Forget about forgetting: The elderly know more and use it better

What happens to our cognitive abilities as we age? If your think our brains go into a steady decline, research reported this week in the journal Topics in Cognitive Science may make you think again. The work, headed by Dr. Michael Ramscar of Tübingen University, takes a critical look at the measures usually thought to show that our cognitive abilities decline across adulthood. Instead of finding evidence of decline, the team discovered that most standard cognitive measures, which date back to the early twentieth century, are flawed. "The human brain works slower in old age," says Ramscar, "but only because we have stored more information over time."

22 jan 2014--Computers were trained, like humans, to read a certain amount each day, and to learn new things. When the researchers let a computer "read" only so much, its performance on cognitive tests resembled that of a young adult. But if the same computer was exposed to the experiences we might encounter over a lifetime – with reading simulated over decades – its performance now looked like that of an older adult. Often it was slower, but not because its processing capacity had declined. Rather, increased "experience" had caused the computer's database to grow, giving it more data to process – which takes time.

Technology now allows researchers to make quantitative estimates of the number of words an adult can be expected to learn across a lifetime, enabling the Tübingen team to separate the challenge that increasing knowledge poses to memory from the actual performance of memory itself. "Imagine someone who knows two people's birthdays and can recall them almost perfectly. Would you really want to say that person has a better memory than a person who knows the birthdays of 2000 people, but can 'only' match the right person to the right birthday nine times out of ten?" asks Ramscar.

The answer appears to be "no." When Ramscar's team trained their computer models on huge linguistic datasets, they found that standardized vocabulary tests, which are used to take account of the growth of knowledge in studies of ageing, massively underestimate the size of adult vocabularies. It takes computers longer to search databases of words as their sizes grow, which is hardly surprising but may have important implications for our understanding of age-related slowdowns. The researchers found that to get their computers to replicate human performance in word recognition tests across adulthood, they had to keep their capacities the same. "Forget about forgetting," explained Tübingen researcher Peter Hendrix, "if I wanted to get the computer to look like an older adult, I had to keep all the words it learned in memory and let them compete for attention."

The research shows that studies of the problems older people have with recalling names suffer from a similar blind spot: there is a far greater variety of given names today than there were two generations ago. This cultural shift toward greater name diversity means the number of different names anyone learns over their lifetime has increased dramatically. The work shows how this makes locating a name in memory far harder than it used to be. Even for computers.

Ramscar and his colleagues' work provides more than an explanation of why, in the light of all the extra information they have to process, we might expect older brains to seem slower and more forgetful than younger brains. Their work also shows how changes in test performance that have been taken as evidence for declining cognitive abilities in fact demonstrates older adults' greater mastery of the knowledge they have acquired.

Take "paired-associate learning," a commonly used cognitive test that involves learning to connect words like "up" to "down" or "necktie" to "cracker" in memory. Using Big Data sets to quantify how often different words appear together in English, the Tuebingen team show that younger adults do better when asked to learn to pair "up" with "down" than "necktie" and "cracker" because "up" and "down" appear in close proximity to one another more frequently. However, whereas older adults also understand which words don't usually go together, young adults notice this less. When the researchers examined performance on this test across a range of word pairs that go together more and less in English, they found older adult's scores to be far more closely attuned to the actual information in hundreds of millions of words of English than their younger counterparts.

As Prof. Harald Baayen, who heads the Alexander von Humboldt Quantitative Linguistics research group where the work was carried out puts it, "If you think linguistic skill involves something like being able to choose one word given another,younger adults seem to do better in this task. But, of course, proper understanding of language involves more than this. You have also to not put plausible but wrong pairs of words together. The fact that older adults find nonsense pairs – but not connected pairs – harder to learn than young adults simply demonstrates older adults' much better understanding of language. They have to make more of an effort to learn unrelated word pairs because, unlike the youngsters, they know a lot about which words don't belong together."

The Tübingen research conclude that we need different tests for the cognitive abilities of older people – taking into account the nature and amount of information our brains process. "The brains of older people do not get weak," says Michael Ramscar. "On the contrary, they simply know more."

More information: Michael Ramscar, Peter Hendrix, Cyrus Shaoul, Petar Milin, Harald Baayen. (2014) The Myth of Cognitive Decline: Non-Linear Dynamics of Lifelong Learning. Topics in Cognitive Science, 6, 5-42.onlinelibrary.wiley.com/doi/10.1111/tops.12078/full

Provided by Universitaet Tübingen

Here comes the sun: How vitamin D relaxes blood vessels

The sun in the mountains allows the body to produce vitamin D in winter. Credit: Heike Hochhauser/Vetmeduni Vienna

It's not just your mood that the dark months of winter can influence. Low levels of sunlight also mean lower levels of vitamin D in the body. Vitamin D deficiency can trigger a range of diseases but until recently little was known about the exact biological mechanisms behind this. A research team at the University of Veterinary Medicine, Vienna has now decrypted one of these unknown molecular mechanisms. Vitamin D regulates the elasticity of blood vessels and thus also affects blood pressure amplitude. The results were published earlier this year in the journal Molecular Endocrinology.

21 jan 2014--UV-B radiation in sunlight is the most important factor for the production of vitamin D, and that is why many people suffer from low levels of vitamin D during the winter months. Although certain foods do contain vitamin D, it is not usually possible to get an adequate supply of the vitamin from food. Many clinical studies have indicated that low vitamin D levels are related to cardiovascular disease such as high blood pressure, but also other diseases such as diabetes mellitus, autoimmune diseases and even cancer. However, the underlying molecular mechanisms were unclear.

Vitamin D deficiency leads to stiffening of the blood vessels

The two primary authors, molecular biologist Olena Andrukhova and medical doctor Svetlana Slavic, of the Institute of Physiology, Pathophysiology and Biophysics at the Vetmeduni Vienna, found that prolonged vitamin D deficiency can stiffenblood vessels. Examining the aorta, an elastic blood vessel that expands with each pulse of blood and then constricts again, the researchers showed that vitamin D deficiency makes the vessel less flexible. Andrukhova explains in detail: "Vitamin D enhances the production of the enzyme eNOS (endothelial nitric oxide synthase) in the inner layer of blood vessels, the endothelium. This is critical for the regulation of blood pressure. The enzyme produces a molecule called nitric oxide (NO), an important factor for the relaxation of smooth muscles in the blood vessels. When too little NO is formed, the vessels become less flexible. This ultimately leads to higher blood pressure which can give rise to other circulatory diseases. So indirectly, vitamin D controls blood pressure."

