Women & Alzheimer's

A new report by the Alzheimer's Foundation shows that women are not only the primary unpaid caregivers and advocates for those with the disease, they are also becoming victims of the disease itself in disproportionate numbers.
According to a recent poll which gathered information from 3,118 adults nationwide, including more than 500 Alzheimer caregivers:

•    60% of Alzheimer's caregivers are women.
•    Of those women, 68% report they have emotional stress from care giving.
•    Nearly half of these 68% rate their stress as a "5" on a scale of "1" to "5."
•    57% of all caregivers, including 2/3 of the women, admit they fear getting Alzheimer's.
•    4 in 10 caregivers say they had no choice about their new role.

The problem is that many of those caregivers are now being diagnosed with the disease. Women suffer disproportionately from various forms of dementia, including Alzheimer's: by some estimates sixty-five percent of those currently  suffering from Alzheimer's are women. Though women are only slightly more likely to develop Alzheimer's than men, its prevalence among women is twice as high simply because women live longer, with a life expectancy of 80 years versus 75 for men. Half of all women over 85 in the U.S. will eventually develop this disease.

New research shows that hormonal differences may increase the risk of Alzheimer's in women. One study, for instance, has found that hormone replacement therapy can increase a person's risk of developing dementia. Another study found that high or low levels of a thyroid hormone called thyrotropin may be associated with an increased risk of Alzheimer's disease in women. Estrogen may also play a role.
Gender also seems to dictate which risk factors matter more in the development of dementia. A French study found that men who had suffered a stroke were three times more likely to develop dementia, while stroke seemed to have no effect at all in women. Yet women prone to depression were twice as likely to suffer from dementia, and women unable to live without assistance due to an inability to perform routine tasks were 3.5 times more likely to develop dementia.

Alzheimer's develops differently in men and women, and they exhibit different symptoms of dementia: men with Alzheimer's disease tend to develop more aggression than women do as the disease progresses. They also tend to wander and perform socially inappropriate actions more frequently than women diagnosed with Alzheimer's. Women on the other hand tend to become more reclusive and emotionally unstable. They hoard items more often than men do, refuse help more often, and exhibit laughter or crying at inappropriate moments. Women also seem more vulnerable to depression and to suffering from delusions.

Because baby boomers are aging and because the population of those over age 85 is reaching record levels in the U.S., the number of people with Alzheimer's is expected to more than triple by 2050. By that time approximately 8 million women will have AD in the USA.
The FDA has only approved two types of medication to improve cognitive symptoms of Alzheimer's disease such as memory loss, according to the Alzheimer's Association. But there is no treatment that stops or reverses its progression. In America about $6 billion of funding is funneled to cancer research, and $4 billion is spent on heart disease research. Only $500 million has been allocated to Alzheimer's research, according to the Alzheimer's Association.

Fortunately there are steps women -and men- can take to protect themselves.
Studies show that getting regular exercise, eating lots of fruits, vegetables and fish, and keeping the mind active can help ward off the disease. So can taking a pass on hormone replacement therapy, which can double the risk of Alzheimer's. If they start showing signs of confusion or memory loss, women can slow Alzheimer's progression by getting diagnosed and taking medication early.
For more information on Alzheimer's disease and dementia, visit alzheimersdisease-info.com .

Advances in Gene Therapy: A new generation of Antisense drugs may hold the key to treating our most debilitating diseases.

Gene therapy is the insertion of genes into cells and tissues to treat disease. The gene, which is a stretch of DNA or RNA, is injected into a vector -the delivery vehicle- such an Adenovirus: the virus (with a now modified DNA) is absorbed by a targeted cell, where the cell nucleus alters its proteins using the new gene. Although the technology is still in its infancy, it has shown great promise in treating diseases such as Cancer and HIV/AIDS, as well as deadly viruses.

Pushing modern technology even further, Antisense Therapy utilizes a synthesized strand of nucleic acid which bonds to the mRNA produced by a specific gene and inactivates it, in effect acting like a micro switch which can alter the way specific cells produce proteins or prevent them from reproducing.

Currently there are no available vaccines or therapies for Ebola. Antisense drugs are useful against viral diseases because they are designed to enter cells and eliminate viruses by preventing their replication. The drugs, which act by blocking critical viral genetic sequences, may be more potent than anti-virals such as protease inhibitors that seek to inhibit a protein needed for viral replication. In a new study using Antisense drugs containing called small interfering RNAs (siRNAs), researchers targeted the L protein which is critical for Ebola virus replication. Using a proprietary technology called SNALP, or stable nucleic acid-lipid particles, to deliver the therapeutics to disease sites in animal models infected with the most potent strain of Ebola they were able to effectively inhibit the growth of the virus in 3 out of 4 infected rhesus monkeys.

