Green tea, coffee may help lower stroke risk

Green tea. Credit: Wikimedia Commons

Green tea and coffee may help lower your risk of having a stroke, especially when both are a regular part of your diet, according to research published in Stroke: Journal of the American Heart Association.

18 mar 2013--"This is the first large-scale study to examine the combined effects of both green tea and coffee on stroke risks," said Yoshihiro Kokubo, M.D., Ph.D., F.A.H.A., F.A.C.C., F.E.S.C., lead author of the study at Japan's National Cerebral and Cardiovascular Center. "You may make a small but positive lifestyle change to help lower the risk of stroke by adding daily green tea to your diet."

Researchers asked 83,269 Japanese adults about their green tea and coffee drinking habits, following them for an average 13 years. They found that the more green tea or coffee people drink, the lower their stroke risks. 

• People who drank at least one cup of coffee daily had about a 20 percent lower risk of stroke compared to those who rarely drank it.
• People who drank two to three cups of green tea daily had a 14 percent lower risk of stroke and those who had at least four cups had a 20 percent lower risk, compared to those who rarely drank it.
• People who drank at least one cup of coffee or two cups of green tea daily had a 32 percent lower risk of intracerebral hemorrhage, compared to those who rarely drank either beverage. (Intracerebral hemorrhage happens when a blood vessel bursts and bleeds inside the brain. About 13 percent of strokes are hemorrhagic.)

Participants in the study were 45 to 74 years old, almost evenly divided in gender, and were free from cancer and cardiovascular disease.

During the 13-years of follow-up, researchers reviewed participants' hospital medical records and death certificates, collecting data about heart disease, strokes and causes of death. They adjusted their findings to account for age, sex and lifestyle factors like smoking, alcohol, weight, diet and exercise.

Green tea drinkers in the study were more likely to exercise compared to non-drinkers.

Previous limited research has shown green tea's link to lower death risks from heart disease, but has only touched on its association with lower stroke risks. Other studies have shown inconsistent connections between coffee and stroke risks.

Initial study results showed that drinking more than two cups of coffee daily was linked to increasing coronary heart disease rates in age- and sex-adjusted analysis. But researchers didn't find the association after factoring in the effects of cigarette smoking—underscoring smoking's negative health impact on heart and stroke health.

A typical cup of coffee or tea in Japan was approximately six ounces. "However, our self-reported data may be reasonably accurate, because nationwide annual health screenings produced similar results, and our validation study showed relatively high validity." Kokubo said. "The regular action of drinking tea, coffee, largely benefits cardiovascular health because it partly keeps blood clots from forming."

Tea and coffee are the most popular drinks in the world after water, suggesting that these results may apply in America and other countries.

It's unclear how green tea affects stroke risks. A compound group known as catechins may provide some protection. Catechins have an antioxidant anti-inflammatory effect, increasing plasma antioxidant capacity and anti-thrombogenic effects.

Some chemicals in coffee include chlorogenic acid, thus cutting stroke risks by lowering the chances of developing type 2 diabetes. Further research could clarify how the interaction between coffee and green tea might help further lower stroke risks, Kokubo said.

More information: For additional information on stroke:

newsroom.heart.org/news/672 
www.heart.org/HEAR… _Article.jsp

Provided by American Heart Association

Resveratrol in a red wine sauce: Fountain of youth or snake-oil?

Resveratrol is being be touted as the latest wonder drug that will add years to our lives. Credit: Greg Bishop

Resveratrol, a molecule found in red wine (and red grape skin and elsewhere) is back in the headlines after an international team of researchers published a paper in the journal Sciencelate last week. The news made headlines around the world.

17 mar 2013--Researchers believe resveratrol could extend the human life span, and protect people against a wide range of diseases such as cancer, type II diabetes, Alzheimer's, and heart disease.

But is it too good to be true?

Is resveratrol the latest wonder drug that will add years to our lives? Or is this simply the newest science and marketing spiel that will take the rest of our lives to unravel?

And what if resveratrol does not live up to its promise? Who is to blame? The scientists? The media? The marketers? Or the gullible fools who make up the general public?

The health-giving properties of red wine have been advanced as a possible explanation for the French Paradox, the observation that the French have relatively low heart disease despite a high-fat diet. Researchers suggest that the resveratrol in the red wine could be a contributing factor.

The promise of resveratrol has been escalated with research suggesting that it has the capacity to activate a protein called SIRT1 found in mammals. SIRT1 is one of a larger class of proteins called sirtuins that have been shown to extend the life span of yeast, worms, flies and, maybe, mice.

Yes, "maybe mice" because whether it extends a mouse's life is disputed. In fact, the truth seems less clear and more highly valued than a couple of cases of 1950s Grange Hermitage.

Despite doubts about the real value of resveratrol, in 2008 GSK paid $720m for SIRTRIS, a company established by some of the scientists advancing the positive claims for resveratrol.

This may just be the latest attempt at finding the fountain of youth. 

The paper published recently in Science simply reaffirms an earlier claim against contrary evidence. This is science as usual; a scientific shoot-out at the frontier of knowledge in an effort to establish truth.

But some of the claims for resveratrol certainly seem overstated. We are, after all, talking about research that, to this point, has been focused on relatively short-term effects observed on just a few leaves on the phylogenetic tree, in carefully controlled laboratory conditions.

Despite the hype about the connection with red wine, even the researchers admit that the amount of resveratrol in a glass or three of red wine is insignificant relative to the dosing that showed effects in mice. Even so, one of the researchers admits taking resveratrol supplements perhaps to amplify his claims in a style akin to Australian Nobel-laureate Barry Marshall.

So, it may be premature to assume that these findings generalise to humans in the wild.

Add to this the problem of falsification. No, not philosopher of science Karl Popper's notion of falsification as a basis for advancing scientific knowledge, but falsification in terms of made-up data. A number of published studies showing the benefits of resveratrol have been retracted for being fabricated.

