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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_378"
                     title="First Lady and Lawmakers Discuss Childhood Obesity"
                     score="0.009"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/18270?impressionId=1265806968127"
                     
      &lt;p&gt;WASHINGTON  --  Still engaged in an intensely partisan debate over healthcare reform, the White House is ready to launch an initiative that&apos;s likely to have widespread backing: a push to combat obesity.&lt;/p&gt;
&lt;p&gt;First Lady Michelle Obama has announced a four-pronged assault on childhood obesity that focuses on increasing the number of &quot;healthy schools,&quot; adding more physical activity to youngsters&apos; lives, encouraging consumers to make smart food choices, and improving access to healthy foods, which she calls a major barrier to healthy eating.&lt;/p&gt;
&lt;p&gt;She invited a bipartisan group of lawmakers and leaders to the Old Family Dining Room of the White House Tuesday to ask for suggestions on dealing with the epidemic.&lt;/p&gt;
&lt;p&gt;&quot;One of the tougher challenges that we need to look at is improving the accessibility and affordability of foods because there are many food deserts in this nation, which makes it difficult for families trying to access good options,&quot; Obama told Senate leaders who oversee agriculture and health, as well as the Secretaries of Agriculture, Education, and Health and Human Services.&lt;/p&gt;
&lt;p&gt;By that she referred to low income areas of many cities where there are no supermarkets, and the only food outlets are neighborhood convenience stores whose inventories are high on snacks but almost devoid of fresh fruit, vegetables, protein, and other healthy foodstuffs.&lt;/p&gt;
&lt;p&gt;She said childhood obesity is a problem that is &quot;eminently solvable,&quot; adding, &quot;Anyone who has access to children in their lives is going to have to work together. And one of the things that&apos;s also very clear is that this problem won&apos;t be solved by any single federal solution. This is going to require national action.&quot;&lt;/p&gt;
&lt;p&gt;Revising federal child nutrition programs, which include school lunch guidelines, will be part the initiative, Obama said, offering &quot;an opportunity to impact more than 30 million kids.&quot;&lt;/p&gt;
&lt;p&gt;Congressional leaders pledged their support.&lt;/p&gt;
&lt;p&gt;&quot;Together with the First Lady, the secretaries of Education, Agriculture, and Health and their congressional counterparts, we are starting a dialogue to combat childhood obesity, one that holds the promise of making real progress toward addressing this public health crisis,&quot; Sen. Tom Harkin (D-Iowa) told reporters after the meeting.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_335"
                     title="Ultrasound Helps Predict Liver Damage in NAFLD (CME/CE)"
                     score="0.007"
                     href="http://www.medpagetoday.com/Gastroenterology/GeneralHepatology/tb/18211?impressionId=1265806968127"
                     
      &lt;p&gt;An ultrasound technique called transient elastography can accurately detect liver damage in most patients with non-alcoholic fatty liver disease (NAFLD), a condition that often accompanies obesity and type 2 diabetes, a new study found.&lt;/p&gt;
&lt;p&gt;Transient elastography (TE) accurately measured levels of liver stiffness, an indication of the amount of fibrosis, in more than 97% of patients with a body mass index below 30 kg/m&lt;sup&gt;2&lt;/sup&gt; and in 75% of obese patients, according to a report in the February issue of &lt;em&gt;Hepatology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The adoption of transient elastography could potentially spare two-thirds of NAFLD patients from liver biopsies,&quot; Victor de L&amp;#233;dinghen, MD, PhD, of H&amp;#244;pital Haut-L&amp;#233;v&amp;#234;que, in Pessac Cedex, France, and colleagues wrote. &quot;Since the prevalence of NAFLD is high in many affluent countries, this approach would be cost saving.&quot;&lt;/p&gt;
&lt;p&gt;Non-alcoholic fatty liver disease has become more common as the incidence of metabolic syndrome and obesity has grown. The condition can progress to cirrhosis and hepatocellular carcinoma, particularly among patients with non-alcoholic steatohepatitis (NASH), in which fat in the liver causes inflammation and tissue damage.&lt;/p&gt;
