According to a new study, being overweight or obese during middle age may increase the risk of certain dementias. The research is published in the May 3, 2011, print issue of Neurology®, the medical journal of the American Academy of Neurology. "Currently, 1.6 billion adults are overweight or obese worldwide and over 50 percent of adults in the United States and Europe fit into this category," said study author Weili Xu, MD, PhD, with the Karolinska Institutet in Stockholm, Sweden. "Our results contribute to the growing evidence that controlling body weight or losing weight in middle age could reduce your risk of dementia."
Researchers studied information from the Swedish Twin Registry on 8,534 twins age 65 or older. Of those, 350 were diagnosed with dementia and 114 had possible dementia. Information on participant's height and weight had been taken 30 years earlier.
Participants were grouped according to their body mass index (BMI), a measure of total body fat: underweight, normal weight, overweight and obese. Being overweight was defined as having a body mass index between 25 and 30 and obesity was defined as a body mass index of higher than 30. In the study, 2,541 twins, or nearly 30 percent, were either overweight or obese during middle age.
The study found that people who were overweight or obese at midlife had an 80 percent higher risk of developing dementia, Alzheimer's disease or vascular dementia in late life compared to people with normal BMI. The results remained the same after considering other factors, such as education, diabetes and vascular disease. A total of 26 percent of those with no dementia had been overweight in midlife, compared to 36 percent of those with questionable dementia and 39 percent of those with diagnosed dementia. Three percent of those with no dementia had been obese in midlife, compared to five percent of those with questionable dementia and seven percent of those with diagnosed dementia.
The researchers also analyzed the data in twin pairs where one twin had dementia and one twin did not and found that there was no longer a significant relationship between overweight and obesity and dementia in midlife. "This suggests that early life environmental factors and genetic factors may contribute to the link between midlife overweight and dementia," Xu said.
**Source: American Academy of Neurology
03 May 2011
In-hospital deaths declined over time at children's hospital without pediatric medical emergency team
A study documents reduction in hospital mortality over ten years in a children's hospital without a Pediatric Emergency Medical Team (PMET), according to a report in the May issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Hospital-based PMETs have been advocated as an approach to reduce rates of in-hospital cardiopulmonary arrest and mortality (death) among children. Several previous studies that have evaluated outcomes before and after implementation of PMETs have found inconsistent results, with some showing benefit and some showing no effect. However, according to Ari R. Joffe, M.D., from the University of Alberta and Stollery Children's Hospital, Edmonton, Canada, and colleagues: "We hypothesized that favorable results in PMET studies may be due to limitations of study design, including the use of historical controls, inadequate risk and temporal trend adjustment, and inadequate accounting for cointerventions that confound the comparisons."
Joffe and colleagues evaluated data from their hospital, which does not have a PMET. They reviewed pediatric discharges and inpatient deaths, the number of code calls, and the number of cardiopulmonary arrests that occurred on the pediatric wards and resulted in admission to the pediatric intensive care unit. Then they compared these data (from 1999 through 2009) during the same time periods used in several published studies of PMET effectiveness.
The authors found that hospital mortality rates decreased over time in their facility. When they compared their results from the same time periods of two PMET studies showing reduction in mortality, the authors also found a decrease in mortality at their hospital, whereas during the time periods of the PMET studies that showed no change in or did not examine hospital mortality, there was no significant change in mortality at their hospital. The authors also report that over the 10-year study period, there were no changes in ward code rates or cardiopulmonary arrest rates at their hospital.
The researchers suggest that other interventions not measured by the PMET studies may have confounded the results of those studies, and that hospitals such as theirs may already have systems and procedures that replicate the role of a PMET. "We claim that this finding demonstrates the limitation of before-and-after study designs (cohort studies with historical controls) in determining the effect of PMET implementation," they conclude, adding that larger and better-designed studies evaluating PMET are needed.
**Source: JAMA and Archives Journals
Joffe and colleagues evaluated data from their hospital, which does not have a PMET. They reviewed pediatric discharges and inpatient deaths, the number of code calls, and the number of cardiopulmonary arrests that occurred on the pediatric wards and resulted in admission to the pediatric intensive care unit. Then they compared these data (from 1999 through 2009) during the same time periods used in several published studies of PMET effectiveness.
