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Below are articles from Medscape March 15, 2010.  We do not endorse content, but share this content in response to patient questions or requests.

Brain Fitness Games Improve Delayed Memory in Elderly Adults
Pam Harrison
March 8, 2010 (Savannah, Georgia) — Elderly adults who play brain fitness games that exercise global aspects of memory show improvements in the domain of delayed memory at 6 months compared with a slight decline in active controls, according to preliminary findings presented here at the American Association for Geriatric Psychiatry 2010 Annual Meeting.Karen Miller, PhD, University of California at Los Angeles, reported that significant differences were observed at 6 months after randomization between the intervention group who were assigned to the Dakim BrainFitness computerized memory program vs active controls, even though after 2 months of training, "controls” were also given the same training as the intervention group.Assessed by 4 different memory tests, the group who played the BrainFitness game for the full 6 months gained almost 2 points on memory scores, increasing from 10.4 at baseline to 12.1 at follow-up.This is in contrast to controls, who, having played the same BrainFitness game from month 2 to month 6, had the same memory scores decrease slightly from 10.2 at baseline to 10.1 at follow-up (P = .001). A total of 38 elderly subjects completed the 6-month trial, 22 at an average age of 82 years in the intervention group and 16 at an average age of 83 years in the control group."By month 6, the intervention group had played more than double the number of sessions at 93 compared with only about 40 sessions played by active controls, so it’s the long-term use that improves overall memory. The maximum benefit comes when you keep on playing," Dr. Miller told Medscape Psychiatry. Pilot Study Before launching the clinical trial, Dr. Miller and colleagues carried out a pilot study involving 22 elderly subjects, with an average age of 74 years, who were assigned to the Dakim BrainFitness computerized game or to an active control group.Participants played the game 5 times a week, each session lasting 30 minutes, for 2 months. At the end of the 2-month pilot study, a modest effect size was seen on 1 memory test.Realizing that this particular version of the BrainFitness game did not exercise traditional aspects of memory training, including encoding and long-term memory, UCLA investigators helped Dakim redesign the game. The version used in their latest clinical trial now exercises short-term memory, critical thinking, visual spatial skills, long-term memory, calculations, and language."There is also a variety of 300 to 400 games or events that cycles through each time a senior plays so they are not going through the same format each time," Dr. Miller said."There are also 5 levels which can be preselected so this machine allows seniors to move up and down between levels, depending on how well they perform on different aspects of memory," she added.Dr. Miller also stressed that to see a training effect on memory, it is likely subjects will need to commit to regular memory training exercises, much in the same way people need to commit to other lifestyle behaviors, such as exercise and stress reduction.She also believes computerized training will only be helpful in preventing memory decline in people whose memory is still relatively healthy.Memory training devices, such as the program modified and used by the UCLA group, are also likely to benefit subjects with amnestic memory impairment and not those with impairment in multiple domains.Dr. Miller noted that, in her experience, subjects with impairment in multiple domains continue to deteriorate relatively quickly even when they used the BrainFitness device on a regular basis."The longer a person is exposed to the BrainFitness program, the more likely they are to improve in verbal and visual memory. Even if you have no computer skills, you are able to use it," said Dr. Miller.Preliminary Results Gary Small, MD, University of California at Los Angeles, told Medscape Psychiatry that these preliminary results are "encouraging" and that the Dakim BrainFitness program is a popular device in centers where it is been tested. "It is very much tailored to the older generation, with an easy-to-use touch screen, so seniors are enjoying it," he added.On the other hand, companies manufacturing these brain fitness games need to make sure the games are more than just fun and engaging and that they exercise all domains of memory, such as the Dakim BrainFitness program appears to do."The issue really is will these devices improve cognitive skills?" Dr. Small added that it is certainly feasible to incorporate the kinds of games and techniques into brain games that improve cognitive skills, as he himself has done it with training programs — companies just need the will to do so.Dr. Miller and Dr. Small disclose a financial conflict of interest with Dakim. Dr. Small has received consulting and speaker's fees from a number of pharmaceutical companies not relevant to his research with Dakim. American Association for Geriatric Psychiatry's (AAGP) 2010 Annual Meeting: Session 212. Presented March 6, 2010. ]

