High-Tech Devices Keep Elderly Safe From Afar

By ELIZABETH OLSON
26 may 2008--First thing every morning, Lynn Pitet, of Cody, Wyo., checks her computer to see whether her mother, Helen Trost, has gotten out of bed, taken her medication and whether she is moving around inside her house hundreds of miles away in Minnesota.
Last summer, Mrs. Trost’s husband had a stroke and died, but she wanted to stay in the house, in Mankato, where she had lived for 36 years. She did not want a live-in helper, and she cannot drive. At 88, Mrs. Trost has macular degeneration and takes medications for seizures, memory loss and restless leg syndrome.
“She’s a feisty gal,” Mrs. Pitet said of her mother. “She is fine when she takes her medicines, but, even so, I was terrified of leaving her alone.”
Mrs. Pitet and her sister decided to become part of a small but growing number of people who have installed motion sensors and a remote monitoring system to keep aging relatives safe. Sensors attached to the wall are able to register when Mrs. Trost gets out of bed and whether she stops at her medication dispenser, and to alert her daughters to any deviations from her routine that might indicate an accident or illness. The family is updated by electronic report every morning.
Monitoring systems like these, which go far beyond the emergency response buttons that have been around for years, are not found in many homes yet. Privacy is an issue for some older people, and the basic package can range from $50 up to $85 a month for the motion sensors and remote monitoring system like Mrs. Trost uses. More comprehensive packages can include devices to track blood pressure, weight or respiration.
Experts on aging say the systems will become commonplace as the 76 million baby boomers approach ages when disabilities or conditions like diabetes and failing eyesight jeopardize the ability to live independently. The population of those 65 years and older is almost 40 million today, and the federal Census Bureau says that will more than double, to nearly 87 million, by midcentury.
Right now, there is little federal health care reimbursement for such devices. And private insurance coverage is evolving because the area is new, said Dr. Jeremy Nobel, a professor at the Harvard School of Public Health who co-wrote a study on the feasibility of such technologies. “We are at the beginning stages regarding the availability of such services and before business models are developed,” said Dr. Nobel, a medical doctor. “I expect we’ll see a significant increase in the adoption of such systems in two to five years, and widespread adoption in 10 years.”
The coming wave of aging Americans threatens to swamp the existing stock of retirement communities, assisted living and nursing home facilities — making it impossible to accommodate everyone who will need, or might want, more structured care.
Experts on aging say motion sensors and other high-tech devices will help cover the shortfall, allowing older people to live independently for longer.
The growing number of Alzheimer’s sufferers, which is expected to more than triple from the current four million by 2050, may also spur wider adoption of technologies like motion sensors to alert others to deviations in routine, trackers to assure medications are taken and emergency response buttons.
Technology systems to underpin living independently, or what some call “aging in place,” are still years from being rolled out in a big way, awaiting adequate financing for research and other incentives, like coverage by insurance companies, according to Mr. Nobel’s study, which was released in March by the Center for Aging Services Technologies, a program of the American Association of Homes and Services for the Aging.
But projects are under way around the country to test high-tech gadgets for home use, including wireless sensors and devices to regulate temperature, lights and appliances, and sophisticated medical monitors. And some care providers have begun to equip clients with devices that fit their needs.
NewCourtland Elder Services, a care provider for some 2,000 people in Philadelphia, started a yearlong pilot in 2006 that equipped 33 patients living on their own with remote sensors that tracked changes in their health or living patterns that required early medical intervention, said Kim Brooks, the vice president for housing and services at NewCourtland.
One of the patients is Cleora Coley, 77, a retired pharmacy technician, who is in a wheelchair after losing a leg to diabetes. Two years ago, Ms. Coley moved to a living complex for the elderly because she could not maneuver the stairs in her family home.
In her apartment, she checks her blood pressure with a cuff that automatically sends the reading to a monitoring center, which notifies her and her doctor of any change. Sensors placed in each room keep track of her movements, and she has a button to summon assistance, which she used in April when she fell.
“I’m alone but I know I’m not all by myself,” Mrs. Coley said, adding, “And I really like my independence.”
NewCourtland is starting a trial in cooperation with health insurance companies and home health agencies, installing medical monitoring devices in 1,000 residences over the next six months.
One major roadblock for wider adoption of in-home monitoring has been concern that older people, unused to everyday technologies like the Internet, would resist their use. That was true for Mrs. Trost, who said she was apprehensive about having electronic gadgets around but said she had found that “they are really no bother.” A survey by AARP found that older people were willing to use high-tech devices at home, and to pay about $50 a month.
The privacy issue made John T. Fowlkes, 86, of Raleigh, N.C., hesitate last year when his children wanted to install a motion sensor system.
“What convinced me was that there are no cameras,” said Mr. Fowlkes, a retired postal service distribution clerk who lives by himself in an apartment building for retired people. “I get peace of mind, but no one is looking at me.”
Some exploration into future technologies is being financed by the National Institute on Aging, part of the National Institutes of Health, which has been giving grants to entrepreneurs to develop devices like a video data collection system to analyze an elderly person’s activity level.
But most research dollars have come from private companies like Intel Corporation.
Intel researchers are developing devices like a “memory bracelet” that vibrates at a specified time to remind the wearer of a doctor’s appointment or to take medication. Also in trials are sensor-infused carpets — Eric Dishman, Intel’s director of product research, calls them “magic carpets” — and wearable sensors, which would measure changes in gait, to help avoid falls.
Intel invested $3 million with the Oregon Center for Aging and Technology, which runs what it calls a living laboratory, with 225 volunteers. The project, which also received $7 million from the federal aging institute, uses sensors on walls, doorways and appliances — and computer games — to detect cognitive decline.
“There is going to be a major transformation in health care because of these technologies,” said Dr. Jeffrey Kaye, director of the center, at the Oregon Health and Science University in Portland, who oversees the project. “It’s more a question of when rather than whether.”
Recognizing the commercial potential of technologies for the aging, dozens of companies, including GE Healthcare, IBM and Medtronic, two years ago formed the Continua Health Alliance to develop products to aid older people. Despite the projects, trials and commercial interest, Mr. Dishman said the United States was “missing in action” in aging technologies, compared with Europe.
“There just hasn’t been enough research and development yet to prove these technologies work,” he said. “None of us wants to put a bunch of technology in homes of frail elders unless it does.”
He said the European Union had committed $1.5 billion to developing independent-living technologies.
Last year, Intel partnered with Ireland’s government to open the Technology Research for Independent Living Center, known as Tril, in Dublin, to invent and test independent-living technologies in the households of hundreds of older people.
So far, he said, a dozen other countries and 30 universities have approached Tril for advice and assistance.

