TIMING OF CALCIUM AND VITAMIN D SUPPLEMENTATION MAY AFFECT HOW BONE ADAPTS TO EXERCISE
TAKING CALCIUM AND VITAMIN D BEFORE EXERCISE MAY INFLUENCE HOW BONES ADAPT TO EXERCISE, ACCORDING TO A NEW STUDY. THE RESULTS WILL BE PRESENTED ON TUESDAY AT THE ENDOCRINE SOCIETYS 95TH ANNUAL MEETING IN SAN FRANCISCO.
19 jun 2013--"The timing of calcium supplementation, and not just the amount of supplementation, may be an important factor in how the skeleton adapts to exercise training," said study lead author Vanessa D. Sherk, PhD, postdoctoral research fellow at the University of Colorado Anschutz Medical Campus. "Further research, however, is needed to determine whether the timing of calcium supplementation affects the skeletal adaptations to exercise training."
Previous research has shown that a year of intense training is associated with substantial decreases in bone mineral density among competitive road cyclists. Experts believe that this kind of exercise-induced bone loss could be related to the loss of calcium during exercise. As blood calcium levels drop, the parathyroid gland produces excess parathyroid hormone, which can mobilize calcium from the skeleton.
In this study, investigators found that an exercise-induced decrease in blood calcium occurred whether calcium supplements were taken before or after exercising. Pre-exercise supplementation, however, resulted in less of a decrease. Although not statistically significant, parathyroid hormone levels increased slightly less among cyclists who took calcium before exercising.
"These findings are relevant to individuals who engage in vigorous exercise and may lose a substantial amount of calcium through sweating," Sherk said. "Taking calcium before exercise may help keep blood levels more stable during exercise, compared to taking the supplement afterwards, but we do not yet know the long-term effects of this on bone density."
The timing of calcium supplementation did not cause a difference in blood levels of a compound that is a biological indicator of bone loss. Both the before- and after-exercise groups exhibited 50-percent increases in the level of this compound, called CTX, for collagen type-1 C-telopeptide.
Study participants included 52 men aged 18 to 45 years. Investigators randomly assigned participants to take 1,000 milligrams of calcium and 1,000 international units of vitamin D either 30 minutes before or one hour after exercise. The exercise comprised a simulated 35-kilometer time trial, and participants wore skin patches to absorb sweat.
Investigators measured blood levels of calcium and parathyroid hormone before and immediately after exercise. They also measured CTX before and 30 minutes after exercise. They used pre- and post-body weight, adjusted for fluid intake, combined with the calcium measured in the sweat from the skin patches, to estimate the amount of calcium lost through the skin during exercise.
Provided by The Endocrine Society
ELDERLY BENEFIT FROM USING IMPLANTABLE DEFIBRILLATORS
This infographic from the article outlines the elderly may benefit from implantable cardioverter defibrillators as much as younger people. Credit: American Heart Association journal Circulation; D. Lee
This infographic from the article outlines the elderly may benefit from implantable cardioverter defibrillators as much as younger people. Credit: American Heart Association journal Circulation; D. Lee
THE ELDERLY MAY BENEFIT FROM IMPLANTABLE CARDIOVERTER DEFIBRILLATORS AS MUCH AS YOUNGER PEOPLE, ACCORDING TO NEW RESEARCH IN THE AMERICAN HEART ASSOCIATION JOURNAL _CIRCULATION_.
18 jun 2013--An implantable cardioverter defibrillator (ICD) is a small battery-powered device placed under the skin of the chest which delivers electrical impulses to restore a normal heartbeat if it detects a dangerous abnormal rhythm.
Overall health—not age alone—should determine how well patients will do after getting an ICD and help guide decisions about who should receive one, researchers said.
"Whether elderly patients benefit from the devices has been controversial and research on the topic is lacking," said Douglas S. Lee, M.D., Ph.D., lead author and scientist at the Institute for Clinical Evaluative Sciences and cardiologist at the Peter Munk Cardiac Centre in Toronto, Ontario, Canada. "The issue is important as the population ages and the number of elderly people living with heart disease grows."
Researchers studied 5,399 patients who had ICDs implanted because of poor heart function due to a prior heart attack or heart failure, or after being resuscitated from cardiac arrest.
"Older patients were just as likely to experience an appropriate electrical shock from the device to treat a life-threatening heart rhythm. However, older patients experienced more non-cardiac and cardiovascular hospitalizations and higher associated rates of death overall," said Lee, who is also associate professor of medicine at the University of Toronto.
Other study findings include:
* Among those who received an ICD with heart failure or after heart attack, 38.5 percent were 70 years or older and 7 percent were 80 years or older.
* Among those who received an ICD after surviving a cardiac arrest, 42.5 percent were 70 years or older and 10.9 percent were in their 80s.
* Older age correlated with increased risk of death after ICD implantation in both groups. For example, among those undergoing ICD implantation for prevention of cardiac arrest, 2 in every 100 patients ages 18-49 died whereas 10 in 100 died among those 80 years and older.
* Use of the devices was equally effective among younger and older patients in restoring heart rhythm after a serious life-threatening rhythm disorder occurred. Across all age groups, ICDs more often delivered appropriate electrical shocks when implanted after cardiac arrest than when used to prevent the first cardiac arrest.
Provided by American Heart Association
COMMONLY-PRESCRIBED DRUGS MAY INFLUENCE THE ONSET AND PROGRESSION OF ALZHEIMERS DISEASE
MULTIPLE DRUG CLASSES COMMONLY PRESCRIBED FOR COMMON MEDICAL CONDITIONS ARE CAPABLE OF INFLUENCING THE ONSET AND PROGRESSION OF ALZHEIMERS DISEASE, ACCORDING TO RESEARCHERS AT THE MOUNT SINAI MEDICAL CENTER. THE FINDINGS ARE PUBLISHED ONLINE IN THE JOURNAL _PLOS ONE_.
17 jun 2013--Led by Giulio Maria Pasinetti, MD, PhD, the Saunders Family Chair and Professor in Neurology at Mount Sinai, a research team used a computer algorithm to screen 1,600 commercially-available medications to assess their impact on the brain accumulation of beta-amyloid, a protein abnormally accumulated in the brain of Alzheimers disease and implicated in neurodegeneration. They found that currently-available medications prescribed for conditions such as hypertension, depression, and insomnia were found to either to block or to enhance the accumulation of beta-amyloid, the component of amyloid plaques.
"This line of investigation will soon lead to the identification of common medications that might potentially trigger conditions associated with the prevention, or conversely the onset, of Alzheimers disease," said Dr. Pasinetti. "They may be a novel reference for physicians to consider when prescribing the most appropriate drug, particularly in subjects at high risk for Alzheimers disease."
To validate the screening protocol, Dr. Pasinetti and his colleagues administered these drugs in mice that were genetically engineered to develop the hallmark amyloid plaques associated with Alzheimers disease. After six months of treatment with blood pressure medicines, amyloid plaques and neurodegeneration were significantly reduced in the mice. One such medicine was Carvedilol, now under clinical investigation in Alzheimer s disease with the intent to slow down memory deterioration.
"In recent years, amyloid plaques have become one of the main focal points in the search to understand and to treat Alzheimers disease," said Dr. Pasinetti. "Thus, identifying novel drug treatments that prevent harmful beta-amyloid generation will help in the development of treatments for Alzheimers disease. For example, one very exciting finding of our study is that Carvedilol, already approved for treatment of hypertension, may immediately become a promising drug for the treatment of Alzheimers as well."
The authors discuss the limitations of the research, noting that studies must be immediately verified in human-safety studies that examine the effects of the drugs independent of the original indication. Dr. Pasinetti hopes these findings will lead to multiple clinical trials in the future to identify preventive drugs, which will need to be prescribed at tolerable dosages.
"If we can repurpose drugs currently used for different indications, such as lowering blood pressure, this could have dramatic implications for this population," said Dr. Pasinetti.
Provided by The Mount Sinai Hospital
DEPRESSION IN POSTMENOPAUSAL WOMEN MAY INCREASE DIABETES AND CARDIOVASCULAR DISEASE RISK
POSTMENOPAUSAL WOMEN WHO USE ANTIDEPRESSANT MEDICATION OR SUFFER FROM DEPRESSION MIGHT BE MORE LIKELY TO HAVE A HIGHER BODY MASS INDEX (BMI), LARGER WAIST CIRCUMFERENCE AND INFLAMMATION—ALL ASSOCIATED WITH INCREASED RISK FOR DIABETES AND CARDIOVASCULAR DISEASE, ACCORDING TO A STUDY LED BY UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL INVESTIGATOR YUNSHENG MA, PHD, MD, MPH, AND PUBLISHED IN THE JUNE 13 ISSUE OF THE _AMERICAN JOURNAL OF PUBLIC HEALTH_.
16 jun 2013--The UMass Medical School study investigated whether elevated depressive symptoms and antidepressant use are associated with biomarkers for glucose dysregulation and inflammation, BMI and waist circumference. The three main findings indicate that both elevated depressive symptoms and antidepressant use are each significantly associated with higher BMI and waist circumference; elevated depressive symptoms are associated with increased levels of insulin and insulin resistance; and antidepressant use is associated with increased C-reactive protein (CRP) levels, a marker of inflammation, which increases the risk of type-2 diabetes and cardiovascular disease.
"It may be prudent to monitor post-menopausal women who have elevated depression symptoms or are taking antidepressant medication to prevent diabetes and cardiovascular disease," said Dr. Ma, associate professor of medicine, who with UMMS colleagues analyzed data from the landmark Womens Health Initiative (WHI).
Postmenopausal women were recruited into the WHI from 1993 to 1998, and data for this analysis were collected at regular intervals through 2005. Using data from 1,953 women who completed all relevant WHI assessments, the study found that elevated depressive symptoms were found to be significantly associated with increased insulin levels and measures of insulin resistance. Significantly, throughout the entire 7.6 years on average that women were enrolled in the WHI, those who had elevated depressive symptoms or were using antidepressants had higher average BMI and waist circumference than did women not using antidepressants or without depressive symptoms among 71,809 women. However, the associations were stronger for waist circumference.
Analysis of data from 2,242 women showed that both elevated depressive symptoms and antidepressant use was associated with higher CRP levels, a marker of inflammation.
"Identifying these markers in women is important for diabetes prevention because they can be monitored for possible action before progression to full-blown diabetes," said Ma.
Few studies have examined the association of BMI, waist circumference and biomarkers of glucose dysregulation and inflammation with depression, antidepressant medication use, or both. The UMMS study included a large, racially and ethnically diverse sample of post-menopausal women. Because the analysis was epidemiological, it could not determine a causal relationship, so further study is needed to confirm the results through clinical trials.
