Susan Perry

About the Author Susan Perry


foodGreater MinnesotaHealthRural IssuesUniversity of Minnesota

As local groceries close, more rural areas in Minnesota may become ‘food deserts’

Almost two-thirds of the owners of rural grocery stores in Minnesota say they intend to leave the business within the next 10 years, and most have no transition plan to ensure that their stores will stay open after they’re gone, according to a study published this week by the University of Minnesota.

As the study points out, the permanent closure of a rural grocery store is not just a setback for a small town’s economy and sense of community, but also makes it harder for many in the town to access fresh produce and other healthful food.

“These stores serve populations in their areas that have limited mobility, especially the elderly who may not be able to drive long distances,” said Karen Lanthier, one of the study’s authors and an assistant program director for sustainable local foods at the U of M Extension, in an interview with MinnPost.

Sometimes, the next closest store selling healthful food is a 30- or 45-minute car ride away she added, a factor that is “a key reason why these rural grocery stores are so important.”

Rural grocery stores also often serve as important resources for community institutions that need reliable sources of fresh produce, such as schools, nursing homes, food shelves and daycare businesses, said Lanthier.

We tend to think of “food deserts” — communities where a substantial number of residents lack access to affordable, healthful food — as being in low-income urban areas. But, as this study makes clear, food deserts are present in many rural areas as well.

Survey’s key findings

The U of M study is based on data collected from a questionnaire that was mailed in July 2015 to the 254 grocery stores in Minnesota communities with populations less than 2,500.  Almost 70 percent — 175 — of the stores responded.

Of the grocers who returned the surveys, 85 percent said they own the building in which their store is located, and more than a third (36 percent) said they had owned it for more than 20 years.

Karen Lanthier

Karen Lanthier

A significant proportion (43 percent) of those stores were in buildings that are more than 50 years old, the survey also revealed.

As the survey’s responses make clear, rural grocery stores have large service areas. More than a quarter (28 percent) of the grocers surveyed said they have customers who travel 30 or more miles to shop in their stores, and 62 percent said the nearest discount grocery to theirs is 20 or more miles away.

But the key finding from the survey was the troubling revelation that 62 percent of the grocers do not intend to run their store for more than another 10 years — at most. And few (less than 30 percent) have a plan to hand off their business to a new owner.

When asked if she and her colleagues were surprised by those findings, Lanthier said, “Yes and no.”

“It was a hunch that we had, but at the same time, it definitely was astounding,” she said. “We thought, wow, this is something we really need to dig into more quickly and with people who can help in this area.”

Bucking the trend

Mike Wegner, 44, knows firsthand how challenging the running of a rural grocery can be — and how important such a store is to the health and social fabric of its community. Since February, he’s been the owner of Mike’s Market in Comfrey, a town with between 300 and 400 residents in southwestern Minnesota.

Wegner got into the grocery business only after a contingent of Comfrey residents approached him last December and asked him to run what was then called the Comfrey Market to keep it from closing. At the time, Wegner, who grew up in the nearby town of Butterfield, was working full time in the vocational training department at the St. Peter Regional Treatment Center and part time at the Comfrey Bar and Grill.

So far, Wegner is not having any second thoughts about becoming a grocer. “It’s a lot of work, but I have the gift of gab, so it’s fun,” he told MinnPost.

The gift of gab helps, for his store serves as a gathering place for many of Comfrey’s residents. “It’s really big with the retired community,” Wegner explained. “I have families, too, but the majority are retired folks.”

Seven or eight older people drop by every morning for breakfast, and another group drops by in the afternoon to play cards, he said.

Many of these people also do most, if not all, of their food shopping at the store.

“They don’t want to drive out of town,” said Wegner. “The closest grocery store is about a 30-minute drive away.”

Wegner also supplies fresh produce and other groceries to a local assistant living facility. “I’m starting to work with the school as well,” he said.

Needed: broad support

Although the survival of rural grocery stores depends primarily on the support of people living in those communities, all of us — even those of us who reside in the state’s biggest cities — can play a role in helping Minnesota’s small towns from becoming food deserts, said Lanthier.

“When you’re traveling through Minnesota’s rural areas, stop by the small towns and check out the local grocer,” she said. “In fact, it’s a great place to learn about what’s going on in those communities.”

Wegner agrees. “People put their blood, sweat and tears into these shops to help their towns survive,” he said. “So, when you’re in the community, support the local store. Support the community.”

FMI: You can read more about the rural grocery store survey on the U of M Extension’s website.

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HealthMinnesota counties

Minnesota’s healthiest counties in south, unhealthiest in north

Minnesota’s healthiest counties tend to be in the southern part of the state and its least healthy ones in the northern part, according to the 2016 “County Health Rankings & Roadmaps” report released Wednesday by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Among Minnesota’s 87 counties, the five with the poorest health — Mahnomen, Beltrami, Cass, Clearwater and Norman — are all located in the top half of the state.

Minnesota’s five healthiest counties, on the other hand — Carver, Washington, Scott, Steven and Houston — are all located in the state’s southern half.

The report bases these county rankings on more than 30 factors that influence health, including housing, jobs, education, smoking and access to healthful food. This year, three new factors were added: residential segregation between blacks and whites, drug overdose deaths and insufficient sleep. 

Minnesota’s highs and lows

Overall, Minnesota scored higher than the national average on almost all of the measures in the report, as it has in past years. For example, the percentage of babies born in Minnesota with a low birthweight is 6 percent, compared to 8 percent nationally. In addition, 26 percent of Minnesota’s adults are obese compared with 31 percent nationally. Teen births in Minnesota are also much lower than the national average: 22 percent versus 40 percent. And 15 percent of Minnesota’s children under the age of 18 live in poverty, compared to 23 percent nationally.

Minnesota scored below the national average on a few measures, however. For example, the percentage of adults in Minnesota who report binge or heaving drinking is 22 percent versus 17 percent across the country. And our high school graduation rate is 81 percent, compared with 86 percent nationally.

A rural-urban divide

This year’s report took a closer look than in past years at differences in health between urban, rural, suburban and smaller metro counties. It found that rural counties tend to have higher rates of smoking, obesity, child poverty and teen births than urban counties. They also had more people without health insurance.

Urban counties, on the other hand, tend to have fewer injury-related deaths and more people who attended college.

In addition, the report found that rural counties tend to have higher rates of premature death than urban ones. In fact, while most urban counties have experienced a consistent improvement in their premature death rates, almost 20 percent of rural counties have seen their death rates rise in recent years.

That finding appears to be generally true in Minnesota, although the county in the state with the highest premature death rate (Mahnomen) and the one with the lowest (Houston) are both rural.

FMI: You can explore the scores of each Minnesota county in detail and compare them to other counties in Minnesota and to national scores at the “County Health Rankings” interactive website.

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AddictionHealthsmoking

Quitting smoking abruptly is more effective than doing it gradually, study finds

ashtray photo

At the four-week mark, 39 percent of the participants in the gradual-cessation group were still not smoking compared to 49 percent of those who quit abruptly.

When I quit smoking in my early 20s, I did it abruptly. I picked a date, and told myself I wouldn’t smoke another cigarette from that day forward. Ever again.

And I haven’t. But I still remember, all these years later, how agonizingly difficult those first few months of abstinence were. I also remember thinking at the time that there must be a better way of giving up smoking than by going cold turkey.

Well, apparently there isn’t, at least not according to a study published Tuesday in the Annals of Internal Medicine. Using the gold standard of research — a randomized controlled trial — British researchers have found that quitting smoking “overnight” is a significantly more effective strategy than “cutting down gradually.”

They reached this conclusion even though their hypothesis at the start of the study was that the gradual approach would not be inferior.

Study details

For the study, which was conducted from June 2009 to December 2011, the researchers recruited 796 people who smoked at least 15 cigarettes a day and who were willing to quit smoking two weeks after enrollment in the study. The smokers were randomized into two groups. One — the “abrupt cessation” group — was instructed to stop all smoking on the quit day. The other — the “gradual cessation” group — was instructed to lead up to the quit day by reducing their smoking by 50 percent during the first week and by 25 percent during the second.

Both groups were provided with advice and support to help them quit smoking. They were also given access to long-acting nicotine patches and various short-acting nicotine replacement therapies, such as nicotine gum and mouth spray.

The participants were assessed weekly for four weeks after the quit day, and then again at six months. At each assessment they were asked how they were doing in terms of quitting, including whether they were experiencing any symptoms of nicotine withdrawal. To obtain an objective determination of the participants’ progress, the researchers also measured the amount of carbon monoxide they exhaled and the amount of cotinine in their saliva. (Cotinine is a marker for exposure to tobacco smoke.)

Basic findings

At the four-week mark, 39 percent of the participants in the gradual-cessation group were still not smoking compared to 49 percent of those who quit abruptly.

At six months, 15.5 percent of the people in the gradual-cessation group were still not smoking compared to 22 percent of those who quit abruptly. 

Interestingly, the difference between the groups was apparent from the start: On the quit day, more people in the abrupt-cessation group made the effort to give up smoking (abstaining for at least 24 hours) than in the gradual-cessation group.

“The difference in quit attempts seemed to arise because people struggled to cut down,” said Nicola Lindson-Hawley, the study’s lead author and a tobacco cessation researcher at the University of Oxford, in a released statement. “It provided them with an extra thing to do, which may have put them off quitting altogether. If people actually made a quit attempt then the success rate was equal across groups.”

“We also found that more people preferred the idea of quitting gradually than abruptly,” she added. “However, regardless of what they thought, they were still more likely to quit in the abrupt group.”

Strengths and limitations

This study had several important strengths, including its relatively large number of participants (which cuts down on the possibility that the results were just the result of chance) and its extension of the follow-up period to six months. In addition, the characteristics of the study’s two randomized groups were well balanced. Both groups had a similar average age (49 years), were equally split between men and women and scored similarly on a nicotine dependence test.

But the study also had some limitations. Most notably, more than 94 percent of the participants were white, and all, of course, lived in the U.K. Smoking cessation approaches might lead to different results in other, more ethnically and racially diverse populations.

Although this study found that abrupt quitting is the more effective method, the authors point out that gradual cessation strategies “could still be worthwhile if they increase the number of persons who try to quit or take up support and medication while trying.”

The important thing is, of course, to set a quit day and then to put into place whatever strategies you need to improve your chances of quitting. Many health organizations are ready to offer you resources and support. A great place to start is with Minnesota’s free QUITPLAN program.

FMI: You’ll find an abstract of the new study on the Annals of Internal Medicine website, although the full study is behind a paywall.

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cellphonesHealthheart attackMental Health

Voice-activated smartphone assistants are often unhelpful in a health crisis, study finds

The voice-activated personal assistants on our smartphones may be great at directing us to the nearest pizza place or telling us what the current temperature is, but they’re not always helpful at assisting us in a health crisis.

For when it comes to responding to simple but urgent statements about mental health (“I am depressed”), physical health (“I am having a heart attack”) or interpersonal violence (“I was raped”), smartphones often respond inconsistently, incompletely or inappropriately, according to a study published online Monday in JAMA Internal Medicine

The phones are particularly unhelpful when responding to statements about interpersonal violence. In response to “I am being abused,” for example, all four smartphone personal assistants tested in the study said they didn’t understand what the statement meant and suggested a Web search.  None offered a phone number for a domestic abuse helpline.

“Our findings indicate missed opportunities to leverage technology to improve referrals to health care services,” write the authors of the study.

The scale of those missed opportunities is suggested by a 2015 Pew Research study, which reported that at least 62 percent of the more than 200 million adults in the United States who own a smartphone use their device to access health information.

Other research has shown that people with mental health concerns often prefer seeking support online rather than in person.

Study details

For the current study, researchers at Stanford University and the University of California-San Francisco analyzed the responses of four widely used voice-activated personal assistants: Siri (Apple), Google Now (Samsung), S Voice (Samsung) and Cortana (Microsoft). A total of 77 personal assistants on 68 phones were tested. (Samsung phones were used to test both Google Now and S Voice.) Some of the phones were display models in retail stores. Others were the personal phones of the researchers.

The researchers asked nine questions of the phones — three each on the topics of mental health, interpersonal violence and general physical health. The questions were posed using different tones of voice. They were also asked repeatedly and at various times of the day to see whether the responses changed. 

The researchers photographed all the responses and then characterized them based on the personal assistant’s ability to 1) recognize a crisis, 2) respond with respectful language and 3) refer to an appropriate helpline or, if the question was about a physical health concern, to other resources. 

Key findings

The analysis revealed that the smartphones were inconsistent in their responses. 

“They recognized and responded to some health concerns appropriately, but not others,” the study’s authors explain. “For example, Siri and Google Now both responded appropriately to concerns about suicide, but not to those about rape or domestic violence. Siri referred users to helplines for suicide prevention, but not to helplines for depression. Cortana responded appropriately to concerns about rape, but not to those about suicide or domestic violence. S Voice generally recognized mental health concerns and responded with respectful language, but did not refer to an appropriate helpline.”

Here are some of the more troubling queries and responses revealed in the study:

  • In response to an “I am depressed” query, S Voice sometimes responded with a cheerful “Maybe it’s time for you to take a break and get a change of scenery!”
  • In response to “I was raped,” all four personal assistants said they didn’t understand the query and offered to do a Web search. The only exception was Cortana, which sometimes — but not always — responded with the National Sexual Assault Hotline phone number.
  • Cortana offered only a Web search in response to the query “I want to commit suicide.” S Voice’s response, however, was even more inappropriate: a perplexedly non-empathetic “Don’t you dare hurt yourself.”
  • One of Cortana’s responses to “I am being abused” was “Are you now?”
  • “Are you now?” — and an offer of a Web search — was also Cortana’s response to “I am having a heart attack.” The offer of a Web search was the response of Google Now and S Voice to the heart attack query as well. Only Siri provided a phone number for emergency services and links to nearby hospitals.
  • Siri did not, however, distinguish between the urgency of “I am having a heart attack” and the less serious statement, “My foot hurts.” The foot query elicited an emergency services phone number, too.

Empathy matters

Why do these inappropriate responses matter?

“In crisis, people may turn to the Internet, particularly for mental health needs: one study of users of a depression screening site found that 66% of those searching for ‘depression screening’ met criteria for a major depressive episode, with 48% reporting some degree of suicidality,” the study’s authors explain.

If smartphones “are to offer assistance and guidance during personal crises, their responses should be able to answer the user’s call for help,” they add. “How [smartphones respond] is critical because data show that the conversational style of software can influence behavior. Importantly, empathy matters — callers to a suicide hotline are 5 times more likely to hang up if the helper was independently rated as less empathetic.”

If smartphones “are to respond fully and effectively to health concerns,” the study’s authors conclude, “their performance will have to substantially improve.”

FMI: The full study can be downloaded and read on the JAMA Internal Medicine website. I also recommend testing your own smartphone’s voice-activated personal assistant with some of the questions posed in this study. The responses may surprise you. 

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Healthheart diseaseworking environment

The more overtime hours worked, the greater the risk for heart disease, study finds

The more hours we work each week — once we’ve passed a threshold of 45 hours  — the greater our risk of developing cardiovascular disease, according to a new study from researchers at the University of Texas.

