Search This Blog
Monday, November 23, 2015
Walking Faster or Longer Linked to Significant Cardiovascular Benefits in Older Adults
Newswise, November 23, 2015— In a large
prospective community-based study of older Americans, modest physical activity
was associated with a lower risk of cardiovascular disease (CVD).
This was true
even among men and women older than age 75 at baseline – a rapidly growing
population for whom regular activity has been advised, but with little
supportive empirical evidence.
Led by senior author, Dariush Mozaffarian, M.D., Dr.P.H., dean
of the Friedman School of Nutrition Science and Policy at Tufts University, the
researchers studied a group of American adults whose mean age was 73 at the
start of the study and who were then followed for 10 years.
Information on various usual activities was assessed at
baseline and regularly updated during follow-up. When the current study’s
research team evaluated different aspects of physical activity by the men and
women during this ten-year period -- a greater pace, walking distance, and
leisure activity-- each was associated with a lower risk of cardiovascular
disease.
The associations found include:
• After adjustment for other risk factors and lifestyle
behaviors, those who were more active had significantly lower risk of future
heart attacks and stroke.
• Adults who walked at a pace faster than three miles per hour (mph) had a 50%, 53%, 50% lower risk of coronary heart disease (CHD), stroke and total CVD, respectively, compared to those who walked at a pace of less than two mph.
• Those who walked an average of seven blocks per day or more had a 36%, 54% and 47% lower risk of CHD, stroke and total CVD, respectively, compared to those who walked up to five blocks per week.
• Those who engaged in leisure activities such as lawn-mowing, raking, gardening, swimming, biking and hiking, also had a lower risk of CHD, stroke and total CVD, compared to those who did not engage in leisure-time activities.
• The findings were similar in both men and women, in those above or below age 75 at baseline, and including only those with similarly good or excellent self-reported health.
• Adults who walked at a pace faster than three miles per hour (mph) had a 50%, 53%, 50% lower risk of coronary heart disease (CHD), stroke and total CVD, respectively, compared to those who walked at a pace of less than two mph.
• Those who walked an average of seven blocks per day or more had a 36%, 54% and 47% lower risk of CHD, stroke and total CVD, respectively, compared to those who walked up to five blocks per week.
• Those who engaged in leisure activities such as lawn-mowing, raking, gardening, swimming, biking and hiking, also had a lower risk of CHD, stroke and total CVD, compared to those who did not engage in leisure-time activities.
• The findings were similar in both men and women, in those above or below age 75 at baseline, and including only those with similarly good or excellent self-reported health.
The researchers studied 4,207 men and women who had been
enrolled in the Cardiovascular Health Study (CHS). CHS is a National Heart,
Lung, and Blood Institute of the National Institutes of Health-supported
national cohort of U.S. men and women who were enrolled in 1989-90 from
Medicare eligibility lists and whose health was followed over time.
The researchers used the information in the CHS database
concerning physical activity, including walking, leisure-time activities and
exercise intensity, and other health information coming from annual study
visits such as physical exams, diagnostic testing, laboratory evaluations,
personal health histories, and measured risk factors.
“Our study of older Americans shows that, even late in life,
moderate physical activity such as walking is linked to lower incidence of
cardiovascular disease,“ commented the first author Luisa Soares-Miranda,
Ph.D., a member of the research team and currently a postdoctoral student with
the Research Centre in Physical Activity, Health and Leisure, Faculty of Sport
at the University of Porto, Portugal.
“It appears that whether one increases the total distance or
the pace of walking, CVD risk is lowered. Fortunately, walking is an activity
that many older adults can enjoy.”
“While national guidelines recommend that older adults engage
in regular physical activity, surprisingly few studies have evaluated potential
cardiovascular benefits after age 75, a rapidly growing age group,” said
Mozaffarian.
“Our findings confirm a
beneficial relationship between walking and leisure activities and CVD late in
life.
“These results are especially relevant because, with advancing
age, the ability to perform vigorous types of activity often decreases. Our
findings support the importance of continuing light to moderate exercise to
improve health across the lifespan.”
Additional authors of this study are David F. Siscovick, M.D.,
M.P.H., senior vice president for research at the New York Academy of Medicine;
Bruce M. Psaty, M.D., M.P.H., Ph.D., professor in the Departments of Medicine
and Epidemiology at the University of Washington and a senior investigator in
the Group Health Research Institute; and W.T. Longstreth, Jr., M.D., M.P.H,
professor of neurology and adjunct professor of epidemiology in the Department
of Neurology at the Harborview Medical Center at the University of Washington.
This research was supported by contracts from the U.S.
Department of Health and Human Services: HHSN268201200036C and
HHSN268200800007C; and awards from the National Heart, Lung, and Blood
Institute of the National Institutes of Health: N01HC55222, N01HC85079,
N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and HL080295. Luisa
Soares-Miranda is supported by a grant funded by the Portuguese Foundation for
Science and Technology (FCT).
Soares-Miranda, Luisa; Siscovick, David S.; Psaty, Bruce M.;
Longstreth, W.T. Jr.; and Mozaffarian, Dariush, “Physical Activity and Risk of
Coronary Heart Disease and Stroke in Older Adults: The Cardiovascular Health
Study.” Circulation (published online before print November 4, 2015) doi:
10.1161/CIRCULATIONAHA.115.018323
About the Friedman School of Nutrition Science and
Policy
The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University is the only independent school of nutrition in the United States.
The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University is the only independent school of nutrition in the United States.
