and applied research projects — BJBC tested new approaches to providing a more stable and qualified long-term care staff and systematically evaluating what works best to achieve this objective. The special issue, which contains 12 articles, represents the findings of the BJBC program.
In addition to a need for better pay and improved work relationships, the studies found that recruitment and retention is an industry-wide problem, not just limited to nursing homes; greater job satisfaction translates to a better quality of life for patients; and older people themselves have roles to play in the long-term care workforce.
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Funding for the special issue came from the Robert Wood Johnson Foundation. Purchase information is available at http://www.geron.org/.
The table of contents is as follows:
INTRODUCTION The Origins of Better Jobs Better Care Better Jobs Better Care: A Foundation Initiative Focusing on Direct Care Workers
FINDINGS FROM THE BETTER JOBS BETTER CARE DEMONSTRATION PROGRAM What Do Direct Care Workers Say Would Improve Their Jobs? Differences Across Settings Implementation of the Better Jobs Better Care Demonstration: Lessons for Long-Term Care Workforce Initiatives
FACTORS THAT PREDICT BETTER RETENTION Nursing Assistants' Job Commitment: Effect of Nursing Home Organizational Factors and Impact on Resident Well-Being Love, Money, or Flexibility: What Motivates People to Work in Consumer-Directed Home Care The Impact of Stress and Support on Direct Care Workers' Job Satisfaction
ORGANIZATIONAL AND MANAGEMENT INTERVENTION A Mixed-Method Evaluation of a Workforce Development Intervention for Nursing Assistants in Nursing Homes: The Case of WIN A STEP UP A Facility Specialist Model for Improving Retention of Nursing Home Staff: Results From a Randomized, Controlled Study
EXPANDING THE LABOR POOL Older Workers: An Opportunity to Expand the Long-Term Care/Direct Care Labor Force Retention of Paid Related Caregivers: Who Stays and Who Leaves Home Care Careers?
MEASURING PERSON-DIRECTED CARE Development and Initial Testing of a Measure of Person-Directed Care
The Gerontologist is a refereed publication of The Gerontological Society of America, the nation's oldest and largest multidisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,000+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public

Alzheimer's Effects on Brain Linked to Physical Frailty

By Crystal Phend
CHICAGO, 13 aug 2008-- Changes in brain structures typical of Alzheimer's disease may be related to physical frailty late in life, researchers found.
The degree of Alzheimer's pathology seen at brain autopsy explained about 4% of variance in physical frailty (P=0.001), reported Aron S. Buchman, M.D., of Rush Medical Center here, and colleagues, in the Aug. 12 issue of Neurology.
In their analysis of patients from a large, longitudinal study of aging, the association was similar for demented and nondemented patients alike and persisted after adjustment for cardiovascular risk and other factors.
A previous analysis of the study linked frailty to incident Alzheimer's disease. The new findings suggest that "frailty may be a noncognitive manifestation of Alzheimer's pathology that can manifest before dementia," Dr. Buchman's group said.
This should come as no surprise, they said. Other studies have shown that individual components of frailty, such as motor function, grip strength, and gait speed predict Alzheimer's.
Accumulation of the plaques and tangles seen in the brain of Alzheimer's disease patients may impair neural systems that handle the planning and monitoring of even simple movements, the researchers speculated.
Another possible explanation for the link between Alzheimer's pathology and frailty is that both share a common cause, they said.
The researchers analyzed brain pathology from 165 consecutive autopsies of patients who died while enrolled in the Rush Memory and Aging Project, a longitudinal study of patients initially free of dementia.
Men and women in the analysis were an average 84.6 years old at baseline. They were followed annually until death at an average age of 88.1 with their last assessment of frailty about six months before death, on average.
Among them, 35.8% had been diagnosed with dementia by the time of death.
All but three of the patients had some degree of the plaques and tangles associated with Alzheimer's disease. The summary scores for this brain pathology ranged from 0 to a high of 3.2 (mean 0.7).
Patients with greater Alzheimer's pathology had poorer physical performance on the composite aspects of frailty (P=0.001).
Among the components of frailty, grip strength and body mass index were significantly linked to Alzheimer's brain changes (P=0.019 and P=0.030, respectively). Although there was a trend for an association with gait (P=0.071), fatigue was not a factor significantly linked to Alzheimer's pathology (P=0.627).
Participants in the 90th percentile for global Alzheimer's pathology (1.6 units) were about twice as frail as those in the 10th percentile (0.2 units).
Together, age, sex, and education explained 18% of the variance between individuals in frailty. Alzheimer's disease-related brain pathology accounted for another 4% of the variance.
Among other common brain pathologies, 34.6% of patients had macroscopic cerebral infarcts and 14.3% had Lewy body pathology, but neither was associated with frailty (P=0.678).
Although all three pathologies were included in a single analysis, Alzheimer's disease pathology was the only one associated with frailty (P<0.001).
Dementia patients were frailer and had more Alzheimer's pathology than those without dementia (both P<0.001), but the interaction between these factors was not significant (P=0.976).
The association between frailty and Alzheimer's remained significant after controlling for a full range of potential confounders, including age, sex, education, physical activity, parkinsonian signs, pulmonary function, vascular risk factors, vascular disease burden, history of joint pain or falls, and use of antipsychotic or antihypertensive medications.
The study was limited by inclusion of a cohort of older patients that differed from those in the general population in education, socioeconomic status, and lifestyle.
The study was supported by National Institute on Aging grants, the Illinois Department of Public Health, and the Robert C. Borwell Endowment Fund. The researchers reported no conflicts of interest.
Primary source: NeurologySource reference:Buchman AS, et al "Physical frailty in older persons is associated with Alzheimer disease pathology" Neurology 2008; 71: 499-504.

