En pleno desarrollo de la Ley de Dependencia, cuando miles de ciudadanos querrían una plaza en un geriátrico, el incremento del número de camas ha sufrido un severo freno. De 2005 a 2008, la cifra de plazas residenciales venía subiendo cada año alrededor del un 5%, pero de 2009 a 2010 solo creció un 1,6%. En total hay 354.955 plazas en toda España, sumadas públicas y privadas. Y no todas están ocupadas. Los datos son de un estudio elaborado por la empresa DBK, especializada en estos análisis sectoriales.
Las grandes empresas del ramo están sufriendo un verdadero ahogo. A una planificación desaforada y sin criterios oportunos se ha sumado la crisis. Las administraciones están sin fondos para establecer conciertos que puedan satisfacer el gasto que requieren esas plazas. La peor parte se la esta llevando el sector privado. Y eso que el aumento en la dotación de las plazas privadas se debe sobre todo a la concertación, que se incrementó en un 8,5%, lo que contrasta con el descenso del 1,7% contabilizado en la dotación de plazas privadas puras, según el estudio de DBK.
"Antes, de cada 100 abuelos que salían del hospital, 20 entraban en residencias, ahora apenas un 5%", asegura el presidente de Vitalia Home, José María Cosculluela. Eso, cuando no ocurre lo contrario, es decir, familias que sacan a los suyos de las residencias porque así se ahorran pagarlas y, de paso, pueden contar con la pensión del abuelo o con una paga para cuidar al dependiente. El Gobierno quiso poner freno a esta tendencia y advirtió que no se podía sustituir una plaza concedida en una residencia por un ayuda económica sin una justificación adecuada. Fue en 2009. Cuando el paro deja a las personas en casa es factible que estas se encarguen de los ancianos.
La tendencia a la baja en el incremento anual del número de plazas tiene que ver también con la reconversión del sector. Porque a pesar de que se consolidan progresivamente los grandes grupos empresariales, "la oferta continua integrada fundamentalmente por pequeñas empresas que gestionan uno o dos centros de reducida dimensión y de ámbito local", se explica en el estudio de DBK. Y muchas de esas pequeñas empresas no se adaptan a los nuevos requisitos, o no podrán adaptarse nunca. Por tanto, irán desapareciendo o bien renovando sus instalaciones para poder recibir dinero público a cambio del ingreso de ancianos.
Así, entre las privadas, algunas comunidades han perdido varias residencias, por ejemplo seis menos en Madrid, cinco en Cataluña, cuatro en Castilla y León o tres en Andalucía. Todo ello entre 2009 y 2010. Lo que no quiere decir que, a cambio no se hayan construido otras.
Pero el número total de plazas residenciales ha de ponerse en relación con la población mayor de 65 años. De esta manera se aprecia qué comunidades están más necesitadas. Murcia, Canarias y Andalucía son las que menos plazas tienen por cada 100 personas mayores de 65 años, según un estudio del CSIC para el Imserso basado en encuestas. Y en Canarias se siguen perdiendo, un 0,6 en ese periodo. Andalucía solo ha ganado un 0,5%. Murcia, sin embargo, ha incrementado el número de plazas entre 2009 y 2010 en un 10,8%. Valencia, que también está por debajo de la media nacional en el número de plazas residenciales tampoco ha creado muchas, apenas un 0,7% en ese periodo.
Madrid, por ejemplo, ha perdido un 0,1%, pero esta comunidad está por encima de la media en la relación entre plazas y personas mayores de 65. Más alta aún es la tasa de La Rioja, así que la pérdida de camas en geriátricos que sufre esta comunidad no es tan reseñable.
Los datos oficiales sobre residencias que debía haber presentado el Gobierno el año pasado y que aún no se han hecho públicos impiden una planificación del sector basada en referencias exactas, es decir, dónde y cómo construir. Y este no es un asunto menor, dada la envejecida población española y las derivaciones sobre el empleo que tiene este sector.
