During my freshman year in high school, my science teacher assigned us to interview people in the community about how they use science in their careers. Although I don’t remember most of the people I spoke with, I can tell you that I spent meaningful time with a local community pharmacist who changed my life.
What I saw was a man who loved his career and truly cared for his patients. In an instant, I knew that I wanted to become a pharmacist, and I never wavered from that goal throughout high school.
Knowing what you want to be when you grow up at age 14 is unusual, but it is very liberating. I simply had to work backwards to figure out how to achieve my goal of becoming a pharmacist.
After high school, I chose to attend Ohio Northern University (ONU) because it had a unique pharmacy program. Rather than attending college for 2 years and then applying to the pharmacy program, ONU students were admitted to the College of Pharmacy from day one.
Although it was expensive, being in pharmacy school from day one and avoiding the risk of rejection made it worthwhile for me.
In college, I spent a lot of time in the library. Although the classwork was difficult, I did well with one exception: organic chemistry.
I did fail organic chemistry—a notorious “weed out” course—but I successfully retook the class over the summer and graduated on time with the rest of my classmates. Failing a course is a difficult stumbling block, but I stood strong and persevered.
Today, I’m thankful for the wonderful pharmacy profession for so many reasons.
First, I’m thankful that community pharmacists are the health care professionals most accessible to the public. If my local pharmacist wasn’t accessible to me, then I likely would have taken a different career path.
Second, I’m proud of the work we pharmacists do, the diversity of our career options, and the relationships we share with our patients and fellow health care providers.
Pharmacy is a profession that makes a real difference in people’s lives. It certainly has made all the difference in mine.
For Latinos with diabetes, new study looks at ways to improve medication adherence
Certain lifestyle changes and low-cost interventions may improve how patients manage their medication regimen
University of Southern California - Health Sciences
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IMAGE: Keck School of Medicine of USC, Los Angeles. view more
Credit: Ricardo Carrasco III
LOS ANGELES -- Latino adults have higher diabetes rates than non-Latinos, yet research shows they are less likely to correctly follow medication instructions provided by their doctors. Furthermore, diabetes can set off a cascade of medical complications, requiring multiple medications that often create a challenging daily regimen. In a new study coming out of the Keck School of Medicine of USC, student researchers have identified several potential approaches for improving medication adherence among Latinos.
Simple measures such as giving patients pillboxes for their medications, helping patients' family members understand their medication regimen and having patients attend weekly education sessions about managing the disease through lifestyle changes are all ways that patients could improve medication adherence.
The study also points toward specific challenges that underserved Latinos may be facing. Such challenges include having difficulty understanding what their medications are for, keeping track of their medications and feeling that they may take too many medications. Cohorts in this study took an average of 6.5 prescribed medications daily.
"Obtaining patients' perspectives is key to finding solutions that help improve their medication adherence and health outcomes," says Andrea Bañuelos Mota, the study's first and corresponding author. "Not only do our findings suggest several potential approaches to intervention for Latinos with diabetes, but they could also pave the way for the development of future evidence-based guidelines." Bañuelos Mota is currently enrolled in the Keck School's Doctor of Medicine/Master of Public Health (MDMPH) degree program.
Published in the Journal of General Internal Medicine (JGIM) on June 4, the cross-sectional study involved conducting surveys of 120 patients from across four safety net clinics in Los Angeles. Patients were at least 18 years old, self-identified as Latino/Hispanic/Chicano, were diagnosed with diabetes for more than six months, and were taking multiple diabetes medications. Furthermore, the study's dependent variable was patients with "controlled diabetes" (i.e., having a hemoglobin A1c level of less than 7.5%) versus patients with "uncontrolled diabetes" (i.e., having a hemoglobin A1c level equal to or greater than 7.5%).
"This study is exemplary of excellent primary care research and brings awareness to the language and literacy barriers faced by our immigrant communities, which health care providers must address to deliver quality medical care," says Jo Marie Reilly, MD, MPH, professor of clinical family medicine (educational scholar). Reilly leads the Keck School's Primary Care Initiative, a program created to promote careers in primary care and the one through which this study was established.