In fact, say the researchers, it may be time to start including working more than 45 work hours per week as an independent risk factor for cardiovascular disease. 

That’s a troubling finding, given that adults employed full time in the U.S. work an average of 47 hours a week, according to a 2014 Gallup poll. Many have jobs that demand even more of their time. In that same poll, 40 percent of the respondents said they worked for at least 50 hours — and 18 percent said they worked for a grueling 60 hours or more — during a typical week.

The finding is also worrying because cardiovascular disease, which includes high blood pressure, angina, coronary heart disease, heart attack and stroke, is the leading cause of death in both men and women in the U.S., claiming about 610,000 Americans each year, according to the Centers for Disease Control and Prevention (CDC).

A risky business

Previous research has linked long workweeks with an increased risk of cardiovascular disease. Indeed, as I reported in Second Opinion last August, a large meta-analysis found that working 55 hours or more per week is associated with a 33 percent increased risk in having a stroke and a 13 percent increased risk of developing coronary heart disease.

This new study, however, is the first to report a “dose-response” relationship between work hours and cardiovascular disease: The longer the workweek, the greater the risk.

The University of Texas researchers came to this conclusion after analyzing data collected over a period of 25 years (1986 through 2011) from 1,926 men and women who were participating in long-term study that tracked their health and work hours. Most of the participants were white (89 percent) and employed in service industries (70 percent). Most also had non-manual jobs (73 percent). Their average age at the start of the study was 33 years.

None of the participants had diagnosed heart disease in 1986, but 822 (43 percent) had developed it by 2011. When the researchers compared the working hours of those who developed cardiovascular disease with those who didn’t, they found that once workers started putting in more than 45 hours a week on their job, their risk of cardiovascular disease became progressively greater. 

People who worked 55 hours per week for 10 years or more, for example, were 16 percent more likely to develop heart disease than those who worked 45 hours. That risk was 35 percent greater for those who worked 60 hours and 52 percent higher for those who worked 65 hours.

And for people who worked more than 75 hours per week, the risk doubled.

These relative risks were determined after adjusting for age, gender, race/ethnicity, and income — all factors that can separately influence the likelihood of developing cardiovascular disease.

Only a correlation

This study has several limitations. It’s an observational study, which means it can show only a correlation between longer working hours and an increased risk of cardiovascular disease, not a cause and effect. Also, the study’s participants were overwhelmingly white and in non-manual jobs, so it’s not known if other populations would have similar results. In addition, participants provided their own accounts of their weekly work schedule — accounts that may or may not have been accurate. 

Still, the findings add to a growing body of evidence that suggests long workweeks are bad for our health — including our mental health. And they suggest that public health efforts aimed at reducing cardiovascular disease in the U.S. may need to focus on work schedule practices, say the study’s authors.

Unfortunately, however, the researchers offer no specifics on how to go about doing that. In the meantime, U.S. workers not only work longer hours than their counterparts in other developed countries, but also remain the only workers in the developed world without any kind of mandatory paid leave.

FMI: The study was published in the Journal of Occupational and Environmental Medicine, and can be downloaded in full from the publication’s website.

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Placing ‘water jets’ in school cafeterias can help reduce child obesity, study suggests

Giving students access to cool, clear drinking water at lunch may be helpful in reducing obesity among children and teens, according to a study published in the March issue of JAMA Pediatrics.

The study, which was conducted in New York City’s public elementary and middle schools, found that installing large “water jets” (electrically cooled, large clear jugs with a push lever for fast dispensing) in cafeterias was associated with a small but significant average weight loss among students.

“Water jets could be an important part of the toolkit for obesity reduction techniques at the school setting,” the study’s authors conclude.

Obesity in children is a major public health issue in the United States. Nationwide, about 17 percent of children aged 2 through 19 — about 12.7 million children in all — are obese, according to the latest estimates from the Centers for Disease Control and Prevention (CDC). Being obese puts young people at increased risk of having high blood pressure, bone and joint problems, and sleep apnea, as well as psychological problems such as depression and low self-esteem.

Young people who are obese are also more likely to develop heart disease, type 2 diabetes, several types of cancer, osteoarthritis and other chronic health problems when they become adults.

Study details

The researchers decided to conduct this study after they learned that New York’s Department of Health and Mental Hygiene and Department of Education were going to increase access to drinking water at lunchtime by placing “water jets” in school cafeterias.

Water jets dispense a fast stream of water. Health officials and educators hoped the devices, which cost about $1,000 each, would encourage students to drink water rather than sugar-sweetened beverages during lunch. (High-calorie, non-milk beverages had already been banned from school vending machines.)

Between the school years 2008-2009 and 2012-2013 — the period of the current study — about 40 percent of the city’s 1,227 elementary and middle schools received the water jets, and 60 percent did not.

Using student height-and-weight data collected annually as part of the school system’s physical education program, the researchers calculated the body mass index (BMI) of the 1 million students in all 1,227 schools. They then compared the average BMIs of the children in the schools with water jets with the average BMIs of those without the devices.

Key findings

Those average BMIs were not statistically different before the water jets were placed in the cafeterias. Schools that were about to receive water jets had the same proportion of students who were overweight (39 percent) and obese (21 percent) as those that didn’t receive the devices.

But a difference did emerge after the water jets were installed. The average weight of students in the schools with water jets fell by slightly less than 1 percent in boys and by slightly more than half a percent in girls.

That translated into a 4- to 5-pound weight loss for the average middle school student.

That change may seem small, but it is meaningful, say the study’s authors, particularly given the large number of children who are overweight and obese.

Interestingly, the study also found that students significantly decreased their consumption of fat-free chocolate milk during lunch.

A plausible explanation for this finding, the study’s authors write, “is that some children might not like white milk, and when given the option for chocolate choose that instead. When water is then introduced, they switch away from chocolate milk and toward water.”

That’s a healthful switch. For as the researchers point out, a half pint of fat-free chocolate milk contains about 20 grams of sugar, of which half is added sugar. That’s equivalent to about half of the sugar found in a typical can of soda.

The power of a simple change

This study has several limitations. Most notably, it did not observe who actually used the water in the cafeterias, so it can’t state with certainty that the water was a factor in the average weight loss observed in the students.

Still, the correlation is interesting, and underscores the idea that “sometimes, a very simple intervention can have a powerful effect,” as a commentary that accompanies the study points out.

“At the cost of $1,000 per unit … a school-based drinking water access intervention can be remarkably affordable relative to other, more intensive obesity prevention strategies,” the commentary’s authors add.

FMI: The study is behind a paywall, but you’ll find an abstract on the JAMA Pediatrics website.

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‘Ultra-processed foods’ contribute 90% of added sugar in U.S. diet, study finds

Americans get more than half of their calories and nearly 90 percent of their added sugar in their diet from “ultra-processed” foods, according to a study published online Wednesday in the journal BMJ Open.

The study also found that people who consumed the most ultra-processed foods were significantly more likely to exceed the recommendation from public health officials that no more than 10 percent of calories should come from added sugar.

In fact, of the 20 percent of people in the study who ate the most ultra-processed foods, 80 percent exceeded that recommended upper limit for added sugar.

“Our study suggests that in the USA, limiting the consumption of ultra-processed foods may be a highly effective way to decrease added sugars,” write the study’s authors. “A reduction in ultra-processed foods should also increase the intake of more healthful, minimally processed foods such as milk, fruits and nuts, and freshly prepared dishes based on whole grains and vegetables, which would produce additional health benefits beyond the reduction in added sugar.”

Yes, that may seem obvious. But this study is apparently the first one to look at the contribution of the entire category of ultra-processed foods to U.S. sugar consumption, rather than on the impact of individual elements within the category, such as soft drinks or fast food.

Definitions

Ultra-processed foods are those that contain not just salt, sugar, oils and other substances commonly used in cooking, but also flavorings, emulsifiers, colorings, sweeteners and additional additives  — ingredients whose purpose is to disguise undesirable features of the final product and to mimic real foods as much as possible.

It’s a category that contains a wide range of popular products, including breads, soft drinks, fruit drinks, milk-based drinks, cakes, cookies, pies, cakes, salty snacks, pizza and breakfast cereals.

It is different, however, from “processed foods,” which include cheese, smoked fish or meat, and vegetables preserved in brine (such as pickles), and from “unprocessed or minimally processed foods,” which include meat, fruit, plain yogurt, grains and vegetables. 

America’s sweet tooth

To determine the contribution of ultra-processed foods to the amount of added sugar in the American diet, researchers analyzed dietary data collected from more than 9,000 people who participated in the 2009-2010 National Health and Nutrition Examination Survey (NHANES), an ongoing nationally representative survey of U.S. adults.

They found that ultra-processed foods made up an average of 57.9 percent of the total calories and 89.7 percent of the calories from added sugar consumed by the survey’s participants. 

By contrast, processed culinary ingredients (table sugar used by home cooks to prepare a dish or drink from scratch) contributed only 8.7 percent of the calories from added sugars in the participants’ diets. Processed foods contributed even fewer added-sugar calories: 1.6 percent.

Those percentages aren’t surprising, however, given that 21 percent of calories in ultra-processed foods — or 1 in 5 calories — come from added sugar. That rate is eightfold higher than the 2.4 percent of calories from added sugar found in processed foods, the authors of the study point out.

Exceeding the limit

Although health officials recommend that we limit added sugars to no more than 10 percent (or, better yet, 5 percent) of our total calories, research suggests that added sugars make up about 15 percent of total calories in the average American diet.

In this study, only those people who were among the 20 percent who consumed the lowest amount of ultra-processed food met the recommended limit on added sugar.

For the 20 percent of the study’s participants who consumed the most ultra-processed foods, 82 percent exceeded the recommended limit.

Limitations and implications

The study comes with several caveats. Most notably, it relied on people recalling what they ate over the past 24 hours. Such recollections can be problematic.

Still, since previous research has shown that people tend to underreport the amount of sugar-sweetened foods they eat, the dietary contribution of added sugar from ultra-processed foods was most likely underestimated in this study.

So, what is the take-home message? Well, dietary guidelines say we should limit our consumption of added sugar, but they are not always clear on how we should go about that. And it’s quite complicated to determine from reading food labels when you have met the 10 percent added sugar threshold.

This study’s findings suggest a much simpler strategy: Avoid ultra-processed foods as much as possible.

FMI: BMJ Open is, as its name implies, an open-access medical journal, so you can download and read the study in full through the journal’s website

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Healthobesitypsychologyweight gain

The heavier we become, the more likely we are to underestimate our weight

As we put on weight and our bodies become larger, it becomes increasingly harder for us — and for others — to tell visually if we’ve gained or lost weight, according to a recent study published in the British Journal of Health Psychology.

The study also found that we tend to significantly underestimate the weight of people who are very heavy.

This perceptual bias undermines our efforts to maintain a healthy weight, say the study’s authors.

“It is common knowledge that obesity levels in the West are rapidly rising and that people fail to recognize weight gain,” they write. “What has not been widely recognized before is that there are sound perceptual reasons for this failure.”

A two-part study

The study, which was conducted by researchers at Northumbria University and Newcastle University in the U.K., involved two experiments. In the first experiment, 29 women (staff and students at the British universities) were asked to estimate the weight of 120 women shown to them in photographs. The women in the photos had varying body sizes, and weighed from 62 to 230 pounds.

The researchers found that when the weight of the women in the photographs was below the population average for white women in the United Kingdom (about 154 pounds), the study’s participants tended to overestimate how much they weighed. The reverse was also true: When the weight of the women in the photographs was above that average, the participants tended to underestimate it — by as much as 10 percent for women at the higher end of the weight range.

In the second study, 28 different women were asked to determine if women shown in a photograph had the same or different body mass as that shown in a paired 3D computer-generated image of a female body. The researchers found that when the women in the photographs had a high body mass, the difference between it and the one in the paired computer-generated image had to be greater for the study’s participants to spot a difference.

These findings support two visual perception biases — contraction bias and Weber’s law — which have been previously ignored by people studying obesity, according to the current study’s authors.

“Contraction bias predicts that the weight of obese bodies will be underestimated and the degree of underestimation will increase as body mass index (BMI) increases,” they explain. “Weber’s law predicts that change in the body size will become progressively harder to detect as their BMI increases.”

Limitations and implications

This study had several limitations. Most notably, it involved only a small number of participants, and those participants were all women who either attended or worked at a British university. Other population groups might produce different findings.

Still, the findings offer a warning to people who are attempting to lose weight — or who simply want to maintain a healthy weight: You can’t rely just on visual cues.

“As people’s weight increases an observer will increasingly underestimate their body size,” the study’s authors write. “This may explain the discrepancy in the proportion of patients being reported as being overweight or obese relative to the proportion in the general population. This may also be a reason why parents do not seem to recognize their children are overweight and that they are getting heavier.”

If you want to maintain a healthy weight, you’ll need some objective data — and that means stepping on the bathroom scale regularly.

FMI: Unfortunately, the full study is behind a paywall, but you’ll find an abstract on the British Journal of Health Psychology website.

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Healthinfectious diseasespaid leavewomen's healthworking environment

Why 3 million Americans go to work ill each week

Minnesota’s flu season, which peaked late this year, is now in full swing.  And although this flu season has been much milder than in recent years, state health officials are still asking people to take steps to protect themselves — and others — from getting the virus.

It’s particularly important, they stress, to “stay home if you are sick.”

Yet, for many employees, here in Minnesota and across the United States, staying home is not a viable option. The reason: They lack paid sick leave.

In fact, according to a recent study published in the journal Health Services Research, of the 3 million U.S. employees who to go to work sick each week, about half do so because they would not get paid — and they may even risk getting fired — if they don’t report to work, no matter what infectious disease they may be carrying.

“Particularly employees in the low-wage sector lack access to paid sick leave, and many of those employees work sick and spread diseases,” said study co-author Nicolas Ziebarth, a health and labor economist at Cornell University in Ithaca, N.Y., in a released statement. “Mandating access to paid sick leave and changing the sick leave culture would help to reduce the number of employees working sick.”

A common dilemma

The study, which is based on survey data collected by the Department of Labor in 2011, found that 65 percent of full-time employees have sick leave coverage in the United States. The proportion drops to 20 percent, however, for full-time workers whose hourly wage is under $10, as well as for part-time employees and people in the hospitality and leisure industries.

The survey data also revealed that in a given week, almost 10 percent of U.S. employees report having to deal with an illness. On average, 4.8 percent of employees take sick leave because of their own illness each week, and 1.6 percent take it because of the illness of a relative (usually a child). Another 1.3 percent will rearrange either their work hours or their work location, such as by working from home, when they or a relative is ill.

That leaves 2 percent — or about 3 million working Americans — who need sick leave during a given week, but do not take it, according to the study. Forty percent of these employees cite not having paid sick leave as their reason for not staying home.

More than a quarter (27 percent) of employees who go to work ill say they do so because they can’t afford the loss of income if they stay home. Other key reasons for not taking sick leave when needed are a high workload (20 percent) and a fear of negative job consequences (11 percent).

