Researchers from the US and the UK who analysed health data on over 17,000 women from midlife to old age found that being overweight or obese in middle age was linked to a significantly lower chance of enjoying good health in old age, with obese middle aged women having a 79 per cent lower chance.

The study was the work of researchers from the Harvard School of Public Health (HSPH) and Brigham and Womens Hospital in Boston, Massachusetts, USA, and the University of Warwick in the UK, and is published online in the 29 September issue of the BMJ.

For the study the researchers used data from over 17,000 participants of the Nurses Health Study, United States, one of the largest and longest running investigations of factors that influence womens health.

All the participants lived at least until the age of 70 and were free from major chronic diseases at midlife (their mean age was 50 in 1976, the baseline date of the study). They continued to give information on physical function, chronic diseases, cognitive function, and mental health as they approached 70 and over.

The researchers defined “healthy survival” as living to 70 and beyond while at the same time having (1) no history of 11 major chronic diseases, and (2) having “no substantial cognitive, physical, or mental limitations”. Thus not only being free of disease, but also having all ones faculties and enough physical and mental ability to go shopping, go up and down stairs and take care of oneself.

“Usual survival” was living to 70 and over but with no particular health status.

After analysing the data the researchers found that9.9 per cent of the women who lived to the age of 70 and over met the criteria for “healthy survival”.
After taking into account lifestyle and diet, the higher a womans BMI at baseline, the lower her odds of healthy survival, compared to “usual survival” (this was a linear relationship with P

Prostate cancer patients of low socioeconomic status are more likely to die than patients with higher incomes. That is the finding of a new study from Swiss researchers to be published in the December 1, 2009 issue of Cancer, a peerreviewed journal of the American Cancer Society. The studys findings indicate that poor prostate cancer patients receive worse care than their wealthier counterparts.

Many of the previous studies on socioeconomic status (SES) and prostate cancer mortality are from North America, particularly from the United States. Researchers wanted to know how disparities affected prostate cancer mortality in Switzerland, a country with an extremely well developed health care system and where healthcare costs, medical coverage, and life expectancy are among the highest in the world, Elisabetta Rapiti, M.D., MPH, of the University of Geneva and her colleagues conducted a populationbased study that included all residents of the region who were diagnosed with invasive prostate cancer between 1995 and 2005.

The analysis included 2,738 patients identified through the Geneva Cancer Registry. A patient with prostate cancer was classified as having high, medium, or low socioeconomic status on the basis of his occupation at the time of diagnosis. The investigators compared patient and tumor characteristics, as well as treatments among the different socioeconomic groups.

Compared with patients of high socioeconomic status, those of low socioeconomic status were less likely to have their cancer detected by screening, had more advanced stages of cancer at diagnosis, and underwent fewer tests to characterize their cancer. These patients were less likely to have their prostates removed and were more likely to be managed with watchful waiting, or careful monitoring.

Patients with low socioeconomic status also had a 2fold increased risk of dying from prostate cancer compared with patients of high socioeconomic status. “The increased mortality risk of patients of low socioeconomic status is almost completely explained by delayed diagnosis, poor workup, and less complete treatment, indicating inequitable use of the health care system,” said Rapiti. The authors say lead time and length time biases linked to early detection through PSA screening may partially explain the survival advantage observed among high SES patients. However, they found that the differences by SES in prostate cancer mortality were limited to patients with advanced disease, for whom the impact of such biases is not as strong, and that treatment choice probably played a more important role. The authors say reducing health inequalities linked to socioeconomic status should receive high priority in public health policies, and that improving patients access to prevention and early diagnostic tests and ensuring that they receive standard treatments could help reduce the socioeconomic differences seen in this study.

Article “Impact of socioeconomic status on prostate cancer diagnosis, treatment, and prognosis.” Elisabetta Rapiti, Gerald Fioretta, Robin Schaffar, Isabel NeyroudCaspar, Helena M Verkooijen, Franz Schmidlin, Raymond Miralbell, Roberto Zanetti, Christine Bouchardy. Cancer; Published Online September 28, 2009 (DOI 10.1002/cncr.24607); Print Issue Date December 1, 2009.

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David Sampson

A new study published in the medical journal Neurology suggests that impaired kidney function is a risk factor for cognitive decline in old age.