The school's eight degree programs – which focus on questions
relating to nutrition and chronic diseases, molecular nutrition, agriculture
and sustainability, food security, humanitarian assistance, public health
nutrition, and food policy and economics – are renowned for the application of
scientific research to national and international policy.
Sound Deprivation Leads to Irreversible Hearing Loss
Researchers show that
chronic conductive hearing loss leads to cochlear degeneration
Newswise, November 23, 2015--Massachusetts Eye and Ear
investigators have shown that sound deprivation in adult mice causes
irreversible damage to the inner ear.
The findings, published in PLOS ONE, suggest that
chronic conductive hearing loss, such as that caused by recurrent ear
infections, leads to permanent hearing impairment if it remains untreated.
Sound waves travel through the ear canal before reaching the
eardrum and the tiny bones of the middle ear. They are then converted into
electrical signals within the inner ear and transmitted to the brain by the
auditory nerve.
Conductive hearing loss occurs when sound transmission from
the ear canal to the inner ear is impaired. It causes a reduction in sound
level and an inability to hear soft sounds.
In this study, a team of researchers led by Stéphane F.
Maison, Ph.D., investigator in the Eaton-Peabody Laboratories at Mass. Eye and
Ear and assistant professor of otolaryngology at Harvard Medical School,
followed the inner ear changes in a group of mice with chronic conductive
hearing loss in one ear.
“After a year of sound deprivation, we observed dramatic
changes in the inner ear — notably, a significant loss of the synaptic
connections through which the sensory cells send their electrical signals to
the brain,” Dr. Maison said.
“Although there have been many studies of acoustic deprivation
on the auditory system, few have looked at adult-onset deprivation, and none,
to our knowledge, has documented changes in the inner ear.”
Leading causes of conductive hearing loss include earwax
blockage, otitis media (ear infections) and otosclerosis.
“Although these conditions are routinely treated in industrial
societies, a number of patients choose not to receive treatment, particularly
when their medical condition affects only one ear,” Dr. Maison said.
“For instance, patients with unilateral atresia, a condition
in which the ear canal is closed or absent, see limited benefits of undergoing
surgery when they can simply use their good ear.”
At least 80 percent of children will experience one or more
bouts of otitis media before they reach 3 years of age. Ear infections are the
most common cause for physician visits and medication prescriptions among
children in the United States.
These bouts can persist for many months in some cases, and
deficits in communication abilities can persist for years after the middle-ear
pathology has resolved.
Data from the present study suggest that the auditory
deprivation, in itself, damages the inner ear in ways similar to that seen in
age-related and noise-induced hearing loss.
Although the mechanisms underlying this inner ear damage
following sound-deprivation are not known, the authors suggest that its effects
need to be considered in the management of chronic conductive hearing loss in
clinic.
“Our findings suggest that audiologists and physicians should
advocate for early intervention and treat these middle ear conditions,” Dr.
Maison said.
Co-authors of this PLOS ONE paper are Leslie D. Liberman,
Laboratory Manager at the Eaton-Peabody Laboratories at Mass. Eye & Ear and
M. Charles Liberman, Ph.D., Director of the Eaton-Peabody Laboratories at Mass.
Eye and Ear and the Harold F. Schuknecht Professor of Otolaryngology at Harvard
Medical School. This work was supported by the National Institute on Deafness
and Other Communication Disorders (Grants RO1 DC 0188 and P30 DC 05209).
About Massachusetts Eye and Ear
Mass. Eye and Ear clinicians and scientists are driven by a mission to find cures for blindness, deafness and diseases of the head and neck. Now united with Schepens Eye Research Institute, Mass. Eye and Ear is the world's largest vision and hearing research center, developing new treatments and cures through discovery and innovation. Mass. Eye and Ear is a Harvard Medical School teaching hospital and trains future medical leaders in ophthalmology and otolaryngology, through residency as well as clinical and research fellowships.
Internationally acclaimed since its founding in 1824, Mass. Eye and Ear employs
full-time, board-certified physicians who offer high-quality and affordable
specialty care that ranges from the routine to the very complex. U.S. News
& World Report’s “Best Hospitals Survey” has consistently ranked the Mass.
Eye and Ear Departments of Otolaryngology and Ophthalmology as top in the
nation. For more information about life-changing care and research, or to learn
how you can help, please visit MassEyeAndEar.org
Viruses Can Spread When Jack Frost Nips at Your Nose
Saint Louis University Infectious Diseases
Physicians Answers Flu Season Questions
Newswise, November 23, 2015 -- A cure for the common cold
isn’t in the crystal ball of an infectious diseases researcher and physician at
Saint Louis University’s Center for Vaccine Development.
“There’s not likely to be a vaccine or cure developed because
colds don’t kill people or make them seriously ill,” says Donald Kennedy, M.D.,
professor of internal medicine at Saint Louis University and a SLUCare
infectious diseases expert.
“They don’t have a major impact on overall health or the
economy because many people keep on working even if they have a cold.”
In addition, many strains of rhinovirus and coronavirus -–
which are sources of respiratory infections -– also cause colds, so there is no
one single virus to target.
“That helps explain the reason people can get repeated colds.
They’re probably getting a different virus from the last one, a virus they’re
not immune to,” Kennedy says. “You also can get two viruses at the same time,
with overlapping symptoms.”
Not all respiratory infections are the same. Some have more
debilitating symptoms and serious health consequences than others. Some are
seasonal, others occur at any time of the year.
As anyone who has spent a vacation on the beach with the
sniffles knows, colds can occur at any time of year. They know no season.