Conceived and led entirely by a team of five medical students -- including Andrea Bañuelos Mota, Emilio Ernesto Feliz Sala, Jennifer M. Perdomo, Joel Alejandro Solis and Walter M. Solorzano -- the study also marks an achievement for the Keck School initiative. "JGIM is one of the highest ranked general internal medicine journals, so it is particularly impressive that a student group got a paper accepted," says Michael Hochman, MD, MPH, a faculty mentor on the project with Reilly. Hochman is an associate professor of clinical medicine and serves as director of the USC Gehr Family Center for Health Systems Science.
Native Hawaiians at far greater risk for pancreatic cancer
Twenty years of data reveal surprising disparities
University of Southern California
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Native Hawaiians are at highest risk for pancreatic cancer, according to a USC study that provides a surprising look at disparities surrounding the deadly disease.
The findings -- published May 8 in the journal Cancer Medicine -- could help focus efforts to prevent pancreatic cancer, which will kill an estimated 45,750 people in the United States this year.
The study shows:
•Native Hawaiians have a 60% increased risk for pancreatic cancer, compared to European Americans.
•Japanese Americans have a 33% increased risk for pancreatic cancer, compared to European Americans.
•African Americans have a 20% increased risk for pancreatic cancer, compared to European Americans.
"The greater risks in Native Hawaiians and Japanese Americans, compared to whites -- in addition to the already reported increased risk in African Americans -- are new, important findings," said senior author Veronica Wendy Setiawan, associate professor of preventive medicine at the Keck School of Medicine of USC. "This study underscores the importance of studying diverse populations in cancer research."
For the research, scientists turned to the Multiethnic Cohort Study, established in 1993-1996 by USC and the University of Hawaii to investigate patterns in cancer incidence. The study includes more than 215,000 people recruited from Los Angeles County and Hawaii. The main ethnic groups represented are European American, African American, Latino American, Japanese American and Native Hawaiian.
Participants completed self-administered questionnaires, which included information on demographics, medical conditions, family history of cancer and lifestyle factors. Individuals were excluded if they had a prior pancreatic cancer diagnosis or were missing information integral to the study.
The resulting group numbered 184,559 individuals: 100,969 females and 83,590 males. The largest racial/ethnic group was Japanese Americans (29%), followed by European Americans (25.1%), Latino Americans (22%), African Americans (16.7%) and Native Hawaiians (7.3%).
There were 1,532 cases of pancreatic cancer over an average follow-up period of 16.9 years. The researchers took into account family history of pancreatic cancer, diabetes, smoking, body mass index, alcohol and red meat consumption. They said 20% of the cases could be attributed to smoking, obesity and red meat intake.
The study doesn't answer why certain groups are more at risk but it did make a number of observations about risk factors, including:
•Family history of pancreatic cancer was slightly more prevalent in Japanese Americans.
•Native Hawaiians and African Americans were more likely to be current smokers.
•Diabetes mellitus was more common in African Americans, Latino Americans and Native Hawaiians.
•Red meat intake was highest among African Americans, Latino Americans and Native Hawaiians.
"Our results show that African Americans are not the only minority populations with increased risk of pancreatic cancer," Setiawan said. She added that Latinos and whites are at similar risk.
Approximately 56,770 people -- roughly 12.9 per 100,000 people -- will be diagnosed with pancreatic cancer in the United States in 2019, according to the National Cancer Institute. There are no symptoms in the early stages; it is often detected late and has a poor prognosis.
Findings could have implications for patients with metabolic and mental disorders
Society for Neuroscience
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IMAGE: This is a model underpinning the effects of metformin on depressive symptoms in mice fed a HFD. view more
Credit: Zemdegs et al., JNeurosci (2019)
The antidiabetic medication metformin reduces anxiety-like behaviors in male mice by increasing serotonin availability in the brain, according to a study published in JNeurosci. These findings could have implications for the treatment of patients with both metabolic and mental disorders.
