A Simple Way For Older Adults To Asses Arterial Stiffness: Reach For The Toes

07 Oct 2009

How far you can reach beyond your toes from a sitting position - normally used to define the flexibility of a person's body - may be an indicator of how stiff your arteries are.

A study in the American Journal of Physiology has found that, among people 40 years old and older, performance on the sit-and-reach test could be used to assess the flexibility of the arteries. Because arterial stiffness often precedes cardiovascular disease, the results suggest that this simple test could become a quick measure of an individual's risk for early mortality from heart attack or stroke.

"Our findings have potentially important clinical implications because trunk flexibility can be easily evaluated," said one of the authors, Kenta Yamamoto. "This simple test might help to prevent age-related arterial stiffening."

It is not known why arterial flexibility would be related to the flexibility of the body in middle age and older people. But the authors say that one possibility is that stretching exercises may set into motion physiological reactions that slow down age-related arterial stiffening.

The study "Poor trunk flexibility is associated with arterial stiffening" appears in the American Journal of Physiology - Heart and Circulatory Physiology. The authors are: Kenta Yamamoto of the University of North Texas and the National Institute of Health and Nutrition, Japan; Hiroshi Kawano, Yuko Gando and Mitsuru Higuchi of Waseda University, Japan; Motoyuki Iemitsu of International Pacific University, Japan; Haruka Murakami, Michiya Tanimoto, Yumi Ohmori, Izumi Tabata, Motohiko Miyachi of the National Institute of Health and Nutrition; and Kiyoshi Sanada of Ritsumeikan University, Japan. The American Physiological Society published the study.

Arteries should be elastic

Healthy blood vessels are elastic, and elasticity helps to moderate blood pressure. Arterial stiffness increases with age and is a risk factor for cardiovascular disease and death. Previous studies have established that physical fitness can delay age-related arterial stiffness, although exactly how that happens is not understood. The authors noted that people who keep themselves in shape often have a more flexible body, and they hypothesized that a flexible body could be a quick way to determine arterial flexibility.

The researchers studied 526 healthy, non-smoking adults, 20 to 83 years old, with a body mass index of less than 30. They wanted to see whether flexibility of the trunk, as measured with the sit and reach test, is associated with arterial stiffness. The researchers divided the participants into three age groups:

- young (20-39 years old)
- middle aged (40-59 years old)
- older (60-83 years old)

The researchers asked participants to perform a sit-and-reach test. The volunteers sat on the floor, back against the wall, legs straight. They slowly reached their arms forward by bending at the waist. Based on how far they could reach, the researchers classified the participants as either poor- or high-flexibility.

The researchers also measured blood pressure and the speed of a pulse of blood as it flowed through the body. They measured how long the pulse takes to travel between the arm and the ankle and between the neck and the leg. They also measured aortic pressure in some participants and tested the participants for cardiorespiratory fitness, muscular strength and endurance.

The study found that trunk flexibility was a good predictor of artery stiffness among middle age and older participants, but not among the younger group. In middle age and older participants, they also found that systolic blood pressure (the peak pressure that occurs as the heart contracts) was higher in poor-flexibility than in high-flexibility groups.

What's happening?

Why would the flexibility of the body be a good indicator of arterial stiffness? In the study, the authors speculate on why this would be. One possibility is that there is a cause and effect: the stretching exercises that provide flexibility to the body may also slow the age-related stiffening of the arteries. The study found that arterial stiffness among middle age and older people was associated with trunk flexibility but was independent of muscle strength and cardiorespiratory fitness (as measured by performance on an exercycle). In addition, they cited another recent study that found that middle age and older adults who began a regular stretch exercise program significantly improved the flexibility of their carotids, a major artery found in the neck.

"Together with our results, these findings suggest a possibility that improving flexibility induced by the stretching exercise may be capable of modifying age-related arterial stiffening in middle-aged and older adults," Dr. Yamamoto said. "We believe that flexibility exercise, such as stretching, yoga and Pilates, should be integrated as a new recommendation into the known cardiovascular benefits of regular exercise."

Loneliness Linked To High Blood Pressure In Aging Adults

08 oct 2009--Loneliness is a major risk factor in increasing blood pressure in older Americans, and could increase the risk of death from stroke and heart disease, new research at the University of Chicago shows.

Scholars found that lonely people have blood pressure readings that are as much as 30 points higher than in non-lonely people, even when other factors such as depressive symptoms or perceived stress are taken into account, said Louise Hawkley, Senior Research Scientist with the Center for Cognitive and Social Neuroscience at the University of Chicago, and John Cacioppo, the Tiffany & Margaret Blake Distinguished Service Professor in Psychology. This is equivalent to the difference between a normal blood pressure of 120 and a level of 150 which signifies Stage 1 hypertension. Blood pressure differences between lonely and non-lonely people were smallest at age 50 and greatest among the oldest adults tested, those at retirement age.

Hawkley and Cacioppo are authors of the paper, "Loneliness is a Unique Predictor of Age-Related Differences in Systolic Blood Pressure," published in the journal Psychology and Aging. Other co-authors were Christopher Masi, Assistant Professor of Medicine at the University of Chicago, and Jarett Berry of the Department of Preventive Medicine, Northwestern.

The increase in blood pressure associated with loneliness is about the same magnitude as reductions attained through weight loss and regular physical activity in people suffering from hypertension. "By these standards, improvements in a sense of social connectedness may have clinical benefits comparable to lifestyle modifications," the authors wrote.

The team based their research on a study of 229 people aged 50 to 68. The randomly chosen group includes whites, African Americans and Latinos who are part of a long-term study on aging. Members of the group were asked a series of questions to determine if they perceived themselves as lonely.

They were asked to rate their connections with others through a series of topics, such as "I have a lot in common with the people around me," "My social relationships are supeficial," and "I can find companionship when I want it."

The research team also examined data on weight, alcohol consumption, smoking, blood pressure medications, and demographic characteristics and found that people who rated high on being lonely had a significantly higher blood pressure than non-lonely people with similar profiles on the other measures.