The study, conducted by researchers at Rush University Medical Center, found that poor kidney function was linked specifically with cognition related to memory functions. Damage to one of these functions, episodic memory, which retrieves memories of time, place, associated emotions and other contextual knowledge, is often the earliest sign of Alzheimers disease.

“Given the dearth of modifiable risk factors for agerelated cognitive decline, these results have important public health implications,” said Dr. Aron Buchman, a neuroscientist in the Rush Alzheimers Disease Center. “Further work to understand the link between kidney function and the brain may provide new strategies for preventing memory loss in elders.”

Buchman said the findings suggest that there are common disease processes that affect both the brain and the kidneys in the elderly, and hypothesized that underlying vascular problems, such as diabetes and hypertension, may account for the association between kidney problems and cognitive decline.

The study analyzed data for 886 older adults who participated in the Rush Memory and Aging Project, a group of communitydwelling seniors with a mean age of 81, all of them initially free of dementia. The participants were examined annually for up to six years to track changes in cognition over time. Cognitive assessments included multiple tests that were summarized as a composite measure of overall cognition and of five individual cognitive abilities.

The individual cognitive systems assessed were visuospatial ability; perceptual speed, or the ability to quickly and accurately compare letters, numbers, objects, pictures or patterns; semantic memory, related to meaning, understanding and other conceptbased knowledge; working memory, which temporarily stores and manipulates information; and episodic memory.

Ruling out the influence of factors like aging and medications, which can affect cognition, the researchers found that poor kidney function, assessed at the beginning of the study, was linked with a more rapid rate of decline in cognition over the next several years not in visuospatial ability or perceptual speed, but in three specific areas episodic, semantic and working memory.

The rate of decline in cognition was equivalent to that of a person seven years older at baseline, Buchman said.

The study was supported by funds from the National Institute on Aging, the Illinois Department of Public Health and the Robert C. Borwell Endowment Fund.

About Rush

Rush University Medical Center includes a 674bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).

Rush is currently constructing a 14floor, 806,000squarefoot hospital building at the corner of Ashland Avenue and Congress Parkway. The new hospital, scheduled to open in 2012, is the centerpiece of a $1billion, 10year campus redevelopment plan called the Rush Transformation, which also includes a new orthopedics building (to open in Fall 2009), a new parking garage and central power plant completed in June 2009, renovations of selected existing buildings and demolition of obsolete buildings. The new hospital is being designed and built to conserve energy and water, reduce waste and use sustainable building materials. Rush is seeking Leadership in Energy and Environmental Design (LEED) gold certification from the U.S. Green Building Council. It will be the first fullservice “green” hospital in Chicago.

Rushs mission is to provide the best possible care for our patients. Educating tomorrows health care professional, researching new and more advanced treatment options, transforming our facilities and investing in new technologies all are undertaken with the drive to improve patient care now, and for the future.

A study published in Science has found that levels of amyloid beta, a protein fragment associated with Alzheimers disease, rose and fell in association with sleep and wakefulness in mice.

It is interesting that there may be a link between sleep and the build up of the protein associated with the development of Alzheimers disease. However, there are many other biological factors that may have an impact on the proteins production, so further research in this area would be needed.

Dementia research is desperately underfunded, with the government investing eight times less in dementia research than cancer research. One million people will develop dementia in the next 10 years. We must act now.

Professor Clive Ballard
Director of Research
Alzheimers Society

JaeEun Kang, Miranda M. Lim, Randall J. Bateman et al, Amyloidbeta dynamics are regulated by Orexin and the SleepWake Cycle, 24 September 2009

Fortyfour percent of workingclass women want to have fewer children or delay pregnancy because of the economic recession, according to a study by the Guttmacher Institute, the Washington Posts “Daily Dose” reports. A nationally representative sample of 947 women ages 18 to 34 at risk of getting pregnant and living in households with incomes less than $75,000 was surveyed in July and August. Of women who reported a desire to reduce or delay childbearing because of the economic recession, 31% said they want to get pregnant later, 28% want fewer children than previously planned and 7% no longer want any additional children (Stein, “Daily Dose,” Washington Post, 9/23).

Laura Lindberg, a senior research associate at Guttmacher, said, “The recession has impacted much more than peoples wallets,” adding, “Women, especially those that are facing financial difficulties, want to avoid unintended pregnancy more than ever, and many of them are having difficulties affording their contraception to do this” (Reinberg, HealthDay/U.S. News & World Report, 9/23).

