December 18, 2005

Testosterone Therapy For Alzheimer Disease

Testosterone replacement treatment may help improve the quality of life for elderly men with mild cases of Alzheimer's disease, as per a studyposted online today that will appear in the February 2006 print issue of the Archives of Neurology, one of the JAMA/Archives journals.

"There is a compelling need for therapies that prevent, defer the onset, slow the progression, or improve the symptoms of Alzheimer disease (AD)," the authors provide as background information in the article. They note that hormonal therapies have been the focus of research attention in recent years since male aging is associated with a gradual progressive decline in testosterone levels. "The gradual decline in testosterone level is associated with decreased muscle mass and strength, osteoporosis, decreased libido, mood alterations, and changes in cognition, conditions that may be reversed with testosterone replacement." The authors add that the age-related decline in testosterone is potentially relevant to AD as prior studies have found significantly lower concentrations of the hormone in middle-aged and elderly men who developed AD.

Po H. Lu, Psy.D., from the David Geffen School of Medicine, University of California, Los Angeles, and his colleagues conducted a 24-week, randomized study to evaluate the effects of testosterone treatment on cognition, neuropsychiatric symptoms, and quality of life in 16 male patients with mild AD and 22 healthy elderly men who served as controls. The study participants were randomized to receive packets of gel to apply on their skin that either contained testosterone or a placebo. Standardized tests were administered at least twice (baseline and end) during the study for the assessment of cognitive functions and quality of life.

"For the patients with AD, the testosterone-treated group had significantly greater improvements in the scores on the caregiver version of the quality-of-life scale," the scientists report. "No significant therapy group differences were detected in the cognitive scores at end of study, eventhough numerically greater improvement or less decline on measures of visuospatial functions was demonstrated with testosterone therapy compared with placebo. In the healthy control group, a nonsignificant trend toward greater improvement in self-rated quality of life was observed in the testosterone-treated group compared with placebo therapy. No difference between the therapy groups was detected in the remaining outcome measures."........

Daniel      Permalink


December 18, 2005

A Digital Solution For Senior Care Providers

A team of UCSD Jacobs School of Engineering students recently spent a day at St. Paul's Senior Homes and Services, demonstrating a system they designed to enable nurses to manage patient information via an easy-to-use computer interface.

The 'Digital Nursing' project is one of the first tangible results from the School's new Teams in Engineering Services (TIES) Program. TIES brings together multi-disciplinary teams of UCSD students to create technology solutions for nonprofit community partners. In turn, the students receive academic credit and a crash course in customer-driven engineering.

TIES was launched in Fall 2004 with 40 students and two community partners, St. Paul's and the Lakeside Conservancy. The program continued to gain momentum in 2005, with three new community clients signing on this fall, more than 70 students participating, and several new industry sponsors.

At St. Paul's, the UCSD team was assigned to create an electronic version of the 24-hour log, which is used to track changes in the condition of each St. Paul's assisted living facility residents. The current log is a hand-written document shared among all the nurses. Moving the log into a digital format would make resident care information easier to track, and a WiFi link would enable multiple nurses to access the log simultaneously from several different laptops.

The 11 students involved in the project (including cognitive science, computer science, electrical and mechanical engineering majors) approached the task by dividing into three teams: the user design team conducted research among the nurses to design user interface pages that coincide with the nurses' work practices; the software team developing the digital log as a web browser-based application; while the hardware team set up a server/workstation, addressed the needs of sustaining power, enabled a touch screen display, and integrated the entire design onto an existing nurses' cart.........

Janet      Permalink


December 17, 2005, 10:24 PM CT

Mental Health A Major Priority At White House Conference On Aging

The American Psychological Association (APA) applauds the inclusion of mental health issues as a priority resolution of the 2005 White House Conference on Aging (WHCoA) .

Seventy-five percent (929 out of 1,200) of Conference national delegates voted to improve "recognition, assessment, and therapy of mental illness and depression among older Americans," a resolution supported by the APA. The resolution on the mental health of older Americans was ranked eighth by the delegates among the 10 most major priorities in dealing with America's aging population.