Proton Pump Inhibitors Over Years Increase Osteoporotic Fracture Risks

By Crystal Phend
WINNIPEG, Manitoba, 13 aug 2008-- Chronic use of proton pump inhibitors over years for gastroesophageal acid reflux is associated with osteoporotic fractures but short-term use seems to be safe, researchers here found.
Proton pump inhibitors used for at least seven years was associated with an almost doubled risk of osteoporotic fracture (P=0.04) whereas shorter-term use did not significantly raise risk, reported William D. Leslie, of St. Boniface Hospital here, and colleagues in the Aug. 12 issue of the Canadian Medical Association Journal.
In a large observational study, long-term proton pump inhibitors use was associated with an even greater, nearly five-fold increased risk of hip fracture (P=0.002).
These findings reinforce increased fracture risk seen in two other large retrospective studies but not the early effects seen after one year of exposure in one of the studies (odds ratio 1.44, 95% confidence interval 1.3 to 1.59). (See: Proton Pump Inhibitors Linked to Fracture Risk)
In an accompanying editorial, J. Brent Richards, M.D., and David Goltzman, M.D., both of McGill University in Montreal, said the discrepancy may simply be an issue of statistical power, although it wouldn't be surprising if skeletal effects required years of exposure.
The researchers suggested, "clinicians must be increasingly vigilant in ensuring that proton pump inhibitors are used sparingly and only when absolutely indicated."
But despite confirmation of bone effects in several large studies, the editorialists stopped short of recommending that physicians change practice.
The risk-benefit equilibrium "should be reconsidered with knowledge of the mounting, yet incomplete, evidence suggesting that proton pump inhibitors increase the risk of fracture," they wrote.
Guidance from randomized, controlled trials or even prospective cohort studies is needed for cases where a PPI would be prescribed appropriately for a non-life-threatening indication over the long term, Drs. Richards and Goltzman said.
The association seems biologically compelling since the acidic environment of the stomach and proximal duodenum appear necessary for absorption of dietary calcium, but further proof is needed of this mechanism as well, they said.
Dr. Leslie's group used the administrative claims database covering all residents of Manitoba to determine whether long-term use of a PPI was associated with fracture risk.
The analysis included 15,792 adults ages 50 and older treated for fracture of the hip, vertebra, or wrist between April 1996 and March 2004 who were not on osteoprotective medications or in long-term care facilities.
Each of these cases was matched for age, sex, and comorbidities with three controls who had never had a hip, vertebral, or wrist fracture.
The association between PPI exposure and fractures strengthened over time, but became significant for osteoporosis-related fractures overall only after seven years of continuous exposure (adjusted OR 1.92, 95% CI 1.16 to 3.18). The adjusted odds ratios for shorter duration use were:
0.99 for use of one year or longer (95% CI 0.90 to 1.11).
0.94 for use of two years or longer (95% CI 0.82 to 1.07).
0.92 for use of three or more years (95% CI 0.78 to 1.07).
1.05 for use of four years or longer (95% CI 0.86 to 1.27).
1.16 for use of five or more years (95% CI 0.91 to 1.46).
1.28 for use of six year or longer (95% CI 0.93 to 1.77).
The associations were stronger for hip fracture specifically, with significantly elevated risk starting at five or more years of exposure (adjusted OR 1.62, 95% CI 1.02 to 2.58). This risk increased over time to an adjusted odds ratio of 2.49 after six years (95% CI 1.33 to 4.67) and to 4.55 after at least seven years of continuous exposure (95% CI 1.68 to 12.29).
The researchers noted that although many of the odds ratios suggested a modestly elevated risk of fracture similar in magnitude to other risk factors like smoking, osteoporotic fractures are common and lead to substantial morbidity and mortality.
"Therefore, relatively small increases in the relative risk of a fracture may have pertinent effects on the absolute risk of events and their associated costs to the individual and society," Dr. Leslie's group said.
For patients who require long-term therapy, it's possible that pharmacologic strategies, such as calcium supplementation or bisphosphonates, could mitigate fracture risk, they said. Further study of this option is needed, they noted.
The researchers also cautioned that the study was limited by inability to control for potential confounding by factors such as use of over-the-counter calcium supplements, vitamin D supplements, tobacco, and alcohol, which were not included in the database.
The study was funded by a grant from the Canadian Institutes of Health Research.
Dr. Leslie reported receiving speaker's fees and research support from Merck Frosst Canada and honoraria and unrestricted educational grants from sanofi-aventis, Procter and Gamble Pharmaceuticals Canada, Amgen Pharmaceuticals and Genzyme Canada.
A co-author reported receiving research funds from Janssen-Ortho Canada and from Astra-Zeneca Canada and having served on advisory boards for Janssen-Ortho Canada and for the Canadian Agency for Drugs and Technology in Healthcare to develop guidelines for PPI use in Canada.
Drs. Richards and Goltzman reported no conflicts of interest.
Additional source: Canadian Medical Association JournalSource reference: Targownik LE, et al "Use of proton pump inhibitors and risk of osteoporosis-related fractures" CMAJ 2008; 179: 319-26. Additional source: Canadian Medical Association JournalSource reference: Richards JB, Goltzman D "Proton pump inhibitors: balancing the benefits and potential fracture risks" CMAJ 2008; 179: 306-7.

Prostatectomy Edges Surveillance in Disease-Specific Mortality at 12 Years

By Charles Bankhead
LONDON, 13 aug 2008-- Radical prostatectomy significantly reduces prostate cancer mortality compared with active surveillance for as long as 12 years, according to a large Scandinavian study of men diagnosed primarily in the pre-PSA era.
Prostatectomy led to a 5.4% absolute reduction in prostate cancer mortality and a 35% reduction in relative risk compared with surveillance, also called watchful waiting, Lars Holmberg, M.D., Ph.D., of King's College London, and colleagues reported in the Aug. 20 issue of the Journal of the National Cancer Institute.
Virtually all of the benefit accrued during the first 10 years of follow-up. Prostatectomy did not significantly reduce overall mortality, although there was a trend favoring surgery.
"It is unclear whether these results would apply to today' Western male populations, who, unlike the men in the Scandinavian Prostate Cancer Group Study Number 4 trial, are diagnosed with prostate cancer mainly by prostate specific antigen screening," the authors wrote. They also pointed out that quality-of-life comparisons were not performed.
"Contrary to our predictions based on shorter follow-up, the absolute difference in cumulative incidence of distant metastasis and prostate cancer death did not further increase after seven to nine years of follow-up," the authors said.
"The relative reduction in all-cause mortality following radical prostatectomy also decreased over time," they added.
Widespread introduction of prostate cancer screening with PSA tests has resulted in a dramatic increase in prostate cancer diagnoses. Many newly diagnosed tumors have questionable clinical relevance, making issues related to localized radical treatment especially pertinent, the authors said.
The Scandinavian Prostate Cancer Group Study Number 4 was the first randomized clinical trial to show that radical prostatectomy significantly reduces cancer-specific mortality and metastasis, they continued. The trial began in 1989, predating widespread use of PSA testing.
Previous reports from the study emerged from a median follow-up of 8.2 years. In the current analysis, investigators examined whether the benefits continued to increase with additional follow-up.
The Scandinavian study involved 695 men with clinically localized prostate cancer, randomized to radical prostatectomy or active surveillance. Men randomized to watchful waiting received no immediate treatment. Transurethral resection of the prostate was first-line therapy in men who developed urethral obstruction. The protocol was amended in 2003 to allow patients in either group to receive hormonal therapy at physician discretion for evidence of tumor progression.
During a median follow-up of 10.8 years, 137 prostatectomy patients died compared with 156 in the surveillance group.
The absolute numbers translated into a 12-year overall mortality of 32.7% in the surgically treated patients and 39.8% in the surveillance group (P=0.09). Prostate cancer mortality at 12 years was 12.5% with prostatectomy and 17.9% with surveillance, representing a 35% reduction in relative risk (P=0.03).
Consistent with previous reports from the study, prostatectomy was associated with a significant reduction in the risk of distant metastasis. The 12-year metastasis rates were 19.3% with radical prostatectomy and 26% with surveillance, representing a 35% reduction in relative risk (P=0.006).
Among men who underwent radical prostatectomy, extracapsular extension conferred a 14-fold increased risk of prostate cancer mortality (P<0.001).
The authors concluded that "radical prostatectomy reduces prostate cancer mortality and the risk of metastases with little or no further increase in benefit 10 or more years after surgery."
The findings demonstrate a clear benefit for prostatectomy in men younger than 65 with prostate cancer detected by means other than PSA testing, Timothy J. Wilt, M.D., of the Minneapolis VA Center, said in an accompany editorial. In such patients, "cure with radical prostatectomy is possible, may be necessary, and should generally be recommended."
"Results are less certain for men older than 65 years or with limited life expectancies due to comorbidities," he added.
The trial had several notable limitations, Dr. Wilt continued. In particular, the study population might not be representative of U.S. patients with prostate cancer. Only 5% of cancers were detected by PSA testing. PSA levels and tumor volume were greater than those seen in most contemporary U.S. series. Three fourths of the patients had T2 tumors and almost half had extracapsular extension.
Several ongoing studies will address some of the questions left unanswered by the Scandinavian trial, particularly the options in between radical surgery and active surveillance, Dr. Wilt said.
The study was supported by the Swedish Cancer Institute and National Institutes of Health.
Neither Dr. Holmberg and co-authors nor Dr. Wilt reported disclosures.
Additional source: Journal of the National Cancer InstituteSource reference: Bill-Axelson A, et al "Radical prostatectomy versus watchful waitin in localized prostate cancer: the Scandinavian Prostate Cancer Group-4 randomized trial" J Natl Cancer Inst 2008; 100: DOI: 10.1093/jnci/djn255. Additional source: Journal of the National Cancer InstituteSource reference: Wilt TJ "SPCG-4: A needed START to PIVOTal data to promote and ProtecT evidence-based prostate cancer care" J Natl Cancer Inst 2008; 100: DOI: 10.1093/jnci/djn259.