"Given that diabetes and cardiovascular disease can be effectively prevented or delayed in high-risk individuals with lifestyle modifications or pharmacological interventions, our findings indicate the prudence of monitoring BMI, waist circumference, along with established biomarkers for diabetes and cardiovascular risk including serum glucose, insulin resistance, and CRP among women with elevated depression symptoms, or who are taking antidepressant medication, to prevent diabetes and cardiovascular disease," adds Simin Liu, MD, MS, MPH, ScD, professor of epidemiology and medicine at Brown University, a WHI investigator and study coauthor. "Further intervention trial is needed to confirm our findings and identify the specific patterns of change associated with diabetic and cardiovascular disease risk markers and individual antidepressants and depression."
Provided by University of Massachusetts Medical School
VOLUNTEERING REDUCES RISK OF HYPERTENSION IN OLDER ADULTS, RESEARCH SHOWS
IT TURNS OUT THAT HELPING OTHERS CAN ALSO HELP YOU PROTECT YOURSELF FROM HIGH BLOOD PRESSURE.
14 jun 2013--New research from Carnegie Mellon University shows that older adults who volunteer for at least 200 hours per year decrease their risk of hypertension, or high blood pressure, by 40 percent. The study, published by theAmerican Psychological Associations _Psychology and Aging_ journal, suggests that volunteer work may be an effective non-pharmaceutical option to help prevent the condition. Hypertension affects an estimated 65 million Americans and is a major contributor to cardiovascular disease, the leading cause of death in the U.S.
"Everyday, we are learning more about how negative lifestyle factors like poor diet and lack of exercise increase hypertension risk," said Rodlescia S. Sneed, a Ph.D. candidate in psychology in CMUs Dietrich College of Humanities and Social Sciences and lead author of the study. "Here, we wanted to determine if a positive lifestyle factor like volunteer work could actually reduce disease risk. And, the results give older adults an example of something that they can actively do to remain healthy and age successfully."
For the study, Sneed and Carnegie Mellons Sheldon Cohen studied 1,164 adults between the ages of 51 and 91 from across the U.S. The participants were interviewed twice, in 2006 and 2010, and all had normal blood pressurelevels at the first interview. Volunteerism, various social and psychological factors, and blood pressure were measured each time.
The results showed that those who reported at least 200 hours of volunteer work during the initial interview were 40 percent less likely to develop hypertension than those who did not volunteer when evaluated four years later. The specific type of volunteer activity was not a factor—only the amount of time spent volunteering led to increased protection from hypertension.
"As people get older, social transitions like retirement, bereavement and the departure of children from the home often leave older adults with fewer natural opportunities for social interaction," Sneed said. "Participating in volunteer activities may provide older adults with social connections that they might not have otherwise. There is strong evidence that having good social connections promotes healthy aging and reduces risk for a number of negative health outcomes."
HOME PALLIATIVE CARE SERVICES DOUBLE PEOPLES CHANCES OF DYING AT HOME AND REDUCE SYMPTOMS
13 JUN 2013—A NEW COCHRANE REVIEW LED BY KINGS COLLEGE LONDON HAS FOUND THAT PROVIDING HOME PALLIATIVE CARE DOUBLES THE ODDS THAT SOMEONE WITH A TERMINAL ILLNESS CAN DIE AT HOME IF THEY WANT TO, AND LEADS TO BETTER CONTROL OF THEIR SYMPTOMS.
Based on this evidence the researchers are calling for the development of specialist home palliative care services to be included in national healthcare strategies, to ensure people who wish to die at home receive the best possible care. Researchers also say that providing palliative care at home could reduce avoidable and often expensive hospital admissions.
Previous studies show that most people with a terminal illness would prefer to die at home if possible. However, often multiple severe symptoms such as pain, breathlessness, nausea, fatigue, or a lack of home support means that they are admitted to hospital as their disease progresses. Earlier research from the Cicely Saunders Institute at Kings found that people with diseases such as advanced cancer, respiratory failure and late stageneurological diseases, can suffer as many as 12-14 different symptoms that need treatment and care.
In this new study, funded by Cicely Saunders International and the Calouste Gulbenkian Foundation, Kings researchers analysed and combined studies from across the globe that compared home palliative care services with usual care, such as that from general practitioners, district nurses and hospital outpatients. The research team at the Cicely Saunders Institute collaborated in this work with colleagues at the Kings Centre for the Economics of Mental and Physical Health and at the geriatrics unit of the Princess Grace Hospital Centre in Monaco. The review gathered information about over 37,500 patients who suffered from terminal illnesses including cancer, heart failure, respiratory diseases and neurological conditions, such as multiple sclerosis. In addition information and views from over 4,000 family caregivers were analysed.
The results showed that expert home palliative care teams improved the odds of dying at home by 2.21 – i.e. more than double. This result was highly significant and so is not likely to have occurred by chance. In addition, home palliative care services improved symptom control and reduced the burden of symptoms for patients. These palliative care teams were working from hospices, home care services and hospitals, and comprised doctors, nurses, and other professionals specially trained in delivering palliative care to ensure that they have the right expertise, skills and experience.
Dr Barbara Gomes from Kings, who led the study, said: These are important findings as they show for the first time clear and reliable evidence of benefits that justify the provision of home palliative care to allow more people to die at home and to reduce patients symptoms. Home palliative care is key to narrowing the gap between where people wish to die and where they actually die, which we know exists in many countries. The research shows these services work. Their development must therefore be central in national strategies to improve the care people receive towards the end of their life."
Professor Irene J Higginson, Director of the Cicely Saunders Institute at Kings, added: With the number of deaths in England and Wales expected to increase by 17 percent by 2030, we need to find ways of improving palliative care for our ageing population.
This review shows the need to provide specialist, dedicated home palliative care services to provide an additional layer of individualised support for people reaching the end of life, and their families. Specialist care teams should work with existing services, and people with progressive and far advanced illness or their families should be able to ask for these services, which should be made available where they are lacking. The goal is to control symptoms, improve quality of life and support individual patients and families where they want to be cared for at the end of life.
As well as providing better care for patients, this approach could minimise unwanted and often expensive hospital admissions, reducing the burden on the NHS.
GENETIC RESEARCH CLARIFIES LINK BETWEEN HYPERTENSION AND VITAMIN D DEFICIENCY
LOW LEVELS OF VITAMIN D CAN TRIGGER HYPERTENSION, ACCORDING TO THE WORLDS LARGEST STUDY TO EXAMINE THE CAUSAL ASSOCIATION BETWEEN THE TWO. ALTHOUGH OBSERVATIONAL STUDIES HAVE ALREADY SHOWN THIS LINK, A LARGE-SCALE GENETIC STUDY WAS NECESSARY BEFORE THE CAUSE AND EFFECT COULD BE PROVEN, THE ANNUAL CONFERENCE OF THE EUROPEAN SOCIETY OF HUMAN GENETICS (ESHG) WILL HEAR TODAY (TUESDAY).
11 jun 2013--Dr. Vimal Karani S, from the Institute of Child Health, University College London, London, UK, will tell the meeting that data from the D-CarDia collaboration, involving 35 studies, over 155,000 individuals, and numerous centres in Europe and North America, showed that those with high concentrations of 25-hydroxyvitamin D (25(OH)D) had reduced blood pressure and therefore a reduced risk of hypertension. "We knew from earlier observational studies that low 25(OH)D concentrations were likely to be associated with increases in blood pressure and hypertension, but correlation is not causality", he says. "Additionally, randomised controlled trials of vitamin D supplementation in humans have produced inconsistent effects on cardiovascular outcomes. The whole picture was somewhat confused, and we decided to try to figure it out once and for all."
The researchers used genetic variants known as single nucleotide polymorphisms, or SNPs, as proxy markers to reflect individuals vitamin D status in order to test for a causal association with blood pressure and hypertension. When the results were analysed, they found a significant link; for every 10% increase in 25(OH)D concentrations, there was a 8.1% decrease in the risk of developing hypertension.
"Even with the likely presence of unobserved confounding factors", Dr. Karani S will say, "the approach we followed, known as Mendelian randomisation, allows us to draw conclusions about causality because the genetic influence on disease is not affected by confounding. To put it in simple terms, by using this approach we can determine the cause and effect and be pretty sure that weve come to the right conclusion on the subject."
Low vitamin D status is common throughout the western world, the researchers say, and hence these data have important public health implications. The best-known manifestation of vitamin D deficiency is the childhood bone disease rickets, where long bones are weakened by the deficiency and start to bend. Recently, however, Vitamin D has been implicated in a number of other non-skeletal-related conditions, but studies involving supplementation have given conflicting results.
"Our study strongly suggests that some cases of cardiovascular disease could be prevented through vitamin D supplements or food fortification", says Dr. Karani S. "Our new data provide further support for the important non-skeletal effects of vitamin D. We now intend to continue this work by examining the causal relationship between vitamin D status and other cardiovascular disease-related outcomes such as lipid-related phenotypes, for example, cholesterol, inflammatory markers such as C-reactive protein, and type 2 diabetes and markers of glucose metabolism. We believe that we still have a lot to find out about the effect of Vitamin D deficiency on health, and we now know that we have the tools to do so."
Provided by European Society of Human Genetics
RECURRENT PNEUMONIA NOT COMMON, LUNG EXPERT SAYS
PNEUMONIA IS ONE OF THE MOST COMMON OF LUNG INFECTIONS AMONG THE ELDERLY BUT CONCERNS OF UNDERLYING CONDITIONS ARISE WHEN IT RECURS, A LEADING SOUTH AFRICAN PULMONOLOGIST SAID SUNDAY.
10 jun 2013--Nelson Mandela was admitted Saturday in a "serious but stable" condition for a recurrent lung infection.
It is his fourth hospital stay since December and his third for lung infection. The Nobel peace prize laureate, who turns 95 next month, was in April hospitalised for 10 days for pneumonia treatment. Officials have not specified if the latest infection afflicting Mandela is pneumonia.
Of the different types of lung infections, "pneumonia is the most serious and the most common in elderly patients," said professor Guy Richards, director of critical care at Johannesburgs Charlotte Maxeke Academic Hospital.
But when it recurs, it means there would be other underlying conditions.
"Its very unusual to get the common pneumonia occurring recurrently unless theres a specific reason for it.
"And those sorts of things are that if your lung has been damaged previously, for example if you had tuberculosis, then often those damaged areas will be colonized with bacteria which are able to cause recurrent infections," he told AFP.
Acute pneumonia can damage other organs of the body such as the kidneys or affect blood pressure, he said.
"If you have severe pneumonia, your body mounts an immune response to that pneumonia. We then sometimes have an overwhelming immune response which can result in multiple organ disfunction," said Richards.
