Cranberry pills and acupuncture found helpful in preventing recurrent urinary tract infection

Daily antibiotics most effective

While daily antibiotic use is the most effective method for preventing recurrent urinary tract infections in women, daily cranberry pills, daily estrogen therapy and monthly acupuncture treatments also have benefits that may be preferable for some patients, according to a new study by researchers at the Los Angeles Biomedical Research Institute (LA BioMed).

The study, published in the Jan. 15 issue of the journal, Clinical Infectious Diseases, said more than half of women suffer from a urinary tract infection at some time in their lives, often requiring antibiotics or other treatments to recover from the infections.

A smaller group of women will have three or more urinary tract infections per year and may require a more pro-active course of treatment to prevent these recurrent infections. The LA BioMed study is the first to use a modeling approach to compare the effectiveness of all of the most commonly used prophylactic measures.

"We described the benefit of each common management option so that women can find an approach to recurrent urinary tract infections that fits their needs," said Loren G. Miller, MD, MPH, LA BioMed infectious disease specialist and lead researcher for the study. "Daily antibiotic usage is the most beneficial by far in preventing recurrent urinary tract infections, but there are benefits to other forms of treatment as well for women who don't want to take antibiotics."

Urinary tract infections cause pain and often require women to miss work or school. They result in more than 6 million outpatient visits and 479,000 hospitalizations per year. The cost to society is estimated to be more than $2.47 billion annually.

The LA BioMed study compared the findings from previous studies and found that daily antibiotic usage reduced the urinary tract infection recurrence rate to 0.4 per year. Acupuncture therapy reduced the recurrence rate to 0.7 per year, but the study data is somewhat limited. Cranberry pills and estrogen therapy reduced the recurrence rate to 1.1 per year. Another approach is self-diagnosis and treatment of urinary tract infections, which, while not reducing recurrence rates, was associated with the highest quality of life of all management strategies.

All of these approaches saved money for insurance providers. All of these approaches – except for self-diagnosis and treatment – added to patients' out-of-pocket costs, from a mean of $140 per year for antibiotics to a mean of $946 a year for acupuncture. The researchers noted that patients usually bore most or all the cost of acupuncture, while health insurance often covered all or part of the cost of antibiotics.

Several forms of vitamin E protect against memory disorders

Elderly people with high serum vitamin E levels are less likely to suffer from memory disorders than their peers with lower levels, according to a study published recently in Experimental Gerontology. According to the researchers, various forms of vitamin E seem to play a role in memory processes. The study was carried out in cooperation between the University of Eastern Finland, the Finnish National Institute for Health and Welfare, Karolinska Institutet, and the University of Perugia.

Studies investigating the link between vitamin E and memory disorders have usually focused on a single form of vitamin E, namely α-tocopherol, which is also used in vitamin E supplements. However, vitamin E exists in eight different natural forms, tocopherols and tocotrienols, all of which have antioxidant properties.

This recently published study comprises a sample of 140 over 65-year-old Finnish persons with no memory impairment at the onset of the study. During the eight-year follow-up, it was discovered that higher total serum levels of vitamin E, and higher levels of γ-tocopherol, β-tocotrienol and total tocotrienols in particular, seemed to protect against memory disorders. According to the researchers, the results show that the entire vitamin E family plays a role in memory processes. Accordingly, measuring the levels of vitamin E from serum is the most reliable way to determine whether they are sufficiently high.

The study comprised part of the more extensive Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study, which focuses on the association between the risk factors of cardiovascular diseases and memory disorders.

Alcohol consumption reduces odds of getting multiple sclerosis

Drinking alcohol appears to have a dose-dependent inverse (opposite) association with the risk of developing multiple sclerosis (MS) and researchers suggest their findings give no support to advising patients with MS to completely refrain from alcohol, according to a study by Anna Karin Hedstrom, M.D., of the Karolinska Institutet, Sweden, and colleagues.

The results of previous studies have been inconsistent about the impact of alcohol and the risk of developing MS.

Researchers investigated the association using two population studies in Sweden with participants between the ages of 16 and 70 years: 745 cases of MS plus 1,761 controls in the Epidemiological Investigation of Multiple Sclerosis (EIMS) study and 5,874 cases of MS with 5,246 controls in the Genes and Environment in Multiple Sclerosis (GEMS) study.

In EIMS, women who reported high alcohol consumption had an odds ratio (OR) of 0.6 of developing MS compared with nondrinking women, and men with high alcohol consumption had an OR of 0.5 compared with nondrinking men, according to the results. The corresponding OR comparison in GEMS was 0.7 for both women and men. Alcohol consumption also appeared to be associated with the attenuation (lessening) of the effect of smoking, the results also indicate.

"Although the effect of alcohol on already established MS has not been studied herein, the data may have relevance for clinical practice since they give no support for advising persons with MS to completely refrain from alcohol," the authors conclude.

Meditation for anxiety and depression?

Some 30 minutes of meditation daily may improve symptoms of anxiety and depression, a new Johns Hopkins analysis of previously published research suggests.

