The Population Reference Bureau (PRB) data included in this data brief are preliminary. A new Centers for Disease Control and Prevention (CDC) report on female genital mutilation/cutting in the United States also will be released soon, providing additional information on women and girls at risk.
(February 2015) Female genital mutilation/cutting (FGM/C), involving partial or total removal of the external genitals of girls and women for religious, cultural, or other nonmedical reasons, has devastating immediate and long-term health and social effects, especially related to childbirth. This type of violence against women violates women’s human rights. There are more than 3 million girls, the majority in sub-Saharan Africa, who are at risk of cutting/mutilation each year. In Djibouti, Guinea, and Somalia, nine in 10 girls ages 15 to 19 have been subjected to FGM/C. Some countries in Africa have recently outlawed the practice, including Guinea-Bissau, but progress in eliminating the harmful traditional practice has been slow.1 Although FGM/C is most prevalent in sub-Saharan Africa, global migration patterns have increased the risk of FGM/C among women and girls living in developed countries, including the United States.
Increasingly, policymakers, NGOs, and community leaders are speaking out against this harmful traditional practice. As more information becomes available about the practice, it is clear that FGM/C needs to be unmasked and challenged around the world.
The U.S. Congress passed a law in 1996 making it illegal to perform FGM/C and 23 states have laws against the practice.2 Despite decades of work in the United States and globally to prevent FGM/C, it remains a significant harmful tradition for millions of girls and women. In the last few years, renewed efforts to protect girls from undergoing this procedure globally and in immigrant populations have resulted in policy successes. In Great Britain and in other European countries, a groundswell of attention has focused on eradicating the practice among the large immigrant populations of girls and women who have been cut or are at risk of being cut. Moreover, in 2012 the 67th session of the UN General Assembly passed a resolution urging states to condemn all harmful practices that affect women and girls, especially FGM/C. The UN resolution was a significant step toward ending the practice around the world.
In the United States, efforts to stop families from sending their daughters to their home countries to be cut led to a 2013 law making it illegal to knowingly transport a girl out of the United States for the purpose of cutting. FGM/C has gained attention in the United States in part because of the rising number of immigrants from countries where FGM/C is prevalent, especially sub-Saharan Africa. Between 2000 and 2013, the foreign-born population from Africa more than doubled, from 881,000 to 1.8 million.3
The Risk of FGM/C in the United States
In 2013, there were up to 507,000 U.S. women and girls who had undergone FGM/C or were at risk of the procedure, according to PRB’s preliminary data analysis. This figure is more than twice the number of women and girls estimated to be at risk in 2000 (228,000).4 The rapid increase in women and girls at risk reflects an increase in immigration to the United States, rather than an increase in the share of women and girls at risk of being cut. The estimated U.S. population at risk of FGM/C is calculated by applying country- and age-specific FGM/C prevalence rates to the number of U.S. women and girls with ties to those countries. A detailed description of PRB’s methods to estimate women and girls at risk of FGM/C is available.
On a related note, during Peace Corps training in Nashville (1979) I came down with a bad cough, often coughing for 5-10 minutes at a time. Don’t think the rainy weather and me going around with an umbrella or raincoat helped. Anyways, was sent to an area doctor and after a few tests, told me and the Peace Corps staff not to be concerned. Just a dormant fungus (and I do live a bit north of the Ohio River Valley). Anyways, after a few days in Monrovia, Liberia (6 am temps of about 85), I stopped coughing.
PS We were boarded in motels. One late night was awakened by a few young men in the group coughing loudly and giggling outside my window. Chalk it up now to some late night drinking and the men still being, well, young.
On another note, my husband quit smoking back in the 80’s after about 25 years of smoking. He had a lung X-ray and a dark spot on the lungs was noticed. He had quit smoking the month before. So now I’m wondering…cancer or fungus? He has not had any firm diagnosis of cancer since.
Beschreibung: Konventionelles Röntgenbild des Thorax (der Lunge) mit rundlicher Verdichtung in der linken Lunge Quelle: selbst erstellt –Benutzer:Lange123 17:18, 11. Nov. 2004 (CEST) (Photo credit: Wikipedia)
…Histoplasma capsulatum is a fungus endemic to the Ohio and Mississippi River Valleys. It is everywhere. You get it by breathing. Prior studies suggest that >80% of those living in these regions have contracted the fungus. The majority of people with histo don’t get sick. But – they get lung nodules. Lots of them. The nodules are benign but often indistinguishable on imaging from “early” lung cancer.
The entrepreneurial owners of the pictured urgent care center likely know this. They also know that Medicare and other carriers have limited coverage (reasonably so) to patients between the ages of 55 and 74 with at least a 30 pack year history of smoking. If patients have quit smoking, they must have quit within 15 years to be eligible for coverage. At first glance, it may seem like offering cheap, $88 screening for Americans ineligible for lung cancer screening coverage, or those eligible citizens too busy to get a physician order for a screening exam, is a good deed. But, $88 is just the tip of the iceberg. Additional screening exams and subsequent procedures/biopsies will all incur additional costs.
Our collective fear of malignancy, the unfortunately high frequency of lung cancer, and the promise of low dose CT screening for this disease will drive people outside of the NLST’s strict inclusion criteria into these low-cost, high-volume CT-scanning conveyor belts to “catch the cancer early.”
And what will they find in the Ohio River Valley?
Lots and lots of lung nodules.
The markedly increased propensity of patients in this region to have pulmonary nodules is likely to lead to an increased number of image-guided and open surgical biopsies (when the image-guided biopsy provides insufficient tissue for analysis). More invasive procedures will naturally lead to more cost-inducing complications (such as pneumothorax and pulmonary hemorrhage) and, in some instances, death.
Medical devices don’t get regular security updates, like smart phones and computers, because changes to their software could require recertification by regulators like the U.S. Food and Drug Administration (FDA). And FDA has focused on reliability, user safety, and ease of use—not on protecting against malicious attacks. In a Safety Communication in 2013, the agency said that it “is not aware of any patient injuries or deaths associated with these incidents nor do we have any indication that any specific devices or systems in clinical use have been purposely targeted at this time.” FDA does say that it “expects medical device manufacturers to take appropriate steps” to protect devices. Manufacturers are starting to wake up to the issue and are employing security experts to tighten up their systems. But unless such steps become compulsory, it may take a fatal attack on a prominent person for the security gap to be closed.
This study tests whether there is substantial undercounting of sexual assault by universities. It compares the sexual assault data submitted by universities while being audited for Clery Act violations with the data from years before and after such audits. If schools report higher rates of sexual assault during times of higher regulatory scrutiny (audits), then that result would support the conclusion that universities are failing to accurately tally incidents of sexual assault during other time periods. The study finds that university reports of sexual assault increase by approximately 44% during the audit period. After the audit is completed, the reported sexual assault rates drop to levels statistically indistinguishable from the preaudit time frame. The results are consistent with the hypothesis that the ordinary practice of universities is to undercount incidents of sexual assault. Only during periods in which schools are audited do they appear to offer a more complete picture of sexual assault levels on campus. Further, the data indicate that the audits have no long-term effect on the reported levels of sexual assault, as those crime rates return to previous levels after the audit is completed. This last finding is supported even in instances when fines are issued for noncompliance. The study tests for a similar result with the tracked crimes of aggravated assault, robbery, and burglary, but reported crimes show no statistically significant differences before, during, or after audits. The results of the study point toward 2 broader conclusions directly relevant to policymaking in this area. First, greater financial and personnel resources should be allocated commensurate with the severity of the problem and not based solely on university reports of sexual assault levels. Second, the frequency of auditing should be increased, and statutorily capped fines should be raised to deter transgressors from continuing to undercount sexual violence. The Campus Accountability and Safety Act, presently before Congress, provides an important step in that direction.
Snow and icy conditions affect human decisions about transportation. These decisions can ripple through other infrastructure systems, causing widespread disruptions. Shown here are points of connectivity.
Credit: Paul M. Torrens and Cheng Fu, University of Maryland, College Park; Sabya Mishra, University of Memphis; Timothy Welch, Georgia Tech.
For Paul Torrens, wintry weather is less about sledding and more about testing out models of human behavior.
Torrens, a geographer at the University of Maryland, studies how snow and icy conditions affect human decisions about transportation. He also studies how these decisions ripple through other infrastructure systems.
“After moving to the Washington, D.C., area from Arizona,” Torrens said, “I saw firsthand how snow upsets even careful plans for getting kids to school and commuting to work.”
Common disruptions such as those associated with snow, while not always catastrophic, have real economic costs, and the costs add up.
“Critical infrastructure systems are the lifelines of society,” said Dennis Wenger, program director in NSF’s Engineering Directorate. “They are complex, highly interdependent processes and systems and are subject to disruption through their normal life cycle and as a result of the impact of natural and technological hazards.”
In real life, transportation is affected by moment-to-moment decisions by people, explained Torrens, who may adjust their transportation routines depending on their individual circumstances and activities.
Relying on big data from social media sources, Torrens is building a dynamic, near-real-time atlas and census of a population from which motifs of human and infrastructure behavior can be extracted as rules for agents’ behavior.
“Social media data is a treasure trove for information scientists, because not only do we have the message content, but the content is stamped with a location and a time,” Torrens said. “We can study how information propagates throughout social networks and correlate that with physical situations as they unfold.”
One school system tried to open on time despite the slick conditions. Soon local Twitter users began posting photographs of snow-covered streets, car crashes and links to television news reports with the quickly viral hash-tag #closeFCPS. Information about the resulting problems seemed to spread, bottom-up, via a viral tag, rather than via official school channels.
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L0052223 A circle incorporating the words \’African American againstCredit: Wellcome Library, London. Wellcome Imagesimages@wellcome.ac.uki mages.wellcome.ac.uk A circle incorporating the words \’African American against AIDS\'; advertisement by the Sacramento County Department of Health and Human Services. Colour lithograph.