La ocupación de plazas residenciales es uno de los principales motores de empleo de todas las ayudas que se prestan por la Ley de Dependencia. Y permite, además, que las personas que cuidan ancianos, mujeres en su mayoría, dispongan del tiempo suficiente para buscar también en el mercado laboral.
**Publicado en "EL PAIS"
09 August 2011
Age and severity of heart failure associated with impairment in verbal memory
Older patients with lower rates of left ventricular ejection fraction (a measure of how well the left ventricle of the heart pumps with each contraction) appear more likely than younger patients to have significantly reduced verbal memory function, according to a report in the August issue of Archives of Neurology, one of the JAMA/Archives journals. Three decades ago, researchers began investigating the association of heart failure with cognitive decline, according to background information in the article. Thirty to 80 percent of patients with heart failure may experience some cognitive deficits. However, research seeking to clarify the correlation of cognitive impairment with decreased left ventricular ejection fraction (EF), a measurement of the severity of heart failure, has generated inconsistent results. "Conflicting evidence about the association of EF with cognitive function suggests a complex relationship between patient variables and the cardiovascular factors that influence cognition," write the authors.
Joanne R. Festa, Ph.D., from St. Luke's–Roosevelt Hospital Center, New York, and colleagues conducted a cross-sectional study to investigate the relationship between age, EF and memory among patients with heart failure. The participants, all adult patients with heart failure, underwent neurocognitive assessment while being evaluated for potential heart transplantation candidacy between September 2006 and September 2008. The testing included verbal and visual memory, attention, executive functioning and self-reported depressive symptoms. Researchers also recorded participants' EF, heart failure cause, medical history, current medications and demographic information. Echocardiography was used to measure EF, which was scored at less than 30 percent or at 30 percent or greater. Age quartiles used by the researchers were 45 years or younger, 46 to 55 years, 56 to 62 years and 63 years or older.
A total of 207 participants were included in the final analysis of the study; 38 had an EF of 30 or greater, and 169 had an EF of less than 30. Stable memory function was maintained across EF levels in patients younger than 63 years, but in older patients a significant association with worse memory performance was noticed when EF was less than 30 percent. Analysis of the results demonstrated that the components of memory with which low EF had the greatest association were verbal delayed recall and recognition.
"In summary, an interaction exists between the age and EF such that older patients with low EF had significantly reduced memory, particularly verbal delayed recall and recognition," write the researchers. However, the association of low EF with "memory in these patients is not entirely explained by EF." The authors suggest further research into additional mechanisms of cognitive dysfunction in patients with heart failure.
**Source: JAMA and Archives Journals
Joanne R. Festa, Ph.D., from St. Luke's–Roosevelt Hospital Center, New York, and colleagues conducted a cross-sectional study to investigate the relationship between age, EF and memory among patients with heart failure. The participants, all adult patients with heart failure, underwent neurocognitive assessment while being evaluated for potential heart transplantation candidacy between September 2006 and September 2008. The testing included verbal and visual memory, attention, executive functioning and self-reported depressive symptoms. Researchers also recorded participants' EF, heart failure cause, medical history, current medications and demographic information. Echocardiography was used to measure EF, which was scored at less than 30 percent or at 30 percent or greater. Age quartiles used by the researchers were 45 years or younger, 46 to 55 years, 56 to 62 years and 63 years or older.
A total of 207 participants were included in the final analysis of the study; 38 had an EF of 30 or greater, and 169 had an EF of less than 30. Stable memory function was maintained across EF levels in patients younger than 63 years, but in older patients a significant association with worse memory performance was noticed when EF was less than 30 percent. Analysis of the results demonstrated that the components of memory with which low EF had the greatest association were verbal delayed recall and recognition.
"In summary, an interaction exists between the age and EF such that older patients with low EF had significantly reduced memory, particularly verbal delayed recall and recognition," write the researchers. However, the association of low EF with "memory in these patients is not entirely explained by EF." The authors suggest further research into additional mechanisms of cognitive dysfunction in patients with heart failure.