The research also showed that the normal increases in blood pressure associated with aging are augmented by loneliness.

The paper builds on Cacioppo's earlier research that demonstrated that the loneliness is related to increased peripheral vascular resistance among young people. Although both lonely and non-lonely people in that study experienced stress, subjects in both studies reacted to stress differently.

"Lonely people differ from non-lonely individuals in their tendency to perceive stressful circumstances as threatening rather than challenging, and to passively cope with stress by failing to solicit instrumental and emotional support and by withdrawing from stress rather than by actively coping and attempting to problem solve," Cacioppo said.

The study on young people showed that stress caused an increase in resistance to blood flow brought on by their response to stress. Greater resistance to blood flow in lonley people compared to non-lonely idnvidiauls could increase blood pressure over the lifetime of lonely people, Cacioppo said.

Longitudinal studies are underway to look at how loneliness, now associated with an increase in blood pressure, may play a causal role in the increase, he said.

"I'm surprised by the magnitude of the relationship between loneliness and hypertension in this well-controlled cross-sectional study," said Richard Suzman, Ph.D., director of the Behavioral and Social Research Program at the National Institute on Aging (NIA), a funder of the research "Older people's relationships are often disrupted by death, illness and geographic mobility. One of NIA's goals is to help determine what can be done to improve the quality of relationships and social connectedness as a way to ease loneliness and reduce blood pressure."

Antioxidants may raise diabetes risk: study

CHICAGO, 07 oct 2009– Instead of protecting against diabetes, antioxidants -- compounds in foods and supplements that prevent cell damage -- may actually increase the chances of getting diabetes, at least in the early stages, Australian researchers reported on Tuesday.

"In the case of early type 2 diabetes ... our studies suggest that antioxidants would be bad for you," Tony Tiganis of Monash University in Australia, whose study appears in the journal Cell Metabolism, said in a statement.

Antioxidants are protective proteins that can prevent cell damage caused by charged particles known as reactive oxygen species. This oxidative stress is thought to add to the progression of several diseases, including type 2 diabetes.

Because antioxidants fight oxidative stress, they have become a popular food supplement. But Tiganis said the picture appears to be a bit more complicated.

"We think there is a delicate balance, and that too much of a good thing -- surprise, surprise -- might be bad," he said.

Tiganis' team studied the effects of oxidative stress in mice fed a high-fat diet for 12 weeks. One group of mice lacked an enzyme known as Gpxl, which helps counter oxidative stress.

They found mice that lacked the enzyme were less likely to develop insulin resistance -- an early sign of diabetes -- than normal mice. But when they treated the enzyme-deficient mice with an antioxidant, "they lost this advantage and become more 'diabetic," Tiganis said in an e-mail.

He said oxidative stress may be working not to damage the body but to inhibit enzymes that hurt the body's ability to use insulin early on in the development of diabetes, and that antioxidants remove this protective mechanism.

"Our work suggests that antioxidants may contribute to early development of insulin resistance, a key pathological hallmark of type 2 diabetes," Tiganis said.

He cautioned that the study was in mice and more study in people is needed.

But he said other studies have suggested that antioxidants can shorten lifespan in both worms and humans. And clinical trials in people have shown that taking antioxidants does not protect healthy people from developing diabetes.

"My belief is that individuals who are otherwise healthy should not take antioxidants, but rather eat healthy and exercise," he said.

An estimated 23.6 million people in the United States and 246 million people globally have diabetes. Most have type 2, the kind linked with a poor diet and lack of exercise.

New guidelines for incorporating spirituality in end-of-life care

New Rochelle, NY, 07 oct 2009—Guidelines derived from a recent Consensus Conference, including recommendations on the role of healthcare providers in the assurance of quality spiritual care to patients in a palliative care setting, are published in a comprehensive report in Journal of Palliative Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc. (www.liebertpub.com). Journal of Palliative Medicine is the official journal of the Center to Advance Palliative Care (CAPC) and an official journal of the Hospice and Palliative Nurses Association (HPNA). The article is available free online at www.liebertpub.com/jpm

The article, "Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference," represents the final Consensus Report of a conference sponsored by the Archstone Foundation of Long Beach, CA. According to Joseph F. Prevratil, JD, President and CEO, "The report's recommendations seek to ensure that spiritual care is a fundamental component of quality palliative care, which strives to prevent and relieve suffering for seriously ill patients and their families."

"For the first time we have a practical model for the implementation of inter-professional spiritual care which will result in improved healthcare outcomes for patients," says Christina Puchalski, MD, MS, FACP, Co-Principal Investigator and lead author of the Consensus Report, from The George Washington Institute for Spirituality and Health (GWish) at the George Washington University Medical Center.

The Consensus Report outlines seven key areas for improving spiritual care: Spiritual Care Models; Spiritual Assessment; Spiritual Treatment/Care Plans; Interprofessional Team; Training/Certification; Personal and Professional Development; and Quality Improvement. Co-authors Christina Puchalski, MD, MS, FACP, and Betty Ferrell, PhD, MA, FAAN, FPCN, Principal Investigator from the City of Hope and colleagues from City of Hope National Medical Center present practical recommendations for implementing spiritual care in palliative care, hospice, long-term care, and other clinical settings. The guidelines provide spiritual care models, recommendations for professional training, advice on how to develop accountability measures to ensure integration of spiritual care, and guidance on engaging community clergy and spiritual leaders in the care of patients and families.

"Of the physical, emotional, practical, and spiritual dimensions of hospice and palliative medicine, spirituality has been least well addressed. This report aims to improve that situation," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine, and Provost, Institute for Palliative Medicine at San Diego Hospice.

