Mortality from CVD in Brazil has increased 3.5 times more than in other developing countries

Despite Brazil's successful prevention campaigns which have contributed to a reduction in risk factors such as smoking, cardiovascular disease (CVD) remains the first cause of death in the country, at 32%. Tobacco consumption and decrease of salt in local diets are some of the risk factors that will be discussed at the 67th Annual Congress of the Brazilian Society of Cardiology (1) which takes place in Recife, Brazil from 14 to 17 September 2012. This meeting is the largest cardiology conference in Latin America. The Brazilian Society of Cardiology is an affiliated society of the European Society of Cardiology since 2009 and has around 13,000 members.

15 sept 2012--Brazil's fast development has brought many positive changes to people's lives, but the move from a rural to an urban society has introduced changes in eating and exercise patterns resulting in growing obesity, diabetes and dyslipidaemia in the 185 million population.Cardiovascular mortality in Brazil has increased 3.5 times more than in other developing countries (2) making prevention of CVD an urgent issue. The recently updated European Guidelines on CVD Prevention (3), will be part of the one-day educational session (4) presented in Recife by senior faculty of the ESC together with representatives of the host society. These Guidelines have been reformatted to help disseminate the information from to where it is needed: health professionals working in the field, politicians and the general public.

"Most of CVD related deaths could be prevented through the widespread adoption of simple interventions such as smoking cessation, improved diets and increased exercise. Evidence that CVD is caused by modifiable risk factors, comes from clinical trials and observational community studies," says Professor Panos Vardas, President of the ESC who is leading the European delegation to Brazil. "We will be promoting these and other ESC Guidelines in Brazil. Our agenda (4) also includes highlights from ESC Congress 2012 with the latest information in diagnosing and treating cardiovascular disease as well as "Meet the expert" sessions where ESC faculty will explain recent Clinical Trials that will impact practice."

In recent years, the Brazilian Society of Cardiology has also sought greater international collaboration. Jadelson Pinheiro de Andrade, President of the Brazilian Society of Cardiology said "We think this will be our most international congress ever. We are happy to welcome the ESC sessions once again. Exchanges with our European colleagues are stimulating and we are hoping to collaborate on projects concerning registries and surveys in the future."

The ESC's GSA Committee was established to meet demand for ESC science and knowledge outside of Europe, to build closer ties with international cardiology organisations, and to extend the ESC mission beyond its traditional borders.

"International collaboration is a key objective of the ESC. There are worrying and significant disparities in the way CVD is diagnosed and treated, both in developed and developing countries. We will only be able to fulfill our mission of reducing the burden of CVD by joining forces across frontiers, exchanging experiences and promoting education and research in the cardiovascular field.," concluded Prof Vardas.

More information:

References

(1) congresso.cardiol.… gramacao.asp

(2) eurheartj.oxfordjo… 13/1541.full and www.who.int/chp/ch… a/brazil.pdf

(3) www.escardio.org/g… x?hit=TLinks

(4) www.escardio.org/c… welcome.aspx

Antidepressants, sleeping pills and anxiety drugs may increase driving risk

Drugs prescribed to treat anxiety, depression and insomnia may increase patients' risk of being involved in motor vehicle accidents, according to a recent study, published in the British Journal of Clinical Pharmacology. Based on the findings, the researchers suggested doctors should consider advising patients not to drive while taking these drugs.

14 sept 2012--Psychotropic drugs affect the way the brain functions and can impair a driver's ability to control their vehicle. Research on the links between psychotropic medication and driving accidents has focused on benzodiazepines, which have been used to treat anxiety and insomnia. Perhaps the best known of these drugs is diazepam. Newer Z-drugs, used to treat insomnia, have received less attention, as have antidepressants and antipsychotics.

To understand the effects of a wider spectrum of psychotropic drugs on driving accidents, the authors compared drug use in two groups of people identified using medical records from the Taiwanese national health insurance programme. The first group included 5,183 people involved in motor vehicle accidents. The second group included 31,093 people, matched for age, gender and the year of vehicle accidents, who had no record of being involved in motor vehicle accidents. In general, those involved in accidents were more likely to have been taking psychotropic drugs, whether they had been taking them for one month, one week or one day.

The results suggest that the increased risk associated with benzodiazepines is mirrored in both Z-drugs and antidepressants. However, antipsychotics were not associated with an increased risk of motor vehicle accidents, even among those taking higher doses.

"Our findings underscore that people taking these psychotropic drugs should pay increased attention to their driving performance in order to prevent motor vehicle accidents," said lead researcher, Hui-Ju Tsai, who is based at the National Health Research Institutes in Zhunan, Taiwan. "Doctors and pharmacists should choose safer treatments, provide their patients with accurate information and consider advising them not to drive while taking certain psychotropic medications."

The research strengthens the findings of previous reports that have assessed the risk associated with individual psychotropic drugs. It also provides more evidence on the link between dose and driving performance, showing that higher doses are associated with a higher risk of an accident. "Our data demonstrated significant dose effects for antidepressants, benzodiazepine and Z-drugs," said Tsai. "This suggests that taking a higher dosage poses a greater danger to those intending to drive."

The authors recommend that patients do not stop taking their medication, but if concerned should consult their doctor.

More information: Chia-Ming Chang, Erin Chia-Hsuan Wu, Chuan-Yu Chen, Kuan-Yi Wu, Hsin-Yi Liang, Yeuk-Lun Chau, Chi-Shin Wu, Keh-Ming Lin, Hui-Ju Tsai; Psychotropic Drugs and Risk of Motor Vehicle Accidents: a Population-based Case-Control Study; British Journal of Clinical Pharmacology; DOI: 10.1111/j.1365-2125.2012.04410.x

Provided by Wiley

Executive function tests key to early detection of Alzheimer's

By the time older adults are diagnosed with Alzheimer's disease, the brain damage is irreparable. For now, modern medicine is able to slow the progression of the disease but is incapable of reversing it. What if there was a way to detect if someone is on the path to Alzheimer's before substantial and non-reversible brain damage sets in?

13 sept 2012--This was the question Erin K. Johns, a doctoral student in Concordia University's Department of Psychology and member of the Center for Research in Human Development (CRDH), asked when she started her research on older adults with mild cognitive impairment (MCI). These adults show slight impairments in memory, as well as in "executive functions" like attention, planning, and problem solving. While the impairments are mild, adults with MCI have a high risk of developing Alzheimer's disease.