**Source: JAMA and Archives Journals
USC scientist develops virus that targets HIV
In what represents an important step toward curing HIV, a USC scientist has created a virus that hunts down HIV-infected cells. Dr. Pin Wang's lentiviral vector latches onto HIV-infected cells, flagging them with what is called "suicide gene therapy" — allowing drugs to later target and destroy them.
"If you deplete all of the HIV-infected cells, you can at least partially solve the problem," said Wang, chemical engineering professor with the USC Viterbi School of Engineering.
The process is analogous to the military practice of "buddy lasing" — that is, having a soldier on the ground illuminate a target with a laser to guide a precision bombing strike from an aircraft.
Like a precision bombing raid, the lentiviral vector approach to targeting HIV has the advantage of avoiding collateral damage, keeping cells that are not infected by HIV out of harm's way. Such accuracy has not been achieved by using drugs alone, Wang said.
So far, the lentiviral vector has only been tested in culture dishes and has resulted in the destruction of about 35 percent of existing HIV cells. While that may not sound like a large percentage, if this treatment were to be used in humans, it would likely be repeated several times to maximize effectiveness.
Among the next steps will be to test the procedure in mice. While this is an important breakthrough, it is not yet a cure, Wang said.
"This is an early stage of research, but certainly it is one of the options in that direction," he said.
**Source: University of Southern California
"If you deplete all of the HIV-infected cells, you can at least partially solve the problem," said Wang, chemical engineering professor with the USC Viterbi School of Engineering.
The process is analogous to the military practice of "buddy lasing" — that is, having a soldier on the ground illuminate a target with a laser to guide a precision bombing strike from an aircraft.
Like a precision bombing raid, the lentiviral vector approach to targeting HIV has the advantage of avoiding collateral damage, keeping cells that are not infected by HIV out of harm's way. Such accuracy has not been achieved by using drugs alone, Wang said.
So far, the lentiviral vector has only been tested in culture dishes and has resulted in the destruction of about 35 percent of existing HIV cells. While that may not sound like a large percentage, if this treatment were to be used in humans, it would likely be repeated several times to maximize effectiveness.
Among the next steps will be to test the procedure in mice. While this is an important breakthrough, it is not yet a cure, Wang said.
"This is an early stage of research, but certainly it is one of the options in that direction," he said.
**Source: University of Southern California
¿Cuál es el mejor momento para decir adiós al pañal?
Para muchos padres, una de las etapas más complicadas de afrontar en el desarrollo de sus hijos es la retirada definitiva del pañal. A las dudas habituales sobre el proceso -¿cuál es la mejor época?, ¿cómo hay que hacerlo?, ¿cuánto tiempo tardará en aprender?- a menudo se unen la frustración y la impaciencia por conseguir que el pequeño avance un paso más en su vida autónoma lo que, según los especialistas, puede dificultar considerablemente la tarea.
La clave, aseguran, es tener paciencia y entender que el control de esfínteres es un proceso complejo que exige su tiempo.
No hay un 'método infalible para aprender a ir al baño', pero sí parece que determinadas pautas son fundamentales para favorecer el proceso.
La primera, tal y como señala un artículo publicado esta semana en la revista 'Canadian Medical Association Journal', es no forzar al pequeño e iniciar el aprendizaje sólo cuando haya mostrado cierto interés en él (a través de manifestaciones directas o signos que indican que es capaz de controlar las evacuaciones).
En ese caso, hay que comenzar utilizando un orinal o un pequeño inodoro portátil –nunca usar el WC convencional porque el niño no puede apoyar sus pies y adoptar una postura adecuada- y reforzar positivamente su uso. "Cuando lo consiguen hay que animarles, apoyarles, aplaudirles. En cambio, si no lo hacen, nunca hay que castigarles ni reñirles porque esto puede tener consecuencias negativas", explica Juan Casado, jefe de Pediatría del Hospital Niño Jesús de Madrid.
