August 8, 2006, 10:01 PM CT

Social Stresses Overlooked

When thinking about the well-being of older adults, most people focus on medical care, but mental health care is a growing, pressing concern for older adults and their families. "At least one in five older adults suffer from a mental disorder and experts in geriatric mental health anticipate an 'unprecedented explosion' of older adults with disabling mental disorder," says Enola K. Proctor, Ph.D., a mental health care expert and professor of social work at Washington University in St. Louis.

"While older adults may receive adequate medical and psychiatric care, they rarely receive the care necessary to deal with the general 'problems with living,' or social stresses. These psychosocial problems, such as isolation and family stress, may exacerbate psychiatric problems, depression in particular, and contribute to functional decline".

Just as the quality of medical care has become a major national concern, the quality of mental health care has become a primary focus of the Institute of Medicine and other national policy groups. In a new study published in the current issue of The Journal of Behavioral Health Services & Research (Vol. 33), Proctor and colleagues examined the quality of follow-up care for 186 patients discharged from the geropsychiatric unit of a large urban hospital after treatment for depression.........

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August 8, 2006, 0:20 AM CT

New Learning Strategy

Central to being human is the ability to adapt: We learn from our mistakes. Previous theories of learning have assumed that the size of learning naturally scales with the size of the mistake. But now biomedical engineers at Washington University in St. Louis have shown that people can use alternative strategies: Learning does not necessarily scale proportionally with error.

In so doing, Kurt Thoroughman, Ph.D., assistant professor of biomedical engineering at Washington University, and his graduate student, Michael Fine, have discovered a new learning strategy they call categorical adaptation in which steps of learning are sensitive to the direction of error, but do not scale proportionally with the size of the error. Eventually, their findings could have an impact in the rehabilitation of people with neurological ailments such as strokes by making use of different learning environments.

If you make a movement error in one direction, in makes sense that your next movement would correct toward the opposite direction, in exact proportion to the error. An example would be a pitcher correcting to the right, after missing home plate to the left with a pitch.

"We show that learning does not necessarily scale with error," said Thoroughman. "I think we have uncovered a part of human adaptation that certainly doesn't do that. We are not claiming that all previous theories are false in the behaviors that were captured. It's just that we have for the first time found a part of human adaptation that clearly does not scale with the size of the error".........

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August 8, 2006, 0:12 AM CT

more effective smoking cessation

Results of a new imaging study, supported in part by the National Institute on Drug Abuse (NIDA), National Institutes of Health, show that the nicotine received in just a few puffs of a cigarette can exert a force powerful enough to drive an individual to continue smoking. Scientists observed that the amount of nicotine contained in just one puff of a cigarette can occupy about 30 percent of the brain's most common type of nicotine receptors, while three puffs of a cigarette can occupy about 70 percent of these receptors. When nearly all of the receptors are occupied (as a result of smoking at least 2 and one-half cigarettes), the smoker becomes satiated, or satisfied, for a time. Soon, however, this level of satiation wears off, driving the smoker to continue smoking throughout the day to satisfy cigarette cravings.

"Imaging studies such as this can add immensely to our understanding of addiction and drug abuse," says Elias A. Zerhouni, M.D., Director of the National Institutes of Health. "These findings suggest that drug therapies or vaccines for smoking cessation need to be extremely potent to compete with nicotine, which binds so readily to these receptors".

The study is reported in the August 2006 issue of the Archives of General Psychiatry.

"This study illustrates the powerfully addictive impact of even small amounts of nicotine. Every time a smoker draws a puff from a cigarette, they inhale numerous toxic chemicals that promote the formation of lung cancer, and contribute in a significant way to death and disability worldwide," says NIDA Director Dr. Nora D. Volkow. "Eventhough a number of smokers endorse a desire to quit, very few are able to do so on their own, and fewer than half are able to quit long-term even with comprehensive therapy. This study helps explain why".........

