Vitamin E may slow early Alzheimer's decline: study

By Andrew M. Seaman

NEW YORK Tue Dec 31, 2013 4:04pm EST

NEW YORK (Reuters Health) – Taking vitamin E during the early stages of Alzheimer’s disease slowed declines in patients’ ability to perform basic tasks by about six months in a new study.

“It will be very interesting to see to what extent this will change practice,” Dr. Maurice Dysken said. “I think it will, but we’ll have to see how people in the field such as providers view the findings and patients too.”

Dysken is the study’s lead author and former director of the Geriatric Research, Education and Clinical Center at the Minneapolis VA Healthcare System.

Researchers have studied vitamin E for possible benefits in slowing the progression of Alzheimer’s, but those studies have yielded mixed results.

For example, the researchers write in JAMA, past research has found the vitamin slowed disease progression in people with moderately severe Alzheimer’s. But the vitamin was not effective at slowing the transition to Alzheimer’s for people with so-called mild cognitive impairment, which typically precedes Alzheimer’s.

To see whether vitamin E – or a combination of the vitamin with memantine, a drug approved in the U.S. to treat Alzheimer’s – would slow the rate of decline in people with mild to moderate forms of the disease, the researchers recruited 613 trial participants from 14 Veterans Affairs medical centers.

The patients were recruited between August 2007 and March 2012. People taking blood thinning drugs were excluded from the study because those drugs are tied to an increased risk of bleeding when combined with vitamin E.

At the start of the study, the participants were randomly assigned to one of four groups.

One group received 2,000 International Units (IU) of vitamin E every day. That’s a considerably larger dose than the 30 IU typically found in multivitamins. A second group received the drug memantine. A third group took both vitamin E and memantine and the final group took inert pills for comparison.

The researchers used a scale to measure the participants’ ability to perform tasks of daily life.

After an average of about 2.3 years, Dysken and his colleagues found that only the group taking vitamin E alone had a significantly slower decline in the ability to perform daily tasks, compared to the participants taking the inert pills.

The difference represented a delay in functional decline of about six months. In practical terms, the difference could represent a person’s ability to dress or bathe themselves for that much longer.

People who took care of the study participants taking vitamin E alone also reported a smaller increase in the amount of time the patients needed assistance, compared to the other groups.

“I think it’s a well done study, but I think the results are modest,” Dr. Ronald Petersen, who was not involved in the new work, said.

Petersen is director of the Alzheimer’s Disease Research Center at the Mayo Clinic in Rochester, Minnesota.

He noted that the benefits need to be weighed against potential risks – for example, a previous study showed an increased risk of death among people taking vitamin E. The current study didn’t detect any such increase.

“Nevertheless, it’s out there and it’s published,” he said. “You have to let people know it could be a small risk.”

Both Petersen and Dysken cautioned that the study doesn’t suggest people should take vitamin E to prevent or stop Alzheimer’s disease.

“This is not a prevention trial,” Dysken said. “We were enrolling patients with a diagnosis and what we’re looking at is slowing the rate of progression. It does not stop it.”

In an editorial accompanying the new study, Dr. Denis Evans of Rush University Medical Center in Chicago agreed that the results show a modest effect on treating symptoms of Alzheimer’s.

“Considering the difficulties inherent in trying to treat rather than prevent very high-prevalence diseases and the limitations thus far of the therapeutic efforts for people with AD, shifting to more emphasis on prevention seems warranted,” he wrote.

While a lot of research is being focused on prevention of the disease itself, rather than of its progression, Petersen said the new study shows researchers are not abandoning people who already have Alzheimer’s.

“I think this is an example that we’re really doing research across the entire spectrum of the disease,” he said.

He added that the new findings will probably not cause him to treat patients differently, but he said it’s something he would mention if they asked if there’s anything else that can be done.

“I think a six-month delay will be meaningful for many – if not most – patients,” Dysken said. “But it really does depend on the conversation that needs to be had between patient and primary care provider.”

SOURCE: bit.ly/JOTmp1 JAMA, online December 31, 2013.

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Antioxidants in diet linked to cataract risk

By Kathryin Doyle

NEW YORK Tue Dec 31, 2013 2:22pm EST

NEW YORK (Reuters Health) – Women who eat foods rich in antioxidants may have a lower risk of cataracts as they age, according to a new Swedish analysis.