Aunque en las guías hay algunas variaciones en cuanto a la fecha de inicio, Casado señala que el control de esfínteres se inicia entre los dos y tres años.
"En algunos casos, el control del esfínter rectal cuesta más porque les molesta, les duele o se asustan, y sólo quieren hacerlo en el pañal", explica Casado, que recomienda "mucha paciencia", refuerzos positivos y una dieta abundante en agua y rica en residuos (fibra) para favorecer las heces blandas.
En cuanto al esfínter vesical, la mayoría lo controla en torno al tercer año, si bien a "muchos se les escapa el pis por la noche hasta el cuarto o quinto año", explica este especialista, quien subraya que esto no debe ser tratado como un problema –enuresis nocturna- hasta superada esta fecha y siempre que el niño tenga alteraciones en su autoestima por ello.
**Publicado en "EL MUNDO"
La clave, aseguran, es tener paciencia y entender que el control de esfínteres es un proceso complejo que exige su tiempo.
No hay un 'método infalible para aprender a ir al baño', pero sí parece que determinadas pautas son fundamentales para favorecer el proceso.
La primera, tal y como señala un artículo publicado esta semana en la revista 'Canadian Medical Association Journal', es no forzar al pequeño e iniciar el aprendizaje sólo cuando haya mostrado cierto interés en él (a través de manifestaciones directas o signos que indican que es capaz de controlar las evacuaciones).
En ese caso, hay que comenzar utilizando un orinal o un pequeño inodoro portátil –nunca usar el WC convencional porque el niño no puede apoyar sus pies y adoptar una postura adecuada- y reforzar positivamente su uso. "Cuando lo consiguen hay que animarles, apoyarles, aplaudirles. En cambio, si no lo hacen, nunca hay que castigarles ni reñirles porque esto puede tener consecuencias negativas", explica Juan Casado, jefe de Pediatría del Hospital Niño Jesús de Madrid.
Aunque en las guías hay algunas variaciones en cuanto a la fecha de inicio, Casado señala que el control de esfínteres se inicia entre los dos y tres años.
"En algunos casos, el control del esfínter rectal cuesta más porque les molesta, les duele o se asustan, y sólo quieren hacerlo en el pañal", explica Casado, que recomienda "mucha paciencia", refuerzos positivos y una dieta abundante en agua y rica en residuos (fibra) para favorecer las heces blandas.
En cuanto al esfínter vesical, la mayoría lo controla en torno al tercer año, si bien a "muchos se les escapa el pis por la noche hasta el cuarto o quinto año", explica este especialista, quien subraya que esto no debe ser tratado como un problema –enuresis nocturna- hasta superada esta fecha y siempre que el niño tenga alteraciones en su autoestima por ello.
**Publicado en "EL MUNDO"
Early morning smokers have increased risk of lung and head and neck cancers
Two new studies have found that smokers who tend to take their first cigarette soon after they wake up in the morning may have a higher risk of developing lung and head and neck cancers than smokers who refrain from lighting up right away. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the results may help identify smokers who have an especially high risk of developing cancer and would benefit from targeted smoking interventions to reduce their risk. Cigarette smoking increases one's likelihood of developing various types of cancers. But why do only some smokers get cancer? Joshua Muscat, PhD, of the Penn State College of Medicine in Hershey, and his colleagues investigated whether nicotine dependence as characterized by the time to first cigarette after waking affects smokers' risk of lung and head and neck cancers independent of cigarette smoking frequency and duration.
The lung cancer analysis included 4,775 lung cancer cases and 2,835 controls, all of whom were regular cigarette smokers. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.31 times as likely to develop lung cancer, and those who smoked within 30 minutes were 1.79 times as likely to develop lung cancer.
The head and neck cancer analysis included 1,055 head and neck cancer cases and 795 controls, all with a history of cigarette smoking. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.42 times as likely to develop head and neck cancer, and those who smoked within 30 minutes were 1.59 times as likely to develop head and neck cancer.