…The results of these analyses indicate that black persons living with HIV experienced higher numbers and rates of deaths during 2008–2012 than other races/ethnicities. However, the numbers and rates of death declined consistently during the same period. The death rate per 1,000 persons living with HIV among blacks decreased 28% during 2008–2012, more than the overall decline (22%) seen among all persons living with HIV. Other than among blacks, such a consistent decline was observed only among Hispanics or Latinos…
….The world is at a dire turning point in the fight against climate change. If the world doesn’t begin taking action to mitigate the impact of climate change the outcomes will be catastrophic (even though some research is saying that’s going to happen, regardless).
A growing discussion in the United States is how we are equipping future citizens, business leaders, health leaders, etc. to be part of the solution to reducing greenhouse gas emissions and mitigating those risks. But according to my preliminary research in climate change science being integrated into science curriculum, we aren’t doing that at all. From personal experience with a Bachelors of Science in Applied Sciences in Public Health, I have never had a professor talk about climate change nor talk about solutions and how we as public health professionals fit into different roles. If young adults and children aren’t aware of climate change, how is it ever going to be brought to the forefront of discussion? How is change going to happen? Sure, federal and state governments can use the power of public policy to control emissions, but what about the solutions to the inevitable problem looming? Solutions such as emergency preparedness planning (since we can safely assume this is going to be a needed expertise), green space, active transportation, infrastructure to prevent rising sea levels from flooding major cities, etc.
As progressive public health departments move towards allocating resources to chronic disease prevention (and obviously, rightfully so), it will be incredibly important to ensure emergency preparedness, epidemiology, and environmental health aren’t lost in the mix. Professionals in health communications and community engagement will be critical pieces, but ultimately don’t have the legal authority of an Environmental Health professional to enforce state and federal mandates, nor have the expertise in emergency preparedness. This is a call for sustained and increased funding for local health departments. The climate change discussion is happening internationally and on a federal level, but those discussions aren’t trickling down to the local level. I would attribute this to climate change being a backburner issue and one that doesn’t have an acute impact (like an Ebola outbreak). The impacts are longitudinal and over long periods of time.
Regions of the brain affected by PTSD and stress. (Photo credit: Wikipedia)
New approach focuses on the appraisal of stressful or threatening situations by the brain
Researchers at the Research Center Translational Neurosciences of Johannes Gutenberg University Mainz (JGU) in Germany have advanced a generalized concept as the basis for future studies of mental resilience. Their new approach is based on a mechanistic theory which takes as its starting point the appraisals made by the brain in response to exposure to stressful or threatening situations. Previously social, psychological, and genetic factors were in the foreground of resilience research. The Mainz-based team has published its conclusions in the renowned journal Behavioral and Brain Sciences.
Stress, traumatic events, and difficult life situations play a significant role in the development of many mental illnesses, such as depression, anxiety, addiction. However, not everyone exposed to such circumstances develops a psychological disorder as a result. Every person has a greater or lesser mental stabilizing capacity and this inherent potential is called ‘resilience’ by psychologists. Resilience helps to effectively master challenges, stress, and difficult situations, thus maintaining mental health. The fact that some individuals either develop only short -term problems or do not become ill at all on experiencing major psychological or physical pressures suggests that there are certain protective mechanisms – in other words, defensive, self-healing processes – which can prevent the development of stress-related illnesses.
The core concern of the Mainz team of researchers is to identify these mechanisms. By means of a thorough review and analysis of the results of previous studies of and investigations into the subject of resilience, they were able to identify a common principle that can be used as a general basis for future studies of resilience. In order to achieve this, the researchers combined various parameters and research concepts – from psychological and social approaches to the results of genetic and even neurobiological investigations. “To date, research into resilience has tended to take into account a very extensive range of social, psychological, and even genetic factors that positively influence mental flexibility, such as social support, certain personality traits, and typical behavior patterns,” explained Professor Raffael Kalisch, one of the authors of the current publication and the director of the Neuroimaging Center, a central research platform of the Mainz University Medical Center and the Research Center on Translational Neurosciences. “We wondered whether there might be a common denominator behind all of these individual approaches and so we systematically examined various examples. As a result, in our new hypothesis we focus less on the already well-known social, psychological, or genetic factors and much more on cognitive processes happening in the brain.We thus consider that the appropriate way forward is to determine how the brain assesses each situation or stimulus. It is quite possibly the positive evaluation of potentially aversive stimuli that is the central mechanism which ultimately determines an individual’s level of resilience. The many already identified factors only impact on resilience indirectly by influencing the way the brain assesses a certain situation.” Assuming this theory is correct and it is the mental processes of evaluation that are of central relevance, this would mean that it is not necessarily the threatening situations or stimuli that decide whether stress develops but rather the manner in which the individual appraises the situation. A person who tends to more positively evaluate such factors would be protected against stress-related illnesses over the long term because the frequency and degree of stress reactions in that person would be reduced. The Mainz-based researchers call their new mechanistic hypothesis ‘Positive Appraisal Style Theory of Resilience’ (PASTOR).
The AWV was established by 2010’s Affordable Care Act to allow Medicare beneficiaries to receive preventive and assessment services during visits with their primary care providers. And although detection of cognitive impairment is among the required AWV services, no specific tools are mandated and no data are available regarding tools used for this purpose.
The new report outlines a plan for addressing this shortcoming and shows how increased detection leads to earlier and optimal diagnostic evaluation, referral to post-diagnosis support and educational services in the community, and ultimately to improved health-related outcomes and well-being for Medicare beneficiaries with diagnosed dementia and their families.
“The Medicare AWV offers a universal opportunity for primary care providers to start a conversation with older adults and their families about cognitive changes that might be worthy of further investigation,” said Richard Fortinsky, PhD, chair of the workgroup. “Our workgroup’s report provides guidance for providers so they can start this conversation and, as appropriate, employ evidence-based assessment tools to detect cognitive impairment.”
The report is available at www.geron.org/ci. The website also contains a link to a companion webinar held in January, led by workgroup members Katie Maslow, MSW, and Shari M. Ling, MD.
“Increased detection of cognitive impairment is essential for earlier diagnosis of Alzheimer’s disease and related dementia — and also earlier diagnosis leads to more timely linkage of older adults and their families with community-based services and supports,” Maslow said.
In the report, the workgroup outlines a recommended for four-step process achieving its goals.
Step 1 is to kickstart the cognition conversation. To increase detection of cognitive impairment and promote earlier diagnosis of dementia in the Medicare population, the GSA workgroup endorses that primary care providers use the AWV as an annual opportunity to kickstart — that is, to initiate and continue — a conversation with beneficiaries and their families about memory-related signs and symptoms that might develop in older adulthood.
Step 2 is to assess the patient if he or she is symptomatic. The GSA workgroup endorses use of a cognitive impairment detection tool from a menu of tools having the following properties: it can be administered in
five minutes or less; it is widely available free of charge; it is designed to assess age-related cognitive impairment; it assesses at least memory and one other cognitive domain; it is validated in primary care or community-based samples in the U.S.; it is easily administered by medical staff members who are not physicians; and it is relatively free from educational, language, and/or cultural bias. The report provides a list of tools that may be suitable for this purpose.
Step 3 is to evaluate with full diagnostic workup if cognitive impairment is detected. The GSA workgroup recommends that all Medicare beneficiaries who exceed threshold scores for cognitive impairment based on the cognitive assessment tools used in step 2 undergo a full diagnostic evaluation. Numerous published clinical practice guidelines are available to primary care providers and specialists to help them arrive at a differential diagnosis.
Step 4 involves referral to community resources and clinical trials, depending on the diagnosis. The GSA workgroup recommends that all Medicare beneficiaries who are determined to have a diagnosis of Alzheimer’s disease or related dementia be referred to all appropriate and available community services to learn more about the disease process and how to prepare for the future with a dementia diagnosis.
“The GSA workgroup views this suggested four-step process as a framework for communicating with a wide variety of stakeholders about the critical importance of incorporating cognitive impairment detection into everyday clinical practice with older adults,” Fortinsky said. “We look forward to building on this report by helping to plan additional activities intended to disseminate and implement the report’s recommendations in communities throughout the country.”
“I think the Affordable Care Act is actually doing quite well,” says Senior Fellow Alice Rivlin in this podcast. Rivlin, the Leonard D. Schaeffer Chair in Health Policy Studies and director of the Engelberg Center for Health Care Reform at Brookings, cited the expansion of medical insurance coverage, declining cost growth, and other positive factors for the ACA. She also reflects on continued political opposition to the law, the impending King v. Burwell Supreme Court case, and what it was like to stand up a new federal agency, the Congressional Budget Office, in 1975.
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Also in the podcast, Senior Fellow David Wessel, director of the Hutchins Center on Fiscal and Monetary Policy, offers his regular “Wessel’s Economic Update.”
How and why our bodies are poorly suited to modern environments—and the adverse health consequences that result—is a subject of increasing study. A new book The Story of the Human Bodyby Daniel Lieberman, chair of the Department of Human Evolutionary Biology at Harvard, chronicles major biological and cultural transitions that, over the course of millions of years, transformed apes living and mating in the African forests to modern humans browsing Facebook and eating Big Macs across the planet.
“The end product of all that evolution,” he writes, “is that we are big-brained, moderately fat bipeds who reproduce relatively rapidly but take a long time to mature.”
But over the last several hundred generations, it has been culture—a set of knowledge, values and behaviors—not natural selection, that has been the more powerful force determining how we live, eat and interact. For most of our evolutionary history, we were hunter-gatherers who lived at very low population densities, moved frequently and walked up to 10 miles a day in search of food and water. Our bodies evolved primarily for and in a hunter-gatherer lifestyle.
Immediately thought of my Liberian FB friends, a nurse and dean at a community college, a healthcare screener upcountry in a small town (my Peace Corps site back in 1980/81), and a Methodist deacon (one of my former students). All went above and beyond the call of duty during the Ebola crisis.