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August 7, 2006, 11:45 PM CT

Use The Abdomen To Deliver Oxygen

Scientists at the University of Pennsylvania School of Medicine have helped develop a technique in animal models for using the abdominal cavity to exchange gas, supplementing the function normally performed by the lungs. The goal is to provide a way to support patients who are on a mechanical ventilator, suffering from reversible lung failure, but who need extra time and support to heal -- beyond what a ventilator can provide -- in order to survive. The findings are in the recent issue of Chest, the journal of the American College of Chest Physicians.

"This is an alternate, novel way to deliver oxygen to the body that does not attempt to wring more function out of an already injured lung, by using ventilator settings that can actually exacerbate the underlying lung injury. The only other alternates that can 'rest' the lung involve variations of bypass machine technology, all of which require anticoagulation," explains Joseph Friedberg, MD, Associate Professor of Surgery and principal investigator of this study. "The ability to rest the lungs and provide supplemental oxygen with a technique that appears nontoxic and does not require anticoagulants could have huge implications some day for patients suffering from potentially reversible pulmonary failure from such diseases as: anthrax, bird flu, SARS, trauma, ARDS, pulmonary embolism, pneumonia and others. Sometimes patients have a condition in which they might have a chance to recover if they could survive the most severe phase of their disease".........

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August 3, 2006, 11:59 PM CT

Race Affects Type 2 Diabetes Treatment

African Americans may be less likely than whites to take their medicine for Type 2 diabetes as it is prescribed, a new study suggests.

The researchers found that adherence rates were as much as 12 percent lower among black people when compared to whites.

"That's an unacceptable difference, particularly because African Americans tend to have higher rates of diabetes and disease-related complications," said Rajesh Balkrishnan, a study co-author and the Merrell Dow professor of pharmacy at Ohio State University.

Each of the nearly 2,700 study participants were covered by Medicaid, which provided prescription medicine coverage to all enrollees. Still, more than a third of the African Americans and whites in this study failed to take their anti-diabetic medications properly.

"Adherence rates for these types of medications should be better than 90 percent, regardless of who takes them," Balkrishnan said. "Such low rates of adherence may be related to lower socioeconomic status and to lower levels of education.

"Many commercial insurers pay for educators to teach patients the importance of taking their medications as prescribed," he continued. "Medicaid needs to do the same thing. While it invests a lot of money in providing services, it does little to educate its recipients about those services and how to use them. People need to understand the importance of taking their medications".........

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August 2, 2006, 11:44 PM CT

Easy Route From Nose To Brain

In a continuing effort to find out if the tiniest airborne particles pose a health risk, University of Rochester Medical Center scientists showed that when rats breathe in nano-sized materials they follow a rapid and efficient pathway from the nasal cavity to several regions of the brain, according to a study in the recent issue of Environmental Health Perspectives.

Researchers also saw changes in gene expression that could signal inflammation and a cellular stress response, but they do not know yet if a buildup of ultrafine particles causes brain damage, said lead author Alison Elder, Ph.D., research assistant professor of Environmental Medicine.

The study tested manganese oxide ultrafine particles at a concentration typically inhaled by factory welders. The manganese oxide particles were the same size as manufactured nanoparticles, which are controversial and being diligently investigated because they are the key ingredient in a growing industry -- despite concerns about their safety.

Nanotechnology is a new wave of science that deals with particles engineered from many materials such as carbon, zinc and gold, which are less than 100 nanometers in diameter. The manipulation of these materials into bundles or rods helps in the manufacturing of smaller-than-ever electronics, optical and medical equipment. The sub-microscopic particles are also used in consumer products such as toothpaste, lotions and some sunscreens.........

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August 1, 2006, 7:07 AM CT

Study Frames Depression Treatment Puzzle

Published in the August 2006 edition of the American Journal of Psychiatry, the study used electroencephalogram (EEG) measurements to demonstrate an association between eventual clinical outcome and regional changes in brain activity during a placebo lead-in phase prior to antidepressant treatment.

The findings suggest that factors such as patient beliefs and expectations, doctor-patient relationships, or treatment history help complete the treatment picture.

In this study, all subjects received blinded treatment with placebo for one week prior to receiving antidepressant medication. A "placebo lead-in" phase is commonly used to familiarize patients with study procedures and to minimize the effect of any pre-existing treatment for depression. The placebo lead-in includes patient care, participation and treatment with placebo; the clinical impact is largely unknown.

