Social Internet-based activities important for healthy ageing
A steadily increasing amount of everyday activities require access to the Internet, and to achieve increased participation in society, we need to pay attention to an increased inclusion of seniors according to study at Umeå University. Credit: Mostphotos11 feb 2016--Meaningful and Internet-based activities promote experiences of participation in society and are important for healthy ageing. In a new dissertation at Umeå University in Sweden, occupational therapists are shown to promote participation, reduce experiences of loneliness and strengthen seniors' social network using an Internet-based intervention programme.
"Digitalisation is increasing the risk of excluding seniors who often can have limited experiences of Internet-based activities," says Ellinor Larsson, doctoral student at the Department of Community Medicine and Rehabilitation.
"A steadily increasing amount of everyday activities require access to the Internet, and to achieve increased participation in society, we need to pay attention to an increased inclusion of seniors. The senior citizen can also experience social change at the loss of loved ones, which makes the loneliness more evident. A joint effort focusing on how the well-being of the elderly can be promoted through meaningful Internet-based activities, is becoming more important in order to support the ageing population of today's society."
In her dissertation, which covers interviews and an evaluation of an Internet-based intervention programme, Ellinor Larsson describes how health-promoting efforts aimed at the seniors can be developed. To enable Internet-based social interventions for seniors, a collaboration between several parties in society is needed.
One of the studies showed that seniors who performed daily activities online also sensed a satisfying participation in society. According to the study, the participation in Internet-based activities can be promoted through support and encouragement from people in the person's surroundings, through greater access to technology and by identifying what online activities that are meaningful and important in the senior's everyday life.
The dissertation also shows how an individual and Internet-based occupational therapy intervention was drawn up to support the seniors in the introduction to social Internet-based activities. In an evaluation of the intervention, the participants showed a significant reduction in loneliness. A follow-up study shows that the online social activities constituted a compliment to other social activities and contacts both online and offline.
Provided by Umea University
Wednesday, February 10, 2016
AGS guidance on diversity proves 'seeing' older patients is about more than seeing age
New guidance from the American Geriatrics Society (AGS) aims to transform approaches to healthcare for our increasingly diverse older population. Developed by a committee of experts in ethnogeriatrics (the study of how ethnicity and culture impact the health and well-being of older people), "Achieving High-Quality Multicultural Geriatric Care" outlines present health disparities and the need for sensitivity to culture and health literacy when working with older individuals. As we look toward a not-so-distant future in 2050 when more than 80 million Americans will be 65-years-old or older, the factors outlined by AGS experts represent aspirational hallmarks of health care for a nation where 'minorities' will soon account for nearly 40 percent of all older adults. Credit: (c) 2016, American Geriatrics Society10 feb 2016--New guidance from the American Geriatrics Society (AGS) aims to transform approaches to healthcare for our increasingly diverse older population. Developed by a committee of experts in ethnogeriatrics (the study of how ethnicity and culture impact the health and well-being of older people), "Achieving High-Quality Multicultural Geriatric Care" outlines present health disparities and the need for sensitivity to culture and health literacy when working with older individuals. As we look toward a not-so-distant future in 2050 when more than 80 million Americans will be 65-years-old or older, the factors outlined by AGS experts represent aspirational hallmarks of health care for a nation where "minorities" will soon account for nearly 40 percent of all older adults.
"With 10,000 people across the U.S. turning 65 every day, virtually all doctors, nurses, social workers, and other health professionals will soon be caring for older adults—and importantly, older adults who are more diverse than ever before," explains VJ Periyakoil, MD, Chair of the AGS Ethnogeriatrics Committee. "The AGS believes that providing high-quality care for older adults means helping healthcare professionals practice self-awareness, develop interpersonal skills, and become skilled in providing respectful care that meets the unique needs of our richly diverse older adult population," Dr. Periyakoil added.
While health inequities are already well-documented among older people, they are even more pronounced for multi-cultural older Americans. Minority individuals over age 65 have higher rates of disease and disability when compared with Caucasian men and women, for example. Furthermore, of the 36 percent of Americans who report limited health literacy (the ability to obtain, process, and understand basic health information), most are older, less educated, and not white. And as AGS researchers note, mistrust of medicine and medical research remains a persistent barrier to high-quality multicultural care.
New guidance from the American Geriatrics Society (AGS) aims to transform approaches to healthcare for our increasingly diverse older population. Developed by a committee of experts in ethnogeriatrics (the study of how ethnicity and culture impact the health and well-being of older people), 'Achieving High-Quality Multicultural Geriatric Care' outlines present health disparities and the need for sensitivity to culture and health literacy when working with older individuals. As we look toward a not-so-distant future in 2050 when more than 80 million Americans will be 65-years-old or older, the factors outlined by AGS experts represent aspirational hallmarks of health care for a nation where 'minorities' will soon account for nearly 40 percent of all older adults. Credit: (c) 2016, American Geriatrics SocietyAs outlined by experts in this new AGS position statement, delivering culturally effective care means exploring and being responsive to the unique care needs of each patient during every clinical encounter. Putting processes or systems in place to ensure that patients are asked about their ethnicity, their preferred language, their level of education, and their familiarity with helpful resources like interpreter services, for example, can go a long way toward incorporating an older person's identity into her or his care.
Healthcare professionals themselves also need to become skilled in communicating effectively with people from different backgrounds, particularly since a provider's personal values and beliefs might inadvertently impede care without a healthy dose of self-awareness. The new AGS position statement walks through several questions for self-reflection, each exploring an aspect of personal identity that can impact the complex, coordinated care that many older people need.
"Culturally sensitive care isn't just about language or helping 'someone else.' For a healthcare professional, it's also an honest and deeply personal reflection on the stigmas and health disparities attached to certain groups. It means looking at ways our own personal journeys influence perspective and how we might respond to older people who look different, sound different, need different resources, or approach well-being with unique values and beliefs," said Steven R. Counsell, MD, AGSF, AGS President. "As a tool for recognizing how we are different, this new guidance from the AGS also helps to uncover what we have in common: a desire for care that is high-quality, person-centered, and supportive of the values and expectations that inform who we are."
The new AGS position statement on high-quality multicultural geriatric care was published online ahead of print in the Journal of the American Geriatrics Society, and will be available for free from GeriatricsCareOnline.org, the online home for AGS resources and publications.
