Optimal Quality Care Of Geriatric Surgical Patients: Landmark Guidelines Just Released

Main Category: Seniors / Aging
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 30 Sep 2012 – 0:00 PDT

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Optimal Quality Care Of Geriatric Surgical Patients: Landmark Guidelines Just Released

New comprehensive guidelines for the pre- operative care of the nation’s elderly patients have been issued by the American College of Surgeons (ACS) and the American Geriatrics Society (AGS). The joint guidelines – published in the October issue of the Journal of the American College of Surgeons – apply to every patient who is 65 years and older as defined by Medicare regulations. The guidelines are the culmination of two years of research and analysis by a multidisciplinary expert panel representing the ACS and AGS, as well as by expert representatives from a range of medical specialties.

“The major objective of these guidelines is to help surgeons and the entire perioperative care team improve the quality of surgical care for elderly patients,” said Clifford Y. Ko, MD, FACS, Director of the ACS National Surgical Quality Improvement Program (ACS NSQIP®) and the ACS Division of Research and Optimal Patient Care in Chicago, professor of surgery at University of California, Los Angeles (UCLA) and director of UCLA’s Center for Surgical Outcomes and Quality.

One of the driving forces behind the guidelines is America’s expanding geriatric population, Dr. Ko explained. The U.S. Census Bureau projects the percentage of men and women 65 years and older will more than double between 2010 and 2050 and will increase by 20 per-cent of the total population by 2030.* In 2006, elderly patients underwent 35 percent of inpatient surgical procedures and 32 percent of outpatient procedures according to study authors.

“For elderly patients undergoing surgical procedures, we want to ensure we are optimiz-ing each patient’s medical condition,” Dr. Ko said. “This population is growing in numbers and we want to emphasize the depth and breadth of care required for them. These evidence-based guidelines will enhance surgical practice by setting higher standards and performance measures for surgeons and the entire perioperative care team,” he said. This is the first time ACS has worked with AGS to develop guidelines for geriatric patients according to Dr. Ko.

The guidelines recommend and specify 13 key issues of preoperative care for the elderly: cognitive impairment and dementia; decision-making capacity; postoperative delirium; alcohol and substance abuse; cardiac evaluation; pulmonary evaluation; functional status, mobility, and fall risk; frailty; nutritional status; medication management; patient counseling; preoperative testing; and patient-family and social support system.

“There is no single magic bullet for rendering this level of surgical care,” Dr. Ko said. “Each of the 13 issues covered by the guidelines is very important, comprehensive, and difficult to prioritize. For example, surgeons and perioperative team members may do perfectly well when analyzing a patient’s cognitive functioning , but not so well on the polypharmacy issue. So then suddenly, polypharmacy becomes the number-one issue for the surgical team to address during the preoperative care phase,” he explained.

Furthermore, the expert panel said there are complex problems specific to the elderly, including use of multiple medications, functional status, frailty, risk of malnutrition, cognitive impairment, and comorbidities. “When surgeons evaluate elderly patients before they undergo operations, they want to know how many and what specific medications their patients are taking. This step will enable them to identify potential medication issues before operations and before the surgeons start adding pain medication to the patient’s medication list,” Dr. Ko explained.

As the guidelines state: “consider minimizing the patient’s risk for adverse drug reac-tions by identifying what should be discontinued before surgery or should be avoided and dose reducing or substituting potentially inappropriate medications.”

Additionally, the number and severity of underlying medical problems call for special strategies by the entire surgical team, according to Dr. Ko.

“Patients who are 90 years old tend to have more comorbidities than those who are 65 years,” he said. “There may be something wrong with the heart, the lungs, the kidneys, the liver. Surgeons have to plan and deal with these comorbidities simultaneously while the patient is undergoing a surgical procedure.”

The guidelines state that evaluating patients for developing heart disease and heart attack is critical to identify patients at higher risk. All patients should be evaluated for perioperative cardiac risk.

“Caring for the elderly generally requires a team approach,” said Dr. Ko. “The surgeon knows how to perform surgery and the cardiologist knows how to take care of the heart. It’s best for everyone to work together to take care of the patient. We want everyone on the same page of providing good quality care.”