“Oxidative damage of the eye lens caused by free radicals has been suggested to be crucial in development of cataract,” said Susanne Rautiainen of the Institute of Environmental Medicine at the Karolinska Institutet, who led the study.

Her team looked at the diets of more than 30,000 middle aged and older women, and found those with the highest total intake of antioxidants had about a 13 percent lower risk of developing cataracts than women who consumed the least.

“Previous studies have focused on individual antioxidants obtained from the diet or supplements and they have reported inconsistent results,” Rautiainen said. “However, in diet much wider ranges of antioxidants are present than those studied previously.”

Instead of looking at single antioxidants, such as vitamins C and E, and plant flavonoids such as lycopene, the researchers used a measure of total antioxidant values in foods, which takes into account how the nutrients work together.

For the study, more than 30,000 Swedish women over age 49 were observed for about 7 years for signs of developing cataracts, and were given a dietary questionnaire.

Foods high in antioxidants include coffee, tea, oranges, whole grains and red wine.

Based on total antioxidant consumption, the researchers divided the women into five groups, ranging from the greatest antioxidant intake to the least. Among those who ate the most antioxidants, 745 cases of cataract were recorded, compared to 953 cases among women with the lowest antioxidant consumption.

The results were published in JAMA Ophthalmology.

Women who ate more antioxidants also tended to be more educated and were less likely to smoke.

More than 20 million Americans aged 40 years and older have cataracts, which cause clouded vision and eventually blindness, in one or both eyes, according to the U.S. Centers for Disease Control and Prevention.

“The results are not that surprising,” William Christen said.

Christen, of Brigham and Women’s Hospital and Harvard Medical School in Boston, studies eye diseases and vitamins and was not involved in the new study.

The findings are in line with previous research suggesting antioxidants may help protect against cataracts, but the study has limitations, he cautioned.

“The women participants simply reported on a questionnaire the food choices they made over the past year,” Christen said. “As an observational study, there is always concern that women who choose healthier diets may also differ in other important ways, like body weight, smoking habits, aspects of the diet other than antioxidants, that may be more directly related to cataract risk.”

Rautiainen suspects the results would be similar among men and in other countries, but can’t say for sure until those studies have been done.

Colorful fruits and vegetables are the best source of antioxidants for people who want to increase their intake, she said.

“Results of numerous observational studies have suggested a possible beneficial role for high antioxidant intake in a number of age-related disorders,” Christen said. But in most randomized controlled trials, which would better isolate the effects of antioxidants alone, the link has not held up, he said.

SOURCE: bit.ly/1eTib4A JAMA Ophthalmology, online December 26, 2013.

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Decision aids reduce mammograms among older women

By Kathryn Doyle

NEW YORK Mon Dec 30, 2013 4:13pm EST

NEW YORK (Reuters Health) – Women over 75 who learned more about the risks and benefits of mammogram screenings were less likely to go through with the test in a new study.

Women should have a mammogram – an X-ray of the breast tissue scanning for early signs of cancer – every two years between ages 50 and 74, according to the U.S. Centers for Disease Control.

According to the U.S. Preventive Services Task Force, a government-backed expert panel, there isn’t enough evidence to recommend for or against mammograms for older women.

A woman’s choice to have a mammogram past the age of 75 should be based on her life expectancy, risk of disease and personal preference, study author Dr. Mara A. Schonberg told Reuters Health.

“Approximately, 20 percent of U.S. women 75 and older have less than five year life expectancy and these women should not be screened since they are very unlikely to benefit and can really only be harmed,” she said.

“About two thirds of women 75 and over have less than 10 year life expectancy and some experts would argue that these women are also unlikely to benefit,” Schonberg added. “About one third of women have more than 10-year life expectancy and it probably makes sense to recommend screening to these women.”

Schonberg studies patient decision making at Beth Israel Deaconess Medical Center in Brookline, Massachusetts.

For the study, 45 women over age 75 who had been regularly having mammograms, as recommended by their doctors, but had not had one in the previous 5 months were given the decision aid – a packet of information on the risks and benefits of screening for women in their age group – before deciding at a doctor’s appointment whether or not to schedule another screening.

The women filled out an experience survey before reading the packet and again after their doctor’s appointment.