New guidance from the American Geriatrics Society (AGS) aims to transform approaches to healthcare for our increasingly diverse older population. Developed by a committee of experts in ethnogeriatrics (the study of how ethnicity and culture impact the health and well-being of older people), 'Achieving High-Quality Multicultural Geriatric Care' outlines present health disparities and the need for sensitivity to culture and health literacy when working with older individuals. As we look toward a not-so-distant future in 2050 when more than 80 million Americans will be 65-years-old or older, the factors outlined by AGS experts represent aspirational hallmarks of health care for a nation where 'minorities' will soon account for nearly 40 percent of all older adults. Credit: (c) 2016, American Geriatrics SocietyMore information: "Achieving High-Quality Multicultural Geriatric Care" onlinelibrary.wiley.com/doi/10.1111/jgs.13924/pdf
Provided by American Geriatrics Society
Tuesday, February 09, 2016
Zika virus: Five things to know
Transmission electron micrograph (TEM) of Zika virus. Credit: Cynthia Goldsmith/Centers for Disease Control and Prevention09 feb 2016--A concise "Five things to know about.... Zika virus infection" article for physicians highlights key points about this newly emerged virus in CMAJ (Canadian Medical Association Journal)
Zika virus is transmitted by Aedes mosquitoes, which are active during the day. They also transmit dengue and chikungunya viruses. Physicians should be alert to symptoms in travellers returning from Central and South America, Mexico and the Caribbean. Zika virus may be linked to Guillain-Barré syndrome and microcephaly in babies born to women infected with Zika virus.
A blood test is used to diagnosis Zika virus infection. Acetaminophen may be used to alleviate pain and fever in affected patients.
The Advisory Committee on Immunization Practices (ACIP) has approved the recommended adult immunization schedule for 2016. The recommendations are published as a clinical guideline in the Feb. 2 issue of the Annals of Internal Medicine.
06 feb 2016--David K. Kim, M.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues present changes to the 2016 adult immunization schedule from the 2015 schedule, based on new ACIP recommendations.
The researchers note that the major changes to the schedule relate to human papillomavirus (HPV), pneumococcal, and serogroup B meningococcal (MenB) vaccines. The nine-valent HPV vaccine was added to the schedule, and can be used for routine vaccination against HPV for males and females. For immunocompetent adults aged 65 years and older, the vaccine interval for 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) was changed from "six to 12 months" to "at least one year." Immunocompromised adults, and those with anatomical or functional asplenia, cerebrospinal fluid leak, or cochlear implant, aged 19 years or older, should receive PPSV23 at least eight weeks after PCV13. All persons aged 10 years and older who are at increased risk for serogroup B meningococcal disease should have the MenB vaccine series.
"Only 29 percent of general internists and 32 percent of family physicians assess their patients' vaccination status at every visit," the authors write. "The health care provider is clearly the central figure in promoting vaccination among adults with high-risk conditions and adults in general."
The amyloid protein alpha-synuclein has been visualised in the cell for the first time
State of the protein α-synuclein in living, healthy cells: The central NAC region (grey) is well protected. The protein ensures that no interaction occurs with the cytoplasm (white) and other cell components. In the case of neurodegenerative changes, the grey areas would grow together and form amyloid structures. Credit: Philipp Selenko03 feb 2016--The protein α-synuclein plays an important role in Parkinson's and other neurodegenerative diseases. Although a considerable amount is known about the structure of the protein within the Parkinson's-typical amyloid deposits, nothing was known about its original state in the healthy cell up to now. Scientists from the Leibniz-Institut für Molekulare Pharmakologie (FMP) in Berlin have now for the first time visualised the protein in healthy cells with the help of high resolution spectroscopic procedures. Surprisingly, they discovered an unstructured state. The new findings, which have appeared in Nature and Nature Communications, represent a milestone for research worldwide: It is now known that the structure of the protein changes dramatically over the course of the disease.
Neurodegenerative diseases such as Parkinson's, Alzheimer's or Huntington's have one thing in common: so-called amyloid aggregates are deposited in the brain. Amyloid is the umbrella term for protein fragments that are produced by the body and that ultimately lead to the demise of nerve cells. The protein α-synuclein is one of the main components of the amyloid aggregates and therefore plays a major role in the development of Parkinson's disease. Much is known about the structural aspects of these aggregates. For example, it is known that α-synuclein has a very concrete structure, which means that it is based on a blueprint that follows a specific pattern. And, in contrast to this, it is known that the isolated, purified protein has no structure whatsoever.
However, up to now, it was not known what α-synuclein looks like inside a healthy cell. And pathological changes can only be fully explained if the original state of the protein is known. Researchers from the Leibniz-Institut für Molekulare Pharmakologie (FMP) in Berlin have therefore literally taken a closer look at the make-up of the protein in healthy cells. As the first research team worldwide, they succeeded in demonstrating – and visualising – α-synuclein in neuronal and non-neuronal cells. This was made possible by a combination of nuclear magnetic resonance spectroscopy (NMR) and electron paramagnetic resonance spectroscopy (EPR), two procedures that make it possible to characterise the structural configuration of a protein at atomic resolution.
"Now we know the starting point of α-synuclein"
"We discovered the unstructured state that the protein also has in the purified state," explains Dr. Philipp Selenko, Head of the In-cell NMR Spectroscopy research group, the research results published in the specialist journals Nature andNature Communications. "This is actually rather surprising, because it was inconceivable up to now that such an unstructured state can survive at all in a cellular milieu."
However, apparently cells can indeed deal with unstructured proteins. The images published in Nature show how the protein in the healthy cell protects the so-called NAC region from the penetration of foreign molecules. This central region plays a decisive role in the development of highly structured amyloid aggregates. Why the protective properties of the protein are lost in neurodegenerative diseases is one of the core questions with which research will be concerned in the future. "In the diseased state, this protein must change structurally to such an extent that the NAC region becomes accessible for other molecules, so that these regions can accumulate, start to grow and thus form the amyloid structures," suspects the biophysicist Selenko.
Watching the protein change its structure
The findings from Berlin provide the basis for an elucidation of these structural changes. The FMP researchers already have concrete plans for the coming months. With a few tricks, they will create artificially aged cells and introduce theamyloid protein and observe it using the same spectroscopic procedures. The age simulation is performed, because Parkinson's and other neurodegenerative diseases are age-related diseases. Ultimately, the researchers want to construct a state that corresponds to the origin of the disease. "We hope to watch the protein as the protection of the NAC region is gradually lost and how it begins to form amyloid-like structures," says research group leader Selenko.
In the study published in Nature Communications, the team of researchers had already made an exciting discovery in this respect. They had damaged the protein α-synuclein at several points in such a way as is normally the case in an aged cell. The proteinwas then introduced into a young, healthy cell. There, the researchers observed how the cell was able to repair the defects with amazing perfection in some regions, but not in others. The region that could not be repaired was the one that is immensely important for the function of the protein.
The discovery of the cause of the disease is getting closer
In the forthcoming study, the researchers want to gain a comprehensive insight into which defects cause the repair mechanisms to fail and thus prepare the ground for neurodegenerative processes. According to Philipp Selenko, this holds the key to at last finding the cause of the disease and thus one day intervening in the destructive process – with active substances that will then have to be developed on the basis of these findings. "With our discovery of the starting state of the protein, we have taken the decisive first step in this direction," says Selenko.
