It's good to think - but not too much, scientists say

People who think more about whether they are right have more cells in an area of the brain known as the frontal lobes.

UK scientists, writing in Science, looked at how brain size varied depending on how much people thought about decisions.

But a nationwide survey recently found that some people think too much about life.

These people have poorer memories, and they may also be depressed.

Stephen Fleming, a member of the University College London (UCL) team that carried out the research, said: "Imagine you're on a game show such as 'Who Wants to Be a Millionaire' and you're uncertain of your answer. You can use that knowledge to ask the audience, ask for help."

The London group asked 32 volunteers to make difficult decisions. They had to look at two very similar black and grey pictures and say which one had a lighter spot.

They then had to say just how sure they were of their answer, on a scale of one to six. Although it was hard to tell the difference, the pictures were adjusted to make sure that no-one found the task harder than anyone else.

People who were more sure of their answer had more brain cells in the front-most part of the brain - known as the anterior prefrontal cortex.

This part of the brain has been linked to many brain and mental disorders, including autism. Previous studies have looked at how this area functions while people make real time decisions, but not at differences between individuals.

Illness link

The study is the first to show that there are physical differences between people with regards to how big this area is. These size differences relate to how much they think about their own decisions.

The researchers hope that learning more about these types of differences between people may help those with mental illness.

Co-author Dr Rimona Weil, from UCL's Institute of Cognitive Neuroscience, said: "I think it has very important implications for patients with mental ill health who perhaps don't have as much insight into their own disease."

She added that they hope they may be able to improve patients' ability to recognise that they have an illness and to remember to take their medication.

However, thinking a lot about your own thoughts may not be all good.

Cognitive psychologist Dr Tracy Alloway from the University of Stirling, who was not involved in the latest study, said that some people have a tendency to brood too much and this leads to a risk of depression.

More than 1,000 people took part in a nationwide study linking one type of memory - called "working memory" - to mental health.

Working memory involves the ability to remember pieces of information for a short time, but also while you are remembering them, to do something with them.

For example, you might have to keep hold of information about where you saw shapes and colours - and also answer questions on what they looked like. Dr Alloway commented: "I like to describe it as your brain's Post-It note."

Those with poorer working memory, the 10-15% of people who could only remember about two things, were more likely to mull over things and brood too much.

Both groups presented their findings at the British Science Festival, held this year at the University of Aston in Birmingham.

Drinking Coffee Lowers Risk of Gout in Older Women

NEW YORK (Reuters Health) Sep 16 - A few cups of coffee every day over many years cuts the risk of gout in postmenopausal women in half, Boston researchers report.

"The pain is described as one of the most severe pains a human being experiences, like a breaking bone. You can't walk and even the weight of a bed sheet is not bearable," lead author, Dr. Hyon Choi of Boston University's School of Medicine, told Reuters Health.

Dr. Choi had previously shown that drinking coffee lowers gout risk for men. He and his colleagues wanted to see if the same held true in women, especially older women who, after menopause, lose the uric-acid clearing benefits of estrogen. Gout is rare in younger women but occurs in about one in 20 postmenopausal women.

The researchers looked for cases of gout in 89,433 women enrolled in the Nurses' Health Study, which began in 1976. The researchers also analyzed the lifestyles, diet, and beverage consumption habits of the women since 1980, as reported in questionnaires they filled out every two to four years.

Eight-hundred ninety-six cases of gout were confirmed among the study participants. But within that group, the number of cases dropped as coffee consumption increased from less than a cup a day (226 cases) to more than four cups a day (85 cases).

After statistically controlling for other gout risk factors such as body-fat mass, alcohol consumption, use of diuretics and dairy intake, they found that a lifetime of drinking coffee appeared to make a significant difference in the risk of a first attack of gout.

"The higher the consumption level, the lower the risk," Dr. Choi said.

"The risk of gout was 22% lower with coffee intake of 1-3 cups a day and 57% lower with a coffee intake of more than 4 cups a day" compared to those with no coffee consumption, the authors wrote in the August 25th issue of American Journal of Clinical Nutrition.

Caffeinated tea or soda pop did not confer a similar advantage, whereas drinking decaffeinated coffee did offer a "modest" benefit. That observation led the researchers to conclude that "components other than caffeine may also contribute" to the risk reduction.

How coffee staves off gout is still not clear, Dr. Choi said. And not everybody can tolerate it, he added, so he is not advocating that all older women start gulping coffee.

It would be "too much of a jump" for a doctor to recommend that anyone, especially an older woman, take up coffee drinking to reduce their gout risk, he said. Not only can caffeine raise blood pressure and leach calcium, he noted, but the research only speaks to a benefit in long-term consumption.

"If you start coffee in a gout patient, it's possible this benefit does not exist and might make it worse," he said.

On the other hand, if you already drink coffee, and have a family history of gout -- it does run in families -- "I wouldn't stop," Dr. Choi said.

Am J Clin Nutr. Posted August 25, 2010. Abstract

NSAID Use Associated With Atrial Fibrillation

September 15, 2010 (Chieti, Italy) — The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of chronic atrial fibrillation (AF), a new study suggests [1]. However, the researchers do not believe the drugs are causing AF; rather, they suggest that the underlying inflammation necessitating the NSAID therapy might be the culprit.