"So for example they might present not only with a chest infection but then they might develop kidney failure, or they might develop failure of the heamodynamic system, their blood pressure might go down."
Treatment, under normal circumstances last just days, but in serious cases where hospitalisation is required, it can last several weeks.
"The majority of patients with pneumonia dont need to be admitted but those that are admitted would generally remain for three to four days. If they develop multiple organ failure and they are in ICU (intensive care unit) and they are on a ventilator, then we are talking weeks."
While he disease can affect people of all ages, it common among the elderly.
"Pneumonia was in fact known for many years as an old mans friend. In other words it was the final illness that often took him away," said Richards.
DOCTORS DIFFER ON PROSTATE SCREENING
PROSTATE SCREENING TESTS DETECT PROSTATE CANCER EARLY, BUT QUESTIONS ABOUT WHETHER THE TESTS DO MORE HARM THAN GOOD HAVE MADE THEM ONE OF THE MOST HOTLY DEBATED AREAS OF MEDICINE.
9 jun 2013--Some doctors and researchers believe testing for PSA, which stands for prostate-specific antigen, leads to unnecessary, costly and even harmful medical procedures because so many early diagnoses are slow-growing cancers that dont require immediate treatment. But men typically demand care once they hear the "C" word.
Those on the other side say PSA screening remains a valuable tool for detecting cancer early and saving lives.
Last month, The American Urological Association reversed course and no longer recommends routine screening for men 40 to 54 years old, who face an average risk of getting prostate cancer. It said testing should be considered primarily for those 55 to 69. Even then, a PSA testshould not be automatic. Men should talk to their doctors about the benefits and risks and "proceed based on their personal values and preferences," the association recommended.
The urology groups announcement followed the 2011 recommendation by the United States Preventive Services Task Force, arguing against routine screening in healthy men because it often leads to unnecessary biopsies and surgery as well as life-altering complications such as impotence and incontinence.
A problem with screening is that PSA levels can be high, indicating cancer, even when a man doesnt have it. Another issue is that if a biopsy detects cancer, it is often very slow-growing and, as cancers go, relatively benign.
In other words, a PSA test was taking healthy men and turning them into cancer patients who underwent radiation therapy, surgery and other invasive procedures for something that would never cause death or even lead to any symptoms.
But even seemingly benign cancer can turn serious. And some men want to turn back any risk of cancer immediately.
Four years ago, Michael LeBlanc, 62, didnt even think about waiting to treat cancer detected in his prostate. Whether the cancer was slow-growing or more aggressive was a moot point, he said.
"Although its slow growing, what says tomorrow it wont change?" said LeBlanc. "Its like calling 911 and you say there is a man who broke into the house but he looks like such a nice guy, I dont think hes going to hurt us right away. A home invasion in a home invasion. Cancer is cancer. You dont dilly dally with that." LeBlanc of Canton underwent robotic surgery to remove his prostate. He said an analysis indicated the cancer "had consumed my prostate." Exercise, he said, helped him make a full recovery.
Dr. Otis Brawley, chief medical officer for The American Cancer Society, has long called for more caution with prostate cancer screening, speaking against mass screenings such as the ones offered by health companies at shopping malls.
Many patients, he said, dont fully realize the potential complications associated with PSA testing.
"My whole campaign has not been one that men should not be screened," he said. "Let the man know the pluses and minuses, and what we know about the disease and the screening of the disease and then let the man decide," Brawley said.
That decision, he said, should be based on weighing the benefits versus potential harm of screening. Research of men 55 to 69 suggests PSA screening may prevent one death from prostate cancer for every 1,000 men screened at two-to-four year intervals over a 10-year-period, according to The American Urological Association. At the same time, many men who get the screening will be harmed because of treatments that can lead to health complications. Even a biopsy poses a risk of infection, for example.
Doctors may recommend "active surveillance" for men with low-risk prostate cancer tumors, in which the tumor is regularly monitored rather than treated. But getting patients to watch and wait is a difficult.
"Part of it is a reaction to cancer. The 1970s Nixon War on Cancer and theres this concept that all cancer is bad," said Dr. Martin Sanda, chairman of the Department of Urology at Emory University School of Medicine and director of the Prostate Cancer Center in Emorys Winship Cancer Institute. "But now we are pushing the envelope. Many of these (cancers) can be watched." Over a 5-to-10-year period, about a third of men whose cancers are considered low risk turn worse and require treatment, according to Sanda.
Sanda said a patients decision about whether to monitor the low-risk cancer or undergo treatment often depends on how the information is presented. The key, he said, is explaining that the biopsies not only detect aggressive cancers that need immediate treatment but also pick up cancers that are "quasi cancer" and safe to watch rather than treat immediately.
But not all doctors are entirely comfortable with the concept of simply waiting and watching.
"These so-called quasi cancers may not be a problem at all. And theres also the possibility these quasi cancers can spread," said Dr. Marc Harrigan, a primary care physician at Piedmont Hospital. "Youve got to put yourself in the shoes of the patient: Do I want something inside of me? I mean, how comfortable would I be as a patient knowing there is a cancer inside of me that can grow at any time?" Harrigan said his patients are predominantly African-Americans who face a higher risk for prostate cancer. They tend to opt for screening before 50. But Harrigan reviews the pros and cons of testing for any patient 40 and up. And then he lets the patient decide whether or not to get the PSA test.
"Who am I to tell patients you really shouldnt be tested until 50?" said Harrigan.
Sanda remains an advocate of screening - which includes not only the PSA blood test but also the digital rectal exam. He sees firsthand what can happen when prostate cancer is not caught in the early stages.
"I see patients every month who are in their late 40s and early 50s and their cancer is too far along and we cant do anything to treat them," he said.
Sanda is also studying a new, more sophisticated blood test that could change the way men are screened. Studies indicate The Prostate Health Index or phi, is more precise than the PSA and better distinguishes an aggressive cancer from a low-risk cancer. Its one of several tests being studied across the country with the same goal: to have more accurate information, prevent unnecessary biopsies and treatments and the anxiety that often accompanies them, while saving lives from a disease expected to kill almost 30,000 men this year alone.
—-
Other than skin cancer, prostate cancer is the most common cancer in American men. The American Cancer Societys estimates for prostate cancer in the United States for 2013 are:
-About 238,590 new cases of prostate cancer will be diagnosed
-About 29,720 men will die of prostate cancer
-Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.5 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.
-About 1 man in 6 will be diagnosed with prostate cancer during his lifetime.
-Prostate cancer occurs mainly in older men. Nearly two thirds are diagnosed in men age 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 67.
A WALKING REVOLUTION HELPS OLDER ADULTS GET AND STAY ACTIVE
Uneven sidewalks are hazardous for older or disabled pedestrians. These are one of the obstacles to outdoor walking for exercise explored in a recent study.
8 JUN 2013—IT SOUNDS SIMPLE: GET OUTSIDE AND TAKE A WALK. WALKING ON ITS OWN IS KNOWN TO OFFER NUMEROUS HEALTH BENEFITS, EVERYTHING FROM LOWER BLOOD PRESSURE TO LESS ACHES AND PAINS. FOR SOME PEOPLE, THOUGH, GETTING OUTSIDE AND TAKING THAT WALK CAN BE A CHALLENGE. THIS IS ESPECIALLY TRUE FOR THE ELDERLY OR THOSE WITH DISABILITIES. HOW WILL I GET TO MY DESTINATION? IS IT A SAFE PLACE TO WALK? ARE THERE STREET LIGHTS? WILL SIDEWALK CRACKS MAKE IT HARDER FOR MY WALKER TO ROLL?
These questions are pondered by millions of Americans who live with physical mobility challenges. After all, more than 40 percent of adults age 45 or older have difficulty with physical movement, and 58 percent of adults age 65 or older have a disability, according to a recent paper appearing in _The Gerontologist_.
The report covers study findings from the University of Washington schools of nursing and public health. The work was led by Basia Belza, professor of biobehavioral nursing and health systems, and Dori Rosenberg, a postdoctoral fellow in rehabilitation medicine and an affiliate assistant professor of health services, based at Group Health Research Institute.
Their research team sought to better understand the needs of adults with mobility disabilities related to neighborhood walkability. The investigators interviewed older adults with mobility disabilities about their experiences and impressions of trying to get about in built environments – the settings in which human activities take place. The researchers learned that poorly lit neighborhoods, lack of public transportation, sidewalks in disrepair, and unmarked or poorly marked intersections prevent people with disabilities from taking advantage of the benefits of walking.
Belza said that older adults, who are the fastest growing demographic, are also the most physically inactive group and the age group most likely to face chronic disease due to inactivity.
"People who are inactive in general have a higher incidence of chronic disease such as stroke, heart disease, arthritis," Belza said. "Regular engagement in physical activities leads to better health outcomes, including improved mobility, weight loss and fewer falls. This is especially important in older adults who may already be dealing with health challenges."
Belza noted that one study participant who lives in the Phinney Ridge neighborhood of Seattle has already approached the Seattle City Council to ask for neighborhood improvements.
In another related project, Belza partnered with an Easter Seals project, called Accessible Community Transportation in Our Nation, and the Centers for Disease Control and Prevention Healthy Aging Research Network to create a Neighborhood Wayfinding Pocket Guide. This guide was designed to show people ways to check out their neighborhoods and assess the state of sidewalks, transportation, street lights and other factors that could encourage or discourage neighborhood walking.
"The guide is a great way for people to get out in their neighborhoods and learn to be more active in general while also helping others," Belza said.
The guide encourages people to consult with their city and town governments to share ideas for improvement, with the hope that this will encourage cities to invest more in communities. Belza continues to look for ways to improve access to the built environment and increase physical activity in older adults. She and her colleagues in the Centers for Disease Control and Prevention Healthy Aging Network are doing a systematic review to better understand how older adults use technology to find their way.
Belza believes that with improved information and resources, older adults who have mobility disabilities will reap the benefits of walking, which has long been reported by adults as the most preferred way to be physically active and applauded by health experts as one of the best ways to improve overall health.
"Walking is a great way to decrease your risk for many chronic conditions, including heart disease, obesity and other health challenges," she said. "We hope that our guide will help people improve their health by finding new and safe places to walk."