Older Patients With Cancer at Heightened Suicide Risk

13 aug 2008-- Cancer patients are at increased risk for suicide, according to three new studies.
In the first study, researchers at the University of Washington analyzed U.S. data from 1973 to 2002 and found that the suicide rate among cancer patients was 31.4 per 100,000 person-years, compared to 16.7 per 100,000 person-years in the general population.
Higher suicide rates were associated being male, white and older at the time of cancer diagnosis. Patients with the highest suicide rates were those with lung, stomach, oral/pharyngeal and larynx cancers. Suicide risk was greatest within the first five years after diagnosis but remained elevated for up to 15 years after diagnosis.
The second study found that older Americans with cancer are more than twice as likely to commit suicide as those without cancer. The Harvard School of Public Health and Harvard Medical School study compared 128 New Jersey residents, age 65 and older, who committed suicide between 1994 and 2002 and 1,280 living people in the same age group.
The suicide risk was 2.3 times higher among cancer patients than among those who were cancer-free. This increased risk held true even after the researchers adjusted for age, sex, race, medical and psychiatric illnesses, and use of prescription medications.
The cancer patients in the study who committed suicide were more likely to have advanced metastatic disease, and two-thirds of them used a firearm to commit suicide. Most of the patients who committed suicide had seen a physician in the month before their death, and 25 percent had seen a doctor within a week before their suicide.
A third study by researchers at the University of Edinburgh in the United Kingdom found that cancer patients are at increased risk for suicidal thoughts. The survey of 2,924 cancer patients receiving outpatient care found that nearly 8 percent reported suicidal thoughts persisted for at least several days over the previous two weeks. A similar survey of the general population in Australia found that only 2.6 percent of respondents reported having similar thoughts.
The University of Edinburgh team found that suicidal thoughts among cancer patients were associated with having substantial emotional distress or pain, but not with cancer severity. Better management of patients' emotional distress and pain may improve quality of life and reduce suicide risk, the researchers concluded.
The research was published online Monday in the Journal of Clinical Oncology.
More attention needs to be given to suicidal thoughts and attempts by cancer patients, Dr. Timothy Quill, a professor of medicine, psychiatry and medical humanities at the University of Rochester Medial Center, said in an accompanying editorial.
"It is important to ask about suicidal thoughts regularly, especially when disease is worsening, symptoms are increasing, or the patient is entering a more serious phase of illness ... Creating an environment where these issues can be openly explored without being judged is critical," Quill wrote.

Mild Cognitive Impairment May Be Diabetic Companion

By John Gever
ROCHESTER, 12 aug 2008-- Mild cognitive impairment and diabetes appear to go hand-in-hand into old age, researchers here said. In a case-control study of 1,969 patients at least 70 years old, mild cognitive impairment was significantly more common in those with diabetes onset before age 75, diabetes duration of at least 10 years, treatment with insulin, and the presence of diabetic complications, reported Rosebud O. Roberts, M.B.Ch.B., of the Mayo Clinic, and colleagues, in the August issue of Archives of Neurology. The findings may signify that mild cognitive impairment is another microvascular complication of long-standing diabetes, similar to diabetic retinopathy, the researchers said.
But because the study only evaluated participants at a single time point, the researchers could not confirm that diabetes preceded the cognitive impairment and was a causative factor.
In an interview, Dr. Roberts said another study was under way in which participants are being tracked over time. The investigators hope to gather at least six years of follow-up data, which should help settle the question, she said.
The current study involved face-to-face interviews with the study participants, who were ages 70 to 89, identifying 329 persons with mild cognitive impairment. The remaining 1,640 showed no evidence of impairment.
The presence of diabetes was determined by a combination of participant self-report, fasting blood glucose levels as measured by the researchers, and medical records.
Overall, the prevalence of diabetes was similar among those with and without cognitive impairment (20.1% versus 17.7%, respectively).
But participants with long-duration or more severe diabetes were significantly more likely to show mental impairment:
Diabetes onset before age 65: OR 2.20 (95% CI 1.29 to 3.73)
Diabetes duration at least 10 years: OR 1.76 (95% CI 1.16 to 2.68)
Insulin treatment: OR 2.01 (95% CI 1.22 to 3.31)
Diabetic complications: OR 1.80 (95% CI 1.13 to 2.89)
These odds ratios were adjusted for age, sex, and educational attainment and defined diabetes by self-report with confirmation from medical records.
Dr. Roberts and colleagues found the odds ratios remained largely unchanged when the adjustments included cardiovascular risk factors, smoking status, and body mass index.
They also remained significant when the definition of diabetes was expanded to include abnormal fasting blood glucose.
Diabetes appeared to be less strongly predictive of cognitive impairment involving memory loss than with non-amnestic impairment.
"Non-amnestic [impairment] may be a prodromal stage for vascular dementia or other non-degenerative dementias, whereas amnestic [impairment] may be a prodromal stage for neurodegenerative dementias such as Alzheimer disease," Dr. Roberts and colleagues suggested. They added, however, that earlier studies have had mixed results on these associations.
Although the study does not prove that diabetes actually causes the cognitive deficits, the findings tend to support the importance of maintaining good glucose control.
She said it was one more reason for diabetics and their physicians to work on reducing obesity, exercising, and eating a healthy diet.
All participants in the trial were from the Rochester, Minn., area, meaning the results may not be generalizable to other locations or populations. The researchers also noted that eligible individuals who declined to participate in the personal interviews tended to be older men, those with lower education, and diabetic according to self-report or medical records.
"This underrepresentation of subjects with diabetes may have precluded our ability to detect a significant association between diabetes overall and mild cognitive impairment," the researchers said.
The study was funded by the National Institutes of Health and by the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program. No potential conflicts of interest were reported.
Primary source: Archives of NeurologySource reference:Roberts R, et al "Association of duration and severity of diabetes mellitus with mild cognitive impairment" Arch Neurol 2008; 65: 1066-73.

