Depression in patients with type 2 diabetes associated with cognitive decline

Main Category: Diabetes
Also Included In: Depression;  Alzheimer's / Dementia
Article Date: 15 Aug 2013 - 2:00 PDT Current ratings for:
Depression in patients with type 2 diabetes associated with cognitive decline

Depression in patients with type 2 diabetes was associated with greater cognitive decline in a study of almost 3,000 individuals who participated in a clinical trial, according to a report published by JAMA Psychiatry, a JAMA Network publication.

Depression and diabetes are among the most common illnesses in older primary care populations. Up to 20 percent of adult patients with type 2 diabetes meet the criteria for major depression. Both depression and diabetes appear to be associated with an increased risk for dementia, Mark D. Sullivan, M.D., Ph.D., of the University of Washington, Seattle, and colleagues write in the study background.

"Depression has been identified as a risk factor for dementia among patients with type 2 diabetes mellitus but the cognitive domains and patient groups most affected have not been identified," the study notes.

The study included 2,977 patients with type 2 diabetes at high risk for cardiovascular disease who were participants in the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) trial. Researchers used tests to gauge cognition and a questionnaire to assess depression.

According to the results, patients with scores indicative of depression showed greater cognitive decline during the 40-month follow-up on all tests. The effect of depression on risk of cognitive decline did not differ according to previous cardiovascular disease; baseline cognition or age; or intensive vs. standard glucose-lowering treatment, blood pressure treatment, lipid treatment or insulin treatment, the results also indicate.

"In summary, this epidemiological analysis of the effect of depression on risk for cognitive decline among participants in the ACCORD-MIND study showed that depression is associated with cognitive decline in all domains assessed and that this effect does not differ in important clinical subgroups. This suggests that a potentially reversible factor may be promoting general cognitive decline in the broad population of patients with type 2 diabetes. Since dementia is one of the fastest growing and most dreaded complications of diabetes, our findings may be important for public health," the study concludes.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our diabetes section for the latest news on this subject.

JAMA Psychiatry. Published online August 14, 2013. doi:10.1001/jamapsychiatry.2013.1965.

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Earlier surgical correction of heart valve disorder associated with greater long-term survival, lower risk of heart failure risk

Main Category: Cardiovascular / Cardiology
Article Date: 13 Aug 2013 - 13:00 PDT Current ratings for:
Earlier surgical correction of heart valve disorder associated with greater long-term survival, lower risk of heart failure risk

In a study that included patients with mitral valve regurgitation due to a condition known as flail mitral valve leaflets, performance of early surgical correction compared with initial medical management was associated with greater long-term survival and lower risk of heart failure, according to a study in the August 14 issue of JAMA.

"Degenerative mitral regurgitation [backflow of blood from the left ventricle to the left atrium due to mitral valve insufficiency] is common and can be surgically repaired in the vast majority of patients, improving symptoms and restoring normal life expectancy. Despite the safety and efficacy of contemporary surgical correction, an ongoing international debate persists regarding the need for early intervention in patients without American College of Cardiology (ACC)/American Heart Association (AHA) guideline class I triggers (no or minimal symptoms and absence of left ventricular dysfunction). This is in part propagated by discordant views of the prognostic consequences of uncorrected severe mitral regurgitation; considered as benign by those supporting medical watchful waiting (nonsurgical observation until a distinct event is encountered) vs. conveying excess mortality and morbidity (including heart failure and atrial fibrillation) by those advocating early surgical intervention," according to background information in the article.

To understand the comparative effectiveness of early surgery vs. initial medical management strategies, Rakesh M. Suri, M.D., D.Phil., of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues conducted a study to ascertain the comparative effectiveness of initial medical management (nonsurgical observation) vs. early mitral valve surgery following the diagnosis of mitral regurgitation due to flail leaflets (an abnormality of the mitral valve in which a portion of the valve has lost its normal support). For the study, the researchers used data from the Mitral Regurgitation International Database (MIDA) registry, which includes 2,097 patients with flail mitral valve regurgitation (1980-2004) receiving routine cardiac care from 6 tertiary centers (France, Italy, Belgium, and the United States). Of 1,021 patients with mitral regurgitation without ACC and AHA guideline class I triggers, 575 patients were initially medically managed and 446 underwent mitral valve surgery within 3 months following detection.