SPANISH RESEARCHERS DESCRIBE THE NINE HALLMARKS OF AGING
FOR SOME SPECIES, LIVING TWICE AS LONG IN GOOD HEALTH DEPENDS ON NO MORE THAN A FEW GENES. WHEN THIS FACT WAS REVEALED BY STUDIES ON WORMS THREE DECADES AGO, IT USHERED IN A GOLDEN AGE OF AGEING STUDIES THAT HAS DELIVERED NUMEROUS RESULTS, BUT ALSO SOWN SOME CONFUSION. THE JOURNAL _CELL_ IS NOW PUBLISHING AN EXHAUSTIVE REVIEW OF THE SUBJECT THAT AIMS TO SET THINGS STRAIGHT AND "SERVE AS A FRAMEWORK FOR FUTURE STUDIES." ALL THE MOLECULAR INDICATORS OF AGEING IN MAMMALS – THE NINE SIGNATURES THAT MARK THE ADVANCE OF TIME – ARE SET OUT IN ITS PAGES. AND THE AUTHORS ALSO INDICATE WHICH CAN BE ACTED UPON IN ORDER TO PROLONG LIFE, WHILE DEBUNKING A FEW MYTHS LIKE THE BELIEF THAT ANTIOXIDANTS CAN DELAY AGING.
7 jun 2013--The authors are Spanish scientists Maria Blasco (Spanish National Cancer Research Centre, CNIO), Carlos López-Otín (University of Oviedo), and Manuel Serrano (CNIO), along with Linda Partridge (Max Planck Institute for Biology of Ageing) and Guido Kroemer (Paris Descartes University). Their inspiration came from a classic 2000 paper, The Hallmarks of Cancer, also published in _Cell_, which marked a watershed in cancer research. Blasco, Serrano and Partridge contacted _Cell_ proposing a similar effort to systematically review and organize the state of knowledge on aging; López-Otín and Kroemer had also come to the conclusion that this kind of analysis was much needed, and decided to share their ideas and efforts to get the project off the ground.
"The current situation of aging research exhibits many parallels with that of cancer research in previous decades," reads the opening paragraph of the resulting paper, titled The Hallmarks of Aging. "The aging field has been notoriously more abundant in theories than experimental evidence," says Blasco; "this review doesnt discuss theories, but molecular and genetic evidence." For López-Otín "the time had come to set out in organized, understandable fashion the molecular keys to what is still a little known process, despite the thousands of scientific papers published on the subject every year."
The papers connection with cancer goes beyond formal parallelisms. Because one of the main conclusions of The Hallmarks of Aging is that by understanding and combating aging we can also fight against cancer and the other diseases of most incidence in the developed world. The relationship is clear: aging is the result of the lifelong accumulation of DNA damage, and it is this same process that causes cancer, diabetes, cardiovascular disease and neurodegenerative conditions like Alzheimers.
"Aging is the cause of the diseases that afflict us as we get older," Blasco explains. "Identifying the molecular markers of aging will help us find the cause of other diseases like cancer. The implications are enormous." As the article puts it, "cancer and aging share common origins," and can be regarded as "two different manifestations of the same underlying process."
"ITS NOT ABOUT NOT HAVING WRINKLES"
For Serrano, this removes the "frivolity" with which aging research is often approached: "Its not about not having wrinkles or living to be a hundred at any cost, but about prolonging disease-free life." In _Cell_ the scientists are explicit about their final goal, which is "to identify pharmaceutical targets to improve human health during aging."
Another milestone of the paper is that it not only defines the nine molecular hallmarks of aging but orders them into primary hallmarks – the triggers; those that make up the organisms response to these triggers; and the functional defects resulting. This hierarchy is important, because different effects can be achieved by acting on one or other of these processes. By acting on just one mechanism, if it numbers among the primaries, we can delay the aging of many organs and tissues.
There are four primary causes of aging: genomic instability; the shortening of telomeres; epigenetic alterations; and loss of proteostasis.
Genomic instability refers to the defects the genes accumulate over time, due to intrinsic or extrinsic causes. The shortening of telomeres – the protective caps over the ends of chromosomes – is one such defect, but so important a one that it stands as a hallmark in its own right. Epigenetic alterations are the result of lived experience – our exposure to the environment.
Loss of proteostasis has to do with the non-elimination of defective proteins, whose accumulation promotes age-related diseases. With Alzheimers, for instance, neurons die because plaques form of a protein that should have been eliminated.
The organism responds to these triggers with mechanisms that try to correct the damage, but which can themselves turn deleterious if they become exacerbated or chronic. This is the case of cellular senescence: the cell is induced to stop dividing, and thus prevent cancer, when too many defects are built up, but if the effect is overdone, the tissues – and the body – age.
This double-edged sword is also present in two processes at the heart of the debate on aging theories: the so-called oxidative damage, linked to the famous free radicals; and metabolism-derived mechanisms, relating, in turn, to the evidence – though not yet in humans – that calorie restriction prolongs life.
FREE RADICALS: A DOUBLE-EDGED SWORD
Everything suggests that the secret to living longer is a lot more complex than simply taking antioxidants or cutting out food. Free radicals may be harmful in large quantities, but their presence also triggers a protective response. As for antioxidants, the authors are adamant: there is no genetic evidence that enhancing antioxidant defenses can delay aging. And while the organism may deploy protective strategies to cope with nutrient scarcity – presumably the reason why calorie restriction appears to work –, these too "in excess and during time, can become pathological," they affirm.
The third group of hallmarks comes into play when the body cannot compensate the damage caused by the two preceding groups. One is the exhaustion of tissue stem cells, which cease to discharge their regenerating function; another is errors in intercellular communication, which give rise, for instance, to inflammation – a process whose chronic form is associated with cancer.
Among the next big challenges is to understand the connections between hallmarks. And, of course, to investigate ways to bring these processes under control. The authors run through the list of already identified therapeutic targets and propose some solutions to slow down aging.
One therapeutic strategy tested successfully in mice is to stop the telomeres from shortening. "The process can be halted and even reversed in mice," remarks Blasco, an expert in the area, who is convinced that, by and large, "we still have ample room for manoeuver to combat aging and enjoy more years of both life and health."
For López-Otín, "We have diverse opportunities to extend longevity in the not too distant future. Treatments aimed at reducing or correcting the genomic damage that occurs with time are still a distant prospect, but those focusing on metabolic regulation systems may be much more achievable. We dont aspire to immortality, just to the possibility of making life a little better for us all."
MORE INFORMATION: The Hallmarks of Aging. Carlos López-Otín, Maria A. Blasco, Linda Partridge, Manuel Serrano, Guido Kroemer. Cell (2013). doi: 10.1016/j.cell.2013.05.039
Provided by Centro Nacional de Investigaciones Oncologicas (CNIO)
VEGETARIAN DIETS ASSOCIATED WITH LOWER RISK OF DEATH
VEGETARIAN DIETS ARE ASSOCIATED WITH REDUCED DEATH RATES IN A STUDY OF MORE THAN 70,000 SEVENTH-DAY ADVENTISTS WITH MORE FAVORABLE RESULTS FOR MEN THAN WOMEN, ACCORDING TO A REPORT PUBLISHED ONLINE FIRST BY _JAMA INTERNAL MEDICINE_.
6 jun 2013--The possible relationship between diet and mortality is an important area of study. Vegetarian diets have been associated with reductions in risk for several chronic diseases, including hypertension, metabolic syndrome, diabetes mellitus and ischemic heart disease (IHD), according to the study background.
Michael J. Orlich, M.D., of Loma Linda University in California, and colleagues examined all-cause and cause-specific mortality in a group of 73,308 men and women Seventh-day Adventists. Researchers assessed dietary patients using a questionnaire that categorized study participants into five groups: nonvegetarian, semi-vegetarian, pesco-vegetarian (includes seafood), lacto-ovo-vegetarian (includes dairy and egg products) and vegan (excludes all animal products).
The study notes that vegetarian groups tended to be older, more highly educated and more likely to be married, to drink less alcohol, to smoke less, to exercise more and to be thinner.
"Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established," the study notes.
There were 2,570 deaths among the study participants during a mean (average) follow-up time of almost six years. The overall mortality rate was six deaths per 1,000 person years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs. nonvegetarians was 0.88, or 12 percent lower, according to the study results. The association also appears to be better for men with significant reduction in cardiovascular disease mortality and IHD death in vegetarians vs. nonvegetarians. In women, there were no significant reductions in these categories of mortality, the results indicate.
"These results demonstrate an overall association of vegetarian dietary patterns with lower mortality compared with the nonvegetarian dietary pattern. They also demonstrate some associations with lower mortality of the pesco-vegetarian, vegan and lacto-ovo-vegetarian diets specifically compared with the nonvegetarian diet," the authors conclude.
ALZHEIMERS DISEASE DRUGS LINKED TO REDUCED RISK OF HEART ATTACKS
DRUGS THAT ARE USED FOR TREATING ALZHEIMERS DISEASE IN ITS EARLY STAGES ARE LINKED TO A REDUCED RISK OF HEART ATTACKS AND DEATH, ACCORDING TO A LARGE STUDY OF OVER 7,000 PEOPLE WITH ALZHEIMERS DISEASE IN SWEDEN.
5 jun 2013--The research, which is published online today (Wednesday) in the _European Heart Journal_ [1], looked at cholinesterase inhibitors (ChEIs), such as donepezil, rivastigmine and galantamine, which are used for treating mild to moderate Alzheimers disease [2]. Side-effects of ChEIs include a beneficial effect on the vagus nerve, which controls the rate at which the heart beats, and some experimental studies have suggested that ChEIs could also have anti-inflammatory properties.
Professor Peter Nordström, of Umeå University, Umeå, Sweden, and colleagues followed 7073 people with Alzheimers disease, who were on the Swedish Dementia Registry from May 2007 to December 2010. They found that those who were on ChEIs had a 36% reduced risk of death from any cause, a 38% reduced risk of a myocardial infarction (heart attack) and a 26% reduced risk of death from cardiovascular causes such as stroke compared to people not taking ChEIs. These results included adjustments for various confounding factors such as age, sex, whether the diagnosis was for Alzheimers dementia or Alzheimers mixed dementia (where more than one type of dementia occur simultaneously), level of care, and medical history including medications for other conditions.
Prof Nordström said: "If you translate these reductions in risk into absolute figures, it means that for every 100,000 people with Alzheimers disease, there would be 180 fewer heart attacks – 295 as opposed to 475 – and 1125 fewer deaths from all causes – 2000 versus 3125 – every year among those taking ChEIs compared to those not using them."
Patients taking the highest recommended doses of ChEIs had the lowest risk of heart attack or death: 65% and 46% lower respectively compared with those who had never used ChEIs.
The researchers also checked whether the reduction in risk applied only to the use of ChEIs or was seen in other drug treatments for dementia. Memantine is a drug indicated for use in moderate to advanced Alzheimers disease and works in a different way to ChEIs [3]. The researchers found it made no difference to the risk of heart attack or death from any cause.