Back in 2009 I participated in a service project group in Liberia. Was taken aback by noticing that at least half of those over 18 seemed to have cell phones. Believed this was quite good. The roads overall are pretty bad, unpaved, and nearly impassible during the 3 month rainy season. So the cell phones really keep people connected, and relay information well. I get rather irked when I read comments (FB, editorials, etc) that say poor people should not have cell phones. Well, I strongly disagree, overall I believe they save money (think transportation costs for many information needs at the least!). How arrogant for some of “the haves” to believe “the have nots” are not using their scarce resources wisely.
Not sure what I can do to advance mobile health in Liberia, but I will do what I can.
Thanks for posting this, I have forwarded this to my Liberian FB friends. Most likely stuff they already know. The deacon obtained his PhD in theology in DC, the nurse/deacon is very aware of technology, and the healthcare screener is from Nigeria and has a good education and is very much a world citizen.
According to a new survey, mobile technology has the potential to profoundly reshape the healthcare industry, altering how care is delivered and received.
Executives in both the public and private sector predict that new mobile devices and services will allow people to be more proactive in attending to their health and well-being.
These technologies promise to improve outcomes and cut costs, and make care more accessible to communities that are currently underserved. Mobile health could also facilitate medical innovation by enabling scientists to harness the power of big data on a large scale.
ASU students find income, education affect calorie menu use
Fast food restaurants around the country are starting to look a little different. Step up to the counter and you may notice calorie counts listed next to food items on the menu. Which customers notice and use that information to make healthier choices depends on their income and education level.
A newly published research study conducted by graduate students Jessie Green and Alan Brown under the guidance of Punam Ohri-Vachaspati, a nutrition researcher at the School of Nutrition and Health Promotion at Arizona State University, examined whether noticing and using calorie menu labels was associated with demographic characteristics of customers at a national fast food chain currently posting calorie counts. They found that approximately 60 percent of participants noticed the calorie menu labels but only 16 percent reported using the labels to determine food and beverage choices.
Green and her co-authors found that customers with higher incomes were twice as likely to notice the calorie labels and three times more likely to use them.
The study, published today in the Journal of the Academy of Nutrition and Dietetics, is the first of its kind specifically designed to examine the likelihood of customers noticing and using calorie menu labels in fast food restaurants in a mixed income and racially diverse sample of adults.
“Studies show consumers and nutritionists alike have trouble estimating the calorie and nutrient content of a restaurant meal,” Ohri-Vachaspati said. “Because fast food is a popular choice among Americans, we wanted to see how effective menu labeling was and if it helped customers make healthier choices. What we found, however, was that while the majority of customers noticed the labels, a very small percentage reported using them to influence their purchasing decisions, and customers with lower income and lower education levels reported using menu labels to a much lesser extent.”
In the United States, fast food is the second-largest source of total energy in the diets of children and adolescents. Studies have found frequently eating out at fast food restaurants is associated with greater weight gain and obesity, leading to a plethora of chronic health issues.
Researchers have cracked a code that governs infections by a major group of viruses including the common cold and polio.
Until now, scientists had not noticed the code, which had been hidden in plain sight in the sequence of the ribonucleic acid (RNA) that makes up this type of viral genome.
But a paper published in the Proceedings of the National Academy of Sciences (PNAS) Early Edition by a group from the University of Leeds and University of York unlocks its meaning and demonstrates that jamming the code can disrupt virus assembly. Stopping a virus assembling can stop it functioning and therefore prevent disease.
Professor Peter Stockley, Professor of Biological Chemistry in the University of Leeds’Faculty of Biological Sciences, who led the study, said: “If you think of this as molecular warfare, these are the encrypted signals that allow a virus to deploy itself effectively.
“Now, for this whole class of viruses, we have found the ‘Enigma machine’—the coding system that was hiding these signals from us. We have shown that not only can we read these messages but we can jam them and stop the virus’ deployment.”
Single-stranded RNA viruses are the simplest type of virus and were probably one of the earliest to evolve. However, they are still among the most potent and damaging of infectious pathogens.
Rhinovirus (which causes the common cold) accounts for more infections every year than all other infectious agents put together (about 1 billion cases), while emergent infections such as chikungunya and tick-borne encephalitis are from the same ancient family.
Other single-stranded RNA viruses include the hepatitis C virus, HIV and the winter vomiting bug norovirus.
This breakthrough was the result of three stages of research:
In 2012, researchers at the University of Leeds published the first observations at a single-molecule level of how the core of a single-stranded RNA virus packs itself into its outer shell—a remarkable process because the core must first be correctly folded to fit into the protective viral protein coat. The viruses solve this fiendish problem in milliseconds. The next challenge for researchers was to find out how the viruses did this.
University of York mathematicians Dr Eric Dykeman and Professor Reidun Twarock, working with the Leeds group, then devised mathematical algorithms to crack the code governing the process and built computer-based models of the coding system.
In this latest study, the two groups have unlocked the code. The group used single-molecule fluorescence spectroscopy to watch the codes being used by the satellite tobacco necrosis virus, a single stranded RNA plant virus.
Technology occupies an unusual place in health care. Some people say that electronic health records are clumsy barriers between patients and their doctors. Others suggest that technology is a kind of secret sauce.
In many places physicians and other clinicians are stymied by awkward technology. In other organizations — Kaiser Permanente included — electronic health records enable some of the finest individual and population health care ever.
This humorous equation speaks volumes about technology and health care:
NT + OO = COO
New technology + old organization = Costly old organization. In other words, technology doesn’t change an organization. Change is about leadership and culture. It is about thinking in new ways and asking new questions.
For example, rather than ask how many patients can you see, let’s ask how many patients’ problems can you solve?
Instead of asking how can we convince patients to get required prevention, let’s ask how can we create systems that significantly increase the likelihood that patients get required prevention?
Instead of asking how often should a physician see a patient to optimally monitor a condition, let’s ask what is the best way to optimally monitor a condition?
When we begin asking these kinds of questions, we see technology as a tool — not a solution by itself, but as a powerful tool we can use to deliver better individual and population care. Technology, like data, is only useful when it enables clinicians and teams to work effectively to provide the highest quality care for patients.
Eliminating discrimination on the basis of preexisting conditions is one of the central features of the Affordable Care Act (ACA). Before the legislation was passed, insurers in the nongroup market regularly charged high premiums to people with chronic conditions or denied them coverage entirely. To address these problems, the ACA instituted age-adjusted community rating for premiums and mandated that plans insure all comers. In combination with premium subsidies and the Medicaid expansion, these policies have resulted in insurance coverage for an estimated 10 million previously uninsured people in 2014.1
There is evidence, however, that insurers are resorting to other tactics to dissuade high-cost patients from enrolling. A formal complaint submitted to the Department of Health and Human Services (HHS) in May 2014 contended that Florida insurers offering plans through the new federal marketplace (exchange) had structured their drug formularies to discourage people with human immunodeficiency virus (HIV) infection from selecting their plans. These insurers categorized all HIV drugs, including generics, in the tier with the highest cost sharing.2
Insurers have historically used tiered formularies to encourage enrollees to select generic or preferred brand-name drugs instead of higher-cost alternatives. But if plans place all HIV drugs in the highest cost-sharing tier, enrollees with HIV will incur high costs regardless of which drugs they take. This effect suggests that the goal of this approach — which we call “adverse tiering” — is not to influence enrollees’ drug utilization but rather to deter certain people from enrolling in the first place.
We found evidence of adverse tiering in 12 of the 48 plans — 7 of the 24 plans in the states with insurers listed in the HHS complaint and 5 of the 24 plans in the other six states (see theSupplementary Appendix for sample formularies). The differences in out-of-pocket HIV drug costs between adverse-tiering plans (ATPs) and other plans were stark (seegraphAverage HIV-Related Costs for Adverse-Tiering Plans (ATPs) versus Other Plans.). ATP enrollees had an average annual cost per drug of more than triple that of enrollees in non-ATPs ($4,892 vs. $1,615), with a nearly $2,000 difference even for generic drugs. Fifty percent of ATPs had a drug-specific deductible, as compared with only 19% of other plans. Even after factoring in the lower premiums in ATPs and the ACA’s cap on out-of-pocket spending, we estimate that a person with HIV would pay more than $3,000 for treatment annually in an ATP than in another plan.
Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans. A recent analysis of insurance coverage for several other high-cost chronic conditions such as mental illness, cancer, diabetes, and rheumatoid arthritis showed similar evidence of adverse tiering, with 52% of marketplace plans requiring at least 30% coinsurance for all covered drugs in at least one class.3 Thus, this phenomenon is apparently not limited to just a few plans or conditions.
Adverse tiering is problematic for two reasons. First, it puts substantial and potentially unexpected financial strain on people with chronic conditions. These enrollees may select an ATP for its lower premium, only to end up paying extremely high out-of-pocket drug costs. These costs may be difficult to anticipate, since calculating them would require knowing an insurer’s negotiated drug prices — information that is not publicly available for most plans.
Second, these tiering practices will most likely lead to adverse selection over time, with sicker people clustering in plans that don’t use adverse tiering for their medical conditions.
Pew and other health care organizations released a report on February 5, 2015 exploring measures that should be considered to address the ongoing issue of drug shortages in the United States, which impacts lifesaving medicines including antibiotics, chemotherapy, and cardiovascular drugs. The report summarizes manufacturing, regulatory, and economic issues related to drug shortages, as well as potential solutions identified at a 2014 Summit attended by 22 stakeholder groups, including health care professionals, non-profit organizations, industry, public interest, and government agencies.
The report explores the potential manufacturing, economic, and regulatory causes of drug shortages, and considers several possible solutions that merit further exploration, including:
Improving quality systems in pharmaceutical manufacturing to better prevent production problems that can lead to shortages by encouraging companies to foster a corporate quality culture, and use FDA’s set of quality metrics to support early collaboration between manufacturers and the agency.