Signs of Alzheimer's disease may be present decades before diagnosis : Lower educational achievement may be early sign

James Mortimer
Tampa, FL , 12 aug 2008— Scientists from the University of South Florida and the University of Kentucky report that people who develop Alzheimer's disease may show signs of this illness many decades earlier in life, including compromised educational achievement. Their research appears online this month in the journal Alzheimer's Disease and Associated Disorders.
Participants in the Nun Study were studied to identify those who became demented before death or had characteristic brain changes of Alzheimer's disease at autopsy. Among nuns who became demented or had evidence of Alzheimer's disease at autopsy, those with small head sizes had significantly lower educational achievement in earlier adult life. In those dying without a dementia diagnosis or autopsy evidence of Alzheimer's disease, head size had no relationship with education.
Adult head size can be used to estimate the size of the fully-developed brain. Previous studies have found that clinical expression of Alzheimer's disease is related to head size, with people having smaller heads more likely to show the characteristic symptoms of this illness. Larger brains provide reserve against Alzheimer's, allowing people to function normally despite having considerable Alzheimer pathology in their brains.
"If brain damage related to Alzheimer's disease begins earlier in adult life, then having less reserve due to a smaller brain could compromise intellectual ability in those destined to get Alzheimer's and lead to them getting less education," said lead author James Mortimer, PhD, Professor of Epidemiology at USF. "Although it has been known for many years that individuals with lower education have a greater risk of getting Alzheimer's, this is the first report showing that reduced educational attainment may actually be an early sign of the underlying disease."
The study findings add to others showing that individuals who will eventually develop Alzheimer's differ from those who don't many decades before. In 1996, the Nun Study found that Alzheimer's disease with onset in old age could be predicted accurately from characteristics of autobiographical essays written at an average age of 22. Other studies have shown that those who develop Alzheimer's have specific deficits on tests of memory and thinking decades before the disease is diagnosed. The fact that subtle signs of Alzheimer's appear many years before symptoms appear may be useful for predicting who is at risk of the illness and identifying individuals earlier in life who could benefit from preventive therapies.

The Nun Study, begun in 1992, is a study of 678 Catholic sisters, initially 75 to 102 years of age, who were evaluated annually for dementia and who agreed to brain donation at the time of their deaths. The study is sponsored by the National Institute on Aging.

Brain imaging may allow Alzheimer's diagnosis

By Will Dunham
12 aug 2008--An imaging method known as a PET scan may enable doctors to determine whether a person has "plaques" in the brain that are a hallmark of Alzheimer's disease, according to a Finnish study published on Monday.
The brain tissue of people with Alzheimer's disease contains abnormal clumps called amyloid plaques, but generally doctors cannot be sure if they are there until the brain is examined after death in an autopsy.
The findings of the small study led by Dr. Ville Leinonen of the University of Kuopio in Finland indicated that positron emission tomography, or PET, imaging can detect the plaques.
This shows PET scans may become a useful tool to diagnose Alzheimer's disease, a fatal and uncurable mind-robbing ailment that is the most common form of dementia in the elderly, Leinonen said.
"It's very promising," Leinonen, whose study was published in the American Medical Association's journal Archives of Neurology, said in a telephone interview.
Experts have been seeking ways to detect the plaques, short of obtaining a sample of brain tissue, in order to diagnose Alzheimer's in its early stages. These plaques and irregular knots of fibers in the brain called neurofibrillary tangles are hallmarks of the disease.
Early diagnosis can allow doctors to give people with Alzheimer's disease drugs aimed at slowing the cognitive decline associated with the condition.
The study involved 10 people, all of whom had undergone a brain biopsy because of a suspected abnormal increase of cerebrospinal fluid in the brain.
By examining this brain tissue, the researchers determined that six of the people had Alzheimer's disease-related plaques in their brain and four had no such brain changes.
The patients later underwent a 90-minute PET scan.
Following an injection of a chemical "marker" intended to help pinpoint the brain plaques, the PET scans accurately determined in nine of the 10 people who had the plaques and who did not, the researchers said.
"It's not 100 percent, but the correlation was very good," Leinonen said.
None of the 10 people in the study had yet developed severe dementia at the time of the study, the researchers said. They said larger studies are needed to verify that PET scans can become a common diagnostic tool.
The researchers said another potential use of PET scans would be to monitor plaque deposits in the brains of people taking part in research into potential new Alzheimer's drugs to see if the drugs are working.
PET scans currently are used by doctors to detect cancer, cardiac problems such as damage following a heart attack, brain abnormalities and other purposes.
Other studies have hinted at the promise of imaging methods in diagnosing Alzheimer's disease. Canadian researchers said last month they used magnetic resonance imaging, or MRI, scans to locate Alzheimer's-like plaques in rabbits.
An estimated 26 million people have Alzheimer's globally and experts predict this number will grow to 106 million by 2050.

Half of Overweight Adults Are Normal Metabolically

By Michael Smith
NEW YORK, 12 aug 2008-- Obese patients don't necessarily show any signs of the metabolic abnormalities associated with cardiovascular disease, researchers here said.
And almost a quarter of those with a normal weight had two or more of the cardiometabolic abnormalities associated with an increased risk of cardiovascular disease, according to Rachel Wildman, Ph.D., of Albert Einstein College of Medicine and colleagues.
The finding from the National Health and Nutrition Examination Surveys (NHANES) from 1999 through 2004 that nearly a third of obese patients are free of metabolic abnormalities was paralleled by a report from German researchers that shows about 24% of obese people have a "metabolically benign" form of obesity.
In those patients, according to Nobert Stefan, M.D., and colleagues from the University of Tubingen, insulin sensitivity is not different from those of normal weight, nor is the intima-media thickness of the common carotid artery.
Both studies appear in the Aug. 11 issue of Archives of Internal Medicine and "emphasize the benign nature of fat accumulation outside the abdomen," according to Lewis Landsberg, M.D., of Northwestern University in Chicago.
Writing in an accompanying editorial, Dr. Landsberg said the studies also reinforce conventional wisdom that visceral fat accumulation is detrimental to cardiovascular health.
The message for doctors, he said, is that calculating a body mass index and measuring waist circumference remain "valuable tools in the assessment of cardiovascular risk in overweight and obese patients."
Dr. Wildman and colleagues looked at a cross-sectional sample of 5,440 participants in NHANES, and stratified them according to BMI and cardiometabolic abnormalities, including elevated blood pressure; triglycerides, fasting plasma glucose, C-reactive protein, and homeostasis model assessment of insulin resistance value, as well as low levels of high-density lipoprotein cholesterol.
Participants were classified as metabolically normal if they had at most one of those abnormalities, and abnormal if they had two or more, the researchers said.
Extending the results to all U.S. adults 20 or over, the study found:
About 16.3 million normal-weight adults (23.5% ) were metabolically abnormal.
About 35.9 million overweight adults (51.3%) remained metabolically healthy.
And about 19.5 million obese adults -- or about 31.7% -- were also metabolically healthy.
Among normal-weight people, older age, lower physical activity, and larger waist circumference were independent correlates of cardiometabolic abnormalities, the researchers said.
On the other hand, the independent correlates of metabolic health among overweight and obese people were younger age, non-Hispanic black race or ethnicity, higher physical activity levels, and smaller waist circumference, they found.
In the German study, Dr. Stefan and colleagues studied 314 patients taking part in a study of the pathophysiological mechanisms of type 2 diabetes. Of those, 54 had a BMI in the normal range, 133 were overweight, and 127 were obese.
When the researchers measured insulin sensitivity, 31 of the obese participants (or 24%) were in the upper quartile -- and were not significantly different from those with a normal body mass index. They were classified as obese, but insulin sensitive.
As expected, total body and visceral fat were significantly higher (P<0.05) in the overweight and obese groups compared with the normal-weight group, but the insulin-sensitive and insulin-resistant obese groups were not different.
On the other hand, compared with the insulin-resistant group, the insulin-sensitive obese participants had significantly lower ectopic fat in skeletal muscle lower fat in the liver (4.3% versus 9.5%), and lower intima-media thickness of the common carotid artery (0.54 versus 0.59 millimeters), all at P<0.05.
At the same time, their insulin sensitivity was 17.4 versus 7.3 (arbitrary units), a difference that was significant at P<0.05.
The unexpected finding, Dr. Stefan and colleagues said, was that the insulin sensitivity and the intima-media thickness of the insulin-sensitive obese group were similar those of the normal BMI participants -- 18.2 arbitrary units and 0.51 millimeters, respectively.
The findings show that "a metabolically benign obesity that is not accompanied by insulin resistance and early atherosclerosis exists in humans," Dr. Stefan and colleagues concluded.
The German study was supported by the Deutsche Forschungsgemeinschaft and European Network on Functional Genomics of Type 2 Diabetes. The researchers reported no conflicts.
The U.S. researchers did not report external support for their study and made no financial disclosures.
Dr. Landsberg reported no financial conflicts.
Primary source: Archives of Internal MedicineSource reference:Stefan N, et al "Identification and characterization of metabolically benign obesity in humans" Arch Intern Med 2008; 168(15): 1609-1616. Additional source: Archives of Internal MedicineSource reference: Wildman RP, et al "The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the U.S. population (NHANES 1999-2004)" Arch Intern Med 2008; 168(15): 1617-1624. Additional source: Archives of Internal MedicineSource reference: Landsberg L "Body fat distribution and cardiovascular risk: a tale of 2 sites" Arch Intern Med 2008; 168(15): 1607-1608.

