Delirium May Accelerate Decline in Alzheimer's Disease

Cognitive function declines faster after an episode of delirium

06 may 2009-- Patients with Alzheimer's disease have a greater acceleration in cognitive decline after an episode of delirium, according to a study in the May 5 issue of Neurology.

Tamara G. Fong, M.D., from the Beth Israel Deaconess Medical Center in Boston, and colleagues analyzed cognitive performance in elderly patients with Alzheimer's disease, where 72 developed delirium and 336 did not develop delirium.

The researchers found that the rate of cognitive decline, as assessed by changes in the Information-Memory-Concentration (IMC) subtest of the Blessed Dementia Rating Scale, significantly accelerated after an episode of delirium. The average decline on the IMC was 2.5 points per year but further declined to an average of 4.9 points per year after an episode of delirium. Patients who developed delirium had a threefold higher rate of change in the IMC score, according to the study.

"Delirium can accelerate the trajectory of cognitive decline in patients with [Alzheimer's] disease (AD)," Fong and colleagues conclude. "Ultimately, the information derived from this study provides the foundation for future randomized intervention studies to determine whether prevention of delirium might ameliorate and/or delay cognitive decline in patients with AD."

Abstract
Full Text (subscription or payment may be required)

High Urine Albumin Linked to Venous Thromboembolism

Microalbuminuria risk for VTE found comparable to its risk for heart attack and stroke

• Del.icio.us
• Digg
• Reddit
• Facebook

06 may 2009 -- Already a recognized risk factor for arterial thromboembolism, microalbuminuria also is a risk factor for venous thromboembolism (VTE), according to a study published in the May 6 issue of the Journal of the American Medical Association.

Bakhtawar K. Mahmoodi, of the University Medical Center in Groningen, Netherlands, and colleagues extracted data on 8,592 participants with higher levels of urinary albumin concentration from among the 40,856 respondents in the 1997 to 1998 Prevention of Renal and Vascular End-Stage Disease (PREVEND) study. The researchers used data from the regional anticoagulation clinic database to identify PREVEND subjects who developed VTE between 1997 and 2007.

Of the 8,574 participants who could be evaluated, the researchers found that 129 experienced VTE subsequent to PREVEND (mean follow-up period 8.6 years), reflecting an overall annual VTE incidence rate of 0.14 percent. The VTE annual incidence rate increased as urinary albumin excretion (UAE) increased: 0.12 percent (UAE less than 15 mg/24 h), 0.20 percent (UAE equal to 15 to 29 mg/24 h), 0.40 percent (UAE equal to 30 to 300 mg/24 h), and 0.56 percent (UAE greater than 300 mg/24 h).

"In conclusion, microalbuminuria is an independent risk factor for VTE. The relative risk of VTE associated with microalbuminuria is comparable to previously reported risk of myocardial infarction or stroke in individuals with microalbuminuria," the authors write.

Abstract
Full Text (subscription or payment may be required)

Molecular Markers Linked to Death From Prostate Cancer

Cancer patients with bcl-2, p53, high microvessel density had higher risk of cancer death

06 may 2009 -- Several molecular factors measured in prostate cancer biopsy specimens at diagnosis may point to a higher long-term risk of death, according to research published in the May 5 Annals of Internal Medicine.

John Concato, M.D., of the Veterans Affairs Connecticut Healthcare System in West Haven, and colleagues analyzed data from 1,172 men diagnosed with prostate cancer between 1991 and 1995, whose median age at diagnosis was 72. Tissue samples from most of the men were evaluated for factors including bcl-2 (related to apoptosis), p53 (tumor-suppressor oncogene), and microvessel density.

The researchers discovered that during follow-up, 21.5 percent of deaths were attributable to prostate cancer. Bcl-2 and p53 were associated with death from prostate cancer (adjusted hazard ratio for positive versus negative staining, 1.61 and 1.48, respectively), as was microvessel density (adjusted hazard ratio for highest versus lowest quartile, 3.20).

"Although Concato and colleagues show that p53 and bel-2 detection and microvessel density are statistically associated with a worse prognosis, the authors themselves describe the advance made by their study as 'incremental.' We agree. We doubt that their findings will have any effect at all on clinical practice for several reasons," write the authors of an accompanying editorial, pointing out that "the hazard ratios are of insufficient magnitude for the markers by themselves to influence clinical decisions."

Full Text
Editorial (subscription or payment may be required)

Modified Protocol Improves Cardiac Arrest Survival

Optimizing chest compressions increases return of spontaneous circulation

06 may 2009-- Modified guidelines on the out-of-hospital management of cardiac arrest patients that optimizes compressions and reduces disruption improves survival rates, according to a study published online on May 4 in Circulation.

Alex G. Garza, M.D., of Georgetown University School of Medicine in Washington, D.C., and colleagues analyzed data on survival rates for 1,097 adult primary ventricular fibrillation and pulseless ventricular tachycardia cardiac arrest cases admitted in the 36 months prior to the introduction of the revised resuscitation protocol, and compared results with those of 339 cases in the 12 months after the protocol was introduced. The protocol included mandatory pre-shock chest compressions at an increased rate of 50:2, delayed intubation, and, where available, strict use of manual defibrillators.

The survival rate of out-of-hospital arrest of presumed primary cardiac origin rose from 7.5 percent before the revised protocol was introduced to 13.9 percent afterwards, the investigators discovered. In the subset of witnessed cardiac arrest patients with initial rhythm of ventricular fibrillation there was an increase in return to spontaneous circulation from 37.8 percent before the revised protocol to 59.6 percent afterwards, the researchers noted.

"Further studies are warranted to look at the impact of the new 2005 American Heart Association guidelines on survival, and further work is needed to benchmark best practices in cardiac arrest," the authors conclude."

Abstract
Full Text (subscription or payment may be required)

Heart Arrhythmias Increase Mortality in Catheterizations

Tachycardia or fibrillation associated with higher 90-day mortality following coronary interventions

06 may 2009-- The incidence of ventricular tachycardia or fibrillation (VT/VF) during and after percutaneous coronary intervention (PCI) is associated with higher death rates within 90 days, according to a study published in the May 6 issue of the Journal of the American Medical Association.

Rajendra H. Mehta, M.D., of the Duke Clinical Research Institute in Durham, N.C., and colleagues studied 5,745 patients with ST-elevation myocardial infarction (STEMI) who underwent PCI at 296 hospitals in 17 countries from 2004 to 2006. The group, drawn from the Assessment of Pexelizumab in Acute Myocardial Infarction trial, was sorted into the following four subgroups related to VT/VF: no episode of VT/VF; VT/VF at any time; early VT/VF (before completion of cardiac catheterization); and late VT/VF (after completion of cardiac catheterization). Study outcome was mortality at 90 days.

The researchers found that VT/VF occurred in 329 STEMI patients, 64 percent of those episodes occurring before the end of catheterization, and 90 percent occurring within 48 hours of presentation with STEMI symptoms. Ninety-day mortality was worse in those who had VT/VF compared to those who did not (23.2 percent versus 3.6 percent), and was worse yet for those in whom VT/VF occurred late (33.3 percent) versus early (17.2 percent). The hazards ratios for late and early VT/VF compared to no VT/VF were 5.59 and 2.34, respectively.

"In this study, occurrence of VT/VF before or after the end of cardiac catheterization in patients presenting for primary PCI was associated with increased 90-day mortality," the authors write.

Abstract
Full Text (subscription or payment may be required)

AGS: Seniors Who Volunteer Outlive Non-Volunteers

Follow-up finds 12 percent deaths among elderly volunteers, 26 percent in non-volunteers

MONDAY, May 4 (HealthDay News) -- Elderly retirees who volunteer have lower mortality than their cohorts who don't volunteer, according to a study presented at the 2009 Annual Scientific Meeting of the American Geriatrics Society, held from April 29 to May 2 in Chicago.

