RxPG News : Aging

Researchers revisit pulmonary arterial hypertension survival

Wed, 06 Jan 2010 04:59:12 PST

( from http://www.rxpgnews.com ) Setting out to determine the survival of patients with pulmonary arterial hypertension (PAH), researchers at the University of Chicago Medical Center and their colleagues also discovered that an equation used for more than 20 years to predict survival is outdated. Accordingly, they developed and recently published a new survival prediction equation that will impact clinical practice and the drug development process.

In PAH, the pulmonary arteries, which carry blood from the heart to the lungs to pick up oxygen, become restricted, forcing the lower right chamber of the heart to pump harder. This leads to shortness of breath, limited exercise capacity, fatigue, heart failure and death. Often the condition goes undetected until it is advanced. Untreated, patients with PAH have a very poor prognosis.

That prognosis is determined using an equation developed by a landmark National Institutes of Health study published in 1987, well before there were any Food and Drug Administration approved therapies for PAH. The first such therapy was approved in 1995; today there are seven.

Since 1987, great progress has been made in understanding and treating PAH, so a few years ago we decided that it was time to study contemporary survival, said Mardi Gomberg-Maitland, MD, MSc, Associate Professor of Medicine and Director of Pulmonary Hypertension at the University of Chicago Medical Center. Our results show that survival is vastly improved today. That led us to rework the NIH equation, which has been a standard measuring stick for more than 22 years.

Gomberg and her colleagues at the Medical Center and Northwestern University's Feinberg School of Medicine studied the survival of 576 PAH patients in their registry. Of these patients, 282 had idiopathic, familial, and anorexigen-associated PAH, which matches the conditions of the 187 patients in the pioneering NIH study.

Using the NIH equation, these 282 patients would have been expected to have one-, three- and five-year survival rates of 65%, 43% and 32%, respectively. In fact, their survival rates were much higher: 92%, 75% and 66%, respectively.

This new formula is important for patients who want to know what, on average, to expect from their disease and for doctors who want to give accurate advice, said Stephen L. Archer, MD, Harold Hines Jr. Professor and Chief of Cardiology at the University of Chicago Medical Center and co-author of the study. We hope others will test our work. If it is validated by others it could be a very useful tool.

Are Physicians ready to face the challenge of caring for the elderly

Wed, 30 Dec 2009 13:05:21 PST

( from http://www.rxpgnews.com ) To assist physicians in caring for a patient demographic that is rapidly growing in size, JAMA is launching a new series, "Care of the Aging Patient: From Evidence to Action."

"The aging of the global population will be a hallmark of the 21st century, when average lifespan may reach 100 years in some countries, at least for women. Worldwide, the proportion of the population aged 60 years or older is expected to increase from 10 percent worldwide in 2005 to 22 percent in 2050, with the steepest rise in the next 25 years. Individuals aged 85 years or older are the most rapidly increasing segment of many populations," according to an editorial in the December 23/30 issue of JAMA.

C. Seth Landefeld, M.D., of the University of California, San Francisco, and colleagues write that aging will shape the lives of patients and the practice of medicine, and that physicians will spend more time caring for older individuals. "Although physicians are knowledgeable about the pathophysiology, diagnosis, and management of organ-specific diseases such as cataract, coronary artery disease, and pneumonia, many geriatric syndromes are not straightforward and do not fit the conventional paradigm of disease. Are physicians ready for these challenges? How can physicians prepare to meet the needs of patients as they age?"

"The Institute of Medicine's 2008 report Retooling for an Aging America concluded, 'The health care workforce … is not prepared to deliver the best care to older patients.' This new series takes a step to address this problem."

The overall goal of this series will be to help improve clinical practice and inform policy in care of older individuals, especially those who have started to lose their independence or are at risk of doing so. "Using the real stories of patients and interviews with them, the new series will analyze how to put existing evidence into practice to address pressing questions that arise for older patients, their families, and their physicians. By focusing on older patients' specific problems, the articles will explore themes that develop with aging," the authors write.

The first 12 articles will explore the course of aging, from the first hints of frailty through events such as difficulty driving a car to the progressive restriction of activities that results from a steady decline. "The series aims to provide clinicians with pragmatic tools and methods for translating published evidence into daily practice, or if evidence does not exist, recommendations with a rationale and a potential research agenda."

"Care of older patients often brings joy and satisfaction to their physicians. With enhancement of their knowledge and skills, all physicians have the opportunity to share in this meaningful and important work, which will be the main work for many in the aging century. With this new series of articles focused on geriatric issues and their policy implications, JAMA begins to enhance physicians' ability to do so."

In the first article in the series, David Reuben, M.D., of the University of California, Los Angeles, discusses the approach to care of older patients beginning with a consideration of life expectancy and patient goals. Such an approach helps tailor the patient's visit to issues of greatest importance to the patient and interventions to maximize prevention, independence, and quality of life. An accompanying commentary by Christine Cassel, M.D., President of the American Board of Internal Medicine, addresses necessary changes in workforce support for primary care, training requirements, payment reform, research, and systems to improve care of older adults.

A new mouse could help understand how some lung cancer cells evade drug treatment

Wed, 09 Dec 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Lung cancer is the leading cause of cancer mortality worldwide and lung adenocarcinoma is the most common type. Many cases of lung adenocarcinoma are attributed to a mutation in a gene for the epidermal growth factor receptor (EGFR). Lung cancer with changes in EGFR is initially treatable with a family of chemotherapeutic agents called tyrosine kinase inhibitors (TKIs), such as gefitinib and erlotinib. However, patients often develop resistance to these drugs through the acquisition of additional changes or secondary mutations that allow cancer cells to evade treatment.

Some secondary mutations to the EGFR gene that allow lung cancer cells to survive in the presence of current chemotherapy are known. These secondary changes are now the focus of targeted efforts to create drugs to specifically interfere with the mutated form of the protein. Unfortunately, in 40% of the cases in which patients become resistant to therapy, the molecular events that confer this resistance are not known. Without knowing the changes that sustain the survival of these cells it remains impossible to specifically and effectively target them with anti-cancer drugs.

Scientists now describe a mouse model of lung cancer that develops resistance to TKI drugs in at least some of the same ways that humans do. Lung cancer occurs in these mice due to a mutation in EGFR that is the same as the mutation that underlies many human lung adenocarcinomas. Some of the defined secondary changes to EGFR, which are known to confer drug resistance in humans, also occur in these mice. But most of these drug resistant mice bear tumors that do not contain known mutations. This important similarity to the human situation suggests that this mouse model might help identify the currently unknown mutations that make lung cancer cells resistant to therapy.

Many techniques are now available to unravel the genetic changes that occur in cancer cells. Since these mice recapitulate many of the known mutations that characterize human lung cancer, the hope is that their cells can be screened to identify the currently unknown mutations that promote drug resistance in lung cancer cells. This provides a model to uncover the molecular events responsible for the 40% of patients that become resistant to TKI therapy due to unknown causes. Once novel mechanisms of resistance are identified, these mice might also become valuable preclinical systems to evaluate the efficacy of therapeutics developed to combat drug-resistant disease.

Apathy common in dementia patients with brain changes

Wed, 02 Dec 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Dementia patients with a certain type of changes in their brain's white matter are more likely to be apathetic than those who do not have these changes, reveals a patient study carried out by the Sahlgrenska Academy and Sahlgrenska University Hospital.

Changes in the brain's white matter are common among the elderly and dementia patients, and often appear as blurred patches on CT and MRI images.

A likely explanation for the changes is that the small blood vessels that supply the white matter are not working as they should, says Michael Jonsson, PhD-student at the Sahlgrenska Academy and consultant psychiatrist at Sahlgrenska University Hospital's memory clinic. This results in that the long nerve fibres and their fatty sheaths degenerate.

Apathy is one of the most common psychological problems associated with dementia. Just over half of all dementia patents are emotionally blunted and lack motivation and initiative. This new study shows that this apathy is far more common in patients who have the characteristic changes in the brain. This discovery suggests that there is a common biological reason behind this apathy, irrespective of which type of dementia a patient has. The changes are located deep in the brain and primarily affect the neural pathways that run from this part of the brain to the frontal lobes, which are important for taking the initiative and the ability to plan.

Even though we think we know a bit about which pathways are affected in cases of apathy, we still need to find out more about the anatomy and chemistry behind the development of these symptoms, says Jonsson. This is vital if we are to develop medication to treat apathy.

The study involved 176 patients with Alzheimer's, vascular dementia or mixed dementia. 82 per cent of the patients with changes in their white matter were apathetic, while 58 per cent of all of the dementia patients were apathetic.

Given that apathy reduces quality of life for patients with dementia and increases the risk of institutionalisation, a great deal of research is under way to find a treatment. Treatments that do not involve medication, such as increased physical exercise, cognitive stimulation and massage, do not seem to work.

Some studies have shown that the medicines currently used for Alzheimer's can have a positive impact on apathy in other types of dementia too, says Jonsson. Other medicines may also be of interest, but we need to carry out more research in this area.

Depression as deadly as smoking

Tue, 17 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) A study by researchers at the University of Bergen, Norway, and the Institute of Psychiatry (IoP) at King's College London has found that depression is as much of a risk factor for mortality as smoking.

Utilising a unique link between a survey of over 60,000 people and a comprehensive mortality database, the researchers found that over the four years following the survey, the mortality risk was increased to a similar extent in people who were depressed as in people who were smokers.

Dr Robert Stewart, who led the research team at the IoP, explains the possible reasons that may underlie these surprising findings: 'Unlike smoking, we don't know how causal the association with depression is but it does suggest that more attention should be paid to this link because the association persisted after adjusting for many other factors.'

The study also shows that patients with depression face an overall increased risk of mortality, while a combination of depression and anxiety in patients lowers mortality compared with depression alone. Dr Stewart explains: 'One of the main messages from this research is that 'a little anxiety may be good for you'.

'It appears that we're talking about two risk groups here. People with very high levels of anxiety symptoms may be naturally more vulnerable due to stress, for example through the effects stress has on cardiovascular outcomes. On the other hand, people who score very low on anxiety measures, i.e. those who deny any symptoms at all, may be people who also tend not to seek help for physical conditions, or they may be people who tend to take risks. This would explain the higher mortality.'

In terms of the relationship between mortality and anxiety with depression as a risk factor, the research suggests that help-seeking behaviour may explain the pattern of outcomes. People with depression may not seek help or may fail to receive help when they do seek it, whereas the opposite may be true for people with anxiety.

Dr Stewart comments: 'It would certainly not surprise me at all to find that doctors are less likely to investigate physical symptoms in people with depression because they think that depression is the explanation, but may be more likely to investigate if someone is anxious because they think it will reassure them. These are conjectures but they would fit with the data.'

The researchers point out that the results should be considered in conjunction with other evidence suggesting a variety of adverse physical health outcomes and poor health associated with mental disorders such as depression and psychotic disorders.

In light of the findings, Dr Stewart makes suggestions on the focus of future developments in the treatment of depression and anxiety: 'The physical health of people with current or previous mental disorder needs a lot more attention than it gets at the moment.

'This applies to primary care, secondary mental health care and general hospital care in the sense that there should be more active screening for physical disorders and risk factors, such as blood pressure, cholesterol, adverse diet, smoking, lack of exercise, in people with mental disorders. This should be done in addition to more active treatment of disorders when present, and more effective general health promotion.'

Professor receives grant to develop more rapid technology for screening blood samples

Wed, 04 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) AUSTIN, Texas - Dr. Jennifer Brodbelt, professor of chemistry and biochemistry at The University of Texas at Austin, has received a $734,068 grant from the National Institutes of Health (NIH) to develop a new method for rapidly screening blood samples for biomarkers.

Biomarkers are small molecules that indicate the presence of a particular physiological condition, typically a disease. The new method, if successful, could prove useful not just for identifying markers of specific diseases such as cancer or heart disease, but for discovering broader metabolic patterns correlated with conditions such as aging or obesity.

There are technologies right now that are very effective at separating and analyzing the different compounds in a blood sample, but they tend to be relatively slow, says Brodbelt, the principal investigator of the grant. It makes it very hard to do analyses of lots of samples. What we're developing is a chip-based method, where entire classes of compounds are captured on the chips and then all the compounds are released and analyzed by mass spectrometry in just a few seconds.

Although the technology, if successful, should be useful in searching for biomarkers in all sorts of conditions, Brodbelt and her collaborators from Southwestern University in Georgetown, Texas, Drs. Lynn and Frank Guziec, are focusing on patterns that correlate with aging.

We're trying to develop maps that can correlate the progression of aging with metabolites that might be circulating in your blood, says Brodbelt. These could be small molecules that increase in quantity as you age, or actually change in composition as one ages.

The new method, says Brodbelt, involves three basic stages.

The first stage is the coating of different regions of a mesh chip with a variety of capture agents, which chemically bind to specific compounds in a blood sample. A burst from an ultraviolet light then severs the chemical bonds between the chip and the captured substances. Then an electrospray, which is similar to a solvent aerosol spray, shoots through the mesh chip and transfers the different compounds into the mass spectrometer for analysis.

By analyzing the mass spectrometric data, says Brodbelt, scientists should be able to measure the presence and quantity of different compounds, and to do so on a scale, and with a speed, that wasn't possible before.

The payoff could be big, she says. It's a different strategy than what might be pursued by molecular biologists or biochemists. They'll often focus on studying one or two proteins at a time, and develop a really deep understanding of those proteins. We're looking for the more generalized profile, and we may notice some patterns that weren't apparent to them.

There are so many other areas where you'd want to do profiling. It might involve looking for pesticides as part of an environmental study, or doing protein-related work or drug profiling work. If this approach is successful, I imagine other groups will try to develop these chips as well.

Brodbelt's grant, which is being funded as part of the American Recovery and Reinvestment Act (ARRA) government stimulus package, is a Challenge Grant, meant to encourage high-risk, high-reward research projects that may produce results quickly.

This is the second NIH grant in two years that Brodbelt and the Guziecs have received. In 2008, the collaborating groups received a four-year, $1,113,615 grant to evaluate an innovative technique that could assess the anti-cancer activity of new compounds.

Statins may worsen symptoms in some cardiac patients

Tue, 03 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Although statins are widely used to prevent heart attacks, strokes, and other cardiovascular disorders, new research shows that the class of drugs may actually have negative effects on some cardiac patients. A new study presented at CHEST 2009, the 75th annual international scientific assembly of the American College of Chest Physicians (ACCP), found that statins have beneficial effects on patients with systolic heart failure (SHF), but those with diastolic heart failure (DHF) experienced the opposite effect, including increased dyspnea, fatigue, and decreased exercise tolerance.

Systolic heart failure is most often due to coronary artery disease and appears to have more of an inflammatory component than diastolic heart failure, said Lawrence P. Cahalin, PhD, PT, Northeastern University, Boston, MA. It is possible that statins would help patients with systolic heart failure more than patients with diastolic heart failure due to the cholesterol-lowering and antiinflammatory effects of statins.

Researchers from Northeastern University and Massachusetts General Hospital, Boston, MA, retrospectively reviewed the charts of 136 patients with heart failure in order to examine the effect of statins on pulmonary function (PF) and exercise tolerance (ET) in patients with DHF vs. SHF. A non-statin group (82 percent of patients had DHF) of 75 patients was compared with a statin group (72 percent of patients had DHF) of 61 patients. Atorvastatin was prescribed in 75 percent of the patients on statins.

Results of the analysis showed that overall PF and ET of patients in the statin group were significantly lower than patients in the non-statin group. Further subgroup analyses revealed that PF measures in the DHF statin group were 12 percent lower than PF measures in the DHF non-statin group. Furthermore, the amount of exercise performed by patients with DHF who were on a statin was almost 50 percent less than patients with DHF not on a statin.

Some patients with diastolic heart failure may be more prone to the adverse effect of statins on muscle. It may be that patients with particular preexisting factors will experience unfavorable results from statin therapy, including exercise intolerance, dyspnea, and fatigue, said Dr. Cahalin.

Although the PF and ET measures in the SHF statin group were not significantly greater than in the SHF non-statin group, the PF measures were 11 percent to 14 percent higher, and the peak ET measures were 2 percent to 7 percent higher than the PF and ET measures of the SHF non-statin group, suggesting that statins did benefit patients with SHF.

Not all statins are alike and not all patients are alike. Some statins are stronger than others and are likely to act differently, given particular patient characteristics, and produce different degrees of wanted and unwanted effects, said Dr. Cahalin. In our continuing study, we hope to identify patient characteristics that are associated with favorable and less than favorable results from statin therapy.

Although the new data suggest that statins may actually worsen symptoms in patients with DHF, researchers feel that the benefits of using statins in patients with SHF and DHF outweigh the risks.

Due to beneficial effects on lipids and other cardiovascular factors, statins are becoming a standard treatment for many patients with or without systolic or diastolic heart failure. It is likely that the use of statins for these conditions will continue to increase, said Dr. Cahalin. However, if patients taking a statin are short of breath, fatigued, and unable to exercise or perform functional tasks, then exams of muscle strength and endurance, as well as pulmonary function and exercise tolerance, are warranted.

Statins provide significant benefits for patients with cardiovascular disease, said Kalpalatha Guntupalli, MD, FCCP, President of the American College of Chest Physicians. However, as for any new medication prescribed, clinicians should closely monitor the effects that different types of statins have on individual patients.

Depression in older cancer patients can be effectively treated with collaborative approach

Tue, 20 Oct 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Depression in older cancer patients can be effectively treated with collaborative approach in primary-care settings

Depression in older cancer patients is very common, and has debilitating effects on their quality of life both during and after treatment. University of Washington (UW) researchers are showing that there are ways to better this situation.

Little is known about the optimal approach to treating depression in this population, and older cancer patients are less likely to be treated for their depression than are younger cancer patients, said Dr. Jesse Fann, University of Washington associate professor of psychiatry and behavioral sciences. Fann is the director of psychiatric services at the Seattle Cancer Care Alliance, and an investigator in the Clinical Research Division at the Fred Hutchinson Cancer Research Center in Seattle.

Fann and his colleagues evaluated the effectiveness in older, depressed cancer patients of an intervention called Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), in comparison to a similar set of patients receiving usual care. All participants had either major depression or a type of chronic depression called dysthymia, or a combination of both.

IMPACT participants worked with a depression care manager in their primary-care clinic for up to a year. Under the supervision of the patient's primary-care provider and a psychiatrist, the care manager offered the patient support in taking anti-depressants if prescribed by the primary-care provider, education about depression, care coordination and structured counseling sessions that helped the patient engage in pleasant activities and that taught problem-solving skills.

The intervention was tested in 18 primary-care clinics in 5 states. The clinics served a variety of different socio-economic, geographic, and ethnic populations.

At the end of six months, 55 percent of the patients in the IMPACT group and 34 percent of the usual care participants showed a 50 percent or greater reduction in their depression symptoms. The IMPACT participants also had higher remission rates from depression, more depression-free days, less fatigue, a better quality of life, less functional impairment and fewer thoughts of death. Many of these benefits persisted during the one-year follow up period after the intervention was completed.

Among the functional impairments older cancer patients can experience with depression are fatigue and thinking problems, such as forgetfulness, feeling mentally slowed down, and having difficulty concentrating or solving problems. Decisions that used to be straightforward or easy for them have become challenging, Fann explained.

Based on their findings, the researchers concluded that the IMPACT collaborative care program is feasible and more effective than standard care in managing depression among older cancer patients in primary-care, and is widely applicable.

The IMPACT intervention can be successfully provided in diverse types of primary-care settings in various locations, and not just at specialized cancer centers. It can literally double the likelihood that the patient's depression will improve over time, said Dr. Jurgen Unutzer, UW professor of psychiatry and behavioral sciences and a co-investigator on the study with Fann and Dr. Ming-Yu Fan, UW research assistant professor of psychiatry and behavioral sciences.

The results were published today, Oct. 20, in a supplement of the

Stress urinary incontinence: Minimally invasive operations as effective as open surgery

Tue, 06 Oct 2009 03:59:36 PST

( from http://www.rxpgnews.com ) New, less invasive surgical treatments for stress urinary incontinence in women are just as effective as traditional open surgical approaches, according to Cochrane Researchers. The researchers carried out a systematic review of trials comparing different surgical approaches to treating the condition.

A third of women suffer from stress urinary incontinence. As well as the social distress involved, the condition places a significant financial burden on health systems and individuals. Surgery is considered a last resort when other treatments, such as pelvic floor muscle training and drug therapies, fail. In sling operations, strips of material are positioned under the urethra and traditionally are anchored to muscles and ligaments to form a sling. When the woman strains the sling tightens and supports the bladder. In newer minimally invasive sling operations a synthetic material is inserted underneath the urethra without fixing to muscles or ligaments. The procedure can be performed blind by inserting the synthetic sling material with a needle in what is called a minimally invasive suburethral sling operation, which can be carried out under local anaesthetic.

The purpose of the current review was to determine whether less invasive versions of the procedure are as effective as traditional open surgery and other surgical approaches.

The authors collected data from 62 trials involving 7,101 women. Minimally invasive synthetic suburethral sling operations were found to be just as effective as traditional sling operations, with short term cure rates of 80%. They also had shorter operating times than conventional methods. Minimally invasive sling operations were also more effective than a second type of open surgery, in which the vagina is lifted using stitches to help support the bladder and urethra. However, when this second type of surgery was carried out using keyhole cuts there was less evidence that minimally invasive sling operations worked better.

Different ways of inserting the tape in sling operations were also compared and those in which the tape was passed behind the pubic bone appeared to be most effective, although this approach was more likely to cause bladder injury. One particular type of material, called type I mesh, was more effective and appeared to result in fewer complications.

These were only small trials and they varied greatly in quality, but we were able to make comparisons between different types of surgery and we found that minimally invasive sling operations for stress incontinence in women are very effective for this condition, says lead researcher, Joseph Ogah, who is based at the Leeds University Teaching Hospital in Leeds, in the UK.

However, few of the trials we looked at reported outcomes after one year and therefore the long term efficacy of these procedures requires further investigation. It is also of utmost importance to assess how these procedures impact on women's quality of life, so this needs to be addressed in further studies, says Ogah.

Pelvic floor muscle exercises can help manage urinary incontinence in older women

Thu, 01 Oct 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Researchers at Rush University Medical Center have found that a program of pelvic floor muscle exercises, combined with pelvic health education, can be an effective way to manage urinary incontinence in elderly women.

The study, involving 65 women between the ages of 67 and 95, is being presented this week at the annual meeting of the North American Menopause Society in San Diego.

Urinary incontinence, or loss of bladder control, is a frustrating, and often embarrassing, problem for more than 13 million Americans. It is twice as common in women as in men, and, according to some estimates, affects half of older women. In women, the muscles that help support the bladder may become weak due to multiple pregnancies and vaginal births.

Urinary incontinence can take a very real emotional and social toll. Not knowing when and where you might have an accident can impact everything from household chores to dinner dates and bowling games, said physiatrist Dr. Sheila Dugan, co-director of the Program for Abdominal and Pelvic Health at Rush and lead author of the study.

Many treatment options exist, but strengthening the pelvic floor muscles, as our study has shown, can be very effective even for older women, avoiding the need for drugs or more invasive procedures.

The women in the study's treatment group underwent a supervised chair-based exercise program for six weeks. The program focused on identifying, isolating and strengthening muscles that support the pelvic area: the transversus abdominus, the corset-like swath of muscles that wraps around the abdomen; the multifidus, which extends along the back of the trunk; and the pelvic floor muscles, which form a sling to hold up internal organs like the bladder. In addition to the exercises, the program incorporated an educational curriculum (four sessions) on basic bladder and pelvic health. The control group received one session of educational basics and no supervised training in pelvic exercises.

At the end of the program, 83 percent of the women in the treatment group reported that their symptoms had improved. On the whole for the control group, there were no statistically significant improvements.

The researchers found statistically significant improvements in the treatment group in a number of areas. Problems with frequency of urination, urine leakage related to feelings of urgency and urine leakage caused by physical activity, coughing or sneezing had all decreased. Bladder control problems were less bothersome and also had less of an impact on daily activities like household chores.

The women in the treatment groups also reported less urgency during night-time hours, better bladder management (especially when physically active or sneezing) and increased self-confidence. Eighty-two percent reported that they planned on continuing the exercise themselves after the intervention.

Weill Cornell Institute for Geriatric Psychiatry awarded $10 million grant

Thu, 24 Sep 2009 03:59:36 PST

( from http://www.rxpgnews.com ) WHITE PLAINS, NY (Sept. 24, 2009) -- The Weill Cornell Institute of Geriatric Psychiatry at NewYork-Presbyterian Hospital/Westchester Division announced today it has received the largest grant in its 20-year history. One of a handful awarded nationally, the new $10 million, five-year Center Grant from the National Institute of Mental Health (NIMH) will enable NewYork-Presbyterian/Weill Cornell investigators to advance their pioneering work in understanding the biological, medical, cognitive and psychosocial problems of depressed seniors. The grant is one of the largest ever given by NIMH to study geriatric depression.

The grant's principal investigator is Dr. George Alexopoulos, founder and director of the Weill Cornell Institute of Geriatric Psychiatry at NewYork-Presbyterian/Westchester, professor of psychiatry at Weill Cornell Medical College and director of the NIMH-supported Advanced Center for Interventions and Services Research (ACISR) in late-life depression. He is recognized as one of the world's leading geriatric psychiatry researchers in late-life depression and its treatment.

Dr. Alexopoulos, who has spent his career of more than 30 years investigating late-life depression, said, To receive a Center Grant by NIMH, a team must have a critical mass of competitively-funded research projects and demonstrate that the Center's new projects and structures will result in a scientific product that will be greater than the sum of its individual projects. As such, the Center Grant represents an endorsement by NIMH of the scope and importance of our team's work.

He added: This is an exciting time in the history of the Weill Cornell Institute of Geriatric Psychiatry. The 'Center Grant' is significant because it will enable our investigators to synthesize their findings in a meaningful way and develop new tools and practices needed to reduce the burden of depression and disability in elderly persons who have limited access to quality care.

As in the past, the Institute will seek individuals over the age of 60 from the community to participate in research studies.

Since its inception in 1994, the Weill Cornell Institute of Geriatric Psychiatry has consistently received support by NIMH. This is the fourth and largest Center Grant awarded to the Institute since its inception.

Dr. Alexopoulos noted that the Institute demonstrated in its grant application that we have the infrastructure and unique mix of innovative findings and synergies in place to take our research to the next level by developing new treatments and improving the care offered to elderly patients in the community.

The research efforts of Weill Cornell Institute's team of 13 NIMH-funded investigators, five at the full professor's level, have concentrated in three interrelated core areas:

Older Americans: How they are faring in the recession

Wed, 16 Sep 2009 03:59:36 PST

( from http://www.rxpgnews.com ) WASHINGTON, DC---Older Americans have weathered the financial crisis relatively well, although many now expect to work longer than they did just a year ago, according to a University of Michigan study released on Capitol Hill today (Sept. 16).

The study is based on data from 4,412 older Americans collected in April and May of this year in a special Internet survey of respondents of the Health and Retirement Study, a nationally representative sample of Americans age 51 and older conducted by the U-M Institute for Social Research (ISR) and funded by the National Institute on Aging.

We asked the same older workers what the chances were that they would still be working full time after age 65, and they went up from 47 percent to 57 percent between 2008 and 2009---a very rapid change after a long period of stability, said ISR economist David Weir, director of the Health and Retirement Study. The chances of working past 62 went up from 60 percent to 65 percent.

Weir presented the findings today (Sept. 16) at a breakfast on Capitol Hill held to mark the 60th Anniversary of the Institute, the largest academic social research and survey organization in the world.

This study is the first to show a clear change in work expectations among the same group of older Americans, Weir said. The findings provide compelling evidence that people have changed their retirement plans as a result of the financial crisis.

The survey found what Weir called an historically unprecedented exposure to the stock market, with 62 percent reporting stock holdings in 401(k)s, IRAs, mutual funds, or other vehicles. Reported losses ranged from 20 percent in IRAs and 401(k)s to 25 percent in mutual funds, and 30 percent in stock in single companies.

The survey also found that nearly a quarter of older Americans reported a decline in the value of their home. Slightly less than half still have home mortgages, and about 7 percent of these reported that they are under water, owing more on their home than it is worth. About 3 percent of those with a mortgage said they had fallen behind on payments, but just three-tenths of one percent reported they had entered foreclosure.

Many more older Americans are experiencing the financial crisis through the housing troubles of their children than through their own difficulties, Weir said. Nearly 10 percent said someone else in their family had fallen behind on a mortgage.

Nearly 24 percent surveyed after the crisis said they were not satisfied with their financial situation, compared to about 17 percent when they were surveyed in 2008.

Weir found that the recession and the resulting financial losses were taking a psychological toll on older Americans as well. About 53 percent surveyed before the crisis reported experiencing no symptoms of depression, such as restless sleep, feeling sad, or feeling that everything was an effort. After the crisis, that percentage dropped by 9 percentage points, to about 44 percent. Those reporting four or more symptoms of depression---a level consistent with a diagnosis of clinically significant depression --increased from 11 percent before the crisis to 18 percent after the crisis.

Anxiety produced by the financial crisis, whether about their own situation, their children's or the nation's, is having an impact on the mental health of older Americans that, if it persists, could have effects on physical health, as well, given what we know about the influence of depression on physical health, he said.

However, Weir found no differences in alcohol consumption among older Americans surveyed before and after the crisis, suggesting that while people may be feeling more depressed, they are not changing their core behaviors.

But, Weir said, while older Americans have been affected by the economic crisis that began last fall, and continue to feel the effects, they are coping relatively well.

Ellison Medical Foundation awards more than $1 million to mid-career scientists

Tue, 25 Aug 2009 03:59:36 PST

( from http://www.rxpgnews.com ) NEW YORK, August 25, 2009 -- Charleen T. Chu, MD, PhD, associate professor at the University of Pittsburgh and David M. Sabatini, MD, PhD, associate professor, Massachusetts Institute of Technology, received the 2009 Julie Martin Mid-Career Awards in Aging Research. Sponsored by The Ellison Medical Foundation, the grants provide funding of $550,000 to mid-career scientists whose research has great potential in advancing understanding of basic aging and its impact on age-related diseases. Through a partnership with the American Federation for Aging Research established in 2005, to date The Ellison Medical Foundation has disbursed $4.4 million to eight researchers.

In Parkinson's disease, dopaminergic neurons lose their ability to function and eventually die. Autophagy or self-eating is an important process by which damaged or unneeded structures in the cell are delivered to specialized compartments called lysosomes for digestion into building blocks that can be reused. The capacity for this recycling process, however, declines with age. Dr. Chu's research will develop methods to cause impairment of autophagy in adult mice to see if this factor contributes to the development of neurodegeneration on its own or in combination with genetic alterations that model familial parkinsonism. Dr. Chu's laboratory also studies the effects of overactivation of autophagy, which may also negatively alter neuritic and synaptic function. The ability to identify and correct age- or disease-related factors that disrupt the balance of autophagy could aid in the development of future therapies for neurological diseases.

The mammalian target of rapamycin (mTOR) signaling pathway is a key regulator of growth and metabolism in response to nutrients. mTOR signaling regulates protein synthesis, as well as cell size and proliferation, and has recently been linked to increased health and lifespan in a variety of organisms including yeast, worms, flies, and mice. Using mice with deletions of key mTOR genes, Dr. Sabatini seeks to learn more about the mechanisms underlying mTOR and its relationship to health and lifespan. The potential of such research is that one day this pathway may be able to be tweaked in people to provide some health benefits and protect against age-related diseases.

These grants address two pressing needs: to sustain the promising work of mid-career researchers and to encourage less conservative approaches to advance research on aging that may be deemed too risky for other sources of funding, said Stephanie Lederman, executive director, American Federation for Aging Research. We thank The Ellison Medical Foundation for their solid commitment to these scientists and the field.

One of the great opportunities in a scientist's career is the point where he/she has recently achieved tenure status and can begin to take greater risks with less concern about career security, said Richard L. Sprott, executive director, The Ellison Medical Foundation. We created this program in collaboration with AFAR in order to capitalize on the unique opportunities at this career stage by providing a funding source that encourages faster development of new ideas and approaches than is possible with more traditional funding.

NYC's first elder abuse center created by NYP/Weill Cornell in collaboration with community partners

Tue, 11 Aug 2009 03:59:36 PST

( from http://www.rxpgnews.com ) NEW YORK (Aug. 11, 2009) -- NewYork-Presbyterian Hospital/Weill Cornell Medical Center will create a New York City Elder Abuse Center in order to improve intervention and treatment for elder abuse cases in the New York City area. The first center in the New York area to focus on coordinating elder abuse cases, the Center has received grants totaling $375,250 -- $300,000 from the Fan Fox and Leslie R. Samuels Foundation and $75,250 from the FJC, A Foundation of Philanthropic Funds -- to develop the first phase of the Center's operations. It is expected to begin operations later this year.

Each year, as many as 10 percent of older Americans are injured physically, debilitated psychologically and exploited financially, often by an adult child or other family relative.

Elder abuse cases are increasingly complex, especially in New York City. For example, both the victim and perpetrator may have mental illness, substance abuse issues or other health conditions. Neither may speak English, says Dr. Mark Lachs, who will serve as executive director at the New York City Elder Abuse Center. He is co-chief of the Division of Geriatrics and Gerontology, and director of the Center for Aging Research and Clinical Care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center; and the Irene F. and I. Roy Psaty Distinguished Professor of Clinical Medicine at Weill Cornell Medical College. We are very grateful to the Samuels Foundation and our other supporters for joining with us during these economically difficult times to address the challenges presented by complex cases of elder abuse.

The New York City Elder Abuse Center will take a case consultation approach, hosting regular meetings with clinicians, city agencies and outreach organizations to decide on the best approach for each case. A given meeting might involve representatives from adult protective services, the district attorney's office, a mental health provider and a geriatrician.

