Exercise can extend your life by as much as five years, researchers find

Adults who include at least 150 minutes of physical activity in their routines each week live longer than those who don't, finds a new study in the American Journal of Preventive Medicine. Promoting the years of life that can be gained from moderate activity may be a better motivator to get Americans moving, said study author Ian Janssen, Ph.D., of Queen's University in Ontario, Canada.

13 dec 2012--Janssen and his team used data from the National Health and Nutrition Examination Survey, the National Health Interview Study mortality linkage, and U.S. Life Tables to estimate and compare the life expectancy at each age for adults who were inactive, somewhat-active and active. "Active" was defined as doing at least 150 minutes of moderate activity per week.

They found that men at age 20 were estimated to gain as much as 2.4 years of life from moderate activity. Women at age 20 gained about 3 additional years from engaging in moderate activity.  The biggest benefit from physical activity was seen in non-Hispanic black women, who gained as many as 5.5 potential years of life.

Janssen hopes the positive message of the study can help health officials better relay the importance of exercise to the public.

"Research has shown that the health messages that have the greatest effect on changing people's behaviors need to be easy to understand, specific to the individual, and be phrased in a gained-framed and positive manner," he explained.

"The messages on longevity gains associated with physical activity that were developed in this paper meet all three of those characteristics," Janssen added. "That is, people will understand what it means if you tell them they will live 2½ years longer if they become active." 

Sara Bleich, Ph.D., assistant professor of Health Policy at the Johns Hopkins Bloomberg School of Public Health, said presenting the issue as "years of life gained" versus "years of life loss" raises the classic issue of the carrot or the stick, that is, when it comes to behavior change, do people prefer to be rewarded or penalized?

"For healthy behavior changes such as dieting or smoking, rewards have been shown to effectively motivate behavior change," she continued. "From the current research, it is unclear whether rewards or penalties are more effective at motivating behavior change, but it is clear that rewards do work."

More information: Janssen I, Carson V, Lee I-M, et al. Years of life gained due to leisure-time physical activity in the U.S. American Journal of Preventive Medicine. In Press, 2012.

Provided by Health Behavior News Service

More than 3,000 epigenetic switches control daily liver cycles 

Thousand of epigenetic switches in the liver control whether genes turn on or off in response to circadian cycles. The figure illustrates daily changes, every six hours, in five different features of chromatin associated with the timed expression of a gene (red track on top). Credit: Courtesy Jamie Simon, Salk Institute for Biological Studies

12 dec 2012—When it's dark, and we start to fall asleep, most of us think we're tired because our bodies need rest. Yet circadian rhythms affect our bodies not just on a global scale, but at the level of individual organs, and even genes.

Now, scientists at the Salk Institute have determined the specific genetic switches that sync liver activity to the circadian cycle. Their finding gives further insight into the mechanisms behind health-threatening conditions such as high blood sugar and high cholesterol.

"We know that genes in the liver turn on and off at different times of day and they're involved in metabolizing substances such as fat and cholesterol," says Satchidananda Panda, co-corresponding author on the paper and associate professor in Salk's Regulatory Biology Laboratory. "To understand what turns those genes on or off, we had to find the switches."

To their surprise, they discovered that among those switches was chromatin, the protein complex that tightly packages DNA in the cell nucleus. While chromatin is well known for the role it plays in controlling genes, it was not previously suspected of being affected by circadian cycles.

Panda and his colleagues, including Joseph R. Ecker, holder of the Salk International Council Chair in Genetics, report their results December 5, 2012 in Cell Metabolism.

Over the last ten years, scientists have begun to discover more about the relationship between circadian cycles and metabolism. Circadian cycles affect nearly every living organism, including plants, bacteria, insects and human beings.

"It's been known since the early eighteenth century that plants kept in darkness still open their leaves in 24 hour cycles. Similarly, human volunteers also maintain circadian rhythms in dark rooms. Now we're determining the regulatory processes that control those responses," says Ecker, who was recently elected a fellow of the American Association for the Advancement of Science for his work on the genetics of plant and human cells.

Panda offers an example of human circadian influenced behavior that is painfully familiar to all parents of newborns: Why do infants wake up in the middle of the night? It isn't because they aren't yet "trained" to a regular schedule, but because their internal circadian clocks haven't even developed.

"Once the clock is developed, the infant can naturally sleep through the night," Panda says. "On the other end of the scale, older people with dementia have sleep problems because their biological clock has degenerated."

In the case of humans and other vertebrates, a brain structure called the suprachiasmatic nucleus controls circadian responses. But there are also clocks throughout the body, including our visceral organs, that tell specific genes when to make the workhorse proteins that enable basic functions in our bodies, such as producing glucose for energy.

In the liver, genes that control the metabolism of fat and cholesterol turn on and off in sync with these clocks. But genes do not switch on and off by themselves. Their activity is regulated by the "epigenome," a set of molecules that signal to the genes how many proteins they should make, and, most importantly from the circadian point of view, when they should be made.

"We know that when we eat determines when a particular gene turns on or off, for example, if we eat only at nighttime, a gene that should be turned on during the day will turn on at night," Panda says.

For this reason, the epigenome is of particular interest for health, since we can control when we eat. An earlier study from Panda's lab, published last May in Cell Metabolism, suggested that we should observe a 16-hour fast between our evening and morning meals.

"In response to natural cycles, our body has evolved to make glucose at nighttime," Panda says. "But if on top of that you eat, you're creating excess glucose and that damages organs, which leads to diabetes. It's like over-charging a car battery. Bad things will happen."

In short, while we can't control what genes we're born with, we do have some influence over what they do. Nevertheless, the interplay between genome and epigenome is extremely complex. Panda, Ecker and their colleagues, including the paper's co-first authors Salk postdoctoral researchers, Christopher Vollmers and Robert J. Schmitz, did their studies in mice. In the mouse liver, they discovered more than 3,000 epigenomic elements, which regulate the circadian cycles of 14,492 genes. Comparing the mouse genome to the human genome, they find many of the same genes.

