RxPG News : Aging

Simple lifestyle changes can prevent Alzheimer's

Wed, 20 Jul 2011 16:57:28 PST

( from http://www.rxpgnews.com ) Over half of all Alzheimer's disease cases can be prevented through lifestyle changes and treatment or prevention of chronic medical conditions.

The biggest risk factors for Alzheimer's disease are physical inactivity, depression, mid-life hypertension, low education, smoking, diabetes and mid-life obesity.

The findings are based on studies involving hundreds of thousands of participants worldwide, by Deborah Barnes, researcher at San Francisco Veterans Affairs Medical Centre and professor of psychiatry at the University of California, San Francisco.

Together, these risk factors are associated with up to 51 percent of Alzheimer's cases globally - and up to 54 percent cases in the US -, according to Barnes, reports journal Lancet Neurology.

'This suggests that some very simple lifestyle changes, such as increasing physical activity and quitting smoking, could have a tremendous impact on preventing Alzheimer's and other dementias in the US and worldwide,' said Barnes, according to Medical Centre statement.

The study results were presented at the 2011 meeting of the Alzheimer's Association International Conference in Paris, France.

Alzheimer's disease is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities.

--Indo-Asian News service

st/rah/tb

Falls- an early sign of Alzheimer's Disease

Tue, 19 Jul 2011 17:33:11 PST

( from http://www.rxpgnews.com ) Falls and balance problems may be early indicators of Alzheimer’s disease, researchers at Washington University School of Medicine in St. Louis report July 17, 2011, at the Alzheimer’s Association International Conference on Alzheimer’s Disease in Paris.

Scientists found that study participants with brain changes suggestive of early Alzheimer’s disease were more likely to fall than those whose brains did not show the same changes. Until now, falls had only been associated with Alzheimer’s in the late stages of dementia.

“If you meet these people on the street, they appear healthy and have no obvious cognitive problems,” says lead author Susan Stark, PhD, assistant professor of occupational therapy and neurology. “But they have changes in their brain that look similar to Alzheimer’s disease, and they have twice the typical annual rate of falls for their age group.”

Stark and her colleagues recruited 119 volunteers from studies of aging and health at Washington University’s Knight Alzheimer’s Disease Research Center. All the participants were 65 or older and cognitively normal.

Brain scans showed that 18 participants had high levels of amyloid plaques, a hallmark of Alzheimer’s. The two major findings in the brain of patients with Alzheimer's are amyloid plaques and neurofibrillary tangles. Amyloid plaques are found outside the neurons, neurofibrillary plaques are found inside the neurons. Amyloid plaques are mostly made up of a protein called B-amyloid protein. The other 101 volunteers had normal amyloid levels in the brain.

Participants in the study were asked to make a note of any falls. Then, the researchers followed up with a questionnaire and a phone interview about the falls. This follow-up allowed researchers to gather information for future analyses that will compare and contrast the nature of the falls.

About one in three adults age 65 or older typically fall each year. But in the 18 participants with high amyloid levels in the brain, two-thirds fell within the first eight months of the study. High levels of amyloid in the brain were the best predictor of an increased risk of falls.

“Falls are a serious health concern for older adults,” Stark says. “Our study points to the notion that we may need to consider preclinical Alzheimer’s disease as a potential cause.”

Vitamin D can help elderly women survive

Tue, 05 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Giving vitamin D3 (cholecalciferol) to predominantly elderly women, mainly in institutional care, seems to increase survival. These women are likely to be vitamin D deficient with a significant risk of falls and fractures. This is the key conclusion in a systematic review published in the latest edition of The Cochrane Library.

Up until now there has been no clear view on whether there is a real benefit of taking vitamin D. A Cochrane meta-analysis published only a couple of years ago found that there was some evidence for benefit, but it could not find an effect on mortality. We were, however, aware that more trials had been published and wanted to assess the effects of vitamin D when you added all the data together, said Dr Goran Bjelakovic, who works at Department of Internal Medicine - Gastroenterology and Hepatology, at the University of Nis, in Serbia and at The Cochrane Hepato-Biliary Group at The Copenhagen Trial Unit in Copenhagen, Denmark.

The eight-strong international team of researchers identified 50 randomised trials that together had 94,148 participants. They had a mean age of 74 years, and 79% were women. Our analyses suggest that vitamin D3 reduces mortality by about 6%. This means that you need to give about 200 people vitamin D3 for around two years to save one additional life, says Bjelakovic.

There were no significant benefits of taking other forms of vitamin D such as vitamin D2, and the active forms of the vitamin, alfacalcidol or calcitriol. However, the researchers point out that they could only find much less data relating to these types of vitamin D and so these conclusions should be taken with caution. We need to have more randomised trials that look specifically to see whether these forms of vitamin D do or don't have benefits, says Bjelakovic. His team did conclude that alfacalcidol and calcitriol significantly increased the risk of hypercalcaemia, and vitamin D3 combined with calcium significantly increased the risk of kidney stones.

There have been reports and comments that taking vitamin D can reduce the risk of getting cancer, but this work showed no evidence that vitamin D reduced cancer-related mortality.

Previous reviews of preventive trials of vitamin D have not included as much information and have not examined the separate influence of different forms of vitamin D on mortality. By taking data from a larger number of trials we have been able to shed much more light on this important issue, says Bjelakovic.

Cutting down on salt doesn't reduce your chance of dying

Tue, 05 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Moderate reductions in the amount of salt people eat doesn't reduce their likelihood of dying or experiencing cardiovascular disease. This is the main conclusion from a systematic review published in the latest edition of The Cochrane Library.

There is lots of evidence that reducing dietary salt intake reduces blood pressure and the researchers did see some indication of this occurring. Intensive support and encouragement to reduce salt intake did lead to a reduction in salt eaten and a small reduction in blood pressure after more than six months, says lead author Professor Rod Taylor who works at the Peninsula College of Medicine and Dentistry at the University of Exeter.

What we wanted to see was whether this dietary change also reduced a person's risk of dying or suffering from cardiovascular events, says Taylor.

An earlier Cochrane review of dietary advice published in 2004 could not find enough evidence to allow the researchers to draw any conclusions about the effects of reducing salt intake on mortality or cardiovascular events. In Taylor's newly published research, however, the team managed to locate seven studies that together included 6,489 participants. This gave a sufficiently large set of data to be able to start drawing conclusions. Even so, Taylor believes he would need to have data from at least 18,000 individuals before he could expect to reveal any clear health benefits.

Most experts are agreed that consuming too much salt is not good for you and that salt reduction is beneficial in people with normal and high blood pressure. We believe that we didn't see big benefits in this study because the people in the trials we analyzed only reduced their salt intake by a moderate amount, so the effect on blood pressure and heart disease was not large, says Taylor. He believes that health practitioners need to find more effective ways of reducing salt intake that are both practicable and inexpensive.

Many countries have government-sanctioned recommendations that call for reduced dietary sodium. In the UK, the National Institute of Health and Clinical Guidance (NICE) has recently called for an acceleration of the reduction in salt in the general population from a maximum intake of 6g per day per adult by 2015 to 3g by 2025.

With governments setting ever lower targets for salt intake, and food manufacturers working to remove it from their products, it's really important that we do some large research trials to get a full understanding of the benefits and risks of reducing salt intake, says Taylor.

Physiotherapy after surgery best for shoulder problems

Tue, 21 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Most patients who receive physiotherapy after surgery experience that pain is reduced by a half within a few months. Most of them are free of pain after one to two years. This is the conclusion of a thesis presented at the University of Gothenburg, Sweden.

Age-related changes in tissue combined with acute trauma can contribute to shoulder problems. The most common cause of such problems, however, is compression of the tendons in the shoulder due to a reduction in the space available, says Ingrid Hultenheim Klintberg, physiotherapist and researcher at the Institute of Neuroscience and Physiology.

Patients with these symptoms should initially be treated by physiotherapy. Those for whom physiotherapy does not have an adequate effect are offered surgical treatment, in which the space available is enlarged and the tendons repaired, if necessary. The two most common procedures are known as arthroscopic subacromial decompression and rotator cuff repair.

The aim is that the patient should become free of pain, regain muscular strength, regain mobility, and be able to resume work and leisure activities. Patients who undergo either of these two procedures are offered physiotherapy, following a tailored programme of treatment.

The results presented in the thesis show that most patients state that pain and discomfort are reduced by 50%, 3-6 months after the surgery. They had achieved full mobility and muscle strength compared with reference values at the two-year follow up after the surgery, says Ingrid Hultenheim Klintberg.

Follow up 8-11 years after the surgery showed that many of the patients had retained good shoulder function, mobility and strength.

Their quality of life was good and they display the same pattern of physical activity as do Swedish people in general, states Ingrid Hultenheim Klintberg.

Hospital outcomes research named 'Article of the Year'

Mon, 13 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Health services researchers who studied controversial aspects of Medicare spending and quality of patient care received a prestigious award yesterday from the nation's largest health services research professional association.

The organization, AcademyHealth, presented its 2011 Article of the Year Award to Jeffrey H. Silber, M.D., Ph.D., director of the Center for Outcomes Research at The Children's Hospital of Philadelphia, and his collaborator, Robert Kaestner, Ph.D., of the University of Illinois at Chicago. The award presentation occurred yesterday at AcademyHealth's Annual Research Meeting in Seattle.

The Article of the Year Award recognized two companion studies by Silber and Kaestner: Aggressive Treatment Style and Surgical Outcomes, published in the December 2010 issue of the journal Health Services Research, and Evidence on the Efficacy of Inpatient Spending on Medicare Patients, published the same month in The Milbank Quarterly.

As an indicator of aggressive care, Silber and Kaestner used the Dartmouth Index, a prominent set of measures of inpatient spending on elderly patients. In studying over 5 million Medicare admissions for various surgeries between 2000 and 2005, they found that surgical patients in hospitals with a more aggressive treatment style were less likely to die within 30 days of admission compared to patients in less aggressive hospitals. They also found that this benefit was stable, persisting after the 30-day mark.

Silber, who is a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, said that these findings contradicted cost-cutting arguments made by those who assert that patients would not be harmed by reductions in Medicare spending. People have recently argued that more spending does not yield gains in quality of care, said Silber. Our study suggests that such a belief may be incorrect, and that cutting spending through reductions in aggressiveness may lead to worse outcomes. We should not kid ourselves that the process of reducing Medicare expenditure will be a painless one.

Much of the high cost associated with surgery is the result of complications. We studied whether more aggressive measures lead to more complications, and found there was no difference in complication rates between aggressive and less-aggressive hospitals, said Silber, adding, However, when complications arise, patients are more likely to survive those complications if they receive aggressive treatment.

The survival rates after 30 days were important, said Silber. After that period, patients at both aggressive and less aggressive hospitals had equal survival rates one year after admission; there was just a greater initial chance of surviving at the more aggressive hospitals. It appears, said Silber, that the survival benefits gained at aggressive hospitals are as stable as in patients who survive at less aggressive ones, suggesting that the life saved at more aggressive hospitals is not more fragile or fleeting than a survivor in the less aggressive hospital.

Excess copper, iron linked with Alzheimer's

Sun, 22 May 2011 11:49:40 PST

( from http://www.rxpgnews.com ) Washington, May 22 - The exact causes of neuro-degenerative disorders like Alzheimer's and Parkinson's disease are unknown, but scientists say excess of copper and iron in the human brain may be one of the influencing factors.

Another is DNA damage by reactive oxygen species, highly destructive molecules usually formed as a byproduct of cellular respiration.

Researchers from the University of Texas Medical Branch at Galveston have discovered how these two pieces of the neuro-degenerative disease puzzle fit together, the Journal of Alzheimer's Disease reports.

'Reactive oxygen species cause the majority of the brain cell DNA damage that we see in Alzheimer's and Parkinson's disease, as well as most other neuro-degenerative disorders,' said post-doctoral fellow Muralidhar Hegde, who led the study.

Alzheimer's sufferers may repeat statements and questions over and over, forget chats, appointments or events, routinely misplace possessions, often putting them in illogical locations. Eventually they forget the names of family members and everyday objects.

Humans ordinarily have small amounts of iron and copper in their bodies - in fact, the elements are essential to health, according to a Texas statement.

But some people's tissues contain much larger quantities of iron or copper, which overwhelm the proteins that normally bind the metals and sequester them for safe storage.

The result -- so-called 'free' iron or copper ions circulating in the blood are able to initiate chemical reactions that produce reactive oxygen species.

A high level of copper or iron, they say, can function as a 'double whammy' in the brain by both helping generate a large numbers of the DNA-attacking reactive oxygen species and interfering with the machinery of DNA repair that prevents the deleterious consequences of genome damage.

Egyptian princess was first person with diagnosed coronary artery disease

Tue, 17 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Embargo: 17 May 2011 18:00 CET-- The coronary arteries of Princess Ahmose-Meryet-Amon - as visualised by whole body computerised tomography (CT) scanning - will feature in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) this week in Amsterdam (15-18 May). ICNC is now one of the world's major scientific event in nuclear cardiology and cardiac CT imaging.

The Egyptian princess Ahmose-Meryet-Amon, who lived in Thebes (Luxor) between 1580 and 1550 BC and who is now known to be first person in human history with diagnosed coronary artery disease, lived on a diet rich in vegetables, fruit and a limited amount of meat from domesticated (but not fattened) animals. Wheat and barley were grown along the banks of the Nile, making bread and beer the dietary staples of this period of ancient Egypt. Tobacco and trans-fats were unknown, and lifestyle was likely to have been active.

The coronary arteries of Princess Ahmose-Meryet-Amon - as visualised by whole body computerised tomography (CT) scanning - will feature in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) currently taking place in Amsterdam (15-18 May). ICNC is now one of the world's major scientific event in nuclear cardiology and cardiac CT imaging.

Both presentations will be based on findings from the Horus study, in which arterial atherosclerosis was investigated in 52 ancient Egyptian mummies. Results have shown that recognisable arteries were present in 44 of the mummies, with an identifiable heart present in 16. Arterial calcification (as a marker of atherosclerosis) was evident at a variety of sites in almost half the mummies scanned, prompting the investigators to note that the condition was common in this group of middle aged or older ancient Egyptians; the 20 mummies with definite atherosclerosis were older (mean 45.years) than those with intact vascular tissue but no atherosclerosis (34.5 years).

Although relatively common at other vascular sites, atherosclerosis in the coronary arteries was evident in only three of the mummies investigated, but was clearly visualised in Princess Ahmose-Meryet-Amon (in whom calcification was present in every vascular bed visualised).