While there are many organizations committed to intervening in elder abuses cases, too often they haven't been effectively communicating with each other, says Risa Breckman, L.C.S.W., who will serve as director of cores at the new Center. She is also director of the Institute for Psychosocial Health on Aging in the Division of Geriatrics and Gerontology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and on faculty there. The New York City Elder Abuse Center will put all these groups at the same table so we can learn from each other and plan a coordinated response.

The Center will initially coordinate cases in Brooklyn, with expansion to the other boroughs planned. The Center's team coordinator will be based in an office at Brooklyn Adult Protective Services.

As it matures and grows, the Center will also serve a larger role, as a training ground and central resource for technical assistance, innovative best practices, multidisciplinary training, research, and policy development in New York City and beyond, says Dr. Lachs.

Queen's University study aims at early diagnosis for ADHD and Parkinson's disease

Mon, 13 Jul 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Eye movement tests developed by Queen's University researchers to aid in understanding childhood brain development and healthy aging may also help in the diagnosis of Attention Deficit Hyperactivity Disorder and detecting the early onset of Parkinson's disease. The project has received close to $1 million in recent funding from the Canadian Institutes of Health Research (CIHR).

An important aspect of what makes us human is the ability to control our behaviour, says Physiology professor Douglas Munoz, who leads the study. Our project investigates how the brain provides this control by observing eye movements. Our experiments have been designed to combine high speed eye movement recording with modern brain imaging techniques to identify brain regions that control our behaviour.

To test this, the team designed a simple yet ingenious experiment. Participants from a wide range of age groups were placed in a magnetic resonance imaging unit that measured their brain activity. While in the unit, they were shown a series of lights and asked to move their eyes toward or away from the lights. The speed and accuracy of their eye movements were recorded and correlated to the activity being documented in specific areas of their brains.

The study showed that at early ages, children scored low. Although they understood the task, sometimes they couldn't help but look at the light, even when asked to look away from it. As the age of the subjects increased, response times decreased and accuracy improved, peaking at age 20-25. As the subjects continued to age, the response times started to increase.

The researchers could also see which sections of the participant's brains were active, and which were less active, with age. With these baselines in place, the same experiments can now be conducted with patients who have ADHD and Parkinson's disease.

In preliminary experiments, kids with ADHD could not help but look at the light no matter if they were asked to look away or not. Normal brain activity was also decreased, says Professor Munoz. When they took their ADHD medication the success rates, and the activity in certain areas of the brain, increased. This test could therefore be used to examine the effectiveness of new ADHD medication.

The same holds true for Parkinson's disease. In preliminary experiments, patients with the disease had a consistent pattern of eye movement time and brain activity. Introducing the tests in clinics as part of regular health exams could result in earlier diagnosis of Parkinson's, allowing the disease progression to be controlled with diet and medication, Dr. Munoz adds.

Other members of the research team include, from Queen's, Drs. Giovanna Pari (Neurology), Angela Garcia (Geriatrics) and Patrick Stroman (Diagnostic Radiology); and Thomas Trappenberg, a computer scientist at Dalhousie University. The investigation into ADHD and Parkinson's disease will take place over the next five years, thanks to the $953,000 funding grant from CIHR.

Queen's University study aims at early diagnosis for ADHD and Parkinson's disease

Mon, 13 Jul 2009 03:59:36 PST

University of Houston research team aims to help caregivers monitor patients' health and whereabouts

Thu, 25 Jun 2009 03:59:36 PST

( from http://www.rxpgnews.com ) For those who are caring for elderly parents, peace of mind is hard to come by. And, for their parents, dignity is hard to retain. But a team of University of Houston researchers hopes to ease worries and frustrations by designing an affordable in-home health-monitoring system that will notify caregivers, via smartphones or PDAs, if their loved ones need attention.

Our system will allow for such things as vital sign monitoring and location tracking using low-cost technologies and offering fast response times for caregivers, said Driss Benhaddou, an assistant professor of engineering technology at UH's College of Technology.

Four years ago, Benhaddou and his team began work on a wireless health-monitoring system in conjunction with the Abramson Center for the Future of Health, a joint partnership between UH's College of Technology and The Methodist Hospital Research Institute, which emphasizes personalized medicine and medical device development.

Our original thought was that sensor networks can be applied to any type of removed health care using off-the-shelf technology, which makes it cheaper, because you don't need to reinvent the wheel, Benhaddou explained. The technology uses processor boards found in a variety of electronics, which cost only about $70 each. You could wire a whole home for about $1,000.

A patient whose movement is being monitored, perhaps because of Alzheimer's or dementia, will wear a sensor the size of a quarter on a belt or piece of clothing. One whose vital signs, such as temperature, heart beat and oxygen level, are being monitored will wear the sensor on his or her skin.

The house would have a handful of sensors in various rooms, depending upon the square footage. Those sensors would communicate with the sensor on the person and with a hub, which would be connected to the Internet and communicate with a caregiver's smartphone or PDA, he said.

Benhaddou said the installation of the system must be simple so that caregivers can do it on their own.

Components can be added or removed without the intricate knowledge of the system, because it uses plug-and-play technology, assistant professor Deniz Gurkan said. It is similar to plugging in a mouse to a computer using a USB port. You don't need to be a computer techie to be able to use it.

Though the technologies the team is employing are readily available, Benhaddou said, the challenge is to integrate them, to interpret data generated by sensors and to provide reliable information to caregivers.

Besides vital sign biosensors, the system has three main components: wireless sensor interface, networking, and digital signal processing, explained assistant professor Xiaojing Yuan. The wireless sensor interface connects different sensors to the wireless communication module. The communication protocols securely transmit the data to the right person at the right time through the network. And the digital signal processing ensures the timeliness of the communication and determines the impact of the vital sign for the patient's health.

Student Bao Quach, a computer engineering technology major, has been working on implementing mechanisms that will send notifications to the smartphone or PDA through either a regular telephone network or a local Wi-Fi network, Benhaddou said.

Bao implemented an interface in a smartphone prototype that was tested in the lab, Benhaddou said. It is amazing how some students can just take the job and run with it.

Meanwhile, post-doctoral student Manikanden Balakrishnan is focused on fine-tuning the quality of service that will be provided to end-users.

My research aims to achieve stable service and the fewest possible delays for emergency reporting during peer-to-peer device operation, Balakrishnan said. This will enable reliable emergency alarming from body sensors directly to doctors' phones, eliminating the Internet interface.

Benhaddou said monitoring vital signs with this kind of system in a hospital setting would take some of the burden off physicians and nurses.

After surgery, for instance, you need to do a lot of monitoring. While you'll always need a nurse, such a system would improve the quality of the data that you're taking. It would track patients every single minute, he said.

Other applications of the wireless system, Benhaddou said, could reduce existing monitoring costs at assisted living centers, keep an eye on potentially sleep-deprived truck drivers and assess astronaut performance during NASA space missions.

Care Management Reduces Suicidal Ideation in Geriatric Depression

Wed, 24 Jun 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Depression in older adults too often goes unrecognized and untreated, resulting in untold misery, worsening of medical illness, and early death. A new study has identified one important remedy: Adding a trained depression care manager to primary care practices can increase the number of patients receiving treatment, lead to a higher remission rate of depression, and reduce suicidal thoughts.

"Almost one in 10 older adults in the United States has some form of depression, and one-fifth among them contemplates suicide. Two-thirds of these patients are treated by primary care physicians. Sadly, their depression is often inadequately treated due to the primary care physician's time constraints and the patient's reluctance to discuss their symptoms and adhere to treatment," says Dr. Alexopoulos.

The critical finding of the PROSPECT study is that adding a trained care manager to primary care practices increases the number of depressed older patients who receive treatment and improves their outcomes, not only in the short term, but over two years.

"This is important because depression can either become chronic or relapse after an initial improvement," adds Dr. Alexopoulos. "Most diseases have worse outcomes when an old person becomes depressed. Depression almost doubles the risk for death. It follows that treating depression effectively can reduce sickness, disability and death."

The study, conduced by NewYork Presbyterian/Weill Cornell, the University of Pittsburgh, and the University of Pennsylvania, followed 599 patients aged 60 years and older with depression at 20 primary care practices of varying sizes in New York and Pennsylvania. Participants were randomized to receive either the PROSPECT intervention or usual care. Those in the PROSPECT group were assigned a care manager -- a trained social worker, nurse or psychologist -- who helped the physician offer treatment according to accepted practice guidelines, monitored treatment response and provided follow-up over two years. Practice guidelines included the antidepressant citalopram (Celexa), with the option of other drugs or psychotherapy.

The PROSPECT intervention worked especially well for a subgroup of patients with major depression, the more severe form of the disease, with a greater number achieving remission, or the near absence of symptoms. Patients with minor depression had favorable outcomes regardless of their study group.

Various forms of care management are being used successfully for cardiovascular patients needing anticoagulation medication and for diabetes patients needing insulin monitoring, says Dr. Alexopoulos. "The PROSPECT study has demonstrated that care management is highly successful for older adults with major depression."

"At this time, our nation is focused on disease prevention as a way to improve the health of Americans and to reduce health care cost. Reducing depression over long periods of time can be one of the ways to achieve this objective," continues Dr. Alexopoulos. "Care management, like that of the PROSPECT study, is relatively inexpensive. Finding ways to reimburse it can make it broadly available and have a major impact on the overall heath care."

New supplement may help slow sight loss in elderly

Fri, 19 Jun 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Queen's University Belfast academics have helped develop an antioxidant supplement which may slow down sight loss in elderly people.

The supplement may help those affected by the leading cause of blindness in the Western World, a five-year research programme has found.

Professor Usha Chakravarthy, from Queen's Centre of Vision and Vascular Science (CVVS), co-ordinated the study, which looked at nutritional supplements for patients with early age-related macular (AMD) degeneration and found they helped sharpen vision.

Details of the findings are being presented in Belfast today (Friday) by Professor Chakravarthy and Dr Stephen Beatty, Head of Vision Research at the Waterford Institute of Technology.

They co-designed the study and the antioxidant supplement was developed with the advice of Professor Ian Young from the School of Medicine, Dentistry and Biomedical Sciences at Queen's and scientists in eyecare companies Dr Mann Pharma and Bausch and Lomb.

AMD is an incurable eye disease which causes blurring of central vision because of its effects on the macula, the central part of the retina.

Over 400 people across Ireland took part in clinical trials investigating whether carotenoids, rich antioxidants which are found in fruit and vegetables, could prevent progression to the more serious late AMD.

When the eye disease progresses to late AMD patients are unable to read, watch television or recognise people's faces as they only have peripheral vision, not central vision.

Professor Chakravarthy, who is also a Consultant Ophthalmic Surgeon at the Royal Hospital in Belfast, said: Late AMD causes severe sight loss and has a huge economic impact both in terms of the effects of sight loss itself and in terms of the expensive treatments that are needed to deal with the condition.

Up to 500 people a year in Northern Ireland will lose sight in one or both eyes as a result of late AMD.

We wanted to carry out the study as prevention of progression to late AMD can result in a reduced financial and societal burden.

As the macula of the eye is very rich in antioxidants the researchers wanted to see if a supplement called CARMA (Caroteneoids and Co-antioxidants in Age-related Maculopathy) containing the carotenoids lutein and zeaxanthin could help slow down AMD.

The supplement also contained vitamins C,E and Zinc, which had been used in a previous study.

The latest study showed that intake of high levels of both carotenoids preserved the macular pigments, slowing down the progression from early AMD to late AMD.

In contrast, the macular pigments of participants in a placebo group declined steadily.

Dr Chakravarthy added: These findings are important because this is the first randomised controlled clinical trial to document a beneficial effect through improved function and maintained macular pigments.

Further research is needed to confirm these findings and to identify the numbers needed to treat to prevent 1 case from progressing from early to late AMD.

Middle-aged women experience more stress but have lower blood pressure

Fri, 05 Jun 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Both blood pressure and serum lipid levels have improved in Swedish middle-aged women during the past 30 years. Levels of perceived mental stress, however, have increased significantly. These are the of a thesis presented at the Sahlgrenska Academy, University of Gothenburg, Sweden.

The study is part of the Prospective Population Study of Women in Gothenburg, Sweden. This study was initiated at the end of the 1960s, when 1,462 middle-aged women were examined, and interviewed about their lifestyle and other matters. These women have subsequently been followed up into the 21st century, as well as compared with new generations of middle-aged women who have been examined at later dates, as part of the Prospective Population Study.

The level of stress among middle-aged women was stable over a long period, but we can see that the number of women who perceive stress rises significantly after the early years of the 1980s. It is the women themselves who describe that they feel stressed, and other research has shown that it is the perceived stress that is most harmful, says general practitioner Dominique Hange, author of the thesis.

In 1968-1969, 28% of women stated that they suffered from nervousness, and 36% stated that they experienced stress. By 2004-2005, the percentage of women who experienced stress had more than doubled, to 75%.

The women who stated at the end of the 1960s that they suffered from nervousness or perceived stress had a higher frequency of abdominal problems, asthma, headache, and frequent infections. This is true both at the time they were examined and nearly 25 years later. We could also in a longer perspective, see that the women who were mentally stressed had a higher mortality, and a somewhat higher incidence of breast cancer, says Dominique Hange.

The results presented in the thesis show also that the risk factors for cardiovascular disease among women have decreased during the past 30 years. The average body mass index of the women was the same in 2000 as it was in the 1960s, while mean blood pressure and levels of serumlipids were lower.

More women today exercise in their leisure time, and we know that physically active people often have a lower blood pressure. Only 15% of women exercised regularly in the 1960s, while the figure today is around 40%, says Dominique Hange.

The Prospective Population Study of Women in Gothenburg, Sweden The Prospective Population Study of Women in Gothenburg, Sweden, was initiated at the end of the 1960s, when 1,400 middle-aged women took part in a health examination and answered extensive questionnaires about their lifestyles, and other matters. New generations have been invited to take part in the study since then. The follow-up of the women as they become older allows scientists to draw conclusions about various factors that have contributed to poor health and premature death.

Comprehensive cardiogenetic testing for families of sudden unexplained death victims can save lives

Tue, 26 May 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Vienna, Austria: Relatives of a young person who dies suddenly should always be referred for cardiological and genetic examination in order to identify if they too are at risk of sudden death, a scientist told the annual conference of the European Society of Human Genetics today (Tuesday 26 May). Dr. Christian van der Werf, a research fellow at the Department of Cardiogenetics, Academic Medical Centre, Amsterdam, The Netherlands said that, although his team's research showed that inherited heart disease was present in over 30% of the families of sudden unexplained death (SUD) victims, the majority of such relatives were currently not being referred for examination.

When an individual aged 1-50 years dies suddenly, autopsy reveals an inheritable heart disease in the majority of the victims. But in approximately 20% autopsy does not reveal the cause of death. We thought that cardiological and genetic examination of surviving first degree relatives of these SUD patients might reveal an inherited heart disease, said Dr. van der Werf.

In the largest such study to date, the team looked at the outcome of first degree relative screening in 127 families who had suffered an SUD and where either there had been no autopsy (53.8%), or the autopsy did not reveal a cause of death. The average age at death of the SUD victims was only 29.8 years old.

The initial examination of the relatives consisted of taking personal and family medical history and a resting ECG. A second cardiac autopsy of the SUD victim was undertaken if tissue had been stored and was available. Additional cardiological examinations of the relatives were performed where necessary. Genetic analysis of the associated candidate gene(s) was performed in material obtained from the deceased person or in those relatives who showed clinical abnormalities.

The researchers found inherited heart disease in 36, or 32% of the families. These results meant that doctors were able to treat affected relatives and try to prevent their succumbing to sudden cardiac death. The scale of heart disease that we found in such families underlines the necessity for general practitioners to refer first degree relatives of SUD victims to a specialised cardiogenetics department as soon as possible, said Dr. van der Werf. Currently we estimate that only 10% of SUD families are being examined for inherited heart conditions.

The study is the second report from the registry of families who attended the Amsterdam centre's cardiogenetics department because of unexplained sudden death of a relative aged 1-50 years. The scientists intend to continue to report the yield of family screening in an increasing number of families.

At present we are conducting a study to stimulate general practitioners and other involved physicians to request autopsy and DNA-storage for SUD patients and to refer relatives to a cardiogenetics department after a case of sudden death at young age. We hope this will lead to identification of more families at risk of sudden cardiac death, in which preventive measures then can be taken said Dr. van der Werf.

Relatives of young sudden death victims are often referred to cardiologists for cardiological examination. We believe relatives should instead be referred to cardiogenetics departments, where clinical geneticists, cardiologists and psychosocial workers cooperate. These professionals specialise in inherited heart diseases and their clinical and psychosocial implications, and can provide a better quality of care. Additionally, cardiologists should receive more education in inherited heart diseases. By taking these measures we can save lives and avoid further distress for families who have already suffered enough, he said.

Early identification of dementia increasingly difficult

Wed, 20 May 2009 03:59:36 PST

( from http://www.rxpgnews.com ) If grandma seems to forget things, will she end up demented? These days, memory loss is one of the very few symptoms that may signal which 70-year-olds risk developing dementia. This is shown in a doctoral thesis at the Sahlgrenska Academy at the University of Gothenburg, Sweden.

Several of the tests previously used to predict which elderly individuals risk developing dementia do not seem to work any longer. The thesis shows that memory loss is the only factor that can still be used to indicate who is at risk, although not among the very old.

The study compared nondemented 70-year-olds examined in the early 1970s with nondemented 70-year-olds examined in the year 2000. The results show that those who were examined in 2000 scored much higher on psychological tests than those examined 30 years earlier. This finding clearly indicates that such tests can no longer be used to predict future dementia.

'In the early 1970s, several different tests could be used to predict people's risks of developing dementia, but today it seems like psychiatric evaluation of the memory is the only useful test. In addition, it is more difficult to predict dementia the higher the person's level of education', says physician PhD Simona Sacuiu, the author of the thesis.

The follow-up of the 70-year-olds five years later showed that 5% had developed dementia. Those with memory problems showed an increased risk of developing dementia, although not everybody with poor memory developed dementia. Consequently, the link between forgetfulness and future dementia is more complex than commonly thought. Memory loss among elderly individuals may, but doesn't have to be, an early sign.

'In order to effectively detect dementia at an early stage, we need a useful tool that includes several types of tests, but the tests need continuous adjustments since the elderly of today perform much better at standardised psychological tests than previous generations', says PhD Sacuiu.

Examinations of a group of nondemented 85-year-olds show that the link between memory problems and dementia is not as clear in this age group. The 85-year-olds' ability to find words, to copy a geometric figure and to take quick decisions were some qualities that were evaluated in a psychiatric assessment. More than 300 individuals participated in the study, of which 17% had developed dementia three years later.

'We can't say that memory loss is the only meaningful sign of future dementia among 85-year-olds, since other symptoms, such as difficulties finding words or drawing a geometric figure, were needed for their risk of developing dementia to increase', says Sacuiu.

ASN increases knowledge of geriatric kidney disease

Thu, 14 May 2009 03:59:36 PST

( from http://www.rxpgnews.com ) The fastest-growing group of patients initiating dialysis is patients 75 years old and older; providing the best care for this group of patients presents significant challenges. The American Society of Nephrology (ASN) introduces the first-ever online curriculum to address aging and the kidney. The curriculum, based on the Accreditation Council for Graduate Medical Education (ACGME)'s six core competences of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice, answers questions about the management of elderly patients.

Twenty-five percent of institutions with accredited US nephrology training programs do not have accredited geriatric training programs, but the Accreditation Council for Graduate Medical Education (ACGME) has mandated that fellows receive formal training in geriatric nephrology. The ASN online curriculum will serve as a primary source of educational material for geriatric nephrology training nationwide.

Dimitrios G. Oreopoulos, MD, PhD, and Jocelyn Wiggins, BM, BCh served as co-chairs of the Geriatrics Task Force and oversaw development of the curriculum. Caring for elderly patients with end-stage renal disease (ESRD) is an issue of growing importance. There remain many unanswered questions about the management of elderly patients with ESRD. This text will help nephrologists in training and those in practice improve and refine their approaches to the care of elderly kidney patients, said Dr. Oreopoulos.

A grant was provided by the Association of Specialty Professors (ASP) for this curriculum, which includes 38 chapters on various aspects of geriatric nephrology. The online resources will be expanded over the next few months to include power point presentations that distill the information written in each chapter. The entire curriculum will be freely available for anyone to access and utilize.

ASN understands the importance of treating the geriatric nephrology population and also collaborates with ASP on three additional endeavors:

1. ASN partners with the Association of Specialty Professors (ASP) to offer the ASN-ASP Junior Development Grant in Geriatric Nephrology. Since 2003, ASN and ASP have funded more than seven junior nephrologists who have decided to focus their research careers on issues related to the geriatric aspects of nephrology. In 2008, there were two recipients of this grant, Steven G. Coca, DO, and Lisa M. Nanovic, DO.

2. ASN and ASP collaborated with the National Institutes of Health (NIH) to hold the ASN-ASP Workshop on Prediction, Progression, and Outcomes of Chronic Kidney Disease in Older Adults. This workshop, which took place in May 2008, was intended to increase NIH funding for the geriatric aspects of nephrology. ASP provided ASN funding for four fellows to attend and participate in the workshop.

3. ASP also provided ASN with a $15,000 grant to fund an In-Depth Nephrology Course focused on the geriatric aspects of nephrology. The course, Geriatric Nephrology: An Epidemiologic and Clinical Challenge, was held at Renal Week 2008. For 2009, this course will be repeated and will follow the chapters of the geriatric nephrology curriculum listed above. Talks from the 2008 course are available on the ASN website.

Penn State professor investigates estrogen, heart disease connection in women

Mon, 04 May 2009 03:59:36 PST

( from http://www.rxpgnews.com ) A new study on old rats by a Penn State researcher will shed light on the connection between estrogen deficiency, heart disease and aging in women.

Heart disease is the leading cause of death in women over the age of 75. After menopause, women lose their ability to produce the hormone estrogen and researchers believe that low estrogen levels somehow make women more vulnerable to heart disease and heart attack.

Donna Korzick, associate professor of physiology and kinesiology in Penn State's College of Health and Human Development, has a $1.8 million, five-year project funded by the National Heart, Lung and Blood Institute of the National Institutes of Health to figure out why estrogen deficiency puts women in danger for heart disease.

Korzick will identify proteins in heart cells that might be affected by both aging and low estrogen levels. She will work with Bruce Stanley, director of scientific programs, Penn State Milton S. Hershey Medical Center, to identify these proteins.

Proteins are the work horses of the cells, said Korzick. When they become activated, they can trigger different functions within the cell. Some are even responsible for cell death as we age.

Proteins can become 'activated' in a variety of ways, including by low estrogen levels.

Korzick will analyze the proteins within one segment of heart cells, the mitochondria. These are the gate keepers of cell survival, says Korzick. The mitochondria play a significant role in whether or not a cell lives or dies as we age, especially while experiencing a heart attack.

Cell death is a natural process, explained Korzick But when heart cells die, it means that the remaining cells have to do more work. In this way, cell death is directly linked to how well the heart can withstand a stress like a heart attack.

After identifying the heart cell's proteins, Korzick will determine which proteins respond to low-estrogen environments. She will then use protein-targeting drugs that can activate or inhibit specific proteins in the heart cells to change what is happening inside the cells. Korzick hopes that these experimental results will provide the missing piece to the estrogen deficiency -- heart disease puzzle.

Because of their short life span -- only two years, Korzick will look primarily at rats. According to Korzick, this short life span allows for a true model of aging. Additionally, other researchers have already completed a large body of work involving aged rats so she will have a comprehensive knowledge base with which to work.

At the very least, we'll be learning about heart disease in older females, says Korzick. Right now, most of the estrogen-specific research is based on males, or young rats. Our research focuses on females, both young and old.

With the assistance of Tim Lancaster, who received his master's degree in kinesiology in 2008, Korzick has already identified nearly 600 proteins within the mitochondria of a rat heart cell.

Exercise reduces falls in older people

Tue, 14 Apr 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Exercise programmes are an effective option for preventing falls among older people living in the community. There is less evidence at present for the effectiveness of other interventions, such as home safety improvements and vitamin D supplements, according to Cochrane Researchers who carried out a systematic review of the available evidence.

Although few falls result in serious injuries, they may have many additional impacts on an older person's quality of life. For example, after a fall, they may feel less confident and decide to restrict their own activities to avoid further accidents. It is therefore important to consider how falls can be prevented in order to provide peace of mind for those at risk, as well as family members.

Exercise may help to prevent falls by improving strength, flexibility, balance, and endurance. Programmes that contain a combination of these components reduce falls. These include exercising in supervised groups, participating in Tai Chi, and carrying out individually prescribed exercise programmes at home, says lead researcher Lesley Gillespie, who is based at Dunedin School of Medicine at the University of Otago in New Zealand. What remains less clear is whether some other interventions really do reduce falls. Some may be of more benefit to those at higher risk of falling. There also seem to be differences in the effectiveness of some kinds of interventions when carried out in different health care settings.

Researchers reviewed data from 111 trials that included 55,303 older people altogether. As well as trials focused on group and individual home-based exercise programmes, they considered interventions such as vitamin D for reducing muscle weakness, home safety improvements, cataract surgery for improving vision, and combination interventions based on individual assessments.

Those who took part in exercise programmes were less likely to suffer a fall and individuals fell less frequently than those who did not. Combination interventions based on individual assessments also reduce falls. There was evidence from single trials that falls are reduced by some other interventions: gradual withdrawal from some types of drugs taken to improve sleep, reduce anxiety and treat depression; bringing forward cataract surgery on the first affected eye, and anti-slip shoes for icy conditions. Vitamin D showed potential for reducing the risk of falls only in those with vitamin D deficiencies. Home interventions were relatively unsuccessful, except in high-risk groups.

Gillespie says further research may help to determine which components are crucial to an effective exercise programme. We need more research to see which components of an exercise programme are most important, but the trials would need to be large trials to discern any differences, she says.

A further Cochrane review focusing on prevention of falls among older people living in residential care facilities and hospitals is nearing completion.

Stroke survivors improve balance with tai chi

Mon, 23 Mar 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Stroke can impair balance, heightening the risk of a debilitating fall. But a University of Illinois at Chicago researcher has found that stroke survivors can improve their balance by practicing the Chinese martial art of tai chi.

Christina Hui-Chan, professor and head of physical therapy at UIC, has studied and used tai chi as a way to improve balance and minimize falls among healthy elderly subjects. Now she and a colleague have seen similar results in a group of stroke survivors.

The study used 136 subjects in Hong Kong who had suffered a stroke more than six months earlier. Participants were randomly assigned to a tai chi group or a control group that practiced breathing, stretching and other exercises that involved sitting, walking, memorizing and reasoning.

Tai chi consists of constant coordinated movement of the head, trunk and limbs requiring tremendous concentration and balance control. Participants learned a simplified form that had been shown to be beneficial to arthritis patients.

Patients were trained in small groups by physical therapists in a weekly class, then practiced at home three days a week for one hour. They received 12 weeks of training but were able to learn the technique in as little as eight. The goal was to make the patients as independent in their treatment as possible, Hui-Chan said.

They were then tested for their ability to maintain balance while shifting weight, leaning in different directions, and standing on moving surfaces to simulate a crowded bus. In these tests the tai chi group out-performed the control exercise group. The two groups performed about the same on another test, which was not focused solely on balance but involved sitting, standing, walking, and returning to sit down.

The tai chi group did particularly better in conditions that required them to use their balance control, Hui-Chan said. In only six weeks, we saw significant improvements. The ability to shift your weight is very important because all reaching tasks require it.

While learning tai chi is not easy, Hui-Chan has found that most people can learn the art if taught by a trained instructor. Many Chinese practice tai chi in morning group exercises, and Hui-Chan thinks the experience can work for Americans and other western nationalities.

It can be taught at community centers, YWCAs or YMCAs, or in parks in the summer, she said.

Hui-Chan said that benefits of tai chi include improved strength and cardio fitness. Group classes also provide a healthy social gathering for isolated seniors at a fraction the cost of physiotherapy or personal training.

Computerized writing aids make writing easier for persons with aphasia

Tue, 03 Feb 2009 04:59:36 PST

( from http://www.rxpgnews.com ) It is possible to improve writing skills for those with aphasia with the aid of computerised writing aids. This is the conclusion of a doctoral thesis from the Sahlgrenska Academy at the University of Gothenburg, Sweden.

Aphasia affects the ability to understand and use spoken language, and the ability to read and write. Persons with aphasia were trained in the use of computerised writing aids in the study on which speech and language pathologist Ingrid Behrns' doctoral thesis is based. The subjects were aided by a computer-based spell-checker and a program for word prediction, similar to that used when writing SMS messages on mobile telephones.

The thesis shows that writing ability improved in several ways with the aid of these programs.

A fairly high reading and writing ability is necessary in order to benefit from the most common spell-checkers. So we used two writing aids that have been specially developed for persons with dyslexia, instead. These programs were also useful for persons who have writing problems arising from aphasia, says Ingrid Behrns.

The programs are easy to use and cheap to purchase, and may be beneficial for many people who have aphasia. The greatest benefit for those who were members of the group receiving writing training was that it became easier to make corrections in what they had written. They also wrote longer sentences with fewer spelling errors.

But is important to remember that time must be invested in learning how to use the computer programs. It was particularly encouraging to find that it is possible to improve writing ability even though several years have passed since the participants developed aphasia, says Ingrid Behrns.

Previous research into writing ability and aphasia has focussed on the spelling of single words, but the work presented in the thesis investigated not only the completed text but also revisions that were made when writing a story. This makes it possible to see the aspects of the writing process for which the writer has had to use most energy. The thesis also shows that persons with aphasia can write stories with high coherence and a good overall structure, despite their language difficulties. The results also show that it is sometimes easier for persons with aphasia to express themselves in writing rather than in spoken language.

The good results from the writing training are very encouraging since the ability to express oneself in writing opens many possibilities for communication using the Internet, says Ingrid Behrns.

APHASIA: Aphasia is a collective term for language difficulties that can arise after a stroke, for example, or from head injuries such as may be suffered in a traffic accident. Older persons are affected more often than younger, but aphasia can affect persons of any age. A person with aphasia has difficulty understanding, speaking, reading and writing, while their intellectual abilities are not impaired in any way. Approximately 12,000 Swedes are affected by aphasia each year.

Mobility test will gauge fitness of elderly

Fri, 30 Jan 2009 10:14:04 PST

( from http://www.rxpgnews.com ) Sydney, Jan 30 - Mobility test, like blood test or blood pressure readings, is also an important indicator of physical fitness and health status.

A new mobility test for elderly patients, developed by Monash University doctoral graduate Natalie de Morton, is being implemented in hospitals and aged-care facilities around the world.

de Morton devised the simple mobility test, called the DEMMI -, in which patients are asked a series of questions and then undergo some basic physical tasks, to quickly identify the patient's level of mobility and in turn, treatment options.

Until now, mobility tests have been created to test either those who are healthy and those who are suffering some sort of disability. The tests weren't interchangeable.

'I tried to make it a very clear and simple instrument. Most of the questions have 'pass' or 'fail' responses. A few of the items have three response options, but most have two,' said de Morton.

'We wanted it to be a quick and easy test to administer, because otherwise it wouldn't be used where it may be the most valuable and that is in the acute clinical setting, when instant diagnoses can be incredibly important to determining potential treatment options for a patient. On average, it takes just under nine minutes to administer,' de Morton said, according to Monash release.

The DEMMI uses a scorecard with 15 simple physical tests for assessing the mobility of elderly patients and includes questions such as: Can the patient stand for 10 seconds with one foot in front of the other, roll over in bed or walk unaided for 50 metres?

The paper was published in the Health and Quality of Life Outcomes Journal.

Annual Congress European Association of Urology: highlights in Stockholm

Thu, 18 Dec 2008 04:59:37 PST

( from http://www.rxpgnews.com ) The 24th Annual Congress of the European Association of Urology (EAU) will be held from 17 to 21 March 2009 in the Stockholm International Fairs (SE). The scientific programme covers the whole range of the urological field. From 'Bladder Unlimited' to 'The art of ageing'; it will all be discussed at the congress.

The traditional half-day joint sessions with regional urological groups are extended to a full-day event called EAU International Day - Urology Beyond Europe.

In Stockholm the EAU expects an estimated 10,000 delegates and 3,000 exhibitors.

The EAU aims to present the best of scientific results, lectures and educational courses. This year's programme has a new dimension with an additional congress day on Tuesday 17 March. This day, entitled 'Urology Beyond Europe' endeavours to intensify the collaboration between the EAU and urological societies worldwide. Included in the programme are international joint sessions and case discussions covering selected urological topics.

Second-day highlights include the meetings of the EAU Section Office, with 14 offices and EAU-affiliated groups simultaneously holding their sessions. The section office meetings annually showcase the latest research projects and initiatives which focus on specialised fields such as uro-technology, female and functional urology, transplantation, andrology and urological imaging. 'Bladder Unlimited' is the focus of the European Society of Urological Technology (ESUT). The ESUT will be presenting live robotic surgery for the first time. Collaborating with the prestigious Karolinska Hospital in Stockholm, procedures such as laparoscopic and robotic cystectomies and robotic bladder surgery will be demonstrated..

From the European Society of Andrological Urology (ESAU), expert lectures and roundtable discussion will revolve on the theme 'Testosterone and the Art of Ageing'. The manifold issues related to testosterone will be linked to discussions on endothelial cell, germ cell and other aspects in the molecular level.

In response to feedback from EAU members, the sub-plenary sessions have scheduled two separate meetings on the topics of infections (chaired by Prof. Truls Erik Bjerklund Johansen (DK)) and testis/penile cancer (chaired by Prof. Peter Albers (DE)). The latter meeting will discuss techniques in organ-sparing surgery and the latest updates on chemo and radiation therapy for testis cancer.