"Now that we know where the switches are, it brings us one step closer to understanding the mechanism of gene regulation," says Panda, "For example, it helps us restrict our search for other factors to particular regions of the genome. In other words, at least we now know to search in Alaska, rather than Australia. But Alaska's still a big place."

Provided by Salk Institute

Feeling lonely linked to increased risk of dementia in later life

Feeling lonely, as distinct from being/living alone, is linked to an increased risk of developing dementia in later life, indicates research published online in the Journal of Neurology Neurosurgery and Psychiatry.

11 dec 2012--Various factors are known to be linked to the development of Alzheimer's disease, including older age, underlying medical conditions, genes, impaired cognition, and depression, say the authors.

But the potential impacts of loneliness and social isolation—defined as living alone, not having a partner/spouse, and having few friends and social interactions—have not been studied to any great extent, they say.

This is potentially important, given the ageing population and the increasing number of single households, they suggest.

They therefore tracked the long term health and wellbeing of more than 2000 people with no signs of dementia and living independently for three years.

All the participants were taking part in the Amsterdam Study of the Elderly (AMSTEL), which is looking at the risk factors for depression, dementia, and higher than expected death rates among the elderly.

At the end of this period, the mental health and wellbeing of all participants was assessed using a series of validated tests. They were also quizzed about their physical health, their ability to carry out routine daily tasks, and specifically asked if they felt lonely. Finally, they were formally tested for signs of dementia.

At the start of the monitoring period, around half (46%; 1002) the participants were living alone and half were single or no longer married. Around three out of four said they had no social support. Around one in five (just under 20%; 433) said they felt lonely.

Among those who lived alone, around one in 10 (9.3%) had developed dementia after three years compared with one in 20 (5.6%) of those who lived with others.

Among those who had never married or were no longer married, similar proportions developed dementia and remained free of the condition.

But among those without social support, one in 20 had developed dementia compared with around one in 10 (11.4%) of those who did have this to fall back on.

And when it came to those who said they felt lonely, more than twice as many of them had developed dementia after three years compared with those who did not feel this way (13.4% compared with 5.7%).

Further analysis showed that those who lived alone or who were no longer married were between 70% and 80% more likely to develop dementia than those who lived with others or who were married.

And those who said they felt lonely were more than 2.5 times as likely to develop the disease. And this applied equally to both sexes.

When other influential factors were taken into account, those who said they were lonely were still 64% more likely to develop the disease, while other aspects of social isolation had no impact.

"These results suggest that feelings of loneliness independently contribute to the risk of dementia in later life," write the authors.

"Interestingly, the fact that 'feeling lonely' rather than 'being alone' was associated with dementia onset suggests that it is not the objective situation, but, rather, the perceived absence of social attachments that increases the risk of cognitive decline," they add.

They suggest that loneliness may affect cognition and memory as a result of loss of regular use, or that loneliness could itself be a sign of emerging dementia, and either be a behavioural reaction to impaired cognition or a marker of undetected cellular changes in the brain.

More information: Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL) Online First doi 10.1136/jnnp-2012-302755

Provided by British Medical Journal

Scientists discover novel mechanism by which calorie restriction influences longevity

Scientists at the Gladstone Institutes have identified a novel mechanism by which a type of low-carb, low-calorie diet—called a "ketogenic diet"—could delay the effects of aging. This fundamental discovery reveals how such a diet could slow the aging process and may one day allow scientists to better treat or prevent age-related diseases, including heart disease, Alzheimer's disease and many forms of cancer.

10 dec 2012--As the aging population continues to grow, age-related illnesses have become increasingly common. Already in the United States, nearly one in six people are over the age of 65. Heart disease continues to be the nation's number one killer, with cancer and Alzheimer's close behind. Such diseases place tremendous strain on patients, families and our healthcare system. But today, researchers in the laboratory of Gladstone Senior Investigator Eric Verdin, MD, have identified the role that a chemical compound in the human body plays in the aging process—and which may be key to new therapies for treating or preventing a variety of age-related diseases.

In the latest issue of the journal Science, available online today, Dr. Verdin and his team examined the role of the compound β-hydroxybutyrate (βOHB), a so-called "ketone body" that is produced during a prolonged low-calorie or ketogenic diet. While ketone bodies such as βOHB can be toxic when present at very high concentrations in people with diseases such as Type I diabetes, Dr. Verdin and colleagues found that at lower concentrations, βOHB helps protect cells from "oxidative stress"—which occurs as certain molecules build to toxic levels in the body and contributes to the aging process.

"Over the years, studies have found that restricting calories slows aging and increases longevity—however the mechanism of this effect has remained elusive" Dr. Verdin said. Dr. Verdin, the paper's senior author, directs the Center for HIV & Aging at Gladstone and is also a professor at the University of California, San Francisco, with which Gladstone is affiliated. "Here, we find that βOHB—the body's major source of energy during exercise or fasting—blocks a class of enzymes that would otherwise promote oxidative stress, thus protecting cells from aging."

Oxidative stress occurs as cells use oxygen to produce energy, but this activity also releases other potentially toxic molecules, known as free radicals. As cells age, they become less effective in clearing these free radicals—leading to cell damage, oxidative stress and the effects of aging.

However, Dr. Verdin and his team found that βOHB might actually help delay this process. In a series of laboratory experiments—first in human cells in a dish and then in tissues taken from mice—the team monitored the biochemical changes that occur when βOHB is administered during a chronic calorie-restricted diet. The researchers found that calorie restriction spurs βOHB production, which blocked the activity of a class of enzymes called histone deacetylases, or HDACs.

Normally HDACs keep a pair of genes, called Foxo3a and Mt2, switched off. But increased levels of βOHB block the HDACs from doing so, which by default activates the two genes. Once activated, these genes kick-start a process that helps cells resist oxidative stress. This discovery not only identifies a novel signaling role for βOHB, but it could also represent a way to slow the detrimental effects of aging in all cells of the body.