&lt;p&gt;Liver biopsy is typically used to determine levels of inflammation and fibrosis associated with NASH, but the procedure carries a small risk of hemorrhage, puncture of other internal organs, infection, and spread of cancer cells. Transvenous liver biopsy carries an additional risk of adverse reaction to the contrast material.&lt;/p&gt;
&lt;p&gt;These problems, in addition to the mixed results due to sampling variance&lt;strong&gt; &lt;/strong&gt;biopsies sometimes deliver, have researchers searching for alternative methods of determining the extent of liver fibrosis.&lt;/p&gt;
&lt;p&gt;L&amp;#233;dinghen and colleagues compared the accuracy of TE to biochemical tests for the diagnosis of fibrosis and cirrhosis in 246 NAFLD patients who underwent liver biopsies between May 2003 and April 2009 at University Hospital of Pessac and Prince of Wales Hospital in Hong Kong. The accuracy of the TE measurements was validated by biopsy results.&lt;/p&gt;
&lt;p&gt;Of the patients, 31 (12.6%) had advanced fibrosis and 25 (10.2%) had cirrhosis.&lt;/p&gt;
&lt;p&gt;The liver stiffness measurements of patients with F0, F1, F2, F3, and F4 stages of fibrosis were 5.7, 6.8, 7.8, 11.8, and 25.1 kPa, respectively (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001, by analysis of variance).&lt;/p&gt;
&lt;p&gt;TE was accurate for predicting fibrosis in patients with liver stiffness of at least 7.9 kPa; measurement and accuracy were not affected by hepatic steatosis, necroinflammation, and obesity.&lt;/p&gt;
&lt;p&gt;The most disagreement between the results of the TE and biopsy methods occurred in patients with short liver biopsy lengths and mild or no fibrosis.&lt;/p&gt;
&lt;p&gt;In patients with complete biochemical data, the accuracy of TE was compared with that of other means of predicting liver stiffness, and was found to be more reliable than aspartate aminotransferase&amp;#8211;to&amp;#8211;alanine aminotransferase ratio, aspartate aminotransferase&amp;#8211;to&amp;#8211;platelet ratio index, FIB-4, BARD, and NAFLD fibrosis scores.&lt;/p&gt;
&lt;p&gt;The authors cautioned that the results of the liver biopsies potentially could have been influenced by sampling bias and that referral&lt;strong&gt; &lt;/strong&gt;patients enrolled in the study may have had more advanced liver disease than the general population. They also noted that a significant proportion of obese patients were not analyzed because a liver stiffness measurement could not be obtained.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Leon Adams, PhD, of the University of Western Australia, noted that the majority of individuals with NAFLD will not develop liver-related morbidity or die from liver disease.&lt;/p&gt;
&lt;p&gt;&quot;Thus, he wrote, &quot;the difficulty facing the managing physician is predicting which patients are at greatest risk of developing cirrhosis, thus identifying those who will benefit most from specific treatments, more intensive therapy, and monitoring.&quot;&lt;/p&gt;
&lt;p&gt;The new study, he wrote, suggests that TE is effective at excluding advanced fibrosis and cirrhosis in patients with NAFLD. However, he argues that the technique requires further validation in obese and morbidly obese populations and that sensitivity of the test is likely to vary between differing patient populations, different medical personnel administering the test, and underlying prior probability of fibrosis.&lt;/p&gt;
&lt;p&gt;&quot;Lastly,&quot; he concluded, &quot;if noninvasive markers are going to form part of the routine assessment of the millions of individuals with NAFLD, the expense and availability of each modality may play a decisive role in which the noninvasive method is most appropriately taken up by community physicians and specialty hepatologists.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Chinese University of Hong Kong.&lt;/p&gt;&lt;p&gt;Co-investigator Henry Lik-Yuen Chan reported receiving advising and speaking fees from Novartis, Bristol-Myers Squibb, Pharmasset, and Schering-Plough.&lt;/p&gt;&lt;p&gt;Co-investigator Sung reported receiving advising and speaking fees from AstraZeneca, GlaxoSmithKline, and Roche.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_341"
                     title="Doctor&apos;s Orders: Brain&apos;s Wiring Makes Change Hard"
                     score="0.007"
                     href="http://www.medpagetoday.com/Psychiatry/Addictions/tb/18207?impressionId=1265806968127"
                     
