Acetaminophen is one of the most commonly used pain and fever relievers for infants and children and is safe and effective when used as directed. However, with recent dosing changes to liquid acetaminophen products for infants, the FDA last week issued a press release urging parents to know the concentration and read the label as the new, less concentrated form of the popular pain reliever arrives on store shelves. Included in this report is a video discussion of these recommendations by Dr. Jim Sears.

Over the past 12 months, several manufacturers of infant’s liquid acetaminophen products, such as PediaCare® and Little Remedies®, voluntarily converted to a single concentration of liquid acetaminophen and added additional product enhancements, including age-appropriate dosing devices. While the new 160 mg per 5 mL concentration is now arriving in drugstores, much of the older, more concentrated 80 mg per 1 mL or 80 mg per 0.8 mL versions may still be in people’s medicine cabinets as well as on store shelves.

To help explain and illustrate the changes to infants and children’s acetaminophen products, Dr. Jim Sears, pediatrician and co-host of The Doctors, teamed up with PediaCare® and Little Remedies® to create a video explaining the new, smart product changes along with a demonstration of the new special dosing mechanisms. Infant products will now contain a special dosing syringe and flow restrictors on the bottles; children’s products, for ages 2 to 11 years, will have the bottles with flow restrictors, and continue to contain dosing cups. Both infant and children’s formulations will continue to have weight-based instructions on the package, as well.

A video discussion of the new FDA advisory by Dr. Jim Sears.

“There continues to be a ‘transition period’ during which the existing concentrated infant products and the new standard strength acetaminophen infant PediaCare and Little Fevers products may be on store shelves simultaneously,” says Albert Hwang, Vice President, OTC Products for Prestige Brands, Inc. “The new infant formula is less concentrated and the dose is therefore more than in the older infant formulation. And while reading and following package directions is always recommended to obtain accurate dosing instructions, it will be even more important while the two concentrations are available. Parents and caregivers should ask a healthcare professional if they have any questions,” he adds.

Material adapted from Robin Leedy & Associates, Inc..

Most epidemiological studies have shown that obesity is associated with increased cardiovascular events and death. “Weight loss might protect against cardiovascular events, but solid evidence is lacking,” according to background information in the article.

Researchers conducted a study to test the hypothesis that bariatric surgery is associated with a reduced incidence of cardiovascular events and examined the relationship between weight change and cardiovascular events. The study (Swedish Obese Subjects [SOS]) is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden, and includes 2,010 obese participants who underwent bariatric surgery and 2,037 matched obese controls who received usual care.

Patients were recruited between September 1987 and January 2001. Date of analysis was December 31, 2009, with median (midpoint) follow-up of 14.7 years. Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Surgery patients underwent gastric bypass (13.2 percent), banding (18.7 percent), or vertical banded gastroplasty (68.1 percent), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals. The average changes in body weight after 2, 10, 15, and 20 years were -23 percent, -17 percent, -16 percent, and -18 percent in the surgery group and 0 percent, 1 percent, -1 percent, and -1 percent in the control group, respectively.

During follow-up, there were 49 cardiovascular deaths among the patients in the control group and 28 cardiovascular deaths among the patients in the surgery group. In total (fatal and nonfatal), there were 234 cardiovascular events among patients in the control group and 199 cardiovascular events among patients in the surgery group. After adjustment for a number of variables, bariatric surgery was associated with a reduced number of fatal cardiovascular deaths and a lower incidence of total cardiovascular events.

Bariatric surgery was associated with reduced number of fatal heart attack deaths (22 in the surgery group vs. 37 in the control group), with analysis indicating that bariatric surgery was related both to reduced fatal heart attack incidence and total heart attack incidence. Also, bariatric surgery was associated both with reduced number of fatal stroke events and total stroke events.

However, the researchers found no significant relationship between weight change and cardiovascular events in the surgery or control group. The authors suggest that the lack of association between weight loss and reduction of cardiovascular events could be related to inadequate statistical power to detect this relationship. “Alternatively, following relatively modest weight loss induced by bariatric surgery, there is no further risk reduction attributable to greater, subsequent weight loss. Our negative findings also emphasize the need to explore weight loss independent of effects of bariatric surgery.”

“In conclusion, this is the first prospective, controlled intervention to our knowledge reporting that bariatric surgery is associated with reduced incidence of cardiovascular deaths and cardiovascular events. These results — together with our previously reported associations between bariatric surgery and favorable outcomes regarding long-term changes of body weight, cardiovascular risk factors, quality of life, diabetes, cancer, and mortality — demonstrate that there are many benefits to bariatric surgery and that some of these benefits are independent of the degree of the surgically induced weight loss.”

Material adapted from American Medical Association (AMA).

Reference
JAMA. 2012;307[1]:56-65.

Researchers reviewed evidence about the relationship between physical activity and academic performance because of concerns that pressure to improve test scores may often mean more instructional time for classroom subjects with less time for physical activity.

The authors identified 10 observational and four interventional studies for review. Twelve of the studies were conducted in the United States, plus one in Canada and one in South Africa. Sample sizes ranged from 53 to about 12,000 participants between the ages of 6 years and 18 years. Follow-up varied from eight weeks to more than five years.

“According to the best-evidence synthesis, we found strong evidence of a significant positive relationship between physical activity and academic performance. The findings of one high-quality intervention study and one high-quality observational study suggest that being more physically active is positively related to improved academic performance in children,” the authors comment.

Background information in the article suggests that exercise may help cognition by increasing blood and oxygen flow to the brain, increasing levels of norepinephrine and endorphins to decrease stress and improve mood, and increasing growth factors that help create new nerve cells and support synaptic plasticity.

Still, “relatively few studies of high methodological quality have explored the relationship between physical activity and academic performance,” the authors conclude. No study in their systematic review used an objective measure of physical activity.

“More high-quality studies are needed on the dose-response relationship between physical activity and academic performance and on the explanatory mechanisms, using reliable and valid measurement instruments to assess this relationship accurately,” the authors conclude.

Material adapted from JAMA.

Reference
Arch Pediatr Adolesc Med. 2012;166[1]:49:55.

The number of people affected by dementia worldwide is estimated to double over the next 20 years from the current number of about 36 million people, the authors provide as background information in the article. AD is the most common form of dementia. The authors write that data suggest an association between insulin resistance and inflammation, hallmarks for type 2 diabetes, and development of dementia. “An additional potential factor that may contribute to the onset of AD and all-cause dementia is adiponectin. Adiponectin is a hormone derived from visceral fat, which sensitizes the body to insulin, has anti-inflammatory properties, and plays a role in the metabolism of glucose and lipids.”

Researchers measured levels of glucose, insulin, and glycated albumin, as well as C reactive protein, lipoprotein associated phospholipase A2, and adiponectin in the plasma of patients at the 19th biennial examination (1985 – 1988) of the Framingham Heart Study.

The 840 patients (541 women, median age of 76 years) were followed-up for an average of 13 years and evaluated for signs of the development of AD and all-cause dementia. During that time, 159 patients developed dementia, including 125 cases of AD. After adjustment for other dementia risk factors (age, apoE genotype, low plasma docosahexaenoic acid, weight change) only adiponectin in women was associated with an increased risk of all-cause dementia and AD.

“It is well established that insulin signaling is dysfunctional in the brains of patients with AD, and since adiponectin enhances insulin sensitivity, one would also expect beneficial actions protecting against cognitive decline,” the authors write. “Our data, however, indicate that elevated adiponectin level was associated with an increased risk of dementia and AD in women.”

“One of the main features of adiponectin is that it has been shown to play a role in the sensitization of insulin and therefore may become a therapeutic target for the treatment of T2D (type 2 diabetes). Surprisingly, a higher adiponectin level was found to be a predictor of all-cause and vascular mortality. In concurrence with the mortality findings, the current investigation shows that an elevated adiponectin level is also an independent predictor for all-cause dementia and AD in women,” the authors conclude.

Material adapted from JAMA.

Reference
Arch Neurol. Published online January 2, 2012. doi:10.1001/archneurol.2011.670.

MTF is an annual survey of eighth, 10th, and 12th-graders conducted by researchers at the University of Michigan, Ann Arbor, under a grant from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The survey was conducted in classrooms earlier this year.

“That cigarette use has declined to historically low rates is welcome news, given our concerns that declines may have slowed or stalled in recent years,” said NIDA director Dr. Nora D. Volkow. “That said, the teen smoking rate is declining much more slowly than in years past, and we are seeing teens consume other tobacco products at high levels. This highlights the urgency of maintaining strong prevention efforts against teen smoking and of targeting other tobacco products.”

The 2011 results showed that 18.7 percent of 12th-graders reported current (past-month) cigarette use, compared to a recent peak rate of 36.5 percent in 1997 and 21.6 percent five years ago. Only 6.1 percent of eighth-graders reported current smoking, compared to a recent peak of 21 percent in 1996 and 8.7 percent five years ago.

“While it is good news that cigarette use has declined to historically low rates, we can and must do more to accelerate that decline,” said Howard K. Koh, MD, MPH, assistant secretary for health. “The actual decline is relatively small compared to the sharp declines we witnessed in the late nineties.”

For alcohol, 63.5 percent of 12th-graders reported past year use, compared to a recent peak of 74.8 percent in 1997. Similarly, 26.9 percent of eighth-graders reported past year use of alcohol in 2011, compared to a recent peak rate of 46.8 percent in 1994. There also was a five-year decrease in binge drinking, measured as five or more drinks in a row in the past two weeks, across all three grades. Binge drinking was reported by 6.4 percent of eighth-graders, 14.7 percent of 10th-graders, and 21.6 percent of 12th-graders, down from the 2006 rates of 8.7 percent, 19.9 percent and 25.4 percent respectively.

Despite the declines noted in the report, use of marijuana has shown some increases in recent years and remains steady. Among 12th-graders, 36.4 percent reported past year use, and 6.6 percent reported daily use, up from 31.5 and 5 percent, respectively, five years ago. The upward trend in teens’ abuse of marijuana corresponded to downward trends in their perception of risk. For example, only 22.7 percent of high school seniors saw great risk in smoking marijuana occasionally, compared to 25.9 percent five years ago. Similarly, 43.4 percent of eighth-graders reported that they saw great risk in smoking marijuana occasionally, compared to 48.9 percent five years ago. In addition, concerns about the use of synthetic marijuana, known as K2 or spice, prompted its inclusion in the survey for the first time in 2011. Surprisingly, 11.4 percent of 12th-graders reported past year use.

“K2 and spice are dangerous drugs that can cause serious harm,” said Gil Kerlikowske, director of National Drug Control Policy. “We will continue to work with the public health and safety community to respond to this emerging threat but in the meantime, parents must take action. Parents are the most powerful force in the lives of young people and we ask that all of them talk to their teens today about the serious consequences of using marijuana, K2, or spice.”

There was mixed news seen in the non-medical use of prescription drugs. Abuse of the opioid painkiller Vicodin was reported by 8.1 percent of 12th graders — similar to 2010 and down from 9.7 percent in 2009. There was also a decline reported by 10th graders — to 5.9 percent from 7.7 percent in 2010. However, no such declines were seen for the opioid painkiller OxyContin.

In 2011, the non-medical use of the ADHD medicines Adderall and Ritalin remained about the same as last year among 12th-graders, at 6.5 and 2.6 percent, respectively. There was, however, a significant decline in the abuse of over-the-counter cough medicine among eighth-graders, down to 2.7 percent in 2011 from 4.2 percent in 2006, when the survey first asked about its abuse. A similar decline in cough medicine abuse was seen among 12th-graders, to 5.3 percent from 6.9 percent five years ago.

“To help educate teens about the dangers of prescription drug abuse, NIDA is launching an updated prescription drug section on our teen website,” said Dr. Volkow. “Teens can go to our PEERx pages to find interactive videos and other tools that help them make healthy decisions and understand the risks of abusing prescription drugs. We are also encouraging teens to provide feedback on these resources through NIDA’s teen blog, Sara Bellum, Twitter, Facebook, YouTube, or email.” PEERx can be seen at http://teens.drugabuse.gov/peerx.

Overall, 46,773 students from 400 public and private schools participated in this year’s MTF survey. Since 1975, the survey has measured drug, alcohol, and cigarette use and related attitudes in 12th-graders nationwide. Eighth and 10th graders were added to the survey in 1991. Survey participants generally report their drug use behaviors across three time periods: lifetime, past year, and past month. Questions are also asked about daily cigarette and marijuana use. NIDA has providing funding for the survey since its inception by a team of investigators at the University of Michigan, led by Dr. Lloyd Johnston.

Material adapted from NIH/National Institute on Drug Abuse.

Those with diets high in omega 3 fatty acids and in vitamins C, D, E and the B vitamins also had higher scores on mental thinking tests than people with diets low in those nutrients. These omega 3 fatty acids and vitamin D are primarily found in fish. The B vitamins and antioxidants C and E are primarily found in fruits and vegetables.

In another finding, the study showed that people with diets high in trans fats were more likely to have brain shrinkage and lower scores on the thinking and memory tests than people with diets low in trans fats. Trans fats are primarily found in packaged, fast, fried and frozen food, baked goods and margarine spreads.

The study involved 104 people with an average age of 87 and very few risk factors for memory and thinking problems. Blood tests were used to determine the levels of various nutrients present in the blood of each participant. All of the participants also took tests of their memory and thinking skills. A total of 42 of the participants had MRI scans to measure their brain volume.

Overall, the participants had good nutritional status, but seven percent were deficient in vitamin B12 and 25 percent were deficient in vitamin D.

Bowman said that the nutrient biomarkers in the blood accounted for a significant amount of the variation in both brain volume and thinking and memory scores. For the thinking and memory scores, the nutrient biomarkers accounted for 17 percent of the variation in the scores. Other factors such as age, number of years of education, and high blood pressure accounted for 46 percent of the variation. For brain volume, the nutrient biomarkers accounted for 37 percent of the variation.

“These results need to be confirmed, but obviously it is very exciting to think that people could potentially stop their brains from shrinking and keep them sharp by adjusting their diet,” Bowman said.

The study was the first to use nutrient biomarkers in the blood to analyze the effect of diet on memory and thinking skills and brain volume. Previous studies have looked at only one or a few nutrients at a time or have used questionnaires to assess people’s diet. But questionnaires rely on people’s memory of their diet, and they also do not account for how much of the nutrients are absorbed by the body, which can be an issue in the elderly.