Prof Nordström said: "As far as we know, this is the first time that the use of ChEIs has been linked to a reduced risk of heart attacks and deaths from cardiovascular disease in general or from any cause. As this is an observational study, we cannot say that ChEI use is causing the reduction in risk, only that it is associated with a reduction. However, the strengths of the associations make them very interesting from the clinical point of view, although no clinical recommendations should be made on the basis of the results from our study. It would be of great value if a meta-analysis of previous, randomised controlled trials could be performed, as this might produce answers on which clinical recommendations could be based."
As the study was based on a nationwide group of patients, Prof Nordström said it should be possible to extrapolate the findings to other countries.
MORE INFORMATION: [1] "The use of cholinesterase inhibitors and the risk of myocardial infarction and death: a nationwide cohort study in subjects with Alzheimers disease", by Peter Nordström, Dorota Religa, Anders Wimo, Bengt Winblad, and Maria Eriksdotter. _European Heart Journal_. doi:10.1093/eurheartj/eht182
[2] Donepezil, rivastigmine and galantamine are also known by the trade names Aricept, Exelon and Reminyl respectively.
[3] Memantine is known by the trade name Ebixa.
Provided by European Society of Cardiology
ONCOLOGISTS ARE STRESSED AND HAVE DIFFICULTY DISCUSSING DEATH WITH PATIENTS, STUDY FINDS
A GROUP OF ONCOLOGISTS HAVE REVEALED IN A NEW STUDY BY BEN-GURION UNIVERSITY OF THE NEGEV (BGU) RESEARCHERS THAT COMMUNICATING ABOUT DEATH AND DYING WITH THEIR PATIENTS IS ONE OF THE MOST DIFFICULT AND STRESSFUL PARTS OF THEIR WORK.
4 jun 2013--In the United States, 577,190 deaths from cancer occurred in 2012, according to the American Cancer Society.
The online paper published ahead of print in the _Journal of Oncology Practice_ reported that despite this important element of their work, oncologists receive little training in this area, and many do not communicate well with patients. The research included interviews with doctorsabout what they found difficult and what they believed they did well.
"To our knowledge, this is the first qualitative exploration of communication about the end of life from an oncologists perspective," explains Dr. Leeat Granek, a professor at BGUs Faculty of Health Sciences.
"What makes our study unique is the opportunity to get into the oncologists heads, to understand what they perceive to be the goals of effective communication about the end of life, as well as what makes it difficult for them to achieve these goals. Through the analysis, it became apparent that there is tension between what are perceived to be good communication strategies and the significant number of barriers to implementing them."
The researchers found that the strategies for effective communication about end of life included: being open and honest with patients, and having ongoing early conversations about treatment goals, while balancing hope and reality about end of life. Barriers to implementing these strategies fell broadly into three domains: physician factors, patient factors and institutional factors.
* Physician factors are difficulties with treatment and palliative care; personal discomfort with death and dying; diffusion of responsibility among colleagues; using the "death-defying mode", i.e. not accepting the inevitability of death and treatment failure; lack of experience; and lack of mentorship.
* Patient factors include patients and/or families being reluctant to talk about end of life; language barriers; and the younger age of patient.
* Institutional factors are stigmas surrounding palliative care; lack of protocol about end-of-life issues; and lack of training for oncologists on how to talk with patients about end-of-life issues.
Dr. Granek concludes that further research and intervention are necessary to aid oncologists in achieving effective communication about end-of-life issues. Dr. Granek and co-researchers interviewed a group of Canadian medical oncologists from three hospitals in Canada. Funding was provided by the Juravinski Cancer Centre Foundation, Hamilton, Ontario.
Provided by American Associates, Ben-Gurion University of the Negev
RESIDENTIAL CARE FOR THE ELDERLY IS MOVING INTO THE DIGITAL AGE
SENSORS UNDER THE MATTRESSES OF ELDERLY RESIDENTS WITH DEMENTIA TRACK HOW MUCH THEY SLEEP AT NIGHT. OTHERS IN THE SHOWERS NOTE HOW OFTEN THEY BATHE, WHILE SENSORS IN THE WALLS WATCH OVER THEIR MOVEMENTS.
3 jun 2013--The data are sent to the nurses at the assisted living center where these residents live, a red dot appearing next to the names of residents whose normal routines have changed dramatically. This was how staff was alerted recently about a patient who is usually up and out of her apartment early, but instead had been lying in bed most of the day. It turns out she was developing pneumonia.
"We caught it early enough that we were able to treat her here instead of in the hospital," said Indra Sooklall, director of resident care at Spring Hills Somerset, a 120-unit assisted living residence in New Jersey that installed "smart sensors" two years ago in a wing for dementia patients.
Technology is changing life inside nursing homes and other residences for seniors. The most cutting-edge among the new systems offer lofty promises of helping providers cope with the coming tsunami of aging baby boomers even as they grapple with funding cutbacks and with the increasing demand to care for sicker and older residents in less-restrictive and less-expensive settings.
Many of the recent technology upgrades inside long-term-care centers mirror the digital advances of the times, with Wii, Skype and YouTube being used to spice up therapy routines and entertainment programs. Wii games are helping get patients in rehabilitation moving again after an injury or surgery, while heath experts believe computer chess, trivia or other skill games can keep brains active and potentially ward off senility.
But the most closely watched technological revolution to hit the long-term-care industry is the growing use of motion sensors and so-called "patient-monitoring systems" to better track changes in a residents health and mobility.
"There are a whole host of things that are arriving on the market and being looked at as ways to improve care," said Paul Langevin, president of the Health Care Association of New Jersey, a trade group that represents the long-term-care industry.
IT Initiatives, a Manalapan, N.J., firm that designs technology and communication systems, is finalizing contracts with seven long-term-care centers in New Jersey to install resident monitoring systems, said John Dalton, the companys president.
One of them is at Friendship Village, a retirement community in Basking Ridge that is in the middle of a multi-year project to install technology specific to the needs of the different facilities on its campus. The nursing home and assisted living residence at Friendship Village is being outfitted with electronic-medical-records kiosks in hallways where staff will type in data about everything from blood pressure readings to when the patient was last bathed. The communitys independent living units will have telephones with LCD screens that allow residents to call for concierge-type assistance as well as high-tech personal emergency systems that send signals to the staffs two-way-monitors.
As technology advances, the big push is going to be installing sensor systems at assisted living residences and independent-style living communities, with data-recording devices in the walls, floors, carpets, beds and bathrooms enabling staff to keep tabs on residents without having to physically send a staff member to every room for routine checks, Dalton said.
Nursing homes, where patients require closer monitoring, are likely to turn to more sophisticated systems - ones that incorporate two-way video communication between patients and their caregivers as well as wearable monitors that alert caregivers if a patient has fallen or wandered out of a unit. There is even a sensor on the market that monitors whether a nursing home patients diaper needs to be changed.
"There are all sorts of technologies available now that can be incorporated into a whole system designed to meet a facilitys needs," Dalton said.
These technologies may one day become more commonplace in private homes as a way to allow elderly residents to remain independent for longer periods, said Michele Kent, president of Leading Age New Jersey, an industry group that represents non-profit long-term-care centers.
The digital advances come at a time when technology is being touted as a way to improve health care overall, with doctors and hospitals switching to electronic medical records and increasingly using remote monitoring systems to check in on patients who have been sent home.
"The whole idea is to keep residents at their highest functioning level, and technology is seen as being able to play a role in that," Langevin said.
The trend is far from widespread, however. While technology in long-term-care settings is much buzzed about these days, many of the systems in place remain in the pilot stage.
"Its too early to say if theres going to be a broad deployment of some of these technologies," said Laurie Orlov, an industry analyst and author of a blog, Aging in Place Technology Watch. "Nobody has really figured out a good model for paying for them."
In New Jersey, recent cuts in Medicaid and Medicare reimbursements have made it harder for long-term-care companies to upgrade or install new technologies unless they secure grants to help pay for it, Langevin said. Even the recent push by the federal government to fund the transition to electronic medical record keeping has largely targeted hospitals and doctors offices.
"Nursing homes and long-term-care centers in general have been left out of all preliminary discussions about going high-tech," Langevin said. "None of the federal money and little of the state money is going to them."
But the market for technology in nursing homes and assisted living centers has begun to pick up significantly in the last year, said Bryce Porter, a sales manager with Intel-GE Care Innovations. His company has installed its Quiet Care sensor systems in hundreds of communities nationwide, including Bella Terra, an assisted living residence in Ocean County.
Over the long run, Langevin predicts, long-term-care centers will find a way to pay for technology upgrades. "Boomers arent going to want to stay in a 30-year-old building without modern technology," he said.
With an eye to the future wants and needs of the boomer generation, many centers have already invested in technology to improve not just clinical care but also the quality of life inside their buildings.
Christian Health Care Center in Wyckoff, N.J., secured a grant to create an electronic medical records system five years ago. At the same time, the non-profit invested in a computer system called IN2L - Its Never 2 Late - which residents use to play games, surf the Web or work on projects.
Residents have become hooked on Chicktionary, a Scrabble-like computer game. "Wed be lost without this," said Betty Mowerson, a 94-year-old resident who had never before owned a computer. "It keeps your mind going."
These computer brain games could actually help ward off dementia symptoms by exercising memories, attention spans, orientation and word-finding skills, said Michelle Zaks, a speech pathologist at Christian Health Care Centers assisted living residence.
In the rehabilitation wing, a Wii computer game system has become a standard tool in treatments. "This makes therapy fun but also functional," said Ritchie Lim, director of rehabilitation at the center.
During one recent session, 92-year-old Leonore Albert found herself doing some virtual snowboarding just three weeks after breaking her pelvis. Albert, of Paterson, N.J., seemed unaware of the exertion of the exercises, laughing good-naturedly when the computer voice told her she was "unbalanced."
"Since when do they qualify as a psychiatrist?" Albert quipped.
Other centers have installed systems focused more on improving entertainment and giving residents more opportunities to connect with the world outside.
Emeritus - a national chain of assisted living residences with locations in Wayne, Emerson and Paramus - partnered recently with a technology company called Connected Living, which has designed easier-to-use-and-read software, with touch-screen capabilities for residents too arthritic to use a mouse. One resident used it to watch her grandsons wedding at the Shore.
Recently, about a dozen residents used the system to prove that kids arent the only ones who enjoy making mash-up videos. The two-minute montage of them vamping - in wheelchairs and walkers - to "The Lion Sleeps Tonight" is filmed over a strange clip of a computer-animated hippo and dog. It hasnt made it to YouTube yet, but thats only because its producer - Emeritus "life enrichment" director Itzik Bader - is a little insecure about letting the world see his dance moves.
"We just decided to do it one day just for fun," Bader said.