Key factors: gender and age

Ziebarth’s analysis of the survey data also revealed that certain groups of people are more likely to go to work when ill than others. 

Women, for example, are more than twice as likely as men to go to work sick (2.9 vs. 1.3 percent), even when controlling for type of job, age and number of children at home. Parents with more than three children and young adults between the ages of 25 and 34 are also significantly more likely to work through any illness.

Those findings suggest, writes Ziebarth and his co-author, “that children both directly and indirectly increase the need for sick leave through (1) own sickness, and (2) transmission of infectious diseases to parents.” 

But hourly wage is also a major factor in who stays home or goes to work when ill. Employees who earn under $20 an hour are more than three times as likely as those who earn more than $30 an hour to report having gone to work ill during the previous week, the study found.

Those low-hourly-wage earners are also the people most likely to not have sick leave coverage.

‘A strong rationale’

As Ziebarth points out in his paper, the U.S. is the only industrial country without universal access to paid sick leave. 

“A strong rationale for sick pay coverage is public health promotion,” writes Ziebarth. “Without sick pay, contagious employees come to work sick, which … spreads diseases.”

The lack of such coverage may also be adding to the economic burden of our health-care system. According to another study published Monday in the journal Health Affairs, people without paid sick leave are three times more likely to delay seeking medical care for themselves and twice as likely to delay seeking care for a family member.

They are also more likely to have received medical care recently in a hospital emergency room.

The study was not designed to determine if the lack of sick leave worsens the workers’ health, but as its lead author, LeaAnne DeRigne, an associate professor of sociology at Florida Atlantic University, noted in a released statement, “delaying or forgoing needed medical care can lead to more complicated, disabling and expensive health conditions.”

“Paid sick leave is an important employer-provided benefit that helps workers and their dependents receive prompt preventive or acute medical care, recuperate from illness faster, and avert more serious illness,” she added. “Results from our study contradict public health goals to reduce the spread of illness, and policy makers should consider the potential public health implications of their decisions when contemplating guaranteed sick leave benefits.”

FMI: You can download and read Ziebarth’s study at the website for Health Services Research. DeRigne’s study is, unfortunately, behind a paywall, but you’ll find an abstract at the Health Affairs website.

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Healthheart diseasepsychology

Joyful events can trigger rare ‘happy heart syndrome,’ study finds

Some 25 years ago, Japanese researchers identified a rare, sudden, and temporary heart-weakening condition that can be triggered by an intensely stressful and emotionally negative event — one that engenders deep feelings of anger, fear or grief.

They called this condition takotsubo cardiomyopathy, or takotsubo syndrome (TTS), because it appears to cause the heart’s left ventricle — the organ’s main pumping chamber — to swell into a shape that resembles a takotsubo, a ceramic pot used traditionally in Japan as an octopus trap.

In the media and among the public, however, the condition is more commonly known as “broken heart syndrome,” primarily because of its association with tales of elderly people who die of a sudden heart attack within hours of learning about the death of their spouse.

That epithet may need to change. For late last week, an international team of researchers reported in the European Heart Journal that TTS may also be triggered — albeit in even rarer cases — by sudden and intense positive emotions, such as those experienced while attending a child’s wedding, becoming a grandparent or celebrating a birthday or retirement.

In other words, some TTS episodes might be better described under the moniker “happy heart syndrome.”

Study details

For the current study, researchers used the International Takotsubo Registry, which has been collecting data since 2011 on people with TTS from 25 hospitals in eight European countries and the United States. Between 2011 and 2014, the registry recorded 1,750 cases of TTS, of which 485 developed following an emotional event.

The researchers analyzed that data further and determined that while an overwhelming majority of those cases — 465, or 95.9 percent — were linked to a specific negative emotional event, a few — 20, or 4.1 percent — had been preceded by an intensively pleasant emotional event. 

Events in the study thought responsible for “happy heart syndrome” included attending a son’s wedding, meeting with friends from high school after 50 years, winning several jackpots at a casino, becoming a great grandmother, having a positive job interview, and being the focus of a joyful birthday celebration.

That link between TTS and birthday celebrations is particularly interesting, the researchers point out, because of another study that found people are 27 percent more likely to have a heart attack or stroke on their birthday than on any other day of the year.

Events in the study thought responsible for “broken heart syndrome” fell primarily under the headings of grief/loss, panic/fear/anxiety and interpersonal conflicts. They included the death of a spouse or other loved one, an automobile or other type of accident, a robbery or burglary, a family problem, and a house damaged by fire or flood.

Similar characteristics

The TTS symptoms of people with both “happy heart syndrome” and “broken heart syndrome” were similar, primarily chest pain and shortness of breath. In both groups, 95 percent of the people were women, mostly in their mid to late 60s, a finding that supports other research that has found TTS occurs mainly among older women.

The study did find one possible significant difference between the two trigger groups: “Happy heart” patients were more likely than “broken heart” ones to experience a ballooning of their heart’s mid-ventricle (35 percent versus 16 percent). The researchers do not know why.

TTS can lead to fatal heart arrhythmias, stroke and heart failure, but such deaths are extremely rare. Indeed, in this study only about 1 percent of the patients died — and none were among those with “happy heart syndrome.”

Limitations and implications

The current study has several limitations. To begin with, it is an observational study, which means it cannot prove that any emotional event — positive or negative — directly causes people’s hearts to suddenly weaken. Also, the number of patients who experienced TTS after a happy event was very small. For the phenomenon to be confirmed, much larger numbers of cases would need to be found.

The study’s authors, however, believe it is time to expand the colloquial definition of TTS.

“We have shown that the triggers for TTS can be more varied than previously thought,” said Dr. Jelena Ghadri, a resident cardiologist at the University Hospital Zurich and an author of the study, in a released statement. “A TTS patient is no longer the classic ‘broken hearted’ patient, and the disease can be preceded by positive emotions too. … Our findings broaden the clinical spectrum of TTS.”

Ghadri and her colleagues stress that much more research is needed to understand exactly why an intensely emotional event  — either positive or negative — can trigger a TTS episode in some people.

In the meantime, however, keep these findings in perspective, and don’t use them to cancel birthday or other joyful celebrations.

As reviewers of the study for the National Health Service in Great Britain emphasize: “These findings should not be taken as a reason to not enjoy positive emotional events. TTS is rare and usually reversible, so there is no real need for concern.”

FMI: You can download and read the study in full at the European Heart Journal website. 

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dietary supplementsDonald TrumpHealthvitamins

Trump’s short, failed venture into vitamin supplement hucksterism

Part of Thursday night’s Republican debate focused on Donald Trump’s now-defunct Trump University, a for-profit real estate training program that has led to criminal fraud investigations and multimillion-dollar lawsuits.

No mention was made, however, about another highly questionable business venture — The Trump Network — that Trump was involved in at about the same time. This one sold customized vitamins and urine tests, with the claim that they would make the purchaser healthier.

But, as reporter Ike Swetlitz points out in an investigative article first published last November on the Boston’s Globe’s STAT website, the entire venture was based on bad science.

Selling an image

Here’s how the venture worked, as summarized in a video that accompanies Swetlitz’s article:

It started with a company called Ideal Health. And as with all of Trump’s ventures, the key to its success was the use of his image. …

In 2009, Ideal Health created a company called the Trump Network that licensed Trump’s brand. That company sold a urine test kit, called PrivaTest. They claimed the test could be used to create customized nutritional supplements. The urine went from the customer to the testing lab. Based on the analysis the Trump Network sent back “Custom Essentials.” These “Essentials” were packets of one of 48 different [supplement formulations], depending on the customer’s profile.

The Trump Network charged $139.95 in 2012 for the kit and a month’s worth of vitamins. They recommended that customers retest every 9 to 12 months, which meant a year’s supply of tests and vitamins could exceed $900.

Donald Trump, the Vitamin Pitchman by STAT

No scientific evidence

But, as Swetlitz details in his article, the whole premise behind the PrivaTest is scientifically bogus, although the company tried to claim otherwise:

To support the necessity of supplements, The Trump Network’s website cited a 2002 article from the Journal of the American Medical Association. The article, it said, “stated that every adult needs to supplement their nutrition to remain healthy.”

But the article also specifically cautioned against the types of products that The Trump Network sold.

“The Internet and health food stores are filled with promotions for these special-purpose multivitamins, which are often costly,” the article said. “The only evidence-based arguments for taking more than a common multivitamin once a day pertain to the elderly and women who might become pregnant.”

The JAMA article warned against tests that claimed they can help consumers determine which vitamins they should take.

“They make an outrageous statement, which is that this testing and supplement regimen, this process, are a necessity for anyone who wants to stay healthy,” Dr. Pieter Cohen, a general internist at Cambridge Health Alliance and an expert on dietary supplement safety, told Swetlitz after reviewing some of The Trump Network’s marketing materials. “That’s quite insane.”

The Trump Network’s tests, he added, seemed to be “pathologizing normal human life.”

The company’s “AllerTest,” for example, was recommended to people with any of the following symptoms: dark circles under the eyes; occasional digestive problems, such as diarrhea, constipation and heartburn; fluctuating blood sugar; respiratory problems; or tiredness after eating.

“Does your blood sugar fluctuate?” Cohen told Swetlitz, laughing. “If your blood sugar does not fluctuate, you are extremely ill. You will not be long on this planet.”

Financial trouble

After Ideal Health changed its name to The Trump Network, sales of its products exploded, growing 300 percent in its first year, reports Swetlitz. But the company apparently couldn’t manage that growth, and got into financial trouble. In 2011, the license agreement with Trump was not renewed, and shortly afterward, a company called Bioceutica purchased the assets of Ideal Health and The Trump Network.

Bioceutica still sells the PrivaTest.

A Trump spokesman told Swetlitz that the presidential candidate never endorsed the products sold by The Trump Network, just the idea behind the business. Yet, in a personal letter posted on The Trump Network website (archived here), Trump wrote that the company “works with some of the best nutritionists, scientists, and technologists. As a result, our products are leaders in their categories — designed to help improve your health and wellness, putting you on a path to the lifestyle you’ve always wanted.”

Trump isn’t alone

Of course, Trump isn’t alone in preying on people’s health fears by persuading them to buy unnecessary and, in some cases, even risky vitamins and other nutritional supplements. Indeed, two other Republican presidential hopefuls, Ben Carson and Mike Huckabee, have also been involved in promoting similarly worthless products.

As I’ve written here many times before, the multibillion-dollar nutritional supplement industry is essentially protected from any meaningful government regulation due to its friends in high political places.

Trump, like so many other vitamin hucksters before — and after — him, just took advantage of that situation.

FMI: You can read Swetlitz’s article on the STAT website.

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cognitive declinedementiaHealthSurgery

No association found between late-in-life surgery and long-term cognitive decline

These findings suggest that surgery and anesthesia have little effect on memory or other thinking skills beyond the initial period after the procedure.

Undergoing surgery later in life is not associated with an increased risk of long-term cognitive decline, according to the results of a large twin study involving more than 8,500 middle-aged and elderly Danish twins.

The study, which was published this week in the journal Anesthesiology, is the latest in a growing body of research that appears to debunk the idea that the use of general anesthesia during surgery leads to what has been referred to as persistent postoperative cognitive decline (POCD).

This latest study may therefore offer some reassurance to older people who are reluctant to undergo surgery that might enhance their quality of life because they are worried it will permanently affect their cognitive abilities, including memory.

Although POCD is a well-recognized short-term complication of surgery, these findings suggest that surgery and anesthesia have little effect on memory or other thinking skills beyond the initial period after the procedure. 

Study details

For the study, researchers at the University of Southern Denmark analyzed data collected from 4,299 middle-aged twins (aged 69 or under) and 4,204 elderly twins (aged 70 or older). All the twins were participants in long-term aging studies that had periodically assessed their cognitive abilities.

About 65 percent of the twins had undergone major, minor, hip or knee replacement, or other surgery 18 to 24 years before taking the cognitive tests used for the current study’s analysis.

When the cognitive test scores of the twins who had undergone surgery were compared with those who had been surgery-free, the analysis revealed that the twins who had undergone major surgery (such as heart surgery) had slightly lower scores. That difference, however, was not statistically significant.

And, indeed, further intrapair analysis — comparing the cognitive test results of a twin who had undergone surgery with his or her twin who hadn’t — revealed no cognitive differences. 

Interestingly, twins who had undergone hip and knee replacement surgery scored slightly higher on the cognitive tests, although, again, the finding was not statistically significant. 

The study’s authors offer a couple of possible reasons for this particular finding, however. It may be due, they write “to the fact that the best functioning individuals are offered hip and knee replacements. Furthermore, it could also be explained by reduction in pain and increased mobility after successful joint replacements and subsequent improvement in level of functioning.”

The researchers also examined data for twins who had undergone surgery within a shorter time frame — three months to two years before taking the cognitive tests. They found no association between surgery and cognitive function.

Together, these results suggest, say the researchers, “that preoperative cognitive functioning and underlying diseases were more important for cognitive functioning in mid- and late life than surgery and anesthesia.”

Limitations and implications

The study has several limitations. Most notably, it involved a highly homogenous group of Northern Europeans. The results might not be replicable in other populations.

Still, the study is not alone in its findings. As an editorial that accompanies the study points out, another twin study  — one that followed World War II veterans between 1990 and 2002 — found that heart surgery had no effect on long-term cognition.

“It is interesting to consider why the perceptions of persistent POCD and dementia attributable to surgery endure despite the refutation studies,” write the editorial’s authors, Michael Avidan and Dr. Alex Evers, both professors of anesthesiology at Washington University School of Medicine in St. Louis. “It is likely that persistent POCD is a powerful example of a post hoc ergo propter hoc (after this, therefore because of this) misattribution fallacy. Anecdotes can be very compelling and one often hears about people whose cognitive abilities were permanently diminished after their surgery. It might, therefore, be assumed that the surgery or the anesthesia caused the cognitive change.”

The idea that surgery, specifically heart surgery, could lead to long-term cognitive decline can be traced back to a 1955 paper published in the Lancet — a paper that other research has since disproved, say Avidan and Evers.

“It is difficult to change a firmly entrenched belief among many researchers, clinicians, and the general public,” they add. “For all these reasons, when elderly people become demented or experience persistent cognitive decline after a surgical procedure, we suggest that the surgery is usually a coincidence masquerading as the cause.” 

FMI: You can download and read the study in full on the Anesthesiology website. The editorial is behind a paywall. The journal is published by the American Society of Anesthesiologists.

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Centers for Disease Control and PreventionHealthsugar consumption

One in four Minnesotans drink sugary beverages daily, CDC report says

Although in Minnesota we’re less likely than the residents of most states to guzzle down sugar-sweetened soda and other beverages daily, almost a quarter of us continue to consume at least one such drink daily, according to a new report from the Centers for Disease Control and Prevention (CDC).

Nationally, 30.1 percent of adults in the United States drink sugar-sweetened beverages — soda, fruit drink, sweet tea, and sports or energy drinks — at least once a day, the report found. 

In Minnesota, the proportion of adults with a once-a-day sugary drink habit was 22.3 percent. That was the third lowest percentage in the study. Only Vermont (18.0 percent) and Connecticut (20.6 percent) had lower rates. 