"A lot of people use meditation, but it's not a practice considered part of mainstream medical therapy for anything," says Madhav Goyal, M.D., M.P.H., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine and leader of a study published online Jan. 6 in JAMA Internal Medicine. "But in our study, meditation appeared to provide as much relief from some anxiety and depression symptoms as what other studies have found from antidepressants." These patients did not typically have full-blown anxiety or depression.

The researchers evaluated the degree to which those symptoms changed in people who had a variety of medical conditions, such as insomnia or fibromyalgia, although only a minority had been diagnosed with a mental illness.

Goyal and his colleagues found that so-called "mindfulness meditation" — a form of Buddhist self-awareness designed to focus precise, nonjudgmental attention to the moment at hand — also showed promise in alleviating some pain symptoms as well as stress. The findings held even as the researchers controlled for the possibility of the placebo effect, in which subjects in a study feel better even if they receive no active treatment because they perceive they are getting help for what ails them.

To conduct their review, the investigators focused on 47 clinical trials performed through June 2013 among 3,515 participants that involved meditation and various mental and physical health issues, including depression, anxiety, stress, insomnia, substance use, diabetes, heart disease, cancer and chronic pain. They found moderate evidence of improvement in symptoms of anxiety, depression and pain after participants underwent what was typically an eight-week training program in mindfulness meditation. They discovered low evidence of improvement in stress and quality of life. There was not enough information to determine whether other areas could be improved by meditation. In the studies that followed participants for six months, the improvements typically continued.

They also found no harm came from meditation.

Meditation, Goyal notes, has a long history in Eastern traditions, and it has been growing in popularity over the last 30 years in Western culture.

"A lot of people have this idea that meditation means sitting down and doing nothing," Goyal says. "But that's not true. Meditation is an active training of the mind to increase awareness, and different meditation programs approach this in different ways."

Mindfulness meditation, the type that showed the most promise, is typically practiced for 30 to 40 minutes a day. It emphasizes acceptance of feelings and thoughts without judgment and relaxation of body and mind.

He cautions that the literature reviewed in the study contained potential weaknesses. Further studies are needed to clarify which outcomes are most affected by these meditation programs, as well as whether more meditation practice would have greater effects.

"Meditation programs appear to have an effect above and beyond the placebo," Goyal says.

High blood pressure potentially more dangerous for women than men

Doctors may need to treat high blood pressure in women earlier and more aggressively than they do in men, according to scientists at Wake Forest Baptist Medical Center.

In a new study, published in the December edition of Therapeutic Advances in Cardiovascular Disease, the researchers for the first time found significant differences in the mechanisms that cause high blood pressure in women as compared to men.

"The medical community thought that high blood pressure was the same for both sexes and treatment was based on that premise," said Carlos Ferrario, M.D., professor of surgery at Wake Forest Baptist and lead author of the study.

"This is the first study to consider sex as an element in the selection of antihypertensive agents or base the choice of a specific drug on the various factors accounting for the elevation in blood pressure."

Although there has been a significant decline in cardiovascular disease mortality in men during the last 20 to 30 years, the same has not held true for women, Ferrario said. In fact, heart disease has become the leading cause of death in women in the United States, accounting for approximately a third of all deaths. So why the discrepancy if men and women have been treated in the same way for the same condition?

The apparent gender-related differences in the disease and the lack of understanding of the basic biological mechanisms involved prompted the research by the Wake Forest Baptist team. In the comparative study, 100 men and women age 53 and older with untreated high blood pressure and no other major diseases were evaluated using an array of specialized tests that indicated whether the heart or the blood vessels were primarily involved in elevating the blood pressure. These tests, which can be done in a doctor's office, can provide important information about the state of an individual's circulation.

The tests measured hemodynamic – the forces involved in the circulation of blood – and hormonal characteristics of the mechanisms involved in the development of high blood pressure in men and women.

The researchers found 30 to 40 percent more vascular disease in the women compared to the men for the same level of elevated blood pressure. In addition, there were significant physiologic differences in the women's cardiovascular system, including types and levels of hormones involved in blood pressure regulation, that contribute to the severity and frequency of heart disease.

"Our study findings suggest a need to better understand the female sex-specific underpinnings of the hypertensive processes to tailor optimal treatments for this vulnerable population," Ferrario said. "We need to evaluate new protocols – what drugs, in what combination and in what dosage – to treat women with high blood pressure."

High Good, Low Bad Cholesterol Levels Are Healthy for Brain, Too

High levels of "good" cholesterol and low levels of "bad" cholesterol are correlated with lower levels of the amyloid plaque deposition in the brain that is a hallmark of Alzheimer's disease, in a pattern that mirrors the relationship between good and bad cholesterol in cardiovascular disease, UC Davis researchers have found.

"Our study shows that both higher levels of HDL -- good -- and lower levels of LDL -- bad -- cholesterol in the bloodstream are associated with lower levels of amyloid plaque deposits in the brain," said Bruce Reed, lead study author and associate director of the UC Davis Alzheimer's Disease Center.

The relationship between elevated cholesterol and increased risk of Alzheimer's disease has been known for some time, but the current study is the first to specifically link cholesterol to amyloid deposits in living human study participants, Reed said.