All this before the media and marketers get to create a label and write advertising copy to make an appetising and digestible sound-bite (or tipple) for the masses.

The great problem here for seekers of truth is to separate fact from fiction, to separate the infinitely more nuanced reality from vastly simplified human representation.

"Science," said Karl Popper, "may be described as the art of systematic over-simplification." And if scientists are bad, then the media and marketers are probably even worse.

Still, they are all simply selling a story; it appeals because people want to believe it.

The search for the fountain of youth has gone on for millennia. And this search has uncovered just one thing – the spring of human hope flows endlessly. We are hopelessly hopeful.

Our eternal optimism offers value to medicine through the placebo effect, which suggests that people's beliefs can help their own healing. Sadly, this also means that it can take a long time for people to realise that they have been duped.

And anyway, who is to blame when the whole thing is a product of human nature? Do we blame the public for their unbridled optimism and desire for a quick fix? Or the scientific, media and marketing professions for desiring social and financial success?

The flipside to all this is that some of the claimed benefits of resveratrol are available to the public right now. Sirtuins can be activated by exercising a bit more, and eating a bit less.

But that's not a very interesting story; fiction feeds dreams while the facts foster drudgery.

The amount of resveratrol in a glass of red wine is unlikely to have any effect on your health, but if it makes you feel better, raise a glass to the placebo effect. And the proof that science, media, marketers and consumers can together create much value from very little.

Source: The Conversation

This story is published courtesy of The Conversation (under Creative Commons-Attribution/No derivatives).

Women live longer, but have a lower quality of life

the Institute of Gender Medicine at the MedUni Vienna has presented an alarming result obtained from gender-specific research. According to recent studies, women's quality of life is significantly worse than that of men in terms of health.

16 mar 2013--In Austria and Europe, women live on average around six years longer than men. This is a very positive result for women, one might think, especially in terms of their health. This popular assumption, however, is incorrect. According to Alexandra Kautzy-Willer, Head of the Gender Medicine Unit at the MedUni Vienna, a closer look at the data indicates that women suffer more frequently than men from chronic diseases and functional restrictions and have a poorer quality of life in terms of their health.

Karin Gutierrez-Lobos, MedUni Vienna's Vice Rector for Teaching, Gender and Diversity and Austria's first Professor of Gender Medicine at the MedUni Vienna, adds: "These recent results confirm just how important gender medicine is. They clearly illustrate that women's equality of treatment status is a vital influencing factor on health. If their social status, quality of treatment index or career opportunities improve, for example, so too does their health-related quality of life."

Sex hormones, role models and social behaviour make the difference

According to Kautzky-Willer, the more marked among women phases of life that are greatly influenced by changes in sex hormones, but also by their role models, are also of tremendous importance.

From puberty, women are more affected than men by painful syndromes such as irritable bowel, fibromyalgia and migraine, but also by autoimmune diseases such as lupus, multiple sclerosis, thyroid glandabnormalities or asthma. Menstrual cycle anomalies, infertility or complications of pregnancy can provide vital indicators of an increased risk of illness later in life. After gestational diabetes, for example, women have a seven times greater risk of developing diabetes and are at significantly increased risk of vascular problems. Lifestyle changes such as smoking, taking the contraceptive pill, stress and lack of exercise lead to an increase in mortality from heart attacks, especially in young women. From the menopause onwards, women are more troubled by fat metabolism problems, high blood pressure, cardiovascular disease and osteoporosis. Elderly women are ultimately significantly more severely affected by Alzheimer's dementia, incontinence and immobility. And if all this wasn't enough, women are also two times more likely to suffer depression than men.

"There are a variety of reasons behind these clear differences. They include, for example, the many differences in biology and sex hormones, but most importantly the different effects of environmental influences, differences in lifestyle, gender roles and differences in social behaviour," says Kautzky-Willer. Even the causes and effects of stress differ between men and women.

Recent study researches gender-specific differences in coping with autoimmune diseases

An interdisciplinary study currently underway at the University Department of Internal Medicine III at the MedUni Vienna and the Gender Medicine Unit is investigating a series of autoimmune diseases from gender-specific perspectives. Preliminary results are already available for Crohn's disease, a common disease of the bowel. Says Kautzky-Willer: "If social support, job satisfaction and self-efficacy improve, the positive effect on the course of the illness is the same for both men and women. For women, however, the activity of the disease but most importantly esteem and good resilience are important." These results may in future lead to new, gender-sensitive approaches to the treatment of autoimmune diseases.

Provided by Medical University of Vienna

Lowering salt intake in diets important and very feasible, study finds

15 mar 2013--—A newly published study has found that it would be relatively easy for New Zealanders to reach recommended levels of lower salt intake to reduce the risk of heart disease, stroke and stomach cancer. This is even if some meals have occasional high salt ingredients such as sausages or other processed foods.

The University of Otago, Wellington study found that a healthy daily diet that reached all nutrient recommendations for men, including salt at under 5.8 grams per day, was readily achievable at a cost of under $9 per day. Similar results were obtained when modelling diets for women. New Zealanders are currently estimated to consume at least twice the recommended intake of salt.

In fact all of the eight sample daily diets studied, many with familiar meal components, but with little of the processed food that is high in salt, achieved the ideal "target" salt intake. This is under 4 grams of salt (two thirds of a teaspoon) per day which is equivalent to 1.6 grams of sodium per day.

"We were interested in studying low-salt diets as a high salt diet is ranked 11th in the world as a risk factor for disease and is also ranked 11th for the New Zealand and Australia region. This ranking is ahead of such risk factors as diet low in vegetables (ranked 12th) and a diet high in processed meat (ranked 14th)," says lead author Associate Professor Nick Wilson.

He says that while the lower salt in diets would help prevent heart disease, there were other features of these optimised low-salt diets which would improve heart health. "These include a better ratio of good fats such as polyunsaturated fats to the more hazardous saturated fat. The higher levels of fruit and vegetables in these diets would also help prevent heart disease and some cancers."