Sei J. Lee, M.D., of the University of California in San Francisco, and colleagues examined 6,360 retired people older than 65 who took part in the 2002 nationwide Health and Retirement Study. Subjects were asked if they had done any volunteer work over the past year for educational, religious, health-related, or other charities. The researchers ascertained deaths in the group by 2006 and then compared the self-reported volunteers and non-volunteers, while adjusting for possible confounding factors, such as demographic differences, geriatric syndromes, chronic conditions, and disabilities.

The researchers concluded that volunteering is strongly associated with lower mortality, with 12 percent of the group of 1,766 self-reported volunteers dying by 2006 compared to 26 percent of the group of 4,594 non-volunteers.

"In this population-based study, we found that volunteering remains a powerful predictor of decreased mortality among current United States' retirees, even after extensive adjustment for possible confounding factors," the authors write.

More Information

Memory grows less efficient very early in Alzheimer's disease

When learning new things, people with emerging symptoms find it harder to separate what's important from what's not

WASHINGTON,05 may 2009 — Even very early in Alzheimer's disease, people become less efficient at separating important from less important information, a new study has found.

Knowing this, clinicians may be able to train people in the early stages of Alzheimer's to remember high-value information better, according to a report in the May issue of Neuropsychology, published by the American Psychological Association.

Remembering what's most important is central to daily life. For example, if you went to the grocery store but left your shopping list at home, you'd at least want to remember the milk and bread, if not the jam. Or, when packing for a trip, you'd want to remember your wallet and tickets more than your slippers or belt.

Participants in the study were recruited from the Washington University in St. Louis Alzheimer's Disease Research Center. They included 109 healthy older adults (average age of almost 75), 41 people with very mild (very early) Alzheimer's disease (average age of almost 76), 13 people with mild (early) Alzheimer's (average age of almost 77), and 35 younger adults (all 25 or under, average age of almost 20).

The researchers asked participants to study and learn neutral words that were randomly assigned different point values. When asked to recall the items, participants were asked to maximize the total value. All participants, even those with Alzheimer's, recalled more high-value than low-value items. However, the Alzheimer's groups were significantly less efficient than their healthy age peers at remembering items according to their value. It meant they no longer maximized learning and memory, which in healthy people are fairly efficient processes.

The authors speculated that Alzheimer's disease makes it harder for people to encode what they learn in a strategic way. Because encoding is the first step in long-term memory, this affects their ability to remember things according to their value.

The findings also demonstrate that value-directed learning stays intact in healthy aging. Older adults might not remember as much as younger adults, but when healthy, they remain able to distinguish what's important.

This research suggests the potential for improved memory training. People with early-stage Alzheimer's might remember important information better by learning to be more strategic and selective when encoding high-value information, even though it comes at the expense of neglecting less-important information, the authors said.

###

Article: "Memory Efficiency and the Strategic Control of Attention at Encoding: Impairments of Value-Directed Remembering in Alzheimer's Disease," Alan D. Castel, PhD, University of California, Los Angeles; David A. Balota, PhD, Washington University in St. Louis; and David P. McCabe, PhD, Colorado State University; Neuropsychology, Vol. 23, No. 3.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/neu233297.pdf)

Vitamin E may slow Alzheimer's disease

NEW YORK,05 may 2009- An analysis of "real-world" clinical data indicates that vitamin E, and drugs that reduce generalized inflammation, may slow the decline of mental and physical abilities in people with Alzheimer's disease (AD) over the long term.

"Our results are consistent for a potential benefit of vitamin E on slowing functional decline and a smaller possible benefit of anti-inflammatory medications on slowing cognitive decline in patients suffering from Alzheimer's disease," Dr. Alireza Atri told Reuters Health.

Atri, at Massachusetts General Hospital (MGH), the VA Bedford Medical Center, and Harvard Medical School, Boston, led the National Institutes of Health-sponsored research. The findings, reported at the annual meeting of the American Geriatrics Society in Chicago, stem from data on 540 patients treated at the MGH Memory Disorders Unit.

All of the patients were receiving standard-of-care treatment with a drug intended to help patients with Alzheimer's. As part of their clinical care, 208 patients also took vitamin E but no anti-inflammatory, 49 took an anti-inflammatory but no vitamin E, 177 took both vitamin E and an anti-inflammatory, and 106 took neither.

While the daily dose of vitamin E ranged from 200 to 2000 units, the majority of patients were given high doses that ranged from 800 units daily to 1000 units twice daily.

Each patient's performance on cognitive tests and their ability to carry out daily functions such as dressing and personal care were assessed every 6 months. After an average of 3 years, "there was a modest slowing of decline in function in those patients taking vitamin E," study investigator Michael R. Flaherty noted in a telephone interview with Reuters Health.

Flaherty, a second-year student at the University of New England College of Osteopathic Medicine in Biddeford, Maine, presented the findings at the meeting. He added that the treatment benefit from vitamin E was "small to medium" but increased with time.

Taking an anti-inflammatory medication was associated with "very consistent but generally only small effects on slowing long-term decline in cognitive functioning," Atri told Reuters Health.

However, in patients who took both vitamin E and anti-inflammatory medications, there appeared to be an additive effect in terms of slowing overall decline.

Given that past studies have produced equivocal results, the investigators conclude that further studies are needed to assess the long-term balance of risks versus benefits for people with Alzheimer's disease from taking vitamin E and anti-inflammatory drugs.

Gel effective for women with overactive bladder

CHICAGO, 05 may 2009- Applying a gel containing the anti-spasmodic agent oxybutynin to the skin is safe and effective for women with overactive bladder, according to a study reported here at the annual meeting of the American Urological Association.

Overactive bladder can be disabling and is associated with a marked decrease in health-related quality of life as well as higher rates of depression, Dr. Roger Dmochowski noted. The condition affects both men and women, but women experience more severe symptoms earlier in life than men.

The gel, which goes by the brand name Gelnique, is applied "once daily to rotating sites on the abdomen, upper arm/shoulders and thigh." Dmochowski of Vanderbilt University Medical Center in Nashville, Tennessee, and others tested it in some 700 women with symptoms of overactive bladder.

The women were randomly assigned to treatment with the oxybutynin gel or an inactive placebo, which they applied once a day for 12 weeks.

By the end of the study period, 27 percent of the women treated with oxybutynin gel achieved complete continence compared with 15.6 percent treated with placebo.

The average daily number of mean urinary episodes dropped by 2.8 episodes with active treatment compared with 2.0 episodes with placebo.

There was also a greater reduction in incontinence, which dropped by 3.0 episodes a day with oxybutynin and by 2.5 episodes a day with placebo.

There were no serious treatment-related adverse events. The most common side effect with oxybutynin gel was dry mouth, occurring in 7.4 percent of the women compared with 2.8 percent with placebo. Itchiness occurred at the application site in 2.3 percent of the study group and 0.9 percent of the placebo group.

The results confirm that the oxybutynin gel "is a novel treatment approach with strong efficacy and excellent tolerability" for women with overactive bladder, Dmochowski commented during the presentation of his team's findings.

"Women with overactive bladder often experience severe symptoms at a young age, so it's important that we have an effective treatment that is both well tolerated and convenient for our female patients," he said.

WHO confirms nearly 1,000 flu cases in 20 countries

GENEVA , 05 may 2009 - The World Health Organization (WHO) said on Monday that its laboratories have identified a total of 985 H1N1 flu infections in 20 countries, including El Salvador and Colombia, and said there have been 25 confirmed deaths in Mexico.

The WHO's toll lags national reports about the virus but is considered more scientifically secure. Its figures about Mexico -- considered the epicenter of the outbreak -- have been rising in recent days because of lab results on previously-collected samples coming in, not because of new infections reported.

Its most recent figures say that 590 people have been infected in Mexico, and 226 people have been infected in the United States, the two countries most affected by the virus widely known as swine flu. There has also been one U.S. death, identified by authorities there as a Mexican infant.

The WHO has also confirmed flu infections, without deaths, in the following countries: Austria (1), Canada (85), Hong Kong - China Region (1), Costa Rica (1), Colombia (1), Denmark (1), El Salvador (2), France (2), Germany (8), Ireland (1), Israel (3), Italy (1) Netherlands (1), New Zealand (4), South Korea (1), Spain (40), Switzerland (1) and Britain (15).

