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In Scientific First, Einstein Researchers Correct Decline In Organ Function Associated With Old Age

2009-06-15T12:09:00.001-07:00

As people age, their cells become less efficient at getting rid of damaged protein - resulting in a buildup of toxic material that is especially pronounced in Alzheimer's, Parkinson's disease, and other neurodegenerative disorders.

Now, for the first time, scientists at the Albert Einstein College of Medicine of Yeshiva University have prevented this age-related decline in an entire organ - the liver - and shown that, as a result, the livers of older animals functioned as well as they did when the animals were much younger. Published in the online edition of Nature Medicine, these findings suggest that therapies for boosting protein clearance might help stave off some of the declines in function that accompany old age. The study's senior author was Dr. Ana Maria Cuervo, associate professor in the departments of developmental & molecular biology, medicine and anatomy & structural biology at Einstein.

The cells of all organisms have several surveillance systems designed to find, digest and recycle damaged proteins. Many studies have documented that these processes become less efficient with age, allowing protein to gradually accumulate inside cells. But aging researchers continue debating whether this protein buildup actually contributes to the functional losses of aging or instead is merely associated with those losses. The Einstein study was aimed at resolving the controversy.

One of these surveillance systems - responsible for handling 30 percent or more of damaged cellular protein - uses molecules known as chaperones to seek out damaged proteins. After finding such a protein, the chaperone ferries it towards one of the cell's many lysosomes - membrane-bound sacs filled with enzymes. When the chaperone and its cargo "dock" on a receptor molecule on the lysosome's surface, the damaged protein is drawn into the lysosome and rapidly digested by its enzymes.

In previous work, Dr. Cuervo found that the chaperone surveillance system, in particular, becomes less efficient as cells become older, resulting in a buildup of undigested proteins within the cells. She also detected the primary cause for this age-related decline: a fall-off in the number of lysosomal receptors capable of binding chaperones and their damaged proteins. Could replenishing lost receptors in older animals maintain the efficiency of this protein-removal system throughout an animal's lifespan and, perhaps, maintain the function of the animal's cells and organs as well?

To find out, Dr. Cuervo created a transgenic mouse model equipped with an extra gene - one that codes for the receptor that normally declines in number with increasing age. Another genetic manipulation allowed Dr. Cuervo to turn on this extra gene only in the liver and at a time of her choosing, merely by changing the animals' diet.

To keep the level of the receptor constant throughout life, Dr. Cuervo waited until mice were six months old (the age that the chaperone system's efficiency begins to decline) before turning on the added receptor gene. When the mice were examined at 22 to 26 months of age (equivalent to approximately 80 years old in humans), the liver cells of transgenic mice digested and recycled protein far more efficiently than in their normal counterparts of the same age - and, in fact, just as efficiently as in normal six-month old mice.

Does maintaining efficient protein clearance in liver cells of an older animal translate into better functioning for the liver as a whole? Since a key function of the liver is metabolizing chemicals, Dr. Cuervo answered this question by injecting a muscle relaxant into very old transgenic mice and very old normal mice. The very old transgenic mice metabolized the muscle relaxant much more quickly than very old normal mice and at a rate comparable to young normal mice.

"Our study showed that functions can be maintained in older animals so long as damaged proteins continue to be efficiently removed - strongly supporting the idea that protein buildup in cells plays an important role in aging itself," says Dr. Cuervo. "Even more important, these results show that it's possible to correct this protein 'logjam' that occurs in our cells as we get older, thereby perhaps helping us to enjoy healthier lives well into old age."

Dr. Cuervo next plans to study animal models of Alzheimer's, Parkinson's and other neurodegenerative brain diseases to see whether maintaining efficient protein clearance in the brain might help in treating them. "Most people with these conditions are born with a mutation that gives rise to defective proteins, but they don't experience symptoms until later in life," says Dr. Cuervo. "We think that's because their protein-clearance systems can handle abnormal proteins when the person is younger but get overwhelmed as their efficiency falls with age. By preventing this decline in protein clearance, we may be able to keep these people free of symptoms for a longer time."

Dr. Cuervo will also investigate whether maintaining efficient protein clearance in all the body's tissues will influence longevity and prevent the functional losses associated with growing old. "There's reason to hope that drugs exerting a similar effect throughout the body may help us enjoy healthier lives well into old age," says Dr. Cuervo. Meanwhile, she notes, evidence is mounting that two dietary interventions - low-fat and calorie-restricted diets - help cells to maintain efficient protein clearance.

Cong Zhang, a graduate student working in Dr. Cuervo's laboratory, was the lead author of the Nature Medicine study. The research was supported by grants from the National Institute on Aging, an Ellison Medical Foundation Award and a Glenn Foundation Award.