The CT scan image below shows that the princess, who died in her 40s, had atherosclerosis in two of her three main coronary arteries. Today, said Dr Gregory S Thomas, director of Nuclear Cardiology Education at the University of California, Irvine, USA, and co-principal investigator of the Horus study, she would have needed by-pass surgery.

Overall, it was striking how much atherosclerosis we found, said Dr Thomas. We think of atherosclerosis as a disease of modern lifestyle, but it's clear that it also existed 3500 years ago. Our findings certainly call into question the perception of atherosclerosis as a modern disease.

If, however, the princess enjoyed a diet deemed to be healthy and pursued a lifestyle probably active, how could this disease of modern life affect her so visibly? Dr Thomas and his co-principal investigator Dr Adel Allam of Al Azhar University, Cairo, suggest three possibilities.

First, that there is still some unknown risk factor for cardiovascular disease, or at least a missing link in our understanding of it. Dr Allam noted a likely effect of genetic inheritance, pointing out that much of the human predisposition to atherosclerosis could be secondary to their genes. He similarly raised the possibility that an inflammatory response to the frequent parasitic infections common to ancient Egyptians might predispose to coronary disease - in much the same way that immunocompromised HIV cases seem also predisposed to early coronary disease. Nor can a dietary effect be excluded, despite what we know of life in ancient Egypt. Princess Ahmose-Meryet-Amon was from a noble family, her father, Seqenenre Tao II, the last pharaoh of the 17th Dynasty.

So it's likely that her diet was not that of the common Egyptian. As a royal, she would have eaten more luxury foods - more meat, butter and cheese. Moreover, foods were preserved in salt, which may also have had an adverse effect.

Despite the suggestion of a genetic, inflammatory or unknown effect, Drs Thomas and Allam were keen not to discount those risk factors for heart disease which we do know about. Indeed, even in the study's apparent association of atheroma with increasing age, there was a pattern of prevalence consistent with our own epidemiology today. Recent studies have shown that by not smoking, having a lower blood pressure and a lower cholesterol level, calcification of our arteries is delayed, said co-investigator Dr Randall C Thompson of the St Luke's Mid-America Heart Institute in Kansas City, USA. On the other hand, from what we can tell from this study, humans are predisposed to atherosclerosis, so it behoves us to take the proper measures necessary to delay it as long as we can.

NJIT and UMDNJ license personal tonometer technology for innovative glaucoma testing

Tue, 17 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) NJIT and UMDNJ have executed a license agreement with The Incubation Factory, St. Louis, MO, covering their personal tonometer technology on which a patent is pending. The tonometer was developed by a research team led by NJIT Professor Gordon Thomas, PhD, and Robert Fechtner, MD, director of the glaucoma division at UMDNJ. NJIT Associate Professor Tara Alvarez was a member of the research team.

We are excited that this innovative technique will generate more accurate eye pressure readings to help doctors monitor glaucoma and thus improve the prevention of blindness, Thomas noted.

Vince Smeraglia, UMDNJ Director of Patents and Licensing, said This is a terrific example of a prominent engineer like Dr. Thomas collaborating closely with Dr. Fechtner, an experienced clinician, to address an unmet medical need for less painful testing and the delivery of significantly faster test results.

Glaucoma, a group of diseases for which 119 million Americans are at risk, is marked by increased eye pressure - known as intra-ocular pressure, which damages the optic nerve. Unless caught and treated, this increased eye pressure can cause vision impairment and ultimately lead to blindness.

Patients at risk for glaucoma generally have their eye pressure tested every three or four months by medical personnel, but recent studies have shown that peak eye pressure occurs during the nocturnal period. Since most ophthalmologist visits occur during the day, it has been shown that 67 percent of patients tested are likely to be incorrectly diagnosed.

The current preferred method of obtaining eye pressure involves a licensed medical practitioner using a specialized instrument to touch the patient's cornea directly through the open eyelid, which may cause discomfort or pain and requires that antibiotic medications be administrated just prior to each exam. The NJIT/UMDNJ tonometer allows for testing through the closed eyelid and thus can be done outside a normal medical setting such as in a pharmacy operated patient care clinic or even at home.

Research shows that those most at risk for glaucoma experience wide variations in their eye pressure throughout the day; these individuals are at a higher risk for disease progression. NJIT/UMDNJ's tonometer would allow a glaucoma patient to check his/her own eye pressure and report readings to the ophthalmologist in real time via the internet.

The personal tonometer holds great potential in helping glaucoma patients better manage their condition, said Incubation Factory President Randy Delkus, The Incubation Factory is excited to collaborate with NJIT and UMDNJ to commercialize this technology.

Results from study of 8,000 older people in Ireland launched

Wed, 11 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The first results from The Irish Longitudinal Study on Ageing (TILDA), a national study of 8,000 older people aged 50 and over in Ireland, were launched this week by the Minister for Health and Children, Dr James Reilly.

TILDA is the most comprehensive study ever conducted on ageing in Ireland. Between 2009- 2011, over 8,000 people aged 50 and over were randomly selected across the country and interviewed about many aspects of their lives including issues such as health, financial circumstances and quality of life. Almost 85 per cent of the participants also underwent a rigorous health assessment. The same group will be interviewed every two years until 2018. Further health assessments will be undertaken on the participants in 2014 and 2018. This report, Fifty Plus in Ireland 2011: First Results from the Irish Longitudinal Study on Ageing, contains initial findings from the study. TILDA is funded by the Department of Health and Children, Irish Life and The Atlantic Philanthropies.

Commenting on the significance of the study, Principal Investigator of TILDA and Professor of Medical Gerontology, Professor Rose Anne Kenny said: The importance of this study cannot be understated. By collecting and analysing this data, we will be able to develop a much deeper understanding of the lives and circumstances of older people and of the factors which lead to good health and good quality of life in older ages. This will mean that Ireland will be better placed to plan for the ageing of our population and to help policy makers ensure that limited resources are correctly targeted to those in need. TILDA provides exciting opportunities for Research and Development and new models of service delivery to create employment in this rapidly developing demographic. We are deeply grateful to our participants. Because of their generosity in taking the time to provide us with this crucial information, Ireland now and in the future will greatly benefit.

When launching the report, the Minister said that the Study's high quality objective and subjective measurements of health coupled with its longitudinal design will provide a truly unique knowledge base that will inform policies for older people in the years ahead.

The findings in the report cover many topics and show that there is considerable diversity across older adults in terms of the various dimensions of their lives. A selection of findings is highlighted below.

When the participants were asked about their quality of life, the following emerged.

Heart failure treatment options have come a long way

Thu, 05 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) This year the Heart Failure Congress 2011, organised by the Heart Failure Association of the European Society of Cardiology (ESC), offers a strong scientific programme featuring 11 late breaking trials and clinical updates, over 1000 original abstracts (submitted by delegates from 61 countries), 14 industry sponsored satellites and mini satellites and over 70 separate sessions.

The presentations will demonstrate the fantastic improvements we've seen in both treatment options for heart failure and understanding of the mechanisms behind the disease. The field has come an awfully long way since the ESC first started holding dedicated heart failure meetings in 1995, said Professor Karl Swedberg, Scientific Chairperson of the Congress programme.

Highlights of the late breaking trials and clinical updates programme will include the SHIFT trial with ivadrabine, EMPHASIS-HF with eplerenone, an update on the MADIT CRT trial on how to predict optimal benefits from CRT, Northstar, and two telemonitoring trials - The TEHAF study and TIM-HF.

The Heart Failure Congress, which represents the largest meeting on heart failure in the world, offers the opportunity for everyone in the heart failure community to come together. It will help get delegates up to speed on the core topics and associated technologies that they need in their daily clinical practice, said Professor Piotr Ponikowski, President of the Heart Failure Association.

Delegates attending the Heart Failure meeting, which expects to attract around 2500 attendees, will include cardiologists, internists, general physicians, basic scientists, epidemiologists, nurses, and industry affiliates.

The overall theme of the congress will be co-morbidities, with sessions focusing on heart failure and diabetes, lung disease, renal impairment, hypertension, cancer, cardio-renal syndrome and anaemia. More and more patients with heart failure are suffering from co-morbidities. The problem heart failure clinicians face on a daily basis is how best to integrate the different medications and approaches to treatments, said Swedberg.

Other important topics that will be covered in depth are devices and technologies, including ICDs, CRT and LVAD, with sessions exploring how to apply the new findings in clinical practice.

One event likely to attract high attendance is an over view of the Surgical Treatment for Ischemic Heart Failure (STICH) trial, which will be presented by Christopher O'Connor (Durham, US) in a debate session at 14.15 on Monday in the Stockholm Lecture Room. The STICH trial, comparing CABG therapy and medical therapy in patients with left ventricular ejection fractions less than 35%, was first presented at the American College of Cardiology meeting in April. This session will provide a good opportunity for delegates to get to grips with how to interpret the results of this really important trial, with opportunities to ask the presenters questions, said Swedberg.

A highlight on Saturday will be the presidential debate that is being held as a joint session with the Heart Failure Society of America, to explore two controversial issues in heart failure treatment. One debate will feature whether ICDs are being over used in Europe, and the other will explore the controversy over whether heart rate reduction beyond beta blockers is effective in heart failure. Other joint sessions that will be held include Imaging heart failure, with the European Association of Echocardiography on Saturday, and the impact of new atrial fibrillation guidelines on heart failure management on Sunday with the European Heart Rhythm Association (EHRA).

For the first time the meeting will not offer a dedicated nursing tract. This was a conscious decision because we want to emphasize the team spirit that goes on in the management of heart failure patients. The work of physicians and nurses in heart failure should be properly integrated, explained Swedberg. Sessions that may be of particular interest to nurses will include palliative care for patients with end-stage heart failure, and how to talk to your patients.

In the opening ceremony a life time achievement award will be presented for the first time to Professor John Kjekshus, from the University of Oslo, Norway, who over the past 40 years has been involved in many trials in the development of treatments for heart failure, including the TIMOLOL trial, CONSENSUS trial, the 4 S trial, the MERIT trial and the CORONA trial.

To recognise the contribution of young researchers the Heart Failure Association Board are inviting delegates under 35 years to a special reception with faculty members that will be held on Monday evening. We want to emphasise the importance that we place on young researchers because they represent our new blood, said Ponikowski. The idea is to provide them with a clear picture of our aims, mission and on-going initiatives in the hope that we can inspire them to get more involved.

On Sunday a poster session providing updates from industry on the latest ongoing trials will be co chaired by John McMurray (Glasgow, GB) and Stefan Anker (Berlin, DE). The objective is to provide industry with an opportunity to present their ongoing trials and the audience to ask questions. It will be a real opportunity for delegates to get a feel for what's in the pipeline, said Ponikowski.

The city of Gothenburg provides an ideal venue for the congress. The many advantages include close proximity between hotels and the congress centre, together with many cultural and social attractions said Swedberg, adding that the closeness to the sea makes Gothenburg particularly special with a half-hour tram ride taking you straight into the southern archipelago.

Older workers benefit from high-tech, high-touch health promotion

Thu, 14 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Older workers benefit most from a modest health behavior program when it combines a web-based risk assessment with personal coaching.

University of Illinois at Chicago researchers conducted a randomized trial to evaluate two worksite wellness interventions assessing older workers' health behaviors and outcomes. The findings are available online and will be published in an upcoming issue of the American Journal of Public Health.

The health behaviors that were examined were physical activity, diet, stress reduction and smoking cessation, says Susan Hughes, professor of community health sciences, co-director of the UIC Center for Research on Health and Aging at the Institute for Health Research and Policy, and principal investigator of the study.

The researchers enrolled 423 participants into three study groups: the COACH intervention, a Web-based risk assessment with personal coaching support; the RealAge intervention, a Web-based risk assessment with behavior-specific online modules; and a control group that received printed health-promotion materials.

Participants ranged in age from 40 to 68 and were staff at UIC. Measures of healthy behaviors and weight, body mass index and waist circumference were assessed at baseline, six months after baseline and 12 months after baseline.

What we found is that there were real differences in uptake between the two groups, Hughes said. Ninety-five percent of people in the COACH program actually used the COACH intervention, as compared to 59 percent of people in the RealAge arm.

Both COACH and RealAge use websites to provide standardized risk assessments, develop risk appraisals, and give participants suggestions for pursing health-related behavior change. The COACH intervention also incorporates individualized counseling -- by phone and in person -- with a public health-educated coach to assist participants with their health-related goals.

RealAge participants were sent one email message to remind them to access the RealAge Web site, but it was up to the individual to stick with the program and determine how much interaction they would have with the website to meet their goals.

At six and 12 months, participants in the COACH program reported eating significantly more fruits and vegetables than the control group and also reported significantly more minutes of physical activity. They also reported a significant reduction in dietary fat intake at 12 months.

In contrast, the RealAge group experienced one significant outcome. They had a decline in waist circumference at six months that was maintained at 12 months.

The researchers are curious to understand how that happened. That's another puzzle, Hughes said. We have to go back and look at the data for an explanation of this interesting outcome.

Childhood psychological problems have long-term economic and social impact, study finds

Mon, 28 Mar 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Psychological problems experienced during childhood can have a long-lasting impact on an individual's life course, reducing people's earnings and decreasing the chances of establishing long-lasting relationships, according to a new study.

Analyzing information about large group of British residents followed for five decades from the week of their birth, researchers found that family income was about one-fourth lower on average by age 50 among those who experienced serious psychological problems during childhood than among those who did not experience such problems.

In addition, childhood psychological problems were associated later in life with being less conscientious, having a lower likelihood of being married and having less-stable personal relationships, according to findings being published in the Proceedings of the National Academies of Sciences.

These findings demonstrate that childhood psychological problems can have significant negative impacts over the course of an individual's life, much more so than childhood physical health problems, said James P. Smith, one of the study's authors and a senior economist at the RAND Corporation, a nonprofit research organization. The findings suggest that increasing efforts to address these problems early in children may have large economic payoffs later in life.

The other two authors of the study are Alissa Goodman and Robert Joyce of the Institute for Fiscal Studies in London.

Researchers found that the impacts of psychological disorders during childhood are far more important individually and collectively over a lifetime than childhood physical health problems. To illustrate, while family income at age 50 is reduced by 25 percent or more due to childhood mental problems, the reduction in family income on average is 9 percent due to major childhood physical health problems and only 3 percent due to minor childhood physical health problems. A central reason for the larger impact of childhood mental health problems is their effects take place much earlier in childhood and persist, researchers say.

