Stephanie Robinson

Preferences of older people for early diagnosis and disclosure of Alzheimer's disease (AD) before and after considering potential risks and benefits.

Studies suggest that most people support screening for and disclosure of dementia, but it is not clear whether respondents have reflected on the benefits and risks of diagnosis. In this study, preferences, rated on a 7-point Likert scale, for diagnosis, disclosure and screening for AD were measured before and after discussion of the potential benefits and hazards of diagnosis in 132 hospital and community subjects in Galway, Ireland. At baseline the percentages with a positive attitude (Likert rating of 5-7) were 79.6% for diagnosis, 85.7% for disclosure and 59.3% for screening. On follow-up, there was no significant change in disclosure responses (12 more positive, 18 more negative, 102 unchanged (p=0.2), 78.1% positive attitude) while there were significant declines in ratings for diagnosis (11 more positive, 27 more negative, 94 unchanged (p=0.03), 69.1% with positive attitude) and screening (10 more positive, 35 more negative, 87 unchanged (p<0.0001), 42.1% positive attitude). In conclusion, although most people want to know if they have AD, there is a diminishing degree of support from disclosure to diagnostic assessment to screening. Preferences for diagnosis and screening decline when respondents have the opportunity to consider the consequences of their decision.

Attitudes to outcomes measured in clinical trials of cardiovascular prevention

BACKGROUNDnSelecting outcome measures in cardiovascular prevention trials should be informed by their importance to selected populations. Major vascular event outcomes are usually prioritized in these trials with considerably less attention paid to cognitive and functional outcomes.nnnAIMnTo examine views on importance of outcome measures used in clinical trials.nnnDESIGNnCross-sectional survey.nnnMETHODSnOf 367 individuals approached, 280 (76%) participated: outpatients attending cardiovascular prevention clinics (nu2009=u200997), active retirement groups members (nu2009=u200975), medical students (nu2009=u2009108). Participants were asked to rank, in order of importance, outcome measures, which may be included in cardiovascular prevention trials. Results were compared between two groups: <65s (nu2009=u2009157) and ≥65s (nu2009=u2009104).nnnRESULTSnWhen asked what outcomes were most important to measure in cardiovascular prevention trials, respondents reported: death (31.6%) stroke (28.5%), dementia (26.9%), myocardial infarction (MI) (7.9%) and requiring nursing home (NH) care (5.1%). When asked the most relevant outcomes regarding successful ageing respondents reported; maintaining independence (32.4%), avoiding major illness (24.3%), good family life (23.6%), living as long as possible (15.8%), avoiding NH care (3.1%) and contributing to society (0.8%) as most important. When asked what outcome concerned them most about the future, respondents reported: dementia (32.6%), dependence (30.4%), death (12.8%), stroke (12.5%), cancer (6.2%) requiring NH care (4.8%) and MI (0.7%). Maintaining independence was considered most important in younger and older cohorts.nnnCONCLUSIONnCognitive and functional outcomes are important patient-relevant outcomes, sometimes more important than major vascular events. Incorporating these outcomes into trials may encourage patient participation and adherence to preventative regimens.

Vitamin D supplementation-clarity required regarding treatment regimens and target plasma levels

The discovery of vitamin D at the beginning of the twentieth century was the result of pioneering work by numerous researchers investigating the role of vitamins and other factors in disease prevention. This culminated in Adolf Windaus being awarded the Nobel Prize for Chemistry in 1928 for his work on steroid chemistry and vitamins.1nnVitamin D deficiency is prevalent in healthy adults and is particularly high among black and Asian subjects living at higher altitudes. The National Health and Nutritional Examination Survey 2006 reports an overall prevalence rate of vitamin D deficiency of 41% in US adults.2 Older people and those who are institutionalized are more likely to have vitamin D deficiency and a UK survey found that only 16.2% of men and 13.2% of women aged ≥65 years had serum 25(OH)D levels ≥75 nmol/l.3 It is apparent but poorly understood that a strong association exists between socio-economic disadvantage and poor health in northern Europe and North America. Grimes4 suggests that poorer health and shorter life expectancy of the socio-economically disadvantaged in the UK may be partially explained by an association with the relative deficiency of vitamin D.nnVery few foods contain vitamin D2 or vitamin D3 and therefore, unlike other vitamins, humans rely primarily on sun exposure to obtain vitamin D. Vitamin D exerts its action through vitamin D receptors which are found in most cellular tissues. These receptors have a wide range of important biological actions including inhibition of cellular proliferation and induction of terminal differentiation, inhibition of angiogenesis, stimulation of insulin production, inhibition of renin production and stimulation of macrophage cathelicidin production.4 Vitamin D is therefore essential for normal calcium homeostasis but also has many other roles in cellular metabolism including modulation of cell growth, neuromuscular and immune function and reduction of …