The WHCoA, is a nonpartisan, cross-disciplinary event made up of 1,200 delegates who formulate nonbinding policy recommendations to the president and Congress. The conference aims to help guide national aging policies and assist the public and private sectors for the next 10 years by promoting dignity, health, independence and economic security of current and future generations of older persons.

With over 36 million Americans older than 65, and the first of the 77 million baby boomers turning 60 this year, a surge of health care problems may soon face older adults. According to APA's Resolution on the 2005 White House Conference on Aging, 20-25 percent of older adults suffer from some form of mental disorder, which can impede physical health and independence. Fortunately, a wide variety of therapys are effective in improving mental and behavioral health problems in later life.

But, there are few geropsychology experts and other mental healthcare providers to provide this care to older adults at this time, particularly for those living in poor rural areas of the U.S. The mental health profession's growing role to address these concerns may reflect the start of a societal shift, said APA President Ronald F. Levant, EdD, a delegate at the conference. "We may be seeing the start of people viewing mental health as part of health overall," he says.........

JoAnn      Permalink


December 16, 2005

Racial Minority Participation in Clinical Trials

Racial minorities participate in health research studies at the same rate as whites when they meet the study criteria and when they are informed about the opportunity to enroll in the study, according to an article by scientists at the National Institutes of Health (NIH) and Yale School of Medicine.

Published in the December 6 PLoS Medicine, the study debunks the common belief that racial minorities are less willing to participate in research studies, and the authors suggest that minority involvement is linked more to access than attitude.

"It's been known for years that black patients are less likely to enroll in research studies than white patients," said a study author, Cary Gross, M.D., associate professor of internal medicine at Yale. "This is a problem because research studies are how we determine which new therapys are effective and which ones shouldn't be used. If the participants in these studies do not reflect the diverse nature of the population, then it won't be clear whether new therapys that may have been promising in the study setting actually work in the real world".

According to lead author Ezekiel Emanuel, M.D., chair of the Department of Clinical Bioethics at NIH, there is a belief that racial and ethnic minorities are less willing to participate in health research due to a distrust of the research community stemming from past abuses. The most notable is the Tuskegee syphilis study, in which hundreds of poor African American men in Alabama were followed for decades without being told they had syphilis, promised therapys and prevented from getting penicillin to treat their syphilis.

The study found that whatever attitudes blacks and other ethnic minorities may have, they are still willing to participate in research when there is an opportunity to do so. The authors say that the main barrier to participation is access, knowledge that these studies exist, eligibility criteria that ensure minorities can participate, and overcoming existing logistical barriers such as the need for child care, the location of the study and reimbursement for travel expenses.........

Janet      Permalink


December 16, 2005

More U.S. Lives Could Be Saved By Ensuring Access To Existing Medical Treatments

More lives could be saved in the United States by spending less money on making medical therapys better and more on getting existing therapys to the patients who need them, as per a studypublished by a Virginia Commonwealth University family medicine and public health physician.

"For every dollar Congress gives the National Institutes of Health to develop blockbuster therapys, it spends only one penny to ensure that Americans actually receive them," said Steven H. Woolf, M.D., professor and director of research in VCU's Department of Family Medicine and a member of the National Academy of Sciences' Institute of Medicine. "This reflects, in part, a misperception that the improved drugs, procedures and the like will improve health outcomes, and that does happen. But the health improvement would be far greater if we worried less about making incremental improvements on existing therapys and more on the system barriers that impede Americans from receiving those therapys correctly." The study was coauthored by Robert E. Johnson, Ph.D., an associate professor in VCU's Department of Biostatistics.

Woolf and Johnson, whose study appears in the Dec. 6 issue of the Annals of Family Medicine, said a mathematical construct proves the point. They used two case studies -- one involving statins and the other antiplatelet drugs -- to show that the billions of dollars spent on new generation drugs saved fewer lives and prevented fewer strokes than if the existing drugs had been taken by all patients who could benefit. They cited reports that Americans receive only half of recommended health care services and that disparities in care are worse for minorities and disenfranchised patients.