Runners Live Longer and Have Fewer Disabilities

By Todd Neale
PALO ALTO, 12 aug 2008-- Regular running in middle age and beyond may lengthen lifespans and retard the disabilities of aging, a longitudinal study showed. Runners ages 50 to 72 had a 40% reduced risk of being moderately disabled or of dying after a 21-year follow-up than healthy controls, Eliza Chakravarty, M.D., of Stanford, and colleagues reported in the Aug. 11 issue of the Archives of Internal Medicine. Disability and survival curves continued to diverge between groups after the 21-year follow-up as participants approached their ninth decade of life, they added.
"Our findings of decreased disability in addition to prolonged survival among middle-age and older adults participating in routine physical activities further support recommendations to encourage moderate to vigorous physical activity at all ages," the researchers said.
The study began in 1984, when 538 members of a nationwide running club for those 50 and older and 423 healthy controls -- Stanford faculty and staff members ages 26 to 70 -- were recruited to complete yearly questionnaires.
At baseline, runners were younger (mean age 58 versus 62), leaner, more likely to be male, and less likely to smoke than the controls (P<0.001 for all).
Both groups had little disability -- measured using the Health Assessment Questionnaire Disability Index (HAQ-DI), which asked the participants about their level of difficulty in completing eight tasks -- but runners had a significantly lower mean score compared with controls (P<0.001).
Two previous reports on this cohort showed that disability was decreased and survival was increased in runners at eight and 13 years of follow-up.
A total of 284 runners and 156 controls completed the study through 21 years of follow-up, and the results extended the previous findings.
Disability scores increased with time for both groups, but at a significantly greater rate for the controls (0.016 points/year versus 0.007, P<0.001). Runners had significantly lower mean disability levels at all time points.
Runners took longer to reach various levels of disability compared with controls -- for example, it took 2.6 years for controls to reach a mean HAQ-DI score of 0.075 and 8.7 years for runners, for a difference of 6.2 years (95% CI 3.9 to 8.9).
Among participants who had a baseline disability score of zero, runners had a significantly lower risk of being moderately disabled (HR 0.62, 95% CI 0.46 to 0.84).
Through follow-up, 15% of runners died compared with 34% of controls (P<0.001). In a multivariate analysis, runners were 39% less likely to die than controls (HR 0.61, 95% CI 0.45 to 0.82).
Rates of death were higher in controls than in runners for cardiovascular disease (P=0.001), cancer (P=0.004), neurological disease (P=0.007), infections (P<0.001), and other causes (P<0.001).
The study's findings were similar when the participants were divided into ever-runners -- those who ran regularly for more than one month at some point in their lives -- and never-runners.
The authors suggested several possible reasons for the disability and survival advantages found in runners, including "increased cardiovascular fitness and improved aerobic capacity and organ reserve, increases in skeletal mass and metabolic adaptations of muscle with decreased frailty, lower levels of circulating inflammatory markers, improved response to vaccinations, and improved higher-order cognitive functions."
They acknowledged some limitations, including the self-reported data, possible self-selection bias, and potential confounding by unmeasured lifestyle variables.
In addition, they said, the results of the study may not be generalizable beyond the mostly white and college-educated study population.
The study was supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging.
The authors made no financial disclosures.
Primary source: Archives of Internal MedicineSource reference:Chakravarty E, et al "Reduced disability and mortality among aging runners: a 21-year longitudinal study" Arch Intern Med 2008; 168: 1638-1646.

In scientific first, Einstein researchers correct decline in organ function associated with old age