"This breakthrough also greatly advances our understanding of the underlying mechanism behind HDACs, which had already been known to be involved in aging and neurological disease," said Gladstone Investigator Katerina Akassoglou, PhD, an expert in neurological diseases and one of the paper's co-authors. "The findings could be relevant for a wide range of neurological conditions, such as Alzheimer's, Parkinson's, autism and traumatic brain injury—diseases that afflict millions and for which there are few treatment options."

"Identifying βOHB as a link between caloric restriction and protection from oxidative stress opens up a variety of new avenues to researchers for combating disease," said Tadahiro Shimazu, a Gladstone postdoctoral fellow and the paper's lead author. "In the future, we will continue to explore the role of βOHB—especially how it affects the body's other organs, such as the heart or brain—to confirm whether the compound's protective effects can be applied throughout the body."

Provided by Gladstone Institutes

Paradox of aging: The older we get, the better we feel?

Presently, there are about 40 million Americans over the age of 65, with the fastest-growing segment of the population over 80 years old. Traditionally, aging has been viewed as a period of progressive decline in physical, cognitive and psychosocial functioning, and aging is viewed by many as the "number one public health problem" facing Americans today.

09 dec 2012--But this negative view of aging contrasts with results of a comprehensive study of 1,006 older adults in San Diego by researchers from the University of California, San Diego School of Medicine and Stanford University. Results of the Successful Aging Evaluation (SAGE) study – comprising a 25-minute phone interview, followed by a comprehensive mail-in survey – will be published in the December 7 online issue of the American Journal of Psychiatry.

"While there is a growing public health interest in understanding and promoting successful aging, until now little published research has combined measures of physical health with cognitive and psychological assessments, in a large and randomly selected sample," said principal investigator Dilip V. Jeste, MD, Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, and director of UC San Diego's Stein Institute for Research on Aging, and the current President of the American Psychiatric Association (which was not involved in this study).

The SAGE study included adults between the ages of 50 and 99 years, with a mean age of just over 77 years. In addition to measures which assessed rates of chronic disease and disability, the survey looked at more subjective criteria such as social engagement and participants' self-assessment of their overall health.

"Sometimes the most relevant outcomes are from the perspective of the subjects themselves," said Jeste.

The study concludes that resilience and depression have significant bearing on how individuals self-rate successful aging, with effects that are comparable to that of physical health. "Even though older age was closely associated with worse physical and cognitive functioning, it was also related to better mental functioning," said co-author Colin Depp, PhD, associate professor of psychiatry at UC San Diego School of Medicine.

After adjusting for age, a higher self-rating of successful aging was associated with higher education, better cognitive function, better perceived physical and mental health, less depression, and greater optimism and resilience.

Participants were asked to rate the extent to which they thought they had "successfully aged," using a 10-point scale and using their own concept of the term. The study found that people with low physical functioning but high resilience, had self-ratings of successful aging similar to those of physical healthy people with low resilience. Likewise, the self-ratings of individuals with low physical functioning but no or minimal depression had scores comparable to those of physically healthy people with moderate to severe depression.

"It was clear to us that, even in the midst of physical or cognitive decline, individuals in our study reported feeling that their well-being had improved with age," Jeste said. This counterintuitive increase in well-being with aging persisted even after accounting for variables like income, education and marriage.

Jeste suggests there's a take-away message for clinicians, which is that an optimistic approach to the care of seniors may help reduce societal ageism. "There is considerable discussion In public forums about the financial drain on the society due to rising costs of healthcare for older adults – what some people disparagingly label the 'silver tsunami.' But, successfully aging older adults can be a great resource for younger generations," he said.

The findings point to an important role for psychiatry in enhancing successful aging in older adults. "Perfect physical health is neither necessary nor sufficient," Jeste said. "There is potential for enhancing successful aging by fostering resilience and treating or preventing depression."

Provided by University of California - San Diego

Deadly pancreatic cancer on the rise

Almost always deadly and steadily on the rise, pancreatic cancer is on track to become the second-leading cause of cancer death in the nation within the next two years, according to a recent report.

08 dec 2012--Currently the fourth-leading cancer killer - and the reason behind the death of Apple founder Steve Jobs at age 56 - pancreatic cancer will likely surpass breast, prostate and colorectal cancers to rank behind only lung cancer, the No. 1 cancer killer, said the report from the Pancreatic Cancer Action Network.

The higher ranking is partly because risk factors associated with pancreatic cancer are trending up, while deaths from the other top cancer killers are trending down, said Dr. Bose Debashish, a pancreatic-cancer surgeon at M.D. Anderson Cancer Center in Orlando, Fla.

The incidence of pancreatic cancer has been rising 1.5 percent each year since 2004, according to the American Cancer Society. At the current rate, one in every 71 Americans will develop the disease in his or her lifetime.

One of the risk factors fueling the upward trend is Americans' lengthening lifespans. Nearly 90 percent of pancreatic-cancer patients are older than 55, and more than 70 percent are older than 65, according to the cancer society.

Increasing rates of obesity and diabetes also contribute to the rising trend. So does smoking, which doubles or triples risk, said Debashish.

What also distinguishes this killer is that it's the only top cancer with a survival rate in the single digits: Only 6 percent of those who get it are alive in five years.

"Everyone who gets pancreatic cancer will likely die of it," said Debashish.

A few, like Alicia Decker of Oviedo, Fla., get lucky. Two years ago, the 34-year-old pharmacist and mother of two young children felt a pain in her side. She tried to ignore it but finally went to the emergency room.

A scan turned up something suspicious on her pancreas. That was the bad news.

"My first thought was, 'I'm going to die,' " said Decker, who didn't have any of the risk factors. Though overweight, she was not obese. She did not have diabetes, had never smoked and had no family history of the cancer.

The good news, however, was that the lesion appeared to be "on its way to becoming cancer," meaning it wasn't too late.

Debashish operated and removed part of Decker's pancreas. Today, she is healthy, active and cancer-free.