The study is the latest in a growing body of evidence that shows psychological troubles early in life can have a long-term negative impact on earnings and social relationships. An earlier study co-authored by Smith showed that childhood psychological problems had a major impact on adult socioeconomic standing, costing $2.1 trillion over the lifetimes of all affected Americans. The results found for the American sample closely parallel those found for the British sample. Another source of concern is that in both America and Britain childhood mental problems appear to be increasing over time.

The latest study was conducted by analyzing information collected as part of the National Child Development Study, which has followed the lives of a single group of 17,634 children who were born in Britain during the first week of March in 1958.

Information has been collected from the group periodically, including surveys about childhood physical and psychological health through physician-led examinations, extensive parental questionnaires and teacher reports. The study includes detailed information about participants' parents, including socio-economic details and family circumstances such as whether there was instability in the home.

Researchers found that the negative economic impact of childhood psychological problems were apparent early in adulthood, with household income 19 percent lower among 23-year-olds who had psychological problems as a child as compared to those who did not.

Some of the smaller family income is caused by a lower likelihood that those who had childhood psychological problems will live with a partner as an adult. By age 50, people who had childhood psychological problems had a 6 percent lower probability of being married or cohabitating and an 11 percent lower chance of working.

The National Child Development Study includes assessments of participants' cognitive functioning and personality traits at age 50, allowing researchers to estimate the impact of childhood psychological problems in those areas.

Children with mental health issues showed reduced cognitive abilities as adults, possibly because their psychological problems make it difficult for them to concentrate and remember, researchers say. Childhood mental health problems also had a negative impact at age 50 on agreeableness and conscientiousness, two key measures of personality.

Researchers found childhood mental health problems also had significant effects on inhibiting social mobility across and within generations and reduced the number of distinct continuous jobs a person held as an adult. This is important because one way people increase their income is by changing jobs by moving on to better opportunities.

You are what your mother ate

Mon, 07 Mar 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Poor diet during pregnancy increases offspring's vulnerability to the effects of aging, new research has shown for the first time.

The research, by scientists from the University of Cambridge, provides important insight into why children born to mothers who consumed an unhealthy diet during pregnancy have an increased risk of type 2 diabetes (a significant contributing factor to heart disease and cancer) later in life.

What is most exciting about these findings is that we are now starting to really understand how nutrition during the first nine months of life spent in the womb shape our long term health by influencing how the cells in our body age, said Dr Susan Ozanne, the senior author on the paper and British Heart Foundation Senior Fellow from the Institute of Metabolic Science at the University of Cambridge.

It is well established that environmental factors interact with genes throughout life, affecting the expression of those genes and, consequently, tissue function and disease risk. Diet during critical periods of development, such as during the nine months in the womb, has been cited as one such environmental factor. Epigenetics, which refers to modifications to the DNA that regulate how much of a gene is produced, has been suggested to underlie these effects.

However, until now, very little was understood about the underlying mechanisms that control the interaction between diet during gestation and gene expression in offspring throughout their adult life. Research, funded by the BBSRC and the British Heart Foundation, has now shown that the gene Hnf4a, which has been linked to type 2 diabetes, is regulated by maternal diet through epigenetic modifications to our DNA. Additionally, they found that poor diet exacerbates the rate at which these key epigenetic modifications accumulate during the aging process.

Previous research has shown that the gene Hnf4a plays an important role both during development of the pancreas and later in the production of insulin. The researchers hypothesised that diet during pregnancy influences the expression of this gene later in life, thereby influencing the risk of diabetes.

To test their theory, the researchers used a well-established rat model where, by altering the protein content of the mother's diet during pregnancy, the offspring develop type 2 diabetes in old age.

First, they studied the RNA from insulin secreting cells in the pancreas from offspring of normally fed as well as malnourished mothers in young adult life and in old age. When they compared the two, they found that there was a significant decrease in the expression of the Hnf4a gene in the offspring prone to type 2 diabetes. The expression of Hnf4a also decreased with age in both groups.

Second, they studied the DNA and found that the decrease of Hnf4a was caused by epigenetic changes. The age associated epigenetic silencing was more pronounced in rats exposed to poor maternal diet. They concluded that the epigenetic changes resulting from maternal diet and aging lead to the reduced expression of the Hnf4a gene, decreasing the function of the pancreas and therefore its ability to make insulin (and thereby increasing the risk of diabetes).

The scientists then studied the DNA from insulin secreting cells from human pancreases to show that expression of this important gene was controlled in the same way in humans.

It is remarkable that maternal diet can mark our genes so they remember events in very early life, said Dr Miguel Constancia, the senior co-author on the paper from the Department of Obstetrics and Gynaecology and Metabolic Research Laboratories at the University of Cambridge. Our findings reveal a novel mechanism by which maternal diet and aging interact through epigenetic processes to determine our risk of age-associated diseases.

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: We already know that a healthy pregnancy is important in shaping a child's health, and their risk of heart disease as they grow up. The reasons why are not well understood, but this study in rats adds to the evidence that a mother's diet may sometimes alter the control of certain genes in her unborn child. It's no reason for expectant mothers to be unduly worried. This research doesn't change our advice that pregnant women should try to eat a healthy, balanced diet.

Older driver screening program expands to other counties, law enforcement

Tue, 18 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Keeping older drivers safe behind the wheel is the goal of a successful program at the University of California, San Diego School of Medicine now expanding into additional counties. A team of experts from the School's Trauma Epidemiology and Injury Prevention Research Center has received two grants to expand the program, which focuses on interventions to assist older drivers who may be at risk for a crash due to age-related health impairments.

Our goal is to help older drivers and their physicians identify and address medical conditions that could interfere with safe driving, said Linda Hill, MD, MPH, clinical professor in the Department of Family and Preventive Medicine at UC San Diego School of Medicine. Treatment may be as simple as a new pair of glasses, some adaptive equipment for the car or physical therapy to improve range of motion. However, there are times when driving safely is no longer possible and health care practitioners need to know the signs and symptoms to watch for.

Hundreds of health care professionals in the San Diego region have been trained through the TREDS (Training, Research and Education for Driving Safety) program using the American Medical Association's screening standards for adult drivers over age 65. The training provides skills to screen and diagnose, make referrals and, when necessary, assist their older patients through the inevitable transition into driving retirement. Hill and her team will expand training to eligible physicians, nurses, medical assistants, occupational therapists and health care workers at hospitals and outpatient medical sites in Riverside, San Bernardino, and Imperial counties, as well as continue their work in the San Diego area.

The TREDS group is expanding its efforts to promote safety for older drivers by encouraging law enforcement to aid in the identification and referral of at-risk drivers.

Getting older does not mean the end of a person's driving days, said California Highway Patrol (CHP) Chief Jim Abele, commander of CHP's Border Division. It's the perfect time to evaluate, improve and maintain the safety and mobility of California's senior drivers.

On a daily basis, law enforcement officers face the challenge of sensitively handling older motorists who are driving unsafely. Sensitivity training as well as how to recognize medical conditions which can mimic 'driving under the influence' are now available to law enforcement organizations in selected counties within Southern California.

If age-related driving issues are left unaddressed, there is a risk of injury not only to the older adults themselves, but also to their families and to others who share the road, said Hill. Our communities rely on these professionals to look out for our seniors' well-being.

Human umbilical cord blood cells found to enhance survival and maturation of key brain cells

Tue, 14 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Laboratory culture (in vitro) studies examining the activity of human umbilical cord blood cells (HUCB) on experimental models of central nervous system aging, injury and disease, have shown that HUCBs provide a 'trophic effect' (nutritional effect) that enhances survival and maturation of hippocampal neurons harvested from both young and old laboratory animals.

As we age, cognitive function tends to decline, said Alison E. Willing, PhD, a professor in the University of South Florida's (USF) Department of Neurosurgery and Brain repair and lead author for a study published in the current issue of Aging and Disease (www.aginganddisease.org) . Changes in cognitive function are accompanied by changes in the hippocampus, an area of the brain where long term memory, as well as other functions, are located, an area of the brain among those first to suffer the effects of diseases such as Alzheimer's disease.

According to Dr. Willing and her USF co-authors, these changes contribute to stroke and dementia in the aging population when neural cells become more susceptible to stressors and disease processes. Because HUCB cells have received attention as an alternative source of stem cells that have been studied and shown to be effective with wide therapeutic potentials, how the cells might be used to repair the diseased, as well as normally aging brain, has become an important question.

It is important to understand how these cells may be manipulated to support hippocampal function in order to develop new therapies, she explained. Accordingly, this study sought to examine the potential for HUCBs to enhance proliferation and increase survival of hippocampal cells derived from aging adult rat brains.

The study found that HUCBs were not only able to protect hippocampal neurons taken from the brains of young adult and aged rats, but also promoted the growth of dendrites - the branching neurons acting as signaling nerve communication channels - as well as induced the proliferation hippocampal neurons.

These protective effects may be a function of growth factors and cytokines (a small signaling protein linked to the inflammatory response) produced by the HUCB cells, observed Dr. Willing.

The researchers also reported that the difference between HUCB-treated cultures and non-treated cultures was more dramatic in the older adult rat brain cultures than in those younger rats. Further, they speculated that synapses - the communication links between neuronal cells -may have been forming in the cultures.

They concluded that HUCB cells benefit aging adult hippocampal neurons by 'increasing their survival, growth, differentiation, maturation and arborization' (branching).

The mechanisms by which HUCB cells extend the life of hippocampal cells may include enhancing the proliferative capacity of the cells or protecting existing and newly generated neurons from damage and death, concluded Dr. Willing.

According to Dr. John Sladek, professor of neurology at the University of Colorado School of Medicine, this study is important for its potential contribution to regenerative medicine's future ability to benefit from an important source for stem cells, the umbilical cord.

The fact that HUCBs enhanced the survival of - and maturation of - hippocampal neurons has profound implications for the treating brain injury and degenerative diseases such as Alzheimer's disease, ALS and Parkinson's disease, said Dr. Sladek.

Widespread vitamin D deficiency a concern in Asia

Mon, 13 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Bone health experts attending the 1st Asia-Pacific Osteoporosis Meeting in Singapore this week have flagged vitamin D deficiency as a major concern in the region, particularly in South Asia where the problem is especially severe and widespread across the entire population.

Dr. Nikhil Tandon, Professor of Endocrinology and Metabolism at the All India Institute of Medical Sciences of New Delhi, India highlighted the results of various studies which show severe deficiency across India and Pakistan in all age groups, as well as insufficiency in populations of South-East and East Asia. A lack of exposure to sunshine, genetic traits and dietary habits are all factors which influence vitamin D levels. In certain regions, vitamin D deficiency can also be attributed to skin pigmentation and traditional clothing, as well as air pollution and limited outdoor activity in urban populations, he stated.

Vitamin D is primarily made in the skin when it is exposed to sunlight, with limited amounts obtained from food sources. However, in people with low sunlight exposure vitamin D is principally obtained from nutritional or supplemental sources. In the elderly, vitamin D deficiency is linked to reduced physical performance and increased risk of fall-related fractures. In children, severe vitamin D deficiency results in inadequate mineralization of bone, leading to growth retardation and bone deformities known as rickets. As well, there is evidence that children born to mothers who are vitamin D deficient during pregnancy may have reduced bone mass, which could in turn be a risk factor for osteoporosis later in life.

At a Vitamin D Roundtable held in conjunction with the meeting, nutrition and bone health experts discussed the importance of encouraging further studies on vitamin D status and risk factors in countries where data are scarce. The group is developing interactive vitamin D maps based on published data of 25(OH)D serum levels, the biomarker used to measure vitamin D status in the blood. Chair of the Roundtable, Professor Robert Josse, Professor in the Departments of Medicine and Nutritional Sciences at the University of Toronto, Canada commented, The maps will track vitamin D levels by region and different population groups, giving a valuable overview of the prevalence of vitamin D deficiency around the world. The global maps are innovative tools that will help identify problem areas, encourage awareness and stimulate research studies. By facilitating global comparisons, the maps should provide an incentive for health authorities to implement strategies to improve vitamin D status in the population.

Exposure of humans to cosmetic UV filters is widespread

Tue, 02 Nov 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Amsterdam, 2 November, 2010 - An investigation conducted in the context of the Swiss National Research Programme (NRP50), Endocrine Disrupters: Relevance to Humans, Animals and Ecosystems, demonstrates for the first time that internal exposure of humans to cosmetic UV filters is widespread.

In the course of the Summer and Fall 2004, 2005 and 2006 (3 cohorts), human milk was sampled by mothers who had given birth at the University Women's Hospital in Basel. The participants filled out a detailed questionnaire with general questions and, as special feature, in depth questions on use of different types of cosmetic products.

Chemicals out of a large range of products including modern chemicals and classical persistent organic pollutants (POPs) were analyzed in the same human milk sample by analytical laboratories in Freiburg, Erlangen and Baden. The list comprised cosmetic UV filters, synthetic musk fragrances, pesticides, phthalates, parabens, flame retardants (polybrominated diphenylethers), and polychlorinated biphenyls (PCBs); in total 89 analyses per milk sample. The chemical analytical data of milk samples of individual mothers were then compared with the information obtained through the questionnaire.

The investigation revealed that one and the same human milk sample contained a large range of chemical contaminants, most of which are known to interact with endocrine systems. Individual exposure patterns differed between different types of chemicals. The study demonstrates for the first time that internal exposure of humans to cosmetic UV filters is widespread. Cosmetic UV filters were present in 85% of human milk samples, at concentrations comparable to PCBs. Synthetic musk fragrances were also present in the milk samples. The presence of UV filters in human milk was significantly correlated with the use of cosmetic products containing these UV filters. As a result, exposure patterns differed between individuals.

It seems plausible that exposure to other cosmetic constituents such as synthetic fragrances is also linked to the use of the corresponding products. However, this could not be investigated because musk fragrances are not declared. In contrast, classical contaminants such as PCBs, DDT and metabolites of DDT as well as some other persistent organochlor pesticides represented a rather uniform background exposure. Their levels were in part correlated with each other and also with fat-rich nutrition.

A total daily intake of each individual chemical was calculated for each individual infant from their individual levels in human milk. Calculation included fat content of individual milk samples, total daily milk intake per infant and body weight of the infant. Some infants exhibited values of daily intake of PCBs and several organochlor pesticides that were above US EPA reference dose values.

Margret Schlumpf and Walter Lichtensteiger, who lead the research said, Research on the effects of endocrine disrupters (chemicals interfering with hormone actions) has shown that it is of utmost importance to obtain information on simultaneous exposure of humans to different types of chemicals because endocrine active chemicals can act in concert. Information on exposure is particularly important for the developing organism at its most sensitive early life stages. Human milk was chosen because it provides direct information on exposure of the suckling infant and indirect information on exposure of the mother during pregnancy.