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Journal of Palliative Medicine, published monthly in print and online, is an interdisciplinary journal that reports on the clinical, educational, legal, and ethical aspects of care for seriously ill and dying patients. The Journal includes coverage of the latest developments in drug and non-drug treatments for patients with life-threatening diseases including cancer, AIDS, cardiac disease, pulmonary, neurologic, respiratory conditions, and other diseases. The Journal reports on the development of palliative care programs around the United States and the world, and on innovations in palliative care education. Tables of contents and a free sample issue may be viewed online at www.liebertpub.com/jpm

Research Indicates People Over 65 Should Take High Dose Of Vitamin D To Prevent Falls

06 oct 2009--A study published on bmj.com today reports that a daily supplement of vitamin D at a dose of 700-1000 IU reduces by 19 percent the risk of falling among older people. However, a dose inferior to 700 IU per day has no effect.

IU is an international unit of measurement for vitamins and other biologically active substances.

One in three people aged 65 and older experience at least one fall, each year. Among those, around 6 percent result in a fracture. With the older segment of the population growing old, fall prevention has become a public health goal.

Earlier research indicates that vitamin D improves strength and balance among older people. However, other trials have found no noteworthy effect on the risk of falling.

In order to find out more, an international team of researchers evaluated the results of eight fall prevention trials. They assessed the effectiveness of vitamin D in preventing falls among older individuals, aged 65 or more. To minimize bias, differences in study design and feature were considered.

The collective results indicated that benefit from supplemental vitamin D on fall prevention depended on treatment dose.

Supplemental vitamin D2 and Vitamin D3 were investigated. 700-1000 IU supplemental vitamin D per day (vitamin D2 or vitamin D3) reduced falls by 19 percent and up to 26 percent with vitamin D3.

This outcome was independent of age, type of dwelling or additional calcium supplementation. The effect was considerable within two to five months of starting treatment. It extended beyond twelve months.

At a dose of less than 700 IU per day, supplemental vitamin D did not reduce falls.

Findings showed that the use of active forms of vitamin D did not appear to be more effective than 700-1000 IU supplemental vitamin D. In addition, active forms of vitamin D cost more than standard supplemental vitamin D. They are also associated with a higher risk for hypercalcaemia which is an elevated calcium level in the blood.

The authors say: "to reduce the risk of falling, a daily intake of at least 700-1000 IU supplemental vitamin D is warranted in all individuals aged 65 and older."

In closing, they suggest that future research should explore the effectiveness of higher doses to optimize the fall prevention benefit with vitamin D.

"Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials"
H A Bischoff-Ferrari, director of centre on aging and mobility, B Dawson-Hughes, director of bone metabolism laboratory, HB Staehelin, professor emeritus , J E Orav, associate professor of biostatistics, A EStuck, professor of geriatrics, R Theiler, head of rheumatology, J B Wong, professor of medicine , A Egli, fellow, D P Kiel, associate professor of medicine, J Henschkowski, fellow
BMJ 2009; 339:b3692
doi:10.1136/bmj.b3692
bmj.com

Very Elderly Age Group: Need For Routine Stroke Prevention Therapies And Research In Epilepsy

06 oct 2009--A review published Online First and in the November edition of The Lancet Neurology reports that routine stroke prevention therapies are underused in the very elderly, but could be very effective in this age group. The article is the work of Dr Nerses Sanossian of the University of Southern California and Dr Bruce Ovbiagele of the UCLA Stroke Center and Department of Neurology, Los Angeles, CA, USA.

The average human lifespan is extending and as a result there are more individuals above 80 years old who have a high quality of life. However, these very elderly individuals are particularly vulnerable to stroke. There have been substantial advances in stroke research, with several therapeutic drugs able to enhance clinical outcomes in people with stroke or who are at risk of stroke. But still, the very elderly seem to be given fewer vascular protection interventions that have been shown to be effective in their younger counterparts. These treatments might be of benefit to this group of patients. However, there has been an under-representation of the very elderly in studies of stroke therapy. In fact, new data indicate that the use of several of these therapies in routine clinical practice in the very elderly can be useful.

The authors write in conclusion: "With the rapidly growing population of individuals above 80 years, future stroke trials need to include the very elderly to facilitate ready generalisability of results and to convince sceptical clinicians that all patients with stroke should benefit from prompt evidence-based treatment, regardless of age."

A second Lancet Neurology review discusses epilepsy in later life. It is written by Professor Martin Brodie, Western Infirmary, Glasgow, UK, and colleagues. They remark: "Epilepsy is most likely to develop in later life. The burden of this disorder on health-care resources will rise further as the world's population continues to age."

There is growing prevalence and potentially deep physical and psychosocial effects of new-onset epilepsy in elderly people. However shockingly, this disorder has received little research attention. There is growing agreement that future treatment strategies should move beyond symptomatic relief like seizure control. Instead, they should focus on achieving cure and prevention for those at risk. In accordance with this objective, the European scientific community has recently identified a number of research priorities. Some of the aspects that are particularly relevant to the elderly population include:

• preventing the development of epilepsy after brain trauma
• translating genetic knowledge to optimise care of patients
• reducing the life-burden of seizures
• improving treatment and prognosis

The authors write in conclusion: "Old age has become the most common time in life to develop epilepsy in high-income societies. Because of the often atypical presentation, concomitant cognitive impairment, and non-specific abnormalities in routine investigations, establishing a correct diagnosis can be particularly challenging. A multispecialty, multi-professional strategy can help to facilitate rapid diagnosis and ensure a comprehensive approach in ameliorating the physical as well as the psychosocial effects of the diagnosis of epilepsy on elderly patients and their families."

A complementary Lancet Neurology editorial comments: "The rapidly increasing elderly population poses a major challenge for future health-care systems. Many of the diseases of old age are neurological disorders, so neurological practice is likely to be disproportionately affected by an ageing society...there is a dearth of clinical trials among older people - indeed, very elderly patients are systematically excluded from many clinical trials. If we are to meet the challenge of caring for rising numbers of elderly patients in the future, more good-quality trials in older people are needed to inform clinical practice."

"Prevention and management of stroke in very elderly patients"
Nerses Sanossian, Bruce Ovbiagele
DOI: 10.1016/S1474-4422(09)70259-5

"Neurology in the elderly: more trials urgently needed"
DOI: 10.1016/S1474-4422(09)70265-0
The Lancet Neurology

Study shows that elderly women sleep better than they think, men sleep worse

Westchester, Ill.05 oct 2009 —A study in the Oct.1 issue of the journal Sleep shows that elderly women sleep better than elderly men even though women consistently report that their sleep is shorter and poorer.