Identifying regulatory efficiencies, such as synchronizing reviews by regulators in different countries to shorten the overall time for full approvals for facility upgrades.
Allowing for commercialization of trial batches of drugs that meet quality specifications to help mitigate losses during the approval process for upgrades to plants or production lines.
Incentivizing manufacturer investments in capacity and reliability by increasing contractual penalties for failing to supply a product, and also allowing price increases.
Supporting the market through better guarantees of demand by committing to the purchase of specified volumes of drugs vulnerable to shortage, either by a group purchasing organization or through a government program.
Establishing limited and/or shared exclusivity agreements to incentivize companies to produce needed drugs where there are no active producers.
Standardizing commonly used doses and concentrations in unit-of-use packaging to reduce waste and avoid contamination.
The 2014 Drug Shortages Summit was organized by the American Hospital Association, the American Society of Anesthesiologists®, the American Society of Clinical Oncology, the American Society of Health-System Pharmacists, the Institute for Safe Medication Practices, and The Pew Charitable Trusts. Previous summits were held in 2010 and 2013.
Reminds me of high school biology (1971). We took samples in the building, including drinking fountains, shower area, cafeteria, and restrooms. Were we ever grossed out!
On another note, am wondering how many folks have strong enough immune systems so these bacteria don’t take hold. From the 5 February article at the Rockefeller University
Forget the five-million plus commuters and untold number of rats – many of the living things crowded into the New York City subway system are too small to see. An interest in the more menacing among these microbes led high school student Anya Dunaif, a participant in Rockefeller’s Summer Science Research Program, to spend her vacation swabbing benches and turn styles beneath the city. Among her findings: bacteria impervious to two major antibiotics.
The samples she collected and cultured in five stations are a component of a city-scale environmental DNA sampling effort led by Chris Mason, an assistant professor at Weill Cornell Medical College with support from Rockefeller’s Science Outreach program, as well as from numerous local, national and international collaborators. This project, called Pathomap, seeks to profile the city’s microbial community, or microbiome, while also capturing DNA from other organisms. All of this genetic evidence could potentially be used to assess biological threats, including those to human health. The project’s initial results are described in a paper published Wednesday (February 4) inCell Systems.
With help from fellow high school student researcher Nell Kirchberger, Dunaif collected the bacteria on swabs and tested to see if they would grow in Petri dishes containing three commonly used antibiotics. Bacteria from five of the 18 swabs she tested grew in spite of the presence of either ampicillin or kanamycin, and in one case, both. None of the cultured bacteria appeared resistant to the third antibiotic, chloramphenicol.
Antibiotic resistance – the ability of disease-causing bacteria to withstand compounds used to kill them off – can make a once treatable infection more serious, even life threatening. A natural consequence of evolution, and the widespread use and misuse of antibiotics, resistance is increasing worldwide.
The intersection between rising consumerism and a growing retail orientation in the health care sector presents challenges, some unprecedented, for existing players. We explore three shifts that health industry players should respond to, and that can set the scene for greater consumer involvement.
Matching a buyer with a seller. On Angie’s List it’s simple: Consumers search, select, and schedule the services that fit their needs.
Could it ever be that easy in health care?
The cost of health care is high and rising. For the past 10 years, health care costs have exceeded US economic growth by an average 2.5 percent annually. The anticipated average annual growth rate of health care costs is 5.7 percent per year through 2023, well above gross domestic product (GDP), average wages, and productivity gains.1 Improving economic conditions, the impact of the ACA’s insurance coverage expansions, and an aging population are expected to drive health care expenditure growth.2 Average annual growth of out-of-pocket health care expenditure is projected to rise to 5.5 percent by 2023 from 3.2 percent in 2013.3
The health care system in the United States is edging toward a recalibration. Existing business models are being challenged to find and deliver new sources of value and to develop innovative approaches to make health care less complicated, and to improve outcomes:
Health care is moving toward value, not volume, as a central organizing principle. That impacts how patients are cared for, how physicians and hospitals are paid, and how life sciences companies approach the market.
Those paying the bills—employers, government, health plans, and increasingly, individuals—are looking for better value and better outcomes.
Entrepreneurs, retail organizations, and communications and technology companies see opportunity in the large and growing health care market. Taking advantage of developing trends, they are slipping across the industry’s increasingly permeable boundaries.
Young adulthood—ages approximately 18 to 26—is a critical period of development with long-lasting implications for a person’s economic security, health, and well-being.
Recognizing the need for a special focus on young adulthood, the Health Resources and Services Administration and the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, the Robert Wood Johnson Foundation, The Annie E. Casey Foundation, and the Department of Defense commissioned the Institute of Medicine (IOM) and National Research Council (NRC) to convene a committee of experts to review what is known about the health, safety, and well-being of young adults and to offer recommendations for policy and research.
The resulting report, Investing in the Health and Well-Being of Young Adults, offers federal, state, and local policy makers and program leaders, as well as employers, nonprofit organizations, and other community partners’ guidance in developing and enhancing policies and programs to improve young adults’ health, safety, and well-being. In addition, the report suggests priorities for research to inform policies and programs for young adults.
A new analysis from Aon Hewitt, the global talent, retirement and health solutions business of Aon plc (NYSE:AON) finds that Millennials put a lower priority on medical care than other generations. However, they are the most likely to want employers to play an active role in supporting their overall health and wellbeing.
The analysis is based on data from the 2014 Consumer Health Mindset report, a joint survey of more than 2,700 U.S. employees and their dependents conducted by Aon Hewitt, the National Business Group on Health and The Futures Company. Aon Hewitt analyzed the perspectives, behaviors and attitudes of employees from different generations towards health and wellness.
According to the analysis, Millennials are the least likely to participate in activities focused on prevention and maintaining or improving physical health compared to other generations. About half (54 percent) have had a physical in the last 12 months, compared to 60 percent of Generation X and 73 percent of Baby Boomers. In addition, just 39 percent say preventive care is one of the most important things to do to stay healthy, compared to 49 percent of Generation X and 69 percent of Baby Boomers.
Millennials are also less likely to participate in a healthy eating/weight management programs (21 percent), compared to Generation X (23 percent) and Baby Boomers (28 percent). Interestingly, they are the most likely generation to engaging in regular exercise (63 percent), compared to 52 percent of Generation X and 49 percent of Baby Boomers.
The literature is clear – when life goes wrong, health goes wrong. Case in point – it’s now estimated that workplace stress alone is causing additional expenditures of between $125 to $190 billion a year – representing 5 to 8 percent of national spending on health care…and even more importantly – 120,000 deaths a year.
There are growing examples of individuals and organizations that get this stuff – and that are fielding solutions to help. Companies like Health Leads (meeting us on the lowest rung of Maslow’s Hierarchy and getting us access to heat, water, safety…), and Iora Health (meeting us squarely where we are and getting us support for our caregiver stress, our divorce, our substance issue…). I recently got to be part of the latest Robert Wood Johnson Foundation’s Pioneering Ideas Podcast (link below) and in the process learned how broadly this idea is spreading…Dr. Paul Tang of linkAges from Palo Alto Medical Foundation(a project RWJF supports) talks about stress, and its effects – especially on seniors – and what we can do about it. Harvard economist/MacArthur Genius Grant winner Sendhil Mullainathan shares ideas for transforming health and healthcare in a world where ‘attentional real estate’ – given the messy realities of life – is scarce. We double dog dare you to listen here:
As an industry with a mantra to heal, this is ground zero. We need to expand our definition of health to include life – and take this on not just as our obligation, but as our opportunity to address the fundamental drivers of health. And let’s not stop there. Let’s practice radical empathy with each other, and with ourselves. Let’s do it in the privacy of our homes, and let’s bring that raw authenticity with us to our work. Whatever you do to start acknowledging that health is life – start it now… maybe just by closing your eyes and inhaling a big fat breath of fresh air while reminding yourself, ‘I am not alone in this crazy world, because we all feel alone and on some level we are all crazy – but only in the very best of well-intentioned ways.’
Courtesy of Dr. Eileen LudersAreas of the brain affected by aging (in red) are fewer and less widespread in people who meditate, bottom row, than in people who don’t meditate.
Since 1970, life expectancy around the world has risen dramatically, with people living more than 10 years longer. That’s the good news.
The bad news is that starting when people are in their mid-to-late-20s, the brain begins to wither — its volume and weight begin to decrease. As this occurs, the brain can begin to lose some of its functional abilities.
So although people might be living longer, the years they gain often come with increased risks for mental illness and neurodegenerative disease. Fortunately, a new study shows meditation could be one way to minimize those risks.
Building on their earlier work that suggested people who meditate have less age-related atrophy in the brain’s white matter, a new study by UCLA researchers found that meditation appeared to help preserve the brain’s gray matter, the tissue that contains neurons
The researchers cautioned that they cannot draw a direct, causal connection between meditation and preserving gray matter in the brain. Too many other factors may come into play, including lifestyle choices, personality traits, and genetic brain differences.
The public continues to express positive views of many agencies of the federal government, even though overall trust in government is near historic lows. Large majorities express favorable views of such government agencies as the Centers for Disease Control and Prevention (CDC), NASA and the Defense Department.
In fact, favorable opinions surpass unfavorable views for seven of eight government agencies tested – the IRS is the lone exception. In a survey last February, however, just 24% said they could trust the government in Washington always or most of time. (See this interactive for more on trust in government.)
While health-conscious individuals understand the benefits of eating fresh fruits and veggies, they may not be aware of the amount of pesticides they could be ingesting along with their vitamin C and fiber. A new study published in the Feb. 5 edition of Environmental Health Perspectives is among the first to predict a person’s pesticide exposure based on information about their usual diet.