Within 3 months following diagnosis, 8 patients died, 5 (1.1 percent) after early surgery vs. 3 (0.5 percent) during initial medical management; 9 patients developed heart failure, 4 (0.9 percent) after early surgery vs. 5 (0.9 percent) during initial medical management; and 30 patients developed new-onset atrial fibrillation, 6.2 percent after early surgery vs. 1.2 percent during initial medical management.

Ninety-eight percent of patients were followed up from diagnosis until death or at least 5 years. A total of 319 deaths were observed during an average follow-up time of 10.3 years. "Survival among the entire unmatched cohort for early surgery was 95 percent at 5 years, 86 percent at 10 years, 63 percent at 20 years vs. 84 percent at 5 years, 69 percent at 10 years, and 41 percent at 20 years for initial medical management, favoring early surgery," the authors write. Early surgical correction of mitral valve regurgitation was associated with a 5-year reduction in mortality of 53 percent.

With class II triggers (atrial fibrillation or pulmonary hypertension), survival was again better with early surgery, both overall and in the matched cohort at 10 years.

During follow-up, 167 patients incurred at least 1 incident episode of heart failure representing a rate of 16 percent at 10 years and 27 percent at 20 years. In the overall cohort, heart failure was less frequent after early surgery (7 percent for early surgery vs. 23 percent for initial medical management at 10 years and 10 percent for early surgery vs. 35 percent for initial medical management at 20 years), with a heart failure risk reduction of approximately 60 percent.

Reduction in late-onset atrial fibrillation was not observed.

"These findings emanate from institutions that together provide a very high rate of mitral valve repair (>90 percent) with low operative mortality, emphasizing that such results might also be achieved in routine practice at many advanced repair centers," the authors write. "The advantages associated with early surgical correction of mitral valve regurgitation were confirmed in both unmatched and matched populations, using multiple statistical methods."

In an accompanying editorial, Catherine M. Otto, M.D., of the University of Washington School of Medicine, Seattle, comments on how the findings of this study may influence patient care.

"The study group is atypical compared with most patients with chronic severe mitral regurgitation seen in clinical practice who are referred for surgical intervention at symptom onset or when serial imaging shows early left ventricular (LV) dysfunction. In patients with severe mitral regurgitation due to mitral valve prolapse, early surgery is reasonable if surgical risk is low and the likelihood of successful valve repair is high, which is often the case for patients with a flail leaflet; the new data support this recommendation."

"However, if surgical risk is high or if the likelihood of valve repair is low, it remains uncertain whether early surgical intervention is appropriate in the asymptomatic patient with severe mitral regurgitation due to a flail leaflet when LV size and systolic function are normal. Although the majority of these patients will develop clear indications for valve surgery within 2 years, it may be reasonable to postpone the risks of having an intervention and having a prosthetic valve as long as possible."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cardiovascular / cardiology section for the latest news on this subject.

Article - JAMA. 2013;310(6):609-616

Editorial - JAMA. 2013;310(6):587-588

JAMA

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Breastfeeding duration appears associated with intelligence later in life

Main Category: Pediatrics / Children's Health
Also Included In: Pregnancy / Obstetrics
Article Date: 29 Jul 2013 - 13:00 PDT Current ratings for:
Breastfeeding duration appears associated with intelligence later in life

Breastfeeding longer is associated with better receptive language at 3 years of age and verbal and nonverbal intelligence at age 7 years, according to a study published by JAMA Pediatrics, a JAMA Network publication.

Evidence supports the relationship between breastfeeding and health benefits in infancy, but the extent to which breastfeeding leads to better cognitive development is less certain, according to the study background.