Women reported less and poorer sleep than men on all of the subjective measures, including a 13.2 minute shorter total sleep time (TST), 10.1 minute longer sleep onset latency (SOL), and a 4.2 percent lower sleep efficiency. When sleep was measured objectively, however, women slept 16 minutes lon¬ger than men, had a 1.2 percent higher sleep efficiency, and had less fragmented sleep. Multivariate regression analysis showed that these discrepancies were partly explained by determinants of sleep duration such as sleep medication use and alcohol consumption.

Principal investigator Henning Tiemeier, MD, PhD, associate professor of psychiatric epidemiology at the Erasmus Medical Center in Rotterdam, Netherlands, said he was surprised that women slept longer and better, and reported their sleep duration more accurately, than men.

"The difference between subjective and objective sleep quality arise not because women are more likely to be complainers, but because men strongly overestimate their sleep duration," said Tiemeier. The study involved 956 participants between the ages of 59 and 79 years; 52.3 percent were women. Information was obtained from the Rotterdam Study, a population-based cohort study aimed at assessing the occurrence of and risk factors for chronic diseases in the elderly.

Subjects used an actigraph that can be worn like a watch for an average of six consecutive nights to objectively measure sleep parameters. Subjective sleep quality was assessed with a sleep diary and the Pittsburgh Sleep Quality Index.

The mean difference between diary-reported and actigraphic total sleep time was larger in men (estimated total sleep time of 7.01 hours versus 6.40 objectively measured hours) than in women (estimated total sleep time of 6.79 hours versus 6.65 objectively measured hours). Sleep medication use was more common in women (14.9%) than men (6.1%), and both sleep medication use and depressive symptoms were related to significantly shorter subjective sleep time in women. Men consumed twice as much alco¬hol as women (1.0 drink/day versus 0.5 drink/day), and only alcohol consumption decreased the sex difference in actigraphic total sleep time.

According to the authors, the sex differences in both self-reported and objective sleep measures may be explained by the fact that women may require more sleep than men, meaning the same amount of sleep may be satisfactory for men but not for women.

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Sleep is the official journal of the Associated Professional Sleep Societies, LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The APSS publishes original findings in areas pertaining to sleep and circadian rhythms. Sleep, a peer-reviewed scientific and medical journal, publishes 12 regular issues and 1 issue comprised of the abstracts presented at the SLEEP Meeting of the APSS.

Sleep Deprivation May Be Associated With Alzheimer's

Sleep-deprived mice have higher levels of amyloid-β, greater amyloid-β plaque deposition

05 oct 2009-- Sleep deprivation may play a role in the development of Alzheimer's disease, according to research published online Sept. 24 in Science.

Jae-Eun Kang, Ph.D., of Washington University in St. Louis, and colleagues analyzed data from experiments on mice examining the effects of wakefulness, sleep deprivation, and orexin -- a molecule that regulates wakefulness -- on amyloid-β (Aβ) measurements.

The researchers found that in transgenic and wild-type mice, animals had a difference in interstitial fluid Aβ levels between dark and light phases, with higher levels during the dark period, though fluctuations were linked to the sleep-wake cycle rather than to exposure to light or darkness. Mice subjected to sleep deprivation had significantly higher Aβ levels. Infusion of orexin-A -- which induces rodent wakefulness -- was associated with higher Aβ levels. In addition, mice subjected to sleep restriction for 21 days had higher Aβ plaque deposition; however, chronic orexin receptor blockade for two months decreased Aβ plaque formation in amyloid precursor protein transgenic mice in several brain regions compared to controls.

"Sleep is a complex behavioral state whose ultimate functions remain poorly understood. Sleep disturbances, in addition to being prominent in neurodegenerative diseases, could exacerbate a fundamental process leading to neurodegeneration, and optimization of sleep time could potentially inhibit aggregation of toxic proteins and slow the progression of Alzheimer's disease," the authors conclude.

Abstract
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Most babies born this century will live to 100

LONDON, 02 oct 2009 – Most babies born in rich countries this century will eventually make it to their 100th birthday, new research says. Danish experts say that since the 20th century, people in developed countries are living about three decades longer than in the past. Surprisingly, the trend shows little sign of slowing down.

In an article published Friday in the medical journal Lancet, the researchers write that the process of aging may be "modifiable."

James Vaupel of the Max Planck Institute in Germany and colleagues in Denmark examined studies published globally in 2004-2005 on numerous issues related to aging. They found life expectancy is increasing steadily in most countries, even beyond the limits of what scientists first thought possible. In Japan, for instance, which has the world's longest life expectancy, more than half of the country's 80-year-old women are expected to live to 90.

"Improvements in health care are leading to ever slowing rates of aging, challenging the idea that there is a fixed ceiling to human longevity," said David Gems, an aging expert at University College London. Gems was not connected to the research, and is studying drugs that can lengthen the life span of mice, which may one day have applications for people.

"Laboratory studies of mice, including our own, demonstrate that if you slow aging even just a little, it has a strong protective effect," he said. "A pill that slowed aging could provide protection against the whole gamut of aging-related diseases."

While illnesses affecting the elderly like heart disease, cancer and diabetes are rising, advances in medical treatment are also making it possible for them to remain active for longer. The obesity epidemic, however, may complicate matters. Extra weight makes people more susceptible to diseases and may increase their risk of dying.

In the U.S., data from 1982 to 2000 showed a major drop in illness and disability among the elderly, though that has now begun to reverse, probably linked to the rise in obesity.

The graying population will slowly radically transform society, and retirement ages may soon be pushed back, said Richard Suzman, an aging expert at the U.S. National Institute on Aging.

"We are within five to 10 years of a watershed event where there will be more people on earth over 65 than there under five," he said. "Those extra years need to be financed somehow and we need to start thinking about it now."