People with diabetes have an increased risk for mood disorders such as depression. Although the mechanisms underlying the relationship between insulin resistance -- the precursor to diabetes -- and depression are not known, studies suggest the neurotransmitter serotonin may be the culprit.
In mice raised on a high fat diet, Bruno Guiard and colleagues demonstrate that the insulin-sensitizing drug metformin reduces levels of amino acids that impair the entry of tryptophan in the brain and thereby limit its conversion into serotonin. The drug's antidepressant-like effects were accompanied by improved neurotransmission in the hippocampus. The researchers achieved similar effects by reducing the amount of so-called branched chained amino acids in the diet.
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Manuscript title: Metformin promotes anxiolytic and antidepressant-like responses in insulin-resistant mice by decreasing circulating branched-chain amino acids
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About JNeurosci
JNeurosci, the Society for Neuroscience's first journal, was launched in 1981 as a means to communicate the findings of the highest quality neuroscience research to the growing field. Today, the journal remains committed to publishing cutting-edge neuroscience that will have an immediate and lasting scientific impact, while responding to authors' changing publishing needs, representing breadth of the field and diversity in authorship.
About The Society for Neuroscience
The Society for Neuroscience is the world's largest organization of scientists and physicians devoted to understanding the brain and nervous system. The nonprofit organization, founded in 1969, now has nearly 37,000 members in more than 90 countries and over 130 chapters worldwide.
VIDEO: Cristina Aguayo-Mazzucato, MD, PhD, explains her research into the application of senolysis to the rejuvenation of beta-cell function in type 2 diabetes. view more
Credit: Joslin Communications Office
BOSTON - (May 30, 2019) --Research from Joslin Diabetes Center has shown in mice that insulin resistance increases the proportion of aged beta-cells which are dysfunction. Such an increase in aged beta-cells could lead to type 2 diabetes. These researchers confirmed similarly increased proportion of aged beta-cells in islets recovered from humans with type 2 diabetes. The study also showed that beta cell function can be recovered by removing these aged populations either via genetic modification or oral medication.
"Our hypothesis was that there was an important component in the development of diabetes which consisted of accelerated aging of beta-cells and that this population could be targeted therapeutically," says Cristina Aguayo-Mazzucato, MD, PhD, Assistant Investigator in the Section on Islet Cell and Regenerative Biology, first author on the paper, recently published in Cell Metabolism.
This research falls into a broader field of the study of senescence. Senescence is the slow decline of proliferation and function of a specific cell population. These cells accumulate as organisms grow older, but certain circumstances can cause some cells in an organism to age faster than the whole.
The research team, led by Dr. Aguayo-Mazzucato, generated animal models of insulin resistance and tracked the proportion of senescent beta-cells.
"What we found is that indeed, insulin resistance was increasing the amount of senescent or old beta-cells," she says.
Next, they deleted the aged cells through either genetic manipulation or medications that are known to remove senescent cells. The results were striking.
"We were able to recover beta cell function, we were able to restore glucose tolerance," says Dr. Aguayo-Mazzucato
The ability to restore beta cell function with minimal intervention could be a game changer in the care of type 2 diabetes. For many people with the disease, beta cell function declines to the point where they need injectable insulin. Should this research be borne out in clinic trials, the implications for treatment could be huge.
"When you look at the absolute percentage or quantity of the senescent beta-cells, they rarely exceed 20 percent of the whole beta cell population and yet targeting this relatively minor population had a huge effect on function and glucose metabolism and cellular identity," she says.
Medications to delete senescent cells , termed senolytics, are still under investigation. Dr. Aguayo-Mazzucato and her team hope to bring a potential treatment closer to the clinic by partnering with companies that are already working on senolytics, to test if their medications would work for people with diabetes.
"This opens a new target to treat diabetes which is basically to target populations of old or senescent cells that are really contributing to the local disfunction," she says.
Senolysis, or the removal of aged or dysfunctional cells, is a growing field in the treatment of age-related diseases. This new research fits into the larger picture of how senolytics could help combat many different diseases of aging, leading to better quality of life.