Mandy B. Belfort, M.D., M.P.H., of Boston Children's Hospital, and colleagues examined the relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7 years. They also studied the extent to which maternal fish intake during lactation affected associations of infant feeding and later cognition. Researchers used assessment tests to measure cognition.

"Longer breastfeeding duration was associated with higher Peabody Picture Vocabulary Test score at age 3 years (0.21; 95% CI, 0.03-0.38 points per month breastfed) and with higher intelligence on the Kaufman Brief Intelligence Test at age 7 years (0.35; 0.16-0.53 verbal points per month breastfed; and 0.29; 0.05-0.54 nonverbal points per month breastfed)," according to the study results. However, the study also noted that breastfeeding duration was not associated with Wide Range Assessment of Memory and Learning scores.

As for fish intake (less than 2 servings per week vs. greater than or equal to 2 servings), the relationship between breastfeeding duration and the Wide Range Assessment of Visual Motor Abilities at 3 years of age appeared to be stronger in children of women with higher vs. lower fish intake, although this finding was not statistically significant, the results also indicate.

"In summary, our results support a causal relationship of breastfeeding in infancy with receptive language at age 3 and with verbal and nonverbal IQ at school age. These findings support national and international recommendations to promote exclusive breastfeeding through age 6 months and continuation of breastfeeding through at least age 1 year," the authors conclude.

In an editorial, Dimitri A. Christakis, M.D., M.P.H., of the Seattle Children's Hospital Research Institute, writes: "The authors reported an IQ benefit at age 7 years from breastfeeding of 0.35 points per month on the verbal scale and 0.29 points per month on the nonverbal one. Put another way, breastfeeding an infant for the first year of life would be expected to increase his or her IQ by about four points or one-third of a standard deviation."

"However, the problem currently is not so much that most women do not initiate breastfeeding, it is that they do not sustain it. In the United States about 70 percent of women overall initiate breastfeeding, although only 50 percent of African American women do. However, by six months, only 35 percent and 20 percent, respectively, are still breastfeeding," Christakis continues.

"Furthermore, workplaces need to provide opportunities and spaces for mothers to use them. Fourth, breastfeeding in public should be destigmatized. Clever social media campaigns and high-quality public service announcements might help with that. As with lead, some of these actions may require legislative action either at the federal or state level. Let's allow our children's cognitive function be the force that tilts the scale, and let's get on with it," Christakis concludes.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pediatrics / children's health section for the latest news on this subject.

Article:

JAMA Pediatr. Published online July 29, 2013. doi:10.1001/jamapediatrics.2013.455.

Editor’s Note: This work was supported by grants from the National Institutes of Health. Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial:

JAMA Pediatr. Published online July 29, 2013. doi:10.1001/jamapediatrics.2013.470.

The author made a conflict of interest disclosure. Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

JAMA

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Glucose intolerance, diabetes or insulin resistance not associated with pathological features of alzheimer disease

Main Category: Alzheimer's / Dementia
Also Included In: Diabetes
Article Date: 29 Jul 2013 - 13:00 PDT Current ratings for:
Glucose intolerance, diabetes or insulin resistance not associated with pathological features of alzheimer disease

Glucose intolerance or insulin resistance do not appear to be associated with pathological features of Alzheimer disease (AD) or detection of the accumulation of the brain protein ß-amyloid (''ß), according to a report published by JAMA Neurology, a JAMA Network publication.

Glucose intolerance and diabetes mellitus have been proposed as risk factors for the development of AD, but evidence of this has not been consistent, the study background notes.

Madhav Thambisetty, M.D., Ph.D., of the National Institute on Aging, Baltimore, and colleagues investigated the association between glucose intolerance and insulin resistance and brain ''ß burden with autopsies and imaging with carbon 11-labeled Pittsburgh Compound B positron emission tomography.

"The relationship among diabetes mellitus, insulin and AD is an important area of investigation. However, whether cognitive impairment seen in those with diabetes is mediated by excess pathological features of AD or other related abnormalities, such as vascular disease, remains unclear," the authors comment.