Co-author Slavic continues: "Stiffness of the blood vessels generally increases with age. Blood pressure amplitude thus tends to increase with age and leads to structural changes in the aorta. Elasticity deteriorates, and prolonged vitamin D deficiency can accelerate this process."

Simulation of vitamin D deficiency in mice

The scientists worked with genetically modified mice to explore the details of the mechanism. The vitamin D receptors in the animals were changed so that no vitamin D signalling was possible. Vitamin D also regulates the body's calcium and phosphate balance, so the rodents were given a special diet to ensure that they had enough calcium and phosphorus. The lack of vitamin D was therefore the only deficiency that could have affected the physiology of the animals.

After about a year without vitamin D signalling, the mice had increased blood pressure amplitude. The researchers conducted a series of studies on various tissues from the animals. To understand what lies behind the increased blood pressure amplitude, they focused particularly on the aorta and found decreased expression of eNOS, increased deposition of collagen and fewer elastic fibres. Over time, the blood vessels had become more rigid and less able to adapt flexibly to the volume of blood streaming through them. The consequence was increased blood pressure amplitude and changes in cardiac structure and function. In future studies, the researchers want to examine whether vitamin D affects different cell types in blood vessels in different ways.

Refuelling light for the heart and the circulation

In Europe, it has often been considered to enrich certain foods with vitamin D, as is customary in the United States, for example. However, an external source of vitamin D also carries risks since any excess vitamin D cannot be excreted by the body. When used at very high doses it can lead to calcium deposits in blood vessels, kidneys, lungs and the heart. However, a lack of vitamin D can also have dramatic consequences. Institute board Professor Reinhold Erben states: "It is not that vitamin D deficiency will lead immediately to an increase in blood pressure amplitude or blood pressure, but over the long term it can lead to cardiovascular damage. Vitamin D is the chemical translation of the sun in our bodies and we should stock up on a regular basis, especially in winter. We have to remember that in Central Europe, vitamin D synthesis in the skin is physically impossible from November to February at sea level. Levels of UV-B radiation are just too low. The alternatives are vitamin D supplements or a stay in the mountains."

More information: "Vitamin D Is a Regulator of Endothelial Nitric Oxide Synthase and Arterial Stiffness in Mice." Olena Andrukhova, Svetlana Slavic, Ute Zeitz, Sabine C. Riesen, Monika S. Heppelmann, Tamas D. Ambrisko, Mato Markovic, Wolfgang M. Kuebler, and Reinhold G. Erben. Molecular Endocrinology 2014 28:1, 53-64. DOI: dx.doi.org/10.1210/me.2013-1252

Provided by University of Veterinary Medicine -- Vienna

Researchers discover how heart arrhythmia occurs

Researchers have discovered the fundamental biology of calcium waves in relation to heart arrhythmias.

20 jan 2014--The findings published this month in the January 19 edition of Nature Medicine outlines the discovery of this fundamental physiological process that researchers hope will one day help design molecularly tailored medications that correct the pathophysiology.

Heart arrhythmias cause the heart to beat irregularly, resulting in symptoms such as dizziness and fainting, or in severe cases, sudden arrhythmic death. While many factors contribute to the development of arrhythmias, including genetics, scientists know that a common mechanism of cardiac arrhythmias is calcium overload in the heart, i.e. calcium-triggered arrhythmias that can lead to sudden death. The underlying mechanism of these calcium-triggered arrhythmias has remained a mystery for decades.

Using a combination of molecular biology, electrophysiology, and genetically engineering mice, scientists at the University of Calgary's and Alberta Health Services' Libin Cardiovascular Institute of Alberta (Libin Institute)have discovered that a calcium-sensing-gate in the cardiac calcium release channel (ryanodine receptor) is responsible for initiation of calcium waves and calcium-triggered arrhythmias.

Utilizing a genetically modified mouse model they were able to manipulate the sensor and completely prevented calcium-triggered arrhythmias.

"The calcium-sensing- gate mechanism discovered here is an entirely novel concept with potential to shift our general understanding of ion channel gating, cardiac arrhythmogenesis, and the treatment of calcium-triggered arrhythmias," says SR Wayne Chen, PhD, the study's senior author and University of Calgary- Libin Institute researcher. "These findings open a new chapter of calcium signaling and the discovery fosters the possibilities of new drug interventions."

More information: The ryanodine receptor store-sensing gate controls Ca2+ waves and Ca2+-triggered arrhythmias, DOI: 10.1038/nm.3440

Provided by University of Calgary

Traditional Chinese medicines stall progression of diabetes

Traditional Chinese herbal medicines hold promise for slowing the progression from prediabetes to an official diabetes diagnosis, according to new research accepted for publication in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

19 jan2014--Prediabetes is diagnosed an individual has developed elevated blood sugar levels, but glucose levels have not yet risen to the point of developing type 2 diabetes. People who are prediabetic face a heightened risk of developing type 2 diabetesas well as heart disease and stroke. According to the Centers for Disease Control and Prevention, about 79 million American adults age 20 years or older have prediabetes.

"With diabetes evolving into a serious public health burden worldwide, it is crucial to take steps to stem the flood of cases," said one of the study's authors, Chun-Su Yuan, MD, PhD, of the University of Chicago. "Patients often struggle to make the necessary lifestyle changes to control blood sugar levels, and current medications have limitations and can have adverse gastrointestinal side effects. Traditional Chinese herbs may offer a new option for managing blood sugar levels, either alone or in combination with other treatments."