BRONX, NY,11 AUG 2008 — As people age, their cells become less efficient at getting rid of damaged protein — resulting in a buildup of toxic material that is especially pronounced in Alzheimer's, Parkinson's disease, and other neurodegenerative disorders.
Now, for the first time, scientists at the Albert Einstein College of Medicine of Yeshiva University have prevented this age-related decline in an entire organ — the liver — and shown that, as a result, the livers of older animals functioned as well as they did when the animals were much younger. Published in the online edition of Nature Medicine, these findings suggest that therapies for boosting protein clearance might help stave off some of the declines in function that accompany old age. The study's senior author was Dr. Ana Maria Cuervo, associate professor in the departments of developmental & molecular biology, medicine and anatomy & structural biology at Einstein.
The cells of all organisms have several surveillance systems designed to find, digest and recycle damaged proteins. Many studies have documented that these processes become less efficient with age, allowing protein to gradually accumulate inside cells. But aging researchers continue debating whether this protein buildup actually contributes to the functional losses of aging or instead is merely associated with those losses. The Einstein study was aimed at resolving the controversy.
One of these surveillance systems — responsible for handling 30 percent or more of damaged cellular protein — uses molecules known as chaperones to seek out damaged proteins. After finding such a protein, the chaperone ferries it towards one of the cell's many lysosomes — membrane-bound sacs filled with enzymes. When the chaperone and its cargo "dock" on a receptor molecule on the lysosome's surface, the damaged protein is drawn into the lysosome and rapidly digested by its enzymes.
In previous work, Dr. Cuervo found that the chaperone surveillance system, in particular, becomes less efficient as cells become older, resulting in a buildup of undigested proteins within the cells. She also detected the primary cause for this age-related decline: a fall-off in the number of lysosomal receptors capable of binding chaperones and their damaged proteins. Could replenishing lost receptors in older animals maintain the efficiency of this protein-removal system throughout an animal's lifespan and, perhaps, maintain the function of the animal's cells and organs as well?
To find out, Dr. Cuervo created a transgenic mouse model equipped with an extra gene — one that codes for the receptor that normally declines in number with increasing age. Another genetic manipulation allowed Dr. Cuervo to turn on this extra gene only in the liver and at a time of her choosing, merely by changing the animals' diet.
To keep the level of the receptor constant throughout life, Dr. Cuervo waited until mice were six months old (the age that the chaperone system's efficiency begins to decline) before turning on the added receptor gene. When the mice were examined at 22 to 26 months of age (equivalent to approximately 80 years old in humans), the liver cells of transgenic mice digested and recycled protein far more efficiently than in their normal counterparts of the same age — and, in fact, just as efficiently as in normal six-month old mice.
Does maintaining efficient protein clearance in liver cells of an older animal translate into better functioning for the liver as a whole? Since a key function of the liver is metabolizing chemicals, Dr. Cuervo answered this question by injecting a muscle relaxant into very old transgenic mice and very old normal mice. The very old transgenic mice metabolized the muscle relaxant much more quickly than very old normal mice and at a rate comparable to young normal mice.
"Our study showed that functions can be maintained in older animals so long as damaged proteins continue to be efficiently removed — strongly supporting the idea that protein buildup in cells plays an important role in aging itself," says Dr. Cuervo. "Even more important, these results show that it's possible to correct this protein 'logjam' that occurs in our cells as we get older, thereby perhaps helping us to enjoy healthier lives well into old age."
Dr. Cuervo next plans to study animal models of Alzheimer's, Parkinson's and other neurodegenerative brain diseases to see whether maintaining efficient protein clearance in the brain might help in treating them. "Most people with these conditions are born with a mutation that gives rise to defective proteins, but they don't experience symptoms until later in life," says Dr. Cuervo. "We think that's because their protein-clearance systems can handle abnormal proteins when the person is younger but get overwhelmed as their efficiency falls with age. By preventing this decline in protein clearance, we may be able to keep these people free of symptoms for a longer time."
Dr. Cuervo will also investigate whether maintaining efficient protein clearance in all the body's tissues will influence longevity and prevent the functional losses associated with growing old. "There's reason to hope that drugs exerting a similar effect throughout the body may help us enjoy healthier lives well into old age," says Dr. Cuervo. Meanwhile, she notes, evidence is mounting that two dietary interventions —low-fat and calorie-restricted diets — help cells to maintain efficient protein clearance.
###
Cong Zhang, a graduate student working in Dr. Cuervo's laboratory, was the lead author of the Nature Medicine study. The research was supported by grants from the National Institute on Aging, an Ellison Medical Foundation Award and a Glenn Foundation Award.

More Than Temperature Puts Elderly at Risk in Heat

11 AUG 2008-- Because aging affects the body's ability to respond to summer heat, older adults are particularly at risk for heat-related illnesses such as heat stroke, heat fatigue, heat cramps and heat exhaustion, according to the U.S. National Institute on Aging (NIA).
Factors that may increase the risk of heat-related illnesses include:Age-related changes to the skin such as poor blood circulation and inefficient sweat glands. Heart, lung and kidney diseases, as well as any illness that causes general weakness or fever. High blood pressure or other conditions that require dietary changes. For example, people on salt-restricted diets may be at increased risk for heat-related illnesses. However, salt pills shouldn't be used without first consulting a doctor. The ability to sweat can be impaired by medications such as diuretics, sedatives, tranquilizers and by certain heart and blood pressure drugs. Taking several drugs for various conditions. However, it's important to continue taking prescribed medications and discuss possible problems with a doctor. Being substantially overweight or underweight. Drinking alcoholic beverages. Being dehydrated.
The risk of heat-related illnesses can also be increased by lifestyle factors such as hot living quarters, lack of transportation, overdressing, visiting overcrowded places, and not understanding weather conditions.
Older adults, particularly those at special risk, should stay indoors on hot and humid days, especially when there is an air pollution alert in effect, the NIA recommends. Those without fans or air conditioners should go to air-conditioned places such as shopping malls, movie theaters, libraries or cooling centers operated by social service agencies and senior citizen centers. If possible, older adults should get family or friends to give them rides to air-conditioned locations.
If you suspect someone is suffering from a heat-related illness, the NIA recommends the following:Get the person out of the sun and into an air-conditioned or other cool place. Have them lie down and rest. Offer fluids such as water, fruit and vegetable juice. Don't offer alcohol or caffeinated beverages. Encourage the person to shower, bathe or sponge off with cool water. Apply a cold, wet cloth to the wrists and/or neck, places where arterial blood passes close to the surface and can be cooled by the cold cloths.

Scientists Create Mice Resistant to Obesity

By Jeffrey Perkel
SUNDAY, 11 AUG 2008-- Researchers have developed a strain of mice resistant to diet-induced obesity.
The findings could one day lead to possible drug treatments for obesity in people. They also shed light on the brain circuitry that controls energy homeostasis -- the balance between how much energy (i.e., food) an animal takes in and how quickly it burns that energy.
Dr. Julio Licinio, a professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine, called the research a "technological tour de force."
Dr. Bradford Lowell, associate professor of medicine at Harvard Medical School, led the study, which was published online Aug. 10 in the journal Nature Neuroscience.
According to lead study author Qingchun Tong, most research into energy homeostasis has involved what scientists call genetically encoded neuropeptides, rather than small molecule neurotransmitters.
Neurotransmitters "have been postulated to play a very important role in neurocommunication, but in this field, essentially no critical studies have been performed to address this issue," Tong said. "So I set up an experiment to create an animal model in which a particular group of neurons in the brain couldn't release a small neurotransmitter, and by examining those animal models, I could know the function of those molecules."
Tong and Lowell focused on one neurotrasmitter in particular, called GABA (gamma-aminobutyric acid). They developed transgenic, or mutant, mice that lacked the ability to release GABA in a subset of brain cells in the hypothalamus -- the brain region that controls processes such as hunger, thirst and body temperature.
On a normal diet, the normal and mutant mice weighed roughly the same, with mutant mice weighing slightly less. On a high fat diet, however, the mutant mice gained far less weight than the normal mice, even though the two groups ate approximately the same amount of food. The reason: The mutant mice were burning energy at a faster rate, the researchers said.
"We found that the mice without GABA release from AgRP neurons have increased energy expenditure and are resistant to diet-induced obesity," Tong said.
These transgenic mice were also resistant to the effects of the hormone ghrelin, which governs hunger. When normal mice were given ghrelin, their food intake increased. In the mutant mice, however, that effect was dampened, Tong said.
Finally, the researchers shed some light on the brain cell networks controlling energy homeostasis. They found that another group of neurons in the hypothalamus, called pro-opiomelanocortin (POMC) neurons, receive the GABA signal from AgRP neurons.
"The function of AgRP neurons is probably to reserve the energy for maintaining life," Tong said. "So if the animal doesn't have enough food, the animal should have some strategy to preserve energy, and this group of neurons, by releasing GABA, restrains energy expenditure to maintain enough energy to survive under the conditions in which food is not readily available."
According to Licinio, these findings underscore the importance of the GABA neurotransmitter in regulating the relationship between food consumed and energy expended. "I think it makes the role of GABA in obesity much more relevant than previously thought," he said.
Of course, as with all animal studies, it remains to be seen whether the findings can be repeated in humans.