Authors and Disclosures

Journalist

Pam G. Harrison

Melanoma Cases on the RiseCharlene LainoMarch 11, 2010 (Miami Beach, Florida) — While some researchers suggest the rising rate melanoma may simply reflect a change in how doctors diagnose melanoma and the increased availability of skin cancer screenings, a leading dermatologist says the increase is real.The average American's risk of developing melanoma in his or her lifetime increased from one in 1,500 in 1930, to one in 250 in 1980 and one in 74 in 2000, says Darrell S. Rigel, MD, clinical professor of dermatology at New York University Medical Center in New York City and a past president of the American Academy of Dermatology.By 2004, a person had a one in 65 chance of getting the deadly skin cancer and now that risk is one in 58, Rigel says."If this rate continues to rise at the same pace, the risk will be one in 50 by 2015," he tells WebMD.A total of 68,720 Americans were diagnosed with melanoma in 2009, compared with 47,700 in 2000, according to the CDC.At the American Academy of Dermatology's annual meeting here, Rigel dispelled what he calls myths about the rise in melanoma.Is Rise in Melanoma Due to Increased Surveillance? Some studies have attributed the rise in melanoma to an increase in the number of skin cancer screenings.If this was true, "you would expect cases to pop up earlier, and then suddenly drop off," Rigel says.Take prostate cancer, for example, he says. There was a steep rise in prostate cancer diagnoses in the early 1990s, when testing for prostate specific antigen (PSA) was introduced, Rigel says. Rising PSA levels may signal prostate cancer.Then, prostate cancer rates dropped dramatically from 1992-1995, after which they leveled off, he says."Until PSA testing was introduced, we had no way to detect early prostate cancers, before symptoms developed. With PSA testing, there was a transient increase in case due to increased detection of preclinical (before symptoms) disease. But once those initial cases of prostate cancer were found, it was not diagnosed as often," Rigel says.Although skin cancer screenings became more readily accessible in the 1980s, no such trend is occurring with melanoma rates, Rigel says.Is Rise in Melanoma Due to a Change in How Melanoma Is Diagnosed? In a large international study, pathologists reviewed 2,665 pigmented lesions that had been originally been analyzed by pathologists from the 1930s to the 1980s. Their diagnoses matched, Rigel says.Is Rise in Melanoma Due to Better Ways of Counting Cancer Cases? The National Cancer Institute's method of counting cancer primarily relies on reports from hospitals about how many cancers are being seen in their institution each year, he says."So if we were better at counting cancer, you would expect rates of all cancers to go up, which is not the case," Rigel says.In fact, melanoma is probably underreported, he says, as it is the only major cancer where patients are not seen in the hospital during the course of their disease."I often diagnose a patient in my office and excise the skin lesion in the office so the patient never even makes it to the hospital," he says.A 1991 study, published in the Journal of the American Academy of Dermatology, showed that up to 19% of cases in Massachusetts were never reported. A 1997 study in the same journal showed a17% rate of underreporting in Iowa, Rigel adds.Melanoma: Deaths vs. Survivals Additional evidence for a real rise in melanoma cases comes from the fact that deaths from skin cancer are also on the rise, Rigel says. Yet at the same time, a patient's chance of surviving for at least five years from diagnosis is also on the rise.If more people are dying of melanoma and more people are surviving melanoma, the only mathematical option is that cases are going up faster, he says.Melanoma: Don't Become a Statistic The bottom line, Rigel says, is "how the rise in melanoma affects our patients.""We know the cause of melanoma is too much exposure to ultraviolet (UV) radiation, whether from the sun or indoor tanning beds and lamps. Simple behavior changes can lower your risk," he says.So when should you see a doctor? If a mole is growing, bleeding, crusting, or changing, he says.Harold S. Rabinovitz, MD, a dermatologist at the University of Miami Miller School of Medicine, says know your ABCs.Look at your moles and check for:

  • Asymmetry: one half unlike the other half.
  • Border: irregular, scalloped or poorly defined.
  • Color: varies from one area to another; shades of tan and brown, black; sometimes white, red or blue.
  • Diameter: the size of a pencil eraser or larger.
  • Evolving: changing in size, shape or color.
 "A mole with any of these characteristics should be brought to a dermatologist’s attention immediately," Rabinovitz says.SOURCES: 68th Annual Meeting of the American Academy of Dermatology, Miami Beach, Fla. March 5-9, 2010. Darrell S. Rigel, MD, past president, American Academy of Dermatology; clinical professor of dermatology, New York University Medical Center. Harold S. Rabinovitz, MD, volunteer professor, department of dermatology, University of Miami Miller School of Medicine. ]

Authors and Disclosures

Journalist

Charlene Laino

Freelance writer for Medscape.

Medicare Part D Has Not Improved Access to Medication Among Beneficiaries With DepressionPam HarrisonMarch 10, 2010 — Despite initial hopes, the introduction of Medicare Part D, a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries, has not improved access to medication among those with depressive symptoms, new research suggests.The study presented at the American Association for Geriatric Psychiatry 2010 Annual Meeting by Kara Zivin, PhD, University of Michigan, Ann Arbor, showed that the unadjusted annual prevalence of cost-related nonadherence (CRNA) among a nationally representative survey of Medicare beneficiaries with depressive symptoms was 27% in 2004 and 2005. Following the introduction of Medicare Part D in 2006, it decreased to 24%.More than 6 million individuals acquired Medicare coverage with the introduction of Part D, and the proportion of those without any prescription drug coverage decreased from 23% in 2004 to 10% in 2006.For Medicare beneficiaries who did not report depressive symptoms, the unadjusted annual prevalence of CRNA was 13% in 2004, 12% in 2005, and 9% in 2006. The reported prevalence of spending less on basic needs was 22% in 2004, 23% in 2005, and 19% in 2006 among those beneficiaries with depressive symptoms. Among beneficiaries who reported no depressive symptoms, the annual prevalence of spending less on basic needs was 8% in 2004, 9% in 2005, and 5% in 2006."Prior to the introduction of Part D, there were significant problems with CRNA overall but for depressed patients in particular," said. Dr. Zivin. "While Part D has improved CRNA for some, mostly this has been among those who were better off to start with because people with more health problems or multiple illnesses have not had the same level of decline in CRNA."Dr. Zivin received the Barry Lebowitz Early Career Scientist Award for the study.The survey included a total of 24,234 community-dwelling beneficiaries, 18% of whom experienced depressive symptoms during the survey period. The main outcome measure was the percentage of beneficiaries who reported skipping or reducing doses of medication or not filling prescriptions because of cost and spending less on basic needs to be able to afford their medications."These results indicate that patients with depressive symptoms are trying to cope with basic needs more than those without depressive symptoms," Dr. Zivin observed. "To me, this is disappointing because we were hoping that people would be doing substantially better as a result of having increasing access."Paul Newhouse, MD, University of Vermont, Burlington, told Medscape Psychiatry that people who are depressed often have comorbidities, and they may be taking a lot more drugs than the average nondepressed individual, "so financially, they may still be having more problems affording these drugs."He also cautioned about generalizing too much with these types of data because the data have significant limitations, including the question about how many of the depressed beneficiaries had CRNA issues because of their need for multiple medications.He also recalled a study performed a number of years ago in Medicaid beneficiaries where the investigators found that nonadherence rates were very high — "and these were people who didn’t even have to pay for their drugs," Dr. Newhouse observed, "so this suggests that there are other factors involved in nonadherence — improving people’s financial access to medication is not the whole issue."The study was supported by the National Institute of Aging. Dr. Zivin and Dr. Newhouse have disclosed no relevant financial relationships. American Association for Geriatric Psychiatry (AAGP) 2010 Annual Meeting: Session 214. Presented March 6, 2010.]