      &lt;p&gt;Doctor&apos;s Orders&lt;em&gt; is a feature in the collaboration between &lt;/em&gt;MedPage Today &lt;em&gt;and&lt;/em&gt; ABC News&lt;em&gt;. In this monthly segment we explore medical issues of interest to physicians and their patients alike. This month, we look at addiction and addictive behaviors, and what neuroimaging studies have revealed about why it&apos;s so hard to break bad habits. &lt;/em&gt;&lt;/p&gt;&lt;hr&gt;

&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

&lt;p&gt;By the end of January, many New Year&apos;s resolutions have been tossed out with the leftover holiday cookies. That&apos;s because change is hard  --  and neuroscientists are learning why.&lt;br&gt;
&lt;br&gt;Advances in neuroimaging have enabled researchers to peer inside the brains of addicts and patients with addictive behaviors. They can see in real-time what gets patients hooked: how the brain&apos;s reward system  --  based largely on the neurotransmitter dopamine  --  thirsts for more, while inhibitory control centers experience a system failure.&lt;br&gt;
&lt;br&gt;The pattern is similar across all kinds of behaviors  --  from cocaine and tobacco addiction to overeating. That&apos;s why changing your mind may be the first step toward breaking a habit, but altering the brain&apos;s neural machinery is the real challenge.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Hijacked Pathways&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Drug-taking and other addictive behaviors &quot;hijack&quot; the brain&apos;s reward system, says Petros Levounis, MD, director of the Addiction Institute of New York at St. Luke&apos;s and Roosevelt Hospitals in Manhattan.&lt;/p&gt;
&lt;p&gt;In normal patients, dopamine plays a major role in motivation and reward, surging before and during a pleasurable activity  --  say, eating or sex  --  to make patients want to repeat a behavior that&apos;s crucial to the survival of the species.&lt;/p&gt;
&lt;p&gt;Dopaminergic pathways connect the limbic system, responsible for emotion, with the hippocampus, etching rewarding behaviors into the brain by creating strong, salient memories.&lt;/p&gt;
&lt;p&gt;The problem arises when the memory and the craving to recapture it takes over a person&apos;s life.&lt;/p&gt;
&lt;p&gt;&quot;Imagine what a strong hold these hijacked reward pathways take on our brains and our whole existence when they&apos;re so closely connected, geographically and anatomically speaking, with our memories and our emotions,&quot; Levounis says.&lt;/p&gt;
&lt;p&gt;As the dopamine surge repeats and repeats, it gains speed, but the brakes begin to fail: Normal function in the brain&apos;s frontal lobes, responsible for inhibitory control and executive functioning (read: willpower), tends to decrease in addicts.&lt;/p&gt;
&lt;p&gt;&quot;Ultimately,&quot; Levounis says, &quot;the war on drugs is a war between the hijacked reward pathways that push the person to want to use, and the frontal lobes, which try to keep the beast at bay. That is the essence of addiction.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Similar Patterns&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;These neural pathways have been well studied in the brains of hardcore addicts. Now, researchers say they see similar pathways involved in other bad behaviors.&lt;/p&gt;
&lt;p&gt;Gene-Jack Wang, MD, of Brookhaven National Laboratory on New York&apos;s Long Island, has conducted several brain imaging studies of obese patients using PET-CT scans.&lt;/p&gt;
&lt;p&gt;The scans have revealed similarities in brain activity  --  or a lack thereof  --  between patients addicted to cocaine or alcohol, and those &quot;addicted&quot; to eating. Normally, the PET scan lights up when a contrast of radioactive glucose is metabolized, revealing an area of red activity in the center of the brain.&lt;/p&gt;
&lt;p&gt;But in both drug-addicted and obese patients, the scans show very little red activity, because there aren&apos;t enough receptors to which the radioactive glucose can bind. Wang says the decreased availability of dopamine receptors is the brain&apos;s way of coping with a constant dopamine overload.&lt;/p&gt;
&lt;p&gt;&quot;If a person constantly has an excess of dopamine, the brain will down-regulate,&quot; Wang says, explaining the principle commonly referred to as tolerance. &quot;Once the system is down-regulated, we have to do more in order to get the same amount of feeling in our normal state.&quot;&lt;/p&gt;
&lt;p&gt;Thus, obese patients &quot;will want to eat more in order to compensate for their down-regulated system.&quot;&lt;/p&gt;
&lt;p&gt;In other experiments, Wang and his colleagues have also found that a higher body mass index (BMI) correlated with lower prefrontal cortex function  --  the area associated with inhibitory control.&lt;/p&gt;