The study was supported by the National Institutes of Health, the National Institute on Aging and National Center for Complementary and Alternative Medicine and the U.S. Department of Veteran Affairs, Portland VA Medical Center.

Material adapted from American Academy of Neurology (AAN).

Researcher Sarah Anderson, PhD

Among those toddlers who had the lowest-quality emotional relationships with their mothers, more than a quarter were obese as teens, compared to 13 percent of adolescents who had closer bonds with their mothers in their younger years.

The findings mirror previous research by these scientists that showed toddlers who did not have a secure emotional relationship with their parents were at increased risk for obesity by age 4.5. This body of work suggests the areas of the brain that control emotions and stress responses, as well as appetite and energy balance, could be working together to influence the likelihood that a child will be obese.

Rather than blaming parents for childhood obesity, the researchers say these findings suggest that obesity prevention efforts should consider strategies to improve the mother-child bond and not focus exclusively on eating and exercise.

“It is possible that childhood obesity could be influenced by interventions that try to improve the emotional bonds between mothers and children rather than focusing only on children’s food intake and activity,” said Sarah Anderson, assistant professor of epidemiology at Ohio State University and lead author of the study.

“The sensitivity a mother displays in interacting with her child may be influenced by factors she can’t necessarily control. Societally, we need to think about how we can support better-quality maternal-child relationships because that could have an impact on child health,” she said.

The study appears online and is scheduled for publication in the January 2012 issue of the journal Pediatrics.

The researchers analyzed data from 977 participants in the Study of Early Child Care and Youth Development, a project of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The sample in this national study included diverse families living in nine U.S. states whose children were born in 1991.

As part of that national study, trained observers assessed child attachment security and maternal sensitivity by documenting interactions between mothers and their children at three time points: when the children were 15, 24 and 36 months old.

In the maternal sensitivity assessment, mothers were instructed to play with their child while investigators rated several aspects of each mother’s behavior, including supportiveness and respect for autonomy as well as signs of intrusiveness or hostility. Investigators rated attachment security of the children at age 15 and 36 months by monitoring a child’s separation from and reunion with the mother. At 24 months, researchers assessed children’s attachment security by observing mothers and children in their home.

Maternal sensitivity refers to a mother’s ability to recognize her child’s emotional state and respond with comfort, consistency and warmth. Psychologists describe securely attached children as those who rely on their parents as a “safe haven,” which allows them to explore their environments freely, adapt easily to new people and be comforted in stressful situations. Toddlers who are insecurely attached tend to have experienced negative or unpredictable parenting, and may respond to stress with extreme anger, fear or anxiety, or avoid or refuse interactions with others.

Using these assessments of maternal sensitivity and child attachment security, Anderson and colleagues developed a maternal-child relationship quality score for their own statistical analysis. With a range of zero to six, the score served as an aggregate measure of a child’s early relationship experience: Each point reflected a child’s display of insecure attachment or a mother’s ranking in the lowest quartile of sensitivity at one of the three assessment time points. The researchers designated a score equal to or greater than three as indicating a poor-quality emotional relationship.

The researchers calculated the body mass index (BMI) of the children using their heights and weights measured at or near age 15 years. BMIs were converted into percentiles for age and sex based on growth charts developed by the Centers for Disease Control and Prevention. In accordance with current guidelines, children were considered obese if their BMI scores were at or above the 95th percentile on those charts.

A total of 241 children, or 24.7 percent, were classified as having a poor quality maternal-child relationship during early childhood based on a score of three or higher. The prevalence of obesity in adolescence was 26.1 percent among these children with the poorest early maternal-child relationships. The teen obesity prevalence was lower for children with better maternal relationships: 15.5 percent, 12.1 percent and 13 percent among those who had scores of two, one and zero, respectively.

Accounting for children’s gender and birth weight – two of several sociodemographic factors that also can influence the quality of the maternal-child relationship and risk for obesity – children with the poorest quality early maternal-child relationship were almost 2.5 times as likely to be obese as adolescents than were children who had the best relationships with their mothers.

Anderson and colleagues suggest that this association between early childhood experiences and teen obesity has origins in the brain. The limbic system in the brain controls responses to stress as well as the sleep/wake cycle, hunger and thirst, and a variety of metabolic processes, mostly through the regulation of hormones.

“Sensitive parenting increases the likelihood that a child will have a secure pattern of attachment and develop a healthy response to stress,” Anderson said. “A well-regulated stress response could in turn influence how well children sleep and whether they eat in response to emotional distress – just two factors that affect the likelihood for obesity.”

Obesity may be one manifestation of dysregulation in the functioning of the stress response system. Parents help children develop a healthy response to stress by protecting children from extreme levels of stress, responding supportively and consistently to normal levels of stress, and modeling behavioral responses to stress.

“The evidence here is supportive of the association between a poor-quality maternal-child relationship and an increased chance for adolescent obesity,” Anderson said. “Interventions are effective in increasing maternal sensitivity and enhancing young children’s ability to regulate their emotions, but the effect of these interventions on children’s obesity risk is not known, and we think it would be worth investigating.”

Material adapted from Ohio State University.

Researcher Martin Gibala

It found that a total of 30 minutes of high-intensity intermittent exercise per week, involving a total time commitment of 75 minutes, lowered 24-hour blood sugar concentrations, reduced blood sugar spikes after meals, and increased skeletal muscle mitochondrial capacity, a marker of metabolic health.

“These findings are intriguing because they suggest that exercising very strenuously for short periods of time, may provide many of the same health benefits as traditional exercise training,” says Martin Gibala, professor in the Department of Kinesiology at McMaster and supervising author of the study. “This is the first study to show that intense interval training may be a potent, time-efficient strategy to improve glycemic regulation in people with type 2 diabetes.”

Current guidelines from the Canadian Diabetes Association call for 150 minutes of moderate to vigorous exercise per week—twice the training time commitment of study participants—which can be tough to manage for many people including those with diabetes, adds Gibala.

He is quick to point out that larger studies are needed to comprehensively examine the potential benefits of this type of training, especially compared to traditional exercise guidelines.

For the study, researchers gave each volunteer a baseline exam to test blood sugar over a 24-hour period, assess fitness levels and take biopsies of thigh muscle to measure proteins linked to health status. Each workout involved riding a stationary bike for 10 bouts of 60 seconds at roughly 90 percent of maximal heart rate, with one minute between each burst of exercise. The routine also included a warm up and cool down such that each training session lasted 25 minutes in total.

Participants showed improved blood sugar levels even though they did not lose weight during the short two-week study.

“The improved glycemic control may be linked to changes in the subjects’ muscles, such as an improved ability to clear glucose from the blood after meals”, says Gibala. “We need to conduct further research to identify the mechanisms behind these results.”

The research was funded by the Natural Sciences and Engineering Council of Canada and the Canadian Diabetes Association.

Material adapted from McMaster University.

Patient activation is defined by patient behaviors, such as being knowledgeable about one’s health and health care and having the skills and confidence to engage in self-management of chronic conditions, according to the study.

Researchers asked 8,140 people in the U.S. with chronic illnesses about their experiences with their physicians, as well as about their socioeconomic status, overall health and how they make use of health services.

The researchers looked at four factors: the quality of the patient-physician relationship, including how well patients felt their doctors communicated with them; how much respect and fairness patients felt they received; the involvement of the patient in setting treatment goals; and the frequency of any patient-physician communications outside of the office setting, such as email or phone calls. Each of these factors was associated with greater patient engagement, with the exception of involvement in the setting of treatment goals.

The quality of the physician-patient relationship had the greatest effect on patient engagement: a one unit increase in the measurement of the quality of interpersonal exchanges led to an almost 10 unit increase in the level of activation by the patient. Patients with higher scores were more likely to monitor their blood pressure, exercise five days a week and adhere to medication regimens, among other healthy behaviors.

Physicians set the tone for making the patient aware that they have some control over their health, said lead study author Jeffrey A. Alexander, Ph.D., Richard C. Jelinek Professor of Health Management and Policy at the University of Michigan at Ann Arbor. “The patient takes a cue from what the doctor does. If the doctor conveys an all-knowing ‘I make the decisions’ attitude, the patient will revert to a passive role,” he said.

Getting patients to be more active in their own care is important and this can be decreased by a power differential in the relationship between physician and patient, said Judith Schaefer, MPH, senior research associate at the MacColl Center for Health Care Innovation in Seattle. “Patients who are less activated do not understand the importance of the role they play and do not understand that they can have an effect on how their condition influences their lives,” she said.

The study’s finding that the joint setting of treatment goals did not influence patient engagement was not surprising, Schaefer said. “This is an activity that requires more collaboration with the patient.” Setting goals is not just about changing lab values, but requires understanding what is important to the patient and what will work in his or her life, she explained.

The authors noted that the study does not indicate whether a change in physician behavior causes greater patient engagement or whether more engaged patients have a tendency to select physicians who are more collaborative. Still, they emphasized that the study provides initial evidence that patient-physician relationships are an important factor in encouraging people to take a more active role in their health care.

Material adapted from Health Behavior News Service, part of the Center for Advancing Health.

The study, out in the December issue of the journal Mental Health and Physical Activity, lends more evidence to mounting research showing the importance of exercise to a number of health factors. Among adults in the United States, about 35 to 40 percent of the population has problems with falling asleep or with daytime sleepiness.

“We were using the physical activity guidelines set forth for cardiovascular health, but it appears that those guidelines might have a spillover effect to other areas of health,” said Brad Cardinal, a professor of exercise science at Oregon State University and one of the study’s authors.

“Increasingly, the scientific evidence is encouraging as regular physical activity may serve as a non-pharmaceutical alternative to improve sleep.”

After controlling for age, BMI (Body Mass Index), health status, smoking status, and depression, the relative risk of often feeling overly sleepy during the day compared to never feeling overly sleepy during the day decreased by 65 percent for participants meeting physical activity guidelines.

Similar results were also found for having leg cramps while sleeping (68 percent less likely) and having difficulty concentrating when tired (45 percent decrease).

Paul Loprinzi, an assistant professor at Bellarmine University is lead author of the study, which was conducted while he was a doctoral student in Cardinal’s lab at OSU. He said it is the first study to examine the relationship between accelerometer-measured physical activity and sleep while utilizing a nationally representative sample of adults of all ages.

‘Our findings demonstrate a link between regular physical activity and perceptions of sleepiness during the day, which suggests that participation in physical activity on a regular basis may positively influence an individual’s productivity at work, or in the case of a student, influence their ability to pay attention in class,” he said.

Cardinal said past studies linking physical activity and sleep used only self-reports of exercise. The danger with this is that many people tend to overestimate the amount of activity they do, he said.

He added that the take-away for consumers is to remember that exercise has a number of health benefits, and that can include helping feel alert and awake.

“Physical activity may not just be good for the waistline and heart, but it also can help you sleep,” Cardinal said. “There are trade-offs. It may be easier when you are tired to skip the workout and go to sleep, but it may be beneficial for your long-term health to make the hard decision and get your exercise.”

Material adapted from Oregon State University.

The research team also said the findings may be applicable to patients with other types of disease or injury who spend time in hospital intensive care units hooked up to ventilators that breathe for them.

“When people are discharged from the ICU, we tend, understandably, to focus on their physical health, but our data tell us we need to focus on their mental health, too,” says study leader O. Joseph Bienvenu, M.D., Ph.D., an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “Depression can make recovery much more difficult. Identifying depressive symptoms early — and treating them — could make a real difference in how patients fare physically in the long term.”

Bienvenu and his colleagues assessed 186 survivors of acute lung injury from four Baltimore hospitals at three, six, 12 and 24 months after they became ill, and surveyed their levels of depression as well as their ability to independently perform important tasks of daily life, such as using the telephone, shopping and preparing food.

The Hopkins team found that 40 percent of the patients developed depressive symptoms in the first two years after discharge even though they had not previously experienced them, and that 66 percent experienced new physical impairments. The average age of patients in the study was 49 years — people who should be in the prime of their lives but became disabled and unable to return to work, the researchers say. The researchers are continuing to follow these patients to see if the problems persist for an even longer period of time.

“Patients are burdened for a very long time after their hospital stays,” says principal investigator Dale M. Needham, M.D., Ph.D., an associate professor of pulmonary and critical care medicine and physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. “We need to figure out what we can do to help these previously productive people get back their lives.”

Needham says it is unclear whether it is the acute lung injury syndrome itself causing the new problems or whether the cause is to be found in how patients are routinely cared for in ICUs. Standard ICU care for patients with acute lung injury often includes deep sedation and bed rest. Long stretches of inactivity are known to cause physical impairment, and the use of high-dose benzodiazepines to sedate ICU patients has been associated with depressive symptoms. Needham suspects that both critical illnesses themselves and typical ICU practices contribute to negative outcomes.

Patients’ lungs typically recover relatively quickly from acute lung injury, a syndrome often caused by pneumonia, but also by other infections or trauma. In acute lung injury, the body’s inflammatory response is revved up and gets out of control, causing fluid to flood into the breathing spaces of the lungs and respiratory failure. An estimated 190,000 Americans suffer from acute lung injury each year and more than 74,000, almost 40 percent, will die while in hospital.

Needham says it is important that intensivists like himself, and psychiatrists like Bienvenu work together to ensure the best outcomes for patients, a collaboration that is frequently missing in the care of ICU patients.

Bienvenu says he was surprised by the finding that depressive symptoms frequently precede new physical impairments, since the conventional wisdom is that the inability after an ICU stay to do things like grocery shopping, driving and walking long distances causes patients to feel demoralized about the loss of these functions. But the reverse appears to be true, he says. Depressed patients, he suggests, are harder to motivate to do the physical activities necessary for recovery and maintenance of function.

Bienvenu says acute lung injury is considered an archetypal critical illness and that its consequences may be present to one degree or another in patients who have suffered other critical illnesses. “All doctors should look out for these symptoms in their patients who have been in the ICU,” he says.

The research was funded by the National Institutes of Health.

Other Hopkins researchers involved in the study include Elizabeth Colantuoni, Ph.D.; Pedro A. Mendez-Tellez, M.D.; Victor D. Dinglas, B.S.; Nadia Husain, M.S.; Cheryl R. Dennison, R.N., Ph.D.; and Peter J. Pronovost, M.D., Ph.D.

Material adapted from Johns Hopkins Medicine.