Fiftytwo percent of respondents said they are financially worse off now than in 2008, and nearly three in four said they worry more about money. Fiftyseven percent of women with children reported worrying more about taking care of their children, and 64% agreed with the statement, “With the economy the way it is, I cant afford to have a baby right now.”

The study also found that 29% of women agreed with the statement, “With the economy the way it is, I am more careful than I used to be about using contraception every time I have sex” (”Daily Dose,” Washington Post, 9/23). According to HealthDay/U.S. News, some women are switching from daily, oral contraception to longer lasting methods, such as intrauterine devices and injectable contraceptives. Fortysix percent of the women who said they did not want more children also said they are “thinking more about sterilization,” the study found (HealthDay/ U.S. News & World Report, 9/23).

At the same time, financial strains are making it more difficult for some women to use effective contraception consistently, the “Daily Dose” reports. The study found that nearly one in four women reported having to delay gynecological or birth control visits in the past year to save money. Twentythree percent of the women said that they are having more difficulty paying for birth control than in the past, and 8% said they sometimes do not use any birth control as a way to save money. In addition, 18% of women using the birth control pills reported inconsistent use as a way to save money.

Sharon Camp, president and CEO of Guttmacher, said the economic downturn is “putting many women and their partners between a rock and a hard place,” adding, “They want to avoid an unplanned pregnancy more than ever, but for many of them the ability to afford the birth control they need is getting harder than ever.” Camp said, “These are women who might not have health insurance or may have lost their health insurance, and so might be most stressed” (”Daily Dose,” Washington Post, 9/23).

Cecile Richards, president of the Planned Parenthood Federation of America, said the study “confirms what we are hearing at Planned Parenthood health centers across the country.” Richards added that 17.5 million women currently are in need of publicly funded family planning services.

Men appear to have similar concerns about childbearing during the recession, according HealthDay/U.S. News & World Report. In early 2009, doctors reported an increase in the number of vasectomies performed since the start of the economic downturn. Doctors said the rise could come from a decreased desire to have children because of financial concerns, as well as fears of losing a job and health insurance.

According to Lindberg, the attitude and behavioral changes reported in the study could continue long after the recession is officially over. “National economic indicators may take a long time to translate into families homes and bedrooms,” she said (HealthDay/U.S. News & World Report, 9/23).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

When they think of attention deficit hyperactivity disorder, most people think of squirming kids unable to sit still. ADHD, as it is more generally known, is one of the most common disorders of childhood. But symptoms of ADHD often linger into adulthood.

Approximately 2 to 4 percent of college students report significant symptoms of ADHD such as difficulty with attention, impulse control, and restlessness.

Although there is a great deal of information about childhood and adult ADHD and treatments, theres scarce information about the effectiveness of medication on college students with ADHD.

That is all about to change. Researchers at the University of Rhode Island and Lehigh University are about to launch a study to test the effectiveness of the stimulant medication, Vyvanse™, on college students with ADHD. It is the first such study for this population.

Lisa Weyandt, an associate professor of psychology at URI and one of the nations leading researchers on ADHD in college students, was awarded a grant from Shire Development Inc. to support the study. Shire, the manufacturer of Vyvanse™, is a global specialty biopharmaceuticals company that focuses on attention deficit and hyperactivity disorder, human genetic therapies, and gastrointestinal diseases.

As principal investigator on the grant, Weyandt has subcontracted the study with her coinvestigator ADHD expert George DuPaul, professor of school psychology who chairs the Department of Education and Human Services at Lehigh. DuPauls research interests include the assessment and treatment of college students with significant ADHD symptoms. DuPaul earned his graduate degrees from URI.

“College students with ADHD are at a greater risk for academic and psychological difficulties. They are also in a unique developmental context at this stage of their lives, when they are expected to live and act independently,” says DuPaul.

“Many colleges and universities offer resources to help students with ADHD from a functional standpoint. However, we are the first to look at the impact of medication to treat the symptoms of ADHD.”

The study will begin this fall. Twentyfive students from URI and Lehigh University will be recruited for the fiveweek study through disability support services offices and advertisements.

Each student will be evaluated during a baseline level (no meds, no placebo), a placebo condition, and during three different levels of medication. The study, designed as a placebo controlled double blind, ensures that neither the student nor the data collector know the level of the drug, if any, the student is taking. Students will receive a $300 honorarium if they complete the study.