More information: Francois-Xavier Theillet et al. Structural disorder of monomeric α-synuclein persists in mammalian cells, Nature (2016). DOI: 10.1038/nature16531
Andres Binolfi et al. Intracellular repair of oxidation-damaged α-synuclein fails to target C-terminal modification sites, Nature Communications (2016). DOI: 10.1038/ncomms10251
Provided by Forschungsverbund Berlin e.V. (FVB)
Wednesday, January 27, 2016
Alzheimer-type brain pathology after transplantation of dura mater
Brown-colored A-beta plaques in the cerebral cortex in Alzheimer's disease. Credit: University Hospital ZurichUp to now Alzheimer's disease has not been recognized as transmissible. Now researchers at the University of Zurich and the Medical University Vienna demonstrated Alzheimer-type pathology in brains of recipients of dura mater grafts who died later from Creutzfeldt-Jakob disease.
27 jan 2016--Alzheimer's disease (AD) is characterized by progressive dementia and brain plaques consisting of the Aβ protein. Conventional wisdom has it that AD is not a transmissible disease. However, plaques recovered from brains of AD patients were repeatedly found to induce further plaques when injected into the brains of laboratory mice, suggesting that transmission may actually occur.
Reporting in today's Swiss Medical Weekly, Karl Frontzek and colleagues (University of Zurich and Vienna Medical University) have investigated individuals who received brain grafts of dura mater during neurosurgery. The dura mater ("tough mother") is the leathery membrane covering the brain and spinal cord. Such grafts were necessary to allow the brain to heal after surgery. Tragically, some of the dura mater donors were infected with prions (the agents causing the fatal Creutzfeldt-Jakob disease), and the grafting procedure transmitted the disease to the recipients.
Frontzek and colleagues now report the presence of Aβ plaques in 5 of 7 brains of relatively young recipients of dura mater grafts who succumbed to Creutzfeldt-Jakob disease. Aβ plaques were detected much more frequently than in brains of people who did not receive any dura mater grafts. Aβ plaques are highly unusual in young individuals and may have been caused by the dural grafts. This study adds to the evidence that the hallmarks of AD may indeed be transmissible under certain circumstances, and calls for heightened attention to an unexpected, potentially very serious problem of transplantation medicine.
More information: Karl Frontzek, Mirjam I. Lutz, Adriano Aguzzi, Gabor G. Kovacs and Herbert Budka. Amyloid-β pathology and cerebral amyloid angiopathy are frequent in iatrogenic Creutzfeldt-Jakob disease after dural grafting. Swiss Medical Weekly. January 26, 2016. DOI: 10.4414/smw.2016.14287
Provided by University of Zurich
Tuesday, January 26, 2016
Depressive symptoms linked to coronary artery calcium
26 jan 2016—Depressive symptoms seem to be associated with coronary artery calcium (CAC) in older men and women, according to a study published in the Feb. 1 issue of The American Journal of Cardiology.
John Bellettiere, M.P.H., from San Diego State University, and colleagues examined the correlation between depressive symptoms and CAC and CAC progression in a cohort of 417 community-dwelling older adults. Participants attended a 1997 to 1999 research clinic visit; depressive symptoms were assessed using the Beck Depression Inventory (BDI). Electron-beam computed tomography was used to measure CAC in 2000 to 2002 and in 2005 to 2007.
The researchers found that 39 percent of men and 10 percent of women had severe CAC in 2000 to 2002. There was a negative association for CAC severity by BDI quartiles in women: Compared with women in the second BDI quartile, women with the lowest depressive symptoms had 2.4-fold odds of increasing CAC severity. In men there was a nonlinear, U-shaped association: Compared with men in the second quartile, those in the first and fourth BDI quartiles had 2.6- and 3.0-fold higher odds of increasing CAC severity, after adjustment for coronary heart disease risk factors. There were no significant correlations for CAC progression, although in men, similar nonlinear patterns were seen.
"Depressive symptoms have a gender-specific, cross-sectional association with CAC but no statistically significant associations with CAC progression," the authors write.
The world's latest health scare is a seemingly minor illness that carries a killer wrapped inside: Zika, the mosquito-borne virus sweeping Latin America, usually lasts less than a week, except when it derails a whole life.
25 jan 2016--Zika, which resembles a light case of the flu, is often so mild that people don't realize they have it.
But health officials in Latin America say the tropical fever is linked to neurological problems and a surge in microcephaly, a condition in which babies are born with abnormally small heads. The defect can cause brain damage and death.
The outbreak has led authorities in some countries to urge couples not to get pregnant, while the US Centers for Disease Control (CDC) has warned pregnant women to avoid traveling to 22 affected countries.
Here are some questions and answers on the virus.
What's Zika?
The virus was first identified in a monkey in Africa in 1947. Its name comes from a forest in Uganda where the first infected rhesus monkeys were found. Within several years the virus had jumped to humans in Uganda and Tanzania, according to the World Health Organization (WHO).
Like dengue fever and chikungunya, two similar diseases, Zika is transmitted by mosquito species found in tropical and sub-tropical regions: Aedes aegypti and Aedes albopictus, or tiger mosquitoes.
How do I know if I have it?
In 70 to 80 percent of cases, the disease goes unnoticed. The symptoms resemble a mild case of the flu—headache, muscle and joint pain, and mild fever—plus a rash.
Symptoms usually last two to seven days.
Why are experts worried?
The disease is suspected of causing two serious complications: neurological problems and birth defects in babies born to infected women. But while there appears to be a connection with Zika, researchers have not definitively confirmed a causal link.
The main neurological complication is Guillain-Barre syndrome, a disorder in which the immune system attacks the nervous system, causing weakness and sometimes paralysis.
Most patients recover, but the syndrome is sometimes deadly. Cases linked to Zika have been reported in Brazil and French Polynesia.
Microcephaly and other brain deformities in newborns have also been reported, particularly in Brazil. Microcephaly cases in the giant South American country surged from 163 per year on average to 3,893 after the Zika outbreak began last year. Forty-nine of those babies have died.
What's the treatment?
There is no vaccine for Zika, and no specific treatment—patients simply take pain-killers and other medication to combat the symptoms.
The virus is transmitted through mosquito bites, so prevention entails fighting mosquitoes and avoiding contact with them. Health officials recommend covering up, using insect repellant and keeping windows closed or screened.
Authorities have responded to the outbreak by fumigating and cleaning up the standing water where mosquitoes breed.
Authorities in Brazil, Colombia, Ecuador, El Salvador and Jamaica have advised couples to avoid pregnancy for the time being.
In Brazil, authorities have announced a crackdown on mosquito breeding grounds ahead of the Olympics, which will bring hundreds of thousands of travelers from around the world to Rio de Janeiro in August.
