Targeting brain, body and heart for cognitive health and dementia prevention

This report looks into the current research regarding dementia and Alzheimer\u27s disease prevention and offers ideas for possible future solutions. Prevention of dementia is the ultimate aim of a large, albeit under resourced, international research effort. The success of this effort would have enormous benefits for millions of people and save billions of dollars in health care costs. Conversely, the status quo will see the number of Australians living with dementia soar in coming years. Many more people will experience and seek help for mild cognitive impairment. There are many different forms of dementia, a syndrome caused by brain disease and characterised by declining cognitive function that impairs daily activities. Dementia can affect memory, language, attention, judgement, planning, behaviour, mood and personality. Mild cognitive impairment does not significantly impair daily activities, but often represents an earlier stage of cognitive decline. There is no cure for the common forms of cognitive decline and dementia, including the most common, Alzheimer’s disease. A cure may only be achieved by prevention, because the diseases that cause dementia begin many years before symptoms become apparent and gradually damage the brain until it can no longer function normally. Intervening early to stop or slow disease progression, before cognitive impairment emerges, offers the best hope of preventing dementia. Is this achievable? It requires breakthroughs in early detection and intervention. New diagnostic technologies have been developed that can detect the presence of abnormal protein accumulations in the brain that characterise Alzheimer’s disease. The disease can now be detected by brain scans or cerebrospinal fluid tests in the preclinical stage, before any cognitive changes occur

Overview of Australian Indigenous health status 2014

This Overview of Australian Indigenous health status provides information about: Aboriginal and Torres Strait Islander populations; the context of Indigenous health; various measures of population health status; selected health conditions; and health risk and protective factors. This Overview of Australian Indigenous health status provides a comprehensive summary of the most recent indicators of the health of Aboriginal and Torres Strait Islander people in Australia (states and territories are: New South Wales (NSW), Victoria (Vic), Queensland (Qld), Western Australia (WA), South Australia (SA), Tasmania (Tas), The Australian Capital Territory (ACT) and The Northern Territory (NT)). It draws largely on previously published information, some of which has been re-analysed to provide clearer comparisons between Aboriginal and Torres Strait Islander peoples and non-Indigenous people (for more details of statistics and methods, readers should refer to the original sources). Very little information is available separately for Australian Aboriginal people and Torres Strait Islander people. It is often difficult to determine whether original sources that use the term ‘Indigenous\u27 are referring to Aboriginal people only, Torres Strait Islander people only or to both groups. In these instances the terms from the original source are used

The Double Burden.

One third of the world's population is latently infected with Mycobacterium tuberculosis, and with the lifestyle changes succeeding the on-going urbanization, populations already burdened by tuberculosis are experiencing a dramatic increase in chronic diseases, with diabetes being a serious challenge. Tuberculosis and diabetes are not only becoming co-existing diseases. In fact, the diseases interact, and there is evidence to suggest that especially diabetes disease increases the susceptibility for developing active tuberculosis disease. Furthermore, it is plausible that tuberculosis leads to, either transient or permanent, impairment of the glucose metabolism, which ultimately will turn into diabetes. A number of studies from the Americas, Europe, Asia, and, most lately, from sub-Saharan Africa have reported strong association between tuberculosis and diabetes; on average, the estimated risk of active tuberculosis is thrice as high among people with diabetes. The study from sub-Saharan Africa was conducted in Tanzania and is the basis of this thesis. Based on available evidence on the association between tuberculosis and diabetes, the primary aim of the study was to assess the role of diabetes for tuberculosis risk, manifestations, treatment outcomes and survival in a Tanzanian population of tuberculosis patients and non-tuberculosis neighbourhood controls. The study was conducted in Mwanza City in northern Tanzania, with a population exceeding half a million inhabitants, with tuberculosis and HIV being common infections in the region, but with little knowledge about the prevalence of diabetes. We recruited newly diagnosed pulmonary tuberculosis patients from spring 2006 and continuously till the fall 2009, with all participating in a nutritional intervention running in parallel with the medical tuberculosis treatment. All participants underwent diabetes and HIV testing as well as a series of measurements such as anthropometric, clinical and paraclinical parameters. The population was followed up during treatment (2 and 5 months) to assess treatment outcome as well as after one year to assess their survival status. Based on data from 1,250 tuberculosis patients and 350 neighbourhood controls, we found that 38 and 21%, respectively, had impaired glycaemia, and that the prevalence of diabetes was 17 and 9% among tuberculosis patients and controls, respectively. This difference in prevalence between patients and controls was equivalent to an adjusted odds ratio of more than four, indicating a strong association between tuberculosis and diabetes. Furthermore, we found that diabetes was associated with tuberculosis among both participants with or without HIV co-infection. Despite the strong association, diabetes had only moderate clinical implications when the tuberculosis patients initiated the tuberculosis treatment; the patients with diabetes co-morbidity had a minor elevation in the immune response and more frequently reported to have fever. Furthermore, diabetes did not seem to delay time to sputum conversion during treatment. Nevertheless, diabetes co-morbidity led to impaired treatment outcome with slower recovery of weight and haemoglobin and a more than four times higher mortality rate within the initial phase of tuberculosis treatment. In conclusion, in the African region, the double burden of tuberculosis and diabetes is becoming a major health problem. Although the tuberculosis incidence has stabilized during the last decade, the increasing incidence of diabetes will possibly interfere with tuberculosis control and may, consequently, make the tuberculosis incidence increase again. Future research strategies should focus on enhanced diagnostic tools to identify tuberculosis patients with diabetes co-morbidity, and on the role of disease-disease, drug-disease and drug-drug interactions between tuberculosis and diabetes diseases and treatments

The road to reducing dementia onset and prevalence: are diet and physical activity interventions worth investing in?