Seasonal influenza -– as the name implies -– is another
matter, Kennedy says, typically occurring in the U.S. between October to
February, for six to eight weeks. And as it infects 60 to 70 million people a
year, influenza kills an estimated 40,000 U.S. residents each year. Funded by
the National Institutes of Health, Saint Louis University’s Center for Vaccine
Development conducts extensive research on influenza vaccines because
protecting people from flu is a significant public health initiative.
So as patients get their annual influenza vaccines because flu
season is around the corner, Kennedy answers questions about the invasion of
the viruses that can make us feel miserable.
How can you tell the difference between the flu
and a cold?
If you have to ask, you don’t have influenza, Kennedy says.
“A cold is just a runny nose. Typically, you don’t even
cough,” Kennedy says. “You carry Kleenex and you blow your nose. Maybe you
don’t feel perfect, but colds are not that big of a deal. Most people get a
couple colds a year, and they last for about a week.”
Influenza is an entirely different story.
“If you get the real flu, you are achy, run a high fever and
feel as if you can’t get out of bed. You won’t be able to come into work, and
you shouldn’t want to transmit influenza to others,” Kennedy says.
“You could have fever, chills, muscle aches all over your
body, fatigue, a cough, sore throat and a headache. And you could have a runny
or stuffy nose, which you also get with a cold.”
Maybe you feel that you are able to function, yet more
miserable than just having a stuffy nose. You might have parainfluenza, which
is a respiratory virus with symptoms that include fever, runny nose, sore
throat and cough.
Anyone can get parainfluenza, but it is most common in
children, those with weakened immune systems or older adults. Parainfluenza can
lead to bronchitis, croup and pneumonia.
“A flu shot won’t protect you from parainfluenza because it is
a different virus than influenza,” Kennedy says.
Should I stay home?
Not if you have a cold. Wash your hands, bring your tissues
and persevere, Kennedy says.
Absolutely, if you have influenza, Kennedy says. “We don’t
want you transmitting the virus to others.”
Maybe, if you have parainfluenza or another type of
respiratory infection. Let your symptoms guide you.
“Whether to stay home really is based on if you have a disease
that is going to be communicable to others. If you have a fever of 100.5
degrees Fahrenheit, that’s usually significant for a systemic illness,” Kennedy
says.
“But use your judgment. Your temperature fluctuates throughout
the day, depending on when you take it. So there’s really no set number that is
the magic ‘you’re sick’ indicator.”
Why does flu occur in winter?
“Nobody really knows,” Kennedy says. “It stands to reason that
we are in closer contact indoors with each other in the winter, but we really
don’t know.”
Influenza is transmitted in the air when someone coughs or
sneezes and those droplets land in the mouths or noses of someone nearby. It
also spreads the same way colds are transmitted –- through hand-to-hand
contact. Someone who is infected touches his nose or mouth, touches someone
else’s hand and that person touches her nose or mouth.
Why do some people seem to get sicker with upper
respiratory infections than others?
Two things likely are at play, Kennedy says, dose and host.
“You’re more likely to get a bad case of flu sleeping next to
someone who is coughing and sneezing all night rather than riding the bus for
15 minutes next to someone who has influenza. It’s the amount of virus that
you’re exposed to,” Kennedy said.
“The host’s ability to fight this off also is relevant.
Someone who has a compromised immune system -– who is fatigued, doesn’t eat
right, is pregnant or has an underlying health problem -– is likely to get
sicker as well.”
Is there anything you can do to make a cold go
away?
Not really. Drink a lot of fluids and treat your symptoms. The
infection will run its course in about a week.
If you have the flu, you may shorten its duration by 24 hours
if you call your doctor at the first sign of symptoms to get a prescription for
Tamiflu or Relenza, which are antiviral medications.
“These drugs reduce symptoms slightly but only if they are
taken early,” Kennedy says. “And you have to be careful not to overuse them
because the virus can become resistant to the medicine.”
Is there a silver lining in getting the flu?
“If you get the flu this year, the chance of getting it next
year is less likely because you boosted your immunity,” Kennedy says.
And if you really hate the possibility of getting the flu, get
vaccinated. It’s the one thing you can do to reduce your odds of being laid up
for days with influenza, he says.
Established in 1836, Saint Louis University School of Medicine
has the distinction of awarding the first medical degree west of the
Mississippi River. The school educates physicians and biomedical scientists,
conducts medical research, and provides health care on a local, national and
international level.
Research at the school seeks new cures and treatments in five
key areas: infectious disease, liver disease, cancer, heart/lung disease, and
aging and brain disorders.
SLUCare Physician Group is the academic medical practice of
Saint Louis University, with more than 500 health care providers and 1,200
staff members in hospitals and medical offices throughout the St. Louis region.
SLUCare physicians are among the most highly trained in their fields -— more
than 50 specialties in all -— and are national and international experts,
renowned for research and innovations in medicine.
Thursday, November 19, 2015
College Studies May Reduce Risk of Dementia for Older Adults, Research Finds
Going back to school could boost cognitive
capacity
Newswise, November 19, 2015 — Older adults who take college
courses may increase their cognitive capacity and possibly reduce their risk
for developing Alzheimer’s disease or other forms of dementia, according to new
research published by the American Psychological Association.
An Australian study called the Tasmanian Healthy Brain Project
recruited 359 participants ages 50 to 79 who took a series of cognitive tests
before completing at least a year of full-time or part-time study at the
University of Tasmania.