These guidelines have been developed in response to a performance measure that the ACS has developed with the Centers for Medicare & Medicaid Services (CMS), according to Dr. Ko. The performance measure evaluates the quality of care in patients eligible for Medicare.

ACS NSQIP has worked with CMS to develop “The Elderly Surgery Measure.” This is a hospital-based measure that assesses the outcome of elderly patients undergoing surgical procedures. The ACS and CMS will launch a pilot program in October that gives hospitals the opportunity to publicly and voluntarily report the outcome results.

* Source: U.S. Census Bureau Statistical Brief. Sixty-five Plus in the United States. Available at http://www.census.gov/population/socdemo/statbriefs/agebrief.html. Accessed September 26, 2012.
American College of Surgeons
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Male Breast Enlargement (Gynecomastia)

Experts explain the causes of and treatments for gynecomastia, or male breast enlargement.

By David Freeman
WebMD Feature

Elliot W. Jacobs, MD, knows a thing or two about enlarged breasts in men, and not just because he specializes in treating the condition. 

“My own breasts became enlarged when I was a teenager,” says the New York plastic surgeon. “It was very embarrassing. Once, I went to my locker after gym class and saw that a classmate had hung a bra on it.”

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Millions of men and boys know what it’s like to have enlarged breasts (sometimes called man boobs or “moobs,” or, in doctor talk, gynecomastia). In many cases, it doesn’t have to be a permanent condition.

Why It Happens

Male breast enlargement can start in puberty as hormone levels are shifting. In those cases, it typically doesn’t last long, ending without treatment as hormone levels settle down.

Enlarged breasts can also start  in adulthood. As men age, they tend to lose testosterone and gain weight. Lower testosterone can lead to enlargement of glands in the breasts. Extra weight adds fatty tissue under the breasts. That can leave a man with bigger glandular tissue and more fat in his breasts. Fat cells make small amounts of estrogen, which can further enlarge men’s breasts.

Though it can be embarrassing, male breast enlargement usually isn’t a health threat. But in some men, it can be a sign of  low testosterone, an overactive thyroid, cirrhosis of the liver, a genetic problem, or some cancers. Certain medications can also cause gynecomastia. Common culprits include anabolic steroids, as well as the stomach acid drug cimetidine (Tagamet), the heart drug spironolactone (Aldactone), the prostate cancer drug bicalutamide (Casodex), and several other drugs.

In many cases, stopping the offending drug and switching to another helps reduce enlarged breasts. 

Abusing alcohol and marijuana can also contribute to gynecomastia.

In many cases, the exact cause isn’t clear. It’s wise to make an appointment with a board-certified endocrinologist to make sure, even if your male breast enlargement hasn’t bothered you a lot.

How to Treat ‘Man Boobs’

The treatment depends on the cause.

If another health condition is causing your enlarged breasts, treating that underlying condition may help.

If the reason for enlarged breasts is being overweight, weight loss is often the first step, says Glenn Braunstein, MD. That’s good for your overall health, too. Braunstein is chairman of the department of medicine at Cedars-Sinai Medical Center in Los Angeles. 

If you have a lot of weight to lose, it may not shrink your breasts back to normal size, due to the stretched-out skin. Plastic surgery is an option for that.

Surgical options for enlarged breasts are to get liposuction to remove fat and scalpel surgery to remove glandular tissue. A plastic surgeon does the surgery, which takes 60-90 minutes. It’s an outpatient procedure, meaning no overnight stay, and it often dramatically improves appearance.

Jacobs has never sought treatment for his own breast enlargement.

“Over the years, I sort of got used to it,” he says. But he has done breast-reduction surgery on more than 1,500 men, transforming lives in the process. “For the first time in years, these men are standing up straight and wearing tight shirts,” he says. “Literally and figuratively, a weight has been lifted off their chests.”

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Are We Too Clean? Letting Kids Get Dirty and Germy

It’s the basic nature of young children to touch the very things in their environment that their parents find most disgusting. Just try to keep your 1-year-old from sticking the dog’s bone in her mouth!