Third-day sessions will highlight current challenges in urology starting with a plenary session on the evolution of new technologies and treatments with particular emphasis on Benign Prostatic Hyperplasia (BPH), including guest lecturers from the Pan African Urological Surgeon's Association (PAUSA). Dr. Michael Chancellor (Detroit, USA) will give the AUA lecture entitled 'Botulinum toxin for the lower urinary tract- past, present and future.'

On Day 4, the morning plenary sessions will focus on hot topics in prostate cancer. Providing the SIU lecture is Dr. Martin Gleave (Vancouver, Canada) who will discuss castration resistant prostate cancer with emphasis on new therapeutic approaches. Sub-plenary sessions will continue in the afternoon meetings focusing on andrology, basic science (oncology) and reconstruction.

The last day plenary session on Saturday, 21 March 2009, pays special attention to bladder cancer with guest lecturers and expert speakers taking up manifold issues and controversies. Aside from state-of-the-art lectures, debates and cases discussion are scheduled with topics such as laparoscopic surgery, challenges in bladder cancer diagnosis and bladder preservation.

Also programmed throughout the five-day meeting are interactive courses organised by the European School of Urology. The courses are limited to 100 participants; registration is necessary.

Both theories about human cellular aging supported by new research

Tue, 16 Dec 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Aging yeast cells accumulate damage over time, but they do so by following a pattern laid down earlier in their life by diet as well as the genes that control metabolism and the dynamics of cell structures such as mitochondria, the power plants of cells.

These research findings, presented at the American Society for Cell Biology (ASCB) 48th Annual Meeting, Dec. 13-17, 2008 in San Francisco, support the theories that old age is the final stage of a developmental program AND the result of a lifelong accumulation of unrepaired cellular and molecular damage.

The diet plus metabolic genes pattern is a modular longevity network, says Vladimir Titorenko of Concordia University in Montreal, who studies baker's yeast, Saccharomyces cerevisiae, as a simpler model for the complex mechanisms of human cellular aging.

Through the yeast model, Titorenko and colleagues identified five groups of novel anti-aging small molecules that significantly delayed aging.

The scientists first identified a mechanism closely linking life span to the dynamics of such lipids as cholesterol, triglycerides and fatty acids: When fatty acids build up, yeast cells explode from within, scattering their contents and spreading inflammation to neighboring cells.

In addition to cell death, the accumulation of fatty acids sets off chemical reactions that ultimately produce a lipid called diacylglycerol, which impairs many of the yeast's stress response-related defenses.

Knowing the link between life span and lipid dynamics, the scientists next evaluated aging effects of both calorie-rich and low-calorie diets.

The calorie-rich diet suppressed the oxidation of fatty acids in peroxisomes, structures in cells that use enzymes to neutralize toxic peroxides.

These fatty acids are constantly synthesized in the endoplasmic reticulum (ER), the cell's protein manufacturing factory. Without peroxisome processing, fatty acids end up deposited within lipid bodies.

Low-calorie diets, which have been shown to increase lifespan and delay age-related disorders in nonhuman primates and other organisms, altered the way fats were processed in the yeast cells.

The researchers assessed calorie restriction along with a number of known mutations that extend yeast lifespan against a variety of age-related changes in fat metabolism and lipid transport.

To determine whether the diet-aging mechanism could be manipulated by a therapeutic drug, Titorenko and his colleagues developed a life-span assay for a high-throughput screening of multi-compound chemical libraries.

The assay identified five groups of novel anti-aging small molecules that significantly delayed yeast aging by remodeling lipid dynamics in the ER, peroxisomes and lipid bodies or by activating stress response-related processes in mitochondria.

These small molecules can be used as research tools to investigate the mechanisms of longevity, says Titorenko, and as possible pharmaceutical agents for age-related disorders that affect lipid metabolism such as heart disease, chronic inflammation, and Type 2 diabetes.

In just 5 years, gene discovery to clinical trial of potential treatment

Sun, 14 Dec 2008 04:59:37 PST

( from http://www.rxpgnews.com ) One of the fastest translations of a basic research discovery into a promising clinical trial for an untreatable and fatal disorder will be discussed publicly for the first time by the key players in this remarkable research story, on Sunday, Dec. 14, at the American Society for Cell Biology (ASCB)'s annual meeting in San Francisco.

The disease is Progeria, or Hutchinson-Gilford Progeria Syndrome (HGPS), a rare, accelerated aging disease that afflicts children.

The discovery of the gene responsible for the disease five years ago led scientists to the experimental drug that is now being evaluated in 28 children with this premature aging disease.

Speaking at the special ASCB session will be the physician heading the clinical trial, the gene-hunter whose research team pinpointed the DNA mutation, and the cell biologist who conducted the basic research on the protein structures in the cell nucleus that were subsequently found to be abnormal in HGPS.

Also on the panel will be the medical director of the Progeria Research Foundation who is both a scientist and the mother of a child with HGPS.

In addition to describing this bench-to-bedside story, the ASCB special symposium will spotlight new research suggesting that the basic cellular mechanism defective in children with HGPS may be at work in normal aging disorders, particularly in cardiovascular disease.

HGPS is estimated to affect about one child in 4 million. At birth, children with the disease appear normal. However, their growth soon slows, and children with HGPS begin to show signs of accelerated aging, such as hair loss, wrinkled skin, and loss of body fat. A 10-year-old child with HGPS typically looks like an 80-year-old adult.

HGPS' lethal damage occurs within the major blood vessels. The children develop premature cardiovascular disease, which typically leads to death from heart attack or stroke at about the age of 13. There currently are no treatments for the disease.

Speaking at the symposium will be:

o Robert D. Goldman, Ph.D., a pioneer in basic research relevant to understanding how the HGPS gene mutation disrupts human body cells. The head of cell biology at Northwestern University Medical School in Chicago (and ASCB's current president), Dr. Goldman has long studied the normal structure and function of a major component of the scaffold-like network of proteins just inside the membrane that surrounds and protects the cell's nucleus. His research team identified the component, called nuclear lamins, as the culprit in HGPS;

o Gene-hunter Francis Collins, M.D., Ph.D., the former National Human Genome Research Institute (NHGRI) director who headed the research team that pinpointed HGPS' genetic mutation in 2003. Just two years later, NHGRI scientists identified the class of experimental cancer drugs, called farnesyl transferase inhibitors (FTIs), that can prevent the cell damage caused by the gene mutation and thus might provide an effective therapy against the disease;

o Harvard Assistant Professor Mark Kieran, M.D., Ph.D., the principal investigator of the Boston Children's Hospital phase 2 clinical trial that is evaluating a FTI drug in children with HGPS. He is director of Dana-Farber Cancer Institute's Pediatric Medical Neuro-Oncology;

o Leslie Gordon, M.D., Ph.D., parent of a child with the disease and medical director of the Progeria Research Foundation, which is funding the clinical trial and which has been the mover and shaker in accelerating research on the disease.

Estrogen therapy could be dangerous for women with existing heart risk

Tue, 25 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---Hormone therapy could accentuate certain pre-existing heart disease risk factors and a heart health evaluation should become the norm when considering estrogen replacement, new research suggests.

The research also showed that in women without existing atherosclerosis, hormone therapy use included some positive effects on lipids but also some negative effects related to heart health, said MaryFran Sowers, lead researcher and professor of epidemiology at the University of Michigan School of Public Health.

The U-M study came about, Sowers said, in trying to explain what's behind the so-called timing hypothesis. The timing hypothesis suggests that if a woman implements a hormone therapy program within six years of her final menstrual period, this narrow window is enough to deter heart disease from developing with the onset of menopause. But the U-M findings suggest that explanation isn't quite so simple, Sowers said.

Even within the six-year window, there were negative aspects related to heart disease. While the positive outcomes on HDL and LDL cholesterol levels were observed, Sowers said, researchers also saw negative outcomes in terms of the inflammation process---which can be related to heart disease.

Sowers said the research shows it's critical for women considering hormone therapy to discuss their heart health with their doctor.

If the woman walks into the doctor's office with a certain degree of (heart disease) burden already, then she and her health care provider may decide that hormone therapy adds too much to the burden, Sowers said. If she doesn't have that burden, they may decide that hormone therapy is an acceptable burden.

The woman should say to her health care provider, 'What kind of information do we need to gather in order to make an informed decision about whether or not hormone therapy should be pursued,' Sowers said. 'I understand there could be some heart disease risk, but that the risk may be based upon where I am now, and can you tell me where that is?'

Heart disease risk can be measured through lipid panels, which are standard, but also by measuring inflammation markers, Sowers said. Tests for inflammation markers exist but their measurement isn't standard when a women is considering hormone therapy, Sowers said.

Hormone therapy has been controversial for years, and there was a time when there was an almost knee jerk reaction against it, Sowers said. This backlash occurred after the findings from the Women's Health Initiative study showed that some women on estrogen therapy had increased heart disease risk. The six-year timing hypothesis was an attempt to explain the findings in the WHI study, Sowers said.

Bittersweet milestones

Mon, 24 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) For many of the elderly, the golden years are anything but. Faced with health problems, financial issues and the death of a spouse or loved one, many adults 65 years and older suffer from depression. While research is emerging to help this group understand and treat the problem, another group - centenarians - has been left largely in the dark.

Centenarians are still rare, and depression hasn't been studied thoroughly in this group, said Adam Davey, a developmental psychologist in the College of Health Professions at Temple University. We've found that it's a very under diagnosed condition among people over 100 years old, yet it's one of the most easily treated forms of mental illness.

According to the U.S. Bureau of the Census, more than 60,000 people in the U.S. are 100 years old or over, and as baby boomers start to hit their 100-year mark, that number is expected to more than quadruple to 274,000. As a result of this new boom, a group of researchers have been studying this group more and more to learn about successful late-life aging.

In a study presented at the Gerontological Society of America's annual meeting on Nov. 24, lead author Davey and colleagues from institutions across the country looked at indicators of depression among respondents enrolled in the Georgia Centenarian Study, a three-phased project to study quality of life for those over age 100.

Based on responses given in the survey by a sample of 244 centenarians, researchers found that more than 25 percent showed clinically relevant levels of depressive symptoms, yet only 8 percent reported having a current diagnosis of depression.

Davey notes that further study will need to pinpoint the reason for these high levels, but his research suggests a number of factors, including poor nutritional status, urinary incontinence, limited physical activity and past history of anxiety.

People who suffer from depression tend to have a high risk of mortality, so it's puzzling to see higher numbers among the oldest old, he said.

In an earlier phase of the Georgia Centenarian Study, researchers found that centenarians living in a community setting were found to have higher levels of depression than their younger counterparts. Davey noted that since caregivers play a large role in the lives of many centenarians, it is important for doctors, nurses and even family members to focus on the larger picture to ensure a better quality of life.

Behavior/lifestyle factors influence cancer risk among the elderly

Mon, 17 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) WASHINGTON, D.C. - Behavioral risk factors have a significant effect on cancer risk in the U.S. elderly population, according to research presented at the American Association for Cancer Research's Seventh Annual International Conference on Frontiers in Cancer Prevention Research. Understanding these factors may allow clinicians to make specific recommendations for their elderly patients in order to reduce their risks of future cancers.

About 80 percent of all cancers are diagnosed in the elderly, and more than 80 percent of known risk factors are potentially preventable, said Igor Akushevich, Ph.D., senior research scientist, Center for Population Health and Aging, Duke University, Durham, N.C.

The primary purpose of the Duke study was to develop an approach to estimate the contributions of measurable risk factors to cancer risk among the elderly. More analysis is needed before the findings can be applied in clinical use.

So far, we have not come to the stage where we are able to make specific recommendations regarding risk factors, Akushevich said. However, we can confirm several of them which are known. As expected, we see associations of cigarette smoking with lung cancer. Moderate physical activities are capable of decreasing cancer risk, as well as careful health care insurance strategy and, hypothetically, general optimism in life.

Although the results need to be verified in subsequent studies, the researchers found significant contributions from a variety of lifestyle, behavioral and demographic variables on the risk of breast, lung, colon and prostate cancers among the elderly.

The study used data from The National Long Term Care Survey (NLTCS), Medicare claims and the Surveillance, Epidemiology and End Results Program. It defined elderly as 65 years of age or greater. What is important, Akushevich said, is the sample of individuals represents the whole U.S. elderly population.

Some associations between risk factors and cancer incidence were significant and were similar to those found in previous NLTCS studies. Light physical activities decrease risk of cancer, and moderate activities decrease the risks in larger extent, while the picture for vigorous activities is contradictory, he said. Colon and prostate cancers were more associative with physical activities. The preventive effect of physical activities, however, may be mitigated by an increasing risk of death due to all causes as people age.

As expected, tobacco consumption was significantly associated with lung cancer. Future research will examine any joint effects of cigarette smoking and other risk factors such as physical activity or obesity, Akushevich said.

The effect of comorbidities demonstrated a larger increase in risk seen for breast and prostate cancers and a lesser increase for lung and colon cancers. Circulatory disease and diabetes increased the risk of breast cancer while immune diseases increased the risk of prostate cancer.

All data came from individuals covered by Medicare. The researchers found an increased cancer and mortality risk depending on the specific Medicare plan. The situation when additional payments have to be made out-of-pocket is the worst in respect to cancer and mortality risk, Akushevich said. The problem is more important for lung and colon cancers.

He added the researchers were surprised at some of the findings. Cancer risk was not associated with alcohol consumption, which has been reported in other studies. A possible explanation may be a moderate level of alcohol consumption by the elderly.

Other interesting associations are increased risk of breast cancer for those women afraid to go to the doctor to investigate health problems and a decreased risk of breast and lung cancers for those who never lose their temper, he said.

A general view of the results leads to a hypothesis that cancer risk increases for individuals who are not completely happy in different aspects of their life, he added.

Future research will entail detailed multivariate analyses and comparison of predictions with other data sets. We hope to find confirmation of found associations and to more extensively study effects of risk factors, Akushevich said.

'Super' aged brains reveal first secrets of sharp memory in old age

Sun, 16 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) CHICAGO --- Maybe you have an 85-year-old grandfather who still whips through the newspaper crossword puzzle every morning or a 94-year-old aunt who never forgets a name or a face. They don't seem to suffer the ravages of memory that beset most people as they age.

Researchers at Northwestern University's Feinberg School of Medicine wondered if the brains of the elderly with still laser sharp memory -- called super aged -- were somehow different than everyone else's. So, instead of the usual approach in which scientists explore what goes wrong in a brain when older people lose their memory, they investigated what goes right in an aging brain that stays nimble.

Now they have a preliminary answer. Scientists examined the brains of five deceased people considered super aged because of their high performance on memory tests when they were more than 80 years old and compared them to the brains of elderly, non-demented individuals. Researchers found the super aged brains had many fewer fiber-like tangles than the brains of those who had aged normally. The tangles consist of a protein called tau that accumulates inside brain cells and is thought to eventually kill the cells. Tangles are found in moderate numbers in the brains of elderly and increase substantially in the brains of Alzheimer's disease patients.

This new finding in super aged brains is very exciting, said Changiz Geula, principal investigator of the study and a research professor of neurology at the Cognitive Neurology and Alzheimer's Disease Center at Northwestern's Feinberg School. It was always assumed that the accumulation of these tangles is a progressive phenomenon through the aging process. But we are seeing that some individuals are immune to tangle formation and that the presence of these tangles seems to influence cognitive performance. Individuals who have few tangles perform at superior levels, while those who have more tangles appear to be normal for their age, Geula noted.

Geula will present his findings Sunday, November 16, at the Society for Neuroscience annual meeting in Washington, D.C.

The number of plaques in the brains of the super aged was similar to that in the brains of the normally aging group. The plaque is an aggregation of protein called amyloid that becomes deposited outside the brain cell and disrupts communication between neurons. Like tangles, plaques also are found in modest numbers in the brains of aged individuals and show a dramatic increase in number in Alzheimer's disease.

Geula said the lower number of tangles in the super aged appears to be the critical difference in maintaining memory skills.

Some of the super aged in the study performed memory tasks at the level of people who were about 50 years old. For example, after being told a story, they were able to remember it immediately after and still accurately recall its details 30 minutes later. They also remembered a list of 15 words and recalled these words equally well when tested after 30 minutes.

Geula said new research will focus on what makes cells in super aged brains more resistant to tangle formation. We want to see what protects the brains of these individuals against the ravages that cause memory loss, he said. Understanding the specific genetic and molecular characteristics of the brains that makes them resistant, someday may lead to the ability to protect average brains from memory loss.

Geula's research is part of a larger super aging study at Northwestern's Cognitive Neurology and Alzheimer's Disease Center (CNADC). The study's goal is to identify high functioning individuals over 80 and investigate what factors are important to maintain this ability into old age. A number of super aged individuals have been identified and are being followed up annually with tests of cognitive abilities. Recruitment continues for the study.

Case Western Reserve receives Ellison Medical Foundation New Scholar in Aging award

Wed, 05 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Eben Alsberg, Ph.D., Assistant Professor of Biomedical Engineering and Orthopedic Surgery has been named a 2008 Ellison Medical Foundation New Scholar in Aging by The Ellison Medical Foundation. Case Western Reserve University was invited to nominate two faculty members to submit a proposal, and Alsberg was one of those nominated for this award after an internal competition. National competition was strong, with only 25 awards being granted out of 97 applicants. Dr. Alsberg received this highly prestigious award based on his project proposal, Novel Microenvironmental Technology to Rescue the Chondrogenic Potential of Mesenchymal Stem Cells from Aged Individuals for Autologous Cartilage Tissue Engineering, which exhibited outstanding promise in the realm of aging research.

The Ellison Medical Foundation New Scholar in Aging awards provide funding for newly independent investigators early in their careers when they are establishing their own labs. Dr. Alsberg's $400,000 award, distributed over the course of four years, is particularly important at a time when federal funds are increasingly difficult for researchers to obtain. The funding provides for laboratory staffing and establishes research programs to support a long, productive career in science.

Alsberg joined the faculty of the School of Engineering and Medicine's Department of Biomedical Engineering in 2005 to establish a research program in tissue engineering, biomaterials development, and bioactive factor delivery. His research aims to better understand what external signals or cues can be used to regulate cell behavior. His lab engineers novel biomaterial systems and microenvironments to present these signals to cells in a defined temporal and spatial manner to control their function and ultimately improve tissue regeneration.

During his graduate work at the University of Michigan, Alsberg concentrated on engineering orthopedic tissues such as bone and cartilage. Cartilage tissue engineering is also an active area of research in his current laboratory. A large fraction of older individuals suffer from painful and often debilitating cartilage damage in their joints as a result of prior injury or diseases such as osteoarthritis, he said. It would significantly improve the lives of these individuals if it were possible to regenerate healthy cartilage tissue that integrated well with surrounding healthy tissue and could function as required by supporting loads imparted to it and allowing for nearly frictionless movement. It is our ultimate goal to contribute to the science that makes this possible.

One cell population of particular interest to Alsberg is mesenchymal stem cells (MSCs). They have the remarkable ability to change into different connective tissue cells when presented with specific signals. The award from The Ellison Medical Foundation is going to help my lab determine how MSCs from older individuals can be guided to become chondrocytes, the cells responsible for forming cartilage tissue, Alsberg said. I am thrilled to receive this award. It is critically important support during the formative years of a young laboratory. It will allow us to pursue an area we a truly passionate about and help us hopefully make an impact in cartilage tissue engineering.

Societies that care for elderly have more centenarians

Wed, 15 Oct 2008 13:23:49 PST

( from http://www.rxpgnews.com ) Toronto, Oct 15 - Societies that care more for the elderly have more centenarians, a new study has found.

France, Japan, Spain, Italy and Canada are the leading nations with the highest concentration of centenarians. The number is declining in Scandinavian countries, according to papers presented at a recent global conference on tracking oldest people around the world, held at Montreal University.

Demographic data also showed that mothering societies - which care more for the elderly - have more centenarians.

'Countries of the South as well as Japan are mothering countries who accept the dependence of the elderly,' said Jean-Marie Robine, director of the Institut national de la sante et de la recherche medicale in France.

'In Italy, for instance, centenarians either live at home with their grown-up children or in their children's homes. In Scandinavian countries, centenarians live in retirement homes,' he said.

According to Robine, this could explain why the number of centenarians is declining in Scandinavian countries.

New research presented at the conference also shattered many myths and urban legends about centenarians. One example was how Japan's Okinawa region has 427 centenarians for every 100,000 inhabitants, compared to just 14 centenarians for every 100,000 inhabitants in Canada.

Another example was that of Sardinia, where - contrarily to the rest of the world - most centenarians are men.

'Research has shown that male mortality rates are the same as the rest of the world in Sardinia. However, female mortality rates are much higher,' Robine said.

'It is this high female mortality rate that is unusual.' Robine added.

Discussing the problems demographers faced in verifying self-reported data, Robert Bourbeau, director of the Department of Demography at Montreal University, said since 'people tend to exaggerate in this type of survey, it is compulsory to verify birth and death certificates'.

Robine concurred with this view and expressed scepticism about the high number of centenarians in Japan's Okinawa region. 'Close to 80 percent of this region was destroyed in the second World War and modern-day registers were all recopied. Therefore, there is a high margin of error,' he said.

Canada has 4,635 centenarians, with one male centenarian for every five to seven women. About 22 percent of them live in Quebec province, including Judith Pinard, a nun who celebrated her 110th birthday last July.

She is said to be the 78th oldest person in the world.

Seniors with vocal problems want treatment but aren't getting it

Tue, 23 Sep 2008 03:59:37 PST

( from http://www.rxpgnews.com ) DURHAM, N.C. -- The breathy, hoarse voice of senior citizens is often thought to be a normal sign of aging. But doctors at the Duke Voice Care Center say that's a false perception that needs to change. And they've discovered that it may partially explain why seniors who want treatment for the condition aren't seeking it.

That's a problem, added Seth Cohen, M.D., a Duke otolaryngologist and the study's lead author, because voice and swallowing concerns can lead to serious quality of life issues including anxiety, depression and social withdrawal.

Nearly 20 percent of the 248 octogenarians studied by the Duke researchers had dysphonia, the medical term for hoarseness, weakness or loss of voice. Fourteen percent had dysphagia or painful swallowing. Approximately three-quarters of the respondents (77.6% for dysphonia and 79.4% for dysphasia) had not sought treatment, even though more than half (55.9%) expressed interest in getting help.

Voice and swallowing issues are serious concerns and people who want medical care are not getting it, says Cohen of the research presented at the 2008 annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery in Chicago, IL. Is it because they have so many medical problems and these issues are getting pushed aside or overlooked? We don't know. What we do know is these medical concerns have a huge impact on quality of life, and more people should be aware of the treatments available and be able to obtain help.

Previous studies have reported that nearly one-fourth of elderly individuals believe vocal and swallowing problems are a normal part of aging, a perception found to be even more common among those who actually suffer. The Duke physicians surmise that this may lead some elderly people to accept their difficulties and not seek treatment.

Half of those surveyed were unaware that treatment existed. This is a concern, says Cohen, because symptoms of depression were found to be more common among those affected. And, previous studies have reported a connection between the conditions and increased depression, anxiety and social withdrawal.

Cohen says part of the problem may be under-recognition. Primary care physicians are currently managing the many medical conditions elderly people routinely face, and may not be discussing voice and swallowing problems with their patients. Regardless, Cohen says the Duke data shows that needs to change.

Our results highlight the need for better education of the general public and, primary care providers, Cohen said. Whether this effort leads to increased awareness and/or better outcomes for these patients is the basis of further study. But for now, we know these problems have a significant negative impact on quality of life, and obtaining appropriate treatment can make a big difference.

The lucky few: FSU researcher shines light on forgotten generation

Thu, 21 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) TALLAHASSEE, Fla. -- John McCain, Elvis Presley, Gloria Steinem and Martin Luther King Jr. took different paths in life, but they were all lucky.

That's because they were born between 1929 and 1945, a generation sandwiched between the Greatest Generation and the Baby Boom that Florida State University Professor Elwood Carlson has dubbed The Lucky Few.

It's an entire generation that's been lost in the shuffle, and it's a generation that's very different from the one before it and the one after, said Carlson, the Charles B. Nam Professor in Sociology of Population. It's also the first generation that is smaller than the one before it.

In a new book, The Lucky Few: Between the Greatest Generation and the Baby Boom (Springer), Carlson argues that 41 million Americans who were born during the 16-year period that began with the crash of the stock market and ended with the conclusion of World War II were blessed by the virtue of their comparatively small numbers and the fortunate timing of world events.

Their childhoods were marked by the Great Depression and wartime rations, but by the time members of this generation came of age, the postwar economy was booming, jobs were plentiful and educational opportunities were abundant. The Lucky Few hopped on the gravy train with the explosion of white-collar jobs in the 1950s and continued to ride it right into retirement, Carlson said.

Because of their childhoods, they had really low expectations, Carlson said. But after the war, those tough times evaporated and the reality exceeded their expectations, so they felt really lucky.

And for good reason. Their transition to adulthood was early, fast and easy. Although a military draft was still in place, most, like Elvis, served in peacetime. They were able to take advantage of veteran's benefits -- such as a college education under the GI Bill -- while suffering only a fraction of the casualties of the Greatest Generation.

Throughout adulthood, they experienced the longest continuous economic boom in the country. They had the highest employment rates of any generation, and they contributed to the rise of corporate America and its accompanying perks. They pioneered the trend of early retirement.

Their economic success fueled social changes as well, Carlson said. Members of this generation married younger and started families sooner, not because of changing mores, but because they could afford to do it.

Of course, some -- namely white men -- were luckier than others. But even blacks and women fared better than their counterparts in the generation that preceded them, Carlson said. Their prosperity afforded them opportunities to become trailblazers throughout their lives. Members of this generation traveled to the moon, championed civil rights and saw one of their own -- Sandra Day O'Connor -- become the first woman appointed to the U.S. Supreme Court.

Now between the ages of 63 and 79, members of this generation are still on a winning streak, according to Carlson, who at 58 counts himself among the baby boomers.

They are still fortunate, he said. They're healthier, living longer and retiring earlier while the younger generations pay for their Social Security benefits.

Carlson said he was inspired to research this generation and its characteristics after requiring his students to read Birth and Fortune: The Impact of Numbers on Personal Welfare by Richard Easterlin. Easterlin's book argues that the number of people born in a generation directly and indirectly affects personal destiny and the economy in general.

While Easterlin used his theory to focus mainly on the negative pressures facing the 78 million baby boomers -- unemployment, high crime, marital stress and divorce -- Carlson saw an opportunity to explore the positive circumstances that shaped the lives of the first baby bust generation in America.

No matter who you are, you can define yourself as part of a generation, he said. The circumstances of your generation may help make sense of the way your life has gone. You can see the broader currents that have shaped your life. The Lucky Few just happened to have a smoother ride.

Survivors of 1918 flu pandemic protected with a lifetime immunity to virus

Sun, 17 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) New research has discovered that infection and natural exposure to the 1918 influenza virus made survivors immune to the disease for the remaining of their lives. Antibodies produced by cells isolated from these survivors served as an effective therapy to protect mice from the highly lethal 1918 infection. The study entitled Neutralizing antibodies derived from the B cells of 1918 influenza pandemic survivors, was released for advanced online publication by the journal Nature. Researchers at Mount Sinai School of Medicine's Department of Microbiology contributed to the research findings. An estimated 50 million people were killed by the 1918 flu pandemic worldwide.

Ninety years after survivors encountered the 1918 pandemic influenza virus, we collected antibody-producing B cells from them, and successfully isolated B cells that produce antibodies that block the viral infection, said contributing author Dr. Christopher Basler, PhD, Associate Professor of Microbiology at Mount Sinai School of Medicine. The antibodies produced by these cells demonstrated remarkable power to block 1918 flu virus infection in mice, proving that, even nine decades after infection with this virus, survivors retain protection from it.

The fact that you can isolate these anti-1918 memory B cells so long after infection will hopefully provide the impetus to further study the mechanisms behind long lived immunity, said Dr. Osvaldo Martinez, post-doctoral fellow at Mount Sinai School of Medicine.

For this study, 32 individuals who were born before 1918 and lived through the influenza pandemic were recruited by Dr. Eric Altschuler at the University of Medicine and Dentistry of New Jersey to donate blood which was tested by Dr. Basler's lab for the presence of antibodies that recognize the 1918 virus. Dr. James Crowe and colleagues at Vanderbilt University produced antibodies from these individuals' blood cells and provided these to Dr. Basler's lab where the potent neutralizing activity against 1918 virus was demonstrated. Antibodies were also provided to Dr. Terrence Tumpey at the CDC to test in mice the strength of the antibodies derived from the 1918 survivors.

Our findings show that survivors of the pandemic have highly effective, virus neutralizing antibodies to this powerful virus, and humans can sustain circulating B memory cells to viruses for up to 9 decades after exposure, said Dr. Tshidi Tsibane, post-doctoral fellow, Department of Microbiology, Mount Sinai School of Medicine. These findings could serve as potential therapy for another 1918-like virus.

Vanderbilt University, Mount Sinai School of Medicine, University of Medicine and Dentistry of New Jersey, Centers for Disease Control and Prevention and The Scripps Research Institute collaborated on this research study.

About The Mount Sinai Medical Center The Mount Sinai Medical Center encompasses The Mount Sinai Hospital and Mount Sinai School of Medicine. The Mount Sinai Hospital is one of the nation's oldest, largest and most-respected voluntary hospitals. Founded in 1852, Mount Sinai today is a 1,171-bed tertiary-care teaching facility that is internationally acclaimed for excellence in clinical care. Last year, nearly 50,000 people were treated at Mount Sinai as inpatients, and there were nearly 450,000 outpatient visits to the Medical Center.

Mount Sinai School of Medicine is internationally recognized as a leader in groundbreaking clinical and basic-science research, as well as having an innovative approach to medical education. With a faculty of more than 3,400 in 38 clinical and basic science departments and centers, Mount Sinai ranks among the top 20 medical schools in receipt of National Institute of Health (NIH) grants.

Birth during a recession raises risk of fatal cardiovascular disease at advanced age

Mon, 11 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) People who suffer from cardiovascular diseases at advanced ages may have reason to suspect that the cause of their illness lies far away ... around the date of their birth. A team of European researchers reports that if economic conditions at the time of birth were bad, then this leads to a higher risk of cardiovascular mortality much later in life.

A recent study published by the Institute for the Study of Labor (IZA) in Bonn, Germany, finds that individuals born in a recession on average live 15 months shorter than those born under better conditions, and that this difference can be mostly attributed to cardiovascular health risks. Extrapolating this, early-life differences in economic household conditions go some way towards explaining why some individuals are hit by cardiovascular diseases at high ages and others are not.

What is surprising is that such effects may pop up seventy or eighty years after birth, said co-author Gerard van den Berg, who is Economics Professor at VU University Amsterdam and Program Director at IZA. In the intervening years, nothing extraordinary may happen in terms of health, but then suddenly the dead hand of the past can reach out and create fatal cardiovascular problems. The authors do not find such long-run effects on cancer in general, although certain types of cancer have been linked to low birth weight, which is another marker of early-life conditions.

The researchers use data on individuals born around 1900. Such old cohorts are necessary to study long-run effects on mortality. Moreover, in order to observe the death cause as well, the researchers had to resort to twins from Denmark, for whom death causes have been systematically collected for many years. The twin data come with an added bonus. They make it possible to check whether a twin pair's health outcomes are more similar later in life if they were born under adverse conditions than if they were born under good conditions. It turns out that, indeed, they are more similar later in life if the starting position was bad. Conversely, if an individual is born under better conditions, then individual-specific factors dominate more. In short, individual-specific qualities come more to fruition if the starting position in life is better.

As to the explanation of why bad economic conditions lead to long-run damage to the cardiovascular system, Van den Berg points to analyses his team carried out for specific parts of Denmark. These analyses suggest that long-run effects are particularly triggered by the combination of suboptimal nutrition and a suboptimal health infrastructure early in life. Low household income is less harmful for the baby's future if the environment has good health care and hygiene facilities. On top of this, it cannot be ruled out that stress is a major factor. Parents who are stressed due to economic hardship may produce offspring with features that make them more susceptible to cardiovascular diseases at advanced ages.

One may wonder whether the results are of significance for present-day birth conditions. Of course, we need another eighty years to know this for sure. But there are signs that long-run effects are as important as ever. For example, birth weight studies among recent cohorts show effects on health and adult height that are as strong as ever. And with the advent of the fast food society, nutritional habits among segments of society may not be as good as they used to be.

From this point of view, it may be worthwhile to screen young individuals born under adverse conditions for cardiovascular markers and predictors, and to expose those who have unfavorable test values to preventive interventions. Moreover, the results support investments in nutritional quality and health infrastructure in countries with a high degree of deprivation, as a means to reduce the cardiovascular mortality rate in future years.

New male circumcision device for HIV prevention studied by NewYork-Presbyterian/Weill Cornell

Fri, 01 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (July 31, 2008) -- With the recent endorsement by the World Health Organization (WHO) and scientists worldwide of adult male circumcision as an important strategy for HIV prevention, there is increased urgency to develop safe and cost-effective circumcision services. This is especially the case in Africa where HIV/AIDS continues to spread at an epidemic rate.

Studying this method are Dr. Marc Goldstein and physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, who are evaluating an innovative circumcision device developed in China and will initiate a study of the device in Africa in the coming months.

The device, named the ShangRing after its inventor, Mr. Jian-Zhong Shang, consists of two concentric plastic rings that sandwich the foreskin, allowing it to be cut away without suturing and with minimal bleeding. Performed in a clinic under local anesthesia, the procedure takes less than five minutes, compared with approximately 20 to 30 minutes for a traditional free hands circumcision that requires suturing. The patient returns in one week for device removal.

Circumcision with this technique promises to be faster, safer and more acceptable to patients than conventional surgical circumcision methods, says Dr. Goldstein, the study's principal investigator. He is urologist and specialist in reproductive medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology at Weill Cornell Medical College, and senior scientist at The Population Council, Center for Biomedical Research, located on the campus of The Rockefeller University.

