Researchers asked more than 2,100 New York City residents aged 65 and older about their dietary habits. Over the course of about four years, 253 developed Alzheimer’s disease.

Those whose diets included the most salad dressing, nuts, fish, tomatoes, poultry, cruciferous vegetables (such as cauliflower and broccoli), dark and green leafy vegetables, and the least red meat, high-fat dairy, organ meat and butter had a 38 percent lower risk of developing Alzheimer’s than those whose diets included fewer fruits, vegetables and poultry and more red meat and high-fat dairy.

“Following this dietary pattern seems to protect from Alzheimer’s disease,” said senior study author Dr. Nikolaos Scarmeas, associate professor of neurology at Columbia University Medical Center in New York City. But he added that “this is an observational study, not a clinical trial,” meaning that researchers cannot say with certainty that eating a certain way helps prevent the disease.

The study was published online April 12 in the Archives of Neurology, and will appear in the journal’s June print issue.

While similar to the well-known Mediterranean diet, the diet that seemed to be beneficial in this study is not identical because researchers didn’t want to restrict themselves to considering only one culinary tradition. The Mediterranean diet included nine food groups; this study included 30, Scarmeas said.

The foods in those 30 groups are those that impact a list of seven fatty acids and nutrients, which previous research has associated with Alzheimer’s disease risk. The nutrient combination included: saturated fatty acids, monounsaturated fatty acids, omega-3 fatty acids, omega-6 fatty acids, vitamin E, vitamin B12 and folate.

“We found there was a combination of foods that affected the levels of these fats and vitamins, and by doing so, also affected the risk for getting Alzheimer’s disease,” Scarmeas said.

The researchers controlled for demographic factors such as age, education and ethnicity; genetic factors; smoking, body mass index and other medical conditions.

Dr. Samuel Gandy, a neurologist and cell biologist at Mount Sinai School of Medicine in New York City, said the findings are consistent with other epidemiological studies that have found that people who stick to a diet that is good for the heart also have a lower risk of Alzheimer’s disease.

“Everything that increases the risk for heart disease — high cholesterol, obesity, high blood pressure, uncontrolled diabetes — all of these things also increase the risk for Alzheimer’s,” Gandy said.

The reasons for the connection are not fully understood. One possibility is that factors that impact the health of the blood vessels throughout the body may also impact the health of the blood vessels in the brain.

Doctors used to believe there were two separate causes of dementia: vascular dementia, due to blood vessel disease; and Alzheimer’s disease, a neurodegenerative process. “We now know that most people with dementia have some of both,” Gandy said.

Still, while eating a “heart healthy” diet is probably a good idea and certainly can’t hurt, what’s not clear is just how much, say, broccoli a person has to eat to see benefits, Gandy added.

As for other lifestyle habits that can lower risk of Alzheimer’s, exercise is the only intervention that has been demonstrated to be beneficial in randomized clinical trials, Gandy said.

A second study in the April issue of the same journal found that people with Alzheimer’s disease lose lean mass as the disease progresses. Lean mass includes weight from the bones, muscles and organs.

People with Alzheimer’s often lose weight unintentionally. The weight loss often begins prior to noticeable memory loss, according to background information in the article.

Researchers from the University of Kansas School of Medicine in Kansas City, assessed the body composition in 70 people aged 60 and older with early-stage Alzheimer’s disease and 70 without the disease. Participants also had their brains scanned using MRI and neuropsychological testing.

Those with Alzheimer’s disease had less lean mass, as well as decreases in the volume of the brain and white matter.

“Our data are consistent with other studies suggesting that brain pathology may contribute to decline in body composition, perhaps by disrupting central nervous system regulation of energy metabolism and food intake,” the study authors wrote.

The strategy appears to make it more likely that the heart will retain the cells, potentially boosting the power of cardiac stem cell therapy.

“Stem cell therapies show great promise as a treatment for heart injuries, but 24 hours after infusion, we found that less than 10 percent of the stem cells remain in the injured area,” Dr. Eduardo Marban, director of the Cedars-Sinai Heart Institute in Los Angeles, said in a news release from the institute. “Once injected into a patient’s artery, many stem cells are lost due to the combination of tissue blood flow, which can wash out stem cells, and cardiac contraction, which can squeeze out stem cells. We needed to find a way to guide more of the cells directly to the area of the heart that we want to heal.”