&lt;p&gt;&quot;If they&apos;re obese,&quot; Wang said, &quot;they have a problem controlling their eating behaviors.&quot;&lt;/p&gt;
&lt;p&gt;Those studies also revealed that a higher BMI was linked to a decrease in memory and executive functioning.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Out of Control&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Ed Susman was 293 pounds when he decided to join a clinical trial for an investigational weight-loss drug and chronicle his year-long experience for &lt;em&gt;MedPage Today&lt;/em&gt;. (See &lt;a href=&quot;http://www.medpagetoday.com/PrimaryCare/Diabetes/8125&quot; mce_href=&quot;http://www.medpagetoday.com/PrimaryCare/Diabetes/8125&quot; target=&quot;_blank&quot;&gt;Journalist Participant to Present Insider View of Weight-Loss Trial&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Eating, to him, was a &quot;compulsion&quot;  --  as was biting his nails, a habit he picked up at age 4.&lt;/p&gt;
&lt;p&gt;Over the course of the trial, not only did Susman lose 52 pounds, he also stopped his nail-biting.&lt;/p&gt;
&lt;p&gt;He doesn&apos;t yet know if he was in the drug arm of the trial, but he strongly suspects he wasn&apos;t experiencing a placebo effect.&lt;/p&gt;
&lt;p&gt;&quot;I believe I was on the drug because it controlled a compulsion that I had had for 50 years,&quot; Susman says of the nail-biting. &quot;This stopped it cold.&quot;&lt;/p&gt;
&lt;p&gt;Unfortunately, he says, the same didn&apos;t happen with his eating habits, but he&apos;s gained back only 10 of those 52 pounds in the year since his participation in the trial ended.&lt;/p&gt;
&lt;p&gt;The still-investigational drug is lorcaserin  --  a combination of benzazepine and hydrochloride, two neurological agents. Susman says it is &quot;supposed to improve your willpower, your ability to overcome compulsions.&quot;&lt;/p&gt;
&lt;p&gt;Lorcaserin is a selective 5-HT&lt;sub&gt;2C&lt;/sub&gt; receptor agonist, working through the serotonin system, which regulates appetite, mood, and motor behavior.&lt;/p&gt;
&lt;p&gt;Two other investigational obesity drugs target the dopamine reward system  --  Contrave, which is a combination of bupropion and naltrexone, and Qnexa, which combines phentermine and topiramate.&lt;/p&gt;
&lt;p&gt;&quot;Some medications that have used similar dopamine modulation, until now, have failed,&quot; Wang said. &quot;These two companies are using the command of the modulation of the dopamine system with other neurological systems, such as the opiate or norepinephrine system. According to the trials, they&apos;ve been very effective.&quot;&lt;/p&gt;
&lt;p&gt;Wang called the new medications &quot;a bright light for the treatment of obesity.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Kicking the Habit&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Basically, the idea of medications that act on the dopamine system is &quot;to cool down those reward pathways,&quot; Levounis says. There are two strategies for doing so: an agonist strategy, or an antagonist strategy.&lt;/p&gt;
&lt;p&gt;The agonist strategy is &quot;feeding the beast, providing activity in the cell so that the cravings go down,&quot; Levounis said. Classic examples are nicotine patches, or methadone for opioid dependence.&lt;/p&gt;
&lt;p&gt;On the other hand, the antagonist strategy is to block the receptors. Naltrexone, for example, will block opioid receptors so that the drug addict won&apos;t feel anything if he or she attempts to get high.&lt;/p&gt;
&lt;p&gt;&quot;After a while, you say, &apos;This is not worth my time, my money, my trouble,&apos; so you stop using,&quot; Levounis explains.&lt;/p&gt;
&lt;p&gt;These have been the two main strategies in addiction pharmacotherapy, but there&apos;s now a &quot;third avenue&quot;  --  the partial agonist approach.&lt;/p&gt;
&lt;p&gt;The partial agonist is one molecule that blocks most receptors while still providing just a little bit of an &quot;oomph&quot; to calm cravings. That&apos;s how varenicline (Chantix) helps smokers quit, and how buprenorphine gets junkies off heroin or other opioids.&lt;/p&gt;
&lt;p&gt;But what about inhibitory control? What if medications could ramp up will power?&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s an area of active research,&quot; Levounis says. &quot;There are some medications proposed, but nothing to write home about.&quot;&lt;/p&gt;
