Pre dementia 'in men more often'

25. January 2012 last health reporter, BBC News updated at 22: 44 GMT by Michelle Roberts the risk of dementia increases with age, even though dementia is more common in women, it seems that men to higher risk of the earliest signs of the disease, according to the latest research.

It is unclear why more men avoid full-blown disease, but understand that this may be to hit key of Neurology reported dementia, archives.

Finally, also a way to stop dementia can cause, hope experts.

Investigators U.S. tracked the health of almost 1,500 older men and women of a three year period.

During this time far more men developed mild cognitive impairment - 72 in every 1,000 compared to 57 per 1,000 women.

The Mayo Clinic researchers as several factors that may distort results, such as age, education and marital status, but found that the gender difference is maintained.

You say more work is needed now to understand if and how men may be slightly prone to dementia.

Dr. Marie Janson, the Alzheimer's research, UK, said: "they show surprising results that may be more vulnerable to MCI (mild cognitive impairment) despite a reduced risk of dementia, and it is men be important to determine whether further investigation these findings can be replicated."

"Read the main story

, if we can understand why some people a greater risk for cognitive decline and dementia, we have a chance better able the condition to prevent"

End quote Dr Marie Janson Alzheimer Research UK "An important objective for the research is to determine why some people with MCI develop dementia while others do not." If we can understand why some people have a greater risk for cognitive decline and dementia, we stand a better chance to be able to prevent the condition.

"With the need for research, find 820.000 people with dementia, and one of the rapidly ageing population, new ways for the treatment and prevention which condition was never more urgent."

It may be simply that fewer people live to reach an age when more expands their dementia. It is known that on average tend to be women survive in men.

Gender difference

But some scientists believe that the difference could be explained only by gender.

Studies have shown, for example, a person gender influence how benefits can performing body and mind.

Women exercise is more associated mortality benefit, while in men, the positive effect of the exercise more is a cognitive improvement.

In an accompanying editorial, Dr. Kenneth Rockwood of at Dalhousie University in Canada, said: "for some men, MCI incomplete disease expression represents;" Alternatively, they resist development more dementia.

"MCI in men could look like this insight in what prevent dementia could give."

Professor Derek Hill of University College London, said: "by the time people get clinical dementia, it may well be too late to treat them."

"This study shows that MCI is a very complex mix of factors, and different types of MCI emerge and progress quite different."

"This information can be important in improving diagnostics to identify patients who benefit from current or future applications."

Source BBC

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Ob-gyn guidelines often based on opinion, weak data

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AppId is over the quota

A nurse feeds a baby in the neonatal intensive care unit at the Virtua Health facility in Vorhees, New Jersey, November 19, 2009.

Credit: Reuters/Tim Shaffer

By Frederik Joelving

NEW YORK | Fri Sep 16, 2011 5:31pm EDT

NEW YORK (Reuters Health) - Solid evidence is often missing from the practice guidelines used by obstetrician-gynecologists across the U.S., a new study shows.

Less than a third of the recommendations from the American College of Obstetricians and Gynecologists (ACOG) are based on gold-standard scientific experiments, researchers found.

The rest are based on anecdotal evidence or expert opinion, which is subject to personal biases, they reported.

"That is often the fall-back when there is no data," said Dr. Andrew D. Auerbach, a professor of medicine at the University of California, San Francisco, who was not part of the study.

He said expert opinion is helpful in pointing out what we don't know, but might not always translate into what's best for patients.

"Many, many times we have the best intentions and the best wishes and yet things don't work out the way we would have liked," Auerbach told Reuters Health.

Guidelines help doctors keep up with the latest developments in their fields and are widely perceived as a recipe for good patient care.

But there is often surprisingly little hard data behind them. Earlier this year, for instance, a group of researchers found that only one in seven treatment recommendations from the Infectious Diseases Society of America was based on high-quality data from clinical trials.

One such recommendation urged doctors to treat pneumonia with antibiotics right away. It ended up fueling overtreatment with no apparent benefits, possibly breeding resistant bacteria and exposing patients to side effects. (See Reuters Health story of January 10, 2011).

In the new study, Dr. Jason D. Wright of Columbia University in New York and colleagues went through 717 practice recommendations from ACOG, the nation's leading group of ob-gyns.