Marban and colleagues developed a technique in which they loaded cardiac stem cells with microscopic bits of iron. Then they injected the cells into rats that had heart attacks and tried to manipulate the cells with a toy magnet.

The researchers found that magnetism attracted the stem cells to injured areas, tripling the retention rate in the heart.

“Tissue viability is enhanced and heart function is greater with magnetic targeting,” Marban said. “This remarkably simple method could easily be coupled with current stem cell treatments to enhance their effectiveness.”

Marban and his wife, Linda, are founders of a company that has filed patents for the techniques.

The study was published online in the journal Circulation Research.

When asked in a national survey why they might order this potentially hazardous procedure that measures blood flow to the human heart, even when it might not be called for clinically, the top two reasons that cardiologists around the country gave were the fact that other doctors do it routinely and that patients might sue if the test wasn’t done.

“We didn’t say unnecessary,” noted study author Frances Lee Lucas, an epidemiologist with the Maine Medical Center in Portland, whose report was published in the April 13 online edition of Circulation: Cardiovascular Quality and Outcomes. “We said how often for non-clinical reasons. We didn’t want to say unnecessary because we knew nobody would ever say they ordered an unnecessary test.”

The study of 598 cardiologists didn’t attempt to determine the number of catheterizations performed that weren’t really needed — an important issue in an era of rising worry about medical costs. That would be a very difficult study to do, and it would have to include errors in both directions, people who need one and don’t get it as well as people who get one and don’t need it, Lucas said.

Instead, they were just asked what outside factor might put them over the edge if they thought that a catheterization wasn’t really essential.

Fewer than 1 percent of those responding said that the added income from doing the procedure might be a motive, a low number that didn’t surprise Lucas. “I was astonished that anyone said it, but a few did,” she said.

One leading reason turned out to be fear of malpractice suits, which was cited by nearly 24 percent of the cardiologists. That response varied when the answers were broken down according to the intensity of treatment in a given region — that is, the level of health-care services in a region.

Only 12 percent of the cardiologists listed fear of malpractice in the regions of lowest intensity, compared to 35 percent in the highest-intensity regions.

About 27 percent of the cardiologists said they would do the procedure because of peer pressure, a number that varied unpredictably, from 20 percent in some regions to 35 percent in others, Lucas said.

But unlike the fear of malpractice, the effect of peer pressure did not rise in step with the intensity of treatment, Lucas said. “It isn’t a nice, neat gradation,” she said. “It bounces around a lot more.”

The study won’t help anyone who wants to point to one region of the country as a hotbed of unnecessary procedures, Lucas noted. It looked at data from 306 hospital referral regions, which could show a lot of variability in the larger, conventional geographical designations.

“Maine is very conservative, New York is very high-intensity,” Lucas said. “So saying northeast isn’t a very good tool.”

Changing current rules on malpractice might help relieve the pressure on medical costs, the report concluded, but it didn’t say what kind of change might be beneficial. Malpractice was specifically not mentioned in the health-care bill just signed into law by President Barack Obama, despite requests by medical organizations for more limits on what lawsuits physicians might face.

The American Heart Association has not taken a position on malpractice reform, said Dr. Clyde W. Yancy, president of the association and medical director of the Baylor Heart and Vascular Institute in Dallas, because “the association’s prime concern is the quality of patient care and research.”

The findings should be interpreted with caution, Yancy noted, because they were based on responses to proposed medical scenarios by a relatively small number of cardiologists. And “if the wording of the vignettes were changed, the responses might have been different,” he added.

“To use these data as a ‘Eureka event’ is not justified,” Yancy said. “I’m not convinced that the evidence we have justifies us to say we know what influences medical costs on the basis of defensive measures.”

SOURCES: Frances Lee Lucas, Ph.D., epidemiologist, Maine Medical Center, Portland, Me.; Clyde W. Yancy, M.D., medical director, Baylor Heart and Vascular Institute, Dallas;

Researchers found that among 12 New York State primary care practices, the six that had adopted “e-prescribing” systems reduced their prescribing errors by nearly seven-fold over one year. Errors included mistakes like giving patients the wrong dose, wrong duration of use or incorrect or missing usage directions.