The study used a mathematical technique of "linear programming" to find different diets which were low in salt and affordable, using New Zealand price and nutrition data. Included on purpose in some of the studied diets were familiar meals and ingredients such as porridge for breakfast and a lunch that include a cheese sandwich and peanut butter sandwich.

One of the evening meals included mince on toast. Another main meal included sausages, potatoes and a dessert of ice-cream with canned fruit. Another involved a tuna pasta dish and a Pacific-style main meal – including tuna, taro and coconut cream.

While all sample diets achieved the desired levels of low salt, the healthiest sample diets were the Mediterranean style and an Asian-style diets that excluded high-salt sauces such as soy sauce. This was mainly because these diets usually have much higher levels of vegetables and fruit.

"While individuals could choose to have healthier low-salt foods it would be much easier for them to make healthy choices if the Government did something to help," says Associate Professor Wilson. "It could do this by regulating down the maximum level of salt permitted in commercially produced foods, particularly in bread, processed meats and sauces."

"A tax on junk food would also help as such food is usually high in salt as well as sugar and saturated fat. The money from such a tax could then fund healthy school lunches and help pay for better health services for diseases caused by high salt – especially stroke and heart attacks."

There has been progress on lowering salt in bread through the Heart Foundation working with the food industry. "But this is not enough and that's why regulating down salt levels as well as considering taxes on junk food are needed to achieve the big gains in health," he says.

Associate Professor Wilson says controls on maximum salt levels are relatively easy as people can't detect minor reductions of salt in food at around 10% per year. Co-researcher Rachel Foster says it makes sense to reduce the burden of strokes and heart attacks on the health system, so this should be a priority for Government action to both protect health and save taxpayer funds.

This study has been published in the international journal PLOS ONE and was funded as part of the BODE3 Programme by the Health Research Council. The BODE3 Programme will be using the results of this study in future modelling work on the most cost-effective ways of reducing the high salt levels in the New Zealand diet.

More information: www.plosone.org/ar… pone.0058539

Provided by University of Otago

Sleep loss precedes Alzheimer's symptoms

Sleep is disrupted in people who likely have early Alzheimer's disease but do not yet have the memory loss or other cognitive problems characteristic of full-blown disease, researchers at Washington University School of Medicine in St. Louis report March 11 in JAMA Neurology.

13 mar 2013--The finding confirms earlier observations by some of the same researchers. Those studies showed a link in mice between sleep loss and brain plaques, a hallmark of Alzheimer's disease. Early evidence tentatively suggests the connection may work in both directions: Alzheimer's plaques disrupt sleep, and lack of sleep promotes Alzheimer's plaques.

"This link may provide us with an easily detectable sign of Alzheimer's pathology," says senior author David M. Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor and head of Washington University's Department of Neurology. "As we start to treat people who have markers of early Alzheimer's, changes in sleep in response to treatments may serve as an indicator of whether the new treatments are succeeding."

Sleep problems are common in people who have symptomatic Alzheimer's disease, but scientists recently have begun to suspect that they also may be an indicator of early disease. The new paper is among the first to connect early Alzheimer's disease and sleep disruption in humans.

For the new study, researchers recruited 145 volunteers from the University's Charles F. and Joanne Knight Alzheimer's Disease Research Center. All of the volunteers were 45 to 75 years old and cognitively normal when they enrolled.

As a part of other research at the center, scientists already had analyzed samples of the volunteers' spinal fluids for markers of Alzheimer's disease. The samples showed that 32 participants had preclinical Alzheimer's disease, meaning they were likely to have amyloid plaquespresent in their brains but were not yet cognitively impaired.

Participants kept daily sleep diaries for two weeks, noting the time they went to bed and got up, the number of naps taken on the previous day, and other sleep-related information.

The researchers tracked the participants' activity levels using sensors worn on the wrist that detected the wearer's movements.

"Most people don't move when they're asleep, and we developed a way to use the data we collected as a marker for whether a person was asleep or awake," says first author Yo-El Ju, MD, assistant professor of neurology. "This let us assess sleep efficiency, which is a measure of how much time in bed is spent asleep."

Participants who had preclinical Alzheimer's disease had poorer sleep efficiency (80.4 percent) than people without markers of Alzheimer's (83.7 percent). On average, those with preclinical disease were in bed as long as other participants, but they spent less time asleep. They also napped more often.

"When we looked specifically at the worst sleepers, those with a sleep efficiency lower than 75 percent, they were more than five times more likely to have preclinical Alzheimer's disease than good sleepers," Ju says.

Ju and her colleagues are following up with studies in younger participants who have sleep disorders.

"We think this may help us get a better feel for the way this connection flows—does sleep loss drive Alzheimer's, does Alzheimer's lead to sleep loss, or is it a combination?" Ju says. "That will help us determine whether we can change the course of disease with pharmaceuticals or other treatments."

More information: Ju Y-E S, McLeland JS, Toedebusch CD, Xiong C, Fagan AM, Duntley SP, Morris JC, Holtzman DM. Sleep quality and preclinical Alzheimer disease. JAMA Neurology, online March 11.

Provided by Washington University School of Medicine

Worming our way to new treatments for Alzheimer's disease 

According to a 2012 World Health Organization report, over 35 million people worldwide currently have dementia, a number that is expected to double by 2030 (66 million) and triple by 2050 (115 million). Alzheimer's disease, the most common form of dementia, has no cure and there are currently only a handful of approved treatments that slow, but do not prevent, the progression of symptoms.

11 mar 2013--New drug development, no matter the disease, is a slow, expensive, and risky process. Thus, innovative techniques to study and assess the possibilities of already-existing drugs for different diseases can be used to alleviate the traditional burdens of cost and time. Detailed in their new article in Biological Psychiatry, researchers from the University of Washington, led by Dr. Brian Kraemer, have developed an exciting new approach to screening potential new treatments for Alzheimer's disease using C. elegans, a small transparent worm.