Participants were reassessed annually for three years
following their studies. More than 90 percent of the participants displayed a
significant increase in cognitive capacity, compared with 56 percent in a
control group of 100 participants who didn’t take any college courses.
“The study findings are exciting because they demonstrate that
it’s never too late to take action to maximize the cognitive capacity of your
brain,” said lead researcher Megan Lenehan, PhD.
“We plan to follow these participants as they age to see if
college studies could help delay the onset or reduce the debilitating effects
of dementia.”
Previous studies have examined how exercise, brain games and
an active social life may boost cognitive capacity and possibly stem cognitive
decline associated with aging. This study is the first to examine similar
positive effects from college courses taken by older adults, said Lenehan, of
the University of Tasmania.
The study participants, who were screened to exclude people
who had dementia, completed a baseline series of tests to measure cognitive
capacity, or an individual’s ability to use brain networks efficiently in areas
such as memory, information processing, decision making and planning.
The participants in the college studies group took a wide
range of courses, including history, psychology, philosophy and fine art. Most
of the students took courses on campus, but some completed online classes.
The researchers suspect that campus study may provide greater
benefits in boosting cognitive capacity because of social interaction with
professors and fellow students, but the study didn’t analyze any differences
between on-campus or online courses.
The participants completed the same cognitive tests each year
during the four-year study, with 92 percent of the college-studies group
displaying a significant increase in cognitive capacity, while the remaining 8
percent generally maintained their cognitive capacity.
For the control group, 56 percent displayed a significant
increase in cognitive capacity, while 44 percent had no change. The
participants’ age, gender, feelings of well-being or level of social
connectedness didn’t affect the find .
Prior research has shown that college study earlier in life
may increase cognitive capacity, and it appears the same may be true for older
adults, Lenehan said.
“It is possible that any mentally stimulating activity later
in life may also enhance cognitive capacity, such as other adult-education
classes or programs to increase social interaction,” she said.
The control group was significantly older than the college
studies group, but there were no significant differences in baseline cognitive
capacity scores, the study noted.
The researchers also didn’t find any correlation between age
and cognitive capacity scores at any point during the study. Some participants
in the control group may have been doing crossword puzzles or other mentally
stimulating activities that boosted their cognitive capacity, Lenehan said.
The participants who took college classes volunteered for the
study so they probably had a greater interest in continuing education that the
general senior population, the journal article noted.
The study was too short to reveal any long-term effects so the
researchers plan to follow the participants as they age to provide additional
evidence of whether college studies may reduce the risk or delay the onset of
dementia.
Monday, November 16, 2015
Stony Brook Docs Says Small Steps May Help When Dealing with a Growing Diabetes Problem
Newswise, November 16, 2015 —– There are currently 29 million
Americans living with diabetes and the World Health Organization predicts that
by 2050 one in every three people will have this disease.
Recent data shows that pre-diabetes, a condition that puts you
at great risk for developing diabetes, exists in 37 percent of the population—
meaning that nearly 50 percent of Americans are dealing with the risks and
implications of diabetes.
With those devastating statistics— and with November being
National Diabetes Month— it is an increasingly important time to raise
awareness about this disease as it reaches epidemic proportions.
Endocrinologist and diabetes expert Joshua D. Miller, MD, MPH,
takes a unique approach with his patients, advocating for small, achievable
changes that can make a big difference.
“I always start off by giving my patients the facts,” says Dr.
Miller. “The number of Americans with diabetes is astounding and I think
shocking to most people. The second thing I tell them is that diabetes affects
nearly every system in the body and every other disease.”
Dr. Miller says that it is important to be proactive with
self-management when it comes to diabetes and that making lifestyle changes to
either prevent diabetes from developing or to better control an existing
condition is key.
“I encourage patients to focus on small, achievable changes to
improve quality of life,” says Dr. Miller. “I help patients identify ways to
make seemingly insurmountable tasks such as weight loss and physical activity
become more manageable.”
And for his patients that do not exercise, Dr. Miller
encourages them to take a brisk walk around the block – starting with just once
or twice a week. “These small steps help because they are doable. Even the
smallest changes can make a difference in a person’s health. ”
Studies show that people have better success achieving goals
when they have a partner on board, which also adds a level of accountability.
“When I consult with a patient with diabetes, I also emphasize
the problem-solving nature of self-management and ask them to work with me and
their other doctors, on achievable, shared goals that both physician and
patient can get behind,” says Dr. Miller.
“At Stony Brook, we have looked into novel approaches to
secondary prevention, education and outreach for both type 1 and type 2
diabetes including one-on-one nutrition counseling available; supporting
self-managed diabetes care for patients hospitalized for other conditions; and
creating diabetes discharge tools,” says Dr. Miller.
Learning about your disease and available treatment for it is
another step. “It's important for patients and their loved ones to have
informative conversations about the various medication and lifestyle options
with their doctors to help identify the best treatment with the greatest
chances of success,” says Dr. Miller.
“The number of new medications available to treat type 2
diabetes including newer insulins for people with both major types of the
disease is growing exponentially. Endocrinologists are recognizing more and
more that treatment for patients with diabetes should be individualized as each
patient is unique.”
Stony Brook Medicine has made diabetes a priority and have
taken the lead in population health initiatives in Suffolk County to overhaul
the management of chronic conditions in the Medicaid population.
On the fourth Monday of the month, Stony Brook holds free
seminars in the hospital’s cafeteria on all kinds of topics— from the latest
research to the best approaches to individualized self-management.
“If someone is concerned about their risk for diabetes, I
would tell them to have a conversation with their doctor and ask about
screening,” says Dr. Miller. “Then start making small changes, every little bit
helps.”