Albert Einstein College of Medicine

Drug Utilization Review Reveals Potentially Inappropriate Medication Use Among Elderly Population

2009-06-15T12:01:00.000-07:00

Research conducted by Prime Therapeutics (Prime) revealed a significant reduction in inappropriate prescription medication use among older adults when a retrospective drug utilization review (RetroDUR) program paired with a provider intervention initiative was implemented. This research was recently published in the American Journal of Geriatric Pharmacotherapy. In addition, a research abstract based on the same study was published in the March issue of the Journal of Managed Care Pharmacy. The study will be presented at the Academy of Managed Care Pharmacy (AMCP) Annual Meeting this week in Orlando, Florida.

According to a 2008 study by Research in Nursing and Health, Persons 65 years of age and older are more likely than younger persons to require hospitalization due to adverse drug events, which have been linked to preventable problems such as depression, confusion, immobility, falls and hip fractures. Although the National Committee for Quality Assurance has created a list of drugs to be avoided in the elderly due to an increased risk of negative health outcomes, the use of these medications, which include muscle relaxants, estrogens and anticholinergic medicines, continues to be widespread.

"Inappropriate prescribing for elderly patients remains prevalent," said Catherine I. Starner, PharmD, BCPS, CGP, lead author and Senior Clinical Pharmacist at Prime Therapeutics. "Our research suggests an actionable provider letter with member specific prescription claims information appears to be associated with a decrease in potentially inappropriate prescription medication use among older adults."

The analysis was conducted using retrospectively analyzed pharmacy claims data from three Medicare Part D Blue Cross Blue Shield plans across four states. Prime identified members who were 65 years of age or older who had a claim for one or more drugs to be avoided in the elderly (DAE). Information was mailed to prescribers with patients who had a claim for one or more DAE and for whom a valid mailing address could be established. Plan members were then assessed for the presence of a drug in the same drug class six months after the initial analysis.

Of the eligible plan members, approximately 5 percent had a claim for one or more DAE during the 30-day review period. Overall, almost half of the claims for DAE were defined as discontinued after six months and when compared to a control group, there was a statistically significant reduction in utilization of potentially inappropriate prescription medications use. This translates into one additional DAE discontinued for every 16 DAE claims intervened upon.

The most common drugs identified in the study were estrogens, the analgesic propoxyphene, muscle relaxants, anticholinergics, antihistamines and the antibiotic nitrofurantoin. As a class, anticholinergics had the highest rate of discontinuation. Further research is needed to demonstrate the impact on health care utilization and costs, adverse drug events, and healthcare and quality of life outcomes.

Prime will be presenting this study and other poster presentations at the AMCP meeting on April 17:

Influence of the Copay Differential Between Generics and Preferred-Brands on the Generic Fill Rate
High-Deductible Health Plans Trends in Pharmaceutical Utilization and Expenditures
Multiple Sclerosis Medication Out-of-Pocket Expense Association with Decline to Fill Rate
Oral Cancer Kinase Inhibitors Utilization Management Opportunity: An Integrated Medical and Pharmacy Claims Analysis
Assessment of a Retrospective Drug Utilization Review Using Beers' List of Potentially Inappropriate Medications
Utilization of the National Provider Identifier for Stratifying Prescribers

Prime Therapeutics LLC is a pharmacy benefit management company dedicated to providing innovative, clinically based, cost-effective pharmacy solutions for clients and members. Providing pharmacy benefit services nationwide to approximately 14.7 million covered lives, its client base includes Blue Cross and Blue Shield Plans, employer and union groups, and third- party administrators. Headquartered in St. Paul, Minnesota, Prime Therapeutics is collectively owned by 11 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those Plans

Source: Prime Therapeutics LLC

Menopause and Weight Gain

2009-04-24T09:45:00.000-07:00

For most women, increases in weight begin during perimenopause — the years leading up to menopause. On average, women gain about a pound a year during this time. Reversing course to lose unwanted pounds requires strict attention to healthy eating habits, an active lifestyle and diligence to keep it all on track.

Causes of weight gain after menopause

Changing hormone levels associated with menopause aren't necessarily the cause of weight gain. Aging and lifestyle factors play a big role in your changing body composition, including:

Exercising less. Menopausal women tend to exercise less than other women, which can lead to weight gain.
Eating more. Eating more means you'll take in more calories, which are converted to fat if you don't burn them for energy.
Burning fewer calories. The number of calories you need for energy decreases as you age because aging promotes the replacement of muscle with fat. Muscle burns more calories than fat does. When your body composition shifts to more fat and less muscle, your metabolism slows down.

Genetic factors may play a role in weight gain as well. If your parents and other close relatives carry extra weight around the abdomen, you may be predisposed to do so, too.