Where is Zika now?
The virus was first reported in Africa, Asia and the Pacific before leaping to the Americas last year.
It is now spreading locally in some 20 Latin American and Caribbean countries, as far north as Mexico. Brazil has been the hardest hit.
Travelers have also brought it back to the US states of Florida, Hawaii and New York. A woman in Hawaii gave birth to a baby with microcephaly after traveling to Brazil.
So far there have been no locally transmitted US cases reported, though the Aedes aegypti mosquito's habitat stretches into the United States.
The European Centre for Disease Prevention and Control (ECDC) says on its website that "there is no evidence of transmission (of) Zika virus in Europe to date and imported cases are rare."
Societies release recommendations for diagnosing chest pain in the emergency department
New recommendations from the American College of Cardiology and American College of Radiology have established appropriate use of diagnostic imaging for patients with chest pain, one of the most common reasons for emergency department visits.
22 jan 2016--The document addresses 20 fundamental clinical scenarios for emergency imaging for chest pain and assesses when imaging is useful in each case, and if so, what information is provided by the specified imaging procedure. The clinical scenarios are broken down into leading critical diagnoses: acute coronary syndrome, pulmonary embolism and acute aortic syndrome. There is a fourth category, triple rule out computerized tomography (CT), for the minority of patients for whom a leading diagnosis is not possible.
Using the well-established modified Rand methodology, an expert panel rated each of the diagnostic procedures for the 20 clinical scenarios on a scale from 1 to 9. Each procedure has a corresponding rating of "rarely appropriate," "may be appropriate" or "appropriate."
"This document captures a wide scope of those patients who come to the emergency department with chest pain, although there will always be patients who present unique situations and no document can be a substitute for clinical judgment," said Frank J. Rybicki, MD, PhD, professor and chair of the department of radiology at the University of Ottawa, head of medical imaging at The Ottawa Hospital and co-chair of the writing committee.
The authors explain that the concept of appropriateness assesses the risks and benefits of a treatment, test or procedure and that these criteria provide imaging guidance to inform the clinician's judgment.
Provided by American College of Cardiology
Wednesday, January 20, 2016
Early weight loss in Parkinson's disease patients may signify more serious form of disease
Immunohistochemistry for alpha-synuclein showing positive staining (brown) of an intraneural Lewy-body in the Substantia nigra in Parkinson's disease. Credit: WikipediaA study led by a Massachusetts General Hospital (MGH) investigator finds evidence of an association between weight loss in patients with early Parkinson disease and more rapid disease progression. While weight loss is common in Parkinson's patients, results of the study - which is being released online prior to publication in the March issue of JAMA Neurology - could suggest that weight loss early in the course of the disease signifies a more serious form of the neurodegenerative disorder.
20 jan 2016--"I suspect we may be looking at several subtypes of this disease," says Anne-Marie Wills, MD, of the MGH Department of Neurology and Neurological Clinical Research Institute, lead and corresponding author of the JAMA Neurologypaper. "The patients who experience early weight loss appear to have a more severe, systemic form of the disease, possible due to involvement of the neuroendocrine system or the gastrointestinal nervous system, while those who gained weight may have a milder form of the disease."
While previous studies have found that a higher body mass index (BMI) - a measure of weight relative to height - is associated with improved survival in Huntington disease and amyotrophic lateral sclerosis (ALS), no published study has examined the relationship of weight to disease progression and survival in Parkinson disease. Wills and her co-authors from eight other U.S. research centers examined data collected in conjunction with an NIH-sponsored clinical trial conducted from 2007 until 2013 to investigate the use of creatine to treat early-stage disease. That trial enrolled more than 1,700 patients who were within five years of diagnosis and from 90 days to two years after beginning treatment with dopamine-releasing drugs and was stopped early when creatine treatment was found to have no benefit.
Data required for the current study - including annual height and weight measurement and results from the Unified Parkinson's Disease Rating Scale (UPDRS) covering the three to five years of trial enrollment - was available for 1,673 study participants. For 77 percent of the participants (1,282), BMI remained stable during the study period; 158 participants (9 percent) experienced weight loss, and 233 (14 percent) actually gained weight. Those who lost weight during the study period showed a greater average increase in UPDRS score - indicating a worsening of symptoms - both in terms of motor symptoms and overall than did those whose weight remained stable. Participants who gained weight had the smallest annual increase in UPDRS scores. There was no significant difference in survival among the three groups, but that may reflect the fact that participants were in the early stages of their disease.
The authors note that it is not currently possible to determine whether maintaining or even increasing weight might help slow disease progression, although this hypothesis was supported by a 2014 interventional study in ALS also led by Wills. "Since this is just the first observation of this association in Parkinson's, we cannot recommend any changes to standard clinical care right now," she says. "But in my own practice, I try to prevent weight loss in patients, and I would recommend providers to be attentive to weight changes in their patients, even early in the disease." Wills is an assistant professor of Neurology at Harvard Medical School.
Fight against little-known Zika virus applies lessons from Ebola
While the world's attention has been focussed on Ebola, another outbreak has been spreading in a number of countries across the world. Now, Oxford University infectious disease specialists are applying the lessons from the Ebola outbreak to try to support local medics and researchers to get ahead of this new pathogen.
14 jan 2016--Zika, carried by the Aedes mosquito, has been known about for some years, typically causing mild illness and a rash. Now, however, reports from South America suggest that it is causing birth defects in newborn babies of women who have had Zika.
The outbreak came to the attention of two Oxford-based organisations: The Global Health Network (TGHN), an online science park that guides and supports medical research around the world, especially in low and middle income countries and ISARIC, a global network of researcher groups whose aim is to enable research in disease outbreaks
Professor Trudie Lang explained: 'I was at an ISARIC meeting about Ebola when Fernando Bozza of the Oswaldo Cruz Foundation told us about the Zika outbreak He asked what we knew about the Zika outbreak. The answer was not much.
'He briefed the ISARIC team and it was clear this was another situation where the research community had to come together to ensure that evidence was gathered as early as possible this time, and that we should apply the lessons from Ebola that we were discussing at that very meeting.'
Zika has been known about since the late 1940s but major outbreaks were not recorded until a 2006 occurrence on the pacific island of Yap. In 2013 there were 30,000 cases in French Polynesia.
However, the South American outbreak is particularly concerning because if its apparent effect on foetal development. Dr Fernando Bozza said: 'Zika Virus has been reported in Brazil since April 2015 and up to mid-December, nine other countries in the Americas have reported local Zika transmission.
'In November, the Brazilian Ministry of Health reported an unusual increase in cases of microcephaly, with a causal link between Zika infection during pregnancy and congenital abnormalities. 2,401 microcephaly cases are under investigation in Brazil, with 134 cases confirmed related to Zika virus infection. Investigations are also ongoing to assess a possible relation between Zika and Guillain-Barré Syndrome and other neurological events.'