&lt;p&gt;He said treatment is typically twofold. For addicts, psychiatrists will try to &quot;cool down&quot; the reward pathways, often with medication. Then, they target the diminished frontal lobes.&lt;/p&gt;
&lt;p&gt;&quot;We try to beef up the frontal lobes as much as we can, and we do that with psychotherapy,&quot; Levounis said.&lt;/p&gt;
&lt;p&gt;Researchers agree that psychotherapy is key to regaining self-control, and it&apos;s the predominant treatment used in patients with addictive behaviors.&lt;/p&gt;
&lt;p&gt;Mark Smaller, PhD, a psychoanalyst in private practice in Chicago, said psychotherapy often reveals an underlying cause for an addiction or compulsive behavior. Usually, it&apos;s anxiety or depression.&lt;/p&gt;
&lt;p&gt;Acknowledging those problems may help change behaviors. Once they&apos;re realized, a patient can start working against them, with the help of the brain&apos;s own neuroplasticity. Essentially, neurons can disconnect and reconnect, or loosen their connections and tighten them, which often manifests in noticeable change.&lt;/p&gt;
&lt;p&gt;&quot;[Psychological] insights can actually begin to change brain chemistry and diffuse compulsions,&quot; he said. &quot;If you address those issues, you can have a positive impact on your life that can change the chemistry of your brain.&quot;&lt;/p&gt;
&lt;p&gt;Smaller said it &quot;creates a new psychological  --  if not neurological  --  structure that can help regulate behavior.&quot;&lt;/p&gt;
&lt;p&gt;Although research on neuroplasticity is relatively young, the concept of &quot;rewiring&quot; the brain is not new.&lt;/p&gt;
&lt;p&gt;In fact, too often, the electrician metaphor has been employed as an excuse for indulging, an explanation for a New Year&apos;s resolution deferred: &quot;I can&apos;t stop eating chocolate, I&apos;m just not wired that way.&quot;&lt;/p&gt;

&lt;hr&gt;
&lt;p&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/30/16717.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/30/16717.jpg&quot; alt=&quot;&quot;&gt;&lt;em&gt; is a collaboration between &lt;/em&gt;MedPage Today &lt;em&gt;and&lt;/em&gt; ABC News&lt;em&gt;.&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_304"
                     title="&apos;Virtual&apos; Colon Scans Effective in Seniors (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18164?impressionId=1265806968127"
                     
      Patients 65 and older are as suitable as younger individuals for CT colonography, said researchers conducting a large retrospective study.&lt;br&gt;
&lt;br&gt;Advanced neoplasias were detected with CT colonography  --  often called &quot;virtual colonoscopy&quot;  --  in older patients at more than double the rate in the general screening population, reported David H. Kim, MD, of the University of Wisconsin in Madison, Wis., and colleagues in the February issue of &lt;em&gt;Radiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;They found that 7.6% of older patients had advanced neoplasias, compared with 3.2% of all patients screened in the university&apos;s clinic (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;On the basis of this and other findings in 577 individuals 65 and older versus the entire group of 3,120 patients undergoing the procedure, Kim and colleagues concluded that &quot;CT colonography performance is maintained in an older cohort.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Overall, the observations from this clinical experience confirm that CT colonography may be a valuable screening modality in the older population,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, the study did not address several objections raised by the Centers for Medicare and Medicaid Services (CMS) in its decision last year to deny Medicare coverage for the procedure. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; target=&quot;_blank&quot;&gt;Medicare Finalizes Denial of Virtual Colonoscopy Coverage&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;CMS had pointed to relatively low sensitivity of CT colonography compared with optical colonoscopy in prospective trials, especially for small lesions.&lt;/p&gt;
&lt;p&gt;The agency also determined that CT colonography increased the costs of positive findings, since abnormalities in the CT scans must be confirmed with optical colonoscopy. In addition, CMS said there was no evidence to support claims that the less invasive imaging procedure would be more acceptable to patients and therefore would raise screening rates.&lt;/p&gt;