These findings indicate that the need to smoke right after waking in the morning may increase smokers' likelihood of getting cancer. "These smokers have higher levels of nicotine and possibly other tobacco toxins in their body, and they may be more addicted than smokers who refrain from smoking for a half hour or more," said Dr. Muscat. "It may be a combination of genetic and personal factors that cause a higher dependence to nicotine."
According to the authors, because smokers who light up first thing in the morning are a group that is at high risk of developing cancer, they would benefit from targeted smoking cessation programs. Such interventions could help reduce tobacco's negative health effects as well as the costs associated with its use.
**Source: Wiley-Blackwell
The lung cancer analysis included 4,775 lung cancer cases and 2,835 controls, all of whom were regular cigarette smokers. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.31 times as likely to develop lung cancer, and those who smoked within 30 minutes were 1.79 times as likely to develop lung cancer.
The head and neck cancer analysis included 1,055 head and neck cancer cases and 795 controls, all with a history of cigarette smoking. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.42 times as likely to develop head and neck cancer, and those who smoked within 30 minutes were 1.59 times as likely to develop head and neck cancer.
These findings indicate that the need to smoke right after waking in the morning may increase smokers' likelihood of getting cancer. "These smokers have higher levels of nicotine and possibly other tobacco toxins in their body, and they may be more addicted than smokers who refrain from smoking for a half hour or more," said Dr. Muscat. "It may be a combination of genetic and personal factors that cause a higher dependence to nicotine."
According to the authors, because smokers who light up first thing in the morning are a group that is at high risk of developing cancer, they would benefit from targeted smoking cessation programs. Such interventions could help reduce tobacco's negative health effects as well as the costs associated with its use.
**Source: Wiley-Blackwell
Encuentran elementos del ADN en algunos meteoritos
Los meteoritos que caen en la Tierra llegan con importantes pistas sobre los elementos químicos que había cuando el Sistema Solar se estaba formando y cada vez hay más evidencias de que pudieron participar en el origen de la vida. En los últimos años, se han encontrado aminoácidos en su composición, pero no se había logrado confirmar la existencia de núcleobases, los 'ladrillos' del ADN y el RNA, hasta ahora.
Una investigación, publicada en la revista 'Proceedings of National Academy os Science' ha concluido que estas nucleobases sí que pueden tener un origen extraterreste porque los hay en gran cantidad y diversidad en algunos de los meteoritos estudiados, 11 condritas y una ureilita.
En las condritas carbonáceas, un tipo de meteorito muy rico en elementos orgánicos, ya se localizó hace unos años la presencia de aminoácidos, que son la base de la formación de las proteínas. En algunas también se habían detectado nucleobases, pero no se tenía la certeza de que no procedieran de una contaminación terrestre.
Los investigadores, dirigidos por Michael P. Callahan, de la NASA, y James Cleaves, del Carnagie Institute, analizaron y purificaron las muestras con una nueva técnica espectroscopica. Sólo dos de las condritas habían sido estudiadas previamente.
Finalmente, encontraron que dos de los meteoritos tenían un gran número de nucleobases, y de una gran diversidad. Incluso había compuestos similares, pero que no eran lo mismo, a los que llamaron 'análogos a las nucleobases'. Tres de estos últimos, además, son muy raros en la Tierra y, de hecho, no se encontraron en las cercanías del lugar donde habían caído las piedras del espacio.
Los autores del trabajo están convencidos de que sólo este hecho prueba que su origen es extraterrestre, pero para confirmarlo decidieron realizar algunos experimentos que lo probaran. Consistieron en reproducir las nucleobases y sus análogos creando las mismas reacciones químicas, gracias al amoníaco y el cianuro, que se producen en el espacio exterior.
Una investigación, publicada en la revista 'Proceedings of National Academy os Science' ha concluido que estas nucleobases sí que pueden tener un origen extraterreste porque los hay en gran cantidad y diversidad en algunos de los meteoritos estudiados, 11 condritas y una ureilita.