With Zika becoming a more serious disease, The Global Health Network recognised the need to move as rapidly as possible into obtaining data, which requires the integration of research into the medical and public health response. Developing research tools and strategies is key and this needed a resource for agreeing research priorities and sharing research documents
Professor Lang said: 'Medical research is vital to understand, manage and hopefully stop the outbreak. However, if samples and patient information are to be used for research purposes then protocols are needed that have been given ethical approval by regulatory authorities and patients need to be informed and asked for their consent. Robust studies need to be planned and this all takes time to put into place. However, a lesson from Ebola was that it can be done faster. The researchers in the affected regions are poised to run and lead these studies, and the international research community, through ISARIC, is working to support them and provide any input and external expertise that is needed.
'The Global Health Network's website for Zika has been set up for the local research community. It will make available documents like case record forms and consent forms, as well as sharing research priorities. By providing a common and open sharing space that is driven by the regional researchers in Brazil and other countries it should be possible to speed up getting this crucial data that is needed to understand, manage and eventually treat Zika virus infection.'
The hope is that a joined up approach, where frontline health organisations are supported by a global network, will mean Zika is understood quicker and that work on treatments can begin sooner.
Task force: Mammograms an option at 40, do more good at 50
Mammograms do the most good later in life, a government task force said Monday in recommending that women get one every other year starting at age 50, and that 40-somethings make their own choice after weighing the pros and cons.
Mammograms do the most good later in life, a government task force declared Monday in recommending that women get one every other year starting at age 50. It said 40-somethings should make their own choice after weighing the pros and cons.
13 jan 2016--When to start routine mammograms and how frequently to get them has long been controversial. The latest guidelines from the U.S. Preventive Services Task Force stick with its advice that women should one every two years between ages 50 and 74. But they also make clear that it's an option for younger women even though they're less likely to benefit.
Some health groups urge mammograms every year starting at 40—although last year the American Cancer Society upped its starting age to 45.
There is some common ground emerging, that mammography advice shouldn't always be one-size-fits all. "Age 50 isn't magic," said task force past chairman Dr. Michael LeFevre of the University of Missouri.
Here are some things to know about mammograms.
___
WHAT THE TASK FORCE SAYS
Women in their 60s are the most likely to avoid dying from breast cancer thanks to mammograms, but there's clearly enough benefit for the average woman to start at 50, the task force found.
The advisory group wants younger women to understand the trade-offs before deciding: Among every 1,000 women screened, one additional death could be prevented by starting mammograms at 40 instead of 50. But there would be 576 more false alarms and 58 additional unneeded biopsies. Also, two extra women would be overdiagnosed, treated for cancer that never would have become life-threatening.
Monday's update, published in Annals of Internal Medicine, is largely a rewording of guidelines originally issued in 2009 and reconsidered in draft form last spring. This time, the task force stresses that "we think the science supports a range of options" for 40-somethings, LeFevre said.
___
DIFFERING GUIDELINES
Mammograms aren't perfect, and different health organizations weigh the trade-offs differently. So do women and their physicians.
The American Cancer Society says to begin annual mammograms at 45 but switch to every other year at 55. After menopause, tumors tend to grow more slowly and women's breast tissue becomes less dense and easier for mammograms to penetrate, says chief medical officer Dr. Otis Brawley. Between ages 40 and 44, when breast cancer is especially uncommon, the society also says women should make their own choice.
"We're moving away from paternalistic medicine where we doctor organizations used to tell women, 'You must do this,'" Brawley said. "We're saying, 'This woman is at higher risk, therefore maybe she should get screened at 40. This woman is at lower risk, maybe she can wait a little later.'"
The American College of Obstetricians and Gynecologists stands by annual mammograms starting at 40, while urging patient education and shared decision-making.
___
THINGS TO CONSIDER
More than 200,000 women are diagnosed with breast cancer each year, and about 40,000 die from it. It is most frequently diagnosed among women ages 55 to 64, and the median age of death from breast cancer is 68.
Women with a mother, sister or daughter with breast cancer have a higher risk than the average 40-year-old. Other factors can play a role, too, including genetics, breast density and menstrual and pregnancy history.
___
PERSONALIZED SCREENING
Dueling guidelines mean "some people get so confused they don't get screened at all. Some are too anxious or afraid not to do more, and it may not be better for them," said breast cancer specialist Dr. Laura Esserman of the University of California, San Francisco. "Maybe we should be screening in a new way."
Esserman leads the first-of-its-kind WISDOM study that soon will begin enrolling 100,000 women to test whether tailoring screening to someone's individual risk is better than age-based mammograms. Women given annual mammograms starting at 40 will be compared with others assigned more or less frequent screenings, starting at different ages, based on in-depth risk assessments.
___
INSURANCE COVERAGE
Insurance usually pays for mammograms. Because of concern about how the task force recommendations might be implemented, Congress recently extended for two years legislation preserving access to routine mammograms without copays starting at age 40.
___
WHEN TO STOP
The task force says more research is needed to know whether to continue mammograms at 75 and beyond. The cancer society says to keep screening as long as women are in good health and have a life expectancy of at least 10 years.
___
WHAT'S NEXT
The task force said more research is needed to tell if newer 3-D mammograms should be used for routine screening and if women with dense breasts benefit from extra testing, such as with ultrasounds or MRIs.
The cancer society's Brawley said the mammogram age argument has distracted from a bigger urgency: "We ought to say this more: We need a better screening test for younger women."
___
Researchers at The University of Western Australia have found that engagement in the arts for enjoyment, entertainment or as a hobby, for two or more hours a week, is associated with good mental wellbeing.
12 jan 2016--The award-winning study, published in BMC Public Health, is the first internationally to quantify the relationship between mental wellbeing and arts engagement in the general population.
Lead author Dr Christina Davies said good mental health was the foundation for individual and community wellbeing, yet every year one in five Australians experience mental illness.
"People need a range of easy enjoyable options they can use to stay well," she said.
"Depending on a person's interests, the arts can provide a range of health enhancing opportunities, activities and events."
Dr Davies said whether a person preferred listening to music, reading, colouring, creative writing, watching movies or attending concerts, the knowledge that arts engagement positively impacts mental wellbeing was empowering.
"Arts engagement increases happiness, confidence, self-esteem and reduces stress and social isolation," she said.
"It results in the creation of good memories and has an impact on a person's knowledge and skills.
"People need to give themselves permission to be creative and to make time for the arts activities and events that they enjoy."
Dr Davies said the study, which won a Department of Health Future Health WA Award, the Public Health Association (WA) Post Graduate Award and the Arts and Health Australia Award for Excellence, provided new insights into the relationship between the arts and population health.