About Stony Brook University Hospital:
Stony Brook University Hospital (SBUH) is Long Island’s premier academic medical center. With 603 beds, SBUH serves as the region’s only tertiary care center and Regional Trauma Center, and is home to the Stony Brook University Heart Institute, Stony Brook University Cancer Center, Stony Brook Children’s Hospital, Stony Brook University Neurosciences Institute, and Stony Brook University Digestive Disorders Institute. SBUH also encompasses Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center. To learn more, visit www.stonybrookmedicine.edu.
Barriers to Health Care Increase Disease, Death Risk for Rural Elderly
Newswise, November 16, 2015 - A new study of adults ages 85 or
older has found that rural residents have significantly higher levels of
chronic disease, take more medications, and die several years earlier than
their urban counterparts.
The findings were just published in The Journal of
Rural Health by researchers from Oregon State University and the
Oregon Health & Science University.
The research confirms some of the special challenges facing
older populations in rural or remote areas, who often have less access to
physicians, long distances to travel for care, sometimes a lower socioeconomic
and educational level, and other issues.
It also reflects health problems that
might have been reduced if they were treated earlier or more aggressively,
researchers say.
Data from several different study groups found that rural
residents measured significantly higher on the Modified Cumulative Illness
Rating Scale, with about an 18 percent higher disease burden.
"It's been known for some time that health care is harder
to access in rural areas, and this helps us better understand the extent of the
problem," said Leah Goeres, a postdoctoral scholar who led the research at
the Oregon State University/Oregon Health & Science University College of
Pharmacy.
"Many physicians do the best they can in rural areas
given the challenges they face," Goeres said.
"But there are fewer
physicians, fewer specialists, a higher caseload. Doctors have less support
staff and patients have less public transportation. A patient sometimes might
need to wait months to see a doctor, and have to drive significant distances.
Adverse effects can increase from taking multiple medications.
"These are real barriers to choice and access, and they
affect the quality of care that's available."
Also worth noting, Goeres said, is that especially in very old
populations, illness can lead to more illness and quickly spiral out of
control. A patient in an urban setting might receive prompt treatment for a
mild ulcer, whereas the same person in a rural setting might have to wait while
the condition worsens and may even lead to cancer.
"It's of particular concern that rural older adults start
with more disease burden, which significantly increased over the next five
years, but the average number of medications they used decreased over the same
time period," said David Lee, an assistant professor in the OSU College of
Pharmacy who oversaw the research.
"This may be due to difficulty accessing health care,
leading to more disease burden over time, yet less use of medications,"
Lee said. "The opposite trends are seen in urban older adults."
This research was done in Oregon with three cohorts of older
adults, one rural and two urban, and 296 people altogether. It was supported by
the Oregon Alzheimer's Disease Tax Checkoff Fund and the National Institutes of
Health.
The findings of the new study include:
- The
rural population of Oregon contains a greater proportion of older adults
than the urban population.
- The
use of many medications can be especially risky for people in their 80s
and 90s, leading to a concern called "polypharmacy" when a
person takes five or more medications.
- Rural
participants were found to use an average of 5.5 medications, compared to
3.7 for urban participants.
- At
baseline measurements, valuable medications to aid bone mineralization
were often used less in rural populations, but pain-killing opioids were
used more often.
- Medication
use for high blood pressure went up significantly over time for rural
populations, but not urban ones, in which their use had already been
higher.
- The
rate of disease accumulation was significant in the rural cohort, and
negligible in their urban counterparts.
- The
median survival time of the rural cohort was 3.5 years, compared to 7.1
years for the urban older adults.
- Risk
factors of chronic diseases were low education, poor socioeconomic status,
a history of chronic disease, being female, and older age. These factors
are associated with a typical rural population.
- Living
with someone, and/or having a large social network are protective factors
against chronic disease, and may be more common in an urban or suburban
population.
- Both
urban and rural residents used a large number of over-the-counter agents,
including vitamins, minerals and herbal supplements.
Increased access to health care, health education, increased
supervision from clinicians, and better management of both prescription and
over-the-counter medications could all be of value in helping rural residents
to live longer and healthier livers, the researchers said in their conclusion.
Friday, November 13, 2015
Melanoma’s Genetic Trajectories Are Charted in New Study
Study Confirms
‘Intermediate’ Disease Stage Between Benign Moles and Malignancy
Newswise, November 13, 2015 — An international team of
scientists led by UC San Francisco researchers has mapped out the genetic
trajectories taken by melanoma as it evolves from early skin lesions, known as
precursors, to malignant skin cancer, which can be lethal when it invades other
tissues in the body.
By tracing the genetic changes that take place over time in
the development of the disease, the research reaffirms the role of sun exposure
in the emergence of precursor lesions, such as the common moles known as nevi,
but also suggests that continued ultraviolet radiation (UV) damage to benign
precursor lesions may push them on a path toward malignancy.
More significantly, the study provides new evidence that
genetic and cellular characteristics of skin lesions that are neither clearly
benign moles nor malignant melanoma place them in a distinctive intermediate
category, the existence of which has been hotly debated among dermatologists
and pathologists.
“What happens to patients now is totally unstandardized,” said
Boris Bastian, MD, PhD, the Gerson and Barbara Bass Bakar Distinguished
Professor of Cancer Research at the UCSF Helen Diller Family Comprehensive
Cancer Center (HDFCCC), and senior author of the new study. “Some doctors
consider these ‘intermediate’ types of lesions to be entirely benign, or shave
off only part of the lesion and leave some behind. But others treat it as an
early melanoma. This work should open the door to understanding how risky these
lesions are and when they should be completely removed.”