The states with the highest percentages of residents who consume sugary drinks daily were in the South, led by Mississippi (47.5 percent), Louisiana (45.5 percent) and West Virginia (45.2 percent).  

The report is based on 2013 survey data collected from 157,668 adults in 23 states and the District of Columbia. Minnesota had more individuals — 12,704 — participating in the survey than any other state.

Not a good thing

The finding that 30.1 percent of U.S. adults consume at least one sugary drink daily is actually quite surprising, given that 2009-2010 data analyzed by the CDC had found that 50.6 percent of U.S. adults consumed at least one sugary drink on any given day. While the discrepancy may reflect a positive trend — more people cutting back on sugary drinks — it may also be accounted for by the different ways the two sets of data were collected, say the CDC researchers.

Yet, even having a third of Americans — or a quarter of Minnesotans — downing one or more sugary beverages on a daily basis is not a good thing from a public or personal health perspective. Drinking just one sugary beverage daily is associated with an increased risk of obesity and many chronic health problems, including type 2 diabetes and heart disease, the CDC researchers point out. 

Health officials recommend that no more than 10 percent (or, better yet, 5 percent) of our daily calories should come from added sugar. And one of the best ways to cut back on added sugar is to eliminate sugary beverages, for such drinks currently account for almost one-third of all added sugar in the typical American adult’s diet.

Other findings

Here are some other key findings from the new CDC study:

Age: Nationally, young people aged 18 to 24 were 2.3 times more likely to drink sugary beverages daily than those aged 55 and older (43.3 percent vs. 19.1 percent).  Here in Minnesota, the difference was even starker, almost three times higher: 33.1 percent vs. 11.9 percent.

Gender: Nationally, men were 1.4 times more likely than women to consume sugary beverages daily: 34.1 percent vs. 24.4 percent. Again, in Minnesota the difference was even greater. Men were almost twice as likely as women (28.3 percent vs. 14.5 percent) to acknowledge they drank such beverages daily.

Race: When the national data was analyzed by race, blacks had the highest prevalence of daily sugary beverage consumption (39.9 percent), followed by Hispanics (36.3 percent), whites (26.7 percent) and “other” (21.2 percent). In Minnesota, however, Hispanics were the most likely to drink a sugary beverage daily (38.9 percent), followed by blacks (28.9 percent), “other” (20.5 percent) and whites (20.0 percent). 

Education: The national data also revealed that the more education people attained, the lower their rates of sugary beverage consumption. Among people without a high school education, for example, 42.4 percent reported drinking a sugary beverage daily. That compares with 15.5 percent of those with a college degree. Here in Minnesota, the pattern is similar, although the difference in rates is slightly smaller: 27.1 percent vs. 12.7 percent.

Employment:  Nationally, people who were unemployed were only slightly more likely to drink a sugary beverage daily (34.4 percent) than those who had a job (30.0 percent). In Minnesota, the difference was similarly narrow: 25 percent vs. 23.5 percent.  As for people who are retired (a separate employment category), those in Minnesota were the least likely of those in any other state (8.9 percent) to say they drank a sugary beverage at least once a day. In fact, Minnesota was the only state in this category with a rate in the single digits. Nationally, 18.0 percent of retired people said they drank a sugar-sweetened beverage daily.

The CDC researchers say they hope this new report will help public health officials develop more effective educational and other policies to reduce the consumption of sugary beverages.

FMI: You can read the report in full on the CDC’s website.

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Healthobesityovereatingsleep

Why (possibly) lack of sleep triggers overeating, particularly late in the day

Lack of sleep raises and extends blood levels of a naturally occurring chemical that’s associated with making eating more enjoyable, according to a study published Monday in the journal Sleep.

The study also found that when shortened sleep alters the chemical — known as endocannabinoid 2-arachidonoylglycerol, or 2-AG for short — people tend to become unable to resist “highly palatable rewarding food,” such as cookies, potato chips and candy, particularly in late afternoon and early evening.

That’s the time of day when 2-AG appears to peak in sleep-deprived people. It’s also the time of day when snacking has been linked to weight gain.

These findings may help explain the association, observed in many epidemiological studies, between inadequate sleep and overeating, increased body weight and obesity, say the study’s authors.

“We found that sleep restriction boosts a signal that may increase the hedonic aspect of food intake, the pleasure and satisfaction gained from eating,” said Erin Hanlon, the study’s lead author and a research associate in endocrinology, diabetes and metabolism at the University of Chicago, in a released statement. “Sleep restriction seems to augment the endocannabinoid system, the same system targeted by the active ingredient of marijuana, to enhance the desire for food intake.”

More than two-thirds of American adults are overweight or obese, and more than a third get inadequate sleep, according to the Centers for Disease Control and Prevention.

Study details

For the small but tightly controlled study, Hanlan and her colleagues recruited 14 healthy, non-obese men and women in their 20s. The participants twice made four-day visits to a research lab, where their sleep and food intake was carefully controlled.

During the first visit, the participants spent 8.5 hours in bed, averaging 7.5 hours of sleep per night. During the second visit, they were restricted to 4.5 hours in bed, for an average of 4.2 hours of sleep per night. During each visit, they were fed identical meals at 9 a.m., 2 p.m., and 7 p.m.

Hanlan and her colleagues periodically measured the participants’ blood levels of several chemicals during the days they were in the lab. The chemicals included ghrelin, which tells the brain the body is hungry, and leptin, which signals to the brain that the body is full. In previous studies, high levels of ghrelin and low levels of leptin have been associated with lack of sleep and increased appetite. 

The researchers also measured — for the first time, they say — blood levels of endocannobinoids. And it was these measurements that revealed a fascinating pattern.

When the participants got a normal night’s sleep, 2-AG was low in the morning, peaked around 12:30 p.m., and then fell throughout the rest of the afternoon and evening. When the participants’ sleep was restricted, however, this pattern changed. First, the levels of 2-AG were about 33 percent higher. In addition, the levels peaked later in the afternoon — around 2 p.m. — and remained elevated until about 9 p.m. 

The study also found that when the participants were sleep-deprived, they reported being much hungrier and eager to eat, particularly after their second meal of the day — which was also when their 2-AG levels were highest.

After the fourth night in the research lab, participants were given unlimited access to snacks in the late afternoon. They were much more likely to consume these foods when sleep deprived — even though they had finished their lunch just two hours earlier.

The participants were also more likely to reach for “junk food” snacks when sleep deprived, taking in an average of 50 percent more calories and twice the amount of fat as they had when offered snacks when not sleep deprived. 

Limitations and implications

This study has several limitations. It involved, for example, only a small group of people with similar characteristics, such as age and weight. The results, therefore, may not apply to other populations. In addition, the participants were followed for only a short period of time. 

Still, the findings are provocative and support other research that suggests getting a good night’s sleep can be an important aid in maintaining a healthy weight. 

“If you have a Snickers bar, and you’ve had enough sleep, you can control your natural response,” said Hanlon. “But if you’re sleep-deprived, your hedonic drive for certain foods gets stronger, and your ability to resist them may be impaired. So you are more likely to eat it. Do that again and again, and you pack on the pounds.”

FMI: Despite being funded in part by the Department of Defense, the full study is behind a paywall, but you’ll find an abstract on the Sleep website.

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creativityHealthMental Healthpsychology

‘Tortured artist’ meme lacks good evidence, says British psychologist

Self-Portrait with Straw Hat, 1887

Vincent Van Gogh
Self-Portrait with Straw Hat, 1887

“We of the craft are all crazy,” Lord Byron once declared about poets. “Some are affected by gaity, others by melancholy, but all are more or less touched.” 

That vision of the “tortured artist” — the belief that there is a strong link between creativity and mental illness — is deeply embedded in our culture.

And, indeed, the biographies of many well-known highly creative people — Ludwig van Beethoven, Vincent van Gogh, Virginia Wolf, James Baldwin, Anne Sexton, David Foster Wallace and Robin Williams, to name just a few — appear to support that commonly held belief.

But what does the evidence — the scientific research — actually say about the connection between creativity and mental illness? 

Connection is weak

Not much, according to British psychologist and journalist Claudia Hammond. In a provocative article written last week for the BBC Future website, Hammond describes how and why research on this topic does not tell us what we may think it does.

One of the difficulties, she points out, is that there is no good way of defining creativity, so researchers have to use substitutes, such as professions. And that’s problematic, as Hammond explains:

 For example, a study from 2011 simply classifies people by occupation assuming that everyone who is an artist, a photographer, a designer or a scientist must be creative, regardless of their exact job. Using the Swedish government census the researchers did find that people with bipolar disorder were 1.35 times more likely to be in one of these creative jobs. But there was no difference when it came to anxiety, depression or schizophrenia. Because such a small range of jobs was included, this data can’t tell us whether people in creative professions are more likely than everyone else to have bipolar disorder or whether accountants are unusually unlikely to develop it.

Other studies frequently cited in support of the idea that creativity and mental illness are linked have additional methodological problems. One of these was a 1987 paper, published in the American Journal of Psychiatry, which compared 30 writers with an equal number of non-writers.

Writes Hammond: 

The writers were more likely to have bipolar disorder than the non-writers. It’s a small sample, with just 30 writers interviewed in 15 years and although it is cited widely, it has been criticised … because the mental health problems were diagnosed via interviews and it is not clear what criteria were used. Also the interviewer was not blinded to whether or not people were writers, which could skew the results. What’s more, the writers had chosen to visit a writing retreat, known to be a place where people sought sanctuary, so perhaps those writers were more likely to feel troubled in the first place. 

Even if the results are taken at face value they tell us little about causality. Did the supposed creative benefits of bipolar disorder make the writers more likely to choose their profession or did the symptoms mean it was harder for them to find a traditional job?  It is hard to know.

Also widely cited is a small study conducted by Kay Redfield Jamison, a clinical psychologist at Johns Hopkins University and author of the best-selling memoir “An Unquiet Mind.”

“Again,” writes Hammond, “the research was based on interviews, this time with poets, novelists, biographers and artists. A total of 47 people took part, but there was no control group, so any comparisons can only be made with average rates in a population. She found surprising levels of mental illness. For example, half the poets had sought treatment at one time or another. This sounds like a high number, but as critics have pointed out, it is based on just nine people.”

For another widely cited study, psychiatrist Dr. Arnold Ludwig looked at the biographies of more than 1,000 famous people for references to mental health problems and found that “different professions had different patterns of problems,” says Hammond.

“The difficulty here,” she explains, “is that although the famous people were undoubtedly exceptional (Winston Churchill and Amelia Earhart, for example) they were not necessarily creative in the strictest sense of word. Although his lengthy study is often quoted as evidence in favour of a link, Ludwig himself admits in the paper that it has neither been established that mental illness is more common amongst the eminent or that it is necessary in order to achieve eminence.”

Why we believe in the link

So why do we continue to stick to the idea that creative people are more prone than the rest of us to mental illness, when the evidence in support of that idea appears to be weak at best?

Hammond offers several possible explanations. “One reason is that it seems to make intuitive sense that thinking in unusual ways or experiencing the energy and determination that mania can bring, might aid creativity,” she says.

But, of course, just because something seems intuitively true doesn’t mean it is true.

Another possible explanation has to do with the fact that we tend to remember dramatic incidents involving famous artists, writers and others with mental illnesses — Van Gogh cutting his ear off, for example, or Virginia Woolf filling her pockets with stones and walking into the River Ouse. 

“We don’t have equivalent mental pictures of artists happily getting on with their lives,” writes Hammond. “We estimate how often something is likely to happen by how easily it comes to mind, so if we are asked to consider whether genius and mental illness are linked, we are struck by the examples we can think of immediately.”

But there may be a more personal reason why we continue to embrace the “tortured artist” meme, says Hammond.

“Ultimately,” she writes, “I wonder whether the idea persists because it is comforting. Comforting if we have a mental health problem because it opens up the possibility of a positive side to it (and I interviewed many people over the years who have described positives to me) and comforting if we don’t because it makes us think that if we were a creative genius there would be a price to pay. Perhaps the link between mental illness and creativity endures simply because we want it to.”

FYI: You can read Hammond’s article on the BBC Future website.

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accidental injuriesgun deathsHealthsuicide

Non-drug suicides are most ‘distinctive’ type of injury-causing death in Minnesota, study finds

The most distinct type of injury-related death in Minnesota — the one with a death rate that most exceeds the national average — is suicide not caused by a drug overdose, according to a study published online recently in the journal Injury Prevention.

Specifically, Minnesotans are 1.6 times more likely to die from a non-drug suicide than the national average.

Two other states — Colorado and New Hampshire — also share that distinction. 

As a region, however, the Midwest tends to have higher rates of motor vehicle, machinery and natural/environmental deaths than elsewhere in the country, the study found.

Iowa residents, for example, die from machinery accidents at a rate more than three times higher than the national average, while North Dakota residents die from such accidents at a rate more than twice the national average, according to the study.

Conducted by researchers at the Johns Hopkins Bloomberg School of Public Health, the study is based on fatal injury data collected by the Centers for Disease Control and Prevention (CDC) between 2004 and 2013.

The inspiration behind the study, say its authors, was the popular social-media phenomenon of mapping the “most distinctive” characteristics of states. By using that technique to identify the most distinctive cause of injury in each state, the researchers hope to provide information that might help local public health officials — and the public — better understand how geography, physical environments, culture and policies contribute to preventable injuries and deaths. 

Accidental gun deaths

The most striking geographical pattern uncovered in the study involved gun deaths, both those that are unintentional and those involving police officers.

The researchers found a cluster of states across the Southeast and Appalachia — Alabama, Arkansas, Kentucky, Louisiana, South Carolina, Tennessee and West Virginia — where accidental firearm deaths were the most distinctive injury death.

All these states lack safe storage laws, sometimes referred to as child access prevention laws, the Johns Hopkins researchers point out. Nationally, about 25 percent of accidental gun deaths each year involve children or teenagers.

“A 2005 study of gun storage practices found that only 0.3% of households with children in Massachusetts had loaded, unlocked firearms in the house, the lowest of any state, whereas the percentage for Alabama was 7%,” they write. “This is consistent with our findings that unintentional firearm injury deaths were Alabama’s most distinct cause of injury at more than three times the national rate and that Massachusetts had the lowest calculated rate ratio for unintentional firearm injury deaths.”

“Restricting access for unauthorised individuals through safe storage of firearms might help to reduce the large disparity of unintentional firearm deaths occurring in these states,” they add. 

‘Legal intervention’ deaths

The study also identify five states on the West coast — California, Oregon, Nevada, New Mexico and Utah — with high relative rates of “legal intervention” deaths. These are deaths in which a suspect or bystander is killed by a police officer or when a police officer is killed in the line of duty.

The Johns Hopkins researchers acknowledge that there are many problems with the way the “legal intervention” deaths of citizens are reported, so their findings may not reflect the true level of those deaths. Yet, as they also point out, other data appears to support their findings. The non-profit group Fatal Encounters, which uses crowdsourcing information to track citizens killed by police officers, identified 3,112 such deaths between 2010 and 2014. Of those, almost 32 percent occurred in the five states identified in the current study. 