En las condritas carbonáceas, un tipo de meteorito muy rico en elementos orgánicos, ya se localizó hace unos años la presencia de aminoácidos, que son la base de la formación de las proteínas. En algunas también se habían detectado nucleobases, pero no se tenía la certeza de que no procedieran de una contaminación terrestre.
Los investigadores, dirigidos por Michael P. Callahan, de la NASA, y James Cleaves, del Carnagie Institute, analizaron y purificaron las muestras con una nueva técnica espectroscopica. Sólo dos de las condritas habían sido estudiadas previamente.
Finalmente, encontraron que dos de los meteoritos tenían un gran número de nucleobases, y de una gran diversidad. Incluso había compuestos similares, pero que no eran lo mismo, a los que llamaron 'análogos a las nucleobases'. Tres de estos últimos, además, son muy raros en la Tierra y, de hecho, no se encontraron en las cercanías del lugar donde habían caído las piedras del espacio.
Los autores del trabajo están convencidos de que sólo este hecho prueba que su origen es extraterrestre, pero para confirmarlo decidieron realizar algunos experimentos que lo probaran. Consistieron en reproducir las nucleobases y sus análogos creando las mismas reacciones químicas, gracias al amoníaco y el cianuro, que se producen en el espacio exterior.
-Recreación en el laboratorio
El resultado fue el esperado: sus nucleobases sintéticos eran prácticamente iguales a las de los meteoritos, y la diferencia podía deberse a que estos últimos habían estado viajando por el espacio.
Estos resultados tienen implicaciones de gran envergadura, según Jesús Martínez-Frías, del Centro de Astrobiología (CSIC-INTA). "Es una prueba más de que vivimos en un planeta abierto al exterior y que lo que hay fuera ha afectado a lo que ha ocurrido en la Tierra".
También destaca su importancia la investigadora Susana Iglesias Groth, del Instituto de Astrofísica de Canarias (IAC). "Trabajos como éste nos dicen que el Universo aporta una formación de moléculas más evolucionadas de lo que se pensaba".
Iglesias Groth en 2008 encontró naftaleno en una estrella de la constelación Perseo. Poco después de publicar su hallazgo, un grupo de científicos lograron generar 13 aminoácidos, de los 20 que forman la vida, con naftaleno, amoníaco, hielo amorfo y una radiación ultravioleta. "Estoy convencida de que la vida surgió de forma espontánea de forma más sencilla de lo que se piensa, con reacciones químicas que no eran extrañas", asegura.
De hecho, recuerda que hace miles de millones de años, en el Sistema Solar caían muchos más meteoritos que ahora, por lo que las probabilidades de que se crearan estos 'ladrillos' de la vida eran mayores.
El resultado fue el esperado: sus nucleobases sintéticos eran prácticamente iguales a las de los meteoritos, y la diferencia podía deberse a que estos últimos habían estado viajando por el espacio.
Estos resultados tienen implicaciones de gran envergadura, según Jesús Martínez-Frías, del Centro de Astrobiología (CSIC-INTA). "Es una prueba más de que vivimos en un planeta abierto al exterior y que lo que hay fuera ha afectado a lo que ha ocurrido en la Tierra".
También destaca su importancia la investigadora Susana Iglesias Groth, del Instituto de Astrofísica de Canarias (IAC). "Trabajos como éste nos dicen que el Universo aporta una formación de moléculas más evolucionadas de lo que se pensaba".
Iglesias Groth en 2008 encontró naftaleno en una estrella de la constelación Perseo. Poco después de publicar su hallazgo, un grupo de científicos lograron generar 13 aminoácidos, de los 20 que forman la vida, con naftaleno, amoníaco, hielo amorfo y una radiación ultravioleta. "Estoy convencida de que la vida surgió de forma espontánea de forma más sencilla de lo que se piensa, con reacciones químicas que no eran extrañas", asegura.