Debashish wishes he could nip more pancreatic lesions before they become cancer, but this type of cancer usually stays under the radar until it's advanced.

"We used to believe that pancreatic cancer was very aggressive and very fast," he said. "But that's not true. It actually moves slowly, and we're bad at detecting it.

"If you put the disease on a 100-point scale, with zero being when the first cancer cell shows up, we're catching it at 90," Debashish said.

By the time this silent cancer presents with symptoms, he said, 85 percent of patients are not candidates for surgical correction.

Complicating treatment further, tumors in the pancreas - an essential organ responsible for producing insulin and aiding digestion - don't respond well to available chemotherapy agents.

Symptoms of pancreatic cancer include jaundice (which causes the skin to turn yellow), dark urine, a chalky stool, pain in the abdomen above the navel and unexplained weight loss, said Debashish. Some astute physicians spot the disease when a normal-weight patient presents with sudden-onset diabetes, he said.

Currently, the best hope lies in helping the 15 percent of patients who could benefit from a pancreatic resection to get it - and today only about half do.

"We are actually under-treating pancreatic cancer patients who have operable disease," Debashish said. Even patients whose cancers are borderline inoperable can convert to surgical candidates after treating the tumor with radiation and chemo.

"With quick, appropriate intervention," he said, "we can raise the grim 6 percent survival rate."

New evidence for epigenetic effects of diet on healthy aging

New research in human volunteers has shown that molecular changes to our genes, known as epigenetic marks, are driven mainly by ageing but are also affected by what we eat.

07 dec 2012--The study showed that whilst age had the biggest effects on these molecular changes, selenium and vitamin D status reduced the accumulation of epigenetic changes, and high blood folate and obesity increased them. These findings support the idea that healthy ageing is affected by what we eat.

Researchers from the Institute of Food Research led by Dr Nigel Belshaw, working with Prof John Mathers and colleagues from Newcastle University, examined the cells lining the gut wall from volunteers attending colonoscopy clinic. The Institute of Food Research is strategically funded the Biotechnology and Biological Sciences Research Council and this study was also funded by the Food Standards Agency.

The study volunteers were free from cancer or inflammatory bowel disease and consumed their usual diet without any supplements. The researchers looked for specific epigenetic modifications of the volunteers' genes that have been associated with the earliest signs of the onset of bowel cancer – an age-related disease. These epigenetic marks, known as DNA methylation, do not alter the genetic code but affect whether the genes are turned on or off. These methylation marks are transmitted when cells divide, and some have been associated with the development of cancer. The investigators studied the relationship between the occurrence of these epigenetic marks at genes known to be affected in cancer, and factors including the volunteers' age, sex, body size and the levels of some nutrients in the volunteers' blood. The biggest influence on gene methylation was age. This fits with the fact that the biggest risk factor for bowel cancer is age, with risk increasing exponentially over 50 years old.

The findings, published in the journal Aging Cell, showed that men tended to have a higher frequency of these epigenetic changes than women, which is consistent with men being at a greater risk of bowel cancer. Volunteers with higher vitamin D status tended to show lower levels of methylation, and a similar effect was observed for selenium status. Again, this is consistent with the known links between higher vitamin D and selenium and reduced bowel cancer risk.

The B vitamin folate is essential for health, but in this study, high folate status was associated with increased levels of epigenetic changes linked with bowel cancer. These findings are consistent with some epidemiological studies suggesting that excessive folate intakes may increase risk in some people. The researchers intend to investigate the mechanism for the observed effect of folate on DNA methylation in a follow-up study.

Obesity is also a risk factor for bowel cancer. This study found relationships between body size (height, weight and waist circumference) and epigenetic changes. How excess body weight induces these epigenetic changes, and the consequences for gut health, are currently being investigated at IFR and in Newcastle University.

In summary, the results of this study support the hypothesis that ageing affects the epigenetic status of some genes and that these effects can be modulated by diet and body fatness.

More information: Nutritional factors and gender influence age-related DNA methylation in the human rectal mucosa, Aging Cell, doi: 10.1111/acel.12030

Provided by Norwich BioScience Institutes

Widely used sedatives/sleeping pills linked to increased fatal pneumonia risk

Commonly prescribed sleeping pills/sedatives may increase the risk of contracting pneumonia by as much as 50% and increase the risk of dying from it, suggests research published online in the journal Thorax.

06 dec 2012--Benzodiazepines have a wide range of uses and are commonly prescribed for anxiety, epilepsy, muscle spasm, and insomnia. They are also frequently used in palliative care, as a sedative, and to help those with an alcohol problem to "dry out."

Around 2% of the population in the UK and the US have taken benzodiazepines for 12 months or more, and among the elderly this prevalence rises to one in 10.

The use of these drugs has been linked to a heightened risk of infections and death from blood poisoning (sepsis) in critically ill patients, and the authors wanted to know if these drugs had a similar impact on the risk of developing fatal pneumonia.

The authors analysed the health records of patients whose details had been entered into the Health Improvement Network (THIN) database. This contains the records of over 9 million patients registered with various primary care organisations across the UK.

They focused on just under 5000 patients (cases) with a first recorded diagnosis of pneumonia between 2001 and 2002 and compared each of them with 6 patients, matched for age and sex, and drawn from the same practice, which added up to more than 29,500 in all (controls).

The cases were more likely to have had pneumonia before, to have had other serious illness, including a heart attack, depression, and psychotic illness; underlying illnesses; and to be current smokers than those in the comparison group.

The use of benzodiazepines in both groups was assessed, and classified as "current," "recent," or "past." The use of zopiclone, which is not a benzodiazepine, but which acts on the same chemical pathways in the body, was also assessed.

The results showed that benzodiazepines as a class of drug were associated with a significantly higher (54%) risk of contracting pneumonia, after taking account of previous bouts of the infection, smoking status, and other serious and underlying illness. An effect of similar magnitude was found for the use of zopiclone.

