Grandparents, Older Adults Encouraged To Seek Help For A Sleep Disorder

September 9 is National Grandparents Day, a day to honor grandparents across America as important members of our families and communities. Grandparents play important roles in life, including that of guardian, comforter, and mentor. As they get older, however, several aspects of their lives change, including their sleep patterns. While older adults need about seven to eight hours of sleep each night, many often get less sleep, which may make them more susceptible to health problems.

“As we get older, our sleep is more easily disturbed,” says James P. Krainson, MD, of the South Florida Sleep Diagnostic Center in Miami and a spokesperson for the American Academy of Sleep Medicine (AASM). “Underlying health issues are often the cause of these disturbances. Arthritis and pain can cause frequent awakenings and interfere with falling asleep. Cardiovascular, neurologic, urologic and psychologic disturbances can likewise play havoc with our sleep. In fact, most all medical problems can disturb our sleep, and the older adults’ sleep is most vulnerable.”

Many older adults often have more trouble falling asleep than persons in other age groups. A study of adults over the age of 65 found that 13 percent of men and 36 percent of women take more than 30 minutes to fall asleep.

There are many other possible explanations for changes in older adults’ sleep patterns, says Dr. Krainson. Older adults may produce and secrete less melatonin, the hormone that promotes sleep. They may also be more sensitive to changes in their environment, such as noise, and this may cause them to awaken. Further, older adults may also have other medical and psychiatric problems that can affect their sleep, says Dr. Krainson, adding that researchers have noted that people without major medical or psychiatric illnesses report better sleep.

Several studies that outline the negative consequences of bad sleep among older adults were presented at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies, this past June:

пЃ® Cognitive behavioral therapy successfully improves both immediate and long-term self-reported sleep and pain in older osteoarthritis patients. This demonstrates that improving sleep can be “analgesic” in older osteoarthritis patients, and that techniques to improve sleep should be considered for addition to treatment programs for pain management in osteoarthritis and possibly other pain-states.

– Regular aerobic exercise, combined with sleep hygiene education, improves sleep and quality of life in older adults with chronic insomnia.

– Untreated sleep complaints may pose a risk for falls.

– Older adults who reported engaging in shorter and less frequent naps during the day also reported spending more time asleep at night. Such older individuals also experienced more sleep time and slept more efficiently at night.

– A sleep-related breathing disorder may be associated with impairments in cognitive function in older men.

– Objectively determined estimates of short sleep were strongly related to obesity in older men and women.

Dr. Krainson notes that several studies published in recent issues of the journal SLEEP have some interesting findings about older persons and sleep:

– The effects of insomnia are different in older and younger people. While associations between insomnia and separated, divorced or widowed marital status were strongest in younger age groups, longer bouts with insomnia were more common in the older population, who are also more likely to be taking types of sedatives that have particular problems with addiction and side effects.

– As sleep quality and quantity typically decrease with age, objectively measured differences in the amount of sleep a healthy older man gets can affect his level of testosterone in the morning.

– A brief behavioral treatment for insomnia appears to be a promising intervention for older adults who suffer from insomnia.

According to Dr. Krainson, some of the more common sleep disorders in older adults include:

– Insomnia affects almost half of adults 60 and older.

– Obstructive sleep apnea (OSA) can elevate the risk for high blood pressure, stroke, heart disease, and cognitive problems. Snoring, a symptom of OSA, is a very common condition affecting nearly 40 percent of adults, and is more common among older people.

– Restless legs syndrome, where one experiences uncomfortable feelings in the legs, affects more than 20 percent of people 80 years and older.

– Periodic limb movement disorder, a condition that causes people to jerk and kick their legs every 20-40 seconds during sleep, is evident in almost 40 percent of older adults.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls and use more over-the-counter or prescription sleep aids. In addition, recent studies associate lack of sleep with serious health problems such as an increased risk of obesity, cardiovascular disease and diabetes.

Despite obstacles many older adults have to overcome in order to get a good night’s sleep, Dr. Krainson says that it does not mean they are doomed to chronic sleep deprivation. While most people require seven to eight hours of sleep a night to perform optimally the next day, older adults might find this harder to obtain, says Dr. Krainson, adding that they must be more aware of their sleep and maintain good sleep hygiene by following these tips:

– Establishing a routine sleep schedule.