Authors and Disclosures

Journalist

Pam G. Harrison

From Medscape Medical News

Cholesterol, Diabetes Medications Top List of Prescription Drug Expenses for Medicare RecipientsNancy Fowler LarsonMarch 11, 2010 — Medicare beneficiaries 65 years of age and older spend more on drugs to control diabetes and lower cholesterol than any other prescription medications, according to a statistical brief published in February by the federal Agency for Healthcare Research and Quality.According to Expenditures for the Top Five Therapeutic Classes of Outpatient Prescription Drugs, Medicare Beneficiaries, Age 65 and Older, nearly one quarter of all prescription drugs purchased by this population in 2007 were metabolic agents. Such medications are used primarily to manage diabetes and cholesterol and may also be indicated for weight control and thyroid conditions.Cardiovascular agents were second on the list of the top 5 medication expenditures for Medicare recipients. The amount spent on each drug category, and their percentages of total prescription spending, were broken down as follows:

  • Metabolic agents, including antihyperlipidemic and antidiabetic agents: $18.6 billion (22.7% of total expenditures)
  • Cardiovascular drugs, such as medications used to control abnormal heart rhythms and blood pressure: $14.7 billion (18.1%)
  • Central nervous system medications, including anticonvulsant, antiparkinsonian, and pain agents: $8.4 billion (10.2%)
  • Gastrointestinal drugs including antacids, H2 blockers, and proton pump inhibitors: $7.0 billion (8.6%)
  • Hormones used to combat conditions such as osteoporosis and thyroid disorders: $5.4 billion (6.6%)
Total Medicaid expenditures for these drug classifications by Medicare recipients were $54.1 billion. The 5 categories account for two thirds (66.2%) of annual prescription drug spending by this population.Although more dollars were spent on metabolic agents, a greater number of Medicare beneficiaries purchased drugs to treat cardiovascular conditions than to address diabetes and cholesterol."Among Medicare beneficiaries age 65 and older with a prescribed drug expense, just over three-quarters (77.3 percent) purchased cardiovascular agents, more than half (57.9 percent) purchased metabolic agents, and nearly half (48.5 percent) purchased central nervous system agents," writes Anita Soni, PhD, survey statistician, Agency for Healthcare Research and Quality, Rockville, Maryland. "Smaller proportions of persons purchased hormones (36.2 percent) or gastrointestinal agents (29.8 percent)."In terms of average expense per prescription, gastrointestinal agents were highest ($114). Next were metabolic agents ($94), central nervous system agents ($65), and hormones ($62). The average cost for cardiovascular agents was the lowest of the 5 categories ($40).The descriptive statistics found in the brief were obtained using figures in the Household and Pharmacy Components of the 2007 Medical Expenditure Panel Survey. Expenditures consist of all 2007 outpatient prescription drug purchases for those aged 65 years and older. Figures and percentages are for Medicare payments of all types including out-of-pocket, pocket, and private and public insurance sources. Also included are insulin and diabetic supplies and equipment.Excluded from the tallies are over-the-counter medicines and prescription drugs given in a medical office. Differences are statistically significant at the level of .05 or better.Expenditures for the Top Five Therapeutic Classes of Outpatient Prescription Drugs, Medicare Beneficiaries, Age 65 and Older, 2007. ]