This study is the first to assess the relationship between brain changes during the placebo lead-in phase and later clinical outcome of antidepressant treatment.

"Treatment results appear to be predicted, in part, by changes in brain activity found during placebo lead-in--prior to the actual use of antidepressant medication," said lead author Aimee M. Hunter, a research associate at the Semel Institute for Neuroscience and Human.........

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August 1, 2006, 6:49 AM CT

Higher Blood Pressure Associated with Decline in Walking Ability

Decline in lower limb function is common in older people, and worsening gait is associated with increased risk of dementia and death. However, factors contributing to gait difficulties in older persons are not well understood. A study by researchers at Rush University Medical Center suggests that higher blood pressure may be one factor associated with a decline in walking ability in later life. The research, by Dr. Raj Shah and colleagues at the Rush Alzheimer's Disease Center, is published in the August 2006 issue of the Journal of Gerontology: Medical Sciences, the scientific journal of The Gerontological Society of America.

Researchers recruited 888 older Catholic clergy without dementia or Parkinson's disease who are participating in the Religious Orders Study. At baseline, blood pressure was measured, the presence of vascular diseases and diabetes was recorded, cognitive function was assessed, and medications were inspected.

At baseline and subsequent annual visits, gait and balance were assessed using performance-based tasks, such as the time and number of steps taken to walk 8 feet, the time to sit up and down five times, the number of steps off the line during an 8-foot heel-to-toe walk, and a comparison of ability to stand with eyes open and eyes closed.........

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July 31, 2006, 6:57 AM CT

HIV hides from drugs

UC Davis researchers have discovered that the human immunodeficiency virus, the virus that causes AIDS, is able to survive efforts to destroy it by hiding out in the mucosal tissues of the intestine. They also found that HIV continues to replicate in the gut mucosa, suppressing immune function in patients being treated with antiretroviral therapy--even when blood samples from the same individuals indicated the treatment was working. Results of the three-year study appear in the August issue of the Journal of Virology (available online today at http://jvi.asm.org).

"This is the first longitudinal study to show that, while current HIV therapy is quite successful in reducing viral loads and increasing T-cells in peripheral blood, it is not so effective in gut mucosa," said Satya Dandekar, professor and chair of the Department of Medical Microbiology and Immunology at UC Davis Health System and senior author of the study.

"The real battle between the virus and exposed individuals is happening in the gut immediately after viral infection," she said. "We need to be focusing our efforts on improving treatment of gut mucosa, where massive destruction of immune cells is occurring. Gut-associated lymphoid tissue accounts for 70 percent of the body's immune system. Restoring its function is crucial to ridding the body of the virus".........

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July 29, 2006, 8:50 PM CT

Genetic Model For Parkinson's Disease

In the mouse model generated by the research team, a gene called TFAM is automatically deleted from the genome in dopamine nerve cells only. Without TFAM, mitochondria cannot function normally. The so called respiratory chain is compromised and energy production decreases severely in the dopamine cells.

The new mice are born healthy from healthy but genetically modified parents and will develop spontaneous disease. Previous studies in the field have been based on researchers delivering neurotoxic substances to kill the dopamine neurons. In the new mice, however, mice develop disease slowly in adulthood, like humans with Parkinson's disease, which may facilitate research aimed at finding novel medical treatments and other therapies.

"We see that the dopamine producing nerve cells in the brain stem slowly degenerate", says Dr. Nils-Gran Larsson. "In the microscope we can see.

that the mitochondria are swollen and that aggregates of a protein, probably alpha-synuclein starts to accumulate in the nerve cell bodies. Inclusions of alpha-synuclein-rich so called Lewy bodies is typical for the human disease".

The causes of Parkinson's disease have long remained a mystery. Genes and environment are both implicated, but recently there has been an increased focus on the roles of genetic factors. It has been found that mutations in a number of genes can lead directly to disease, while other mutations may be susceptibility factors, so that carriers have an increased risk of becoming ill. A common denominator for some of the implicated genes is their suggested role for the normal functioning of mitochondria.........

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