– Avoiding utilizing bed for activities other than sleep or intimacy.

– Avoiding substances that disturb your sleep, like alcohol or caffeine.

– Not napping during the day. If you must snooze, limit the time to less than one hour and no later than 3 p.m.

– Stick to rituals that help you relax each night before bed. This can include such things as a warm bath, a light snack or a few minutes of reading.

– Don’t take your worries to bed. Bedtime is a time to relax, not to hash out the stresses of the day.

– If you can’t fall asleep, leave your bedroom and engage in a quiet activity. Return to bed only when you are tired.

– Keep your bedroom dark, quiet and a little cool.

Dr. Krainson says that, although sleep patterns change as people age, disturbed sleep and waking up tired every day are not part of normal aging. Those who have trouble sleeping are advised to see a sleep specialist at a facility accredited by the AASM.

“Be prepared to tell the doctor how you spend your day and night, including your medicines, fluid intake and activities so that they will have all the information needed to decide how best to help you,” says Krainson.

For a listing of AASM-accredited facilities in your area, visit SleepCenters.

AASM is a professional membership organization dedicated to the advancement of sleep medicine and sleep-related research.


Smoking Indicator Of Alcohol Misuse

Where there is cigarette smoking there is probably misuse of alcohol too, according to a study by Yale School of Medicine researchers in the Archives of Internal Medicine.

“This means cigarette smoking status can be used as a clinical indicator for alcohol misuse, which presents an opportunity for intervention,” said the principal investigator, Sherry McKee, assistant professor of psychiatry.

She said that although brief screening and brief intervention provided in primary care settings are effective, clinicians do not frequently screen for alcohol misuse. This is a matter of concern because 26 percent of the U.S. population is drinking at hazardous levels, which puts them at increased risk for alcohol-related consequences such as injuries from motor vehicle crashes, hypertension, depression, and certain cancers.

“Only an estimated 30 percent of individuals who had a primary care visit reported being screened for an alcohol or drug use problem,” McKee said. “Physicians are much more likely to ask patients whether and how often they smoke.”

She and her collaborators arrived at their conclusions after analyzing data obtained from 42,374 adults in a national epidemiological survey on alcohol misuse and other related conditions. Following guidelines that physicians use to assess tobacco and alcohol use, they found that non-daily smokers are five times more likely to have a problem with alcohol compared to people who have never smoked. Daily smokers are three times more likely to have an alcohol problem.

“This is the first study to document that individuals who are smokers, but don’t smoke every day, have the highest rates of problem drinking,” McKee said. “Using smoking status as a ‘red flag’ for more aggressive assessment of alcohol use is a highly feasible and clinically sensible approach to screening.”

The findings, she said, highlight the importance of physicians adopting standard alcohol screening questions into their practice.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines hazardous drinking as exceeding either daily or weekly drinking limits. Men should consume no more than four drinks in a day, and no more than 14 drinks in a week. Women should consume no more than three drinks in a day, and no more than seven drinks in a week. Additional information about NIAAA guidelines concerning problem drinking can be found here .

The NIAAA and the Robert Wood Johnson Foundation supported the study.

Archives of Internal Medicine 167: 716-721 (April 9, 2007)

Salt’s Effect On Blood Pressure Decreased By Physical Activity

The more physically active you are, the less your blood pressure rises in response to a high-salt diet, researchers reported at the American Heart Association’s Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention 2011 Scientific Sessions.

“Patients should be advised to increase their physical activity and eat less sodium,” said Casey M. Rebholz, M.P.H., lead author of the study and a medical student at the Tulane School of Medicine and doctoral student at the Tulane University School of Public Health & Tropical Medicine in New Orleans. “Restricting sodium is particularly important in lowering blood pressure among more sedentary people.”

Investigators compared study participants’ blood pressure on two one-week diets, one low in sodium (3,000 mg/day) and the other high in sodium (18,000 mg/day).

The American Heart Association recommends consuming less than 1,500 mg/day of sodium.