The WHO is waiting to see evidence of sustained spread of the virus outside of the Americas region before raising its global alert level from 5 to the highest level, 6, and declaring a full pandemic.

Asked on Sunday about the relatively large number of infections confirmed in Spain, WHO spokesman Gregory Hartl said most of those appeared to be "imported" cases involving people returning from Mexico, the disease epicenter, and not a situation where the virus was spreading widely through the Spanish population.

Half a glass of wine a day may boost life expectancy by 5 years

Long-term wine consumption is related to cardiovascular mortality and life expectancy independently of moderate alcohol intake

04 may 2009--Drinking up to half a glass of wine a day may boost life expectancy by five years—at least in men—suggests research published ahead of print in the Journal of Epidemiology and Community Health.

The Dutch authors base their findings on a total of 1,373 randomly selected men whose cardiovascular health and life expectancy at age 50 were repeatedly monitored between 1960 and 2000.

The researchers looked into how much alcohol the men drank, what type it was, and over what period, in a bid to assess whether this had any impact on the risks of their dying from cardiovascular disease, cerebrovascular disease, and from all causes.

They also tracked weight and diet, whether the men smoked, and for how long, and checked for the presence of serious illness.

During the 40 years of monitoring, 1,130 of the men died. Over half the deaths were caused by cardiovascular disease.

The proportion of men who drank alcohol almost doubled from 45% in 1960 to 86% in 2000, with the proportion of those drinking wine soaring from 2% to 44% during that period.

The researchers found that light long term alcohol consumption of all types—up to 20 g a day— extended life by around two extra years compared with no alcohol at all. Extended life expectancy was slightly less for those who drank more than 20 g.

And men who drank only wine, and less than half a glass of it a day, lived around 2.5 years longer than those who drank beer and spirits, and almost five years longer than those who drank no alcohol at all.

Drinking wine was strongly associated with a lower risk of dying from coronary heart disease, cerebrovascular disease, and death from all causes.

These results held true, irrespective of socioeconomic status, dietary and other lifestyle habits, factors long thought to influence the association between wine drinking and better health.

HBO's Alzheimer's series aims to push for cure

LOS ANGELES, 04 may 2009- It's been almost 15 years since former U.S. President Ronald Reagan told the world he had been diagnosed with Alzheimer's disease, hoping his disclosure would promote awareness of the heart-breaking brain disorder that slowly destroys memory.

Now, with an estimated 26 million people worldwide living with disease and a predicted 11 million by 2050 in the United States alone, a unique series by cable TV network HBO aims to change how people think of Alzheimer's so they will put time and money into finding a cure.

The unprecedented multi-platform series runs throughout May and features four documentaries, 15 short films, a book, a community outreach program and a website (www.HBO.com/alzheimers) covering every aspect of Alzheimer's.

"The numbers are growing at a rate that nobody ever fathomed. As babyboomers age, it is coming right at us and we have to do something," said Maria Shriver, wife of California Governor Arnold Schwarzenegger and executive producer of "The Alzheimer's Project."

"This is an epidemic for this generation. A cure is within our reach if we focus on it, allocate the money and pressure our lawmakers. If we don't, the impact has devastating consequences," Shriver told Reuters.

"The Alzheimer's Project", starting on May 10, looks at the disease's impact on victims, their families and caregivers. It also includes a science film that takes viewers inside the labs and clinics of 25 leading physicians and researchers.

HOPE FOR CLINICAL TRIALS

While there is no cure for what is the most second-feared illness in America after cancer, the program concludes there are reasons to be optimistic.

"There are about 90 clinical trials under way in different phases," Shriver said. "There is a lot of hope within the scientific and research community that there is a cure out there, without saying the cure is around the corner."

Shriver has direct experience with the disease. Her father, long-time Washington figure Sargent Shriver, was diagnosed in 1983. As part of the HBO series, she presents a film for young teens in which kids talk about being the grandchild of a loved one whose memory is in various stages of slipping away.

"When my father was diagnosed, this was not a disease that people wanted to talk about," Shriver said. "The more families sit down and have these open, honest conversations where everybody can air their questions and express their fears -- that is empowering and really helpful."

Shriver said there were no difficulties finding families willing to talk on camera.

"People know how powerful it is to share their stories," she said. "People who've had someone who has gotten Alzheimer's really want to help others not go through the same thing. They want to be part of the solution."

One film features a man called Chuck, 54, who cared for his mother until she died and is one of 12 of the 14 children in her family who is now suffering from Alzheimer's.

Shriver acknowledged some films are overwhelming. "It's not easy to watch," she said, "but I think it is television worth viewing.

"I am hopeful people won't just sit and watch it and think that was moving and sad and then go about their business. It's always a challenge to move people and then move them off the couch."

Women live longer, not better, largely because of obesity and arthritis

CHICAGO, 04 may 2009 – Obesity and arthritis that take root during early and middle age significantly contribute to women's decreased quality of life during their senior years, according to researchers at Duke University Medical Center.

In a study that included 5,888 people over 65, women suffered up to two and a half times more disabilities than men of the same age.

Higher rates of obesity and arthritis among these women explained up to 48 percent of the gender gap in disability – above all other common chronic health conditions.

"While women tend to live longer than men, this study shows that they are at greater risk of living with disability and much of the excess disability is attributable to higher rates of obesity and arthritis," said Heather Whitson, M.D., assistant professor of medicine and lead investigator of the study presented today at the Annual Scientific Meeting of the American Geriatrics Society. "This is important because it suggests that women's tendency to pack on extra pounds in their child-bearing and peri-menopausal years translates into loss of independence in their old age."

Researchers said the study is the first to isolate the impact of specific chronic health conditions on the difference in disability rates between older men and women. While many people are studying how chronic conditions affect mortality, the investigators were surprised to see the extent to which these conditions explained the gender difference in disability.

"The reason for this discrepancy in disability has not been well understood but we found that chronic health conditions that women experience in greater numbers than men may explain part of that gap," said Harvey Jay Cohen, M.D., the study's senior author, chair of the Department of Medicine and director of Duke's Center for the Study of Aging and Human Development.

"Women have a natural tendency to gain more weight than men over the lifespan, but may be more motivated to maintain a healthy weight if they realize that those extra pounds make it more likely that they will be disabled in later years – potentially becoming a burden to their children or requiring a nursing home," Whitson said.

The current study is an analysis of the Cardiovascular Health Study which asked participants about their ability to conduct common activities of daily living, such as grooming, eating, getting dressed, managing money and upper and lower body movement, including reaching, grasping, walking and climbing stairs.

The Duke team said the study also draws attention to two concerning health trends that could worsen the average quality of life for women in the future. First, as the rate of obesity continues to rise, the rates of disability in older adults are expected to increase. To the extent that women are more likely than men to develop obesity, the obesity epidemic will have its greatest impact on older women's quality of life.

Second, the investigators note that women are gaining equality with men on cardiovascular disease, stroke and emphysema, which had previously been less common among women. Rates of cardiovascular disease are not improving as quickly among women as they are among men and smoking-related disease is becoming more common in women. If the occurrence of these conditions becomes more comparable between men and women, the result would be an even wider gap in disability rates.

"The findings of our study are more troubling when you consider the increasing rates of obesity among women and the higher rates of other conditions that are currently over-represented among men," Cohen said. "We need to help women make better decisions earlier in life."

In addition to obesity and arthritis, the study found the women were more likely than men to experience fractures, vision problems and bronchitis. Men were more likely to have emphysema, coronary heart disease, congestive heart failure, stroke, diabetes and hearing problems.

Researchers say that the next step is to determine whether older women who have been disabled by obesity or arthritis regain function if they undergo treatment to help them achieve a healthy weight or to control their arthritis pain. If not, then it becomes even more important to focus efforts on preventing obesity and arthritis in younger populations.

###

Study co-authors include Drs. Lawrence L. Landerman, Anne B Newman, Linda P. Fried and Carl F. Pieper.