Dr Raffaele De Caterina (G d'Annunzio University, Chieti, Italy) and colleagues found a statistically significant 44% increase in the risk of chronic AF, but no association with paroxysmal AF, in users of NSAIDs. They also confirmed previous findings regarding the association of steroids with AF, with those taking steroids two and a half times more likely to develop chronic AF than those not taking them, they report in their paper in the September 13, 2010 issue of the Archives of Internal Medicine.

"A likely explanation for our findings is the existence of an underlying inflammatory condition, increasing the risk of AF on the one hand and prompting the use of NSAIDs on the other," they say. Future research should ideally include a description of left ventricular function, atrial size and/or function, and inflammatory markers, which would help make the association "more biologically plausible," they add.

A Hypothesis That Deserves Further Investigation

De Caterina et al identified patients aged 40 to 89 years with a first-ever diagnosis of AF in 1996 in the UK General Practice Research Database and classified them as having paroxysmal or chronic AF. After validation with their primary-care physicians, 1035 patients were confirmed as having incident chronic AF and 525 as having paroxysmal AF. Two separate nested case-control analyses estimated the risk of first-time chronic and paroxysmal AF among users of steroids and NSAIDS.

Increased risk of chronic AF with NSAID use was present irrespective of treatment duration, although the researchers did find an even greater risk associated with long-term use (RR 1.80 in those who used NSAIDs for more than one year). But there was no apparent dose-response relationship when they divided daily use into low, medium, and high.

The findings cannot be explained by the occurrence of heart failure, either, say De Caterina and colleagues, because further stratification found the increased risk of AF associated with NSAIDs was absent in those with prior HF (but present in those without HF).

They go on to explain that the most frequent pathoanatomical changes in AF are atrial fibrosis and loss of atrial muscle mass, and although it is difficult to distinguish between changes due to AF and those due to associated heart disease, fibrosis may precede the onset of AF and may be caused by inflammation.

"It is possible, and we would like to propose, that conditions presenting systemic inflammation, such as autoimmune and rheumatic disorders, represent an independent risk factor for atrial fibrosis and subsequently for an increased risk of onset or persistence of AF. We believe this hypothesis deserves further investigation," they conclude.

Data collection for the determination of AF cases was performed with an unrestricted research grant to Centro Español de Investigación Farmacoepidemiológica from AstraZeneca. The authors report no disclosures.

Depressed heart patients 'at risk'

The combination of depression and coronary heart disease in a patient could be much more deadly than either condition alone, researchers say.

French and British experts say people with both conditions could be four times more likely to die from heart or circulatory disease.

The study, in Heart journal, tracked the mental and physical health of 6,000 middle-aged people over five years.

Experts said doctors must pay more heed to depression in heart patients.

Experts from the University College London and the University of Versailles followed the health of just under 6,000 male and female civil servants for an average of five and a half years.

The volunteers were taking part in the British Whitehall Study II, which is looking at social and economic factors in long-term health.

Exercise

They found people with heart disease alone had a 67% higher chance of dying from any cause than those without either heart disease or depression.

But the combination of heart disease and depression tripled the risk of death from any cause and quadrupled the risk of dying from cardiovascular disease.

Amy Thompson, a senior cardiac nurse at the British Heart Foundation, which partly funded the study, said: "This study builds on previous research which suggests that depression is linked to coronary heart disease.

"Enjoying regular exercise and eating a healthy, balanced diet can help if you are feeling low - so, good news for your mental health as well as your heart health.

"Whether or not you have heart disease, if you feel depressed it's essential to talk to your doctor."

Gene therapy for blood disorder a 'success'

Gene therapy has been used for the first time to treat an inherited blood disorder in what doctors say is a major step forward.

A man given pioneering treatment to correct a faulty gene has made "remarkable" progress, a US and French team has revealed.

Gene therapy is an experimental technique that manipulates genes in order to treat disease.

It has seen some successes, but also setbacks, including a patient's death.

Beta thalassaemia is an inherited blood disorder that affects the body's ability to create red blood cells.

The first gene therapy trial was in an 18-year-old man with a severe form of the condition, who had been receiving regular blood transfusions since the age of three.

Stem cells from his bone marrow were treated with a gene to correct for the faulty one.

They were then transfused back into his body, where they gradually gave rise to healthy red blood cells.

Three years after the treatment, which took place in 2007, the man remains mildly anaemic, but no longer needs blood transfusions, doctors said.

The team, led by Philippe Leboulch, of Harvard Medical School in Boston, said: "At present, approximately three years post-transplantation, the biological and clinical evolution is remarkable and the patient's quality of life is good."

But, reporting in the science journal Nature, the doctors sounded a note of caution, saying there was a possibility that the patient could be at risk of developing leukaemia in the future due to side effects from the gene therapy.

Gene therapy has been used since the 1990s as a new approach to treating a number of incurable conditions, including inherited disorders, some cancers, and viral infections.

There have been some positive results, but in 1999 an 18-year-old US volunteer, Jesse Gelsinger, died after the treatment.