They found 30 percent of those were based on top-notch evidence, so-called randomized controlled trials. About 38 percent came from observational studies, whose value is limited, and 32 percent were purely expert opinion.

"It is disappointing, but I don't think it reflects their process," said Auerbach, who was recently part of an Institute of Medicine committee to develop standards for better guidelines. "It is really a call for better evidence."

In an editorial published along with the new study in ACOG's journal Obstetrics and Gynecology, Editor-in-Chief Dr. James R. Scott said the group's guidelines compared favorably with those in other areas of medicine.

He added that the guidelines panels conduct extensive reviews of the medical literature to find all relevant evidence and also take care to exclude experts with financial conflicts of interest.

According to Dr. Sheldon Greenfield, who chaired the Institute of Medicine guideline committee, those are two key elements in creating good guidelines.

A third component is to ensure that guideline panels represent all stakeholders -- including doctors from other specialties and patients, he told Reuters Health.

If those requirements are fulfilled, he added, there is room for opinion.

"For many of the recommendations there simply is not enough data, or it is disputed," said Greenfield, a professor of medicine at the University of California, Irvine. "So there has to be a role for expert opinion."

So far, however, few if any guideline panels meet all three requirements.

"It's about as common as peace in the Middle East," Greenfield said. "People are struggling with it."

SOURCE: bit.ly/pkPZu4 Obstetrics and Gynecology, September 2011.

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Depressed often hide symptoms

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AppId is over the quota
"We know that depression is undertreated everywhere," study coauthor Richard Kravitz says. Survey finds 43% of people would keep their depression symptoms to themselvesResults highlight the need to educate patients, doctors, and nurses, coauthor saysStudy offers more evidence that the stigma surrounding mental illness is still an obstacle

(Health.com) -- Family doctors and other primary care physicians are often the first health professionals to learn that a patient is depressed, but that doesn't mean they identify all of the depression cases that walk through their offices.

Far from it: A new survey of California adults has found that 43% of people would keep their depression symptoms to themselves during a doctor's appointment, because they feel their emotional difficulties are off-topic, they don't want to be prescribed antidepressants, or they're afraid a record of the conversation will be seen by employers.

The results aren't especially surprising, but they do highlight the need to educate patients, doctors, and nurses about the importance of discussing mood problems during checkups and other routine appointments, says study coauthor Richard Kravitz, M.D., a professor of internal medicine at the University of California, Davis.

Health.com: 10 things to say (and not say) to someone with depression

"The primary care sector cares for a majority of patients with mental health conditions in America, and we know that depression is undertreated everywhere," Kravitz says. "The number one reason for that is because recognition of depression starts with disclosure from the patient."

Gerard Sanacora, Ph.D., a professor of psychiatry at the Yale University School of Medicine, says this study offers more evidence that the stigma surrounding mental illness is still an obstacle that prevents many people from seeking effective, timely treatment.

"I was actually surprised that even more people didn't feel that it was a burden to talk to their doctor," says Sanacora, who was not involved in the study. He suspects that if the survey hadn't been conducted in California -- one of the states most accepting of mental illness, he says -- the patients would have been even more hesitant to discuss depression.

Health.com: The 10 most depressing states in the U.S.

The National Institute of Mental Health funded the survey and analysis. The results were published today in the Annals of Family Medicine.

Kravitz and his colleagues surveyed 1,054 adults over the phone about their general health, access to doctors and insurance, demographics, and family and personal histories of mental health problems. The researchers then asked the respondents whether 11 potential reasons for not wanting to talk with a doctor about depression applied to them a little, a lot, or not at all. (The reasons were gathered from focus groups in a related study.)

The most common concern, which 23% of respondents said applied a lot to them, was that the doctor would recommend antidepressants. Other popular reasons were that it's not a primary care physician's job to deal with emotional issues (16%) and that their medical records could fall into the hands of an employer or another outside party (15%). Respondents also expressed fear about being referred to a specialist or being labeled a "psychiatric patient."

Health.com: Mental illness -- the last stigma

The people who had the most to gain from talking with their doctor -- individuals with moderate to severe depression symptoms at the time of the phone survey -- subscribed to the most beliefs that would prevent them from doing so.