De hecho, recuerda que hace miles de millones de años, en el Sistema Solar caían muchos más meteoritos que ahora, por lo que las probabilidades de que se crearan estos 'ladrillos' de la vida eran mayores.
**Publicado en "EL MUNDO"
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Soy tablets not associated with reduction in bone loss or menopausal symptoms in women
Soy isoflavone tablets do not appear to be associated with a reduction in bone loss or menopausal symptoms in women within the first five years of menopause, according to a report in the August 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The beginning stages of menopause are often accompanied by rapid bone loss, hot flashes, vaginal dryness and sleep disturbances among other symptoms, according to background information in the article. "Estrogen therapy with or without progesterone prevents most of these changes. However, as a result of the Women's Health Initiative findings suggesting that the overall risks outweigh the benefits, most menopausal women now decline estrogen therapy, increasingly seeking other alternatives," the authors write. "Soy-derived products have been proposed to provide comparable benefits to estrogens but without the risks."
Silvina Levis, M.D., of the Miami Veterans Affairs Healthcare System and Miller School of Medicine, University of Miami, and colleagues, conducted a randomized controlled trial from July 2004 to March 2009 to determine the effectiveness of soy isoflavone tablets in preventing bone loss and other menopausal symptoms. Study participants received a soy isoflavone dose equivalent to approximately two times the highest intake through food sources in a typical Asian diet to ensure they received an effective dose. Women 45 to 60 years of age, within five years of menopause and with a bone mineral density T score (bone density compared with what is normally expected in a healthy young adult of the same sex) of -2.0 or higher in the lumbar spine or total hip were eligible for the study.
A total of 248 women were eligible for the study; 126 were randomized to the group receiving placebo tablets and 122 were randomized to the soy isoflavone group, who received 200 mg of soy isoflavone tablets daily. During two years of follow-up, no significant differences were found between women in the soy isoflavone group and placebo group regarding changes in bone mineral density of the spine (-2 percent vs. -2.3 percent), the total hip (-1.2 percent vs. -1.4 percent) or the femoral neck (-2.2 percent vs. -2.1 percent), respectively.
Additionally, the number of menopausal symptoms was comparable between the two groups at baseline and the end of the study, except hot flashes. At the end of the study, 48.4 percent of women in the soy isoflavone group and 31.7 percent of women in the placebo group reported hot flashes. The authors also found that a higher number of women in the soy group reported constipation compared with women taking placebo (31.2 percent vs. 20.6 percent) but this was not statistically significant.
"Because of concerns regarding the risk of estrogens, a need exists for alternative interventions that could provide the beneficial effects of estrogens in bone and menopausal symptoms without the adverse effects on breast and cardiovascular health," the authors conclude. However, "we found that our population of women in the first five years of menopause, on average, had low rates of bone loss, and that 200 mg of soy isoflavone tablets taken once daily does not prevent bone loss or reduce bone turnover or menopausal symptoms."
(Arch Intern Med. 2011;171[15]:1363-1369. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Soy Isoflavones for Prevention of Menopausal Bone Loss and Vasomotor Symptoms
"Every woman who lives long enough will go through the menopause transition; approximately 80 percent will experience hot flashes and night sweats, and approximately 20 percent will experience sufficient discomfort to seek treatment," write Katherine M. Newton, Ph.D., of the Group Health Research Institute, Group Health Cooperative, Seattle, and Deborah Grady, M.D., M.P.H., of the University of California, San Francisco and San Francisco VA Medical Center.
"In this issue of the Archives, Levis et al report the results of the National Institutes of Health–funded Soy Phytoestrogens as Replacement Estrogens (SPARE) trial," the authors write. "The SPARE study was designed to overcome the limitations of many prior trials of soy products, including poor design, small sample size and short duration."
The authors do note that, "the main shortcoming of the study was that only 248 of an expected 306 participants were enrolled, and higher-than-expected dropout rates led to a final sample size substantially lower than that predicted." However, even with the smaller sample size, "given the virtually identical results in the two groups, it is difficult to imagine that the results would have differed substantially with additional participants or better retention," the authors write. "Overall it does not appear that soy supplementation will play an important role in osteoporosis prevention."