Epidemic-scale flu seasons have health authorities imploring regular hand washing, and with talk of sanitizer gel like it was liquid gold, it’s tough not to worry about what your children are getting into and the ultimate impact it will have on their health.

Infectious diseases are a legitimate cause for concern, but some would argue that our society has gone overboard when it comes to protecting our kids from germs.

How clean an environment do our kids really need for good health? Here’s what experts told WebMD.

Hygiene Hypothesis

A mounting body of research suggests that exposing infants to germs may offer them greater protection from illnesses such as allergies and asthma later on in life.

This line of thinking, called the “hygiene hypothesis,” holds that when exposure to parasites, bacteria, and viruses is limited early in life, children face a greater chance of having allergies, asthma, and other autoimmune diseases during adulthood.

In fact, kids with older siblings, who grew up on a farm, or who attended day care early in life seem to show lower rates of allergies. 

Just as a baby’s brain needs stimulation, input, and interaction to develop normally, the young immune system is strengthened by exposure to everyday germs so that it can learn, adapt, and regulate itself, notes Thom McDade, PhD, associate professor and director of the Laboratory for Human Biology Research at Northwestern University.

Exactly which germs seem to do the trick hasn’t yet been confirmed. But new research offers clues.

In a recent study, McDade’s team found that children who were exposed to more animal feces and had more cases of diarrhea before age 2 had less incidence of inflammation in the body as they grew into adulthood.

Inflammation has been linked to many chronic adulthood illnesses, such as heart disease, diabetes, and Alzheimer’s.

“We’re moving beyond this idea that the immune system is just involved in allergies, autoimmune diseases, and asthma to think about its role in inflammation and other degenerative diseases,” McDade says. “Microbial exposures early in life may be important… to keep inflammation in check in adulthood.”

Purging Germs: Health Booster or Bad Idea?

Most of the germs lurking about our environment and that live on our bodies are not only harmless; they’ve been with us for millennia, says Martin Blaser, MD, professor of internal medicine at New York University. 

As human behavior has changed over the past half century, many microbes, such as some that live in the gut, are disappearing.

“These perform important physiological functions but because of modern life they are changing and some are disappearing,” Blaser says. “Those disappearances have consequences — some good, some bad.”

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Humira Approved for Ulcerative Colitis Treatment

Sept. 28, 2012 — The FDA has approved Abbott’s Humira for the treatment of moderate to severe ulcerative colitis.

Humira (adalimumab) now is approved for both forms of inflammatory bowel disease (IBD): ulcerative colitis and Crohn’s disease.

It was already approved to treat Crohn’s disease, rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, juvenile idiopathic arthritis, and ankylosing spondylitis.

For ulcerative colitis, Humira is approved when other drugs to suppress immune responses haven’t worked.

“Each patient with ulcerative colitis experiences the disease differently, and treatment must be adjusted to meet each individual’s needs,” says Donna Griebel, MD, director of the FDA’s gastroenterology division. “Today’s approval provides an important new treatment option for patients who have had an inadequate response to conventional therapy.”

Clinical studies tested Humira in treating ulcerative colitis patients with moderate to very severe disease. Clinical remission — defined as relatively mild disease — happened after eight weeks of Humira treatment in 16.5% to 18.5% of patients, compared to 9.2% to 9.3% of patients given an inactive placebo.

The FDA-approved dosing regimen for Humira for ulcerative colitis begins with an initial dose of 160 milligrams, a second dose two weeks later of 80 mg, and a maintenance dose of 40 mg every other week, thereafter. The drug is given by injection.

Ulcerative colitis patients who do not get clinical remission after eight weeks of treatment should stop taking Humira.

Common side effects of Humira include infections, reactions at the injection site, headache, and rash.

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Genetic Researchers Find New, Low-Cost Approach For Ovarian And Breast Cancer Testing

Main Category: Ovarian Cancer
Also Included In: Breast Cancer;  Medical Devices / Diagnostics;  Genetics
Article Date: 29 Sep 2012 – 0:00 PDT

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Genetic Researchers Find New, Low-Cost Approach For Ovarian And Breast Cancer Testing

In a new genetic study, researchers said they may have found a way to cut the cost of genetic screening for breast and ovarian cancers from $3000 to $400.