Weight gain can also have serious implications for your health. Excess weight increases your risk of high cholesterol, high blood pressure and insulin resistance, which can lead to type 2 diabetes. These factors also put you at increased risk of heart disease and stroke.

There's also evidence that weight gain after menopause increases breast cancer risk. Women who gain in excess of 20 pounds after menopause increase their breast cancer risk by nearly 20 percent. On the other hand, losing weight after menopause can reduce breast cancer risk.

What you can do to prevent or reverse weight gain

There's no magic formula for avoiding weight gain as you get older. The strategies for maintaining a healthy weight at any age remain the same: Watch what you eat and get moving.

The most effective approach to reversing weight gain after menopause includes a combination of the following:

Increase your physical activity. Aerobic exercise boosts your metabolism and helps you burn fat. Strength training exercises increase muscle mass, boost your metabolism and strengthen your bones.

You can become more physically active even without starting a formal exercise program. Just spend more time doing the things you love that also get you moving. Do more gardening and dancing. Take longer walks or try out a bike. Make it your goal to be active for a total of 30 minutes or more a day on most days.

Increased physical activity, including strength training, may be the single most important factor for maintaining a healthy body composition — more lean muscle mass and less body fat — as you get older.
Reduce calories. Pay attention to the foods you're eating and slightly reduce the amount of calories you consume each day. By choosing a varied diet composed mainly of fruits and vegetables, you can safely cut back on calories and lose weight. Be careful not to cut back too drastically on calorie intake, or your body will respond by conserving energy, making extra pounds harder to shed.

Because your metabolism slows as you get older, you need about 200 fewer calories a day to maintain your weight as you get into your mid- to late 40s. This shouldn't be a problem if you eat only when hungry and only enough to satisfy your hunger.
Decrease dietary fat. Eating large amounts of high-fat foods adds excess calories, which can lead to weight gain and obesity. Limit fat to 20 to 35 percent of your daily calories. Emphasize fats from healthier sources, such as nuts and olive, canola and peanut oils.

Useful Steps to Fight Obesity

2009-04-24T09:39:00.000-07:00

1. Make a commitment

Permanent weight loss takes time and effort. It requires focus and a lifelong commitment. Make sure that you're ready to make permanent changes and that you do so for the right reasons.

No one else can make you lose weight. In fact, external pressure — often from people closest to you — may make matters worse. You must undertake diet and exercise changes to please yourself.

As you're planning new weight-related lifestyle changes, try to resolve any other problems in your life. It takes a lot of mental and physical energy to change your habits. So make sure you aren't distracted by other major life issues, such as marital or financial problems. Timing is key to success. Ask yourself if you're ready to take on the challenges of serious weight loss.
2. Get emotional support

Only you can help yourself lose weight by taking responsibility for your own behavior. But that doesn't mean that you have to do everything alone. Seek support when needed from your partner, family and friends.

Pick people who you know want only the best for you and who will encourage you. Ideally, find people who will listen to your concerns and feelings, spend time exercising with you, and share the priority you've placed on developing a healthier lifestyle.
3. Set a realistic goal

When you're considering what to expect from your new eating and exercise plan, be realistic. Healthy weight loss occurs slowly and steadily. Aim to lose 1 to 2 pounds (0.5 to 1 kilogram) a week. To do this, you need to burn 500 to 1,000 calories more than you consume each day, through a low-calorie diet and regular exercise.

Make your goals "process goals," such as exercising regularly, rather than "outcome goals," such as losing 50 pounds (23 kilograms). Changing your process — your habits — is the key to weight loss. Make sure that your process goals are realistic, specific and measurable, for example, you'll walk for 30 minutes a day, five days a week.
4. Enjoy healthier foods

Adopting a new eating style that promotes weight loss must include lowering your total calorie intake. But decreasing calories need not mean giving up taste, satisfaction or even ease of meal preparation. One way you can lower your calorie intake is by eating more plant-based foods — fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without giving up taste or nutrition.
5. Get active, stay active

Dieting alone can help you lose weight. Cutting 500 calories from your daily diet can help you lose about a pound a week: 3,500 calories equals 1 pound (0.5 kilogram) of fat. But add a 45- to 60-minute brisk walk four days a week, and you can double your rate of weight loss.

The goal of exercise for weight loss is to burn more calories, although exercise offers many other benefits as well. How many calories you burn depends on the frequency, duration and intensity of your activities. One of the best ways to lose body fat is through steady aerobic exercise — such as walking — for more than 30 minutes most days of the week.