If a person’s average systolic blood pressure (the top number in the reading, measured when the heart is contracting) increased 5 percent or more from the low-sodium to the high-sodium regimen, the researchers labeled them as high salt-sensitive.

Based on physical activity questionnaires, researchers divided participants into four groups ranging from very active to quite sedentary.

The average increases in systolic blood pressure after switching from low to high sodium, adjusted for age and gender, were:
5.27 mm Hg in the least active group
5.07 mm Hg in the next-to-lowest activity group
4.93 mm Hg in the next to highest activity group
3.88 mm Hg in the most active group

Compared with the sedentary group, the odds of being salt-sensitive, adjusted for age and gender, fell:
10 percent in the next-to-lowest activity group
17 percent in the next-to-highest activity group
38 percent in the most active group

“In all the analyses we found a dose-response relationship with the more activity, the better,” Rebholz said.

The participants were 1,906 Han Chinese adults (average age 38) in the Genetic Epidemiology Network of Salt Sensitivity (GenSalt), a large project to identify genetic and environmental factors contributing to salt sensitivity. Siblings and their parents were invited to become involved in GenSalt if at least one sibling had pre-hypertension (blood pressure between 120/80 and 139/89 mm Hg) or stage-1 hypertension (between 140/90 and 159/99 mm Hg). No one was on blood pressure medication during the study.

The GenSalt project is located in rural China because the homogeneous population makes it more likely that genes influential to blood pressure control will be identified.

“The study needs to be repeated, but I suspect that the relationship between physical activity and salt-sensitivity will apply to other populations,” Rebholz said.


Co-authors are: Dongfeng Gu, Ph.D.; Jing Chen, M.D., M.S.; Jian-feng Huang, M.D.; Jie Cao, M.D., M.S.; Ji-chun Chen, M.D., M.S.; Jianxin Li, M.D.; Fanghong Lu, M.D.; Jianjun Mu, M.D.; Jixiang Ma, M.D.; Dongsheng Hu, M.D., M.S.; Xu Ji, M.D.; Lydia A. Bazzano, M.D., Ph.D.; Depei Liu, M.D., Ph.D.; and Jiang He, M.D., Ph.D.

Author disclosures and sources of funding are on the abstract.

American Heart Association

U Of MN Adult Stem Cell Research Shows Promise For Transplant Therapies

University of Minnesota stem cell researchers, together with collaborators at Stanford University, have successfully used adult stem cells to replace the immune system and bone marrow of mice, offering the promise of new therapies for people in the future. With this advance and other recent discoveries, the researchers are winning over previous skeptics.

For decades, researchers have tried in the lab to expand hematopoietic stem cells (cells that give rise to the blood system). Success in this venture would mean increasing the supply of cells available for bone marrow transplant patients. The researchers used multipotent adult progenitor cells (MAPCs), which can be isolated from bone marrow and have the ability in the laboratory to differentiate into different specific types of cells such as liver, bone and neural cells.

Catherine Verfaillie, M.D., director of the University’s Stem Cell Institute, first identified MAPCs in 2001. Since then, many in the scientific community have been skeptical of their existence and their functioning as Verfaillie has described. This skepticism mostly arose due to difficulty in reliably growing these cells, which made reproduction in other labs problematic. Since their identification, the methods to isolate and grow MAPCs have been improved (see publication in Experimental Hematology, October 2006). This latest research will be available online from the Journal of Experimental Medicine on January 15; it will appear in the Jan. 22, 2007; print edition of the journal.

Verfaillie and her team isolated MAPCs from mice and expanded them for at least 80 doublings in the lab. They then transplanted the cells into mice that received radiation and thus had no immune system.

“The cells not only survived when transplanted but they completely repopulated the blood system of the mice,” Verfaillie said. The MAPCs did not differentiate into other cell types, such as liver or brain cells, nor did they form tumors in any animals.

Irving Weissman, M.D., Stanford University professor of pathology and developmental biology and co-author on the manuscript, was admittedly skeptical at first about the ability of MAPCs to contribute to blood formation. This skepticism made him an ideal collaborator, as he insisted on rigorous evaluation of the data. “These experiments point to potential precursors of blood forming stem cells in an unexpected population of cultured cells,” said Weissman, who directs Stanford’s Institute for Stem Cell Biology and Regenerative Medicine.