"To some extent, we are constrained because the mechanism of hot flashes and night sweats remains unknown," the authors conclude. "Perhaps efforts should be directed away from the hope of a one-size-fits-all therapy for menopausal symptoms toward using existing treatments to target the symptoms that disturb patients most."
**Source: JAMA and Archives Journals
Silvina Levis, M.D., of the Miami Veterans Affairs Healthcare System and Miller School of Medicine, University of Miami, and colleagues, conducted a randomized controlled trial from July 2004 to March 2009 to determine the effectiveness of soy isoflavone tablets in preventing bone loss and other menopausal symptoms. Study participants received a soy isoflavone dose equivalent to approximately two times the highest intake through food sources in a typical Asian diet to ensure they received an effective dose. Women 45 to 60 years of age, within five years of menopause and with a bone mineral density T score (bone density compared with what is normally expected in a healthy young adult of the same sex) of -2.0 or higher in the lumbar spine or total hip were eligible for the study.
A total of 248 women were eligible for the study; 126 were randomized to the group receiving placebo tablets and 122 were randomized to the soy isoflavone group, who received 200 mg of soy isoflavone tablets daily. During two years of follow-up, no significant differences were found between women in the soy isoflavone group and placebo group regarding changes in bone mineral density of the spine (-2 percent vs. -2.3 percent), the total hip (-1.2 percent vs. -1.4 percent) or the femoral neck (-2.2 percent vs. -2.1 percent), respectively.
Additionally, the number of menopausal symptoms was comparable between the two groups at baseline and the end of the study, except hot flashes. At the end of the study, 48.4 percent of women in the soy isoflavone group and 31.7 percent of women in the placebo group reported hot flashes. The authors also found that a higher number of women in the soy group reported constipation compared with women taking placebo (31.2 percent vs. 20.6 percent) but this was not statistically significant.
"Because of concerns regarding the risk of estrogens, a need exists for alternative interventions that could provide the beneficial effects of estrogens in bone and menopausal symptoms without the adverse effects on breast and cardiovascular health," the authors conclude. However, "we found that our population of women in the first five years of menopause, on average, had low rates of bone loss, and that 200 mg of soy isoflavone tablets taken once daily does not prevent bone loss or reduce bone turnover or menopausal symptoms."
(Arch Intern Med. 2011;171[15]:1363-1369. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Soy Isoflavones for Prevention of Menopausal Bone Loss and Vasomotor Symptoms
"Every woman who lives long enough will go through the menopause transition; approximately 80 percent will experience hot flashes and night sweats, and approximately 20 percent will experience sufficient discomfort to seek treatment," write Katherine M. Newton, Ph.D., of the Group Health Research Institute, Group Health Cooperative, Seattle, and Deborah Grady, M.D., M.P.H., of the University of California, San Francisco and San Francisco VA Medical Center.
"In this issue of the Archives, Levis et al report the results of the National Institutes of Health–funded Soy Phytoestrogens as Replacement Estrogens (SPARE) trial," the authors write. "The SPARE study was designed to overcome the limitations of many prior trials of soy products, including poor design, small sample size and short duration."
The authors do note that, "the main shortcoming of the study was that only 248 of an expected 306 participants were enrolled, and higher-than-expected dropout rates led to a final sample size substantially lower than that predicted." However, even with the smaller sample size, "given the virtually identical results in the two groups, it is difficult to imagine that the results would have differed substantially with additional participants or better retention," the authors write. "Overall it does not appear that soy supplementation will play an important role in osteoporosis prevention."
"To some extent, we are constrained because the mechanism of hot flashes and night sweats remains unknown," the authors conclude. "Perhaps efforts should be directed away from the hope of a one-size-fits-all therapy for menopausal symptoms toward using existing treatments to target the symptoms that disturb patients most."
**Source: JAMA and Archives Journals
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