When a melanoma is diagnosed, its precursor lesion is sometimes
still present on the skin adjacent to the cancer. As reported in the November
12, 2015 issue of The New England Journal of Medicine, the research team took
advantage of this unique feature of the disease to identify the genetic
differences between precursors and melanoma.
Led by A. Hunter Shain, PhD, a postdoctoral fellow in the
Bastian laboratory and HDFCCC member, the scientists gathered skin samples
containing both precursor lesions and melanoma that had been obtained from 37
patients, and they then sequenced 293 cancer-causing genes in 150 distinct
areas micro-dissected from those samples.
In a clever study design, to determine how genetic analysis
would align with standard techniques used in melanoma diagnosis, each of these
150 areas was independently examined through microscopes by eight pathologists
specializing in skin disease.
The pathologists assigned each area to four main
categories ranging from “benign” to “invasive melanoma” based on their
judgments of how far the cells in each area had progressed toward malignancy.
Intriguingly, in all of the 13 areas that were unanimously
assessed as benign by the pathologists, the researchers found only a single
pathogenic mutation, one called BRAF V600E, which has long been associated with
melanoma. Based on these data, this single alteration in the BRAF gene appears
to be sufficient for the formation of a nevus, the term for a common mole that
can sometimes progress to melanoma.
Likewise, there was quite good agreement among the
pathologists regarding invasive melanomas, which on genetic analysis were found
to contain a large number of point mutations—alterations of a single genetic
“letter”—affecting many genes, as well as a significant number of copy-number
alterations, in which sizeable segments of the genome containing genes are
either deleted or duplicated.
As expected, most disagreement among the pathologists was seen
in their assessments of non-invasive melanomas (known as “in situ” melanomas)
and so-called intermediate lesions, which were sub-classified as “probably
benign” or “probably malignant.”
But the genetics of these lesions presented a clearer picture:
in most cases, BRAF mutations, most often the V600E mutation seen in the benign
lesions, were accompanied by additional pathogenic mutations, but not the full
set observed in invasive melanoma.
In particular, many BRAF mutations in the
intermediate lesions were accompanied by mutations in a gene known as TERT. The
TERT gene helps to set the limits of cell division, and the gene has been implicated
in a number of types of cancer.
Moreover, while the researchers found more point mutations in
intermediate lesions than in benign moles, there were far fewer point mutations
in intermediate lesions than in invasive melanomas, and copy-number alterations
were rare.
“There’s good agreement between the pathologists’ assessments
at the extremes of the spectrum, but less so with intermediate lesions,” said
Shain.
“On a genetic level, however, this work clearly shows that there are
intermediate lesions. These things really exist—it’s not a binary situation.”
Mutations caused by UV damage have a distinctive genetic
“signature,” and in another significant finding, the researchers observed this
signature in cancer-causing genes at every stage of melanoma progression.
“A lot of melanomas have been sequenced at this point, and
while it’s clear they carry UV-induced mutations, no one knew when they
occurred,” Bastian said.
“This study shows that they occur in benign moles, in
the melanoma that arises from these moles, and in intermediate lesions. UV both
initiates and causes the progression of melanoma, so exposing even benign moles
to the sun is dangerous.”
According to Shain, the new study’s findings on UV-induced
mutations provides additional grounding to well-documented aspects of melanoma
epidemiology.
“Kids who are in the sunlight more tend to have a greater
number of benign moles, and if they continue to stay in the sunlight, those
moles are more likely to progress to melanoma,” Shain said.
“This study shows that
UV-radiation-induced mutations start to accumulate before a benign mole forms,
and that UV-radiation-induced mutations continue to drive the progression of
some benign and intermediate lesions towards melanoma. So exposing even benign
moles to UV is not without risk.”
In addition to Bastian and Shain, UCSF researchers
participating in the study included Iwei Yeh, MD, PhD, assistant professor of
dermatology; Eric Talevich, PhD, programmer and analyst in the department of
pathology; Alexander Gagnon, BA, a former research assistant in the Department
of Pathology and Department of Dermatology, now at Genia Technologies in
Oakland, Calif.; Jeffrey North, MD, assistant professor of dermatology and
pathology; Laura Pincus, MD, assistant professor of dermatology and pathology;
and Beth Ruben, MD, professor of clinical dermatology and pathology.
They were
joined by colleagues from the Cleveland Clinic, in Ohio; Orlando Health, in
Florida; University Hospital of Zurich, in Switzerland; Dorset County Hospital,
in Dorchester, England; and St. John’s Institute of Dermatology, in London,
England.
The work was supported by grants from the National Institutes of Health and the Gerson and Barbara Bass Bakar Distinguished Professorship in Cancer Research.
UC San Francisco (UCSF) is a leading university dedicated to
promoting health worldwide through advanced biomedical research, graduate-level
education in the life sciences and health professions, and excellence in
patient care.
It includes top-ranked graduate schools of dentistry, medicine,
nursing and pharmacy, a graduate division with nationally renowned programs in
basic, biomedical, translational and population sciences, as well as a
preeminent biomedical research enterprise and two top-ranked hospitals, UCSF
Medical Center and UCSF Benioff Children’s Hospital San Francisco.
Wednesday, November 11, 2015
Orchestra Helps Boost Confidence and Mood for Those with Dementia
Newswise, November 11, 2015 — A special orchestra for people
with dementia has helped boost their confidence and mood, according to a new
research project.