The Magnifying Glass Gets an Electronic Twist

By ANNE EISENBERG
26 may 2008--PEOPLE who lose part of their sight to macular degeneration, diabetes or other diseases may now benefit from some new technology. Several portable video devices that enlarge print may help them make the most of their remaining vision.
Swipe one of the devices over an airline ticket, or point it at a medicine bottle on a shelf, and all of the fine print is blown up and displayed in crisp letters on a screen.
Sturdy desktop video-based systems that magnify print have long been available, but lightweight, portable devices have become popular only in the past decade, as the size of consumer electronics products in general has shrunk. The new hand-held models typically weigh 9 ounces or less and can enlarge the print on closeby or more distant objects: users can pass the magnifier over a menu in a dimly lit restaurant, for example, or aim it at a grocery display on a store aisle.
The tiny, high-resolution video camera within the device captures the image, and the electronics bolster the contrast in the display, making it easier to read words on the monitor.
Dr. Bruce P. Rosenthal, chief of low-vision programs at Lighthouse International in Manhattan, which offers services for people with vision loss, said the portable magnifiers, with their built-in illumination and powerful electronics, have many advantages over traditional optical devices like magnifying glasses. “Optical devices can’t increase the contrast like these devices,” he said. “Loss in contrast causes as many problems as loss of visual acuity.”
Electronics in the new devices can make black print darker, or switch black lettering on white to white lettering on black — which some people with macular degeneration prefer.
Dr. Rosenthal said the devices could help people with low vision continue with their normal rounds — for instance, shopping in the supermarket or reading a prayer book at a religious service. “One of the concerns we have in working with the visually impaired is depression,” he said. The more that people can complete everyday activities like everyone else, he added, “the more they can cope and feel that their lives are no different than others.”
The devices have a substantial drawback, however, when compared with a $40 magnifying glass: They typically cost $700 to $1,300, and Medicare and most private insurance plans usually do not pay for them, said Robert McGillivray, low-vision specialist at the Carroll Center for the Blind in Newton, Mass.
“But if the devices get you back to work, or help you with your education, or increase your pleasure in reading,” he said, “it’s well worth considering them.”
The gadgets have a bigger area of view than a traditional magnifying glass and allow for far more flexibility in viewing an image, Mr. McGillivray said. And while the cost is typically not reimbursable, “if people are looking for a job, they may be eligible for vocational rehabilitation funds,” he said.
“State agencies might provide them with this type of product if it helps them get or retain a job,” he added.
One new portable device is the Quicklook Focus ($995), which weights 8.8 ounces. It has a camera head that sends digital video to the display, where the image is magnified, said Fergal Brennan, a design engineer at Ash Technologies outside of Dublin, the manufacturer. Users can pass the camera over a document they want to read, or hold it up at arm’s length to read the print on more distant objects.
The camera focuses electronically at the touch of a button and has a range of magnification starting at three times the original print size. The device runs off its own battery for four and a half hours at full power and for up to seven hours when the brightness is turned down, he said.
THE Quicklook Focus should be available by mid-June, said James McCarthy, president of Freedom Vision, the Mountain View, Calif.-based distributor for Ash in North America (www.freedomvision.net).
Another new device, the SenseView Duo ($1,299), available at the end of this month, has two cameras — one for close-up reading of text, the other for viewing objects eight feet or farther away, like classroom blackboards, said Doug Geoffray, co-owner of GW Micro, the Fort Wayne, Ind.-based distributor of the devices in North America (www.gwmicro.com). The product is made by the HIMS Company of South Korea.
The SenseView Duo, with a liquid crystal display 4.3 inches wide, stores up to 20 images — for instance, a screen shot of a railway timetable. Users can enlarge the image, then scan through it, moving up and down or left and right to read all the information.
Video magnification devices are valuable products in a world of often-frivolous consumer electronics, said Dr. Rosenthal of Lighthouse International.
“One of the objectives of this new technology is to improve the quality of life for people with low vision,” he said. “That’s exactly what these products are starting to do.”

Partial Recall

By KYLA DUNN
26 may 2008--Behind all the good-natured joking about “senior moments” lies real frustration and fear. How empowering, then, that we can do something to ward off normal, age-related memory loss: exercise. No, it’s not as easy as popping a pill. But as Sue Halpern reports in “Can’t Remember What I Forgot,” even a few brisk walks per week can have a measurable effect. Exercise promotes the birth of new neurons in the very part of the hippocampus (a brain structure crucial to forming new memories) that begins to malfunction with age. Exercise also counters age-related shrinking of the prefrontal cortex, an area involved in concentration and working memory (as in remembering a phone number long enough to dial).
Of course, if you’re unwilling to exercise for your health, or even to look good in a bathing suit, perhaps you’re still hoping for an easier solution. The problem, Halpern explains, is that solid, peer-reviewed science has not yet proved that anything else works: not herbal supplements, fish oil, vitamin E, almonds, $400 interactive computer software or even crossword puzzles. (After reading her section on blueberries, however, you’ll want to buy them by the bucketful.)
To cut through the hype and confusion, Halpern, whose father had dementia, set out to discover what scientists really know, and how close they are to a drug or therapy that works — either for the pathological memory loss caused by Alzheimer’s, or the “normal” kind that happens inexorably as we age. Her most interesting passages highlight the distinctions between the two. Both ravage the hippocampus; yet a different part of the hippocampus is “broken” in each condition, and different molecules have stopped doing their jobs. “To understand something to the point of being able to fix it you have to get down to the molecular level,” Scott Small, a neurologist at Columbia, tells Halpern. “And that’s where we’re at.”
Yet for a book subtitled “The Good News From the Front Lines of Memory Research,” the hope it contains is markedly thin. Most of this “good news” involves new methods for the early detection of Alzheimer’s, which can offer patients only time to plan for an unavoidable fate.
As part of her research, Halpern volunteered for a host of tests that can help diagnose dementia, including a variety of brain scans. She puts her own process of discovery front and center, reporting on cutting-edge science through the story of her interactions with scientists. Halpern, a nature writer and novelist, seems most at home unfolding a scene in naturalistic detail. The richest material comes from her 2005 New Yorker article about Scott Small’s boss, Richard Mayeux, and his research team’s search for a new gene linked to late-onset Alzheimer’s. Suddenly we’re among gamblers, prostitutes and chickens in the early-morning streets of the Dominican Republic, driving to meet the families with Alzheimer’s whose blood samples will reveal the new risk-factor gene.
Unfortunately, Halpern’s enviable powers of description are often squandered on details that seem off-point. For instance, she gives a blow-by-blow account of her six-hour marathon of memory testing, and of her experience lying prone in each brain scanner. She also walks us down too many blind alleys in her reporting. Consider her enthusiasm for a memory drug being developed at a secretive start-up called Sention. “I was the first writer allowed through the door,” she boasts, exhilarated, describing the history and science behind this “honest-to-God gold mine of a wonder drug” in detail. Next thing we know, Sention has gone out of business.
More troublesome are some of Halpern’s sloppy descriptions of the science itself. She writes that flavanoids, celebrated for their cardiovascular health benefits, are a “class of plants” (in truth, they are chemicals found in plants) and at one point assigns “red wine” to this group. She writes that two human genes — the presenilin genes — cause early-onset Alzheimer’s, but are “carried by only a few hundred families worldwide.” (We all carry the genes; what most of us don’t carry are rare, Alzheimer’s-causing mutations in them.)
Part of Halpern’s self-deprecating charm is that she is one of “us,” the general public, fretting about her lapses in memory and pushing scientists to answer our most pressing questions. But readers may sometimes wish for a more authoritative guide. When Small proposes that the “giant, complex thing called normal memory decline could be accounted for by a single molecule,” Halpern is stunned. If this “renegade idea” is correct, she suggests, Small may set off an explosive scientific revolution à la Thomas Kuhn. Well, perhaps the revolution was not adequately televised, but what Small is proposing is a now-standard idea: that changes to single molecules can radically alter brain function and behavior. (Think of SSRIs, like Prozac, for depression.) He even gives Halpern several examples, ranging from Huntington’s disease to the sexual behavior of male prairie voles.
All told, Halpern sees “many reasons to cheer,” given the “smart and committed people” searching for cures. Still, her book ends with a note of disappointment. When Small announces another incremental breakthrough, Halpern can’t help thinking: “All that work in his lab and, so far, in the clinic, not a lot to show for it.” The book itself is a valuable snapshot in time. It lacks, however, a vivid, overarching narrative that would have maintained its value once the science moves on. In the current glut of books about memory, sad to say, this one is likely to be forgotten.

Suicides linked to work-related stress up in Japan

By MARI YAMAGUCHI
26 may 2008--The number of people who committed suicide or tried to in Japan because of work-related stress has doubled in the last five years, a government report said, illustrating the growing anxiety many here feel from increased workloads and competition.
The Health Ministry report said 81 people committed suicide or tried to commit suicide because of stress at work in fiscal year 2007 — up from 66 in 2006 and 40 in 2003. It did not specifically say how many of the 81 committed suicide.
The report also found that a record high 268 people — including the 81 — developed work-related mental conditions such as depression. The report was published Saturday in Japanese newspapers.
Japan has one of the highest suicide rates in the world. About 32,160 people killed themselves in 2006 — the latest government statistics available for a full year. The report comes as the country battles a series of suicide fads including the latest string that involves people mixing household chemicals to create lethal fumes.
People in their 30s and 40s were most prone to stress due to working too many hours or personal relationships at work, the report said. Some of the workers had worked about 160 hours of overtime a month, it said. A typical work week in Japan is 40 hours.
"Many people endure their sufferings alone, trying not to show their weakness" to colleagues, the mainstream newspaper Yomiuri said in a commentary. "We urge employers to work harder to create a stress-free working environment."
The report based its findings on the number of people who committed suicide or attempt to whose families received workers compensation for their deaths or injuries.
Under the Japanese labor law, an employer has to pay compensation to employees or their families for work-related accidents, illnesses and deaths. The families of suicide victims fill out applications to receive the compensation, and the government determines their eligibility.
If illnesses or deaths are proven to be work-related, employees or their families can receive a one-time payment or an annual stipend based on his or her base salary.
Separately, the government granted workers compensation last year to 392 other people who had strokes, heart attacks and other brain and cardiac illnesses, including 142 who died.
Most of the cardiac and brain patients were people who worked excessively long hours, the report said.
More than one-third of them reported working between 80 and 100 hours of overtime a month, with another 25 percent saying they worked between 100 and 120 hours of overtime monthly. About 10 percent of them did more than 160 hours of overtime, or an average of five extra hours a day, including the weekend.
Under the Health Ministry guidelines, the family an employee who died after filing monthly overtime of 80 hours or more is usually entitled to receive compensation.