Authors and Disclosures

Journalist

Nancy Fowler Larson

Women Benefit as Much as Men From Statins for Primary Prevention of CVDNEW YORK (Reuters Health) Mar 05 - Statin use by women cuts their risk of primary cardiovascular disease (CVD) events by roughly a third, which is similar to the risk reduction seen in men, research shows."Statin therapy in women without CVD is controversial, given the insufficient evidence of benefit," Dr. Samia Mora, from Brigham and Women's Hospital, Boston, and colleagues note in the March 9th issue of Circulation.Dr. Mora and colleagues analyzed gender-specific outcomes from the randomized JUPITER trial and performed a meta-analysis of statin trials that focused on women.JUPITER included 6801 women at least 60 years of age, and 11,001 men at least 50 years of age. All had high C-reactive protein levels (at least 2 mg/L) and normal to low levels of low density lipoprotein cholesterol (no higher than 130 mg/dL). Participants took either rosuvastatin or placebo daily.The meta-analysis included 7 primary prevention trials, with 13,154 women who had 240 CVD events and 216 deaths.Compared to the men in the JUPITER trial, the women had lower absolute CVD rates per 100 person-years (0.57 vs. 0.88 for rosuvastatin groups and 1.04 vs. 1.54 for placebo groups) - but both genders had relative risk reductions of roughly 44%.Further analysis showed that statin therapy significantly reduced revascularization and unstable angina in women, but did not affect other CVD events.In the meta-analysis, statin use by women cut primary CVD events by 37% (p < 0.001), but did not significantly affect total mortality.When the results of JUPITER and the meta-analysis are taken together, the researchers conclude, "statin therapy resulted in about a one-third relative reduction in primary CVD in women, a benefit similar to that seen in previous meta-analyses of men."Circulation 2010;121:1069-1077.From 
Psychotropic Medications Linked to Increased Rates of ObesityCrina Frincu-Mallos, PhDMarch 8, 2010 (Baltimore, Maryland) — Psychotropic medications, specifically antidepressants and antipsychotics, are associated with higher rates of obesity, new national data suggest.The research, presented here at the Anxiety Disorders Association of America 30th Annual Conference, shows that the obesity rate among individuals taking antidepressants during the past 12 months was 1.5 times greater compared with individuals not taking these medications. In addition, the obesity rate among subjects taking antipsychotics was more than double.A collaboration between researchers from the United States and Canada, the study examined the relationship between obesity and specific classes of psychotropic medications, including antidepressants, antipsychotics, anxiolytics, hypnotics, and mood stabilizers, in a large, nationally representative sample of 36,984 participants.Study subjects were participants in the Canadian Community Health Survey Mental Health and Well-being."There are issues that haven’t really been addressed in a population that already is at risk for unhealthy behaviors, since the risk for obesity is added on top of their mental illness," said first author Candyce D. Tart, MA, doctoral candidate in the Psychology Department at Southern Methodist University, Dallas, Texas.The preliminary results of the study, with principal investigator Jasper Smits, associate professor and director of the Anxiety Research & Treatment Program at Southern Methodist University, Dallas, Texas, suggest that the increased odds of obesity in mood disorders and anxiety disorders is mediated by psychotropic medication use.More precisely, the effects of psychotropic medication use appear to be specific to antidepressants and antipsychotics. The investigators found no relationship between mood stabilizers and obesity — a finding that contradicts previous research showing that these drugs are associated with significant weight gain.Exercise, Nutrition Advice: A Valuable Addition "If we are going to prescribe medications, we need to assist with addressing the possible risk of increased obesity and counsel them accordingly about weight management,” Ms. Tart told Medscape Psychiatry.She added that physicians could also help such patients by providing them with nutritional and physical activity counseling.Physical activity interacts positively with medication on a biological level by improving serotonin levels, added Ms. Tart. She added that although psychotropic medications are "miracle drugs" for many patients, the weight gain properties of these agents can also contribute to depression.Discussing the potential weaknesses of the study, Ms. Tart noted that this is a cross-sectional study. Also, she acknowledged that, as with “all psychological processes, there is likely bidirectional meaning: if you are obese, with the stigma associated with it, the lack of energy, the physical pain, and problems that come with it may make you more depressed.”Ms. Tart added that this research should be followed by longitudinal studies in which the relationships among diagnosis, medication use, and weight are followed over time. This would help better understand how much mood and medication affect weight and vice versa.Important Reminder "Several psychotropics are associated with weight gain as a risk factor: we still have to look at whether that is an outcome or an association," said Jerrold F. Rosenbaum, MD, psychiatrist-in-chief at Massachusetts General Hospital and Stanley Cobb Professor of Psychiatry at Harvard Medical School in Boston, Massachusetts. Dr. Rosenbaum, who is not associated with the study, commented on these findings in an interview with Medscape Psychiatry."Are people with obesity and psychiatric symptoms more likely to get treated, for example? The fact is, we know that with many psychotropic drugs you have to be aware of the risk-benefit ratio and monitor weight gain," he added. "There are choices one can make among the class of psychotropics, drugs that are greater or lesser offenders as far as weight gain.”"The study is an important reminder that there are health consequences in drug choice and those have to be weighed against symptom control and treatment," said Dr. Rosenbaum.Ms.Tart and Dr. Rosenbaum have disclosed no relevant financial relationships. Anxiety Disorders Association of America (ADAA) 30th Annual Conference: Abstract 149. Presented March 5, 2010.]

Authors and Disclosures

Journalist

Crina Frincu-Mallos, PhD

Crina Frincu-Mallos is a freelance writer for Medscape Medical News

 Psychotropic Medications Linked to Increased Rates of ObesityCrina Frincu-Mallos, PhDMarch 8, 2010 (Baltimore, Maryland) — Psychotropic medications, specifically antidepressants and antipsychotics, are associated with higher rates of obesity, new national data suggest.The research, presented here at the Anxiety Disorders Association of America 30th Annual Conference, shows that the obesity rate among individuals taking antidepressants during the past 12 months was 1.5 times greater compared with individuals not taking these medications. In addition, the obesity rate among subjects taking antipsychotics was more than double.A collaboration between researchers from the United States and Canada, the study examined the relationship between obesity and specific classes of psychotropic medications, including antidepressants, antipsychotics, anxiolytics, hypnotics, and mood stabilizers, in a large, nationally representative sample of 36,984 participants.Study subjects were participants in the Canadian Community Health Survey Mental Health and Well-being."There are issues that haven’t really been addressed in a population that already is at risk for unhealthy behaviors, since the risk for obesity is added on top of their mental illness," said first author Candyce D. Tart, MA, doctoral candidate in the Psychology Department at Southern Methodist University, Dallas, Texas.The preliminary results of the study, with principal investigator Jasper Smits, associate professor and director of the Anxiety Research & Treatment Program at Southern Methodist University, Dallas, Texas, suggest that the increased odds of obesity in mood disorders and anxiety disorders is mediated by psychotropic medication use.More precisely, the effects of psychotropic medication use appear to be specific to antidepressants and antipsychotics. The investigators found no relationship between mood stabilizers and obesity — a finding that contradicts previous research showing that these drugs are associated with significant weight gain.Exercise, Nutrition Advice: A Valuable Addition "If we are going to prescribe medications, we need to assist with addressing the possible risk of increased obesity and counsel them accordingly about weight management,” Ms. Tart told Medscape Psychiatry.She added that physicians could also help such patients by providing them with nutritional and physical activity counseling.Physical activity interacts positively with medication on a biological level by improving serotonin levels, added Ms. Tart. She added that although psychotropic medications are "miracle drugs" for many patients, the weight gain properties of these agents can also contribute to depression.Discussing the potential weaknesses of the study, Ms. Tart noted that this is a cross-sectional study. Also, she acknowledged that, as with “all psychological processes, there is likely bidirectional meaning: if you are obese, with the stigma associated with it, the lack of energy, the physical pain, and problems that come with it may make you more depressed.”Ms. Tart added that this research should be followed by longitudinal studies in which the relationships among diagnosis, medication use, and weight are followed over time. This would help better understand how much mood and medication affect weight and vice versa.Important Reminder "Several psychotropics are associated with weight gain as a risk factor: we still have to look at whether that is an outcome or an association," said Jerrold F. Rosenbaum, MD, psychiatrist-in-chief at Massachusetts General Hospital and Stanley Cobb Professor of Psychiatry at Harvard Medical School in Boston, Massachusetts. Dr. Rosenbaum, who is not associated with the study, commented on these findings in an interview with Medscape Psychiatry."Are people with obesity and psychiatric symptoms more likely to get treated, for example? The fact is, we know that with many psychotropic drugs you have to be aware of the risk-benefit ratio and monitor weight gain," he added. "There are choices one can make among the class of psychotropics, drugs that are greater or lesser offenders as far as weight gain.”"The study is an important reminder that there are health consequences in drug choice and those have to be weighed against symptom control and treatment," said Dr. Rosenbaum.Ms.Tart and Dr. Rosenbaum have disclosed no relevant financial relationships. Anxiety Disorders Association of America (ADAA) 30th Annual Conference: Abstract 149. Presented March 5, 2010.]