"We wanted to help provide more reliable tools to identify people who are at increased risk for developing Alzheimer's so that they can be targeted for preventive strategies that would stop brain damage from progressing," says Johns.

The new study was published in the Journal of the International Neuropsychological Society and was funded by the Quebec Network for Research on Aging and the Canadian Institutes of Health Research. In it, Johns and her colleagues found that people with MCI are impaired in several aspects of executive functioning, the biggest being inhibitory control.

This ability is crucial for self-control: everything from resisting buying a candy bar at the checkout aisle to resisting the urge to mention the obvious weight gain in a relative you haven't seen in a while. Adults with MCI also had trouble with tests that measure the ability to plan and organize.

Johns and her colleagues found that all the adults with MCI they tested were impaired in at least one executive function and almost half performed poorly in all the executive function tests. This is in sharp contrast with standard screening tests and clinical interviews, which detected impairments in only 15 percent of those with MCI.

"The problem is that patients and their families have difficulty reporting executive functioning problems to their physician, because they may not have a good understanding of what these problems look like in their everyday life." says Johns. "That's why neuropsychological testing is important."

Executive function deficits affect a person's everyday life and their ability to plan and organize their activities. Even something as easy as running errands and figuring out whether to go to the drycleaners or to the supermarket can be difficult for adults with MCI. Detecting these problems early could improve patient care and treatment planning.

"If we miss the deficits, we miss out on an opportunity to intervene with the patient and the family to help them know what to expect and how to cope," says Johns. She is now conducting a follow-up study funded by the Alzheimer Society of Canada and Canadian Institutes of Health Research, along with her supervisor, Natalie Phillips, associate professor in the Department of Psychology and member of CRDH.

Johns hopes her continued research will lead to a better understanding of why these deficits start at such an early stage of Alzheimer's and what other tools could be used for earlier detection of the disease.

Rewarding research: In recognition of the excellence of this research, Johns was awarded the Canadian Institutes of Health Research Institute of Aging Age+ Prize.

Provided by Concordia University

Omega-3 fatty acid supplementation not associated with lower risk of major CVD events

In a study that included nearly 70,000 patients, supplementation with omega-3 polyunsaturated fatty acids was not associated with a lower risk of all-cause death, cardiac death, sudden death, heart attack, or stroke, according to an analysis of previous studies published in the September 12 issue of JAMA.

12 sept 2012--"Treatment with marine-derived omega-3 polyunsaturated fatty acids (PUFAs) for the prevention of major cardiovascular adverse outcomes has been supported by a number of randomized clinical trials (RCTs) and refuted by others. Although their mechanism of action is not clear, their postulated effect on cardiovascular outcomes may be due to their ability to lower triglyceride levels, prevent serious arrhythmias, or even decrease platelet aggregation and lower blood pressure. Current guidelines issued by major societies recommend their use, either as supplements or through dietary counseling, for patients after myocardial infarction [MI; heart attack], whereas the U.S. Food and Drug Administration has approved their administration only as triglyceride-lowering agents in patients with overt hypertriglyceridemia, and some (but not all) European national regulatory agencies have approved the omega-3 administration for cardiovascular risk modification. The controversy stemming from the varying labeling indications causes confusion in everyday clinical practice about whether to use these agents for cardiovascular protection," according to background information in the article.

Evangelos C. Rizos, M.D., Ph.D., of the University Hospital of Ioannina, Ioannina, Greece, and colleagues performed a large-scale synthesis of the available randomized evidence by conducting a systematic review and meta-analysis to determine the association between omega-3 PUFAs and major cardiovascular outcomes.

Of the 3,635 citations retrieved, 20 studies with 68,680 randomized patients were included, reporting 7,044 deaths, 3,993 cardiac deaths, 1,150 sudden deaths, 1,837 heart attacks, and 1,490 strokes. Analysis indicated no statistically significant association with all-cause mortality,cardiac death, sudden death, heart attack, and stroke when all supplement studies were considered.

"In conclusion, omega-3 PUFAs are not statistically significantly associated with major cardiovascular outcomes across various patient populations. Our findings do not justify the use of omega-3 as a structured intervention in everyday clinical practice or guidelines supporting dietary omega-3 PUFA administration. Randomized evidence will continue to accumulate in the field, yet an individual patient data meta-analysis would be more appropriate to refine possible associations related to, among others, dose, adherence, baseline intake, and cardiovascular disease risk group," the authors conclude.

More information: JAMA. 2012;308[10]:1024-1033.

Provided by JAMA and Archives Journals

One million people commit suicide each year: WHO

One million people die by their own hand each year, accounting for more deaths than wars and murders put together, the World Health Organisation said Friday, calling for urgent action to address the problem.

11 sept 2012--"Data from the WHO indicate that approximately one million people worldwide die by suicide each year. This corresponds to one death by suicide every 40 seconds," the organisation said in a report launched ahead of the World Suicide Prevention Day on Monday.

And while the number of deaths by suicide is staggering, the number of attempts each year is 20 times higher, the WHO said, pointing out that five percent of people in the world try to kill themselves at least once during their lifetime.

And the problem is getting worse, the organisation said, insisting that "given the magnitude of the public health problem of suicidal behaviours", urgent action was needed.

"As suicide is largely preventable, it is imperative that governments, through their health, social and other relevant sectors, invest human and financial resources in suicide prevention," the report said.

According to Dr. Shekhar Saxena, who headed the team behind the report, suicide rates have risen sharply in some parts of the world in recent years, with some countries seeing their rates jump by as much as 60 percent.

"Although suicide continues to remain a serious problem in high income countries, it is the low and middle income countries that bear the larger part of the global suicide burden," the report said, adding: "It is also these countries that are relatively less equipped to prevent suicide".

The highest documented suicide rates can be found in Eastern European countries like Lithuania and Russia, while they are lowest in Latin America, WHO said.

The United States, Western European countries and Asia fell in the middle of the range, the report showed, but stressed that statistics are not available for many countries in Africa and South-East Asia.

Globally, suicide is meanwhile the second cause of death worldwide among 15-19 year-olds, with at least 100,000 adolescents killing themselves each year, according to the study.