Electronic prescribing has been widely seen as a way to improve efficiency, save money and cut medication errors, such as cases where a pharmacy dispenses the wrong drug due to a doctor’s illegible handwriting. The systems also typically provide doctors with a drug’s allergy warnings, potential for interacting with other medications and other information that could help prevent adverse effects.

President Barack Obama has promoted greater use of e-prescribing and electronic patient records as part of healthcare reform, and the economic stimulus package passed last year included funds to encourage more doctors to adopt e-prescribing — which as of 2009, only an estimated 13 percent of U.S. doctors had done.

But it is unclear how the commercially available e-prescribing systems have so far performed in the real world, in solo and small-group medical practices, according to the researchers on the new study, led by Dr. Rainu Kaushal of Weill Cornell Medical College in New York City.

To study the question, the researchers focused on a dozen small practices in a largely suburban and rural area of New York. According to their report in the Journal of General Internal Medicine, half of the practices adopted e-prescribing systems, while the other six stayed with paper prescribing.

Kaushal’s team found that over one year, the e-prescribing practices cut their average prescribing error rate from 42.5 per 100 prescriptions to 6.6 for every 100 prescriptions.

In contrast, practices that stayed with paper saw their error rate remain nearly the same; at the outset, about 37 percent of prescriptions contained an error, and one year later that figure was 38 percent.

As expected, e-prescribing eliminated the problem of poor handwriting, Kaushal’s team found. At the outset, 88 percent of written prescriptions from practices that adopted e-prescribing had some illegible information, according to the researchers.

There was no significant improvement, the researchers found, in the rate of “near misses” — potentially harmful errors that were either caught or reached patients but did not cause serious problems. Among e-prescribers, such errors were seen in almost 1.5 percent of prescriptions at the outset, and in 1.3 percent one year later.

The rate of near misses increased, however, at practices that stuck with paper prescriptions — from 1 percent to nearly 3 percent.

“Our study is one of the first to demonstrate a reduction in prescribing errors in ambulatory solo and small group community practices, where e-prescribing adoption and usage has lagged,” Kaushal and her colleagues write.

The study has a number of limits, including the small number of doctors involved, the researchers note. The practices were also all using the same e-prescribing system, from the health information service provider MedAllies.

“Future studies,” the researchers write, “should be performed with more providers, at diverse sites, and with multiple systems.”

The study was funded by the federal Agency for Healthcare Research and Quality.

SOURCE: Journal of General Internal Medicine

At a two-day meeting to review blood glucose meters, Food and Drug Administration officials and staff pointed to a number of issues that can prevent people from getting proper treatment and sought input from medical experts and industry on ways to improve test results with the widely used devices.

The FDA gets about 12,000 reports of errors with such meters each year and is currently weighing new industry guidelines, said Jeffrey Shuren, director of the agency’s Center for Devices and Radiological Health.

Such errors are likely underreported, but must be weighed against the billions of glucose tests done annually as patients test their sugars several times a day, other FDA staff noted.

“The importance of blood glucose meters in the management and control of diabetes is unquestionable,” Shuren said.

“Some in the clinical and patient communities… have challenged FDA to require tighter performance standards,” he said, while “Others believe… that there is no evidence to support the need for higher standards.

Companies such as Roche, Bayer and others make blood glucose meters used by diabetics on their own or by healthcare providers at doctors’ offices or hospitals to monitor patients. They are not currently FDA-approved to screen for diabetes although they are used to do so.

The devices, which have been around for more than 30 years, use small blood samples to check sugar levels in the blood. If levels are too low, patients may then need to eat something or, depending on their condition, may need insulin.

Accurate readings are key to prevent over-treating or under-treating patients, experts told the FDA. Otherwise, patients can experience sugar levels that are too high or too low and experience complications such as confusion and weakness. Over time, overall improper blood sugar control in diabetics can lead to more serious problems such as ulcers, amputation and even death.

At issue is whether incorrect meter readings stem from problems with the technology or other issues such as patients or doctors and nurses not using the devices properly. Other problems can include trouble with test strips, blood samples, hand washing and other factors that can impact results.

The concerns are particularly important as the number of Americans with diabetes grows. Roughly 24 million people in the United States have the condition — a figure largely expected to double by 2025.