Authors and Disclosures

Journalist

Crina Frincu-Mallos, PhD

Crina Frincu-Mallos is a freelance writer for Medscape Medical News



Travelers From Haiti Bringing Malaria to USCHICAGO (Reuters) Mar 04 - Health experts watching for signs of a malaria outbreak have noticed several cases of the mosquito-borne disease among people traveling back from Haiti, where an earthquake in January killed as many as 300,000 people.So far, 11 laboratory-confirmed cases of malaria have been reported among emergency responders and those traveling in the United States from Haiti, the U.S. Centers for Disease Control and Prevention said on Thursday."Displaced persons living outdoors or in temporary shelters and thousands of emergency responders in Haiti are at substantial risk," researchers at the Pan American Health Organization and colleagues wrote in the CDC's weekly report on death and disease.Each year, Haiti reports about 30,000 confirmed cases of malaria to the Pan American Health Organization, but the CDC estimates as many as 200,000 may occur each year.Three cases the CDC cited occurred among Haitian residents traveling to the United States and one case involved a U.S. resident who was visiting Haiti. All are expected to recover fully.Six out of eight patients, including seven emergency responders, had been advised to take drugs to prevent malaria but had not done so, the PAHO experts said.According to the CDC, malaria transmission peaks after the two rainy seasons - November to January and again during May to June.The CDC said the reported cases do not require a change in policy, but said anyone traveling to Haiti should take drugs to help prevent infection.The CDC said it is continuing to monitor malaria in Haiti.Reuters Health Information © 2010 on is a freelance writer f From Heartwire

Components of Metabolic Syndrome Linked to Plaque ProgressionLisa NainggolanMarch 10, 2010 (Cleveland, Ohio) — A new intravascular ultrasonography (IVUS) study has found that the metabolic syndrome is associated with accelerated plaque progression, but this is attributed to the individual component risk factors rather than the presence of the syndrome itself [1]. Dr Ozgur Bayturan (Cleveland Clinic, OH) and colleagues report their findings in the March 8, 2010 issue of the Archives of Internal Medicine."Simply put, if you had the metabolic syndrome, you had twice as much [atheroma] progression as patients who didn't have the syndrome," senior author Dr Stephen J Nicholls (Cleveland Clinic) told heartwire . "But if you then started to control for the individual risk factors, you no longer saw greater progression. In a nutshell, what this tells us is that the metabolic syndrome reflects the patient at high risk, but it doesn’t suggest a direct effect of the syndrome itself on the vessel wall."
The metabolic syndrome reflects the patient at high risk, but it doesn’t suggest a direct effect of the syndrome itself on the vessel wall.
In this respect, the findings are consistent with previous population studies indicating that the syndrome probably doesn't represent a distinct disease entity, says Nicholls. It shows that "the metabolic syndrome continues to be important, but it's important in pointing to those with coronary disease who really need to have their major risk factors aggressively modified," he says.In an invited commentary [2], Drs Eric L Ding (Harvard School of Public Health, Boston, MA), Liesbeth A Smit (VU University, Amsterdam, the Netherlands), and Frank B Hu (Harvard School of Public Health) agree: "Existing data do not support that metabolic syndrome provides better disease prediction than its individual components or represents a distinct disease syndrome."High Triglycerides, Obesity Strongly Associated With Plaque Progression In their systematic review of 3459 patients participating in seven clinical trials that monitored coronary atheroma progression with IVUS, Bayturan et al compared patients with or without metabolic syndrome for clinical characteristics, coronary atheroma burden at baseline, and change on serial evaluation. A person with three of the following five components is described as having metabolic syndrome--hyperglycemia, hypertriglyceridemia, hypertension, low HDL-C level, and central adiposity.Relationships between plaque progression (>5% increase in percent atheroma volume [PAV]), metabolic syndrome, and its component risk factors were investigated.More than half the patients had metabolic syndrome (57.8%), and it was associated with greater progression of PAV (+0.51% vs +0.23%; p=0.003) and a greater likelihood of undergoing progression of PAV (multivariate adjusted odds ratio 1.25; p=0.01).The researchers also found that the risk of plaque progression differed depending on which of these five components were present. When the individual components were used in the model instead of metabolic syndrome, hypertriglyceridemia (OR 1.26; p=0.008) and a body-mass index (BMI) of 30 or higher (OR 1.18; p=0.05) predicted progression of PAV. "The ones that really stood out in this analysis were obesity and high levels of triglycerides," Nicholls noted.But after adjustment for its individual components, metabolic syndrome was no longer an independent predictor (OR 1.04; p=0.79).A "Diagnosis" of Metabolic Syndrome Is Helpful in Controlling Risk Factors Nevertheless, a diagnosis of the syndrome may be useful, say the researchers, if only for the fact that it highlights a patient with multiple atherogenic risk factors.In particular, high triglycerides and obesity in these patients provide important targets for potential therapeutic intervention to more effectively reduce cardiovascular risk, they conclude.Ding, Smit and Hu agree. Recognition of the metabolic syndrome is "highly relevant for prevention efforts at both the individual and population level," they state. A diagnosis of metabolic syndrome "could help motivate patients to make lifestyle changes that prevent progression of the syndrome to diabetes or cardiovascular disease."Bayturan reports no conflicts of interest. Nicholls has received honoraria from Pfizer, AstraZeneca, Takeda, and Merck/Schering-Plough; consultancy fees from Pfizer, AstraZeneca, Roche, Novo Nordisk, Merck/Schering-Plough, Liposcience, and Anthera Pharmaceuticals; and research support from AstraZeneca, Lipid Sciences, Novartis, and Resverlogix. Disclosures for the other coauthors are listed in the paper. Ding, Smit, and Hu report no conflicts of interest. [ CLOSE WINDOW ]