During the double-blind, randomized, placebo-controlled trial, 389 participants at 11 research sites in China were randomly assigned to take either a capsule containing a mixture of 10 Chinese herbal medicines or a placebo. For a year, subjects took capsules of either the Chinese herb mixture, called Tianqi, or the placebo three times a day before meals. All participants received a month of lifestyle education at the outset of the trial and met with nutritionists several times during the course of the study. Subjects' glucose tolerance was measured on a quarterly basis.

At the end of the trial, 36 participants in the Tianqi group and 56 in the placebo group had developed diabetes. The analysis found taking Tianqi reduced the risk of diabetes by 32.1 percent compared with the placebo, after adjusting for age and gender. The overall reduction in risk was comparable to that found in studies of diabetes medications acarbose and metformin, and study participants reported few side effects from the Tianqi herbs. Tianqi includes several herbs that have been shown to lower blood glucose levels and improve control of blood glucose levels after meals.

"Few controlled clinical trials have examined traditional Chinese medicine's impact on diabetes, and the findings from our study showed this approach can be very useful in slowing the disease's progression," said one of the study's lead authors, Xiaolin Tong, MD, PhD, of Guang'anmen Hospital in Beijing, China, said. "More research is needed to evaluate the role Chinese herbal medicine can play in preventing and controlling diabetes."

More information: The study, "Chinese Herbal Medicine Tianqi Reduces Progression from Impaired Glucose Tolerance to Diabetes: A Double-Blind, Randomized, Placebo-Controlled, Multicenter Trial," appears in the February issue of JCEM.

Provided by The Endocrine Society

Using progesterone for hot flashes shown safe for women's cardiovascular health

Treatment with progesterone, a naturally occurring hormone that has been shown to alleviate severe hot flashes and night sweats in post-menopausal women, poses little or no cardiovascular risk, according to a new study by the University of British Columbia and Vancouver Coastal Health.

18 jan 2014--The findings, published today in PLOS ONE, help to dispel a major impediment to widespread use of progesterone as a treatment for hot flashes and night sweats, said lead author Dr. Jerilynn C. Prior, a professor of endocrinology and the head of Centre for Menstrual Cycle and Ovulation Research.

For decades, women used a combination of synthetic estrogen and progesterone to reduce the frequency and severity of hot flashes and night sweats, as well as to prevent osteoporosis. Use of this so-called "hormone replacement therapy" dropped dramatically after 2002, when a large study revealed that it increased risk of heart disease, breast cancer, strokes and other serious conditions.

To evaluate the cardiovascular risk of using progesterone to alleviate symptoms, Prior and her collaborators recruited 110 healthy Vancouver-area women who had recently reached postmenopause (a year after the final menstruation), giving half of them oral progesterone and the others a placebo for three months.

The team used each woman's age and changes in blood pressure and cholesterol levels to calculate their 10-year risk of a heart attack and other blood vessel diseases, and found no difference between those taking progesterone and the control group. The study also found no significant difference on most other markers for cardiovascular disease.

"Many women are apprehensive about taking progesterone for hot flashes because of a belief that it carries the same – or even greater – risks than estrogen," Prior said. "We have already shown that the benefits of progesterone alone have been overlooked. This study demonstrates that progesterone's risks have been overblown."

Provided by University of British Columbia

Review finds lack of delirium screening in the emergency department

Delirium in older patients in an emergency room setting can foretell other health issues. But according to a new study published in the Annals of Emergency Medicine, the condition is frequently overlooked because of a lack of screening tools in emergency departments.

17 jan 2014--An estimated one in 10 older adults seen in hospital emergency departments in the United States experiences delirium, but this acute change in mental status is often not recognized. Researchers from the Regenstrief Institute and Indiana University conducted a systematic review of existing studies on delirium in emergency departments and found that neither completely validated delirium screening instruments nor an ideal schedule to perform delirium assessments exist there.

The emergency department is a unique environment with significant time pressure challenges. Emergency department physicians typically don't have long-term relationships with patients; they are often unaware of patients' baseline mental status as the health care team tends to the emergency.

"Fewer than a third of older adults with delirium in the ED are being recognized, and we need to improve that detection rate," said Regenstrief Institute investigator Michael A. LaMantia, M.D., MPH, who led the systemic review of delirium screening. "Patients sent home from the ED with undetected delirium have six-month mortality rates almost three times greater than their counterparts in whom delirium is detected. Unrecognized delirium presents a major health challenge to older adults and an increased burden on the health care system.

"Patients with delirium will have hospital stays that are more than twice as long—21 versus nine days," said Dr. LaMantia, who is also an IU Center for Aging Research scientist and assistant professor of medicine at IU School of Medicine. "They will also have a greater probability of being discharged from the hospital to a long-term-care facility and a much higher probability of developing dementia than individuals who do not experience delirium."

Delirium is a state of confusion that can develop suddenly and usually goes away in days to weeks if treated properly, according to the American Delirium Society. The society estimates that more than 7 million hospitalized Americans experiencedelirium annually.

Dr. LaMantia, who is a geriatrician, said further work is needed to develop and validate emergency department-specific screening instruments and to determine how often to administer screenings in the rapid-paced environment. He also encourages those accompanying an older adult to the emergency department to serve as patient advocates by passing along baseline mental status information.

"The ED doctor is unaware of what the person looks like in daily life," he said. "They aren't seeing a complete set of colors. A family member or friend can help fill in the colors and gradations of colors. Nothing can replace having someone who knows the patient telling you that person's baseline."

More information: "Screening for Delirium in the Emergency Department: A Systematic Review" has been published online in advance of publication in the Annals of Emergency Medicine.

Provided by Indiana University

Geriatric health professionals experience added burden when caring for own family members

16 jan 2014--—In what is believed to be the first study of its kind, researchers from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM) have found that in addition to the well-known burdens of caring for an older family member, a further set of complex stressors is imposed on geriatric health care professionals serving in this capacity. These findings, which appear online in Gerontologist, highlight the critical challenges facing all caregivers, even those who deal with these patients daily on a professional basis.