The research was supported by National Institutes of Health, University of Pittsburgh Claude D. Pepper Older Americans Independence Center, John A. Hartford Center for Excellence, Duke Claude D. Pepper Older American Independence Center, a John A. Hartford Foundation Geriatrics Outcomes Research Award and Paul B. Beeson Career Development Award.

Cementless hip implants are durable for at least 20 years

Despite the common perception that total hip replacements last about 10 years, researchers at Rush University Medical Center have found that the devices are extremely durable, even 20 years after surgery.

04 may 2009--Clinical and radiological evidence showed that 96 percent of the 124 cementless metal components assessed remained securely fixed in place 20 years post surgery, according to a study published in the May issue of the Journal of Bone and Joint Surgery. These components, which fit into the cup-shaped hip socket, or acetabulum, were among the first implants designed with a porous structure to allow bone to grow into the surface in the hopes of achieving long-term fixation.

"Our results confirm earlier work done at Rush and at other institutions: that cementless acetabular components work very well and that long-term biological fixation can be obtained," said Dr. Craig Della Valle, an orthopedic surgeon and principal author of the study.

Over the last two decades, the researchers have been studying the results for 204 total hip replacements performed at Rush in the mid-1980s in a group of 184 patients ranging in age from 20 to 84 years. Findings were previously reported at 10 and 15 years.

The implants studied were the Harris-Galante I acetabular component, whose design was based on pioneering research work done by Dr. Jorge Galante, former chairman of orthopedics at Rush and a co-author of this study. Earlier-generation implants, which relied on special cement to secure the device to the patient's bones, had been shown to have higher rates of failure, particularly beyond 10 years.

"The hope was to provide more durable fixation, especially for younger patients with a longer life span," Galante said.

In the present study, the researchers analyzed results for 124 hip replacements in the 111 patients who were still alive 20 years or more after surgery. Since the previous report at 15 years, two metal cup implants, in addition to the three noted earlier, were found to be loose, or 4 percent of the 124 implants. Of the original 204 hip replacements, five cases, or 2.5 percent of the total, had failed. Two of these five implants were revised, but three were left intact because the patients did not suffer significant symptoms.

However, in nearly 20 percent of the patients still living 20 years post surgery, the plastic lining of the metal shell had worn enough that repeat, but less involved, surgery was required or recommended. Younger age strongly correlated with a higher risk of wear-related problems, the study showed.

"The average age of the patients in this study was 52 years, much younger than most patients who underwent hip replacements at the time. So the high rate of wear-related complications was not completely unexpected," Galante said.

Also, with time, the number of surgical revisions has increased due to osteolysis, or bone resorption as a result of the body's reaction to debris created by wear and corrosion of the metal implants.

"With time, the number of repeat surgeries due to wear and osteolysis has increased, as have the numbers of cases of osteolysis we identified radiologically. But with the newer, more wear-resistant bearing surfaces we are now using, we believe that fewer patients today will need revision surgery for these reasons," Della Valle said.

"This longitudinal study gives us a wealth of data to use as we continue to improve on techniques and materials for total hip replacements," Galante said.

###

Rush University Medical Center's orthopedics program ranks tenth in the nation, according to U.S. News & World Report. Physicians from Rush serve as the team physicians for the Chicago Bulls and the Chicago White Sox. For more information on orthopedics at Rush, visit http://www.rush.edu/rumc/page-R11726.html or call (888) 352-RUSH.

Single gene defect can cause stroke, other artery diseases

UT Houston researchers publish study results

HOUSTON, 04 may 2009– For the first time, scientists have discovered a single gene defect that causes thoracic aortic aneurysms and dissections as well as early onset coronary artery disease, ischemic stroke and Moyamoya disease. The research is led by scientists at The University of Texas Health Science Center at Houston.

The study, "Mutations in Smooth Muscle Alpha-Actin (ACTA2) Cause Early Onset Coronary Artery Disease, Stroke and Moyamoya Disease, Along with Thoracic Aortic Aneurysms and Dissections," was published early online April 30 in the American Journal of Human Genetics.

"If someone is found to have an alteration or mutation in this gene, we can do screening for vascular diseases, and if diagnosed with disease, they can take medications and undergo surgical approaches to prevent premature death or disability," said senior author and principal investigator Dianna Milewicz, M.D., Ph.D., professor and director of the Division of Medical Genetics at The University of Texas Medical School at Houston.

The discovery of the causal relationship between the mutated gene ACTA2 and artery diseases has opened the door to a new way of thinking about the vascular system, Milewicz said.

"We need to look at the artery system as a continuous system or organ," said Milewicz, the President George Bush Professor in Cardiovascular Medicine. "We've been looking at it the wrong way. If you have this particular genetic mutation, it can present in several different diseases affecting different arteries."

Milewicz and her team studied 127 members of 20 families from around the world who had ACTA2 mutations. They were phenotyped for premature vascular diseases, defined as an age of onset less than 55 years in men and less than 60 years in women.

Premature thoracic aortic aneurysms and dissections were the main vascular disease for 76 mutation carriers, while 26 had premature coronary artery disease, 15 had ischemic stroke, including Moyamoya disease, and 15 had more than one vascular disease.

In thoracic aortic disease, the wall of the aorta, the main blood vessel leading out of the heart, weakens and forms an aneurysm that can ultimately lead to an aortic dissection and death. Coronary artery disease, the most common type of heart disease, is the leading cause of death for both men and women in the United States. Stroke is the third leading cause of death in the country.

In the study, none of the family members without the ACTA2 defect had any vascular disease, helping to rule out other genetic or environmental causes. In four families, members younger than age 20 suffered a stroke and five strokes resulted from Moyamoya disease, a rare stroke disease in which the internal carotid arteries become occluded.

The main function of smooth muscle cells is to contract in response to the stretching from pulsing blood flow. Vascular pathology from mutant aortas and analysis of smooth muscle cells removed from patients and grown in the laboratory suggest that persons with ACTA2 have increased multiplication of smooth muscle cells that contribute to blocked or enlarged arteries, according to the study.

Milewicz and her team previously discovered the role of the mutated ACTA2; mutations in ACTA2 account for 14 percent of the inherited form of thoracic aortic aneurysms and dissections, making it the major gene identified for the condition.

During the research, Milewicz identified a large family with persistent livedo reticularis, a purplish mesh-like skin discoloration caused by the occlusion of arteries in the skin. This family also had a history of premature onset coronary artery disease and premature stroke without the risk factors know to cause these diseases (smoking, high cholesterol)

"Family members asked if it all could be related and I told them at the time that they just had really bad luck with several mutated genes," Milewicz said. "It didn't occur to me until later that it might be from the same genetic defect."

###

The study results from collaborative efforts of physicians and scientists in the Texas Medical Center including surgeons Hazim Safi, M.D., professor and chairman of the Department of Cardiothoracic Vascular Surgery at the UT Houston Medical School; Dong Kim, M.D., chairman of the medical school's Department of Neurosurgery and director of the Mischer Neuroscience Institute at Memorial Hermann—Texas Medical Center; and Anthony Estrera, M.D., associate professor of cardiothoracic vascular surgery.

What you need to know about the new swine flu

WASHINGTON, 03 may 2009– As the new swine flu spreads, people have lots of questions about how it affects their day-to-day life. Here are some answers.

Q: How easy is it to catch this virus?

A: It's spreading as easily as regular winter flu, which infects millions each year. Early estimates are that 25 percent to 30 percent of family members are getting sick once a relative brings it home.

Q: How dangerous is it?

A: Nobody knows yet. Genetically, it doesn't share the same traits that made the infamous 1918 pandemic so deadly, nor does it seem as virulent as the bird flu that scientists have tracked for several years. While Mexico reported many deaths, the virus is causing less severe illness in the U.S. In fact, the Centers for Disease Control and Prevention says most cases so far haven't needed medical attention.

Q: Could I have some immunity?

A: Since it's a never-before-seen mix of mostly pig but also human and bird viruses, the CDC has cautioned that's unlikely. But it is a member of the H1N1 family of flu viruses, which circulate widely. Flu specialist John Treanor at the University of Rochester says people born before 1957 spent their childhood repeatedly exposed to H1 viruses. So experts are withholding final judgment on that question.

