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Editorial says primary care system must change how it approaches dementia

10-15-2007 · EurekAlert!

In an editorial in the November issue of the Journal of General Internal Medicine, geriatrics researchers from the Indiana University School of Medicine, the Indiana University Center for Aging Research and the Regenstrief Institute, Inc. say that primary care doctors, the physicians seen by most older adults, cannot meet the needs of the growing number of older adults with dementia without changing how the primary care system approaches dementia.

Keywords: editorial, primary, care, system, change, approaches, dementia, approache

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Advance in understanding of blood pressure gene could lead to new treatments
02-04-2007 · EurekAlert!
Research by scientists at UCL (University College London) has clearly demonstrated for the first time the structure and function of a gene crucial to the regulation of blood pressure. The discovery could be important in the search for new treatments for illnesses such as heart disease, the UK's biggest killer. In a paper published online today in Nature Medicine, the team, led by Professor Patrick Vallance and Dr James Leiper, UCL Department of Medicine, reveal the role of the human gene dimethylarginine dimethylaminohydrolase (DDAH), showing that loss of DDAH activity disrupts nitric oxide (NO) production. NO is critical in the regulation of blood pressure, nervous system functions and the immune system. The role of DDAH is to break down modified amino acids (Asymmetric dimethylarginine (ADMA) and monomethyl arginine (L-NMMA)) that are produced by the body and have been shown to inhibit NO synthase. These molecules accumulate in various disease states including diabetes, renal failure and pulmonary and systemic hypertension, and their concentration in plasma (the fluid component of blood) is strongly predicative of cardiovascular disease and death. In a healthy human body, the majority of ADMA is eliminated through active metabolism by DDAH. Scientists have hypothesised that if DDAH function is impaired, NO production is reduced, and that this could be an important feature of increased cardiovascular risk. To examine this pathway in more detail, the researchers deleted the DDAH gene in mice. These mice went on to develop hypertension, or high blood pressure. They also designed specific inhibitors (small molecules) which bind to the active site of human DDAH. These small molecule inhibitors also induced hypertension in mice, confirming the importance of DDAH in the regulation of blood pressure. Dr Leiper, UCL Medicine, said: “These genetic and chemical approaches to disrupt DDAH showed remarkably consistent results, and provide compelling evidence that loss of DDAH function increases the concentration of ADMA and thereby disrupts vascular NO signalling. “There has been considerable scientific interest in this pathway and the role of ADMA as a novel risk factor, but so far there's been little evidence to support the idea that it's a cause of disease, rather than just a marker. Genes and their pathways are crucial to our understanding of cardiovascular disease and a better understanding of DDAH-1 could lead to important new treatments. “It could help us to establish if genetic variation predisposes certain people to these diseases, or whether environmental factors exert some of their effects through modulation of DDAH activity. “Our research also shows that this pathway could be harnessed therapeutically to limit production of NO in certain situations where too much nitric oxide is a bad thing; for example, hypotension and septic shock. These are some of the biggest problems in intensive care medicine and there is a huge unmet need for drug treatments.” The study, which was carried out at UCL's Rayne Institute, was funded by grants from the British Heart Foundation, the Wellcome Trust and the Medical Research Council. Professor Jeremy Pearson, Associate Medical Director of the British Heart Foundation, said: "The unexpected finding in the 1980s that a simple gas, nitric oxide (NO), is made by cells in the blood vessel wall and is a powerful control of blood vessel relaxation led to the award of the Nobel Prize in 1998 to its discoverers. "More recently, there has been increasing evidence that impairment of NO production is likely to be an important factor in the development of heart and circulatory disease, but the mechanisms responsible are not fully understood. "This study suggests for the first time that the loss of the activity of the enzyme DDAH-1 leads to reduced NO production and may cause heart and circulatory disease. These findings are likely to be important in the search for new ways to optimise the health of our blood vessels." ### Notes for Editors 1. For more information, please contact Ruth Metcalfe in the UCL Media Relations Office on tel: +44 (0)20 7679 9739, mobile: +44 (0)7990 675 947, out of hours: +44 (0)7917 271 364, e-mail: r.metcalfe@ucl.ac.uk2. 'Disruption of methylarginine metabolism impairs vascular homeostasis' is published in the February issue of the journal Nature Medicine. Advance online publication is embargoed to 18.00 GMT (13.00 US Eastern) Sunday 4 February 2007. Journalists can obtain copies of the paper by contacting the UCL Media Relations Office.3. The study was funded by the British Heart Foundation, the Wellcome Trust and the Medical Research Council. About UCL Founded in 1826, UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender, and the first to provide systematic teaching of law, architecture and medicine. In the government's most recent Research Assessment Exercise, 59 UCL departments achieved top ratings of 5* and 5, indicating research quality of international excellence. UCL is the fourth-ranked UK university in the 2006 league table of the top 500 world universities produced by the Shanghai Jiao Tong University. UCL alumni include Mahatma Gandhi (Laws 1889, Indian political and spiritual leader); Jonathan Dimbleby (Philosophy 1969, writer and television presenter); Junichiro Koizumi (Economics 1969, Prime Minister of Japan); Lord Woolf (Laws 1954, Lord Chief Justice of England & Wales); Alexander Graham Bell (Phonetics 1860s, inventor of the telephone), and members of the band Coldplay.