The authors found that hospital mortality rates decreased over time in their facility. When they compared their results from the same time periods of two PMET studies showing reduction in mortality, the authors also found a decrease in mortality at their hospital, whereas during the time periods of the PMET studies that showed no change in or did not examine hospital mortality, there was no significant change in mortality at their hospital. The authors also report that over the 10-year study period, there were no changes in ward code rates or cardiopulmonary arrest rates at their hospital.
The researchers suggest that other interventions not measured by the PMET studies may have confounded the results of those studies, and that hospitals such as theirs may already have systems and procedures that replicate the role of a PMET. "We claim that this finding demonstrates the limitation of before-and-after study designs (cohort studies with historical controls) in determining the effect of PMET implementation," they conclude, adding that larger and better-designed studies evaluating PMET are needed.
**Source: JAMA and Archives Journals
Los Médicos de familia contra la especialidad de Urgencias
La creación de nuevas especialidades en la formación de los médicos no ha sido recibida con el mismo apoyo por todo el sector. El pasado 13 de abril la ministra de Sanidad, Leire Pajín, anunció que se ultimaba la incorporación de cuatro nuevas especialidades: Infecciosas, Urgencias, Psiquiatría Infanto-juvenil y Genética.
Casi no ha habido voces discrepantes (por lo menos en público), salvo en un caso: la postura de los médicos de familia agrupados en la Sociedad Española de Medicina Familiar y Comunitaria (Semfyc) respecto a la especialidad de Urgencias. Sobre todo, de los más jóvenes. Estos creen que la decisión les perjudicaría doblemente. "Con la creación de esta especialidad no se resolvería uno de los problemas fundamentales que es facilitar la homologación de los médicos sin especialidad, sino que por el contrario la complicaría y reabriría el problema de los mestos, de manera que habrá especialistas, profesionales a los que les homologuen el título y médicos de familia a los que el periodo de tiempo trabajado en Urgencias no les permita acogerse a ninguna de las dos opciones", asegura Manuel Sarmiento, responsable de la sección Jóvenes de la organización.
Por ello, lo que proponen es que dentro de la reordenación que se prepara de la formación, con la inclusión de troncalidades (currículos comunes previos a la especialización) se cree un área de capacitación de Urgencias.
Lógicamente, la Sociedad Española de Urgencias y Emergencias (Semes) opina justo lo contrario. "Solo con la creación de la especialidad en Medicina de Urgencias y Emergencias se podrá garantizar la asistencia de calidad que demandan los ciudadanos", afirman.
**Publicado en "EL PAIS"
Casi no ha habido voces discrepantes (por lo menos en público), salvo en un caso: la postura de los médicos de familia agrupados en la Sociedad Española de Medicina Familiar y Comunitaria (Semfyc) respecto a la especialidad de Urgencias. Sobre todo, de los más jóvenes. Estos creen que la decisión les perjudicaría doblemente. "Con la creación de esta especialidad no se resolvería uno de los problemas fundamentales que es facilitar la homologación de los médicos sin especialidad, sino que por el contrario la complicaría y reabriría el problema de los mestos, de manera que habrá especialistas, profesionales a los que les homologuen el título y médicos de familia a los que el periodo de tiempo trabajado en Urgencias no les permita acogerse a ninguna de las dos opciones", asegura Manuel Sarmiento, responsable de la sección Jóvenes de la organización.
Por ello, lo que proponen es que dentro de la reordenación que se prepara de la formación, con la inclusión de troncalidades (currículos comunes previos a la especialización) se cree un área de capacitación de Urgencias.
Lógicamente, la Sociedad Española de Urgencias y Emergencias (Semes) opina justo lo contrario. "Solo con la creación de la especialidad en Medicina de Urgencias y Emergencias se podrá garantizar la asistencia de calidad que demandan los ciudadanos", afirman.
**Publicado en "EL PAIS"
La Fundación Reina Sofía investiga acerca del uso de la resonancia magnética para adelantar el diagnóstico del Alzheimer
Todavía no está claro que diagnosticar precozmente el alzhéimer sirva para frenarlo, pero ese es el objetivo de los investigadores. Con motivo del año internacional contra la enfermedad, la Fundación Reina Sofía ha financiado, junto a GE Healthcare y la Fundación Eulen, un proyecto, desarrollado por el Grupo de Demencia de la Comunidad de Madrid (Demcam), que trata de avanzar en la fiabilidad del diagnóstico precoz a través de la resonancia magnética.