The grant will fund the salaries of two graduate students at each institution.

“The study will measure changes in attention and executive functions and social/psychological functioning, as well as perceived changes among the students,” said Weyandt. “Feedback from the students professors will also be sought.”

Study results will be announced in fall of 2010.

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Jan Wenzel

The Dallas Morning News reports on the lure of the medical imaging business, which is many say is a “growth industry,” including the idea that a “second or thirdhand MRI machine” can be purchased by a physician practice or freestanding imaging center for a few hundred thousand dollars but yield millions in new revenue. A report by Americas Health Insurance Plans says as many as half the scans are unnecessary, and a McKinsey Global Institute study found the extra machines produce around $26.4 billion in additional costs each year. In addition, they expose patients to avoidable radiation (McNeill, 9/22).

Separately, drug maker Eli Lilly recently disclosed payments to 3,400 doctors around the country who promoted the companys products to other doctors in their communities, the Orlando Sentinel reports. The payments to the socalled “Lilly faculty” totaled more than $22 million in the first quarter of this year, and were disclosed as part of a settlement with the federal government. An Institute of Medicine panel said the speaking payments lead to increased drug sales and should be halted. A Harvard medical school professor and panelist said the speeches also drive up health costs by encouraging doctors to choose more expensive, brandname drugs (LaMendola and Quintero, 9/23).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Cancer predisposition resulting from the presence of a specific gene variant shows a strong gender bias, researchers at the University of Cincinnati (UC) have demonstrated.

In addition, the research indicates that the risk for development of cancer in individuals harboring the gene variant can be further increased as a result of environmental exposure.

Peter Stambrook, PhD, a professor in the department of molecular genetics, biochemistry and microbiology, and colleagues report their findings this week in Proceedings of the National Academy of Sciences (PNAS). Coauthors include researchers from Wright State University and the Laboratory for Health Protection Research, National Institute of Public Health and the Environment, the Netherlands.

Stambrook says the gene CHEK2 is part of a DNA damage response pathway that can have an impact on whether or not cancers develop. A CHEK2 variant, CHEK2*1100delC, is associated with increased risk of cancer.

“Women who carry this particular gene variant are predisposed to developing breast or ovarian cancer,” says Stambrook, “while men have a higher risk of developing prostate cancer.”

Stambrooks team has produced a mouse model in which the CHEK2 gene was replaced by the variant and found that the overwhelming majority of mice that developed cancer were female about 80 percent, as opposed to slightly more than 15 percent for males. This contrasts sharply with the incidence of cancer in wildtype mice (those with the normal CHEK2 gene), in which male and female mice developed cancer to about the same extent but at a much lower frequency.

Stambrook says his team will be exploring possible reasons behind the difference, looking at hormonal involvement and possible interactions between the gene variant and estrogen receptors or estrogen itself.

By using a known carcinogen, dimethyl benzanthracene, the researchers also determined that mice that harbor the variant are more susceptible to an environmental challenge than those that dont. The compound was administered orally to female mice.

“When they delivered the compound, the lifespan of the mice was reduced significantly they developed breast cancer as well as other types of cancers,” Stambrook says. “In addition, the mice that harbored this variant were more susceptible in other words, they developed tumors more quickly than wildtype mice.”

Stambrook says that by learning more about the signaling pathway of the CHEK2 gene, researchers can explore ways to “rescue” it and identify potential therapeutic targets.

“Its an interesting gene,” says Stambrook, “and there are a lot of interesting directions that this finding will take us.”

The work was supported in part by grants from the National Institutes of Health and UCs Center for Environmental Genetics.

Keith Herrell Keith Herrell

An article published Online First and in a future edition of The Lancet reports that hormone replacement therapy (HRT) using oestrogen and progestin increases the risk of death from lung cancer. This finding should be included into riskbenefit consideration for women considering HRT. It is especially essential for women at high risk of lung cancer. The article is the work of Professor Rowan Chlebowski, of the Los Angeles Biomedical Research Institute at HarbourUCLA Medical Center, Torrance, CA, USA, and colleagues.