Caregiving for older adults is a major social issue with enormous implications for health care
 and with an estimated cost of $450 billion in the United States alone. More than 60 million Americans were family caregivers in 2009 that involved hands-on help and supervision, financial management/support, emotional support, medical and legal decision making and health care needs. The research team recruited 16 geriatric health care professionals who participated in 60- to 90- minute individual interviews, based on a semi-structured guide. Questions explored participants' dual experiences as geriatrics professionals and as family caregivers. The authors identified three major themes: dual-role advantages and disadvantages, emotional impact of dual roles, and professional impact of family caregiving.

Participants described their health care expertise as a huge advantage in caring for older family members. All participants used their skills and knowledge as geriatric health care providers to aid in their caregiving role. However, because of the participants' professional backgrounds, they had high expectations for their own performance as caregivers, and many experienced conflicts and disappointment.

Participants' professional experiences impacted their ability to intervene in ways other nonprofessional caregivers might not have been able to do so. And though the impact of their interventions were usually positive, respondents described internal angst over their use of health care knowledge. "All participants described multiple ways in which the child/health professional dual role caregiving experience affected them emotionally. Caregivers gladly provided care and felt a strong sense of reward, but there was a significant theme of emotional struggle," explained lead author Clare M. Wohlgemuth, RN, GCNS-BC Nursing Director, Geriatric Services at BMC and a clinical instructor at BUSM.

The researchers also found that the participants' experiences as caregivers resulted in using what they learned to improve the care of their patients and to reduce caregiver stress. "Although their expertise introduced a significant emotional intensity to their personal caregiving experiences, those experiences positively influenced their professional insight, empathy and advocacy for the caregivers of their own patients," added Wohlgemuth.

The participants experienced emotions common to all caregivers of any background: emotional exhaustion, guilt and stress from struggling with multitasking to provide and coordinate care.

According to the researchers, given the challenges reported by experienced geriatric health care professionals, attention must also be focused on the lay caregivers who have more limited experience coping with aging and end of life.

"All caregivers need support in the use of communication and negotiation skills to effectively engage with providers regarding concerns about care. Both lay and professional caregivers would benefit from developing tools and techniques to discuss the many difficult issues and decisions related to increased frailty, dependence and dignity of risk. It is imperative to focus on empowering and teaching all caregivers and providers how best to have these difficult conversations with family members and with each other," she added.

Provided by Boston University Medical Center

Epigenetics: A new link between nutrition and cancer

In "Epigenetics: A New Link Between Nutrition and Cancer", a recent article from Nutrition and Cancer: An International Journal, a publication of Routledge, researchers explore the possible effects that diet can have on gene expression through epigenetic mechanisms.  Explaining the impact of nutrition on epigenetic mechanisms may help to predict an individual's susceptibility to cancer, provide dietary recommendations, or provide therapeutic applications of natural compounds to fight against cancer.

14 jan 2014--Epigenetic modifications are heritable and potentially reversible changes in gene expression that do not require changes to the actual DNA sequence.  By taking advantage of these modifications, researchers believe it is possible to mediate environmental signals and provide a link between susceptibility genes and environmental factors in the cause of cancer.

However, it should be noted that any protective effect is unlikely due to a single dietary component and thus, the identification of specific relevant compounds and metabolites is necessary.  Metabolism can also play a large role in affecting the potential to induce epigenetic changes.  Along with dietary components, eating patterns, and environmental factors, there are many variables that can complicate studies aiming to identify specific components which might prevent cancer development. 

Further studies are necessary to determine effective doses and concentrations of bioactive food components in cancer prevention or treatment.  More research is also necessary to determine proper responses for healthy individuals attempting to prevent cancer, as well as individuals with different stages of cancer. 

More information: "Epigenetics: A New Link Between Nutrition and Cancer." Gordana Supic, Maja Jagodic, Zvonko Magic . Nutrition and Cancer. Vol. 65, Iss. 6, 2013. DOI: 10.1080/01635581.2013.805794

Provided by Taylor & Francis

Five questions: The recognition of clinical informatics as medical sub-specialty

Clinical informatics, a field at the intersection of clinical medicine and information technology, has reached a new milestone: Physicians can now become board-certified in this medical sub-specialty.

13 jan 2014--Christopher Longhurst, MD, who is the chief medical information officer at Lucile Packard Children's Hospital Stanford and the leader of a new Stanford clinical informatics fellowship training program for physicians, talked with science writer Erin Digitale about this field's history and where it's going.

Q: First off, what exactly is clinical informatics?

Longhurst: In clinical informatics, we leverage information technology to improve outcomes for patients. Research has been done in this area since the 1960s and '70s, but what's different now is the ubiquitous nature of computing devices. Everybody has access to information and communications technologies. The majority of U.S. hospitals are implementing an electronic health record.

And yet electronic health records are not something most front-line doctors are really excited about—they can be seen as disruptive to the patient-care process. I really think we have yet to deliver on the promise of electronic health records. There's a tremendous opportunity to use data in those records to build a health-care system that can make personalized care recommendations and automatically learn from patients.

Q: How is clinical informatics changing the way that medical discoveries are made?

Longhurst: The idea when I was in grad school was that randomized trials were the gold standard for medical evidence. But, increasingly, people are recognizing that this "level A" evidence is cost-prohibitive to generate. And the subjects are so narrowly selected that the results are not always generalizable. I know what medication to give a white male in his 50s because of high blood pressure, but what if I have a different kind of patient?

So a lot of people are advocating for a shift away from traditional trials toward using enormous, anonymized data sets gleaned from existing electronic medical records. The idea is that you can make valid conclusions based on retrospective research if the data set is large enough.

That's why we want to create a "patients like mine" button in every electronic health record that would essentially allow real-time comparative-effectiveness studies. Then, if you're treating a 40-year-old, half-Vietnamese, half-black woman for high blood pressure, you can instantly generate a similar cohort and see which medications have provided the best outcomes for those patients. It's a really exciting concept that has already been used once at Lucile Packard Children's Hospital Stanford to help make a treatment decision for a child with a rare autoimmune disease.

A "patients like mine" button would also help us start to understand what questions doctors ask. Today, we don't always know the information needs of physicians. If we start to collect this meta-data, we can better focus randomized, controlled trials so that they match doctors' biggest questions.