Their focus was on tau, a protein involved in maintaining brain cell structure. In Alzheimer's disease and related disorders, tau protein becomes abnormally modified and forms clumps of protein called aggregates. These aggregates are a hallmark of the dying nerve cells in Alzheimer's disease and other related disorders. Diseases with abnormal tau are called tauopathies.

Dr. Kraemer's lab previously developed a worm model for tauopathy by expressing human tau in C. elegans nerve cells. This model has behavioral abnormalities, accumulates abnormal tau protein, and exhibits loss of nerve cells—all of which are general features of Alzheimer's disease.

Using their worm model for this study, they screened a library of 1,120 drugs approved for human use and tested each at three different concentrations to identify compounds that suppress the effects of abnormal tau aggregation.

"We have identified six compounds capable of reliably alleviating tau induced behavioral abnormalities in our C. elegans model for tauopathy. In a human cultured cell model for abnormal tau protein, we have also seen that azaperone treatment can decrease the amount of abnormal tau," said Kraemer.

Azaperone, an antipsychotic drug, normally binds to certain dopamine receptors found in nerve cells. They demonstrated that removing those receptors in either C. elegans or human cells has the same effect as azaperone treatment, indicating that azaperone and related drugs should alter abnormal tau accumulation. Other antipsychotic drugs also have a similar effect to azaperone.

Tests of these compounds for anti-tau properties are now underway in existing mouse models of Alzheimer's disease.

"This study is an exemplary instance of how a simple C. elegans model system may be used to rapidly screen drugs for diseases and evaluate mechanism of action," said Drs. Sangeetha Iyer and Jonathan Pierce-Shimomura, authors of a commentary that accompanies this article.

Dr. John Krystal, Editor of Biological Psychiatry, agrees and added: "Studying the worm, C. elegans, has already provided us with fundamental insights into how the brain develops. The new approach described by McCormick and colleagues suggests that this animal model may be a powerful new approach to studying novel treatments that prevent its decline."

More information: The article is "Dopamine D2 Receptor Antagonism Suppresses Tau Aggregation and Neurotoxicity" by Allyson V. McCormick, Jeanna M. Wheeler, Chris R. Guthrie, Nicole F. Liachko, and Brian C. Kraemer (doi: 10.1016/j.biopsych.2012.08.027). The commentary is "Worming Our Way to Alzheimer's Disease Drug Discovery" by Sangeetha Iyer and Jonathan T. Pierce-Shimomura (doi: 10.1016/j.biopsych.2012.12.026). Both appear in Biological Psychiatry, Volume 73, Issue 5 (March 1, 2013)

Provided by Elsevier

End-of-life plans benefit patients and families

Without an EOL plan, it can be difficult for health care providers to provide care which meets the needs of patients.

10 mar 2013—Health care at the end of life is a difficult issue but a new study highlights the importance of making a plan for end-of-life decisions.

The study, published in the Australian Health Review, aimed to identify end-of-life (EOL) decision-making processes for patients with non-cancer illnesses in a major metropolitan hospital.

Lead researcher Dr Susan Lee, from the Palliative Care Research Team at Monash University, said most patients involved in the study did not discuss plans for end-of-life care until the last 24 hours, affecting their quality of care at the end of their lives.

"In 64 per cent of people, the first discussions about EOL care did not occur until the last 24 hours of life. There were some patients who had a clear plan developed with patient/family involvement, which was fully implemented. However, many others had no plan and minimal patient/family involvement in decision-making," Dr Lee said.

"Without an EOL plan, it can be difficult for health care providers to provide care which meets the needs of patients and reflects their priorities and beliefs. For example, decisions about pain relief, resuscitation, the location of treatment as well as psychological and spiritual care can be outlined in an EOL plan which can give health services guidance when providing care."

The study involved a review of 47 randomly selected patient records over a six-month period. This represented 53 per cent of total deaths in the study period.

The study also found the development and effective implementation of EOL plans was associated with the active involvement of both family members and health professionals. It also identified that there were risks in delaying EOL discussions until illness has progressed to a late stage.

Health care services and providers also played an important role. The study found that trust in, and positive communication with, health professionals and timely referral to palliative care help in the development and successful implementation of EOL plans.

"Factors which were associated with having an EOL plan were multiple previous admissions, shorter hospitalisations and being older at the time of death," Dr Lee said.

"Based on this study, more effort needs to be put into promoting the benefits of EOL plans and supporting health services and providers to implement plans as closely as possible. This will assist in improving the quality of care for people at the end of their lives."

Provided by Monash University

Emotion-health connection not limited to wealthy nations

09 mar 2013—Positive emotions are known to play a role in physical well-being, and stress is strongly linked to poor health, but is this strictly a "First World" phenomenon? In developing nations, is the fulfillment of basic needs more critical to health than how one feels? A UC Irvine researcher has found that emotions do affect health around the world and may, in fact, be more important to wellness in low-income countries.

The study, which appears online in Psychological Science, is the first to examine the emotion-health connection in a representative sample of 150,000 people in 142 countries. Previous research on the topic has been limited to industrialized nations.

"We wondered whether the fact that emotions make a difference in our health is simply because we have the luxury of letting them," said Sarah Pressman, assistant professor of psychology & social behavior and the study's lead author. "We wanted to assess the impact of emotions on health in places where people face famine, homelessness and serious safety concerns that might be more critical correlates of wellness."

Against expectations, researchers found that the link between positive emotions (enjoyment, love, happiness) and health is stronger in countries with a weaker gross domestic product. In fact, the association increased as GDP decreased, according to Pressman.

People in Malawi, which has a per capita GDP of $900, show a more robust connection between positive emotions and health than residents of the U.S., which has a per capita GDP of $49,800.

"A hostile American with hypertension can take blood pressure-lowering medication. A Malawian cannot," Pressman said. "Medical interventions might lower the impact of emotions on health."