“Weight loss and reduced insulin levels are required for breast cancer prevention, but [these levels] are difficult to achieve and maintain with conventional dietary approaches,” said Michelle Harvie, Ph.D., SRD, a research dietician at the Genesis Prevention Center, who presented the findings at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

Harvie and her colleagues compared three diets during four months for effects on weight loss and blood markers of breast cancer risk among 115 women with a family history of breast cancer. They randomly assigned patients to one of the following diets: a calorie-restricted, low-carbohydrate diet for two days per week; an “ad lib” low-carbohydrate diet in which patients were permitted to eat unlimited protein and healthy fats, such as lean meats, olives and nuts, also for two days per week; and a standard, calorie-restricted daily Mediterranean diet for seven days per week.

Data revealed that both intermittent and low-carbohydrate diets were superior to the standard, daily Mediterranean diet in reducing weight, body fat and insulin resistance. Mean reduction in weight and body fat was roughly 4 kilograms (about 9 pounds) with the intermittent approaches compared with 2.4 kilograms (about 5 pounds) with the standard dietary approach. Insulin resistance reduced by 22 percent with the restricted low-carbohydrate diet and by 14 percent with the “ad lib” low-carbohydrate diet compared with 4 percent with the standard Mediterranean diet.

“It is interesting that the diet that only restricts carbohydrates but allows protein and fats is as effective as the calorie-restricted, low-carbohydrate diet,” Harvie said.

She and her colleagues plan to further study carbohydrate intake and breast cancer.

Material adapted from American Association for Cancer Research (AACR).

“The findings add to the body of evidence indicating that obesity, in general, increases a patient’s chance for having a worse prognosis,” said lead researcher Sao Jiralerspong, M.D., Ph.D., an assistant professor of medicine at Baylor College of Medicine.

“Obesity is a probable risk factor for worse breast cancer outcomes, and ours is the latest study to suggest it has an effect on treatment outcome as well,” Jiralerspong said.

Using data from the Lester and Sue Smith Breast Center at Baylor, Jiralerspong and colleagues examined the link between weight and treatment modality in 4,368 patients treated between 1970 and 1995. For the group as a whole, data revealed that overweight patients had similar outcomes to normal-weight patients, but obese patients had an increased risk for worse TTR, DFS and OS.

Among patients who received no adjuvant chemotherapy or endocrine therapy, there was a trend for worse survival outcomes in obese patients compared with normal-weight patients.

Obese patients who received chemotherapy fared significantly worse compared with normal-weight patients, “with the magnitude of this effect approaching that of the degree of benefit expected from chemotherapy,” Jiralerspong said.

In contrast, overweight patients who received endocrine therapy, predominantly tamoxifen, fared significantly better compared with normal-weight patients.

“Finding that overweight patients have a better outcome than normal-weight patients after tamoxifen treatment is surprising. We are examining the possible reasons for this,” Jiralerspong said.

He said that obesity could contribute to worse outcomes because of biological factors associated with excess weight, such as higher blood insulin and estrogen levels, inflammation and growth factors secreted by fat cells. But Jiralerspong also added that more research is needed to understand the effect of body mass on adjuvant treatment because of the unexpected findings and because additional agents are in use today compared with the time period studied.

The study was funded by the Lester and Sue Smith Breast Center at Baylor College of Medicine.

Material adapted from American Association for Cancer Research (AACR).

The study results were reported at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

Researchers evaluated health care data from a region of 1.5 million people living in Southwestern Sweden to provide a comprehensive picture of cancer risk.

“We are looking at everybody, and we found that diabetes in adult women and obesity in women aged 60 and older significantly increased breast cancer risk,” said Håkan Olsson, M.D., professor in the departments of oncology and cancer epidemiology at Lund University. “This is useful information for women who want to know their risk and who can take steps to lower it.”

He and his colleagues examined records of 2,724 patients up to 10 years before they developed cancer and 20,542 patients who never developed the disease. They found that obesity in women after age 60 increased risk for developing breast cancer by 55 percent. “At the most, 15 out of 100 obese women would get breast cancer compared with slightly less than 10 out of 100 in the general population,” Olsson said.

Women with diabetes had a 37 percent increased risk for developing breast cancer if their diabetes had been diagnosed up to four years before cancer was diagnosed.

Women with abnormally low levels of blood lipids (mostly cholesterol) had a 25 percent greater risk for developing breast cancer, while high levels of blood lipids appeared to be associated with a lower risk for breast cancer. The mechanisms behind these effects are unclear, and the finding needs to be replicated in a different population-based study, Olsson said.

Researchers also looked at the national drug prescription registry to examine the link between risk for all cancers and use of two diabetes drugs, glargine and metformin. In this study, investigators found that glargine use, which had been associated with increased cancer development in previous European studies, almost doubled the risk for development of any cancer, while metformin was linked to an 8 percent lower risk for cancer in patients with diabetes.

Olsson said more research is needed to clarify the specific cancers at increased risk. The number of patients in this study who developed breast cancer using these medications was too small to make any link to breast cancer risk, specifically, he said.

The study was funded by Sweden’s Southern Health Care Region.

Material adapted from American Association for Cancer Research (AACR).

Olshansky became interested in the subject when, in the summer of 2011, President Obama celebrated his 50th birthday and a flurry of news reports focused on his graying hair, pronounced wrinkles, and rapidly aging appearance.

“In the world of biology we know that you can’t actually measure the aging of an individual,” says Olshansky, professor of epidemiology at the UIC School of Public Health. “There isn’t any single test to actually measure how long you’ve aged from point A to point B, nor is it possible to predict specifically how long an individual will live.”

Using the assumption that presidents age at twice the normal rate, Olshansky calculated how long U.S. presidents would have been expected to live based on their age and the year they were inaugurated – and compared it to how long they actually lived. Aging at twice the normal rate was estimated by removing two days of life for every day in office (for example, a 4-year term led to a reduction in estimated remaining lifespan of 8 years).

Olshansky found that 23 of the 34 U.S. presidents who died from natural causes lived longer, and in many instances significantly longer, than predicted. Their average age at inauguration was 55.1 years. Four presidents who were assassinated were removed from the analysis.

Conventional wisdom suggests that the longevity of U.S. presidents is shortened due to the stresses of the office, but the average lifespan of the first eight presidents was 79.8 years – during a time when life expectancy at birth for men was less than 40.

“This is about how long females born in the U.S. today live,” Olshansky said.

The study also found that living ex-presidents have either already exceeded their predicted longevity at the time of their inauguration, or are likely to do so.

“We know that socioeconomic status has an extremely powerful effect on longevity now,” Olshansky said, “and it was likely to have been a factor in the past.” All but 10 U.S. presidents were college educated; all were wealthy; and all had access to health care. “We don’t die from gray hair and wrinkled skin,” said Olshansky. “What we’re seeing in President Obama is really not inconsistent with what we see for any other man his age in the U.S. or elsewhere.”

Material adapted from University of Illinois at Chicago.

Dr. Eliana Perrin

The study was published online ahead of print on Dec. 5, 2011, by the journal Archives of Pediatrics & Adolescent Medicine.

“Parents might be more motivated to follow healthy eating and activity advice if they knew their children were overweight, but very few parents of overweight children say they have ever heard that from their doctor,” Perrin said.

“As health care providers, it’s our job to screen for overweight and obesity and communicate those screening results in sensitive ways, and we are clearly either not doing it or not doing it in a way that families can hear or remember. While we’ve done better in recent years, clearly there’s more work to be done.”

Perrin and UNC-Chapel Hill study co-authors Asheley Cockrell Skinner, PhD, and Michael J. Steiner, MD, performed a secondary statistical analysis of data collected from 4,985 children ages 2 to 15 years old who had a body mass index (BMI) at or above the 85th percentile based on measured height and weight. These data were collected as part of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2008.

During that time, only 22 percent of parents reported that a doctor or other health professional told them their child was overweight. However, this percentage increased from 19.4 percent in 1999 to 23.4 percent and 2004, and then to 29.1 percent in 2007-2008. Even among parents of very obese children, only 58 percent recall a doctor telling them.

In future research, Perrin said, “We need to figure out two things: How much does communication of weight status influence parents’ behaviors? And, if hearing that their children are overweight is as big a wakeup call to changing lifestyle as we know from some other small studies, we need to figure out where this communication is breaking down so we can do better in the future. Our research group is working on both those issues.”

Material adapted from University of North Carolina at Chapel Hill School of Medicine.

“Children spend the majority of their waking hours in school, thus schools are important locations to focus obesity prevention activities, such as increasing physical activity opportunities,” the authors write as background information in the article. “The national recommendation for school physical education [PE] – endorsed by the National Association of Sports and Physical Education (NASPE) and the American Heart Association – is that elementary school students be offered at least 150 minutes/week of PE. However, fewer than 20 percent of third grade students in the United States were offered this amount during the 2007-2008 school year.”

Sandy J. Slater, Ph.D., and colleagues with the University of Illinois at Chicago, examined the association between state and local school district-level policies requiring or recommending minimum requirements for in-school physical activity and the odds that elementary schools within those states and districts meet the levels of physical activity recommended, with an emphasis on physical education and recess. The authors collected data on existing state PE and recess-related laws and collected data at the local school level through mail-back surveys that included questions on the number of days per week and number of minutes for which PE class was scheduled during a typical week for a third grade student. The study sample included 47 states, 690 districts and 1,761 schools, during the 2006-2007 through 2008-2009 school years.

The authors found that approximately 70 percent of schools included in the analysis offered at least 20 minutes of daily recess, and 17.9 percent offered 150 minutes/week of physical education. The majority of states (83 percent) offered no daily recess law and less than half offered some kind of law addressing the recommended 150 minutes/week of physical education. The authors found that the odds of schools meeting the NASPE recommendation for physical activity increased if they were located in states or school districts having a law requiring 150 minutes/week of physical education.

Schools in states with policies encouraging daily recess had higher odds of having 20 minutes of recess daily, however district policies were not significantly associated with school-level recess practices. The authors also found that adequate physical education time was inversely associated with recess, with schools offering at least 150 minutes/week of physical education being 50 percent less likely to meet recommendations on recess time. Additionally, schools with students of predominantly white race/ethnicity were more likely than all other racial/ethnic groups to have daily recess, and schools with the highest number of students receiving free or reduced-cost lunch were less likely to have 20 minutes of recess daily.

“Our results show that mandating only increased physical education or recess time does not result in more overall physical activity as schools and/or districts appear to compensate for any increased physical activity in one area by decreasing other physical activity opportunities,” the authors conclude. “By mandating physical education or recess, policy makers can effectively increase school-based physical activity opportunities for youth.”

Material adapted from JAMA.

Reference
Arch Pediatr Adolesc Med. Published online December 5, 2011. doi:10.1001/archpediatrics.2011.1133.

“During the 1980s and 1990s, the number of adults diagnosed with and treated for depression increased, and the modality of treatment shifted,” the authors write as background information in the article. “The percentage of adults with depression who received antidepressants increased, and the percentage who received psychotherapy or were hospitalized for depression decreased.”

Researchers examined data from Medicaid claims in Florida to evaluate changes in depression health service utilization, spending, and quality of care from July 1996 through June 2006. Using Medicaid claims data, the authors identified annual cohorts of adults with depression consisting of enrollees age 18 to 64 years having one or more hospitalizations with a principal diagnosis of depression or having at least two outpatient claims of depression on different days.

The number of enrollees identified annually varied from 8,970 to 13,265 with more persons identified toward the end of the study period. Total number of individuals with depression identified over the study period was 56,805. The authors found that during the study period, mental health care spending increased from a mean (average) $2,802 per enrollee to $3,610 per enrollee, reflecting a 29 percent increase. This increase appears to result from a large increase in pharmacotherapy spending (110 percent increase), majority of which was due to spending on antipsychotics (949 percent increase).

During the study period, the percentage of enrollees with depression who received psychotherapy decreased from 56.6 percent to 37.5 percent and the percentage of individuals who were hospitalized decreased from 9.1 percent to 5.1 percent. Conversely, the percentage of individuals who filled prescriptions within any mental health medication classes remained stable or increased, depending on the type of prescription filled.

Antidepressant use increased from 80.6 percent to 86.8 percent, anxiety medication use was unchanged at 62.7 percent and 64.4 percent, and antipsychotic use increased from 25.9 percent to 41.9 percent, during the study period. However, the authors also found that changes in quality of care were mixed, with antidepressant use improving slightly, psychotherapy utilization fluctuating, and follow-up visits decreasing.

“In summary, during the 10-year period between 1996 and 2005, we found a substantial increase in spending for patients with depression, with minimal improvements in quality of care,” the authors conclude. “Our findings underscore the importance of continued efforts to improve quality of care for individuals with depression, as well as the need to understand the efficacy and cost-effectiveness of using antipsychotics for the treatment of individuals with depression in the general community.”

Material adapted from JAMA.

Reference
Arch Gen Psychiatry. 2011;68[12]:1218-1226.

High rates of vitamin D deficiency have been found in obese populations and past studies have linked low vitamin D levels to cardiovascular disease and type 2 diabetes. The mechanisms by which obesity and its comorbidities are related to vitamin D deficiency are not fully known. This new study examined associations between vitamin D levels and dietary habits in obese children, and tested whether there were correlations between vitamin D levels and markers of abnormal glucose metabolism and blood pressure.

“Our study found that obese children with lower vitamin D levels had higher degrees of insulin resistance,” said Micah Olson, MD, of The University of Texas Southwestern Medical Center in Dallas and lead author of the study. “Although our study cannot prove causation, it does suggest that low vitamin D levels may play a role in the development of type 2 diabetes.”

In this study, researchers measured vitamin D levels, blood sugar levels, serum insulin, BMI and blood pressure in 411 obese subjects and 87 control non-overweight subjects. Study participants were also asked to provide dietary information including daily intake of soda, juice and milk, average daily fruit and vegetable intake, and whether or not they routinely skipped breakfast.

“Poor dietary habits such as skipping breakfast and increased soda and juice intake were associated with the lower vitamin D levels seen in obese children,” said Olson. “Future studies are needed to determine the clinical significance of lower vitamin D levels in obese children, the amount and duration of treatment necessary to replenish vitamin D levels in these children and whether treatment with vitamin D can improve primary clinical endpoints such as insulin resistance.”

Other researchers working on the study include Naim Maalouf, Jon Oden, Perrin White and Michele Hutchison of The University of Texas Southwestern Medical Center.

Material adapted from Material adapted from Endocrine Society.

Reference
The article, “Vitamin D Deficiency in Obese Children and Its Relationship to Glucose Homeostasis,” appears in the January 2012 issue of JCEM.