Phelps’s Mother Recalls Helping Her Son Find Gold-Medal Focus

By MICHAEL WINERIP
11 AUG 2008--DEBORAH PHELPS’S third baby and only son was larger than life from Day 1 — 9 pounds, 6 ounces and 23 inches long. As a little boy, said the mother, he asked 25 zillion questions, always wanting to be the center of attention. If he wasn’t zooming by on his big-wheel tricycle, he was swinging past on the monkey bars.
Starting with preschool, teachers complained: Michael couldn’t stay quiet at quiet time, Michael wouldn’t sit at circle time, Michael didn’t keep his hands to himself, Michael was giggling and laughing and nudging kids for attention.
As he entered public school, he displayed what his teachers called “immature” behavior. “In kindergarten I was told by his teacher, ‘Michael can’t sit still, Michael can’t be quiet, Michael can’t focus,’ ” recalled Ms. Phelps, who was herself a teacher for 22 years. The family had recently moved, and she felt Michael might be frustrated because the kindergarten curriculum he was getting in the new district was similar to the pre-K curriculum in their old district.
“I said, maybe he’s bored,” Ms. Phelps recalled saying to his teacher. “Her comment to me — ‘Oh, he’s not gifted.’ I told her I didn’t say that, and she didn’t like that much. I was a teacher myself so I didn’t challenge her, I just said, ‘What are you going to do to help him?’ ”
In the elementary grades at their suburban Baltimore school, Ms. Phelps said, Michael excelled in things he loved — gym and hands-on lessons, like science experiments. “He read on time, but didn’t like to read,” she said. “So I gave him the Baltimore Sun sports pages, even if he just read the pictures and captions.”
She will never forget one teacher’s comment: “This woman says to me, ‘Your son will never be able to focus on anything.’ ”
His grades were B’s and C’s and a few D’s.
It was a tough period. Ms. Phelps and her husband, a state trooper, were divorcing. She had just gone back to school to get a master’s degree to become an administrator, she said, and at the same time she had to be the 24/7 parent.
Michael grew like crazy, but not evenly — his ears looked huge, and when he ran, his arms swung below his knees. (He was on his way to being 6 feet 4 inches tall with an arm span of 6 feet 7 inches.) Kids bullied him, and when he whacked one on the school bus, he was suspended from the bus for several days.
When he was in fifth grade, during his annual check-up, Ms. Phelps and the family physician, Dr. Charles Wax, discussed whether Michael might have A.D.H.D. — attention deficit hyperactivity disorder. By then, the Phelpses were a swimming family. (Michael’s older sister Whitney at 15 was ranked first in the country in the 200-meter butterfly, though her career would be cut short by a back injury.) Dr. Wax’s children also swam, and he’d noticed Michael at the Phelps sisters’ swim meets. “Michael used to run around like a little crazy person mooching food off people,” said Ms. Phelps.
The doctor suggested sending assessment forms to his teachers. Their consensus: Can’t sit still, can’t keep quiet, can’t focus.
At age 9, Michael was put on Ritalin, a stimulant used to treat hyperactivity.
His mother thinks it helped a little. “He seemed to be able to focus longer,” she said. “He could get through homework without moving around so much.” She said he was still a middling student. “It might have raised some C’s to B’s,” she said. But if a homework assignment had to be at least four sentences, she said, “he’d just do four sentences.”
After two years, Michael asked to get off the meds. He had to go to the school nurse’s office to take a pill at lunch, she said, and felt stigmatized. “Out of the blue, he said to me: ‘I don’t want to do this anymore, Mom. My buddies don’t do it. I can do this on my own.’ ”
“I was always stern as a parent,” she said, “but from Day 1, I included my children as part of the decision process. So I listened.” After consulting with Dr. Wax, Michael stopped medication.
In the meantime, Michael the swimmer had appeared. By 10, he was ranked nationally in his age group. Ms. Phelps watched the boy who couldn’t sit still at school sit for four hours at a meet waiting to swim his five minutes’ worth of races.
When Michael was 11, his swim coach at the North Baltimore Aquatic Club, Bob Bowman — still his coach — took the Phelpses aside and talked about Michael’s gift. “Bob says, ‘By 2000, I look for him to be in the Olympic trials,’ ” recalled Ms. Phelps. “ ‘By 2004, he makes the Olympics. By 2008, he’ll set world records. By 2012, the Olympics will be in New York and’ — I said ‘Bob, stop, he’s 11, he’s in middle school.’ ”
As it turned out, the boy would move four years faster than his coach’s prediction (and New York would lose its Olympic bid).
At age 12 Michael needed an algebra tutor, and was so antsy in school that his mother suggested the teacher sit him at a table in the back. And yet he willingly got up at 6:30 daily for 90-minute morning practices and swam 2 to 3 hours every afternoon.
By 15, in 2000, he was at the Olympics; at 16 he had his first world record; and by 19, at the 2004 Olympics, he had won 8 medals, 6 of them gold.
Of all his mental gifts, the one that amazes his mother the most is this: “Michael’s mind is like a clock. He can go into the 200 butterfly knowing he needs to do the first 50 in 24.6 to break the record and can put that time in his head and make his body do 24.6 exactly.”
He always did his swimming homework. “In high school, they’d send tapes from his international races,” Ms. Phelps said. “He’d say, ‘Mom I want to have dinner in front of the TV and watch tapes.’ We’d sit and he’d critique his races. He’d study the turns — ‘See, that’s where I lifted my head.’ I couldn’t even see what he was talking about. Over and over. I’m like, ‘whoa.’ ”
These days, Ms. Phelps, 57, is principal of Windsor Mill, a middle school in Baltimore County. Her A.D.H.D. son is so renowned, she was hired this summer by a pharmaceutical firm, Ortho-McNeil-Janssen, as a “celebrity mom” who will answer questions about her experiences with A.D.H.D. on a company-sponsored Web site.
While the company makes an A.D.H.D. medication, Concerta, and arranged my interview with Ms. Phelps, during our three hours together, Ms. Phelps never mentioned the drug. Nor did her son ever take it. Like so many parents, she seemed conflicted about having given her son any medication. “There were so many things going on at the time — the divorce, Michael’s maturity, we changed school districts,” she said. “Were meds the right thing? I could be on the fence either way. That was the decision that was made.”
More to the point, I think, is the moral of her story, which offers hope for parents of any child with a challenge like A.D.H.D.: Too many adults looked at Ms. Phelps’s boy and saw what he couldn’t do. This week, the world will be tuned to the Beijing Olympics to see what he can do.