Using data from the Gallup World Poll, researchers noted whether participants had reported experiencing enjoyment, love, happiness, worry, sadness, stress, boredom, depression or anger during the previous day. They also measured physical health and the degree to which subjects' basic needs were met. Security was assessed by asking if participants felt safe walking alone at night or whether they had been robbed, assaulted or mugged.

"We hope that by showing that this phenomenon is prevalent and stronger than some factors considered critical to wellness, more attention will be drawn to the importance of studying both positive and negative emotions," Pressman said.

She co-authored the study with Shane Lopez of the Gallup Organization and Matthew Gallagher of Boston University.

Provided by University of California, Irvine

Green tea extract interferes with the formation of amyloid plaques in Alzheimer's disease

07 mar 2013—Researchers at the University of Michigan have found a new potential benefit of a molecule in green tea: preventing the misfolding of specific proteins in the brain.

The aggregation of these proteins, called metal-associated amyloids, is associated with Alzheimer's disease and other neurodegenerative conditions.

A paper published recently in the Proceedings of the National Academy of Sciences explained how U-M Life Sciences Institute faculty member Mi Hee Lim and an interdisciplinary team of researchers used green tea extract to control the generation of metal-associated amyloid-β aggregates associated with Alzheimer's disease in the lab.

The specific molecule in green tea, (—)-epigallocatechin-3-gallate, also known as EGCG, prevented aggregate formation and broke down existing aggregate structures in the proteins that contained metals—specifically copper, iron and zinc.

"A lot of people are very excited about this molecule," said Lim, noting that the EGCG and other flavonoids in natural products have long been established as powerful antioxidants. "We used a multidisciplinary approach. This is the first example of structure-centric, multidisciplinary investigations by three principal investigators with three different areas of expertise."

The research team included chemists, biochemists and biophysicists.

While many researchers are investigating small molecules and metal-associated amyloids, most are looking from a limited perspective, said Lim, assistant professor of chemistry and research assistant professor at the Life Sciences Institute, where her lab is located and her research is conducted.

"But we believe you have to have a lot of approaches working together, because the brain is very complex," she said.

The PNAS paper was a starting point, Lim said, and her team's next step is to "tweak" the molecule and then test its ability to interfere with plaque formation in fruit flies.

"We want to modify them for the brain, specifically to interfere with the plaques associated with Alzheimer's," she said.

Lim plans to collaborate with Bing Ye, a neurobiologist in the LSI. Together, the researchers will test the new molecule's power to inhibit potential toxicity of aggregates containing proteins and metals in fruit flies.

More information: www.pnas.org/conte… 110.abstract

Provided by University of Michigan

New clinical tool assesses health risks for older adults

A UC San Francisco team has developed a tool that can help determine – and perhaps influence – senior citizens' 10-year survivability rates.

06 mar 2013--The simple checklist helps doctors assess health risks that influence the longevity of older adults, and according to the authors, could be an opportunity for seniors to really engage with their primary care provider in having informed discussions about their health care maintenance.

The UCSF team created a 12-item "mortality index" based on data of more than 20,000 adults over the age of 50 from 1998 until 2008, from the Health and Retirement Study (HRS), a nationally-representative sample of independently living U.S. adults. The point system was based on their risk factors and survival rate at the end of 10 years.

Their findings will be published Tuesday, March 5, in the Journal of the American Medical Association (JAMA).

Calculating medical risk can be an inexact science, especially for older adults. Many factors from environmental to chronic diseases can help determine how long a person lives.

"The most important thing we found was the risk factors that go into estimating shorter intermediate survival are very similar to risk factors that go into estimating the likelihood of longer-term survival," said first author Marisa Cruz, MD, a clinical fellow with the UCSF School of Medicine. "We also found that building a tool that clinicians can use to estimate that likelihood of longer-term survival requires considering many different types of risk factors.

"Not one particular risk factor tells you whether or not you are likely to survive but a host of attributes about your life and your medical conditions will give you a clearer picture," she said.

Points for Risk Factors

The clinical tool operates on a point system, and the total determines a patient's 10-year risk of mortality. For example, age, gender and medical conditions were given specific points. Adults between the ages of 60 and 64 received one point, for example, compared to those over the age of 85 who received seven points. Health risks such as current tobacco use, non-skin cancers, chronic lung disease and heart failure each were assigned two points.

"It's an easily usable simple model with only 12 factors. The clinician can ask the patient 'yes' or 'no' questions about his or her health and functional status and then can then go over how the patient could benefit from certain medical interventions," Cruz said.

The ability to complete cognitive or motor skills such as managing one's finances or walking several blocks also was factored into the equation. The difficulty in performing each aptitude generated one to two points.

"The goal of the study is to build a clinical tool that can be used in any setting," Cruz said. "So you want to have these kinds of models to be able to be generally applicable to a primary care provider no matter where they are."

This current research builds on a study that senior author Sei Lee, MD, MAS, assistant professor with the UCSF Division of Geriatrics, did in 2006. He and his team looked at factors that were most likely to influence intermediate term life expectancy.

"We looked at things like what factors are most predictive of someone's likelihood of surviving for four years," he said. "The new study takes that research even further by helping doctors be able to counsel patients on what clinical interventions are most likely to benefit them."

A National Sample

Researchers could not determine any difference in outcome based on geography or ethnicity. Theoretically, someone from Louisiana would have the same outcome as someone from Maine with similar risk factors.

"The goal of health care in general is to improve people's lives but I think that this project and this model in particular are meant to be able to make sure that people live the highest quality life they can," Cruz said. "Any interventions that we do in the name of promoting health must yield more benefit than harm."

"There are national guidelines that most providers are very familiar with like getting a colonoscopy every 10 years or getting a mammogram every two years. I think those are excellent and well-founded and well-studied guidelines," Cruz said. "But I do think that there are some variability in tailoring that to your particular situation, so there's benefit to engaging your primary care provider and asking, 'Does this make sense for me?'"