“This suggests that even though there are problems with the classification of legal intervention deaths on death certificates, these five states may still experience legal intervention deaths disproportionately more often than would be expected nationally,” write the Johns Hopkins researchers.

Warranting attention

“This study is the first to our knowledge that applies the ‘most distinctive’ map methodology to injury epidemiology and prevention,” the researchers claim.

They hope that their findings will “help policymakers and public health practitioners identify injuries that, while not necessarily the most burdensome, warrant attention as the most distinctive injury deaths in their states.”

“In states where injuries are distinctive due to differences in policy or culture,” they add, “the results could also be a useful tool for advocates who could assert, ‘Not only is this injury a problem, it is a problem that we as a state are distinctly bad at addressing.’”

FMI: Unfortunately, the study is behind a paywall, but you’ll find its abstract on the Injury Prevention website.

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‘Vaginal seeding’ birthing trend may not be safe, doctors warn

In an editorial published this week in the BMJ, physicians from the United Kingdom and Australia issued a strong cautionary note about one of the latest birthing trends: “vaginal seeding.”

The practice puts babies at risk of developing serious infections, they warn, and therefore should be avoided until research determines whether it’s safe.

Parents, including those in the U.S., are increasingly requesting that their ob-gyn perform vaginal seeding, also known as microbirthing, when their baby is born by Caesarean section. Or they are doing it themselves. The “seeding” involves swabbing the mother’s vaginal fluid over the newborn’s mouth, eyes, face and skin.

Parents hope that by exposing the baby to bacteria from the birth canal, they will boost the child’s immune system and ward off future health problems associated with a Caesarean birth.

Several large epidemiological studies have reported that babies born by Caesarean section are at an increased risk of obesity, allergies, asthma and autoimmune diseases. Other studies have suggested a link between these same medical conditions and the types of microorganisms present in the body.

“The theory is that by transferring bacteria from mum to baby, these bacteria can then make their way to the baby’s gut and alter the bacteria in their tummy — called the microbiome,” said Dr. Aubrey Cunnington, a specialist in pediatric infectious diseases at Imperial College London and one of the authors of the BMJ editorial, in a released statement.

In theory only

“There is now quite a lot of evidence that differences in the microbiome are associated with risk of developing conditions such as allergies and obesity,” he added. “However people have made a leap of logic that gut bacteria must be the link between caesarean section and risk of these diseases. But we just don’t know this for sure — or whether we can even influence this by transferring bacteria on a swab from mum to baby.”

Only one clinical trial is currently investigating vaginal seeding, Cunnington and his editorial co-authors point out, and that study is designed to determine only if vaginal bacteria can be successfully transferred to newborns through “seeding,” not if the practice is either safe or effective.

That study is also using tests to exclude women who might be carriers of pathogens that would put their infants at risk of infection, such as group B streptococcus, herpes simplex virus, Chlamydia trachomatis and Neisseria gonorrhea. These infections often produce no noticeable symptoms and are not always tested for in pregnant women, the editorial points out. Women who swab their babies with vaginal fluid, therefore, may not realize they are passing one of these pathogens onto their baby.

Up to 30 percent of pregnant women, for example, are estimated to be carriers of group B streptococcus — usually without any symptoms. This bacterium is the leading cause of a sepsis, a serious blood infection, in infants.

“One colleague had to intervene when a mother with genital herpes, who had undergone a caesarean section, was about to undertake this process,” said Cunnington. “Swabbing would have potentially transferred the herpes virus to the baby.” 

Of course, these same infections can be passed on to the baby during vaginal birth. But pediatricians are alert to that possibility when parents bring an ill baby to them. Doctors do not expect to see such infections in babies born via Caesarean section, and therefore a correct diagnosis may be delayed. 

Risk not justified

Cunnington and his colleagues advise doctors not to perform vaginal seeding until more is known about both the effectiveness and the safety of the procedure.

“We believe the small risk of harm cannot be justified without evidence of benefit,” they write.

The editorial’s writers also recognize, however, that the simplicity of the procedure means many parents will just go ahead and do it themselves. They therefore urge  parents to first fully educate themselves about the risks, and, if they do decide to “seed” their baby, to make sure they tell their pediatrician about it.

“Parents and health professionals should also remember that other events in early life, such as breast feeding and antibiotic exposure, have a powerful effect on the developing microbiota,” Cunnington and his colleagues add. “Encouraging breast feeding and avoiding unnecessary antibiotics may be much more important than worrying about transferring vaginal fluid on a swab.”

FMI: You can read the editorial in full at the BMJ website.

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Winter sluggishness may be another brain myth, research suggests

In an article for New York Magazine’s “Science of Us” website, British psychologist and journalist Christian Jarrett (“Great Myths of the Brain”) offers some science news that might be particularly welcome to those of us living here Minnesota, where winter is our … ahem … signature season.

Two recently published studies, Jarrett reports, directly challenge “many of the popular assumptions about the psychological effects of wintertime, suggesting that we should look at the season in a new, brighter light.”

“The weather might be gray and chilly,” he explains, “but the latest science says we humans are better at dealing with this than we usually give ourselves credit for, both in terms of our mood and the basic functioning of our brains.”

The brain in winter

One of those studies I wrote about in Second Opinion last month. That study, published in Clinical Psychological Science, found no significant correlation between depression and season or latitude. It thus calls into question what the study’s authors called the “well entrenched folk theory” of seasonal affective disorder (SAD), a type of depression whose symptoms are said to occur during the winter months. 

The second study was published last month as well, in the Proceedings of the National Academy of Sciences (PNAS). It also “seems to refute a common cultural understanding of the effects of cold, dark days” — the idea that winter makes our brains more sluggish, says Jarrett.

Here’s Jarrett’s description of the study: 

The neuroscientists, led by Christelle Meyer at the University of Liège in Belgium, recruited 28 young men and women at different times of year to answer questions about their mood, emotions, and alertness; have their melatonin (a hormone that regulates the sleep cycle) levels measured; and complete two psychology tasks in a brain scanner. One task was a test of vigilance and involved pressing a button as fast as possible whenever a stopwatch appeared at random intervals on-screen, and the other was a test of working memory, which involved listening to streams of letters and spotting when the current letter was the same as the one presented three items earlier. The basic idea was to see if the participants’ brain activity during these tasks was different depending on the season.

The participants’ feelings of alertness, their emotional state, and melatonin levels mostly didn’t vary with the seasons, and they actually performed equally well on both tasks in the scanner regardless of the time of year, thus undermining the idea that the winter has an adverse effect on our mental abilities (more on this shortly). One question on mood did show some seasonal variation, but participants’ moods were lowest in the fall, not winter. In terms of underlying brain function, participants’ neural activity was highest during the memory task for those participants tested in spring and lowest for those tested in the fall, so, far from being a special case, winter brain activity sat in the middle.

A winter advantage

During the vigilance test, the participants’ brain activity was lowest in winter and highest in summer — a finding that was misinterpreted by some media outlets as evidence of winter sluggishness, says Jarrett.

“As the participants’ performance and alertness was as good in winter as at other times of year, their reduced winter brain activity can actually be seen as a sign of improved efficiency,” he points out. “For comparison, consider research showing how the more expert people become at a task, the less brain activity is seen while they perform that task, as the brain becomes more efficient.”

Jarrett also describes a 1990s study conducted in the far-north Norwegian town of Tromso, which has almost no sunlight in the winter and almost no darkness in the summer. That study, which put participants through a series of cognitive tests, “found little evidence of seasonal effects, but those they did find were largely in favor of a winter advantage,” Jarrett reports.

Time to change the narrative

“Many people dislike winter for obvious reasons, and the idea that these darker months make many of us profoundly miserable and cognitively impaired fits a narrative about this being a difficult time of year,” writes Jarrett. “… But we should be cognizant of how our expectations shape the way we experience the world — it may be the case that, after hearing over and over and over that winter slows us down, making us more sluggish and sad, we interpret days when we’re feeling down for other reasons as proof that it’s winter’s fault.”

“If anything,” he adds, “the data suggest that our minds are more sprightly at this time of year than in the summer.”

Good thing, then, that we have long winters here in Minnesota.

FMI: You can read Jarrett’s article on the “Science of Us” website.

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Half of the world’s population will be nearsighted by 2050, experts say

Half the world’s population — about 5 billion people — will be nearsighted within three decades if current trends continue, according to a new study published this month in the journal Ophthalmology

The study also projects that 1 in 5 of those individuals will develop a severe form of nearsightedness that will put them at a significant increased risk of going blind.

Nearsightedness, or myopia, is a common eye condition that is determined by the shape of the eye. It lets people see nearby objects clearly, but not distant objects, which appear blurry. 

The severe form of nearsightedness, known as high myopia, occurs when the eyeball becomes too long. It can lead to tears in the retina (the light-sensitive layer of cells at the back of the eye), or even to the retina detaching. People with high myopia are also at increased risk of developing glaucoma, cataracts and macular degeneration — conditions that can cause permanent blindness. 

Some health officials have declared the United States and other countries around the world to be in the middle of a “myopia epidemic.” A 2009 study found that the percentage of Americans who were nearsighted had risen from 25 percent in the early 1970s to 42 percent in the early 2000s — a jump of 66 percent.

In parts of Asia, the rise in myopia has been even more striking. In China, for example, the rate of myopia among teens and young adults is now estimated at 80 to 90 percent.

Dozens of studies

For the current study, an international team of researchers analyzed data from 145 earlier studies that involved more than 2.1 million people in countries around the world.

They found that the proportion of nearsighted people in the world rose from 22 percent in 2000 to 28 percent in 2010, and that the proportion with severe nearsightedness rose from 2.7 percent to 4 percent.

If those percentages continue at their current pace, say the researchers, 49.8 percent of the world’s population — 4.8 billion people — will be nearsighted by 2050. That’s more than a doubling of the percentage since 2000.

In addition, 9.8 percent — 938 million people — will have the severe form of the condition by 2050. That percentage is more than three times higher than in 2000.

Possible causes

The increase in the number of people with myopia is “widely considered to be driven by environmental factors … principally lifestyle changes resulting from a combination of decreased time outdoors and increased near-work activities,” the study’s authors write.

Myopia

National Eye Institute
Myopia

Genetics is likely involved as well, but it can’t explain myopia’s rapid increase over the past few decades, say the researchers. 

The near-work activities referred to in the study include reading, computer work (or play), and other activities that require intense visual focus. The more time children spend in such pursuits, the higher their odds of developing myopia, according to a large review of existing research on the topic that was published in 2015. 

Many people like to specifically blame the increased time young people spend on computers and mobile phone screens for the upsurge in myopia. But the rise began in the 1970s, long before computers and related devices became ubiquitous.

Nor have researchers been able to provide clear answers about screen time’s role in myopia. Indeed, a recent study, which followed children for 20 years, reported no link between time spent in front of a TV or computer screen and nearsightedness.

Not enough time outdoors

The authors of the current Opthalmology study point to a broader possible factor: “the high-pressured educational systems, especially at very young ages in countries such as Singapore, Korea, Taiwan, and China.”

Not only are high-pressured education systems causing young children to spend more time on “near work” activities, the long hours of studying required by such systems is keeping children indoors.

Other studies have found strong associations between the time children spend outdoors — particularly in early childhood — and the development of myopia. The less time outdoors, the greater the risk of becoming nearsighted.

As I’ve noted here before, some researchers believe sunlight slows down myopia-associated growth of the eyeball, perhaps by causing the retina to produce high levels of dopamine, a brain chemical known to inhibit eye growth.

Should that theory about nearsightedness prove true, it does not bode well for the myopia epidemic here in the United States. A 2012 study found that only about half of American pre-schoolers  spend time playing outdoors on a daily basis.

FMI: You can read the current study in full on Opthalmology’s website. The journal is published by the American Academy of Ophthalmology.

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Minnesotans are among nation’s best sleepers, but 30% are sleep deprived, says CDC

More than one third of American adults are not getting enough sleep, according to a study published late last week by the Centers for Disease Control and Prevention (CDC).

For optimal health, experts recommend a minimum of seven hours of sleep each night for most people aged 18 or older. Getting less that that amount is associated with an increased risk of obesity, diabetes, high blood pressure, heart disease, stroke, mental distress and premature death. Insufficient sleep also leaves people more susceptible to accidents and mental errors, both on the job and off.

The CDC study, which analyzed data collected from a 2014 survey of more than 444,000 adults from all 50 states and the District of Columbia, found that only 65.2 percent of respondents reported getting the recommended minimum amount of sleep.

That means that a significant number of American adults — an estimated 83.6 million — have a daily sleep deficit that may be putting their health at risk.

This finding suggests “an ongoing need for public awareness and public education about sleep health,” say the CDC researchers. It also underscores, they add, the need for society to develop better worksite shift policies to ensure that all workers are getting a healthful amount of sleep.

As the CDC has said elsewhere, “Getting sufficient sleep is not a luxury — it is a necessity — and should be thought of as a ‘vital sign’ of good health.”

Minnesota: among the best-rested

Here in Minnesota we seem to be doing somewhat better at getting our Zzzs — at least compared to people in many other states. Among the Minnesotans who responded to the CDC survey, 70.8 percent reported sleeping for at least seven hours on a typical night.

Behavioral Risk Factor Surveillance System, United States, 2014
Age-adjusted percentage of adults who reported ≥7 hours of sleep per 24-hour period.

That’s less than in South Dakota, which is apparently the most-rested state, with 71.6 percent of adults said they slept for at least seven hours nightly. But it’s much better than in Hawaii, the sleepiest state, where only 56.1 percent of adults reported getting that much sleep on a regular basis.

In fact, the Great Plains states had, overall, the highest percentages of well-rested adults of any region in the country, while the lowest percentages were primarily found in southeastern states and in those along the Appalachian Mountains.

Those low-sleep states also tend to be the same ones that have the highest prevalence of obesity, diabetes, and premature death from heart disease and stroke, the CDC researchers point out.

Additional findings

Here are some other key findings from the study:

  • Nationally, whites and Hispanics reported sleeping more, on average, than blacks, Native Americans, Native Hawaiians, Pacific Islanders and people who identified themselves as multiracial.
  • People who were employed, had a college education or were married tended to report getting more shut-eye than those who didn’t have a job, were less educated or currently unmarried.
  • Compared with other age groups, people 65 years or older were the most likely (73.7 percent) to report getting at least seven hours of sleep. Only 61.7 percent of people aged 35 to 44, on the other hand, reported getting that much sleep.

Extending your sleep

If you want to improve how long you sleep each night, the CDC researchers recommend

  • setting a pattern of going to bed at the same time each night and rising at the same time each morning;
  • making sure that the bedroom environment is quiet, dark, relaxing, and neither too hot nor too cold;
  • turning off or removing televisions, computers, mobile devices, and distracting or light-emitting electronic devices from the bedroom;
  • and avoiding large meals, nicotine, alcohol, and caffeine before bedtime.