Q: Is it treatable?

A: Yes, with the standard anti-flu drugs Tamiflu and Relenza. They lessen symptoms if taken within 48 hours of the first symptoms.

Q: Is there a vaccine?

A: No. The government is working to develop one and the earliest shots could roll out would be in the fall, if authorities decide the virus remains enough of a threat to offer those shots. Manufacturers are preparing regular flu shots for the fall, when routine influenza strains will start circulating regardless of swine flu.

Q: Why does CDC stress hand-washing?

A: Flu viruses do spread through the air, so cover coughs and sneezes with a tissue or by sneezing into your elbow rather than your hand. But flu also can spread by touching your mouth or nose with unwashed hands. The viruses can live on surfaces such as doorknobs or handrails for a few hours, or be passed by a handshake.

Q: Do hand gels work better?

A: No, they're just an alternative, says Dr. Richard Besser, the CDC's acting chief. He keeps a bottle in his pocket. The bigger issue is to wash hands well enough to get rid of germs. Sing "Happy Birthday" or "Twinkle, Twinkle, Little Star" to know you've scrubbed long enough, he advises.

Q: How long do I have to worry if I just got back from Mexico?

A: The incubation period is two days to seven days, regardless of where you were exposed.

Q: How long should I stay home if I get the flu?

A: Certainly call your doctor about bad symptoms or if you're at all worried, especially if you have any chronic condition, such as asthma, that makes you more susceptible to any kind of flu. But other than going out for medical care, stay home for seven days or for one day after symptoms end. The CDC also says family members should consider staying home or decreasing their contact with others in case they're incubating the infections.

Q: Why are so many schools closing?

A: It's not clear just how much good school closings do in slowing flu's spread. It doesn't help much if kids then gather at the mall or a friend's house or day care. But because children spread all kinds of viruses easily — they don't wash as well, have close contact in crowded classes, and sometimes are contagious for a few days longer than adults — the CDC has advised schools with cases to consider closing for at least 14 days.

Q: Can pets get sick?

A: Besser says there's no evidence that this flu affects anyone other than humans.

Q: Can flu spread on imported fruits and vegetables from Mexico?

A: No. It doesn't spread through any food, including pork.

Q: Is it safe to fly? How about the subway?

A: Yes, the CDC says. Just don't travel if you're sick — stay home.

Q: Do I need a mask in crowded areas?

A: The CDC hasn't yet recommended that anyone other than health workers use masks.

Q: Why hasn't the U.S. closed the border with Mexico?

A: By the time authorities detected the new virus, it already had spread here. That makes closing the border moot, the Obama administration says.

Q: I have a summer trip planned to a state with lots of cases. Should I cancel?

A: Not yet, just stay tuned, Besser advises. Doctors should know much more about this flu by then.

Q: Why did the government quit using the name "swine flu" this past week?

A: Because of concern that people thought they might catch the virus from pigs or pork — which is wrong. It is spread person to person.

Q: How can I get more information?

A: On the Web, check http://www.cdc.gov/swineflu or call CDC's 24-hour hot line, in English or Spanish, at 1-800-CDC-INFO.

Don't Forget About Bird Flu

CANNES, France, 03 may 2009-- While the world waits to see whether the 2009 H1N1 (swine) influenza virus will cause a pandemic, researchers here said the threat of H5N1 avian flu should not be forgotten.

Avian flu has been at the top of everybody's "hit list" of viruses with pandemic potential for the past decade, Robert Webster, Ph.D., of St. Jude Children's Research Hospital in Memphis, said today at the conference on Influenza Vaccines for the World.

But that changed last week with the emergence of a virus containing fragments from swine, human, and avian viruses, he said.

"H1N1 has come in from left field . . . and stunned us all," he said.

David Fedson, M.D., formerly of the University of Virginia School of Medicine and Aventis Pasteur MSD, now retired, agreed with Dr. Webster.

"We've had no way to anticipate this," he said. "It just shows once again how, if there's anything consistent about influenza virology and influenza virus behavior, it's that you're always going to be surprised . . . and we've been surprised."

Nevertheless, even at number two, H5N1 remains a serious threat, according to John Oxford, Ph.D., scientific director of Retroscreen Virology and a professor of virology at St. Bartholomew's and the Royal London Hospital.

"Just because there's an immediate problem with the swine virus from Mexico, we shouldn't forget H5N1," he said.

Although H5N1 is not easily transmissible between birds and humans, a genetic reassortment could remove that barrier, Dr. Webster said.

The result could be catastrophic considering that, as of April 2009, 61% of the 421 human cases of avian influenza infection have died.

The high death rate is "what scares the bejesus out of us," he said.

Dr. Fedson said that H5N1 "could cause a global population collapse if it developed easy transmissibility and maintained the same virulence characteristics of this virus, which exists in Indonesia, southeast Asia, and other countries. I mean, that is just horrifying to think about."

The avian flu virus has been found in more than 60 countries and has established three epicenters -- in southern China, Indonesia, and Egypt, according to Dr. Webster.

It continues to evolve, as evidenced by the failure of 21 different poultry vaccines against the virus tried in Egypt.

"H5N1 is still alive and well," he said.

Dr. Oxford noted that nobody in the world has an immunity to H5N1, but that most people have been exposed to H1N1 viruses before, although not the newest variation.

Even so, he said that he's sure the previous exposure will at least partially impede the spread of the new virus.

And even though a forecast avian flu pandemic has not yet materialized, the attention the virus garnered when it first appeared could actually help dealing with the current situation.

The avian flu fears led to investment, the building of vaccine production facilities, and government stockpiles of antivirals and other supplies, Dr. Oxford said.

In turn, the current situation with H1N1 "could be a dress rehearsal for something very, very big," he said.

"The [H5N1 avian flu] is the virus most likely to cause a big pandemic, a world shattering affair," he said, "whereas I don't think this swine is going to do that."

Flu pandemic still likely but Mexico toll drops

MEXICO CITY,03 may 2009- Mexico's flu outbreak appeared to be stabilizing on Saturday but officials warned the unpredictable virus still threatened a global pandemic.

Mexican officials said hospitals were seeing fewer new cases of people with symptoms from the new swine flu virus and cut the estimated death toll from the outbreak.

"It would still be imprudent to say that we're past the worst of it but I do think ... we are in a stage of stabilization," Mexican Health Minister Jose Angel Cordova told reporters.

Costa Rica, Italy, and Ireland confirmed cases of the virus, which has now been found in 18 countries.

In Geneva, the World Health Organization said H1N1 influenza had not spread in a sustained way outside North America, as would be required before the pandemic alert level is raised to its highest level. But it said that would probably happen soon.

"I would still propose that a pandemic is imminent because we are seeing the disease spread," Michael Ryan, WHO director of Global Alert and Response, told a briefing.

Few are ready to take chances with the new virus, widely dubbed swine flu.

In Hong Kong, police quarantined a hotel after a Mexican guest fell ill with the virus, which may have killed more than 100 people in Mexico, the worst-hit country. Mexico called the action "unjustified" and advised its citizens to avoid travel to China.

Mexican authorities cut their suspected death toll to up to 101 from as many as 176 as more test samples came back negative. Fewer patients with severe flu symptoms were checking into hospitals, suggesting a falling infection rate, and no new deaths were reported in Mexico City in the past two days.

REMAIN VIGILANT

The World Health Organization said 15 countries had reported 615 infections, not including the later reports of confirmed cases in Ireland, Italy and Costa Rica.

The United States, the second hardest-hit country, said it had confirmed 160 cases in 21 states.

U.S. officials said they were encouraged by reports from Mexico that the outbreak may be leveling off, although they said it was too early to relax.

"We are remaining vigilant," said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention. "We have seen times where things appear to be getting better and then get worse again. ... I think in Mexico we may be holding our breath for some time."

Almost all infections outside Mexico have been mild. The only death in another country has been a Mexican toddler who was taken to the United States before he fell sick.

President Barack Obama said the United States was responding aggressively to the new flu strain and was closing some schools temporarily and distributing antiviral drug supplies as needed.