Beer Drinking May Speed Pancreatic Cancer Onset

By Kathleen Doheny
26 may 2008 -- Heavy smoking and drinking, especially beer, may hasten the onset of pancreatic cancer, according to researchers who presented their data Tuesday at the Digestive Disease Week 2008 conference in San Diego.
Beer appears to exert a stronger influence than hard liquor or wine in lowering the age of onset of pancreatic cancer, said researcher Dr. Michelle A. Anderson, assistant professor of medicine at the University of Michigan.
Anderson and her colleagues evaluated patients from The Pancreatic Cancer Collaborative Registry, a multi-center, international patient registry, looking at whether the patients drank or smoked, and if so, how much and what type of liquor.
They evaluated the smoking and drinking (or abstinence) patterns of 453 patients in all, about equal numbers of men and women.
Patients who smoked did tend to develop pancreatic disease at a younger age and there were dose-related effects, Anderson said. Heavy smokers (such as those who have smoked more than a pack a day for 40 years, or more than two packs for 20 years) presented with pancreatic cancer an average of seven years before nonsmokers.
The average age of onset of pancreatic cancer is between 70 to 80, experts noted.
Heavy drinkers, defined as having more than three daily drinks, presented with pancreatic cancer 10 years younger than those who did not drink.
Comparing beer, wine and hard liquor, the team found that beer lowered the age of developing pancreatic cancer most, Anderson said. When she compared beer drinkers to non-beer drinkers, the effect was statistically significant; however, when she considered other variables that may affect cancer onset, the effect disappeared.
Cigarette smoking is already a well-known risk factor for pancreatic cancer. Heavy alcohol intake may induce chronic inflammatory changes that are also linked with cancer, Anderson said.
The combination of chronic smoking plus drinking had no stronger effect on pancreatic risk than either habit alone, the researchers found.
Pancreatic cancer is expected to be diagnosed in nearly 38,000 people in the United States this year, according to the American Cancer Society, and about 34,000 will die of the disease. The lifetime risk is about 1 in 79 but is affected by factors such as advancing age, obesity and family history.
Because it is often emerges without symptoms, pancreatic cancer is often not detected until its later stages, when treatment is less effective. But even if caught at stage one the outlook is bleak, researchers said. At stage one, the 5-year survival from pancreatic malignancy is about 33 percent.
The pancreas, about 6 inches long and less than 2 inches wide, extends across the abdomen. It makes key hormones, including insulin, and helps to balance blood sugar.
Finding pancreatic tumors earlier -- especially important for people with a family history, or other factor indicating high risk -- is the focus of much research. And a new study suggests that combining two methods may provide better screening, according to another researcher, Dr. Richard Zubarik, associate professor of medicine and chief of endoscopy at Fletcher Allen Health Care in Burlington, Vt.
His research team used a blood test called CA19-9 -- a test to detect a tumor marker most often used to monitor disease progress and predict survival rates. They then combined that screen with an endoscopic ultrasound to try to detect the cancer in the earliest stages.
Of the 272 patients enrolled, one patient was diagnosed with pancreatic cancer and one with abnormal pancreatic cell growth.
However, the method is expensive -- it cost $14,000 to detect the cancer and about $11,000 to detect the abnormal cell growth, Zubarik said.
Other strategies are being studied to see if they can increase the bleak survival rates. In another study, researchers compared the records of more than 4,000 patients with pancreatic cancer and divided them into two groups -- those who had the ultrasound (about 12 percent of the sample) and those who did not.
Those who received the ultrasound at diagnosis had a somewhat longer average survival time, said Dr. Ananya Das, associate chair of medicine, Mayo Clinic in Scottsdale, Ariz. Undergoing this screen increased average survival time for patients from 5 months to 9 months.
Going to a center that offers this method may mean that patients receive better overall care, he said. Endoscopic ultrasound is available at leading medical centers, he said.
In patients at very high risk of pancreatic cancer, such as those with a family history, surveillance performed by a team of specialists can also help, said Dr. Teresa A. Brentnall, associate professor of medicine at the University of Washington, Seattle.
"Our goal is to protect them from pancreatic cancer," she said. Her team found that two tests could help. One is the endoscopic ultrasound, the other is called an endoscopic retrograde cholangiopancreatography.
Brentnall's team followed 100 patients using these methods. Of the 100 patients, two developed cancer (one inoperable), and 20 had abnormal cell growths. The combination can help lead to detection of pancreatic pre-cancer, she said.

Pushing Paper Out the Door

By HANNAH FAIRFIELD
25 may 2008--CHRIS UHLIK’S children can be found in their home computer lab almost every morning. Nicole is writing a story about her two lizards. Tony is playing an interactive spelling game, while Andy is learning multiplication tables. Even 5-year-old Joceline is clicking away at a storybook game.
Mr. Uhlik, an engineering director at Google, and his family live a practically paper-free life. The children are home-schooled on computers. Other sources of household paper — lists, letters, calendars — have become entirely digital.
Going paperless was a conscious decision by the Uhliks. But many families may be closer to entering a paperless world than they realize. Paper-reducing technologies have crept into homes and offices, perhaps more for efficiency than for environmentalism; few people will dispute the convenience of online bill-paying and airline e-tickets.
“Paper is no longer the master copy; the digital version is,” says Brewster Kahle, the founder and director of the Internet Archive, a nonprofit digital library. “Paper has been dealt a complete deathblow. When was the last time you saw a telephone book?”
Some homes may no longer have phone books, but many have scanners — and, increasingly, more than one. Flatbed scanners, which most people use for photographs, offer high resolution but are cumbersome for scanning large volumes of paper. New, cheap document-feed scanners that can digitize a stack of papers, receipts or business cards in seconds are becoming popular. Add multiple computers, digital cameras and maybe an electronic book reader, and suddenly paper seems to be on the endangered-species list.
After rising steadily in the 1980s and ’90s, worldwide paper consumption per capita has plateaued in recent years. In the richest countries, consumption fell 6 percent from 2000 to 2005, from 531 to 502 pounds a person. The data bolsters the view of experts like Mr. Kahle who say paper is becoming passé.
Businesses like Fujitsu and Hewlett-Packard that focus on transforming print documents into digital data are beginning to exploit a largely untapped market.
A paperless world isn’t automatically a boon for the environment, though. While these digital toys reduce dependence on one resource, they increase it on another: energy. Some devices are always plugged in, eating electricity even when not in use, and gobbling huge amounts of power when they are. Others, like digital cameras and laptop computers, use electricity while they are recharging.
And the shift might not happen as fast as some technology gurus predict. The paperless office, which some experts had said would be the norm by the 1990s, has so far failed to materialize. Employees are reckless about printing long e-mail messages, reports and memos, largely because the company picks up the bill for the laser printers, photocopiers, ink and paper.
But at home, where printers are slow, noisy and devour expensive ink cartridges, people are more cautious about hitting the “print” button. What little paper comes into the home — receipts, bills, invitations — can be scanned and then shredded. Filing cabinets can be emptied, the data kept, the paper gone.
“Some people are happy to throw away their past. Not me,” says Brad Templeton, who has founded an Internet newspaper and a software company and is the chairman of the Electronic Frontier Foundation. “I’m a digital pack rat. I have phone bills from 1983 and taxes from the 1990s. But I have everything scanned, so it takes up no physical space. For me, scanners provide the magic of still having all my documents without the clutter.”
Although he would like to scan his entire book collection, Mr. Templeton, who is based in Silicon Valley, instead typically reads e-books when he is delayed at the airport or caught in a line somewhere. “It’s not as pleasant as reading a paper book,” he said. “But the e-book you have is better than the book you don’t.”
Many companies, like H-P, Fujitsu, and Canon, have leapt into the paperless home market with new scanners for personal and home use, which is the fastest-growing sales segment. Worldwide shipments jumped to 623,000 in 2007 from 354,000 in 2005, and sales are expected to top 1.1 million by 2010, according to IDC, a market research company.
Fujitsu introduced a document-fed scanner called the ScanSnap in 2003, expecting to sell it mostly to businesses. But the company quickly realized that there was a huge market for inexpensive, fast household scanners. Its small, portable ScanSnap was introduced in November, at a price of $295, well below the $495 price of the larger original.
Worried that you won’t be able to find what you need if it’s digital? That’s generally not a problem. Most scans can immediately be turned into text-searchable documents, so the information is just a few keystrokes away.
Some people prefer to bypass the purchase of a scanner and instead farm out the scanning — to India, where it can be done on the cheap. ScanCafé, which specializes in digitizing and retouching photographs, has an office in the San Francisco Bay Area, but most of its employees are in Bangalore. They will take a shoe box full of prints or a photo album and return the originals with a CD and your own online digital library. They scan paper documents, too, for about 40 cents a page.
Those services are useful for getting rid of accumulated paper, but the trend is not to produce the paper at all. Students and professors at colleges have traditionally used large amounts of paper, but they are moving away from the bulk of it as readings, papers, problem sets and exams are posted online.
Robert Burdock, a student at the University of St. Andrews in Scotland, carries a digital camera to class so he can take a picture of any handout and immediately turn it into a text-searchable document on his laptop.
“Say I’m writing an essay on Edward III. A quick input of the term in Google Desktop and I’m presented with everything I have on the subject,” Mr. Burdock wrote in an e-mail message, which had a note at the bottom asking the recipient to consider the environment before printing. “This is a massive time saver when compared to manual searching and sifting.”
IN the desire for efficiency — to find exactly what you need the moment you need it — paper is being left behind. Mr. Uhlik, who also worked on Google’s Book Search, the book scanning project, has scanned about 100 of his reference books to try to make his home library digital and searchable. Because he wants to keep the house nearly paper-free, most of his remaining 1,000 books are in a shed. He occasionally pays his children to help scan them.
“Once the books are all scanned and backed up on several hard drives, I’ll never have to worry about the shed roof leaking and ruining them,” he says. “I’ve preserved them forever if I put them on the computer.”