Individually, prescriptions for diazepam, lorazepam and temazepam, but not chlordiazepoxide, were all associated with an increased risk of contracting pneumonia.

A second analysis showed that the risk of dying within 30 days of being diagnosed with pneumonia was 22% higher among those taking benzodiazepines. And it was 32% higher within three years of diagnosis.

Diazepam, chlordiazeopoxide, lorezapam and temazapam were all individually associated with the long term risk of death in these patients.

The authors caution that their findings do not definitively prove cause and effect, but they suggest that there may be grounds for further investigation, especially as their findings echo those of clinical trials of sedative doses of benzodiazepines.

"Benzodiazepines and zopiclone are commonly prescribed medications that have significant immune effects," they write. "Given the widespread use of benzodiazepine drugs, further studies are required to evaluate their safety in the context of infection" they conclude.

More information: The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population cohort, Online First, doi 10.1136/thoraxjnl-2012-202374

Provided by British Medical Journal

Under similar stress, rich live longer than poor, study reports 

People with money have more methods for coping, one expert says.

05 dec 2012—Money may not buy you happiness, but it can help you avoid the ill effects of unhappiness and stress. That's the upshot of a new British study that finds stressed-out rich people live longer than the stressed-out poor.

The findings show that the combination of poverty and stress "is a bomb," said study lead author Dr. Antonio Ivan Lazzarino, clinical research associate at University College London. "Those people have really higher mortality, more than you would expect by just adding the two separate effects."

Researchers already know that stress and poverty take a toll on longevity. The new research aims to "study both stress and income to see how their combinations—low-low, low-high, high-low, high-high—affect mortality," Lazzarino said.

The research design doesn't specify how much longer someone may live if he's rich and stressed versus poor and stressed. And why wealthier people may tolerate stress better biologically is not well understood. Also, the study only found an association with wealth, stress and mortality, it didn't prove cause-and-effect.

For the study, published online Dec. 3 in the Archives of Internal Medicine, the researchers examined a database of more than 66,500 people in England who were 35 years or older between 1994 and 2004. The participants were questioned about their jobs—whether they were unskilled workers or held managerial jobs, for instance—and whether they had symptoms of anxiety, depression, low confidence or social dysfunction. None had cancer or heart disease at the start of the study, which followed participants for eight years on average.

After adjusting their statistics so they wouldn't be thrown off by factors such as age or gender, the researchers found that poor and stressed-out people died earlier.

Having more money seemed to serve as a buffer, even when wealthier people had high levels of stress. In the other direction, it seems that "low income amplifies the adverse effects of stress," Lazzarino said.

One expert wasn't surprised by the findings. Poorer people have fewer ways to combat stress, said Glyn Lewis, professor of psychiatric epidemiology at the University of Bristol in England.

"For example, if your car breaks down, then a wealthier person could afford to rent a new car or get their old one mended quickly or will have insurance for this," Lewis said. "It is much less stressful if you have the money to seek out alternatives."

The study authors suggest that wealthier people may have better ways to manage or contain their distress and more people around them who can help. Also, previous research has shown that the cardiovascular systems of richer people recover faster from acute stress, which might contribute less to long-term cardiovascular damage, the authors noted.

However, the study didn't document how stress levels changed over time, and the authors acknowledge that that is a limitation of their study.
Still, Lazzarino said the findings might help researchers refine tools for stress measurement. "Since we know that stress is very bad for your health, one could argue that every person on the planet should do tests to measure his/her own stress and that family doctors should screen all patients they have for stress," he said.

"However, this strategy may not be cost-effective," he added. "We say that if you specifically target low-income people, stress screening may be very useful and cost-effective."

More information: For more about health and stress, visit the U.S. National Library of Medicine.

Psychiatry gets revised diagnostic manual

One of the biggest changes: 'autistic disorder' will now be known as 'autism spectrum disorder.'

04 dec 2012—The long-awaited revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has been approved, bringing with it a series of revisions, additions and subtractions to the tome that is considered the Bible of psychiatry.

The revision, announced Saturday, has been more than a decade in the making and included input from more than 1,500 experts in all walks of medicine in 39 countries.

The changes to the DSM "will have some impact because there are some substantial changes in diagnostic criteria," said Dr. Bryan Bruno, acting chair of psychiatry at Lenox Hill Hospital in New York City. "The implications [will relate] not only to insurance coverage but to what we consider psychopathology. That is very much influenced by what the DSM says," he added.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4) has been in use since 1994. The new DSM-5 will be available in its entirety in the spring of 2013, according to the American Psychiatric Association (APA), which publishes the volume.

"We have produced a manual that best represents the current science and will be useful to clinicians and the patients they serve," APA president Dr. Dilip Jeste said in a statement from the association.

Although the new manual will include roughly the same number of disorders as the one it is replacing, a number of changes in content are significant.

One of the biggest revisions is a change in nomenclature for "autistic disorder," which will now be known as "autism spectrum disorder." That means Asperger's syndrome, a less debilitating form of autism, will be folded into the larger category and no longer have its own designation.

This change was met with some concern.

"Although there is a strong scientific rationale for these changes in the diagnostic criteria, we are concerned about the impact of the new DSM-5 criteria when they are used in real-world settings," said Geraldine Dawson, chief science officer of Autism Speaks, adding that the trials on the new criteria were based on a relatively small number of children.

"It is crucial that we monitor how the DSM-5 impacts diagnosis and access to services in the real world," she continued. "We want to make sure that no one is excluded from obtaining a diagnosis and accessing services who needs them."

Bruno said it was difficult to predict what sort of impact the inclusion of Asperger's within autism spectrum disorder would have on insurance coverage and access to services. Many clinicians already consider Asperger's part of the autism spectrum, he noted.

Another expert agreed.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park, said the new DSM is "codifying or formalizing what experts have been doing informally for years."

This is true not only for the term "autism spectrum disorder," which is already in wide use, but also for the age cutoff for symptoms of individuals with the inattentive form of attention-deficit/hyperactivity disorder (ADHD). The new DSM extends the age for symptom manifestation to 14, said Adesman.

