Archive for April, 2012

Latest Info on Alzheimer’s Prevention

Thursday, April 19, 2012 // Uncategorized

Here’s Journal Watch’s report on an article in Neurology which further supports the efficacy of exercise in reducing the risk of Alzheimer’s Disease.  Following that is the abstract from Neurology.  Keep exercising.  It helps at any age.

Physical Activity in Advanced Age Associated with Lower Alzheimer’s Risk
Daily physical activity is associated with reduced risk for Alzheimer disease among the elderly, according to a Neurology study.
Roughly 700 adults (average age, 82) free of dementia wore actigraphs on their wrists 24 hours a day for up to 10 days to measure their daily physical activity. Over a mean 3.5 years’ follow-up, 10% were diagnosed with Alzheimer disease.
Participants in the lowest decile of physical activity had more than twice the Alzheimer’s risk as those in the highest decile. The results remained significant after adjustment for self-reported physical, social, and cognitive activities. More physical activity on actigraphy was also associated with less cognitive decline.
Editorialists conclude: “In a world that is becoming progressively sedentary, and in the context of very limited success of the currently available medications to treat or delay AD, physical activity provides a promising, low-cost, easily accessible, and side-effect-free means to prevent AD.”

Total daily physical activity and the risk of AD and cognitive decline in older adults

  1. A.S. Buchman, MD,
  2. P.A. Boyle, PhD,
  3. L. Yu, PhD,
  4. R.C. Shah, MD,
  5. R.S. Wilson, PhD and
  6. D.A. Bennett, MD

 


  1. From the Rush Alzheimer’s Disease Center (A.S.B., P.A.B., L.Y., R.C.S., R.S.W., D.A.B.), Neurological Sciences (A.S.B., L.Y., D.A.B.), and Department of Family Medicine (P.A.B., R.C.S.), Rush University Medical Center, Chicago, IL.

Ceregene, Inc.; Danone Research B.V.; Eisai, Inc.; Elan Pharmaceuticals,Inc.; Merck & Co., Inc.; Metabolic Solutions Development Company; Pamlab, L.L.C.; Orasi, Inc.; Pfizer, Inc.

Research Support, Government Entities:

  1. NIH P30 AG101061, Education and Information Transfer Core Leader, Clinical Core Coinvestigator; NIH P01 AG009466, Coinvestigator, Administrative Core; NIH R01 NR009543, Coinvestigator; NIH R01 AG11101, Coinvestigator; NIH R01 AG029824, Coinvestigator; NIH U01 AG010483, Site Investigator; NIH U01 AG029824, Coinvestigator, Site Investigator; NIH U01 AG024904, Site Coinvestigator; Illinois Department of Public Aid Alzheimer’s Disease Assistance Center.

    Abstract

Objective: Studies examining the link between objective measures of total daily physical activity and incident Alzheimer disease (AD) are lacking. We tested the hypothesis that an objective measure of total daily physical activity predicts incident AD and cognitive decline.

Methods: Total daily exercise and nonexercise physical activity was measured continuously for up to 10 days with actigraphy (Actical® ; Philips Healthcare, Bend, OR) from 716 older individuals without dementia participating in the Rush Memory and Aging Project, a prospective, observational cohort study. All participants underwent structured annual clinical examination including a battery of 19 cognitive tests.

Results: During an average follow-up of about 4 years, 71 subjects developed clinical AD. In a Cox proportional hazards model adjusting for age, sex, and education, total daily physical activity was associated with incident AD (hazard ratio = 0.477; 95% confidence interval 0.273–0.832). The association remained after adjusting for self-report physical, social, and cognitive activities, as well as current level of motor function, depressive symptoms, chronic health conditions, and APOE allele status. In a linear mixed-effect model, the level of total daily physical activity was associated with the rate of global cognitive decline (estimate 0.033, SE 0.012, p = 0.007).

Conclusions: A higher level of total daily physical activity is associated with a reduced risk of AD.

  • Received September 13, 2011.
  • Accepted December 8, 2011.
  • Copyright © 2012 by AAN Enterprises, Inc.
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Disease Outbreaks: Stay Informed with a New Iphone App

Wednesday, April 11, 2012 // Uncategorized

Here’s today’s post from ProMed Digest about the latest way to keep on top of disease outbreaks.

 

Date: Tue, 10 Apr 2012 22:10:56 -0400 (EDT)
From: ProMED-mail <[email protected]>
Subject: PRO/ALL> Announcements (02): HealthMap iPhone, iPad and Android apps

ANNOUNCEMENTS (02): HEALTHMAP IPHONE, IPAD AND ANDROID APPS
***********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 10 Apr 2012
From: John Brownstein
HealthMap <http://healthmap.org>

HealthMap is announcing the release of new iPhone, iPad and Android
apps. Visit the iTunes Store and Google Play to download “HealthMap:
Outbreaks Near Me.”

With Outbreaks Near Me, users have access to the latest information on
infectious disease worldwide. Check the most recent health news in
your neighborhood or travel destination, or submit reports of new
outbreaks that have not yet been identified.

The new app maintains familiarity but features a sleeker look,
increased usability, and more features. Switch between map view, list
view, and news from our publication, The Disease Daily. Submit a new
report, or view your past submissions by entering your email address.

 

Outbreaks Near Me

With HealthMap’s Outbreaks Near Me application, you have all of HealthMap’s latest real-time disease outbreak information at your fingertips. Open the app and see all current outbreaks in your neighborhood, including news about H1N1 influenza (“swine flu”). Search and browse outbreak reports on the interactive map, and set up the app to alert you with a notice automatically whenever an outbreak is occurring in your area. If you know of an outbreak not yet on the map, be the first to report it using the app’s unique outbreak reporting feature. You will be credited and your report will be featured on the website.