Among adults, the suicide rate is highest among those aged 75 and older, the WHO said, pointing out that "elderly people are likely to have higher suicide intent and use more lethal methods than younger people, and they are less likely to survive the physical consequences of an attempt".

The report also showed that men were three times more likely to commit suicide, but that three times as many women as men attempted to kill themselves.

"The disparity in suicide rates has been partly explained by the use of more lethal means and the experience of more aggression and higher intent to die, when suicidal, in men than women," it explained.

Even the very elderly and frail can benefit from exercise

A study carried out by Dr. Louis Bherer, PhD (Psychology), Laboratory Director and Researcher at the Institut universitaire de gériatrie de Montréal (IUGM), an institution affiliated with Université de Montréal, has shown that all seniors, even those considered frail, can enjoy the benefits of exercise in terms of their physical and cognitive faculties and quality of life and that these benefits appear after only three months.

10 sept  2012--his discovery is excellent news, as increased life expectancy has also increased the number of frail seniors in our communities. In geriatrics, frailness is characterized by decreased functional reserves in an individual, which increases vulnerability to stressors and the risk ofadverse health effects. Frailty is associated with a higher risk of falls, hospitalizations, cognitive decline and psychological distress. Currently, 7% of seniors aged 65 to 74, 18% of those aged 75 to 84, and 37% of seniors over the age of 85 are considered frail.

"For the first time, frail senior citizens have participated in a study on exercise thanks to the collaboration of medical doctors at IUGM, who provided close medical supervision. My team was able to demonstrate that sedentary and frail senior citizens can benefit from major improvements not only in terms of physical function but also brain function, such as memory, and quality of life," stated Dr. Bherer.

"We hope to adapt the exercise program used in the study and make it available to the public through the seniors' health promotion centre that the IUGM is developing. We believe that by transferring our research findings to the public, we will help both healthy and frail senior citizens stay at home longer," concluded the researcher.

Research summary

In this study, 43 of the 83 participants between the ages of 61 and 89 years, some of whom were considered frail, took part in group exercises (3 times a week for 12 weeks), while the control group of 40 participants did not follow the exercise program. All participants were evaluated one week before the start of the program and at the end of the program for physical capacity, quality of life and cognitive health. Compared to the control group, trained participants showed larger improvement in physical capacity (functional capacities and physical endurance), cognitive performance (executive functions, processing speed and working memory) and quality of life (overall quality of life, recreational activities, social and family relationships and physical health). Most importantly, benefits were equivalent among frail and non-frail participants suggesting that there is't never too late to engage in exercise intervention programs . These findings were published online on the Web site of the Journals of Gerontology. This research received financial support from the IUGM's Comité aviseur de la recherche clinique (CAREC) along with the Canadian Institutes of Health Research (CIHR).

Provided by University of Montreal

Non-alcoholic red wine may help reduce high blood pressure

Men with high risk for heart disease had lower blood pressure after drinking non-alcoholic red wine every day for four weeks, according to a new study in the American Heart Association journal Circulation Research.

09 sept 2012--Non-alcoholic red wine increased participants' levels of nitric oxide, which helped decrease both systolic and diastolic blood pressure, researchers said. Nitric oxide is a molecule in the body that helps blood vessels relax and allows more blood to reach your heart and organs.

Researchers studied 67 men with diabetes or three or more cardiovascular risk factors who ate a common diet plus one of the following drinks: about 10 ounces of red wine, non-alcoholic red wine or about 3 ounces of gin. All of the men tried each diet/beverage combination for 4 weeks.

The red wine and nonalcoholic wine contained equal amounts of polyphenols, an antioxidant that decreases blood pressure.

During the red wine phase, the men had very little reduction in blood pressure and there was no change while drinking gin. However, after drinking non-alcoholic red wine, blood pressure decreased by about 6mmHg in systolic and 2mmHg in diastolic blood pressure—possibly reducing the risk of heart disease by 14 percent and stroke by as much as 20 percent.

Researchers concluded that the alcohol in red wine weakens its ability to lower blood pressure. But polyphenols—still present after alcohol is removed from wine—are likely the beneficial element in wine.

Provided by American Heart Association

In body-conscious Brazil, half are now overweight

One of the world's most body-conscious countries, Brazil is now threatened by growing obesity rates, with half of the population already overweight.

08 sept 2012--As a result of an unbalanced diet and a rise in more sedentary lifestyles, Brazil, which moved 30 million people out of poverty and into the middle class over the past decade, is paying a heavy price for its frenetic growth.

Official statistics corroborate the alarming rise in the number of overweight or obese people in the world's sixth largest economy.

Nearly half of the country's 194 million people are overweight and 16 percent obese, according to a health ministry report released in April.

The percentage of overweight people jumped from 42.7% in 2006 to 48.5% in 2011, while the obesity rate increased from 11.4% to 15.8% in the same period.

The most overweight section of the population are men aged 35-45, of whom almost two thirds are fat, and women aged 45-54.

"It is high time to reverse the trend so as to avoid becoming like the United States, where nearly 35.7 percent of the adult population is obese," Health Minister Alexandre Padilha warned.

"Brazilians have a poor diet. They could eat green vegetables but they prefer beans and fat," said Solange de Goncalves, a 38-year-old from Rio who weighs 123 kilos (271 pounds) and is among Brazil's 30 million obese citizens.

Overweight since her childhood, she also suffers from high blood pressure and diabetes and concedes that her life is not easy.

"People look at you in the street. You cannot find clothes matching your size. Once I even got stuck in a bus turnstile," she told AFP, her voice cracking with emotion.

Goncalves is envious of the celebrities who make headlines or star in telenovelas, like Suede Junior, a male model sporting a "Made in Brazil" tattoo on his chest.

"To go to the gym, take good care of one's body is something common in Rio," he told AFP on Ipanema beach.

After a 12-year wait, Goncalves had a gastric ring inserted in July, a procedure covered by her public health insurance.

"I am happy. I already lost 15 of the 50 kilograms I want to lose," she said.

With the operation, which reduces the size of the stomach, a patient can lose 80 percent of his excess weight but must be monitored by a surgeon, an endocrinologist, a psychologist and a nutritionist for the rest of his life.