Two groups of participants were involved in the study. One group consisted of 197 participants enrolled in the Baltimore Longitudinal Study of Aging who had two or more oral glucose tolerance tests (OGTT) while they were alive and then underwent a brain autopsy when they died. The second group included 53 living study participants who had two or more OGTTs and underwent imaging.

"In this prospective cohort with multiple assessments of glucose intolerance and insulin resistance, measures of glucose and insulin homeostasis are not associated with AD pathology and likely play little role in AD pathogenesis," the study concludes. "Long-term therapeutic trials are important to elucidate this issue."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alzheimer's / dementia section for the latest news on this subject.

JAMA Neurol. Published online July 29, 2013. doi:10.1001/jamaneurol.2013.284.

This study was supported by grants from the National Institute on Aging, by the Burroughs Wellcome Fund for Translational Research and by the Intramural Research Program, NIA, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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'The stigma associated with raising concerns has to be removed'

Whistleblowing can be a frightening and daunting task and people feel it is easier not to speak out about bad practice. Photograph: Christopher Thomond for the Guardian

The term whistleblower often conjures up anxiety and fear in those wishing to raise concerns. Meanwhile, the response to those brave enough to do so can be defensive and doubting. This is enough to deter someone from coming forward to raise concerns.

I know from my experience at Mid Staffordshire how frightening and daunting a task it is to raise concerns in the workplace. There are many reasons why people feel that it is just easier to turn a blind eye and not raise your head above the parapet. While these reasons are often valid and must not be dismissed, it is vital that where problems exist those who witness them must speak out in order for things to change.

The stigma associated with raising concerns has to be removed. This can be achieved by increasing awareness of how to raise concerns safely and appropriately, so that it becomes not only expected, but also accepted. The option of whether you should act upon your concerns and blow the whistle should not exist. There are two main factors that prevent people raising concerns. Staff do not know enough about the actual process and they fear personal and professional repercussions.

All NHS trusts and organisations should provide standardised policies for raising concerns and deliver training and awareness of the process so that staff feel informed and empowered. It is vital for these trusts and organisations to promote the importance of raising concerns and offer reassurance and positive feedback to those who do. This united message would soon encourage people to raise concerns if they have them. If this is then evidenced by action rather than just words, the historic culture of people failing to speak out, or no effective action being taken if they do, will begin to change.

Those of us working in health and social care have a duty to act as advocates for the people we care for and this sometimes means speaking out when things are not right.

Through my own difficult personal experience I am clear that there is so much more that can be done to raise awareness and support staff who want to raise concerns. In my role as ambassador for cultural change, I hope the situations I faced at Mid Staffordshire, and what I learnt from them, can really help to encourage a more open and transparent culture across the partnership trust.

I want to encourage even greater professionalism, support staff to raise concerns and ensure that the voice of the frontline is heard clearly at a senior level within the organisation. I have a clear remit from partnership trust chief executive Stuart Poynor and the trust board to act freely and with complete autonomy from the management team, as another route for issues of concern to be raised at the highest level. This is essential and will help ensure an open transparent workforce.

My aim is to help empower staff to deliver an excellent service and be an ally for anyone on the frontline who is worried about raising concerns. I wish to hear the voice of those who are delivering care and services. I question:

• How supported do staff feel?
• Are staff confident that they know how to raise concerns?
• Have staff raised concerns in the past? What has been the response?
• Do staff feel listened to?
• What helps and hinders staff from doing their jobs well?
• What do patients/service users and relatives feel? 

I want staff to know that I am here as their support to improve the way we all work and ultimately give the best possible care.

Because of this role and my chief executive's forward thinking, I am optimistic about the future. The only way forward is to extend this type of role to all trusts. Trust boards throughout the NHS should embrace the concept and unite to help change the culture. We have a responsibility to protect and restore confidence in the NHS and, most importantly, protect those who need to use it.