Provided by University of California, San Francisco

New data show countries around the world grappling with changing health challenges

Alzheimer's disease is the fastest growing threat to health in the US. HIV/AIDS and alcohol are severely eroding the health of Russians. Violence is claiming the lives of young men in large swaths of Latin America, constituting a homicide-driven health crisis. Despite health gains in sub-Saharan Africa, infectious diseases still cause hundreds of thousands of child deaths.

05 mar 2013--These are just some of the new findings from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study (GBD 2010), a systemic, scientific effort to quantify the comparative magnitude of health loss by age, sex, andgeography over time. GBD 2010 involves nearly 500 researchers around the world, and is led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Country-specific findings, including for the United States, will be announced on March 5 at the Bill & Melinda Gates Foundation in Seattle, by IHME Director Dr. Christopher Murray and Foundation Co-chair and Trustee Bill Gates.

These findings detail health trends for the three Ds: demographics, disease, and disability, for 187 countries. The work, which involves researchers at more than 300 institutions in 50 countries, generated 1 billion estimates for health challenges large and small, and was funded by the Bill & Melinda Gates Foundation.

The full range of dynamic visualizations of GBD findings for the US and other countries can be found at http://www.healthmetricsandevaluation.org/gbd. Commentaries on the global findings will also be published on March 5 in The Lancet. In addition, IHME is releasing a brief summary of the findings for each country as well as a report on GBD methods and findings called The Global Burden of Disease: Generating Evidence, Guiding Policy.

"Our goal is to help governments and citizens make well-informed decisions about health policies and investments by arming them with information that is up-to-date, comprehensive, and accurate," said IHME Director Dr. Christopher Murray. "With these new ways of making the data understandable, people everywhere for the first time can see the incredible progress being made in health and the daunting challenges that remain."

IHME expects that the GBD and its online visualization tools will allow health researchers worldwide to engage in a broader discussion with policymakers and the general public about how health challenges should be measured and how improvements in health should be gauged.

"We created these data visualizations to help people explore how diseases, injuries, and risk factors impact their health and the health of people around the world," said IHME Director of Data Development Peter Speyer. "The visualizations make it easy for users to look at the big picture or drill into details by location, age group or gender, and instantly have clear and up-to-date data at their fingertips."

The data and visualizations reveal new developments and persistent problems in global health.

"The GBD allows us to both celebrate progress and keep the momentum going around the world's urgent, unfinished health agendas," said Dr. Rafael Lozano, one of the GBD researchers and a Professor of Global Health at IHME. "We cannot stop caring about things like HIV and malaria or childhood and maternal deaths. At the same time, we need to make similar progress in addressing mental health issues, road traffic injuries, and musculoskeletal disorders."

The GBD is already influencing health policy. Countries are using the findings to measure progress against their peers. The United Kingdom worked closely with the GBD Collaborative to benchmark its performance in improving health against other European countries and the United States. The findings are being published in The Lancet.

"We found that the UK had made significant improvements in health overall, but those were masking serious problems in certain age groups," explained Dr. Alan Lopez, Head of the School of Population Health at the University of Queensland and one of the founders of GBD. "If you look at adults aged 20 to 54, increases in deaths from alcohol and drugs overshadowed the substantial reductions in deaths from greater cervical cancer screenings and efforts to reduce road traffic injuries."

The UK is now looking at ways to address these challenges.

GBD reveals surprising health trends around the world. The global population is increasing and getting older, but those longer lives are also filled with more sickness and disability. In the US, for example, the average life expectancy of women increased from 78.6 years in 1990 to 80.5 years in 2010, yet only 69.5 of those 80.5 years were lived in good health. Similar and even more dramatic gains can be seen in many developing countries. In Rwanda, life expectancy for men increased from 48.2 years in 1990 to 62 years in 2010, but Rwandan men spent nearly nine of those additional years in poor health.

"This is what we are seeing in the hospitals and clinics here in Zambia and throughout Africa," said Dr. Felix Masiye, Head of the Department of Economics at the University of Zambia and a leading health metrics researcher in East Africa. "We are extending our life spans, but we need to be thinking about how we make sure that we are living more of those years in full health."

Much of this increased life expectancy is due to the dramatic progress that has been made in preventing child deaths. In India in 1990, for example, more than 800,000 children ages 1 to 4 died. By 2010, that number was down to 300,000. Yet in sub-Saharan Africa, where significant health strides have been made in the past two decades, diseases like malaria, lower respiratory infections, and diarrheal disease still top the list of child killers in 44 countries.

In many countries, children who survive past the age of 5 are plagued by new, deadly ailments as young adults. In Russia, HIV/AIDS, suicide, and cirrhosis and other alcohol-related disorders have placed a huge burden on health for young adults, according to GBD 2010 estimates. In Colombia and other parts of Central and South America, violence was the number one killer of young men. Even in Japan, which has one of the best health records in the world, suicide became one of the top causes of death among young women in 2010.

People who live into older adulthood are impacted by a range of complex health issues, many of which are disabling but not deadly. In Brazil, and in many countries, low back and neck pain, and other musculoskeletal problems cause a disproportionate amount of disability and health burden. Depression, anxiety, and migraines are other leading ailments in countries rich and poor. In the US, longer life spans have been accompanied by a tremendous increase in the health burden due to Alzheimer's disease. Alzheimer's is now the number 12 cause of health burden in the US, and the number four cause of death. Other wealthy countries have witnessed similar rises.

Health is increasingly being eroded preventable risks that cause lung ailments, musculoskeletal stress, and obesity-related illnesses such as heart disease and diabetes. For example, in Kuwait, the three leading risk factors associated with poor health are high body mass index, dietary risks, and high blood sugar; the burden of disability and premature death associated with each of these is climbing, as are the burdens from heart disease and diabetes. In Thailand, the number of years of disability and premature death attributable to high body mass index increased by 208% between 1990 and 2010. In South Africa, the number went up by 130%.