A Musician Who Performs With a Scalpel

By DAVID DOBBS
25 may 2008--For Claudius Conrad, a 30-year-old surgeon who has played the piano seriously since he was 5, music and medicine are entwined — from the academic realm down to the level of the fine-fingered dexterity required at the piano bench and the operating table.
“If I don’t play for a couple of days,” said Dr. Conrad, a third-year surgical resident at Harvard Medical School who also holds doctorates in stem cell biology and music philosophy, “I cannot feel things as well in surgery. My hands are not as tender with the tissue. They are not as sensitive to the feedback that the tissue gives you.”
Like many surgeons, Dr. Conrad says he works better when he listens to music. And he cites studies, including some of his own, showing that music is helpful to patients as well — bringing relaxation and reducing blood pressure, heart rate, stress hormones, pain and the need for pain medication.
But to the extent that music heals, how does it heal? The physiological pathways responsible have remained obscure, and the search for an underlying mechanism has moved slowly.
Now Dr. Conrad is trying to change that. He recently published a provocative paper suggesting that music may exert healing and sedative effects partly through a paradoxical stimulation of a growth hormone generally associated with stress rather than healing.
This jump in growth hormone, said Dr. John Morley, an endocrinologist at St. Louis University Medical Center who was not involved with the study, “is not what you’d expect, and it’s not precisely clear what it means.”
But he said it raised “some wonderful new possibilities about the physiology of healing,” and added: “And of course it has a nice sort of metaphorical ring. We used to talk about the neuroendocrine system being a sort of neuronal orchestra conductor directing the immune system. Here we have music stimulating this conductor to get the healing process started.”
Born in Munich, Dr. Conrad took up the piano when he was 5 and trained in elite music schools in Munich, Augsburg and Salzburg, Austria. After high school he served his obligatory military service as a sniper in the German Army’s mountain corps, where his commander found every opportunity to fly him out of the Alps for some piano time.
After his service he decided to pursue medicine while continuing to study music. He earned a bachelor’s degree at the University of Munich and then, more or less simultaneously, two doctorates and a medical degree.
Dr. Conrad’s music dissertation examined why and how Mozart’s music seemed to ease the pain of intensive-care patients. He concentrated not on physiological mechanisms but on mechanisms within Mozart’s music.
“It is still a controversial idea,” he said recently, “whether Mozart has more of this sort of effect than other composers. But as a musician I wanted to look at how it might.”
Dr. Conrad noted that Mozart used distinctive phrases that are fairly short, often only four or even two measures long, and then repeated these phrases to build larger sections. Yet he changed these figures often in ways the listener may not notice — a change in left-hand arpeggios or chord structures, for instance, that slips by unremarked while the ear attends the right hand’s melody, which itself may be slightly embellished.
These intricate variations are absorbed as part of a melodic accessibility so well organized that even a sonata for two pianos never feels crowded in the ear, even when it grows dense on the page. The melody lulls and delights while the underlying complexity stimulates.
But even if this explains the music’s power to stimulate and relax, “an obvious question that comes up,” Dr. Conrad said, “is why Mozart would write music that is so soothing.”
Mozart’s letters and biographies, Dr. Conrad said, portray a man almost constantly sick, constantly fending off one infection or ailment after another.
“Whether he did it intentionally or not,” Dr. Conrad said, “I think he composed music the way he did partly because it made him feel better.”
Recently, Dr. Conrad has focused on specific mechanisms that may help explain music’s effects on the body.
In a paper published last December in the journal Critical Care Medicine, he and colleagues revealed an unexpected element in distressed patients’ physiological response to music: a jump in pituitary growth hormone, which is known to be crucial in healing. “It’s a sort of quickening,” he said, “that produces a calming effect.” Accelerando produces tranquillo.
The study itself was fairly simple. The researchers fitted 10 postsurgical intensive-care patients with headphones, and in the hour just after the patients’ sedation was lifted, 5 were treated to gentle Mozart piano music while 5 heard nothing.
The patients listening to music showed several responses that Dr. Conrad expected, based on other studies: reduced blood pressure and heart rate, less need for pain medication and a 20 percent drop in two important stress hormones, epinephrine and interleukin-6, or IL-6. Amid these expected responses was the study’s new finding: a 50 percent jump in pituitary growth hormone.
No one conducting these studies had yet measured growth hormone, whose work includes driving growth, responding to threats to the immune system and promoting healing. Dr. Conrad included it because research over the last five years has shown that growth hormone generally rises with stress and falls with relaxation.
“This means you would expect G.H., like epinephrine and IL-6, to go down in this case,” Dr. Morley, of St. Louis University, said of growth hormone. “Yet here it goes up.”
He added, “The question is whether the jump in growth hormone actually drives the sedative effect or is part of something else going on.”
Dr. Conrad argues that the growth hormone does have a sedative effect. In his paper he cites a 2005 study showing that growth hormone releasing factor, a chemical messenger that essentially calls growth hormone to duty, reduced activity of interleukin-6. This suggests, he said, that growth hormone itself may reduce the interleukin-6 and epinephrine levels that produce inflammation that in turn causes pain and raises blood pressure and the heart rate.
This explanation gets a mixed reception among stress researchers. “The two dynamics aren’t necessarily the same,” said Dr. Keith W. Kelley, an endocrinologist at the University of Illinois at Urbana-Champaign and an expert on inflammatory responses. “I personally don’t buy the particular cellular mechanism he’s proposing.”
Yet Dr. Kelley and other stress-response experts, including Dr. Morley and Dr. Bruce S. McEwen of Rockefeller University in New York, say Dr. Conrad’s study clearly suggests that a rise in growth hormone may somehow dampen inflammation and stress responses.
“This is a really intriguing possibility that bears a closer look,” Dr. McEwen said.
For Dr. Conrad, the finding offers a sort of scientifico-musical elegance: Here, it seems, may be a hormonal parallel to music’s power to simultaneously rouse and soothe.
He hopes to expand his study of music’s effects on growth hormone in intensive-care patients. He is also planning roughly similar studies of how music affects a surgeon’s performance. That line of study goes way back — at least to 1914, when The Journal of the American Medical Association published “The Phonograph in the Operating Room,” by E. Kane.
More recent studies have shown that surgeons perform math calculations faster and more accurately when they listen to music they like. Dr. Conrad hopes to find neurophysiological dynamics related to this performance enhancer.
In short, he will continue to carry his study of music into the operating room — along with his music itself.
“When I was a resident, you just picked a radio station,” said Dr. Randall Gaz, an attending surgeon at Massachusetts General Hospital who is one of Dr. Conrad’s teachers in the operating room, and an amateur pianist, oboist and church organist as well.
“This new wave of surgeons bring their iPods,” he continued. “They bring whole mixes. It’s like they have the whole thing choreographed.”
When Dr. Conrad operates, he brings an iPod stocked not just with Mozart, Liszt and Scarlatti but also with gigabytes of European techno-rap bands his colleagues have never heard of (and cannot understand), including Klee, M.C. Solaar and Armin van Buuren.
Asked if he could actually work with that kind of music, he replied, slightly sheepishly: “Well, that’s not the music you want when you’re in the middle of a delicate procedure. But once you’re through that part and you’re closing up” — he shrugged — “it’s a good time to liven things up.”
Occasionally, his operating room colleagues do give him grief. Then, he said with a grin, “I remind them that there is only one person in the room with a doctorate in music philosophy, so if you don’t like the music, the expertise is on my side.”