The study poses a contrast between efficacy, or how well a therapy works, and what they call the "fidelity of health care." Independent of the efficacy, fidelity is the extent to which the health care system provides patients the precise interventions they need, delivered properly, precisely when they need them.........

Janet      Permalink


December 16, 2005

Tobacco Scenes In Movies Boost Teen Smoking

The first complete review of research on the link between teenagers viewing on-screen smoking and then taking up smoking themselves finds that one leads to the other.

The review concludes that eliminating scenes of smoking in new youth-rated films should substantially reduce smoking initiation in the adolescent years, when the vast majority of smokers start.

"The weight of dozens of studies, after controlling for all other known influences, shows the more smoking that kids see on screen, the more likely they are to smoke," said lead author Annemarie Charlesworth, a research specialist at the University of California, San Francisco Institute for Health Policy Studies. "This strong empirical evidence affects hundreds of thousands of families".

The research review, published in the recent issue of Pediatrics, a peer-reviewed publication of the American Academy of Pediatrics, examined the findings of 42 studies on how viewing on-screen smoking affects adolescent and teen smoking behavior.

Among the conclusions:

• U.S. movies again show as much smoking as they did in 1950. The balance of smoking has swung toward youth-rated (G/PG/PG-13) films.
• Films very rarely depict negative consequences of smoking. They depict smoking as "adult" and skew smoking unrealistically toward higher status characters.
• For teen audiences, anti-tobacco spots shown before movies with on-screen smoking countered much of the promotional effect of smoking in the movies.

........

Janet      Permalink


December 16, 2005

tips to avoid "Holiday Heart Syndrome"

Thanksgiving--the official start of the holiday season, is over.

And the parties, the official way to celebrate the holidays, have begun.

Be careful, though, warns Marc Tecce, M.D., a cardiologist at Thomas Jefferson University Hospital in Philadelphia. Watch what you eat, and particularly what you drink. After all, he points out, more and more people today are living with some form of heart disease. The only caveat is to be smart--don't let having a "good time" ruin your good health.

"Prolonged alcohol consumption over the period between Thanksgiving and New Year's Day can bring on what is usually known as Holiday Heart Syndrome. This is a period where partaking in too much holiday cheer can cause cardiac rhythm abnormalities," he says.

Dr. Tecce recommends that people take special note of their holiday patterns. "Even if you are not a heavy drinker, if you go to even three parties a week--and partake of anything more than soda, juice or sparkling water, your alcohol consumption will be higher than normal," he says. "Those extra flutes of champagne or glasses of wine can affect more than just your waistline."

"You want to avoid several episodes of drinking more than what you consider to be normal for you. Never binge--which means having six or more alcoholic drinks in one afternoon or evening," warns Dr. Tecce, who is also clinical assistant professor of Medicine at Jefferson Medical College of Thomas Jefferson University.

Particularly during the holiday season, Dr. Tecce says, people should be aware of how they feel. One potential indication of a problem is when the heart beats too slow, too fast or has extra or skipped beats. This condition is known as arrhythmia.

"Arrhythmia is a serious condition that can be treated, so you should be sure to consult a clinician if your heart is beating irregularly. Better still," he suggests, "don't put yourself in a position where you have to learn about arrhythmias."........

Daniel      Permalink


December 15, 2005, 11:17 PM CT

"Hospital at Home" Offers Quality Care

Being hospitalized can be a traumatic experience, particularly for older persons. Hospitals are noisy, disorienting, full of strangers and infections often spread among patients.

Now a new study has shown that for older persons with certain acute conditions, hospital-level care can be provided at home for less money and with fewer clinical complications than in-hospital care.

In addition, patients recovered sooner when "hospitalized" at home, the study found, and they and their families were more satisfied with the whole experience.