"In fact, it's a very exciting and rapidly growing field in medicine, which is called Senolytics or Senolysis," says Dr. Aguayo-Mazzucato. "It has promises, as shown by other laboratories, in osteoarthritis, muscle frailty or degeneration, renal function, some brain function."
While the work was completed in models of type 2 diabetes, the findings could also be relevant in type 1 diabetes.
"What we're seeing is that senescence is, in reality, a response to stress. In the case of type two diabetes, this stress is insulin resistance. In the case of type one diabetes, it is the immune attack on beta-cells," she says. "But in both models, beta-cells are responding to these stresses by becoming senescent. So, we think that the potential of this new vision of preventing diabetes will be valid for both type one and type two."
New repository 'Kipoi' improves access to machine learning models
Technical University of Munich (TUM)
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Although the importance of machine learning methods in genome research has grown steadily in recent years, researchers have often had to resort to using obsolete software. Scientists in clinical research often did not have access to the most recent models. This will change with the new free open access repository: Kipoi enables an easy exchange of machine learning models in the field of genome research. The repository was created by Julien Gagneur, Assistant Professor of Computational Biology at the TUM, in collaboration with researchers from the University of Cambridge, Stanford University, the European Bioinformatics Institute (EMBL-EBI) and the European Molecular Biology Laboratory (EMBL).
Trained models freely available
"What makes Kipoi special is that it provides free access to machine learning models that have already been trained," says Julien Gagneur. "What we are doing with Kipoi is not just sharing data and software, but sharing models and algorithms that are already trained on the most relevant data. These models are ready to use, because all the cumbersome work of applying them to data has already been done," says Anshul Kundaje, Assistant Professor at Stanford. More than 2,000 trained models are currently freely accessible on Kipoi. In a recent study published in Nature Biotechnology, the researchers show that the new repository will accelerate exchange in the genomics community and thereby advance genome research.
Fast algorithms and easy operation
Because Kipoi simplifies access to already trained models, researchers can perform transfer learning. This means that a model that has already been trained with a particular dataset is capable of learning a similar task faster. Kipoi also simplifies the process of feeding data into the models stored there: Standardized file formats and software frameworks reduce the installation and execution of a model to three simple commands. Those who previously had no experience in machine learning can thus also easily use the repository.
Understanding individual genomes
As Kipoi is oriented towards models that link genotype and phenotype, the new platform will make it easier to identify genetic causes of disease: "Kipoi puts the latest deep learning models trained on massive genomics data at the fingertips of clinical researchers," says Julien Gagneur. "This provides very exciting opportunities to understand individual genomes, for instance to pinpoint genetic variants causing diseases or to interpret mutations occurring in tumors."
However, the extent of the platform's contribution to genomic research will also depend on the genomics community. "We hope that in the future more researchers will bring their models to our repository," says Oliver Stegle, team leader at the EMBL-EBI. "That is the only way we can make genomics analysis accessible and ultimalely make a wider range of predictive machine learning tools available to the genomics community
Bariatric surgery can be safe and effective for adolescents
Pediatricians are often reluctant to recommend bariatric surgery for teen-agers, but a Rutgers-led study concludes it is a justifiable treatment for adolescents with persistent extreme obesity if they can maintain a healthy lifestyle afterward.
The researchers reviewed studies on bariatric surgery in adolescents and adults in their report in The Journal of Pediatrics.
"If we look at obesity as a disease with the real possibility of eventual organ system failure and special health concerns for adolescents, we need to ask whether health care practitioners are doing enough to manage it," said lead author Ahmed Khattab, a physician at Rutgers Robert Wood Johnson Medical School's Division of Pediatric Endocrinology. "The objective evidence shows that, under the right circumstances and with the right patients, bariatric surgery is an effective treatment for adolescents with obesity."
The findings are consistent with those of a separate study, published May 16 in the New England Journal of Medicine.
Obesity and its related conditions, including hypertension, cardiovascular disease and type 2 diabetes, are increasing worldwide in adults and children, according to the study. Excess weight and obesity in adolescents cost more than $14 billion per year. Meanwhile, type 2 diabetes causes more severe insulin deficiency and other complications in youths than in adults and the steps being taken to avoid obesity or prevent its complications are often ineffective.