The Efficient MD Wiki

25 may 2008--Every doctor has strategies to help them practice better. What are yours?Wikis — collaborative websites — are powerful tools for education. The Efficient MD Wiki is designed to help healthcare professionals and medical students discover clinical pearls, useful resources, life hacks, and strategies to improve the practice of medicine. Although this Wiki is currently in its infancy, it is growing rapidly and needs your help. Please post your ideas, mnemonics, best practices, tricks, timesavers, presentations, helpful links, or other advice you'd care to share. (Don't worry if your writing is disorganized. Someone will always edit it later.)While posting anonymously is allowed, if you'd like to have a link to your personal website added to this page — as our way of saying thanks — please join this wiki and send us a message.

http://wiki.efficientmd.com/

Understanding Sen. Kennedy's Cancer Diagnosis

25 may 2008-- Massachusetts Sen. Edward Kennedy was diagnosed with a malignant brain tumor Tuesday after a related seizure sent him to the hospital over the weekend.
The 76-year-old senator was transported to Massachusetts General Hospital in Boston following the incident at his Cape Cod home. In a statement released by the Kennedy family, the seizure was attributed to a malignant glioma, a type of brain cancer.
Dr. Andrew Norden of the Dana-Farber Cancer Institute in Boston spoke with Michele Norris about possible treatments and the prognosis in Sen. Kennedy's situation.
What is a glioma?
It's a primary brain tumor, meaning it starts in the brain. It's not the kind of brain cancer that's spread by metastasis from another organ. Gliomas are the most common primary brain tumors in adults. When they are malignant, they can be quite difficult to treat. We see about 10,000 to 15,000 of them newly diagnosed in the U.S. each year.
What are the treatment options?
It's difficult to say for sure which treatment would be recommended for the senator because there are a number of different types of malignant gliomas and we don't yet know which type he has. But in general, the treatment consists of radiation and chemotherapy, given together for six weeks. Then there is a brief treatment break, followed by chemotherapy alone, in monthly cycles for six to 12 months.
The chemotherapy usually used for gliomas is an oral chemotherapy called temozolomide. It's well-tolerated by most patients.
Would there be an effort to remove it by surgery?
Yes, I think so. Typically, treatment for this type of tumor begins with maximal surgical resection. What that means is that a surgeon tries to take out as much of the tumor as can be safely done without causing the patient any harm. We don't know what kind of surgery the senator has had, but I imagine an attempt at a surgical resection was undertaken.
Would age be a factor, since the senator is 76?
Age is a factor. We know that on average older patients — which means over 80 in this population — don't have as favorable of outcomes as younger patients do. That said, there are older patients who do quite well, particularly healthy ones. And my understanding of the senator's current medical condition is that it's quite good, so I would expect him to do better than average.
Has the senator already undergone surgery?
He has. We know that he has had a biopsy according to the press release. It's difficult to know what is meant by the term biopsy in this situation, but every biopsy involves at least taking a piece of tumor to a pathologist to review and determine the type.
The tumor is said to be in the left parietal lobe. What does that tell you about prognosis and function, since this lobe controls sensory comprehension and visual control?
In general, the left parietal lobe is thought to be primarily important for sensory function on the right side of the body and also for visual sensation on the right. Because the parietal lobe is rather large and because every individual has somewhat different brain anatomy, it's very difficult to say in any individual case exactly what might be affected.
It's certainly possible to have a tumor in that location that causes no symptoms whatsoever; it's possible to have a tumor in that location that causes only occasional seizures, which might be managed with medication; or it's possible to have a tumor in that location that causes very significant numbness of the right side of the body and perhaps some difficulty seeing off to the right side. So without examining an individual patient it's difficult to determine, but those are the spectrum of things one might see.
What about speech?
In general, with a tumor in the parietal lobe, one would not expect significant speech difficulties. The speech centers are generally thought to be in the bottom portion of the frontal lobe and the top portion of the temporal lobe. One troubling problem with brain tumors, though, is they tend to have a fair amount of surrounding swelling.
So if this tumor in the left parietal lobe has some swelling involving speech areas, either in the frontal or temporal lobes, then it's possible to have difficulty either with expressive speech — finding words or simply getting fluent sentences out — or to have difficulty understanding speech, either spoken or written. But, again, one would need to examine an individual to determine if those deficits are present, and it's possible one would have no symptoms at all.
Because of high blood flow to the brain, is there worry that the tumor might be fast growing?
In general when one speaks of a malignant glioma, which is what they're calling Sen. Kennedy's tumor, we're talking of a tumor that is fast growing. Gliomas are graded on a scale of 1 to 4 by the World Health Organization, and grades 3 and 4 are also called malignant gliomas. That doesn't mean that they spread, but that they have the potential to grow quickly.
The most common gliomas are grade 4 tumors, which are called glioblastomas. But until we have a final pathology report, I don't think we'll know if that's the diagnosis.
The Kennedy family has reported that Sen. Kennedy has had no further seizures, is in good overall condition, and is up and walking around. What does that tell you?
That's a good sign. It indicates he hasn't had any serious consequences of the surgery. It also indicates that any swelling around this tumor is in reasonably good control. I suspect he's on medication to control swelling and also on medication to prevent further seizures. The fact that he's able to be up and about, watching television, which I understand he did over the weekend, indicates that he has made a good recovery, and I suspect he may be ready to leave the hospital in the next few days.

Google Health

25 may 2008--Google Health allows you to store and manage all of your health information in one central place. And it's completely free. All you need to get started is a Google username and password.
Google believes that you own your medical records and should have easy access to them. The way we see it, it's your information; why shouldn't you control it?
Keep your doctors up-to-date
Stop filling out the same paperwork every time you see a new doctor
Avoid getting the same lab tests done over and over again because your doctor cannot get copies of your latest results
Don't lose your medical records because of a move, change in jobs or health insurance
With Google Health, you manage your health information — not your health insurance plan or your employer. You can access your information anywhere, at any time.
It's safe and secure
We believe that your health information belongs to you, and you should decide how much you share and whom you share it with. We will never sell your data. We store your information securely and privately.
You are in control — you choose what you want to share and what you want to keep private.
Features
With Google Health, you can:
Build online health profilesYou can enter your health conditions, medications, allergies, and lab results into your Google Health profile and you can name the profile anything you want. You can even create multiple profiles for family members or others you care for.
Import medical records from hospitals and pharmaciesChoose from a list of Google Health partners to see if your hospital or pharmacy can send copies of your medical records or prescriptions to your Google Health profile. This way, you can save an accurate history of your medical conditions, medications, and test results all in one place.
Learn about health issues and find helpful resourcesReview trusted information on diseases and conditions and learn about possible medication interactions and other topics to talk your doctors about.
Search for doctors and hospitalsYou can search for a doctor's name or location, find a doctor's website, get directions to a doctor's office, and save a doctor's information to your medical contacts list.
Connect to online health servicesBrowse the online health services directory to find services that are integrated with Google Health that can help you better manage your health needs.

https://www.google.com/health/html/faq.html

What is Cases Journal?