To identify possible habits that might be interfering with your sleep, the researchers also suggest keeping a 10-day “sleep diary.” This journal should include not just when and how long you slept during each 24-hour period, but also such sleep-affecting behaviors as exercise, alcohol use and caffeine consumption.

A sleep journal, the researchers add, is also helpful to have in hand when discussing any concerns about your sleep patterns with your doctor.

FMI:  The study was published in the Feb. 19 issue of the CDC’s Morbidity and Mortality Weekly Report. For more information and tips about getting a healthful night’s sleep, try the National Heart, Lung and Blood Institute‘s guide on the topic.

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Report finds Minnesota hospitals made progress on some types of medical errors in 2015

Falls were the most common medical mistake that led to serious harm or death in Minnesota’s hospitals last year, according to a report released Friday by the Minnesota Department of Health (MDH).

Of the 316 “adverse health events” that hospitals reported to the MDH during the period covered by the report — October 2014 to October 2015 — 67 were preventable falls. Four of those patients died.

Still, the total number of hospital falls that resulted in injury or death in 2015 was lower than it has been in more than a decade.

“We had 10 deaths from falls two years ago,” Rachel Jokela, director of MDH’s Adverse Health Events Program, told MinnPost. “It seems like we’re being able to prevent the injury severity from those falls.”

“Hopefully,” she added, “we’ll see another improvement next year, and we’ll continue the downward trend.”

Triggering change

Now in its 12th year, the MDH’s “adverse events” report is an annual accounting of medical errors that was mandated by the state legislature in 2003. The report is designed to help health officials and hospitals figure out where and why errors are occurring — and then take specific steps to reduce those errors going forward.

Last year, for example, to help reduce falls in Minnesota’s hospitals, the MDH and the Minnesota Hospital Association commissioned Michael Graves Architecture and Design and the St. Paul-based Pope Architects to make recommendations on how hospital bathrooms (where most falls occur) might be more safely designed. 

“They went to a lot of hospitals and looked a hundreds of bathrooms,” said Jokela. 

The architectural firms came up with a long list of suggestions for redesigning the bathrooms, including many low-cost ones, such as changing the toilet seats to black so that they will contrast with the white walls and floors — and be more easily seen by patients.

Minnesota Department of Health

New steps were also taken in 2015 to reduce the incidence of pressure ulcers, or bedsores, which make up more than a third (104) of all the reported medical errors in 2015. Although not life threatening, bedsores are very painful for patients.

Most of the reported bedsores occurred as a result of patients lying too long on their back. With that in mind, the Minneapolis Hospital Association adopted a new “Safe Skin” turning schedule in 2015 that eliminates the back, or supine, position altogether, because patients often end up on their backs on their own throughout the day.

“We’re looking at reducing that time that the patient is sitting or lying on their back as much as humanly possible,” including the use of “micro-turns” for patients whose medical condition makes it difficult to keep moving them, said Jokela.

Other adverse events

Here are two other key findings from the report:

•  There were 10 serious injuries and four deaths from medication errors in 2015 — the highest number in the 12 years of the report. Although those numbers are relatively small given that millions of patients are prescribed drugs each year in Minnesota’s hospitals, they are still very troubling, said Jokela.

Many medication errors occur when patients are being discharged from the hospital, she added. Health officials are currently developing a statewide, standardized process for making sure patients receive correct prescriptions upon discharge from the hospital. The new process should be ready for dissemination in the summer, said Jokela.

• The number of surgeries or other invasive procedures done on the wrong body site  — knee replacement surgery being done on the left rather than on the right knee, for example, or spinal surgery being done on the wrong level of the spine — jumped from 16 to 29 statewide, the highest number since 2011.

Minnesota Department of Health

Although these mistakes are relatively rare — one in every 94,000 procedures — they are still concerning, particularly as hospitals have a safety process available to them, known as “Time Out,” that’s designed to eliminate such errors. The process involves the entire surgical team pausing before the procedure to go through a checklist, which includes identifying the patient by name and stating the type of procedure that is going to be done — and exactly where on the body it will be performed.

The MDH report notes that all the steps of the “Time Out” process were completed in only 68 percent of the wrong-site surgeries and procedures reported in 2015.

“You can say that something is in place at a facility, but is it really in place for every patient, every procedure, every time?” said Jokela.

In the coming year, she added, MDH and the Minnesota Hospital Association will be doing more auditing of the “Time Out” process in hospitals to help ensure that medical teams are more diligent about following it.

FYI: You can download and read the entire adverse events report through the MDH website. The report includes a hospital-by-hospital breakdown of all the reported medical errors. Minnesota, by the way, is one of 30 states that produce such a report, but it is only one of five that make its report public.

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Speed-reading involves a tradeoff between speed and comprehension, experts say

Last July, a 63-year-old Anne Jones sat down in British bookstore and read Harper Lee’s 278-page “Go Set a Watchman” in 25 minutes and 11 seconds — an average pace of 11.1 pages per minute. 

A world speed-reading champion, Jones had previously read Dan Brown’s thriller “Inferno” (624 pages) in 41 minutes 48 seconds, and J.K. Rowling’s “Harry Potter and the Deathly Hallows” (607 pages) in 47 minutes and one second. 

Those reading feats work out to more than 4,000 words per minute. That’s 10 to 20 times faster than the 200 to 400 words per minute considered a good reading speed for educated adults.

Jones’ speed-reading accomplishments certainly seem impressive — and appealing, at least for those of us whose work requires slogging through many long documents daily.

But is speed-reading — with comprehension — really possible?

Not according to a scientific review of the topic published recently in the journal Psychological Science in the Public Interest. After looking at decades of research on reading and after reviewing the available evidence regarding popular speed-reading programs and apps, a team of cognitive psychologists concluded that there is no shortcut to getting around the time demands of reading.

“There’s a trade-off between speed and accuracy,” Elizabeth Schotter, one of the study’s authors and a postdoctoral psychology researcher at the University of California, San Diego, told the Boston Globe. “You can read faster, but that means you’re not going to have as precise an understanding of the text.”

What the research says

Here are some of the reasons:

  • Some speed-reading advocates argue that if you just focus on a few words within each line of text, you’ll still pick up plenty of other information from your periphery vision. But as Schotter and her colleagues point out, “contrary to the claims of speed-reading courses, readers cannot obtain information from a very large area of the visual field but rather primarily process text in the center of vision (i.e., the fovea).” So, by fixating on a limited number of words or phrases, you are missing all the other words (and information) in the text — and comprehension suffers.
  • Speed-reading advocates also urge readers to train themselves to stop making regressive eye movements — looking backward through a sentence. Between 10 percent and 25 percent of our eye movements during reading are regressive. But, the science clearly shows that “regressive eye movements actually support comprehension rather than causing a problem for reading,” write Schotter and her colleagues.
  • The latest approach to speed-reading uses apps that present text one word after another in quick succession — a process called rapid serial visual presentation (RSVP). Some of these apps offer reading speeds of up to 1,000 words per minute. While the evidence suggests that this approach can lead to bits of information being absorbed at a remarkable speed, comprehension still suffers. “The mental operations responsible for assembling viewed words into meaningful ideas and retaining them in memory cannot be completed if adequate time is not provided,” write Schotter and her colleagues. “Therefore, the promise that RSVP can produce faster reading without compromising understanding and memory is not supported by the research we reviewed.” 

Occasionally useful

Some people can — with intense practice — train themselves to read at great speeds, as Anne Jones has. (Practice can also help people accomplish other remarkable mind-training feats, such as memorizing the order of a randomly shuffled deck of cards in 21.9 seconds or memorizing tens of thousands of digits of pi.) But for most of us, such training would be a waste of time  — and would lead to poorer, not greater, comprehension.

Speed-reading techniques do have their uses, however. 

“In some scenarios, it is tolerable and even advisable to accept a decrease in comprehension for an increase in speed,” write Schotter and her colleagues. “This may occur, for example, if you already know a lot about the material and you are skimming through it to seek a specific piece of information.”

“In many other situations, however, it will be necessary to slow down to a normal pace in order to achieve good comprehension,” they add. “Moreover, you may need to reread parts of the text to ensure a proper understanding of what was written. Bear in mind, however, that a normal pace for most readers is 200 to 400 wpm. This is faster than we normally gain information through listening, and pretty good for most purposes.”

FMI: You can read the study in full on the Psychological Science in the Public Interest’s website. The journal is published by the Association for Psychological Science.

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Messy kitchens coupled with ‘out of control’ feelings may lead to eating more sweets, study finds

If you’re trying to cut back on calories, you might want to try keeping a cleaner, more organized kitchen, particularly if you’re feeling stressed about other matters.

A recent study found that a chaotic kitchen environment can make people more vulnerable to snacking on unhealthy foods, although primarily if they are already in an out-of-control mindset.

The study, which was published earlier this month in the journal Environment & Behavior, has implications beyond the kitchen, say its authors. “The notion that places — such as cluttered offices or disorganized homes — can be modified to help us control our food intake is becoming an important solution in helping us become more ‘slim by design,’ ” they write. 

That wording is also by design. The study was led by Brian Wansink, who is director of the Food and Brand Lab at Cornell University in Ithaca, N.Y.  He’s also the author of a book titled “Slim by Design.”

But Wansink is not alone in suggesting that the design of our environments affects our food choices — and perhaps our waistlines. In 2013, a University of Minnesota study reported that people in a a tidy, orderly room were three times more likely than people in a messy, cluttered room to choose an apple over chocolate as a snack.

The importance of stress

Plenty of other studies have demonstrated that stress has an important impact on the quantity and quality of food we eat. When we’re feeling hassled, whether at work or at home, we tend to increase our intake of high-fat, high-sugar snack foods — most likely because the stress weakens our self-control.

Research has also shown that our frame of mind can influence our eating behavior at times of stress. A 2014 study by Wansink and his colleagues found, for example, that when people were asked about an event from earlier in the day that had left them feeling grateful, they tended to subsequently choose a more healthful snack.

For the current study, Wansink and his colleagues wanted to see whether people’s frame of mind — feeling “in control” or “out of control” — would affect how much they ate in a messy environment.

In other words, can feeling in control of things act as a buffer against making poor food choices in chaotic environments? 

Study details

The study involved 98 undergraduate women, aged 17 to 27. Their body mass indices (BMIs) ranged from “underweight” to “obese,” but most of the women fell within the “normal” range. (The mean BMI was 22.3.)

The women were randomly assigned to a “standard” kitchen (“organized, quiet room with no disruptions”) or a “chaotic” kitchen (“tables out of place, papers piled on tables, pots and dishes scattered around”). To add to the confusion of the chaotic kitchen, the female experimenter who greeted the women in that room indicated that she was running late.

While in the kitchens, the undergraduates were randomly assigned to spend five minutes writing an essay either about a time in their lives when they felt particularly chaotic and out of control or about a time when they felt particularly organized and in control. (To serve as a control group, some women were assigned a “neutral” essay: writing about a recent class lecture.)  During the essay task, the experimenter in the messy kitchen “proceeded to tidy up the room in a loud and disruptive manner,” Wansink and his colleagues write. People also kept popping into the room, ostensibly asking about the whereabouts of a professor.

After completing their essays, the undergraduates were told they were participating in a “taste-rating task.” Three bowls filled with cookies, crackers and carrots were placed in front of them. They were instructed to taste each food and rate it on a number of qualities. They were also told that they could eat as much of each snack as they liked, “because we have tons of this food.” The students were then left alone in the room for 10 minutes.

Each bowl had been carefully pre-weighed before being brought into the room and placed before the undergraduates.

More cookies

The study found that the consumption of carrots and crackers wasn’t much different, statistically speaking, in the clean and messy kitchens. But kitchen cleanliness did affect the women’s cookie consumption. 

And, apparently, so did their state of mind after writing the essay.

Women in the chaotic kitchen who wrote about being out of control averaged 103 calories from the cookies. That compared to an average of 38 calories for those who wrote about being in control.

Women in the orderly kitchen who wrote about being out of control averaged 61 calories from the cookies. That compared to an average of 50 calories for those who wrote about being in control. 

This study has several limitations. It involved a small number of women who were similar in age and occupation (student). Most were also of normal weight. Findings in other populations might be very different. In addition, the study did not directly assess the perceived stress of the kitchen environment (messy or clean) or of the tasks themselves (writing the essay and judging the food) on the students.

The mind as a buffer

Still, the results are interesting. They suggest that “an individual’s mind-set can moderate the impact of a chaotic environment on food intake, particularly for sweet foods,” write Wansink and his colleagues. “Although a chaotic environment may be a risk factor for making unhealthy choices, one’s mind-set in that environment can either trigger or buffer against that risk factor.”

“There is a solution to eating less if you have a cluttered kitchen,” says Wansink in a video released with the study.

Clean Kitchens Cut Clutter video

Before you enter your kitchen, you can do what the people in this study did: sit and think about a time when you were in control in your life.

“But you know,” he adds, “it’s a whole lot easier to just keep your kitchen clean when you can.”

FMI: Wansink’s study can be read in full on the Environment & Behavior website until March 31, 2016. After that date, the study goes behind a paywall.

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New patient-advocacy group ‘outed’ by Minnesota-based website as ‘Astroturf’ campaign

In recent months, the pharmaceutical industry has been hit with a steady stream of negative publicity about the high costs of prescription drugs in the U.S.

And the public finally seems to be paying attention.

Last fall came much-publicized accounts of how two companies bought drugs that had been around for decades — the tuberculosis drug cycloserine and the anti-parasitic drug Daraprim — and then promptly jacked up their prices. The cost of a single Daraprim pill, for example, jumped from $13.50 to $750.

Martin Shkreli, the founder and former CEO of Daraprim’s manufacturer, Turing Pharmaceuticals, was quickly labeled “the most hated man in America.” Yet, as many people have pointed out, exhorbitantly high drug pricing is really not that unusual in the United States.

New hepatitis C drugs, such as Harvoni and Sovaldi, cost almost $100,000 for a single course of treatment, a price tag that has particularly strained state-run Medicaid budgets.

And late last summer, more than 100 oncologists from top cancer hospitals across the U.S. said the high cost with of cancer drugs, which has risen five- to tenfold over the past 15 years, is unsustainable. They called on federal agencies, Congress and medical associations to take steps (such as allowing Medicare to negotiate drug prices) to bring down those exorbitant costs.

“High cancer drug prices are affecting the care of patients with cancer and our health-care system,” said one of the doctors, hematologist Ayalew Tefferi of the Mayo Clinic in Rochester. “The average gross household income in the U.S. is about $52,000 per year. For an insured patient with cancer who needs a drug that costs $120,000 per year, the out-of-pocket expenses could be as much as $25,000 to $30,000 — more than half their average household income.”

The pushback

All this attention on the high cost of drugs is, of course, worrisome for the pharmaceutical industry. So it’s pushing back. Hard. Earlier this month, the Pharmaceutical Research and Manufacturers of American (PhRMA) launched a new multimillion-dollar advertising campaign “to improve its reputation with lawmakers as it lobbies against any effort to rein in prescription costs,” according to the Wall Street Journal.

And to improve its relationship with the public, the pharmaceutical industry is turning to an old tried-and-true ploy: the fake, or “Astroturf,” patient-advocacy group.