The sympathetic nervous system is widely distributed throughout the body and subconsciously regulates many physiological functions including the control of resting metabolic rate and the dissipation of calories after food intake. The present study examined the relationship between activity of the sympathetic nervous system and weight-loss outcome in a group of obese individuals on a low-calorie diet intervention program.

“We have demonstrated for the first time that resting muscle sympathetic nerve activity (MSNA) is a significant independent predictor of weight-loss outcome in a cohort of overweight or obese subjects,” said Nora Straznicky, PhD, of the Baker IDI Heart & Diabetes Institute in Melbourne, Australia and lead author of the study. “Our findings provide two opportunities. First, we may be able to identify those persons who would benefit most from lifestyle weight-loss interventions such as dieting. Secondly, the findings may also help in developing weight-loss treatments through stimulating this specific nervous activity.”

In this study, researchers examined 42 overweight or obese subjects who had participated in dietary-lifestyle intervention trials that cut their daily caloric intake by 30 percent for 12 weeks. MSNA was measured by microneurography, a process involving the insertion of metal microelectrodes into nerve fascicles (a bundle of nerve fibers). Researchers found that weight loss was independently predicted by baseline resting MSNA.

“We also found that successful weight losers demonstrated large increases in nerve activity following a carbohydrate test meal, whereas the responses were completely blunted in weight-loss resistant subjects,” said Straznicky. “Our findings suggest a significant contribution of subconscious nervous system activity to the success of dietary weight loss.”

Other researchers working on the study include Nina Eikelis, Paul Nestel, John Dixon, Tye Dawood, Mariee Grima, Carolina Sari, Markus Schlaich, Murray Esler, Alan Tilbrook, Gavin Lambert and Elisabeth Lambert of Baker IDI Heart & Diabetes Institute.

Material adapted from Endocrine Society.

Reference
The article, “Baseline sympathetic nervous system activity predicts dietary weight loss in obese metabolic syndrome subjects,” appears in the February 2012 issue of JCEM.

Now is the time for psychologists to make their voices heard and remind Congress that their patients and practices will soon face a 5% cut to psychotherapy payments in addition to a 27.4% Sustainable Growth Rate (SGR) cut to all services scheduled for 2012 if they fail to act. Congress has blocked the SGR cut 12 times since 2001 and the APA Practice Organization has successfully secured the psychotherapy restoration 3 times since 2008, but practitioners face a tougher climate this time around in light of the unprecedented focus on deficit reduction and the broadening divide between legislative leaders.

Your profession needs you to take action NOW to ensure your legislators are attentive to these critical priorities. 

Take Action Now!
Click here to urge your Senators and Representative to halt Medicare cuts to psychological services

If possible, please take action by Tuesday, December 6.

Grassroots feedback is also extremely important to our advocacy efforts, so we would very much appreciate it if you would e-mail (email is below) or fax (202-336-5797) us any substantive responses you receive from your Representative or Senators.

Suggested Message:

My patients and practice are only a few weeks away from major reimbursement cuts that will impact patient access and put my small business at risk.  As a psychologist and constituent, I urge you to extend the Medicare mental health add-on through 2012.

Congress has repeatedly found extension of the 5% psychotherapy payment restoration necessary to address the unintended impact of CMS’s last Five-Year Review on access to Medicare mental health services.  An extension is necessary until completion of the current Five-Year Review of psychotherapy codes, which has been delayed into 2012.

As Congress works toward end-of-year action on several pressing priorities, please make my patients and the mental health extender a priority, as well as halting the 27.4% Sustainable Growth Rate (SGR) cut.  Thank you for your time and consideration.

Additional Background:

CONGRESS SHOULD PROTECT MEDICARE MENTAL HEALTH PAYMENT

To ensure the viability of the Medicare outpatient mental health benefit, Congress should extend through 2012 the restoration of cuts to Part B mental health services made in 2007.

Mental Health Extender. Congress restored payments temporarily but they now need to be extended. Through the Medicare Improvements for Patients and Providers Act of 2008, Congress partially restored the cuts made by the Centers for Medicare & Medicaid Services (CMS) “Five-Year Review” through 2009. Subsequent laws then extended the restoration through December 2011. The valuation of psychotherapy codes in the 2011 Five-Year Review has been delayed into 2012.  Congress should pass new legislation to extend payments through 2012, until the Five-Year Review is completed.

Effect on Beneficiaries. Extending psychologist payments cut by the Five-Year Review is crucial to protecting access to Medicare mental health services.  Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, but many have indicated that they may have to reduce their caseloads or leave Medicare if they are faced with these reimbursement cuts. The cost of protecting mental health services is very low, increasing costs by only $30 million per year.

Cut By MEI Rebasing. A CMS technical advisory panel will be asked to examine the effect of a 4% cut to Medicare part B reimbursement for psychologists in January 2011 due to “rebasing” of the Medicare Economic Index (MEI).  In the 2011 fee schedule, CMS used more recent survey data that showed practice expense and malpractice became a larger share of the payment formula while provider’s time became smaller. This increased payments for some services, particularly of professionals who utilize expensive technology.  Due to budget neutrality requirements, CMS reduced other reimbursement work values, which hit services of psychologists and social workers the hardest because they are typically provided at lower cost and lower overhead.

These cuts are not related to the Sustainable Growth Rate.  Psychologists were saved from a second and even more devastating reduction when Congressional action halted the projected 25% SGR cut through December 31, 2011.  Ultimately Congress must replace the flawed SGR formula with one that responsibly and permanently addresses provider payments.

Psychologists will leave Medicare. In a 2008 survey, 11% of psychologists reported that they have dropped out of Medicare participation and a primary reason cited was low reimbursement rates.

Jeff Cook, J.D.
Director of Field & State Operations
American Psychological Association Practice Organization
750 First Street, NE Washington, DC 20002
(202) 336-5875 (Office)
(202) 336-5797 (Fax)
jco…@apa.org (click to verify and reveal email)

Republished with permission: APAPO

“Understanding the interaction between exercise and a healthy diet could improve preventative and therapeutic measures against obesity by strengthening current approaches and treatments,” explains Miguel Alonso Alonso, researcher at Harvard University (USA) who has published a bibliographical compilation on the subject, to SINC.

The data from epidemiological studies suggest that tendencies towards a healthy diet and the right amount of physical exercise often come hand in hand. Furthermore, an increase in physical activity is usually linked to a parallel improvement in diet quality.

Exercise also brings benefits such as an increase in sensitivity to physiological signs of fullness. This not only means that appetite can be controlled better but it also modifies hedonic responses to food stimuli. Therefore, benefits can be classified as those that occur in the short term (of metabolic predominance) and those that are seen in the long term (of behavioral predominance).

According to Alonso Alonso, “physical exercise seems to encourage a healthy diet. In fact, when exercise is added to a weight-loss diet, treatment of obesity is more successful and the diet is adhered to in the long run.”

The authors of the study state how important it is for social policy to encourage and facilitate sport and physical exercise amongst the population. This should be present in both schools and our urban environment or daily lives through the use of public transport or availability of pedestrianised areas and sports facilities.

Exercise modifies the brain
Eating and physical activity are behaviors and are therefore influenced by cognitive processes that are a result of activity in different areas of the brain. Previous studies have already assessed changes in the brain and cognitive functions in relation to exercise: regular physical exercise causes changes in the working and structure of the brain.

The experts point out that these changes seem to have a certain specificity. The Harvard researcher supports the notion that “regular exercise improves output in tests that measure the state of the brain’s executive functions and increases the amount of grey matter and prefrontal connections.”

Inhibitory control is one of the executive functions of the brain and is basically the ability to suppress inadequate and non-conforming answers to an aim (the opposite of this would be impulsiveness), which makes modification or self-regulations of a behavior possible.

With regard to losing weight and sustaining weight loss in the long run, various recent studies suggest that executive functions such as inhibitory control and optimal functioning of the brain’s prefrontal areas could be the key to success. This success is mainly the fruit of a behavioral change. Inhibitory control could also help to prevent weight gain in healthy people.

The researcher outlines that “in time, exercise produces a potentiating effect of executive functions including the ability for inhibitory control, which can help us to resist the many temptations that we are faced with everyday in a society where food, especially hypercaloric food, is more and more omnipresent.”

Spain – Alarming Rise In Obesity
There has been an alarming rise in cases of obesity in Spain in recent years, so much so that prevalence in various areas of the country is higher than in many parts of the USA, which is traditionally thought of as the paradigm of obesity in the western world.

Furthermore, along with other Mediterranean countries, Spain has one of the highest rates of childhood obesity in Europe. The experts are urging society to become aware of the problem and join forces to prevent and treat all types of obesity.

Material adapted from Plataforma SINC.

Reference
R. J. Joseph, M. Alonso-Alonso, D. S. Bond, A. Pascual-Leone y G. L. Blackburn. “The neurocognitive connection between physical activity and eating behavior”. Obesity Reviews 12, 800–812; octubre de 2011.

Further analysis showed that the relationship between these two factors was largely mediated by psychosocial factors such as self-esteem, parents’ educational level, and friendships.

Based on these results, the authors conclude that abnormal weight and substance abuse are not directly related in a cause-effect relationship, but instead are likely both due to common underlying social factors and dissatisfaction.

“Eating disorders have largely increased during the last decades, and obesity is a major public-health problem, especially since the phenomenon is spreading among children. Thus we believe that the results are important to better define targeted interventions”, says Dr. Sabrina Moinaro.

The data on which this paper is based are a part of the 2007 ESPADHItalia data funded by “Ministero della Solidarieta Sociale”.

Material adapted from Public Library of Science.

Download / Reference
Denoth F, Siciliano V, Iozzo P, Fortunato L, Molinaro S (2011). The Association between Overweight and Illegal Drug Consumption in Adolescents: Is There an Underlying Influence of the Sociocultural Environment? PLoS ONE 6(11): e27358. doi:10.1371/journal.pone.0027358

Taiwanese researchers conducted an experiment in which they gave placebos to 82 adults (45 women, 37 men, average age 31). Half of this group was led to believe that the placebo they were taking was a multivitamin. After one week, all participants took surveys regarding their inclinations towards various healthy vs. less healthy behaviors. The results were astounding. Those subjects thinking they were taking multivitamins registered a 44% higher tendency to engage in hedonistic activities (e.g., casual sex, sunbathing, partying, binge drinking), as well as a 61% increased preference for all-you-can-eat buffets over healthy meals. Compared to the placebo group, the “multivitamin” group not only reported exercising 14% less, they were 66% more likely to walk the shortest distance to their goal over a given time.

The authors conclude that people relying on a multivitamin pay a hidden price, believing they have greater invulnerability and so adopt lazy, riskier behaviors that may actually lead to the exact opposite health outcomes they desire. With regard to direct health impact, a “state-of-the-science” NIH panel found insufficient evidence to recommend multivitamin usage, while the National Cancer Institute actually found that men who take more than seven multivitamins a week are a third more likely to experience advanced prostate cancer.

The American Heart Association urges people to forgo antioxidant supplements in favor of fruit and vegetables to minimize cardiovascular disease risk. Antioxidant pills may even block certain metabolic benefits of exercise.

Material adapted from Dole Nutrition Institute.

“Coffee has already been shown to be protective against diabetes due to its effect on insulin,” said Giovannucci, a senior researcher on the study. “So we hypothesized that we’d see a reduction in some cancers as well.”

Giovannucci, along with Youjin Je, a doctoral candidate in his lab, and colleagues observed cumulative coffee intake in relation to endometrial cancer (i.e., cancer that starts in the uterus) in 67,470 women who enrolled in the Nurses’ Health Study. During the course of 26 years of follow-up, researchers documented 672 cases of endometrial cancer.

Drinking more than four cups of coffee per day was linked with a 25 percent reduced risk for endometrial cancer. Drinking between two and three cups per day was linked with a 7 percent reduced risk. A similar link was seen in decaffeinated coffee, where drinking more than two cups per day was linked with a 22 percent reduced risk for endometrial cancer.

Giovannucci said he hopes this study will lead to further inquiries about the effect of coffee on cancer because in this and similar studies, coffee intake is self-selected and not randomized.

“Coffee has long been linked with smoking, and if you drink coffee and smoke, the positive effects of coffee are going to be more than outweighed by the negative effects of smoking,” said Giovannucci. “However, laboratory testing has found that coffee has much more antioxidants than most vegetables and fruits.”

Material adapted from American Association for Cancer Research (AACR).

“The introduction of the right kind of fat into a healthy diet is another tool to reduce the risk of future heart disease,” says Meghana Gadgil, M.D., M.P.H., a postdoctoral fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine who will be presenting the research.

Gadgil and her colleagues analyzed data from the OmniHeart Trial, which studied the cardiovascular effects of three different balanced diets on 164 people with mild hypertension but no diabetes. The researchers compared the body’s ability to regulate blood sugar and maintain healthy insulin levels while on a carbohydrate-rich diet, a protein-rich diet, and a diet rich in unsaturated fats. People whose bodies fail to effectively use insulin usually develop type 2 diabetes, which is a major risk factor for heart disease.

The researchers found that a generally balanced diet higher in unsaturated fats such as those in avocados, olive oil, and nuts improves insulin use significantly more than a diet high in carbohydrates, particularly such refined carbs as white bread and pasta. The preferred diet is very similar to the Mediterranean diet, inspired by the foods of southern Italy and Greece and emphasizing healthy fats, fruits, and vegetables.

Each participant in the study was fed each of the three diets for six weeks in a row, with two to four weeks off in between. Blood samples were collected after fasting periods in weeks four and six of each diet, and used to monitor insulin and glucose levels. The study was designed to keep participants at their starting weights.

“A lot of studies have looked at how the body becomes better at using insulin when you lose weight,” Gadgil says. “We kept the weight stable so we could isolate the effects of the macronutrients. What we found is that you can begin to see a beneficial impact on heart health even before weight loss.”

Other Hopkins researchers involved in the study include Cheryl Anderson, Ph.D., M.P.H.; Lawrence J. Appel, M.D., M.P.H.; and Edgar R. Miller III, M.D., Ph.D.

Material adapted from Johns Hopkins Medicine.

There is much at stake for psychologists, including cuts resulting from the triple threat of the Sustainable Growth Rate, or SGR (previously estimated at 29.5% for 2012), expiration of the psychotherapy payment restoration (5% for 2012) and an additional 2% beginning in 2013 if the panel fails to reach a deal. APAPO has been hard at work on the legislative front, mobilizing more than 15,000 constituent messages through the Legislative Action Center, coordinating meetings of key contact psychologists with members of the Joint Committee in district and in DC and providing testimony to the House Ways and Means Committee.