And some children given gene therapy for the immune disorder "bubble baby" syndrome have developed cancer.

Proof of principle

Prof Adrian Thrasher, of University College London, has carried out gene therapy on children with immune disorders.

He said the latest study was an encouraging proof of principle that gene therapy could have genuine therapeutic effects in other blood disorders.

"The good news is that technology is advancing rapidly, and it shouldn't be too long before diseases such as thalassaemia can be reliably and safely treated in this way," he said.

Dr Derek Persons, of St Jude Children's Research Hospital in Memphis, Tennessee, said the work was "a major step forward for the gene therapy of haemoglobin disorder".

He said further trials were planned at several centres in the US, including his own.

"This is very early days," he added. "The field will advance from people doing different trials."

Test To Speed up Meningitis Fight

The most dangerous form of meningitis can kill within hours - but doctors think they have developed the best way to identify it early.The "predictive model" developed by the Health Protection Agency could clear the way for the right treatment to be given quickly.

It uses a combination of blood tests and symptoms to help identify bacterial meningitis.

Charities welcomed the model, while calling for further testing.

Meningitis is an inflammation in the membranes surrounding the spinal cord and brain. It is most often caused by either bacterial or viral infection.

Knowing which is which can make a big difference to the best treatment.

Bacterial meningitis needs antibiotic treatment as soon as possible - and it is often prudent to give these drugs to close family members as well.

Rash

There are tests to identify the cause of meningitis, the best known being a lumbar puncture to obtain spinal fluid for analysis.

However, this does not always yield clear-cut results.

The new model has a simple set of three criteria which helps doctors tell the difference without having to wait for conclusive spinal fluid results.

Researchers found them by examining 385 confirmed meningitis cases over a 12-month period.
The first two criteria are blood tests positive for two specific chemicals associated with bacterial meningitis, the third is the presence of the "classic" meningitis rash of spots which do not disappear when pressed with a glass.

The three results are combined to provide a score which then tells the doctor how likely bacterial meningitis is.

Dr Toyin Ejidokun, a consultant in communicable disease at the HPA, said: "The total score allows a treating clinician to simply and quickly assess the likelihood of whether or not the case is bacterial meningitis by checking it against the predictive probabilities we have developed.

"While further testing needs to take place to test the accuracy of the model, it offers the prospect of a rapid predictive tool to help clinical and public health management of suspected bacterial meningitis cases."

'Step forward'

Steve Dayman, the chief executive of Meningitis UK, said the protocol was "an excellent step forward".

He said: "It's vital that the differentiation between bacterial and viral meningitis is made straight-away because the bacterial form can kill in less then four hours. Quick treatment can mean the difference between life and death.

"In the absence of a vaccine to protect against all forms of meningitis, this new model could help to save precious lives."

Experts said people should still be vigilant for the warning signs of meningitis to maximise the chances of recovery.

Although not every patient has every symptom, common signs include a combination of "classic rash", suddenly appearing high fever, a severe and worsening headache, stiff neck, vomiting, joint and muscle pain, a dislike of bright lights, very cold hands and feet, and severe drowsiness.

A spokesman for the Meningitis Research Foundation said: "Early detection of meningitis and septicaemia is critical when treating these diseases, every second matters.

"We welcome all research and development to identify meningitis early so treatment of antibiotics can be administered as soon as possible to prevent the worst outcome."

However, she said that doctors should stick with existing protocols for diagnosing and treating meningitis until the new version had been fully tested.

Chest Compressions Alone Can Save Lives

Chest compressions prior to defibrillation are just as good as immediate treatment with an electrical defibrillator for out-of-hospital cardiac arrest, according to a new research study. In some respects, chest compression may even be better, particularly with regard to one-year survival, Dr. Pascal Meier of the University of Michigan and colleagues reported in BMC. "Based on our study, current guidelines emphasizing early defibrillation still are important," Meier said in a statement. "However, since the outcomes with the chest compression-first approach were not inferior and might be even better in the long-term, and in case of longer response times, this study may have an impact on future guidelines." Still, survival rates for out-of-hospital cardiac arrest are low, hovering at about 7.6 percent over the last 30 years, the researchers noted. Current guidelines recommend immediate electrical defibrillation for this type of cardiac arrest. But some recent studies have shown an advantage for earlier treatment with chest compressions before defibrillation. So to compare the effects of compression-first versus defibrillation-first on outcomes for out-of-hospital cardiac arrest, the researchers conducted a review of the literature, and came up with four randomized controlled trials totaling 1,503 patients. They found no differences between the approaches in terms of the rate of return of spontaneous circulation, survival to hospital discharge or favorable neurologic outcomes. There was, however, a trend toward an advantage for one-year survival that didn't reach statistical significance. The proportion of patients able to leave the hospital after cardiac arrest with chest compression first was 11 percent compared with 8.6 percent of those treated with defibrillation first, the researchers wrote. There was also a trend for better outcomes among patients with a response interval greater than five minutes that pointed to the superiority of chest compression-first approach, but again, the finding was not significant. But the researchers emphasized that the study was not sufficiently powered to detect this relationship, which should be explored further.