"The key to a successful treatment is dieting. The surgery is meant to help the patient, but if he drops the diet, he will regain weight," explained Octavio Falcao, a specialist who carries out the surgery.

The number of Brazilians undergoing the ring procedure soared 275 percent between 2003 and 2010 to 60,000 a year.

After enduring 10 years of obesity, Jederson Edealdo das Dores finally decided to undergo the 45-minute operation by coelioscopy, the most common procedure used by private doctors.

"I used to be thin. I want to be normal again," said Dores.

Vitamin D supplement fails to lower cholesterol in short term

Taking vitamin D supplements to compensate for vitamin D deficiency didn't improve cholesterol—at least in the short term, according to new research in Arteriosclerosis, Thrombosis and Vascular Biology, an American Heart Association journal.

07 sept 2012--Researchers studied 151 people with vitamin D deficiency who received either a mega-dose (50,000 internationals units) of vitamin D3 or placebo weekly for eight weeks. Participants' cholesterol levels were measured before and after treatment.

Correcting vitamin D deficiencies with high doses of oral vitamin D supplements did not change cholesterol levels, researchers found. This was despite effectively increasing vitamin D to recommended levels. Vitamin D levels nearly tripled in the group that received actual supplements, but were unchanged in the placebo group.

"Our study challenges the notion that vitamin D repletion improves cholesterol levels" said Manish Ponda, M.D., M.S., study lead author and assistant professor of clinical investigation in Dr. Jan Breslow's laboratory of biochemical genetics and metabolism at The Rockefeller University in New York, N.Y. "These clinical trial results confirm those from a recent data mining study."

The researchers also tested the effect of vitamin D supplementation on more sophisticated biomarker measures of cholesterol, such as particle size and number. "These measures of cholesterol, which are not used in routine clinical practice, also did not change in response to vitamin D therapy," Ponda said.

As expected, replenishing subjects with high-dose supplements of oral vitamin D decreased parathyroid hormone levels and increased calcium levels—physical functional changes that were linked to participants' increase in low-density lipoprotein (LDL, bad cholesterol).

"For example, participants receiving vitamin D who had an increase in calcium levels experienced a 7 percent increase in LDL cholesterol, while those whose calcium levels fell or did not change had a 5 percent decrease in LDL cholesterol," Ponda said.

The study questions the use of vitamin D supplements to improve cholesterol, Ponda said. While the dose of vitamin D in this study was high, it was appropriate for correcting a vitamin D deficiency over an eight week period.

However, longer-term studies on the impact of the changes in LDL cholesterol as a result of high dose vitamin D supplementation are needed to make stronger recommendations. And questions remain about whether increasing vitamin D levels with exposure to sunlight, the predominant natural source, would have a different effect than with high-dose oral supplements.

To address these issues, Ponda and Breslow will begin another clinical trial this fall, comparing the effect of oral vitamin D to ultraviolet light exposure with a longer follow-up period.

Provided by American Heart Association

Ginkgo biloba extract does not prevent Alzheimer's dementia

Ginkgo biloba extract does not significantly reduce the likelihood of diagnosis of Alzheimer's disease in older people, according to the results of the largest ever Alzheimer's prevention study in Europe, published in Lancet Neurology.

06 sept 2012--The study examined whether a twice-daily dose of 120 mg standardised ginkgo biloba extract – derived from the leaves of the Ginkgo biloba tree – affected the number of participants who were diagnosed with Alzheimer's disease, compared with those who took a placebo. The randomised, double-blind trial took place over five years, involving 2854 people in France who were 70 years old or over, and who had presented to their primary care physician with memory complaints.

1406 patients were given the ginkgo biloba extract, and 1414 given a placebo, designed to have a similar taste and appearance to the ginkgo biloba pills. Over five years, researchers used standard tests to assess the patients' memory, cognitive function and dementia status.

After five years, 61 (4%) participants in the ginkgo biloba group had been diagnosed with probable Alzheimer's disease, compared with 73 (5%) participants in the placebo group. The difference was not statistically significant, and the researchers also found no significant difference between the groups in the number of participants who had died or had a stroke.

The study appears to confirm the findings of a 2009 trial which took place in the USA* and showed similar results. Together, the results suggest that use of ginkgo extract by elderly people who complain of memory loss will not significantly affect the likelihood of diagnosis of Alzheimer's disease.

According to lead author Professor Bruno Vellas of the Hôpital Casselardit, in Toulouse, France, "Effective and safe prevention strategies are urgently needed to tackle the growing public health burden of Alzheimer's disease, and the efficacy of any such intervention needs to be shown through randomised controlled trials. This is only the third Alzheimer's prevention trial to be completed, and is the first to be done outside the USA, so further research in this area is urgently needed."

"While our trial appears to have shown that regular use of ginkgo biloba does not protect elderly patients from progression to Alzheimer's disease, more studies are needed on long term exposure. The fact that prevalence of this debilitating disorder is expected to quadruple by 2050 suggests that research into preventative therapies for this disease needs to receive urgent attention."

In a linked Comment, Professor Lon Schneider, Director of the University of Southern California's (USC) Alzheimer's Disease Research and Clinical Center, states that "If ginkgo biloba were a drug, and not marketed as a food supplement, clinical testing for efficacy against Alzheimer's disease and cognitive impairment would have ended long ago. Nevertheless, the fact that ginkgo biloba extract is widely promoted, derived from a plant, and fairly safe were reasons enough for its use in two landmark prevention trials for Alzheimer's disease [i.e. the GuidAge study presented here, and the 2009 GEM study*]… It would be unfortunate if users of ginkgo biloba, nevertheless, are led to believe that the extract prevents the dementia. Some users will rationalise that, in the absence of effective treatments, ginkgo biloba could still possibly help and, appearing safe, will not harm them. Other users of ginkgo biloba, however, might now consider letting it go."

More information: * DeKosky ST, Williamson JD, Fitzpatrick AL, et al. Ginkgo biloba for Prevention of Dementia: A Randomized Controlled Trial. JAMA 2008; 300(19): 2253-62.

Lancet Neurology paper: www.thelancet.com/… 6-5/abstract

Provided by Lancet

Overactive bladder linked to sleep apnoea in women

Sleep apnoea in women has been linked to overactive bladder syndrome in a new study.