Most of the residents werent sure at first about why they were dancing. But like the millions of teenagers and college students putting themselves out there on YouTube, they found it entertaining to see themselves on video. "They get a kick out of watching it over and over again," he said.
BRAIN RESEARCH HAS MADE UNPRECEDENTED PROGRESS OVER THE YEARS, WITH EUROPE AT THE FOREFRONT OF SCIENTIFIC ADVANCES. BUT MORE CAN BE DONE. THIS COMES FROM ALZHEIMERS DISEASE INTERNATIONAL WHO ISSUED THEIR REPORT ON THE GLOBAL ECONOMIC IMPACT OF DEMENTIA. THEY ESTIMATE THAT IF DEMENTIA CARE WERE A COUNTRY, IT WOULD BE THE WORLDS 18TH LARGEST ECONOMY, RANKING BETWEEN TURKEY AND INDONESIA.
02 jun 2013--The European MIMOVAX project has high hopes of making a significant breakthrough in this important area of medical research. Alzheimers Disease (AD) is a progressive, degenerative and irreversible brain disorder that causes intellectual impairment and disorientation. With no effective treatment, the MIMOVAX team has set out to develop a vaccination which can ensure safe and effective treatment, and ultimately halt progression of this crippling disease.
MIMOVAX is a Specific Targeted Research Project (STREP) which targets truncated peptides Aß40/42 - derived from the Amyloid Precursor Protein (APP) - through active immunisation. The team focused on the use of immune reactions to fight known and less well-known beta amyloid (BA) proteins, which are thought to cause the disease.
The initial three-year project (extended to another 15 months to fulfil clinical objectives) was led by the Austrian company AFFiRiS AG. The consortium comprised three other industrial companies, two university institutes and a clinic, with a total of 20 scientists. The project received funding of EUR 4.3 million, of which EUR 2.4 came from the European Commission.
During the course of MIMOVAX, several AD vaccine candidates have been identified, which demonstrate the ability to reduce amyloid plaque load and alleviate the pathologic hallmarks of AD in the brain of animal models. In addition, according to the research team, a vaccination using AD vaccine candidates, improved spatial memory and learning in transgenic animals, thereby showing the potential for altering disease progression in these models. These experiments led to the identification of the AD03 vaccine as a candidate for clinical testing.
Dr Markus Mandler, the scientific coordinator at AFFiRiS AG explains: A clinical study using AD03 was conducted on 24 elderly patients with mild AD. Over the course of 12 months we studied the safety and tolerability of the vaccine. We then followed the patients up for a further 12 months to assess their behaviour. The results from these tests are currently being evaluated and we should see the final analysis in a few months.
He adds: Once we see the full results we will decide whether to embark on further clinical testing, eventually leading to studies and data which can be presented to regulatory authorities for review and approval.
STUDY SHOWS EMOTIONAL CONTAGION INCREASES IN ALZHEIMERS PATIENTS
01 JUN 2013—A TEAM OF RESEARCHERS WORKING AT THE UNIVERSITY OF CALIFORNIAS MEMORY AND AGING CENTER HAS FOUND THAT EMOTIONAL CONTAGION APPEARS TO INCREASE IN A LINEAR PROGRESSION WITH PATIENTS WHO HAVE ALZHEIMERS DISEASE (AD). IN THEIR PAPER PUBLISHED IN THE JOURNAL _PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES_, THE TEAM SAYS THEIR FINDINGS INDICATE THAT EMOTIONAL CONTAGION GROWS STRONGER IN PATIENTS WITH BOTH THE PRECURSOR MILD COGNITIVE IMPAIRMENT (MCI) AND FULL-BLOWN AD.
Emotional contagion is where one person mimics the emotions of another. The phenomenon is very common in human infants—upon seeing someone else smile, they tend to smile too. Babies have also been found to cry upon hearing other babies cry. The tendency to mimic others emotions regresses as people age, but this new study suggests it makes a reappearance in people who experience some forms of cognitive impairment later on in life.
Prior research has shown that AD causes damage to parts of the brain that are responsible for emotion—thus not all emotional problems with AD patients can be attributed to a natural human response to mental adversity. Both MCI and AD patients have been found to experience higher rates of depression and anxiety. Until now however, little research has been done to find out if people revert to mimicking the emotions of others as a type of response mechanism.
To learn more, the researchers performed psychological surveys on 120 people diagnosed with AD or MCI. Their inquiries focused mostly on emotional empathy. The team also enlisted the assistance of 111 healthy volunteers to serve as a control group. All of the participants also underwent MRI exams to test for levels of disease progression.
The brain scans revealed damage to the medial temporal lobe—known to be associated with emotional control—in those with dementia and also in the hippocampus, the part of the brain responsible for memory and recall.
An analysis of the results of the surveys and brain scans showed that emotional contagion became apparent in patients with MCI and grew more pronounced at each stage of the progression of AD. They also found that there appeared to be more of a connection between the degree of emotional contagion and damage to the right side of the medial temporal lobe, as compared to the left.
The researchers suggest that patients with dementia may mimic the emotions of others as their ability to gauge their own emotional state deteriorates. Doing so, they suggest, may help patients cope with their ailment. They add they it may also help patients hide their condition from others.
MORE INFORMATION: "Heightened emotional contagion in mild cognitive impairment and Alzheimers disease is associated with temporal lobe degeneration," by Virginia E. Sturm. _PNAS_. To be available at www.pnas.org/cgi/d… s.1301119110
THE STANDARD OF PALLIATIVE CARE PROVIDED FOR THOSE APPROACHING THE END OF THEIR LIVES VARIES GREATLY, ACCORDING TO THE FIRST COMPREHENSIVE EUROPEAN OVERVIEW OF THE SERVICE.
31 may 2013--Researchers, led by Professor David Clark from the University of Glasgow and Professor Carlos Centeno of the University of Navarra, Spain have compiled a European Atlas of provision which will be unveiled at the World Congress of Palliative Care, in Prague, May 30th – June 2nd 2013.
The Atlas offers a comprehensive overview of services, policies and strategies to improve end of life care in the 53 countries which make up the World Health Organisations (WHO) European Region through a series of maps which chart the relationship in many countries between high Gross Domestic Product (GDP), Human Development Index (HDI) and indicators relating to health expenditure. The Atlas also contains detailed profiles of palliative care delivery in each country, with information updated from a previous study in 2007.
The team found that some countries, including the United Kingdom, Sweden and Iceland scored consistently high on all indicators, with the highest concentration of palliative care services per head of population found to be in Ireland, Belgium, Luxembourg and Sweden.
Although levels end of life provision were poorer in the former Communist block the research did conclude that Eastern European palliative care provision was generally good, in spite of the relatively lower standards of living in that part of the continent, with the Republic of Moldova, Romania and Poland noted as areas where a significant level of palliative care development has been reached.
Professor David Clark, who is Director of the Dumfries Campus and Head of the School of Interdisciplinary Studies at the University of Glasgow and a leading researcher in the field said that "As the population in Europe ages, there is a growing interest in palliative care and how individuals can be supported towards the end of life. This Atlas is a key tool to drive policy and practice across Europe and to assist in the development of new services."
Other significant findings since 2007 include:
* A substantial number of countries have achieved Specialty or Sub-specialty accreditation in Palliative Medicine (with a further number in process);
* There has been a significant increase in the integration of palliative care legislation into the health policy of many countries;
* The ´vitality´ of palliative care (identified national associations, published journals, related directories, attendees at conferences, etc.) has improved in the vast majority of European countries;
* Palliative care service provision for children continues to develop throughout the WHO European Region.
MORE INFORMATION: The EAPC Atlas of Palliative Care in Europe 2013 Cartographic Edition is available to be viewed from issuu.com/universi… full_edition
For more information about the conference, go to eapc-2013.org/
Provided by University of Glasgow
META-ANALYSIS CONFIRMS COMMON PAINKILLERS INCREASE RISK OF HEART PROBLEMS AND DEATH
NSAIDS HAVE BEEN THE CORNERSTONE IN MANAGING PAIN IN PEOPLE WITH INFLAMMATORY DISORDERS LIKE RHEUMATOID ARTHRITIS, AND ARE SOME OF THE MOST COMMONLY USED DRUGS WORLDWIDE. EARLIER RESEARCH HAS LINKED THEIR USE WITH AN INCREASED RISK OF SERIOUS GASTROINTESTINAL COMPLICATIONS, WHILE A NEW GENERATION OF NSAIDS (COXIBS) DEVELOPED TO REDUCE THESE GASTROINTESTINAL SIDE EFFECTS HAVE COME UNDER SCRUTINY FOR INCREASING THE RISK OF HEART ATTACKS AND DEATH.
30 may 2013--This new study now shows that higher dose regimens of older NSAIDs, such as diclofenac 150mg and ibuprofen 2400mg daily, are associated with similar risks of heart disease.
As such, for every 1000 individuals with a moderate risk of heart disease allocated to 1 year of treatment with high-dose diclofenac or ibuprofen, about three would experience an avoidable heart attack, of which one would be fatal.
In addition, all NSAIDs double the risk of heart failure and produce a 2-times increased risk of serious upper gastrointestinal complications such as bleeding ulcers.
The Coxib and traditional NSAID Trialists (CNT) Collaboration combined data on outcomes of over 353 000 patients comparing one NSAID with another NSAID or placebo.
The meta-analysis of patient data from 639 randomised trials shows that the size of these risks can be predicted, which may help physicians decide which types of patient are best suited to which NSAID regimen.
Importantly, the increased risk of heart attacks from individual NSAIDs seemed to be proportional to a patients underlying risk of such heart attacks, so that the risk is highest in those with a previous history of heart disease or those with cardiac risk factors such as raised blood pressure or cholesterol.
According to lead author Professor Colin Baigent from the Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, UK, "Whilst NSAIDs increase vascular and gastrointestinal risks to a varying extent, our analyses indicate that the effects of different regimens in particular patients can be predicted, which may help physicians choosing between alternative NSAID regimens to weigh up which type of NSAID is safest in different patients."
Writing in a linked Comment, Marie Griffin from Vanderbilt University Medical Center in the USA says, "The meta-analysis offers considerable certainty about relative and absolute major vascular risks of high doses of the most commonly prescribed NSAIDs, but leaves large gaps about risks associated with lower NSAID doses, longer durations of use, and residual effects after stopping treatment."
She adds, "Identification of safe and effective strategies for chronic pain is sorely needed. In the meantime, long-term use of high dose NSAIDs should be reserved for those who receive considerable symptomatic benefit from the treatment and understand the risks."