The study was led by Cynthia Curl, an assistant professor in Boise State University’s School of Allied Health Sciences. She recently joined Boise State from the University of Washington.
While Curl’s study is not the first to link organic produce with reduced pesticide exposure, the method she used may have significant implications for future research. By combining self-reported information on typical food consumption with USDA measurements, researchers will be able to conduct research on the relationship between dietary pesticide exposure and health outcomes in bigger populations, without needing to measure urinary metabolites.
“If we can predict pesticide exposure using dietary questionnaire data, then we may be able to understand the potential health effects of dietary exposure to pesticides without having to collect biological samples from people,” Curl said. “That will allow research on organic food to be both less expensive and less invasive.”
Independent journalist Lola Butcher reports that debate about the government’s 340B Drug Pricing Program continues to build as the program expands.
“Like all good controversies, this one has enthusiastic advocates and wild-eyed opponents, and it’s easy to get snagged by the passion of the partisans,” she writes in a new tip sheet.
The program, which started in 1992, requires pharmaceutical companies to sell outpatient drugs to eligible health care organizations at significantly reduced prices.
Over the years, the eligibility criteria to participate has expanded repeatedly. Currently, safety-net hospitals, children’s hospitals, critical access hospitals, federal health centers and other organizations are eligible; organizations that fall into those categories must register and enroll in the 340B program.
My sentiments exactly. A few months ago, I collapsed at church. Although I couldn’t stand up well, I knew it was from exhaustion, and not anything needing immediate expensive care. I was talked into going to the hospital by the first responders. Battery of tests showed everything was normal. Thank goodness for insurance, the bill was nearly $2,000.
When we are sick, how much health care is good health care? These days when we call an ambulance, the medics rush in with all sorts of equipment and medications — called advanced life support, which replaces the basic life support that many of us learned in CPR classes.
Doing More for Patients Often Does No Good, a January 12, 2015 article appearing in the New York Times, makes the point that more advanced therapies and medical care do not guarantee higher quality or better outcomes. Written by Aaron E. Carroll, M.D., the piece shares a study in the journal JAMA Internal Medicine that compared the outcomes for patients who had received life support — basic or advanced — before being admitted to the hospital. He also writes about other studies that appear to show how the most advanced emergency care does not necessarily mean longer survival.
For American Heart Month 2015, the editorial team at Women’s Health Issues has assembled a special collection of research on women’s cardiovascular health published in the journal since mid-2011, following the release of updated American Heart Association guidelines on the prevention of cardiovascular disease in women. The articles address healthcare services for women at risk for cardiovascular disease; social determinants of health; and physical activity in specific populations of women.
These articles will be accessible for free during the month of February 2015 so that they are available to a wider interested audience.
Taking in such spine-tingling wonders as the Grand Canyon, Sistine Chapel ceiling or Schubert’s “Ave Maria” may give a boost to the body’s defense system, according to new research from UC Berkeley.
Researchers have linked positive emotions – especially the awe we feel when touched by the beauty of nature, art and spirituality – with lower levels of pro-inflammatory cytokines, which are proteins that signal the immune system to work harder.
“Our findings demonstrate that positive emotions are associated with the markers of good health,” said Jennifer Stellar, a postdoctoral researcher at the University of Toronto and lead author of the study, which she conducted while at UC Berkeley.
While cytokines are necessary for herding cells to the body’s battlegrounds to fight infection, disease and trauma, sustained high levels of cytokines are associated with poorer health and such disorders as type-2 diabetes, heart disease, arthritis and even Alzheimer’s disease and clinical depression.
It has long been established that a healthy diet and lots of sleep and exercise bolster the body’s defenses against physical and mental illnesses. But the Berkeley study, whose findings were just published in the journal Emotion, is one of the first to look at the role of positive emotions in that arsenal.
Systems that capture, analyze, and report surgical outcomes are an increasingly important part of the quality improvement movement in health care in the United States. Within the U.S., the most widely used surgical outcomes reporting system is the National Surgical Quality Improvement Program (NSQIP), which is coordinated through the American College of Surgeons.
The study analyzed data regarding surgical outcomes — complications, serious complications, and mortality — in over 345,000 patients treated between 2009 and 2013 at academic hospitals throughout the United States. Of these patients, approximately half were treated at hospitals that participated in the NSQIP. The study showed that surgical outcomes significantly improved overall in both study groups during the period of analysis.
“In our study we weren’t interested in whether patients had better outcomes in NSQIP vs. non-NSQIP hospitals,” says David Etzioni, M.D., chair of Colorectal Surgery at Mayo Clinic in Arizona and the study author. “We wanted to know whether the outcomes experienced by patients treated at NSQIP hospitals improved, over time, in a way that was different from patients treated at non-NSQIP hospitals.”
The study found no association between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time, suggesting that a surgical outcomes reporting system does not provide a clear mechanism for quality improvement. According to the research team, the failure of these types of outcomes monitoring systems to produce measurable improvements in outcomes may be related to difficulties in identifying mechanisms that translate reports into changes in how surgical care is provided.
“I think if there is one lesson that we have learned at Mayo Clinic; real quality is achieved through a system — not just a doctor, not just a nurse or other staff,” Dr. Etzioni says. “All of these elements of care have to work together closely to provide patients with the best possible outcomes.”
An examination of process measures endorsed by the National Quality Forum finds that these measures focus predominantly on management of patients with established diagnoses, and that quality measures for patient presenting symptoms often do not reflect the most common reasons patients seek care, according to a study in the February 3 issue of JAMA.
Health care reform efforts, such as accountable care organizations, focus on improving value partly through controlling use of services, including diagnostic tests. Publicly reported quality measures that evaluate care provided prior to arriving at a diagnosis could prevent financial incentives from producing harm. The National Quality Forum (NQF) currently serves as the consensus-based quality-measure-endorsement entity called for in the Affordable Care Act. Endorsed measures are often adopted by the Centers for Medicare & Medicaid Services in payment and public reporting programs, according to background information in the article.
Hemal K. Kanzaria, M.D., M.S.H.P.M., of the University of California, Los Angeles, and colleagues examined NQF-endorsed process measures that evaluate the prediagnostic (prior to making a diagnosis) care of patients presenting with signs or symptoms. There were 372 process quality measures listed on the NQF website as of June 4, 2014; from these, 385 codings were determined, by categorizing the process quality measures by a system developed by the Institute of Medicine. Approximately two-thirds (n = 267) targeted disease management and 12 percent (n = 46) targeted evaluation/diagnosis. The remaining were evenly distributed among prevention, screening, and follow-up.
Of 313 measures pertaining to evaluation/diagnosis or management, 211 (67 percent) began with an established diagnosis, whereas 14 (4.5 percent) started with a sign/symptom. The sign/symptom-based measures focused on geriatric care (e.g., memory loss, falls, urine leakage) or emergency department care (e.g., chest pain). In contrast, many common reasons for which patients seek care, including fever, cough, headache, shortness of breath, earache, rash, and throat symptoms, were not reflected by the quality measures. The performance of a lab test or medical imaging study was the action required by 59 of 313 (19 percent) endorsed quality measures; many others required actions related to medication prescribing.
Recent research indicates that most of the variation in hospital readmission rates in the United States is related to geography and other factors over which hospitals have little or no control. Access and quality of care outside of the hospital setting seem to be especially important.
A new editorial that addresses these findings notes that a broader focus on community health systems, not just performance of individual hospitals, may be needed to reduce hospital readmissions.
Because high readmission rates trigger reductions in Medicare reimbursements to hospitals, facilities in socioeconomically disadvantaged and underserved communities may be disproportionately penalized. The editorial is published in Health Services Research.
Access and quality outside the hospital may affect the degree to which the HRRP can achieve its intended outcome, fewer readmissions, but other factors are likely to determine whether the policy is an operational success. For the HRRP, operational success could be defined as whether hospitals respond in a manner consistent with the underlying motivations of improving quality of care and reducing costs. In terms of improving quality, a recent meta-analysis of randomized trials found that interventions designed to prevent readmissions tended be moderately effective (relative risk of 30-day readmission 0.82, 95 percent CI, 0.73–0.91). The studied interventions addressed care both during and after hospitalization, such as through case management, patient education, home visits, and patient self-management support, among other activities. Multifaceted interventions were more common and were 30–40 percent more effective than one-dimensional ones (Leppin et al. 2014), yet they may also be more challenging to implement and more costly. The degree to which hospitals nationwide are implementing quality improvement interventions that target readmissions does not appear to have been described.
Study does not address why, which I would really like to know!
My cholesterol is high, but I do not take a statin, against the advice of the doctor. Still not convinced they work after reading several evidence based biomedical journal articles. But I admit I am not consistent. Am exercising and watching what I eat.
In a survey, one in three adults say they would risk living a shorter life rather than taking a daily pill to prevent cardiovascular disease.
About one in five say they were willing to pay $1,000 or more to avoid taking a daily pill for the rest of their lives.
Most respondents weren’t willing to trade any weeks of life to avoid daily medication.
Embargoed until 3 p.m. CT/4 p.m. ET Tuesday, Feb. 3, 2015
DALLAS, Feb. 3, 2015 — One in three people say they would risk living a shorter life instead of taking a daily pill to prevent cardiovascular disease, according to new research inCirculation:Cardiovascular Quality and Outcomes, an American Heart Association journal.
Researchers at the University of California San Francisco (UCSF) and the University of North Carolina at Chapel Hill surveyed 1,000 people (average age 50) via the Internet hypothetically asking how much time they were willing to forfeit at the end of their lives to avoid taking daily medication. They were also asked the amount of money they would pay and the hypothetical risk of death they were willing to accept to avoid taking medications to prevent cardiovascular disease.
The survey showed:
More than 8 percent of participants were willing to trade as much as two years of life to avoid taking daily medication for cardiovascular disease; while roughly 21 percent would trade between one week and a year of their lives.