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Researchers show that veins stiffen as we age
10-31-2006 · EurekAlert!
As if creaking joints and hardening of the arteries weren't bad enough, a research team from the University of Delaware and the Christiana Care Health System has now confirmed that even our veins stiffen as we age.And that physiological change may be an important factor in the development of high blood pressure, or hypertension, which currently affects an estimated 65 million Americans, most of them older adults, according to UD researcher William Farquhar.
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Tip sheet Annals of Internal Medicine, Nov. 21, 2006, issue
11-20-2006 · EurekAlert!
The following articles are in the Nov. 21, 2006, issue of Annals of Internal Medicine Tip Sheet: Support program for dementia caregivers improved their lives; Coordinated support for caregivers improved dementia care; Editorial: These studies show what works, so what do we do now?; Editorial: Career changes in medicine: Part II; and Insurance coverage and care of patients with non-ST-segment elevation acute coronary syndromes.
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Increasing survival of organ transplant patients by reducing time interval for transported organs
04-26-2007 · EurekAlert!
Preservation of an organ intended for transplant during transport from donor to recipient is of primary concern in ensuring a successful transplant. Research presented at the ISHLT 27th Annual Meeting and Scientific Sessions today explores two diverging systems for pump preservation -- the Organ Care System and the cold preservation method, and how they each effect survival for heart transplant patients.
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Comparison study shows US low in primary care physician visits
06-13-2007 · EurekAlert!
The average American spends a total of about 30 minutes a year with a primary care physician in a system that is less comprehensive than that of Australia or New Zealand, according to a new study comparing primary care practice in the three countries.
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Firms covering large majority of nation's workers view health benefits as important recruitment tool
11-14-2006 · EurekAlert!
Despite intense health care cost pressures, firms covering more than 90 percent of the nation's workforce view health benefits as an important tool to attract and retain qualified workers, according to a national study by researchers at the Center for Studying Health System Change (HSC) and the Commonwealth Fund published in the November/December edition of Health Affairs.
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Vasectomy may put men at risk for type of dementia
02-12-2007 · EurekAlert!
Northwestern University researchers have discovered men with an unusual form of dementia have a higher rate of vasectomy than men the same age who are cognitively normal. The dementia is Primary Progressive Aphasia (PPA), a disease in which people have trouble recalling and understanding words. A vasectomy breeches the protective barrier between the blood and the testes, provoking the immune system to produce anti-sperm anti-bodies, which may reach the brain and cause damage.
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1 size may not fit all
10-29-2007 · EurekAlert!
In an editorial in the October issue of the journal Gastroenterology, Thomas F. Imperiale, M.D., professor of medicine at the Indiana University School of Medicine and a Regenstrief Institute, Inc. research scientist, says that studies that can help determine who is at risk for colorectal cancer as well as who is not at risk, and how to stratify risk for each group can help determine which screening test is best for each individual and will better serve both patients and the health care system.
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Building efficient, effective, locally sensitive solutions for dementia care
10-11-2007 · EurekAlert!
Dementia is a growing burden for society, propelling patients and caregivers to increasingly use the health-care system. A year ago, local researchers, health-care professionals and community advocates came together to form the Indianapolis Discovery Network for Dementia to enhance dementia care in the nation's twelfth largest city.
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Should primary care doctors assess safety of older drivers?
04-16-2007 · EurekAlert!
In an editorial published in the April issue of the Journal of General Internal Medicine, Malaz Boustani, M.D., M.P.H., of the Indiana University Center for Aging Research and the Regenstrief Institute, Inc., writes that assessing the safety of older drivers is not a responsibility that should reside with the primary care physician.
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