The devices also “have migrated” to wider use in hospitals’ intensive care units even though they are not intended for such critical care use, said Courtney Harper, the head of the FDA’s office that oversees glucose and other testing devices.

Device makers said they support changes to improve meter readings.

The industry’s current standard calls for devices used by patients to be accurate within 20 percent, but companies back changes to tighten that to within 15 percent. Standards should also be set for devices used by doctors and nurses, an industry representative said.

Still, the industry lauded changes over the years that have made monitors easier and more convenient to use, adding that consistent monitoring helps prevent costly complications from diabetes.

“Today’s meters can fit into a patient’s pockets… are virtually pain free, and can produce data in as little as five seconds,” said Steve Brotman, a senior vice president at the industry group Advanced Medical Technology Association.

David Sacks, a pathologist and internal medicine physician at Harvard Medical School, agreed the current standard “is inadequate” and pushed officials to adopt a 10 percent margin of error. A 5 percent range would be even better but is impossible given current technology, he added.

Other experts said more attention must be paid to how medical professionals use the devices, since some studies show that patients who constantly test themselves tend to have fewer error rates.

Additionally, “how much accuracy you need depends on who you are,” said industry consultant Barry Ginsberg. Those with type 2 diabetes who treat their condition with diet changes and oral drugs don’t need to monitor their blood levels as closely as those with type 1 diabetes who take insulin, he said.

Simple steps like better hand washing, patient education and clearer device labels could also reduce errors, experts said.

The FDA on Wednesday will continue its public meeting, focusing on use of the meters in hospitals.

The FDA does not anticipate a supply problem for these products. Pfizer Inc. markets FDA-approved sublingual nitroglycerin tablets in the same strengths and is able to supply the market with approved products. The FDA also will work with patient organizations and health care professionals to ensure that they are aware that an approved product is available.

The agency’s warning letters require Glenmark and Konec to remove the unapproved tablets as part of the FDA’s Unapproved Drugs Initiative. The initiative was announced in 2006 to address marketed drugs that had not received FDA approval.

The unapproved nitroglycerin tablets have not been proven safe and effective, and the FDA has not reviewed the quality and labeling of these products. The unapproved products may differ from approved nitroglycerin products in some respects, such as formulation and labeling. The FDA has seen significant quality and efficacy problems with some unapproved nitroglycerin products.

“Doctors and patients should know that not all drugs on the market are backed by an FDA approval,” said Deborah M. Autor, director of the Office of Compliance at the FDA’s Center for Drug Evaluation and Research (CDER). “This lack of approval undermines the FDA’s efforts to ensure that safe and effective drug products are available to the American public.”

Consumers using the unapproved products should continue taking their medication and consult a health care professional for guidance on alternative treatment options.

“Consumers are entitled to know that their drugs meet FDA standards, and it is a priority for the agency to remove from the market unapproved products that expose consumers to potentially unsafe, ineffective, or poor quality drugs,” said CDER Director Janet Woodcock, M.D. “The FDA remains committed to ensuring that prescription drugs obtain the necessary FDA approval, and we urge companies to actively pursue such approvals.”

Glenmark and Konec have 15 days to respond to the FDA with a plan for removing their products from the market. They have 90 days from the date of the warning letters to stop manufacturing new products and 180 days to stop further shipment of existing products.

Mirapex was first approved more than a decade ago. Approval of the extended-release form was based on a clinical study of more than 400 people with early Parkinson’s who were assessed after nine weeks and 18 weeks.

The safety, tolerability and adverse effects of the extended-release form were similar to those of original Mirapex, the company said. The most frequently reported side effects included nausea, dizziness, sleepiness, insomnia, weakness and constipation.

Parkinson’s is a chronic, progressive and often debilitating neurological disease affecting close to 1 million people in the United States, the drug maker said. One person is diagnosed with Parkinson’s every nine minutes.

The bulletin also said that combined contraceptives containing both estrogen and progesterone reduce the risk of endometrial, ovarian and colorectal cancer. Other potential benefits include prevention of menstrual migraines, treatment of pelvic pain caused by endometriosis and treatment of bleeding because of uterine fibroids.