____

On the Net:

http://www.lancet.com

Vitamin D May Improve Melanoma Survival

02 oct 2009-- Higher levels of vitamin D are linked to less severe, less deadly melanoma lesions in people with skin cancer, new research suggests.

The findings provide more support for the idea that vitamin D is crucial to skin health. Many Americans, however, don't get enough of it, perhaps because they limit sun exposure and drink less milk than in the past.

"Although avoiding sunburn is very important in order to prevent melanoma, it is also important to avoid becoming deficient in vitamin D," said Dr. Julia A. Newton-Bishop, a dermatology professor at the University of Leeds in England and a study co-author. "This is especially important for melanoma patients in whom low vitamin D levels appear to be harmful."

Newton-Bishop and her research colleagues looked at the medical records of 872 people with melanoma and tried to link their vitamin D levels to the severity of their lesions and their likelihood of surviving without a relapse.

Those with higher levels of vitamin D in their bodies had less severe lesions -- the lesions were thinner -- and a lower rate of relapse, the researchers found.

The results are reported in the Sept. 14 issue of the Journal of Clinical Oncology.

"The research suggests that low levels of vitamin D allow the melanoma tumors to grow better and, therefore, to be more of a threat to the patient," Newton-Bishop said.

It's not clear how food, sun exposure and supplements contributed to the higher levels of vitamin D in some people, although they did take more multivitamins and cod liver oil, she said.

Melanoma is the cause of most skin cancer deaths, even though it accounts for less than 5 percent of skin cancer cases. The best way to prevent melanoma is by avoiding excessive sun exposure.

To boosts levels of vitamin D, people with melanoma should take daily supplements, the authors concluded, and consume foods that contain vitamin D, such as fatty fish and some fortified cereals.

The study is provocative and "somewhat contrary to traditional thinking," said Dr. Adit Ginde, an assistant professor of surgery at the University of Colorado Denver School of Medicine. More work needs to be done to prove that vitamin D levels directly affect skin cancer development and to determine if increasing the levels will help people with melanoma, he said.

Vitamin D appears to be more than a cancer fighter. Low levels of vitamin D have been linked to a variety of health problems, including heart disease, infections and poor overall health. And adults with low levels may suffer from lower bone mineral density.

But researchers have noticed that vitamin D deficiency has been on the rise in recent decades. An earlier study led by Ginde found that more than 75 percent of Americans don't have high enough vitamin D levels, with African-Americans and Latinos at especially high risk.

Vitamin D is naturally present in few foods, and some researchers recommend supplements containing as many as 2,000 International Units (IU) of vitamin D for many people, and even more for those who are obese.

The current recommendations, however, are 200 to 600 units a day, depending on age.

More information

The U.S. National Library of Medicine has more on vitamin D.

More Research Finds Limited Benefit From PSA Test

Also, many men not fully sharing in decision with provider whether to undergo testing

01 oct 2009-- Men should be aware of their chances of benefits and harms from prostate-specific antigen (PSA) testing before the test, but many are not discussing screening before making the decision, according to the results of two studies in the Sept. 28 Archives of Internal Medicine.

Kirsten Howard, Ph.D., of the University of Sydney in Australia, and colleagues analyzed data from a model comparing outcomes from prostate cancer in men with and without annual screening. The authors presumed a 20-percent relative risk reduction in prostate cancer mortality in screened men as a best case. If 1,000 men were screened from ages 40 to 69, they would have 27.9 prostate cancer deaths and 639.5 deaths overall by age 85, compared with 29.9 prostate cancer deaths and 640.4 deaths overall in their unscreened counterparts. False alarms were a concern, along with the attendant risks of biopsies triggered by the screening.

Richard M. Hoffman, M.D., of the New Mexico VA Health Care System in Albuquerque, and colleagues analyzed data from 375 men, ages 40 and older, who had undergone or discussed PSA testing with their health care provider in the previous two years. Only 69.9 percent discussed screening before making a decision. The provider was more likely to raise the idea and was more likely to emphasize benefits of testing than shortcomings (71.4 versus 32 percent).

"Even if there is a small expected benefit from screening under optimistic assumptions, it is unlikely that screening represents a good value for the expenditure of resources based on the potential cost per quality-adjusted life-year gained," writes the author of an accompanying editorial.

Several authors of the second study reported financial associations with the Foundation for Informed Medical Decision Making, which supported the study.

Abstract - Howard
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Abstract - Hoffman
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Moderate Drinking May Reduce Men's Risk of Heart Disease

But pomegranate juice appears to have no effect on progression of atherosclerosis

01 oct 2009-- In hypertensive men, moderate drinking may reduce the risk of coronary heart disease. However, in men and women at moderate risk of heart disease, pomegranate juice appears to have no effect on the overall progression of carotid intima-media thickness, according to two studies in the Oct. 1 American Journal of Cardiology.

Kathryn A. Britton, M.D., of Harvard Medical School in Boston, and colleagues analyzed 1982 to 2008 data on 5,164 participants in the Physicians' Health Study. Compared to consumption of less than one alcoholic drink per week, their adjusted analysis showed that consumption of one to four drinks, five to seven drinks, and more than eight drinks per week was associated with a decreasing risk of myocardial infarction (hazard ratios, 1.05, 0.78, and 0.57, respectively).

Michael H. Davidson, M.D., of the University of Chicago, and colleagues randomly assigned 289 patients with more than one major coronary heart disease risk factor and a baseline posterior wall carotid intima-media thickness of 0.7 to 2.0 mm to receive either 240 ml of pomegranate juice per day or a control beverage for 18 months. Although they found no group differences in the overall carotid intima-media thickness progression rate, results suggested that pomegranate juice may slow progression in patients with increased oxidative stress and disturbances in the triglyceride-rich lipoprotein/high-density lipoprotein axis.

"Consumption of pomegranate juice is very safe; thus, demonstration of a benefit on atherosclerotic disease progression, even in a subset of the population, would have important public health implications," Davidson and colleagues conclude.