Even though regularly scheduled aerobic exercise is best for losing fat, any extra movement helps burn calories. Lifestyle activities may be easier to fit into your day. Think about ways you can increase your physical activity throughout the day. For example, make several trips up and down stairs instead of using the elevator, or park at the far end of the lot.
6. Change your lifestyle

It's not enough to eat healthy foods and exercise for only a few weeks or even several months. You have to include these behaviors in your lifestyle. To do that, you have to change the behaviors that helped make you overweight in the first place. Lifestyle changes start with taking an honest look at your eating habits and daily routine.

After assessing your personal challenges to weight loss, try working out a strategy to gradually change habits and attitudes that have sabotaged your past efforts. Simply admitting your own challenges won't get you past them entirely. But it helps in planning how you'll deal with them and whether you're going to succeed in losing weight once and for all.

You likely will have an occasional setback. But instead of giving up entirely, simply start fresh the next day. Remember that you're planning to change your life. It won't happen all at once, but stick to your healthy lifestyle and the results will be worth it.

Obesity as Psychological Injury

2009-04-24T05:58:00.000-07:00

As you could already guess, this article concerns an overwhelming disease that touches absolutely all social layers. It bothers many people irrespective of their sex, age and their hobbies. So, we will talk about obesity. There is a huge number of reasons and consequences of its manifestation. You could get all the necessary information from this article.

So, let's start. Obesity is an excessive storage of superfluous fat in the body of a person. This accumulation of fat results, naturally, in occurrence of a superfluous weight of the body. Fat during obesity accumulates in the hypodermic fatty cellular tissue and around of internal parts of a body.

There are some basic types of obesity. If the major part of fat has collected in the abdominal region and above, then this kind obesity is referred to an upper type. It is sometimes named as male obesity. If fat starts accumulating in thighs and buttocks, then this obesity is of a lower type. It can also be called as a "female" adiposity.

The most frequent and main reasons of obesity are overeating and an inactive way of life. We all know that to gain an excess weight is very easy, and here, to get rid of it can be a difficult challenge. Very often people start to absorb food simply to cheer themselves up or to snack in a stressful situation. Often enough, we eat with zest simply sitting in front of the TV or a computer. There are also people who prowl at night imperceptibly to a refrigerator. However, the majority of people simply love to eat a tasty food.

A plenty of people most of their day spend basically in a sitting position. They do not do jogging in the mornings; do not go in for sports and do not do make daily physical exercises. All this finally leads to the excess of a reasonable weight limit.

One more reason for obesity is the age. It plays a very important role in the storage of fat in the human body. All medical personnel confirm that the senior a person is, the greater is the probability for obesity. It occurs because of deterioration of the metabolism and infringement in the activity of the appetite center in the brain. With years, as a rule, a person is required more food to suppress a usual feeling of esurience.

Obesity is, first of all, a psychological injury for a person. For this reason before eating a greater portion of fat meal and to rise at ten o'clock instead of seven, think what such a way of life can result in. Probably, the thought of future obesity will stop you in a necessary moment. Try to include fruit and vegetables into your diet. Go in for sports instead of sitting in front of the TV. Rise up in the morning, half an hour earlier and do some exercises. Believe, all this helps to struggle with obesity.

Insomnia Aspects and Independent Review

2009-04-23T11:28:00.000-07:00

You are likely know that not getting adequate sound sleep may impress both how your run at work and your personal human relationship as well. We all get the odd late nighttime, and that's normal, but if you're escaping a bit much sleep as you're struck by insomnia, your head may cope with the problem. Detecting habitual insomnia relief becomes urgent if your sleep deficiency affects your lifestyle.

You could be stormed to cognize that most grownups have had some level of insomnia or wakefulness during their lives. And it is recognized that ten percent of the worldwide population addresses chronic insomnia problems. This never-ending sleep deficiency may cause people to feel a depressive disorder, amnesia and even delusions. Apparently, the habitual insomnia treatment is essential for anyone with this frustrative long-run condition. First, you've to specify whether or not you've genuine insomnia in progress.

If you've a difficulty in falling asleep at times, you believably don't have insomnia. Habitual, or insomnia in progress is classed as occurring at least 3 nights a week over a month or more. As a matter of fact, insomnia is more than just a symptom. Actual insomnia is the inability to drift off and stay asleep or the miss of quality sleep. Insomnia isn't as mere as accounting the amount of sleep hours you get. You've to recognize that people vary widely in their sleep demands and procedures.

The great news is that there is a lot of research on best chronic insomnia treatments. The initiative advance is to assure that your entire environment promotes good sleep and will not give you any trouble at night. Most sufferers from insomnia consider that light and noise aspects are main issues.
If these outside effects don't influence your problem, take a look onto natural remedies which become more and more popular. Habitual insomnia therapies are now available with homeopathic and herbal components instead of chemicals and sedatives.