The packet included information on breast cancer risk for women over 75 and the risks of screening including false positives and costly and stressful follow up testing.

For older women, many tumors that a mammogram would find would actually grow too slowly to harm the woman in her lifetime, Schonberg said. But nearly all women with breast cancer are treated for it, and the risks of treatment increase with age.

Based on the two surveys, women tended to be more informed about the benefits and risks after reading the packet than before.

Before reading the decision aid, 37 of the 45 women planned on having a mammogram, compared to 25 out of 45 who planned to do so after reading it.

According to medical records, 26 of the women had a mammogram in the two years following the study.

Schonberg thinks it would be feasible to give this type of decision aid to all women over 75 as they make screening decisions, but “it requires our health care system placing greater value and resources in decision support for patients.”

Giving the decision aid to women over 75 before a visit with their primary care doctor seemed to work well in the study, but in the real world it would take resources to identify these women and send them the information, she said.

“In practice, it may be faster for a physician to simply recommend a mammogram than to discuss patients’ preferences around screening,” she said. Doctors should be compensated for spending time discussing this issue with patient, she said.

“In addition, most of the educational materials regarding mammography screening have been uniformly positive. It takes a change in culture to acknowledge that there are both benefits and risks to screening and that each woman should be allowed to make an informed decision for herself.”

All women should be informed of the risks and benefits of screening, she said, but especially those over 75, since there are more risks and uncertain benefits for this group.

The study did not follow the women to determine which, if any, were later diagnosed with breast cancer.

“Most women over age 75 should not get mammograms,” Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy & Clinical Practice in Hanover, New Hampshire, said. “But this is not unique to mammography, or women,” he said.

Welch authored another study on the risks of mammography screening for older women in the same issue of JAMA Internal Medicine. In it, he estimates that for 1,000 women who get annual mammograms starting at age 50 for 10 years, “0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly.”

“As people get older – closer to death – there is less reason to look for cancer early,” he said. “Most people, men and women, over age 75 should not be screened for cancer,” Welch told Reuters Health in an email.

SOURCE: bit.ly/1emvR3n and bit.ly/1ggIUWa JAMA Internal Medicine, online December 30, 2013.

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Most minority patients cared for by non-white docs

By Andrew M. Seaman

NEW YORK Mon Dec 30, 2013 4:09pm EST

NEW YORK (Reuters Health) – More than half of U.S. minority patients are cared for by doctors who are also minorities, according to a new analysis.

Using data from a 2010 U.S. survey, researchers found that about 54 percent of minority patients report their doctors are not white. That number was even greater – about 70 percent – among non-English speaking patients.

“Among patients who fell into one of our disadvantage categories . . . These individuals were more likely than other patients to be served by a minority physician,” Dr. Lyndonna Marrast said.

Marrast, who led the new analysis, is a fellow in general internal medicine and a physician at Cambridge Health Alliance in Massachusetts.

For the new study, she and her colleagues used data from 7,070 people who identified a physician on the 2010 Medical Expenditure Panel Survey.

They then estimated the odds for minority, low-income, Medicaid, uninsured and non-English speaking patients of having a non-white doctor.

Compared to white patients, the researchers found that minority, low-income, Medicaid and non-English speaking patients were more than five times more likely to see a non-white doctor, compared to non-Hispanic white patients.

Uninsured patients, however, were just as likely to see a non-white doctor as a white patient.

The numbers can be seen as an update to a similar study conducted in 1987, Marrast said. That study, the researchers write in JAMA Internal Medicine, found that non-white doctors were more likely to care for underserved and sicker patients.

“What’s new is that we comment on Hispanic physicians, which is particularly important because of the increase in the Hispanic population, and we report on people who report not speaking English at home,” Marrast said.

Because non-white doctors care for a majority of underserved patients, she and her colleagues suggest that increasing the number of non-white doctors may help alleviate concerns over doctor shortages brought on by the large number of low-income and uninsured adults soon-to-be covered under the Affordable Care Act, commonly known as Obamacare.

In an editorial accompanying the new analysis, Dr. Somnath Saha of the Portland VA Medical Center in Oregon, wrote that simply training more doctors will not meet the nation’s growing needs.