"Unhealthy patterns of cholesterol could be directly causing the higher levels of amyloid known to contribute to Alzheimer's, in the same way that such patterns promote heart disease," he said.

The study, "Associations Between Serum Cholesterol Levels and Cerebral Amyloidosis," is published online in JAMA Neurology.

In the United States, cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. For HDL cholesterol, a level of 60 mg/dl or higher is best. For LDL cholesterol, a level of 70 mg/dL or lower is recommended for people at very high risk of heart disease.

Charles DeCarli, director of the Alzheimer's Disease Center and an author of the study, said it is a wake-up call that, just as people can influence their late-life brain health by limiting vascular brain injury through controlling their blood pressure, the same is true of getting a handle on their serum cholesterol levels.

"If you have an LDL above 100 or an HDL that is less than 40, even if you're taking a statin drug, you want to make sure that you are getting those numbers into alignment," DeCarli said. "You have to get the HDL up and the LDL down."

The study was conducted in 74 diverse male and female individuals 70 years and older who were recruited from California stroke clinics, support groups, senior facilities and the Alzheimer's Disease Center. They included three individuals with mild dementia, 33 who were cognitively normal and 38 who had mild cognitive impairment.

The participants' amyloid levels were obtained using a tracer that binds with amyloid plaques and imaging their brains using PET scans. Higher fasting levels of LDL and lower levels of HDL both were associated with greater brain amyloid -- a first-time finding linking cholesterol fractions in the blood and amyloid deposition in the brain. The researchers did not study the mechanism for how cholesterol promotes amyloid deposits.

Recent guidelines instituted by the American College of Cardiology, the American Heart Association and the National Heart, Lung, and Blood Institute have suggested abandoning guidelines for LDL targets. Reed said that recommendation may be an instance in which the adage that "what's good for the heart is good for the brain" does not apply.

"This study provides a reason to certainly continue cholesterol treatment in people who are developing memory loss regardless of concerns regarding their cardiovascular health," said Reed, a professor in the UC Davis Department of Neurology.

"It also suggests a method of lowering amyloid levels in people who are middle aged, when such build-up is just starting," he said. "If modifying cholesterol levels in the brain early in life turns out to reduce amyloid deposits late in life, we could potentially make a significant difference in reducing the prevalence of Alzheimer's, a goal of an enormous amount of research and drug development effort."

Vitamin E May Delay Decline in Mild-to-Moderate Alzheimer’s Disease

Difficulty with activities of daily living often affect Alzheimer's patients, which is estimated to affect as many as 5.1 million Americans. These issues are among the most taxing burdens of the disease for caregivers, which total about 5.4 million family members and friends. New research from the faculty of Icahn School of Medicine at Mount Sinai working with Veterans Administration Medical Centers suggests that alpha tocepherol, fat-soluble Vitamin E and antioxidant, may slow functional decline (problems with daily activities such as shopping, preparing meals, planning, and traveling) in patients with mild-to-moderate Alzheimer's disease and decrease caregiver burden. There was no added benefit for memory and cognitive testing with the vitamin. The study is published online first in the Jan. 1 Journal of the American Medical Association.

“Since the cholinesterase inhibitors [galantamine, donepezil, rivastigmine], we have had very little to offer patients with mild-to-moderate dementia,” said Mary Sano, PhD, trial co-investigator, and professor in the department of psychiatry, Icahn School of Medicine at Mount Sinai, and director of research at the James J. Peters Veteran’s Administration Medical Center, Bronx, New York. “This trial showed that vitamin E delays progression of functional decline by 19% per year, which translates into 6.2 months benefit over placebo.”
The finding is valuable because vitamin E is easy to purchase at local drugstores and it is also inexpensive. The clinical trial investigators believe it can be recommended as a treatment strategy, based on the double-blind randomized controlled trial.

The Veteran’s Administration Cooperative Randomized Trial of Vitamin E and memantine in Alzheimer’s Disease (TEAM-AD examined the effects of vitamin E 2,000 IU/d, 20 mg/d of memantine, the combination, or placebo on Alzheimer’s Disease Cooperative Study/Activities of Daily Living (ADCS-ADL) Inventory Score. Cognitive, neuropsychiatric, functional, and caregiver measures were secondary outcomes. A group of 613 patients with mild to moderate Alzheimer’s disease were in the study, which was launched in August 2007 and finished in September 2012 at 14 Veterans Affairs Medical Centers.

Dr. Sano previously led a study on vitamin E in patients with moderately severe Alzheimer’s disease. She found that the vitamin slowed disease progression in this group of patients as well.

Kenneth Davis, MD, Chief Executive Officer and President of the Mount Sinai Health System and Gustave L. Levy Distinguished Professor, applauded the study. “This study is the first to show an added benefit for vitamin E in mild-to-moderate disease,” he said. “Now that we have a strong clinical trial showing that vitamin E slows functional decline and reduces the burdens on caregivers, vitamin E should be offered to patients with mild-to-moderate Alzheimer’s disease.” Research by Dr. Davis and colleagues contributed to the establishment of conventional medical therapies for Alzheimer’s disease.