Q: How does Stanford lead the field?

Longhurst: Stanford is often considered the place where clinical informatics all started. The father of this field, Ted Shortliffe, MD, PhD, was a graduate student at Stanford when, in the 1970s, he wrote a software program called MYCIN to make decisions about prescribing antibiotics. MYCIN performed better at those decisions than your average internist. Shortliffe came back to Stanford in the early '80s and founded the division of medical informatics, now the Stanford Center for Biomedical Informatics Research, starting the master's and PhD programs.

More recently, we have a really solid history of finding unique ways to use and study electronic medical records: In addition to making a treatment decision for a patient with a rare disease, we've provided automatic daily updates to parents whose infants are hospitalized in our neonatal intensive care unit, reduced unnecessary use of blood transfusions, assisted in selecting the appropriate IV fluid to give to kids and more, all under this one umbrella.

We have nine physicians who received the new board certification, placing us among the largest programs in the country.

Q: Why was this formal recognition of the field as a medical sub-specialty needed?

Longhurst: In the past, there was never a formal approach to ensuring that physicians were adequately trained in clinical informatics. Creation of the sub-specialty allows us to standardize elements of training, create training opportunities and create a recognized credential for people seeking to hire in the field.

Q: What's the role of Stanford and Lucile Packard Children's Hospital Stanford in educating the next wave of clinical informatics specialists?

Longhurst: We're establishing a two-year fellowship to train more doctors. The unique thing about clinical informatics as a board-certified sub-specialty is that physicians from any specialty can pursue subspecialty training; physicians from a huge variety of backgrounds have expressed interest in our program.

We're really excited that the fellows will have hands-on opportunities to work in a variety of settings in the IT groups at Lucile Packard Children's Hospital Stanford, Stanford Hospital & Clinics and the Stanford University School of Medicine. We're also partnering with Kaiser Permanente and the Palo Alto Medical Foundation to provide opportunities for fellows to see community care networks, and with HP Labs for an industry opportunity.

Stanford's location in Silicon Valley and the partnership we have with industry, particularly HP Labs, is another factor that makes our fellowship program stand out. An unrestricted grant from HP to Lucile Packard Children's Hospital Stanford for fellowship training has already enabled us to support the development of a quality and safety dashboard for caregivers that can automatically alert us to a variety of potential problems in patient care.

Provided by Stanford University Medical Center

High uric acid level linked to coronary stent restenosis

12 jan 2014--—A high level of serum uric acid prior to implantation of bare-metal coronary stents predicts stent restenosis, according to research published in the Jan. 15 issue of The American Journal of Cardiology.

Osman Turak, M.D., of the Turkiye Yuksek Ihtisas Training and Research Hospital in Ankara, Turkey, and colleagues analyzed data from 708 consecutive patients (mean age, 60.3 ± 9.3 years; 71 percent men) with stable or unstable angina pectoris who received bare-metal coronary stents. The authors sought to assess the association between serum uric acid (SUA) level and in-stent restenosis (ISR).

The researchers found that, among patients grouped by tertiles according to preprocedural SUA level, stent restenosis occurred in 23 percent in the lowest tertile, 34 percent in the middle tertile, and 46 percent in the highest tertile. Independent predictors of ISR identified by multiple logistic regression analysis included diabetes mellitus, smoking, high-density lipoprotein cholesterol level, stent length, C-reactive protein level, and preprocedural SUA level. Further analysis showed that SUA level greater than 5.5 mg/dL had 75 percent sensitivity and 71 percent specificity in predicting ISR.

"In conclusion, higher preprocedural SUA is a powerful and independent predictor of bare-metal stent restenosis in patients with stable and unstable angina pectoris," the authors write.

More information: Abstract 

Comprehensive, nonsurgical treatment improves pelvic floor dysfunction in women

One in three women suffer from pelvic floor dysfunction (PFD), a range of symptoms which include bladder and bowel problems as well as pelvic pain, according to the American Urogynecologic Society. Now, University of Missouri researchers have demonstrated that a comprehensive, nonsurgical treatment significantly improves symptoms in women with PFD.

11 jan 2014--"Pelvic floor rehabilitation is effective in helping women overcome pelvic floor problems with little or no medication," said Julie Starr, a doctoral student in the Sinclair School of Nursing and a family nurse practitioner at the University of Missouri Women's Health Center. "The treatment involves muscle strengthening for improved bladder control and muscle relaxation for those with symptoms of constipation and pelvic pain."

Starr and other MU researchers analyzed data from nearly 800 women with symptoms of pelvic floor dysfunction who underwent therapy for bowel, urinary or pelvic pain, and sexual dysfunction. The researchers found patients who completed at least five comprehensive pelvic floor rehabilitation therapy sessions reported an average of 80 percent improvement in three main areas: urinary incontinence, defecatory dysfunction and pelvic pain.

"We attribute the success of our program to patients' regular contact with health care providers who provide biofeedback and vaginal electrogalvanic (e-stim) therapy as well as advice on behavior modification," Starr said. "The e-stim therapy, a painless treatment in which a stimulator is used to send electrical pulses to relax pelvic muscles, improves symptoms of bladder and bowel incontinence as well as pelvic pain and pain with intercourse. We rarely prescribe medications for these complaints; in fact, many women are able to stop taking their medications for bladder control and pain after therapy."

Starr says women of any age with bladder, bowel or pelvic pain symptoms could benefit from pelvic floor rehabilitation, as could women who experience tearing after vaginal deliveries.

"Most women are embarrassed to talk about these types of problems, or they don't think there is anything anyone can do to help them," Starr said. "Some women have been to multiple providers without relief of their symptoms, so they become discouraged and give up. A nurse practitioner who provides pelvic floor therapy will focus on decreasing all of the patients' unpleasant pelvic symptoms instead of referring them to multiple providers."

Many women are offered medication to treat their symptoms and are not aware that alternative treatment methods exist for their pelvic pain, Starr said.