Helene Donnelly is ambassador for cultural change at Staffordshire and Stoke on Trent partnership NHS trust.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

'The stigma associated with raising concerns has to be removed'

Whistleblowing can be a frightening and daunting task and people feel it is easier not to speak out about bad practice. Photograph: Christopher Thomond for the Guardian

The term whistleblower often conjures up anxiety and fear in those wishing to raise concerns. Meanwhile, the response to those brave enough to do so can be defensive and doubting. This is enough to deter someone from coming forward to raise concerns.

I know from my experience at Mid Staffordshire how frightening and daunting a task it is to raise concerns in the workplace. There are many reasons why people feel that it is just easier to turn a blind eye and not raise your head above the parapet. While these reasons are often valid and must not be dismissed, it is vital that where problems exist those who witness them must speak out in order for things to change.

The stigma associated with raising concerns has to be removed. This can be achieved by increasing awareness of how to raise concerns safely and appropriately, so that it becomes not only expected, but also accepted. The option of whether you should act upon your concerns and blow the whistle should not exist. There are two main factors that prevent people raising concerns. Staff do not know enough about the actual process and they fear personal and professional repercussions.

All NHS trusts and organisations should provide standardised policies for raising concerns and deliver training and awareness of the process so that staff feel informed and empowered. It is vital for these trusts and organisations to promote the importance of raising concerns and offer reassurance and positive feedback to those who do. This united message would soon encourage people to raise concerns if they have them. If this is then evidenced by action rather than just words, the historic culture of people failing to speak out, or no effective action being taken if they do, will begin to change.

Those of us working in health and social care have a duty to act as advocates for the people we care for and this sometimes means speaking out when things are not right.

Through my own difficult personal experience I am clear that there is so much more that can be done to raise awareness and support staff who want to raise concerns. In my role as ambassador for cultural change, I hope the situations I faced at Mid Staffordshire, and what I learnt from them, can really help to encourage a more open and transparent culture across the partnership trust.

I want to encourage even greater professionalism, support staff to raise concerns and ensure that the voice of the frontline is heard clearly at a senior level within the organisation. I have a clear remit from partnership trust chief executive Stuart Poynor and the trust board to act freely and with complete autonomy from the management team, as another route for issues of concern to be raised at the highest level. This is essential and will help ensure an open transparent workforce.

My aim is to help empower staff to deliver an excellent service and be an ally for anyone on the frontline who is worried about raising concerns. I wish to hear the voice of those who are delivering care and services. I question:

• How supported do staff feel?
• Are staff confident that they know how to raise concerns?
• Have staff raised concerns in the past? What has been the response?
• Do staff feel listened to?
• What helps and hinders staff from doing their jobs well?
• What do patients/service users and relatives feel? 

I want staff to know that I am here as their support to improve the way we all work and ultimately give the best possible care.

Because of this role and my chief executive's forward thinking, I am optimistic about the future. The only way forward is to extend this type of role to all trusts. Trust boards throughout the NHS should embrace the concept and unite to help change the culture. We have a responsibility to protect and restore confidence in the NHS and, most importantly, protect those who need to use it.

Helene Donnelly is ambassador for cultural change at Staffordshire and Stoke on Trent partnership NHS trust.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

Health Tips & Info : Physical and Emotional Disorders Associated with Panic Attacks.

Various physical and emotional disorders and ailments are associated with the people suffering from panic attacks. It has been researched that 30% of the people suffering from panic attacks fall a victim to alcoholism and around 17% of them become drug addicts so as to reduce the stress and anxiety which is caused due to the panic attacks. However, such drug and alcohol abuse does not reduce or refrain the panic attacks for long. This is the reason why 20% of the panic disorder patients tend to commit suicide. People suffering from panic attacks are usually phobic of different places of public gathering such as stores, malls, streets as they fear attacks at such places. Therefore, such people avoid visiting these places and confine themselves at home. This further develops agoraphobia in them wherein they are completely unable to visit even the safe environments because of the developed fear and anxiety. Such patients also suffer from irritable bowel syndromes which lead to gastrointestinal cramps, diarrhea and even constipation. They also face various heart ailments, although minor, which includes Mitral valve prolapse. Chest aches are also very common in such people.

View the original article here