The hope is that with these advantages, circumcision will become more commonplace (currently only between 15 and 50 percent of sub-Saharan males are circumcised). Its advantages include reduced risk of a variety of sexually transmitted diseases (STDs), notably HIV.

Circumcision is the only new HIV prevention method to demonstrate consistent efficacy in randomized controlled trials, notes co-principal investigator Dr. Philip S. Li, associate research professor of urology and reproductive medicine and director of microsurgical research and training at the Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical College.

Three randomized controlled trials in Kenya, Uganda and South Africa reported a protective effect (up to 60 percent) of circumcision against HIV infection. The World Health Organization, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other global reproductive health organizations such as EngenderHealth have recognized circumcision as an important method to reduce HIV infection.

The ShangRing has been used to circumcise several thousand Chinese men since 2005. Preliminary reports of 1,200 patients indicate good results with minimal complications. The ShangRing, with 15 patents pending in 85 countries, is currently available only in China. FDA evaluation is under way.

The beauty of this device is its simple, innovative design, says Dr. Howard Kim, a fellow in male reproductive medicine and microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and member of the Weill Cornell team that traveled to China to learn this new technique. Although many male circumcision devices are available, they have not gained widespread acceptance due to high complication rates or difficulties with surgical technique.

Even non-physician health care providers will be able to learn this procedure to safely perform circumcisions in resource-poor regions, adds Dr. Richard Lee, a chief resident in urology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and another member of the China team.

The NewYork-Presbyterian/Weill Cornell team, in collaboration with the nonprofits EngenderHealth and The Population Council, are planning a small pilot study in Nyanza, Kenya, to test efficacy, safety and acceptability of the technique. Local health providers who perform circumcisions in a clinical setting will be recruited and trained in the procedure by the NewYork-Presbyterian/Weill Cornell team. The pilot study is expected to be followed by a multicenter clinical trial that will compare the ShangRing technique to traditional circumcision methods.

Male circumcision has been performed as far back as ancient Egypt, and the practice has continued through the ensuing centuries for religious, cultural and sociopolitical reasons. Performing circumcision for potential health benefits gained momentum in the 19th century with the advent of anesthesia and the initial epidemiological studies demonstrating lower rates of venereal diseases in circumcised men. Recent studies have shown that circumcised men are at significantly lower risk of urinary tract infections and sexually transmitted infections such as syphilis and chancroid. Additional studies point to lower risk of invasive penile carcinoma, gonorrhea and chlamydia (in female partners).

Indiana University Alzheimer's disease researcher earns lifetime achievement honor

Wed, 30 Jul 2008 03:59:37 PST

( from http://www.rxpgnews.com ) INDIANAPOLIS - Indiana University School of Medicine neuroscientist and neuropathologist Bernardino Ghetti, M.D., has been honored by the Alzheimer's Association with the Henry M. Wisniewski Award for Lifetime Achievement in Alzheimer's Disease Research. The award was presented July 27 during the 11th International Conference on Alzheimer's Disease and Related Disorders in Chicago.

Dr. Ghetti has spent the past 40 years studying the pathology, biochemical and molecular mechanisms of dementias. A Distinguished Professor and Chancellor's Professor at Indiana University, Dr. Ghetti is director of the Indiana Alzheimer Disease Center at the IU School of Medicine and director of the division of neuropathology. A professor of pathology, psychiatry, medical and molecular genetics, and neurology, he has been on the IU faculty since 1976.

Dr. Ghetti and his colleagues have contributed to the understanding of how certain genes and mutations in them can lead to various types of dementia, including those types that manifest early in the adult life. Since the discovery of a mutation in the APP gene in 1991, Dr. Ghetti and his colleagues have investigated numerous familial forms of Alzheimer's disease and clarified the nature of the amyloid protein that accumulates in plaques in the brain.

Between 1993 and 1998, he led an international research team that identified a new form of autosomal dominant of frontotemporal dementia, called multiple system tauopathy with presenile dementia. This dementia first appears in individuals in their 40s and 50s and is both pathologically and clinically different from Alzheimer disease.

Dr. Ghetti's work also has produced seminal research on the protein that makes the neurofibrillary tangles believed to be a cause for the onset of many dementias.

For the past 20 years, Dr. Ghetti has made significant contributions to the understanding of Gerstmann-Straussler-Scheinker disease, a prion disease that is chronic and leads to dementia.

Dr. Ghetti received his medical degree at the University of Pisa, Italy, and completed postdoctoral fellowships at the University of Pisa and Naples, Italy, and Albert Einstein College of Medicine in New York.

In 1999, Dr. Ghetti was awarded the Potamkin Prize for Research in Alzheimer and Pick Disease by the American Academy of Neurology for his work in the discovery and identification of prefrontal lobe dementias. In 2005, he received an honorary doctorate from the University of Sienna, Italy, and he is currently in the second year of a four-year term as president of the International Society of Neuopathology. The Wisniewski life-time achievement award is particularly significant to Dr. Ghetti, since Dr. Wisniewski was a mentor to Dr. Ghetti when he was a graduate fellow at Albert Einstein College.

Statins may protect against memory loss

Mon, 28 Jul 2008 03:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---People at high risk for dementia who took cholesterol-lowering statins are half as likely to develop dementia as those who do not take statins, a new study shows.

The study consisted of older Mexican-Americans in Sacramento, Calif., who suffered from metabolic conditions that put them at risk for developing dementia, Alzheimer's or cognitive impairment without dementia, said Mary Haan, epidemiology professor at the University of Michigan School of Public Health and lead author of the study. Some of the risk factors for dementia include high cholesterol, Type 2 diabetes, obesity and hypertension.

The bottom line is that if a person takes statins over a course of about 5-7 years, it reduces the risk of dementia by half, and that's a really big change, said Haan, who notes that the study did not look at statins as a treatment for existing dementia, only as a preventative. Statins are drugs that specifically lower LDL or bad cholesterol.

The longitudinal study was originally funded in 1997 to look at metabolic and vascular conditions like hypertension and diabetes and their effect on the risk of dementia and Alzheimer's disease. Earlier landmark findings by Haan's group of the same study cohort established that certain metabolic and vascular disorders predicted Alzheimer's and dementia. For instance, people with Type 2 diabetes are up to three times more likely to develop Alzheimer's disease, they found.

In this current study, Haan's group set out to measure whether taking statins over time lowered the development of dementia in that same high-risk population. The resulting paper, Use of Statins and Incidence of Cognitively Impaired Not Demented and Dementia in a Cohort Study, will appear in the July 29 issue of Neurology.

In older people you have so many different chronic conditions, especially in this group, that the chance of any intervention having an effect is fairly limited, Haan said. Say you're 75 or 80 and you've got six diseases. How much is a treatment really going to help? This showed if you started using statins before the dementia developed you could prevent it in about half of the cases.

It's likely that many people taking statins have already benefited unknowingly from the dementia fighting properties, she said. Haan hopes the study will help fuel randomized trials to test statins and their ability to prevent dementia.

Of 1,674 participants who were free of dementia at the start of the study, 27 percent, or 452 people, took statins at some point in the study. Over the five-year follow up period, 130 participants developed dementia or cognitive impairment. Researchers adjusted for factors such as education, smoking status, the presence of a particular gene thought to predict dementia, and history of stroke or diabetes.

We aren't suggesting that people should take statins for purposes other than what they are indicated for, but hopefully this study and others will open the door to statin testing for dementia and other types of cognitive impairment, Haan said.

It's not clear exactly how statins work to decrease the development of dementia. An emerging risk factor for dementia is high insulin, Haan said, and one theory is that statins may work on those insulin pathways in a way that lowers the high insulin levels in the brain that can lead to the classic Alzheimer's pathology.

Statins lowered the risk of dementia in all participants, but the statins had more of an impact on the group at high risk due to metabolic syndrome. The next step, Haan said, is to determine exactly how the statins work on the biochemical pathways involved in dementia.

WUSTL to lead new international Alzheimer's disease research network

Tue, 22 Jul 2008 03:59:37 PST

( from http://www.rxpgnews.com ) July 22, 2008 -- The Alzheimer's Disease Research Center (ADRC) at Washington University School of Medicine in St. Louis will lead a six-year, $16 million international research collaboration dedicated to understanding inherited forms of Alzheimer's disease. The National Institute on Aging (NIA) will fund the project.

Forms of Alzheimer's disease linked to inherited mutations are rare but have provided scientists with many important insights into the more common sporadic forms of the disease. Because individuals with these inherited forms of Alzheimer's are widely dispersed geographically, there have been too few at any one center to conduct extensive research. Through the newly created Dominantly Inherited Alzheimer's Network (DIAN), investigators hope to organize and enroll a broad pool of qualified volunteers.

For treatments now in development to be optimally beneficial for patients, we have to find ways of diagnosing Alzheimer's disease as early as possible, says DIAN principal investigator John C. Morris, M.D., the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology and director of the ADRC. That's likely to happen much more quickly as we move from studying the few family members in St. Louis with inherited Alzheimer's to the 300 family members who will be accessible through the DIAN.

DIAN will include Washington University; a consortium involving Harvard University, Massachusetts General Hospital and Brown University; Columbia University; Indiana University; the University of California at Los Angeles; the University College of London's Institute of Neurology at Queen's Square; and a consortium of the universities of Brisbane, Perth and Sydney in Australia.

DIAN is modeled after the Adult-Children Study at the ADRC. That study regularly conducts detailed physical and mental assessments of healthy middle-aged children whose parents have been diagnosed with Alzheimer's. Researchers hope this will help them to identify telltale changes in the central nervous system decades before the symptoms of Alzheimer's disease become apparent.

The Adult-Children Study is another genetic investigation, but it's focused on less overtly inherited forms of the disease, says Morris. If a parent develops Alzheimer's disease at a relatively young age in a family with no known mutation that causes the disease, a genetic factor that we have yet to identify may be present, and this can notably increase the risk to the children.

Scientists are aware of inherited mutations in three genes that can cause Alzheimer's disease: amyloid precursor protein, presenilin 1 and presenilin 2. Changes in all three genes cause Alzheimer's to develop early, potentially pushing the age of onset down into a patient's 50s, 40s or even 30s. Researchers believe all the mutations lead to increased production of amyloid beta 42, a protein fragment that is the principal ingredient of brain plaques found in Alzheimer's patients. This has made amyloid beta a primary target for researchers developing new drugs for Alzheimer' s disease.

Scientists already have several potential indicators, known as biomarkers, of the early onset of Alzheimer's disease. However, the only current way to confirm their validity is to wait years or decades and see whether volunteers who have the biomarkers eventually get the disease. DIAN may help scientists shorten this process dramatically by allowing them to look for the potential biomarkers in individuals who have inherited a known mutation from an affected parent and are almost certain to develop the disease.

To get important clues about how and why the disease develops, scientists plan to closely monitor possible biomarkers in DIAN volunteers age 21 and older.

The most exciting aspect of DIAN is that we have a chance to determine the type and order of brain changes that herald the onset of dementia in years to come, says Morris. If we're going to develop preventive therapies, we have to know when to target each of the mechanisms in the brain that may be contributing to the beginnings of Alzheimer's disease.

If DIAN volunteers develop the disease, they will be monitored closely to assess how comparable the inherited and sporadic forms of Alzheimer's are.

The grant includes travel funds to allow DIAN volunteers who enrolled at one network site to travel to another network site in order to participate in research unique to the other site.

The range of the seven sites raises a challenge for DIAN in ensuring that all research and diagnostic procedures are standardized so that data can be appropriately compared across all centers.

If one institution obtains cerebrospinal fluid at 6 a.m. to test brain protein levels and another obtains samples at 6 p.m., it may be impossible to compare results because protein levels naturally fluctuate throughout the day, Morris explains.

Morris has been a leader in the process of standardizing assessment procedures and practices. In 2005, he led the development of a comprehensive set of patient assessment procedures for the 29 federally funded Alzheimer's disease research centers in the United States. He plans to work with other DIAN investigators to integrate these standards and others already developed for Alzheimer's research into the new collaboration.

For your eyes only: Custom interfaces make computer clicking faster, easier

Tue, 15 Jul 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Insert your key in the ignition of a luxury car and the seat and steering wheel will automatically adjust to preprogrammed body proportions. Stroll through the rooms of Bill Gates' mansion and each room will adjust its lighting, temperature and music to accommodate your personal preference. But open any computer program and you're largely subject to a design team's ideas about button sizes, fonts and layouts.

Off-the-shelf designs are especially frustrating for the disabled, the elderly and anybody who has trouble controlling a mouse. A new approach to design, developed at the University of Washington, would put each person through a brief skills test and then generate a mathematically-based version of the user interface optimized for his or her vision and motor abilities. A paper describing the system, which for the first time offers an instantly customizable approach to user interfaces, was presented today in Chicago at a meeting of the Association for the Advancement of Artificial Intelligence.

Assistive technologies are built on the assumption that it's the people who have to adapt to the technology. We tried to reverse this assumption, and make the software adapt to people, said lead author Krzysztof Gajos, a UW doctoral student in computer science and engineering. Co-authors are Dan Weld, a UW professor of computer science and engineering, and Jacob Wobbrock, an assistant professor in the UW's Information School.

Tests showed the system closed the performance gap between disabled and able-bodied users by 62 percent, and disabled users strongly preferred the automatically generated interfaces.

This shows that automatically generating personalized interfaces really does work, and the technology is ready for prime time, Weld said.

The system, called Supple, begins with a one-time assessment of a person's mouse pointing, dragging and clicking skills. A ring of dots appears on the screen and as each dot lights up, the user must quickly click on it. The task is repeated with different-sized dots. Other prompts ask the participant to click and drag, select from a list, and click repeatedly on one spot. Participants can move the cursor using any type of device. The test takes about 20 minutes for an able-bodied person or up to 90 minutes for a person with motor disabilities.

An optimization program then calculates how long it would take the person to complete various computer tasks, and in a couple of seconds it creates the interface that maximizes that person's accuracy and speed when using a particular program.

Researchers tested the system last summer on six able-bodied people and 11 people with motor impairments. The resulting interfaces showed one size definitely did not fit all.

A man with severe cerebral palsy used his chin to control a trackball and could move the pointer quickly but spastically. Based on his skills test, Supple generated a user interface where all the targets were bigger than normal, and lists were expanded to minimize scrolling.

By contrast, a woman with muscular dystrophy who participated in the study used both hands to move a mouse. She could make very precise movements but moved the cursor very slowly and with great effort because of weak muscles. Based on her results, Supple automatically generated an interface with small buttons and a compressed layout.

There is a temptation to think that we can come up with a universal design. But if we look at the results, the design that helps one person will actually be hurtful to a person with a different set of abilities, Gajos said.

From an accessibility standpoint, it's always better to change the environment, rather than use specialized assistive technologies, said Kurt Johnson, a UW professor of rehabilitation medicine who coordinated the tests. Supple could be useful for many people with limitations in function, ranging from the elderly, to people with low vision, to people with hand tremors.

The program could also be used to create interfaces that can adapt to different sizes of screen, for example on handheld devices.

But deploying this system would require a radically different approach to designing computer interfaces, Gajos said. He predicts the first applications are likely to be for Web-based applications. The researchers also plan to look at adapting interfaces that were designed in the traditional way into ones that Supple can use.

Older workforce requires variety of recruitment strategies

Tue, 08 Jul 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Employers globally are facing challenges and needs posed by baby-boom generation employees. A new Penn State study of 208 U.S. employers found a wide range of strategies used to recruit and retain older workers, rather than a single approach.

Today's employers will need to be innovative in hiring and motivating their workforce employees who can vary widely in age from Generation X and Y to Baby Boomers, said researchers Diane Spokus, a recent Ph.D. recipient in workforce education, and William Rothwell, professor of workforce education and training and development. Few institutions have retention efforts under way to retain their mature workforce. But managers will need a smorgasbord approach to fully use the untapped assets of an aging workforce.

Since fewer younger people will be available to fill entry-level jobs due to lower birth rates in the late 1960s and 1970s, the older workers, with their experience and knowledge, may be ideally suited to fill the critical workforce areas in all industry, according to the researchers. Some baby boomers will continue to work because they can't afford to retire, but others will stay on because they want to pursue meaningful activities.

In a study of 208 employers, Rothwell and Spokus identified best practices that were reportedly being used in recruitment, training, and management of older workers by companies in the United States. This study was a cross-sectional online survey conducted in cooperation with the American Management Association (AMA) and the Human Resource Institute (HRI). AMA is a global, not-for-profit, membership-based association that provides a full range of management development and educational services to individuals, companies, and government agencies worldwide.

The study is published in a new book Working Longer: New Strategies for Managing, Training and Retaining Older Workers Chapter topics range from adapting the workplace to accommodate physiological changes, training and instructional design for older workers, managing organizational knowledge, to what employers can do to plan for an aging workforce. The purpose of the book is to guide employers and trainers on how to optimize the talents of the incumbent aging workforce.

The responses indicate that 49 percent of employers use employee incentives for referrals to recruit older workers; 57.7 percent use flex time work schedules as incentives to hire and retain older workers; 58.6 percent of older workers are flexible and open to change; and 31.9 percent invite retirees and semi-retirees to holiday events and get-togethers to maintain personal and professional ties.

Employers in the survey felt that some management practices are particularly important to managing older workers and creating a work environment friendly to them. These practices could include extended lunch breaks and flexible workdays. Sponsoring health fairs was also named as a desirable practice. The authors revealed practices that older workers can sometimes be best trained together and that training can be designed to connect to previous work experience.

Employers in the survey indicated that offering employees incentives for referrals and using newspaper advertisements were particularly good practices in recruiting older workers. Of lesser value were other common recruiting options, such as online ads on the web that have grown popular with the advent of e-recruiting.

In contrast, individuals participating in the authors' survey of older workers indicated that they were attracted to employers most by positive referrals coming from friends or colleagues. Challenging work is the thing that older workers want most, says the study.

Online service lets blind surf the Internet from any computer, anywhere

Wed, 25 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Visions of future technology don't involve being chained to a desktop machine. People move from home computers to work computers to mobile devices; public kiosks pop up in libraries, schools and hotels; and people increasingly store everything from e-mail to spreadsheets on the Web.

But for the roughly 10 million people in the United States who are blind or visually impaired, using a computer has, so far, required special screen-reading software typically installed only on their own machines.

New software, called WebAnywhere, launched today lets blind and visually impaired people surf the Web on the go. The tool developed at the University of Washington turns screen-reading into an Internet service that reads aloud Web text on any computer with speakers or a headphone connection.

This is for situations where someone who's blind can't use their own computer but still wants access to the Internet. At a museum, at a library, at a public kiosk, at a friend's house, at the airport, said Richard Ladner, a UW professor of computer science and engineering. The free program and both audio and video demonstrations are at

Ladner will demonstrate the tool next week in Dallas at the National Federation of the Blind's annual convention. WebAnywhere was developed under Ladner's supervision by Jeffrey Bigham, a UW doctoral student in computer science and engineering. The research was funded by the National Science Foundation.

Free screen readers already exist, as do sophisticated commercial programs. But all must be installed on a machine before being used. This is the first accessibility tool hosted on the Web, meaning it doesn't have to be downloaded onto a computer. It processes the text on an external server and then sends the audio file to play in the user's Web browser.

You don't have to install new software. So even if you go to a heavily locked-down computer, say at a library, you can still use it, Bigham said.

In May, Bigham was named the winner of the Accessible Technology Award for Interface Design for the Imagine Cup, a student programming contest sponsored by Microsoft Corp. The prize comes with $8,000 and a trip to Paris in early July.

For the past month WebAnywhere has been available on request. Bigham said he's received inquiries from librarians who would like to make all their machines accessible on a limited budget. He's also had interest from teachers who struggle to find the time to locate free software, get permission to install it on a school computer and then maintain the program so that a single computer is accessible to a visually impaired student. This software would make any computer in the lab instantly accessible for Internet tasks. The Web-based service also eliminates the need for local technical support: there is no software to install or update because each time a person visits the site he or she gets the latest version.

To test the software, researchers had people use the tool to do three things typically done at public machines: check e-mail, look up a bus schedule and search for a restaurant's phone number. People using WebAnywhere were able to successfully complete all three tasks, using a variety of machines and Internet connections.

Like other screen readers, WebAnywhere converts written text to an electronically generated voice. So far the system works only in English. But the source code was released a few weeks ago and a Web developer in China has expressed interest in developing a Chinese version.

The UW team plans to create updates that will allow users to change the speed at which the text is read aloud and add other popular features found in existing screen readers. The service is currently hosted on a server at the UW campus.

Bigham is also working with Benetech, a Palo Alto, Calif., technology nonprofit that distributes free electronic books, to make its collection of more than 30,000 books accessible to blind users without them having to install any screen-reading software.

He believes this could be the first of many Web-based accessibility tools.

Traditional desktop tools such as e-mail, word processors and spreadsheets are moving to the Web, Bigham said. Access technology, which currently runs only on the desktop, needs to follow suit.

New photo 'op' for ovaries may solve some mysteries of infertility

Thu, 19 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) CHICAGO -- What causes a woman's eggs to deteriorate in quality with age, and can that be reversed?

How does the ovary choose an egg -- out of a stash of roughly one million -- to release for ovulation? And can the ovary be influenced to pick a good quality egg rather than one with chromosomal damage?

These questions are much on the mind of fertility researcher Teresa Woodruff. Woodruff, director of the Center for Reproductive Research at Northwestern University's Feinberg School of Medicine, hopes to find the answers and, with them, new treatments for fertility disease and age-related infertility. Her research, funded by a new $6.5 million National Institutes of Health grant, has a novel approach.

Instead of measuring hormones and looking at genes -- the more traditional approaches to infertility research -- Woodruff and colleagues are studying the architecture and behavior of the ovaries.

We're going to approach fertility disease from a new perspective, said Woodruff, the Thomas J. Watkins Professor of Obstetrics and Gynecology at the Feinberg School. If we continue to look at the diseases of women's fertility traditionally, we're not going to solve the problems.

The inner daily workings of the ovary largely remain a mystery waiting to be solved.

We don't understand how each follicle is selected to begin the process of ovulation, Woodruff said. What caused this one to be selected when it's May and you're 19 years old while there might be one sitting right next to it quiescently for another 20 years before it is moved to the position where it can ovulate? Something controls or parcels those follicles over time so that you have enough from puberty until menopause.

There aren't many tools to help researchers examine the way ovaries function. Enter Frank Miller, M.D., who is developing a new imaging device to do exactly that.

Ovaries are small and deep and they are more challenging to look at, said Miller, a professor of radiology at the Feinberg School and medical director of magnetic resonance imaging at Northwestern Memorial Hospital.

So he, along with colleagues in radiology, are designing a non-invasive magnetic resonance elastography device inspired by a larger one currently used for imaging livers.

Miller's new device will resemble a tiny drum, the size based on its future photo op with its subject - ovaries the size of walnuts. The device will generate sound waves (like the sub-woofer system of a car, Miller says) to measure the rigidity of the ovaries.

Ovary rigidity is important to measure because it is one of the symptoms of polycystic ovary syndrome, a metabolic disease that is the leading cause of hormone-related infertility. In the syndrome, a woman's follicles do not function or ovulate normally.

We hope that we will soon be able to understand more about age-related infertility and polycystic ovary syndrome, Woodruff said. We're tackling problems that have been difficult to solve.

US could face shortage of 44,000 primary care physicians by 2025

Tue, 17 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) COLUMBIA, Mo.- By 2025, the wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn't increase soon, according to a new University of Missouri study. Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians.

Today, generalist physicians are a third of the U.S. physician workforce and are responsible for more than half of all patient visits at doctors' offices.

Concern about the supply of generalists is not new, said Colwill, who also is a member of the National Academy of Sciences Institute of Medicine. It has been with us since the 1960s and was gradually improving. However, during the past decade, the number of generalist graduates has fallen by 22 percent and declines continue as medical school graduates enter other specialties. At the same time, the U.S. population is increasing by about one percent each year, and the baby boomer generation will significantly increase the number of Americans older than 65 by 2025.

In the study, which was published in a recent edition of Health Affairs, Colwill and co-researchers, James Cultice from the U.S. Health Resources and Services Administration and Robin Kruse from the University of Missouri, used data from the National Ambulatory Medical Care Survey to estimate the future demand for generalist care. The Census Bureau predicts that the number of adults will increase 21 percent by 2025, and the number of Americans older than 65 will rise by 73 percent.

Typically, older adults seek care from generalists nearly three times each year, double the rate of adults younger than 65. Because of this, Colwill and his researchers expect the number of doctor visits to increase by 29 percent by 2025. At the same time, they project that the supply of general internists and family physicians will increase less than 5 percent.

As patient numbers rise, these practitioners will be doing more 'urgent care' and will have less time for preventive services, coordinating care with other specialists, and getting to the depth of their patients' problems, Colwill said. This will increase the load on other, already overloaded specialists and lead to even more referrals and increased costs of care. We need to change the incentives by making primary care practice more manageable and income comparable with that in other specialties.

Colwill strongly endorsed development of new models of primary care called medical homes where teams of physicians, nurse practitioners, physician assistants and others provide comprehensive primary care services that also focus on management of patients with chronic illnesses. These models promote more access through expanded hours and use of telephone, e-mail and electronic medical records. If appropriately reimbursed, these models should increase quality, reduce overall costs and improve both patient and physician satisfaction.

At the same time, numbers of graduates must be increased, Colwill said. Students' interest in generalist careers can be enhanced if medical schools renew their commitment to the education of generalists as they have done earlier. Further, incentives such as forgiveness of loans for primary care practice would tip the scales for many medical students and residents as they select a specialty and type of practice.

The Association of American Medical Colleges recommends that medical schools increase their enrollment by 30 percent, but have not indicated specific specialty areas for the increase. Colwill said this enrollment increase could result in more specialists, but little increase in primary care physicians if the incentive for becoming generalists is not examined soon.

'Cancer was one of the best things to happen to me... but I worry about the future'

Tue, 10 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) London, UK: For Dan Savage, surviving testicular cancer has been a spur to him making the most of his life and taking more adventurous decisions, and he says, that in retrospect, it was probably one of the best things that has happened to him. But as he approaches the end of his fifth year in remission from the disease, when he will be signed off as cured by the medical profession, he worries that from now on he will have no regular medical checks that might pick up early signs of the cancer returning. It will be down to him to contact the cancer clinic if he is worried about any new symptoms.

Dan, aged 25, is now an award-winning artist. He has set up his own studio in York (UK) and specialises in creating glass artwork for architectural spaces. He is also an ambassador for Teenage Cancer Trust and will be speaking at the charity's Fifth International Conference on Teenage and Young Adult Cancer Medicine on Tuesday.

Dan was 20 and studying art at Lancaster University when he discovered a lump the size of half a pea in his right testicle. After having surgery at Lancaster he was transferred to St James's hospital in Leeds for chemotherapy.

The chemotherapy was largely precautionary. The outward appearance of the tumour suggested it had been caught early, but when they dissected it, they found it was quite developed, just on the brink of spreading and they didn't want to take that risk. Also they found that I had the most aggressive form of testicular cancer, teratoma, says Dan.

Dan feels he got off fairly lightly, although the chemotherapy made him very sick and he lost his hair. Looking back now, he says: Having cancer, for me, was one of the best things to happen. It gave me a real drive to succeed and make the most of my life. I know, from speaking to other cancer survivors, that many of them agree. I have gained more confidence. Starting up my own business isn't necessarily what I would have done prior to having cancer. Cancer didn't stop his studies: he went back to university, completed his degree and went on to do a Masters degree in Glass. He has also married his long-term girlfriend.

Dan has not suffered any particular problems following his treatment, although he finds he is more susceptible to common colds and other illnesses that are going around.

I'm much more aware now of my own body and if anything is slightly out of kilter, I'm probably a lot more paranoid about it, he says. On a day-to-day basis I'm fairly relaxed, but if I have an ache or pain I start to worry.

One thing I am getting a bit worried about is that I'm coming up to five years in remission, and will be signed off by the doctors in June. Thereafter it's up to me. People say I'm cured but I don't see it like that. Something could crop up. It worries me that I won't have any more medical checks. I know that if I find anything that's odd I can go straight back to the clinic rather than the GP, which is good because the GP route was a bit of a nightmare. So that is reassuring. But I get reassurance from having regular checks, from having a blood test and even if I don't hear anything after the blood test has been taken, I still know someone has seen it and it's OK. I would prefer to keep the checks going for longer.

Before his chemotherapy the doctors talked to him about fertility and he had sperm samples frozen. The samples were good quality, but, as he was young, fit and healthy (apart from the cancer), he knows he has a good chance of his fertility returning to normal levels, although he hasn't re-visited the fertility clinic to check yet.

Dan says he has become very health conscious in terms of fitness levels and diet. I drink a lot of green tea!

Use of bright lighting may improve dementia symptoms for elderly persons

Tue, 10 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The use of daytime bright lighting to improve the circadian rhythm of elderly persons was associated with modest improvement in symptoms of dementia, and the addition of the use of melatonin resulted in improved sleep, according to a study in the June 11 issue of JAMA.

In elderly patients with dementia, cognitive decline is frequently accompanied by disturbances of mood, behavior, sleep, and activities of daily living, which increase caregiver burden and the risk of institutionalization, the author write. These symptoms have been associated with disturbances of the circadian rhythm (the regular recurrence, in cycles of about 24 hours, of biological processes or activities). The circadian timing system is highly sensitive to environmental light and the hormone melatonin and may not function optimally in the absence of their synchronizing effects. In elderly patients with dementia, synchronization may be [diminished] if light exposure and melatonin production are reduced.

Rixt F. Riemersma-van der Lek, M.D., of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, and colleagues conducted a trial at 12 elderly group care facilities in the Netherlands that evaluated the effects of up to 3.5 years of daily supplementation of bright light and/or melatonin on a number of health outcomes, including symptoms of dementia and sleep disturbances. The study included 189 facility residents, average age 85.8 years; 90 percent were female and 87 percent had dementia.

Six of the facilities had bright lighting installed in ceiling-mounted fixtures. Lights were on daily between approximately 9 a.m. to 6 p.m. Participants were randomized to receive evening melatonin (2.5 mg) or placebo and participated an average of 15 months (maximum period of 3.5 years).

The researchers found that bright light lessened cognitive deterioration by a relative 5 percent, reduced depressive symptoms by a relative 19 percent and diminished the gradual increase in functional limitations by a relative 53 percent.

Melatonin reduced the time to fall asleep by a relative 19 percent and increased total sleep duration by 6 percent, but adversely affected caregiver ratings of withdrawn behavior and mood expressions. The addition of bright light improved the adverse effect on mood. In combination with bright light, melatonin reduced aggressive behavior by a relative 9 percent.

In conclusion, the simple measure of increasing the illumination level in group care facilities [improved] symptoms of disturbed cognition, mood, behavior, functional abilities, and sleep. Melatonin improved sleep, but its long-term use by elderly individuals can only be recommended in combination with light to suppress adverse effects on mood. The long-term application of whole-day bright light did not have adverse effects, on the contrary, and could be considered for use in care facilities for elderly individuals with dementia, the authors write.

New guidelines for treating resistant hypertension

Fri, 06 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) BIRMINGHAM, Ala. -- Resistant hypertension, blood pressure that remains above goal despite taking three antihypertensive medications or high blood pressure that is controlled but requires four or more medications to do so, may benefit from specialized diagnostic and therapeutic treatment by health care providers according to guidelines issued by the American Heart Association and co-authored by UAB physicians.

Lead author David A. Calhoun, M.D., professor of medicine in the UAB Division of Cardiovascular Disease, and colleagues said successfully treating resistant hypertension requires patients to modify lifestyle factors that contribute to treatment resistance, including using less salt, losing weight and drinking less alcohol. It also requires physicians to better diagnose and treat secondary causes of high blood pressure and more effectively use multiple-drug treatments. This is the first consensus statement to define resistant hypertension and recommend an approach for evaluation and treatment.

Calhoun said while it is not known how many people in the U.S. with high blood pressure have resistant hypertension clinical trials suggest it may as high as 20 to 30 percent.

Older age and obesity are two of the strongest risk factors associated with resistant hypertension and unfortunately, with an aging and increasing heavy population, we can anticipate resistant hypertension becoming more and more common, he said. And people need to recognize the importance of blood pressure control. Persons with resistant hypertension are at increased risk for cardiovascular diseases, including heart attacks and strokes.

Calhoun and colleagues emphasize in the statement that effective use of diuretics is essential for treatment of resistant hypertension. Calhoun said they recommend that a long-acting diuretic be part of the treatment regimen of all patients with resistant hypertension in order reduce fluid retention and thereby blood pressure. He added that some patients may also benefit from adding mineralocorticoid receptor antagonists (MRAs) to their treatment regimens. MRAs have traditionally been used to treat a condition called primary aldosteronism, which is found in about 20 percent of patients with resistant hypertension. However, recent clinical studies indicate that MRAs may be useful in treating resistant hypertension even in the absence of demonstrable aldosterone excess.

The benefit of MRAs for treating resistant hypertension has been recently appreciated, he said. Hypertension specialists are using them more commonly, but they are probably not being routinely used by other physicians. Prescription of MRAs does require biochemical monitoring, particularly measurement of serum potassium levels, which does limit there use.

Calhoun said it is important to note that uncontrolled high blood pressure and resistant hypertension are not the same and effectively evaluating a patient to distinguish between the two possibilities is key to successful treatment.

High blood pressure readings can be caused by poor medication adherence, which is not the same as resistant hypertension, he said. Confirming treatment resistance is the first step in evaluating difficult-to-treat high blood pressure. It also is important to evaluate the condition correctly because often, patients with resistant hypertension have other medical conditions that complicate their blood pressure management. If a secondary cause of hypertension is identified such as obstructive sleep apnea, renal parenchymal disease, primary aldosteronism or renal artery stenosis, treating these disorders, which may require referral to a specialist, can improve blood pressure control.