TREATMENTS FOR DEPRESSION THAT DONT INVOLVE ANTIDEPRESSANT DRUGS BUT RATHER FOCUS ON DIFFERENT FORMS OF TALKING THERAPY (REFERRED TO AS PSYCHOTHERAPEUTIC INTERVENTIONS) ARE ALL BENEFICIAL, WITH NO ONE FORM OF THERAPY BEING BETTER THAN THE OTHERS, ACCORDING TO A STUDY BY INTERNATIONAL RESEARCHERS PUBLISHED IN THIS WEEKS _PLOS MEDICINE_.
29 may 2013--These findings are important as they suggest that patients with depression should discuss different forms of non-drug therapy with their doctors and explore which type of psychotherapy best suits them.
The researchers, led by Jürgen Barth from the University of Bern in Switzerland, reached these conclusions by reviewing 198 published studies involving over 15,000 patients receiving one of seven types of psychotherapeutic intervention: Interpersonal psychotherapy, behavioural activation, cognitive behavioural therapy, problem solving therapy, psychodynamic therapy, social skills training and supportive counselling.* The authors compared each of the therapies with each other and with a control—patients on a waiting list or continuing usual case—and combined the results.
The authors found that all seven therapies were better at reducing symptoms of depression than waiting list and usual care and that there were no significant differences between the different types of therapy. They also found that the therapies worked equally well for different patient groups with depression, such as for younger and older patients and for mothers who had depression after having given birth. Furthermore, the authors found no substantial differences when comparing individual with group therapy or with face-to-face therapy compared with internet-based interactions between therapist and patient.
The authors say: "We found evidence that most of the seven psychotherapeutic interventions under investigation have comparable effects on depressive symptoms and achieve moderate to large effects vis-à-vis waitlist."
They continue: "All seven psychotherapeutic interventions achieved a small to moderate effect compared to usual care."
The authors add: "Overall, we found that different psychotherapeutic interventions for depression have comparable, moderate-to-large effects."
*"Interpersonal psychotherapy" is short and highly structured, using a manual to focus on interpersonal issues in depression.
"Behavioral activation" raises the awareness of pleasant activities and seeks to increase positive interactions between the patient and his or her environment.
"Cognitive behavioural therapy" focuses on a patients current negative beliefs, evaluates how they affect current and future behaviour, and attempts to restructure the beliefs and change the outlook. "Problem solving therapy" aims to define a patients problems, propose multiple solutions for each problem, and then select, implement, and evaluate the best solution.
"Psychodynamic therapy" focuses on past unresolved conflicts and relationships and the impact they have on a patients current situation.
In "social skills therapy," patients are taught skills that help to build and maintain healthy relationships based on honesty and respect.
"Supportive counselling" is a more general therapy that aims to get patients to talk about their experiences and emotions and to offer empathy without suggesting solutions or teaching new skills.
MORE INFORMATION: Barth J, Munder T, Gerger H, Nu¨ esch E, Trelle S, et al. (2013) Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis. PLoS Med 10(5): e1001454. doi:10.1371/journal.pmed.1001454
Provided by Public Library of Science
SCIENTISTS DISCOVER CINNAMON COMPOUNDS POTENTIAL ABILITY TO PREVENT ALZHEIMERS
Graduate student researcher Roshni George, left, and Don Graves, University of California, Santa Barbara, adjunct professor in the Department of Molecular, Cellular, and Developmental Biology, have found that certain compounds in cinnamon are showing some promise in the effort to fight Alzheimers. Credit: UCSB
CINNAMON: CAN THE RED-BROWN SPICE WITH THE UNMISTAKABLE FRAGRANCE AND VARIETY OF USES OFFER AN IMPORTANT BENEFIT? THE COMMON BAKING SPICE MIGHT HOLD THE KEY TO DELAYING THE ONSET OF –– OR WARDING OFF –– THE EFFECTS OF ALZHEIMERS DISEASE.
28 may 2013--That is, according to Roshni George and Donald Graves, scientists at UC Santa Barbara. The results of their study, "Interaction of Cinnamaldehyde and Epicatechin with Tau: Implications of Beneficial Effects in Modulating AlzheimersDisease Pathogenesis," appears in the online early edition of the _Journal of Alzheimers Disease_, and in the upcoming Volume 36, issue 1 print edition.
Alzheimers disease is the most common form of dementia, a neurodegenerative disease that progressively worsens over time as it kills brain cells. No cure has yet been found, nor has the major cause of Alzheimers been identified.
However, two compounds found in cinnamon –– cinnamaldehyde and epicatechin –– are showing some promise in the effort to fight the disease. According to George and Graves, the compounds have been shown to prevent the development of the filamentous "tangles" found in the brain cells that characterize Alzheimers.
Responsible for the assembly of microtubules in a cell, a protein called tau plays a large role in the structure of the neurons, as well as their function.
"The problem with tau in Alzheimers is that it starts aggregating," said George, a graduate student researcher. When for the protein does not bind properly to the microtubules that form the cells structure, it has a tendency to clump together, she explained, forming insoluble fibers in the neuron. The older we get the more susceptible we are to these twists and tangles, Alzheimers patients develop them more often and in larger amounts.
The use of cinnamaldehyde, the compound responsible for the bright, sweet smell of cinnamon, has proven effective in preventing the tau knots. By protecting tau from oxidative stress, the compound, an oil, could inhibit the proteins aggregation. To do this, cinnamaldehyde binds to two residues of an amino acid called cysteine on the tau protein. The cysteine residues are vulnerable to modifications, a factor that contributes to the development of Alzheimers.
"Take, for example, sunburn, a form of oxidative damage," said Graves, adjunct professor in UCSBs Department of Molecular, Cellular, and Developmental Biology. "If you wore a hat, you could protect your face and head from the oxidation. In a sense this cinnamaldehyde is like a cap." While it can protect the tau protein by binding to its vulnerable cysteine residues, it can also come off, Graves added, which can ensure the proper functioning of the protein.
Oxidative stress is a major factor to consider in the health of cells in general. Through normal cellular processes, free radical-generating substances like peroxides are formed, but antioxidants in the cell work to neutralize them and prevent oxidation. Under some conditions however, the scales are tipped, with increased production of peroxides and free radicals, and decreased amounts of antioxidants, leading to oxidative stress.
Epicatechin, which is also present in other foods, such as blueberries, chocolate, and red wine, has proven to be a powerful antioxidant. Not only does it quench the burn of oxidation, it is actually activated by oxidation so the compound can interact with the cysteines on the tau protein in a way similar to the protective action of cinnamaldehyde.
"Cell membranes that are oxidized also produce reactive derivatives, such as Acrolein, that can damage the cysteines," said George. "Epicatechin also sequesters those byproducts."
Studies indicate that there is a high correlation between Type 2 diabetes and the incidence of Alzheimers disease. The elevated glucose levels typical of diabetes lead to the overproduction of reactive oxygen species, resulting in oxidative stress, which is a common factor in both diabetes and Alzheimers disease. Other research has shown cinnamons beneficial effects in managing blood glucose and other problems associated with diabetes.
"Since tau is vulnerable to oxidative stress, this study then asks whether Alzheimers disease could benefit from cinnamon, especially looking at the potential of small compounds," said George.
Although this research shows promise, Graves said, they are "still a long way from knowing whether this will work in human beings." The researchers caution against ingesting more than the typical amounts of cinnamon already used in cooking.
If cinnamon and its compounds do live up to their promise, it could be a significant step in the ongoing battle against Alzheimers. A major risk factor for the disease –– age –– is uncontrollable. In the United States, Alzheimers presents a particular problem as the population lives longer and the Baby Boom generation turns gray, leading to a steep rise in the prevalance of the disease. It is a phenomenon that threatens to overwhelm the U.S. health care system. According to the Alzheimers Association, in 2013, Alzheimers disease will cost the nation $203 billion.
"Wouldnt it be interesting if a small molecule from a spice could help?" commented Graves, "perhaps prevent it, or slow down the progression."
Provided by University of California - Santa Barbara
HORMONE REPLACEMENT THERAPY—CLARITY AT LAST
THE BRITISH MENOPAUSE SOCIETY AND WOMENS HEALTH CONCERN HAVE TODAY RELEASED UPDATED GUIDELINES ON HORMONE REPLACEMENT THERAPY (HRT) TO PROVIDE CLARITY AROUND THE ROLE OF HRT, THE BENEFITS AND THE RISKS. THE NEW GUIDELINES APPEAR IN THE SOCIETYS FLAGSHIP TITLE,_MENOPAUSE INTERNATIONAL_.
26 may 2013--Over the last 11 years, HRT has changed from being branded the "elixir of youth" to being considered extremely risky and only to be used in certain circumstances. Since the publication of the Womens Health Initiative (WHI) trial in 2002, and the Million Women study (MWS) in 2003, confusion and controversy has surrounded the use of HRT and the known benefits have often been forgotten.
A panel of experts have carefully considered, researched and reanalyzed the WHI and MWS studies alongside conducting further trials and studies, to offer practioners a detailed review of the evidence to help them optimize their clinical decisions, and provide women with more balanced and accurate advice on HRT treatment for menopause.
The new HRT recommendations are designed to complement the BMS Observations and Recommendations on menopause. The updated guidelines detail key recommendations targeting access to advice on how women can optimize their menopause transition and beyond, focusing in particular on lifestyle and diet and an opportunity to discuss the pros and cons of complementary therapies and HRT.
"Our aim is to provide helpful and pragmatic guidelines for health professionals involved in prescribing HRT and for women considering or currently using HRT" says Nick Panay, Chair of The British Menopause Society and lead author of the recommendations. "With these updated recommendations, it is hoped that HRT will once again be used appropriately and provide benefits for many women in their menopause."
MORE INFORMATION: "The 2013 British Menopause Society & Womens Health Concern recommendations on hormone replacement therapy" by Nick Panay, Haitham Hamoda, Roopen Arya and Michael Sarvas on behalf of the British Menopause Society and Womens Health Concern, published by SAGE in _Menopause International_, June 2013.
Provided by SAGE Publications
STUDY IDENTIFIES GENES, PATHWAYS ALTERED DURING RELAXATION RESPONSE PRACTICE
A NEW STUDY FROM INVESTIGATORS AT THE BENSON-HENRY INSTITUTE FOR MIND/BODY MEDICINE AT MASSACHUSETTS GENERAL HOSPITAL (MGH) AND BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) FINDS THAT ELICITATION OF THE RELAXATION RESPONSE – A PHYSIOLOGIC STATE OF DEEP REST INDUCED BY PRACTICES SUCH AS MEDITATION, YOGA, DEEP BREATHING AND PRAYER – PRODUCES IMMEDIATE CHANGES IN THE EXPRESSION OF GENES INVOLVED IN IMMUNE FUNCTION, ENERGY METABOLISM AND INSULIN SECRETION. PUBLISHED IN THE OPEN-ACCESS JOURNAL _PLOS ONE_, THE STUDY COMBINED ADVANCED EXPRESSION PROFILING AND SYSTEMS BIOLOGY ANALYSIS TO BOTH IDENTIFY GENES AFFECTED BY RELAXATION RESPONSE PRACTICE AND DETERMINE THE POTENTIAL BIOLOGICAL RELEVANCE OF THOSE CHANGES.