An important question during the research was: To what extent lifestyle can influence the presence of chemicals in breast milk? This question was the foundation for the preparation of the questionnaire. The questions were focused particularly on the use of cosmetic products; information on the relationship between the exposure of human populations to constituents of cosmetics and the presence of these constituents in the human body was limited and, in the case of UV filters, absent.

Gert-Jan Geraeds, Executive Publisher of

Grant to fund aging research

Fri, 15 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) For the second time this year, a postdoctoral fellow in UT Dallas' Center for Vital Longevity has earned a prestigious, highly competitive career-development grant from the National Institutes of Health (NIH).

Dr. Karen M. Rodrigue was selected to receive the K99/R00 Pathway to Independence Award. The five-year, two-phase grant totals just under $1 million. It comes from the National Institute on Aging, which usually awards only seven or eight K99s per year.

The central aim of Rodrigue's grant is to examine a vascular hypothesis of aging that involves the role of risk factors, such as hypertension, and specific cerebrovascular mechanisms such as hypoperfusion, in shaping the course of brain and cognitive aging.

An additional goal of her project is to test the hypothesis that vascular risk factors lead to the deposition of a sticky protein found in the brains of people with Alzheimer's disease and in about 30 percent of non-demented healthy adults.

Rodrigue sees this area of research as vital to future preventive approaches. Understanding the contributions of vascular health to successful, as well as pathological aging, is fundamentally important, given both the prevalence of vascular risk in the aging population and its amenability to prevention and treatment, she said.

The first phase of the K99 grant provides $90,000 per year for two years to support Rodrigue's postdoctoral work in the School of Behavioral and Brain Sciences. She then will transition into a faculty position at UT Dallas or another institution, and the grant will follow her, providing three more years of research funding at $250,000 per year.

I'm deeply honored to the be a recipient of such a competitive award and am particularly excited to embark on my first series of funded studies here at UT Dallas, where we have a great depth of resources to conduct cutting-edge cognitive neuroscience research, Rodrigue said.

The NIH career-development programs are designed to ensure a wide range of highly trained scientists are available in adequate numbers and in appropriate areas to address vital clinical, biomedical and behavioral research needs. The K99/R00 program was created to ease the transition from postdoctoral positions into junior faculty roles and to provide earlier independent research support to the most promising young investigators.

After her next two years at UT Dallas, Rodrigue will decide whether to stay and continue her projects here or go elsewhere. The grant probably will make her attractive to many universities and give her a competitive edge when she seeks her first professor position.

The grant requires that 75 percent of Rodrigue's time as a newly minted faculty member be devoted directly to research. So her teaching load will be lower than most assistant professors face. She will be able to set up an independent lab and hire research assistants to facilitate projects.

Dr. Kristen Kennedy, another center researcher, received a K99 grant last spring, to support her research into the role of white matter in the reorganization of age-related brain function.

Dr. Denise Park, director of the center and Distinguished University Chair in Behavioral and Brain Sciences, has served as a mentor to Rodrigue.

These awards are given to the most elite new PhDs to support the next generation of scientists in the United States, Park said. They provide significant resources to further the careers of the best and see that they are provided with everything they need for the first five years of their career. To have one young scientist at the Center for Vital Longevity with such an award is a significant honor. To have two is unprecedented. Dr. Rodrigue will play an important role in understanding how cardiovascular health and Alzheimer's disease are intertwined.

Researchers find nonprofit weight loss program beats obesity

Thu, 14 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) AURORA, Colo. (October 14, 2010) - In the battle against obesity, new research has found that it may not be necessary to spend a lot on a weight loss program when cheaper, nonprofit alternatives may work just as well.

Researchers at the University of Colorado Anschutz Medical Campus found those who spent three years in the nonprofit Take Off Pounds Sensibly (TOPS) program lost five to seven percent of their body weight and kept it off.

This is the first time a study of this size and duration has ever been done on a weight loss program, said Nia Mitchell, MD, MPH, and a primary care physician who worked on the study. The natural history of weight loss is weight regain and we were happy to see that people were able to keep off the weight.

The three-year study, published last month in the research journal, Obesity, followed thousands of people enrolled in TOPS. The program provided access to their database, but no funding for the research. Milwaukee-based TOPS helps members lose weight through group support and education. They are encouraged to get a weight goal from their doctors and make it their target. At the same time, they attend weekly meetings and weigh-ins. Members receive a booklet with a six week lesson plan, a one-year subscription to TOPS News and membership in the local chapter.

The study points out the large price difference between TOPS and other well-known weight loss programs. TOPS costs about $90 a year while Weight Watchers is between $480 and $625 annually. Programs like Nutrisystem and Jenny Craig, which include the price of food, can cost between $3,600 and $6,500 a year.

Mitchell said there have been studies of popular commercial weight loss programs but little investigation of nonprofits like TOPS or Overeaters Anonymous. A 1974 study concluded that behavior modification resulted in greater weight loss than other methods. TOPS incorporated the technique into its program along with group support, exercise, and monitoring food intake. It also uses volunteers to run meetings rather than paid staff.

Peer mentoring has been shown to encourage behavioral change in other areas and appears to be effective when it comes to weight loss, Mitchell said.

During the study, 42,481 people renewed their TOPS membership at least once including 2,427 with nonconsecutive renewals. Those who renewed each year lost the most weight and kept it off for up to three years. Those who didn't renew every year, lost less. The research shows that the weight lost by those who remained in TOPS is similar to the weight loss seen in a previous study of individuals who completed one year of Weight Watchers.

The lesson in all of this, says Mitchell, is that the TOPS results are comparable to more expensive commercial programs. She said future studies should look more closely into the use of nonprofits to reach populations most at risk for obesity.

High death and disability rates due to fractures in Russia, Central Asia and Eastern Europe

Mon, 27 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Preliminary findings from an upcoming new report by the International Osteoporosis Foundation (IOF) show alarming projections and reveal the poor state of post-fracture care in the Russian Federation and many other countries in the region. The findings were announced today at a press conference in St. Petersburg at the IOF Summit of Eastern European and Central Asian Osteoporosis Patient Societies.

Osteoporosis, a disease of the bone which leaves people at increased risk of fracture, is most common in the older population. Population projections for most countries in the region predict that by 2050 there will be a decrease of the total population, but a significant increase (up to 56%) in the percentage of people aged 50 and over. As a result, in the Russia Federation alone the number of people with osteoporosis is expected to increase by a third by 2050.

Despite the major public health burden of osteoporosis-related fractures, the disease suffers from severe under recognition - mainly due to the lack of solid epidemiological and economic data which would help convince health authorities of the urgency of osteoporosis prevention. There are no formal hip or fragility fracture registries in most countries within the region and data on vertebral fractures, the most common osteoporotic fracture, are completely lacking. IOF President John Kanis stated, It is clear from the key findings that governments need to support wide scale epidemiological studies to collect data on the incidence of osteoporotic fractures.

DXA technology, diagnostic equipment which provides the most accurate method of diagnosis, is usually only accessible in main cities - yet in about one-third of the countries, more than 40% of the population lives in a rural area. In most countries, drug treatment for those at high risk of fracture is not, or is only partially, reimbursed - effectively making treatment unaffordable for the majority of citizens.

Low levels of calcium and vitamin D intake impact negatively on bone health. The average daily calcium intake in nearly all countries outlined in the report falls far below the FAO/WHO recommendations. In addition the majority of populations in the region suffer from severe vitamin D insufficiency. This not only affects fracture rates, but also causes rickets. In recent years the incidence of rickets (pediatric vitamin D deficiency) among Russian infants has ranged from 54% to 66% in some regions.

Although older people who sustain a hip fracture are at increased risk of death and suffer long term disability throughout the world, the report indicates that this problem is far more severe in the Russia Federation and in many other countries of the region. Professor Olga Lesnyak, Vice-President of the Russian Association on Osteoporosis and author of the report, called for action, There is an urgent need for health care providers to improve post hip fracture surgical care, she said. While in Western Europe most hip fracture patients receive operative treatment (the optimal standard of care), in the Russian Federation there is an extremely low rate of surgical treatment. Consequently there is high mortality rate after a hip fracture, reaching up to 45-52% during the first year after fracture in some Russian cities. Of the surviving hip fracture patients, 33% remain bed-ridden and 42% are capable of only very limited activities. Only 9% are able to return to the same level of daily activity as they had before their fracture.

IOF Chief Operating Officer Judy Stenmark stated, Wider and more equitable access to diagnostic tests and appropriate medication are required to stem the growing tide of fractures in the region.

Gene-environmental interactions and MS progression is focus of new study

Tue, 21 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- A $634,000 grant from the Department of Defense is allowing researchers at the University at Buffalo to investigate a trio of environmental factors and their influence on the progression of multiple sclerosis.

The two-year project, headed by Murali Ramanathan, PhD, tests the hypothesis that nicotine metabolism, the byproducts of vitamin D metabolism and increased levels of anti-Epstein-Barr virus (EBV) each interact with variations in specific genes to cause increased neurodegeneration and increased lesions in MS patients.

Ramanathan is a professor of pharmaceutical sciences and neurology in the School of Pharmacy and Pharmaceutical Sciences and the School of Medicine and Biomedical Sciences, respectively.

The study is a collaboration between the UB and investigators from Charles University in Prague, Czech Republic, and will be conducted on samples obtained at both universities' MS centers.

The research aims to identify gene-environmental interactions between key molecules in the vitamin D pathway, anti-Epstein-Barr virus antibodies, cigarette smoking and key genetic variants that are implicated in conversion of patients with clinically isolated syndrome (CIS) to definite MS.

They will assess the risk of developing clinically definite MS and the time to progression, as well as the neurodegeneration in the brain of MS patients, as measured by brain atrophy, and the extent of brain injury caused by lesions.

We will use a novel approach to measure the levels of vitamin D and its metabolites, EBV exposure and nicotine metabolites from cigarette smoking, says Ramanathan. We have developed sensitive and selective measurements for key metabolites in the vitamin D and nicotine metabolism pathways using mass spectrometry, a method that has not been used previously to study vitamin D metabolism.

The novel study design will include the genetic variations that were associated with the risk of developing MS, as well as genes that determine the levels and responses to environmental factors. MS patients will be divided into two equal groups: a training group that will be used to identify gene-environmental interactions, and a group that will be used to replicate the training group result.

Identifying gene-environmental interactions is critical for developing better strategies for slowing the progression of MS, because it could enable patients with preexisting genetic risk factors to reduce the rate of disease progression through lifestyle modification, Ramanathan says.

The study results will identify the gene-environment interactions that promote disease progression in MS and facilitate the development of preventive and therapeutic interventions for MS that disrupt these interactions, notes Ramanathan.

Aerobic exercise relieves insomnia

Wed, 15 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- The millions of middle-aged and older adults who suffer from insomnia have a new drug-free prescription for a more restful night's sleep. Regular aerobic exercise improves the quality of sleep, mood and vitality, according to a small but significant new study from Northwestern Medicine.

The study is the first to examine the effect of aerobic exercise on middle-aged and older adults with a diagnosis of insomnia. About 50 percent of people in these age groups complain of chronic insomnia symptoms.

The aerobic exercise trial resulted in the most dramatic improvement in patients' reported quality of sleep, including sleep duration, compared to any other non-pharmacological intervention.

This is relevant to a huge portion of the population, said Phyllis Zee, M.D., director of the Sleep Disorders Center at Northwestern Medicine and senior author of a paper to be published in the October issue of Sleep Medicine. The lead author is Kathryn Reid, research assistant professor at Feinberg.

Insomnia increases with age, Zee said. Around middle age, sleep begins to change dramatically. It is essential that we identify behavioral ways to improve sleep. Now we have promising results showing aerobic exercise is a simple strategy to help people sleep better and feel more vigorous.

The drug-free strategy also is desirable, because it eliminates the potential of a sleeping medication interacting with other drugs a person may be taking, Reid said.

Sleep is an essential part of a healthy lifestyle, like nutrition and exercise, noted Zee, a professor of neurology, neurobiology, and physiology at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital.

By improving a person's sleep, you can improve their physical and mental health, Zee said. Sleep is a barometer of health, like someone's temperature. It should be the fifth vital sign. If a person says he or she isn't sleeping well, we know they are more likely to be in poor health with problems managing their hypertension or diabetes.

The study included 23 sedentary adults, primarily women, 55 and older who had difficulty falling sleep and/or staying asleep and impaired daytime functioning. Women have the highest prevalence of insomnia. After a conditioning period, the aerobic physical activity group exercised for two 20-minute sessions four times per week or one 30-to-40-minute session four times per week, both for 16 weeks. Participants worked at 75 percent of their maximum heart rate on at least two activities including walking or using a stationary bicycle or treadmill.

Participants in the non-physical activity group participated in recreational or educational activities, such as a cooking class or a museum lecture, which met for about 45 minutes three to five times per week for 16 weeks.

Both groups received education about good sleep hygiene, which includes sleeping in a cool, dark and quiet room, going to bed the same time every night and not staying in bed too long, if you can't fall asleep.

Exercise improved the participants' self-reported sleep quality, elevating them from a diagnosis of poor sleeper to good sleeper. They also reported fewer depressive symptoms, more vitality and less daytime sleepiness.

Better sleep gave them pep, that magical ingredient that makes you want to get up and get out into the world to do things, Reid said.

The participants' scores on the Pittsburgh Sleep Quality Index dropped an average of 4.8 points. (A higher score indicates worse sleep.) In a prior study using t'ai chi as a sleep intervention, for example, participants' average scores dropped 1.8 points.

Exercise is good for metabolism, weight management and cardiovascular health and now it's good for sleep, Zee said.

Tinnitus study looks for cure to 'ringing in the ears'

Wed, 11 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The NIH has granted a University of Texas at Dallas researcher and a university-affiliated biomedical firm $1.7 million to investigate whether nerve stimulation offers a long-term cure for tinnitus.

Described as a ringing in the ears, tinnitus affects 20 percent to 40 percent of recently returned military veterans and about 10 percent of all people over 65 years old. The U.S. Veterans Administration spends about $1 billion a year in disability payments related to tinnitus, said Dr. Michael Kilgard, associate professor in UT Dallas' School of Behavioral and Brain Sciences. The disorder causes mild irritation for some people but is disabling and painful for many others.