25 may 2008--Cases Journal is an open access, peer-reviewed online journal that publishes case reports from any area of medicine. The journal will publish any report that is understandable, ethical, authentic, and includes all information essential to its interpretation.
All case reports published in the journal will be aggregated into a database, which will allow users to search for case reports by disease, drug, patient demographics and more, to find cases of most relevance to their clinical practice or research interests.
We believe that aggregating the articles in a database in this way makes every case important - hence we welcome submission of 'everyday' cases as well as rare disorders or unusual events. Case reports with negative outcomes are as welcome as those with positive outcomes. The journal aims to publish thousands of case reports - many more than any other medical journal.
Cases Journal accepts submission of case reports from any physician. Authors are encouraged to invite the patient to contribute to the case report - each article can include an optional 'Patient's perspective’ section, where the patient describes their experience of the disorder and treatment.
We do not see publication of your case report as the end of the process. Once your case report is published, you will be able to add extra information in response to comments from the reviewers. Readers may post questions on your published case report, and we strongly encourage you to post a reply. We will also invite you to share information on any follow-up to the case - we will contact you one year after your case report is published to invite you to share with readers any changes that may have occurred with the patient.
Peer review policies
Each case report will be subject to immediate screening by the editorial team. Appropriate manuscripts will be reviewed by at least one member of the Editorial Board.
Editorial Board members will be asked to answer the following questions:
Can you understand the case report?
Do you think that it is authentic?
Do you see any ethical problems?
Is there any missing information that you think must be added before publication?
In addition to answering these questions, the Editorial Board members will be able to add comments and ask questions of the authors. Case reports will be accepted unless our Editorial Board give adequate justification for rejection.
Cases Journal is a sister publication to Journal of Medical Case Reports. JMCR is a more selective journal, publishing only those case reports that are the first of their kind. Case reports published in JMCR will be aggregated into the same database as those from Cases Journal. If the Editorial Board feel that a manuscript submitted to Cases Journal is of sufficient importance and interest to meet the acceptance criteria, we will offer authors the chance for their case report to be considered by the Editorial Board of JMCR.
Cases Journal has a policy of open peer review, meaning that the name and comments of the Editorial Board member handling each manuscript will be published with the article online.
Every effort will be made to give authors a decision on their manuscript within two weeks of submission.
Manuscripts will not be reviewed unless the authors can confirm that the patient gave written, informed consent for publication in an open access journal. Authors will need to confirm that this has been completed, and the editorial office may request a copy at any time.
Manuscripts will not be reviewed until every effort has been made to ensure the anonymity of the patient.
http://casesjournal.com/home/

AUA: PSA Testing Might Not Be Necessary for Older Men

By Charles Bankhead
ORLANDO, 24 may 2008 -- At age 75, men who have PSA levels less than 3 ng/mL can safely discontinue routine prostate cancer screening because they have a low risk of developing aggressive disease, data from a large prospective cohort study suggest.
In fact, the probability of prostate cancer death and high-risk disease declined steadily in those men, Anna E. Kettermann, of Johns Hopkins, reported at the American Urological Association meeting.
In contrast, a PSA level of 3 ng/mL or greater was associated with an increased probability of developing high-risk prostate cancer.
"Men who have a PSA level below 3 ng/mL at age 75 to 80 are unlikely to develop aggressive prostate cancer during their remaining life, and for these men, PSA testing might be safely discontinued," said Kettermann.
The findings came from an analysis of data on 849 participants in the Baltimore Longitudinal Study on Aging. Investigators calculated each man's probability of developing high-risk prostate cancer in five-year increments, beginning at ages 60 to 65, stratified by PSA cutoff points of <1>3 ng/mL.
High-risk prostate cancer was defined as death from prostate cancer, a PSA value greater than 20 ng/mL, or a prostate biopsy Gleason score of 8 or higher at diagnosis.
The study population comprised 727 men who did not have prostate cancer and 122 who did -- 35 had aggressive disease and 87 were alive with cancer or had died of other causes.
The entire cohort had been followed for a median of 10 years, during which time they had a median of four repeat PSA tests.
The median baseline PSA level was 0.76 ng/mL. The median PSA level was 1.2 ng/mL in men who had high-risk prostate cancer, 1.3 ng/mL in those who had lower-risk prostate cancer, and 0.7 ng/mL in those who remained free of prostate cancer.
Overall, 18 patients died of prostate cancer, and 17 others had high-risk disease. All 35 had PSA values that exceeded 3 ng/mL at some point during follow-up.
None of the remaining 87 patients with lower-risk prostate cancer or those who remained free of prostate cancer had PSA levels that exceeded 3 ng/mL during follow-up.
"Our analysis showed that the probability of high-risk prostate cancer increased with PSA value," said Kettermann.
Primary source: Journal of UrologySource reference:Carter HB, et al "Prostate specific antigen testing among the elderly: When to stop?" J Urol 2008; 179(suppl): 600. Abstract 1751.

Metabolic Syndrome Not Useful in Predicting Cardiovascular Risk

By Todd Neale
GLASGOW, Scotland, 24 may 2008-- A diagnosis of metabolic syndrome is strongly associated with a risk of developing diabetes, but not cardiovascular disease, researchers here concluded.
They reported the results of two prospective studies -- the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) and the British Regional Heart Study -- online this week in The Lancet.
In PROSPER, metabolic syndrome was not associated with increased risk of cardiovascular disease (HR 1.07, 95% CI 0.86 to 1.32) but was associated with a greater risk of diabetes (HR 4.41, 95% CI 3.33 to 5.84), Naveed Sattar, M.B.Ch.B., of the University of Glasgow, and colleagues found.
On the basis of initial findings in PROSPER, they conducted the British Regional Heart Study and found that metabolic syndrome was "modestly associated" with cardiovascular disease risk (HR 1.27, 95% CI 1.04 to 1.56) and strongly associated with risk of diabetes (HR 7.47, 95% CI 4.90 to 11.46).
"Our clear finding in both studies of substantial differing diabetes versus cardiovascular disease associations of metabolic syndrome and its components should aid better general understanding of differing risk patterns for these two diseases, which therefore should not be considered together," the researchers said.
The clinical usefulness of a diagnosis of metabolic syndrome in predicting risk of cardiovascular disease and diabetes is debated, according to the researchers.
To explore the issue, they first enrolled 4,812 men and women ages 70 to 82 in the PROSPER trial. To "corroborate and generalize" those findings, they enrolled 2,737 males ages 60 to 79 in the British Regional Heart Study. All participants were free from diabetes at baseline.
In PROSPER, after a mean follow-up of 3.2 years, there were 772 cases of incident cardiovascular disease and 287 cases of diabetes.
Overall, about 28% of participants met the criteria for metabolic syndrome.
Metabolic syndrome and each of its components were significantly associated with an increased risk of diabetes, with a fasting glucose of 6.1 mmol/L or higher most strongly predicting risk (HR 18.42, 95% CI 13.86 to 24.49).
Neither metabolic syndrome nor any of its components were significantly associated with risk of cardiovascular disease.
In the British Regional Heart Study, after a mean follow-up of seven years, there were 440 cases of cardiovascular disease and 105 cases of diabetes.
Overall, 27% of patients met the criteria for metabolic syndrome.
As in PROSPER, metabolic syndrome and each of its components were significantly associated with an increased risk of diabetes, with a fasting glucose of 6.1 mmol/L or higher representing the component that most strongly predicted risk (HR 5.97, 95% CI 4.07 to 8.76).
Metabolic syndrome (HR 1.27) and the components of low HDL cholesterol (HR 1.46, 95% CI 1.17 to 1.81) and high blood pressure (HR 1.68, 95% CI 1.26 to 2.24) were associated with risk of cardiovascular disease. The other three components of metabolic syndrome were not.
"These findings suggest that the pattern of risk factors for new-onset diabetes differs in many respects to that which predicts vascular events in elderly people," the researchers said.
"Our findings concur with data in middle-age populations for whom criteria for metabolic syndrome are inferior to, and do not enhance conventional methods for, risk prediction of coronary heart disease," they said.
In an accompanying comment, Richard Kahn, Ph.D., of the American Diabetes Association in Alexandria, Va., wrote that the findings of the study "put yet another nail in the coffin of the metabolic syndrome," noting that a simple, inexpensive test for fasting plasma glucose would be a better predictor of diabetes than the expensive procedure of diagnosing the syndrome.
"What seems to make the most sense is for clinicians to focus on global risk assessment that takes into account all the well-established cardiometabolic risk factors, and then to treat each abnormality appropriately," he said.
"Also," he said, "more research is needed to understand the cause of risk-factor clustering and the pathogenesis of insulin resistance. Both actions would better serve the health of those at risk of diabetes and cardiovascular disease than seeking a diagnosis of the metabolic syndrome."
The authors listed several limitations to the studies, including the lack of oral glucose tolerance tests, the use of BMI instead of waist circumference in PROSPER, and the potential weakening of associations by attrition bias.
The metabolic syndrome analysis for PROSPER was funded by a Diabetes U.K. project grant and the British Regional Heart Study is a British Heart Foundation Research Group. The study authors and Dr. Kahn declared no conflicts of interest.
Primary source: The LancetSource reference:Sattar N, et al "Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcomes data from two prospective studies" Lancet 2008; DOI: 10.1016/S0140-6736(08)60602-9.