&lt;p&gt;The data analyzed by Kim and colleagues did not allow for calculations of false-negative rates or predictive values of positive or negative findings. Nor did the researchers report cost information.&lt;/p&gt;
&lt;p&gt;Mean age of their older cohort was 69.2 (SD 3.8). The oldest was 79.&lt;/p&gt;
&lt;p&gt;The researchers reported that 15.3% of the older patients were referred for optical colonoscopy on the basis of the CT results, compared with 7.9% of the overall screening group.&lt;/p&gt;
&lt;p&gt;Less than 4% of positive findings were determined to be false with the optical procedure (3.6% for polyps 6 to 10 mm in diameter, 2.1% for larger lesions).&lt;/p&gt;
&lt;p&gt;Of the 59 advanced neoplasias identified in the older patients, all but three were at least 10 mm in size.&lt;/p&gt;
&lt;p&gt;The scans also suggested abnormalities outside the colon in 89 (15.4%) patients. Of these, 45 received a full workup, which revealed substantial and previously unsuspected diagnoses in 21 cases  -- 18 were vascular aneurysms. The other three included one lung tumor, a femoral hernia, and a malrotation.&lt;/p&gt;
&lt;p&gt;Kim and colleagues reported that no &quot;substantial complications&quot; such as perforations or major hemorrhage occurred in the older patients, either with the CT scan or follow-up colonoscopy.&lt;/p&gt;
&lt;p&gt;They also indicated that the ratio of large to small neoplasias was similar in the older patients compared with their CT screening group as a whole. Histologic and morphologic findings were similar as well.&lt;/p&gt;
&lt;p&gt;The researchers cited the observational nature of the study, in which negative findings were not corroborated with optical colonoscopy, and its restriction to a single center as its main limitations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Kim and one co-author reported relationships with Viatronix and Medicsight and are co-founders of a company called VirtuoCTC, which produces educational materials on CT colonography.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_281"
                     title="Multiple Benefits Seen for Exercise in Seniors (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/PrimaryCare/ExerciseFitness/tb/18140?impressionId=1265806968127"
                     
      Regular exercise can help stave off the cognitive and physical impairments of aging that many people dread more than death, a series of new studies found.&lt;br&gt;
&lt;br&gt;Ability to walk and perform other daily tasks, avoidance of major chronic diseases, and overall good quality of life  --  all were more common in people who exercised at least three times a week, according to four studies published in the Jan. 25 issue of &lt;em&gt;Archives of Internal Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;For example, analysis of some 13,500 participants in the Nurses&apos; Health Study found that the likelihood of &quot;successful survival&quot; (living past 70 in general good physical and mental health) was nearly doubled (OR 1.99, 95% CI 1.66 to 2.38) for those who had been in the highest quintile of overall physical activity 10 to 15 years earlier than for the most sedentary participants.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Even among those in the middle quintile, the chances of successful survival improved by 37% (OR 1.37, 95% CI, 1.13 to 1.65), Qi Sun, MD, ScD, of Harvard School of Public Health, and colleagues reported.&lt;/p&gt;
&lt;p&gt;&quot;The notion that physical activity can promote successful survival rather than simply extend the lifespan may provide particularly strong motivation for initiating activity,&quot; Sun and colleagues wrote.&lt;/p&gt;
&lt;p&gt;Only 1,456 of the Nurses&apos; Health Study Participants qualified as successful survivors when evaluated from 1995 to 2001, meaning they were free of significant cognitive and physical disabilities as well as 10 major chronic conditions that included cancer, major cardiovascular and lung disease, kidney failure, diabetes, and Parkinson&apos;s.&lt;/p&gt;