References

1.       Bayturan O, Tuzcu M, Lavoie A, et al. The metabolic syndrome, its component risk factors, and progression of atherosclerosis. Arch Intern Med 2010; 170:478-484.2.       Ding EL, Smit AL, Hu FB et al. The metabolic syndrome as a cluster of risk factors: Is the whole greater than the sum of its parts? Arch Intern Med 2010; 170: 484-485.[CLOSE WINDOW]

Authors and Disclosures

Journalist

Lisa Nainggolan

Lisa Nainggolan is a journalist for theheart.org, part of the WebMD Professional Network. She has been with theheart.org since 2000. Previously, she was science editor of Scrip World Pharmaceutical News, covering news about research and development in the pharmaceutical industry, and a consultant editor of Scrip Magazine. Graduating in physiology from Sheffield University, UK, she began her career as a poisons information specialist at Guy's Hospital before becoming a medical journalist in 1995. She can be reached at LNainggolan@webmd.net.or Medscape.From Reuters Health Information

Rosuvastatin Beneficial for Patients With Kidney Disease and Elevated CRPNEW YORK (Reuters Health) Mar 03 - In patients with moderate kidney disease and elevated high-sensitivity C-reactive protein, rosuvastatin helps reduce cardiovascular events and all-cause mortality, new research shows.The findings stem from a secondary analysis of data from the JUPITER trial, which compared rosuvastatin to placebo for preventing first-ever cardiovascular events in men over 50 and women over 60.The original study involved nearly 18,000 participants. The post hoc analysis, reported in the March 23rd Journal of the American College of Cardiology, focused on 3267 subjects with moderate chronic kidney disease at baseline, as defined by an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. At baseline, they had low density lipoprotein cholesterol levels below 130 mg/dL but high-sensitivity C-reactive protein levels of 2 mg/L or higher.Lead author Dr. Paul M. Ridker, from Brigham and Women's Hospital, Boston, and colleagues report that over a median follow-up period of 1.9 years, the men and women with moderate chronic renal disease were 54% more likely to experience a vascular event, compared to the 14,528 JUPITER participants with normal renal function (p = 0.0002).In patients with moderate chronic kidney disease, rosuvastatin cut the rate of the primary endpoint (myocardial infarction, angina hospitalization, revascularization, or cardiovascular death) to 1.08 per 100 person-years, from the 1.95 per 100 person-years seen with placebo (hazard ratio, 0.55; p = 0.002). In addition, use of the drug reduced all-cause mortality from 1.53 to 0.85 per 100 person-years (HR 0.56, p = 0.005).Compared to patients in the placebo group, patients in the rosuvastatin group had slightly improved renal function at 12 months.Rosuvastatin had similar effects on cholesterol and C-reactive protein levels in patients with and without kidney disease, and similar side effects.J Am Coll Cardiol 2010From WebMD Health News