This reluctance among patients is crucial to overcome, Sanacora says, because the longer depression goes undiagnosed, the harder it can be to treat and the more permanent damage it can do. "There's increasing evidence that the state of being depressed could actually be injurious to the brain," he says. "Delaying treatment is probably the worst thing a patient can do for their mental health."

Primary care physicians need to actively promote mental-health treatment in their offices, Kravitz says. "Putting pamphlets in the waiting rooms, using appropriate posters, or providing questionnaires to patients are all ways to show that depression lies within the scope of their practice," he says.

Health.com: 12 signs of depression in men

Kravitz and his colleagues are also developing a public service announcement targeted toward high-risk demographic groups. In the survey, for instance, people who were female, Hispanic, had no family history of depression, and had less education or lower household income were all more likely than their peers to express reluctance about talking with their doctors.

Sanacora says that doctors can also do a better job at picking up on physical signs of depression that patients may be more vocal about, such as chronic pain, lack of appetite, and sleep problems.

"The emotional aspect is only a small part," he says. "Physicians need to consider these other symptoms, and ask some pointed questions. That may eventually lead to more diagnoses."

Copyright Health Magazine 2010

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Peliculas Online

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Ob-gyn guidelines often based on opinion, weak data

AppId is over the quota
AppId is over the quota

A nurse feeds a baby in the neonatal intensive care unit at the Virtua Health facility in Vorhees, New Jersey, November 19, 2009.

Credit: Reuters/Tim Shaffer

By Frederik Joelving

NEW YORK | Fri Sep 16, 2011 5:31pm EDT

NEW YORK (Reuters Health) - Solid evidence is often missing from the practice guidelines used by obstetrician-gynecologists across the U.S., a new study shows.

Less than a third of the recommendations from the American College of Obstetricians and Gynecologists (ACOG) are based on gold-standard scientific experiments, researchers found.

The rest are based on anecdotal evidence or expert opinion, which is subject to personal biases, they reported.

"That is often the fall-back when there is no data," said Dr. Andrew D. Auerbach, a professor of medicine at the University of California, San Francisco, who was not part of the study.

He said expert opinion is helpful in pointing out what we don't know, but might not always translate into what's best for patients.

"Many, many times we have the best intentions and the best wishes and yet things don't work out the way we would have liked," Auerbach told Reuters Health.

Guidelines help doctors keep up with the latest developments in their fields and are widely perceived as a recipe for good patient care.

But there is often surprisingly little hard data behind them. Earlier this year, for instance, a group of researchers found that only one in seven treatment recommendations from the Infectious Diseases Society of America was based on high-quality data from clinical trials.

One such recommendation urged doctors to treat pneumonia with antibiotics right away. It ended up fueling overtreatment with no apparent benefits, possibly breeding resistant bacteria and exposing patients to side effects. (See Reuters Health story of January 10, 2011).

In the new study, Dr. Jason D. Wright of Columbia University in New York and colleagues went through 717 practice recommendations from ACOG, the nation's leading group of ob-gyns.

They found 30 percent of those were based on top-notch evidence, so-called randomized controlled trials. About 38 percent came from observational studies, whose value is limited, and 32 percent were purely expert opinion.

"It is disappointing, but I don't think it reflects their process," said Auerbach, who was recently part of an Institute of Medicine committee to develop standards for better guidelines. "It is really a call for better evidence."

In an editorial published along with the new study in ACOG's journal Obstetrics and Gynecology, Editor-in-Chief Dr. James R. Scott said the group's guidelines compared favorably with those in other areas of medicine.

He added that the guidelines panels conduct extensive reviews of the medical literature to find all relevant evidence and also take care to exclude experts with financial conflicts of interest.

According to Dr. Sheldon Greenfield, who chaired the Institute of Medicine guideline committee, those are two key elements in creating good guidelines.

A third component is to ensure that guideline panels represent all stakeholders -- including doctors from other specialties and patients, he told Reuters Health.

If those requirements are fulfilled, he added, there is room for opinion.

"For many of the recommendations there simply is not enough data, or it is disputed," said Greenfield, a professor of medicine at the University of California, Irvine. "So there has to be a role for expert opinion."