While most eyes in Washington have been closely watching the Joint Committee, APAPO has also been awaiting the recent release of the Centers for Medicare and Medicaid Services (CMS) final rule on the 2012 Medicare Fee Schedule. The rule indicates several payment changes that are expected to impact reimbursement for psychological services.

Sustainable Growth Rate
CMS has recalculated the scheduled SGR cut’s estimated impact, reducing the projection to 27.4% (as opposed to 29.5%). Congress has blocked the SGR cut 12 times since 2001, and APAPO continues work with our allies among patients and providers to urge legislators to permanently replace the flawed formula and prevent the resulting reductions for 2012.

Practice Expense
In 2009 CMS announced changes beginning in 2010 to Medicare’s payments for the practice expense portion of numerous services including those commonly billed by psychologists. Members of more than fifty physician and non-physician organizations participated in a survey of the indirect costs associated with providing certain services, after which CMS began a four-year phase in of revised values. As a result, reimbursement for a few services commonly billed by psychologists have gone up, including psychological and neuropsychological testing by computer, while values for most other such services have gone down, including diagnostic interviews, psychotherapy and other forms of psychological and neuropsychological testing.

The rule projects a 3% overall reduction in reimbursement for psychological services in 2012, followed by a final 2% reduction when the phase-in completes in 2013. This reduction is not subject to change by Congress and would not be eliminated by any congressional action on the SGR or an extension of the psychotherapy payment restoration.

Psychoanalysis
After reviewing the psychoanalysis code (90845) in September, the American Medical Association (AMA)/Specialty Society Relative Value Update Committee (RUC) recommended that the code’s work value be increased from 1.79 to 2.10. This change in the work value represents on average about $10 more for a single psychoanalysis session.

CMS, however, declined to adopt this recommendation for 2012 and is maintaining the code’s current value while other codes in the psychotherapy family are under review by the AMA’s CPT Editorial Panel. The federal agency stated that it wants to consider the value for the psychoanalysis code relative to any revised psychotherapy codes once their work values also have been reviewed by the RUC. CMS anticipates reviewing the psychotherapy family of codes, including psychoanalysis, for any changes in work values for 2013.

Physician Quality Reporting System
Since 2007, Medicare has offered incentive payments to eligible professionals, including psychologists, who report data on designated outpatient service measures as part of a program known as the Physician Quality Reporting System. The 2012 final Medicare fee schedule rule contains several changes pertaining to the PQRS:

• CMS is eliminating the 6-month reporting period for individual measures reported through claims or a registry based on the rationale that data from a 12-month reporting period is more meaningful to patient experience and care. The 6-month reporting period will still be allowed for measures groups that are reported through a registry.
• A new measures group for dementia has been created that can only be reported through a registry due to the way in which the measures must be analyzed.
• The incentive payment for eligible professionals who successfully report on PQRS measures in 2012 will be 0.5% of all allowed Medicare charges.
• The measures most commonly reported by psychologists will continue to be part of the PQRS in 2012. These measures are:
• # 9 – Major Depressive Disorder: Antidepressant Medication During Acute Phase for Patients with MDD
• #106 – Major Depressive Disorder: Diagnostic Evaluation
• #107 – Major Depressive Disorder: Suicide Risk Assessment
• #128 – Preventive Care and Screening: Body Mass Index Screening and Follow-Up
• #130 – Documentation of Current Medications in the Medical Record
• #131 – Pain Assessment Prior to Initiation of Patient Therapy and Follow-Up
• #134 – Screening for Clinical Depression and Follow-Up Plan
• #173 – Preventive Care and Screening: Unhealthy Alcohol Use – Screening
• #181 – Elder Maltreatment Screen and Follow-Up Plan
• #226 – Measure pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention

As you know, Medicare reimbursement remains a top priority of the APA Practice Organization. As challenges and opportunities arise, APAPO will continue to press at both the legislative and regulatory levels for the professional interests of psychologists. We have much work left to ensure psychology has a fighting chance to avert the SGR cut, extend the psychotherapy payment restoration through 2012 and prevent other reductions in psychologist reimbursement. We will keep you posted as your grassroots assistance is needed. Thanks for your ongoing support.

Jeff Cook, J.D.
Director of Field & State Operations
American Psychological Association Practice Organization
750 First Street, NE Washington, DC 20002
(202) 336-5875 (Office)
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Roughly 40 percent of obese patients enrolled in each of the two weight-loss programs lost at least five percent of their body weight, an amount associated with real health benefits such as lower blood pressure, lower cholesterol, and better diabetes control, the researchers say.

“Until now, doctors had no proven strategy to help their patients lose weight and keep it off. Now, we have two programs that work,” says study leader Lawrence J. Appel, M.D., M.P.H., a professor of medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research at the Johns Hopkins University School of Medicine and the Bloomberg School of Public Health.

Appel, who is scheduled to present his team’s findings at the American Heart Association’s annual Scientific Sessions in Orlando, identified several possible reasons why the interventions were effective: frequent counseling (by phone or in person), physician support and an interactive website with tools to track weight and provide regular feedback by email. Patients were encouraged to sign in at least weekly to the program’s website to track their weight and to learn how to reduce it. If patients didn’t log in for more than a week, they got automated reminders. If they were out of touch for too long, patients got phone calls from their coaches and letters from their doctors.

For the study, the researchers recruited 415 obese people with an average body mass index (BMI) of 36.6 and an average weight of 229 pounds. The group was diverse, but predominantly middle-aged women. They were randomly split into three groups: the control group received information about weight loss but did not receive counseling; another group received counseling over the phone with a coach; and a third group was offered in-person and phone counseling. Those in the control group lost an average of less than two pounds over the course of two years. Those who had telephone sessions or in-person coaching lost a similar amount of weight — an average of 10 pounds over two years.

According to Appel, in-person programs are the standard, and such programs do lead to weight loss. But he was surprised to see that those who only had telephone contact with coaches did just as well as those who had in-person one-on-one and group sessions. He says that as the study progressed, the in-person group opted to trade in the face-to-face sessions for the convenience of using the telephone.

“In most weight loss studies, there is a lot of emphasis on frequent, in-person counseling sessions, but from a logistical perspective, it’s a disaster,” Appel says. “Patients start off strong but then stop attending in-person sessions. That’s why I like the telephone program. It is convenient to individuals and can be done anywhere. You could be living in rural South Dakota, and we could deliver this intervention. It removes some of the major logistical barriers.”

Obesity is an important and growing public health problem in the United States, where one in three adults is obese and thus at increased risk of mortality, especially from cardiovascular disease. Obesity by some estimates costs the U.S. more than $110 billion a year in health care and lost productivity costs.

As part of the new study, phone calls and in-person sessions were weekly for the first three months. For the next three months, the in-person program offered three monthly contacts (one group and two individual sessions), and then two monthly contacts for the rest of the two year study. Those who were contacted by telephone were offered monthly calls from the end of the third month on.

Other Hopkins researchers involved in the study include Jeanne M. Clark, M.D., M.H.S.; Hsin-Chieh (Jessica) Yeh, Ph.D.; Nae-Yun Wang, Ph.D.; Janelle W. Coughlin, Ph.D.; Gail Daumit, M.D., M.P.H.; Edgar Miller, M.D., Ph.D.; Arlene Dalcin, R.D.; Gary Noronha, M.D.; Thomas Pozefsky, M.D.; Jeanne Charleston, R.N.; Jeffrey B. Reynolds; Nowella Durkin; Richard Rubin, Ph.D.; Thomas A. Louis, Ph.D.; and Frederick L. Brancati, M.D., M.H.S.

Material adapted from Johns Hopkins Medicine.

“The message for parents is that encouraging daily physical activity and limiting computer use outside of what’s necessary for schoolwork, can help students get the sleep they need,” Foti said. Foti is a health scientist at the Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health and lead author of the paper.

“It is a vital issue,” said Judith Owens, M.D., director of sleep medicine at Children’s National Medical Center in Washington, D.C. “Insufficient sleep increases the risk of obesity, affects academic performance and has implications for safety. Chronic sleep restriction affects the immune system, the developing brain and the cardiovascular system.” Many adolescents, she added, are “extremely sleep deprived.”

Analyzing data on nearly 15,000 high school students taken from the CDC’s biennial Youth Risk Behavior Survey, the researchers found that those who spent at least an hour engaging in physical activity daily were significantly more likely to report “sufficient” sleep — eight hours or more per night — than students who were inactive.

On the other hand, youths who devoted two hours or more to non-academic computer use or video games every day were less apt to sleep sufficiently than non-computer users.

The analysis also linked extensive TV watching — four or more hours daily—to sufficient sleep. “This is different from what we expected,” and contradicted earlier studies, Foti said. “It shows the need for further research.”

Future studies should also investigate the influence of other electronic devices, such as smart phones, and explore more deeply the mechanism through which physical activity and behavior influence sleep “in order to make more informed recommendations about how to help adolescents get enough sleep,” she said.

Owens called the correlation between physical activity and sleep particularly intriguing, but cautioned against inferring cause and effect. “More exercise may increase fatigue and make it easier to fall asleep, but getting more sleep may also make you less fatigued and more likely to exercise.”

Generally, self-reporting of sleep tends to be somewhat unreliable, she explained. “These findings are interesting, but we have to be cautious about drawing too many conclusions from a data set like this.”

Owens also questioned whether eight hours truly constituted sufficient sleep for teens, noting that other researchers had found that teens needed nine hours or more to be “optimally rested.”

Material adapted from Health Behavior News Service, part of the Center for Advancing Health.

This cut, although slightly less than previously estimated by the Centers for Medicare and Medicaid Services (CMS), would create devastating access problems for patients, and would more than offset modest improvements in primary care and other undervalued services also included in the rule.

ACP noted that going small — enacting a short-term fix to prevent the January 1 cut — will add hundreds of billions of dollars to projected Medicare spending compared to a permanent solution, continue to endanger patient access to doctors and create roadblocks to promising new models to improve outcomes and lower the costs of care.

A framework for “going big” on physician payment reform would include:

• Stable payments to prevent scheduled cuts to physician services for five years and provide for higher annual updates for undervalued primary care services.
• Over the next five years, engage in expanded and accelerated implementation and evaluation of innovative payment and delivery models, including models being developed by the Center on Medicare and Medicaid Innovation, such as the Comprehensive Primary Care Initiative, Accountable Care Organizations (ACOs), Advance Payment and Pioneer ACOs and bundled payments.
• Create opportunities for physicians who voluntarily participate in such models, and/or other programs that meet designated criteria related to quality improvement, clinical effectiveness, and cost savings to earn higher updates.
• Establish a timetable, to be set by statute, for physicians to begin to transition over several years to the most effective models following the period of voluntary adoption and evaluation.

The need for a permanent physician payment solution, the ACP notes, has broad and deep bipartisan support. Today, HHS Secretary Kathleen Sebelius said “the pattern of threatened SGR cuts and last-minute Congressional rescues is in itself not a sustainable solution and must be remedied.” On October 25, Senator Richard Lugar (R-IN) wrote to the Joint Select Committee on Deficit Reduction, urging “a full repeal of the SGR formula . . . to be paired with provisions outlining a clear path forward to comprehensive reform.” On October 6, Rep. Allyson Schwartz (D-PA) and 113 Members of Congress sent a bipartisan letter urging the Joint Select Committee on Deficit Reduction to recommend repealof the SGR. On March 28, 2011, House Energy and Commerce Chair Fred Upton (R-MI) and ranking Democrat Henry Waxman (D-CA) wrote, “Unless we begin the process of developing a long-term solution, we will once again be faced with the unwanted choice of extending a fundamentally broken payment system or jeopardizing access for Medicare beneficiaries. We cannot allow either to happen.”

And both the bipartisan Commission on Fiscal Responsibility and Reform and the Senate “Gang of Six” deficit reduction proposals also called for permanent reform of physician payments.

ACP agrees — now is the time for the 112th Congress to accomplish something historic that none of its predecessors could do: reach bipartisan agreement, as part of its deficit reduction plan, on a permanent solution to the SGR paired with transition to a better payment system.

Finally, the American College of Physicians noted that in September it provided the Joint Select Committee on Deficit Reduction with a comprehensive list of options to reduce federal health care spending in a socially and fiscally-responsible manner, yielding enough savings to permanently repeal the SGR and reform physician payments, fund other critical programs, and reduce the deficit.

Material adapted from American College of Physicians.

“The findings suggest that if young people can get improvements from dietary supplements, then the elderly and people at high risk for certain diseases might benefit even more,” said Janice Kiecolt-Glaser, professor of psychiatry and author of the study, which was published this month in the journal Brain, Behavior and Immunity.

“The more we understand about the complex interplay between inflammation and immunity, the closer we’ll get to figuring out which lifestyle choices and changes have the biggest impact on long term health.”

Omega-3 polyunsaturated fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have long been considered as positive additives to the diet.

Earlier research suggested that the compounds might play a role in reducing the level of cytokines in the body, compounds that promote inflammation, and perhaps even reduce depression. Psychological stress has repeatedly been shown to increase cytokine production so the researchers wondered if increasing omega-3 might mitigate that process, reducing inflammation.

To test their theory, they turned to a familiar group of research subjects – medical students. Some of the earliest work these scientists showed that stress from important medical school tests lowered students’ immune status.

“We hypothesized that giving some students omega-3 supplements would decrease their production of proinflammatory cytokines, compared to other students who only received a placebo,” explained Kiecolt-Glaser. “We thought the omega-3 would reduce the stress-induced increase in cytokines that normally arose from nervousness over the tests.”

The team assembled a field of 68 first- and second-year medical students who volunteered for the clinical trial. Half the students received omega-3 supplements while the other half were given placebo pills. The students were randomly divided into six groups, all of which were interviewed six times during the study.

At each visit, blood samples were drawn from the students who also completed a battery of psychological surveys intended to gauge their levels of stress, anxiety, or depression. The students also completed questionnaires about their diet during the previous weeks.

“The omega-3 supplement the students received was probably about four or five times the amount of fish oil you’d get from a daily serving of salmon,” explained Martha Belury, professor of human nutrition and co-author in the study.

Part of the study, however, didn’t go according to plans.

Changes in the medical curriculum and the distribution of major tests throughout the year, rather than during a tense three-day period as was done in the past, removed much of the stress that medical students had shown in past studies.