Kilgard will use his portion of the grant, $448,000 over two years, to continue testing whether vagus nerve stimulation (VNS) can retrain the brain to ignore the nerve signals that simulate ringing. The researchers in earlier tests found that VNS stimulation, when paired with the presentation of alternative tones, appeared to reverse the effects of tinnitus.

We're glad to get an opportunity to further our research on tinnitus, Kilgard said. This grant will support advances in our understanding of VNS treatment, and it will move the technological development forward so we can better deliver that therapy to patients.

The researchers plan to change the pattern for stimulation, increasing the frequency to see if more intensive therapy might reverse the effects of tinnitus faster. The primary aim of the new research is to accumulate enough data to design clinical trials using VNS to treat tinnitus in human subjects in the United States.

VNS previously translated successfully to humans for the treatment of epilepsy, depression and other neurological disorders.

The new grant resulted from the NIH's partnership with the federal government's Small Business Innovation Research program (SBIR). Part of the grant will go to Kilgard and his work in the lab, and the other portion will further research by MicroTransponder, a biomedical start-up company that works in conjunction with UT Dallas researchers and has helped bring in more than $6 million in grants in the past two years.

MicroTransponder is attempting to develop a less invasive method for delivering the electric charge that stimulates the vagus nerve in the neck. Currently, Kilgard uses wires attached to the neck to stimulate the nerve. The goal is to create a remotely controlled device similar to the technology used for toll tags on highways, Kilgard said.

Will Rosellini, a PhD student in neuroscience at UT Dallas, is CEO of MicroTransponder. Dr. Larry Cauller, associate professor of neuroscience, developed the neural interface technology that led to MicroTransponder. He is the company's chief science officer.

For medical devices, the ultimate goal is to have the least invasive procedure possible, but this is usually accomplished in an iterative fashion, with each new version being less invasive than the past, Rosellini said. The eventual goal is to have our SAINT System be injectable via a needle, but there are several intermediary versions of the device that must be developed and thoroughly tested before that will be possible.

Rosellini said Dr. Roger Miller, a scientific program director at the National Institute on Deafness and Other Communication Disorders, has been a champion of MicroTransponder's efforts to use VNS to combat tinnitus. Kilgard said Miller has been extremely helpful in advancing the new therapy closer to a clinical reality.

The VNS treatment would be an improvement over current therapies involving medications or counseling because it offers a possible permanent end to the condition, an actual cure instead of just a treatment, Kilgard said. Current therapies have limited success and frequently must be modified over time because they cease to be effective.

MicroTransponder and Kilgard now are working with researchers in Belgium to set up a protocol for conducting the first round of tests in humans. Less than half of therapies that are successful in animals prove successful when tested on people, Kilgard said.

We want to find out as much as we can about how well this works in rats. That is what this phase of the research is about, he said. Once we have that additional data, we can try out a similar therapy on humans, and we hope to find this offers a permanent end to their tinnitus discomfort.

Dr. Bert Moore, dean of the School of Behavioral and Brain Sciences, said UT Dallas' relationship with MicroTransponder continues to yield results.

The story behind this research is a wonderful example of how investigators such as Drs. Cauller and Kilgard, exploring basic mechanisms of how the brain adapts and learns, can collaborate with corporate partners to develop new technologies to address a variety of human problems, he said. This is the goal of our research mission at UT Dallas, creating new knowledge so that we can impact and improve people's lives.

Nurses will test method for determining if it's dementia or delirium

Wed, 04 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) In the future, nurses may more accurately detect and alleviate symptoms of delirium in persons with dementia, thanks to a five-year, $2.7-million grant from the National Institute of Nursing Research.

The project, led by Donna Fick, professor of nursing, Penn State, seeks to improve nurses' assessment skills and reduce the use of drugs to treat delirium and dementia.

Delirium and dementia have similar symptoms -- decline in cognitive abilities such as memory, attention, and problem solving -- but they have radically different causes and treatments. Dementia is a chronic, progressive condition that increases with age. Delirium, in contrast, is an acute condition that has a rapid onset and results from insults to the body, such as dehydration, infection, or a drug side effect.

Delirium is reversible, preventable and treatable, said Fick.

About 40 percent of patients with dementia also develop bouts of delirium, a condition known as Delirium Superimposed on Dementia or DSD. The condition substantially worsens outcomes in a population who are already burdened by functional decline, said Fick.

Sorting through the various types of cognitive decline is not easy, according to Fick. Unfortunately, some doctors and nurses automatically opt for a drug treatment, which can lead to further problems including falls or worsened delirium.

Fick's solution is a multifaceted training approach that she will implement and test in three hospitals: one in urban Tennessee and two in rural Pennsylvania. She and her colleagues will integrate electronic medical records as one component of the training. They are testing an approach that provides decision-making support and integrates reminders to check for specific symptoms. This approach is already used to assess the risk of falling and the integrity of the skin.

The project will establish a nursing opinion leader on the staff who will encourage evidence-based practices to treat delirium and dementia. These leaders will also be reliable information sources for nurses.

The training incorporates a weekly feedback session for nurses and the use of video, in person presentations, articles, case studies, on-line presentations -- narrated power point -- for continuing education.

In addition to assessing whether the training helps nurses distinguish between delirium and dementia and choose non-drug treatment options, the study will assess how effectively the approach improves patients' health.

In past research, Fick found that nurses are common initiators of drug treatments, so educating nurses is the most efficient way to address the medication issues. A survey she conducted on nurses who deal with dementia and delirium patients showed that 32 percent of nurses would call a physician to ask for medication in a patient with DSD before trying other non-drug approaches to the problem.

Not recognizing and treating these conditions efficiently can result in people being put in nursing homes quicker, higher health care costs, and in the worst-case scenario early death, said Fick.

Study describes health effects of occupational exposures in Paducah Gaseous Diffusion Plant workers

Thu, 22 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A five-year study into the causes of deaths of workers at Paducah Gaseous Diffusion Plant (PGDP) shows significantly lower death rates from all causes and cancer in general when compared to the overall United States population. This is known by occupational health researchers as the healthy worker effect. However, death from lymphatic and bone marrow cancers such as leukemia or multiple myeloma were slightly above national rates.

The study was conducted by faculty at the University of Louisville School of Public Health and Information Sciences and collaborators from the University of Cincinnati and the University of Kentucky. It was funded through the National Institute for Occupational Safety and Health, thanks to the effort of U.S. Senator Mitch McConnell, who was instrumental in getting the study off the ground.

This was an important study, because it addressed lingering concerns about the health of workers at the Paducah Gaseous Diffusion Plant, said David Tollerud, MD, MPH, professor of environmental and occupational health sciences at UofL's School of Public Health and Information Sciences. It is important for occupational health and public health research to attempt to answer pressing concerns of impacted populations, and we were able to report that we didn't find unexpectedly high rates of disease in this workforce.

Security workers had higher overall death rates than other employees, while chemical operators had higher death rates from leukemia and multiple myeloma than the rest of the workers.

The increased number of lymphatic and bone marrow cancer deaths is consistent with what we expected. Based on other studies, these forms of cancer have been linked to low levels of radiation exposure, Tollerud said.

The team compiled data on thousands of employees who worked at the plant for at least 30 days in different job classifications from 1952 through 2003. The data were used to assess exposure levels. Overall, 1,638 workers died out of the 6,759 in the study. This is less than the 2,253 deaths that would have been expected in the general public during the same time.

The team now plans to present its findings to PGDP workers and distribute a study fact sheet that summarizes the main findings and directs workers to resources that are available if they have concerns or questions.

The Paducah Gaseous Diffusion Plant, located in western Kentucky, is the only operating uranium enrichment facility in the United States, and the only one where a worker mortality study had not been conducted. The plant was commissioned in 1952 under the U.S. Department of Energy as part of a U.S. government program to produce enriched uranium to fuel military reactors and nuclear weapons. The plant's mission changed in the 1960s from enriching uranium for nuclear weapons to enriching uranium for use in commercial nuclear reactors to generate electricity.

Study finds lifelong doubling in death risk for men who are obese at age 20 years

Tue, 13 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Stockholm, Sweden: Men who enter adult life obese face a life-long doubling of the risk of dying prematurely, new research has found.

In a study presented today (Tuesday) at the International Congress on Obesity in Stockholm, researchers tracked more than 5,000 military conscripts starting at the age of 20 until up to the age of 80. They found that at any given age, an obese man was twice as likely to die as a man who was not obese and that obesity at age 20 years had a constant effect on death up to 60 years later. They also found that the chance of dying early increased by 10% for each BMI point above the threshold for a healthy weight and that this persisted throughout life, with the obese dying about eight years earlier than the non-obese.

As the obesity epidemic is still progressing rapidly, especially among children and adolescents, it is important to find out if obesity in early adulthood has lifelong mortality effects, said the study's leader, Esther Zimmermann, a researcher at the Institute of Preventive Medicine, Copenhagen University Hospital and the Institute of Biomedical Sciences at University of Copenhagen in Denmark. Previous studies have investigated obesity and mortality in middle-aged populations, which only tells us about the detrimental effects of obesity in middle age. Our study sheds light on how obesity at age 20 years affects obesity throughout adult life. It is the first study with such a long follow-up time and thus the first study to investigate the lifelong effect.

In the study, the researchers compared mortality in a sample of 1,930 obese male military conscripts with that in a random sample of 3,601 non-obese male conscripts. Body mass index (BMI) was measured at the average ages of 20, 35 and 46 years, and the researchers investigated that in relation to death in the next follow-up period. A total of 1,191 men had died during the follow-up period of up to 60 years. The results were adjusted to eliminate any influence on the findings from year of birth, education and smoking.

At age 70 years, 70% of the men in the comparison group and 50% of those in the obese group were still alive and we estimated that from middle age, the obese were likely to die eight years earlier than those in the comparison group, Zimmermann said. The researchers also investigated the effect of the broad BMI range on mortality from the age of 20 and found the lowest death risk in the men who had a BMI of 25. Underweight men had a slightly elevated risk, and the risk of early death crept up steadily by 10% for each BMI unit above 25 for those men who were overweight or obese.

Zimmermann said it is unclear whether it is being obese at age 20 that conferred the men's increased death risk or whether the lifelong effect is due to obesity often being a lifelong condition for them. She said more research is warranted to find the answer to that question.

More than 70% of the obese young men were still obese at the follow-up examinations, whereas only 4% of the men in comparison group developed obesity during follow-up. Obesity seems to be a persistent condition and it appears that if it has not occurred in men by the age of 20, the chance of it developing later are quite low. The persistence of obesity may partly explain why obesity at 20 years of age has lifelong mortality effects, but it needs to be proven whether that is the full explanation or whether, by itself, being obese at an early age increases the risk of early death, she said.

Zimmermann said her group plans to study the patterns of ill health that caused the early death in the obese group, in order to determine whether the same diseases are causing death at different ages. Such information may shed some light on the mechanisms through which obesity works at different ages, she said.

Higher testosterone may raise risk of heart disease in elderly men

Thu, 01 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A large U.S. multicenter study shows that older men with higher testosterone levels are more likely to have a heart attack or other cardiovascular disease in the future. The results were presented at The Endocrine Society's 92nd Annual Meeting in San Diego.

The study finding contradicts smaller studies that have shown that testosterone levels are not associated with higher rates of cardiovascular disease, said presenting author Kristen Sueoka, MD, a resident physician at the University of California, San Francisco.

Many in the general public are using testosterone supplements for various medical problems, including low sex drive and mood disorders, which are not life-threatening. These men may unknowingly be placing themselves at higher risk for cardiovascular disease, she said.

Study participants were age 65 or older and included 697 community-dwelling men who were participating in the National Institutes of Health-funded study, Osteoporotic Fractures in Men (MrOS). None of these men were receiving testosterone therapy, according to the study abstract.

All subjects had blood tests to determine their testosterone levels. The investigators then divided the men into quartiles, or four groups, of testosterone range to observe trends in rates of coronary heart disease events. This type of heart disease results from plaque-clogged or narrowed coronary arteries, also called atherosclerosis. A coronary heart disease event included a heart attack; unstable angina, which is chest pain usually due to atherosclerosis and which doctors consider a prelude to a heart attack; or an angioplasty or bypass surgery to clear blocked arteries.

During an average follow-up of nearly 4 years, 100 men, or about 14 percent, had a coronary disease event, in particular, heart attacks, Sueoka said. After the researchers adjusted for other potential contributing risk factors for heart disease, such as elevated cholesterol, they found that higher total testosterone level relates to an increased risk of coronary disease. Men whose total testosterone was in the highest quartile (greater than or equal to 495 nanograms per deciliter, or ng/dL) had more than twofold the risk of coronary disease compared with men in the lowest quartile (below 308 ng/dL).

Other important measures of testosterone in the body and of a protein that tightly binds with testosterone (sex hormone-binding globulin) also showed a close relationship between testosterone and coronary heart disease, Sueoka said.

The investigators did not divide the men by normal or abnormal testosterone levels because the definition of abnormal levels depends on many factors, including increasing age. In fact, says Sueoka, Men with the highest testosterone could potentially be at risk for heart disease regardless of the definition of normal levels.

One day testosterone measurements may be used to help predict which men are more likely to develop cardiovascular disease, she said. But we need more studies to confirm that high testosterone is a risk factor for heart disease.

Ovarian transplantation restores fertility to old mice and also lengthens their lives

Tue, 29 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Rome, Italy: Scientists have discovered that when they transplant ovaries from young mice into aging female mice, not only does the procedure make the mice fertile again, but also it rejuvenates their behaviour and increases their lifespan. The question now is: could ovarian transplants in women have the same effect?

Dr Noriko Kagawa will tell the 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome today (Tuesday) that successful ovarian transplants increased the lifespan of the mice by more than 40%. At present ovarian transplants are performed with the aim of preserving a woman's fertility after cancer treatment for instance, or of extending her reproductive lifespan. However, the completely unexpected extra benefit of fertility-preserving procedures in our mouse studies indicates that there is a possibility that carrying out similar procedures in women could lengthen their lifespans in general, she said.

A very small number of women in the world have had ovarian transplants, and some have been more successful than others. Dr Kagawa stressed that there was still a lot of research to be carried out before it would be known whether ovarian transplants had similar, rejuvenating effects in women, particularly as it would involve waiting for many years until the patients became older.

Dr Kagawa, Associate Director for Research at the Kato Ladies' Clinic in Tokyo (Japan), told the conference that she and her colleagues had conducted two mouse experiments. In the first, both ovaries were removed from young female mice (about 140 days old), and transplanted in to six older mice (aged over 525 days) that were too old to be fertile any more. In the second experiment, only one ovary was removed from the young mice (about 170 days old) and transplanted into eight aged mice (over 540 days old). The average normal lifespan for this particular breed of mice (C57BL/6J) is 548 days, and they normally reach a mouse menopause at about 525 days old.