“Scientists must now understand that mouse MAPCs can make normal blood, and we need to explore how they do it,” Weissman said. “It is very important to note that MAPCs were not themselves radioprotective, thus they alone could not be used in patients in whom the bone marrow is totally eliminated due to radiation or chemotherapy, but it is still remarkable that they can give rise to blood cells.”

Bruce Blazar, M.D., professor of Pediatrics at the University of Minnesota, who is co-author of the paper, has continued with experiments conducted in his laboratory after the completion of this study. “Our results independently confirmed in an additional series of animals the finding that MAPCs can make blood cells,” Blazar said. While more research will need to be done and studies need to be replicated with human MAPCs before human treatments are available, this research suggests that MAPCs could be used to help reduce rejection of tissue transplants. In the future, physicians may be able to introduce MAPCs in the blood system of the recipient to trick the immune system into accepting the MAPC-generated transplanted tissue. In addition to this paper, in the last few months further evidence of MAPCs existence and function was published in scientific peer-reviewed journals based on research done at the University and other research institutions across the world. “I am pleased to see this science replicated at other research universities,” Verfaillie said. “Now there is further confirmation that the MAPCs could be a valid source of new therapies.” Verfaillie added this research shows the importance of continuing to pursue all types of stem cell research, adult and embryonic, because scientists do not yet know which cell type will prove most promising for treating a particular disease.

MAPCs found in pigs

Verfaillie and colleagues had previously isolated MAPCs from bone marrow of humans, mice and rats. But in order to study potential treatments for people, the research needs to be tested in animal models that are more physiologically similar to humans. In the November 2006 issue of the journal Stem Cells, Verfaillie described how MAPCs can be isolated from pig bone marrow. Pigs are routinely used as a model for humans, especially in cardiovascular research. The researchers were able to isolate and grow the pig MAPCs with some modifications much like they identify human, mouse and rat MAPCs. After isolating the MAPCs, the scientists were able to differentiate the cells into different types of cells that give rise to bone, smooth muscle, fat, cartilage, endothelium (cells that line blood vessels), and cells that are similar to liver and brain cells.

MAPCs and endothelial cells

A team of researchers from the University of Navarra in Pamplona, Spain, the Catholic University of Leuven, Belgium, and the University of Minnesota published in the journal Blood (November 2006) on the ability of MAPCs to differentiate into two types of endothelial cells, which line the inner walls of blood vessels. By adding various growth factors, the researchers, led by Felipe Prosper, M.D., of Spain, were able to make the human MAPCs differentiate into both arterial endothelial and venous endothelial cells in both a laboratory environment and in mice. Like the studies showing that MAPCs can make blood when transplanted, this is a second example demonstrating that MAPCs can contribute to a tissue when grafted in vivo. “This work provides the first evidence that human MAPCs can be induced to differentiate into the different types of cells needed to form arteries,” Prosper said. “This may suggest future clinical applications for MAPCs in diseases and conditions such as stroke and heart attack.” In addition, this discovery provides researchers a model to study how human arteries and veins develop.

MAPCs create smooth muscle

Verfaillie and colleagues published in the December 2006 issue of the Journal of Clinical Investigation that MAPCs can generate smooth muscle cells in the laboratory. Smooth muscle cells contract, often without conscious control, regulating body functions such as blood pressure and movement of food through the digestive system.

“While previous research has demonstrated that various types of stem cells can turn into cells that express the proteins consistent with smooth muscle, this is the first study that shows that the cells we generated have the same functional properties as smooth muscle, as well as express the same proteins,” said Jeffrey Ross, Ph.D., research associate at the Stem Cell Institute. These observations suggests that in the future, researchers may be able to make functional tissue in the lab from MAPCs, such as engineering a new blood vessel for use in bypass surgery. As smooth muscle cells are involved in many diseases like hypertension or asthma, the ability to generate smooth muscle cells with all functional attributes of this cell type also opens the possibility that they can be used to screen new drugs in the lab to determine how the cells react to potential new therapies.