Although bariatric surgery requires lifelong follow-up and monitoring of nutritional deficiencies, it is considered effective for severe obesity in adults, leading to long-term improvement or remission in obesity-related diabetes and other disorders, sustained weight loss and an improved quality of life.
Studies of bariatric surgery in adolescents, although scarce, show it is associated with remission of type 2 diabetes, abnormal kidney function and other complications of obesity, and that resulting nutritional deficiencies can be corrected with dietary supplements.
When considering bariatric surgery for teenagers, the researchers recommend pediatricians follow the guidelines published by the Endocrine Society. They recommend the procedure only for patients who have neared the end of puberty and are close to their final adult height; who have extreme obesity and related complications that persist despite the patient's compliance with a formal program of lifestyle modification; and who demonstrate the ability to follow a regimen of healthy eating and living habits.
The researchers also follow the Endocrine Society in saying bariatric surgery is not recommended for patients who have not mastered healthy eating and living habits or who have unresolved substance abuse, eating or psychiatric disorders
Stiffening arteries in teenagers with persistent obesity
University of Gothenburg
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IMAGE: Frida Dangardt, first author, Associate Professor in Clinical Physiology at Sahlgrenska Academy, University of Gothenburg, and a doctor at Queen Silvia Children's Hospital, part of Sahlgrenska University Hospital in Gothenburg,... view more
Credit: Photo by Johan Wingborg
Children and adolescents with long-term obesity have increased arterial stiffness by their late teens, a study of more than 3,000 children followed from age 9 to 17 shows. These results, in the researchers' view, call for more initiatives to reduce teenage obesity.
"The teens are a key period for measures to tackle obesity, since doing so then brings better health in the long term," states Frida Dangardt, the first author of the article. She is Associate Professor in Clinical Physiology at Sahlgrenska Academy, University of Gothenburg, and a doctor at Queen Silvia Children's Hospital, part of Sahlgrenska University Hospital in Gothenburg, Sweden.
The study, published in The Lancet Child & Adolescent Health, covers 3,423 children whose body composition was measured at ages 9, 11, 13, 15 and 17. The method used was DEXA (dual energy X-ray absorptiometry) scanning for whole-body measurement with weak X-rays. DEXA scans yield clear figures on fat, muscle and bone proportions in the body.
Assessing obesity in a population of children and adolescents through puberty is otherwise difficult. Using Body Mass Index (BMI) as a measuring method is complicated by children's increasing muscle mass and rapid growth spurts.
In the study, the scientists investigated whether blood vessels, too, were affected by other risk factors for cardiovascular disease, such as high blood pressure, high blood lipid (fat) levels and high blood sugar. These factors were associated to some extent with increased arterial stiffness at age 17, but mainly for those who had obesity.
"We've been able to demonstrate that fat mass as such is what is most strongly associated with arterial stiffness, but that inferior metabolic health boosts this effect," says Frida Dangardt.
Stiffness in the arteries, which is gauged by measuring pulse-wave velocity, is a clear sign of atherosclerosis. In adults, it entails elevated risks of heart attack, stroke and death from cardiovascular disease.
However, the study showed that it is possible to influence arterial stiffness. The children and adolescents who normalized their fat mass also attained normal arterial resilience -- a key result for future research on weight-loss programs.
"The fact that we can see, already in the teenage years, that a decrease in fat mass brings about a normalization of the arterial stiffness is positive, since it shows we can do something about this risk," says Frida Dangardt.
The DEXA scanning measurement method is emphasized as a key factor in the context. The study makes it clear that this method is considerably more reliable than BMI for studying obesity trends in childhood and adolescence.
High sugar levels during pregnancy could lead to childhood obesity
Audio interviews available
University of Tennessee at Knoxville
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AUDIO: Samantha Ehrlich, professor of public health at the University of Tennessee, explains how gestational diabetes can increase the risk of early childhood obesity. view more
Credit: University of Tennessee
The children of women who have high glucose blood levels during pregnancy, even if their mothers are not diagnosed with gestational diabetes, are at an increased risk of developing obesity in childhood, according to a new study published in PLOS One.