05 sept 2012--The research, presented today at the European Respiratory Society's Annual Congress in Vienna, has provided new evidence suggesting a connection between the two conditions.

Overactive bladder syndrome is characterised by an increased frequency to urinate along with incontinence and frequent awakening periods during night time to use the toilet (nocturia). The need to urinate during the night is also a common symptom of sleep apnoea, but little research has been carried out to investigate any links between the two conditions.

Researchers from the Hospital del Mar in Barcelona, Spain, analysed 72 female patients referred to a sleep disorders clinic with suspected sleep apnoea. All patients completed a questionnaire asking them about four symptoms associated with their bladder control; urgency and frequency of urination, incontinence and nocturia. They were also asked to rate their discomfort with each of these symptoms.

The results from the questionnaires were then analysed and rated on two scales in order to evaluate both the severity of symptoms and discomfort for each of the four variables, scoring from 0 to 3 for each of these four items.

The analysis showed that 62 of the women were diagnosed with sleep apnoea. The people within this group showed significantly higher scores for the prevalence of symptoms associated with bladder control and their discomfort with these symptoms.

Within the group diagnosed with sleep apnoea, the symptoms were rated a median average score of 5, out of a possible total of 12, compared to a score of 3 in the group not diagnosed with the condition. The median average score for discomfort with bladder control symptoms was 4 out of 12, compared with a score of 1 in the group of women who weren't diagnosed with sleep apnoea.

Lead author, Núria Grau from the Hospital del Mar in Spain, said: "Overactive bladder has a prevalence of 16% among people over 40 years in Europe and it is a difficult condition to live with, affecting a person's quality of life. The findings of this study provide evidence that bladder control could be linked to sleep apnoea, although we do not know whether one of the conditions causes the other.

"The next step in our research is to investigate the role of continuous positive airway pressure therapy in these patients and its impact on the symptoms of overactive bladder."

Provided by European Lung Foundation

Does wisdom really come with age? It depends on the culture

04 sept 2012—"Wisdom comes with winters," Oscar Wilde once said. And it's certainly comforting to think that aging benefits the mind, if not the body. But do we really get wiser as time passes?

There are many way to define what exactly wisdom is, but previous literature suggests that having wisdom means that you are also good at resolving conflict. But conflict is not handled the same way across cultures. Americans have been shown to emphasize individuality and solve conflict in a direct manner, such as by using direct persuasion. In contrast, the Japanese place a greater emphasis on social cohesion, and tend to settle conflict more indirectly, using avoidance strategies or relying on mediation through another person.

In a study forthcoming in Psychological Science, a journal of the Association for Psychological Science, psychological scientist Igor Grossmann of the University of Waterloo, Canada and his colleagues investigated how the resolution of conflict and, by extension, wisdom differ between Japanese and American cultures.

The researchers hypothesized that Japanese individuals, who tend to be socialized to value interpersonal harmony, would be better at resolving conflict and show more wisdom earlier in life. Americans, on the other hand, experience more conflict over time and the researchers hypothesized that this would result in continued learning about conflict resolution across the lifespan and greater wisdom later in life.

Japanese participants and American participants, ranging in age from 25 to 75, were asked to read newspaper articles that described a conflict between two groups and respond to several questions, including "What do you think will happen after that?" and "Why do you think it will happen this way?" Next, they read stories about conflict between individuals – including siblings, friends, and spouses – and answered the same questions.

The researchers measured the extent to which participants' responses illustrated six previously established characteristics of wise reasoning: (1) considering the perspectives of others, (2) recognizing the likelihood of change, (3) recognizing multiple possibilities, (4) recognizing the limits of one's own knowledge, (5) attempting to compromise, and (6) predicting the resolution of the conflict.

As Grossmann and his colleagues predicted, young and middle-aged Japanese participants showed higher wisdom scores than same-aged Americans for conflicts between groups. For conflicts between people, older Japanese still scored higher than older Americans, though this cultural difference was much smaller than the difference observed between the younger adults.

Interestingly, while older age was associated with higher wisdom scores for the American participants, there was no such relationship for the Japanese participants.

These findings underscore the point that culture continues to be important for human development, even into old age. While wisdom may come with winters for Americans, the same may not be true for other cultures.

"Cross-cultural researchers have been very good at situating their results in a cultural context, but don't often consider how lifespan development may contribute to cultural differences (or lack thereof)," says Grossmann. This study is one of the few extensive cross-cultural studies in psychology that includes people of different ages and different socio-economic backgrounds.

This research also shows that some abilities – specifically those involved in resolving social conflicts – remain intact into old age. Grossmann hopes that the study may act as an antidote to the detrimental ageism stereotypes in both Western and East Asian societies.

Provided by Association for Psychological Science

Marathons safe for aging boomers, study finds

Signs of heart stress in 50-somethings resolved within a week, tests showed.

03 sept 2012—It's safe for older adults to run marathons, a new study finds.

Researchers at the University of Manitoba in Canada tested marathon participants over age 50 before and after their 26.2-mile run. Using blood tests, ultrasounds and scans up to three months later, they found the runners had temporary heart effects similar to those seen in runners aged 18 to 40.

The effects included a brief increase in blood indicators of heart damage and temporary swelling and weakness in the right side of the heart immediately after the marathon. All of these effects disappeared within a week.

"There was no evidence of permanent heart damage from repeated marathon running in individuals over the age of 50," primary study author Davinder Jassal, an associate professor of medicine, radiology and physiology, said in a university news release.

The study was published online in August in the Journal of Cardiovascular Magnetic Resonance.

Aging populations in Canada and the United States mean there's a growing number of people over age 50 who exercise regularly, the researchers noted. For example, the number of older people taking part in marathons has doubled over the past two decades. 

More information: The U.S. National Heart, Lung, and Blood Institute offers a guide to physical activity.

Healthy living into old age can add up to 6 years to your life

Living a healthy lifestyle into old age can add five years to women's lives and six years to men's, finds a study from Sweden published in the British Medical Journal today.

02 sept 2012--The authors say this is the first study that directly provides information about differences in longevity according to several modifiable factors.

It is well known that lifestyle factors, like being overweight, smoking and heavy drinking, predict death among elderly people. But is it uncertain whether these associations are applicable to people aged 75 years or more.