Also in the new DSM-5, binge-eating disorder has been bumped up to a bona fide medical condition from one that simply needed "further study." With a formal code in hand, mental-health practitioners may now be able to get insurance reimbursement for treatment efforts.

Children may also now receive a diagnosis of "disruptive mood dysregulation disorder," a condition new to the DSM-5, which is characterized by "persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year."

Although the new diagnosis is intended to cut down on the number of children labeled with bipolar disorder, some say it simply medicalizes temper tantrums.

Bruno stressed, however, that the new disorder refers only to particularly severe tantrums that occur frequently. "This is much more extreme than a tantrum," he explained. "There are definitely those kids where the tantrums and irritability are very chronic and very severe. A lot of kids who were captured by a bipolar diagnosis may be captured by this."

Both excoriation (skin-picking) disorder and hoarding disorder are new to the DSM-5 and will appear in the chapter on "obsessive-compulsive and related disorders."

In another controversial change, certain people who are experiencing grief can now be diagnosed as having depression, an acknowledgment that "bereavement is a severe psychosocial stressor that can precipitate a major depressive episode," according to a news release issued by the APA.

Bruno believes that there will likely still be distinctions between "normal" grief and grief that is labeled depression.

In other changes, "gender identity disorder" is now "gender dysphoria," and dyslexia was not dropped from the manual, as some had feared might happen. Also, excessive "Internet gaming" now belongs to the category of conditions requiring "further research."

And there was one notable condition not added to the DSM-5: "hypersexual disorder," which many in the lay public refer to as sex addiction.

"The non-inclusion of sex addiction was not particularly surprising," Bruno said, because usually this behavior occurs as a symptom of other disorders, such as personality disorders, and is not something that psychiatrists commonly treat.

"We rarely see this as an entity in and of itself," Bruno said.

More information: The American Psychiatric Association has more on the DSM-5.

Depression a key factor in health of Parkinson's patients: study

Researchers add that it is difficult to diagnose because movement disorder masks symptoms.

03 dec 2012—Depression is the most important determinant of the health status of people with Parkinson's disease, according to early findings from a large study of Parkinson's patients.

Parkinson's is a brain disease that affects muscle and causes tremors, muscle rigidity and slowed movement. It's believed that about half of Parkinson's patients experience some form of depression at some point, and research suggests that depression and anxiety are more common in Parkinson's patients than in patients with other chronic diseases.

The early findings from the Parkinson's Outcomes Project were released Wednesday by the National Parkinson Foundation and suggest that the impact of depression on the health status of Parkinson's patients is almost twice that of the movement problems associated with the disease.

The researchers also noted that depression can be difficult to diagnose in Parkinson's patients because many common disease symptoms, such as fatigue and masked facial expressions, may hide mood changes. Studies show that it is common for depression to be undiagnosed or under-treated in Parkinson's patients.

Based on these new findings, the National Parkinson Foundation recommends that doctors screen Parkinson's patients for depression at least once a year, and that patients discuss any mood changes with a health care professional.

When going to doctors' appointments, a patient should be accompanied by a family member who can provide information about any mood changes they've noticed in the patient.

The Parkinson's Outcomes Project began in 2009 and includes more than 5,500 Parkinson's patients in the United States and three other countries.

"Routine aspects of care are rarely studied, so this research is invaluable in proving that there are vast disparities in Parkinson's treatment and showing which aspects of care really work," Dr. Matthew Stern, of the University of Pennsylvania, who is also president-elect of the Movement Disorder Society, said in the news release.

"For example, this latest data demonstrates how important it is to quality care to refer patients for multi-faceted treatment of depression," he added.

More information: We Move has more about Parkinson's disease.

Race, education, income impact trust in health information

Race, education, and income impact health information-seeking, confidence in obtaining health information and trust in health information sources.

02 dec 2012--A recent study in the Journal of Healthcare for the Poor and Underserved, found that while 70 percent of all U.S. adults seek health-related information from the Web, their doctors, television and other sources, factors such as race, ethnicity, education level and economic status can make it harder for some to access such essential information.

The study of 3,243 respondents to the Health Information Network Trends Survey (HINTS), found that minorities, especially those with less education and lower incomes, were less likely than Whites to seek health information and were not as confident about their ability to obtain health information. And, although doctors and other health professionals were rated as the most trustworthy source of information, Hispanics and Blacks were slightly less likely to trust them.

"It is critical that everyone has equal access to and trust in our healthcare system," said Amanda Richardson, Ph.D., lead author of the study. "Unequal access and lack of trust only contributes to existing disparities in health outcomes."

Those with less education, especially with a high school diploma or less, were less confident in their ability to find health information and less likely to trust government health agencies than those with college degrees. People with lower incomes were less likely to trust a doctor or health professional or the Internet as sources of information than those with higher incomes.

"People who are not well informed are going to make worse decisions," said Doug Evans, Ph.D., professor of Prevention and Community Health and of Global Health at the George Washington University School. "They are not going to know how to promote or maintain their own health, how to seek proper screenings or seek care in a way that will keep illness from progressing."

The answer, says Richardson, is better communication. "Outreach efforts from the healthcare community, tailored health messages and improved communication between health care providers and underserved populations will likely improve health information seeking among those who most need it, as well as the confidence and trust they have in our healthcare system," said Richardson.

Further research may be needed to determine the best method of delivery.

"We need to make it easier," said Evans. "For example, many people now have Internet access but for some lower income folks, the primary means may be a mobile device. There is reliable information out there, but the question is how to get it to traditionally medically disadvantaged populations. That's the question we need to ask."

More information: A. Richardson, J. Appleyard Allen, X. Haijun, D. Vallone (2012). Effects of Race/Ethnicity and Socioeconomic Status on Health Information-Seeking, Confidence, and Trust, Journal of Health Care for the Poor and Underserved.