“We should be deliberately selecting and training physicians who will go into undersupplied specialties . . . serve vulnerable patient populations . . . and practice in underserved communities,” he wrote.

Marrast cautioned, however, that creating a more diverse doctor workforce is not a quick solution.

“We just want to call attention to this again, because it takes time to produce a physician,” she said.

For example, initiatives would need to be started when children are in elementary and high school to prepare them for college and a medical education.

“Ideally we would live in integrated neighborhoods, where everyone has equal access to healthcare, but we don’t,” she said.

“Training more minority physicians is really one solution of many that can be implemented until larger societal changes occur.”

SOURCE: bit.ly/MbBLb9 JAMA Internal Medicine, online December 30, 2013.

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Thicker brain sections tied to spirituality: study

By Andrew M. Seaman

NEW YORK Mon Dec 30, 2013 2:14pm EST

NEW YORK (Reuters Health) – For people at high risk of depression because of a family history, spirituality may offer some protection for the brain, a new study hints.

Parts of the brain’s outer layer, the cortex, were thicker in high-risk study participants who said religion or spirituality was “important” to them versus those who cared less about religion.

“Our beliefs and our moods are reflected in our brain and with new imaging techniques we can begin to see this,” Myrna Weissman told Reuters Health. “The brain is an extraordinary organ. It not only controls, but is controlled by our moods.”

Weissman, who worked on the new study, is a professor of psychiatry and epidemiology at Columbia University and chief of the Clinical-Genetic Epidemiology department at New York State Psychiatric institute.

While the new study suggests a link between brain thickness and religiosity or spirituality, it cannot say that thicker brain regions cause people to be religious or spiritual, Weissman and her colleagues note in JAMA Psychiatry.

It might hint, however, that religiosity can enhance the brain’s resilience against depression in a very physical way, they write.

Previously, the researchers had found that people who said they were religious or spiritual were at lower risk of depression. They also found that people at higher risk for depression had thinning cortices, compared to those with lower depression risk.

The cerebral cortex is the brain’s outermost layer made of gray matter that forms the organ’s characteristic folds. Certain areas of the cortex are important hubs of neural activity for processes such as sensory perception, language and emotion.

For the new study, the researchers twice asked 103 adults between the ages of 18 and 54 how important religion or spirituality was to them and how often they attended religious services over a five-year period.

In addition to being asked about spirituality, the participants’ brains were imaged once to see how thick their cortices were.

All the participants were the children or grandchildren of people who participated in an earlier study about depression. Some had a family history of depression, so they were considered to be at high risk for the disorder. Others with no history served as a comparison group.

Overall, the researchers found that the importance of religion or spirituality to an individual – but not church attendance – was tied to having a thicker cortex. The link was strongest among those at high risk of depression.

“What we’re doing now is looking at the stability of it,” Weissman said.

Her team is taking more images of the participants’ brains to see whether the size of the cortex changes with their religiosity or spirituality.

“This is a way of replicating and validating the findings,” she said. “That work is in process now.”

Dr. Dan Blazer, the J.P. Gibbons Professor of Psychiatry at Duke University Medical Center in Durham, North Carolina, said the study is very interesting but is still exploratory.

“I think this tells us it’s an area to look at,” Blazer, who was not involved in the new study, said. “It’s an area of interest but we have to be careful.”

For example, he said there could be other areas of the brain linked to religion and spirituality. Also, spirituality may be a marker of something else, such as socioeconomic status.

Blazer added that it’s an exciting time, because researchers are actively looking at links between the brain, religion and risk of depression.

“We’ve seen this field move from a time when there were virtually no studies done at all,” he said.

Weissman said the mind and body are intimately connected.

“What this means therapeutically is hard to say,” she added.

SOURCE: bit.ly/1jYo6ro JAMA Psychiatry, online December 25, 2013.

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Donors pitch in to pay for surgery for extremely obese Texas girl

AUSTIN, Texas Mon Dec 30, 2013 2:09pm EST

AUSTIN, Texas (Reuters) – Nearly 1,500 donors have pledged more than $62,000 to help pay for surgery for a 12-year-old Texas girl diagnosed as morbidly obese due to a brain disease that is causing her to gain about two pounds a week.