Regular Analgesic Use May Increase Risk for Hearing LossFran LowryMarch 11, 2010 – Regular use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or acetaminophen may increase the risk for hearing loss in men, and the impact is larger on those younger than 60 years, according to a prospective study published in the March issue of the American Journal of Medicine."Aspirin, acetaminophen, and ibuprofen are the 3 most commonly used drugs in the US," write Sharon G. Curhan, MD, ScM, from Brigham and Women's Hospital, Boston, Massachusetts, and colleagues. "Given that analgesic use might result in pathophysiologic changes in the cochlea and that regular use of these analgesics is so common, the relation of these medications and hearing loss might be an important public health issue."However, Curhan and colleagues point out several study limitations that may affect the results of their study. Two independent commentators interviewed by Medscape Family Medicine reiterate these limitations and emphasize that causality cannot be determined from the study results. Yet, both agree that the study focuses on an important issue.Findings of the Study The aim of this study was to determine if there was an association between regular analgesic use and the risk for hearing loss.The study subjects were participants in the Health Professionals Follow-up Study, which enrolled 51,529 male dentists, optometrists, osteopathic physicians, pharmacists, podiatrists, and veterinarians aged 40 to 75 years at baseline in 1986. The participants filled out detailed questionnaires about their diet, medical history, and medication use, including their use of aspirin, NSAIDs, and acetaminophen, at baseline and every 2 years thereafter. Regular analgesic use was defined as 2 or more times per week.In 2004, the questionnaire asked participants if they had been professionally diagnosed with hearing loss and, if so, the year of their diagnosis. Incident cases were defined as hearing loss diagnosed after 1986.The authors analyzed 26,917 men from the original cohort. They excluded men who were diagnosed with hearing loss before 1986; those who had been exposed to ototoxic chemotherapeutic agents; and, because age is such a strong risk factor and the prevalence of hearing loss is so high among the elderly population, those who had reached age 75 years during follow-up.During 369,079 person-years of follow-up, 3488 cases of hearing loss were reported. Regular analgesic use was independently associated with an increased risk for hearing loss for all 3 types of analgesics.After controlling for age, race, profession, body mass index, alcohol intake, folate intake, physical activity, smoking, hypertension, diabetes, and the use of other classes of analgesics, the hazard ratios of hearing loss in regular users vs those who used aspirin, NSAIDs, or acetaminophen less than twice per week were 1.12 (95% confidence interval [CI], 1.04 - 1.20) for aspirin, 1.21 (95% CI, 1.11 - 1.33) for NSAIDs, and 1.22 (95% CI, 1.07 - 1.39) for acetaminophen.These results were further adjusted for a history of elevated cholesterol, cardiovascular disease, use of furosemide, rheumatoid arthritis, and osteoarthritis, and remained the same, the study authors report.The risk for hearing loss also increased with longer duration of regular use. Men who used aspirin regularly for 1 to 4 years were 28% (95% CI, 17% - 40%) more likely to develop hearing loss than those who did not, although this risk did not increase with longer duration of use, the study authors report.Men who used NSAIDs for 4 or more years were 33% (95% CI, 18% - 49%) more likely to develop hearing loss, and men who used acetaminophen for 4 or more years were also 33% (95% CI, 14% - 56%) more likely to develop hearing loss.The study authors also report that the magnitude of the association between analgesic use and hearing loss was substantially higher in younger men. For men younger than 50 years, the hazard ratio (HR) for hearing loss was 1.33 for regular aspirin use, 1.61 for NSAIDs, and 1.99 for acetaminophen. No such association was observed in men 60 years and older.Combining 2 classes of analgesics also increased the risk for hearing loss, the study authors report. The risk was highest when NSAIDs and acetaminophen were combined (HR, 1.58; 95% CI, 1.16 - 2.16).Study Limitations That the diagnosis of hearing loss was self-reported is a limitation of this study. Another is the lack of information on lifetime noise exposure, which is a known risk factor for hearing loss.In addition, the study population consisted of predominantly white men; therefore, the results may not be generalizable to other racial groups. Other studies in women, younger men, and other racial groups are needed to examine whether similar associations between analgesic use and hearing loss exist in these groups, the study authors write.Hearing loss because of regular use of analgesics represents an important public health issue, "given the high prevalence of regular analgesic use and health and social implications of hearing impairment," the study authors conclude.Can Definitive Conclusions Be Made From the Study? Commenting on the study in an interview with Medscape Family Medicine, Pamela Roehm, MD, PhD, of the New York University School of Medicine, New York, NY, said it was potentially interesting but had certain limitations that make it difficult to draw any definite conclusions.Dr. Roehm comments on the limitations cited by the study authors: "The study was not designed to look at the link between hearing loss and analgesic use. They don't have any measures of noise exposure, and this is a huge issue, especially with sensory neural hearing loss in men."The issue of familial hearing loss was not addressed, and neither was the type of hearing loss. "The genetic predilection for hearing loss was not taken into account. Also, this was a study of professional men, mainly Caucasian. There are going to be some genetic tendencies for hearing loss that have not been taken into account by the study," she said.She agreed that the association between NSAID use and hearing loss has yet to be explained. However, the association between aspirin and hearing loss is well known to be reversible and therefore a problem that is easily remedied.With regard to the link between acetaminophen and hearing loss, Dr. Roehm said she would have liked to know if codeine was also involved."There is not a lot of literature on acetaminophen on its own being linked to hearing loss. In fact, I couldn't find any at all. But there is quite a bit of recent literature on acetaminophen plus codeine and sensory neural hearing loss. This study brings up interesting associations, but a lot of avenues still need to be explored further," she said.Medscape Family Medicine also interviewed John K. Niparko, MD, director of otolaryngology at Johns Hopkins Medicine in Baltimore, Maryland, for an independent comment on the study. Dr. Niparko told Medscape Family Medicine that the fact that there is no information about noise exposure is a very serious limitation of the study."This is a study of observation and association and does not prove that these medicines caused the hearing loss," he said. "These are very valuable medications for a variety of disorders, so we have to be cautious in interpreting results that show an association but do not prove causality."However, he congratulated the study authors for investigating the potential causes of hearing loss, which "has become a major public health concern in the US."This study was supported by the National Institutes of Health and the Massachusetts Eye and Ear Infirmary Foundation, Boston. Drs. Curhan, Roehm, and Niparko have have disclosed no relevant financial relationships. Am J Med. 2010;123:231-237. Abstract  

Authors and Disclosures

Journalist

Fran Lowry

is a freelance writer for Medscape.

FDA NEWS RELEASE

For Immediate Release: March 4, 2010
Media Inquiries: Rita Chappelle, 301-796-4672, rita.chappelle@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

Salmonella Tennessee Identified in a Processed Food Ingredient
FDA taking steps to instruct industry and protect consumers

The U.S. Food and Drug Administration is taking steps to protect the public following the early identification of Salmonella Tennessee in one company’s supply of hydrolyzed vegetable protein (HVP). This is a common ingredient used most frequently as a flavor enhancer in many processed foods, including soups, sauces, chilis, stews, hot dogs, gravies, seasoned snack foods, dips and dressings.

In coordination with the Centers for Disease Control and Prevention, the U.S. Department of Agriculture, other federal agencies, and state health departments, FDA is closely monitoring and assessing the potential risks of illness from affected products.

“Our investigators were able to identify this problem before any illnesses occurred," said FDA commissioner Dr. Margaret A. Hamburg. "While the investigation is continuing, the agency is supporting reasonable steps to continue to protect the public health.”