The ground-breaking research forms part of Dr Davies "Healthy Arts" PhD. The study was funded by Healthway and the Department of Health WA. Her PhD supervisors and co-authors were Professor Matthew Knuiman and Associate Professor Michael Rosenberg, senior academics in health promotion and public health.
More information: Christina Davies et al. The art of being mentally healthy: a study to quantify the relationship between recreational arts engagement and mental well-being in the general population, BMC Public Health (2016). DOI: 10.1186/s12889-015-2672-7
Provided by University of Western Australia
Sunday, January 10, 2016
Questions and answers about new UK drinking guidelines
A man walks by a wines and spirits shop in central London. British health officials say that drinking any alcohol regularly increases the risk of cancer, in tough new guidelines that could be hard to swallow for a nation where having a pint is a hallowed tradition. In recommendations released on Friday, Jan. 8, 2016, Britain's Chief Medical Officer advised both men and women not to drink any more than 14 units of alcohol, or about six pints of beer a week—that still carries a low risk of liver disease or cancer.
British health officials say drinking any alcohol regularly increases the risk of cancer, and have issued tough new guidelines that could be hard to swallow in a nation where having a pint is a hallowed tradition.
10 jan 2016--In recommendations released Friday, Britain's Chief Medical Officer advised both men and women not to drink any more than 14 units of alcohol—about six pints of beer or about four large glasses of wine—a week and said even that still carries a low risk of liver disease or cancer.
Alcohol is a known carcinogen; in the U.S., experts estimate it causes about 3.5 percent of all cancer deaths. People who have more than about four drinks a day have up to a three-fold greater risk of cancers of the head and neck than non-drinkers.
Here are some questions and answers about the new guidelines and their likely effect:
WHAT'S NEW?
For women, the guidelines remain unchanged, recommending no more than 14 units of alcohol a week.
Men, however, had previously been told they could drink up to 21 units a week. That now drops to the same limit as for women. The original guidance was published in 1995, before much of the recent evidence about the link between alcohol and cancer was released.
The guidance clarifies advice to pregnant women, recommending they avoid alcohol "as a precaution." The recommendations say "the risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy."
In the U.S., the Centers for Disease Control and Prevention says there is no known safe amount of alcohol use during pregnancy or while trying to get pregnant.
WILL BRITONS GO TEETOTAL?
Probably not. In a nation known for its ales and its pubs, Britons are unlikely to abandon drinking in droves. Lax control of retail sales and cheap alcohol have fueled a rise in binge-drinking, which was once declared a national scandal by Prime Minister David Cameron. Even the new guidance acknowledges people are unlikely to give up drinking and advises them not to regularly drink more than 14 units a week rather than calling for abstinence.
To help Britons avoid binge drinking, the government recommends people spread their drinking over at least three days a week. It warns that the risk of cancers of the mouth, throat and breast increases with any amount drunk on a regular basis.
"This is not a crackdown on alcohol," said Dr. Niamh Fitzgerald, a lecturer in alcohol studies at the University of Stirling, who was not involved in drafting the government guidelines. "It is about supporting people to make up their own minds." In a statement, she said the new advice reflects the scientific consensus on the risks from drinking.
HOW DOES THIS COMPARE WITH OTHER COUNTRIES?
Each country measures alcohol consumption slightly differently. The new guidelines are stricter than some other countries in Europe including Ireland and Spain, but roughly similar to what's recommended in the U.S. According to American dietary guidelines, women should drink no more than one drink a day and men should have no more than two.
WHAT ABOUT THOSE SUPPOSED BENEFITS OF ALCOHOL?
While some studies have suggested drinking moderate levels of red wine is good for the heart, British officials say that only applies to women over age 55, in whom the greatest benefit is seen when women drink no more than about two glasses a week. "The group concluded that there is no justification for drinking for health reasons," the government said.
WHAT'S THE VIEW DOWN AT THE PUB?
"This won't change a thing," said David Evans, an engineer enjoying a pint at a north London pub. He said he regularly exceeds the new limitation of about six pints of beer a week in a single day and has no intention of changing his drinking habits. "A lot of people will let their own body tell them what's right and what's wrong," he said.
U.K. Independence Party leader Nigel Farage said the advice was "over the top" and called for a mass protest against such "nannying."
"We all know there is a big problem with excessive alcohol consumption in this country," he told LBC radio. "But frankly, if we choose to enjoy a few drinks four or five nights a week after a hard day at work, whether it slightly shortens our lives or not, so what?"
Saturday, January 09, 2016
Reducing sugar content in drinks could prevent one million cases of obesity
Reducing sugar content in sugar sweetened drinks (including fruit juices) in the UK by 40 per cent over five years could prevent one million cases of obesity, according to research by Queen Mary University of London (QMUL). This would in turn prevent around 300,000 cases of type 2 diabetes, over two decades.
09 jan 2016--Based on the UK's salt reduction experience, which has seen salt content in many food products successfully reduced by 40 per cent over five years, the researchers studied the potential effects of a similar reduction in added sugars.
The study, published in The Lancet Diabetes & Endocrinology, used data from the National Diet and Nutrition Survey rolling programme and British Soft Drinks Association annual reports. The researchers calculated sugar sweetened beverage (SSB) consumption level and its contribution to free sugar and energy intakes in the UK population.
The calculations showed that a 40% reduction in free sugars added to SSBs over five years would lead to an average reduction in energy intake of 38.4 kcal (calories) per day by the end of the fifth year and this would lead to an average reduction in body weight of 1.20kg in adults. This would result in a reduction of 500,000 overweight adults and one million obese adults, and in turn prevent around 300,000 cases of obesity-related type 2 diabetes over the next two decades.
The predicted impact was greater in adolescents, young adults, and individuals from low income families who consume more SSBs.
The authors add that previous research has shown that the calories lost from SSBs are unlikely to be replaced by other sources. The reduction in added sugar also has little influence on the cost and price of the product and is therefore unlikely to affect sales and profit of the soft drink industry. They say it is therefore potentially attractive to industry, although some—for instance, the sugar industry—may be resistant.
Professor Graham MacGregor and his co-authors from QMUL's Wolfson Institute of Preventive Medicine said: "The proposed strategy could lead to a profound reduction in energy intake from sugar-sweetened beverages and could therefore lower the prevalence of overweight, obesity, and type 2 diabetes in the long term. These findings provide strong support for the implementation of the proposed strategy."
The authors say that reducing consumption of sugar-sweetened beverages in the long term can be difficult for individuals because of the advertising power of industry. They add: "Our proposed strategy provides an innovative and practical way to gradually reduce energy intake from sugar-sweetened beverages and its combination with other strategies, including a tax on sugar-sweetened beverages, would produce a more powerful effect."
