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Older women who suffer from major depression are at greater risk of developing urinary incontinence than women of the same age who are not depressed, new research shows.

Since urinary incontinence and depression often occur together in women, Dr. Jennifer Melville from the University of Washington in Seattle and colleagues set out to determine if a causal relationship exists between the two conditions.

Previous studies demonstrated a high rate of depression among women being treated for urinary incontinence but none had examined whether one condition led to the other.

Melville’s team hypothesized that because the brain chemical serotonin plays a role in both depression and bladder function, the physiological changes brought on by one illness may set the stage for the other.

“We thought maybe we’d see it both ways. In some people because of chemical changes in the body, depression could lead to incontinence but in others, the cause would run the other way because of the psychologic reaction to incontinence,” Melville told Reuters Health in a telephone interview.

They scoured data gathered over six years in the ongoing Health and Retirement Study of the financial and physical health of recent retirees in 70,000 households.

The investigators conducted two analyses. In the first, women who entered study with depression were examined to see if urinary incontinence developed. The second analysis looked at women who entered the study with urinary incontinence to see if depression was reported at follow-up.

In this sample of nearly 6,000 women with an average age of 59 years, “we just saw the one pathway, very strong, leading from depression to incontinence and in fact incontinence not leading to depression,” Melville said.

The unambiguous results of the study were not expected, she admitted. “We were surprised at was how one-sided the effect looked.”

Doctors can use the findings in the current study “to counsel women with depression about a potentially increased risk for development of urinary incontinence or what to do if incontinence symptoms begin to emerge,” Melville and her colleagues write in the American Journal of Obstetrics and Gynecology.

The loss of bladder control may take a large toll emotionally because of the impact it can have on daily life, they note in their report. Many people feel humiliated and helpless about their condition and restrict social and work activities as a result.

The findings, Melville and colleagues add, also highlight “the importance of addressing depression urgently as a public health priority,” because of the effect it may have on other biological functions.

Among people aged 75 and older, the herbal supplement Ginkgo biloba does not prevent heart attacks, stroke or death, a new study finds.

There is some evidence that the popular herbal remedy might help prevent the leg-circulation problem known as peripheral artery disease, however.

Ginkgo contains nutrients called flavonoids, which are also found in fruits, vegetables, dark chocolate and red wine, and are believed to offer some protection against cardiovascular events, the researchers say. The supplement, which is popular in the United States and Europe, has been touted to improve memory, and to prevent dementia, heart disease and stroke.

However, “ginkgo had no benefit in preventing heart attack or stroke,” said study lead researcher Dr. Lewis H. Kuller, distinguished university professor of public health and professor of epidemiology at the University of Pittsburgh.

“But, surprising to us, was that the results were consistent with the observations in Europe that ginkgo appeared to have some benefit in preventing peripheral vascular disease,” he said.

This could be due to flavonoids acting as both antioxidants and also causing blood vessels to expand, Kuller said.

The report was released online Nov. 24 in advance of publication in an upcoming print issue of the journal Circulation. Last year the same University of Pittsburgh team reported that ginkgo biloba had no effect on preventing dementia.

For their latest study, Kuller’s group randomly assigned 3,069 patients to 120 milligrams of highly purified ginkgo biloba or placebo, twice a day as part of the Ginkgo Evaluation of Memory Study.

Over the six years of the trial, 385 participants died, 164 had heart attacks, 151 had strokes, 73 had mini-strokes (”transient ischemic attacks”) and 207 had chest pain, the researchers found.

There was no significant difference between those taking ginkgo or placebo for any of these outcomes, Kuller said.

However, among the 35 people who were treated for peripheral artery disease, 23 received placebo and 12 were taking ginkgo — a statistically significance difference, the researchers noted.

About 8 million Americans have peripheral artery disease, which typically affects the arteries in the pelvis and legs. Symptoms include cramping and pain or tiredness in the hip muscles and legs when walking or climbing stairs, although not everyone who has PAD is symptomatic. The pain usually subsides during rest.

“This study demonstrated that there were absolutely no benefits of ginkgo biloba in reducing cardiovascular events such as heart attack or stroke or in reducing death due to cardiovascular disease,” said Dr. Gregg A. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles.