So a team of researchers based in Sweden measured the differences in survival among adults aged 75 and older based on modifiable factors such as lifestyle behaviours, leisure activities, and social networks.

The study involved just over 1,800 individuals who were followed for 18 years (1987-2005). Data on age, sex, occupation, education, lifestyle behaviours, social network and leisure activities were recorded.

During the follow-up period 92% of participants died. Half of the participants lived longer than 90 years.

Survivors were more likely to be women, be highly educated, have healthy lifestyle behaviours, have a better social network, and participate in more leisure activities than non-survivors.

The results show that smokers died one year earlier than non-smokers. Former smokers had a similar pattern of survival to never smokers, suggesting that quitting smoking in middle age reduces the effect on mortality.

Of the leisure activities, physical activity was most strongly associated with survival. The average age at death of participants who regularly swam, walked or did gymnastics was two years greater than those who did not.

Overall, the average survival of people with a low risk profile (healthy lifestyle behaviours, participation in at least one leisure activity, and a rich or moderate social network) was 5.4 years longer than those with a high risk profile (unhealthy lifestyle behaviours, no participation in leisure activities, and a limited or poor social network).

Even among those aged 85 years or older and people with chronic conditions, the average age at death was four years higher for those with a low risk profile compared with those with a high risk profile.

In summary, the associations between leisure activity, not smoking, and increased survival still existed in those aged 75 years or more, with women's lives prolonged by five years and men's by six years, say the authors.

These associations, although attenuated, were still present among people aged 85 or more and in those with chronic conditions, they add.

"Our results suggest that encouraging favourable lifestyle behaviours even at advanced ages may enhance life expectancy, probably by reducing morbidity," they conclude.

Provided by British Medical Journal

Guidance to rehabilitate patients with hearing and balance problems and tinnitus

Hearing and balance-related problems are often chronic conditions which can be managed but not always cured. Now new guidance by the British Society of Audiology – devised in collaboration with the National Institute for Health Research – promises to improve quality of life for patients with hearing and balance problems and tinnitus.

01 sept 2012--Effective rehabilitation is best achieved through a process that goes beyond addressing the sensory impairment by providing support both to the person experiencing the hearing or balance-related problem and their partner or immediate family.

New Practice Guidance on Common Principles of Rehabilitation in Routine Audiology Services will be launched in Nottingham on Wednesday 5 September by Professor Deborah Hall with collaborator Dr Daniel Rowan, during the Annual Conference of the British Society of Audiology (BSA). 

Consultation and expert collaboration

Over the past decade there have been important developments in understanding how people with chronic conditions can be helped to maximise their quality of life. This includes unifying some general principles across a wide range of conditions including hearing loss, tinnitus and dizziness.

There is widespread acceptance that rehabilitation will fail to deliver its full potential if it focuses exclusively on addressing sensory impairment, without considering clients' specific social and emotional needs.

The guidance was developed by the Professional Practice Committee of the British Society of Audiology (BSA) in collaboration with the National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, the Ida Institute, the BSA Adult Rehabilitation Interest Group, the BSA Balance Interest Group, and the wider audiology community. 

Professor Deborah Hall, Director of the National Institute for Health Research Nottingham Hearing Biomedical Research Unit, said: "This guidance brings together the latest scientific evidence concerning what rehabilitative strategies best improve people's quality of life."

Utilising "considerable improvements in technology"

Dr Daniel Rowan, Chair of the BSA's Professional Practice Committee, said: "This guidance was inspired by growing efforts within audiology to utilise fully the considerable improvements in technology at times of great challenge.

"The BSA aims to support these efforts by recognising the end goals of audiology and by promoting the core principles that we currently understand are necessary to achieve them. The intention is for audiology professionals to consider these principles as being at the heart of their practice, helping to guide their interactions with clients with a wide variety of needs and in a wide variety of contexts."

This general approach is in keeping with current trends seen across other clinical disciplines in the rehabilitation of chronic illnesses. Although this new guidance is intended primarily to inform the practice of audiology professionals directly involved in the rehabilitation process, it is also intended to be a reference for commissioners, policy makers and other stakeholders as to what comprises best practice in rehabilitation

This new Practice Guidance will be presented during the BSA's Annual Conference, which is being held this year at Nottingham Trent University.

Provided by University of Nottingham

New diagnostic biomarkers offer ray of hope for Alzheimer's disease

Alzheimer's disease (AD) is one of the most common brain disorders, with an estimated 35 million people affected worldwide. In the last decade, research has advanced our understanding of how AD affects the brain. However, diagnosis continues to rely primarily on neuropsychological tests which can only detect the disease after clinical symptoms begin. In a supplement to the Journal of Alzheimer's Disease, investigators report on the development of imaging-based biomarkers that will have an impact on diagnosis before the disease process is set in motion.

31 aug 2012--"There is an urgent need for the development of reliable diagnostic biomarkers that can detect AD pathology at an incipient phase," says Guest Editor Dr. Pravat Mandal, Adjunct Associate Professor of the Department of Radiology, Johns Hopkins Medicine, Baltimore, MD and Additional Professor, National Brain Research Center, India. "This special issue focuses on the latest strides made in identifying diagnostic biomarkers using state-of-the-art imaging modalities."

The issue looks at the application of various magnetic resonance imaging (MRI) technologies for diagnosing AD and monitoring the progression of the disease. For example, Brian T. Gold and colleagues report on the use of diffusion tension imaging (DTI) to identify changes in the white matter of patients with amnestic mild cognitive impairment (MCI), an early symptom of AD. Charles D. Smith and colleagues describe MRI-based detection of key structural alterations in cognitively normal subjects that can serve as a predictor of memory impairment.

While MRI provides information about the anatomy of the brain, functional MRI (fMRI) provides crucial information about the regions involved during specific tasks. The issue explores how fMRI can detect changes in functional activation and connectivity in AD patients. Monitoring alterations in functional brain activity related to visual processing deficits in AD has immense potential as an early diagnostic biomarker, according to a review by Dr. Mandal and colleagues. By using fMRI to study normal older individuals, patients with MCI, and those with AD as they perform cognitive tasks and at rest, Jasmeer P. Chhatwal and Reisa Sperling reveal the functional alterations associated with healthy aging as well as MCI and AD.