In cancer studies Antisense drugs have shown the ability to target the proto-oncogenes found in normal cells. These genes, when mutated or expressed at high levels, help turn a normal cell into a tumor cell. Other Antisense drugs can inhibit the protein kinase C-alpha, which signals the cell to divide in other cancers. Scientists have discovered a way to improve the effectiveness of antisense cancer drugs by attaching multiple strands of antisense DNA to the surface of a gold nanoparticle (forming an "antisense nanoparticle"). The DNA then becomes more stable and can bind to the target messenger RNA (mRNA) more effectively.

In HIV/AIDS treatment, researchers have been conducting clinical trials using a HIV lentiviral vector, which has the unique ability to integrate into the genome of non-dividing cells( other Retroviruses can infect only dividing cells). Because "short" antisense -such as ribozymes or RNAi- may be more likely to result in HIV strains that are resistant to the therapy, these new drugs contain a very long antisense that inhibits HIV replication and debilitates HIV's ability to resist the treatment. The antisense lies inactive in a patient’s white blood cells (specifically the CD4+cells), waiting for HIV to enter that cell. When HIV does enter, replication of HIV within that cell activates the vector, which then binds to and destroys the HIV.

Ongoing clinical trials are attempting to determine if patients can go off antiretroviral drugs permanently: while the data from this trial is still not complete, the results are very encouraging.

With the completion of the Human Genome Project draft in 2003, researchers have been given detailed knowledge of the human genome which will provide new avenues for advances in medicine and biotechnology. This information can provide a deeper understanding of the disease processes at the level of molecular biology, and will potentially determine many new therapeutic procedures.

Given the established importance of DNA in molecular biology and its central role in determining the fundamental operation of cellular processes, it is likely that expanded knowledge in this area will facilitate medical advances in numerous areas of clinical interest that may not have been possible without them.

Don’t Have a Seat: New study shows that we spend too much time on our butts and it’s killing us.

How much time do you spend sitting? Think about it: an average American office worker gets out of bed, and then sits in a car on the way to work where they sit down at their desk. Maybe you’ll go out for lunch and sit at a table. Back to work, a commute home, then a few hours sitting in front of the TV before bed.

A new study published in the Journal of the American Heart Association has found that every hour per day spent sitting without physical activity increases a person's risk of dying from heart disease by almost one-fifth, regardless of how physically fit or unfit they are. "Even if someone has a healthy body weight, sitting for long periods of time still has an unhealthy influence on their blood sugar and blood fats," according to Professor David Dunstan, head of the Physical Activity laboratory at Australia’s Baker IDI Heart and Diabetes Institute.

The study measured the intensity of physical activity in 168 subjects over seven days. It found that regardless of how much moderate-to-vigorous exercise they did or their total sedentary time, those who took more breaks from sitting had lower waist circumferences, lower body mass indexes and lower levels of triglycerides and glucose in blood. Higher levels of triglycerides, or blood lipids, have been linked to a heightened risk of heart disease and stroke. High blood glucose levels are linked to the development of diabetes, which itself is a major risk factor for heart disease.

The studies found that the enzymes responsible for breaking down fat are suppressed when a person is sitting instead of standing.

"To hold a body that weighs [77 kilograms] upright takes a fair amount of energy from muscles," he said. "There is a large amount of energy associated with standing every day that can't easily be compensated for by 30 to 60 minutes in the gym."

His studies found that the enzymes responsible for breaking down fat are suppressed when a person is sitting instead of standing.

But the good news is that pottering about the house or gently walking around the office while on the phone might be enough to keep you fit: regardless of how much moderate-to-vigorous exercise they did or their total sedentary time, those who took more breaks from sitting had lower waist circumferences, lower body mass indexes and lower levels of triglycerides and glucose in blood. In fact, the sheer effort of standing up is enough to double the metabolic rate and the amount of calories burnt.

"If you stand up, you are much more likely to end up pacing or pottering around and that seems to make a crucial difference."

New breast cancer screening guidelines create confusion and controversy.

The U.S. Preventive Services Task Force (USPSTF) has updated their 2002 recommendation statement on screening for breast cancer in the general population, and the new statement has created a loud controversy among physicians, cancer survivors, women's health advocates and, inevitably, politicians. Making its debut in the midst of a hotly debated healthcare reform bill the timing could hardly be worse.