In Australia, deaths as a result of dementia have now taken over cerebrovascular disease as the second leading cause of death. At present, over a quarter million Australians suffer from dementia and projected estimates indicate that the figure can reach a high of nearly one million by 2050. Diet and physical activity have been shown to promote brain health and offer some protection against cognitive decline. Moreover, they have also been recognised as risk factors for developing other conditions such as cardiovascular disease, diabetes, hypertensive diseases and certain cancers all of which are leading causes of death in Australia. Research shows that higher ratios of saturated fat to monounsaturated fats are predictive of negative mental function. In addition, high mid-life serum cholesterol levels and excessive caloric intake have been found to be associated with impaired cognitive function. Increased intakes of fish, vegetables and legumes, antioxidant rich foods and adequate amounts of certain B-vitamins have been reported to have a protective brain effect. Increased levels of physical activity have been found to promote neuro-protective changes in the hippocampus of the brain – a region central to learning and memory. This brain region is one of the first areas affected by dementia. Most studies have demonstrated that a high level of physical activity in adults with no dementia is associated with a 30% to 50% reduction in the risk of cognitive decline and dementia. Some studies have also theorised that poor physical function may precede the onset of dementia and Alzheimer’s disease and higher levels of physical function may be associated with delayed onset. Results from the Australian Bureau of Statistics National Health Survey (2011 – 2013) show that many Australian adults do not meet the National Physical Activity Guidelines (to do at least 30 minutes of moderate intensity physical activity on most days) as more than half the population is inactive. Further, two-thirds of Australians are now overweight/obese and a large proportion of total energy consumed comes from foods considered to be of little nutritional value. An intervention that focuses on improving diet and physical activity habits therefore has the ability to produce inestimable benefits. There are many factors that must be considered when developing a successful diet and physical activity intervention. These span a gamut of issues from carefully defining the target audience, utilising a multidisciplinary approach, tailoring content and materials, determining forms of delivery and identifying specific behaviour change techniques to determining financial costs in relation to health benefits and training staff. The success of any intervention also relies on the setting and method that will be employed in its implementation. Policy-makers must be cognizant of the fact that no singular government intervention/policy, operating on its own, can have the effect of directly reducing dementia onset/prevalence and changing lifestyle habits. Six actions for policy-makers are identified in this issues brief which have the potential to have immeasurable benefits: i) development of a comprehensive dementia prevention strategy, ii) establishment of a body whose aim is to keep track of scientific research (central to this will be the establishment of a national digital dementia research repository), iii) ensuring a multisectoral approach is adopted in the fight against dementia that includes both ‘traditional’ and ‘incidental’ health agencies, iv) continued investment into research and innovation, v) identifying incentives beyond the health domain and vi) development of longevity literacy programs. These actions all have as their foundation the Health in all Policies Initiative and social determinants of health approach

Audit of Antenatal Testing of Sexually Transmissible Infections and Blood Borne Viruses at Western Australian Hospitals

In August 2007, the Western Australian Department of Health (DOH) released updated recommendations for testing of sexually transmissible infections (STI) and blood-borne viruses (BBV) in antenates. Prior to this, the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG) antenatal testing recommendations had been accepted practice in most antenatal settings. The RANZCOG recommends that testing for HIV, syphilis, hepatitis B and C be offered at the first antenatal visit. The DOH recommends that in addition, chlamydia testing be offered. We conducted a baseline audit of antenatal STI/BBV testing in women who delivered at selected public hospitals before the DOH recommendations. We examined the medical records of 200 women who had delivered before 1st July 2007 from each of the sevenWAhospitals included in the audit. STI and BBV testing information and demographic data were collected. Of the 1,409 women included, 1,205 (86%) were non-Aboriginal and 200 (14%) were Aboriginal. High proportions of women had been tested for HIV (76%), syphilis (86%), hepatitis C (87%) and hepatitis B (88%). Overall, 72% of women had undergone STI/BBV testing in accordance with RANZCOG recommendations. However, chlamydia testing was evident in only 18% of records. STI/BBV prevalence ranged from 3.9% (CI 1.5– 6.3%) for chlamydia, to 1.7% (CI 1–2.4%) for hepatitis C, 0.7% (CI 0.3–1.2) for hepatitis B and 0.6% (CI 0.2–1) for syphilis. Prior to the DOH recommendations, nearly three-quarters of antenates had undergone STI/BBV testing in accordance with RANZCOG recommendations, but less than one fifth had been tested for chlamydia. The DOH recommendations will be further promoted with the assistance of hospitals and other stakeholders. A future audit will be conducted to determine the proportion of women tested according to the DOH recommendations. The hand book from this conference is available for download Published in 2008 by the Australasian Society for HIV Medicine Inc © Australasian Society for HIV Medicine Inc 2008 ISBN: 978-1-920773-59-