The study was coauthored by Samantha Ehrlich, professor of public health at the University of Tennessee, Knoxville and fellow researchers at Kaiser Permanente Northern California.
For the research, scientists analyzed the data of more than 40,000 pregnant women who delivered babies between 1995 and 2004 in the Kaiser Permanente Northern California health care system. They also considered the data of the children, whom they followed until 5 to 7 years of age.
In the United States, pregnant women get a blood glucose screening test between weeks 24 and 28. If the test shows elevated blood glucose levels, an additional test is then done to determine whether the woman has gestational diabetes mellitus, or GDM.
However, Ehrlich and team found that once elevated levels of blood glucose are found on the screening test, even if the blood glucose is not elevated enough for a diagnosis of gestational diabetes, the children are at higher risk of developing obesity between 5 to 7 years of age. In this scenario, the risk increases by 13 percent when compared to women with normal blood glucose levels on the screening test.
"And if the woman is indeed diagnosed with gestational diabetes, the risk of the child developing obesity increases by 52 percent," according to Ehrlich.
Additionally, researchers also found that if the mother has a normal body mass index (BMI), elevated blood glucose levels during pregnancy were no longer associated with the development of childhood obesity.
"This information is important because it suggests that we may be able to prevent childhood obesity in two ways: by helping mothers to achieve a normal BMI before they become pregnant, and by reducing hyperglycemia during the pregnancy," Ehrlich said.
You don't only avoid holes in your teeth by keeping good oral hygiene, Norwegian researchers have discovered a clear connection between gum disease and Alzheimer's disease
The University of Bergen
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IMAGE: For several years, Piotr Mydel has done research investigating how different bacteria are implicated in Alzheimer's disease. view more
Credit: Kim E. Andreassen
The researchers have determined that gum disease (gingivitis) plays a decisive role in whether a person developes Alzheimer´s or not.
"We discovered DNA-based proof that the bacteria causing gingivitis can move from the mouth to the brain," says researcher Piotr Mydel at Broegelmanns Research Laboratory, Department of Clinical Science, University of Bergen (UiB).
The bacteria produces a protein that destroys nerve cells in the brain, which in turn leads to loss of memory and ultimately, Alzheimer´s.
Brush your teeth for better memory
Mydel points out that the bacteria is not causing Alzheimer´s alone, but the presence of these bacteria raise the risk for developing the disease substantially and are also implicated in a more rapid progression of the disease. However, the good news is that this study shows that there are some things you can do yourself to slow down Alzheimer´s.
"Brush your teeth and use floss". Mydel adds that it is important, if you have established gingivitis and have Alzheimer´s in your family, to go to your dentist regularly and clean your teeth properly.
New medicine being developed
Researchers have previously discovered that the bacteria causing gingivitis can move from the mouth to the brain where theharmful enzymes they excrete can destroy the nerve cells in the brain. Now, for the first time, Mydel has DNA-evidence for this process from human brains. Mydel and his colleagues examined 53 persons with Alzheimer´s and discovered the enzyme in 96 per cent of the cases.According to Mydel, this knowledge gives researchers a possible new approach for attacking Alzheimer´s disease.
"We have managed to develop a drug that blocks the harmful enzymes from the bacteria, postponing the development of Alzheimer´s. We are planning to test this drug later this year, says Piotr Mydel.
Facts: Gingivitis
•The bacteria Porphyromonas gingivalis (P.gingivalis) is one of the main causes to infection in the gums.
•The bacteria causes chronic infection in the gums, but can move to the brain where it can damage nerve cells in the brain.
•Circa 50 per cent of the population have this bacteria in one or another form.
•Circa 10 per cent of the ones having this bacteria will develop serious gum disease, loose teeth, and have an increased risk of developing Alzheimer´s disease.
•In addition to Alzheimers, the bacteria is linked to rheumatism, COPD and esophageal cancer.