Substance in red wine found to keep hearts young

Wed, 04 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) GAINESVILLE, Fla. --- How do the French get away with a clean bill of heart health despite a diet loaded with saturated fats? Scientists have long suspected that the answer to the so-called French paradox lies in red wine. Now, the results of a new study bring them closer to understanding why.

Writing this week in the online, open-access journal Public Library of Science (PLoS) ONE, researchers from industry and academia, including the University of Wisconsin-Madison and the University of Florida, report that low doses of resveratrol -- a natural constituent of grapes, pomegranates, red wine and other foods -- can potentially boost the quality of life by improving heart health in old age.

The scientists included small amounts of resveratrol in the diets of middle-aged mice and found that the compound has a widespread influence on the genetic causes of aging. Specifically, the researchers found that low doses of resveratrol mimic the heart-healthy effects of what is known as caloric restriction, diets with 20 to 30 percent fewer calories than a typical diet. The new study is important because it suggests that resveratrol and caloric restriction, which has been widely studied in animals from spiders to humans, may govern the same master genetic pathways related to aging.

Caloric restriction is highly effective in extending life in many species. If you provide species with less food, the regulated cellular stress response of this healthy habit actually makes them live longer, says study author Christiaan Leeuwenburgh, chief of the division of biology of aging at UF's Institute on Aging. In this study, the effects of low doses of resveratrol (on genes) were comparable to caloric restriction, the hallmark for life extension.

Previous research has shown that high doses of resveratrol extend life in invertebrates and prevent early death in mice given a high-fat diet. The new study extends those findings, showing that resveratrol in low doses, beginning in middle age, can elicit many of the same benefits as a reduced-calorie diet.

Resveratrol is active in much lower doses than previously thought, said Tomas Prolla, a UW professor of genetics and a senior author of the new report.

The group explored the agent's influence on the heart, muscle and brain by looking to see which genes were switched on and off during the aging process.

In the new study -- which compared the genetic responses of animals to either restricted diets or normal diets including small doses of resveratrol -- the similarities were remarkable, explains lead author Jamie Barger of Madison, Wis.-based LifeGen Technologies, who spearheaded the research.

In the heart, for example, there are at least 1,029 genes whose functions change with age. In animals on restricted diets, 90 percent of those heart genes experienced alterations in gene expression, while low doses of resveratrol thwarted age-related change in 92 percent. The new findings, say the study's authors, reveal how red wine's special ingredient helps keep the heart young.

In short, the authors note that a glass of wine or food or supplements containing even small doses of resveratrol are likely to help stave off cardiac aging.

That finding, may also explain the remarkable heart health of people who live in some regions of France where diets are soaked in saturated fats but the incidence of heart disease, a major cause of mortality in the United States, is low. In France, meals are traditionally complemented with a glass of red wine.

There must be a few master biochemical pathways activated in response to caloric restriction, which in turn activate many other pathways, explained Prolla. And resveratrol seems to activate some of these master pathways as well.

Resveratrol is currently sold over-the-counter as a nutritional supplement with supposed anti-cancer, anti-viral, anti-inflammatory and anti-aging benefits, although few scientific studies have verified these claims in humans. That may soon change: Researchers at the University of Florida hope to explore the effects of resveratrol on older people in a phase 1 clinical trial, set to begin this summer.

The study will assess the supplement's effects on memory, physical performance, inflammation and oxidative damage, according to Steve Anton, a principal investigator of the upcoming trial and an assistant professor of aging and geriatrics in the UF College of Medicine.

Mitochondria, the tiny power plants that keep a cell functioning, are especially vulnerable to the oxidative damage that accumulates during the aging process.

In animal studies, (resveratrol) seems to promote mitochondrial health, said Todd Manini, also a principal investigator of the upcoming trial and an assistant professor of aging and geriatrics in the UF College of Medicine. Mitochondria are everywhere: They're in the brain, in the muscle, the liver. So it could have kind of a global impact on many different organ systems.

Agent in red wine found to keep hearts young

Tue, 03 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) MADISON - How, scientists wonder, do the French get away with a clean bill of heart health despite a diet loaded with saturated fats?

The answer to the so-called French paradox may be found in red wine. More specifically, it may reside in small doses of resveratrol, a natural constituent of grapes, pomegranates, red wine and other foods, according to a new study by an international team of researchers.

Writing this week (June 3) in the online, open-access journal Public Library of Science One, the researchers report that low doses of resveratrol in the diet of middle-aged mice has a widespread influence on the genetic levers of aging and may confer special protection on the heart.

Specifically, the researchers found that low doses of resveratrol mimic the effects of what is known as caloric restriction - diets with 20-30 percent fewer calories than a typical diet - that in numerous studies has been shown to extend lifespan and blunt the effects of aging.

This brings down the dose of resveratrol toward the consumption reality mode, says senior author Richard Weindruch, a University of Wisconsin-Madison professor of medicine and a researcher at the William S. Middleton Memorial Veterans Hospital. At the same time, it plugs into the biology of caloric restriction.

Previous research has shown that resveratrol in high doses extends lifespan in invertebrates and prevents early mortality in mice given a high-fat diet. The new study, conducted by researchers from academia and industry, extends those findings, showing that resveratrol in low doses and beginning in middle age can elicit many of the same benefits as a reduced-calorie diet.

Resveratrol is active in much lower doses than previously thought and mimics a significant fraction of the profile of caloric restriction at the gene expression level, says Tomas Prolla, a UW-Madison professor of genetics and a senior author of the new report.

The group explored the influence of the agent on heart, muscle and brain by looking for changes in gene expression in those tissues. As animals age, gene expression in the different tissues of the body changes as genes are switched on and off.

In the new study - which compared the genetic crosstalk of animals on a restricted diet with those fed small doses of resveratrol - the similarities were remarkable, explains lead author Jamie Barger of Madison-based LifeGen Technologies. In the heart, for example, there are at least 1,029 genes whose functions change with age, and the organ's function is known to diminish with age. In animals on a restricted diet, 90 percent of those heart genes experienced altered gene expression profiles, while low doses of resveratrol thwarted age-related change in 92 percent. The new findings, say the study's authors, were associated with prevention of the decline in heart function associated with aging.

In short, a glass of wine or food or supplements that contain even small doses of resveratrol are likely to represent a robust intervention in the retardation of cardiac aging, the authors note.

That finding may also explain the remarkable heart health of people who live in some regions of France where diets are soaked in saturated fats but the incidence of heart disease, a major cause of mortality in the United States, is low. In France, meals are traditionally complemented with a glass of red wine.

The new resveratrol study is also important because it suggests that caloric restriction, which has been widely studied in animals from spiders to humans, and resveratrol may govern the same master genetic pathways related to aging.

There must be a few master biochemical pathways activated in response to caloric restriction, which in turn activate many other pathways, explains Prolla. And resveratrol seems to activate some of these master pathways as well.

The new findings, according to Weindruch and Prolla, provide strong evidence that resveratrol can improve quality of life through its influence on the different parameters of aging such as cardiac function. However, whether the agent can extend lifespan in ways similar to caloric restriction will require further study, according to the new report's authors.

Aggression between nursing-home residents more common than widely believed, studies find

Mon, 02 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) When people hear about elder abuse in nursing homes, they usually think of staff members victimizing residents. However, research by Cornell University faculty members suggests that a more prevalent and serious problem may be aggression and violence that occurs between residents themselves.

Although such aggression can have serious consequences for both aggressors and victims, the issue has received little attention from researchers, and few proven solutions exist to prevent resident altercations, says Karl Pillemer, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology. He has co-authored two articles -- in Aggression and Violent Behavior and in the Journal of the American Geriatrics Society -- on resident-to-resident mistreatment this spring with Weill Cornell Medical College professor of medicine Mark S. Lachs, M.D., and medical student Tony Rosen. Both studies report that verbal and physical aggression between residents is common and problematic, and that more research is necessary to identify risk factors and preventative measures.

Anyone who spends much time in a nursing home will observe arguments, threats and shouting matches among residents, as well as behaviors like pushing, shoving and hitting, Pillemer said.

Given that nursing homes are environments where people live close together, and many residents have lowered inhibitions because of dementia, such incidents are not surprising, he said. Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem.

The studies found 35 different types of physical and verbal abuse between residents at a large urban nursing home. Screaming was the most common form of aggression, followed by such physical violence as pushing and punching or fighting.

In related work, the authors found that 2.4 percent of residents reported personally experiencing physical aggression from another resident and 7.3 percent reported experiencing verbal aggression over just a two-week period. Most respondents rated the events as moderately or extremely disruptive to daily activities.

In another study, 12 nurse-observers identified 30 episodes of resident-to-resident aggression on just a single eight-hour shift, 17 of which were physical. Research also indicates that victims are more likely to be male, have behavioral problems like wandering and be cognitively impaired.

While such incidents are difficult to prevent, these types of studies will help nursing-home staff manage aggression among patients, Pillemer said.

At present, staff have few solutions available to them and typical interventions in the nursing home may have negative consequences for aggressive residents, including the use of psychotropic medications or isolation of the resident, said Lachs, co-chief of geriatrics at Weill Cornell. We hope our work will help inspire a vigorous search for programs that work to prevent aggression and violence among residents in long-term care.

Active social life may delay memory loss among US elderly population

Thu, 29 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Boston, MA -- One of the features of aging is memory loss, which can have devastating effects on the quality of life among older people. In a new study, Harvard School of Public Health (HSPH) researchers found evidence that elderly people in the U.S. who have an active social life may have a slower rate of memory decline. The study appears in the July 2008 issue of the American Journal of Public Health and appears in an advance online edition on May 29, 2008.

We hope this study adds to and advances our growing understanding of the important role that social forces play in shaping health, said Karen Ertel, postdoctoral fellow in the Department of Society, Human Development and Health at HSPH.

Previous studies have suggested that an active social life may reduce the risk of dementia and cognitive decline among the elderly. Memory loss is a strong risk factor for dementia, a syndrome estimated to affect up to 10% of the U.S. population 65 years and older. The researchers wanted to test whether memory loss might also be associated with social connectedness.

Ertel and her HSPH colleagues, senior author Lisa Berkman, chair of the Department of Society, Human Development and Health, and Maria Glymour, assistant professor, Department of Society, Human Development and Health, used data gathered from 1998 to 2004 from the Health and Retirement Study, a large, nationally representative population of U.S. adults 50 years and older. (Previous studies were conducted outside of the U.S. or using smaller, non-representative population samples.) Memory was assessed in 1998, 2000, 2002 and 2004 by reading a list of ten common nouns to survey respondents, then asking them to recall as many words as possible immediately and after a five-minute delay. Social integration was assessed by marital status, volunteer activities, and contact with parents, children and neighbors.

The results showed that individuals with the highest social integration had the slowest rate of memory decline from 1998 to 2004. In fact, memory decline among the most integrated was less than half the rate among the least integrated. These findings were independent of sociodemographic factors (such as age, gender, and race) and health status in 1998. The researchers found that the protective effect of social integration was largest among individuals with fewer than 12 years of education.

The researchers found no evidence that the results could be due to reverse causation, that is, poor memory or memory decline causing social withdrawal.

Social participation and integration have profound effects on health and well being of people during their lifetimes, said Berkman. We know from previous studies that people with many social ties have lower mortality rates. We now have mounting evidence that strong social networks can help to prevent declines in memory. As our society ages and has more and more older people, it will be important to promote their engagement in social and community life to maintain their well being.

Memory loss and dementia pose a major public health burden among the elderly U.S. population. The results suggest that increasing social integration may help slow memory decline among older Americans and could help alleviate the public health burden, particularly because the aging population in the U.S. is expected to increase substantially. We need to understand more about how social integration reduces the risk of memory decline in order to target interventions that can help slow the decline, said Ertel. Future research should focus on identifying the specific aspects of social integration most important for preserving memory.

Harmful blood glucose levels linked to defective gene

Thu, 01 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) A genetic mutation that can raise the amount of glucose in a person's blood to harmful levels is identified today in a study in the journal Science.

High levels of blood glucose increase the risk of cardiovascular disease and early death, even in healthy people who do not have diabetes and whose blood glucose levels are at the higher end of the range considered 'normal' by doctors. One in five people in the UK has a high blood glucose level.

The study, by researchers from Imperial College London, the French National Research Institute and McGill University in Canada, reveals an association between high levels of blood glucose and a mutation in a gene known as G6PC2 or IGRP.

The research shows that the mutated IGRP gene blocks the action of a sensor called glucokinase. By stopping glucokinase from doing its job, the gene prevents the body from keeping tight control over its levels of blood glucose. Glucokinase works by signalling to cells known as beta cells which then secrete insulin to keep blood glucose levels under control.

The researchers hope their findings could enable a therapy to be developed to stop the defective IGRP gene from blocking the glucokinase sensor. This would restore control of glucose levels in the blood and help prevent these levels from becoming too high.

The researchers believe that the mutation in the IGRP gene could cause an increase of around five percent in the level of glucose in the blood. This small percentage increase would be enough to raise a person's risk of health problems because levels of blood glucose are so tightly controlled.

Epidemiological studies have shown that 80 percent of the risk of cardiovascular disease is related to a blood glucose level just above the average. High blood glucose levels are linked to obesity, poor nutrition and lack of exercise.

Professor Philippe Froguel, leading author of the research from the French National Research Institute and the Department of Genomic Medicine at Imperial College London, said: Having a high level of blood glucose is a bit like having high cholesterol or high blood pressure in that the higher the level, the greater your risk of serious health problems. Our study helps unravel the genetic reasons why some people have higher levels of glucose in their blood than others.

At present, doctors advise people with high blood glucose levels to lose weight and exercise. We hope that ultimately our research will mean we can develop new treatments to stop people from developing high blood glucose levels, which would enable them to live longer and healthier lives, added Professor Froguel.

The scientists reached their conclusions after comparing the genetic makeup of 654 non diabetic people with differing levels of blood glucose, from the low to the high end of the 'normal' range. The researchers looked at mutations in the building blocks, called nucleotides, which make up DNA.

There are mutations, known as single-nucleotide polymorphisms, in around one in every 600 nucleotides. The scientists examined over 392,000 of these mutations to find the ones specific to high blood glucose levels. The researchers confirmed their findings by analysing the genetic makeup of a further 8000 individuals with blood glucose levels within the non diabetic range, to verify that the same genetic mutations were visible in these individuals.

Today's study follows on from a study published in February 2007 by the same team, where they identified the most important genes associated with a risk of developing type-2 diabetes.

Princeton University survey finds 'pain gap'

Thu, 01 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) A novel study that attempts to paint the most accurate and detailed description yet of how Americans experience pain has found that a significant portion of the population -- 28 percent -- are in pain at any given moment and those with less education and lower income spend more of their time in pain. Those in pain are less likely to work or socialize with others and are more inclined to watch television than the pain-free.

The study, which appears in the May 3 issue of The Lancet, was prepared by Alan Krueger, a professor of economics at Princeton University, and Arthur Stone, a professor of psychiatry and behavioral science at Stony Brook University. The work is the first of its type, according to the authors, to quantify a pain gap in American society, with the have-nots suffering a disproportionate amount in relation to the haves.

To a significant extent, pain does divide the classes, said Krueger, the Bendheim Professor in Economics and Public Policy. And just how the levels of pain vary among people and across activities -- that has never been found before until now.

Participants with less than a high school degree were found to report twice the average pain rating throughout the day as did college graduates. The researchers also found the average pain rating to be twice as high for those in households with annual incomes below $30,000 as for those in households with incomes above $100,000.

People in households making less than $30,000 a year spend almost 20 percent of their time in moderate to severe pain, compared with less than 8 percent for those in households with income above $100,000 a year, Krueger said.

Pain imposes considerable costs on the health care system and economy. Americans spend billions of dollars each year on painkillers, more than on any other type of medication. And, when workers are suffering, the resulting lost productivity costs business more than $60 billion annually.

Yet, according to Krueger, the phenomenon of pain -- who is in pain and when -- is not well understood.

The authors constructed a new approach in which participants, a representative group of 4,000 Americans, reported their activities and the occurrence and intensity of pain in a diary survey over a 24-hour period. From the data, the researchers could tie the participants' pain to certain activities, demographic characteristics and times of the day. Pain tended to be more frequent when people received medical care or cared for adults.

The researchers did not ask the survey participants to make a distinction between physical and mental pain because all pain, the researchers said, is subjective. Yet clearly, they said, many of the participants were reporting physical pain.

The novelty of this study is the possibility to relate people's pain experiences to their daily activities, wrote Juha H.O. Turunen, a professor in the Department of Social Pharmacy at the University of Kuopio in Finland, in an accompanying commentary.

The study, Turunen noted, may have broad implications for policymakers. Social programs could be constructed to help those who are in pain while caring for relatives. The burdensome life of those caring for their loved ones must be supported by society, he wrote. The differing levels of pain recorded by varying income groups, he said, emphasizes the need for pain preventing measures such as better ergonomics and better availability of occupational health services for jobs with high physical strains.

Workers in blue collar jobs reported higher occurrences and more severe pain than did those in white collar jobs. For blue collar workers, pain was lower when they were off work than when they were working. The 13 percent of people who reported a work-related disability experienced very high rates of pain, and accounted for 44 percent of the total amount of time that Americans spent in moderate to severe pain.

Those in the most pain expressed the least satisfaction with life and health, the authors found. People were more likely to feel pain when they were alone compared with when they were with friends or a spouse. In addition, those in pain spent a disproportionate amount of their time -- almost 25 percent -- watching television, compared with 16 percent for others.

Alarmingly, those in pain were likely to suffer over years, even decades. The pain doesn't go away in many cases, when people stop working, Krueger said. Pain was higher and more common for older individuals, but the amount of pain reported remained relatively constant for individuals from their mid-40s to their mid-70s.

Depression increases risk of Alzheimer's disease

Tue, 08 Apr 2008 09:37:44 PST

( from http://www.rxpgnews.com ) Washington, April 8 - Depressed people are more likely to develop Alzheimer's disease than those with a more positive outlook to life, says a new study.

The finding is based on a six-year survey of 486 healthy people aged 60 to 90. Of those, 134 people had experienced depression once, prompting them to seek medical advice - 33 of them developed Alzheimer's.

People who experienced depression were 2.5 times more likely to develop Alzheimer's disease than normal people, the study found.

The risk was four times greater for those who were depressed before 60, according to the study, which has been published in the latest issue of the journal Neurology.

'We don't know yet whether depression contributes to the development of Alzheimer's disease or whether another unknown factor causes both depression and dementia,' said the study's author Monique MBreteler of Erasmus University Medical Centre in Rotterdam.

'We'll need to do more studies to understand the relationship between depression and dementia.'

One theory is that depression leads to loss of brain cells, which contributes to Alzheimer's disease.

One third of risk for dementia attributable to small vessel disease, autopsy study shows

Sun, 06 Apr 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Alzheimer's disease may be what most people fear as they grow older, but autopsy data from a long-range study of 3,400 men and women in the Seattle region found that the brains of a third of those who had become demented before death showed evidence of small vessel damage: the type of small, cumulative injury that can come from hypertension or diabetes.

Dr. Thomas Montine, University of Washington, presented the study results at Experimental Biology 2008 in San Diego on April 6. His presentation was part of the scientific program of the American Society for Biochemistry and Molecular Biology (ASBMB).

In the autopsied brains of people who had experienced cognitive decline and dementia, 45 percent of the risk for dementia was associated with pathologic changes of Alzheimer's disease. Another 10 percent of dementia risk was associated with Lewy bodies, neocortical structural changes that indicate a degenerative brain disease known as Lewy Body Dementia, believed by some clinicians to be a variant of Alzheimer's and/or Parkinson's disease. But a third of the risk for dementia (33 percent) was associated with damage to the brain from small vessel disease.

Dr. Montine and his colleagues believe that, and are now studying in more detail, this small vessel damage is the cumulative effect of multiple small strokes caused by hypertension and diabetes, strokes so small that the person experiences no sensation or problems until the cumulative effect reaches a tipping point. This may be good news, says Dr. Montine. At a time when prevention and treatment for Alzheimer's remain investigational, methods for preventing complications of hypertension and diabetes are currently available.

These findings are very different from both conventional wisdom and from those of most autopsy studies of brain aging and dementia, says Dr. Montine.

Why such different results? Perhaps because of the broad reach of the population on which the autopsy study was based, says Dr. Montine. Most studies looking at the structural changes on autopsy in brains of persons with dementia have focused on participants in Alzheimer's disease center studies or in populations limited to one gender, ethnic or professional group. Individuals in this study were part of the Group Health Cooperative, one of the oldest and largest managed care programs in the United States.

Members in the group who reach 65 with normal cognitive ability are eligible to volunteer for an Adult Changes in Thought (ACT) study, established by Dr. Eric Larson, director of Research at the Group Health Cooperative. ACT participants undergo cognitive, neurological and psychological tests every two years until their death.

Between 1994 and 2006, the period covered by this study, 3,400 men and women entered the ACT study. They were representative of the Seattle urban and suburban area: white, Asian, African American and Hispanic, with a range of educational and professional levels. During this 12-year period, some participants suffered cognitive impairment and dementia, while others did not. Roughly a third of all participants died, and autopsies were performed on the 221 who had given permission for this to be done.

With 55 percent of the risk for dementia attributable to Alzheimer's and Lewy Body Dementia, these findings underscore the therapeutic imperative for developing new pharmacologic and other means of preventing or delaying the onset of Alzheimer's and Lewy Body disease, says Dr. Montine. But the unexpected finding that a third of the risk for dementia is related to small vessel disease also provides an additional reason to control hypertension and diabetes: not only to protect cardiovascular and renal health but also to protect the health of the brain.

Lithium chloride slows onset of skeletal muscle disorder

Tue, 18 Mar 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Irvine, Calif., March 18, 2008 -- A new UC Irvine study finds that lithium chloride, a drug used to treat bipolar disorder, can slow the development of inclusion body myositis, a skeletal muscle disease that affects the elderly.

In the study by scientists Frank LaFerla and Masashi Kitazawa, mice genetically engineered to have IBM demonstrated markedly better motor function six months after receiving daily doses of lithium chloride, compared with non-treated mice. The muscles in treated mice also had lower levels of a protein that the study linked to muscle inflammation associated with IBM.

These data are the first to show that lithium chloride is a potential IBM therapy.

Lithium chloride is an approved drug for treating humans. We already know it is safe and can be used by people, said LaFerla, professor of neurobiology and behavior at UCI and co-author of the study. Given our findings, we believe a clinical trial that tests the effectiveness of lithium chloride on IBM patients should be conducted as soon as possible.

Results of the study appear online this month in the journal Annals of Neurology.

IBM is the most common skeletal muscle disorder among people older than 50. People with IBM experience weakness, inflammation and atrophy of muscles in their fingers, wrists, forearms and quadriceps. There is no cure for IBM, nor is there an effective treatment, according to the National Institutes of Health.

LaFerla, a noted Alzheimer's disease researcher, began studying IBM about 10 years ago after learning the disorders have similar tissue characteristics. In the brain, a buildup of phosphorylated tau protein leads to the development of tangles, one of the two lesions that are hallmarks of Alzheimer's disease. High phospho-tau levels also are present in IBM, though patients do not experience dementia or memory loss. In a previous study,

LaFerla found that lithium chloride reduced phospho-tau levels in mice genetically engineered to develop Alzheimer's disease. LaFerla and his research team then wondered: Could lithium chloride also reduce phospho-tau levels and symptoms in mice with IBM?

First, they sought to determine how the inflammation affects the skeletal muscle fibers. They injected the mice with a drug to trigger muscle inflammation, then put them on tiny treadmills to test their motor function. As expected, mice with inflammation could not keep up with the control mice, indicating reduced motor function. Examining their brain tissue, the scientists discovered the mice with muscle inflammation also had higher levels of phospho-tau.

Through additional testing, they discovered an enzyme called GSK-3 beta was responsible for increasing the tau phosphorylation. Previous studies have shown that same enzyme to cause tau buildup in the Alzheimer's brain.

Next, the scientists sought to block the accumulation of phospho-tau in the IBM mice with the goal of curbing motor function loss. In mice six months of age, one group was fed lithium chloride-laced food for six months, and a second group was fed regular food. At 12 months of age, mice in the first group performed on the treadmill as if they were six months of age, while mice in the second group had reduced motor function. Lithium chloride, the scientists found, blocked the GSK-3 beta enzyme that caused higher levels of phospho-tau.

The older animals were performing as if they were younger animals, said Kitazawa, a postgraduate researcher of neurobiology and behavior at UCI and co-author of the study. Lithium chloride was delaying their rate of decline.

The scientists then sought evidence that their results in mice might translate to humans with IBM. They performed tests on human muscle tissue samples and found the GSK-3 beta enzyme again played a role in the phosphorylation of tau. That was not the case, though, in patients with other muscle disorders. This suggests that our IBM mouse model may have the same skeletal muscle mechanism as in human cases, LaFerla said.

Scientists identify new longevity genes

Wed, 12 Mar 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Scientists at the University of Washington and other institutions have identified 25 genes regulating lifespan in two organisms separated by about 1.5 billion years in evolutionary change. At least 15 of those genes have very similar versions in humans, suggesting that scientists may be able to target those genes to help slow down the aging process and treat age-related conditions. The study will be published online by the journal Genome Research on March 13.

The two organisms used in this study, the single-celled budding yeast and the roundworm C. elegans, are commonly used models for aging research. Finding genes that are conserved between the two organisms is significant, researchers say, because the two species are so far apart on the evolutionary scale -- even farther apart than the tiny worms and humans. That, combined with the presence of similar human genes, is an indication that these genes could regulate human longevity as well.

Now that we know what many of these genes actually are, we have potential targets to go after in humans, said Brian Kennedy, UW associate professor of biochemistry and one of the senior authors of the study. We hope that in the future we could affect those targets and improve not just lifespan, but also the 'health span' or the period of a person's life when they can be healthy and not suffer from age-related illnesses.

Several of the genes that the scientists identified as being involved in aging are also connected to a key nutrient response pathway known as known as the Target of Rapamycin, or TOR. That finding gives more evidence to the theory that calorie intake and nutrient response affect lifespan by altering TOR activity. Previous studies have found that drastically restricting the caloric intake of organisms, an approach known as dietary restriction, can prolong their lifespan and reduce the incidence of age-related diseases. TOR inhibitors are being tested clinically in people for anti-cancer properties, and this work suggests they may also be useful against a variety of age-associated diseases.

What we'd like to eventually do is be able to mimic the effects of dietary restriction with a drug, explained Matt Kaeberlein, another senior author on the paper and a UW assistant professor of pathology. Most people don't want to cut their diet that drastically, just so they may live a little longer. But someday in the future, we may be able to accomplish the same thing with a pill.

These findings also give new insight into the genetic basis of aging, the scientists said, and provide some of the first quantitative evidence that genes regulating aging have been conserved during the process of evolution. Earlier evolutionary theories suggested that aging was not genetically controlled, since an organism does not get any advantage in natural selection by having a very long lifespan that goes far past their reproductive age.

To find these lifespan-controlling genes, the scientists took a genomic approach to comprehensively examine genes that affect aging in yeast and worms. Based on published reports, they first identified 276 genes in C. elegans that affected aging, and then searched for similar genetic sequences in the yeast genome. Of the 25 aging-related genes they found in both worms and yeast, only three had been previously thought to be conserved across many organisms.

Clinical depression raises risk of death for heart attack patients years after attack

Mon, 03 Mar 2008 04:59:37 PST

( from http://www.rxpgnews.com ) March 3, 2008 -- Depressed heart attack patients have a higher risk for sudden death in the months following a heart attack. Now a team led by researchers from Washington University School of Medicine in St. Louis has found that the risk continues for many years.

There's a two- to four-fold increase in a person's risk of dying following a heart attack if they also happen to be depressed, says Robert. M. Carney, Ph.D., lead author of the new study and professor of psychiatry at Washington University. Previously we thought the impact of depression was strongest for the first three to six months following a heart attack and then gradually dropped off within a couple of years. Instead, we found that the effect lasts for at least five years.

Carney, with colleagues from Duke University Medical Center, Harvard University, Yale University, the National Heart, Lung and Blood Institute (NIH) and the Mayo Clinic, followed more than 750 heart attack patients for five years. The findings will appear in an upcoming issue of the Journal of Affective Disorders and are currently available online.

Patients followed in the study had participated in the NIH-funded project Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD). A little less than half were diagnosed with depression.

In the five years following a heart attack, 106 patients died. Of those, 62 had been diagnosed with depression, while 44 had not. In gauging the effects of depression, the investigators also considered other risks including age, smoking, hypertension, gender and diabetes.

Some of those factors, like younger age and female gender, lower mortality risk. Smoking and diabetes tend to raise the risk of dying. Carney says his team used statistical methods to evaluate the ways in which the various factors influenced mortality risk. Then they removed the influence of all other factors from the risk equation in order to consider the statistical impact of depression itself.

We found that after adjusting for those risk factors, depression continues to play a statistically significant role, he says.

One possible explanation for depression's lingering influence on mortality is its recurring nature. Because the disorder can come and go over many years, it also may continue to increase the risk of death for many years.

People typically are depressed for a while, then they'll either get better with treatment or it may subside on its own, Carney says. But depression can always recur, and we think that because it is a recurring problem, whatever depression is doing to mortality risk after a heart attack, it continues doing for quite a long time.

Past studies have differed over how much depression affects survival following a heart attack. But Carney believes these new findings are more reliable because all of the patients in this study were personally interviewed to determine their depression status, whereas other studies have relied on self-reporting.

Merging discovery with therapy: Second generation memory care debuts

Tue, 19 Feb 2008 04:59:37 PST

( from http://www.rxpgnews.com ) INDIANAPOLIS -- Researchers and clinicians from the Indiana University School of Medicine and the Regenstrief Institute are blurring the distinction between lab and clinic as they debut the second generation of memory care.

Building upon a care model they developed and extensively tested over the past 7 years, the focus of second generation memory care is on two groups -- patients with cognitive disorders such as Alzheimer's disease and their caregivers. Results of the clinical trial of the IU-Regenstrief care model were published in the Journal of the American Medical Association in 2006.

The initial second generation memory center -- the Healthy Aging Brain Center opens at the IU Center for Senior Health at Wishard Health Services this month.

When we make the lab from which we develop treatments and the clinic into one entity, we are constantly learning from our patients -- what works for them and what does not. Our approach to memory care is on the fast track because by eliminating the distinction between the lab and the clinic, we compress the long timeline traditionally needed to go from discovery to treatment. For us and for those we treat, who are both those with memory problems and their caregivers, this means that they will be receiving the support and care they need now, said Malaz Boustani, M.D., M.P.H., an assistant professor of medicine at Indiana University School of Medicine, an Indiana University Center for Aging Research investigator and a Regenstrief Institute research scientist.

Dr. Boustani is also the chief research officer of the Indianapolis Discovery Network for Dementia, an expanding group of researchers, clinicians, caregivers and community advocates who are working to enhance dementia care in the nation's twelfth largest city. IDND is a national model for how members of the community, caregivers, clinicians and researchers can work together to improve the delivery of dementia care. Second generation memory care has benefited from IDND's panoramic approach to the issue.

Caregivers have not been a primary focus in first generation memory care in spite of the fact that caregivers are hospitalized at a very high rate and that they provide millions of unpaid care hours per year (180 million hours valued at $1.7 billion in 2005 in Indiana alone). Passively handing out brochures and web links to caregivers isn't enough. We need to recognize that they have significant issues and address them, said Dr. Boustani.

The new Healthy Aging Brain Center is putting cutting edge research into the hands of patients and caregivers as well as their primary care physicians, from whom most older adults receive their health care, said Greg Sachs, M.D., professor of medicine at IU School of Medicine, an IU Center for Aging Research investigator and a Regenstrief Institute research scientist. Dr. Sachs directs the medical school's Division of General Internal Medicine and Geriatrics.

He and Dr. Boustani, along with a team which includes social workers, psychologists, nurses and others will see patients and caregivers in the new outpatient facility. Dementia is a growing burden for society, propelling patients and caregivers to increasingly use the health-care system. Dr. Boustani and Dr. Sachs, who are both geriatricians, say second generation memory care is key to decreasing overutilization of emergency rooms and inpatient services.

Nationwide, the health-care system is not delivering good dementia care because we have not presented a comprehensive assessment of the biopsychosocial needs of a person with dementia and have not followed up with solutions that are sensitive to local community needs and resources, said Dr. Boustani, who has been instrumental in the development of IDND.

There are currently an estimated 5 million Americans with Alzheimer's disease. Eight out of 10 individuals with dementia living outside of nursing homes have significant behavioral and/or psychological symptoms that require medical and psychological care.

Active seniors curb health care costs

Wed, 13 Feb 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Group Health seniors are not only sweating to the oldies in local health clubs. They are also keeping health care costs down, according to a study by researchers at Group Health and the University of Washington (UW). The study appears in the January 2008 issue of the journal Preventing Chronic Disease.

The research found long-term total health care costs grew more slowly for older Group Health patients who regularly used their SilverSneakers health club benefit. Group Health members age 65 and older can choose either or both of two activity programs: EnhanceFitness®; or SilverSneakers, which includes access to a health club and free physical activity classes geared to seniors' needs.

Physical activity can help seniors improve their balance to prevent falls; boost cardiovascular health to prevent heart attacks; and improve overall metabolism to help delay diabetes onset and complication of diabetes, said study co-author Dr. James LoGerfo, a professor of medicine and health services at the UW and an affiliate investigator at the Group Health Center for Health Studies.

The researchers studied nearly 5,000 senior Group Health patients who participated in SilverSneakers. More than 9,000 control patients were matched to participants by age and sex. By year two, compared with control participants, SilverSneakers participants had significantly fewer inpatient admissions and lower total health care costs.