"Non-operative management of pelvic floor dysfunction is a safe and effective way to overcome many pelvic floor complaints," Starr said. "Medication and surgical management are options that always will be available if pelvic floor rehabilitation does not provide the desired relief."

More information: "Outcomes of a Comprehensive Nonsurgical Approach to Pelvic Floor Regabilitation for Urinary Symptoms, Defecatory Dysfunction, and Pelvic Pain," was published in Female Pelvic Medicine & Reconstructive Surgery.

Provided by University of Missouri-Columbia

Patch outperforms Holter for prolonged heart rhythm tracking

Research by the Scripps Translational Science Institute (STSI) has found that a small adhesive wireless device worn on the chest for up to two weeks does a better job detecting abnormal and potentially dangerous heart rhythms than the Holter monitor, which is typically used for 24 hours and has been the standard of care for more than 50 years.

09 jan 2014--The findings, which were published and made publically available online by the American Journal of Medicine today, suggest that the ZIO Service—which includes the ZIO Patch, data analysis and a diagnostic report provided by device maker iRhythm Technologies of San Francisco—could replace the Holter monitor as the preferred method of tracking electrical heart activity in ambulatory patients.

"This is the first large prospective validation that this new technology superseded the device invented by Norman Holter in 1949," said study senior author Eric Topol, M.D., a cardiologist who directs STSI and serves as the chief academic officer of Scripps Health. "By tracking every heart beat for up to two weeks, the ZIO Service proved to be significantly more sensitive than the standard Holter, which uses multiple wires and typically is only used or tolerated for 24 hours.

"For millions of people who present each year with suspected arrhythmia, this may prove to be the new standard for capturing the culprit heart rhythm electrical disturbance, most commonly atrial fibrillation which carries a significant risk of stroke," he said.

The ZIO Patch is a Food and Drug Administration-cleared compact, low-profile, noninvasive, water-resistant device that is worn for up to two weeks throughout normal activity then mailed by the patient to iRhythm for data analysis with a proprietary algorithm. The Holter monitor, which was first introduced in the 1940s, includes a cell-phone sized recorder typically worn at the waist and five to seven lead wires that attach to the chest.

The STSI study used electrocardiograph data collected from 146 patients who were fitted with a ZIO Patch and a Holter monitor after being referred to the cardiac investigations laboratory at Scripps Green Hospital for ambulatory heart monitoring. The Holter monitor was worn for 24 hours, and the ZIO Patch was worn for up to 14 days.

Over the course of the study, the ZIO Service detected 96 arrhythmia events while the Holter monitor detected 61. The researchers credited the patch's superior performance primarily to prolonged monitoring.

Physicians who reviewed data from both devices reported reaching a definitive diagnosis 90 percent of the time when using the patch results and 64 percent of the time when using Holter monitor data. A survey of study participants found that 81 percent of them preferred wearing the patch over the Holter monitor, with 76 percent saying the Holter monitor affected their daily living activities.

One unexpected finding was that the Holter monitor detected 11 more arrhythmias than the ZIO Service during the initial 24 hour period when both devices were working simultaneously. However, all of those arrhythmias were picked beyond 24 hours by the patch during the device's extended monitoring period. The ZIO Service detected two arrhythmias not captured by the Holter during the initial 24 hour period.

Provided by The Scripps Research Institute

Growing number of seniors caring for other seniors

In this Nov. 21, 2013, photo, Paul Gregoline rests in his favorite chair as caregiver Warren Manchess leaves the room, in Noblesville Ind. Burgeoning demand for senior services like home health aides is being met by a surprising segment of the workforce: Other seniors. Twenty-nine percent of so-called direct-care workers are projected to be 55 or older by 2018 and in some segments of that population older workers are the single largest age demographic. With high rates of turnover, home care agencies have shown a willingness to hire older people new to the field who have found a tough job market as they try to supplement their retirement income.(AP Photo/Darron Cummings)

08 jan 2014--Burgeoning demand for senior services like home health aides is being met by a surprising segment of the workforce: Other seniors.

Twenty-nine percent of so-called direct-care workers are projected to be 55 or older by 2018. And in some segments of that population, older workers are the single largest age demographic.

Though the jobs are among the fastest-growing in the U.S., they may seem a curious choice for older workers for their physical demands, low pay and high rates of injury.

But with high rates of turnover, home care agencies have shown a willingness to hire older people new to the field who have found a tough job market as they try to supplement their retirement income.

© 2014 The Associated Press. All rights reserved.

Heart disease linked with dementia in older postmenopausal women

Heart disease may put older postmenopausal women at higher risk for decreased brain function such as dementia, according to new research in Journal of the American Heart Association.

07 jan 2014--"Our study provides further new evidence that this relationship (between heart disease and dementia) does exist, especially among postmenopausal women," said study author Bernhard Haring, M.D., M.P.H., clinical fellow in the Comprehensive Heart Failure Center and the Department of Internal Medicine I at the University of Würzburg in Germany. "And many different types of heart disease or vascular disease are associated with declining brain function."

Researchers, conducting neurocognitive exams on nearly 6,500 U.S. women ages 65-79 who had healthy brain function at the start of the study, found:

• Postmenopausal women with heart disease or vascular disease were 29 percent more likely to experience cognitive decline over time compared with women without heart disease.
• The risk for cognitive decline was approximately double among women who had a heart attack compared with those who had not had a heart attack.
• Women who had heart bypass surgery, carotid endarterectomy (surgical removal of a blockage in a neck artery) or peripheral artery disease were at greater risk for cognitive decline.
• Risk factors such as high blood pressure and diabetes increased risk for cognitive decline over time.
• Obesity didn't notably increase cognitive decline in elderly women.

"Women with heart disease—in particular women who have had a heart attack, bypass surgery, heart failure, atrial fibrillation, peripheral vascular disease or carotid endarterectomy—should be monitored by their doctors for potential cognitive decline," Haring said. "It is also very important to adequately manage heart disease risk factors such as high blood pressure and diabetes."

Dementia is an increasingly significant problem in developed countries, so researchers said more study is warranted on how preventing cardiovascular disease may preserve cognitive health.