&lt;p&gt;When initially evaluated at baseline in 1986, these successful survivors walked more (mean 9.5 metabolic-equivalent task [MET) hours per week versus 7.2 hours for other survivors, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) and their overall physical activity levels were greater (mean 19.1 MET hours per week versus 14.1 hours, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Major highlights of the three other studies included: &lt;ul&gt; &lt;li&gt;Among women 65 and older in a randomized trial, an increasingly intense, supervised exercise program led to significantly enhanced bone mineral density, reduced falls, and better marks on standard cardiovascular risk factors than a more passive wellness program.&lt;/li&gt; &lt;li&gt;Risk of impaired performance on the six-item Cognitive Impairment Test in a prospective cohort study of about 3,900 people 55 and older was cut nearly in half among people with moderate or high levels of physical activity, relative to those with low levels (odds ratio 0.57 and 0.54, respectively, &lt;em&gt;P&lt;/em&gt;&amp;#8804;0.01).&lt;/li&gt; &lt;li&gt;Another randomized trial found that nursing-home residents 65 and older showed slower declines in health-related quality of life with two different exercise programs than with usual care.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Exercise was not a panacea, however. In the last study, involving 160 patients, it seemed to have little or no effect on psychiatric diagnoses such as dementia and psychosis.&lt;/p&gt;
&lt;p&gt;In the other randomized trial, involving a supervised exercise program with 246 participants, no improvement in cardiovascular disease risk was seen relative to the control group.&lt;/p&gt;
&lt;p&gt;Moreover, the improvements seen with exercise in that study also failed to translate into significant healthcare cost savings, according to the researchers, led by Wolfgang Kemmler, PhD, of the University of Erlangen-Nuremberg in Germany.&lt;/p&gt;
&lt;p&gt;They estimated that the total 18-month cost of healthcare for those in the exercise program averaged about $3,202, compared with $3,948 in the control group (&lt;em&gt;P&lt;/em&gt;=0.20).&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, two gerontologists from the University of Florida in Gainesville, Fla., commented that the most important clinical question about exercise in the elderly remained unanswered by these and earlier studies.&lt;/p&gt;
&lt;p&gt;&quot;While scientific value of these studies cannot be disputed, whether the results can or should be translated into recommendations for preventing disability progression in the broader community of older adults typically seeking care in the outpatient setting is the burning question that remains. This is because most of these studies and other published studies have enrolled younger and generally healthier older people,&quot; wrote Jeff Williamson, MD, MHS, and Marco Pahor, MD.&lt;/p&gt;
&lt;p&gt;&quot;The primary issue is the lack of randomized controlled trials (RCTs) of adequate scope examining the feasibility, safety, and impact of exercise over a long duration (&amp;gt;2 years) in persons who are at highest risk for loss of independence on relevant geriatric outcomes, such as onset of major disability,&quot; they added.&lt;/p&gt;
&lt;p&gt;Williamson and Pahor have planned a clinical trial that they said could begin to provide answers.&lt;/p&gt;
&lt;p&gt;A multicenter study called Lifestyle Interventions and Independence for Elders (LIFE) is set to recruit 1,600 older sedentary people considered at risk to lose substantial mobility. They will be assigned to an exercise program or to receive general health education and will be followed for four years.&lt;/p&gt;
&lt;p&gt;&quot;The LIFE study will provide definitive evidence regarding whether physical activity is effective and practical for preventing major mobility disability,&quot; Williamson and Pahor asserted.&lt;/p&gt;
&lt;p&gt;Meanwhile, the four new &lt;em&gt;Archives&lt;/em&gt; studies &quot;move the scientific enterprise in this area further along the path toward the goal of understanding the full range of important aging-related outcomes for which exercise has a clinically relevant impact,&quot; the editorialists wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study by Sun and colleagues was funded by the National Institutes of Health and the Boston Obesity Nutrition Research Center, along with support from Unilever and the American Heart Association.&lt;/p&gt;&lt;p&gt;The study by Etgen and colleagues was funded by AOK, a health insurer in Germany.&lt;/p&gt;&lt;p&gt;The study by Kemmler and colleagues was funded by Siemens Betriebs Krankenkasse, Behinderten-und-Rehabilitations-Sportverband Bayern, Netzwerk Knochengesundheit e.V., Opfermann Arzneimittel GmbH, Thera-Band, Institute of Sport Science, and Institute of Medical Physics.&lt;/p&gt;&lt;p&gt;The study by Dechamps and colleagues was funded by Conseil Regional d&apos;Aquitaine.&lt;/p&gt;&lt;p&gt;None of the study authors or the editorialists reported any competing financial interests.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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