The White House said Obama spoke to Mexican President Felipe Calderon on Saturday about U.S.-Mexican cooperation on limiting the spread of the virus.

Scientists are still trying to assess how the new virus behaves and how it compares to regular seasonal flu strains, which kill between 250,000 and 500,000 globally every year.

The outbreak remains tiny compared with other epidemics such as malaria, hepatitis and meningitis. But the WHO hiked its pandemic alert level to 5 from 3 this week -- the last step before a pandemic -- due to its rapid spread and the possibility it could hit hard in poor and disease-prone communities, including among people with HIV.

Ryan said the WHO would send more than 2 million treatment courses of antiviral drugs to poor countries to help them prepare for the virus, which is already causing havoc with a travel industry that flies hundreds of thousands of people to and from Mexico each week.

China suspended flights to Mexico after Hong Kong authorities on Friday confirmed a Mexican man who flew via the Chinese mainland was infected with the flu strain. Hong Kong was hit hard by the 2003 SARS outbreak.

Police in surgical masks quarantined 200 guests and 100 staff inside a Hong Kong hotel where the Mexican, 25, had been staying, saying they would be confined for a week.

"They said everybody needed to go back to their rooms. I don't want to go to my room because I want to be out," an Australian man at the hotel told a TV reporter by telephone.

Public hospitals in Mexico have noted a steady drop in patients turning up with fevers, suggesting the infection rate may be declining as people don face masks and use hand gel.

Cordova said of 159 suspected flu deaths, tests showed 58 died of other causes. He said 16 deaths were confirmed as caused by the H1N1 flu and 85 were being tested.

In Mexico City, big parks, museums and zoos were shut and in the sprawling metropolis of 20 million people many were heeding a government call to stay home for a prolonged five day-holiday to try to stem new infections.

Jose Francisco Suarez, 15, said he wanted to get back to school. "We're sick of this situation. A few days off school wouldn't be so bad but now there's nothing to do," he said during a break playing basketball with two friends.

Lower Mexico flu death toll calms nervous world

MEXICO CITY , 03 may 2009- New laboratory data showed fewer people have died in Mexico than first thought from a deadly new influenza strain, a glint of good news for a world rattled by the threat of a flu pandemic.

Mexico cut its suspected death toll from the H1N1 flu to up to 101 from as many as 176, as dozens of test samples came back negative. Fewer patients with severe flu symptoms were also checking into hospitals, suggesting the infection rate of a flu that has spread to Europe and Asia was declining.

South Korea confirmed its first H1N1 case on Saturday, a 51-year-old woman who returned from Mexico in mid-April.

The U.S. Centers for Disease Control and Prevention agreed the outbreak may not be as severe as it looked a few days ago, citing many mild cases that were not immediately noticed.

For Mexicans -- who are spending a second weekend stuck indoors with stores and businesses shuttered across the country and the capital, Mexico City, devoid of its lively restaurants, bars, cinemas and museums -- the data is cheering.

Health Minister Jose Angel Cordova acknowledged the numbers were encouraging but cautioned it was too early to say Mexico had control of a flu that has infected people in 15 countries.

"For now it's unpredictable," Cordova said late on Friday, noting epidemics can peak again after an initial spurt in infections drops off.

"We need more days to see how it behaves and whether there is really a sustained decline so we can conclude that it's going down," he said.

The new virus is only the third infectious disease experts regard as having pandemic potential in the past 10 years.

It has world health experts racing to work on a vaccine and is wreaking havoc with a travel industry that flies hundreds of thousands of people to and from Mexico each week.

China suspended flights to Mexico after Hong Kong authorities on Friday confirmed a Mexican man who flew via the Chinese mainland was infected with the flu strain.

Police in surgical masks quarantined 200 guests and 100 staff inside a Hong Kong hotel where the 25-year-old Mexican had been staying, saying they would be confined for a week.

"They said everybody needed to go back to their rooms. I don't want to go to my room because I want to be out," an Australian man at the hotel told a TV reporter by telephone.

The measures taken by the authorities in Hong Kong underscore the concern there about the new flu. Hong Kong was badly hit by the SARS virus in 2003 and has had many episodes of H5N1 bird flu for more than a decade.

ANTIVIRAL DEMAND UP, PANAMA CATCHES RUNAWAY

Various European countries have confirmed cases of the virus.

The United States has been hit with 145 cases in 22 states, sending demand shooting up for antiviral medicine and prompting preventative measures such as a Boston University dropping handshakes for graduating students accepting diplomas.

In Panama, police detained an American who ran away from a hospital that was testing him for the swine flu.

Almost all infections outside Mexico have been mild, however, with only a handful needing hospital treatment. The only death in another country has been a Mexican toddler who was taken to the United States before he fell sick.

Mexico has released a confusing batch of flu data in recent days but public hospitals have noted a steady drop in patients turning up with fevers, suggesting the infection rate may be declining as the nation dons face masks and hand gel.

"There are very few deaths worldwide," said Marcelo Musi, a salesman shopping for vegetables in Mexico City, where residents weary of masks, hand sanitizer and frightening headlines clutched at signs of an end to the crisis.

"If there are no more cases, they say things will get better," said Musi.

President Felipe Calderon ordered non-essential businesses to close for five days from Friday, extending a three-day holiday weekend over Monday and Tuesday.

Analysts say the move will dent already negative economic growth this year as it pinches businesses, but inspectors will fine or forcibly close companies that defy the order.

Countless families were devastated at having their long weekend ruined. Young couples, children and the elderly were mainly stuck indoors as restaurants, bars, playgrounds and parks that hold outdoor "cumbia" dances all stayed closed.

Cordova said that out of 159 files on suspected flu deaths, tests showed 58 died of other causes. He said 16 deaths are confirmed as caused by the H1N1 flu and 85 are being tested.

AGS: Older Adults Benefit From Moderate Alcohol Intake

One to two drinks a day associated with lower incidence of dementia in 75 and older

02 may 2009 -- Moderate alcohol intake, limited to eight to 14 drinks a week, is associated with lower incidence of dementia among older adults, according to a study presented at the 2009 Annual Scientific Meeting of the American Geriatrics Society, held from April 29 to May 2 in Chicago.
Deanna A. Mangieri, D.O., of Wake Forest University in Winston-Salem, N.C., and colleagues conducted a study of 3,069 community-dwelling adults aged 75 years and over who were participants in the Gingko Evaluation of Memory Study. The subjects were tested and 2,587 classified as cognitively normal, while 482 had mild cognitive impairment and there were 523 incident cases of dementia.

The subjects self reported their level of weekly alcohol consumption with 42.6 percent reporting none, 38.2 percent reporting one to seven drinks, 9.4 percent consuming eight to 14 drinks, and 9.8 percent reporting more than 14 drinks a week. Moderate drinkers had 40 percent lower incidence of dementia among cognitively normal subjects but not among those with mild cognitive impairment, and among this group, heavy drinkers were more likely to progress to dementia, the researchers found.

"In mild cognitive impairment, alcohol does not appear beneficial and heavy use is associated with greater risk of progression to dementia," the authors write. "Recommendations not to exceed two drinks a day are supported by these data."

More Information

Is it the flu, or just a sore throat?

CIBOLO, Texas, 02 may 2009 - When Hayden Henshaw came down with a new and worrying kind of influenza last month, he thought he had strep throat.

Henshaw, 18, and a senior at Steele High School northeast of San Antonio, was among the first U.S. patients to catch a new strain of the H1N1 swine flu virus, which has spread to 13 countries.

Within days Henshaw's fever spiked to 102 degrees Fahrenheit (39 degrees Celsius), and he was confined to bed.

"I couldn't lift my head up to get out of bed to take a drink. I was really sick," said Henshaw, who along with his family have been under voluntary quarantine for a week. "I couldn't stop coughing."

Mexico, the worst-hit country, has reported as many as 176 deaths from the virus. Cases have been reported around the world, mostly among travelers from Mexico, but they have been mild and most people recovered so far with little or no treatment.