Magnetic resonance spectroscopy (MRS) is a powerful non-invasive imaging technique that can provide crucial information about neurochemical changes in AD. Dr. Mandal and colleagues report that the identification of neurochemical changes in the brains of MCI and AD patients may provide a "signature" of early AD pathology, and may aid in diagnosing patients who are moving from MCI to more advanced AD.

Imaging is also used to examine the molecular and therapeutic effects of potential AD treatments. Liam Zaidel and colleagues found that patients treated with donepezil for mild cognitive symptoms had a significant increase in interhemispheric functional connectivity of the left and right dorsolateral prefrontal cortices. Giulia Liberati and colleagues describe a non-invasive brain-computer interface that can detect a patient's emotional and cognitive state. It could provide vital information on the effect of clinical drugs on brain function and cognition in patients with AD.

The issue also includes a thought-provoking argument from Edo Richard and colleagues calling for a paradigm shift in dementia research and biomarker development. Current biomarker research focuses on correlates of plaques and tangles, which are poor markers in older dementia subjects. The authors suggest that the acknowledgement that dementia in older subjects is different from dementia at a young age will lead to new approaches in biomarker development and research.

"Research is needed to understand which molecular, structural, and functional changes are causally related to the onset of AD," says Dr. Mandal. "This special issue aims to conceptualize more effective and reliable biomarkers for AD."

George Perry, PhD, Editor-in-Chief, Journal of Alzheimer's Disease, and Dean and Professor, College of Sciences, University of Texas at San Antonio, says, "The development of biomarkers to aid in early detection of the onset of AD is critical. This special issue will spur research into multi-model imaging based biomarker development for AD."

More information: "Biomarkers for Alzheimer's Disease Using Multi-Model Imaging Research," Guest Edited by Pravat K. Mandal. Journal of Alzheimer's Disease, Volume 31 (2012), Supplement 3.

Provided by IOS Press

Low-calorie diet may not prolong life: study

A low-calorie diet boosts health but does not prolong life, at least not in rhesus monkeys, scientists reported Wednesday in a new study into a long-held link between food restriction and longevity.

30 aug 2012--Spanning 23 years, the research found monkeys that ate fewer calories than non-dieting counterparts were healthier but did not live any longer.

Rhesus monkeys are a preferred choice for lab study, as they are long-lived primates like humans—their average lifespan in captivity is 27 years and the usual maximum is 40 years.

The exceptionally long study, launched at the National Institute on Aging (NIA) in Maryland in 1987, saw monkeys of different ages fed a diet 30 percent lower in calories than others that followed a "normal," nutritious diet.

Animals in both groups lived on average longer than wild rhesus monkeys and were heavier too. None was malnourished, and they were given vitamin and mineral supplements, the researchers wrote in the journal Nature.

Those on the calorie-restricted diet had a lower incidence of diabetes, cardiovascular disease and cancer than the rest, and dieting males also had lower cholesterol.

"However, these effects did not translate directly to a beneficial effect in longevity," over the control monkeys, Rafael de Cabo of the NIA's Laboratory of Experimental Gerontology, told AFP.

The study was not designed to explain this phenomenon, and the authors say matching research to measure the impact of calorie restriction on longevity in humans was unlikely.

The findings seem to contradict those of other projects, including an ongoing study at the Wisconsin National Primate Research Centre (WNPRC) which has shown that rhesus monkeys placed on a restricted calorie diet lived longer.

These "mixed results" raised intriguing questions about the benefits of calorie restriction in primates, Steven Austad of the University of Texas' Barshop Institute for Longevity and Aging Studies wrote in a comment on the study, also published by Nature.

WNPRC senior scientist Ricki Colman told AFP there were many differences between the two studies that may explain the conflicting outcomes.

Importantly, the WNPRC control monkeys (those whose calorie intake was not restricted) were allowed free access to food, therefore mimicking a human in charge of his own nutrition intake.

In contrast, the NIA control group were given a limited amount of food, thus resembling an ideal human diet—which may explain why they lived as long as the monkeys on the low-calorie diet.

They were also given vitamin and mineral supplements and the WNPRC group not.

Comparing the two approaches, a compelling picture emerges, said De Cabo: a healthy diet does improve longevity, and eating less of it may slow the onset of some diseases but will not actually prolong life.

More information: DOI: 10.1038/nature11432

Healthy lifestyle reduces the risk of hypertension by two thirds

Healthy behaviours regarding alcohol, physical activity, vegetable intake and body weight reduce the risk of hypertension by two thirds, according to research presented at the ESC Congress today. The findings were presented by Professor Pekka Jousilahti from National Institute for Health and Welfare.

29 aug 2012--According to the World Health Organization, hypertension is the leading cause of mortality in the world, contributing annually to over 7 million deaths (about 15% of all deaths). Therefore, prevention of hypertension is essential to improving health and preventing morbidity and mortality, both in developing and developed countries.

The purpose of this study was to examine whether five major cardiovascular disease related lifestyle factors – smoking, alcohol consumption, physical activity, obesity and consumption of vegetables – predict the future increase of blood pressure and development of clinical hypertension, and need for antihypertensive drug treatment.

This large prospective population-based cohort study included 9,637 Finnish men and 11,430 women who were 25 to 74 years of age and free of hypertension during the baseline measurements (1982-2002). Healthy lifestyle factors were defined as: (1) not smoking, (2) alcohol consumption less than 50g per week, (3) leisure time physical activity at least 3 times per week, (4) daily consumption of vegetables, and (5) normal weight (BMI<25kg m2="m2" p="p">

Data on the development of hypertension during the follow-up period were obtained from the Social Insurance Institution of Finland register of people entitled to special reimbursement for antihypertensive drugs. During a mean follow-up of 16 years, 709 men and 890 women developed hypertension.

Smoking was omitted from the final analysis. Professor Jousilahti said: "Even though smoking is a major risk factor for cardiovascular disease, it was not associated with the development of hypertension in our analyses, which is in accordance with previous studies."

The four remaining healthy lifestyle factors were included in the analysis. Hazard ratios for hypertension associated with adherence to 0 (the reference group), 1, 2, 3, and 4 healthy lifestyle factors were calculated after adjusting for age, year of entering the study, education, and smoking.