Lorraine and Jack Swisher of Bellevue are Group Health members and regulars at the Bellevue Family YMCA SilverSneakers. Age 73 and 75, respectively, they both have chronic conditions and believe their increased physical activity has let them stay healthy and save their funds to travel to Antarctica, snorkel the Great Barrier Reef, and go on a recent safari in Africa. Granted, few seniors are quite as active—or well-traveled—as the Swishers, but the researchers said that all people can benefit from regular physical activity.

The class is a very social time for everyone, plus it helps me with my balance and flexibility, said Lorraine. The exercises can be adapted to any ability, and you can easily practice them while traveling or at home.

Dr. Huong Q. Nguyen, assistant professor of biobehavioral nursing systems at the UW, is the study's lead author. She stresses the important takeaway from this study is for older adults, especially on fixed incomes, to remain active and incorporate physical activity in their lives for many reasons, including cutting down on unexpected health care costs. The other important message is for health plans that offer such physical activity benefits to have mechanisms in place that support wide adoption and consistent use by senior members.

Silver Sneakers is one of the few programs that health plans can offer which have been shown to benefit their senior population, said LoGerfo. Another is EnhanceFitness, a program for seniors available locally in community and senior centers around Puget Sound and Spokane. The program focuses on simple exercises that build not only flexibility and aerobic fitness but also balance and strength, which are the most important elements for preventing falls. Group Health offers both programs.

Seeing our spouses more negatively might be a positive

Tue, 05 Feb 2008 04:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---While our relationships with children and best friends tend to become less negative as we age, we're more likely to see our spouses as irritating and demanding.

That's according to a University of Michigan study that analyzed long-term patterns of relationship negativity among more than 800 adults ages 20 and older.

There's been a lot of research showing that marriage and other close relationships enhance well-being, said Kira Birditt, a research fellow at the U-M Institute for Social Research (ISR). But less work has focused on the negative aspects of close relationships.

Viewing our spouses more negatively over time may not be all bad, Birditt says. In fact, it might even be, well, positive. As we age, and become closer and more comfortable with one another, it could be that we're more able to express ourselves to each other. In other words, it's possible that negativity is a normal aspect of close relationships that include a great deal of daily contact.

For the analysis, presented late last year at the annual meeting of the Gerontological Society of America, Birditt and colleagues Lisa Jackey and Toni Antonucci looked at individual changes over time and also at differences among people at different stages in life--- young, middle-aged and older adults. Participants in the study were interviewed first in 1992 and again in 2005.

Participants were asked about the negativity of their relationships with three key people in their lives: their spouse or partner, a child, and a best friend. Specifically, they rated the extent to which they agreed or disagreed with the following two statements about each relationship: My (spouse/partner, child, friend) gets on my nerves and My (spouse/partner, child, friend) makes too many demands on me.

At both points in time, older adults (age 60-plus) had the least negative relationships with spouses, children and friends. According to Birditt, this finding is consistent with other research showing that older adults are likely to report less conflict than do younger adults in their relationships.

Participants in their 20s and 30s reported having the most negative relationships overall.

For all age groups, including adults in their 40s and 50s, the spousal relationship was seen as the most negative and it tended to increase in negativity over time.

The increases in negativity over time may be indicative of learned patterns of interaction which have been reinforced and tend to persist over time, Birditt said. Other studies have found that negative communication increases over time and relationship quality decreases, especially after having children.

Interestingly, as relationships with spouses become more negative, relationships with children and friends appear to become less demanding and irritating over time.

In future research, Birditt plans to study how the way we respond to negativity influences well-being. How we respond to negativity in close relationships affects every aspect of our lives---at work and at home, she said. In fact, it's likely that how we deal with it---not whether it exists---is what really matters. One thing I'm interested in exploring is how avoidance affects negativity over time. All kinds of research show that older people have less negative relationships. And we also know that older adults are more likely than younger people to report that they try to deal with conflict by avoiding confrontations, rather than by discussing problems.

That may be another reason that negativity tends to increase over time in the relationship with a partner or spouse---when you're living together, it's a lot harder to avoid each other.

Less education may lead to delayed awareness of Alzheimer's onset

Wed, 23 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Jan. 23, 2008 -- A review of epidemiological data has found evidence that people who spend fewer years in school may experience a slight but statistically significant delay in the realization that they're having cognitive problems that could be Alzheimer's disease.

Scientists at the Alzheimer's Disease Research Center (ADRC) at Washington University School of Medicine in St. Louis reviewed data on 1,449 Alzheimer's patients from their center and 21,880 patients from the National Alzheimer's Coordinating Center (NACC), a collaboration of approximately 30 Alzheimer's disease research centers nationwide.

We may have a group of people who are at risk for slightly delayed detection of Alzheimer's disease, says lead author Catherine Roe, Ph.D., a neurology research instructor at the ADRC. Early detection of Alzheimer's disease is important as we progress toward treatments and cures because those treatments will need to be applied as early as possible to have the maximum possible benefit.

The paper appears in this month's issue of Archives of Neurology.

In an earlier study of patients with a form of Alzheimer's disease linked to a genetic mutation, Roe and other Washington University researchers found patients with more years of education were likely to be diagnosed with Alzheimer's disease earlier. This surprised them because higher levels of education have typically been associated with decreased risk of Alzheimer's disease.

The new study confirmed those surprising results, revealing that patients with 12 years or more of schooling were on average slightly younger when diagnosed with Alzheimer's disease than patients with less than eight years of schooling. Age of diagnosis for a group with eight to 11 years of schooling fell in-between the other two groups.

Next, researchers analyzed the severity of patients' dementia when they went to the Alzheimer's disease center for the first time. They found that patients with fewer years of education were likely to be more severely impaired on their first visit.

Alzheimer's disease is cumulatively disabling: The longer one has it, the worse the symptoms become. This suggested to the researchers that those with lower education levels may be slower to notice the early signs of disease, only going to see a specialist after their symptoms become impossible to ignore. Those with more education may be becoming aware of their symptoms while they are still relatively subtle, and seek a specialists' help early on in the disease process.

People with higher education levels may be more likely to have a job or a hobby that highlights early cognitive impairment as well as better access to medical care, Roe says. These could be factors that we need to incorporate into our procedures for screening patients for early signs of cognitive impairment.

Researcher transplants stem cells to try to save patients' legs

Mon, 21 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) CHICAGO -- A Northwestern University Feinberg School of Medicine researcher has launched the first U.S. trial in which a purified form of subjects' own adult stem cells was transplanted into their leg muscles with severely blocked arteries to try to grow new small blood vessels and restore circulation in their legs.

The first two subjects in the 20-site national trial recently underwent the stem cell transplant process at Northwestern Memorial Hospital.

Severely blocked arteries in the leg and sharply diminished blood flow can result in wounds that don't heal, the breakdown of tissue and gangrene. This painful condition is called critical limb ischemia (CLI) and results in the amputation of more than 100,000 limbs every year in the United States. It's a serious, emerging health problem that affects 1.4 million people. An estimated 15 percent of the population will have this disease by the time they reach age 70.

The Northwestern-led phase I/IIa study -- which will include 75 people with CLI around the country -- targets patients who have exhausted all other medical options including angioplasty, stents and bypass surgery to repair blocked circulation in their legs.

They're at the end of the therapeutic road and they're ultimately facing potential amputation, said Douglas Losordo, M.D., the Eileen M. Foell Professor of Heart Research and principal national investigator for the study. This is hopefully a way to help them avoid that.

Losordo is director of the university's Feinberg Cardiovascular Research Institute and director of cardiovascular regenerative medicine at Northwestern Memorial Hospital.

The stem cells themselves can assemble into blood vessels, Losordo said. They can also secrete growth factors that stimulate and recruit other stem cells to come into the tissue and help with the repair. It's an amazing biology we're trying to leverage in these folks.

He said preclinical studies transplanting stem cells into the limbs have shown this approach to be effective in mice and rats. Based on that, we think it has a good chance of helping humans, Losordo noted.

This is a dreadful disease in which the profession has failed to offer much in the way of relief for these patients, Losordo said. We're hoping this will have some impact.

Critical limb ischemia is the result of advanced peripheral artery disease, which affects about 10 million people in the United States. In peripheral artery disease, people develop blockages in their arteries and vessels that slow or stop the blood flow to their legs. When they have pain at rest in their lower legs and wounds on their legs or feet that will not heal, the condition is called CLI. If left untreated, CLI can result in a patient having toes, a foot or even a leg amputated.

As CLI progresses, people begin to experience pain when they walk, then when just sitting. The worst pain is at night because blood flow is decreased when people lie down. Some have to sleep in chairs to aid the blood flow and lessen the pain.

Peripheral artery disease is a big health problem, Losordo said. There is an emerging awareness of this disease on public health.

High blood pressure, high cholesterol, smoking and diabetes all raise the risk of having the condition. But some people don't smoke, have diabetes or high blood pressure and can still have blocked arteries in their legs, Losordo said.

For the randomized, double blind, placebo-controlled trial, Losordo uses the subject's own purified stem cells. The subject first takes a drug for five days to stimulate the release of his or her stem cells, called CD34+ cells, from bone marrow. An intravenous line is then inserted into a subject's vein to collect blood through a machine that removes a population of blood cells that contains the CD34+ stem cells. Losordo further selects and enriches the cells to select only CD34+ cells.

Why fish oil is good for you

Tue, 25 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) It's good news that we are living longer, but bad news that the longer we live, the better our odds of developing late-onset Alzheimer's disease.

Many Alzheimer's researchers have long touted fish oil, by pill or diet, as an accessible and inexpensive weapon that may delay or prevent this debilitating disease. Now, UCLA scientists have confirmed that fish oil is indeed a deterrent against Alzheimer's, and they have identified the reasons why.

Reporting in the current issue of the Journal of Neuroscience, now online, Greg Cole, professor of medicine and neurology at the David Geffen School of Medicine at UCLA and associate director of UCLA's Alzheimer Disease Research Center, and his colleagues report that the omega-3 fatty acid docosahexaenoic acid (DHA) found in fish oil increases the production of LR11, a protein that is found at reduced levels in Alzheimer's patients and which is known to destroy the protein that forms the plaques associated with the disease.

The plaques are deposits of a protein called beta amyloid that is thought to be toxic to neurons in the brain, leading to Alzheimer's. Since having high levels of LR11 prevents the toxic plaques from being made, low levels in patients are believed to be a factor in causing the disease.

Alzheimer's is a debilitating neurodegenerative disease that causes memory loss, dementia, personality change and ultimately death. The national Alzheimer's Association estimates that 5.1 million Americans are currently afflicted with the disease and predicts that the number may increase to between 11 million and 16 million people by the year 2050.

The researchers examined the effects of fish oil, or its component DHA, in multiple biological systems and administered the oil or fatty acid by diet and by adding it directly to neurons grown in the laboratory.

We found that even low doses of DHA increased the levels of LR11 in rat neurons, while dietary DHA increased LR11 in brains of rats or older mice that had been genetically altered to develop Alzheimer's disease, said Cole, who is also associate director of the Geriatric Research Center at the Veterans Affairs Medical Center.

To show that the benefits of DHA were not limited to nonhuman animal cells, the researchers also confirmed a direct impact of DHA on human neuronal cells in culture as well. Thus, high levels of DHA leading to abundant LR11 seem to protect against Alzheimer's, Cole said, while low LR11 levels lead to formation of the amyloid plaques.

Fish oil and its key ingredient, omega-3 fatty acids (found in fatty fish like salmon), have been a mainstay of alternative health practitioners for years and have been endorsed by the American Heart Association to reduce the risk of cardiovascular disease.

Fatty acids like DHA are considered essential fatty acids because the body cannot make them from other sources and must obtain them through diet. Years of research have shown that DHA is the most abundant essential fatty acid in the brain, Cole said, and that it is critical to fetal and infant brain development. Studies have also linked low levels of DHA in the brain to cognitive impairment and have shown that lower levels may increase oxidative stress in the brains of Alzheimer's patients.

Wild chimpanzees appear not to regularly experience menopause

Thu, 13 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) CAMBRIDGE, Mass. -- A pioneering study of wild chimpanzees has found that these close human relatives do not routinely experience menopause, rebutting previous studies of captive individuals which had postulated that female chimpanzees reach reproductive senescence at 35 to 40 years of age.

Together with recent data from wild gorillas and orangutans, the finding -- described this week in the journal Current Biology -- suggests that human females are rare or even unique among primates in experiencing a lengthy post-reproductive lifespan.

We find no evidence that menopause is common among wild chimpanzee populations, says lead author Melissa Emery Thompson, a postdoctoral researcher in anthropology at Harvard University. While some female chimpanzees do technically outlive their fertility, it's not at all uncommon for individuals in their 40s and 50s -- quite elderly for wild chimpanzees -- to remain reproductively active.

While wild chimpanzees and humans both experience fertility declines starting in the fourth decade of life, most other human organ systems can remain healthy and functional for many years longer, far outstripping the longevity of the reproductive system and giving many women several decades of post-reproductive life.

By contrast, in chimpanzees reproductive declines occur in tandem with overall mortality. A chimpanzee's life expectancy at birth is only 15 years, and just 7 percent of individuals live to age 40. But females who do reach such advanced ages tend to remain fertile to the end, Emery Thompson and her colleagues found, with 47 percent giving birth once after age 40, including 12 percent observed to give birth twice after age 40.

Fertility in chimpanzees declines at a similar pace to the decline in survival probability, whereas human reproduction nearly ceases at a time when mortality is still very low, the researchers write in Current Biology. This suggests that reproductive senescence in chimpanzees, unlike in humans, is consistent with the somatic aging process.

In other words, human evolution has resulted in an extended life span without complementary extended reproduction.

Why hasn't reproduction kept pace with the general increase in human longevity It may be because there hasn't been anything for natural selection to act on, though there is heritable variation in age of menopause, Emery Thompson says. However, it may be that the advantage older females gain by assisting their grandchildren outstrips any advantage they might get by reproducing themselves.

The oldest known wild chimpanzee, who died earlier this year at approximately age 63, gave birth to her last offspring just eight years ago, at about 55. Female chimpanzees only give birth every 6 to 8 years, on average, and they generally begin reproducing at age 13 to 15. This makes the chimpanzee reproductive profile much longer and flatter than that of humans, whose procreation is concentrated from age 25 to 35.

Emery Thompson and her colleagues gathered data from six wild chimpanzee populations in Tanzania, Uganda, Guinea, and Gambia. They compared these chimpanzees' fertility patterns to those seen among two well-studied human foraging populations, in Botswana and Paraguay.

Exercise testing may help predict seriousness of mitral regurgitation

Tue, 11 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Dec. 11, 2007) -- In as many as one in five people over age 55, when the heart contracts to send blood around the body, some degree of backward leakage occurs across the mitral valve, a condition known as mitral regurgitation (MR). When sufficiently severe, MR causes buildup of blood in the lungs, leading to difficulty in breathing (dyspnea, or shortness of breath), a serious condition called congestive heart failure. MR also can cause heart rhythm irregularities (arrhythmias) such as atrial fibrillation, which can lead to strokes and other problems, and ventricular tachycardia, which can cause sudden death.

A new study finds that monitoring the capacity of these patients to exercise on a treadmill -- an evaluation called exercise tolerance testing (ETT) -- may be useful in predicting the condition's progression and whether the patient will need surgery. Led by NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the research is published in the American Journal of Cardiology.

Mitral regurgitation can be very benign, going unnoticed for many years, or can be severe, impeding the heart's proper function and leading to complications, even death. There are few accurate ways to predict the seriousness of a single case, and these methods require fairly sophisticated and expensive imaging. Our study shows that exercise tolerance testing, a simple procedure often performed in doctors' offices, is an excellent tool for predicting if the patient is deteriorating and needs surgery, says Dr. Jeffrey S. Borer, a study co-author ; director of the Howard Gilman Institute for Valvular Heart Diseases at NewYork-Presbyterian/Weill Cornell; and the Gladys and Roland Harriman Professor of Cardiovascular Medicine and professor of cardiovascular medicine in cardiothoracic surgery at Weill Cornell Medical College.

We found that exercise testing is a simple and relatively inexpensive way to predict outcomes. Patients with mitral regurgitation who perform well on the treadmill will likely remain healthy and not have to undergo further testing for a number of years. This gives these patients peace of mind, says principal investigator Dr. Phyllis G. Supino, associate research professor of public health in medicine and associate research professor of public health at Weill Cornell Medical College.

Developed in its most simple form in the 1920s, exercise tolerance testing (ETT) is used commonly to assess the progression of coronary artery disease and the severity of aortic stenosis.

In mitral regurgitation, the mitral valve does not close completely, as it should, when the heart contracts, allowing blood to flow backward instead of forward, limiting blood flow to the body. Symptoms include shortness of breath, fatigue, cough, heart palpitations, swollen feet or ankles, and excessive urination. A characteristic heart murmur can be heard with a stethoscope.

In the current study, researchers followed 38 patients with chronic severe nonischemic MR (that is, MR not due to a prior heart attack) for an average of seven years. All underwent ETT at study entry. Patients who could continue exercising for 15 minutes or longer (of a maximum total of 18 minutes) had a fivefold lower annual risk of developing heart failure or other evidence of severe heart dysfunction necessitating surgery, compared to patients who were unable to exercise for that length of time.

In patients with chronic severe nonischemic MR, progression to surgical indications generally is rapid. There are two surgical options for the treatment of MR: mitral valve replacement and mitral valve repair.

Aging with GRACE: Improving health care for older adults

Tue, 11 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) INDIANAPOLIS - Most older adults obtain their health care in the offices of busy primary care physicians or, in the case of those without physicians, in even busier hospital emergency departments. In either location, seniors often don't receive the recommended care for preventive services, chronic disease management and geriatric syndromes. A study published in the December 12 issue of the Journal of the American Medical Association reports on GRACE, the largest randomized clinical trial of a health system and home-based geriatrics care concept designed to improve health care for community-dwelling low-income older adults.

GRACE, developed by researchers from the Indiana University School of Medicine, the Indiana University Center for Aging Research and the Regenstrief Institute Inc., was designed to involve seniors and their primary care physicians in a program to optimize health and functional status, and decrease high-cost emergency department visits and hospital admissions. The JAMA study reports GRACE's success in both improving quality of care and health-related quality of life measures while reducing emergency department use. Hospital admissions also were reduced in the second year of the program in a group at high risk for hospital admission.

GRACE, short for Geriatric Resources for Assessment and Care of Elders, is geriatrics care specifically targeting medically vulnerable individuals. The key to GRACE is two teams. The support team, consisting of a nurse practitioner and a social worker, meet with each patient at home to conduct an initial comprehensive geriatric assessment from the medicine cabinet to the kitchen cabinet. Based on the support team's findings, a larger interdisciplinary team (including a geriatrician, pharmacist, physical therapist, mental health social worker, and community-based services liaison) develops an individualized care plan.

Then the ball is back in the support team's court. The nurse practitioner and the social worker meet with the patient's primary care doctor to come up with a health-care plan consistent with the patient's goals, for example maintaining the ability to participate in prized social and religious activities. The support team then works with the patient to implement the plan which contains strategies for medical issues of concern as well as elements related to maintaining quality of life. With the assistance of an electronic medical record and tracking system, the GRACE support team provides ongoing comprehensive care management.

Rather than concentrating on individual diseases, we focused on the many issues faced by aging low-income adults -- access to needed services, medications, mobility, depression, transportation, diet, as well as other health issues of aging, said study leader Steven R. Counsell, M.D., Mary Elizabeth Mitchell Professor of Geriatrics at the IU School of Medicine, IU Center for Aging Research center scientist, and affiliated scientist at the Regenstrief Institute. Using a model for geriatrics care based on our prior work, we were able to deliver care which was very popular with patients and their doctors, improved health outcomes, and helped keep seniors from having to use the emergency department.

Stanford researchers produce short-term reversal of skin aging in mice

Thu, 29 Nov 2007 04:59:37 PST

( from http://www.rxpgnews.com ) STANFORD, Calif. - Researchers at the Stanford University School of Medicine have reversed the effects of aging on the skin of mice, at least for a short period, by blocking the action of a single critical protein.

The work could one day be useful in helping older people heal from an injury as quickly as they did when they were younger, said senior author Howard Chang, MD, PhD, assistant professor of dermatology. However, Chang and his colleagues warned their finding will likely be useful in short-term therapies in older people but not as a potential fountain of youth.

The work backs up the theory that aging is the result of specific genetic changes rather than accumulated wear and tear, Chang said. What's more, those genetic changes can be reversed even late in life.

The implication is that the aging process is plastic and potentially amenable to intervention, Chang said. The results will be published in the Dec. 15 issue of the journal Genes and Development.

The work came about thanks to existing data from experiments using microarrays, which detect the activity of all genes in a cell. In past experiments, researchers have found a large number of diverse genes that become either more active or less active in older people.

Chang and graduate student Adam Adler, the study's first author, searched through this existing data to see if those age-related genes had anything in common. It turned out that their activity gets dialed up or down with the help of the protein called NF-kappa-B.

Chang said people had long known that NF-kappa-B winds its way into a cell's nucleus to control which genes were active. What they didn't know is that many of those genes regulated by the protein have a role in aging.

Chang and Adler tested whether blocking the activity of NF-kappa-B in the skin of older mice for two weeks had a youthful effect. We found a pretty striking reversal to that of the young skin, Chang said.

First they looked at the genetic changes resulting from blocking NF-kappa-B. After two weeks, the skin of 2-year-old mice had the same genes active as cells in the skin of newborn mice-a striking difference when compared with the skin of a normal 2-year-old mouse. The skin looked more youthful too. It was thicker and more cells appeared to be dividing, much like the skin of a younger mouse.

Chang and Adler caution that their findings aren't likely to be the source of the long-sought fountain of youth. That's because they don't know if the rejuvenating effects of NF-kappa-B are long-lasting. Also, the protein has roles in cancer, the immune system and a range of other functions throughout the body. Suppressing the protein on a long-term basis could very well result in cancers or other diseases that undermine its otherwise youthful effect.

You might get a longer lifespan but at the expense of something else, Chang said.

Instead, the researchers believe their work could point to a way of helping older people heal more quickly after surgery or boost organ function during illness. These short-term applications aren't as likely to risk side effects that could accompany blocking such a critical protein.

Older workers stress less, U-M study suggests

Mon, 19 Nov 2007 04:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---Older workers generally report low levels of work-related stress, according to a University of Michigan study of a nationally representative sample of older workers.

The study, presented in San Francisco at the annual meeting of the Gerontological Society of America, is based on 2006 data from 1,544 participants in the U-M Health and Retirement Study, conducted by the U-M Institute for Social Research (ISR) and funded by the National Institute on Aging.

By the year 2010, middle-aged and older workers are expected to outnumber their younger colleagues, making the physical and emotional well-being of older workers a growing concern for U.S. employers.

For the analysis, ISR researcher Gwenith Fisher, Quinnipiac University researcher Carrie Bulger and colleagues examined the prevalence of different kinds of job stressors reported by participants between the ages of 53 and 85. They also examined how those stressors relate to workers' life satisfaction and physical health. All participants worked at least 20 hours per week.

Slightly more than half of the participants were male, 87 percent were Caucasian, about eight percent were African American and seven percent were Hispanic. On average, they had about 14 years of education.

In general, older workers did not report high levels of work-related stressors, said Fisher, an organizational psychologist who is particularly interested in issues of work-life balance.

Just over half agreed or strongly agreed that they have competing demands being made on them at work, and 47 percent agreed that time pressures are a source of job stress.

Only 19 percent of older workers indicated that they have poor job security, however. Given what we know about the extent of age discrimination at work and the current economic climate regarding unemployment, this is a surprisingly low number, said Fisher.

Just 15 percent reported that their work often or almost all the time interfered with their personal lives and a scant 2 percent said their personal lives interfered with their work.

Many older workers are empty-nesters, Fisher said. They don't have the same work-personal conflicts that younger and middle-aged workers deal with, juggling responsibilities to children along with their jobs and their personal needs.

Results from the study also indicated that workers who experience less job stress are more satisfied with their life and are overall in better physical health compared with those who report higher levels of job stressors.

For both younger and older workers alike, time pressure has been increasing over the last two decades, many studies have shown. Technological advances like Blackberries, along with out-sourcing and down-sizing, have all increased the amount of work and pace at work, Fisher said. But it's particularly important to look at the effects this pressure may have on older workers, whose health may be more vulnerable than that of younger workers.

At this time of year, time pressure may be even greater because work loads may increase, Fisher said. Year-end goals need to be met at the same time as the holidays mean less time at work and more personal errands and activities, she said.

For older and younger workers facing work-related stress, Fisher recommended a few basic guidelines.

First, she advised, take good care of yourself. Get enough sleep, she said. In the short-term, you may be able to cut corners but in the long-term, cutting back on sleep may compromise your immune system and you'll be more likely to get sick. Also, be sure to get regular physical exercise. This can go a long way toward helping your body handle stressors, and reduce strains like anxiety and increase your energy level on the job.

Secondly, engage in active time management, Fisher advised. Use strategies that work for you, like creating a to-do list so you can keep track of tasks and set priorities. Establish clear boundaries. With all the technologies that blur the boundaries between work and personal life, it's important to set aside some time that isn't available for any work, she said.

Screening for abdominal aortic aneurysms in women may save lives

Fri, 09 Nov 2007 04:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Nov. 9, 2007) -- In 9 out of 10 cases, a burst abdominal aortic artery is quickly fatal for its most common victim: elderly males. A new study -- the largest yet performed -- now confirms that women over 65 with a history of smoking or heart disease are also at high risk for an abdominal aortic aneurysm (AAA) -- supporting the notion that they should also receive ultrasound screening to help spot and correct the dangerous condition.

The findings, reported in the Journal of Vascular Surgery, challenge current recommendations on AAA screening issued by the United States Preventive Services Task Force. Those guidelines recommend that screening only be performed -- and reimbursed by Medicare -- for men aged 65 to 75 who have ever smoked.

The Task Force ruled against screening for older women, citing a lack of evidence to support the cost-effectiveness of such a move.

That left us scratching our heads, says the study's senior author, Dr. K. Craig Kent, chief of vascular surgery at NewYork-Presbyterian Hospital, the Greenberg-Starr Professor of Surgery at Weill Cornell Medical College and professor of surgery at Columbia University College of Physicians and Surgeons. We know that AAA kills up to 30,000 Americans each year, with the ratio of males to females at about 4 to 1. But that still means that thousands of American women will die from this type of event each year. We wanted to discover whether certain subgroups of women might be at especially heightened risk and therefore benefit from screening.

An AAA occurs when a bubble-like swelling occurs in a portion of the aorta, the major artery that carries blood from the heart through the abdomen to the lower body. As this 'bubble' swells over time, the artery wall can thin out and rupture.

Ruptures can occur suddenly and typically prove fatal. In fact, 85 percent of people who suffer a ruptured AAA die before making it to the hospital, and only half of the 15 percent who do receive hospital care survive the attack.

That's why detecting these aneurysms early and monitoring or repairing them is crucial, Dr. Kent says.

But right now, doctors are actually being advised against providing their female patients with the 10-minute ultrasound test that could spot the problem. The noninvasive test itself is relatively inexpensive (about $40) and is often bundled with other diagnostic screens.

In the new study, Dr. Kent and colleagues recruited 17,540 patients from 100 hospitals and clinics spread across the United States. Overall, the cohort included 10,012 women over the age of 65 (average age 69.6 years) and 7,528 men over the age of 60 (average age 70).

Patients were questioned as to their demographics, history of smoking and medical histories. They also underwent conventional AAA ultrasound screening.

Overall, AAA showed up in 291 (3.9%) of the men and 74 (0.7%) of the women -- similar to the usual rate. But certain subgroups of women fared much worse. For example, women over age 65 were more than four times as likely to have this type of aneurysm than women younger than 65, and that risk grew by 10 percent with every added year of age.

Women with a history of smoking, or a history of heart disease (i.e., a prior heart attack or coronary bypass) faced triple the risk of AAA, the researchers found.

Any combination of the above risk factors boosted a woman's odds of AAA by up to six-fold, the team found.

The bottom line, in terms of the cost-effectiveness of screening older women, is that these tests are probably not useful for the general population, but are certainly warranted for women over 65 with risk factors such as smoking and a history of heart disease, Dr. Kent says. In fact, having just one of those risk factors alone may also indicate a need for screening, based on a discussion between the patient and her doctor.

We hope that this data provides the evidence that the Task Force and others in the field have needed to push for screening of AAA in at-risk females, Dr. Kent says. Women can also benefit greatly from this data, as they decide with their doctors whether or not testing is right for them.

Patients enrolled in the study were screened through the Stroke and Aneurysm Vascular Evaluation (SAVE) Program, which is sponsored and funded by medical device maker Medtronic Inc., of Minneapolis, and conducted by Life Line Screening, Cleveland.

U of I scientist does nutritional detective work in Botswana

Thu, 25 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Many Americans have a soft spot for Botswana, developed while reading the best-selling #1 Ladies Detective Agency series. But few have had a chance to do any sleuthing of their own in that African country.

That changed when University of Illinois scientist Karen Chapman-Novakofski acquired a Batswana doctoral student and learned how little data existed about the health and nutrition of that country's elderly.

In Botswana, which has the highest incidence of AIDS of any African country, the aged are often raising many grandchildren whose parents have died from the disease. So the elderly's good health is very important, she said.

The two traveled to Africa, secured each tribal chief's permission, then set up shop in front of Botswanan post offices on the days the elderly received their pension checks and questioned them about their eating habits.

The results of their detective work have clarified the situation for Botswanan policy makers and were published in the November/December issue of the Journal of Nutrition Education and Behavior. The article has also been selected for inclusion in a special issue of that journal dedicated to the problem of world poverty.

The information that we gathered will support needed changes in the country's nutrition policy. For example, should foods be fortified And what foods are best to fortify said Chapman-Novakofski, a U of I professor of nutrition.

Because of our research, Sega (her former doctoral student and collaborator Segametsi D. Maruapula, now a professor at Botswana's University of Gabarone) is well positioned to assume leadership in this area, she said.

Elderly Batswana have little variety in their diet, and, of the five major food groups, they receive only enough grain, and not nearly enough milk, fruits, vegetables, and meat. Only 41 percent had eaten meat in the 24-hour period before they were surveyed, the researcher said.

She noted that mixed dishes--for example, samp (a grain) and beans--are a source of protein for Batswana, and added that people who consume lower-calorie diets may need higher protein levels in order to function well.

The most widely consumed foods were tea, sorghum and maize meal, followed by milk and bread, she said. Although up to 40 percent of the elderly drink milk, they mainly drink it in their tea. And Botswanan milk is ultrapasteurized, canned milk that may not be fortified with vitamins A and D.

The scientists also investigated dietary patterns, Chapman-Novakopfski said.

For example, persons living in urban areas had more access to fruits and vegetables than their rural counterparts. And, in a pattern that also occurs in the West, single, widowed, and elderly females consumed less meat and fruit than elderly men and married people, she said.

Eating vegetables was more common if older persons had children in their homes, also a Western behavior, she said. As a rule, people make an effort to prepare more nutritious meals if children are also eating them.

The elderly Batswana's frequent role as caretakers of their grandchildren makes it all the more necessary that government policy makers promote good health and nutrition among that group, said Chapman-Novakofski.

Although, as a researcher, the amazing thing to me was that the people we interviewed were as old and as mobile as they were. Most had walked to the post office to get their pension, she said.

Many live to be 80 or 90, yet they're obviously not eating the five fruits and vegetables a day that we recommend. They may not be in robust good health, yet they seem to be healthy enough, especially in a country that has severe infectious disease, she said.

So there may be other factors that promote their longevity, which is an interesting area for further research, she said.

Also, as Batswana begin to adopt Western consumption patterns, they'll have the challenge of promoting good eating habits while avoiding some of the bad habits that we have, such as overconsumption of fats and calories, she said.

Severely restricted diet linked to physical fitness into old age

Wed, 24 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BUFFALO, NY -- Severely restricting calories leads to a longer life, scientists have proved.

New research now has shown for the first time that such a diet also can maintain physical fitness into advanced age, slowing the seemingly inevitable progression to physical disability and loss of independence.

The study, using a rat model of life-time caloric restriction, showed that the diet reduces the amount of visceral fat, which expresses inflammatory factors that in humans cause chronic disease and a decline in physical performance and vitality across the lifespan.

The study appears in the October issue of Journals of Gerontology Series A: Biological Sciences and Medical Sciences.

Have we finally discovered the Fountain of Youth?

No. But we may be getting a little closer.

�This is the first study to report that caloric restriction reduced production in visceral fat of the inflammatory cytokine IL-6 and enhanced performance on overall physical function assessments,� said Tongjian You, Ph.D., assistant professor of exercise and nutrition sciences in the UB School of Public Health and Health Professions and principal investigator.

�In addition, rats that ate a normal diet lost a significant amount of lean muscle mass and acquired more fat, while calorie-restricted rats maintained lean muscle mass as they aged.�

The study was conducted with male rats in three age groups -- 18, 24 and 29 months, comparable to ages 50-70 years in humans -- that had been fed either a normal or

40-percent calorie-restricted diet from birth. The animals were put through tests to determine grip strength, muscle tone, stamina and swimming speed. Data also were collected on whole body mass, lean body mass, fat mass, percent body fat, the ratio of fat-to-lean body mass, amount of visceral fat and the amount of pro-inflammatory cytokines and C-reactive protein, a marker of chronic inflammation.

Results showed that animals on the restricted calorie diet had significantly higher physical performance scores than animals fed a normal diet. They also had less fat, a lower fat-to-lean ratio, and lower adipose tissue secretion of IL-6 and circulating levels of C-reactive protein.

The stumbling block on this path to remaining forever young is that humans could not adhere to such a severe diet.