More information: Yuan Ma et al. Gradual reduction of sugar in soft drinks without substitution as a strategy to reduce overweight, obesity, and type 2 diabetes: a modelling study, The Lancet Diabetes & Endocrinology (2016). DOI: 10.1016/S2213-8587(15)00477-5
Provided by Queen Mary, University of London
Friday, January 08, 2016
New dietary guidelines: lean meat OK, cut the added sugars
Some Americans may not have to cut back on eggs and salt as much as they once thought and eating lean meat is still OK. But watch the added sugars, especially the sugary drinks. The Obama administration's new dietary guidelines, released Thursday, back off the strictest sodium rules included in the last version, while still asserting that Americans consume too much salt. The guidelines reverse previous guidance on the dangers of dietary cholesterol and add strict new advice on sugars.
08 jan 2015--After a backlash from the meat industry and Congress, the administration ignored several suggestions from a February report by an advisory committee of doctors and nutrition experts. That panel suggested calling for an environmentally friendly diet lower in red and processed meats and de-emphasized lean meats in its list of proteins that are part of a healthy diet.
But, as in the previous years, the government still says lean meats are part of a healthy eating pattern.
Released every five years, the guidelines are intended to help Americans prevent disease and obesity. They inform everything from food package labels to subsidized school lunches to your doctor's advice. And the main message hasn't changed much over the years: Eat your fruits and vegetables. Whole grains and seafood, too. And keep sugar, fats and salt in moderation.
This year, one message the government wants to send is that people should figure out what type of healthy eating style works for them, while still hewing to the main recommendations. The Agriculture Department, which released the guidelines along with the Department of Health and Human Services, is also releasing a tweaked version of its healthy "My Plate" icon to include a new slogan: "My Wins."
"Small changes can add up to big differences," said Agriculture Secretary Tom Vilsack.
One new recommendation is that added sugar should be 10 percent of daily calories. That's about 200 calories a day, or about the amount in one 16-ounce sugary drink. The recommendation is part of a larger push to help consumers isolate added sugars from naturally occurring ones like those in fruit and milk. Added sugars generally add empty calories to the diet.
Sugar-sweetened beverages make up a large portion of those empty calories. According to the guidelines, sugary drinks comprise 47 percent of the added sugars that Americans eat every day.
Americans also need to lower salt intake, the government says. New figures from the Centers for Disease for Disease Control and Prevention show that around 90 percent of people eat too much. The average person eats 3,400 milligrams of sodium a day, and the guidelines say everyone should lower that amount to 2,300, or about a teaspoon.
Lowering sodium intake was the major push of the 2010 guidelines, and that document recommended that those most at risk of heart disease, or about half the population, lower their intake to 1,500. The new guidelines drop that lower amount as part of the top recommendations. Still, advice buried deeper in the guidelines says that those with high blood pressure and prehypertension could benefit from a steeper reduction.
After years of doctors saying that Americans shouldn't eat too many eggs, recommendations for cholesterol have also shifted. The 2010 guidelines made a key recommendation that Americans consume less than 300 mg a day of dietary cholesterol, or about two eggs. That recommendation is gone, following increasing medical research showing the amount of cholesterol in your bloodstream is more complicated than once thought. Some more recent studies have shown little relationship between heart disease and how much dietary cholesterol one eats.
Still, egg lovers aren't completely off the hook. Discussion of cholesterol deeper into the document says "individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern."
As in previous years, the report advises limiting saturated fats to 10 percent of total calories. And while lean meats are promoted, the government does suggest certain populations, such as teen boys and adult men, should reduce their meat intake and eat more vegetables. Data included in the report shows that males ages 14 to 70 consume more than recommended amounts of meat, eggs and poultry, while women are more in line with advised amounts.
While the guidelines always have been subject to intense lobbying by food industries, this year's version set off unprecedented political debate, fueled by Republicans' claims the Obama administration has gone too far in telling people what to eat.
Congress got involved, encouraging the administration to drop the recommendations based on environmental impact and at one point proposing to set new standards for the science the guidelines can use. That language did not become law, however. A year-end spending bill simply said the guidelines must be "based on significant scientific agreement" and "limited in scope to nutritional and dietary information."
Thursday, January 07, 2016
New study suggests benefits of regular mammography extend to the elderly
Breast cancer is the second most common cancer in women after skin cancer and occurred in 230,000 women in the United States in 2015. Breast cancer afflicts 1 in 8 women in their lifetime and 1 in 25 die from this disease. Although a number of randomized trials demonstrate the clear benefits of mammography screening in women up to age 74 on reducing mortality, data are sparse in women over the age of 74, especially minorities. In 2010, 41 percent of breast cancer deaths occurred in the more than 19 million women who are between the ages of 65 to 84 years.
07 jan 2015--In a new study published in the American Journal of Medicine, Charles H. Hennekens, M.D., senior author and first Sir Richard Doll Professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University, indicates that black and white women ages 75 to 84 years who had an annual mammogram had lower 10-year breast cancer mortality than corresponding women who had biennial or no/irregular mammograms.
Among elder women, the American Cancer Society and the United States Preventive Services Task Force recommend regular mammography for ages 65 to 74.
Although many guidelines rely on self-reports, Hennekens and his collaborators from Baylor College of Medicine and Meharry Medical College, used the Surveillance, Epidemiology, and End Results (SEER) program file linked to the Medicare administrative claims file, which allowed them to identify screening mammography use from 1995 to 2009 from 64,384 non-Hispanic women (4,886 black and 59,498 white). These linked files also permitted them to explore breast cancer mortality differences between elderly black or white women who self-selected for regular annual or biennial mammography screening. The researchers selected 69 as the lower age limit because Medicare coverage of the general population begins at age 65, and the exposure of interest was regular mammography screening in the four years immediately preceding breast cancer diagnosis.
Three mutually exclusive categories were defined: no or irregular mammography; biennial mammography; and annual mammography. They looked at data from non-Hispanic, white or black women; Hispanics were not included because Hispanic white women have substantially lower mortality than non-Hispanic whites, and the number of Hispanic blacks is small. The researchers also measured socioeconomic status looking at median household income, the percentage of individuals living below the poverty level, and whether or not they had a high school education. Other significant findings from the study show that:
White women who had died tended to be older, to have a later stage diagnosis, to have received chemotherapy, and to have a higher socioeconomic status.
White women who died were less likely to have undergone surgery and receive radiation therapy.
Similar characteristics were seen in black women as in white women.
69- to 84-year-old women receiving regular annual screening mammography during the four years immediately preceding breast cancer diagnosis had consistently lower five-year and 10-year risks of breast cancer mortality thanwomen with no or irregular screening regardless of race.
10-year risks were more than three times higher among white and more than two times higher among blacks aged 69 to 84 years with no or irregular screening compared with annual screening.
Hennekens notes that further research is needed, but that in the future, the use of regular claims-based surveillance for mammography as a source of data may offer some unique advantages over self-reports.