All the mice that received transplants in both experiments became fertile again, while control mice that had not received transplants did not. In the first experiment the mice resumed normal reproductive cycles that lasted for more than 80 days, and in the second experiment, they lasted for more that 130 days.

Dr Kagawa said: All the mice in both experiments that had received transplants resumed the normal reproductive behaviour of young mice. They showed interest in male mice, mated and some had pups. Normally, old mice stay in the corner of the cage and don't move much, but the activity of mice that had had ovarian transplants was transformed into that of younger mice and they resumed quick movements. Furthermore, the lifespan of the mice who received young ovaries was much longer than that of the control mice: the mice that had received two ovaries lived for an average of 915 days, and the mice that had received one ovary, for an average of 877 days. The newest of our data show the life span of mice that received transplants of young ovaries was increased by more than 40%.

The results show that transplanted normal ovaries from young mice can function in old, infertile mice, making them fertile again, but, in addition, extending their lifespan. Women who have ovarian tissue frozen at young ages, perhaps because they are about to embark on cancer treatment, can have their young ovarian tissue transplanted back when they are older. Normally we would be doing this simply to preserve their fertility or to expand their reproductive lifespan. However, our mice experiment suggests that this might also improve overall longevity. Further research has to be conducted before we can know whether or not this is the case.

Dr Kagawa said it was not known why the ovarian transplant increased the lifespan of the mice, but it might be because the transplants were prompting the continuation of normal hormonal functions.

She and her colleagues have been collaborating for the past six years with Dr Sherman Silber, from St Luke's Hospital, in St Louis, Missouri (USA), who has performed a number of successful ovarian transplants in women, either because they were about to be treated for cancer or because they had not yet found the right partner in life. Their future collaborative research will include investigating whether it is possible for a woman to have a transplant using an ovary that is not her own and with minimal drugs to suppress the body's natural immune response to what it perceives as a foreign body. They are also looking at culturing follicles in ovarian tissue in the laboratory in order to obtain mature eggs that can be used for IVF.

In the meantime, the researchers believe it is very important for doctors and patients to know that women have options when faced with cancer treatment that could destroy their fertility. We have been successful in getting frozen ovaries to function completely normally after thawing and transplantation, said Dr Kagawa. So this should no longer be considered an 'experimental' procedure. Ovarian transplantation is the proper and necessary accompaniment to otherwise sterilising treatment for young cancer patients. We must not neglect to freeze and save at least one of their ovaries before cancer treatment.

ESC supports traffic light food labeling vote

Wed, 16 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Sophia Antipolis, 16 June 2010: The European Society of Cardiology (ESC) http://www.escardio.org/ and its branch, the European Association for Cardiovascular Prevention and Rehabilitation (EACPR) http://www.escardio.org/communities/EACPR/Pages/welcome.aspx are joining forces with 12 other European Health and consumer communities to urge MEPs to vote in favour of a traffic light system for food labelling today.

If MEPs vote against the traffic light system they will be failing the next generation. Widespread introduction of the system would enable people in Europe to make informed choices about eating healthily. That would make a significant contribution to reducing the toll of cardiovascular disease. The plain facts are that four out of five cases of heart disease are directly related to diet, physical activity and smoking, said ESC spokesperson Joep Perk, from the School of Health and Caring Sciences at Linnaeus University (Sweden). A vote against the traffic light system, he adds, would give out the message to society that European politicians are hand in glove with the food industry.

In 2008, the European Commission proposed new legislation on providing food information to consumers. The idea behind traffic light labelling is simple: consumers deserve clear information about the key nutrients in food. Traffic light labels use colours (red, orange and green) to signal whether products contain high, medium or low levels of the harmful nutrients. The actual levels of these nutrients (salt, fat, saturated fat, and sugars) in every product are also given in absolute grams per 100-gram (or 100 millilitre).

Sadly, on 16 March 2010, the European Parliament's environment, public health and food safety committee voted against the introduction of a mandatory traffic-light labelling system. Regulation, they said, should lay down general rules on how information should be displayed, which would allow different countries to keep or adopt national rules. This vote is then taken forward as a recommendation from the committee, to the plenary session, taking place 16 June 2010, where all MEPs have the opportunity to vote.

Failure to introduce the traffic lights system, says Perk, will widen the health differences that already exist between different socio economic classes in Europe. The beauty of the traffic light approach is that people don't have to be highly educated or even literate to understand the information. It gives everyone equal opportunities to make informed choices about eating healthily, he says, adding that people can make these decisions where ever they are in Europe, regardless of whether they speak the local language.

One of the criticisms levelled against the traffic light system is that insufficient research has been undertaken to measure its effectiveness.

That is nonsense, said ESC spokesperson Simon Capewell, Professor of Clinical Epidemiology at the University of Liverpool (UK). Extensive solid evidence exists showing that more people understand the simple traffic light system than other, more complicated schemes.

It is also sad, he added, that some companies have been lobbying MEPs to oppose traffic lights, and thus keep consumers ignorant about what is actually hidden in the packet. In truth, millions of deaths from heart disease and stroke could be prevented if the industry halved the amount of salt, saturated fat and sugar hidden in our food. This is technically feasible, and has already been achieved in some countries.

Residential care home workers need more training to give older people a 'home for life'

Mon, 24 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Carers working in residential homes need funding and support to upskill to ensure more older people have a home for life instead of being transferred to hospitals and nursing homes, according to a new report.

Research from the University of Warwick and the University of West England is calling for social care home workers to be trained in basic clinical nursing skills to meet the changing needs of residents as they get older.

The report, funded by the Joseph Rowntree Foundation, also recommends a new registration system with formal qualifications for social care staff.

Professor Ala Szczepura from Warwick Medical School and Deirdre Wild from the University of the West of England, Bristol led the study, which has evaluated the introduction of enhanced care for older people in three types of residential home.

The report follows in the tracks of the recent White Paper: Building the National Care Service. The team compared a voluntary sector home, a privately-owned home and a local authority-owned home which all introduced 'enhanced residential care', based on developing new type of worker roles. Extensive fieldwork was carried out over three years and a total of 108 interviews were undertaken with residents and relatives, care staff, home managers and senior managers.

Survey questionnaires were also sent out to all staff, focus groups were conducted with care staff, residents and relatives and home managers and activity data was collected across the three residential homes and a comparator nursing home.

In England, more than 18,000 care homes currently provide places for more than 453,000 residents. Six out of ten places are in residential homes with no nursing staff employed on-site. Three quarters of residential homes are privately owned. Residential homes employ 230,000 care workers and senior care workers and this figure is set to rise with an ageing population.

Professor Szczepura said: Our research shows that the future care of older people is likely to be reliant on extending the spectrum of care provided by residential homes. As residents age, their health needs inevitably increase with nearly half of residents in the homes we studied classed as needing the intervention of a registered nurse on at least a daily basis. In such cases, if appropriate care cannot be provided on site, residents may find they are admitted to hospital or moved to a nursing home when this is not absolutely necessary.

The development of a cadre of new role carers would enable these homes to provide high quality care as residents' needs increase. This could save the NHS money as well as improving older people's quality of life. The new coalition Government's plans includes a commitment to addressing the future funding of long-term care; our research provides valuable information for this.

Professor Szczepura said the research findings supported the view that care staff can be trained in clinical skills so that good basic health and nursing care can be delivered in a residential home setting with the support of community nurses. This needs a strong relationship between health and social care which ensures that care staff know when and how to seek more specialist clinical support.

She added: Residential care homes currently differ significantly in their access to community nursing, clinical training and medical expertise.Fellow researcher Deirdre Wild from the University of the West of England, Bristol said there were also cultural barriers to overcome.

She said: As a society we tend not to value older people. Despite the policy rhetoric, we have found a continuing climate of ageism. Older residents are depicted as a burden on community services because it is believed that the demand they place upon community staff will outstrip available resource. Home managers frequently experience dismissive attitudes from hospital staff with little consideration given to the wellbeing of elderly residents on discharge. Older residents in one home described the poor quality of care they received in hospital that left them traumatised following discharge and with a dread of re admission. What seems to be forgotten is that older residents have rights as NHS patients and that one day health professionals too could be old, dependent and vulnerable.

MU awarded $8.5 million to explore tiny vessels' role in cardiovascular diseases

Thu, 06 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) One of the largest medical research grants ever awarded to the University of Missouri was announced today by MU scientists and administrators. The National Institutes of Health grant will help answer important questions about such prevalent health problems as high blood pressure, diabetes and stroke. The conditions are closely associated with cardiovascular disease, which is the leading cause of death in Missouri and the nation.

The $8.47 million program project grant from the NIH's National Heart, Lung and Blood Institute (NHLBI) will fund an integrated research effort involving more than 20 scientists across campus. Their discoveries will further understanding of the smallest blood vessels in the body, collectively known as the microcirculation. How the miniscule vessels contribute to health and disease is a growing field of study for cardiovascular researchers.

The grant has given us a very large opportunity that will help us focus on the many questions we have about microvascular function, said Gerald Meininger, PhD, the program director and project principal investigator, as well as director of MU's Dalton Cardiovascular Research Center. By focusing the efforts of many scientists, we hope to further understand the underlying conditions that contribute to many different types of cardiovascular diseases.

Life literally depends on the microcirculation. The network of vessels, with walls as small as a single cell thick, are responsible for transferring gases, nutrition and hormones throughout the body. The vessels also remove waste, such as carbon dioxide, from organs and tissues. The ability of these processes to function properly, over and over again through many of miles of tiny vessels, is what determines the health of the entire cardiovascular system and all the organs and tissues it supports.

MU has spent decades developing one of the most productive groups of cardiovascular investigators in the world, with a special emphasis on the emerging field of microcirculation, said Robert Churchill, MD, Hugh E. and Sarah D. Stephenson Dean of the MU School of Medicine. This grant is the latest example of what MU can achieve when scientific talent and resources from across campus come together to achieve a critical mass in a critical area of medical research.

The grant projects are particularly reliant on scientists and resources at MU's Dalton Cardiovascular Research Center, School of Medicine and College of Veterinary Medicine. Other key collaborators include MU's Center for Gender Physiology and Environmental Adaptation, Cosmopolitan International Diabetes and Endocrinology Center, Charles W. Gehrke Proteomics Center, and research support cores for computing, translational science and electron microscopy. Microscopy and spectrometry technology at Dalton and MU's Christopher S. Bond Life Sciences Center provide advanced tools for high-resolution imaging and analysis.

The imaging resources give MU a powerful advantage in terms of trying to answer questions about blood vessels that are thinner than human hair, as well as cells and tissues, said Ronald Korthuis, PhD, chair of the Department of Medical Pharmacology and Physiology and a project leader for the grant. Where others can only speculate, we are able to show the world.

All of the project leaders in the program grant are faculty members in the MU School of Medicine Department of Medical Pharmacology and Physiology, which is ranked 12th in the nation in terms of research grant funding. The prominence of Dalton and the department in microcirculation research led to MU's selection as host for more than 150 scientists from around the world for a meeting of the Microcirculatory Society in October 2009.

The pharmacology and physiology department also is generously supported by private gifts for endowed faculty positions and research centers. Grant program director Meininger, project leader Michael Davis, PhD, and George Davis, MD, PhD, and other department scientists involved in the grant are Margaret Proctor Mulligan Distinguished Professors in Medical Research. Korthuis, a project leader, is the George L. and Melna A. Bolm Distinguished Professor in Cardiovascular Health. Center for Gender Physiology director Virginia Huxley, PhD, is the James O. Davis Distinguished Professor in Cardiovascular Research. She and other scientists are housed in the Thomas W. and Joan F. Burns Center for Diabetes and Cardiovascular Research.

These endowments helped transform MU into a highly competitive institution for cardiovascular research, said Chancellor Brady Deaton, PhD, who recently led MU in receiving more than $1 billion in gifts for a campuswide fundraising campaign. With this new NIH grant, we'll continue to leverage our significant investments in cardiovascular research to improve the health and quality of life for people across our state and throughout the world.

Better vitamin D status could mean better quality of life for seniors

Sun, 25 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) According to legend, it was The Fountain of Youth that the famed Spanish explorer Ponce de Leon was seeking when he landed on the Floridian coast in 1513. It has long been said that he who drinks from the Fountain will have his youth restored. Without a doubt, the quest for eternal youth is as ancient as any pursuit. However, although we are now living longer than ever, there is now growing concern that quantity of years is not nearly as important as quality of those years. Indeed, as we experience the many joys of living longer, we also must deal with myriad consequences accompanying this aging trend. For instance, osteoporosis, arthritis, and other serious and often painful bone and joint diseases are much more common as we get older. And, not surprisingly, seniors often struggle daily with what was once the simple task of getting around. Hence, the obvious question in today's society concerning our longevity is What choices can we make to help ease these inconveniences of aging?

One area of particular interest is the role that diet plays in keeping bones and muscles strong from infancy to old age. For instance, a limited number of studies point to the possibility that optimal intake of vitamin D (the sunshine vitamin) might help keep our muscles strong and preserve physical function. Although there are only few longitudinal studies investigating this relationship, their findings have been mixed. To help understand this diet-health association, Dr. Denise Houston from the Sticht Center on Aging at Wake Forest University and her collaborators studied the relationship between vitamin D status and physical function in a group of relatively healthy seniors living in Memphis, TN and Pittsburgh, PA. Their results will be presented on Sunday, April 25 as part of the scientific program of the American Society for Nutrition, composed of the world's leading nutrition researchers, at the Experimental Biology 2010 meeting in Anaheim.

This study was part of the Health, Aging, and Body Composition (Health ABC) study initially designed to assess the associations among body composition, long-term health conditions, and mobility in older adults. For Houston's segment of the investigation, she studied 2788 seniors (mean age: ~75 years) for 4 years. At the beginning of the study, they assessed vitamin D status by analyzing each person's blood for 25-hydroxyvitamin D, a precursor for activated vitamin D. At baseline and then 2 and 4 years later, the research team then determined whether circulating 25-hydroxyvitamin D was related to the participants' physical function. Specifically, they looked at how quickly each participant could walk a short distance (6 meters) and rise from a chair five times as well as maintain his or her balance in progressively more challenging positions. Each participant was also put through a battery of tests assessing endurance and strength.