Abstract - Britton
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Abstract - Davidson
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Oleocanthal may help prevent, treat Alzheimer's

Natural compound in extra-virgin olive oil targets toxic beta-amyloid proteins

PHILADELPHIA, 30 sept 2009-- Oleocanthal, a naturally-occurring compound found in extra-virgin olive oil, alters the structure of neurotoxic proteins believed to contribute to the debilitating effects of Alzheimer's disease. This structural change impedes the proteins' ability to damage brain nerve cells.

"The findings may help identify effective preventative measures and lead to improved therapeutics in the fight against Alzheimer's disease," said study co-leader Paul A.S. Breslin, PhD, a sensory psychobiologist at the Monell Center.

Known as ADDLs, these highly toxic proteins bind within the neural synapses of the brains of Alzheimer's patients and are believed to directly disrupt nerve cell function, eventually leading to memory loss, cell death, and global disruption of brain function. Synapses are specialized junctions that allow one nerve cell to send information another.

"Binding of ADDLs to nerve cell synapses is thought to be a crucial first step in the initiation of Alzheimer's disease. Oleocanthal alters ADDL structure in a way that deters their binding to synapses," said William L. Klein, PhD, who co-led the research with Breslin. "Translational studies are needed to link these laboratory findings to clinical interventions." Klein is Professor of Neurobiology & Physiology, and a member of the Cognitive Neurology and Alzheimer's Disease Center, at Northwestern University.

Klein and his colleagues identified ADDLs in 1998, leading to a major shift in thinking about the causes, progression and treatment of Alzheimer's disease. Also known as beta-amyloid oligomers, ADDLs are structurally different from the amyloid plaques that accumulate in brains of Alzheimer's patients.

Reporting on a series of in vitro studies, the team of Monell and Northwestern researchers found that incubation with oleocanthal changed the structure of ADDLs by increasing the protein's size.

Knowing that oleocanthal changed ADDL size, the researchers next examined whether oleocanthal affected the ability of ADDLs to bind to synapses of cultured hippocampal neurons. The hippocampus, a part of the brain intimately involved in learning and memory, is one of the first areas affected by Alzheimer's disease.

Measuring ADDL binding with and without oleocanthal, they discovered that small amounts of oleocanthal effectively reduced binding of ADDLs to hippocampal synapses. Additional studies revealed that oleocanthal can protect synapses from structural damage caused by ADDLs.

An unexpected finding was that oleocanthal makes ADDLs into stronger targets for antibodies. This action establishes an opportunity for creating more effective immunotherapy treatments, which use antibodies to bind to and attack ADDLs.

Breslin commented on the implications of the findings. "If antibody treatment of Alzheimer's is enhanced by oleocanthal, the collective anti-toxic and immunological effects of this compound may lead to a successful treatment for an incurable disease. Only clinical trials will tell for sure."

In earlier work at Monell, Breslin and co-workers used the sensory properties of extra virgin olive oil to identify oleocanthal based on a similar oral irritation quality to ibuprofen. Oleocanthal and ibuprofen also have similar anti-inflammatory properties, and ibuprofen – like extra virgin olive oils presumably rich in oleocanthal – is associated with a decreased risk of Alzheimer's when used regularly.

Future studies to identify more precisely how oleocanthal changes ADDL structure may increase understanding of the pharmacological actions of oleocanthal, ibuprofen, and structurally related plant compounds. Such pharmacological insights could provide discovery pathways related to disease prevention and treatment.

The findings are reported in the October 15 issue of Toxicology and Applied Pharmacology.

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First author Jason Pitt, a graduate student in Klein's lab, conducted the studies. Also contributing to the work were chemist Amos B. Smith, III, of Monell and the University of Pennsylvania, who supplied the oleocanthal; William Roth, Pascale Lacor and Pauline Velasco from Northwestern; Matthew Blankenship from Western Illinois University; and Fernanda De Felice from the Universidade Federal do Rio de Janeiro. In addition to his faculty appointment at Monell, Breslin is Professor of Nutritional Sciences in the School of Environmental and Biological Sciences at Rutgers University.

The National Institute on Aging funded the research; Dr. Breslin is funded by the National Institute on Deafness and Other Communication Disorders.

Sexually satisfied women have better general well-being and more vitality

Older women have higher well-being scores than younger women

30 sept 2009--Pre- and post-menopausal women who self-rated themselves as being sexually satisfied had a higher overall psychological well-being score and scores for "positive well-being" and "vitality," compared with sexually dissatisfied women in a study of 295 women sexually active more than twice a month. The study, published today in The Journal of Sexual Medicine, also uncovered a positive association between age and well-being, but a negative association for general health.

The most commonly reported sexual problems in the area of consensual sexuality in women relate to sexual desire and interest, pleasure and satisfaction, and for most women these are part of the overall sexual experience, and are inextricably related. In contrast to studies of interventions for male erectile dysfunction, benefit of treatment in women with sexual dysfunction cannot be measured simply by the frequency of sexual events, as women frequently continue to be sexually active despite a high level of sexual dissatisfaction. Thus the frequency of self-reported satisfactory sexual events has been used as the primary outcome in recent studies.

To assess whether there was a correlation between sexual satisfaction and well-being, the team of Australian researchers recruited women from the community aged 20-65 who self-identified as being satisfied or dissatisfied with their sexual function. Participants were also asked questions which identified whether they were pre- or post menopausal, with recruitment closed when there was an equal number of women in each of the four subgroups.

"We wanted to explore the links between sexual satisfaction and wellbeing in women from the community, and to see if there was any difference between pre- and postmenopausal women," said lead author Dr Sonia Davison, of the Women's Health Program at Monash University, Australia. "We found that women who were sexually dissatisfied had lower well-being and lower vitality. This finding highlights the importance of addressing these areas as an essential part of women's healthcare, because women may be uncomfortable discussing these issues with their doctor."

"The problem with interpreting this finding is that it is impossible to determine if dissatisfied women had lower well-being because they were sexually dissatisfied, or if the reverse is true, such that women who started with lower well-being tended to secondarily have sexual dissatisfaction," added Davison. "As such, pharmacotherapies aimed to treat sexual dysfunction may have secondary effects on well-being, and the reverse may be true."