Contact: Sara E. Buss

University of Minnesota

House Approves Stem Cell Research Enhancement Act; Bush Threatens Veto

The House on Thursday voted 247-176 to pass a bill (S 5) that would allow federal funding for research using stem cells derived from human embryos originally created for fertility treatments and willingly donated by patients, the New York Times reports (Zeleny/Wade, New York Times, 6/8).

Federal funding for human embryonic stem cell research is allowed only for research using embryonic stem cell lines created on or before Aug. 9, 2001, under a policy announced by President Bush on that date. The Senate in April voted 63-34 to pass the bill, called the Stem Cell Research Enhancement Act of 2007. The measure differs from a House-approved bill (HR 3) of the same name because it includes language that would require NIH to research and fund methods of creating embryonic stem cell lines without destroying embryos (Kaiser Daily Women’s Health Policy Report, 6/1).

Bush — who is attending the Group of Eight industrialized nations 2007 summit in Heiligendamm, Germany — said he plans to veto the measure after he returns June 11 (George, CQ Today, 6/7). House Speaker Nancy Pelosi (D-Calif.), Senate Majority Leader Harry Reid (D-Nev.) and other Democratic lawmakers on Thursday at a ceremony marking the bill’s passage called on Bush to not veto the legislation, CongressDaily reports (Edney, CongressDaily, 6/7).

Vote Details
According to the Times, 210 Democrats and 37 Republicans in the House voted for the measure, which is 35 votes short of what would be needed to override a presidential veto. Sixteen Democrats and 160 Republicans voted against the legislation, the Times reports. If Bush vetoes the measure, the Senate would attempt to override the veto first; however, even counting the three Democratic senators that were absent for the original vote, the chamber is one vote short of the two-thirds majority needed to override a veto, the Times reports (New York Times, 6/8).

Bush in a statement said, “I am disappointed the leadership of Congress recycled an old bill that would simply overturn our country’s carefully balanced policy on embryonic stem cell research.” He added that under the bill, “American taxpayers would for the first time in our history be compelled to support deliberate destruction of human embryos. Crossing that line would be a grave mistake. For that reason, I will veto the bill.”

Rep. Diana DeGette (D-Colo.) — noting a Gallup poll that indicates that 64% of U.S. residents support embryonic stem cell research — said, “The Senate gets it. The public gets it. The House gets it. Why doesn’t the president of the United States get it?” DeGette added that “stem cell research is the most promising source of potential treatments and cures,” but “[u]nfortunately, because of the stubbornness of [Bush], these people continue to suffer and wait” (Weiss, Washington Post, 6/7).

According to the Times, several Republicans who voted against the measure cited new research reported on Wednesday (New York Times, 6/8). Three independent teams of scientists said they have developed experimental approaches using the skin cells of mice to create embryonic stem cells without creating or destroying embryos (Kaiser Daily Women’s Health Policy Report, 6/7). Bush said, “Recent scientific developments have reinforced my conviction that stem cell science can progress in ethical ways.” DeGette said that “this new scientific research should not be used as an excuse to say that it is a substitute for embryonic stem cell research” (New York Times, 6/8).

Sen. Dianne Feinstein (D-Calif.), a sponsor of the bill, said, “We will continue to [pass the legislation] again, and again, and again until this bill becomes law” (Epstein, San Francisco Chronicle, 6/8). House Minority Leader John Boehner (R-Ohio) said, “This is politics. This is not about expanding research.” He added, “They understand clearly that the president has vetoed this bill in the past and will veto it again” (New York Times, 6/8).

Broadcast Coverage
Several broadcast programs on Thursday reported on the House vote and studies released on Wednesday about embryonic stem cells.
CBS’ “Evening News”: The segment includes comments from Bruce Stillman of Cold Spring Harbor Laboratory; David Stevens, CEO of the Christian Medical Association; Evan Snyder of the Burnham Institute for Medical Research; and Reid (LaPook, “Evening News,” CBS, 6/7). Video of the segment is available online.