"Countries have an opportunity with these new GBD visualization tools to narrow their focus on the problems that can be addressed and must be addressed," said Dr. Ali Mokdad, one of the GBD researchers and a Professor of Global Health at IHME. "The GBD provides the evidence for a range of new research projects and targeted policymaking in countries around the world. It also presents the opportunity for countries to conduct detailed burden studies of their own populations."

More information: www.thelancet.com/… 8-9/abstract

Provided by Institute for Health Metrics and Evaluation

Study shows need for improved empathic communication between hospice teams and caregivers

A new study authored by University of Kentucky researcher Elaine Wittenberg-Lyles shows that more empathic communication is needed between caregivers and hospice team members.

04 Mar 2013—A new study authored by University of Kentucky researcher Elaine Wittenberg-Lyles shows that more empathic communication is needed between caregivers and hospice team members.

The study, published in Patient Education and Counseling, was done in collaboration with Debra Parker Oliver, professor in the University of Missouri Department of Family and Community Medicine. The team enrolled hospice familycaregivers and interdisciplinary team members at two hospice agencies in the Midwestern United States.

Researchers analyzed the bi-weekly web-based videoconferences between family caregivers and their hospice teams. The authors coded the data using the Empathic Communication Coding System (ECCS) and identified themes within and among the coded data. The team reviewed 82 total meetings.

Overall, the researchers noted that members of the hospice team tended to react to caregiver empathic opportunities with a perfunctory response, implicit recognition, or simple acknowledgement as defined by the ECCS scale. Most caregiver statements were met with biomedical or procedural talk from the hospice team.

Few responses went beyond to offer confirmation with a positive remark to the caregiver, and even fewer provided a shared experience to address the caregivers' emotional needs.

Prior research has shown that a physician's expression of empathy positively influences the patient-physician relationship, but as this study shows, this is often not the norm. Other research shows that physicians tend to respond more to informational cues from patients than emotional cues, and often respond to patient concerns by turning the conversation to biomedical information or medical explanation, nonspecific acknowledgement or reassurance.

"This study shows the need for better empathic communication between caregivers and hospice team members," said Wittenberg-Lyles, who holds a joint appointment in the UK College of Communications and the UK Markey Cancer Center. "Improving communication about psychosocial issues, emotional losses and frustrations for the caregiver will lead to better patient-centered care for hospice patients and their families."

Provided by University of Kentucky

Mediterranean-style diets found to cut heart risks (Update)

In this Thursday Jan. 17, 2013 file photo, a woman buys fruit at a market in Barcelona, Spain. Mediterranean diets have long been touted as heart-healthy, but that's based on observational studies. Now, one of the longest and most scientific tests suggests this style of eating can cut the chance of suffering heart-related problems, especially strokes, in older people at high risk of them. The study lasted five years and involved about 7,500 people in Spain. Results were published online Monday, Feb. 25, 2013 by the New England Journal of Medicine. (AP Photo/Emilio Morenatti)

Pour on the olive oil, preferably over fish and vegetables: One of the longest and most scientific tests of a Mediterranean diet suggests this style of eating can cut the chance of suffering heart-related problems, especially strokes, in older people at high risk of them.

03 mar 2013--The study lasted five years and involved about 7,500 people in Spain. Those who ate Mediterranean-style with lots of olive oil or nuts had a 30 percent lower risk of major cardiovascular problems compared to those who were told to follow a low-fat diet but who in reality, didn't cut fat very much. Mediterranean meant lots of fruit, fish, chicken, beans, tomato sauce, salads, and wine and little baked goods and pastries.

Mediterranean diets have long been touted as heart-healthy, but that's based on observational studies that can't prove the point. The new research is much stronger because people were assigned diets to follow for a long time and carefully monitored. Doctors even did lab tests to verify that the Mediterranean diet subjects were consuming more olive oil or nuts as recommended.

Most of these people were taking medicines for high cholesterol and blood pressure, and researchers did not alter those proven treatments, said one study leader, Dr. Ramon Estruch of Hospital Clinic in Barcelona.

But as a first step to prevent heart problems, "we think diet is better than a drug" because it has few if any side effects, Estruch said. "Diet works."

Results were published online Monday by the New England Journal of Medicine and were discussed at a nutrition conference in Loma Linda, California

People in the study were not given rigid menus or calorie goals because weight loss was not the aim. That could be why they found the "diets" easy to stick with—only about 7 percent dropped out within two years. There were twice as many dropouts in the low-fat group than among those eating Mediterranean-style.

Researchers also provided the nuts and olive oil, so it didn't cost participants anything to use these relatively pricey ingredients. The type of oil may have mattered—they used extra-virgin olive oil, which is minimally processed and richer than regular or light olive oil in the chemicals and nutrients that earlier studies have suggested are beneficial.

The study involved people ages 55 to 80, just over half of them women. All were free of heart disease at the start but were at high risk for it because of health problems—half had diabetes and most were overweight and had high cholesterol and blood pressure.

They were assigned to one of three groups: Two followed a Mediterranean diet supplemented with either extra-virgin olive oil (4 tablespoons a day) or with walnuts, hazelnuts and almonds (a fistful a day). The third group was urged to eat a low-fat diet heavy on bread, potatoes, pasta, rice, fruits, vegetables and fish and light on baked goods, nuts, oils and red meat.

Independent monitors stopped the study after nearly five years when they saw fewer problems in the two groups on Mediterranean diets.

Doctors tracked a composite of heart attacks, strokes or heart-related deaths. There were 96 of these in the Mediterranean-olive oil group, 83 in the Mediterranean-nut group and 109 in the low-fat group.

Looked at individually, stroke was the only problem where type of diet made a big difference. Diet had no effect on death rates overall.

The Mediterranean diet proved better even though its followers ate about 200 calories more per day than the low-fat group did. The study leaders now are analyzing how each of the diets affected weight gain or loss and body mass index.