"El alzhéimer es todavía una enfermedad fea, se oculta"
"Se han realizado estudios, mediante esta técnica, en 170 pacientes de diferentes unidades de demencia y las imágenes se han obtenido en menor tiempo, con más definición y mejor contraste, repercutiendo en una mejora en la fiabilidad del diagnóstico. La aplicación de esta tecnología ha permitido desarrollar un programa automático capaz de evaluar el riesgo individual de pertenecer al grupo de personas cognitivamente sanas, pacientes con deterioro cognitivo leve y enfermos de alzhéimer, con un nivel de acierto de entre el 90% y el 95%", señala la Fundación Reina Sofía en una nota.
El estudio está dirigido por el doctor Juan Álvarez Linera, de la Fundación Centro de Investigación de Enfermedades Neurológicas (CIEN), y la doctora Ana Frank, del Hospital La Paz.
**Publicado en "EL PAIS"
"El alzhéimer es todavía una enfermedad fea, se oculta"
"Se han realizado estudios, mediante esta técnica, en 170 pacientes de diferentes unidades de demencia y las imágenes se han obtenido en menor tiempo, con más definición y mejor contraste, repercutiendo en una mejora en la fiabilidad del diagnóstico. La aplicación de esta tecnología ha permitido desarrollar un programa automático capaz de evaluar el riesgo individual de pertenecer al grupo de personas cognitivamente sanas, pacientes con deterioro cognitivo leve y enfermos de alzhéimer, con un nivel de acierto de entre el 90% y el 95%", señala la Fundación Reina Sofía en una nota.
El estudio está dirigido por el doctor Juan Álvarez Linera, de la Fundación Centro de Investigación de Enfermedades Neurológicas (CIEN), y la doctora Ana Frank, del Hospital La Paz.
**Publicado en "EL PAIS"
02 May 2011
Common blood disorder may be a risk factor for fractures
A common blood disorder, hyponatremia, may be a risk factor for fractures in elderly patients, new research presented at the European Congress of Endocrinology shows. The study from researchers at Erasmus MC suggests that it may be beneficial to screen elderly patients with fractures for this condition.
Hyponatremia is a deficiency of sodium in the blood. It most often occurs in elderly subjects and hospitalised patients. Mild hyponatremia usually does not cause any symptoms and is regarded as a benign condition that does not require treatment. Recent studies indicate mild hyponatremia may be linked to an increased risk of fractures, but this has not been demonstrated in a prospective study before. Fractures in the elderly are most commonly caused by osteoporosis, a condition where bone mineral density is decreased. This predisposes patients to vertebral fractures (which occur to the backbone and can lead to back pain, immobility and loss of height) and non-vertebral fractures (which involve other bones in the body, most commonly the wrist, upper arm or hip).
Using data collected in the population-based Rotterdam study, researchers led by Dr Carola Zillikens at Erasmus MC in The Netherlands analysed blood samples from 5208 elderly men and women to assess their levels of sodium. They also examined how this related to their bone mineral density, recent falls, the number of vertebral and non-vertebral fractures, and mortality over a number of years.
399 (7.7%) patients had hyponatremia. Patients with hyponatremia were 40% more likely to experience a non-vertebral fracture during follow-up than non-sufferers (P=0.004). They were also more likely to have suffered a vertebral fracture at first presentation (P=0.037), but not at follow up. However, hyponatremia was not associated with bone mineral density. Although people with hyponatremia were significantly more likely to have recently suffered a fall (23.8% vs. 16.4%, P<0.01), this had no effect on their likelihood of experiencing a fracture.
The results suggest hyponatremia is associated with an increased risk of vertebral and non-vertebral fractures. It is not associated with decreased bone mineral density, as is the case in osteoporosis. From this, it is unclear whether hyponatremia is a causal factor in the development of fractures or whether it is just an indicator that a patient may be at risk. As fracture risk in hyponatremia patients was independent of recent falls, this indicates that hyponatremia may be affecting some other aspect of bone quality.