C-SPAN’s “Washington Journal”: The segment includes a discussion with Reps. James Lagevin (D-R.I.) and Dave Weldon (D-Fla.) (“Washington Journal,” C-SPAN, 6/7). Video of the segment is available online.

MSNBC: The segment includes comments from Pelosi; Reps. Ed Perlmutter (D-Colo.), Mike Pence (R-Ind.) and Randy Neugebauer (R-Texas); Kathrin Plath of the University of California-Los Angeles; and Karl Robb, an advocate for embryonic stem cell research (Potts, MSNBC Web site, 6/7). Video of the segment is available online.

NPR’s “Day to Day”: The segment includes a discussion with NPR science correspondent Joe Palca (Brand, “Day to Day,” NPR, 6/7). Audio of the segment is available online.

PBS’ “NewsHour with Jim Lehrer”: The segment includes a discussion with Kenneth Miller, a stem cell biologist at Brown University, and Rick Weiss, a science reporter for the Washington Post (Brown, “NewsHour with Jim Lehrer,” PBS, 6/7). Audio and a transcript of the segment are available online. Video will be available Friday afternoon.

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Results Of Third EUROASPIRE Survey For Treatment Of European Coronary Patients

Large proportions of European coronary patients are failing to achieve lifestyle, risk factor and therapeutic targets for the prevention of further disease, according to results of the third EUROASPIRE survey.(1) The survey, conducted on behalf of the European Society of Cardiology (ESC), analysed medical records and interviewed almost 9000 patients with coronary heart disease in 22 countries of Europe.

“It is a matter of the greatest professional concern that so many coronary patients are not being managed to the standards set in European prevention guidelines and as a result are at increased risk of atherosclerotic disease and a shorter life expectancy,” said Professor David Wood from the National Heart & Lung Institute in London, the principal investigator of EUROASPIRE III.

EUROASPIRE III is the third survey of the series and was carried out in 2006-2007 in patients from 76 coronary care centres in Europe. Consecutive patients with a diagnosis of coronary heart disease were identified and interviewed and examined at least six months after their coronary event.

Results from the interviews showed that
17% smoked cigarettes

35% were obese

53% were centrally obese

56% had blood pressure levels above target (140/90 mmHg, 130/80 mmHg for patients with diabetes)

51% had serum cholesterol levels above target (4.5 mmol/l)

25% had a history of diabetes, of whom only 10% were adequately controlled (fasting glucose levels under 6.1 mmol/l)

The report, published by the European Journal of Cardiovascular Prevention and Rehabilitation, also found that the use of cardioprotective medication was below recommendations.

Lifestyle, risk factor and therapeutic targets for the prevention of cardiovascular disease are clearly set out in the Joint European Societies guidelines, and give the highest priority to those with coronary disease.(2) Among the goals of the guidelines are to stop smoking, follow a healthy diet, be physically active, maintain a maximum body mass index of 25 kg/m2, blood pressure no higher than 140/90 mmHg (130/80 in diabetics) and total cholesterol no higher than 4.5 mmol/l.

Detailed results showed that almost one-third of all EUROASPIRE subjects were smokers in the month prior to their event, and this proportion had fallen by around half by the time of interview. Only one in seven patients was advised to attend a smoking cessation service, and only one-third of those actually did so.

Forty per cent of patients reported no increase in physical activity after their event, and only one-third reported doing regular exercise to increase their physical fitness. One in five obese patients said they had never been told they were overweight, one half had not followed dietary advice to lose weight, and almost two-thirds had not increased their physical activity.

Investigator Dr Kornelia Kotseva from the National Heart & Lung Institute in London described the prevalence of smoking and obesity in European coronary patients as “alarming”, noting that nearly one in five patients continued smoking after a coronary event and fewer than one in five were within target BMI. “Compared to our two previous surveys,” she said, “the prevalence of obesity has substantially increased. All coronary patients should be professionally encouraged to lose weight.”

She also noted that, despite an increase in the use of preventative drug treatments, the majority of patients are still not achieving blood pressure and cholesterol targets.