The program, called Hospital at Home, was carried out by the University at Buffalo, Yale University and Oregon Health and Science University. Bruce Leff, M.D., from The Johns Hopkins University, oversaw the project.

Results of the program appear in the current issue (Dec. 6) of Annals of Internal Medicine.

The program in Buffalo was a collaboration among four institutions -- UB, Kaleida Health, Independent Health and Univera.

"The success of our collaboration provides a model for establishing home hospital programs within communities with multiple competing health-care organizations," said Bruce Naughton, M.D., principal investigator on the Buffalo project and director of the UB Division of Geriatrics.

"Work is continuing in Buffalo with the goal of establishing a sustainable home hospital program," added Naughton, associate professor of medicine at UB.

The program was carried out in two consecutive 11-month phases. All patient participants came to a hospital suffering from one of four target illnesses: community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease or cellulitis.........

Janet      Permalink


December 15, 2005, 8:07 PM CT

Patients Who Trust Their Doctors

Patients with higher levels of trust in their regular physicians are more likely than patients with less trust to have better care, a new study finds.

"Increasing patients' trust in a clinician may be associated with improvement among patients in two important areas: getting care promptly and getting needed health care," the authors write in the recent issue of the journal Health Services Research.

"This study emphasizes the importance of examining multiple levels of the context of health care simultaneously," said lead author Stefanie Mollborn of Stanford University. "We found that insurance status and poverty, and race-ethnicity factors influence the interaction level aspect of trust and its associations with unmet needs and delayed care".

The scientists measured the association of trust with unmet health care needs and delayed care in patients from a variety of ethnicities and income levels who had a regular physician.

They found that less trust was associated with delayed care and particularly with unmet health care needs in most patients; however, among African-Americans, Hispanics, the poor and the uninsured, delayed care was not affected by trust. Surprisingly, patients who are more educated are more likely to have unmet or delayed health care needs than patients with less education.

Peter Muennig, M.D., of Columbia University, said that some of the findings need to be examined more closely and the patients' characteristics disentangled. "It could be that physicians who rush and fail to address all of a patient's needs are leading to lower levels of trust," Muennig said. "If this is the direction of causality, then delayed care might be seen as an institutional factor and unmet needs as a personal factor between the provider and the patient".
........

Janet      Permalink


December 15, 2005, 7:41 PM CT

Fatal Heart Condition Among Young Athletes

A Johns Hopkins study has provided the most comprehensive description to date of people most likely to develop a relatively rare heart condition, called arrhythmogenic right ventricular dysplasia (ARVD), known to be among the top causes of sudden cardiac death among young athletes.

In their study, would be published in the journal Circulation online Dec. 12, the Hopkins researchers analyzed characteristics of 100 ARVD patients, including 69 while still alive and 31 diagnosed postmortem. The subjects included men and women of a number of ethnic backgrounds, with a median age of 31.

The subjects were part of Hopkins' registry of U.S. patients with the condition, which appears on MRI scans as either a protruding or pouch-like bulge from the right side of the heart or a dilated, poorly functioning right ventricle.

As noted in numerous memorials to athletes posted to the Internet, ARVD is composed of a range of symptoms, including irregular heartbeat and the presence of excess amounts of fatty tissue in the heart's right ventricle, the lesser known of the heart's two main pumping chambers and the one that pumps blood to the lungs. As a result, the abnormal and often weakened and scarred right ventricle dramatically increases the risk of harmful ventricular arrhythmias and possible sudden cardiac death.

Estimates from scientists and the Heart Rhythm Society suggest that ARVD accounts for up to 5 percent of the 300,000 deaths each year in the United States from sudden cardiac death. A family history of sudden cardiac death at a young age is considered a major risk factor for the disorder. Athletes are also at particular risk, but the precise biological reasons for this remain unknown.

According to senior study investigator and cardiac electrophysiologist Hugh Calkins, M.D., "physicians need to know that this is a serious disease, and they should be on the lookout for its early signs and symptoms because it is an important cause of sudden cardiac death in apparently healthy young individuals.........

Daniel      Permalink