About the USPSTF:

The USPSTF was established in 1984 to "evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care." The USPSTF is an independent, voluntary body, and "...recommendations made by the USPSTF are independent of the U.S. government, and they should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services."

Here is the outline of the new recommendations:

• The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
• The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
• The USPSTF recommends against teaching breast self-examination (BSE).
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

The primary controversy revolves around the statements against routine screening in women through their 40's, and biennial (rather than annual) screening between 50 to 74 as well as the recommendation against teaching breast self-examination.
The position of the Task Force is that the routine annual screening for breast cancer can cause "...psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results." They also note the overdiagnosis of cancer that would not become clinically apparent during a woman's lifetime, and unnecessary early treatment of breast cancer that may become clinically apparent but would not actually shorten a woman's life. Although "...false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups." They also state that there is adequate evidence that teaching breast self examination (BSE) is associated with harms that are "at least small."

However, The American Cancer Society "...continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider."
Many physicians and women's health advocates are also either confused or seem to be  misinterpreting the recommendations to insinuate that women shouldn't -or won't be allowed to- have a screening at all until they're 40; Dr. John Larrinaga, Medical Director at the Ross Breast Center states: "It doesn't make sense on any level for any person to put their heads in the sand like an ostrich and say we shouldn't be checking ourselves or shouldn't be vigilant about the disease...This is just wrong, this is not scientifically supported." Dr. Ann Marie Shorter, a radiologist with a specialty in breast care says "The statistics are meaningless when it comes to breast cancer deaths if it's your wife, your best friend; these guidelines are a travesty. They don't make sense."
And Rep. Debbie Wasserman Schultz (D-Fla.) "blasted" the report, saying "We can't turn literally 20 years of recommendations ...upside down, and discourage women from becoming familiar with the look and feel of their breasts," and "We can't allow the insurance industry to continue to drive healthcare decisions"

Given the current climate of political diversity on the healthcare bill, the controversy isn't likely to die soon. Meanwhile, breast cancer continues to be the most common form of cancer among women in the US, with about 192,370 new cases of invasive breast cancer expected to be diagnosed in 2009. In our opinion, the best guideline is the old adage: If in doubt, check it out.
_______________________________________________________

Signs and symptoms of breast cancer may include:

• A breast lump or thickening that feels different from the surrounding tissue
• Bloody discharge from the nipple
• Change in the size or shape of a breast
• Changes to the skin over the breast, such as dimpling
• Inverted nipple
• Peeling or flaking of the nipple skin
• Redness or pitting of the skin over your breast, like the skin of an orange

When to see a doctor:
If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor.

Uninsured trauma patients are much more likely to die -- latimes.com

Uninsured trauma patients are much more likely to die -- latimes.com

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Food Allergies on the Rise in US Children... maybe.

A new cross-sectional survey of data on food allergy among children published online November 16, 2009 in Pediatrics shows that the prevalence of self-reported food allergies in the U.S. increased by 18% from 1997 to 2007, and outpatient visits to medical facilities for treatment of food allergies nearly tripled from 1993 to 2006. The study was the first to make nationally representative trend estimates of food allergy prevalence and healthcare utilization in the U.S. It also took the unusual step of characterizing some food allergy characteristics according to race and ethnicity.The study found that increases in food allergy prevalence were found across gender, age, and race, and findings include:

• Between 2003 and 2006, children were taken for an estimated average of 317,000 food allergy-related visits per year to emergency rooms and outpatient departments and doctors offices
• Hospitalizations of children with diagnoses related to food allergy increased from an average of 2,600 discharges per year during the period of 1998 to 2000 to 9,500 discharges per year from 2004 to 2006
• Black children were twice as likely as white children to test positive for peanut allergies on blood tests and were nearly twice as likely to have detectable signs of milk allergies.
• Black children were four times as likely as white children to have detectable antibodies for shellfish. While not as likely to have food allergies as black children, Hispanic children were more likely to have food allergies than were white children.

But are allergies really on the rise?

According to previous reports, true food allergies are not as common as most people believe and only affect about 2% of children, although they are more common in younger children. And fortunately, most younger children will outgrow these food allergies by the time they are three years old.
More common than food allergies is food intolerance, which can cause vomiting, diarrhea, spitting up, and skin rashes. An example of such a reaction occurs in children with lactose intolerance, which occurs because of a deficiency of the enzyme lactase, which normally breaks down the sugar lactose. Children without this enzyme or who have a decreased amount of the enzyme, develop symptoms after drinking lactose containing food products, such as cow's milk. However, because this reaction does not involve the immune system, it is not a real food allergy.