Oral HRT More than Doubles Thrombotic Risk

By Judith Groch
VILLEJUIF CEDEX, France, 24 may 2008-- Among postmenopausal women taking oral hormone replacement therapy (HRT), the risk of venous thromboembolism was 2.5 times greater than that for non-users, but transdermal delivery appeared to be safer, according to a meta-analysis.
The increased risk was higher within the first year of treatment, with no noticeable difference in risk between women taking unopposed and opposed oral estrogen, Marianne Canonico, Ph.D., of Université Paris-Sud here, and colleagues reported in BMJ Online First.
By contrast, the risk of clots among women using transdermal estrogen was no different from that of non-users of estrogen, the researchers said.
HRT is regularly prescribed to relieve postmenopausal symptoms, despite evidence that oral estrogen activates blood coagulation.
Until now, however, no systematic meta-analysis has assessed the size of the increased risk, or whether the risk varies according to the type of delivery, such as a skin patch versus oral HRT, the investigators said.
Their findings, from a Medline analysis, came from eight observational studies and nine randomized controlled trials.
Analysis of the observational studies showed that oral estrogen -- but not transdermal estrogen -- increased the risk of venous thromboembolism. Conjugated estrogens and estradiol were used in both the observational and the randomized trials that showed increased risk.
Compared with non-users of estrogen, the odds ratio of a first-time venous thromboembolism in current users of oral estrogen was 2.5 (95% CI 1.9 to 3.4); it was 1.2 (0.9 to 1.7) in current users of transdermal estrogen.
Past users of oral estrogen had a similar risk of thromboembolism to never-users.
Information on duration of treatment for oral estrogen was available for only five case-control studies. These results showed that the clot risk in women using oral estrogen was significantly higher in the first year of treatment (OR 4.0, 95% CI 2.9 to 5.7) compared with treatment for more than one year (pooled OR 2.1, 95% CI 1.3 to 3.8, P<0.05).
No noticeable difference in the clot risk was observed between unopposed oral estrogen (OR 2.2, 95% CI 1.6 to 3.0) and opposed oral estrogen (OR 2.6, 95% CI 2.0 to 3.2).
Results from the nine randomized controlled trials confirmed the increased clot risk among women using oral estrogen (OR 2.1, 95% CI 1.4 to 3.1).
The combination of oral estrogen and thrombogenic mutations or obesity further enhanced the risk, whereas transdermal estrogen did not seem to confer additional risk even among women at high risk of venous clots.
Women with prothrombotic mutations or a high body mass index should avoid oral estrogens, the investigators advised.
Reviewing biological mechanisms for these findings, the researchers wrote that oral estrogen is absorbed into the blood stream, thus affecting the liver. This may impair the balance between procoagulant factors and antithrombotic mechanisms.
Oral estrogen increases plasma concentrations of prothrombin fragments 1 + 2, lowers antithrombin concentrations, and causes an acquired resistance to activated protein C. However, transdermal estrogen seems to have little or no effect on hemostasis, the investigators said.
Among the study's limitations, the researchers noted the limited data for transdermal-patch users. Thus these results need to be interpreted with caution, they said.
Another limitation is the lack of data on the impact of progestogens. Although this study found a similar risk for estrogen alone and opposed estrogen, recent data have found progestogen to be a risk.
Heterogeneity among studies of oral estrogen users in this analysis may have affected the results, especially differences in duration of treatment, the investigators noted.
More data are required to investigate differences in risks across the wide variety of hormone regimens, especially the different types of progestogens, the researchers said.
In addition, they said, recent guidelines recommend that women receive the lowest effective dose of hormone replacement therapy for the shortest time possible, inasmuch as pulmonary embolism becomes a main adverse effect from oral therapy within the first year of treatment.
Reducing clot risks by using transdermal estrogen could improve the benefit and risk profile of hormone replacement therapy.
Future randomized trials of transdermal estrogen compared with placebo will clarify the skin patch's apparent safety, they concluded.
In an accompanying editorial, Helen Roberts, M.D., of the University of Auckland, New Zealand, discussed the need for more research.
In the meantime, she said, healthy menopausal women ages 50 to 59 can be advised that the risk is about 11 additional cases per 10,000 women per year for combined therapy and two additional cases per 10,000 women per year for estrogen only.
Because studies have shown that a dose response seems to exist, these absolute risks may be lower with lower doses of hormones, she said.
However, women with previous venous thromboembolism or a mutation affecting prothrombin should be offered alternatives to estrogen, Dr. Roberts said.
Dr. Canonico and co-author Pierre-Yves Scarabin are funded by Inserm (Institut National de la Santé et de la Recherche Biomédicale). Other authors received funding from Assistance Publique des Hôpitaux de Paris, and the University of Glasgow.
Dr. Canonico and Dr. Roberts, the editiorialist, declared no competing interests.
Primary source: BMJSource reference:Canonico M, et al "Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: Systemic review and meta-analysis" BMJ 2008; DOI: 10.1136/bmj.39555.441944.BE Additional source: BMJSource reference: Roberts H "Type of hormone replacement therapy and risk of venous thromboembolism" BMJ 2008; DOI: 10.1136/bmj.39556.666944.80

Antidepressant may help head/neck cancer patients

By Karla Gale
24 may 2008--The results of a pilot study suggest that antidepressant therapy with Celexa during treatment for head and neck cancer reduces the risk of depression and diminishes the impact of cancer treatment on quality of life.
Depression has been reported in up to 40 percent of patients with head and neck cancer "typically within the first 3 months of diagnosis," Dr. William M. Lydiatt and colleagues write in the journal, Archives of Otolaryngology -- Head and Neck Surgery.
The elevated suicide rates associated with cancer are particularly high among patients with head and neck cancer, Lydiatt told Reuters Health. "The relative intensity of treatment, and the fact that treatments tend to affect the most basic aspects of living, including speech, swallowing, and breathing" contribute to the increased rates of depression and suicide in head and neck cancer patients, he explained.
Because most of the treatment for head and neck cancer -- surgery and radiation -- is completed in 12 weeks, Lydiatt's team conducted their pilot study during 12 weeks of treatment, with a final 16-week follow-up visit.
The research team, based at the University of Nebraska Medical Center in Omaha, randomly assigned 36 patients to Celexa (also called citalopram) or to matching placebo. Thirteen patients in the Celexa group and 10 in the placebo group completed the trial.
"All measures of psychiatric well-being favored the group taking citalopram," Lydiatt and his colleagues report.
Fifteen percent of patients taking Celexa had symptoms of depression that were at least "mild" at week 16, whereas 60 percent in the placebo group were rated "mildly ill" or worse.
Similarly, the percentage diagnosed with major depression was 17 percent in the Celexa group compared with 50 percent at weeks 12 and 16 in the placebo group.
In the placebo group two patients experienced suicidal thoughts and one patient was hospitalized for depression, compared with none in the Celexa group.
Quality of life declined in both groups, but less so in the antidepressant group, and while quality of life continued to worsen between 12 and 16 weeks in the placebo group, it actually improved in the Celexa group.
"These findings are hopeful, but this study was too small for us to make a definitive recommendation to treat all head and neck cancer patients with antidepressants," Lydiatt noted.
"We have started a similar trial in a larger group of patients, with funding by the National Institutes of Mental Health, to study this issue more completely using the antidepressant escitalopram, also known as Lexapro."
SOURCE: Archives of Otolaryngology Head and Neck Surgery, May 2008.