Three teams of infertility scientists in New York and Austria collaborated to study gene mutations that increase a woman’s likelihood of breast and ovarian cancers. In the process, they made a discovery that could reduce to the cost of breast and ovarian cancer screening, making diagnosis more widely available to women in need.

The study, which was recently published in the PLoS ONE1 medical journal, examined the genetic variables in woman who were known carriers of the mutated breast and ovarian cancer susceptibility gene BRCA1/2. Women without BRCA 1/2 mutations have a lifetime risk f 12 percent for breast and 1.4 percent for ovarian cancers. However, with a BRCA 1/2 mutation, the risk for breast cancer increases to 60 percent and for ovarian cancer to between 15 and 40 percent.

Researchers from the Center for Human Reproduction (CHR) in New York, the Medical University Vienna in Vienna, Austria, and the Medical University Graz in Graz, Austria worked on the study.

Together they found nearly all of the 99 subjects who were carriers of the BRCA1/2 mutations also had a very specific genotype known as “low” FMR1. In contrast, over 300 control subjects, who were not carriers of the mutated BRCA1/2 gene, showed normal distribution of the FMR1 genotypes with only about 25% of the subjects having the “low” FMR1.

The authors concluded that because BRCA1/2 mutations are almost exclusively found in women with low FMR1, women without the low FMR1 genotype would not be at risk for BRCA1/2 mutations and, therefore, associated breast and ovarian cancer risks.

Researchers found the link between the genotype and these specific cancer risks suggests that less expensive FMR1 gene testing could be used in place of the current method of the costly BRCA1/2 screening for these cancer risks.

“We were very surprised by these results,” said David H. Barad, MD, MS, Director of Clinical ART and Senior Scientist at CHR, a senior author of the study. “This observation, if confirmed, can greatly impact current cancer screening methods for BRCA1/2-associated cancers in women, and greatly reduce costs.”

At the moment, the only available genetic screening for breast and ovarian cancers is through the testing of the BRCA1/2 gene, but since the procedure requires extremely high costs – about $3,000 – testing is only recommended for women with a strong family history of these cancers. FMR1 testing, on the other hand, is available for as little as $400.

The finding is especially important, as recent research has shown females with a BRCA gene mutation today are being diagnosed with breast and ovarian cancer about eight years earlier than their mothers or aunts were.

University of Texas researchers at the MD Anderson Cancer Center identified 132 women with the BRCA 1/2 genes who also had breast cancer. Of the 132, they 106 had a mother or aunt who was also diagnosed with BRCA-related breast or ovarian cancer, and the researchers recorded the female’s age at the time of diagnosis. In the end, they saw a 7.9 year age difference between the generations – finding that may change the screening and genetic counseling for women with BRCA genes in the future.

CHR and Austrian researchers hope their findings will help explain the mystery of the “BRCA-paradox,” which has puzzled scientists for years. This paradox refers to the fact that BRCA1/2 mutation prevents cell growth and replication in embryonic tissue – making it lethal to a growing human embryo. However, in cancerous tissues, these mutations have exactly the opposite effect, allowing cancer cells to proliferate.

“Confirmed, these findings could mean that ‘low’ FMR1 alleles de-suppress the anti-proliferative activity of BRCA1/2 in both tissues, in embryonic tissues allowing the embryo to survive, while in cancers having the negative effect of allowing cancer to proliferate,” said Norbert Gleicher, MD, Medical Director and Chief Scientist of CHR, and another senior author of the study. “This, of course, could open major therapeutic options for improving embryo growth and inhibiting cancer growth.”

Written by Diego Cupelo

Reviewed by Robyn Nazar, RN.

Center for Human Reproduction. “Genetic study reveals potential low-cost testing and treatment alternatives for ovarian and breast cancers”. 12, Sept. 2012

Funding

Funding for this article has been provided by New Wave Enterprises LLC. The sources of the research cited in article, Center for Human Reproduction, is a client of NWE.