Dartmouth study reveals how ACOs use home visits to improve care and reduce hospital use
The Dartmouth Institute for Health Policy & Clinical Practice
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A new Dartmouth-led study, published this week in the June issue of Health Affairs, offers new details about how one key approach--home visits--is helping many ACOs improve care management and identify patient needs while aiming to reduce hospital use. The study was part of a broader set of research based at Dartmouth focused on how ACOs care for patients with complex clinical and social needs.
ACOs--groups of physicians, hospitals, and other healthcare providers who voluntarily form partnerships and agree to take responsibility for meeting certain quality and total costs of care measures--may employ a variety of strategies, approaches, and processes to meet their goals. Over the past decade, they have played an increasingly prominent role in efforts to reform the American healthcare system.
"We focused on ACOs because we felt that their responsibility for total costs of care might motivate them to implement care delivery innovations that otherwise might be too resource-intensive," explains lead author Taressa Fraze, PhD, a research scientist at The Dartmouth Institute for Health Policy and Clinical Practice.
The researchers used national survey data from physician practices and ACOs, paired with qualitative interviews with 18 ACOs across the country to learn more about home-visiting programs.
They found that the majority of ACOs believed that home visits were valuable--80 percent reported using home visits within 72 hours of post-discharge for at least some of their patients. These ACOs were more likely to be larger and part of a system, including a hospital, and to participate in risk-bearing contracts or other payment reforms. They also found that physician practices with ACO contracts were more likely to report using home visits for care transition than non-ACO practices.
Home visits were typically embedded as part of a larger care management, care transition, or disease management program. "ACOs used home visits much more broadly than we might have expected, and they were usually conducted by a care management team member rather than a clinician," says Fraze, who is presenting the study's findings this week in Washington, DC, as part of a national panel discussion on community care for high-needs patients.
"These visits were not focused on providing clinical care," she emphasizes. "At their heart, they were essentially a fact-finding mission--described by several ACOs as providing 'eyes in the home.'"
The three most commonly reported activities during home visits were: needs assessments, which included inspecting the patient's home; medication reconciliation; and identifying patient barriers to managing their health. These activities provided staff members with an opportunity to coach patients on how to manage their health needs.
Interestingly, the researchers also found that home visits functioned similarly across different patient cohorts--patients who were post-discharge, for example, had similar home visits as those with social risks or specific chronic conditions.
"One of the things that was quite unique about ACOs, and that we really didn't expect, was that several used home visits as a way to locate patients, such as those who might have missed their primary care appointment, were unresponsive, or if the ACO was concerned that the patient might be at especially high risk for costly utilization," Fraze says.
However, despite the value perceived in home visits, ACOs continued to face challenges such as reimbursement, staffing capacity, and the inability to address observed patient needs.
"Our findings that larger and system-based ACOs were more likely to implement resource-intensive home visits creates concerns about the ability of smaller, independent practices and organizations to use home visits as a tool to engage patients and discover barriers to improved care," she says. "These organizations may need further financial or logistical support to implement home visits."
Facial bones of black adults age differently than other races, Rutgers study finds
Study has implications for cosmetic surgery, which black individuals seek twice as often as white
Facial bones in black adults maintain higher mineral density as they age than other races, resulting in fewer changes to their facial structure, a Rutgers study finds.
The study, published in JAMA Facial Plastic Surgery, is the first to document how facial bones change as black adults age. The findings suggest significant differences in how facial bones age across races, which can affect how plastic surgeons approach facial rejuvenation. About 16 percent of black adults seek cosmetic procedures -- double that of whites.
"It is important for plastic surgeons to understand how the facial aging process differs among racial and ethnic groups to provide the best treatment," said study lead author Boris Paskhover, an assistant professor at Rutgers New Jersey Medical School's Department of Otolaryngology, who specializes in facial plastic and reconstructive surgery.
How a face ages is determined by a combination of changes to the skin, muscle, fat and bones that naturally occur as people grow older. However, most facial rejuvenation procedures historically have focused on the soft tissue, using treatments like face-lifts and injectable fillers.