Provided by Health Behavior News Service

Increasing poverty in older age will lead to adverse health outcomes, researchers warn

Many people will be much poorer than they had expected in their older age and this has profound implications for the health of our ageing population claims an editorial published today in Age & Ageing, the scientific journal of the British Geriatrics Society.

01 dec 2012--Professor Martin McKee, public health physician at the London School of Hygiene and Tropical Medicine, and sociologist Dr David Stuckler from Cambridge University, paint a picture of the economic challenges facing the UK. They cite poor performing pensions, changes to taxation, possible changes to the universal benefits system and the absence of cross-party agreement to resolve the future funding of social care as factors which will impact not only on people's wealth in their older age but also on their health.

In 2010, British pensioners were already at greater risk of poverty in all but three other European Union countries, Cyprus, Bulgaria and Spain. The authors argue that the failure of the economy to grow threatens to reduce older people's access to advanced medical care, such as cancer treatment, where outcomes at older ages lag well behind those in some other high income countries.

Professor McKee said: "If the UK's economic situation deteriorates further, there will be increasingly adverse effects on older people's health. This will have profound consequences for an increasingly cash-strapped and fragmented health system."

Dr Stuckler said: "Older people often have multiple and complex health problems, requiring inputs from a range of professionals in different settings. Co-ordinating their care is challenging at the best of times not least as these individuals often have the most complex, and thus expensive and unpredictable, problems. We are concerned about the impact of reforms to health and social care in England and how the needs of these vulnerable individuals will be met, especially if there is a move towards service delivery by private for profit providers."

More information: Martin McKee and David Stucker, Older people in the United Kingdom: under attack from all direction. Age Ageing 2012, doi: 10.1093/ageing/afs168

Provided by British Geriatrics Society

Findings support safety of whooping cough vaccine for older adults

A new study of the safety of the tetanus-diphtheria-acellular pertussis (Tdap) vaccine supports the recommendation that those 65 and older get the vaccine to protect themselves and others, particularly young babies, from pertussis. Published online in Clinical Infectious Diseases, the findings come as reported U.S. cases of the bacterial infection, also known as whopping cough, are at the highest level since the 1950s.

30 nov 2012--An extremely contagious respiratory illness, pertussis puts infants at greatest risk for severe complications, including death. More than half of infants younger than 1 year old who get pertussis are hospitalized, according to the Centers for Disease Control and Prevention (CDC), and 1 or 2 in 100 hospitalized infants die. Immunity is difficult to maintain in the community because infants cannot be vaccinated until they are 2 months old. As a result, they may be at risk, especially from family members and care givers who have the disease.

In their study, Hung Fu Tseng, PhD, MPH, and his team at Kaiser Permanente Southern California found that adverse events following Tdap vaccination in seniors were mostly minor. "Although there is a small increased risk of injection site reaction following Tdap vaccination in the elderly, it is no more common than that following the traditional tetanus and diphtheria (Td) vaccine," Dr. Tseng said.

The researchers' study included 119,573 seniors who received the Tdap vaccine and the same number of people who received the traditional Td vaccine. Safety data were collected from seven health maintenance organizations across the U.S. The risk for adverse events following vaccination was comparable among both groups.

The authors hope the findings will allay any fears among older adults about the safety of the Tdap vaccine and prompt more doctors to urge across-the-board immunization, which is crucial in the wake of recent pertussis outbreaks, such as those in Minnesota, Washington state, Wisconsin, and elsewhere. Current recommendations call for infants older than 2 months, children, teens, adults (including pregnant women, parents, and health care workers), and those over 65 to be vaccinated.

"Pertussis immunization is important, particularly since one of the most common sources of pertussis in infants is their relatives, including their grandparents," Dr. Tseng said. "We suggest that clinicians follow CDC's recommendation and talk to older adult patients about vaccination against pertussis to protect themselves and their family members."

Provided by Infectious Diseases Society of America

Four common antipsychotic drugs found to lack safety and effectiveness in older adults

In older adults, antipsychotic drugs are commonly prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications – schizophrenia and bipolar disorder. The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia, some of which carry FDA warnings on prescription information for these drugs.

29 nov 2012--In a new study – led by researchers at the University of California, San Diego School of Medicine, Stanford University and the University of Iowa, and funded by the National Institute of Mental Health – four of the antipsychotics most commonly prescribed off label for use in patientsover 40 were found to lack both safety and effectiveness. The results will be published November 27 in The Journal of Clinical Psychiatry.

The study looked at four atypical antipsychotics (AAPs) – aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) – in 332 patients over the age of 40 diagnosed with psychosis associated with schizophrenia, mood disorders, PTSD, or dementia.

"Our study suggests that off-label use of these drugs in older people should be short-term, and undertaken with caution," said Dilip V. Jeste, MD, Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, and director of the Stein Institute for Research on Aging at UC San Diego.

Results of the five-year study led by Jeste, who is also current president of the American Psychiatric Association (which was not involved in this research), showed that within one year of treatment, one-third of the patients enrolled in the study developed metabolic syndrome (medical disorders that can increase the risk of cardiovascular disease or diabetes). Within two years, nearly a quarter of the patients developed serious adverse effects and just over half developed non-serious adverse effects.

Because the patients enrolled in the study were all diagnosed with conditions with psychotic symptoms that required antipsychotic drug treatment according to their treating physicians, no placebo was used in the trial. Instead, the researchers used a technique called "equipoise stratified randomization" which is a hybrid of complete randomization and a clinician's choice method.

"Our goal was to ensure clinical relevance," said Jeste. Patients had to agree to be randomized to 2, 3 or 4 of the study drugs, as they or their physicians were allowed to exclude one or two of the study AAPs, due to past experience or anticipated risk of the particular drug. Treating clinicians could determine the optimal dosage. "We attempted to make the study as 'user-friendly' as possible, to allow the drugs the best chance of success, while seeking to minimize the amount of bias," he explained.