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Following Radiation In Prostate Cancer, Risk Markers Discovered For Erectile Dysfunction

Main Category: Prostate / Prostate Cancer
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Radiology / Nuclear Medicine
Article Date: 29 Sep 2012 – 0:00 PDT

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Following Radiation In Prostate Cancer, Risk Markers Discovered For Erectile Dysfunction

In the first study of its kind, a research team led by Mount Sinai School of Medicine and Albert Einstein College of Medicine of Yeshiva University discovered 12 genetic markers associated with the development of erectile dysfunction (ED) in prostate cancer patients who were treated with radiation. The findings, published online in advance of the October 1, 2012 print issue in the International Journal of Radiation Oncology• Biology• Physics, the official scientific journal of the American Society for Radiation Oncology, are an important step towards helping clinicians determine the best course of treatment for prostate cancer patients and may lead to the development of therapies that alleviate side effects.

The main treatments for prostate cancer – surgery, brachytherapy (seed implants) and external beam radiation therapy – are all very effective at curing prostate cancer. Unfortunately, each treatment places patients at risk for ED. According to the National Cancer Institute, the prevalence of erectile dysfunction following external beam radiation for prostate cancer ranges from 65 percent to 85 percent. The Prostate Cancer Foundation estimates prevalence of ED following seed therapy at 25 to 50 percent. Many men will be able to regain their potency with time and treatments, but doctors would like to identify which men may be more likely to develop this side effect.

In the first large scale Genome-Wide Association Study to identify single nucleotide polymorphisms (SNPs) associated with susceptibility for the development of erectile dysfunction following radiotherapy for prostate cancer, researchers conducted a two-part study, first, to discover the candidate genetic markers of side effect risk, and second, to confirm which of those markers are replicated in a second group of patients. In the first group of prostate cancer patients, which included 132 men who developed erectile dysfunction after radiotherapy and 103 men similarly treated who did not develop erectile dysfunction, they found a set of genetic markers associated with erectile dysfunction. In the second part of the study, which examined 128 patients who developed erectile dysfunction after radiotherapy and 102 who did not, researchers confirmed that 12 SNPs were associated with erectile dysfunction.

“Thankfully, current treatments for prostate cancer offer excellent rates of long-term survival, so patients and their physicians have a choice about which treatment path to take,” said Barry Rosenstein, PhD, Professor of Radiation Oncology, Mount Sinai School of Medicine. “However, the risk of developing erectile dysfunction after radiation treatment is highly variable, suggesting there may be a genetic component to determining that risk. Our study confirms that specific markers make certain patients more susceptible to this side effect.”

Patients in the study cohort were given one of three treatments: internal radiotherapy, known as brachytherapy; brachytherapy plus external beam radiation; or external beam radiation alone. They were followed for an average length of nearly four years to determine level of sexual function after treatment.
Interestingly, the 12 SNPs identified in this study were located near genes that seem to be related to erectile function rather than related to radiation response. The researchers conclude that these SNPs may affect genes that sensitize a patient to developing erectile dysfunction when exposed to radiation during therapy.

“Prostate cancer screening and treatment are undergoing major shifts,” said Harry Ostrer, MD, Professor of Pathology and Genetics at Albert Einstein College of Medicine and Director of Genetic and Genomic Testing at Montefiore Medical Center and co-principal investigator of the study. “This is part of our ongoing effort to identify men at highest risk for disease, identify the aggressive tumors that would be responsive to therapy, and to improve quality of life for men with indolent prostate cancers who might benefit from active surveillance, rather than therapy.”

The authors indicate that examination of a large, independent cohort of similarly treated patients will be necessary to definitively determine which SNPs to include as part of a clinically useful predictive test to identify which men are at greatest risk for developing erectile dysfunction following prostate cancer radiotherapy. The researchers are also evaluating the impact of radiation treatment on urinary complications and proctitis, the inflammation of the rectum.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our prostate / prostate cancer section for the latest news on this subject.
This study was supported by the American Cancer Society, United States Department of Defense, and the National Institutes of Health.
The Mount Sinai Hospital / Mount Sinai School of Medicine
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Knowledge Of The Biochemical Events Needed To Maintain Erection May Lead To New Therapies For Erectile Dysfunction

Main Category: Erectile Dysfunction / Premature Ejaculation
Article Date: 28 Sep 2012 – 0:00 PDT

Knowledge Of The Biochemical Events Needed To Maintain Erection May Lead To New Therapies For Erectile Dysfunction

For two decades, scientists have known the biochemical factors that trigger penile erection, but not what’s needed to maintain one. Now an article by Johns Hopkins researchers, scheduled to be published this week by the Proceedings of the National Academy of Sciences (PNAS), uncovers the biochemical chain of events involved in that process. The information, they say, may lead to new therapies to help men who have erectile dysfunction.