When the results were tabulated, participants with the highest levels of 25-hydroxyvitamin D had better physical function. And, although physical function declined over the course of the study, it remained significantly higher among those with the highest vitamin D levels at the beginning of the study compared to those with the lowest vitamin D levels. The scientists were not surprised to learn that, in general, vitamin D consumption was very low in this group of otherwise healthy seniors. In fact, more than 90% of them consumed less vitamin D than currently recommended, and many were relying on dietary supplements.

The good news: higher circulating 25-hydroxyvitamin D is related to better physical function in seniors. But it's impossible to tell from this type of research whether increasing vitamin D intake will actually lead to stronger muscles and preserve physical function. This is partly due to the fact that our bodies can make vitamin D if they get enough sunlight. So, it is possible that the participants with better physical function had higher vitamin D status simply because they were able to go outside more often. Indeed, the ominous chicken-or-the-egg question can only be answered by carefully controlled clinical intervention trials. Nonetheless, it is possible that getting more vitamin D from foods (like fortified milk and oily fish) or supplements will help maintain youth and vitality as we enjoy longer lifespans. As Houston points out: Current dietary recommendations are based primarily on vitamin D's effects on bone health. It is possible that higher amounts of vitamin D are needed for the preservation of muscle strength and physical function as well as other health conditions. However, clinical trials are needed to definitively determine whether increasing 25-hydroxyvitamin D concentrations through diet or supplements has an effect on these non-traditional outcomes.

Will vitamin D research lead us to The Fountain of Youth? Probably not. But paying attention to how much vitamin D we get is likely important at every age and will help enhance the quality component of life as we enter our senior years.

Older drivers often involved in daytime crashes more severe than younger drivers' crashes

Thu, 15 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Kansas State University researchers are discovering the challenges aging creates for drivers.

To help improve traffic safety, K-State engineers identified the characteristics of older drivers in Kansas and the types of crashes they are involved in. Their research found most car accidents involving older drivers occur during the daytime and are more severe, often ending in injury or fatality, than those for younger populations.

With this knowledge, the researchers will follow up with a study to learn what changes can be made to improve these difficulties for older drivers. The focus will be on countermeasures to reduce the number of crashes involving older drivers and the severity of the crashes.

Highway safety of older drivers is an issue, said Sunanda Dissanayake, K-State associate professor of civil engineering. If you live in an area like Kansas, there's not much public transportation, so drivers have to rely on a personal vehicle. The older population should be able to drive. It's a significant predictor of their quality of life.

Dissanayake started the project, which is funded by the Kansas Department of Transportation, in 2008 with Loshaka Perera, a former K-State graduate student in civil engineering. Dissanayake presented the research in March at the Institute of Transportation Engineers Annual Meeting

For the study, older drivers were defined as people 65 years and older. The researchers analyzed Kansas crash data from 1997 to 2006, which included crashes based on involvement and severity. The data were analyzed and compared among drivers aged 15 to 25, drivers aged 25 to 65, and older drivers.

If you look at the number of total crashes in Kansas involving older drivers, it's not that much. That's because they don't drive as much as the rest of the population, Dissanayake said. But if you look at crash involvement per mile driven, that's very high for older drivers.

The crash analysis showed that the severity of crashes for older drivers also is very high compared to the rest of the population. When looking at the categories of crash severity, older drivers have the highest incidents in fatal crashes, as well as incapacitating and non-incapacitating crashes. Older drivers also had a higher percentage of crashes occurring at intersections and accidents happening during daylight.

That doesn't necessarily mean it's more dangerous during daytime, Dissanayake said. It could be because older drivers do most of their driving during the daylight hours.

Most of the older-driver crashes involved colliding with another vehicle while in traffic. Few involved running off the road and hitting something, which is more common for young drivers, Dissanayake said. Right before their crashes, most of the older drivers were driving straight ahead, but a significant amount were making a left turn. Dissanayake said making a left turn is especially difficult when there is no green arrow, leaving the maneuver to the driver's judgment.

The study also identified the personal opinions and experiences of older drivers. The researchers distributed a survey for older drivers around Kansas at places like senior centers, retirement communities and churches. The results showed that more than 92 percent of the participants had more than 50 years of driving experience. Most of them reported driving cars, and 41 percent said they drove every day. However, the majority of older drivers said they drove less than 100 miles per month. The survey also showed that 65 percent of participants had never taken a driver education course, and 18 percent of the participants were involved in a crash in the last 10 years.

The survey also asked questions regarding the drivers' perceptions of the difficulties for different driving conditions. The participants said they don't mind driving in windy or rainy conditions, though they try to avoid driving in snow. Men reported to be more wiling to drive in bad weather compared to women.

Only 38 percent of the drivers said they are likely to drive during the night, and 39 percent said they are likely to drive on freeways. Participants also answered questions regarding factors of driving that have become more difficult as they have gotten older.

One of the most difficult things for them is identifying the speed and distance of oncoming traffic, Dissanayake said. This is important for making a left turn, and looking at the crash data, we see a lot of left-turn crashes.

The participants also said they have difficulty and feel less comfortable making sudden, unexpected stops while driving, as well as merging and changing lanes. Fifty percent said they would like to avoid high-traffic roads, as well as freeways and two-lane undivided highways.

One of the challenging situations that could be improved is the safety at intersections, Dissanayake said.

In areas where there are more older drivers, I think we should always look at the possibility of having the green arrow indication at left turns, Dissanayake said. Additionally, for driver education perhaps we need to have a closer look at the driver license renewal process, such as its frequency and what is covered.

She said the fonts and sizes of road signs also could be further improved to ensure older driver safety.

As the older population gradually increases in the United States, so will the number of older drivers, Dissanayake said. We need to be taking steps to improve their safety while driving, which also would be beneficial to all road users.

Investigational immune intervention slows brain shrinkage in Alzheimer's patients

Tue, 13 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) TORONTO (April 13, 2010) -- An investigational intervention using naturally ocurring antibodies in human blood has preserved the thinking abilities of a group of mild- to moderate-stage Alzheimer's patients over 18 months and significantly reduced the rate of atrophy (shrinkage) of their brains, according to a study performed at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center. These and other findings from the Phase II clinical trial of GAMMAGARD LIQUID and GAMMAGARD S/D Immune Globulin Intravenous (Human) (IGIV) for Alzheimer's disease (AD) were presented today at the American Academy of Neurology (AAN) meeting in Toronto.

In a Late-Breaking News presentation at the AAN on Wednesday, April 14, at 7:30 am, Dr. Norman Relkin, director of the Memory Disorders Program at NewYork-Presbyterian/Weill Cornell, will report that patients receiving IGIV once or twice a month for 18 months had significantly lower rates of ventricular enlargement (6.7% vs 12.7% per year) and less whole-brain atrophy (1.6% vs 2.2% per year) than control subjects who initially received placebo. Dr. Relkin's findings were based on two independent analyses of brain-imaging data from 20 patients who underwent serial MRI scans during the Phase II study of IGIV for AD.

Past AD studies that used MRI measures found no change or an accelerated rate of brain shrinkage after investigational treatments, Dr. Relkin notes. To the best of my knowledge, this is the first trial in which long-term clinical benefits in Alzheimer's patients were accompanied by objective signs of reduced brain degeneration. Dr. Relkin is also an associate professor of clinical neurology and neuroscience at Weill Cornell Medical College in New York City. He was the principal investigator in the Phase II study and is currently leading a multicenter Phase III study of IGIV for Alzheimer's.

A typical AD patient's brain shrinks three to four times faster than a healthy older adult's as a consequence of accelerated brain cell death. This shrinkage of brain tissue causes the fluid-filled ventricles at the center of the brain to enlarge at a faster than normal rate. Changes in the size of the brain and ventricles can be measured accurately by analyzing results from two or more MRI scans obtained at an interval of at least several months apart.

The unprecedented reductions in these measures after IGIV reported by Dr. Relkin and his colleagues could indicate that IGIV exerts a disease-modifying effect that the current generation of approved AD treatments lack.

Dr. Relkin also found that rates of brain shrinkage after IGIV intervention were independent of the subject's age, gender and brain volume at the start of the study but strongly correlated with dose of IGIV and the clinical outcomes after 18 months of intervention.

The Weill Cornell research team also found that AD patients who responded best to IGIV did not measurably decline over 18 months, and had an average rate of brain shrinkage and average rate of ventricular enlargement comparable to the rate previously reported in normal elderly individuals. A dose-related effect of an Alzheimer's intervention on brain ventricular enlargement has never been seen before, and it suggests that IGIV may, indeed, be sparing brain tissue, says Dr. James Brewer, a neurologist and assistant professor of neurology at the University of California at San Diego.

Dr. Brewer independently analyzed the MRIs from the Phase II IGIV study, and his findings closely matched those obtained by Dr. Dana Moore, a postdoctoral fellow working with Dr. Relkin at Weill Cornell. I am particularly looking forward to examining the Phase III data when that study is completed, Dr. Brewer states. Since it involves a considerably larger group of patients, it will permit us to obtain more detailed measures of atrophy in the brain regions specifically vulnerable to Alzheimer's disease.

More details about the study's cognitive testing results will be reported in a later presentation at the AAN meeting by Dr. Diamanto Tsakanikas, who performed cognitive and other testing of the study's participants. Dr. Tsakanikas is a clinical assistant attending neuropsychologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and an instructor of neuropsychology in the Department of Neurology and Neuroscience at Weill Cornell Medical College. While conducting the testing, Dr. Tsakanikas was blinded to whether patients were receiving IGIV or placebo and to the IGIV dose.

When the unblinded study results were later analyzed, her testing indicated that AD patients who received uninterrupted IGIV for 18 months showed significantly less decline in their overall function and thinking abilities than AD patients initially given an inactive placebo. In some cases, IGIV intervention resulted in improvements in certain areas of cognitive functioning. Functions mediated by the frontal regions of the brain showed the most consistent benefits in IGIV responders, says Dr. Tsakanikas.

The Phase II study involved 24 patients with mild to moderate Alzheimer's disease who were randomly assigned to receive IGIV (16 patients) or saline placebo (eight patients) for six months. Over the following 12 months, the initially placebo-treated group were subsequently received various doses of IGIV while the other 16 patients had uninterrupted IGIV at the initially assigned dose. The study included a comparison of four dosing regimens of IGIV, with doses ranging from 0.2 g/kg every two weeks to 0.8 g/kg every four weeks. The Phase II study was carried out with the explicit goal of determining whether further testing of IGIV for Alzheimer's was justified, Dr. Relkin points out. It succeeded in achieving that goal with a relatively small number of subjects. However, we now have to await the results of the larger, pivotal Phase III study to establish the magnitude of its effects on rate of brain atrophy and to confirm whether IGIV is safe and effective for treating AD.

IGIV is being tested as a potential agent for AD immunotherapy because it contains antibodies against beta-amyloid (A?), which is the main constituent of amyloid plaques in the brains of AD patients. IGIV is not approved to treat Alzheimer's disease but it is approved in the United States and other countries for certain immune deficiency and autoimmune disorders. A critical Phase III study of IGIV for AD, supported jointly by the National Institutes of Health (NIH) and Baxter Healthcare, is currently enrolling patients at 35 sites in North America (see more below).

$3.7 million trial uses genes to balance risks, benefits of blood thinner

Thu, 08 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A five-year, $3.7 million clinical trial will investigate how to balance the benefits and risks of warfarin, a drug that helps prevent potentially deadly blood clots.

The multicenter study, led by researchers at Washington University School of Medicine in St. Louis, will evaluate customized warfarin dosage based on patient genetics and will test which range of blood clotting is optimal in orthopedic patients.

Blood clots contribute to the death of 100,000 Americans every year. Most of these deaths occur suddenly, so prevention with a blood thinner, or anticoagulant, such as warfarin (Coumadin) is widely regarded to be the best form of protection. However, a number of factors including drug interactions and genetics can interfere dangerously with warfarin, making it tricky to pinpoint the correct dose.

To help determine the best way to establish the right dose, knee or hip replacement surgery patients at Barnes-Jewish Hospital and several other institutions will be eligible to enroll in the Genetics InFormatics Trial of Warfarin (GIFT).

Without any anticoagulant, orthopedic patients have a nearly 50 percent chance of having a blood clot after hip or knee replacement, says Brian Gage, MD, associate professor of medicine at Washington University and lead investigator of the trial. These are the people at highest risk for blood clots, and because they've just had surgery they are also at high risk for bleeding. This balance is why this question of warfarin dosing is critical. Finding the right dose is like walking a tightrope.

The National Heart, Lung, and Blood Institute will fund the study. Collaborating institutions include the University of Utah, Intermountain Health Care, and the Hospital for Special Surgery in New York. Gage and colleagues hope to enroll 1,600 patients recovering from hip or knee replacement surgery, which will allow them to investigate two problems that make determining optimal warfarin dosage challenging.

First, individual genetic variation affects how warfarin is tolerated and broken down by the body. Based on years of research, the team has developed several formulas that take genetic information into account when calculating warfarin dosage. The newest of these formulas has been published online April 7, 2010, in Clinical Pharmacology and Therapeutics.

In the GIFT trial, they will use a formula that includes three gene variations that have been shown to influence a person's warfarin sensitivity or metabolism. They have made these formulas available to physicians through the Web site warfarindosing.org.

What's special about warfarin is that there are only a few drugs that are at this stage of incorporating genetics into clinical use, says Petra Lenzini, a research statistician in the Division of General Medical Sciences and coordinator of the GIFT trial. How we conduct this trial will set the stage for future research in relating genetics to pharmacology.

The second problem GIFT will tackle is the long-standing debate concerning appropriate target levels of clotting ability in the blood, a quantity known as the International Normalized Ratio (INR). INR refers to blood clotting speed: the higher the number, the longer blood takes to clot. A higher INR increases the chances that a patient will start bleeding, but also decreases the chances that a patient will develop a clot.

The American Academy of Orthopedic Surgeons currently recommends an INR of less than 2.0. However, the American College of Chest Physicians has set forth a recommended target INR of 2.0 to 3.0. Until now, no study has attempted to compare these two guidelines of warfarin treatment to determine which strikes the best balance between bleeding and clot risk.

All participants in GIFT will receive warfarin treatment. For half of the patients, warfarin dose will be decided based on clinical formulas that account for age, body size, medications and smoking status. The other half will receive a warfarin estimate based on these factors plus genetics. Each group will also be split, with one half trying to reach a target INR of less than 2.0 and the other half striving for an INR of 2.5. The researchers anticipate that after the initial two weeks of treatment, patients will have reached an appropriate level of warfarin with little adjustment needed thereafter.