While the researchers' intent was to continue the patients on the randomized medications for two years, the average length turned out to be only six months, after which the medications were halted or switched because they didn't work and/or had side effects.

Because of a notably high incidence of serious adverse events, quetiapine had to be discontinued midway through the trial. The researchers found that there were significant differences among patients willing to be randomized to different AAPs – thus, treating clinicians tended to exclude olanzapine and prefer aripiprazole as one of the possible choices in patients with existing metabolic problems. Yet, the different AAP groups did not appreciably differ in most outcome measures.

Using a common scale called the Brief Psychiatric Rating Scale (BPRS), to measure symptoms such as delusions, hallucinations, unusual behavior, depression, and anxiety, assessments were made at 6 weeks, 12 weeks, and then every 12 weeks. Results using "blind" raters showed no significant improvement in BPRS over a six-month period.

"While there were a few significant differences among the four drugs, the overall risk-benefit ratio for the AAPs in patients over age 40 was not favorable, irrespective of diagnosis and drug," said Jeste.

Jeste points out that clinicians, patients, and caregivers are often left with difficult and unclear choices for treatment for older persons with psychosis, such as that associated with dementia. Not only are psychosis and agitation common in persons with dementia but they also frequently cause considerable caregiver distress and hasten institutionalization of patients. At the same time, there are no FDA-approved alternatives to antipsychotics for this population, and the high cost of newer AAPs also makes their use problematic.

While the researchers say their findings do not suggest that these AAPs should be banned in older patients with psychiatric disorders, they do indicate that considerable caution is warranted in off-label, long-term use of the drugs in older persons.

"When these medications are used off-label, they should be given in low dosages and for short durations, and their side effects monitored closely," said Jeste. "Clearly, there is also a critical need to develop and test new interventions that are safe and effective in older people with psychotic disorders."

Provided by University of California - San Diego

U.S. task force: Baby boomers should be tested for hepatitis C

Generation has highest rate of infection, likely contracted decades ago.

27 nov  2012—A U.S. task force suggests that people at high risk for the hepatitis C virus should be screened, which includes those with a history of intravenous drug use and those who received blood transfusions before 1992.

But, the guidelines also address another, lower-risk group—the baby boomer generation.

The new U.S. Preventive Services Task Force guidelines, released Monday and updated from 2004, take a somewhat softer stance than those of the U.S. Centers for Disease Control and Prevention, which say that all baby boomers should get screened for hepatitis C. By contrast, the task force suggests that clinicians "consider" screening for this age group, which includes those born between 1946 and 1964.

Screening for hepatitis C involves a simple, inexpensive blood test. Unlike other types of hepatitis, there is no vaccine available for hepatitis C. Treatment typically involves a course of antiviral medication.

Hepatitis C is considered a silent killer because it is often symptomless. Undiagnosed and untreated, hepatitis C can result in liver cancer, liver failure and liver transplants.

Risk factors for hepatitis C infection include a history of blood transfusions before widespread adoption of screening and infection control measures, long-term dialysis treatment, exposure to hepatitis C in health care settings, having HIV/AIDS, tattooing in unregulated or unsafe parlors and IV drug use.

"Our recommendations are that people who are known to be at high risk—such as people with a history of IV drug [use] and those who had blood transfusions prior to 1992—should be screened," said task force member Dr. Kirsten Bibbins-Domingo, an associate professor of medicine and of epidemiology and biostatistics at the University of California, San Francisco.

People at highest risk have about a 50 percent chance of being infected with hepatitis C; whereas people born between 1946 and 1964 have a 3 percent to 4 percent chance of being infected, she said.

Bibbins-Domingo said the task force took less a stringent stance on testing for all baby boomers because many people with hepatitis C will live for a long time without progressive disease, and current treatments don't help everyone. "We have effective treatments, but not everybody who has hepatitis C will go on to develop liver failure or liver cancer," she said. "We are in an era where treatments are rapidly evolving, and recommendations may change as treatments get better."

One liver disease expert weighed in on screening for the 47-to-67 age group.

Dr. David Bernstein, chief of hepatology at North Shore-LIJ Healthcare System, in Manhasset, N.Y, said baby boomers should get screened for hepatitis C. "I think the guidelines should have been a little stronger for people born from 1945 to 1965," he said.

"The current therapies have cure rates of 70 to 75 percent," Bernstein said. "In a couple of years, newer therapies may be available which will have much higher cure rates but this is [already] very high."

Get screened, he advised. "Hepatitis C is the most common reason for a liver transplant and development of liver cancer, but if you catch it, you can halt the progression of disease and cure it."

The task force guidelines are now open for a period of public comment.

More information: Get the facts about hepatitis C at the U.S. National Library of Medicine.

Study finds strong ethnic neighborhoods can boost health of seniors

A new study from the Mailman School of Public Health suggests that African-American and Mexican-American seniors are less likely to have cancer or heart disease if they live in an ethnically homogeneous community.

26 nov 2012--Contrary to earlier studies, the researchers found that "living in the barrio or ethnically dense communities isn't always bad for your health," said Kimberly Alvarez, a Ph.D. candidate at Mailman who conducted the study with Becca Levy, associate professor of epidemiology and psychology at the Yale School of Public Health.

The researchers used survey data from 2,367 Mexican-Americans and 2,790 African-Americans over age 65 living in communities with high percentages of residents of the same ethnic background.

Among African-Americans, those living in a county with an ethnic density of 50 percent or more were 46 percent less likely to report doctor-diagnosed heart disease and 77 percent less likely to report cancer than those who lived in a community with an ethnic density of less than 25 percent. Mexican-Americans living in a county with an ethnic density of 50 percent or more were 33 percent and 62 percent less likely to report heart disease and cancer, respectively, than those who lived in a community with an ethnic density of less than 25 percent.

Cultural factors such as respect for elders and close-knit families could help explain the phenomenon. "These networks may facilitate better health behaviors and, in turn, better health outcomes," Alvarez said.

The study was published online last month in the American Journal of Public Health.

Provided by Columbia University