One theory of interest suggests the recent rise could be related to a phenomenon known as the hygiene hypothesis, according to the Food Allergy and Anaphylaxis Network. "Because children in our culture are exposed to fewer germs than their bodies are used to dealing with, the immune system is deprived of the full-time germ-fighting job they have to do, and [immune systems] misidentify food as harmful" she says.
After identifying food as harmful, the body reacts by trying to fight the food—resulting in an allergic reaction with symptoms ranging from relatively benign ones, like hives, rashes and tingling in the mouth, to terrifying ones, like swelling in the throat, difficulty breathing and loss of consciousness.

However the study notes that "Several national health surveys indicate that food allergy prevalence and/or awareness has increased among US children in recent years."
And researcher Amy M. Branum, MSPH, of National Center for Health Statistics at the CDC adds "Reported food allergy is increasing among children of all ages, among boys and girls, and among children of different races/ethnicities, however, it cannot be determined how much of the increases in estimates are truly attributable to increases in clinical disease and how much are attributable to increased awareness by physicians, other health care providers, and parents."

So the reality is that while there may be some actual increase in allergic reactions to our children's food, the study suggests more of an increase in the general awareness and reporting of food allergies.

About Food Allergies:

Some food allergies result in immediate, severe and even life-threatening symptoms (such as severe peanut allergy), whereas others cause symptoms which may take longer to develop (for example, gluten allergy, also known as coeliac disease). They can result in immediate, severe and even life-threatening symptoms (such as severe peanut allergy), whereas others cause symptoms which may take longer to develop (for example, gluten allergy, also known as coeliac disease).
The diagnosis of a food allergy isn't always straightforward. Many food allergy symptoms can also be caused by a number of other conditions and it may take some time before the problem food is identified and your doctor can confirm that you have an allergy.

The only treatment for food allergy is not to eat the problem food. A registered dietitian can help you identify and remove a problem food from your diet and replace it with alternatives, to make sure you don't miss out on essential nutrients. Your dietitian can also explain what you need to look for on food labels and when eating out. Symptoms of mild food allergies, such as a rash or runny nose, may be treated with antihistamines. However, it's important that you only take medicines for your allergy on the advice of your doctor. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

AIDS Vaccine Breakthrough Provides New Hope

A new clinical trial has produced a combination of two genetically engineered vaccines- neither of which had worked before in humans- that was declared a qualified success after six years of testing on more than 16,000 volunteers in Thailand. Those who were vaccinated became infected at a rate nearly one-third lower than the others.
The trial used a combination of ALVAC HIV - from Sanofi-Aventis, the French pharmaceutical company - as "prime" vaccine, with a second vaccine booster called AIDSVAX B/E, developed by GenVax of the US, and since ceded to the non-profit group Global Solutions for Infectious Diseases. It was overseen by the Thai authorities, with US military support. The work, beginning in 2003, was complex, involving initial interviews of 60,000 people aged 18-30 from the Rayong and Chon Buri provinces, before 16,402 initially took part. Almost 0.8 per cent contracted HIV, including 51 per cent who were vaccinated and 74 per cent who were not.

But the findings leave many questions unanswered: most importantly, while those who were vaccinated had a lower rate of HIV infections, it had no effect in reducing the "viral load" or presence of HIV for those who had been vaccinated. This reinforces uncertainty over the mechanism by which vaccines affect the human immune system. There are also uncertainties about the longer term probability of infection and the development of HIV in those who have been vaccinated, and the effects in other groups at higher risk of HIV including sex workers, gay men and intravenous drug users.
"We don't really know why and how this vaccine worked and did what it did," said Dr. Alan Bernstein, executive director of the Global HIV Vaccine Enterprise, an alliance of AIDS scientists, governments and donors.
"This trial is raising more questions almost than it's answering," he said. "It's opened the door and it's opened up a whole lot of questions that are answerable and will be answered over the next months and years to come."
Because of the long time frame, health advocates warn that people should not count on a potential vaccine to treat and contain infections.
An estimated 33.2 million people around the world were living with HIV in 2007, according to the Joint United Nations Program on HIV/AIDS. The Centers for Disease Control and Prevention estimates that about 1.1 million adults and adolescents were living with diagnosed or undiagnosed HIV infection in the United States at the end of 2006.