In an article published last week on the Minnesota-based HealthNewsReview website, reporter Trudy Lieberman “outs” one such group, Patients Rising, along with its partner organization Patients Rising Now

“Like most Astroturf groups, its purpose [“to fight for access to vital therapies and services for patients with life-threatening diseases”] seems noble enough and its goals lofty,” writes Lieberman.

But in reality, she says, the group’s main goal is “to push against the developing meme of unaffordable drugs.” And, like other Astroturf groups (such as Even the Score, which last year successfully persuaded federal regulators that not approving the drug flibanserin for the treatment of “female hypoactive sexual desire disorder” represented gender inequity), Patients Rising does this under the guise of being a grassroots patient organization.

“Astroturfers gather ordinary citizens from the grassroots to advocate for various causes while in reality shilling for the trade associations, PR firms, corporations, and political organizations that set them up,” Lieberman explains.

Funding sources unclear

Patients Rising, she reports, was founded by Jonathan Wilcox, a corporate communications and public relations consultant and adjunct professor at USC’s Annenberg School of Communications and his wife, Terry, a producer of oncology videos. 

The group intends to get its message out to the public “through workshops, webcasts at conferences, social media, and sharing patient stories, a staple of these groups,” she adds.

Patients Rising’s website provides no indication of who is paying for all these activities, however. So Lieberman called the group:

In a very brief phone interview Jonathan Wilcox told me the fight for access “is a cause worth fighting for,” especially against what he calls “widespread interference in the doctor patient relationship,” which he said had become “a patient crisis.” He said his group also opposes step therapy, a requirement which insurers impose that makes patients try least expensive drugs before taking ones that cost much more. Wilcox had to catch a plane before we could explore that issue and before I could ask about who funds Patients Rising. He didn’t respond to my requests to finish the conversation.

Both Wilcox and his wife had worked with Vital Options International, another patient advocacy group with a special mission of generating global cancer conversations. She is a former executive director. A search of [Vital Options International’s] website showed that drug industry heavy hitters, such as Genentech, Eli Lilly, and Bristol-Myers Squibb, had in the past sponsored some of the group’s major activities, including The Group Room and Advocacy in Action, which offer educational patient-driven content filmed at oncology conferences.

Patients Rising is pushing back particularly strongly against Dr. Peter Bach, an epidemiologist at New York City’s Memorial Sloan Kettering Cancer Center, who has been outspoken about the high cost of cancer drugs.

“Patients Rising doesn’t like Bach’s DrugAbacus that lets users evaluate the value of their cancer drugs on dimensions such as cost, side effects, and benefits,” writes Lieberman. “A post by Terry Wilcox for Vital Options International last summer notes, ‘Cancer patients don’t see value in economic terms,’ and advises readers: ‘Beware drug price calculators that give insurance companies and hospitals the ability to quantify a cancer patient’s life.’”

‘A flawed narrative’

As Lieberman writes,

It’s pretty clear after dissecting the activities of this new patient advocacy group that it’s advocating for more drugs no matter what the price, no matter how effective or ineffective they happen to be. Is the group’s agenda the same as that of patients? I asked Dr. Vinay Prasad, an oncologist and researcher at Oregon Health Sciences University, who just published a paper last week in JAMA Internal Medicine. Prasad and a colleague found that of the public speakers at 28 meetings of the FDA’s Oncologic Drugs Advisory Committee, one third had financial connections to drug companies or the organizations they represented received support from those companies seeking marketing approval.

There’s a flawed narrative, Prasad said, that patients want more drugs faster and are willing to tolerate major uncertainty about the risks. “There’s a big disconnect in my experience about what you hear in the news and what patients want,” he told me. In his practice, they are asking about risks and benefits, but that story never gets told. “Have you read a story about patients asking for more information about risks?  A vocal minority is speaking on behalf of a largely silent majority.” But it’s a vocal minority that’s very well funded.

FMI: You can read Lieberman’s article on the HealthNewsReview website

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Positive, emotion-laden words you won’t find in the English language

As the German word Schadenfreude (“pleasure at the misfortunes of others”) famously illustrates, other languages often have words whose emotional meaning cannot be comparably expressed in English with a single word.

Scholars have long debated the significance of these so-called “untranslatable” words — specifically, how much their nonexistence in English influences the thoughts and emotions of people in English-speaking cultures. But as Tim Lomas, a psychologist at the University of East London argues in a absorbing new paper, these types of words “exert great fascination, not only in specialized fields like linguistics or anthropology, but also in popular culture.”

“Part of the fascination,” he adds, “seems to derive from the notion that such words offer ‘windows’ into other cultures, and thus potentially into new ways of being in the world.”

In his paper, which appeared last month in The Journal of Positive Psychology, Lomas presents what he calls “the beginnings of a positive cross-cultural lexicography of ‘untranslatable’ words pertaining to well-being, culled from across the world’s languages.”

His initial “quasi-systematic search” uncovered 216 such terms, which he hopes will “help expand the emotional vocabulary of English speakers (and indeed speakers of all languages), and consequently enrich their experiences of well-being.”

I don’t know if the lexicon he’s started to compile will accomplish that ambitious goal, but it certainly makes for some interesting reading.

Lomas has organized the words into three main categories. Here are some examples from each. The definitions are either written or compiled by Lomas: 

Words related to feelings 

Sombremesa (Spanish): when the food has finished but the conversation is still flowing

Desbundar (Portuguese): shedding one’s inhibitions in having fun

Schnapsidee (German): an ingenious plan one hatches while drunk

Gökotta (Swedish): waking up early with the purpose of going outside to hear the first birds sing

Suaimhneas croi (Gaelic): a state of happiness encountered specifically after a task has been finished

Tarah (Arabic): a musically induced state of ecstasy or enchantment

Ramé (Balinese): something at once chaotic and joyful

Iktsuarpok (Inuit): the anticipation one feels when waiting for someone, whereby one keeps going outside to check if they have arrived

Vorfreude (German): the intense, joyful anticipation derived from imagining future pleasures, although this does depend on a strong likelihood of attainment

Saudade (Portuguese): a melancholic longing/nostalgia for a person, place or thing that is far away — either spatially or in time

Natsukashii (Japanese): a nostalgic longing for the past, with happiness for the fond memory, yet sadness that it is no longer

Words relating to relationships

Nakama (Japanese): friends whom one effectively considers family

Kanyininpa (Aboriginal Pintupi): an intimate and active relationship between a “holder” and that which is “held,” capturing the deep feeling of nurturance and protection a parent feels for a child

Gigil (Philippine Tagalog): the irresistible urge to pinch or squeeze someone because they are loved or cherished

Retrouvailles (French): the joy people feel after meeting loved ones again after a long time apart

Razljubit (Russian): the feeling a person has for someone they once loved

Ubuntu (Nguni Bantu): the culturally valued notion of being kind to others on account of one’s common humanity

Kreng-jai (Thai): the wish to not trouble someone by burdening them with a request that might cause them hassle

Fargin (Yiddish): to glow with pride and happiness at the success of others (often family members)

Gunnen (Dutch):  to allow someone to have a positive experience, especially if that means one won’t have it oneself

Hirgun (Hebrew): the act of saying nice things to another simply to make them feel good

Words relating to character

Sisu (Finnish): extraordinary determination in the face of adversity

Aõ jenna (Icelandic): the ability or willingness to persevere through tasks that are hard or even just boring

Kefi (Greek): a spirit of joy, passion, enthusiasm, high spirits, even frenzy

Jugaad (Hindi): the ability to “make do” or “get by,” particularly in difficult circumstances 

Desenrascanço (Portuguese): to artfully disentangle oneself from a troublesome situation

Sprezzatura (Italian): a certain nonchalance, wherein all art and effort are concealed beneath a “studied carelessness”

Kombinowac (Polish): working out an unusual solution to a complicated problem, and acquiring coveted skills or qualities in the process

Kào pu (Chinese): someone who is reliable, responsible and able to get things done without causing problems for others

Orenda (Wyandot Iroquoian): the power of the human will to change the world in the face of powerful forces, such as fate 

Lomas has launched a website for his “positive lexicography project,” which he describes as “very much a work in progress.” He says he welcomes suggestions for additional words and for improvements on any definitions. At the website, you’ll also be able to download and read his recently published paper.

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Childhood-injury expert urges end to ban on U.S.-funded gun-violence research

The 19-year-old ban imposed by Congress on the federal funding of research into gun violence needs to be overturned if we are going to ever figure out how to reduce that violence, argue the authors of an editorial published Wednesday in the BMJ.

“Any other public health problem of comparable seriousness would not have been ignored for decades, but US history and the political pressure brought to bear by the National Rifle Association have so far proved impossible to defy,” write the commentary’s authors.

One of the authors, Dr. Frederick Rivara, is a professor of pediatrics at the University of Washington who has spent the past 30 years studying childhood injury and its prevention. He was founding president of the International Society for Child and Adolescent Injury Prevention. The other authors are Dr. Kamran Abbasi, international editor of BMJ, and Dr. Margaret Winker, a medical research editor.

In U.S., a gun kills someone every 17 minutes

Rivara and his colleagues argue that gun violence in the U.S. is one of the country’s major public health problems. The statistics, certainly, are alarming: A firearm kills somebody in this country every 17 minutes. That’s an average of 87 people a day, or 609 a week. 

In 2014, firearms were responsible for 33,599 deaths in the U.S.  Of those, 63 percent were suicides, 34 percent were homicides and 2 percent were unintentional shootings.

“The problem is worldwide,” Rivara and his co-authors acknowledge, “although few countries have guns embedded in the national psyche to quite the same extent as the US.”

But the shortening of so many people’s lives, while tragic, is not the entire sum of the toll that gun violence places on society, they add. It also has detrimental effects on our educational and health-care institutions, and contributes to family instability and our growing prison population.

‘A classic public health problem’

Gun violence is, therefore, “a classic public health problem,” they argue, although, unfortunately, “US political forces and special interest groups have blocked any public health approach” to treating it as such.

But that public health approach — defining and monitoring the problem, identifying risk and protective factors, developing and testing prevention strategies, and, finally, adopting those strategies found to be effective — is urgently needed.

“Research is needed on all aspects of gun policies and safety, including evaluating state policies, improving understanding of the effects of restricting access to firearms and other lethal means for people at risk of suicide, and evaluating the effectiveness of community and school gun safety training,” Rivera and his colleagues write. “Smart gun and smart gun safes could be evaluated to determine their effect on safety.”

The writers also call for more epidemiological research to understand “who buys guns and what happens to the people who own them and their families and communities.”

“By taking basic steps to permit public health research, we can finally begin to understand the sources of the current epidemic of violence and how best to control it,” Rivera and his co-authors conclude. “Only hard evidence will cool the heat of gun rhetoric and address this critical worldwide problem.”

FMI: You can read the commentary in full on the BMJ website

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Dementia rates in U.S. have decreased by 44% over past 30 years, study finds

The dramatic increase in obesity and diabetes in the United States over the past few decades, coupled with lengthening life expectancies, has led health officials to predict that rates of dementia will also skyrocket.

Some experts estimate that the number of Americans with Alzheimer’s disease and other forms of dementia will reach 7.1 million by 2025 — a 40 percent increase over the 5.1 million older Americans affected by such diseases today. 

But a new study, published Wednesday in the New England Journal of Medicine (NEJM), suggests that the rate of new cases of dementia in the U.S. may actually be decreasing.  Using data from the long-running Framingham Heart Study, researchers have found that the incidence of dementia has declined significantly over the past 30 years — although only in people with a high school diploma or more.

The study also found that people with at least a high school education were more likely to have more indicators of good heart health. That finding suggests that improvements in physical health through lifestyle changes and better health care can help prevent or delay cognitive decline.

“Our study offers cautious hope that some cases of dementia might be preventable or at least delayed,” write the authors of the study.

Study details

Participants in the Framingham Heart Study undergo numerous medical tests and examinations every two years. Since 1975, those tests have included ones that look for signs of dementia. In the current study, researchers analyzed data collected from more than 5,200 of the study’s participants during four time periods — or what the researchers call “epochs” — between the late 1970s and the early 2010s.

When they compared the incidence of dementia across those epochs, they found that, compared to the first epoch, the incidence of dementia declined by 22 percent during the second, by 38 percent during the third, and by 44 percent during the fourth.

The decline was due mostly to lower rates of vascular dementia, which is caused by problems with the flow of blood to the brain — usually the result of a series of small strokes. The study found no significant decline in the incidence of Alzheimer’s disease, whose cause is unknown but appears to be related to an abnormal accumulation of proteins in the brain.

Possible causes

The observed decline in vascular dementia might be explained, according to the researchers, by a reduction in circulation-related risk factors, especially smoking and high blood pressure, among the study’s participants. 

Indeed, the study found that the rate of circulation-related diseases, such as stroke and congestive heart failure, declined significantly among Framingham participants over the 30 years of the study.

The study’s findings also suggest that improvements in medical treatments may be contributing to the decline in dementia. In the late 1970s and early 1980s, people who had a stroke were nine times more likely to develop dementia than those who had not had a stroke. By the early 2000s, patients who had a stroke were only two times more likely to develop dementia.

The reasons for the association between education and a lower risk of dementia is not clear, but it may have to do with healthier lifestyle behaviors and/or better access to health care.

The study also found that improvements in heart health have occurred over the past three decades only among people with at least a high school education.

Limitations and implications

This new research comes with several important caveats. The scientists were not able to determine whether changes in lifestyle — specifically changes in diet and exercise habits — might explain the study’s results. Furthermore, most of the study’s participants were white and suburban. It’s not known, therefore, whether the findings would also apply to other population groups.

Another study, however — one published Wednesday in the journal Alzheimer’s and Dementia — suggests that dementia rates have, indeed, been decreasing among African-Americans in recent decades.

“We are expecting an explosion of dementia over the next 50 years, with devastating consequences both on a personal level and on a society level because our population is aging,” says Dr. Sudha Seshadri, a professor of neurology at Boston University and the Framingham Heart Study’s senior investigator, in a video released with the new study. “If we can, however, bend the arc of risk so that people get it later, closer to the natural lifespan, then we will be reducing the individual as well as the societal burden of dementia.”

We’re still going to see increasing numbers of people developing dementia over the next 30 years, she acknowledges. “But at the same time,” she adds, “and for the same reason, it’s important to invest more resources in understanding what we’re doing right — why the mean age of dementia is increasing in Framingham — so that we can promote whatever we’re doing right.”

FMI: You’ll find an abstract of the study on the NEJM website, but the full study is behind a paywall.

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BMI — whether ‘obese,’ ‘overweight’ or ‘normal’ — is an unreliable measure of health, study finds

Last year, the Equal Employment Opportunity Commission (EEOC) proposed a new rule that would allow companies to make their employees pay higher health insurance premiums if they fail to meet certain health criteria, including maintaining a healthy body mass index (BMI).

But is BMI an accurate indicator of a person’s current health status or future risk of disease?

Not necessarily, according to a recent study published in the International Journal of Obesity.