Provided by American Heart Association

Study shows benefit in activities of daily living and savings in caregiver time with vitamin E

Difficulty with activities of daily living often affect Alzheimer's patients, which is estimated to affect as many as 5.1 million Americans. These issues are among the most taxing burdens of the disease for caregivers, which total about 5.4 million family members and friends. New research from the faculty of Icahn School of Medicine at Mount Sinai working with Veterans Administration Medical Centers suggests that alpha tocepherol, fat-soluble Vitamin E and antioxidant, may slow functional decline (problems with daily activities such as shopping, preparing meals, planning, and traveling) in patients with mild-to-moderate Alzheimer's disease and decrease caregiver burden. There was no added benefit for memory and cognitive testing with the vitamin. The study is published online first in the Jan. 1 Journal of the American Medical Association.

06 Jan 2014--"Since the cholinesterase inhibitors [galantamine, donepezil, rivastigmine], we have had very little to offer patients with mild-to-moderate dementia," said Mary Sano, PhD, trial co-investigator, and professor in the department of psychiatry, Icahn School of Medicine at Mount Sinai, and director of research at the James J. Peters Veteran's Administration Medical Center, Bronx, New York. "This trial showed that vitamin E delays progression of functional decline by 19% per year, which translates into 6.2 months benefit over placebo."

The finding is valuable because vitamin E is easy to purchase at local drugstores and it is also inexpensive. The clinical trial investigators believe it can be recommended as a treatment strategy, based on the double-blind randomized controlled trial.

The Veteran's Administration Cooperative Randomized Trial of Vitamin E and memantine in Alzheimer's Disease (TEAM-AD examined the effects of vitamin E 2,000 IU/d, 20 mg/d of memantine, the combination, or placebo on Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS-ADL) Inventory Score. Cognitive, neuropsychiatric, functional, and caregiver measures were secondary outcomes. A group of 613 patients with mild to moderate Alzheimer's disease were in the study, which was launched in August 2007 and finished in September 2012 at 14 Veterans Affairs Medical Centers.

Dr. Sano previously led a study on vitamin E in patients with moderately severe Alzheimer's disease. She found that the vitamin slowed disease progression in this group of patients as well.

Kenneth Davis, MD, Chief Executive Officer and President of the Mount Sinai Health System and Gustave L. Levy Distinguished Professor, applauded the study. "This study is the first to show an added benefit for vitamin E in mild-to-moderate disease," he said. "Now that we have a strong clinical trial showing that vitamin E slows functional decline and reduces the burdens on caregivers, vitamin E should be offered to patients with mild-to-moderate Alzheimer's disease." Research by Dr. Davis and colleagues contributed to the establishment of conventional medical therapies for Alzheimer's disease.

More information: doi:10.l001/jama.2013.282834 and doi:10.l001/jama.2013.282835

Provided by The Mount Sinai Hospital

Severe mental illness tied to higher rates of substance use

People with severe mental illness such as schizophrenia or bipolar disorder have a higher risk for substance use, especially cigarette smoking, and protective factors usually associated with lower rates of substance use do not exist in severe mental illness, according to a new study funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

05 jan 2014--Estimates based on past studies suggest that people diagnosed with mood or anxiety disorders are about twice as likely as the general population to also suffer from a substance use disorder. Statistics from the 2012 National Survey on Drug Use and Health indicate close to 8.4 million adults in the United States have both a mental and substance use disorder. However, only 7.9 percent of people receive treatment for both conditions, and 53.7 percent receive no treatment at all, the statistics indicate.

Studies exploring the link between substance use disorders and other mental illnesses have typically not included people with severe psychotic illnesses.

"Drug use impacts many of the same brain circuits that are disrupted in severe mental disorders such as schizophrenia," said NIDA Director Dr. Nora D. Volkow. "While we cannot always prove a connection or causality, we do know that certainmental disorders are risk factors for subsequent substance use disorders, and vice versa."

In the current study, 9,142 people diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features, and 10,195 controls matched to participants according to geographic region, were selected using the Genomic Psychiatry Cohort program. Mental disorder diagnoses were confirmed using the Diagnostic Interview for Psychosis and Affective Disorder (DI-PAD), and controls were screened to verify the absence of schizophrenia or bipolar disorder in themselves or close family members. The DI-PAD was also used for all participants to determine substance use rates.

Compared to controls, people with severe mental illness were about 4 times more likely to be heavy alcohol users (four or more drinks per day); 3.5 times more likely to use marijuana regularly (21 times per year); and 4.6 times more likely to use other drugs at least 10 times in their lives. The greatest increases were seen with tobacco, with patients with severe mental illness 5.1 times more likely to be daily smokers. This is of concern because smoking is the leading cause of preventable death in the United States.

In addition, certain protective factors often associated with belonging to certain racial or ethnic groups – or being female – did not exist in participants with severe mental illness. "In the general population, women have lower substance use rates than men, and Asian-Americans have lower substance use rates than white Americans, but we do not see these differences among people with severe mental illness," said Dr. Sarah Hartz, from the Washington University School of Medicine in St. Louis and first author on the study. "We also saw that among young people with severe mental illness, the smoking rates were as high as smoking rates in middle-aged adults, despite success in lowering smoking rates for young people in the general population."

Previous research has shown that people with schizophrenia have a shorter life expectancy than the general population, and chronic cigarette smoking has been suggested as a major contributing factor to higher morbidity and mortality from malignancy as well as cardiovascular and respiratory diseases. These new findings indicate that the rates of substance use in people with severe psychosis may be underestimated, highlighting the need to improve the understanding of the association between substance use and psychotic disorders so that both conditions can be treated effectively.

More information: JAMA Psychiatry. Published online January 01, 2014. DOI: 10.1001/jamapsychiatry.2013.3726

Provided by NIH/National Institute on Drug Abuse

Obesity ballooning in developing world: report

The number of obese and overweight people in the developing world nearly quadrupled to almost a billion between 1980 and 2008, a think-tank report said Friday.