The orchestra group has been set up by the Bournemouth
University Dementia Institute (BUDI) in Dorset to create a sense of community
among participants and also includes professional musicians, carers and
students.
A screening of performances from the BUDI Orchestra will be
showcased at an event as part of the annual Economic and Social Research
Council’s (ESRC) Festival of Social Science.
The orchestra was initially set up in partnership with
Bournemouth Symphony Orchestra (BSO) with a repertoire ranging from Ravel’s
Bolero to Henry Mancini’s Moon River.
Rehearsals have demonstrated a positive effect on all
participants who have also learned new skills and rediscovered old ones.
“Music touches everyone in some way, either by listening or
playing – and the BUDI Orchestra has been a life-enhancing project which has
benefited everyone,” says Professor Anthea Innes, Head of BUDI.
“Performing and showcasing skills of those with dementia
creates a well-deserved opportunity for them to demonstrate their abilities and
to challenge the negative public perceptions that surround the diagnostic label
of ‘dementia’.
Working together to produce a collaborative output is a
powerful way to bring out the best in people - not just in terms of their
musical skills, but their communication skills, friendships, care and support
for one another.”
Around 850,000 people in the UK currently live with dementia,
a figure which is estimated to double by 2050. Dorset has one of the oldest
populations in England, so many people in the local community can relate to the
challenges caused by the condition.
The arts are being used increasingly to support health and
wellbeing, both in healthcare settings and in the community for people with
dementia and their families.
Research has already shown that arts activities, especially music, can reawaken and exercise the brain.
The BUDI Orchestra, funded by Dorset County Council, is one of
BUDI’s numerous ongoing creative projects to demonstrate that people with
dementia can have fun while learning.
A total of eight people with dementia and seven carers were
involved in a course of eight weekly two-hour sessions led by Andy Baker, a
former BSO community musician and double bass player. They were also supported
by two additional professional musicians, Bournemouth University students and
staff volunteers.
Previous workshops with the orchestra have identified that
most of the people with dementia learned a new skill and the sessions were
highly enjoyed by all who took part.
One of the participants was Jack, a professional bass player
who was forced by eye cancer and dementia to leave his bands. His wife also
joined BUDI and played the violin for the first time since school.
Both found that the orchestra helped overcome feelings of
loneliness, and Jack’s confidence returned as a result of being part of the
sessions.
The project has also highlighted that the musicians’ and
volunteers’ preconceptions of music learning were positively challenged as a
result of their experiences with the BUDI Orchestra.
Professor Innes and her research team have produced a guide in
collaboration with the professional musicians for those interested in setting
up their own community-based music group.
Dr Michelle Heward, also from BUDI, says: “Our creative
projects show that it is possible for people with dementia to take part, learn
something new and have fun, all at the same time.”
Extra Holiday Stress Could Be Rough on a Woman’s Heart
Newswise, November 11, 2015 — Many women put a lot pressure on
themselves to make the holidays perfect for everyone. Everything from cooking
to buying presents to organizing family gatherings can add a lot of unnecessary
stress that can damage their hearts.
“We have seen more than a few cases of stress-induced cardiomyopathy around the holidays,” said Dr. Karla Kurrelmeyer, a cardiologist with Houston Methodist DeBakey Heart & Vascular Center.
“This occurs when women are under great amounts of stress for
a short period of time and that stress is compounded with another traumatic
event such as a death in the family, a car accident, loss of money, etc. If it
is ignored it can be fatal.”
Stress-induced cardiomyopathy is a weakening of the left
ventricle, the heart’s main pumping chamber.
It is brought on by the release of stress hormones that shock
the heart, causing changes in the heart muscles that then cause the left
ventricle to not work properly. The vast majority of people who are affected by
this condition are women in the late 50s to mid-70s.
“Someone experiencing this condition might develop chest pains
or shortness of breath after severe stress, either emotional or physical,”
Kurrelmeyer said.
“In most cases, it is treated with medication such as beta
blockers or ACE inhibitors. It’s important to have an echocardiogram as soon as
possible if you are experiencing any symptoms.”
A spike in blood pressure is also seen a lot around the
holidays. Kurrelmeyer says many women end up in the ER with chest pains or
palpitations and, in the most severe cases, can suffer a stroke.
If a woman has a history of high blood pressure it’s important
to monitor it closely, especially during those times when the stress level
rises.
Heart problems in women are not usually as recognizable as they are in men.
Heart problems in women are not usually as recognizable as they are in men.
Some of the symptoms for women include:
• Extreme weakness, anxiety, or shortness of breath.
• Discomfort, pressure, heaviness or pain in the chest, arm, below the breastbone or in the middle of the back.
• Sweating, nausea, vomiting, dizziness.
• Fullness, indigestion, a tightness in the throat area.
• Rapid or irregular heartbeats.
• Extreme weakness, anxiety, or shortness of breath.
• Discomfort, pressure, heaviness or pain in the chest, arm, below the breastbone or in the middle of the back.
• Sweating, nausea, vomiting, dizziness.
• Fullness, indigestion, a tightness in the throat area.
• Rapid or irregular heartbeats.
“It’s important to take time for yourself during the holiday
season and do things that will help relieve your stress,” Kurrelmeyer said.
“Exercise, either walking or running, yoga, meditation, a nice walk with a
loved one, whatever it takes, make it happen. The holidays should be a joyous
time spent with family and friends at home, not with doctors in an emergency
room.”