Alexis Shapiro suffered damage to her pituitary gland, which helps regulate weight, as a result of the brain disease. She has gained about 140 pounds (63.5 kgs) in less than two years because of the problem, her mother said. Her extreme excess of body fat is clinically defined as morbid obesity.

“It has been heartbreaking for her and for us. She cannot do the things she used to love,” Jennifer Shapiro, her mother, said on the fundraising site GoFundMe.

The mother said she is seeking about $50,000 for life-saving surgery to reduce the size of her daughter’s stomach because the family’s insurance company will not pay for the procedure unless the patient is at least 18 or has achieved full bone growth.

Dr. Thomas Inge, a specialist in pediatric obesity at the Cincinnati Children’s Hospital Medical Center, told NBC News that Alexis could receive the surgery at the hospital where he works within six weeks now that the funding appears to be in place.

“Alexis will be seen this week in Cincinnati, and the preparations for surgery will be made at that time,” Inge told Reuters by email.

(Reporting by Jon Herskovitz; editing by Andrew Hay)

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Straumann to cut prices of some dental implants

ZURICH Sun Dec 29, 2013 10:43am EST

ZURICH (Reuters) – The world’s largest dental implant maker, Straumann, will cut the price of its standard titanium implants by around 15 percent next year in Germany, Austria and Switzerland, the firm’s chief executive told a Swiss newspaper on Sunday.

The Swiss company said its price gap with rivals must be reduced, and that it may adjust prices in other parts of Europe at a later date.

Premium implant makers like Straumann and local rival Nobel Biocare have been hit by weak consumer confidence in Europe, as cash-strapped consumers cut back on non-essential dental treatment or trade down to cheaper brands.

“If we don’t adapt prices to the market situation, then in a few years we’ll be selling a third less in price-sensitive markets such as Germany than we do today,” Chief Executive Marco Gadola told the NZZ am Sonntag.

The Basel-based firm wants to become a global leader in the value segment of the market, which is growing at a faster pace than the premium segment.

Straumann also plans to offer its new Roxolid implants at the same prices as models it is phasing out to try to create better value and a competitive edge.

The Roxolid implants are made from an alloy of titanium and zirconium that is stronger than the titanium used on its own in older models.

In October, the Straumann raised its full-year sales forecast, expecting a better performance in North America and Japan to offset weak sales in Europe, where it makes more than half of its revenues.

(Reporting by Alice Baghdjian; Editing by Erica Billingham)

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Patient doing well with French company's artificial heart: report

PARIS Sun Dec 29, 2013 10:36am EST

PARIS (Reuters) – A 75-year-old Frenchman was feeding himself and chatting to his family, more than a week after becoming the first person to be fitted with an artificial heart made by French biomedical company Carmat, one of his surgeons said.

“He is awake, feeding himself and talking with his family. We are thinking of getting him up on his feet soon, probably as early as this weekend,” Professor Daniel Duveau, who saw the patient on Thursday, told Le Journal du Dimanche newspaper.

A more detailed account of the patient’s health would be made public on Monday, the paper wrote.

Heart-assistance devices have been used for decades as a temporary solution for patients awaiting transplants, but Carmat’s bioprosthetic product is designed to replace the real heart over the long run, mimicking nature using biological materials and sensors.

It aims to extend life for patients suffering from terminal heart failure who cannot hope for a heart transplant, often because they are too old and donors too scarce.

The artificial heart, which can beat up to five years, has been successfully tested on animals but the December 18 implant in a Paris hospital was the first in a human patient.

Three more patients in France are due to be fitted with the device. The next operation is scheduled for the first weeks of January, the newspaper reported.

In this first range of clinical trials, the success of the device will be judged on whether patients survive with the implant for at least a month.

The patients selected suffer from terminal heart failure – when the sick heart can no longer pump enough blood to sustain the body – and would otherwise have only a few days or weeks to live.

Artificial hearts thus fuel huge hope amongst patients, their families, and investors. Shares in Carmat have risen more than five-fold since floating on the Paris exchange in 2010.

Duveau told the JDD that Carmat’s first patient was very combative and confident with his new prosthetic heart.

“When his wife and his daughter leave him, he tells them: ‘See you tomorrow!’ All he wants is to enjoy life. He can’t wait to get out of the intensive care unit, out of his room, and out of uncertainty.”

(Reporting by Natalie Huet; Editing by Mark Trevelyan)

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