Data from the Womens Health Initiative (WHI) trial was studied. This large trial, of HRT (oestrogen plus progestin) in postmenopausal women, was stopped prematurely when health risks were found to outweigh benefits. Followup after an average of 5.6 years showed that participants assigned to HRT had higher risks of cardiovascular disease, coronary heart disease, stroke, venous thromboembolism, and breast cancer, and lower risks of fractures and colorectal cancers than did women assigned to placebo. Between study groups, allcause mortality did not fluctuate. In addition, results from further followup of an additional 2.4 years (totalling 8 years of monitoring) suggested that the combined hormone therapy might increase mortality from lung cancer. In order to corroborate this association, the authors evaluated the number of lung cancers diagnosed in the trial over the whole followup period.

The WHI study involved 16,608 postmenopausal women aged 50 to 79 years with an intact uterus. It was a randomised controlled trial that took place in 40 centres in the USA. A group of 8,506 women received a oncedaily tablet of 0.625 mg conjugated equine oestrogen plus 2.5 mg medroxyprogesterone acetate. The other group of 8,102 women received matching placebo. After the 8 years total followup the researchers found that more women died from lung cancer in the combined hormone therapy group than in the placebo group (73 compared to 40 deaths). In other words, women in the HRT group were 71 percent more likely to die. This was mostly as a result of a higher number of deaths from nonsmallcell lung cancer (NSCLC) in the combined therapy group (62 compared to 31 deaths). Women in the HRT group were 87 percent more likely to die particularly of NSCLC. In addition, women in the HRT group were 28 percent more likely to be diagnosed with lung cancer than those given placebo, although this finding was not statistically significant. Between groups, incidence and mortality rates of smallcell lung cancer were comparable.

Dr. Rowan T. Chlebowski, MD, PhD, Los Angeles Biomedical Research Institute (LA BioMed) chief of oncology and author of the study comments”Postmenopausal women, especially current smokers or longterm past smokers, should carefully consider these new lung cancer findings before initiating or continuing combined estrogen plus progestin use.”

The authors write in conclusion “Treatment with oestrogen plus progestin in postmenopausal women…increased the number of deaths from lung cancer, in particular deaths from nonsmallcell lung cancer. These findings should be incorporated into riskbenefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer…such as current smokers or longterm past smokers.”

In a supplementary note, Dr Apar Kishor Ganti, University of Nebraska Medical Center, Omaha, NE, USA, remarks “Because the optimum safe duration of hormonereplacement therapy in terms of lungcancer survival is unclear, such therapy should probably be avoided in women at a high risk of developing lung cancer, especially those with a history of smoking. These results, along with the findings showing no protection against coronary heart disease, seriously question whether hormonereplacement therapy has any role in medicine today. It is difficult to presume that the benefits of routine use of such therapy for menopausal symptoms outweigh the increased risks of mortality, especially in the absence of improvement in the quality of life.”

“Oestrogen plus progestin and lung cancer in postmenopausal women (Womens Health Initiative trial) a posthoc analysis of a randomised controlled trial”
Rowan T Chlebowski, Ann G Schwartz, Heather Wakelee, Garnet L Anderson, Marcia L Stefanick, JoAnn E Manson, Rebecca J Rodabough, Jason W Chien, Jean WactawskiWende, Margery Gass, Jane Morley Kotchen, Karen C Johnson, Mary Jo OSullivan, Judith K Ockene, Chu Chen, F Allan Hubbell, for the Womens Health Initiative Investigators
DOI 10.1016/S01406736(09)615269
The Lancet

Nicola Rossi, Director of Communications, BT Health, has been appointed Director of Communications for the National Pharmacy Association. Nicola will be taking up her new role in December 2009.

Nicola has spent the last three years managing communications for BTs NHS contracts and in that time she has worked with her team to build a comprehensive proactive communications programme as well as ensuring that external interest in BTs work in health is handled professionally. Immediately prior to that, she set up BTs first analyst relations programme, independently benchmarked as one of the best in the Europe. She has been working in communications management roles for BT for more than 20 years.

Nicola said “Community pharmacy is extremely popular with the general public. With its ubiquitous membership the NPA has a legitimate voice on a whole range of healthcare issues. My job will be to ensure that voice is heard, on behalf of community pharmacy, helping it to play a strategic role in policy making and service delivery.”

John Turk, Chief Executive of the National Pharmacy Association said “We have made this appointment to strengthen our representation with our most influential stakeholders. I am delighted that Nicola is joining us. She has a very strong track record working with strategic audiences and I look forward to working with her.”

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