“We’ve known for many years that hormonal contraceptives have health advantages beyond preventing pregnancy,” Dr. Robert L. Reid, who led the development of the bulletin, said in a news release from the organization. “These recommendations examine the scientific data supporting the non-contraceptive uses of hormonal contraceptives to treat specific conditions.”

“Combined oral contraceptives are effective in normalizing irregular periods, reducing symptoms of premenstrual dysphoric disorder, improving acne and allowing women to avoid having their period at inconvenient times, such as during a business trip, vacation or honeymoon,” Reid added. “Although there is little data on the newer forms of hormonal contraception in terms of their off-label benefits, experts suggest that they may be as effective as the more studied ones in treating the same conditions.”

The findings, from researchers at Case Western Reserve Medical School in Cleveland, suggest that “people with the same genetic composition are more likely to have the same sort of sun damage,” said Dr. Jonette Keri, an assistant professor of dermatology at University of Miami Miller School of Medicine.

In other words, “if your mom aged poorly, you are going to age poorly,” she said.

But while you can’t run away from your genes, you can control certain environmental or lifestyle factors to keep your skin looking younger for longer.

The report is published in the December issue of the Archives of Dermatology.

According to the study authors, long-term sun exposure causes physical and structural changes to the skin that damages the skin. But while usual skin aging is characterized by the development of fine wrinkles and skin growths, sun-damaged skin includes more coarsely wrinkled skin, spots of extra pigment or lost pigment and dilated blood vessels on the face.

However, as much as 40 percent of aging-related changes are due to environmental or lifestyle factors, not a person’s genetics, the researchers said.

The new study in twins — who share so much of the same genetic material — seems to make that clear, one expert said.

“I would think that twins would each have the same response to sun exposure as their sibling,” said Dr. Jeffrey Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine. He was not involved in the new research.

For the study, Kathryn J. Martires, from Case Western, and her colleagues collected data on 65 pairs of twins (both identical and fraternal) who attended the 2002 annual Twin Days Festival in Twinsburg, Ohio.

Martires’s team asked each participant about skin type, history of skin cancer, smoking, drinking habits and weight.

Skin damage was similar among the twins whether they were identical of fraternal, the researchers found. But factors outside of genes appeared highly linked with increased skin damage. These included a history of skin cancer, heavier weight and smoking. Drinking was associated with having less skin damage, Martires’s group noted.

The overweight-wrinkle connection isn’t so obvious, Keri said. Often, weight makes people look older but it can also hide skin damage as the weight fills out their face. “They won’t look as wrinkly because the fat on their face is plumping out their skin,” she said.

Salomon was surprised by one finding: that the skin cancer rate among the twins was found to be higher than it is in the general population.

“This study, with an 8 percent skin cancer rate in twins, seems high when the general population has an incidence of less than 0.5 percent. This in of itself would merit further examination to look at other [potential risk] factors, such as prenatal x-rays, prenatal sonograms and low birth weights,” he noted.

Martires’s team hopes people will use the findings from this study to change their own behaviors and prevent excessive skin damage from controllable environmental factors.

“The Twins Days Festival provides a rare opportunity to study a large number of twin pairs to control for genetic susceptibility,” the authors wrote. “The relationships found between smoking, weight, sunscreen use, skin cancer and photodamage in these twin pairs may help to motivate the reduction of risky behaviors.”

The scanning technology at issue is known as multi-detector computed tomography (MDCT). In the new international study, researchers looked at scans of 291 patients with clogged arteries and found that images from black patients had poorer quality than those from white patients. The findings are to be published in the January issue of the American Journal of Roentgenology.

“Physiologic factors such as high heart rate, arrhythmia, obesity and high coronary calcium burden with motion continue to limit the diagnostic accuracy of MDCT as compared with conventional invasive coronary angiography. Our study is significant because we found a relevant influence of body-mass index [height/weight ratio], heart rate, ethnicity and breathing artifact on the degradation of image quality,” study author Dr. Melvin E. Clouse said in a news release.

Doctors use the scans because they are accurate and reliable, the researchers noted. But “the diagnostic ability of any imaging method is directly dependent on image quality,” Clouse added. “With this new knowledge combined with new and advanced CT scanners, we have the potential to improve image quality of coronary CT angiography, further making the test even more accurate and independent of patient characteristics.”