24 may 2013--"Many studies have shown that mind/body interventions like the relaxation response can reduce stress and enhance wellness in healthy individuals and counteract the adverse clinical effects of stress in conditions like hypertension, anxiety, diabetes and aging," says Herbert Benson, MD, director emeritus of the Benson-Henry Institute and co-senior author of the PLOS ONE report. "Now for the first time weve identified the key physiological hubs through which these benefits might be induced."
Towia Libermann, PhD – director of the Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center and co-senior author of the study – adds, "Some of the biological pathways we identify as being regulated by relaxation response practice are already known to play specific roles in stress, inflammation and human disease. For others, the connections are still speculative, but this study is generating new hypotheses for further investigation."
Benson first described the relaxation response – the physiologic opposite of the fight-or-flight response – almost 40 years ago, and his team has pioneered the application of mind/body techniques to a wide range of health problems. Studies in many peer-reviewed journals have documented how the relaxation response both alleviates symptoms of anxiety and many other disorders and also affects factors such as heart rate, blood pressure, oxygen consumption and brain activity. In 2008, Benson and Libermann led a study finding that long-term practice of the relaxation response changed the expression of genes involved with the bodys response to stress. The current study examined changes produced during a single session of relaxation response practice, as well as those taking place over longer periods of time.
The study enrolled a group of 26 healthy adults with no experience in relaxation response practice, who then completed an 8-week relaxation response training course. Prior to starting their training, the participants went through what was essentially a control group session – blood samples were taken before and immediately after they listened to a 20-minute health education CD and again 15 minutes later. After completing the training course, a similar set of blood tests was taken before and after participants listened to a 20-minute CD used to elicit the relaxation response as part of daily practice.
The sets of blood tests taken before the training program were designated "novice," and those taken after training completion were categorized as from "short-term practitioners." For further comparison a similar set of blood samples was taken from a group of 25 individuals with 4 to 25 years experience regularly eliciting the relaxation response through many different techniques before and after they listened to the same relaxation response CD. Blood samples from all participants were analyzed to determine the expression of more than 22,000 genes at the different time points.
The results revealed significant changes in the expression of several important groups of genes between the novice samples and those from both the short- and long-term sets, with even more pronounced changes in the long-term practitioners. A systems biology analysis of known interactions among the proteins produced by the affected genes revealed that pathways involved with energy metabolism, particularly the function of mitochondria, were upregulated during the relaxation response. Pathways controlled by activation of a protein called NF-κB – known to have a prominent role in inflammation, stress, trauma and cancer – were suppressed after relaxation response elicitation. The expression of genes involved in insulin pathways was also significantly altered.
"The combination of genomics and systems biology in this study provided great insight into the key molecules and physiological gene interaction networks that might be involved in relaying beneficial effects of relaxation response in healthy subjects," says Manoj K. Bhasin, PhD, co-lead author of the study and co-director of the BIDMC Genomics, Proteomics, Bioinformatics and Systems Biology Center. He notes that these insights should provide a framework for determining, on a genomic basis, whether the relaxation response will help alleviate symptoms of diseases triggered by stress and developing biomarkers that may suggest how individual patients will respond to interventions.
Benson stresses that the long-term practitioners in this study elicited the relaxation response through many different techniques – various forms of meditation, yoga or prayer – but those differences were not reflected in the gene expression patterns. "People have been engaging in these practices for thousands of years, and our finding of this unity of function on a basic-science, genomic level gives greater credibililty to what some have called new age medicine, " he says.
Libermann says, "While this and our previous studies focused on healthy participants, we currently are studying how the genomic changes induced by mind/body interventions affect pathways involved in hypertension, inflammatory bowel disease and irritable bowel syndrome. We have also started a study – a collaborative undertaking between the Dana Farber Cancer Institute, the Massachusetts General Hospital and the Beth Israel Deaconess Medical Center – in patients with precursor forms of multiple myeloma, a condition known to involve activation of NF-κB pathways."
Provided by Massachusetts General Hospital
CALCIUM SUPPLEMENTS LINKED TO LONGER LIFESPANS IN WOMEN
TAKING A CALCIUM SUPPLEMENT OF UP TO 1,000 MG PER DAY CAN HELP WOMEN LIVE LONGER, ACCORDING TO A RECENT STUDY ACCEPTED FOR PUBLICATION IN THE ENDOCRINE SOCIETYS _JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM_ (JCEM).
23 may 2013--Calcium, an essential nutrient for bone health, is commonly found in dairy products as well as vitamins. Although calcium is an essential nutrient for bone health, past studies have linked calcium supplements to heart disease risk. Researchers analyzing data from the large-scale Canadian Multicentre Osteoporosis Study (CaMos) sought to clarify this issue and found moderate doses of calcium supplements had a beneficial effect in women.
"Our study found daily use of calcium supplements was associated with a lower risk of death among women," said the studys lead author, David Goltzman, MD, of McGill University in Montreal, Canada. "The benefit was seen for women who took doses of up to 1,000 mg per day, regardless of whether the supplement contained vitamin D."
The longitudinal cohort study monitored the health of 9,033 Canadians between 1995 and 2007. During that period, 1,160 participants died. Although the data showed women who took calcium supplements had a lower mortality risk, there was no statistical benefit for men. The study found no conclusive evidence that vitamin D had an impact on mortality.
"Higher amounts of calcium were potentially linked to longer lifespans in women, regardless of the source of the calcium," Goltzman said. "That is, the same benefits were seen when the calcium came from dairy foods, non-dairy foods or supplements."
MORE INFORMATION: The article, "Calcium and Vitamin D Intake and Mortality: Results from the Canadian Multi-centre Osteoporosis Study," will appear in the July 2013 issue of JCEM.
Provided by The Endocrine Society
THE COMPOUND IN THE MEDITERRANEAN DIET THAT MAKES CANCER CELLS MORTAL
NEW RESEARCH SUGGESTS THAT A COMPOUND ABUNDANT IN THE MEDITERRANEAN DIET TAKES AWAY CANCER CELLS "SUPERPOWER" TO ESCAPE DEATH. BY ALTERING A VERY SPECIFIC STEP IN GENE REGULATION, THIS COMPOUND ESSENTIALLY RE-EDUCATES CANCER CELLS INTO NORMAL CELLS THAT DIE AS SCHEDULED.
21 mau 2013--One way that cancer cells thrive is by inhibiting a process that would cause them to die on a regular cycle that is subject to strict programming. This study in cells, led by Ohio State University researchers, found that a compound in certain plant-based foods, called apigenin, could stop breast cancer cells from inhibiting their own death.
Much of what is known about the health benefits of nutrients is based on epidemiological studies that show strong positive relationships between eating specific foods and better health outcomes, especially reduced heart disease. But how the actual molecules within thesehealthful foods work in the body is still a mystery in many cases, and particularly with foods linked to lower risk for cancer.
Parsley, celery and chamomile tea are the most common sources of apigenin, but it is found in many fruits and vegetables.
The researchers also showed in this work that apigenin binds with an estimated 160 proteins in the human body, suggesting that other nutrients linked to health benefits – called "nutraceuticals" – might have similar far-reaching effects. In contrast, most pharmaceutical drugs target a single molecule.
"We know we need to eat healthfully, but in most cases we dont know the actual mechanistic reasons for why we need to do that," said Andrea Doseff, associate professor of internal medicine and molecular genetics at Ohio State and a co-lead author of the study. "We see here that the beneficial effect on health is attributed to this dietary nutrient affecting many proteins. In its relationship with a set of specific proteins, apigenin re-establishes the normal profile in cancer cells. We think this can have great value clinically as a potential cancer-prevention strategy."
Doseff oversaw this work with co-lead author Erich Grotewold, professor of molecular genetics and director of Ohio States Center for Applied Plant Sciences (CAPS). The two collaborate on studying the genomics of apigenin and other flavonoids, a family of plant compounds that are believed to prevent disease.
The research appears this week in the online early edition of the journal _Proceedings of the National Academy of Sciences_.
Though finding that apigenin can influence cancer cell behavior was an important outcome of the work, Grotewold and Doseff point to their new biomedical research technique as a transformative contribution to nutraceutical research.
They likened the technique to "fishing" for the human proteins in cells that interact with small molecules available in the diet.
"You can imagine all the potentially affected proteins as tiny fishes in a big bowl. We introduce this molecule to the bowl and effectively lure only the truly affected proteins based on structural characteristics that form an attraction," Doseff said. "We know this is a real partnership because we can see that the proteins and apigenin bind to each other."
Through additional experimentation, the team established that apigenin had relationships with proteins that have three specific functions. Among the most important was a protein called hnRNPA2.
This protein influences the activity of messenger RNA, or mRNA, which contains the instructions needed to produce a specific protein. The production of mRNA results from the splicing, or modification, of RNA that occurs as part of gene activation. The nature of the splice ultimately influences which protein instructions the mRNA contains.
Doseff noted that abnormal splicing is the culprit in an estimated 80 percent of all cancers. In cancer cells, two types of splicing occur when only one would take place in a normal cell – a trick on the cancer cells part to keep them alive and reproducing.
In this study, the researchers observed that apigenins connection to the hnRNPA2 protein restored this single-splice characteristic to breast cancer cells, suggesting that when splicing is normal, cells die in a programmed way, or become more sensitive to chemotherapeutic drugs.
"So by applying this nutrient, we can activate that killing machinery. The nutrient eliminated the splicing form that inhibited cell death," said Doseff, also an investigator in Ohio States Davis Heart and Lung Research Institute. "Thus, this suggests that when we eat healthfully, we are actually promoting more normal splice forms inside the cells in our bodies."
The beneficial effects of nutraceuticals are not limited to cancer, as the investigators previously showed that apigenin has anti-inflammatory activities.
The scientists noted that with its multiple cellular targets, apigenin potentially offers a variety of additional benefits that may even occur over time. "The nutrient is targeting many players, and by doing that, you get an overall synergy of the effect," Grotewold explained.
Doseff is leading a study in mice, testing whether food modified to contain proper doses of this nutrient can change splicing forms in the animals cells and produce an anti-cancer effect.
MORE INFORMATION: Molecular basis for the action of a dietary flavonoid revealed by the comprehensive identification of apigenin human targets, www.pnas.org/cgi/d… s.1303726110