The only death outside Mexico was a Mexican toddler visiting Texas.

Henshaw has recovered and is feeling better. But he's still confined to his two-story stucco house, along with his family, who were advised by local health officials to remain in "voluntary quarantine."

A "do not disturb" sign hangs from the front door and the phone has been turned off in an attempt to ward off an onslaught of calls from journalists. Inside, surgical masks hang from the doors and cans of Lysol and hand sanitizers are in plentiful supply.

Henshaw said he has grown tired of television and video games, and fears to venture onto the Internet because his class-mates are blaming him and two other flu-infected classmates for interrupting their lives.

"I tell them, hey, I didn't ask for any of this," he said. "I just want to leave."

"It's been a constant turmoil," said Patrick Henshaw, Hayden's father. "It's like we've done something wrong or something."

Mexican flu outbreak may be mild: CDC

WASHINGTON , 02 may 2009 - The outbreak of a new and worrying kind of influenza in Mexico may not be as severe as it first looked, with many mild cases that were not immediately noticed, U.S. health experts reported on Friday.

Health workers are rushing to get a fuller picture of the outbreak of H1N1 swine flu, which the World Health Organization fears could tip into a pandemic.

Mexico, the worst-hit country, has reported 176 deaths from the new strain of the H1N1 virus. Cases have been reported around the world, mostly among travelers from Mexico, but they have been mild and most people recovered so far with little or no treatment.

The only death outside Mexico was a Mexican toddler visiting Texas.

Experts have been struggling to explain why so many deaths in Mexico and nowhere else, but the CDC report suggests there is a simple explanation -- there are many cases in Mexico, most are mild, and just the bad ones have been seen so far.

"The clinical spectrum of swine-origin influenza A (H1N1) virus illness is not yet well characterized in Mexico. However, evidence suggests that swine-origin influenza A (H1N1) virus transmission is widespread and that less severe (uncomplicated) illness is common," the CDC said in a special report.

"To date, case-finding in Mexico has focused on patients seeking care in hospitals, and the selection of cases for laboratory testing has focused on patients with more severe disease. Therefore, a large number of undetected cases of illness might exist in persons seeking care in primary-care settings or not seeking care at all."

But more information is needed, the CDC team stressed. The CDC has sent test kits to Mexico that will help get a better picture of who is sick. It is difficult to know without special tests because respiratory diseases are so common and many infection look like flu.

"Additional investigations are needed urgently to evaluate the full clinical spectrum of disease in Mexico, the proportion of patients who have severe illness, and the extent of disease transmission," the CDC said.

Even garden-variety flu can be deadly, with seasonal influenza killing an estimated 250,000 to 500,000 people globally every year.

Dense breasts found in many older women, too

NEW YORK, 02 may 2009- In general, a woman's breasts get less dense as she ages. However, a new study shows that there remain a substantial proportion of older women with very dense breasts -- a finding that could have important implications for breast cancer screening.

Dense breast tissue can cloud tumors on mammography. "Our data," Dr. Freya Schnabel from NYU Cancer Center in New York, told Reuters Health, "would suggest that mammographic density, in conjunction with age and overall breast cancer risk assessment, should be considered when assessing the potential benefit of other imaging studies in addition to yearly mammography."

Prior research has linked having dense breasts to a 4- to 6-fold increased risk of developing breast cancer, compared to women with less dense breasts. Moreover, dense breasts may impair the sensitivity of screening mammography, as mentioned. Younger age is a well-known correlate of dense breasts, whereas the percentage of older women with dense breasts is unknown.

To investigate, Schnabel's team analyzed data from 500 consecutive patients who had annual screening mammography and were entered in the NYU institutional radiology database.

Overall, 4 percent of women were younger than 40 years of age, 27 percent were 40 to 49 years, 30 percent were 50 to 59 years, 24 percent were 60 to 69 years, 9 percent were 70 to 79 years, and 6 percent were 80 years and older.

As expected, breast density was highest in younger women. Among women in their 40s, for instance, 74 percent had dense breasts.

Nonetheless, dense breasts were still common among older women. Dense breasts were seen in 54 percent, 42 percent, and 31 percent of women in their 50s, 60s, and 70s, respectively.

The findings were presented at the 10th annual meeting of the American Society of Breast Surgeons in San Diego, California.

Experts identify genes linked to chronic diseases

HONG KONG, 02 may 2009 - Researchers in South Korea have identified genes that are linked to key indicators such as blood pressure and bone density that have a bearing on chronic diseases such as hypertension and osteoporosis.

In an article published in Nature Genetics, the scientists said they studied the DNA of nearly 9,000 people in South Korea and were able to identify genes that controlled indicators such as blood pressure, bone density, body mass index, waist-to-hip ratio, height and pulse rate.

"We found some genes affecting systolic blood pressure, bone density etc," Hyung-Lae Kim of the National Institute of Health in Seoul, South Korea, told Reuters by telephone.

These bodily measurements affect key chronic diseases including diabetes, hypertension, obesity and osteoporosis that are becoming massive problems in many countries.

And knowing which genes are involved can potentially open the way for better prevention, management and control of these conditions in the future.

Such genetic studies have been carried out in Caucasian populations, but less so among Asians.

"The study also found new gene variants that either confer health risks specific to Asian ancestry or which show greater effects in combination with environmental factors prevalent in Asia," the researchers said in a statement.

Survey finds nearly half of Americans concerned they or their family may get sick from swine flu

Boston, MA, 01 may 2009—Following the declaration of a public health emergency due to the new H1N1 virus, also known as swine flu, the Harvard Opinion Research Program at the Harvard School of Public Health conducted a poll about how concerned Americans are about the outbreak, how they are responding and what they believe about transmission, prevention and treatment.

Concerns about the outbreak

The survey finds that nearly half of Americans are concerned (46%) that they or someone in their immediate family may get sick from swine flu during the next 12 months.

Americans' response to the outbreak

More than half of Americans are responding to the outbreak by washing their hands or using hand sanitizer more frequently (59%), and a quarter are avoiding places where many people are gathered, like sporting events, malls or public transportation (25%). Some Americans have also responded in other ways: avoiding people who they thought may have recently traveled to Mexico (20%), avoiding Mexican restaurants or stores (17%), wearing a face mask (8%), buying a face mask (5%), talking with their doctor about health issues related to swine flu (5%), or getting a prescription for antiviral medications (1%). Only a small number (4%) of parents have kept their children home from school or daycare.

"It is a good sign that most people, though not all, are taking the most important precaution recommended by the Centers for Disease Control and Prevention to prevent the spread of swine flu: washing their hands," said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

Beliefs about swine flu

An overwhelming majority of Americans believe that they can get the current swine flu from being in close contact with someone who has it (83%), and few believe that they can get the disease from eating pork (13%). Some Americans also believe that they can get the swine flu from being near, but not in close contact with, someone with swine flu (29%), or from being in contact with pigs (34%).

Americans are less certain about prevention and medicine for swine flu. Just over half believe that there is an effective medicine to treat the disease (54%). Most Americans (65%) don't believe that there is a vaccine to prevent the disease. About half of Americans (53%) believe that wearing a face mask could prevent them from getting sick from the swine flu, while more than three-quarters (78 percent) believe that wearing a face mask when sick would help keep them from getting others sick.

"In the days ahead it's important that public health officials explain more clearly what can be done to effectively treat those who are ill, so the public can better understand the choices that are available if they or a family member become sick," said Blendon.

Awareness of "H1N1" versus "swine flu"

The term "swine flu" has been widely used in the media to describe the current outbreak; however, recently some public health officials have used the term "H1N1 virus." The survey found that the majority of Americans (55%) have not heard of the term "H1N1" virus. Only one in five (20%) think it means the same thing as swine flu.

Methodology

This is the 29th in a series of studies on the public and biological security by the Harvard Opinion Research Program (HORP) at Harvard School of Public Health. The study was designed and analyzed by researchers at the Harvard School of Public Health (HSPH). The project director is Robert J. Blendon of the Harvard School of Public Health. The research team also includes John M. Benson, Gillian K. SteelFisher, and Kathleen J. Weldon of the Harvard School of Public Health, and Melissa J. Herrmann of SSRS/ICR. Fieldwork was conducted via telephone (including both landline and cell phone) for HORP by SSRS/ICR of Media (PA) on April 29, 2009.