�Based on an average of 2,000 calories per day for adult women and 2,500 for men, cutting by 40 percent would mean surviving on 1,200 and 1,500 calories per day, respectively, said You.

�It�s very difficult for people to maintain that type of diet for short periods of time, and it would be nearly impossible over a lifetime, while staying healthy. Starting on a diet like that in the senior years would be harmful.�

You said that a more moderate form of caloric restriction, 8 percent, is achievable in humans, based on recent findings, and may have positive effects on specific oxidative stress and inflammatory biomarkers.

�Preclinical testing of this 8-percent regimen could be informative and beneficial in translating to humans,� he said.

Largest ever Alzheimer's gene study underway

Tue, 23 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The genetics underlying late-onset Alzheimer's disease could soon be revealed thanks to a collaboration of leading UK experts. The team, led by scientists at Cardiff University, has received �1.3 million from the Wellcome Trust, the UK's largest medical research charity, to scan the entire human genome in search of the genes that predispose people to or protect them from developing the disease.

According to the Alzheimer's Research Trust, there are over 700,000 people currently living in the UK with dementia, of which Alzheimer's is the most common form. This figure is expected to double within the next twenty years. Yet currently, only �11 is spent on UK research into Alzheimer's for every person affected by the disease, compared to �289 for cancer patients.

Now, a team led by Professor Julie Williams from Cardiff University will use a technique known as genome-wide association scanning to analyse DNA samples taken from 14,000 people � 6,000 with late-onset Alzheimer's disease and 8,000 healthy control samples from the UK and US � to identify common genetic variations that increase the risk of the disease.

Alzheimer's is a genetically-complicated story involving many genes, so we need large sample sizes to make sure any genetic links that we find are not mere coincidence, says Professor Williams. With access to 14,000 DNA samples, our study is the largest genetic study ever to look at Alzheimer's and will undoubtedly produce some valuable insights into what causes this devastating illness.

It's very likely that we will find some unexpected associations. We know already that certain genes are involved in more than one form of dementia and that even genes that affect cholesterol level can be a risk factor for Alzheimer's. We need to build a complete picture of the different pathways that lead to the disease. With this knowledge, we should, in time, be able to derive tangible clinical benefits.

Genome-wide association scanning is a powerful technique involving studying 500,000 genetic markers across the human genome. Work on genotyping the DNA samples � in other words, screening for the particular genetic mutations that are linked to Alzheimer's disease � will be performed by Dr Panos Deloukas�s group at the Wellcome Trust Sanger Institute.

Alzheimer's disease is a major burden on our society and this burden will only increase as our population ages, says Professor Richard Morris, Head of Neurosciences and Mental Health at the Wellcome Trust, which is funding the study. It is essential that we develop our understanding of the underlying causes of the disease, and genome-wide association scans offer a powerful tool to do just this.

The project has been welcomed by Rebecca Wood, Chief Executive of the Alzheimer's Research Trust.

This is an exciting project that could lead to real progress in our understanding of Alzheimer�s, said Mrs Wood. We are delighted to see this research receive such a huge boost after we funded the initial collection of tissues together with the Medical Research Council.

�Alzheimer�s is a devastating disease which urgently needs more research funding. It is fantastic that the Wellcome Trust is supporting such a significant project that has the potential to improve the lives of the 420,000 people with Alzheimer�s in the UK and their families.

A longer-living, healthier mouse that could hold clues to human aging

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) A study by scientists at UCL (University College London) shows that mice lacking the insulin receptor substrate (IRS)-1 are more resistant to ageing than normal mice. The research adds to a growing body of work showing the importance of insulin signalling pathways as an ageing mechanism in mammals � and potentially humans.

The team studied �knock-out� mice engineered to lack either insulin receptor substrate (IRS)-1 or -2. These proteins are activated by insulin, a hormone that regulates glucose and fat metabolism, informing the body�s cells when the animal is well fed.

The study, published in The FASEB Journal, shows that mice lacking IRS-1 had an average lifespan increase of 20 per cent when compared to normal mice. In female mice lacking IRS-1 this figure was even higher, averaging 30 per cent. While the expected life-span for a mouse is about 25 months, one of the IRS-1deficient mice in this research lived for 38 months � 66 per cent longer than a normal mouse.

As well as living longer, the mice without IRS-1 also experienced better health than the normal mice as they aged � they had brighter eyes, were more alert and were much healthier overall. In comparison, the mice that lacked IRS-2 were shorter-lived than the normal mice and displayed signs of obesity and type 2 diabetes.

Professor Dominic Withers, who works with the UCL Centre for Research on Ageing and is lead author of the study, said: �Our provisional results indicate that mice lacking IRS-1, particularly female mice, are more long-lived and show resistance to a range of markers that indicate ageing � including skin, bone, immune, and motor dysfunction.

�What�s more, these improvements were seen despite the fact that removing IRS-1 made the mice resistant to insulin throughout their lives. These results suggest that IRS-1 is a pathway conserved by evolution that regulates the lifespan of mammals, and it may point to methods of potentially delaying ageing in humans.

�We do not yet fully understand why lacking IRS-1 leads to longer life in mice. One possible explanation is that it makes them only mildly insulin resistant and that this, rather than having a negative effect on health, increases stress resistance, protects from damage and generally triggers other reactions in the body which extend life without compromising health.�

Dr David Gems, another of the study�s authors, added: �Other research has shown that mutations in single genes in the insulin pathway can extend the life of animals. However, our research adds new information because it shows that not only does manipulation of this pathway regulate how long animals live, it also shows that these effects allow the mice to stay healthier for longer. In these animals we see delay in the onset of age-related illnesses such as osteoporosis, diabetes and immune dysfunction. Obviously it�s much harder to study these mechanisms in humans because our life expectancy is so much longer, but this study and our other work on ageing are laying crucial scientific groundwork.�

The study follows other ageing research pioneered at the UCL Centre for Research on Ageing, led by Professor Linda Partridge. The teams at the Centre analyse the cellular and biochemical mechanisms of ageing in fruit flies, nematode worms and mice, and in particular the role of insulin signalling. Their work was recognised in June 2007 by a Strategic Award from the Wellcome Trust totalling �5.1 million, to support their work examining what causes human bodies to age and decay. The UCL Institute of Healthy Ageing, incorporating the existing Centre, will be established in 2008 and will encourage further collaboration between UCL scientists working in this area.

Zinc may reduce pneumonia risk in nursing home elderly

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BOSTON � When elderly nursing home residents contract pneumonia, it is a blow to their already fragile health. Simin Nikbin Meydani, DVM, PhD of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and colleagues report that maintaining normal serum zinc concentration in the blood may help reduce the risk of pneumonia development in that population.

�Based on our data, it appears that daily zinc intake can help nursing home residents who are susceptible to pneumonia, especially those with low serum zinc concentrations in their blood,� says Meydani, corresponding author and director of the Nutritional Immunology Laboratory at the USDA HNRCA . �The study participants with normal serum zinc concentrations in their blood reduced their risk of developing pneumonia by about 50 percent. Additionally, deaths from all causes were 39 percent lower in this group.�

Meydani and colleagues analyzed blood samples from a previous study that investigated the role of Vitamin E in preventing respiratory infections in nursing home residents ages 65 and older. The study enrolled 617 men and women from 33 nursing homes in the Boston area. All of the participants received daily supplements containing 50 percent of the recommended dietary allowance of several vitamins and minerals, including zinc, for one year. Foods that provide zinc include oysters, red meat, poultry, whole grains, beans and dairy products.

In the present study, published in the October issue of the American Journal of Clinical Nutrition, the authors compared blood samples collected at the beginning and the conclusion of the one-year study. The participants whose serum zinc concentrations remained low throughout that 12-month period had more difficulty battling pneumonia. �Not only did those participants have a higher risk of developing pneumonia when they did become sick, they did not recover as quickly and required a longer course of antibiotics,� says Meydani, who is also a professor at the Friedman School of Nutrition Science and Policy and the Sackler School of Graduate Biomedical Sciences, both at Tufts University. �We also noted a higher rate of death from all causes.�

Maintaining normal serum zinc concentration in the blood throughout the 12-month study period benefited the participants even if they did develop pneumonia. Meydani adds, �Those participants with normal serum zinc concentrations in their blood were more likely to spend fewer days on antibiotics and recover more quickly.�

Meydani and colleagues conclude that zinc may reduce the risk of pneumonia, and its associated complications in nursing home residents. �Zinc is already known to strengthen the immune system; however, there needs to be further investigation of zinc and its effect on pneumonia development and prevention in nursing homes,� Meydani says. �The next step would likely be a clinical trial.�

Endobronchial valve significantly improves emphysema

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) CHICAGO, Oct. 22 � Emphysema patients whose lungs are implanted with a pencil eraser-sized, one-way endobronchial valve experience significantly improved measures of lung function and report better quality of life, University of Pittsburgh School of Medicine researcher Frank C. Sciurba, M.D., reported today at CHEST 2007, the annual meeting of the American College of Chest Physicians. Scientific sessions continue through Thursday, Oct. 25, at the McCormick Place Lakeside Center in Chicago.

�Normally, lungs easily expand and contract with breathing. But with emphysema, air sacs in the lungs lose elasticity and become hyper-inflated, resulting in decreased function and a feeling of breathlessness,� said Dr. Sciurba, principal investigator of the multi-center trial, known as the Endobronchial Valve for Emphysema Palliation Trial (VENT) and director of the Emphysema Research Center at the University of Pittsburgh. �Endobronchial valves can allow these over-distended, diseased portions of lung to deflate, improving overall function.�

The 31-center, two-year study ended in April 2006 and involved 321 patients in the United States. In the trial, emphysema patients were randomly assigned to either a treatment or control group. Lung function was re-evaluated at six months using a common clinical measure of the volume of air forcibly exhaled in one second (FEV-1) and a six-minute walk test, said Dr. Sciurba. Of the 220 patients who received valve implants, there was a 6.4 percent greater improvement in FEV-1, and a 5.7 percent improvement in distance walked, compared to controls, he said. For some important subsets of treated patients, the results were even more dramatic, Dr. Sciurba added.

�For example, patients who had a fissure completely separating the lobes of the lung and whose endobronchial valves were placed to exclude the entire diseased lobe had changes in FEV-1 of greater than 20 percent,� he said. �This is akin to the results achieved in unilateral lung-volume reduction surgery, without the risks of major surgery. Lessons learned in this trial can lead us to more effective targeting of regions in the lung that could provide an even greater response.�

Most patients required implantation of three to five valves to isolate the most damaged sections of their lungs. Computed tomography (CT) scanning confirmed significant reduction in size of the lung region where valves were placed, particularly among the subsets of patients with the most favorable responses.

Emphysema is the most common cause of respiratory-related death and the fourth most common cause of death overall in the United States. There are an estimated 1.8 million people in the U.S. who have emphysema, a disease heavily related to smoking.

Treated patients had a slightly higher risk of pneumonia. Most complications resolved within eight days of the procedure, and included shortness of breath, chest pain and low oxygen concentration in the bloodstream. Some patients who received valve treatment later had the valves removed for reasons including lack of efficacy or shifting of position. In nearly all cases, valves were easily removed up to a year following insertion.

Endobronchial valve data must be presented to the Food and Drug Administration and the Center for Medicare and Medicaid Services before the treatment becomes widely available to emphysema patients. Currently, the treatment is limited to those who took part in the clinical trial.

More educated people who develop dementia lose their memory faster

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BRONX, NY � People with more years of education lose their memory faster than those with less education in the years prior to a diagnosis of dementia, according to a study by researchers at Albert Einstein College of Medicine of Yeshiva University, published in the October 23rd issue of the medical journal Neurology.

The study included 117 people who developed dementia out of an original cohort of 488. The researchers, led by Charles B. Hall, Ph.D., associate professor of epidemiology and population health at Einstein, followed study participants for an average of six years using annual cognitive tests. Study participants ranged in formal education levels of less than three years of elementary school to individuals with postgraduate education.

The study found for each additional year of formal education, the rapid accelerated memory decline associated with oncoming dementia was delayed by approximately two and one half months. However, once that accelerated decline commenced, the people with more education saw their rate of cognitive decline accelerate 4 percent faster for each additional year of education. The latter portion of this finding corroborates previous research, which had shown that people with more education had more rapid memory loss after diagnosis of dementia.

For example, a college graduate with 16 years of education, whose dementia is diagnosed at age 85, would have begun to experience accelerated memory decline 3.8 years earlier, at age 81, while a person with just four years of education, who is diagnosed at the same age, would have begun to experience a less rapid rate of decline around age 79, 6.3 years before diagnosis.

�While higher levels of education delay the onset of dementia, once it begins, the accelerated memory loss is more rapid in people with more education,� said Dr. Hall. �Our study showed that a person with 16 years of formal education would experience a rate of memory decline that is 50% faster than someone with just 4 years education.

�This rapid decline may be explained by how people with more education have a greater cognitive reserve, or the brain�s ability to maintain function in spite of damage,� added Hall. �So, while they�re often diagnosed with dementia at a later date � which we believe may be because of their ability to hide the symptoms � there�s still damage to their brain.�

Hall noted that this is the first study to confirm important predictions of the effects of cognitive reserve in people with preclinical dementia. He also said that the study is limited since the participants were born between 1894 and 1908 and their life experiences and education may not represent that of people entering the study age range today.

Kaiser Permanente study shows electronic medical records and outreach improve osteoporosis care

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) October 22, 2007 (Oakland, CA) �Electronic medical records and outreach programs of e-mail messages, letters and phone calls to patients and their primary care providers after a bone fracture can dramatically improve the diagnosis and management of the patients� osteoporosis, according to a Kaiser Permanente study in the September issue of the Journal of the American Geriatrics Society. This is the largest study to show that electronic medical records improve the continuity of care for osteoporosis.

�Often when a patient sustains a fracture, there is a disconnect between the treating orthopedist and the patient�s primary care physician. With Kaiser Permanente�s computerized database and integrated care delivery system, we can closely monitor and follow patients with fractures and prevent that disconnect,� said Adrianne Feldstein, MD, MS, an investigator at the Kaiser Permanente Center for Health Research (CHR) in Portland and the lead author of the study. �This intervention has broad applicability to a large group of health care providers � from local health departments to HMOs to PPOs � with access to electronic billing or clinical data. Armed with that data, these health organizations can make sure their patients with fractures get appropriate bone density screening follow up.�

This study of 3,588 women shows that an outreach program targeted to patients with a previous fracture meant there was an improvement from 13.4 percent to 44 percent of patients being evaluated and/or treated for osteoporosis. Osteoporosis management is the receipt of a bone mineral density (BMD) measurement or osteoporosis medication in the six months after a fracture. If widely implemented, this approach could substantially improve the secondary prevention of osteoporosis, according to the study authors.

Osteoporosis, a bone disease that leads to increased risk of fracture, is a prevalent condition in older adults, and affects about 20 percent of women 65 and older. Medication can reduce fracture risk in people with osteoporosis significantly, yet many patients, even those who already sustained a previous fracture, do not receive the necessary BMD screening and subsequent treatment. It is estimated that in 2005 there were 2 million fractures at a cost of $17 billion in the United States; by 2025, this number is expected to increase by 50 percent as the population ages.

�Osteoporosis now causes more deaths annually than breast cancer and ovarian cancer combined, said Dr. Feldstein �This study shows that we can cost-effectively improve management with interventions as simple as e-mails, letters and phone calls. That in turn should reduce fractures and mortality, and improve quality of life.�

Researchers at the Kaiser Permanente Center for Health Research used the organization�s integrated databases to analyze medical records of 3,588 women aged 67 and older who sustained qualifying clinical fractures. The women were members of the health plan in Oregon and had not received a BMD measurement or osteoporosis treatment in the 12 months before the fracture.

The goal of the study was to evaluate the effect of the interventions on the National Center for Quality Improvement, Health Employer Data and Information Set (HEDIS) measure that evaluates the proportion of women age 67 and older who sustained a qualifying clinical fracture and had not received a BMD measurement or osteoporosis treatment in the 12 months before the fracture and who received either of these six months after the fracture.

The study was conducted in two phases: In Phase 1, primary care physicians with eligible patients were sent an electronic medical record (EMR) in-basket message that contained patient-specific clinical guideline advice consistent with national guidelines, as well as offered outreach to the patient. If the PCP elected, patients were then contacted via an introductory letter and phone call by outreach staff, who completed a patient record review, counseled the patients regarding risk of osteoporosis and future fractures, and ordered laboratory testing, medication, or a BMD measurement. During Phase 2 clinicians and staff were eligible for a financial incentive for quality improvement based on the osteoporosis HEDIS measure.

�Although the financial incentive helped staff define what the organizational priority was, being a team player is what drove behavior,� said Dr. Feldstein. �The increase in performance resulted from re-engineering the patient�s care and ensuring continuity of care from orthopedist and primary care physician.�

MacArthur commits $11 million to further UCSF work in maternal safety

Fri, 19 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The John D. and Catherine T. MacArthur Foundation has promised $10.75 million to extend a ground-breaking UCSF project to help combat maternal mortality in Nigeria and India � two countries that comprise one-third of all maternal deaths worldwide.

MacArthur Foundation President Jonathan Fanton announced the grant today in London at the Women Deliver conference.

The funding will go to the nongovernmental organization Pathfinder International, which will use the grant to implement a spectrum of interventions developed and tested by UCSF researchers to treat women suffering from post-partum hemorrhaging. UCSF will continue to advise the group on the roll-out, including development of a plan for monitoring and evaluating the project�s outcomes.

The centerpiece of the program is the non-pneumatic anti-shock garment, or NASG, a low-cost and reusable body suit made of lightweight neoprene that was originally designed for battlefield use. When the suit's five Velcro closures are tightened around the patient's body, the compression stops blood from flowing to the lower extremities and forces it back to the heart, lungs, and brain to counteract shock.

The suit has now been shown to effectively stem hemorrhaging after childbirth, according to Suellen Miller, CNM, PhD, who proposed the garment�s use as a maternal life-saver and pilot-tested the project in Egypt over the past four years with Egyptian colleagues Mohammed Mourad Yousiff, MD, from El Galaa Maternity Hospital, in Cairo; and Mohamed Fathalla, MD, from the Assiut Teaching Hospital, in Assiut.

�It is tremendously gratifying to see this work being expanded by Pathfinder,� said Miller, an associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Services and director of the Safe Motherhood Programs of the UCSF Women�s Global Health Imperative.

�Hundreds of thousands of new mothers die needlessly every year due to hemorrhaging, simply because they don�t have access to a hospital,� she said. �This simple garment appears extremely promising in pilot studies and could potentially have a huge impact on the lives of both the women and their families.�

In the pilot study, 158 obstetrical hemorrhage patients underwent standard hemorrhage treatment and 206 patients with obstetrical hemorrhaging underwent standard treatment plus the anti-shock garment.

Study results showed a 50 percent decrease in blood loss among women treated with the garment, which is statistically significant, Miller said. Pilot results, which were published in the April 2006 issue of the �British Journal of Obstetrics and Gynecology,� showed a 69 percent decrease in death and severe illness.

�In our research, women who appeared clinically dead, with no blood pressure and no palpable pulse, were resuscitated and kept alive for up to two days until they could be transported to a hospital,� said Miller.

The World Health Organization estimates that 529,000 women died in pregnancy or childbirth in the year 2000. More than 99 percent of these deaths occurred in developing countries, where Miller said the majority of women give birth at home, with poorly trained or untrained attendants. Of the risks, postpartum hemorrhage is the most common cause of maternal mortality, accounting for approximately 25-30 percent of all maternal deaths.

Pathfinder will use the MacArthur grant to introduce a package of low-tech interventions at several hundred health facilities in seven Indian states and eight states in Nigeria. Those interventions, called the Continuum of Care for PPH (post partum hemorrhage), were developed by Miller and Stacie Geller, PhD, an associate professor at the University of Illinois College of Medicine.

The package of interventions includes the anti-shock garment, a uterus-contracting drug to prevent bleeding, a calibrated blood collection drape to diagnose postpartum hemorrhage, and a community-developed communication and transportation plan to get patients to a health facility for assessment and emergency obstetrical treatment.

�It is important to address postpartum hemorrhage wherever there is the potential for it to occur, from the community up through the health system,� said Dan Pellegrom, president of Pathfinder International. �Prevention and management starts in homes and communities, so it is important to cultivate informed and engaged communities that are aware of the danger signs of hemorrhaging and can transport women to skilled service providers.�

The current funding builds upon nearly $2 million in previous MacArthur grants to UCSF for preliminary pilot studies of the anti-shock garment in Egypt, Mexico and Nigeria. Fanton, from MacArthur, said the introduction of the garment on a large-scale could help save hundreds of thousands of lives and help strengthen national health care systems.

�No other major cause of maternal death can be prevented as easily as postpartum hemorrhage,� Fanton said. �Our hope is that the anti-shock garment will eventually become part of a standard package of care for postpartum hemorrhage in developing countries.�

Miller and her team will continue a rigorous NIH funded randomized cluster trial of the garment in Zambia and Zimbabwe.

Septic survival

Wed, 17 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) While survival rates for sepsis have increased over the past two decades, children under four and those in adolescence remain highly susceptible to the condition. Researchers in The Netherlands have now demonstrated that age and to a lesser extent, gender, are critical factors in whether or not a child sufferer will develop a more severe disease state and survive or not. These findings could help to improve the treatment of sepsis and improve survival rates further still.

Writing in the online open access journal Critical Care, Jan Hazelzet and colleagues at the Erasmus MC-Sophia Paediatric Intensive Care Unit (PICU) in Rotterdam describe their study of almost 300 children admitted with sepsis and purpura (red patches caused by bleeding under the skin) between 1988 and 2006. The researchers recorded the age, gender, ethnic origin, severity of condition, therapy, and survival of the patients. They then pooled the data and analyzed the outcomes retrospectively.

The results showed that the fatality rate from sepsis and purpura was 15.7%. However, during the study period, they observed a marked improvement in the numbers of children surviving sepsis. Nevertheless, they found that younger children were affected more severely and fatality rate was higher (4.3 times) for those under the age of three years. They found no difference in fatality rates between boys and girls, but boys were admitted to the PICU for longer periods and had more severe symptoms. The team found that the course of sepsis and purpura was not related to a child's ethnic origin.

In almost all cases, the infection that led to sepsis was Neisseria meningitidis, the bacterium commonly known as meningococcus. The team also reports how the drugs used to treat sepsis changed during the course of the study. There has been a marked reduction in the use of dopamine and a concomitant increase in the use of dobutamine, norepinephrine and corticosteroids to treat sepsis. The finding of the important influence of young age and to a lesser extent gender can lead to a better understanding of the disease, which in turn can lead to better therapy, says Jan Hazelzet.

Sepsis is a serious medical condition triggered by infection, which leads to body-wide inflammation, fever, increased pulse and breathing, and potentially organ failure and death. Each year, more than 750,000 people in the USA will develop severe sepsis, and more than 215,000 will die from the condition. In the UK, sepsis kills around 30,000 people annually.

Study shows reducing class size may be more cost-effective than most medical interventions

Tue, 16 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) October 16, 2007 -- Reducing the number of students per classroom in U.S. primary schools may be more cost-effective than most public health and medical interventions, according to a study by researchers at Columbia University Mailman School of Public Health and the Virginia Commonwealth University. The study indicates that class-size reductions would generate more quality-adjusted life-year gains per dollar invested than the majority of medical interventions. The findings will be published in the November issue of the American Journal of Public Health.

The researchers estimated the health and economic effects of reducing class sizes from 22�25 students to 13�17 students in kindergarten through grade 3 nationwide, based on an intervention tested in Project STAR (Student Teacher Achievement Ratio), a large multi-school randomized trial that began in 1985. Project STAR is considered the highest quality long-term experiment to date in the field of education.

The study shows that a student graduating from high school after attending smaller-sized classes gains an average of 1.7 quality-adjusted life-years and generates a net $168,431 in lifetime revenue. �Higher earnings and better job quality enhance access to health insurance coverage, reduce exposure to hazardous work conditions, and provide individuals and families with the necessary resources to move out of unfavorable neighborhoods and to purchase goods and services,� says Peter A. Muennig, MD, MPH, assistant professor of Health Policy and Management at the Mailman School. �Regardless of class size, the net effect of graduating from high school is roughly equivalent to taking 20 years of bad health off of your life.

When targeted to low-income students, the estimated savings would increase to $196,000 per additional graduate. �This is because low-income students seem to benefit more from the additional attention afforded by small classes,� noted Dr. Muennig. �Because we focused on a relatively expensive intervention and examined outcomes over a range of values, our results should provide a conservative framework for evaluating this and other interventions as long-term data on educational interventions become more plentiful,� he commented.

The performance of students in the U.S. has been declining relative to the performance of students in other countries. With health costs soaring and student performance falling, the United States is in jeopardy of losing its economic dominance.

The findings not only raise issues of whether investments in social determinants of health can be more cost-effective than investments in conventional medical care, �but more intriguing still, also bring up the idea that each dollar invested in education could also potentially produce other long-term returns,� observes Dr. Muennig. He notes that further analysis will refine models and produce more-precise estimates, but �these findings do point to the importance of looking more broadly at the options available for improving health outcomes�including those outside the boundaries of clinical medicine.�

Severely mentally ill at high risk for cardiovascular disease

Tue, 16 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) St. Louis, Oct. 15, 2007 � A psychiatrist at Washington University School of Medicine in St. Louis writes in the Journal of the American Medical Association (JAMA) that although mortality from cardiovascular disease has declined in the United States over the past several decades, patients with severe psychiatric illness are not enjoying the benefits of that progress.

In a commentary article in the Oct. 17 issue of JAMA, John W. Newcomer, M.D., professor of psychiatry, of psychology and of medicine and medical director of the Center for Clinical Studies at Washington University, reports that those with illnesses such as schizophrenia, bipolar disorder and major depression lose 25 to 30 years of life expectancy compared to the general population. And although suicide does claim the lives of many psychiatric patients, most of those premature deaths are due to cardiovascular disease.

This is really a double hit, Newcomer says. Not only are these patients dealing with the serious burden that accompanies their psychiatric disorder, but they also have an increased risk and an increased burden from major medical conditions like diabetes, heart disease and stroke. Ultimately, it is the unrecognized risk factors and the under-diagnosed and under-treated conditions that significantly shorten the lifespan.

Newcomer says several factors conspire to elevate risk including reduced access to appropriate medical care. Major mental disorders significantly impair a person's ability to work and learn, so patients tend to have lower incomes and poorer dietary habits, often relying instead on fast food. In addition, patients with serious psychiatric illness are much more likely to smoke � between 50 percent and 80 percent smoke cigarettes � and although the severely mentally ill make up only between 5 percent and 10 percent of the population, they consume a disproportionate amount of all cigarettes smoked in the United States. Many psychiatric medications also tend to contribute to weight gain, in part by making people less active and sometimes by stimulating appetite, and weight gain can be a prominent side effect of some antipsychotic drugs in particular.

All of this adds up, Newcomer says. They are more likely to eat more high-fat food and to burn fewer calories, so it's not surprising that this population also tends to have higher rates of overweight and obesity.

But that's not the whole story. Newcomer also reports that patients with severe mental illness are significantly less likely to receive therapies of proven benefit for problems with cholesterol, diabetes, hypertension or heart disease. Those who have survived a heart attack are less likely to receive appropriate medications, cardiac catheterization procedures or bypass surgery than heart-attack patients without mental illness.

Regarding preventive care, Newcomer cites data from a national study of 1,500 patients with chronic schizophrenia. They participated in the National Institute of Mental Health-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. The CATIE study found that 88 percent of patients entering the study with high cholesterol did not take lipid-lowering drugs. Another 30 percent with diabetes at the start of the study received no anti-diabetes medications, and 62 percent of those with high blood pressure were not taking any antihypertensive medication.

Those with severe psychiatric illness also are less likely to be screened for high cholesterol, high blood pressure or diabetes despite the evidence of increased risk in general and specific evidence that some antipsychotic drugs can have adverse effects on body weight, glucose metabolism and lipid levels.

A solution, Newcomer argues, will emerge only if psychiatrists and primary-care providers can work together.

This requires coordination, he says. And coordination between psychiatric professionals and primary-care providers is not easy when they often are physically located in different places. There are transportation issues and scheduling issues. For healthy people, the need to make an extra appointment lowers the probability that it will actually happen, and research further indicates that when patients with severe mental disorders have to go across the hall, it reduces the probability they will get care. If they have to cross the street, the probability gets even lower. If it's across town � well, without case managers and others working closely with these patients, in general those follow-ups won't happen.

Newcomer says another problem is that lifestyle interventions that encourage healthy eating, smoking cessation and exercise can be difficult enough in the general population, but they are even more difficult when patients with schizophrenia or other mental disorders are involved. He says such behavioral interventions have been shown to work even in those with severe psychiatric illness, but achieving success requires extra commitment and resources from the health-care community.

Getting psychiatrists to change their routine is important. Newcomer says that to lower risk of cardiovascular complications, psychiatrists may need to regularly weigh their patients, take blood pressure and screen appropriately for blood glucose, cholesterol and triglycerides.

We're not saying psychiatrists should start prescribing lipid-lowering agents or diabetes drugs, but they are on the 'front lines,' seeing psychiatric patients much more than primary-care providers, Newcomer says. It's important that psychiatrists begin to employ some of these basic screening techniques.

He also says that it's vital that patients with severe mental disorders receive needed psychiatric medications, even though some of those drugs may contribute to weight gain, abnormal lipid levels and risk for cardiovascular disease and diabetes.

If you have a serious psychiatric condition like schizophrenia, you really need to take medication, Newcomer says. Clearly we don't want people to stop taking their medicine, but in some cases, there may be alternative drugs that have fewer effects on risk for obesity or diabetes. Combinations of diet, exercise and selected medication are being studied to lower these risks without losing the benefits that antipsychotic drugs provide for these patients with severe psychiatric illness.

And Newcomer believes if such strategies can be developed and implemented, it is possible to quickly lower rates of cardiovascular disease and increase life expectancy in this population.

I think there's some 'low-hanging fruit' here, he says. Just getting psychiatrists engaged in this type of general health monitoring should help. Most of these patients already are seeing a physician, and if that physician and medical team can screen for cardiovascular risk factors, we may be able to intervene and find ways to lower that risk significantly.

Genes that both extend life and protect against cancer identified

Sun, 14 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) A person is 100 times more likely to get cancer at age 65 than at age 35. But new research reported today in the journal �Nature Genetics� identifies naturally occurring processes that allow many genes to both slow aging and protect against cancer in the much-studied C. elegans roundworm.

Many of the worm genes have counterparts in humans, suggesting that new drugs may some day ensure a long, cancer-free life. The new research and a related study the scientists reported in �Science� last year indicate that cellular changes leading to longevity antagonize tumor cell growth.

The studies are by scientists at the University of California, San Francisco, who say the research also underscores the deep evolutionary connection between lifespan and cancer.

The worms, known formally as Caenorhabditis elegans, were the stars of a startling 1993 discovery by UCSF biologist Cynthia Kenyon, PhD. She found then that a change in just one gene, called daf-2, doubled the worms� lifespan. This finding led to the understanding that lifespan is regulated by genes and is therefore changeable, rather than the inevitable result of the body�s breakdown. The discovery in worms has been confirmed in other animals including mice.

The new research by Kenyon and graduate student Julie Pinkston is reported in the advanced online edition of the journal.

Kenyon is the American Cancer Society Professor and director of the Hillblom Center for the Biology of Aging at UCSF.

�This is very exciting,� Kenyon said. �There is a widely held view that any mechanism that slows aging would probably stimulate tumor growth. But we found many genes that increase lifespan, but slow tumor growth. Humans have versions of many of these genes, so this work may lead to treatments that keep us youthful and cancer-free much longer than normal.�

Since her early finding that the gene daf-2 and another gene known as daf-16 regulate lifespan, Kenyon�s research team has hoped to identify the genes that they in turn affect -- those that more directly affect aging and tumor growth.

�Now we are really getting there,� Kenyon said.

The gene daf-2 codes for a receptor for insulin and also for an insulin-like protein that promotes growth. It influences daf-16, which makes a so-called transcription factor � a protein that determines when and where hundreds of other genes are turned on. The focus of the new study was to identify specific genes regulated by daf-16 which affect cancer and/or lifespan.

The scientists used an established tumor model in the worms. Then, starting with a list of 734 genes known to be targets of daf-16, they identified 29 genes that either promote or suppress tumor cell growth. They did this using several techniques, including RNA interference or RNAi, a powerful tool that allows scientists to control the expression of just one kind of gene at a time.

About half of the genes stimulated tumor growth and half suppressed it, they found. Strikingly, about half of these genes also affect lifespan in animals that do not have tumors, further strengthening the model Kenyon and others have conceived in which the insulin receptor, daf-2, works in concert with the transcription factor daf-16 to link longevity and tumor resistance. The �downstream� genes appear to act in a cumulative way, they found.

The genes that stimulated tumor growth also accelerated aging itself, and the genes that prevented tumor growth slowed down the aging process and extended lifespan. These findings greatly strengthen the view that the controls of lifespan and cancer have deep, common roots, Kenyon and Pinkston conclude.

AFAR/Ellison Medical Foundation increase commitment to scientists studying aging

Fri, 12 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) New York, October 11, 2007 - At a time when established scientists are leaving academia because of a lack of funding for biomedical research and a potential new generation of scientists are considering whether to even enter a field with a competitive funding environment, the Ellison Medical Foundation in partnership with the American Federation for Aging Research (AFAR), has increased funding for two critical grant programs: the new Ellison Medical Foundation/AFAR Postdoctoral Fellows in Aging Research Program and the Julie Martin Mid-Career Awards in Aging Research.

The Ellison Medical Foundation has awarded AFAR more than $2.8 million to support 45 postdoctoral fellows (both MDs and PhDs at any level of postdoctoral training) over the next three years in the fundamental mechanisms of aging. With this new commitment, the Ellison Medical Foundation/AFAR partnership has increased five-fold the number of researchers it will support.