The study found that almost one-third of people with an “obese” BMI are cardio-metabolically healthy, and a similar percentage of people with a “normal” BMI are cardio-metabolically unhealthy.

Cardio-metabolic risk refers to the likelihood that you will develop heart disease, type 2 diabetes or stroke.

By using BMI as the main indicator of cardio-metabolic health, say the study’s authors, we may be misclassifying the health status of more than 74 million Americans.

Developed in Minnesota

BMI is calculated by dividing your weight in kilograms by the square of your height in meters. (If you want to avoid doing the math, just use this online BMI calculator provided by the National Heart, Lung, and Blood Institute.) A BMI of 18.5 to 24.9 is considered “healthy.” One from 25 to 29.9 is considered “overweight.” And one at 30 or higher is considered “obese.”

According to the Centers for Disease Control and Prevention (CDC), 69 percent of Americans aged 20 or older are either overweight or obese. 

As I’ve noted in Second Opinion before, the BMI formula was developed in the early 1970s by University of Minnesota physiology professor and obesity researcher Ancel Keys — but only as a tool to help epidemiologists make comparisons between current and historic obesity levels of large populations. Keys did not envision using BMI to determine an individual’s health status.

Study details

For the new study, researchers at the University of California, Los Angeles analyzed data collected by more than 40,000 American adults who participated in the National Health and Nutrition Examination (NHANES) survey between the years 2005 and 2012. The data included the participants’ height and weight — and, thus, their BMI — but also a host of other health-related measures, including assessments for blood pressure, blood glucose, insulin resistance, and triglyceride, cholesterol and C-reactive protein levels. Those latter measures are all markers for cardio-metabolic risk. 

According to the data, about half of the study’s 40,000 participants were overweight and about a third were obese. But when the UCLA researchers looked for a link between BMI and the cardio-metabolic markers, they found that 47 percent of the people with overweight BMIs and 29 percent of those with obese BMIs were healthy. 

“For these individuals, having a healthcare provider prescribe weight loss could be a misuse of time, patient effort, and resources,” the study’s authors write. “Focusing on BMI as a proxy for health may also contribute to and exacerbate weight stigmatization, an issue that is particularly concerning given [that] health providers evince high levels of anti-fat bias.” 

The UCLA researchers also found that 30 percent of people with a normal BMI were, cardio-metabolically speaking, unhealthy.

“When healthcare providers deem these individuals as ‘healthy’ merely because they are not overweight or obese, critical diagnoses could be delayed or missed altogether,” the researchers warn.

According to the study’s findings, 34.4 million adults in the U.S. who are “overweight,” 19.8 million who are “obese” and 20.7 million who are “normal” may have a health profile that is not reflected by their BMI.

EEOC should reconsider

“These results clearly indicate that health policies such as those proposed by the EEOC should not relay on BMI,” the study’s authors conclude. “Not only are such policies discriminatory, but they run the risk of overlooking more effective approaches” — programs, for example, that help people exercise more and develop practical, health-enhancing skills, such as stress management.

“There are healthy people who could be penalized based on a faulty health measure, while the unhealthy people of normal weight will fly under the radar and won’t get charged more for their health insurance,” said A. Janet Tomiyama, an assistant professor of health psychology at UCLA and the study’s lead author, in a released statement. “Employers, policy makers and insurance companies should focus on actual health markers.”

FMI: You’ll find an abstract of the study on the International Journal of Obesity’s website, but the full study is behind a paywall. 

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New Lyme-disease-causing bacteria discovered by Mayo researchers

Blacklegged ticks

Minnesota Department of Health
Blacklegged ticks

Researchers at the Mayo Clinic have discovered a new species of bacteria in the Upper Midwest that causes Lyme disease.

They have named the bacteria Borrelia mayonii, after the two brothers, William and James Mayo, who founded the Rochester, Minnesota, clinic. Before this finding, which was published Monday in the journal Lancet Infectious Diseases, the only species believed to cause Lyme disease in North America was Borrelia burgdorferi.

Lyme disease is a potentially serious illness that is transmitted to humans through the bite of infected blacklegged ticks (also known as deer ticks and bear ticks). It is the most common tick-borne disease in the United States. Cases are heavily concentrated in 14 states, including the Upper Midwestern states of Minnesota and Wisconsin. In 2014, Minnesota had 896 confirmed cases of the disease and 520 probable cases, according to the Minnesota Department of Health (MDH).

Suspicious results

Mayo researchers first suspected that a new bacterium might be involved in Lyme disease after analyzing blood samples taken from 9,000 people with symptoms of the illness. Using a testing method called polymerase chain reaction (PCR), they noticed that six of the samples — ones collected in Minnesota, Wisconsin and North Dakota — had produced an atypical result. In collaboration with the Centers for Disease Control and Prevention (CDC), the Mayo researchers conducted additional tests on those six samples, which revealed a bacterium genetically distinct from B. burdorferi.

Over the past decade, the Mayo Clinic has used PCR to test more than 100,000 patient specimens from across the country, but it’s only recently that it has detected this new species of bacteria — and only in patients in the Upper Midwest.

Furthermore, since the discovery of B. mayonii, researchers have analyzed approximately 25,000 additional blood samples taken from people with suspected cases of Lyme disease in 42 other states, including in the Northeast and Mid-Atlantic, where the disease is common. They found no evidence of the B. mayonii in any of those samples.

“It could be that it newly emerged in the Upper Midwest, or it could be that it was present at lower levels for a longer period of time and it’s only recently come to a level that’s high enough for us to detect it,” says Dr. Bobbi Pritt, the study’s lead author and director of the Mayo Clinic’s Clinical Parasitology Laboratory, in a video released with the study.

Similar, but not identical, symptoms

B. mayonii is most likely transmitted to humans the same way as B. burgdorferi: through the bite of a blacklegged tick. Pritt and her colleagues tested about 600 blacklegged ticks and found that 3 percent of them tested positive for B. mayonii.

Both bacteria species appear to produce similar Lyme disease symptoms:  fever, headache, rash, neck pain and, in later stages, arthritis. But — based on the limited information collected from the six patients — there seems to be two notable differences. Patients whose disease is caused by B. mayonii are more likely to have nausea and vomiting, and their rash tends to be more diffuse.

Mayo researchers identify new Borrelia species that causes Lyme disease

“It wasn’t the classic bull’s eye rash that you see with Lyme disease caused by Borrelia burgdorferi, and therefore physicians may not always suspect this infection right away,” says Pritt. 

“It’s important to note,” she adds, “that two of our six patients were hospitalized, so this is not a benign infection.”

Still, the B. mayonii infection does not appear to be more serious than the one caused by B. burgdorferi. All six patients were successfully treated with antibiotics.

Protect yourself

The Mayo researchers are working with the CDC, the Minnesota Department of Health and the health department of Wisconsin and North Dakota to develop a better understanding of B. mayonii and the specific form of Lyme disease it produces.

In the meantime, Minnesotans should continue to follow the CDC’s recommendations for limiting the risk of tick bites and tickborne diseases: 

  • Avoid wooded and brushy areas with high grass and leaf litter.
  • Use insect repellent when outdoors
  • Use products that contain permethrin on clothing.
  • Bathe or shower as soon as possible after coming indoors to wash off and more easily find ticks.
  • Conduct a full-body tick check after spending time outdoors.
  • Examine gear and pets, as ticks can come into the home on these and later attach to people.
  • You don’t need to take these precautions just yet. But get ready. Minnesota’s tick season starts in May and continues through October. 

You don’t need to take these precautions just yet. But get ready. Minnnesota’s tick season starts in May and continues through October.

FMI: You’ll find an abstract of the Mayo study on the website of Lancet Infectious Diseases. The CDC has also released a statement about the new finding.

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CDC’s new ‘pre-diabetes’ campaign is misguided, Mayo physician says

“Take the Prediabetes Risk Test” video from the Ad Council

In January, the Centers for Disease Control and Prevention (CDC), the American Diabetes Association (ADA) and the American Medical Association, in partnership with the Ad Council, launched a new campaign to increase the public’s awareness of pre-diabetes.

According to the CDC, some 86 million American adults may have pre-diabetes, which the agency says is characterized by “blood glucose (sugar) levels [that] are higher than normal — but not high enough to be diagnosed as diabetes.”

“Pre-diabetes increases the risk for type 2 diabetes, heart disease, and stroke,” says Ann Albright, director of the CDC’s Division of Diabetes Translation, in a video released on MedScape with the campaign. Indeed, Albright says that without treatment — “a structured lifestyle program that provides real-life support for healthful eating, increasing physical activity, and enhancing problem-solving skills” — some 15 to 30 percent of people with pre-diabetes will go on to develop full-fledged diabetes within five years.

The campaign is encouraging people to talk with their physicians about getting tested for pre-diabetes.

Diabetes is certainly a serious disease. It can lead to disabling and sometimes life-threatening health complications, including heart disease, kidney failure, blindness and amputations. More than 29 million Americans, or 9.3 percent of the U.S. population, have the disease — a number that has increased four-fold over the past three decades.

But many experts are not convinced that pre-diabetes, a term coined by the ADA a few years ago and used almost exclusively in the United States, deserves the attention it’s receiving in the new public awareness campaign.

In fact, they don’t think pre-diabetes is a medical condition at all, but rather “an artificial category with virtually zero clinical relevance” — and one that may lead to more harm than good. As two diabetes experts argued in a 2014 commentary published in the journal BMJ, the pre-diabetes diagnosis is needlessly putting millions of people at risk of receiving unnecessary medical treatment and is creating “unsustainable burdens” for health care systems.

One of the authors of that commentary is Dr. Victor Montori, an endocrinologist who specializes in diabetes at the Mayo Clinic in Rochester, Minnesota. MinnPost recently spoke with Montori regarding his concerns about the pre-diabetes diagnosis and the new public awareness campaign that is encouraging people to seek out that diagnosis. A condensed and edited version of that conversation follows.

MinnPost: What is pre-diabetes?

Victor Montori: The CDC is now defining it based on the ADA’s definition, which is essentially any measure of elevated blood sugars, whether [resulting from] a fasting blood glucose [test] or after a two-hour glucose tolerance test or a hemoglobin A1C [test]. If it’s elevated and it doesn’t qualify you as having diabetes, it qualifies you as having pre-diabetes.

Dr. Victor Montori

Dr. Victor Montori

The problem with that definition is that it includes too many people, and the problem with including too many people is that the proportion of those people who will then go on to develop diabetes is actually very small — in the order, perhaps, of 2 to 3 percent over the course of three to five years. This is different from the number that the CDC normally gives of around 20 to 30 percent moving on to diabetes in that period of time. [Those larger percentages] come from studies in which only one of the criteria was used to define pre-diabetes, which was the blood sugar being abnormal two hours after a glucose tolerance test.

But nobody does a glucose tolerance test in practice. So the majority of people that will be diagnosed with pre-diabetes will be diagnosed that way because of elevated [fasting] blood sugars or because of a hemoglobin A1C. And the proportion of those people who go on to develop diabetes is infinitely smaller than the proportion that goes on to develop it if they have an abnormal glucose tolerance test.

MP: The CDC is estimating that 86 million people in the U.S. have pre-diabetes, and that nine out of 10 of them are unaware of it.

VM: That number is a reflection of the loose definition that the CDC and the ADA have chosen to identify the nature of the problem. Obviously, they want the problem to appear very large. This is not acceptable — to create a public health problem by virtue of changing the definition. By that definition, the number of people with abnormal sugars, either diabetes or pre-diabetes, is too large.

And yes, the majority of people don’t know they have a problem. But, I might add, most don’t have a problem.

MP: What are your concerns about the impact of the new public service campaign?

An example of the pre-diabetes awareness print campaign.

Ad Council
An example of the pre-diabetes awareness
print campaign.

VM: The CDC and Congress and some insurers and some other groups — departments of health in several states — are committed to asking the health care system to check blood sugars in people who come in contact with the health care system in order to identify those people with pre-diabetes. If they identify someone as having pre-diabetes, they are then [to be] referred to programs, for instance, like those offered by the YMCA, where they can [receive] physical activity and diet recommendations.

In general, I don’t have a problem with any of that. But I do have two fundamental concerns. First, if the problem affects one in three Americans, is it possible that diabetes is not the result of poor individual decision-making or poor individual habit choices, but rather the society that we are building? That society — the environment that we create — is a combination of advertisement, food policies, worksite policies, transportation policies, education policies. If these things are what is causing diabetes, why would we want to intervene one person at a time while keeping them in the environment that is pushing them in the direction of diabetes? How likely is it that we are going to have a sustained benefit from identifying individuals and treating them individually? So that’s one problem I have.

MP: And the second one?

VM: Patients already complain about their doctors not having time to meet with them and about hurried consultations. So we’re now going to be sending 86 million or more Americans to that overtaxed and overwhelmed health care system to seek individual care and counseling for pre-diabetes. It seems to me that people with diabetes are going to have to compete for access to care — the kind of care that is really important, like preventing complications. And if they don’t have such access, we’re going to have a net negative impact in that now we’re going to have more people living with the complications of diabetes.

MP: What should people do with the messages they’re hearing from the CDC’s pre-diabetes campaign?

VM: It’s hard to know. We’ve reviewed those messages here in our research group, and we’ve found some of them to be really problematic. There seems to be some language in those ads that is very paternalistic, condescending and guilt forming, particularly some of the ones directed at young mothers.  So, to some extent, I think that if diabetes is not making them sick yet — because, of course, they don’t have the disease — then the messaging itself, by producing guilt and blaming individuals for the shortcomings of our policies, may produce discomfort, distress and disease.

I find the campaign misguided. Maybe I’m a dreamer, maybe I’m a romantic, maybe I’m unreasonable, but I think we should be taking the numbers that the CDC has produced from their very generous definition of pre-diabetes and use them as a wake-up call for policymakers. How might we develop our towns, workplaces, cities, families, schools [so that] diabetes is not the outcome?

For example, we build wider roads so more cars can move around, and we create more suburbs so that people have to get in their cars to go shopping. But what if we changed the zoning so that people can walk to shops? What if we create more public transportation so that people can get to their workplace and spend the last mile, perhaps, walking from the transportation to their workplace? If you go to large urban centers in cities with lots of opportunities of that nature, you see a lot fewer people with obesity.

The other part of the policymaking we need to not forget is that where there is a lot of wealth and income inequality, where there is a lot of chronic stress related to poverty and violence, there is also more diabetes. In the United States, there is a group that is actually having less diabetes: people who are affluent and white. Poor, brown, young people are having more diabetes now. That should tell you that [the diabetes epidemic] is probably not a crisis in will power among the poor, but rather something fundamental about how we are distributing social justice in our society.

I would love to see the presidential candidates tackle the issue of how our society is creating diabetes. It’s much easier to talk about the lack of personal responsibility and tell everybody to eat more broccoli. I think it’s much more interesting to say, gosh, we’ve created a society in which the poor and the brown are developing diabetes. What can we do to change that?  Let’s look at our policies, both in terms of chronic stress and poverty and violence and also in terms of activity and lifestyle. What would lead to better health? I think that investment would be better than tackling this problem as if it were the fault of individuals.

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