Obese Patients at Greater Infection Risk After Hip Replacement


FRIDAY, 24 may 2008 -- Obese patients are at increased risk for infection and dislocation following revision (second) hip replacement surgery, according to a study by researchers at Geneva University Hospitals in Switzerland.
They evaluated the impact of obesity on the incidence of serious complications after revision total hip arthroplasty (THA) in 114 women and 90 men, mean age 71.6, over a period of up to five years. The researchers also evaluated whether functional improvement, pain and satisfaction differed between obese patients and healthy-weight patients.
The findings revealed a strong correlation between obesity and high rates of adverse events, as well as lower functional gains and more persistent pain, following revision THA.
Overall, 20 complications occurred in 17 (33 percent) of the 52 obese patients, compared with 18 complications in 13 (9 percent) of the 152 non-obese patients. Obese patients (body-mass index of 30 or more) had four times more surgical site infections and 3.5 times more dislocations than non-obese patients.
The risk of one or more adverse events increased with rising BMI. Patients with a BMI of between 30 and 34.9 were 4.5 times more likely than normal weight patients to suffer problems, while those with a BMI of 35 or more were 10.5 times more likely to experience complications.
After five years, obese patients had moderately lower functional improvements and higher levels of routine hip pain.
The study was published in the May issue of Arthritis Care & Research.
"Surgeons, patients and referring physicians should be aware of an increased risk in this [obese] patient group," lead author Dr. Anne Lubbeke said in a prepared statement. "Further studies are necessary to evaluate whether changes in medical preparation, surgical technique, and implant choice can help reduce the adverse event rate in obese patients undergoing revision THA."

AUA: Urinary Symptoms in Older Men Linked to Increased Fall Risk

By Charles Bankhead

ORLANDO, 23 may 2008-- Lower urinary tract symptoms significantly increase the risk of falls in older men, a large prospective cohort study suggested.
Both moderate and severe symptoms independently influenced the risk of falls, J. Kellogg Parsons, M.D., of the University of California San Diego, reported at the American Urological Association meeting here. Falls were most closely associated with urgency, straining to start urination, and nocturia.
"These results may justify routine assessment of urinary symptoms in primary care," Dr. Parsons concluded.
Lower urinary tract symptoms affect 15% to 60% of men age 40 and older, and the prevalence increases with age. Falls also become more prevalent with age, and 25% of men older than 65 have one or more falls each year, Dr. Parsons noted.
Symptoms, particularly nocturia and incontinence, have been postulated to increase the risk of falls, but the association had not been studied in detail, he continued. The Osteoporotic Fractures in Men (MrOS) study afforded a chance to examine the link between LUTS and falls in a large group of community-dwelling men.
Dr. Parsons and colleagues analyzed data on 5,872 MrOS participants, all 65 or older. Baseline information included the prevalence of lower urinary tract symptoms, as defined by the AUA Symptom Index: mild, 0-7; moderate, 8-19; and severe, 20+. Stratification by symptom score showed that 54% of the men had mild symptoms, 39% had moderate symptoms, and 7% severe.
Overall, 1,231 men (21%) reported falling at least once in the previous 12 months. The risk of falls increased significantly with age (P<0.0001)>

Bangladesh reports 1st human case of H5N1 bird flu

23 may 2008--Bangladesh's Health Ministry says the nation's first human case of the H5N1 strain of bird flu has been detected.
The Directorate General of Health Services statement says a child was infected by the virus in January.
The statement Thursday did not give the child's name, age, or other details, but said the child was recovering after treatment.
The statement says the case was diagnosed by the Centers for Disease Control and Prevention in Atlanta.
Bangladesh has slaughtered hundreds of thousands of birds in recent months after the H5N1 virus was detected in the impoverished South Asian nation last year.

Lowering Cholesterol May Also Lower Prostate Cancer Risk

By Steven Reinberg
WEDNESDAY, 23 may 2008-- Men who keep their cholesterol down might also help lower their levels of prostate specific antigen, a protein that can warn of prostate cancer, a new study says.
"Prostate cancer is controlled by the male hormone testosterone. The main molecule that forms testosterone is cholesterol," said Dr. Murugesan Manoharan, an associate professor of urology at the University of Miami Sylvester Comprehensive Cancer Center, who was not involved in the study. "So it is known that prostate cancer is related to testosterone, and testosterone is related to cholesterol."
The study's inference is that by lowering cholesterol, you also lower PSA, which in turn may reduce the risk of prostate cancer, Manoharan said. "Obviously this is a very small study and does not confirm anything, but it is a very good start that could lead to something more at a later point," he said.
The results of the study were expected to be presented Wednesday at the American Urological Association annual meeting, in Orlando, Fla.
For the study, researchers collected data on 1,214 men taking cholesterol-lowering drugs called statins. The researchers found that PSA levels were lower after starting the statins, and the drop in PSA was proportional to the drop in cholesterol.
The results of the study confirm those of a previous study that also found that lowering cholesterol lowered PSA, the researchers noted. If confirmed, the results of the new study would provide more evidence that cholesterol plays a role in the biology of the prostate, the researchers said.
It's still not clear, however, whether lowering PSA with cholesterol-lowering drugs may actually hide developing prostate cancer, Manoharan said.
"Bringing down the PSA levels artificially does not mean necessarily decreasing the chance of developing prostate cancer," he said. "It might just bring the blood test reading down without reducing the risk of prostate cancer. In fact, we could miss the prostate cancer, because the PSA readings are on the lower side."
Manoharan said the new findings need to be studied further. "If statins do, in fact, reduce the incidence of prostate cancer that would be a very good thing," he said.
Two other studies presented Wednesday confirmed that so-called "watchful waiting" of men with a low risk of prostate cancer is a viable option. Watchful waiting is a strategy in which no treatment is given, but the patient is monitored to check the progress of the cancer.
But, the researchers of one of the studies noted that PSA exams and digital rectal exams aren't good predictors of the progress of prostate cancer. They suggest that better monitors of the disease need to be developed.
In another study presented Wednesday, researchers from Johns Hopkins University found that men 75 to 80 years of age with low PSA levels -- less than 3 nanograms per milliliter of blood -- may be able to stop regular prostate cancer screenings.
The researchers found that these older men who have PSA levels below 3 nanograms per milliliter have a low probability of dying from prostate cancer, while men with PSA levels of 3 nanograms or more have an increased risk of dying from the disease.

FDA Plans Near-Instantaneous Sentinel for Safety of Drugs and Devices

By Michael Smith
WASHINGTON, 23 may 2008-- The FDA revealed plans today to develop a system that will allow nearly real-time monitoring of drug and device safety.
The so-called Sentinel initiative will permit "proactive surveillance of medical products on the market," Mike Leavitt, the secretary of Health and Human Services, said at a press conference.
The initiative is a response to last year's Food and Drug Administration Amendments Act, which called for active post-market surveillance of medical products.
The idea is to link both public and private medical databases -- starting with the Medicare and Medicaid system -- so that it's possible to follow adverse events almost as they happen.
Andrew C. von Eschenbach, M.D., the FDA Commissioner, said the system will mean "we will no longer have to wait years to see how a drug or medical device is affecting millions of people. The era of 'wait and see' is going to become the era of 'tell me right now.'"
Dr. von Eschenbach added, "The sentinel system will give us an unprecedented ability to detect problems as they first begin to surface."
In a technical briefing after the press conference, FDA officials said the cost of the plan will not be large because there's no thought of building an expensive new information technology system.
Instead, the FDA will collaborate with owners of data -- both public and private -- and work out ways to query their databases, according to Janet Woodcock, M.D., director of the agency's Center for Drug Evaluation and Research.
The actual data mining would take place "behind the firewall of each organization," Dr. Woodcock said, and the results would be sent back to the FDA.
But Dr. Woodcock gave no concrete estimate of the cost of the initiative, although she said that more staff would be needed and the FDA is currently hiring.
The first agency to sign on is the Centers for Medicare & Medicaid Services (CMS), whose database is especially important because the agency's clients consume most of the prescription drugs in America, according to CMS Acting Administrator Kerry Weems.
Using CMS data, for instance, would allow the FDA to track adverse events associated with annual flu vaccinations by comparing immunization records with hospitalizations and other drug prescriptions, said Jesse Goodman, M.D., director of the FDA's Center for Biologics Evaluation and Research.
Such an approach could be much faster than waiting for local doctors and healthcare providers to notice adverse events and make reports, Dr. Goodman said.