“We’ve closed a gap in our knowledge,” says Arthur Burnett, M.D., professor of urology at Johns Hopkins Medicine and the senior author of the study article. “We knew that the release of the chemical nitric oxide, a neurotransmitter that is produced in nerve tissue, triggers an erection by relaxing muscles that allow blood to fill the penis. We thought that was just the initial stimulus. In our research, we wanted to understand what happens next to enable that erection to be maintained.”

In a study of mice, Burnett and his colleagues found a complex positive feedback loop in the penile nerves that triggers waves of nitric oxide to keep the penis erect. He says they now understand that the nerve impulses that originate from the brain and from physical stimulation are sustained by a cascade of chemicals that are generated during the erection following the initial release of nitric oxide. “The basic biology of erections at the rodent level is the same as in humans,” he says.

The key finding is that after the initial release of nitric oxide, a biochemical process called phosphorylation takes place to continue its release and sustain the erection.

In a landmark study published in the journal Science in 1992, Burnett and his Johns Hopkins co-author, Solomon S. Snyder, M.D., professor of neuroscience (who is also an author on the current study), showed for the first time that nitric oxide is produced in penile tissue. Their study demonstrated the key role of nitric oxide as a neurotransmitter responsible for triggering erections.

“Now, 20 years later, we know that nitric oxide is not just a blip here or there, but instead it initiates a cyclic system that continues to produce waves of the neurotransmitter from the penile nerves,” says Burnett.
With this basic biological information, it may be possible, according to Burnett, to develop new medical approaches to help men with erection problems caused by such factors as diabetes, vascular disease or nerve damage from surgical procedures. Such new approaches could be used to intervene earlier in the arousal process than current medicines approved to treat erectile dysfunction.

In particular, Burnett says, “The target for new therapies would be the protein kinase A (PKA) phosphorylation of neuronal nitric oxide synthase (nNOS). Now that we know the mechanism for causing the ‘activated’ form of nNOS in penile nerves, we can develop agents that exploit this mechanism to help with erection difficulties.”

One of the agents studied by the researchers was forskolin, an herbal compound that has been used to relax muscle and widen heart vessels. They found that forskolin also ramps up nerves and can help keep nitric oxide flowing to maintain an erection.

“It has been a 20-year journey to complete our understanding of this process,” says Snyder. “Now it may be possible to develop therapies to enhance or facilitate the process.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our erectile dysfunction / premature ejaculation section for the latest news on this subject.
The new study, “Cyclic AMP Dependent Phosphorylation of Neuronal Nitric Oxide Synthase Mediates Penile Erection,” was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), under grant number RO1DK067223.
In addition to Burnett and Snyder, the study article’s authors are K. Joseph Hurt from the University of Colorado, Sena F. Sezen, Gwen F. Lagoda and Biljana Musicki from Johns Hopkins, and Gerald A. Rameau from Morgan State University.
Johns Hopkins Medicine
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n.p. (2012, September 28). “Knowledge Of The Biochemical Events Needed To Maintain Erection May Lead To New Therapies For Erectile Dysfunction.” . Retrieved fromhttp://www.medicalnewstoday.com/releases/250747.php.