The first aim is a test of the paradigm of personalized medicine, Gage says. We have been working in the field for eight years. Now, it's exciting to go see that results of these efforts will be used to care for thousands of patients.

What if all software was open source? A code to unlock the desktop

Tue, 30 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) What if all software was open source? Anybody would then be able to add custom features to Microsoft Word, Adobe Photoshop, Apple iTunes or any other program. A University of Washington project may make this possible.

Microsoft and Apple aren't going to open up all their stuff. But they all create programs that put pixels on the screen. And if we can modify those pixels, then we can change the program's apparent behavior, said James Fogarty, a UW assistant professor of computer science and engineering.

His approach hijacks the display to customize the user's interaction with the program. He will demonstrate his system April 14 in Atlanta at the Association for Computing Machinery's Conference on Human Factors in Computing Systems.

We really see this as a first step toward a scenario where anybody can modify any application, Fogarty said. In a sense, this has happened online. You've got this mash-up culture on the Web because everybody can see the HTML. But that hasn't been possible on the desktop.

These days a Web page might include a map from Google, an embedded video from YouTube and a list of recent headlines. This is not yet possible on the personal computer.

Let's say I'm writing a paper in Microsoft Word but I want to listen to music at the same time, explained co-author Morgan Dixon, a UW doctoral student in computer science and engineering.

Right now he would have to click back and for the between Word and iTunes, but the system he helped create can simply add a few iTunes buttons to the Word toolbar.

I'm using some program that I love, Dixon said, and I'm going to stick in some features from some other program that I love, so I have a more unified interface.

More importantly, having more control over widely used programs would allow people to benefit from accessibility tools that have been gathering dust in academic research labs.

An example is target-aware pointing, which can make many interfaces easier for people with muscular dystrophy, Parkinson's disease, cerebral palsy or other motor-control disabilities. One such tool, the bubble cursor, highlights the button closest to it, making it easier for people with disabilities to click a button without having to hit it dead on. Fogarty and Dixon show the first implementation of a bubble cursor in various commercial applications.

The human-computer interaction community has done 30 years of research on how to make computers more accessible to people with disabilities. But no one change is perfect for everybody, Fogarty said. That's why you don't see these tools out there.

His research allows people to personalize programs based on their needs.

The UW tool, named Prefab, takes advantage of the fact that almost all displays are made from prefabricated blocks of code such as buttons, sliders, check boxes and drop-down menus. Prefab looks for those blocks as many as 20 times per second and alters their behavior.

The researchers are continuing to develop Prefab and are exploring options for commercialization.

Prefab unlocks previously inaccessible interfaces, allowing people to add the same usability tool to all the applications they run on their desktop. The system could translate a program's interface into a different language, or reorder menus to bump up favorite commands.

The authors hope Prefab will spur development of new innovations.

If you come up with a new technology, too often it's evaluated in a test environment, Fogarty said. This lets researchers put it into practice in something real, like Photoshop or iTunes.

Prefab can also produce more advanced effects. One demonstration that will be presented at the conference creates multiple previews of a single image in Photoshop. Behind the scenes, Prefab moves the sliders to different points, captures the output and then displays all of them on a single screen. This could save time by showing a range of effects the user frequently adjusts.

The system could also allow programs to move from computer screens to mobile devices, which do not have a standard operating system.

Survival in metastatic breast cancer patients is improving: targeted therapies have contributed

Fri, 26 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: Trends indicate that survival is improving in patients with metastatic breast cancer, especially in those patients whose tumours are described as being HER2 (human epidermal growth factor receptor-2) positive, a surgical oncologist will say today (Friday 26 March) at the seventh European Breast Cancer Conference (EBCC7).

Dr Marie Sundquist, from the Department of Surgery, County Hospital, Kalmar, Sweden, will say that the median survival times for five-year intervals of 557 metastatic breast cancer patients in Kalmar, Sweden, increased steadily, from 10 months for the 1985 to 1990 period, to 22 months for the 2000 to 2004 period.

She will be reporting the findings of a retrospective analysis of follow-up data of breast cancer patients who were diagnosed in hospitals in Kalmar County since 1985. A strength of our work is that we have studied a consecutive population in a defined geographical area for a continuous period of 25 years, Dr Sundquist will tell the conference.

Dr Sundquist will tell delegates that for 288 patients with grade III tumours, the most aggressive type of breast cancer, the median survival time increased from 10 months for the 1985 to1990 period to 17 months for the 2000 to 2004 period. The increased use of the chemotherapy drugs called anthracyclines and taxanes led to the improved survival outcomes in this group of patients with the aggressive form of metastatic breast cancer, she said.

Some breast cancer cells have receptors, which allow certain types of hormones or proteins to attach to the cancer cell. Breast cancer hormone-receptor status can affect the individual patient's treatment options as well as overall prognosis. Analysis of the data by HER2 positive status revealed that HER2 positive patients with metastatic breast cancer had improved survival rates. Prior to the year 2000, 40 HER2 positive patients had a median survival of 14 months compared to 21 months for 40 HER2 positive patients diagnosed with breast cancer from the year 2000 onwards.

Dr Sundquist said: There is no doubt that trastuzumab (Herceptin), which targets the HER2 gene, is the most important reason for the improved survival in this group of patients, and use of the chemotherapy drugs known as anthracyclines also contributed.

In the group of HER2 positive patients that had the most aggressive type of breast cancer (grade III), 45% of those patients that received trastuzumab had survived more than three years and 30% more than five years, Dr Sundquist added.

Patients whose breast tumours have spread outside of the breast and armpit areas are essentially incurable. However, some patients live even decades with a good quality of life despite an initially widespread tumour burden, while others fail to respond to any therapy. To explore and try to understand these mechanisms would make it easier to tailor the treatment for each individual patient, Dr Sundquist will say.

A new era of breast cancer treatment started with the gene-targeted therapy of trastuzumab. Since then, a number of similar targeted therapies including antibodies or inhibitors of specific genes have been developed. This will open new avenues in the treatment of all metastatic breast cancers and also of primary breast cancer.

These new targeted therapies will, at least in the beginning after their development, be very costly for healthcare systems. On the other hand they will make it possible for many women to lead almost normal lives, work and contribute to society for an increased number of years, she concluded.

The researchers intend to follow up their work by performing genetic analyses of the tumours with different responsiveness to specific treatments. Health care systems will need to provide tools for the routine clinical assessment of a number of genes related to treatment response, she added.

The sea squirt offers hope for Alzheimer's sufferers

Tue, 02 Mar 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Alzheimer's disease affects an estimated 27 million people worldwide. It is the most common form of age-related dementia, possibly the most feared disease of old age. There is no cure, and the available drugs only help to relieve symptoms without slowing progression of the disease. One of the characteristic changes in the brains of Alzheimer's patients is the accumulation of plaques and tangles; currently, the best hope for curing or at least slowing the disease lies in developing drugs that target this buildup. Some drugs are already in clinical trials, but there is still a pressing need for more research, and for more and better drugs directed against both known and novel targets.

One of the big problems in rapidly screening potentially useful drugs has been the lack of a good model system in which Alzheimer's plaques and tangles appear quickly. However, Mike Virata and Bob Zeller, scientists working at San Diego State University, California, have come up with a new, and perhaps unlikely candidate; the humble sea squirt, Ciona intestinalis. Sea squirts are tunicates, marine organisms protected by an outer hard tunic with a soft body inside. Adults spend their lives attached to one spot on underwater structures like the pilings of piers, sucking in water through one siphon, filtering out small plants to eat, and squirting the water back out through another siphon. However, as long ago as Darwin, it has been recognized that sea squirts may be our closest invertebrate relatives; in their immature, tadpole form, they resemble proper vertebrates, and they share about 80% of their genes with us.

Bob Zeller has been a fan of sea squirt tadpoles since starting work with them in the 1990s, when he helped develop a way of introducing foreign DNA into fertilized sea squirt eggs with almost 100% efficiency, opening the way for their use as model organisms. He and his colleague Mike Virata decided to see whether it would be possible to model Alzheimer's disease in the tiny animals, which share all the genes needed for the development of Alzheimer's plaques in humans. Incredibly, dosing the sea squirt tadpoles with a mutant protein found in human families with hereditary Alzheimer's resulted in aggressive development of plaques in the tadpoles' brains in only a day, and these, along with the accompanying behavioral defects seen in the tadpoles, could be reversed by treating with an experimental anti-plaque forming drug. This is an important breakthrough, as all other invertebrates tested have been unable to process the plaque-forming protein, and vertebrates take months or years to make plaques. These exciting results make it a real possibility that sea squirts are an excellent model for testing new drugs in the fight against Alzheimer's disease.

Research: How you think about your age may affect how you age

Tue, 02 Mar 2010 05:00:00 PST

( from http://www.rxpgnews.com ) WEST LAFAYETTE, Ind. - The saying You're only as old as you feel really seems to resonate with older adults, according to research from Purdue University.

How old you are matters, but beyond that it's your interpretation that has far-reaching implications for the process of aging, said Markus H. Schafer, a doctoral student in sociology and gerontology who led the study. So, if you feel old beyond your own chronological years you are probably going to experience a lot of the downsides that we associate with aging.

But if you are older and maintain a sense of being younger, then that gives you an edge in maintaining a lot of the abilities you prize.

Schafer and co-author Tetyana P. Shippee, a Purdue graduate who is a research associate at Purdue's Center on Aging and the Life Course, compared people's chronological age and their subjective age to determine which one has a greater influence on cognitive abilities during older adulthood. Nearly 500 people ages 55-74 were surveyed about aging in 1995 and 2005 as part of the National Survey of Midlife Development in the United States.

In 1995, when people were asked what age do you feel most of the time, the majority identified with being 12 years younger than they actually were.

We found that these people who felt young for their age were more likely to have greater confidence about their cognitive abilities a decade later, Schafer said. Yes, chronological age was important, but the subjective age had a stronger effect.

What we are not sure about is what comes first. Does a person's wellness and happiness affect their cognitive abilities or does a person's cognitive ability contribute to their sense of wellness. We are planning to address this in a future study.

Schafer also said that the current study's findings have both positive and negative implications.

There is a tremendous emphasis on being youthful in our society and that can have a negative effect for people, Schafer said. People want to feel younger, and so when they do inevitably age they can lose a lot of confidence in their cognitive abilities.

But on the other hand, because there is such a desire in America to stay young, there may be benefits of trying to maintain a sense of youthfulness by keeping up with new trends and activities that feel invigorating. Learning new technologies is one way people can continue to improve their cognitive abilities. It will be interesting to see how, or if, these cultural norms shift as the Baby Boomer generation ages.

Other studies have shown that women are prone to aging stereotypes, so Schafer expected to see that women who felt older about themselves would have less confidence in their cognitive abilities.

There is a slight difference between men and women, but it's not as pronounced as we expected, Schafer said. This was surprising because of the emphasis on physical attractiveness and youth that is often disproportionately placed on women.

Schafer also is studying how stressful events, such as family members' health issues, affect aging, as well as how happiness and aging relate.

Multicenter study finds little effect of soy isoflavones on bone loss in postmenopausal women

Tue, 09 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) AMES, Iowa -- A previous six-month study by Iowa State University researchers had indicated that consuming modest amounts of soy protein, rich in isoflavones, lessened lumbar spine bone loss in midlife, perimenopausal women. But now an expanded three-year study by some of those same researchers does not show a bone-sparing effect in postmenopausal women who ingested soy isoflavone tablets, except for a modest effect at the femoral (hip) neck among those who took the highest dosage.

The multi-center clinical trial of 224 postmenopausal women -- led by D. Lee Alekel, professor of nutrition and interim associate director of the Nutrition and Wellness Research Center (NWRC) at Iowa State, and supported by the National Institute of Arthritis, Musculoskeletal and Skin Diseases, one of the research institutes of the National Institutes of Health (NIH) -- was the longest ever conducted on the effects of soy isoflavones on bone mineral density (BMD). It compared the effects of either ingesting daily 80-mg daily or 120-mg soy isoflavone tablets, compared to placebo tablets on BMD and other health outcomes.

Iowa State NWRC researchers collaborated with research physiologist Marta D. Van Loan and her colleagues at the USDA Agricultural Research Service's Western Human Nutrition Research Center, located at the University of California, Davis. The primary results of their study were published in the January issue of The American Journal of Clinical Nutrition.

Our six-month preliminary study, published in 2000, indicated that soy protein, rich in isoflavones, exerted the greatest impact in slowing the loss of bone mineral density in the lumbar spine, Alekel said. But we believed that we needed to replicate these results in a study with a greater sample size and longer duration, which is what we did with this three-year intervention.

In this longer study, we had sufficient power to detect change, she continued. We monitored adverse events, had excellent compliance throughout, and accounted for potential confounding factors.

NWRC research staff members Laura Hanson, Jeanne Stewart and Kathy Hanson also joined Kenneth Koehler and C. Ted Peterson from statistics as part of the eight-member ISU team that conducted the research.

The researchers ran statistical analyses to determine change in BMD at the lumbar spine, total proximal femur (hip), femoral neck and whole body. They accounted for treatment, age, whole body fat mass and bone removal (using a biochemical marker).

While the 120-mg dose soy isoflavones did reveal a small protective effect on femoral neck bone BMD, researchers found no significant effect of treatment on lumbar spine, total hip, or whole-body BMD.

This trial used isoflavones extracted from soy protein, compressed into tablet form, consumed over the course of three years, which is very different than either providing soy protein or soy foods, Alekel said. In our recent study, we did not demonstrate an important biological effect on BMD or bone turnover.

The new study calls into question the value of postmenopausal women consuming soy isoflavone tablets to help lessen bone loss and minimize the effect of osteoporosis.

The preponderance of studies that have been published -- particularly the longer term, more carefully conducted studies, like our own -- have shown little to no biological effects of soy isoflavones on BMD, she said. This field of research has attracted 'believers,' making it difficult to convince them otherwise. They may continue to believe what they want to believe, rather than what the evidence shows.

And when it comes to minimizing the consequences of osteoporosis in postmenopausal women, Alekel urges a more holistic approach.

People in general, would like an easy fix. We would all like soy isoflavones to be that magic pill, but this study has found that they are not, she said.

Results from other health outcomes from this research have been published in six manuscripts to date, with six additional manuscripts underway. The NWRC research team will continue to study factors that influence bone mineral density and health outcomes in postmenopausal women.

Researchers revisit pulmonary arterial hypertension survival

Wed, 06 Jan 2010 04:59:36 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 13:05:45 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 PST

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

Thu, 25 Jun 2009 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 05:00:00 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 10:14:28 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 13:24:12 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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.