“Adverse lifestyle trends in our coronary patients – more smoking in younger females, increasing obesity and central obesity, more diabetes – now represent the biggest challenge for those leading prevention and rehabilitation programmes,” said Dr Kotseva. “We need to invest in prevention across Europe. All coronary patients need to be involved in professional, multidisciplinary prevention programmes.”

Professor Wood added: “These results show that, despite the existence of clear, evidence-based guidelines, their integration into routine clinical care is still disappointing, and there is still much room throughout Europe to raise the standards of preventive cardiology.”


1. Kotseva K, Wood D, De Backer G, et al. EUROASPIRE III: A survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from twenty-two European countries. Eur J Cardiovasc Prev Rehabil 2009; doi: 10.1097/HJR.0b013e3283294b1d

2. Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: fourth joint task force of the European Society of cardiology and other societies. Eur J Cardiovasc Prev Rehabil 2007; 14 (Suppl 2): S1-S113. And at escardio/guidelines-surveys/esc-guidelines/Pages/cvd-prevention.aspx

3. The European Journal of Cardiovascular Prevention and Rehabilitation is a journal of the European Society of Cardiology.

4. The ESC has performed three surveys as part of its EUROASPIRE programme (European Action on Secondary Prevention through Intervention to Reduce Events); the first two were published in 1998 (findings from 1995/96) and 2001 (findings from 1999/2000). Dr Kornelia Kotseva, EURASPIRE III’s first author and medical co-ordinator of the study, is a consultant cardiologist at the National Heart & Lung Institute, Imperial College, London; Professor David Wood, the study’s principal investigator, is professor of cardiovascular medicine at the National Heart & Lung Institute, Imperial College, London.

5. Cardiovascular disease, and particularly coronary heart disease, is the leading cause of death in Europe, accounting for 43% of all deaths in men and 55% in women. There are marked differences in prevalence between countries.

Source: ESC Press Office

European Society of Cardiology

Bone Marrow Cells Produce Nerve Growth Factor And Promote Angiogenesis Around Transplanted Islets

Islet transplantation is a promising treatment for type 1 diabetes mellitus. The promotion of angiogenesis is an important endeavor to prevent islet graft failure. Endothelial precursor cells (EPCs), a heterogeneous group originating in the hematopoietic compartment of bone marrow, have an important role in the angiogenesis of adult tissues. Transplanted EPCs induce hypoxia-inducible factor-1О± (HIF-1О±) under hypoxic conditions which leads to upregulation of vascular endothelial growth factor (VEGF) and promotes vascularization. Nerve growth factor (NGF), which plays an important role in promoting growth, differentiation and function of nerve cells has been shown to have an important role in angiogenesis by stimulating VEGF. Moreover, NGF is secreted by islets and may have a beneficial effect on islet function.

This research, lead by Dr. Eba Hathout and her colleagues in Loma Linda University School of Medicine, has recently published in the World Journal of Gastroenterology. They focused on NGF levels and its effects to clarify the mechanism of angiogenesis brought by bone marrow cell transplantation.

They found that NGF may have a role in islet transplantation by promoting angiogenesis and preventing hypoxia at the early post-transplant period. However, this remains to be tested and reproduced in appropriate trials.

Reference: Sakata N, Chan NK, Chrisler J, Obenaus A, Hathout E. Bone marrow cells produce nerve growth factor and promote angiogenesis around transplanted islets. World J Gastroenterol 2010; 16(10): 1215-1220

Lin Tian

World Journal of Gastroenterology

UNICEF Highlights Needs Of Flood-affected Ugandans

UNICEF expressed its deep concern over the situation of some 300,000 people affected by flooding in eastern and northern Uganda. The large majority of them are children and women.

The worst flooding to hit Uganda in decades, the aftermath of steady rains since July, has forced an estimated 200,000 people from their homes and in need of immediate, emergency shelter and household items to ward off disease and stave off further casualties. This displacement is in addition to the 110,000 already forced from their homes because of the conflict in northern Uganda, causing a double displacement.

“Many of these children and their families were already vulnerable to natural disasters because of more than 20 years of armed conflict in northern Uganda,” said UNICEF Representative Keith McKenzie. “Basic services, such as access to health facilities and water and sanitation services were already overstretched and have become further disrupted. Flooding has only compounded the risks of disease outbreak, and further limited their access to basic education.”