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Eating Cherries Reduces Gout Attacks

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Also Included In: Nutrition / Diet
Article Date: 28 Sep 2012 – 12:00 PDT

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Eating Cherries Reduces Gout Attacks

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Eating cherries over a two-day period reduced the risk of gout attacks by 35%, according to a new study led by Boston University (BU) in the US that is being published in the journal Arthritis & Rheumatism.
Lead author Yuqing Zhang, Professor of Medicine and Public Health at BU, says in a press statement:
“Our findings indicate that consuming cherries or cherry extract lowers the risk of gout attack.”
Estimates suggest about 8.3 million adults in the US have gout, an inflammatory arthritis that occurs when uric acid crystals form in the joints, causing great pain and swelling.
There are several standard treatments, but with these gout attacks tend to re-occur, so researchers and patients are on the look-out for alternatives. Cherries have been mentioned as having urate-lowering and inflammation-reducing properties, but there have been no rigorous studies of whether they can reduce the risk of gout attacks.
For their case-crossover study, Zhang and colleagues recruited 633 people with gout and followed them online for a year. 88% of participants were white, had an average age of 54, and 78% of them were male. They answered questions about gout onset, symptoms, risk factors, medications, and whether they ate cherries or took cherry extract, and for how long.
The researchers classed any cherry intake in servings, with one serving being half a cup, or 10 to 12 cherries.
When they analyzed the participant responses, they found of those who had eaten cherries in one form or another, 35% ate fresh cherries, 2% took cherry extract, and 5% consumed both.
They also counted 1,247 gout attacks over the one-year follow-up, 92% of which were in the joint at the base of the big toe.
They compared the cherry consumption against the gout attack incidence, and found those participants who ate cherries for two days, had a 35% lower risk of gout attacks or flares compared to participants who did not have them at all.
They also found that the threat of gout flares fell by as much as 75% when cherry intake was combine with allopurinol, a drug that lowers uric acid levels, compared to not taking the drug or having the cherries.
These benefits persisted even after taking into account factors that can affect gout risk, such as gender, obesity (BMI), purine intake (in foods that can increase gout risk), plus use of alcohol, diuretics and anti-gout medications.
Zhang says:
“The gout flare risk continued to decrease with increasing cherry consumption, up to three servings over two days.”
He and he colleagues found cherry intakes above this number of servings did not give any additional benefit.
In an accompanying editorial, Allan Gelber from Johns Hopkins University School of Medicine in Baltimore, and Daniel Solomon from Brigham and Women’s Hospital and Harvard University Medical School in Boston, say the study is significant because it looks at diet and the risk of gout flares recurring.
But while these findings are promising, they urge patients who currently suffer from gout not to “abandon standard therapies”.

They agree with the study authors that further randomized clinical trials should now be done to confirm the findings.

As does Alan Silman, professor and medical director of Arthritis Research UK.

He says in a press statement from the charity that he welcomes the findings, because for some time there has been talk of fruits like cherries being of benefit to people with gout and rheumatoid arthritis, both of which occur with chronic inflammation.

The study shows good evidence that perhaps cherries, together with traditional drugs that reduce uric acid, could significantly lower the risk of painful gout attacks, and, “it has been suggested that antioxidant compounds found in cherries may be natural inhibitors of enzymes which are targeted by common anti-inflammatory medications such as ibuprofen” says Silman.

“Eating cherries, in fact, is not dissimilar to taking ibuprofen on a daily basis. However, we’d like to see additional clinical trials to further investigate and provide confirmation of this effect,” he adds.

Written by Catharine Paddock PhD
Copyright: Medical News Today

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“Cherry Consumption and the Risk of Recurrent Gout Attacks”; Yuqing Zhang, Tuhina Neogi, Clara Chen, Christine Chaisson, David Hunter, Hyon K. Choi; Arthritis & Rheumatism, anticipated online publication 28 September 2012; DOI: 10.1002/art.34677; Additional sources: Wiley-Blackwell, Arthritis Research UK.
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Smoking on the Rise in Youth Movies

Sept. 28, 2012 — Onscreen tobacco use increased by 34% per movie last year in films targeted at children and teens, according to a new study.

Researchers say the dramatic rise in smoking scenes in top-grossing U.S. movies with a G, PG, or PG-13 rating ends five years of steady decline in onscreen tobacco use.

“The growth in onscreen tobacco use in 2011 reversed years of progress toward tobacco-free youth-rated movies,” write researcher Stanton Glantz, PhD, of the Center for Tobacco Control Research and Education at the University of California, San Francisco, and colleagues in Preventing Chronic Disease.

Studies have shown exposure to onscreen smoking encourages young people to start smoking. Reducing youth exposure to tobacco use in movies is a goal of the U.S. Department of Health and Human Services.