The survey was conducted with a representative national sample of 1,067 adults age 18 and over, including oversamples of non-Hispanic African Americans and Hispanics. Altogether 130 non-Hispanic African Americans and 107 Hispanics were interviewed. In the overall results, these groups were weighted to their actual proportion of the total adult population.

The margin of error for the total sample is plus or minus 3.6 percentage points. Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases, sample data are weighted to the most recent Census data available from the Current Population Survey for gender, age, race, education, region, and number of adults in the household. Other techniques, including random-digit dialing and systematic respondent selection within households, are used to ensure that the sample is representative.

Funding

This Harvard School of Public Health series is funded under a cooperative agreement with the Centers for Disease Control and Prevention. The award enables HORP to provide technical assistance to the Centers for Disease Control and Prevention (CDC) as well as to other national and state government health officials in order to support two critical goals: 1) to better understand the general public's response to public health emergencies, including biological threats and natural disasters; and 2) to improve related public health communications.

About 1 in 5 Americans say they are disabled

CHICAGO, 01 may 2009- About 1 in 5 Americans have a disability and that will increase as baby boomers age, U.S. health officials said on Thursday.

The number of Americans with a disability rose 7.7 percent, or by 3.4 million people, to nearly 48 million between 1999 and 2005, the U.S. Centers for Disease Control and Prevention said.

"The number of adults reporting a disability likely will increase, along with the need for appropriate medical and public health services, as more persons enter the highest risk age group," Dr. Chad Helmick, of the U.S. Centers for Disease Control and Prevention, wrote in the CDC's weekly report on death and disease.

Helmick said meeting the expected increased demand of these people will require more and better interventions aimed at preventing disability.

Arthritis was the leading cause of disability, affecting 8.6 million people. Another 7.6 million Americans said back or spine problems were the main cause of their disability and 3 million people reported heart trouble.

Women were slightly more likely to be disabled than men at any age. The CDC also found that the number of people reporting a disability doubled for each successive age group, with about 11 percent of people ages 18-44 reporting a disability, 23.9 percent for ages 45-64, and 51.8 percent for ages 65 or older.

Dr. John H. Klippel, president and CEO of the Arthritis Foundation, said in a statement 46 million Americans have some form of arthritis.

"With the aging of baby boomers, the prevalence of arthritis is expected to rise by 40 percent - that is up to 67 million people -- by the year 2030," he said.

"These findings suggest a critical need to expand the reach of effective strategies aimed at disability prevention and management," Klippel said.

New flu virus may be a real mongrel: study

WASHINGTON , 01 may 2009 - The new virus that has killed as many as 177 people and spread globally is a mongrel that appears to have mixed with another hybrid virus containing swine, bird and human bits, U.S. researchers reported on Thursday.

Raul Rabadan and colleagues at Columbia University in New York analyzed the published genetic sequences from the H1N1 virus that has brought the world to the brink of a pandemic.

"The closest relatives to the virus we have found are swine viruses," Rabadan said in a telephone interview.

"Six segments of the virus are related to swine viruses from North America and the other two from swine viruses isolated in Europe/Asia," they wrote in the online journal Eurosurveillance.

The U.S. Centers for Disease Control and Prevention said last week after discovering this virus in two U.S. children that it had four virus types -- two swine, an avian and a human component.

It may be even more complex than that.

Influenza viruses mutate constantly and they also swap genetic material with one another promiscuously, especially if an animal or person is infected with two strains at once.

Rabadan's team said this particular strain looked partly like another hybrid, or what scientists call a reassortant, virus.

"The North American ancestors are related to the multiple reassortants, H1N2 and H3N2 swine viruses isolated in North America since 1998," they wrote.

"In particular, the swine H3N2 isolates from 1998 were a triple reassortment of human, swine and avian origin."

Scientists can study those genetics to try to track the origin of the new virus. Mexican officials have denied it came from pigs in Mexico and pork producers have been battling rumors it could have come from pig farms there.

Rabadan said the findings did not show the virus came directly from pigs. "We don't know how long this virus has been in humans," he said.

Many different influenza strains are circulating at any given time and pandemic strains -- the ones that cause global outbreaks from a whole new strain -- are believed to have come from animals.

"We know that with the two pandemics in 1957 and 1968 they were coming from a mixture of human and avian viruses," Rabadan said. The H1N1 strain that caused the far more serious 1918 pandemic appears to have been virtually a pure avian strain, according to published analyses.

Consider Heart and Bones With Androgen-Deprivation Therapy

Prostate cancer therapy carries risk for heart, bone side effects, as well as diabetes

01 may 2009-- Androgen-deprivation therapy for men with prostate cancer carries significant risk for cardiovascular and bone-related side effects, as well as for diabetes, according to a review of the medical literature published online April 27 in the journal Cancer.

Lockwood G. Taylor, of the University of Texas Health Science Center in Houston, and colleagues reviewed the medical literature on adverse events related to androgen-deprivation therapy in prostate cancer. In all, 683 articles were screened for data on cardiovascular and bone-related outcomes, with 14 articles meeting the inclusion criteria. In some cases, researchers pooled relevant data and calculated risk estimates.

Men receiving androgen-deprivation therapy for prostate cancer had a 23 percent increase in risk of fracture (relative risk, 1.23) and a 17 percent increase in cardiovascular-related mortality (hazard ratio, 1.17) compared to prostate cancer patients who did not receive androgen-deprivation therapy, the investigators discovered. In two large studies, increased risk of diabetes between 36 and 49 percent also was observed.

"Androgen-deprivation therapy was associated with an increased risk of skeletal fracture, incident diabetes, and cardiovascular-related mortality, although the absolute risk of these events was low. Preventive measures against these adverse effects and careful assessment of patient's baseline health status should be considered," the authors conclude.

Abstract
Full Text (subscription or payment may be required)

Drug-Like Compounds Break Down Alzheimer's Protein

Amyloid β-protein abnormally accumulates in the brain in patients with Alzheimer's disease

01 may 2009-- Two small molecules can promote the breakdown of amyloid β-protein, which accumulates in the brain in patients with Alzheimer's disease and is implicated in disease pathogenesis, according to a report published online April 22 in PLoS ONE.

Christelle Cabrol, from the Mayo Clinic in Jacksonville, Fla., and colleagues performed high-throughput screening in the presence and absence of adenosine triphosphate (ATP) using a library of about 32,000 compounds to identify small molecules that would activate insulin-degrading enzyme (IDE), an enzyme that breaks down the amyloid β-protein.

The researchers identified two compounds, Ia1 and Ia2, that significantly stimulated the proteolytic activity of IDE. Both compounds bound in the ATP-binding site of the enzyme. Ia1 activated the degradation of amyloid β-protein by about 700 percent, while Ia2 activated degradation by about 400 percent, according to the study.

"This study describes the first examples of synthetic small-molecule activators of IDE, showing that pharmacological activation of this important protease with drug-like compounds is achievable," Cabrol and colleagues conclude.

Full Text

AUA: Nighttime Urination Linked to Death in Elderly

Elderly with nocturia have a higher risk of death

01 may 2009 -- Elderly individuals who need to urinate at least twice per night have a higher risk of death, according to a study presented at the annual meeting of the American Urological Association held April 25 to 30 in Chicago.

Haruo Nakagawa from Tohoku University Hospital in Sendai, Japan, and colleagues surveyed 788 elderly (70 years and older) community-dwelling individuals in Japan about nocturia and investigated its association with mortality over three years using data from the national health insurance system.

The researchers found that after adjusting for possible confounding factors, individuals with nocturia (two voids/night or greater) had a significantly higher risk of mortality (hazard ratio 2.68).

"We conclude that there is a significantly increased mortality rate associated with nocturia [two voids/night or greater], even after adjustment for several factors which may contribute to mortality," Nakagawa and colleagues conclude.

Abstracts (log in required)