The manufacturer of the affected product is Basic Food Flavors Inc in Las Vegas, Nevada. Only HVP manufactured by Basic Food Flavors is involved in this recall. The FDA conducted an investigation at the facility after a customer of Basic Food
Flavors reported finding Salmonella Tennessee in one production lot of HVP to the new FDA Reportable Food Registry.

FDA collected and analyzed samples at the facility and confirmed the presence of Salmonella Tennessee in the company’s processing equipment. The company is recalling all hydrolyzed vegetable protein in powder and paste form that it has produced since Sept. 17, 2009. 

“This situation clearly underscores the need for new food safety legislation to equip FDA with the tools we need to prevent contamination," said Dr. Jeff Farrar, associate commissioner for food protection, FDA’s Office of Foods.

At this time, there are no known illnesses associated with this contamination.

At this time, FDA is taking several steps to instruct industry and protect consumers from potential Salmonella infection.

FDA is advising industry that the recalled bulk HVP product should be destroyed or reconditioned according to FDA-approved procedures. FDA is also recommending recalls of certain products that might be eaten by consumers without any processing or
cooking steps to address the potential risk. FDA is recommending that consumers should:

  • Check www.foodsafety.gov1 for a list of recalled products;
  • Remember to follow cooking instructions for all foods.
  • Report symptoms of Salmonella or other food-related illness to your local
    health care professional.

Salmonella is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy people infected with Salmonella often experience fever, diarrhea (which may be blood), nausea,vomiting, and abdominal pain. Most healthy people recover from Salmonella infections within four to seven days without treatment. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses, such as arterial infections (infected aneurysms), infection of the lining of the heart, and arthritis.

For more information on the basics on Salmonella (such as sources, symptoms, duration of illness):

Brain Fitness Games Improve Delayed Memory in Elderly AdultsPam HarrisonMarch 8, 2010 (Savannah, Georgia) — Elderly adults who play brain fitness games that exercise global aspects of memory show improvements in the domain of delayed memory at 6 months compared with a slight decline in active controls, according to preliminary findings presented here at the American Association for Geriatric Psychiatry 2010 Annual Meeting.Karen Miller, PhD, University of California at Los Angeles, reported that significant differences were observed at 6 months after randomization between the intervention group who were assigned to the Dakim BrainFitness computerized memory program vs active controls, even though after 2 months of training, "controls” were also given the same training as the intervention group.Assessed by 4 different memory tests, the group who played the BrainFitness game for the full 6 months gained almost 2 points on memory scores, increasing from 10.4 at baseline to 12.1 at follow-up.This is in contrast to controls, who, having played the same BrainFitness game from month 2 to month 6, had the same memory scores decrease slightly from 10.2 at baseline to 10.1 at follow-up (P = .001). A total of 38 elderly subjects completed the 6-month trial, 22 at an average age of 82 years in the intervention group and 16 at an average age of 83 years in the control group."By month 6, the intervention group had played more than double the number of sessions at 93 compared with only about 40 sessions played by active controls, so it’s the long-term use that improves overall memory. The maximum benefit comes when you keep on playing," Dr. Miller told Medscape Psychiatry. Pilot Study Before launching the clinical trial, Dr. Miller and colleagues carried out a pilot study involving 22 elderly subjects, with an average age of 74 years, who were assigned to the Dakim BrainFitness computerized game or to an active control group.Participants played the game 5 times a week, each session lasting 30 minutes, for 2 months. At the end of the 2-month pilot study, a modest effect size was seen on 1 memory test.Realizing that this particular version of the BrainFitness game did not exercise traditional aspects of memory training, including encoding and long-term memory, UCLA investigators helped Dakim redesign the game. The version used in their latest clinical trial now exercises short-term memory, critical thinking, visual spatial skills, long-term memory, calculations, and language."There is also a variety of 300 to 400 games or events that cycles through each time a senior plays so they are not going through the same format each time," Dr. Miller said."There are also 5 levels which can be preselected so this machine allows seniors to move up and down between levels, depending on how well they perform on different aspects of memory," she added.Dr. Miller also stressed that to see a training effect on memory, it is likely subjects will need to commit to regular memory training exercises, much in the same way people need to commit to other lifestyle behaviors, such as exercise and stress reduction.She also believes computerized training will only be helpful in preventing memory decline in people whose memory is still relatively healthy.Memory training devices, such as the program modified and used by the UCLA group, are also likely to benefit subjects with amnestic memory impairment and not those with impairment in multiple domains.Dr. Miller noted that, in her experience, subjects with impairment in multiple domains continue to deteriorate relatively quickly even when they used the BrainFitness device on a regular basis."The longer a person is exposed to the BrainFitness program, the more likely they are to improve in verbal and visual memory. Even if you have no computer skills, you are able to use it," said Dr. Miller.Preliminary Results Gary Small, MD, University of California at Los Angeles, told Medscape Psychiatry that these preliminary results are "encouraging" and that the Dakim BrainFitness program is a popular device in centers where it is been tested. "It is very much tailored to the older generation, with an easy-to-use touch screen, so seniors are enjoying it," he added.On the other hand, companies manufacturing these brain fitness games need to make sure the games are more than just fun and engaging and that they exercise all domains of memory, such as the Dakim BrainFitness program appears to do."The issue really is will these devices improve cognitive skills?" Dr. Small added that it is certainly feasible to incorporate the kinds of games and techniques into brain games that improve cognitive skills, as he himself has done it with training programs — companies just need the will to do so.Dr. Miller and Dr. Small disclose a financial conflict of interest with Dakim. Dr. Small has received consulting and speaker's fees from a number of pharmaceutical companies not relevant to his research with Dakim.

American Association for Geriatric Psychiatry's (AAGP) 2010 Annual Meeting: Session 212. Presented March 6, 2010.

Authors and Disclosures

Journalist

Pam G. Harrison

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