About 70 percent said they wouldn’t trade any weeks of their lives to avoid taking a CVD pill daily
About 13 percent of participants said they would accept minimal risk of death to avoid taking a pill daily; 9 percent said they’d risk a 10 percent chance; and about 62 percent weren’t willing to gamble any risk of immediate death.
About 21 percent said they would pay $1,000 or more to avoid taking a pill each day for the rest of their lives, but 43 percent said they wouldn’t pay any amount.
Fifteen years ago, the name “Aiden” was hardly on the radar of Americans with new babies. It ranked a lowly 324th on the Social Security Administration’s list of popular baby names. But less than a decade later, the name became a favorite, soaring into the top 20 for five years and counting.
While some may attribute its popularity to a “Sex in the City” character, a new study led by the University of Pennsylvania’s Damon Centola provides a scientific explanation for how social conventions – everything from acceptable baby names to standards of professional conduct – can emerge suddenly, seemingly out of nowhere, with no external forces driving their creation.
The research used an original Web-based experiment to test whether and how large populations come to consensus. The findings have implications for everything from understanding why different regions of the country have distinct words for the same product — soda versus pop, for example — to explaining how norms regarding civil rights gained widespread traction in the United States.
“Our study explains how certain ideas and behaviors can gain a foothold and, all of a sudden, emerge as big winners,” Centola said. “It is a common misconception that this process depends upon some kind of leader, or centralized media source, to coordinate a population. We show that it can depend on nothing more than the normal interactions of people in social networks.”
To understand how social norms arise, Centola and Baronchelli invented a Web-based game, which recruited participants from around the World Wide Web using online advertisements. In each round of the “Name Game,” participants were paired, shown a photograph of a human face and asked to give it a name. If both players provided the same name, they won a small amount of money. If they failed, they lost a small amount and saw their partner’s name suggestion. The game continued with new partners for as many as 40 rounds.
Though the basic structure of the game remained the same throughout the experiment, the researchers wanted to see whether changing the way that players interacted with one another would affect the ability of the group to come to consensus.
They began with a game of 24 players, each of whom was assigned a particular position within an online “social network.” The participants, however, weren’t aware of their position, didn’t know who they were playing with or even how many other players were in the game.
Centola and Baronchelli tested the effects of three different types of networks.
In the “geographical network” version, players interacted repeatedly with their four closest neighbors in a spatial neighborhood. In the “small world network” game, participants still played with only four other players, but the partners were chosen randomly from around the network. And in the “random mixing” version, players were not limited to four other partners, instead playing each new round with a new partner selected at random from all the participants.
As the games proceeded, the researchers observed clear patterns in people’s behavior that distinguished the different networks.
In the geographical and small world network games, participants easily coordinated with their neighbors, but they were not able to settle on one overall “winning” name for the population. Instead, a few competing names emerged as popular options: Sarah, Elena, Charlene and Julie all vying for dominance, for instance, with no global agreement.
“Between 2002 and 2010, both improvements in health (ie, increased physical activity and life satisfaction) and declines in health (increased body mass and physical symptoms) in young people were recorded. At the same time, the difference in health between the least and the most well-off became larger.”
Over the past decade, rising national wealth across high-income countries has contributed to some improvements in health and well-being among adolescents. But the gap in health between rich and poor has widened, an international study of nearly half a million adolescents from 34 countries  across Europe and North America has found.
The findings, published in The Lancet, reveal that socioeconomic differences across multiple areas of adolescent mental and physical health increased between 2002 and 2010, with young people from the poorest socioeconomic groups more likely to be in worse health: being less physically active, with larger body mass index (BMI), and reporting more physical and psychological symptoms (such as irritability or headaches).
“A strong international focus on reducing child poverty and mortality in children under 5 years has not been matched by a similar response in older age groups, resulting in widening socioeconomic inequalities in adolescent health,”  explains Frank Elgar, lead author and a psychiatry Professor at McGill University in Quebec, Canada.
“If health inequalities are now widening in such abundantly rich countries, particularly during the so-called ‘healthy years’ of adolescence, then these trends are especially alarming for future population health.” 
The aim of the study was to measure socioeconomic-related inequalities in five areas of adolescent health (physical activity, body mass index, psychological symptoms [irritability, feeling low, feeling nervous, and difficulty sleeping] and physical symptoms [headache, stomach ache, backache, and feeling dizzy, and life satisfaction]), and to track their changes between 2002 and 2010.
The researchers analysed nationally representative data from almost 500000 young people across Europe and North America who participated in the WHO Health Behaviour in School-aged Children study. The adolescents (age 11 to 15) were surveyed in 2002, 2006, and 2010. Socioeconomic status was based on material assets and common indicators of wealth such a owning a car. The researchers also examined whether differences in health and health inequalities between socioeconomic groups related to national wealth and income inequality.
Between 2002 and 2010, both improvements in health (ie, increased physical activity and life satisfaction) and declines in health (increased body mass and physical symptoms) in young people were recorded. At the same time, the difference in health between the least and the most well-off became larger. For example, the difference in amount of physical activity between the least and most affluent groups increased from 0.79 days to 0.83 days per week. Increasing differences were also found for body mass index (0.15 to 0.18), psychological symptoms (0.58 to 0.67), and physical symptoms (0.21 to 0.26). Only in life satisfaction did inequality decline, from a 0.98 point difference in 2002 to a 0.95 point difference in 2010 (see figure 1 page 3 and table 4 page 5).
The research also showed that adolescents living in countries with greater income inequality were less physically active had larger body mass index, lower life satisfaction, and reported more psychological and physical symptoms. Young people in these countries also had larger health inequalities between socioeconomic groups in psychological and physical symptoms and life satisfaction.
According to Professor Elgar, “The many health and social problems that relate to income inequality and the current global trends in rising income inequality all lead to a grim prediction about future population health. Urgent action is needed to tackle inequities in health in adolescence.”
Writing in a linked Comment, John Santelli, Wendy Baldwin, and Jennifer Heitel from Columbia University Mailman School of Public Health, New York, USA point out, “Investment in youth now could pay huge dividends in health outcomes and reduce health disparities in later years…Although some interventions should always support individual behaviour change, Elgar and colleagues remind us of the importance of social context. To improve health and reduce health disparities across the lifespan, a focus should be on social factors that affect the health and wellbeing of young people .”
The New York State attorney general’s office accused four major retailers on Monday of selling fraudulent and potentially dangerous herbal supplements and demanded that they remove the products from their shelves.
The authorities said they had conducted tests on top-selling store brands of herbal supplements at four national retailers — GNC, Target, Walgreens and Walmart — and found that four out of five of the products did not contain any of the herbs on their labels. The tests showed that pills labeled medicinal herbs often contained little more than cheap fillers like powdered rice, asparagus and houseplants, and in some cases substances that could be dangerous to those with allergies.
The investigation came as a welcome surprise to health experts who have long complained about the quality and safety of dietary supplements, which are exempt from the strict regulatory oversight applied to prescription drugs.
The Food and Drug Administration has targeted individual supplements found to contain dangerous ingredients. But the announcement Monday was the first time that a law enforcement agency had threatened the biggest retail and drugstore chains with legal action for selling what it said were deliberately misleading herbal products.
Among the attorney general’s findings was a popular store brand of ginseng pills at Walgreens, promoted for “physical endurance and vitality,” that contained only powdered garlic and rice. At Walmart, the authorities found that its ginkgo biloba, a Chinese plant promoted as a memory enhancer, contained little more than powdered radish, houseplants and wheat — despite a claim on the label that the product was wheat- and gluten-free.
A study including data from 346 hospitals found that readmissions during the first 30 days after surgery were associated with new complications—post-discharge problems related to the surgical procedure—and not, as previously suspected, to the worsening of medical conditions the patient already had or acquired while hospitalized for surgery.
In this study, published in the February 3 issue of JAMA, Ryan P. Merkow, MD, MS, a clinical scholar in residence at the American College of Surgeons, now chief surgery resident at the University of Chicago, and colleagues examined the reasons, timing, and factors associated with unplanned postoperative hospital readmissions within 30 days after surgery.
Financial penalties for readmissions have made them an important quality and cost-containment issue for hospitals and clinicians. Hospitals try to reduce readmissions, but until now little has been known about the reasons for readmission after surgery. Identifying these reasons could advance quality-improvement efforts and reduce surgical readmissions.
“The Hospital Readmission Reduction Program is federal law and is here to stay,” Merkow said. “Hospital administrators and quality departments must determine how to approach readmissions, and in particular readmissions after surgery.”
“Until recently, efforts were primary focused on medical conditions,” he said, “namely heart failure, myocardial infarction and pneumonia. However, a growing emphasis by policy makers now specifically targets readmissions after surgery. Yet, surprisingly, little is known about why surgical patients are being readmitted. It is completely unclear if oversight initiatives such as public reporting and pay-for-performance should be similarly applied to both medical and surgical patients.”
“Unlike patients being admitted for a medical condition, surgical patients experience a discrete, invasive event (i.e., surgery) with known risks of complications,” Merkow said. “We believe this study definitively separates medical and surgical readmissions as distinct entities that require unique reduction strategies.”
In this study, the unplanned 30-day readmission rate following 498,875 operations was 5.7 percent. Rates ranged from 3.8 percent after hysterectomy to 14.9 percent after lower-extremity vascular bypass. Only 2.3 percent of patients were readmitted for a complication they had experienced during their index hospitalization.
The researchers found that the most common reason for unplanned readmissions was surgical-site infections, followed by intestinal ileus or obstruction, bleeding or anemia, blood clots, and surgical-device issues. Surgical-site infections (SSI) ranged from 11.4 percent after bariatric surgery to 36.4 percent after lower extremity vascular bypass.