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“Best Practices” Revisited

Sunday, April 1, 2012 // Uncategorized

 

Here is another article from Hartzband and Groopman in the WSJ that discusses the fallacies of best practices.

 

 

Rise of the Medical Expertocracy

Both Democrats and Republicans want to introduce the paternalism of ‘best practices’ into health care

By PAMELA HARTZBAND and JEROME GROOPMAN

Should everyone take vitamin D, and if so, how much? At what age and how often should a woman have a mammogram? Should a healthy man be screened for prostate cancer, and if cancer is diagnosed, how should he be treated?

As the health-care debate heats up again in Washington, both Democrats and Republicans will try to convince us that they have the experts to answer all our health questions. President Barack Obama and the Democrats propose panels of government experts to evaluate treatments and, in the president’s words, “Figure out what works and what doesn’t.” Republicans claim that the free market (that is, insurance companies with their own experts) will pay for value and empower consumers. Both sides insist that no one will come between us and our doctors.

[PATIENTS] Alex NabaumPatients and doctors can differ with experts and not be ignorant—despite what politicians think.

Democrats and Republicans share a fundamental misconception about medical care. Both assume that, as in mathematics, there is a single right answer for every health problem. These “best practices,” they believe, can be found by gathering large amounts of data for experts to analyze. The experts will then identify remedies based strictly on science—impartial and objective.

Yet in medicine, there are many contrary opinions about “best practices.” You cannot pick up a newspaper, turn on the TV or surf the Internet without encountering conflicting reports about various tests and treatments. Medical experts disagree about many issues, often dramatically.

This has not stopped a government panel of experts, the U.S. Preventive Services Task Force, from issuing sweeping recommendations regarding clinical care. In November 2009, this government group announced that women under 50 should no longer undergo routine mammograms. Despite an estimate that as many as 12,000 lives could be saved by earlier screening, the panel concluded that the potential benefit was not sufficient to balance the pain and suffering related to false positive diagnoses, unnecessary biopsies, the unknown risks of exposure to radiation and toxic treatment of cancers that might ultimately prove indolent. A statistician on the panel told reporters that the decision was a “no brainer.” Last autumn, the Preventive Services Task Force declared that healthy men should no longer be tested for prostate cancer, another “no brainer” according to the panel’s chair.

But these are hardly consensus positions. The American Cancer Society’s own experts took a very different view of the trade-offs between risks and benefits. They still recommend mammograms for women under 50, and they believe that the issue of screening for prostate cancer is not settled.

 

Ashby Jones on Lunch Break examines the three days of arguments over the Obama health-care law before the Supreme Court, including key takeaways and what the justices’ questions suggest about the court’s decision.

Republicans take a different approach to health-care reform; they depend on insurance companies and their experts to determine the best care. Consider the recent marketing campaign of United Healthcare, one of the largest insurers in the country. It is called “Health in Numbers,” and the insurer promises that, by trusting its expert data and analysis, patients will have the right outcomes. But this is a false promise. No one can guarantee the right outcome from a treatment for any individual patient.

And where do patients stand in all of this? In June 2009, President Obama voiced a common point of view when he told Diane Sawyer of ABC News, “If we know what those best practices are, then I’m confident that doctors are going to want to engage in best practices. But I’m also confident patients are going to insist on it.… In some cases, people just don’t know what the best practices are.”

But every patient does not, in fact, react in the same way to expert opinion. Research shows that the more patients understand the risks and benefits of treatments, the more varied are their choices. They do not conform to the advice of a single group of experts.

Over the past four years, we have interviewed scores of patients around the country about how they make medical decisions. We found “maximalists” who want to do everything possible and “minimalists” who are convinced that less is more; “believers” who are certain that a good solution exists for their illness and “doubters” who worry that almost any treatment will be worse than the disease. They developed these mind-sets largely based on past experience with illness, and they use them as a starting point for weighing risks and benefits in their health care.

Experts also have these distinct mind-sets, both as individuals and as groups. The federal Preventive Services Task Force, for one, embodies a minimalist, doubter mind-set. That is why experts can look at the same data and still disagree about what is best.

For patients and experts alike, there is a subjective core to every medical decision. The truth is that, despite many advances, much of medicine still exists in a gray zone where there is not one right answer. No one can say with certainty who will benefit by taking a certain drug and who will not. Nor can we say with certainty what impact a medical condition will have on someone’s life or how they might experience a treatment’s side effects. The path to maintaining or regaining health is not the same for everyone; our preferences really do matter.

For much of the 20th century, the model of medical care was paternalism: A doctor dictated what was to be done and the patient complied. This model has largely been abandoned, but now Democrats and Republicans are offering a new form of paternalism, based on the assumption that Americans are not receiving “quality” care. A lucrative industry has grown up to generate ever more medical metrics, to give report cards to doctors and hospitals, and to base payments on compliance with “best practices.” Yet beyond safety protocols, there is scant evidence that such measures improve our health.

Patients and doctors can differ with experts and not be ignorant or irrational. Policy makers need to abandon the idea that experts know what is best. In medical care, the “right” clinical decisions turn out to be those that are based on a patient’s goals and values.

—Drs. Hartzband and Groopman are on the faculty of the Harvard Medical School and the Beth Israel Deaconess Medical Center in Boston. They are co-authors of “Your Medical Mind: How to Decide What Is Right for You.”A version of this article appeared Mar. 31, 2012, on page C3 in some U.S. editions of The Wall Street Journal, with the headline: Rise of the Medical Expertocracy.

 
 

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