For more on Houston Methodist Hospital, visit us online or call 713.790.3333. Follow us on Twitter and Facebook.
For more on Houston Methodist Hospital, visit us online or call 713.790.3333. Follow us on Twitter and Facebook.
Tuesday, November 10, 2015
How Low to Go for Blood Pressure? Lower Target Could Affect Millions of Americans
Systolic Blood Pressure
Intervention Trial recommendations may have broad impact
Newswise, November 10, 2015 - A new study finds that at least
16.8 million Americans could potentially benefit from lowering their systolic
blood pressure (SBP) to 120 mmHg, much lower than current guidelines of 140 or
150 mmHg.
The collaborative investigation between the University of
Utah, University of Alabama at Birmingham, and Columbia University, will be
published Nov. 9 online in the Journal of the American College of Cardiology (JACC).
The scientists calculated the potential impact of preliminary results from the Systolic Blood Pressure
Intervention Trial (SPRINT) that will be presented in full at the American
Heart Association meeting and published online in the New
England Journal of Medicine, also on Nov. 9.
The initial analysis of SPRINT, reported in September, 2015,
showed that using antihypertensive medications to reach a lower SBP target of
120 mmHg could greatly reduce risk for heart failure, heart attack, and death,
compared to a target of 140 mmHg (SBP is the top number in a blood pressure
reading).
It’s estimated that one
in three U.S. adults have high blood pressure, or hypertension, a significant
health concern.
“SPRINT could have broad implications,” says lead author Adam Bress, Pharm.D., M.S., assistant professor of
pharmacotherapy at the University of Utah College of Pharmacy. “Millions of
Americans whose blood pressure is under control according to current guidelines
may be considered uncontrolled if new guidelines adopt the intensive target of
less than 120 mmHg studied in SPRINT.”
While new medical guidelines for treating hypertension could
be months to years away, this research finds that more than 16.8 million
Americans, 7.6 percent of the population, could be recommended for intensive
blood pressure management if guidelines incorporate a new, lower, SBP target
based on SPRINT results. The number represents Americans who meet the same
criteria as SPRINT participants: they are age 50 or older, have an SBP between
130-180 mmHg, are at high risk for cardiovascular disease, and do not have
diabetes or a history of stroke, among other inclusion and exclusion criteria.
The current study also reports that new guidelines may affect
some segments of the population more than others. Compared to Caucasians,
African Americans and Hispanics were less likely to meet SPRINT eligibility
criteria (9 percent vs. 4.8 percent, 4.3 percent).
The differences are largely due to the fact that these
minority populations have a higher prevalence of diabetes and other health
conditions that could preclude them from being SPRINT eligible. Men were also
more likely to be eligible for SPRINT than women (8.8 percent vs. 6.5 percent),
in part because unlike men, women tend not to show increased risk for
cardiovascular disease until they are over 65.
However in practice, it’s common for physicians to prescribe
treatments to patients who may have not been eligible for a clinical trial that
demonstrated the efficacy and safety of a particular treatment.
For example, some physicians may deviate from SPRINT
eligibility by aggressively treating the blood pressure of any adult over 50,
even if they do not have a high risk of cardiovascular disease. “Physicians are
going to need to decide how far outside the SPRINT inclusion criteria to go,”
says co-author Rachel Hess, M.D., M.S., also a professor of internal medicine
and population health sciences at the University of Utah School of Medicine.
“It’s going to be a tough decision.”
The numbers of Americans meeting each sequential SPRINT
eligibility requirement are:
• 219 million adults
• 95.1 million age 50 or older
• 37.3 million with elevated blood pressure (≥130 mmHg)
• 26.4 million at high risk for cardiovascular disease
• 16.8 million with no diabetes, history of stroke, or other SPRINT exclusion criteria
• 219 million adults
• 95.1 million age 50 or older
• 37.3 million with elevated blood pressure (≥130 mmHg)
• 26.4 million at high risk for cardiovascular disease
• 16.8 million with no diabetes, history of stroke, or other SPRINT exclusion criteria
Potential impacts of SPRINT results on the U.S. population
were based on analyzing data from the 16,260 participants in the National
Health and Nutrition Examination Survey (NHANES) between 2007 – 2012 who met
certain SPRINT inclusion and exclusion criteria. NHANES includes a
representative cross-section of the American population, allowing for
projection of these findings to the overall population.
Most, but not all, SPRINT inclusion and exclusion criteria
were accounted for in NHANES. For example information on subclinical
cardiovascular disease and a history of medical non-adherence are not
represented in the national survey.
New blood pressure guidelines will have to weight potential
adverse effects that could overshadow its benefits, and whether increasing
blood pressure medications over the course of multiple years is cost-effective.
But the numbers obtained in this study offer a glimpse into
the potentially wide ranging impact of changing blood pressure guidelines.
“Given that millions of U.S. adults meet SPRINT eligibility
criteria, the implementation of SPRINT recommendations could have a profound
impact on how blood pressure is treated in this country,” says senior author
Paul Muntner, Ph.D., a professor of epidemiology at the University of Alabama.
“Even more important, is its potential for greatly reducing
the incidence of cardiovascular disease.”
In addition to Bress, Hess, and Muntner, the co-authors are
Rikki Tanner and Lisandro Colantonio from the University of Alabama, and Daichi
Shimbo from Columbia University.
“Generalizability of results from the Systolic Blood Pressure
Intervention Trial (SPRINT) to the US adult population” will be published
online in the Journal of the American College of Cardiologists on Nov. 9, 2015
Subscribe to:
Posts (Atom)