So far, however, few if any guideline panels meet all three requirements.

"It's about as common as peace in the Middle East," Greenfield said. "People are struggling with it."

SOURCE: bit.ly/pkPZu4 Obstetrics and Gynecology, September 2011.

View the original article here

Peliculas Online

Read More

HEALTH MANAGEMENT. Depressed often hide symptoms

"We know that depression is undertreated everywhere," study coauthor Richard Kravitz says. Survey finds 43% of people would keep their depression symptoms to themselvesResults highlight the need to educate patients, doctors, and nurses, coauthor saysStudy offers more evidence that the stigma surrounding mental illness is still an obstacle
(Health.com) -- Family doctors and other primary care physicians are often the first health professionals to learn that a patient is depressed, but that doesn't mean they identify all of the depression cases that walk through their offices.
Far from it: A new survey of California adults has found that 43% of people would keep their depression symptoms to themselves during a doctor's appointment, because they feel their emotional difficulties are off-topic, they don't want to be prescribed antidepressants, or they're afraid a record of the conversation will be seen by employers.
The results aren't especially surprising, but they do highlight the need to educate patients, doctors, and nurses about the importance of discussing mood problems during checkups and other routine appointments, says study coauthor Richard Kravitz, M.D., a professor of internal medicine at the University of California, Davis.
Health.com: 10 things to say (and not say) to someone with depression
"The primary care sector cares for a majority of patients with mental health conditions in America, and we know that depression is undertreated everywhere," Kravitz says. "The number one reason for that is because recognition of depression starts with disclosure from the patient."
Gerard Sanacora, Ph.D., a professor of psychiatry at the Yale University School of Medicine, says this study offers more evidence that the stigma surrounding mental illness is still an obstacle that prevents many people from seeking effective, timely treatment.
"I was actually surprised that even more people didn't feel that it was a burden to talk to their doctor," says Sanacora, who was not involved in the study. He suspects that if the survey hadn't been conducted in California -- one of the states most accepting of mental illness, he says -- the patients would have been even more hesitant to discuss depression.
Health.com: The 10 most depressing states in the U.S.
The National Institute of Mental Health funded the survey and analysis. The results were published today in the Annals of Family Medicine.
Kravitz and his colleagues surveyed 1,054 adults over the phone about their general health, access to doctors and insurance, demographics, and family and personal histories of mental health problems. The researchers then asked the respondents whether 11 potential reasons for not wanting to talk with a doctor about depression applied to them a little, a lot, or not at all. (The reasons were gathered from focus groups in a related study.)
The most common concern, which 23% of respondents said applied a lot to them, was that the doctor would recommend antidepressants. Other popular reasons were that it's not a primary care physician's job to deal with emotional issues (16%) and that their medical records could fall into the hands of an employer or another outside party (15%). Respondents also expressed fear about being referred to a specialist or being labeled a "psychiatric patient."
Health.com: Mental illness -- the last stigma
The people who had the most to gain from talking with their doctor -- individuals with moderate to severe depression symptoms at the time of the phone survey -- subscribed to the most beliefs that would prevent them from doing so.
This reluctance among patients is crucial to overcome, Sanacora says, because the longer depression goes undiagnosed, the harder it can be to treat and the more permanent damage it can do. "There's increasing evidence that the state of being depressed could actually be injurious to the brain," he says. "Delaying treatment is probably the worst thing a patient can do for their mental health."
Primary care physicians need to actively promote mental-health treatment in their offices, Kravitz says. "Putting pamphlets in the waiting rooms, using appropriate posters, or providing questionnaires to patients are all ways to show that depression lies within the scope of their practice," he says.
Health.com: 12 signs of depression in men
Kravitz and his colleagues are also developing a public service announcement targeted toward high-risk demographic groups. In the survey, for instance, people who were female, Hispanic, had no family history of depression, and had less education or lower household income were all more likely than their peers to express reluctance about talking with their doctors.
Sanacora says that doctors can also do a better job at picking up on physical signs of depression that patients may be more vocal about, such as chronic pain, lack of appetite, and sleep problems.
"The emotional aspect is only a small part," he says. "Physicians need to consider these other symptoms, and ask some pointed questions. That may eventually lead to more diagnoses."

Read More