“These students were not anxious. They weren’t really stressed. They were actually sleeping well throughout this period, so we didn’t get the stress effect we had expected,” Kiecolt-Glaser said.

But the psychological surveys clearly showed an important change in anxiety among the students: Those receiving the omega-3 showed a 20 percent reduction in anxiety compared to the placebo group. An analysis of the of the blood samples from the medical students showed similar important results.

“We took measurements of the cytokines in the blood serum, as well as measured the productivity of cells that produced two important cytokines, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα),” said Ron Glaser, professor of molecular virology, immunology & medical genetics and director of the Institute for Behavioral Medicine Research.

“We saw a 14 percent reduction in the amounts of IL-6 among the students receiving the omega-3.” Since the cytokines foster inflammation, “anything we can do to reduce cytokines is a big plus in dealing with the overall health of people at risk for many diseases,” he said.

Inflammation is a natural immune response that helps the body heal, but it also can play a harmful role in a host of diseases ranging from arthritis to heart disease to cancer.
Even though the study showed omega-3 supplements can reduce both anxiety and inflammation – and some of the researchers said that they take omega-3 supplements – the researchers are not ready to recommend that the public start taking them daily.

“It may be too early to recommend a broad use of omega-3 supplements, especially considering the cost and the limited supplies of fish needed to supply the oil,” Belury said. “People should just consider increasing their omega-3 through their diet.”

Also working on the research with Kiecolt-Glaser, Glaser and Belury were William Malarkey, professor emeritus of internal medicine, and Rebecca Andridge, an assistant professor of public health.

Material adapted from Ohio State University Center for Clinical and Translational Science.

“In the past 25 years, sources of energy intake among youth have shifted toward greater consumption of sugar-sweetened beverages, such as soda, sports drinks, and high-calorie fruit drinks,” the authors write as background information in the study. “The Institute of Medicine recommended that all sugar-sweetened beverages be banned in schools, but many state competitive food policies have focused primarily on soda while allowing sports drinks, fruit drinks and other sugar-sweetened beverages.”

Researchers examined state policies that banned all sugar-sweetened beverages in schools compared with states that banned only soda or had no beverage policy for in-school purchases to determine whether these policies were associated with reduced in-school access and purchase of sugar-sweetened beverages. The authors also sought to determine if these polices were associated with reduced overall consumption of sugar-sweetened beverages among adolescents.

The analysis included 6,900 students from public schools in 40 states, who were sampled during their fifth and eighth grade years (Spring 2004 and 2007, respectively) and had completed questionnaires about their in-school access to and purchase of sugar-sweetened beverages, as well as their overall consumption of sugar-sweetened beverages. The authors found that the proportion of students who reported in-school sugar-sweetened beverage access and purchasing were similar in states that banned only soda (66.6 percent and 28.9 percent) compared with states with no beverage policy (66.6 percent and 26 percent, respectively).

Overall, sugar-sweetened beverage consumption was not associated with state policy as the authors found that in each policy category, approximately 85 percent of students reported consuming sugar-sweetened beverages at least once in the past seven days, and 26 percent to 33 percent of students reported daily consumption. Additional analysis indicated that overall consumption had only a modest association with in-school sugar-sweetened beverage access.

“To summarize, state policies regulating beverages sold in middle schools were associated with reduced in-school sugar-sweetened beverage access and purchasing only if they banned all sugar-sweetened beverages,” the authors write. “Access and purchasing were equivalent in states that banned only soda compared with those with no policy at all. However, even comprehensive sugar-sweetened beverage policies were not associated with overall consumption of sugar-sweetened beverages, which was largely independent of students’ in-school sugar-sweetened beverage access.”

“Our study adds to a growing body of literature that suggests that to be effective, school-based policy interventions must be comprehensive,” the authors conclude. “States that only ban soda, while allowing other beverages with added caloric sweeteners, appear to be no more successful at reducing adolescents’ sugar-sweetened beverage access and purchasing within school than states that take no action at all.”

Material adapted from JAMA.

Reference
Arch Pediatr Adolesc Med. Published online November 7, 2011. doi:10.1001/archpediatrics.2011.200.

Researcher Andrew Littlefield

However, we find individuals who show the most decreases in impulsivity also are more likely quit smoking. If we can target anti-smoking efforts at that impulsivity, it may help the young people stop smoking.”

In the study, MU researchers compared people, aged 18 to 35, who smoked with those who had quit smoking. They found that individuals who smoked were higher in two distinct personality traits during young adulthood:

• impulsivity – acting without thinking about the consequences
• neuroticism – being emotionally negative and anxious, most of the time

Littlefield found that those with higher levels of impulsivity and neuroticism were more likely to engage in detrimental behaviors, such as smoking. However, Littlefield also found that those who quit smoking had the biggest declines in impulsivity and neuroticism from ages 18 to 25.

“Smokers at age 18 had higher impulsivity rates than non-smokers at age 18, and those who quit tended to display the steepest declines in impulsivity between ages 18 and 25,” Littlefield said. “However, as a person ages and continues to smoke, smoking becomes part of a regular behavior pattern and less impulsive. The motives for smoking later in life – habit, craving, loss of control and tolerance – are key elements of smoking dependence and appear to be more independent of personality traits.”

Despite the evidence from this study, substance use is still a complex relationship of genetic and environmental factors, Littlefield said.

The study, “Smoking Desistance and Personality Change in Emerging and Young Adulthood,” has been accepted by the journal Nicotine and Tobacco Research. The study was co-authored by Kenneth J. Sher, a professor in the MU Department of Psychology.

Littlefield says the tobacco use study will contribute to ongoing research on the relationship between personality and substance abuse. He recently received a $30,000 grant from the National Institutes of Health to study genetic influences on personality and alcohol drinking motives.

Material adapted from University of Missouri-Columbia.

Knee osteoarthritis is a common form of osteoarthritis and is caused by cartilage breakdown in the knee joint. Factors that increase the risk of knee osteoarthritis — including being overweight, age, injury or stress to the joints, and family history — can increase the risk of knee osteoarthritis.

Losing weight by monitoring diet is potentially one of the best treatments for controlling pain associated with knee OA. Researchers from Wake Forest University in North Carolina recently conducted a long-term study that evaluated the impact of weight loss with or without exercise in reducing pain caused by OA. The researchers also measured function and mobility in older, overweight adults with knee osteoarthritis.

The researchers conducted the Intensive Diet and Exercise for Arthritis trial that measured 454 overweight adults with pain caused by knee osteoarthritis. Participants were selected randomly to lose weight in 18-months by either diet restriction only, or combining dietary restrictions with exercise. These groups were compared to an exercising-only control group. The researchers set a weight loss goal for the diet groups of at least 10 percent of body weight and required the exercise groups to participate in one hour of low-to-moderate walking and resistance training three days a week. The researchers compared the changes between the groups after the 18 month trial.

A total of 399 participants, or 88 percent, completed the study. Researchers determined that 85 percent of all participants had bilateral knee OA. Average age was 65.6 – of which 72 percent were female and 81 percent were white. Weight loss results included 11.4 percent for the diet plus exercise group, and 9.5 percent for the diet only group. The exercise-only group lost 2.2 percent of their body weight.

Measures of pain, function, and mobility were all improved to a greater degree in the diet plus exercise group. The researchers concluded that intense weight loss coupled with exercise led to the greatest improvement in people with knee OA, with a reduction in pain by approximately 50 percent.

Dr. Messier further comments, “Clinicians can tell their patients that they will see marked improvement in pain and function in six months or less with intensive diet and exercise. Significant between-group differences, however, may not appear (between diet, exercise, and diet combined with exercise) until 18 months. This underscores the need for long-term studies to detect clinically and statistically meaningful results.”

Material adapted from American College of Rheumatology (ACR).

Environmental factors have been connected with the development of RA, and exposure through a person’s airways is of particular interest to researchers. Researchers from Brigham and Women’s Hospital in the United States and the Karolinska Institute in Sweden recently examined whether long-term exposure to air pollution is associated with an increased risk of RA. They studied 1,330 cases of RA (as well as an additional 2,235 people without the disease) from the Swedish Epidemiological Investigation of Rheumatoid Arthritis, and 91,203 women from the US Nurses’ Health Study (among whom 762 developed RA over 30 years of follow up).

The researchers predicted exposures to several common air pollutants, classified as either gaseous (air pollution in gas form, such as carbon monoxide, sulfur dioxide and nitrogen dioxide) or particulate (air pollution that contains tiny particles, such as soot or dust), at homes of all participants based upon residential addresses. Then, they examined the association between increases in these different components of air pollution with the increased risk of developing RA. While looking at the risk associations between air pollution and RA, the researchers took into account other variables that might affect RA risk, such as age, gender, socioeconomic status, education, race, smoking ,reproductive factors, hormone use, physical activity and body mass index.

click to enlarge figure

In contrast, in the Swedish study, increasing exposure to the gaseous air pollutants (sulfur dioxide and oxides of nitrogen) in the 10 and 20 years prior to onset of RA were associated with an increased risk of the disease. Going from low to high exposure to sulfur dioxide, nitrogen dioxide, or nitrogen oxide were associated with an up to seven percent, 11 percent, and seven percent increased risk for RA, respectively.

These risks were higher in individuals with less than a university education, a measure of socioeconomic status, than in individuals with at least a university education. Dr. Hart explains, “This may be because individuals with a lower socioeconomic status are more likely to live in houses where more air pollution leaks in from the outside or other factors such as general health status that may make them more susceptible to the effects of air pollution.”

In the U.S. study, only exposures to sulfur dioxide were associated with modest increases in total RA risk – with a five percent increased risk for in going from low to high exposure. Given the findings among those with lower socioeconomic status in the Swedish study, Dr. Hart feels that the lack of similar findings in the Nurses’ Health Study may be because members of the NHS cohort — all trained nurses —may have relatively higher levels of socioeconomic status.

“Overall, in both studies it appeared that individuals with higher exposures to sulfur dioxide had a modestly increased risk of RA. As this is the first study to examine the effects of air pollution on RA risk, it is important to validate these findings in other studies, and in populations with a wide range of socioeconomic backgrounds,” explains Dr. Hart.

Material adapted from American College of Rheumatology (ACR).

“The intricate interdependencies between BMI, SDB and cognition shown in our study are of particular importance in children, as their brains are still rapidly developing,” says study author Karen Spruyt, PhD, assistant professor in the Department of Pediatrics at the Pritzer School of Medicine. “Rising rates of obesity in children may amplify these relationships. Public health campaigns targeting obesity should emphasize not only the health benefits but the potential educational benefits of losing weight.”

According to Dr. Spruyt, “SDB amplified the risk of adverse cognitive and weight outcomes, while weight amplified the risk of SDB and adverse cognitive outcomes. Impaired cognitive functioning was associated with an increased risk of adverse weight outcomes and SDB.”

In contrast, she noted, “good cognitive abilities may be protective against increased body weight and SDB.”

The study enrolled 351 schoolchildren (mean age 7.9 years) in Louisville, Kentucky, who underwent neurocognitive testing with the Differential Abilities Scale following an overnight polysomnogram or sleep study. SDB was measured with the obstructive apnea/hypopnea index (AHI), defined as the number of apnea and hypopneas per hour of total sleep time. Anthropometric measurements included body mass index (BMI). Data were analyzed by Structural Equation Modeling, a statistical technique for testing and estimating causal relations between the variables of interest.

Models using “sleep-disordered breathing” revealed a substantive mediator role of SDB on the relationship between BMI and cognitive performance, with SDB increasing both adverse cognitive and adverse weight outcomes. In analyses using “weight,” BMI increased the risks of adverse SDB and cognitive outcomes. Finally, in models using “cognition” as the mediator, the poor ability to perform complex mental processing functions was shown to increase the risk of adverse weight and SDB outcomes.

“The mediator roles of weight and SDB were comparable, both adversely affecting cognitive functioning.” Dr. Spruyt noted. “Poorer integrative mental processing may also increase the risk of adverse health outcomes.”

The study had some limitations. The study included only normally developing children, limiting generalization of the results to more impaired populations. The authors also note that inclusion of children with more severe SDB might have altered the magnitude of the mediation effects.

“Along with campaigns targeting childhood obesity,” Dr. Spruyt adds, “screening for SDB in overweight children and children with learning difficulties may be justified based on our results.”

Material adapted from American Thoracic Society (ATS).

Download / Reference
SPRUYT, Karen & Gozal, David (2011). A Mediation Model Linking Body Weight, Cognition, And Sleep Disordered Breathing. American Journal of Respiratory and Critical Care Medicine.

In an analysis of findings from the Philadelphia Youth Risk Behavioral Survey, Lenhart and colleagues organized data from nearly 44,000 adolescents into different types of health behaviors, such as: recent smoking; amount of weekly physical activity; daily soda consumption; and hours per day playing video games.

While most of the obese teens reported trying to lose weight (about 75 percent), this group was also more likely to report smoking. In addition, females trying to lose weight were more likely to report participating in 60 minutes or more of physical activity per day; however, data showed that these females were also prone to consume soda on a daily basis – regular, not diet. Males who were trying to lose weight were more likely to report having no days of physical activity, and also reported playing more than three hours of video games per day.

“From a health education standpoint, finding out that three-quarters of students who are obese want to lose weight is exactly what we want,” said Lenhart. “But the behavior they’re engaging in is puzzling; it’s counterproductive to what they’re trying to do.”

While the researchers aren’t sure whether teens realize this behavior is counterproductive, Lenhart suggests there could be a lack of information on the teens’ part. “For example, among the girls who are exercising, they may not realize that one soda could undo that 30-minute walk they just took.”

She is encouraged that so many teens appear to be motivated to lose weight, and says that a more intensive line of questioning from health care providers could help.

“If a child is going to their pediatrician, and he asks them if they’re losing weight, an appropriate follow up question might be, ‘How are you doing that?’” said Lenhart. “It could help guide those teens to more productive weight loss activities.”

Material adapted from Temple University.

No previous evidence
Exercise is also frequently recommended as a treatment, though there has not been sufficient scientific evidence that it really has any effect on migraine patients.

In a randomized controlled study researchers from the University of Gothenburg’s Sahlgrenska Academy have now analysed how well exercise works as a preventative treatment for migraines relative to relaxation exercises and topiramate.

40 minutes of exercise
Published in the journal Cephalalgia, the study involved 91 migraine patients, a third of whom were asked to exercise for 40 minutes three times a week under the supervision of a physiotherapist, with another third doing relaxation exercises, and the final third given topiramate. The study lasted for a total of three months, during which the patients’ migraine status, quality of life, aerobic capacity and level of phyical activity were evaluated before, during and after their treatment. Follow-ups were then carried out after three and six months.