The findings have at least two significant policy implications, the authors insist. First, because most readmissions result from post-operative complications, “readmissions after surgery penalize hospitals twice.” And second, because it has been difficult to reduce the most common post-operative complications, such as surgical site infections, penalizing hospitals for problems they do not know how to prevent could be counterproductive, leading to untested solutions that may be ineffective or even counterproductive.
“Understanding the underlying reasons for readmission, the timing, and the associated factors should help hospitals undertake targeted quality-improvement initiatives to reduce readmissions,” the authors wrote. “However, surgical readmissions mostly reflect post-discharge complications, and readmission rates may be difficult to reduce until effective strategies are put forth to reduce common complications such as SSI.”
Efforts should focus on reducing complication rates overall rather than just those that occur after discharge, the authors insist. “This will subsequently reduce readmission rates as well. Readmissions after surgery may not be an appropriate measure for pay-for-performance programs but rather better suited as a measure for hospitals to track internally.”
Analysis of research on the effect of negative stereotypes on older people’s abilities has concluded these stereotypes are a major problem for the demographic.
A research team at the University’s School of Psychology carried out a review and meta-analysis of Aged-Based Stereotype Threat (ABST).
They statistically analysed international evidence from 37 research studies, both published and unpublished. They concluded that older adults’ memory and cognitive performance is negatively affected in situations that signal or remind them of negative age stereotypes. These effects affect both men and women.
The research, funded by the Economic and Social Research council (ESRC), was carried out by Ruth Lamont, working with Dr Hannah Swift and Professor Dominic Abrams. It further found that older people’s cognitive performance suffers more when the threat is induced by stereotypes rather than by facts.
This latest research studied how pain and anxietycan be reduced under local anaesthetic varicose vein surgery. This sort of surgery is also called “keyhole” orendovenous surgery for varicose veins.
Reducing pain of varicose vein surgery – Research from The Whiteley Clinic and University of Surrey
The research showed that both:
one-to-one talking with a specific nurse
using a stress ball
both significantly reduced the pain and anxiety of the varicose vein surgery.Interesting, watching a DVD during the surgery reduced the anxiety, but not the pain of varicose vein surgery. Listening to music had no effect.
This study is part of the continuing research program that makes treatment at The Whiteley Clinic unique.This projectwas funded by The Whiteley Clinic andwas performed at our Whiteley Clinic, Guildford.The researcher, Briony Hudson,was supervised by Prof Jane Ogden at The University of Surrey and Prof Mark Whiteley. Her workhas been submitted to the University of Surrey and shewas awarded her PhD in Autumn 2014.The workis going to be published:
Hudson BF, Ogden J, Whiteley MS. Randomised Controlled Trial to Compare the Effect of Simple Distraction Interventions on Pain and Anxiety Experienced During Conscious Surgery. European Journal of Pain. 2015.
A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) illuminates important trends — many positive — in Americans’ behavioral health, both nationally and on a state-by-state basis.
SAMHSA’s new report, the “National Behavioral Health Barometer” (Barometer), provides data about key aspects of behavioral healthcare issues affecting American communities including rates of serious mental illness, suicidal thoughts, substance use, underage drinking, and the percentages of those who seek treatment for these disorders. The Barometer shows this data at the national level, and for each of the 50 states and the District of Columbia.
The Barometer indicates that the behavioral health of our nation is improving in some areas, particularly among adolescents. For example, past month use of both illicit drugs and cigarettes has fallen for youth ages 12-17 from 2009 to 2013 (from 10.1 percent to 8.8 percent for illicit drugs and 9.0 percent to 5.6 percent for cigarettes). Past month binge drinking among children ages 12-17 has also fallen from 2009 to 2013 (from 8.9 percent to 6.2 percent).
The Barometer also shows more people are getting the help they need in some crucial areas. The number of people receiving treatment for a substance use problem has increased six percent from 2009 to 2013. It also shows that the level of adults experiencing serious mental illness who received treatment rose from 62.9 percent in 2012 to 68.5 percent in 2013.
The data in the Barometer is drawn from various federal surveys and provides both a snapshot of the current status of behavioral health nationally and by state, and trend data on some of these key behavioral health issues over time. The findings will be enormously helpful to decision makers at all levels who are seeking to reduce the impact of substance abuse and mental illness on America’s communities.
“The Barometer provides new insight into what is happening on the ground in states across the country,” said SAMHSA’s Administrator, Pamela S. Hyde. “It provides vital information on the progress being made in each state as well as the challenges before them. States and local communities use this data to determine the most effective ways of addressing their behavioral healthcare needs.”
The Barometer also provides analyses by gender, age group and race/ethnicity, where possible, to further help public health authorities more effectively identify and address behavioral health issues occurring within their communities, and to serve as a basis for tracking and addressing behavioral health disparities.
For the first time, the Barometer provides analyses broken down by poverty level (above or below) and health insurance status. This data can help provide researchers, policy makers, public health authorities and others a better understanding of how income and insurance coverage affect access and utilization of behavioral healthcare services.
For more information, contact the SAMHSA Press Office at 240-276-2130.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (DHHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
To better understand the current use of physical activity as medicine among Family Health Teams (FHTs) in Ontario, researchers at the Department of Kinesiology at the University of Waterloo and the Centre for Family Medicine Family Health Team conducted an environmental scan of 102 FHTs. They published their findings today in the journalApplied Physiology, Nutrition, and Metabolism.
Family Health Teams (FHTs) are part of a shift towards a multidisciplinary primary care model that addresses the healthcare needs of a community by allowing different healthcare professionals to work collaboratively under one roof. Currently, FHTs serve a relatively small percentage of Ontarians; however, their multi-disciplinary structure may create an ideal environment to enable physical activity promotion as most Canadians receive healthcare though the primary care system. Physical activity has well-established health benefits; however, the best way to engage Canadians in an active lifestyle remains largely unknown.
Before this environmental scan, the number and types of physical activity promotion services, and the types of professionals providing physical activity counselling in Ontario FHTs was not known .
The researchers found that almost 60% of responding FHTs in Ontario offered a physical activity service. However, the types, durations and targeted populations of the services varied depending on the individual FHT. Physical activity services were often restricted to people with specific conditions or needs rather than available to all individuals.
According to the study, “many different types of allied health professionals were facilitating physical activity services. The diversity in the qualifications is concerning, as it suggests that individuals providing physical activity therapy do not always have qualifications related to physical activity prescription and counselling.”
Cameron Moore, from the Department of Kinesiology at the University of Waterloo and co-author of the study said, “It is promising that almost 60% of responding FHTs offered a physical activity service. However, continued efforts are needed to increase the accessibility and standardization of physical activity therapy offered though primary care.“
“In Ontario, Kinesiology is a newly accredited professional designation with a scope of practice that includes physical activity promotion and prescription. We feel that physical activity counsellors who are Registered Kinesiologists with expertise in physical activity prescription and behavior change counselling are ideally suited as primary care providers in FHTs.”
Ten years after the 2005 Paris Declaration on Aid Effectiveness reported on the need for better coordination in the global fight against disease, global pharmaceutical supply chains remain fragmented and lack coordination, facing at least 10 fundamental challenges, according to a newly published paper by professors at NYU Wagner and MIT-Zaragoza.
“Heroes may win battles, but it is capable supply chains that win wars [against disease],” write Natalie Privett, assistant professor of management and policy at the Robert F. Wagner Graduate School of Public Service at New York University, and David Gonsalvez, professor of supply chain management at the MIT-Zaragova International Logistics Program, and former global supply chain director with General Motors. Yet, they add, the global health pharmaceutical delivery (GHPD) supply chains are wanting.
The research article, entitled “The top ten global health supply chain issues: Perspectives form the field,” has been published in Operations Research for Health Care, an academic journal. It sheds light on the key areas of weakness and what specifically is needed to strengthen the pharmaceutical supply chains.
Privett and Gonsalvez interviewed and surveyed 22 individuals with various roles in supply chains and asked them to identify the “top ten” challenges as they see them. The areas of concern which were most often cited include: lack of coordination; inventory management; absent demand information; human resource dependency; order management; shortage avoidance; expiration; warehouse management; temperature control; and shipment visibility.
“Lack of coordination in the GHPD supply chain is a root cause issue whose existence aggravates nearly every other issue director or indirectly,” according to the article.
The paper draws attention to both the needs and opportunities in GHPD supply chains in an attempt to “drive future actions, policies, and research which can ultimately improve pharmaceutical delivery in developing regions and save lives.”
A research consortium headed by Professor Hossam Haick of the Technion-Israel Institute of Technology is developing a product that, when coupled with a smartphone, will be able to screen the user’s breath for early detection of life-threatening diseases.
Funded by a grant from the European Commission, the SNIFFPHONE project will link Prof. Haick’s acclaimed breathalyzer screening technology to the smartphone to provide non-invasive, fast and cheap disease detection. It will work by using micro- and nano-sensors that read exhaled breath and then transfer the information through the attached mobile phone to an information-processing system for interpretation. The data is then assessed and disease diagnosis and other details are ascertained.
The technology is supported by a recent €6 million (US$6.8 million) grant to the consortium to expand the “electronic nose” breathalyzer technology that Prof. Haick has been developing since he joined the Technion in 2006. That technology can identify individuals from the general population who have a higher likelihood for contracting a specific disease, and treat them in advance or at an early stage.
The entities participating in the winning consortium include Siemens; universities and research institutes from Germany, Austria, Finland, Ireland and Latvia; and Israeli company NanoVation-GS Israel. NanoVation-GS is a Technion spin-off headed by Dr. Gregory Shuster and Sagi Gliksman, who are both graduates of Prof. Haick’s laboratory. Prof. Haick serves as Chief Scientific Officer.
“The SNIFFPHONE is a winning solution. It will be made tinier and cheaper than disease detection solutions currently, consume little power, and most importantly, it will enable immediate and early diagnosis that is both accurate and non-invasive,” says Prof. Haick. “Early diagnosis can save lives, particularly in life-threatening diseases such as cancer.”