“Individuals interested in maintaining cardiovascular health should stick to interventions that have been proven to be beneficial, including not smoking, engaging in regular exercise, and maintaining healthy weight, blood pressure and cholesterol levels rather than taking herbal supplements,” Fonarow said.

Mark Blumenthal, founder and executive director of the American Botanical Council, an independent non-profit educational organization, pointed to the study’s more positive outcome.

“I believe it is important to emphasize that the results of this current exploratory trial do not in any manner reduce or negate the existing positive results of ginkgo biloba as an effective treatment in peripheral artery disease patients, which has been evaluated, confirmed, and approved by government regulatory drug authorities in leading Western European countries like Germany and France,” he said.

In addition, Blumenthal said, the trial showed that ginkgo biloba was safe and well-tolerated.

Three-stage graduated licensing for teens and other new drivers prevents injuries and saves lives, say U.S. researchers who analyzed five years of crash data from six states — Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.

More than 300 lives could have been saved if all of these states had added new, evidence-based modifications to their graduated driver’s licensing (GDL) programs, study leader Dr. Timothy Corden, an associate professor of pediatrics at the Medical College of Wisconsin, and colleagues reported in a university news release.

The study authors also concluded that more than 21,400 traffic injuries could have been prevented if all these states had instituted at least five of seven components recommended by the Insurance Institute for Highway Safety:
Minimum age of 16 years for obtaining a learner’s permit.
A waiting period of at least six months after obtaining a learner’s permit before applying for an intermediate-phase license.
At least 30 hours of supervised driving.
Minimum age of 16.5 years for entering the intermediate phase.
No unsupervised driving at night after 10 p.m. during the intermediate phase.
No unsupervised driving during the intermediate phase with more than one passenger younger than 20.
Minimum age of 17 for a full license.

“Our study lends support for states moving to include more of the best-practice components included within the Insurance Institute for Highway Safety recommendations for state GDL regulations,” the researchers said. “This could be viewed as a ‘policy treatment prescription’ capable of keeping teenagers alive and families intact.”

While some politicians may be reluctant to revise GDL laws, parents are generally supportive of GDL programs and play an important role in the development of successful GDL policies, the researchers said.

Some herbal supplements may boost the levels of lead in the blood of women, new research shows.

Among 12,807 men and women age 20 and older, Dr. Catherine Buettner, at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues found blood lead levels about 10 percent higher in women, but not men, who used specific herbal supplements.

When they examined herbal supplement use among women of reproductive age (age 16 to 45 years old), “the relationship with lead levels was even stronger, with lead levels 20 percent higher overall, and up to 40 percent higher among users of select herbal supplements compared to non-users,” they report in the Journal of General Internal Medicine.

Lead accumulates in the body over time and may pass from a woman’s placenta and breast milk to developing fetuses and infants. The U.S. Food and Drug Administration does not specify safe lead limits, or even routinely test for this toxin in herbal supplements.

Buettner’s team found that women using Ayurvedic or traditional Chinese medicine herbs had lead levels 24 percent higher than non-users, while those using St. John’s wort and “other” herbs had lead levels 23 percent and 21 percent higher, respectively, than non-users.

When combined with prior studies hinting at excess lead in specific supplements, the evidence strongly suggests use of specific herbal supplements may result in higher lead levels among women, Buettner said.

In the current study, Buettner was reassured to find “no evidence of lead toxicity,” she told Reuters Health in an email.

The researchers point out that the use of some herbal supplements among study participants was low, which limited the power to detect associations among specific herbal supplements.

They also emphasize that the current study does not prove that herbal supplements cause higher lead levels. They urge further studies to analyze how other lead exposures, calcium intake, or use of other dietary supplements alter lead levels.

Dr. Adriane Fugh-Berman, at Georgetown University Medical Center in Washington, D.C. concurs in an editorial on the study, and also cautions, “let us not use too broad a brush to tar all herbal products.”

Specific analyses of specific herbal products or the blood of users, Fugh-Berman writes, should be used to establish products containing problematic amounts of lead.