The researchers now plan to examine the exact relationship between hyponatremia and fracture occurrence and to see if their findings can be replicated in independent populations. If this is the case, it may be advisable to screen for hyponatremia in elderly patients presenting with fractures.
--Researcher, Dr Carola Zillikens from Erasmus MC said:
“Osteoporosis and resulting fractures are a huge burden on national health systems and result in decreased quality of life for millions of patients. Our research shows that patients with hyponatremia are significantly more likely to suffer a fracture than patients without this condition.
“Our next step is to see if these findings can be replicated in independent populations. If we can do this, it may be advisable to implement a screening programme for hyponatremia in elderly patients that present with fractures. Physicians may consider treatment of mild hyponatremia if future studies show that treatment of mild hyponatremia decreases fracture risk.”
Hyponatremia is a deficiency of sodium in the blood. It most often occurs in elderly subjects and hospitalised patients. Mild hyponatremia usually does not cause any symptoms and is regarded as a benign condition that does not require treatment. Recent studies indicate mild hyponatremia may be linked to an increased risk of fractures, but this has not been demonstrated in a prospective study before. Fractures in the elderly are most commonly caused by osteoporosis, a condition where bone mineral density is decreased. This predisposes patients to vertebral fractures (which occur to the backbone and can lead to back pain, immobility and loss of height) and non-vertebral fractures (which involve other bones in the body, most commonly the wrist, upper arm or hip).
Using data collected in the population-based Rotterdam study, researchers led by Dr Carola Zillikens at Erasmus MC in The Netherlands analysed blood samples from 5208 elderly men and women to assess their levels of sodium. They also examined how this related to their bone mineral density, recent falls, the number of vertebral and non-vertebral fractures, and mortality over a number of years.
399 (7.7%) patients had hyponatremia. Patients with hyponatremia were 40% more likely to experience a non-vertebral fracture during follow-up than non-sufferers (P=0.004). They were also more likely to have suffered a vertebral fracture at first presentation (P=0.037), but not at follow up. However, hyponatremia was not associated with bone mineral density. Although people with hyponatremia were significantly more likely to have recently suffered a fall (23.8% vs. 16.4%, P<0.01), this had no effect on their likelihood of experiencing a fracture.
The results suggest hyponatremia is associated with an increased risk of vertebral and non-vertebral fractures. It is not associated with decreased bone mineral density, as is the case in osteoporosis. From this, it is unclear whether hyponatremia is a causal factor in the development of fractures or whether it is just an indicator that a patient may be at risk. As fracture risk in hyponatremia patients was independent of recent falls, this indicates that hyponatremia may be affecting some other aspect of bone quality.
The researchers now plan to examine the exact relationship between hyponatremia and fracture occurrence and to see if their findings can be replicated in independent populations. If this is the case, it may be advisable to screen for hyponatremia in elderly patients presenting with fractures.
--Researcher, Dr Carola Zillikens from Erasmus MC said:
“Osteoporosis and resulting fractures are a huge burden on national health systems and result in decreased quality of life for millions of patients. Our research shows that patients with hyponatremia are significantly more likely to suffer a fracture than patients without this condition.
“Our next step is to see if these findings can be replicated in independent populations. If we can do this, it may be advisable to implement a screening programme for hyponatremia in elderly patients that present with fractures. Physicians may consider treatment of mild hyponatremia if future studies show that treatment of mild hyponatremia decreases fracture risk.”
New method to measure cortisol could lead to better understanding of development of common diseases
A new method to measure the amount of the stress hormone cortisol found in the body over the long term could lead to new research avenues to study the development of common conditions, such as heart disease, diabetes and depression. In results announced at the European Congress of Endocrinology, researchers found that hair can be used to create a retrospective timeline of exposure to cortisol. Cortisol is implicated in the development of many common conditions and this new technique could allow us to study its role better.