Exercise just as effective
The results show that the number of migraines fell in all three groups. Interestingly, there was no difference in the preventative effect between the three treatments.

The researchers concluded that exercise can act as an alternative to relaxations and topiramate when it comes to preventing migraines, and is particularly appropriate for patients who are unwilling or unable to take preventative medicines, says Emma Varkey, the physiotherapist and doctoral student at the Sahlgrenska Academy who carried out the study.

Material adapted from University of Gothenburg.

Reference
Title: Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls
Authors: Emma Varkey, Åsa Cider, Jane Carlsson and Mattias Linde
Published by:Cephalalgia published online 2 September 2011
DOI: 10.1177/0333102411419681

One of the biggest risks for becoming an obese child is having an obese parent, and data show that childhood obesity is strongly associated with obesity in adulthood, according to background information in the article. “The obesity rate in children of mothers who have had Roux-en-Y gastric bypass is 52 percent lower after surgery compared with the obesity rate in children born to the same mothers before surgery,” the authors write. “If one member of the family makes drastic lifestyle changes following surgery, it is possible that other family members will adopt similar healthy habits.”

Researchers observed the weight and lifestyle changes of patients who underwent Roux-en-Y gastric bypass surgery and their family members. The study was conducted between January 2007 and December 2009, and included 85 participants; 35 bariatric surgery patients, 35 adult family members and 15 children under 18 years of age. Obese adult family members were define as having a BMI greater than 30 and obese children were defined as having a BMI at the 95th percentile or higher, using the BMI for sex and age growth charts of the Centers for Disease Control and Prevention (CDC).

The weight loss in patients observed by the authors one year following surgery was typical for patients undergoing gastric bypass surgery at the study institution. The mean (average) weight loss of all adult family members decreased from 220 pounds to 198 pounds but was not statistically significant. However, among obese family members, the weight decreased from 234 to 226 pounds, a difference that did reach statistical significance. The same results were observed for waist circumference, as the results among all adult family members did not change significantly (from 108 cm to 105 cm; 42.5 inches to 41.3 inches), but did significantly decrease among obese adult family members (from 119 to 111 cm; 46.9 inches to 43.7 inches).

In obese children only, the authors observed a lower BMI than was expected for their growth curve at the one-year follow-up, however this finding did not reach statistical significance.*

One year following surgery, both patients and adult family members had significant changes in their eating habits, with patients significantly increasing cognitive control of eating while decreasing uncontrolled and emotional eating. Adult family members showed no significant changes in cognitive control of eating, but did significantly decrease uncontrolled eating and emotional eating. Additionally, children of bariatric patients were twice as likely to report being on a diet to lose weight one year post-surgery. Children also benefited from fewer daily hours of television watching and increased hours of physical activity after a parent underwent bariatric surgery.

“Obesity is a family health concern,” the authors write. “This study demonstrates that performing a gastric bypass operation on one patient has a halo of positive effect on the weight, eating habits, activity level and health behaviors of the entire family.”

Material adapted from JAMA.

Reference
Arch Surg. 2011;46[10]:1185-1190.

The paper, titled “Exposure Limits: The underestimation of absorbed cell phone radiation, especially in children,” notes that the industry-designed process for evaluating microwave radiation from phones results in children absorbing twice the cellphone radiation to their heads, up to triple in their brain’s hippocampus and hypothalamus, greater absorption in their eyes, and as much as 10 times more in their bone marrow when compared to adults.

The paper’s authors include three team members at Environmental Health Trust: Devra Davis, PhD, MPH, Founder and President; L. Lloyd Morgan, Senior Science Fellow; and Ronald B. Herberman, MD, Chairman of the Board.

The existing process is based on a large man whose 40 brain tissues are assumed to be exactly the same. A far better system relies on anatomically based models of people of various ages, including pregnant women, that can determine the absorbed radiation in all tissue types, and can account for the increased absorption in children. It allows for cell phones to be certified with the most vulnerable users in mind—children—consistent with the “As Low As Reasonably Achievable” (ALARA) approach taken in setting standards for using radiological devices.

In the United States, the FCC determines maximum allowed exposures. Many countries, especially European Union members, use the “guidelines” of the International Commission on Non-Ionizing Radiation Protection (ICNIRP), a non-governmental agency.

Three additional authors contributed to the paper: Om P. Gandhi, ScD, of the Department of Electrical Engineering at the University of Utah; Alvaro Augusto de Salles, PhD, of the Electrical Engineering Department at the Federal University of Rio Grande do Sul in Brazil; and Yueh-Ying Han, PhD, of the Department of Epidemiology and Community Health at New York Medical College. Drs. Gandhi and De Salles serve on EHT’s Scientific Advisory Group.

Material adapted from Environmental Health Trust.

Their article is entitled “Exercise Training Increases Mitochondrial Biogenesis in the Brain.” It appears in the Articles in Press section of the American Journal of Physiology – Regulatory, Integrative, and Comparative Physiology, published by the American Physiological Society.

Methodology
The researchers assigned mice to either an exercise group, which ran on an inclined treadmill six days a week for an hour, or to a sedentary group, which was exposed to the same sounds and handling as the exercise group but remained in their cages during the exercise period. After eight weeks, researchers examined brain and muscle tissue from some of the mice in each group to test for signs of increases in mitochondria. Additionally, some of the mice from each group performed a “run to fatigue” test to assess their endurance after the eight-week period.

Results
Confirming previous studies, the results showed that mice in the exercise group had increased mitochondria in their muscle tissue compared to mice in the sedentary group. However, the researchers also found that the exercising mice also showed several positive markers of mitochondria increase in the brain, including a rise in the expression of genes for proxisome proliferator-activated receptor coactivator 1-alpha, silent information regulator T1, and citrate synthase, all regulators for mitochondrial biogenesis; and mitochondrial DNA. These results correlate well with the animals’ increased fitness. Overall, mice in the exercise group increased their run to fatigue times from about 74 minutes to about 126 minutes. No change was seen for the sedentary mice.

Importance of the Findings
These findings suggest that exercise training increases the number of mitochondria in the brain much like it increases mitochondria in muscles. The study authors note that this increase in brain mitochondria may play a role in boosting exercise endurance by making the brain more resistant to fatigue, which can affect physical performance. They also suggest that this boost in brain mitochondria could have clinical implications for mental disorders, making exercise a potential treatment for psychiatric disorders, genetic disorders, and neurodegenerative diseases.

“These findings could lead to the enhancement of athletic performance through reduced mental and physical fatigue, as well as to the expanded use of exercise as a therapeutic option to attenuate the negative effects of aging, and the treatment and/or prevention of neurological diseases,” the authors say.

The study was conducted by Jennifer L. Steiner, E. Angela Murphy, Jamie L. McClellan, Martin D. Carmichael, and J. Mark Davis, all of the University of South Carolina.

Material adapted from American Physiological Society (APS).

“Lifetime risk of prostate cancer in the United States is currently estimated to be 16 percent. Although most cases are found at an early, curable stage, treatment is costly and urinary, sexual, and bowel-related adverse effects are common,” according to background information in the article. There has been considerable preclinical and epidemiological evidence that selenium and vitamin E may reduce prostate cancer risk. “The initial report [published December 2008] of the Selenium and Vitamin E Cancer Prevention Trial (SELECT) found no reduction in risk of prostate cancer with either selenium or vitamin E supplements but a statistically nonsignificant increase in prostate cancer risk with vitamin E. Longer follow-up and more prostate cancer events provide further insight into the relationship of vitamin E and prostate cancer.”

Researchers examined the long-term effect of vitamin E and selenium on risk of prostate cancer in relatively healthy men. SELECT included a total of 35,533 men from 427 study sites in the United States, Canada, and Puerto Rico who were randomized between August 2001 and June 2004. Eligibility criteria included a prostate-specific antigen (PSA) measure below a certain level, a digital rectal examination not suspicious for prostate cancer, and age 50 years or older for black men and 55 years or older for other men. The primary analysis included 34,887 men who were randomly assigned to 1 of 4 treatment groups: 8,752 to receive selenium (200 micrograms/day); 8,737, vitamin E (400 IU/day); 8,702, both agents; and 8,696, placebo, with a planned follow-up of a minimum of 7 years and maximum of 12 years. Analysis reflect the final data collected by the study sites on their participants through July 5, 2011.

Since the initial report, a total of 521 additional prostate cancers have been diagnosed: 113 in the placebo group, 147 in the vitamin E group, 143 in the selenium group, and 118 in the combination group. The researchers found that the rate of prostate cancer detection was greater in all treatment groups when compared with placebo but was statistically significant only in the vitamin E alone group (a 17 percent increased rate of prostate cancer detection). Compared with the placebo group, in which 529 men developed prostate cancer, 620 men in the vitamin E group developed prostate cancer, as did 575 in the selenium group and 555 in the selenium plus vitamin E group. The difference in rates of prostate cancer between vitamin E and placebo became apparent during the participants’ third year in the trial. The elevated risk estimate for vitamin E was consistent across both low- and high-grade disease.

“In this article, we report an observation of important public health concern that has emerged with continued follow-up of SELECT participants,” the authors write. “Given that more than 50 percent of individuals 60 years or older are taking supplements containing vitamin E and that 23 percent of them are taking at least 400 IU/d despite a recommended daily dietary allowance of only 22.4 IU for adult men, the implications of our observations are substantial.”

The researchers note that the fact that the increased risk of prostate cancer in the vitamin E group of this trial was only apparent after extended follow-up suggests that health effects from these agents may continue even after the intervention is stopped, emphasizing the need for long-term follow-up. They add that the findings of this and other studies illustrate the importance of large-scale, population-based, randomized trials in accurately assessing the benefits and harms of micronutrients as dietary supplements.

“The observed 17 percent increase in prostate cancer incidence demonstrates the potential for seemingly innocuous yet biologically active substances such as vitamins to cause harm. The lack of benefit from dietary supplementation with vitamin E or other agents with respect to preventing common health conditions and cancers or improving overall survival, and their potential harm, underscore the need for consumers to be skeptical of health claims for unregulated over-the-counter products in the absence of strong evidence of benefit demonstrated in clinical trials.”

Material adapted from JAMA.

Reference
JAMA. 2011;306[14]:1549-1556.

“This research provides an experimental rationale for the effects of beneficial behavioral stimuli experienced by the pregnant mother affecting the disease status of an as yet-unborn child. Epigenetic alterations (alterations in gene and protein expression caused by mechanisms other than changes in the underlying DNA sequence) provide a most probable mechanism by which mothers could have transferred their own behavioral experience to their progeny,” said Kathy Keyvani, M.D., a researcher involved in the work from the Institute of Pathology and Neuropathology at the University Hospital Essen in Essen, Germany. “A better understanding of the underlying pathways may provide novel treatment and/or prevention strategies for Alzheimer’s disease and bring more insight into the fascinating link between brain and behavior.”

To make this discovery, Keyvani and colleagues mated male mice that express a mutant form of the APP gene found in some Alzheimer’s patients with healthy female wild-type mice. After weaning, healthy and “Alzheimer-diseased” offspring were kept in standard cages for five months. Mouse brains were examined for signs of disease shortly thereafter. The “Alzheimer-diseased” mice whose mothers ran on a exercise wheel during pregnancy had fewer Beta-amyloid plaques, smaller plaque size, less inflammation, less oxidative stress, and a better functioning vascular network than those whose mothers did not run. Additionally, the mice whose mothers ran on the wheel also showed an up-regulation of plasticity-related molecules, which are indicators for more and better connections between the nerve cells.

“No one is resistant to the health benefits of exercise,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal, “and this research confirms that reasonable workouts can have a lifetime of benefits for your offspring. Whether you work out at home or go to the gym, you should do it for the sake of your health and that of your offspring.”

Material adapted from Federation of American Societies for Experimental Biology.

Reference
Arne Herring, Anja Donath, Maksym Yarmolenko, Ellen Uslar, Catharina Conzen, Dimitrios Kanakis, Claudius Bosma, Karl Worm, Werner Paulus, and Kathy Keyvani. Exercise during pregnancy mitigates Alzheimer-like pathology in mouse offspring. FASEB J. doi:10.1096/fj.11-193193 ; http://www.fasebj.org/content/early/2011/09/23/fj.11-193193.abstract

The use of dietary supplements in the United States has increased considerably over the last decade, according to background information in the article. “At the population level, dietary supplements contributed substantially to the total intake of several nutrients, particularly in elderly individuals,” the authors write.

Jaakko Mursu, Ph.D., of the University of Eastern Finland, Kuopio, Finland, and the University of Minnesota, Minneapolis, and colleagues used data collected during the Iowa Women’s Health Study to examine the association between vitamin and mineral supplements and mortality (death) rate among 38,772 older women (average age 61.6 years). Supplement use was self-reported in 1986, 1997 and 2004 via questionnaires.

Among the 38,772 women who started follow-up with the first survey in 1986, 15,594 deaths (40.2 percent) occurred over an average follow-up time of 19 years. Self-reported supplement use increased substantially between 1986 and 2004, with 62.7 percent of women reporting use of at least one supplement daily in 1986, 75.1 percent in 1997 and 85.1 percent in 2004.

The authors found that use of most supplements was not associated with reduced total mortality in older women, and many supplements appeared associated with increased mortality risk. After adjustment, use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper, were all associated with increased risk of death in the study population. Conversely, calcium supplements appear to reduce risk of mortality. The association between supplement intake and mortality risk was strongest with iron, and the authors found a dose-response relationship as increased risk of mortality was seen at progressively lower doses as women aged throughout the study.

Findings for both iron and calcium supplements were replicated in separate, short-term analyses with follow-up occurring at four years, six years and 10 years.

“Based on existing evidence, we see little justification for the general and widespread use of dietary supplements,” the authors conclude. “We recommend that they be used with strong medically based cause, such as symptomatic nutrient deficiency disease.”

Material adapted from JAMA.

Reference
Arch Intern Med. 2011;171[18]:1625-1633.

“Having people rate their own health may be a simple tool for doctors to determine a person’s risk of dementia, especially for people with no symptoms or memory problems,” said study author Christophe Tzourio, MD, PhD, director of the Inserm unit 708 Neuroepidemiology at the University of Bordeaux 2 in France.