From 1995 to 2005, according to Science Watch, Hennekens was the third most widely cited medical researcher in the world and five of the top 20 were his former fellows and/or trainees. In 2012, Science Heroes ranked Hennekens No. 81 in the history of the world for having saved more than 1.1 million lives, which placed him two ahead of professor Jonas Salk ranked No. 83 for the development of the polio vaccine. In 2013, he received the "Fries Prize for Improving Health" and in 2014, he received the Alton Ochsner Award for his pioneering work on smoking and health. In 2015, he was ranked the No. 14 "Top Scientist in the World" based on his H-index of 173.
Provided by Florida Atlantic University
Wednesday, January 06, 2016
Study finds cerebrovascular disease to be major determinant of psychosis in patients with Alzheimer's
Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.About half of all patients with Alzheimer's disease develop symptoms of psychosis, such as delusions or hallucinations. But the pathological mechanisms that underlie psychotic symptoms are unclear, limiting the ability to manage and treat them. Some studies have suggested they are related to the underlying causes of Alzheimer's disease such as the protein deposits found in the brains of Alzheimer's patients, but others found no correlation.
06 jan2016--A study published today in the Journal of Alzheimer's Disease found that cerebrovascular disease is a major determinant of psychosis in people with Alzheimer's disease. Cerebrovascular disease is a group of conditions that restrict the circulation of blood to the brain.
Using data from the National Alzheimer's Coordinating Centre database collected from 29 Alzheimer's disease centres in the United States between 2005 and 2012, researchers led by Dr. Corinne Fischer, a psychiatrist and researcher at St. Michael's Hospital, analyzed autopsy data from 1,073 people.
Of the 890 people who had been clinically diagnosed with Alzheimer's while they were alive, the people most likely to be psychotic were those whose autopsies showed they had more physical signs of Alzheimer's such as neuritic plaques (protein deposits) and neurofibrillary tangles (twisted fibers found inside brain cells).
But when they looked at the 728 people whose autopsies confirmed they had Alzheimer's, those with psychosis did not show increased physical evidence of Alzheimer's disease. Alzheimer's can only be confirmed through an autopsy, so some patients in the clinically diagnosed group had been misdiagnosed with Alzheimer's.
In both groups of patients, psychosis correlated significantly with Lewy bodies, abnormal protein aggregates found in nerve cells of patients with Parkinson's disease. This was not an unexpected finding since psychosis is prominent when dementia accompanies Parkinson's disease.
What was entirely unexpected was the prominent role in psychosis of vascular risk factors (hypertension, diabetes, age at quitting smoking) and cerebral injuries related to small vessel disease,
About 19 per cent of people with Alzheimer's who live in the community (rather than in institutions) are thought to have delusions and 14 per cent have hallucinations. Psychotic symptoms are significant in Alzheimer's patients because they have been shown to be associated with increased burden on caregivers, increased functional decline and more rapid progression of the disease.
Provided by St. Michael's Hospital
Tuesday, January 05, 2016
Impact of 2012 USPSTF guideline against PSA screening explored
05 jan 2016—Patients undergoing prostate needle biopsies after the 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen-based screening for prostate cancer for men of any age are more likely to be diagnosed with high-risk disease, according to research published in the January issue of The Journal of Urology.
John S. Banerji, M.D., from the Virginia Mason Medical Center in Seattle, and colleagues reviewed data from a prospective database of patients undergoing prostate needle biopsies from 2004 to 2014. The authors compared patients seen before and after the USPSTF recommendations.
The researchers found that, compared with the 1,416 patients in the pre-USPSTF group, the 310 patients in the post-USPSTF group had a higher prostate-specific antigen (P < 0.001); they were also more likely to be diagnosed with higher clinical stage (2b, P = 0.003; 2c-3a, P = 0.027) and D'Amico high-risk prostate cancer (P = 0.036), with an adjusted relative risk of 1.25 for high-risk prostate cancer. Similar results were seen when the pre-USPSTF group was limited to 448patients seen in the 30 months before the draft guidelines. There was a 31 percent decrease in the absolute number of biopsies performed, with most of the decrease occurring in the detection of intermediate-risk tumors.
"Future focus on informed application of screening techniques may prevent the reversal of decades of improvement in the prostate cancer mortality rate," the authors write.
Taking vitamin D may benefit people with multiple sclerosis
Demyelination by MS. The CD68 colored tissue shows several macrophages in the area of the lesion. Original scale 1:100. Credit: Marvin 101/WikipediaTaking a high dose of vitamin D3 is safe for people with multiple sclerosis and may help regulate the body's hyperactive immune response, according to a pilot study published by Johns Hopkins physicians in the Dec. 30 online issue of Neurology, the medical journal of the American Academy of Neurology.
04 jan 2016--"These results are exciting, as vitamin D has the potential to be an inexpensive, safe and convenient treatment for people with MS," says study author Peter Calabresi, M.D., director of the Johns Hopkins Multiple Sclerosis Center and professor neurology at the Johns Hopkins University School of Medicine. "More research is needed to confirm these findings with larger groups of people and to help us understand the mechanisms for these effects, but the results are promising."
Low levels of vitamin D in the blood are tied to an increased risk of developing MS. People who have MS and low levels of vitamin D are more likely to have greater disability and more disease activity.
For the study, 40 people with relapsing-remitting MS received either 10,400 international units or 800 international units of vitamin D3 supplements per day for six months. Patients with severe vitamin D deficiency were not included in the study. The current recommended daily allowance of vitamin D3 is 600 international units. Blood tests at the start of the study and again at three and six months measured the amount of vitamin D in the blood and the response in the immune system's T cells, which play a key role in MS.
While researchers are still determining the optimal level of vitamin D in the blood for people with MS, a suggested range of 40 to 60 nanograms per milliliter (ng/ml) has been proposed as a target. Participants taking the high dose of vitamin D reached levels within the proposed target, whereas the group taking the low dose did not reach the target.
Side effects from the vitamin supplements were minor and were not different between the people taking the high dose and the people taking the low dose. One person in each group relapsed.
The people taking the high dose had a reduction in the percentage of inflammatory T cells related to MS severity, specifically IL-17+CD4+ and CD161+CD4+ cells. When the increase in vitamin D levels in the blood over base line levels was greater than 18 ng/ml, every additional 5 ng/ml increase in vitamin D led to a 1 percent decrease in the percentage of IL-17+CD4+ T cells in the blood. The people taking the low dose did not have any noticeable changes in the percentages of their T cell subsets.
"We hope that these changes in inflammatory T cell responses translate to a reduced severity of disease," says Calabresi. "Other clinical trials are underway to determine if that is the case."
Provided by Johns Hopkins University School of Medicine
Mammograms do the most good later in life, a government task force said Monday in recommending that women get one every other year starting at age 50, and that 40-somethings make their own choice after weighing the pros and cons. 