Cortisol is a hormone produced by the adrenal glands and its primary role is to help maintain body metabolism. If the body is put under (psychological or physical) stress, cortisol levels increase to allow the body to respond to the situation. Currently the standard method to measure cortisol levels is to take a blood or saliva sample. However, since cortisol is released in a circadian rhythm and with pulses throughout the day, levels can fluctuate considerably, meaning it is difficult to estimate an individual’s long-term exposure to cortisol through blood and saliva tests alone. Finding a new non-invasive method to measure long-term cortisol exposure could have a major impact on our ability to determine the role of cortisol in the development of many common diseases, such as cardiovascular disease, diabetes and depression.
Dr Laura Manenschijn and her team from Erasmus MC in The Netherlands collected scalp hair samples from 195 healthy individuals and from 11 patients with Cushing’s syndrome (a condition where the adrenal glands produce too much cortisol) and 3 patients with Addison’s disease (a condition where the adrenal glands are unable to produce cortisol) and tested their cortisol levels. All participants filled out a questionnaire to assess what products and treatments they used on their hair. A subset of 46 participants also had their waist and hip measurements taken
The team found that hair cortisol levels correlated positively with waist to hip ratio (r=0.425, p=0.003) and waist circumference (r=0.392, p=0.007), meaning people with higher exposure to cortisol showed higher abdominal obesity. In individuals with Cushing’s syndrome the levels of cortisol in hair were significantly higher than in healthy individuals (p<0.0001). In long hair of individuals with Cushing’s syndrome and Addison’s disease, the levels of hair cortisol corresponded with clinical records of the amount of cortisol they had been exposed to. Additionally, in long hair of healthy women, the team were able to record alterations in cortisol exposure due to psychological stress over time. Hair cortisol levels were not influenced by gender (p=0.353), hair colour (p=0.413), frequency of hair wash (p=0.673) or hair products (p=0.109), although there was a slight, borderline significant, decrease in cortisol levels in hair that was treated (dyed/bleached) (p=0.08).
This is the first time that cortisol measurements taken from hair have been shown to correlate with known tissue effects of cortisol, such as abdominal obesity, and to provide a retrospective timeline of exposure to this hormone. The next step is to use this technique in larger studies to examine the role of long-term cortisol exposure in the development of cardiovascular disease and depression. Ultimately, this could lead to a better classification of individuals at risk of common conditions and novel approaches to prevent these.
-Researcher Dr Laura Manenschijn from Erasmus MC said:
“We have suspected for a while that cortisol may be implicated in the development of many common conditions, such as heart disease, diabetes and depression. However, until now, doctors have not been able to accurately measure cortisol exposure over the long-term and so research into this has been limited.
“Our results are very exciting as they show that measuring the amount of cortisol in hair can potentially be used to monitor a person’s long-term exposure to cortisol. This technique could lead to many potential uses in clinical research and has the additional benefit that it is easy to use and non-invasive.
“The results of this study show that hair cortisol is a reliable measure of long-term cortisol exposure. Now, we would like to use this tool in larger studies to examine the role of cortisol in the development of conditions such as cardiovascular disease and depression.”
Cortisol is a hormone produced by the adrenal glands and its primary role is to help maintain body metabolism. If the body is put under (psychological or physical) stress, cortisol levels increase to allow the body to respond to the situation. Currently the standard method to measure cortisol levels is to take a blood or saliva sample. However, since cortisol is released in a circadian rhythm and with pulses throughout the day, levels can fluctuate considerably, meaning it is difficult to estimate an individual’s long-term exposure to cortisol through blood and saliva tests alone. Finding a new non-invasive method to measure long-term cortisol exposure could have a major impact on our ability to determine the role of cortisol in the development of many common diseases, such as cardiovascular disease, diabetes and depression.
Dr Laura Manenschijn and her team from Erasmus MC in The Netherlands collected scalp hair samples from 195 healthy individuals and from 11 patients with Cushing’s syndrome (a condition where the adrenal glands produce too much cortisol) and 3 patients with Addison’s disease (a condition where the adrenal glands are unable to produce cortisol) and tested their cortisol levels. All participants filled out a questionnaire to assess what products and treatments they used on their hair. A subset of 46 participants also had their waist and hip measurements taken
The team found that hair cortisol levels correlated positively with waist to hip ratio (r=0.425, p=0.003) and waist circumference (r=0.392, p=0.007), meaning people with higher exposure to cortisol showed higher abdominal obesity. In individuals with Cushing’s syndrome the levels of cortisol in hair were significantly higher than in healthy individuals (p<0.0001). In long hair of individuals with Cushing’s syndrome and Addison’s disease, the levels of hair cortisol corresponded with clinical records of the amount of cortisol they had been exposed to. Additionally, in long hair of healthy women, the team were able to record alterations in cortisol exposure due to psychological stress over time. Hair cortisol levels were not influenced by gender (p=0.353), hair colour (p=0.413), frequency of hair wash (p=0.673) or hair products (p=0.109), although there was a slight, borderline significant, decrease in cortisol levels in hair that was treated (dyed/bleached) (p=0.08).