Other studies have shown that people who rate their own health as poor are more likely to die or develop a disease, especially vascular disease such as heart attack or stroke, than people who rate their health as good. The results hold true even after researchers account for other health conditions, such as high blood pressure or high cholesterol.

At the start of the study, 8,169 people age 65 years or older were asked to rate their health and were followed for nearly seven years. During the study, 618 people developed dementia.

The risk of dementia was 70 percent higher in people who rated their health as poor and 34 percent higher in people who rated their health as fair compared to those who rated their health as good.

In addition, the study found that the association between people’s health ratings and developing dementia was even stronger for those who did not have any memory problems or other issues with thinking skills. Among those with no cognitive problems, those who rated their health as poor were nearly twice as likely to develop dementia as those who rated their health as good.

“We know that having a large social network and social activities are associated with a decreased risk of dementia,” said Tzourio. “Therefore, it’s possible that rating one’s health as poor might be associated with behaviors that limit social interaction and in turn accelerate the dementia process.”

The study was supported by the French National Institute of Health and Medical Research, the Victor Segalen Bordeaux II University, Sanofi-Aventis and the Foundation for Medical Research in France.

Material adapted from American Academy of Neurology (AAN).

The study, initiated by Centre for Cognitive Neuroscience (CCN) at University of Turku, was methodologically unique combining the expertice in brain imaging (National PET-Center and CCN), measurements and modeling of radiation (Radiation and Nuclear Safety Authority in Finland, STUK) and measurements of skin temperature (Finnish Institute of Occupational Health, TTL). No conclusions concerning health risks can be made based on the result.

The study was financed by Finnish Technology Agency (Tekes) as part of the national Wirecom (wireless communication) research program. The results were published in Journal of Blood Circulation and Metabolism (advance online publication, 14 September 2011).

Material adapted from Suomen Akatemia (Academy of Finland).

Reference
Journal of Blood Circulation and Metabolism (advance online publication, 14 September 2011).

The authors state in background information that folic acid supplementation and food fortification has been effective in preventing neural tube defects, but folic acid does not prevent all birth defects. “Nutrition research on birth defects has tended to focus on one nutrient (or nutritional factor) at a time,” the authors write. “However, the reality of nutrition is much more complex.”

Researchers used data from the National Birth Defects Prevention Study “to examine whether better maternal diet quality was associated with reduced risk for selected birth defects.” The data were collected in 10 states from pregnant women with estimated due dates from October 1997 through December 2005. Information was collected via telephone interviews with 72 percent of case and 67 percent of control mothers. Included in the analysis were 936 cases with neural tube defects, 2,475 with orofacial clefts, and 6, 147 controls without birth defects. Mothers reported their food intake using a questionnaire. The researchers developed two diet quality indices that focused on overall diet quality based on the Mediterranean Diet (Mediterranean Diet Score or MDS) and the U.S. Department of Agriculture Food Guide Pyramid (Diet Quality Index or DQI).

“…Increasing diet quality based on either index was associated with reduced risks for the birth defects studied,” the authors found. “Most mothers of controls [children without birth defects] were non-Hispanic white and had more than a high school education; 19 percent smoked, 38 percent drank alcohol, and 78 percent took folic-acid-containing supplements during early pregnancy; and 16 percent were obese,” the authors report. “Women who were Hispanic had substantially higher values for the DQI and the MDS, whereas values were lower among women with less education and women who smoked, did not take supplements, or were obese…”

“Based on two diet quality indices, higher maternal diet quality in the year before pregnancy was associated with lower risk for neural tube defects and orofacial clefts. This finding persisted even after adjusting for multiple potential confounders such as maternal intake of vitamin/mineral supplements,” the authors write. “These results suggest that dietary approaches could lead to further reduction in risks of major birth defects and complement existing efforts to fortify foods and encourage periconceptional multivitamin use,” the authors conclude.

(Arch Pediatr Adolesc Med. Published online October 3, 2011. doi:10.1001/archpediatrics.2011.185. Available pre-embargo to the media at www.jamamedia.org.)

Editor’s Note: This project was partially supported by grants from the National Institutes of Health and the Centers for Disease Control and Prevention. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: The Importance of Food

In an accompanying editorial, David R. Jacobs, Jr., Ph.D., from the University of Minnesota, Minneapolis, and colleagues note that while maternal intake of folate is important for fetal development, recent studies suggest the supplemental folic acid may have adverse health effects on older adults.

“The importance of the findings of Carmichael et al lies in showing that women obtain benefit from the consumption of a high-quality diet, beyond the benefits derived through grain fortification. This raises the question of whether a high-quality diet alone may be sufficient to prevent NTDs (neural tube defects) – a strategy that would also remove the potential harm from fortification.”

“The lesson from the article by Carmichael et al is an important one: people, including women of childbearing age, should eat good food.”

“Reduction of NTDs may be achievable by diet alone, at the same time reducing potential risk for other chronic diseases in the rest of the population.”

Material adapted from JAMA.

Reference
Arch Pediatr Adolesc Med. Published online October 3, 2011. doi: 10.1001/archpediatrics.2011.184.

Step You Need To Take
To reach the Legislative Action Center, please visit http://capwiz.com/apapractice/issues/alert/?alertid=53048676. If possible, please take action by Friday October 7. Grassroots feedback is extremely helpful; if you receive a substantive response please email to Jeff Cook (email is available below).

What Is the Latest on This Issue?
Enactment of the Budget Control Act has significantly altered the dynamics on Capitol Hill, as a newly empowered Joint Committee seeks to identify $1.2 trillion in additional deficit reduction. If the committee fails to reach an agreement that can pass both chambers, Medicare provider payments would be cut by up to 2% in addition to the already pending 29.5% Sustainable Growth Rate (SGR) cut. Psychologists could face a triple hit because the 5% psychotherapy payment restoration, which we have won through several tough fights since 2008, is scheduled to expire at the end of 2012 if Congress fails to act.

Further complicating the picture, the Medicare Payment Advisory Committee (MedPAC), which was created by Congress for its advice in this area, will soon recommend replacing the SGR with an 18% cut to psychologists and other providers over the next three years followed by a payment freeze for seven more years. There is a lot at stake – and psychologists cannot afford to be silent.

Given the steep challenges we face, the APA Practice Organization (APAPO) is pushing forward in every forum available to us. Last week APAPO provided testimony before a hearing of the House Ways & Means Subcommittee on Health to press the case for our psychotherapy extender, which we are pleased has earned the support of the American Medical Association. We are working with allied provider organizations to make the case that psychologists and other health professionals are struggling in this economy and serving vulnerable patients who need and deserve access to quality mental health care. At the same time, psychologists have sent nearly 7,000 messages to the Hill on reimbursement already this year.

We can’t let up. Even if you sent a message earlier this year, we need you to do so again. Your profession needs you to take action NOW to ensure the Joint Committee and other members are reminded of these critical priorities.

APAPO: Putting Your Practice Assessment to Work

Additional Background:

CONGRESS SHOULD PROTECT MEDICARE MENTAL HEALTH PAYMENT

To ensure the viability of the Medicare outpatient mental health benefit, Congress should extend through 2012 the restoration of cuts to Part B mental health services made in 2007.

Mental Health Extender. Congress restored payments temporarily but they now need to be extended. Through the Medicare Improvements for Patients and Providers Act of 2008, Congress partially restored the cuts made by the Centers for Medicare & Medicaid Services (CMS) “Five-Year Review” through 2009. Subsequent laws then extended the restoration through December 2011. The valuation of psychotherapy codes in the 2011 Five-Year Review has been delayed into 2012. Congress should pass new legislation to extend payments through 2012, until the Five-Year Review is completed.

Effect on Beneficiaries. Extending psychologist payments cut by the Five-Year Review is crucial to protecting access to Medicare mental health services. Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, but many have indicated that they may have to reduce their caseloads or leave Medicare if they are faced with these reimbursement cuts. The cost of protecting mental health services is very low, increasing costs by only $30 million per year.

Cut By MEI Rebasing. A CMS technical advisory panel will be asked to examine the effect of a 4% cut to Medicare part B reimbursement for psychologists in January 2011 due to “rebasing” of the Medicare Economic Index (MEI). In the 2011 fee schedule, CMS used more recent survey data that showed practice expense and malpractice became a larger share of the payment formula while provider’s time became smaller. This increased payments for some services, particularly of professionals who utilize expensive technology. Due to budget neutrality requirements, CMS reduced other reimbursement work values, which hit services of psychologists and social workers the hardest because they are typically provided at lower cost and lower overhead.

These cuts are not related to the Sustainable Growth Rate. Psychologists were saved from a second and even more devastating reduction when Congressional action halted the projected 25% SGR cut through December 31, 2011. Ultimately Congress must replace the flawed SGR formula with one that responsibly and permanently addresses provider payments.

Psychologists will leave Medicare. In a 2008 survey, 11% of psychologists reported that they have dropped out of Medicare participation and a primary reason cited was low reimbursement rates.

Jeff Cook, J.D.
Director of Field & State Operations
American Psychological Association Practice Organization
750 First Street, NE Washington, DC 20002
(202) 336-5875 (Office)
(202) 336-5797 (Fax)
jco…@apa.org (click to verify and reveal email)

Republished with permission: APAPO

Caffeine is the most frequently used central nervous system stimulant in the world, and approximately 80 percent of consumption is in the form of coffee, according to background information in the article. Previous research, including one prospective study among men, has suggested an association between coffee consumption and depression risk. Because depression is a chronic and recurrent condition that affects twice as many women as men, including approximately one of every five U.S. women during their lifetime, “identification of risk factors for depression among women and the development of new preventive strategies are, therefore, a public health priority,” write the authors. They sought to examine whether, in women, consumption of caffeine or certain caffeinated beverages is associated with the risk of depression.

Researcheres studied 50,739 U.S. women who participated in the Nurses’ Health Study. Participants, who had a mean (average) age of 63, had no depression at the start of the study in 1996 and were prospectively followed up with through June 2006. Researchers measured caffeine consumption through questionnaires completed from May 1980 through April 2004, including the frequency that caffeinated and noncaffeinated coffee, nonherbal tea, caffeinated soft drinks (sugared or low-calorie colas), caffeine-free soft drinks (sugared or low-calorie caffeine-free colas or other carbonated beverages) and chocolate were usually consumed in the previous 12 months. The authors defined depression as reporting a new diagnosis of clinical depression and beginning regular use of antidepressants in the previous two years.

Analysis of the cumulative mean consumption included a two-year latency period; for example, data on caffeine consumption from 1980 through 1994 were used to predict episodes of clinical depression from 1996 through 1998; consumption from 1980 through 1998 were used for the 1998 through 2000 follow-up period; and so on. During the 10-year follow-up period from 1996 to 2006, researchers identified 2,607 incident (new-onset) cases of depression. When compared with women who consumed one cup of caffeinated coffee or less per week, those who consumed two to three cups per day had a 15 percent decrease in relative risk for depression, and those consuming four cups or more per day had a 20 percent decrease in relative risk. Compared with women in the lowest (less than 100 milligrams [mg] per day) categories of caffeine consumption, those in the highest category (550 mg per day or more) had a 20 percent decrease in relative risk of depression. No association was found between intake of decaffeinated coffee and depression risk.

“In this large prospective cohort of older women free of clinical depression or severe depressive symptoms at baseline, risk of depression decreased in a dose-dependent manner with increasing consumption of caffeinated coffee,” write the authors. They note that this observational study “cannot prove that caffeine or caffeinated coffee reduces the risk of depression but only suggests the possibility of such a protective effect.” The authors call for further investigations to confirm their results and to determine whether usual caffeinated coffee consumption could contribute to prevention or treatment of depression.

Material adapted from JAMA.

Reference
Arch Intern Med. 2011;171[17]:1571-1578.

Diabetes has become increasingly common in the United States and the world, according to background information in the article. Elevated levels of hemoglobin A1c (a measure of blood glucose levels and control over two to three months), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) are associated with an increase in the risk of complications. Reducing the levels decreases those risks, but the article notes that most patients with diabetes do not have these levels under control. Currently, treatment guidelines do not include recommendations for how frequently physicians should see patients with diabetes, although recommended intervals for testing and adjustments to medication may range from every two to three days for insulin to every three months for hemoglobin A1c. “However,” the authors write, “benefits of more frequent provider encounters may not be limited to treatment intensification and testing.”

Fritha Morrison, M.P.H., from Brigham and Women’s Hospital, Boston, and colleagues conducted a retrospective cohort study to determine whether more frequent encounters with a physician help patients improve control of diabetes. The authors analyzed data from 26,496 adult patients with diabetes and elevated hemoglobin A1c, BP and/or LDL-C levels who visited primary care physicians affiliated with two Boston hospitals for at least two years between January 2000 and January 2009. Treatment goals at the beginning of the study were hemoglobin A1c of less than 7 percent, BP of less than 130/85 mm Hg (millimeters of mercury) and LDL-C of less than 100 mg/dL (milligrams per deciliter). The researchers assessed the relationship between the frequency of clinician encounters (defined as notes in the medical record) and time to control of hemoglobin A1c, BP and LDL-C.

Among patients who had encounters with their physicians every one to two weeks, the median (midpoint) time to reaching the treatment goals was 4.4 months (without insulin) and 10.1 months (with insulin) for hemoglobin A1c, 1.3 months for BP and 5.1 months for LDL-C. Among patients who had physician encounters every three to six months, the median time to goal achievement was 24.9 months (without insulin) and 52.8 months (with insulin), 13.9 months and 32.8 months, respectively. When, after analysis, the time between physician encounters was doubled, the median time to reaching hemoglobin A1c goal increased 35 percent without insulin and 17 percent with insulin; for BP and LDL-C, these median times to goal increased 87 percent and 27 percent, respectively. As the physician encounter frequency increased up to once every two weeks for most goals, the time to control decreased progressively, consistent with the pharmacodynamics (the time course and effects of medications) for the respective classes of medication.

“The present findings provide evidence that for many patients with elevated hemoglobin A1c, BP, or LDL-C, more frequent patient-provider encounters were associated with a shorter time to treatment target, and control was fastest at two-week intervals,” report the authors. They suggest that this interval may be appropriate for the most severely uncontrolled patients, but recognize that innovative approaches to achieve this frequency may be necessary because of the increasing demand on health care resources. The authors add, “The retrospective nature of this study prevents us from establishing a causal relationship between encounter frequency and patient outcomes,” and call for further research.

Material adapted from JAMA.

Reference
Arch Intern Med. 2011;171[17]:1542-1550.