The Spanish government's health research agency initiated and paid for the study, and foods were supplied by olive oil and nut producers in Spain and the California Walnut Commission. Many of the authors have extensive financial ties to food, wine and other industry groups but said the sponsors had no role in designing the study or analyzing and reporting its results.

Rachel Johnson, a University of Vermont professor who heads the American Heart Association's nutrition committee, said the study is very strong because of the lab tests to verify oil and nut consumption and because researchers tracked actual heart attacks, strokes and deaths—not just changes in risk factors such as high cholesterol.

"At the end of the day, what we care about is whether or not disease develops," she said. "It's an important study."

Rena Wing, a weight-loss expert at Brown University, noted that researchers provided the oil and nuts, and said "it's not clear if people could get the same results from self-designed Mediterranean diets"—or if Americans would stick to them more than Europeans who are used to such foods.

Dr. George Bray of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, said he would give the study "a positive—even glowing—comment" and called it "the best and certainly one of the largest prospective dietary trials ever done."

"The data are sufficiently strong to convince me to move my dietary pattern closer to the Mediterranean Diet that they outline," he added.

Another independent expert also praised the study as evidence diet can lower heart risks.

"The risk reduction is close to that achieved with statins," cholesterol-lowering drugs, said Dr. Robert Eckel, a diet and heart disease expert at the University of Colorado.

"But this study was not carried out or intended to compare diet to statins or blood pressure medicines," he warned. "I don't think people should think now they can quit taking their medicines."

More information: Journal: www.nejm.org

AAD: Older men should screen themselves for skin cancer

Men aged 50 years or older are more likely to be diagnosed with invasive melanoma by a dermatologist than to detect it themselves; and they are less likely to seek a skin cancer screening due to a suspicious lesion, according to the results of two studies presented at the annual meeting of the American Academy of Dermatology, held from March 1 to 5 in Miami Beach.

02 mar 2013—Men aged 50 years or older are more likely to be diagnosed with invasive melanoma by a dermatologist than to detect it themselves; and they are less likely to seek a skin cancer screening due to a suspicious lesion, according to the results of two studies presented at the annual meeting of the American Academy of Dermatology, held from March 1 to 5 in Miami Beach.

Laura K. Ferris, M.D., from the University of Pittsburgh School of Medicine, and colleagues examined which patients detect their own melanomas before assessment by a dermatologist in a cohort of 167 patients diagnosed with melanoma. The researchers found that the patients discovered 60.5 percent of the melanomas, and that cases detected by the dermatologist were more likely in older patients. Men aged 50 years or older were more likely to be diagnosed with invasive melanoma by a dermatologist, compared with women in the same age group and younger men and women.

In a second study, to examine the impact of age and gender, Ferris and colleagues surveyed 478 adults who went for skin cancer screening by a dermatologist. The researchers found that men aged 50 years or older mainly sought a skin examination because they had had a previous diagnosis of skin cancer (64.6 percent). Compared with other patients, this group was less likely to seek a skin cancer screening because of a suspicious spot (11 versus 22.5 percent).

"Older men are most at risk for melanoma and are most likely to die due to a delayed diagnosis," Ferris said in a statement. "This should be a wake-up call to men over 50 and their loved ones."

More information: Press Release 
More Information

Defining the new normal in aging

Diana McIntyre approaches her 80th birthday later this year with the same energy and zest for life of friends decades her junior. Aside from back surgery years ago, she's never been sick and, through a busy volunteer schedule, never seems to slow down.

01 mar 2013--McIntyre's good health feels normal—at least to her—although she recognizes not all seniors are so fortunate. But when it comes to terms like "normal," "healthy" or "successful" aging, she shakes her head.

"I don't know what would be considered normal aging," said McIntyre, past president of the Seniors Association of Greater Edmonton. "What's normal for a 45-year-old? What's normal for an 80-year-old? Those are really irrelevant terms as far as I'm concerned. My own philosophy is I would like to do as much as I can, for as long as I can, as well as I can."

Hannah O'Rourke, a PhD student and Vanier scholar in the Faculty of Nursing at the University of Alberta, says terms such as normal or healthy aging are commonly used by health-care professionals to describe or influence how seniors should age. Often they emphasize personal lifestyle choices in staying healthy, such as eating well, staying active and not smoking.

Chronic disease might be the norm, but doesn't have to be the focus

But those terms can fall short of the experiences of most older Canadians, and how they're used affects how a society views older generations—especially seniors living with chronic diseases such as cancer, diabetes and heart disease, says O'Rourke.

"Normal aging is not something we can easily define," she says. "There are many older adults with chronic disease who report they still enjoy life. When aging is just defined as 'healthy' and 'devoid of disease,' it doesn't leave a place for what to do with all of these older adults who are still aging with chronic illnesses.

"Cures for chronic illnesses are not always around the corner, and health-care teams have patients to care for now. We need to find ways to support older adults with chronic disease to live well according to their own definitions of health and normality."

O'Rourke, a registered nurse whose research focuses on quality of life for people with dementia, points out that many Canadian seniors are well enough to live at home, yet 80 per cent have some form of chronic disease. With that large a majority, putting the onus on individual choices to age successfully sends the wrong message.

"The implication is that if you have a chronic illness as an older adult, you've somehow failed in this goal of aging without chronic disease, which is perhaps not that realistic a goal."

Sound the alarm, a grey wave is here

O'Rourke says much of the policy work, research and teaching about aging also relies on statistics to describe Canada's greying population, such as estimates that, by 2026, one-fifth of the country will be over the age of 65. But those statistics frame aging as a problem to be fixed, she says, and that affects how we view seniors.

McIntyre feels these implications, and not in a positive way.

"When people think of seniors, they think of their limitations instead of their capabilities," she says. "The huge majority of us are doing very well on our own, thank you."

O'Rourke points out that an aging society can also be viewed as a success story because it means the majority of us are living well into our older years.

"Just because something requires resources doesn't necessarily mean it's a huge problem."

Provided by University of Alberta