This is the first time that cortisol measurements taken from hair have been shown to correlate with known tissue effects of cortisol, such as abdominal obesity, and to provide a retrospective timeline of exposure to this hormone. The next step is to use this technique in larger studies to examine the role of long-term cortisol exposure in the development of cardiovascular disease and depression. Ultimately, this could lead to a better classification of individuals at risk of common conditions and novel approaches to prevent these.
-Researcher Dr Laura Manenschijn from Erasmus MC said:
“We have suspected for a while that cortisol may be implicated in the development of many common conditions, such as heart disease, diabetes and depression. However, until now, doctors have not been able to accurately measure cortisol exposure over the long-term and so research into this has been limited.
“Our results are very exciting as they show that measuring the amount of cortisol in hair can potentially be used to monitor a person’s long-term exposure to cortisol. This technique could lead to many potential uses in clinical research and has the additional benefit that it is easy to use and non-invasive.
“The results of this study show that hair cortisol is a reliable measure of long-term cortisol exposure. Now, we would like to use this tool in larger studies to examine the role of cortisol in the development of conditions such as cardiovascular disease and depression.”
La complejidad de un carnet genético según los especialistas
No está tan cercana y sencilla la posibilidad de un "carnet genético" para cada persona para solucionar enfermedades a la vista. De este tema y de la Genética y Farmacogenética en Neurología habló en Valencia en un Seminario de Prensa organizado por el "Instituto Roche" Adolfo López de Munain, jefe clínico del Servicio de Neurología del Hospital Donostia de San Sebastián. Destacó la importancia de la Farmacogenética en los conocimientos del genoma humano. "Es la disciplina que trata sobre la aplicación de los conocimientos genéticos a la prescripción del fármaco correcto a la dosis correcta al paciente adecuado, maximizando el beneficio terapeútico y evitando las reacciones idiosincráticas tóxicas", como perfecta definición de la especialidad.
Cuestionado sobre la posibilidad de un carnet genético fue claro: "Depende del dinero y de la capacidad personal de análisis. En este asunto hay muchas luces y sombras. Por ejemplo considero una tomadura de pelo que se estén comercializando en EEUU moléculas como objetivo de determinar la esquizofrenia y que no se tratan de tests genéticos para enfermedades psiquiátricas". Destacó cómo sólo 5 de cada 5o0 casos de esquizofrenia se deben a una mutación genética. En estos momentos en el CIBERSAM se dispone de una base de datos muy amplio para permitir volcarlos en otros estudios clínicos en psicosis. Son casi 5.741 datos DNA de un trabajo donde colaboran Hospitales de Granada, Valencia, Madrid, Oviedo, Vitoria y Barcelona.
En los próximos años el reto será el diseñar herramientas integradas que permitan realizar una aplicación clínica sistematizada de este conocimiento a una terapia personalizada en pacientes correctos. Esta es la base de la Medicina Genómica que otros denominan personalizada y que abre un campo inmenso de posibilidades y desarrollo de una industria dedicada al servicio de la caracterización genómica de los individuos como requisito para un diagnóstico precoz y un tratamiento individualizado de las enfermedades.
En el capítulo de conclusiones de su charla destacó éstas:
*el descubrimiento de formas genéticas de esquizofrenias son muy poco frecuentes
*es necesario la búsqueda de nuevos fenotipos
*la necesidad de insistir en el análisis de interacción entre genes y medio ambiente
*la necesidad de establecer modelos matemáticos que permitan analizar combinaciones de más de un millón de SNPs
*el futuro pasa por proyectos de colaboración internacional integrados en estudios con modelos nacionales
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