Smoking Surge in Youth Movies

In the study, researchers counted use or implied use of a tobacco product by actors in movies with a box office gross that ranked in the top 10 for at least one week in 2011.

The results showed the total instances of tobacco use, almost exclusively smoking, rose by 7% per movie from 2010 to 2011.

Tobacco incidents rose by 34% in movies rated G, PG, or PG-13, and by 7% in movies rated R.

The biggest increase in onscreen tobacco use was in movies aimed at the youngest audiences. The average number of tobacco incidents per movie rated G and PG rose by 311% in 2011, up from less than one smoking scene per movie to more than three.

No-Smoking Policy Backfires

Researchers say the increase in onscreen smoking means the motion picture industry is no longer progressing toward the goal of reducing onscreen tobacco use to curb youth smoking.

From 2005 to 2010, three major movie studios (Comcast/Universal, Disney, and Time Warner) had policies designed to discourage smoking in their movies. These efforts reduced average tobacco use per youth-rated movie by more than 90%.

But the study shows that those policies didn’t hold up in 2011.

Studios with a smoking policy had an average of 7.6 more instances of tobacco use in their movies in 2011 compared with 2010. Studios without any smoking policy actually had 1.3 fewer examples of tobacco use in their movies in 2011.

Researchers say the results suggest a change in the movie rating system is needed to encourage movie studies to reduce tobacco use in movies and combat youth smoking.

“The reversal of progress toward less onscreen smoking in youth-rated movies underscores the need to rate movies with tobacco imagery as R, establishing an industry-wide market incentive to keep youth-marketed movies tobacco-free,” the researchers write.

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Insomnia, Anxiety Drugs May Raise Dementia Risk

Sept. 27, 2012 — Seniors who take certain kinds of drugs to treat anxiety or insomnia may be more likely to develop dementia than those who do not, a new study shows.

Seniors are often prescribed benzodiazepines or similar drugs to help with sleeping problems or anxiety. And even though most of these drugs are only meant to be used for a few weeks or months at a time, the drugs can be habit forming. Studies have found that many older adults stay on them longer, sometimes for years.

The new study, which is published in the BMJ, compared the risk of dementia in two groups of French seniors — 95 who were recent users of any of 23 benzodiazepines or similar drugs at the start of the study and 968 who were not.

During the next 15 years, doctors diagnosed 253 cases of dementia. Thirty people (32%) who had taken benzodiazepines or similar drugs developed memory loss and difficulty thinking, compared to 223 people (23%) who had not taken them. Drugs used by people in this study included Ambien, Halcion, Klonopin, Restoril, Valium, and Xanax.  

Even after accounting for other things that are known to affect brain function, like age, living alone, depression, high blood pressure, and diabetes, researchers found that seniors who took benzodiazepines were about 60% more likely than those who didn’t to develop dementia.

Association, Not Cause

The study doesn’t prove that benzodiazepines cause declines in memory and brain function. And researchers say very short-term use of the drugs is probably safe.

But other experts say seniors may want to avoid the drugs altogether.

“There is a growing body of evidence that the use of benzodiazepines is a risk factor for poor [brain function] in older adults,” says Cara Tannenbaum, MD, of the University of Montreal in Canada.

Tannenbaum has recently reviewed evidence that supports a link between benzodiazepines and dementia, but she was not involved in the current research.

“In my opinion there is a very definite cause for concern, not only because of obvious memory impairment but because of the well-documented risk of falls and car accidents,” she says.

A Mixed Bag

Two previous studies found that benzodiazepine users had no increased risk, or perhaps even a decreased risk of dementia, compared to seniors who didn’t take the drugs.

Three other studies, on the other hand, have noted increased risks for memory trouble in benzodiazepine users.

Those studies followed people for shorter periods of time, so they couldn’t rule out the possibility that people had started taking the drugs to relieve the first symptoms of dementia, which often include increased anxiety, agitation, and trouble sleeping.

The new study got around that problem by following study participants for five years before they were even considered for the analysis. This allowed researchers to exclude people who were showing signs of memory problems before they started the drugs.

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