04 jan 2014--There are now far more obese or overweight adults in the developing world than in richer countries, the Overseas Development Institute (ODI) said.

The London-based institute said more than a third of all adults around the world—1.46 billion people—were obese or overweight.

Between 1980 and 2008, the numbers of people affected in the developing world rose from 250 million to 904 million. In the developed world, the figure rose from 321 million to 557 million.

This represented a rise from 23 percent to 34 percent of the world population.

"The growing rates of overweight and obesity in developing countries are alarming," said ODI research fellow Steve Wiggins, who co-authored the Future Diets report.

"On current trends, globally, we will see a huge increase in the number of people suffering certain types of cancer, diabetes, strokes and heart attacks, putting an enormous burden on public healthcare systems."

The report said overweight and obesity rates have almost doubled in China and Mexico since 1980, and risen by a third in South Africa.

The study said the rise in obesity was down to diets changing in developing countries where incomes were rising, with people shifting away from cereals and tubers to eating more meat, fats and sugar.

The over-consumption of food, coupled with increasingly sedentary lives, was also to blame.

The report found that North Africa, the Middle East and South America saw overweight and obesity rates increase to a level similar to Europe, around 58 percent.

At 70 percent, North America still has the highest percentage of overweight adults.

The report said there seemed to be little will among the public and leaders to take action on influencing diet in the future.

"Governments have focused on public awareness campaigns, but evidence shows this is not enough," said Wiggins.

"The lack of action stands in stark contrast to the concerted public actions taken to limit smoking in developed countries.

"Politicians need to be less shy about trying to influence what food ends up on our plates. The challenge is to make healthy diets viable whilst reducing the appeal of foods which carry a less certain nutritional value."

The report gave the example of South Korea as having made efforts to preserve healthy elements of the country's traditional diet, via public campaigns and education, providing large-scale training for women in preparing healthy, traditional food.

Researchers say fructose does not impact emerging indicator for cardiovascular disease

Fructose, the sugar often blamed for the obesity epidemic, does not itself have any impact on an emerging marker for the risk of cardiovascular disease known as postprandial triglycerides, new research has found.

03 jan 2014--However, overconsumption of calories from fructose can have substantial adverse effects on health, said Dr. John Sievenpiper, a researcher in the Clinical Nutrition and Risk Factor Modification Centre of St. Michael's Hospital.

"This is more evidence that fructose has adverse effects only insofar as it contributes to excess calories," said Dr. Sievenpiper.

Fructose, which is naturally found in fruit, vegetables and honey, is a simple sugar that together with glucose forms sucrose, the basis of table sugar. It is also found in high-fructose corn syrup, the most common sweetener in commercially prepared foods.

Dr. Sievenpiper conducted a meta-analysis of existing studies on fructose and its impact on the level of triglycerides, a fat found in blood, after eating. Testing for these triglycerides—in addition to the standard testing for blood glucose levels—is becoming more common for people trying to determine their risk for cardiovascular disease, although health care professionals remain divided on its usefulness.

Dr. Sievenpiper's results appear in the January 2014 issue of the journal Atheroclerosis.

"Fructose doesn't behave any differently than other refined carbohydrates," he said. "The increases you see are when fructose provides extra calories."

Provided by St. Michael's Hospital

The best New Year's resolutions are those you can keep

Taking small steps may help you reach goals by keeping you from getting discouraged, expert says.

02 jan 2014—You'll be more likely to stick to your New Year's resolutions if you establish realistic and achievable goals, an expert suggests.

Too many people try to do too much too fast and set unattainable goals, which simply sets them up for failure, according to Luis Manzo, executive director of student wellness and assessment at St. John's University in New York.

"There is no sense in making a resolution to wake up every morning at 5 a.m. and run five miles if you know you are not a morning person and you have never run more than a mile in your life. Such a goal will just demoralize you when you are unable to stick to it," he said in a university news release.

"Rather, play to your strengths, select goals that you can do and that work for you," Manzo suggested. "Maybe a more realistic goal is running after work for 20 minutes two days during the week and once on the weekend for 25 minutes. Start small, build your confidence and your motivation will skyrocket."

He offered a number of other suggestions to help you stick with your resolutions, including:

• Set aside time each day to work on your goals. For example, if you want to exercise, put it in your calendar. Be sure to factor in the time you need to get to the gym, shower and get dressed.
• Make your resolution part of your routine. The more you do this, the easier it will be to achieve your goal. For example, if you want to connect more with family and friends, make it a habit to call them on a certain night of the week.
• Write your goals down and make them public. This will make you more accountable.
• Surround yourself with people who are supportive of your goals. Or you can set goals with a friend so that you can encourage each other. For example, if you plan to write a book, find a friend who has the same goal and agree to share your progress and give each other feedback once a week.

More information: The U.S. General Services Administration offers tips for sticking with popular New Year's resolutions.

Avoiding that new year's hangover

Drink in moderation and eat beforehand, doctor says.

31 dec 2013—Hangover headaches are a common problem over the holidays, but there are ways to prevent them, an expert says.

The best way to avoid a hangover headache is to stick to non-alcoholic drinks such as sodas, spritzers and punches, said Dr. Noah Rosen, director of the Headache Center at North Shore-LIJ's Cushing Neuroscience Institute in Manhasset, N.Y.

If you do drink alcohol, do so in moderation, he advised.

"It is also best to eat beforehand as having food in the stomach slows the absorption of alcohol in the body," Rosen noted. "High-fat foods are particularly good in absorbing alcohol. Also, it is a good idea to snack throughout the party to keep blood sugar levels up."

Drink alcohol slowly and make every other drink a non-alcoholic one. Water is the best choice, because caffeinated sodas can boost heart rate and contribute to dehydration, he explained.

"Avoid darker alcohols as they contain more congeners, which are toxic chemicals," Rosen said. "Red wine has high congeners that can contribute to a hangover headache."

If you've been drinking, taking an anti-inflammatory drug—such as aspirin or ibuprofen or naproxen—before going to sleep will help reduce the pain of a hangover headache, Rosen said.

More information: The U.S. National Library of Medicine offers hangover treatment tips.