Advocates Share Ideas in Teaching About AIDS

By MARC LACEY and LAWRENCE K. ALTMAN
MEXICO CITY, 11 AUG 2008 — Like most scientific conferences, the 17th International AIDS Conference, which ended here on Friday, had its share of researchers presenting and discussing the findings of multiyear investigations in clinical terms.
There was “a ‘planting and eating soybean’ project for people living with H.I.V./AIDS in rural Anhui, China,” “situational analysis and client satisfaction evaluation of A.R.T. centers in India” and “coordinating procurement planning using logistics data,” to name but a few such studies.
Mixed among the strait-laced scientists, though, were activists wearing condom costumes and T-shirts that asked, “Got AIDS?”
More than a quarter of a century since the AIDS epidemic was first recognized, the advocates say, they must be increasingly imaginative in their efforts to educate the public about the disease. Posters on display showed condom-shaped superheroes sailing through the air and oversize insects, representing the virus, having sex with unsuspecting victims. The worst thing, those involved in drawing attention to the epidemic say, is to be so dull that people’s eyes glaze over.
“There is a need to renew and freshen efforts because the virus does not get bored, nor does it fail to find new people at risk every year,” said Dr. James W. Curran, who led the AIDS Program at the Centers for Disease Control and Prevention for many years before becoming dean of the Rollins School of Public Health at Emory University.
One attention-getting advertising campaign on display — called “If I were H.I.V. positive...” — was created by a French group called AIDES. For two years, AIDES has printed posters and postcards and created advertisements using photographs of prominent people above questions meant to challenge stereotypes about infected people.
“If I were H.I.V. positive, would you let me be your doctor?” says one ad bearing the likeness of Dr. Pedro Cahn, the immediate past president of the International AIDS Society, which ran the meeting.
Another showing a blonde woman asked, “If I were H.I.V. positive, would you invite me to your home?” The picture was of Crown Princess Mette-Marit of Norway.
After former President Bill Clinton gave the keynote address on Monday, Floriane Cutler, an AIDES staff member, ducked under a rope and handed him a poster that the group had prepared of him in the hope that he would approve its distribution.
“Would I ever have been president of the United States, if I were H.I.V. positive?” it read. The group used a photo of Mr. Clinton that it had downloaded from the Internet.
Ms. Cutler said Mr. Clinton listened to her quick spiel about the idea behind the antistigma campaign, smiled at her and then moved along with a copy of the poster in his hand.
During France’s presidential campaign last year, the group printed posters of all the candidates. Nicolas Sarkozy, who eventually won, was the toughest to deal with, the group said. His representatives did not initially respond to the questionnaire they were sent seeking his positions on AIDS-related issues or approve an ad campaign.
So the group pressed him into it with a poster that asked: “Even though I don’t care about AIDS, will you vote for me?”
In Mr. Clinton’s case, the group has no plans to issue such a challenge. Olivier Denoue, deputy managing director of AIDES, said Mr. Clinton’s foundation was doing important work on combating AIDS in the developing world and that the former president was regarded as a leader in the field. But the group is eager for an answer on whether he will join the actors, sports figures and other celebrities, most of them French, who are already part of the advertising campaign.
And AIDES is already preparing a backup plan in case Mr. Clinton, whose office did not respond to a request for comment on the campaign, says no.
“If we don’t get Bill Clinton,” Ms. Cutler said, “maybe we’ll get Madonna or Barack Obama or Sharon Stone.”

Healthy People 2010

10 aug 2008--In January 2000, the Department of Health and Human Services launched Healthy People 2010, a comprehensive, nationwide health promotion and disease prevention agenda. Healthy People 2010 contains 467 objectives designed to serve as a framework for improving the health of all people in the United States during the first decade of the 21st century.
Healthy People 2010 builds on similar initiatives pursued over the preceding two decades. Two overarching goals—to increase quality and years of healthy life and to eliminate health disparities—served to guide the development of objectives that would be used to measure progress. Each objective has a target to be achieved by the year 2010. These objectives are organized into 28 focus areas, each representing an important public health area. A selected set of objectives, known as the Leading Health Indicators, was created to help identify sentinel measures of public health, and to encourage wide participation in improving health in the next decade. These indicators were chosen based on their ability to motivate action, the availability of data to measure their progress, and their relevance as broad public health issues.
NCHS is responsible for coordinating the effort to monitor the Nation's progress toward the targets, using data from NCHS data systems as well as many other data sources. National data are gathered from more than 190 different data sources, from more than seven Federal Government Departments (including Health and Human Services, Commerce, Education, Justice, Labor, Transportation, and the Environmental Protection Agency), and from voluntary and private non-governmental organizations. To the extent appropriate, data for the objectives are provided for subgroups defined by relevant dimensions such as sociodemographic subgroups of the population, health status, or geographic classifications.
Data are made available through DATA2010, an interactive database system accessible through the NCHS web site and the CDC WONDER system.
Because these objectives are national, not solely Federal, their achievement is dependent in part on the ability of health agencies at all levels of the government and on non-governmental organizations to assess objective progress. To inform that effort, NCHS maintains an online update of the November 2000 publication, Tracking Healthy People 2010. This report includes technical information on general data issues and major data sources, detailed definitions for each objective, and additional resources.

Falls Among Older Adults: An Overview
Older Adult Falls

10 aug 2008--How big is the problem?
More than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001).
Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (CDC 2006).
In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2008).
The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006).
What outcomes are linked to falls?
Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001).
Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).
Most fractures among older adults are caused by falls (Bell et al. 2000).
The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).
Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).
In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).
Who is at risk?
Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005).
Women are 67% more likely than men to have a nonfatal fall injury (CDC 2006).
Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005).
In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).
The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005)
Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2006).
People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999).
There is little difference in fatal fall rates between whites and blacks from ages 65 to 74 (CDC 2006).
After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2006).
White women have significantly higher rates of fall-related hip fractures than black women (Stevens 2005).
Among older adults, non-Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).

How can older adults prevent falls?Older adults can take several steps to protect their independence and reduce their risk of falling. They can:
Exercise regularly; exercise programs like Tai Chi that increase strength and improve balance are especially good.
Ask their doctor or pharmacist to review their medicinesboth prescription and over-the counterto reduce side effects and interactions.
Have their eyes checked by an eye doctor at least once a year.
Improve the lighting in their home.
Reduce hazards in their home that can lead to falls.

What is CDC doing to prevent falls among older adults?
CDC supports research and dissemination on ways to help prevent falls among older adults. To read about these activities, follow the link to CDC Fall Prevention Activities.
CDC has also developed brochures and posters, in partnership with the CDC Foundation and MetLife Foundation, to educate older adults and those who care for them about preventing falls and the injuries that result.
References
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Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):1767.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2006) [cited 2007 Jan 15]. Available from URL: www.cdc.gov/ncipc/wisqars.
Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:1215.
Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):10506.
Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):1623.
Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 19921994. Academic Emergency Medicine 2000;7(2):13440.
Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990; 16(3): 717-40.
Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma-Injury, Infection and Critical Care 2001;50(1):1169.
Stevens JA. Falls among older adultsrisk factors and prevention strategies. NCOA Falls Free: Promoting a National Falls Prevention Action Plan. Research Review Papers. Washington (DC): The National Council on the Aging; 2005.
Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:2905.
Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 199098: sex, race, and ethnic disparities. Injury Prevention 2002;8:2725.
Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention 2005;11:1159.
Stevens JA. Fatalities and injuries from falls among older adults  United States, 19932003 and 20012005. MMWR 2006;55(45).
Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189193.