This is the first time that any professional organization has developed age-specific recommended sleep durations based on a rigorous, systematic review of the world scientific literature relating sleep duration to health, performance and safety,”
National Sleep Foundation’s Sleep Duration Recommendations:
May be appropriate
14 to 17 hours
11 to 13 hours18 to 19 hours
Less than 11 hoursMore than 19 hours
12 to 15 hours
10 to 11 hours16 to 18 hours
Less than 10 hoursMore than 18 hours
11 to 14 hours
9 to 10 hours15 to 16 hours
Less than 9 hoursMore than 16 hours
10 to 13 hours
8 to 9 hours14 hours
Less than 8 hoursMore than 14 hours
School-aged Children6-13 years
9 to 11 hours
7 to 8 hours12 hours
Less than 7 hoursMore than 12 hours
8 to 10 hours
7 hours11 hours
Less than 7 hoursMore than 11 hours
Young Adults18-25 years
7 to 9 hours
6 hours10 to 11 hours
Less than 6 hoursMore than 11 hours
7 to 9 hours
6 hours10 hours
Less than 6 hoursMore than 10 hours
Older Adults≥ 65 years
7 to 8 hours
5 to 6 hours9 hours
Less than 5 hoursMore than 9 hours
The recommendations are the result of multiple rounds of consensus voting after a comprehensive review of published scientific studies on sleep and health.
Health economics helps insurers, health care systems and providers make treatment decisions based on the cost of extra “units” of health arising from a specific treatment. By calculating the cost for each year of life or quality-adjusted year of life gained, these groups can decide whether changing treatments or adding in a new treatment beyond the existing standard of care is “worth it.”
However, while the resulting incremental cost effectiveness ratio (ICER) is often presented as an absolute measure upon which to base these decisions, an opinion published by University of Colorado Cancer Center researchers D. Ross Camidge, MD, PhD, and Adam Atherly, PhD, suggests that the consumers of these data need to be much more aware of the assumptions underlying these calculations.
“Increasingly physicians are being presented with health economic analyses in mainstream medical journals as a means of potentially influencing their prescribing. However, it is only when you understand the multiple assumptions behind these calculations that you can see that they are by no means absolute truths,” Camidge says.
A new discovery shows how a simple intervention—self-affirmation – can open our brains to accept advice that is hard to hear.
“Self-affirmation involves reflecting on core values,” explained Emily Falk, the study’s lead author and director of the Communication Neuroscience Laboratory at University of Pennsylvania’s Annenberg School for Communication. Has your doctor ever told you to get more exercise? Has your spouse ever suggested you eat healthier? Even though the advice comes from good intentions, most people feel defensive when confronted with suggestions that point out their weaknesses. Reflecting on values that bring us meaning can help people see otherwise threatening messages as valuable and self-relevant. “Our work shows that when people are affirmed, their brains process subsequent messages differently.”
Past studies have shown that brain activity in VMPFC during health messages can predict behavior change better than individuals’ own intentions, and this study sheds new light on why. VMPFC is the brain region most commonly activated when participants think about themselves and when they ascribe value to ideas. The new results show that opening the brain in this way is a key pathway to behavior change. “Understanding the brain opens the door to new health interventions that target this same pathway,” Falk noted.
“We were particularly interested in using self-affirmation to help people become more active because sedentary behavior is one of the biggest health threats faced by both Americans and people around the world,” said Falk. Overly sedentary lifestyles are becoming a big problem; in some regions nearly 85 percent of an adult population leads an inactive lifestyle. This can cause multiple health problems, including poor heart health, diabetes, and cancer, just to name three. Increasing activity even small amount can have an important impact on both mental and physical health.
Psychologists have used self-affirmation as a technique to improve outcomes ranging from health behaviors in high risk patients to increasing academic performance in at risk youth, suggesting that the findings may be applicable across a wide range of interventions. “Our findings highlight that something as simple as reflecting on core values can fundamentally change the way our brains respond to the kinds of messages we encounter every day,” Falk noted. “Over time, that makes the potential impact huge.”
Pornography is not a victimless crime, it affects all of us through dehumanization of women, children, and men. Sex is distorted, people are viewed as objects. How can this not affect behaviors of the viewers in their everyday life, and thus victimize (or at the very least adversely effect us all? The brain cannot possibly just shut off and on when it comes to what it views.
English: Nations based on their laws involving pornography. Please see the legend for more details. Nederlands: Landen op basis van hun wetten over pornografie. Zie de legenda voor meer details. (Photo credit: Wikipedia) Legend at http://commons.wikimedia.org/wiki/File:Pornography_laws.svg#Legend
From the abstract at Cyberpsychology, Behavior, and Social Networking (14 January 2015)
The purpose of this review was to determine whether an association exists between sexual risk behaviors and pornography consumption. Consumption of pornography is common, yet research examining its link with sexual risk behaviors is in its infancy. Indicators of sexual risk behavior, including unsafe sex practices and a higher number of sexual partners, have been linked to poor health outcomes. A systematic literature search was performed using Medline, PsycINFO, Web of Knowledge, Pubmed, and CINAHL. Studies were included if they assessed the association between pornography use and indicators of sexual risk behaviors in an adult population. A total of 17 were included in the review, and all were assessed for research standards using the Quality Index Scale. For both Internet pornography and general pornography, links with greater unsafe sex practices and number of sexual partners were identified.Limitations of the literature, including low external validity and poor study design, restrict the generalizability of the findings. Accordingly, replication and more rigorous methods are recommended for future research.
You know when you finish an incredible book, and you spend the next few days or weeks just going over everything? It’s your brain obsession for a while, you process everything and go over details. I love those books. When you just connect for some reason; writing style, the topic, a character, a paragraph. Everyone has these handful of books that stay with them.
TMAO Found To Be A Contributing Factor To Development Of Chronic Kidney Disease And Associated Mortality Risk
Thursday, January 29th
Cleveland Clinic researchers have, for the first time, linked trimethylamine N-oxide (TMAO) – a gut metabolite formed during the digestion of egg-, red meat- or dairy-derived nutrients choline and carnitine – to chronic kidney disease.
TMAO has been linked to heart disease already, with blood levels shown to be a powerful tool for predicting future heart attacks, stroke and death. TMAO forms in the gut during digestion of choline and carnitine, nutrients that are abundant in animal products such as red meat and liver. Choline is also abundant in egg yolk and high-fat dairy products.
According to the Centers for Disease Control and Prevention, more that 20 million Americans are estimated to have chronic kidney disease, many of whom are undiagnosed. It is caused by a gradual loss of kidney function over time. As the disease worsens, waste products can accumulate in the blood and can be fatal without interventions. It has long been known that patients with chronic kidney disease are at an increased risk for cardiovascular disease, but the exact mechanisms linking the two diseases are not known. This newly discovered TMAO link offers further insight into the relationship between cardiovascular disease and chronic kidney disease.
Scientists have identified a biological clock that provides vital clues about how long a person is likely to live.
Researchers studied chemical changes to DNA that take place over a lifetime, and can help them predict an individual’s age. By comparing individuals’ actual ages with their predicted biological clock age, scientists saw a pattern emerging.
People whose biological age was greater than their true age were more likely to die sooner than those whose biological and actual ages were the same.
Four independent studies tracked the lives of almost 5,000 older people for up to 14 years. Each person’s biological age was measured from a blood sample at the outset, and participants were followed up throughout the study.
Researchers found that the link between having a faster-running biological clock and early death held true even after accounting for other factors such as smoking, diabetes and cardiovascular disease.
The same results in four studies indicated a link between the biological clock and deaths from all causes. At present, it is not clear what lifestyle or genetic factors influence a person’s biological age. We have several follow-up projects planned to investigate this in detail.
Dr Riccardo Marioni
Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh
Scientists from the University of Edinburgh, in collaboration with researchers in Australia and the US, measured each person’s biological age by studying a chemical modification to DNA, known as methylation.
The modification does not alter the DNA sequence, but plays an important role in biological processes and can influence how genes are turned off and on. Methylation changes can affect many genes and occur throughout a person’s life.
This new research increases our understanding of longevity and healthy ageing. It is exciting as it has identified a novel indicator of ageing, which improves the prediction of lifespan over and above the contribution of factors such as smoking, diabetes, and cardiovascular disease.
Professor Ian Deary
Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh
The study is published in the journal Genome Biology and was conducted by researchers from the University of Edinburgh, University of Queensland, Harvard University, University of California, Los Angeles (UCLA), Boston University, the Johns Hopkins University Lieber Institute for Brain Development and the U.S. National Heart, Lung and Blood Institute.
This study was carried out at the University of Edinburgh’s Centre for Cognitive Ageing and Epidemiology (CCACE), which is supported by the Medical Research Council (MRC) and the Biotechnology and Biological Sciences Research Council (BBSRC) as part of the Lifelong Health and Wellbeing programme, a collaboration between the UK’s Research Councils and Health Departments which is led by the MRC.
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner. (For those wishing to see pictures of a 2009 Friends of Liberia service trip to this West African country, please visit www.fol.org. My photo album is included).
Do you have an informational question in the health/medical area?
Email me at email@example.com I will reply within 48 hours.
My professional work experience and education includes over 10 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news,
I subscribe to the following to glean entries for this blog
Krafty (Medical)Librarian,” a collection of writings from Michelle Kraft on items of interest to medical librarians. She tends to write on technology and medical libraries but she also writes about things in general on librarianship, medicine and health”
Research Buzz, “news about search engines, digital archives, online museums, databases, and other Internet information collections since 1998″
Free Government Information, a “place for initiating dialogue and building consensus among the various players (libraries, government agencies, non-profit organizations, researchers, journalists, etc.) who have a stake in the preservation of and perpetual free access to government information”
Scout Report, a “weekly publication offering a selection of new and newly discovered Internet resources of interest to researchers and educators”