Specifically, water sources have become contaminated following the collapse of flooded latrines, posing a direct threat to the health of children and their families even when floodwaters recede. Waterborne diseases, malaria and acute respiratory infections have reportedly increased by as much as 30 per cent.

Children have also been forced out of school because of damage to classrooms; this has prevented over 100,000 children from beginning the third term of the academic year.

Emergency response has been hindered by limited access due to damaged, submerged or washed-away roads and bridges, requiring expensive air and boat transport to deliver aid and conduct assessments.

Floods have also washed away many families’ July/August harvest and delayed their next planting, potentially extending the normal hunger season from two to 10 months.

UNICEF urgently requires $7.2 million to continue its lifesaving response. To date, it has provided 1 million measles and 1.2 million polio vaccines as well as emergency and basic drug kits for up to 20,000 people for three months and 17,400 insecticide-treated mosquito nets to prevent malaria.

To address the need for clean water, UNICEF and partners have also distributed 177,000 water purification tablets and conducted education campaigns on hygiene and sanitation. Some 300 tents have been provided to affected schools to be used as temporary classrooms for over 150,000 students. UNICEF is also helping to rehabilitate damaged sanitation equipment in 49 primary schools and will provide emergency latrines in 100 schools to serve both pupils and the local population using the schools as shelter.

For shelter and non-food items, UNICEF has distributed 9,200 family kits consisting of blankets, kitchen utensils, a tarpaulin, collapsible jerry can, soap and other household items.


UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.


Adjuvant Treatment With Bicalutamide In The N American Cohort Of The Early Prostate Cancer Trial Demonstrates No Benefit At 7.7 Years Follow-Up

The Early Prostate Cancer Trial (EPC) consisted of three international groups of patients treated with either placebo or bicalutamide in addition to standard of care. The US cohort of men primarily chose radical prostatectomy (80%) as their standard of care. Most men were in the low risk category and evidence of positive lymph nodes or metastasis was exclusion criteria.

Participants were evaluated for prostate cancer (CaP) status at trial entry and every 3 months thereafter or until disease progression. The primary trial endpoints were progression-free survival (PFS) and overall survival (OS).

A total of 3,292 men were recruited in the North American trial. Median follow-up for this analysis was 7.7 years. The median duration of therapy was 1.83 years for bicalutamide and 1.84 years for placebo (standard of care alone). There was no difference in objective progression in men treated with bicalutamide vs. placebo with the rates of objective progression 15.4% and 15.3%, respectively. Mortality rates were 12.9% in the bicalutamide patients and 12.3% in the standard of care alone patients. No differences in PFS or OS were found between the two groups. However, bicalutamide improved the time to PSA progression.

Gynecomastia was experienced in 73% and breast pain in 85% of patients treated with bicalutamide. Withdrawal rates for this were 29%, compared to 0.9% in the placebo group. These data do not support a role for adjuvant bicalutamide in this group of patients.

By Christopher P. Evans, M.D.

J Urol 2006;176:75-80.
Link Here.

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:

Copyright © 2006 – UroToday

Kaiser Family Foundation Study Examines Seniors’ Medicare Part D Plan Choices From Economic Perspective

“Choosing a Medicare Part D Plan: Are Medicare Beneficiaries Choosing Low-Cost Plans?” Kaiser Family Foundation: The study, Massachusetts Institute of Technology economist Jonathan Gruber for the Foundation, finds that most Medicare Part D beneficiaries did not choose one of the lowest-cost drug plans in their area in 2006. The study found that 6% of beneficiaries in 2006 opted for the lowest-cost plan available and that those who did not choose the lowest-cost plans could have saved an average of $520 that year if they had opted for a less costly plan. The study also found that 10% of beneficiaries chose one of the lowest-cost plans available — defined as the 5% of plans that would have resulted in the lowest costs — and that others would have saved an average of $400 if they had chosen those plans. Fifty-three percent of beneficiaries enrolled in one of the lowest-cost 25% of the plans, and had others opted for those plans, they would have saved $220 on average (Kaiser Family Foundation release, 3/9).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.