As over 90% of women in this study reported their sexual activity involved a partner, and was initiated by the partner at least 50% of the time, the sexual activity of the women may have been affected by partner presence (or absence), partner health, and sexual function, which were not addressed in this study. "The fact that women who self-identified as being dissatisfied maintained the level of sexual activity reported most likely represents established behaviour and partner expectation," said Professor Susan Davis, senior author of this study, also based at the Women's Health Program at Monash University, Australia. "It also reinforces the fact that frequency of sexual activity in women cannot be employed as a reliable indicator of sexual well-being."

"We are proud to publish this extremely important study in women's sexual health" said Dr. Irwin Goldstein, Editor-in-Chief of The Journal of Sexual Medicine. "This large study performed in the community emphasizes the role and importance of women's sexual health in women's overall health and well-being. Previous criticism equated physicians' efforts to improve a woman's satisfaction with her sexual life as medicalization. Dr. Davison's and co-workers' research will help health care professionals appreciate the need for overall women's healthcare to include women's sexual health care."

Uninterrupted chest-compressions key to survival in cardiac arrest outside hospital setting

DALLAS 29 sept 2009– Maximizing the proportion of time spent performing chest compressions during cardiopulmonary resuscitation (CPR) substantially improves survival in patients who suffer cardiac arrest outside a hospital setting, according to a multicenter clinical study that included UT Southwestern Medical Center.

The findings, available in today's issue of Circulation, come from the largest clinical investigation to evaluate the association between chest compressions by emergency medical service (EMS) providers before the first attempted defibrillation and survival to hospital discharge. Out-of-hospital cardiac arrest is a leading cause of premature death worldwide, and survival is often less than 5 percent.

One of the most important aspects of quality CPR is the proportion of time spent performing chest compressions, but EMS providers typically perform chest compressions only 50 percent of the total time spent on resuscitative efforts.

"It's a common problem, because rescuers are involved in so many other tasks – checking for a pulse, starting intravenous therapy and giving ventilation, among other things," said Dr. Ahamed Idris, professor of emergency medicine at UT Southwestern and a pioneer in resuscitation research and CPR. Dr. Idris also is the principal investigator for the Dallas portion of the new study, conducted at seven clinical centers across North America.

"Compressions are being interrupted half of the time or more, and that has a detrimental effect on the survival of patients," Dr. Idris said. "This study reinforces that interrupting chest compressions has a bad effect on survival. It also provides a rationale for relatively simple changes to CPR training and practice, that if implemented are likely to improve survival."

Dallas-area paramedics and firefighters are being trained to begin CPR immediately and to administer uninterrupted chest compressions for two minutes before re-checking the heart rhythm or using a defibrillator to shock the heart. UT Southwestern's emergency medicine program provides medical oversight for EMS providers in more than a dozen Dallas-area cities.

In this study, researchers studied data from patients in the Resuscitation Outcomes Consortium (ROC) who had suffered from cardiac arrest with a heart rhythm indicating ventricular fibrillation or ventricular tachychardia. The researchers focused on the effect of the number of chest compressions paramedics administered per minute before they shocked the heart.

"People who received chest compressions 60 to 80 percent of the time during CPR did better than those who received fewer chest compressions," Dr. Idris said.

Previous animal studies have demonstrated that interruptions in chest compressions decrease coronary and cerebral blood flow. Based on further clinical and laboratory observations, the American Heart Association and the European Resuscitation Council Guidelines for Cardiopulmonary Resuscitation in 2005 recommended increasing the proportion of time spent delivering chest compressions.

In 2008 the American Heart Association updated its CPR guidelines and now advocates that bystanders only perform continuous chest compressions for cardiac arrest instead of combining chest compressions with mouth-to-mouth ventilation.

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The data for this study was collected from the ROC, which is comprised of 11 regional clinical centers funded by the National Institutes of Health and several U.S. and Canadian agencies to test lifesaving interventions for critical trauma and sudden cardiac arrest.

In addition to UT Southwestern in Dallas, the other U.S. resuscitation centers are in Birmingham, Ala.; Iowa City, Iowa; Milwaukee; Portland, Ore.; Seattle and King County, Wash.; Pittsburgh; and San Diego. Toronto and Ottawa also have resuscitation centers.

Impaired kidney function linked to cognitive decline in elderly

A new study published in the medical journal Neurology suggests that impaired kidney function is a risk factor for cognitive decline in old age.

29 sept 2009--The study, conducted by researchers at Rush University Medical Center, found that poor kidney function was linked specifically with cognition related to memory functions. Damage to one of these functions, episodic memory, which retrieves memories of time, place, associated emotions and other contextual knowledge, is often the earliest sign of Alzheimer's disease.

"Given the dearth of modifiable risk factors for age-related cognitive decline, these results have important public health implications," said Dr. Aron Buchman, a neuroscientist in the Rush Alzheimer's Disease Center. "Further work to understand the link between kidney function and the brain may provide new strategies for preventing memory loss in elders."

Buchman said the findings suggest that there are common disease processes that affect both the brain and the kidneys in the elderly, and hypothesized that underlying vascular problems, such as diabetes and hypertension, may account for the association between kidney problems and cognitive decline.

The study analyzed data for 886 older adults who participated in the Rush Memory and Aging Project, a group of community-dwelling seniors with a mean age of 81, all of them initially free of dementia. The participants were examined annually for up to six years to track changes in cognition over time. Cognitive assessments included multiple tests that were summarized as a composite measure of overall cognition and of five individual cognitive abilities.

The individual cognitive systems assessed were visuospatial ability; perceptual speed, or the ability to quickly and accurately compare letters, numbers, objects, pictures or patterns; semantic memory, related to meaning, understanding and other concept-based knowledge; working memory, which temporarily stores and manipulates information; and episodic memory.

Ruling out the influence of factors like aging and medications, which can affect cognition, the researchers found that poor kidney function, assessed at the beginning of the study, was linked with a more rapid rate of decline in cognition over the next several years – not in visuospatial ability or perceptual speed, but in three specific areas: episodic, semantic and working memory.