The hazard ratios for hypertension associated with adherence to 0, 1, 2, 3, and 4 healthy lifestyle factors were 1.00, 0.74, 0.51, 0.34, and 0.33 for men, and 1.00, 0.89, 0.68, 0.41, and 0.37 for women. "The risk of hypertension was only one third among those having all four healthy lifestyle factors compared to those having none," said Professor Jousilahti. "Even having one to three healthy lifestyle factors reduced the risk of hypertension remarkably. For example having two healthy lifestyle factors reduced the risk of hypertension by nearly 50% in men and by more than 30% in women."

"Our analysis suggests that adherence to healthy lifestyle factors may have more of an impact on risk of hypertension in men than women," he added. "This could be because of the stronger association of obesity and alcohol consumption with the risk of hypertension in men than in women."

"Four modifiable lifestyle factors: alcohol consumption, physical activity, consumption of vegetables and keeping normal weight have a remarkable effect on the development of hypertension," said Professor Jousilahti. "Lifestyle modification has a huge public health potential to prevent hypertension. While our research suggests that lifestyle modification may produce greater reductions in hypertension in men than women, it also shows large benefits in women, and adherence to all four healthy lifestyle factors had a nearly similar effect in both sexes. Both men and women should take steps towards a healthier lifestyle to decrease their risk of hypertension."

He concluded: "Our study was focused on prevention of hypertension and therefore included subjects who did not have hypertension at baseline. But the results should apply to the treatment of patients with hypertension, who can reduce their blood pressure by modifying the four lifestyle factors alone, or by making these modifications while taking blood pressure lowering medication."

Provided by European Society of Cardiology

Mild cognitive decline in nearly half lacunar stroke patients

Mild cognitive impairment is present in nearly half of patients with lacunar stroke, according to a study published online Aug. 18 in the Annals of Neurology.

28 aug 2012—Mild cognitive impairment (MCI) is present in nearly half of patients with lacunar stroke, according to a study published online Aug. 18 in the Annals of Neurology.

Claudia Jacova, Ph.D., of the University of British Columbia in Vancouver, Canada, and associates conducted a study to characterize, and estimate the prevalence of, neuropsychological impairment in 1,636 English-speaking lacunar stroke patients. Using published norms, raw scores were converted to z scores. Participants underwent neuropsychological testing at baseline and those with impairment (z score of ≤1.5) in memory and/or non-memory domains were classified as having MCI.

The researchers found that the average z scores at baseline testing were below zero. The largest deficits were seen in measures of episodic memory (range of means, −0.65 to −0.92), verbal fluency (mean, −0.89), and motor dexterity (mean, −2.5). Of the participants, 47 percent were classified as having MCI, which included 36 percent amnestic, 37 percent amnestic multidomain, and 28 percent non-amnestic. Forty-one percent of those with Rankin score of 0 to 1 and Barthel score of 100 percent had MCI.

"In this large, well-characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities," the authors write. "Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae."

Study medication was donated by Sanofi/BMS USA.

More information: Abstract 
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Women with Alzheimer's deteriorate faster than men

Women with Alzheimer's show worse mental deterioration than men with the disease, even when at the same stage of the condition, according to researchers from the University of Hertfordshire.

27 aug 2012--In the paper published in the Journal of Clinical and Experimental Neuropsychology, the researchers discovered that men with Alzheimer's consistently and significantly performed better than women with the disease across the five cognitive areas they examined. Most remarkably, the verbal skills of women with Alzheimer's are worse when compared to men with the disease, which is a striking difference to the profile for the healthy population where females have a distinct advantage.

The researchers led by Professor Keith Laws completed a meta-analysis of neurocognitive data from fifteen published studies, which revealed a consistent male advantage on verbal and visuospatial tasks, and tests of both episodic1 and semantic2 memory.

Keith Laws, Professor of psychology, said: "Unlike mental decline associated with normal aging, something about Alzheimer's specifically disadvantages women.

"There has been some previous, but limited, evidence that females with Alzheimer's deteriorate faster than males in the earlier stages of the disease. And possible explanations are for a hormonal influence, possibly due to oestrogen loss in women or perhaps a greater cognitive reserve in males which provides protection against the disease process. But further studies to examine sex differences with the disease are needed to provide greater clarity on these issues."

Further analysis of the study data showed that age, education level and dementia severity did not explain the advantage that men with the disease have over women with the disease.

Alzheimer's disease, a common progressive condition affecting memory, thinking, behaviour and emotion, is the most common form of dementia. Alzheimer's Disease International estimates that there are currently thirty million people in the world with dementia, with 4.6 million new cases every year. The incidence of Alzheimer's is greater among women than men, with the difference increasing with age.

More information: DOI:10.1080/13803395.2012.712676

Provided by University of Hertfordshire

Global study suggests need for strategies to combat unhealthy lifestyles among the poor and the rich

Healthy foods such as fruits and vegetables, proteins and total fats are consumed more often by the wealthy while poorer people consume more carbohydrates, says a new study involving people from 17 countries.

26 aug 2012--The Prospective Urban Rural Epidemiology (PURE) study involving 154,000 individuals from 628 communities reported on the patterns of diet, physical activity and smoking, was presented at the European Society of Cardiology 2012 Congress on Sunday, Aug. 26, 2012.

The study found individuals who were poor, or from poorer countries were more active chiefly because of higher energy expenditure in jobs, at home, and during transportation.

The markedly lower level of obligatory physical activity was not compensated for by higher levels of recreational physical activity in richer countries or richer individuals. Those who were rich and those in richer countries quit smoking much more often so that rates of smoking was lower in the wealthier individuals and wealthier countries.

"Policies to prevent cardiovascular disease need to focus on different aspects of lifestyle among the rich versus the poor and between rich and poor countries," said professor Salim Yusuf of the Population Health Research Institute, McMaster University and Hamilton Health Sciences and principal investigator of the study.

The study was conducted in 17 countries and coordinated worldwide by the Population Health Research Institute and supported by the Canadian Institutes of Health Research, the Indian Council of Medical Research, several other peer review organizations and pharmaceutical companies.

"These results provide new insights into the need to customize prevention policies differently for the rich and the poor and for countries at different economic levels," said professor David Wood of the University of London, UK and an expert in cardiovascular disease prevention.

Provided by McMaster University