�We are grateful to the ongoing and continued support of the Ellison Medical Foundation in expanding the postdoctoral fellowship program, said Stephanie Lederman, Executive Director of the American Federation for Aging Research. �There are so many promising scientists yet we are only able to fund eight percent of the applicants who seek grants. There�s a potential to lose a tremendous brain trust of future leaders in aging research. The Ellison Medical Foundation has taken a lead role in helping the next generation of researchers establish careers and an aging society will benefit,� she added.

�The potential for dramatic discoveries in biological and biomedical science applied to aging is greater now than at any other time in history,� said Richard L. Sprott, PhD, Executive Director of the Ellison Medical Foundation. �In the face of this opportunity we currently see declining federal support for scientists. Those just beginning their careers are especially vulnerable as support dries up. Our hope is that this decline is temporary, yet even a temporary reduction in support for scientists just beginning their careers, or those deciding whether to stay in science or build a career elsewhere, could result in the loss of most of a whole generation of scientists. Our partnership with AFAR is an important part of our overall strategy to help sustain as many developing investigators of aging as can survive the current funding shortage. Partnership with AFAR helps both organizations maximize the impact of funding by maximizing the quality of the review process using AFAR reviewers and minimizing the administrative burdens by combining our programs into a single, highly effective program,� Dr. Sprott added.

Time and Money Constraints; other barriers hinder care for dementia

Thu, 11 Oct 2007 14:48:39 PST

( from http://www.rxpgnews.com ) (SACRAMENTO, Calif.) -- Built-in limitations of the health-care system in the United States, such as time and reimbursement constraints, inhibit the ability of primary care doctors to best meet the needs of dementia patients and their families, according to a new study by researchers at UC Davis Health System.

In a study now available in the online edition of the Journal of the Society of General Internal Medicine, the researchers found that physicians often feel challenged in caring for dementia patients, especially those who are more behaviorally complex. Constraints that are intrinsic to the contemporary practice of medicine may lead to the delayed detection of behavioral problems, a reactive as opposed to proactive management of dementia, and an increased reliance on treatment with drugs instead of psychosocial approaches.

However, the researchers also note that short of major organizational changes, there are steps that individual primary care physicians can take to help dementia patients and their families.
Based on interviews with 40 primary care physicians in Northern California, the study assessed a variety of practice constraints, including low reimbursements, lack of teamwork, and rushed office visits. The principal investigator is Ladson Hinton, associate professor in the UC Davis Department of Psychiatry and Behavioral Sciences.

“Our study highlights layer after layer of issues that are contributing to a growing public health crisis where patients with dementia and Alzheimer’s are concerned,” said Hinton. “The present system is just not set up to meet their needs. These structural constraints are clearly very important, but we found that physicians often omit simple interventions that may help families find help for behavioral issues, such as a referral to the local Alzheimer’s Association or the National Institute on Aging’s Alzheimer’s Disease Education and Referral Center, at (800) 438-4380.”

The interviews identified these systemic constraints to providing good care to people with dementia and their families:
· Lack of sufficient time
· Low reimbursement
· Difficult access and communication with specialists and social service agencies
· Lack of an interdisciplinary team approach

The physicians interviewed said it was difficult to care for persons with dementia during the standard 15 minutes typically allotted for appointments. This lack of time and the subsequent failure to systematically assess behavioral problems may delay their detection and management until a time of crisis, according to the study.

Insufficient time, overwhelming workloads and unfamiliarity with dementia-related problems inhibited some physicians’ desire to see patients with dementia.

“We are all trying to keep our heads above water,” said one doctor. “These people (patients with dementia) do take a lot of time and energy. Sometimes … you just don’t want these people in your practice because a 15-minute visit turns into much more than that.”

The time constraints were noted across different types of practice settings. In large group practices, clinicians are pressured to practice in a “time-efficient” manner and have little control over scheduling. In smaller group and solo practices, clinicians had more flexibility but still felt compelled to see patients quickly because of economic pressures.

One of the interviewed physicians said that the lack of time and other barriers to good care leads to “reactive care” that may contribute to family burnout and, ultimately, to the patient’s institutionalization. In addition, the study states, “Clinicians may rely more on medications if they are less familiar with psychosocial approaches or perceive these as potentially more time-consuming.”

An over-reliance on drugs has important public-health implications, the study says, because recent research calls into question “the efficacy and safety of psychotropic medications for older adults with dementia, making non-pharmacological approaches more attractive from a risk-benefit perspective.”

Interviewees also noted that the reimbursement process for physicians inaccurately reflects the time required to care for patients with dementia. They cited limitations of “relative value units,” or RVUs, a nationally standardized scale that is used by Medicare and many health insurance companies, and is intended to reflect the time, technical skill and mental effort required of a provider to perform a service.

“When you deal with a patient who has dementia … as well as hypertension and diabetes, it’s a lot more complicated than the intact 50-year-old hyperintensive diabetic, but the reimbursement is the same,” said one physician.

Because of their relative unfamiliarity with dementia, primary care physicians often seek consultations with specialists such as neurologists and psychiatrists, but just as often find it difficult to do so “because of limited availability and cumbersome referral processes,” the study states. Access to specialists is complicated further by certain insurance plans in which mental health benefits are “carved out” to a mental health care manager. Under this system, patients are required to set up their own appointments.

“I have not had very many patients who have been successful in getting into the system, and they have to be very persistent,” said one physician. “It is really a harsh system the way it is set up.”

Better education of and support for families to be more proactive in making requests for appropriate treatments is one of the study authors’ suggestions for improving care for patients with dementia. Improvement in care also might be achieved via physician education on the management of behavioral problems and availability of community services and agencies. In larger practices, dementia care teams could be established to help manage more complicated cases. Improved medical coding that more accurately reflects time spent with patients and families also could help, the study states.

“More ambitious” reforms include increasing reimbursement for treating patients with “substantial behavioral complexity,” and establishing incentives for delivering more comprehensive, albeit costly, care upfront to delay costlier, subsequent outcomes, such as institutionalization.

Without improvements, “dementia in primary care settings is likely to continue to fall short of standards of good care,” the researchers state. “As a result, persons with dementia, particularly those with difficult behavioral issues, will be unnecessarily exposed to psychopharmacological drugs and increased risk of institutionalization.”

Among the study’s limitations noted by the authors was its reliance on physician perspectives rather than those of other stakeholders, such as families. Also, the surveyed physicians were in a single geographic region and not representative of physicians nationwide.

However, the study stated “that despite this geographic limitation, physicians were practicing in a variety of treatment settings, making it more likely that the findings will generalize across settings.”

Prostate cancer increases hip fracture risk by eight times in 50 to 65 year-olds

Thu, 11 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Men who have prostate cancer are on average four times more likely to suffer a hip fracture, with rates rising to eight times in men aged 50 to 65, according to a study of more than 60,000 men published in the October issue of the urology journal BJU International.

Danish researchers looked at 62,865 men aged 50 and over, with an average age of just under 67.

15,716 had suffered a fracture of some description and 47,149 formed the non-fracture control group.

They discovered that prostate cancer made men 1.8 times more likely overall to suffer a fracture and 3.7 times as likely to suffer from a hip fracture. But the hip fracture risk was eight times higher in men from 50 to 65 years of age. No increased risk of vertebral fractures was found by the research.

�Our study showed that more than three per cent of hip fractures in men aged 50 and over can be attributed to prostate cancer� says lead researcher Dr Bo Abrahamsen from Copenhagen University Hospital, Gentofte. �And the risk remains even when men have recovered from the disease.�

The researchers - urologists and endocrinologists from Danish hospitals attached to the University of Southern Denmark and Copenhagen University - now plan to establish a multi-centre initiative focussing on the early diagnosis and treatment of osteoporosis in men with prostate cancer.

�Prostate cancer is now the cancer that men are most likely to develop and is a leading cause of male deaths in Europe and the USA� stresses Dr Abrahamsen.

�American research has also shown that men have a 17 per cent chance of prostate cancer during their lifetime. And Danish research has discovered that deaths from the disease have more than tripled since the Second World War.

�Medical advances are improving survival rates, but the downside is that treatment can lead to osteoporosis, where the bone loses density and becomes more fragile. This is turn increases the risk of fractures.�

The researchers used data from the Danish National Hospital Discharge Register, the National Bureau of Statistics and the National Prescription Database to identify patients aged 50 and over who had suffered a fracture. They then used the same data to identify an age-matched control group.

�Our research showed that the increased fracture risk became apparent in the early stages after diagnosis and remained pronounced even in long-term survivors� says Steen Walter, Professor of Urology at Odense University Hospital.

�Men who received hormone therapy (ADT) or had their testicles surgically removed to slow the progression of the disease were 1.7 times more likely to suffer a fracture.�

The authors point out that the research only covered the 15 per cent of ADT doses issued on prescription. The majority of the doses are issued by hospital departments, which means they cannot be traced to individual patients. So the actual impact of ADT on national fracture levels could be even greater.

Other issues were also found to lead to increased fracture rates.

�The study showed that the men in the fracture group were almost three times as likely as the control group to have suffered a previous fracture. They were also more likely to live alone and be in a lower income group� says Dr Abrahamsen.

Building efficient, effective, locally sensitive solutions for dementia care

Thu, 11 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) INDIANAPOLIS � Dementia is a growing burden for society, propelling patients and caregivers to increasingly use the health-care system. A year ago, local researchers, health-care professionals, and community advocates came together to form the Indianapolis Discovery Network for Dementia (IDND) to enhance dementia care in the nation�s twelfth largest city.

On Oct. 20, IDND will launch RAPID-PC � Recognizing and Assessing the Progression of Cognitive Impairment and Dementia in Primary Care with a summit meeting for researchers, clinicians, nurses, nurse practitioners and physician assistants to share experiences and progress.

The group is drawing upon unique features of the Indianapolis health-care environment, the most wired in the nation, to develop a model which they believe other communities can use to enhance the delivery of dementia care.

�If tomorrow we developed a breakthrough in dementia treatment such as a vaccine, it would take 17 years and $800 million for that development to become available as a prescription and it would reach only a fraction of those who could benefit from it. That isn�t acceptable,� said Malaz Boustani, M.D., M.P.H., an assistant professor of medicine at Indiana University School of Medicine, an Indiana University Center for Aging Research investigator and a Regenstrief Institute research scientist. Dr. Boustani, IDND�s chief research officer, bases his estimates on a systematic review of drug development literature.

According to Dr. Boustani, in the state of Indiana, which he says is representative of the U.S. as a whole, 60 percent of people with dementia or pre-dementia (also known as mild cognitive impairment) are not recognized as having these conditions when they go to a hospital and 80 percent are not recognized as having dementia or pre-dementia by their primary care physicians. The result is that less than 10 percent receive medications appropriate to their level of cognitive impairment and approximately a quarter receive medications which are inappropriate.

�Nationwide, the health-care system is not delivering good dementia care because we have not presented a comprehensive assessment of the biopsychosocial needs of a person with dementia and have not followed up with solutions that are sensitive to local community needs and resources,� said Dr. Boustani, who is a geriatrician. Eight out of 10 individuals with dementia living in the community have significant behavioral and/or psychological symptoms that require medical and psychological care.

He also notes that caregivers have been largely ignored in spite of the fact that they provide millions of unpaid care hours per year (180 million hours valued at $1.7 trillion in Indiana in 2005) and are hospitalized at a very high rate (24 percent over a six-month period in Indiana).

With Rapid-PC, IDND is taking a major step toward its goal of building efficient, effective, locally sensitive solutions for dementia care.

Patients can't recall their medications to tell doctors

Thu, 11 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) CHICAGO --- Doctors rely on patients to accurately tell them what prescription medications � and what dosages -- they are taking in out-patient visits. (A patient's chart may not always be available or complete.) That information is essential for physicians to monitor whether a drug is working, and whether it may have adverse interactions with any new medications prescribed.

Depending on patients� recall of their drugs, however, may be dangerous to their health.

New research from Northwestern University�s Feinberg School of Medicine has found that nearly 50 percent of patients taking antihypertensive drugs in three community health centers were unable to accurately name a single one of their medications listed in their medical chart. That number climbed to 65 percent for patients with low health literacy.

�It was worse than we expected,� said lead author Stephen Persell, M.D., an assistant professor of medicine, and of the Institute for Healthcare Studies at the Feinberg School, and a physician at Northwestern Memorial Hospital. �It means doctors can�t ask patients to tell them the medications they are taking for their chronic conditions like hypertension. It�s very hard to get at the truth of what medications the patient is actually taking.�

The study will be published in the November issue of the Journal of General Internal Medicine.

The Northwestern study looked at 119 patients, average age 55, from community health centers in Grand Rapids, Mich. Researchers asked them to name their antihypertensive drugs and then compared their answers to the drugs listed in their medical charts.

While the study focused on low-income patients, Persell said other patients likely have similar trouble recalling the names and dosages of all their medications, particularly those who take a lot of different drugs and the elderly, who may have cognitive limitations.

The gap between what medications a doctor thinks a patient is taking � and what a patient actually takes � is a new focus for improving the safety and quality of health care. One third of the nation's 1.5 million adverse drug events occur in out-patient settings, resulting in a cost of $1 billion annually. Persell thinks this knowledge of medication gap may be one of the causes.

The goal is medication reconciliation, a term in the healthcare field that means patients and their healthcare providers understand and agree on the medications the patients are using and should be using.

Persell's study also showed patients with low health literacy were prescribed more antihypertensive medications than other patients and had higher blood pressure by about five points.

�We think doctors may be prescribing more medications because the patients aren�t giving them the right information about what they are taking,� he said.

Even examining patients� medical records won�t necessarily tell a doctor what pills a patient is swallowing. Persell said some patients continue to fill old prescriptions even if a doctor has changed the dosages or the medication.

�I�ve seen patients who continued on drugs that I told them to discontinue and stop taking drugs I never told them to stop using, Persell said.

The solution is to ask patients to bring all their current medicine bottles to doctor appointments, so the physician can compare them to what has actually been prescribed in the medical charts, Persell noted. That's how he learned a patient he had switched to a cheaper version of a drug continued to take the older expensive one along with the new one, so he was double dosing himself.

This could have caused a dangerous drop in his heart rate and blood pressure, Persell said.

The Northwestern study indicates a need for future research to address how patients� inability to name their medications -- particularly those with limited health literacy -- impacts hypertension control and drug safety, Persell said.

Limiting refined carbohydrates may stall AMD progression

Mon, 08 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Eating fewer refined carbohydrates may slow the progression of age-related macular degeneration (AMD), according to a new study from researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University.

AMD results in partial or total blindness in 7 to 15% of the elderly, according to the Eye Diseases Prevalence Research Group. �Dietary changes may be the most practical and cost-effective prevention method to combat progression of AMD,� says Allen Taylor, PhD, director of the Laboratory for Nutrition and Vision Research at the USDA HNRCA. �It is surprising there is so little attention focused on the relationship between AMD and carbohydrates.�

The current study, published in the October issue of the American Journal of Clinical Nutrition, builds on a recent analysis by Taylor and colleagues that found men and women older than 55 who consumed diets with higher-than-average dietary glycemic index foods appeared to have an increased risk for both early and later stages of AMD.

Dietary glycemic index is a scale used to determine how quickly carbohydrates are broken down into blood sugar, or glucose. Foods with a high glycemic index are associated with a faster rise and subsequent drop in blood sugar. Refined carbohydrates like white bread and white rice have high glycemic indices. Whole wheat versions of rice, pasta and bread are examples of foods with low glycemic indices.

In the present study, Taylor and colleagues analyzed diet questionnaires completed by 4,757 non-diabetic men and women participating in the nationwide Age-Releated Eye Disease Study (AREDS). The eight-year AREDS study enrolled participants between the ages of 55 and 80 with varying stages of AMD. Taylor and colleagues examined the participants� carbohydrate intake over a one-year period and used the data to calculate the participants� dietary glycemic index.

�Our data showed those people in the high-glycemic-index group were at greater risk of AMD progression, especially those already in the late stages,� says first author Chung-Jung Chiu, DDS, PhD, scientist in the Laboratory for Nutrition and Vision Research at the USDA HNRCA and assistant professor at Tufts University School of Medicine. �Participants who consumed the most refined carbohydrates were 17 percent more likely to develop blinding AMD than the group that consumed the least.�

According to the authors, public health officials believe the condition could spur a public health crisis in the United States by 2020, when they predict the cases of AMD-related vision loss will have doubled to three million.

�No one has been able to identify an effective noninvasive intervention that will slow the progression of AMD� says Taylor, who is also a professor at the Friedman School of Nutrition Science and Policy at Tufts and Tufts University School of Medicine. �We feel we have identified a risk factor that could postpone the debilitating loss of vision with very little economic or personal hardship. Based on our data, limiting refined carbohydrate intake, such as by limiting sweetened drinks or exchanging white bread for whole wheat, in at-risk elderly could reduce the number of advanced AMD cases by 8 percent in five years. This can equate to saving the sight of approximately 100,000 people.�

The authors note that their findings warrant randomized controlled clinical trials.

New telomere discovery could help explain why cancer cells never stop dividing

Thu, 04 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Lausanne, Switzerland, October 4, 2007 � A group working at the Swiss Institute for Experimental Cancer Research (ISREC) in collaboration with the University of Pavia has discovered that telomeres, the repeated DNA-protein complexes at the end of chromosomes that progressively shorten every time a cell divides, also contain RNA. This discovery, published online October 4 in Science Express, calls into question our understanding of how telomeres function, and may provide a new avenue of attack for stopping telomere renewal in cancer cells.

Inside the cell nucleus, all our genetic information is located on twisted, double stranded molecules of DNA which are packaged into chromosomes. At the end of these chromosomes are telomeres, zones of repeated chains of DNA that are often compared to the plastic tips on shoelaces because they prevent chromosomes from fraying, and thus genetic information from getting scrambled when cells divide. The telomere is like a cellular clock, because every time a cell divides, the telomere shortens. After a cell has grown and divided a few dozen times, the telomeres turn on an alarm system that prevents further division. If this clock doesn�t function right, cells either end up with damaged chromosomes or they become �immortal� and continue dividing endlessly � either way it�s bad news and leads to cancer or disease. Understanding how telomeres function, and how this function can potentially be manipulated, is thus extremely important.

The DNA in the chromosome acts like a sort of instruction manual for the cell. Genetic information is transcribed into segments of RNA that then go out into the cell and carry out a variety of tasks such as making proteins, catalyzing chemical reactions, or fulfilling structural roles. It was thought that telomeres were �silent� � that their DNA was not transcribed into strands of RNA. The researchers have turned this theory on its head by discovering telomeric RNA and showing that this RNA is transcribed from DNA on the telomere.

Why is this important In embryonic cells (and some stem cells), an enzyme called telomerase rebuilds the telomere so that the cells can keep dividing. Over time, this telomerase dwindles and eventually the telomere shortens and the cell becomes inactive. In cancer cells, the telomerase enzyme keeps rebuilding telomeres long past the cell�s normal lifetime. The cells become �immortal�, endlessly dividing, resulting in a tumor. Researchers estimate that telomere maintenance activity occurs in about 90% of human cancers. But the mechanism by which this maintenance takes place is not well understood. The researchers discovered that the RNA in the telomere is regulated by a protein in the telomerase enzyme. Their discovery may thus uncover key elements of telomere function.

�It�s too early to give yet a definitive answer,� to whether this could lead to new cancer therapies, notes Joachim Lingner, senior author on the paper. �But the experiments published in the paper suggest that telomeric RNA may provide a new target to attack telomere function in cancer cells to stop their growth.�

Linking cigarette smoke and obesity: What our genes and environmental factors tell us

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) RICHLAND, Wash. � Identifying biomarkers for the key environmental risk factors responsible for two diseases that significantly contribute to death and disease of hundreds of thousands annually will be the initial focus of a new center being established at Pacific Northwest National Laboratory. PNNL will house the Center for Novel Biomarkers of Response, made possible by a $5.9 million grant recently awarded by the National Institutes of Health�s Gene and Environment Initiative.

Scientists at the center intend to create new exposure assessment tools to better understand the role of gene-environmental interactions in human disease. Development of these tools will help scientists precisely measure personal exposure to environmental, chemical and biological agents.

�While the Human Genome Project has enabled faster, cheaper gene sequencing of individuals,� said PNNL Center Director and toxicologist Joel Pounds, �genes alone don�t tell the whole story. The environment plays an enormous role in complex disease development including cancers, asthma, diabetes and neurodegerative diseases.�

�We can identify genetic variability and the genetic factors in an individual person, but it is much more difficult to define an individual�s environment and chemicals he or she is exposed to,� said Pounds. �Our challenge will be to understand how genes and the environment interact. To do that, we have to improve the ability to measure environmental factors at the individual level.�

Two of the most important risk factors for human morbidity and mortality � cigarette smoke and obesity � will be the primary targets of interest for PNNL scientists. Research will focus on biomarkers for systemic stress caused by mainstream and second-hand cigarette smoke, with obesity as a confounding physiological factor. PNNL will team with researchers from the University of Utah and Battelle Toxicology Northwest in conducting this research.

This research, in support of the NIH Gene and Environmental Initiative, is comprised of two basic elements. The genetic component will rely on newfound abilities to swiftly identify genetic differences between people with illnesses and those who are healthy, leading to a greater understanding of genetic contribution to the disease. The environmental biology component will focus on developing new technologies to accurately measure personal exposures with small, wearable sensors that can be used to assess environmental agents.

The center will provide NIH�s National Institute of Environmental Health Sciences with a database of response biomarkers, as well as chemical substances for selected markers that are tested and validated in humans and supported by parallel studies in mice. The researchers will also develop prototype nanotechnology-based sensors for measurement of biomarkers at the point of care.

Plasma samples for the study will be obtained from 500 individuals participating in a study being conducted by the University of Utah. That study includes non-smokers, smokers, smokers with chronic obstructive pulmonary disease, and people exposed to second-hand smoke. Researchers at the W.R. Wiley Environmental Molecular Sciences Laboratory located at PNNL will identify the peptides from these samples using state-of-the art tandem mass spectrometry.

Over the course of the four-year project, scientists will work closely with PNNL�s Environmental Biomarkers Initiative. The EBI is an internally funded program, which has provided the scientific foundation and initial laboratory tools for the NIH center.

CU-Boulder worm study sheds light on human aging, inherited diseases

Mon, 01 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Microscopic worms used for scientific research are living longer despite cellular defects, a discovery that is shedding light on how the human body ages and how doctors could one day limit or reverse genetic mutations that cause inherited diseases, according to a new University of Colorado at Boulder study.

In the first formal study of its kind, researchers manipulated the metabolic state of genetically engineered lab worms called C. elegans and discovered a window of high-efficiency cellular processing that enabled the worms to slow their rate of aging. The findings could one day contribute to the creation of gene therapies to reverse or lessen the effects of mitochondrial diseases, the largest family of human genetic diseases, said lead study author Shane Rea of CU-Boulder's Institute for Behavioral Genetics.

Diseases labeled as mitochondrial are those that affect the mitochondria, the membrane-enclosed power sources present in all cells, Rea said. Researchers believe their insights might find application in treating diseases linked to mitochondrial dysfunction such as Huntington's, Parkinson's and Alzheimer's.

We appear to have found a window where life is able to preserve itself even better than when operating in the absence of any cellular defects, said Rea. It's a metabolic state where cells are probably getting close to the best they can be for long life and good health.

Pioneering CU-Boulder worm researcher and Professor Thomas E. Johnson and the University of Rome's Natascia Ventura co-authored the study. Grants from the National Institutes of Health and other agencies funded the research. The findings will appear in the Oct. 2 edition of the Public Library of Science journal PLoS Biology.

Rea, who will continue his research at the University of Texas Health Science Center in San Antonio later this year, said the study validates the worm model for research into the causes of human aging and disease.

For nearly a decade, scientists have experimented with RNA interference, or RNAi, technology to reduce gene expression with an eye toward learning more about human disease, Rea said. The technique is an effective way to silence specific pieces of DNA -- the genetic material that makes up the basic building blocks of life -- in living organisms, he said.

Rea and his team used RNAi to produce worms with varying levels of mitochondrial dysfunction with the hope of solving a mystery that has baffled scientists for years. They wanted to know why the genetically engineered worms, known as Mit mutants, lived longer despite cellular defects that would have caused similarly damaged human cells to become diseased or die off in the lab.

The team concluded that long life occurs in worms only when energy production by their mitochondria is reduced to very discrete levels. By tweaking cells into that tight little window of high efficiency, we may be able to increase the life span and health span of both sick and healthy people, Rea said.

The research suggests that the worms' cells receive signals from their nuclei as DNA problems are sensed and not, as previously thought, from their disrupted mitochondrial power sources. The signal-sending nuclei order cells to shut down DNA replication, allowing them time to fix problems and create an environment that copes better with DNA damage and stress, researchers believe.

It is only in this window that survival is enhanced. Once you move too far outside, then, like human cells, worm cells also die, Rea said. We think there's a whole shift in the metabolism and the way it protects DNA. We show very clearly in our work that long life is intimately linked with the control of cell division.

The process appears to mimic the hunker down survival mode that stressed animals adopt during times of famine and danger. When conditions improve, the animals procreate again to ensure the survival of their species.

In the future, Rea and his collaborators hope to build on these findings with biochemistry and genetics to discover what controls this pro-longevity mode and how humans can reduce oxidative stress that causes cellular damage. Life extension in humans is around the corner. There is no doubt about it, Rea said.

Acute lung injury patients one-third less likely to die in 'closed' model ICUs

Fri, 28 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Patients with acute lung injury (ALI) are nearly one-third less likely to die if they are treated at ICUs that require board-certified critical care physicians to oversee patient care, as compared to patients treated at ICUs that allow any attending physician to oversee admission and case management.

ALI is an inflammatory disorder of the lung often seen in patients with pneumonia or sepsis. Mortality rates are high -- about 40 percent -- and worsen with age and co-morbidities. Treatment generally involves addressing the underlying condition and providing protective low tidal volume mechanical ventilation and supportive therapy.

�ICUs that require patient transfer to an intensivist run team or mandate a co-attending intensivist are associated with reduced mortality in patients with ALI,� wrote Miriam Treggiari, M.D., M.P.H., of the Harborview Medical Center at the University of Washington, who led the study that appears in the first issue for October of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

The study is the first to use data from a population-based prospective cohort of patients to evaluate outcomes of different ICU organizational models. As part of the National Institutes of Health funded King County Lung Injury Project, all patients in Seattle area ICUs receiving mechanical ventilation were screened for ALI, between April 1999 and July 2000. Detailed data on co-morbidities, length of hospital stay and discharge information was collected. Questionnaires were sent to both the medical directors and/or attending physicians of the ICUs and the nurse managers to assess the organizational model and structure of the ICUs. The final study group included 1,075 patients in 22 ICUs across 16 hospitals.

Two-thirds of the patients were treated at �closed� ICUs�units that require cases to be managed by board-certified critical care physicians or that mandate intensivists to co-manage on all patients. The remaining third received care at �open� ICUs, where cases could be managed by any attending physicians with admitting privileges, and pulmonary consultations were optional. According to the American College of Chest Physicians, only 25 percent of ICUs nationwide follow the closed model.

There were no significant differences in the degree of illness between patients who were cared for in closed versus open ICUs as measured by Acute Physiological and Chronic Health Evaluation III (APACHE III) scores, but patients at closed ICUs were younger and more likely to be male.

�Patients cared for in a closed ICU had statistically significantly lower mortality than patients cared for in open ICUs,� the researchers reported. Interestingly, the effect remained significant after adjusting for a number of variables in the analysis. While 77 percent of patients in closed ICUs were seen by a pulmonary consultant, consults alone did not have a significant effect on mortality. Similarly, adjusting for nurse-to-patient ratio and hospital volume of mechanically ventilated patients had no effect on mortality. Of patients treated in open ICUs, 45 percent died; in closed ICUs there was 35 percent mortality.

The investigators noted that because of the small sample size of hospitals and the date of the data collection, it would be difficult to extrapolate their results to a general trend among ICUs in the United States. Noting that the use of low tidal volume mechanical ventilation differed between closed and open ICUs, the researchers remarked that other unrecognized differences in patient care could exist, but that their results add support for the positive effect of a closed ICU model on patient outcome.

�These findings add to the evidence of the important role of intensivist staffing in caring for critically ill patients, and support the recommendations to implement closed-model ICUs in the United States,� said Dr. Treggiari. �Further studies will need to investigate if the beneficial effects of closed ICU derive from higher degree of staffing that could facilitate earlier recognition of critical/deteriorating conditions or greater expertise in the specific management aspects of critical care patients.�

Genes linked to suicidal thinking during antidepressant treatment

Thu, 27 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Specific variations in two genes are linked to suicidal thinking that sometimes occurs in people taking the most commonly prescribed class of antidepressants, according to a large study led by scientists at the National Institutes of Health�s (NIH) National Institute of Mental Health (NIMH). Depending on the particular mix inherited, these versions increased the likelihood of such thoughts from 2- to15-fold, the study found. About 1 percent of adult patients were deemed to be at high genetic risk, 41 percent at elevated risk and 58 percent at lower risk.

If confirmed, the findings may hold promise for genetic testing, as more such markers are identified.

Risk increased proportionately if a participant had two, as opposed to just one of the suspect versions. Both genes code for components of the brain�s glutamate chemical messenger system, which recent studies suggest is involved in the antidepressant response.

Overall, about 6 percent of 1,915 patients with depression reported that they started to have suicidal thoughts while taking an antidepressant. This rate soared to 36 percent among the few patients with both of the suspect gene versions; 59 percent of the patients who had suicidal thoughts had at least one of the versions.

Francis J. McMahon, M.D., Gonzalo Laje, M.D., NIMH Mood and Anxiety Disorders Program, and colleagues at the National Human Genome Research Institute (NHGRI), Mount Sinai School of Medicine, and the University of Texas Southwestern Medical Center, report on their findings in the October, 2007 issue of The American Journal of Psychiatry.

�These data suggest that genetics may soon help us in our quest to individualize treatments for depression,� said NIMH Director Thomas R. Insel, M.D.

�In the future, we hope that genetic testing will help doctors identify those few patients who are at high risk for suicidal thinking during antidepressant therapy and need close monitoring or alternative treatments,� said McMahon. �This should help allay concerns for the vast majority of patients. The best way to prevent suicide is to treat depression.�

In the most comprehensive study of its kind to date, McMahon and colleagues screened genetic material from 1,915 adult participants with major depression in level one of the NIMH-funded STAR*D (Sequenced Treatment Alternatives for Depression) trial. Study participants were treated with the selective serotonin reuptake inhibitor (SSRI) citalopram. The researchers looked for associations between self-reports of suicidal thinking and more than 700 sites in 68 suspect genes where letters in the genetic code vary across individuals, creating different versions of the same gene.

The researchers found that certain versions of two genes that code for glutamate receptors � the receiving stations for the neurotransmitter�s chemical messages � were more prevalent in patients with suicidal thinking. How the newly identified versions affect the workings of glutamate receptors to confer increased risk remains to be discovered. It�s also not yet known whether the findings generalize to other antidepressants.

One percent of the study participants had a version of the kainate receptor gene, GRIK2, that increased the odds for suicidal thinking more than 8-fold. Forty-one percent of participants had a version of the AMPA receptor gene, GRIA3, that raised the odds nearly 2-fold. About one-half of 1 percent of participants had both high risk gene versions, boosting the odds 15 fold � but this was the case for only 11 participants, of whom four developed suicidal thinking.

Neither version was related to self-reported history of suicide attempts. This suggests that the versions are specific to suicidal thoughts that occur during antidepressant treatment, rather than the much more common suicidal thoughts and behavior that occur outside of the treatment setting.

More than 40 percent of those who developed suicidal thoughts lacked either of the two versions, indicating that other genes and environmental factors were also likely involved. But the potential value of predictive testing is increasing as more genes are analyzed. McMahon�s group will report at a genetics conference in October on identification of additional versions that emerged from a scan of the whole genome in STAR*D patients. In July, NIMH funded researchers at Massachusetts General Hospital reported an association between variations in the CREB1 gene and treatment-emergent suicidal thinking among men in the STAR*D sample.

Earlier studies had shown that about 4 percent of youth treated with antidepressants experience suicidal thinking compared with about 2 percent of those taking placebos.

The resultant climate of concern culminated in the 2004 Food and Drug Administration decision requiring that antidepressants carry a black box warning about risk of suicidal thinking for children and adolescents � and later proposing that it be extended to young adults up to age 24. In 2004, the Centers for Disease Control recorded the largest spike in youth suicide rates in 15 years. NIMH-funded researchers recently suggested that this may have been related to a drop in antidepressant prescriptions for youth. By contrast, they note that suicide rates reached a record low in 2004 for adults over 60, for whom antidepressant prescription rates continued to rise; this inverse relationship held with increasing age. A more definitive analysis must await release of 2005 U.S. suicide rate data later this year, researchers say.

However, evidence suggests that neither suicidal thoughts, nor the high-risk gene versions, are necessarily related to actual suicide attempts, according to McMahon. Other studies have shown that the rate of such attempts is higher before antidepressant treatment begins � and suicide attempts are not always preceded by suicidal thoughts. For example, in the current study, one of the two participants who actually attempted suicide carried high-risk versions, but denied experiencing suicidal thoughts.

Even if suicidal thinking does not predict suicidal behavior, it is associated with a poorer response to antidepressant medication, the researchers say. Only 25 percent of patients with suicidal thinking fully recovered from their depression during the initial phase of the STAR*D trail, compared with 42 percent of patients not affected by such thoughts.

McMahon and colleagues hope that the newly identified versions may prove useful in identifying patients who need closer monitoring, alternative treatments and/or specialty care � while reassuring those for whom antidepressants are appropriate.