The rate of decline in cognition was equivalent to that of a person seven years older at baseline, Buchman said.

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The study was supported by funds from the National Institute on Aging, the Illinois Department of Public Health and the Robert C. Borwell Endowment Fund.

About Rush: Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).

Multiple Strokes Linked to Higher Risk for Post-Stroke Dementia

Characteristics of the stroke itself more important than underlying vascular risks

28 sept 2009-- The risk of developing dementia after stroke is higher in patients who have had multiple strokes, according to a study published online Sept. 24 in The Lancet Neurology.

Sarah T. Pendlebury and Peter M. Rothwell of John Radcliffe Hospital in Oxford, U.K., conducted a review and meta-analysis of studies published over a period of almost 60 years to May 2009, and analyzed 73 papers comprising 7,511 patients in eight population-based and 22 hospital-based cohorts.

Approximately 10 percent of patients had dementia before the occurrence of the first stroke, 10 percent were newly diagnosed with dementia after their first stroke, and over a third of cases with recurrent stroke had dementia, the investigators found. The most important predictors of post-stroke dementia were the characteristics of the stroke and multiple occurrence of stroke, not underlying vascular risk factors, the researchers note.

"Optimum acute stroke care and secondary prevention of stroke are likely to be effective for reducing the burden of post-stroke dementia," the authors write. "Further studies are needed to identify independent predictive factors, to develop a risk factor score for use in clinical practice and trials, and to ascertain the relative contributions of and interactions between degenerative and vascular processes in the causes of post-stroke dementia."

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AHA/HBP: Low Vitamin D Connected to Hypertension

Women with deficient levels have a tripled risk of systolic hypertension 14 years later

28 sept 2009-- Younger women with low vitamin D levels may have a tripled risk of subsequently developing systolic hypertension, according to research presented this week at the American Heart Association's 63rd High Blood Pressure Research Conference, held from Sept. 23 to 26 in Chicago.

Flojaune C. Griffin, of the University of Michigan in Ann Arbor, and colleagues studied 559 Caucasian women who were ages 24 to 44 years when first assessed in 1993, at which time the prevalence of 25-OH-D deficiency was 81 percent. When the subjects were assessed again in 2007, the prevalence of diagnosed hypertension (systolic and diastolic) was 19 percent.

After adjusting for age, fat mass, anti-hypertensive medication use, and smoking, the researchers found that women with a vitamin D deficiency in 1993 were significantly more likely to have systolic hypertension in 2007 (risk ratio, 3.0) but not diastolic hypertension.

"These results suggest that early vitamin D deficiency may increase the long-term risk of hypertension in women at mid-life," the authors conclude.

Rosuvastatin Merits Wider Use for Heart Disease Prevention

Good risk reduction profile in those with low cholesterol, high C-reactive protein levels

28 sept 2009-- Prescribing rosuvastatin for patients with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein levels has enough benefits in terms of number needed to treat values to merit wide use in primary prevention of cardiovascular events, according to a study published online Sept. 22 in Circulation: Cardiovascular Quality and Outcomes.

Paul M. Ridker, M.D., of Harvard Medical School in Boston, and colleagues analyzed data from a trial evaluating rosuvastatin in 17,802 apparently healthy subjects with low-density lipoprotein cholesterol levels below 130 mg/dL and high-sensitivity C-reactive protein levels at or above 2 mg/L who were randomized to receive either 20 mg rosuvastatin or placebo.

The researchers looked at absolute risk reductions and the number needed to treat for a range of end points, time frames and sub-groups, and found that for myocardial infarction, stroke, revascularization or death, the five-year number needed to treat was 20, and that the number needed to treat was less than 50 for all sub-groups. The calculations compare favorably with those for other primary cardiovascular prevention therapies, the investigators note.

"The current analyses indicate that number needed to treat values associated with statin therapy among men and women with low levels of low-density lipoprotein cholesterol but elevated high-sensitivity C-reactive protein are at least comparable to number needed to treat values observed in prior primary prevention trials evaluating statin therapy for the treatment of hyperlipidemia," the authors write. "These data may be informative in policy discussions regarding new guidelines for the primary prevention of cardiovascular disease."

The JUPITER trial was funded by AstraZeneca; several authors reported financial relationships with the pharmaceutical industry.

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Study Casts Further Doubt on PSA for Cancer Screening


In terms of likelihood ratios, PSA didn't attain numbers needed for a screening test

27 sept 2009-- Based on likelihood ratios, prostate specific antigen (PSA) concentrations at any cutoff value didn't meet the criteria needed for a screening test, according to research published online Sept. 24 in BMJ.

Benny Holmstrom, M.D., of Umea University in Sweden, and colleagues analyzed data from 540 cases of prostate cancer and 1,034 matched controls drawn from a longitudinal cohort study. Blood samples were taken from cases an average of 7.1 years before diagnosis. The researchers assessed the likelihood ratios of PSA concentrations in predicting later cancer diagnosis. A positive likelihood ratio above 10 is considered strong evidence for ruling in disease, and a negative likelihood ratio below 0.1 is thought to be sufficient for ruling out disease.

The researchers found that, at PSA cutoff values of 3, 4 and 5 ng/mL, the positive likelihood ratios were 4.5, 5.5 and 6.4, respectively. Negative likelihood ratios were 0.47, 0.61 and 0.70, respectively. However, the authors note that concentrations below 1.0 almost completely ruled out a later diagnosis of cancer, suggesting that this cutoff might help identify men with very low risk.

"Converting sensitivity and specificity into likelihood ratios would help clinicians to evaluate how effective the test might be in ruling in or ruling out the disease. Clinicians should consider using likelihood ratios together with a patient's individual risk factors for the disease to explain the potential benefits and harms of the PSA test, allowing patients to contribute to decisions," write the authors of an accompanying editorial.

The editorial authors are members of the Cochrane Prostatic Diseases and Urologic Cancers Group.

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