"As bones change, they affect the soft tissue around them, resulting in perceived decreases in facial volume," Paskhover said. "Treatment should consider the underlying bone structure."
As people grow older, they can lose bone mineral density, which results in bone loss. In the face, this loss can affect the shape of the nose, lower jowl area, cheekbones and middle and lower areas of the eye sockets.
To understand how facial bones age in black adults, researchers analyzed medical records from 1973 and 2017 of 20 black patients -- 14 women and six men between ages 40 and 55 -- who had at least two facial computed tomographic (CT) images taken on average a decade apart without any surgical intervention and self-reported as being black. While the comparative images showed a significant change in the facial bones over time in the black patients, these changes were minor compared to similar studies on the aging white population.
"This finding reflects other studies that show black adults have higher bone mineral density, decreased rates of bone loss and lower rates of osteoporosis as compared to the general population," Paskhover said.
Previous studies on how facial bones age have ignored race or were limited to whites, and studies on ethnic groups focused on the differences in skin composition rather than bone changes, he said.
"These other studies have shown that the Caucasian population saw more significant bone changes over a decade, especially in the lower forehead and upper jawbone, than the black group in this study, Paskhover said. "Since this population may experience less mid-facial bone loss than whites, it suggests that bony volume loss may not contribute as much to the aging face appearance."
Researchers identify link between more frequent, intense heat events and deaths in Las Vegas
Desert Research Institute
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IMAGE: Heat Index (HI) and Excess Heat Factor (EHF) are metrics that go beyond just temperature to also account for the human body's response to heat. This study found that rising... view more
Credit: DRI
Over the last several decades, extreme heat events around the world--particularly in the American Southwest--have gotten hotter, occurred more frequently, and lasted longer. These trends pose significant health risks to the growing number of people making cities like Las Vegas home.
A new study by scientists at the Desert Research Institute (DRI), Nevada State College, Universidad de Las Americas Puebla, and several undergraduates from Nevada State College traces the relationship between extreme heat and mortality rates, identifying a clear correlation between heat wave episodes and heat-related deaths in Las Vegas over the last ten years.
"Current climate change projections show an increased likelihood of extreme temperature events in the Las Vegas area over the next several years," explained Erick Bandala, Ph.D., an assistant research professor at DRI and lead author on the study. "Understanding recent extreme heat trends and their relationship to health hazards is essential to protecting vulnerable populations from risk in the future."
Urban areas of the Southwest are of particular concern because several factors compound the health-related risks of extreme heat events. The heat-absorbing properties of common materials like asphalt exacerbate already high temperatures in cities (called the urban heat island effect), particularly at night. What's more, populations in cities like Las Vegas are growing rapidly, especially among those 55 and older, which means that more and more people are exposed to risk.
In this study, the research team analyzed two measures of extreme heat--heat index and excess heat factor--for the Las Vegas metropolitan area in the June, July, and August months from 2007 to 2016. Heat index (HI) accounts for how the human body reacts to surface temperature and relative humidity. Excess heat factor measures (EHF) heat wave intensity in relation to historic temperature trends to account for how acclimated the public is to a given temperature threshold. Because both HI and EHF incorporate the human body's response to extreme heat, they are ideal metrics for assessing public health impacts, and both were shown to rise over the study period.
The annual average of severe heat events per year in Las Vegas also showed significant increases in this study, from an average of 3.3 events per year from 2007-2009 to 4.7 per year in the 2010-2016 period. These findings match historic trends, which show a steady increase in the severity and frequency of excess heat in Las Vegas since 1980.
Strikingly, the number of heat-related deaths in Las Vegas map onto these trends: as heat wave intensity increases, the number of heat-related deaths does, too.
"From 2007 to 2016, there have been 437 heat-related deaths in Las Vegas, with the greatest number of those deaths occurring in 2016," explained Bandala. "Interestingly, 2016 also shows one of the highest heat index measures over the last 35 years. This shows a clear relationship between increasingly intense heat events in our area and public health effects."
Bandala's team found that the subpopulation, particularly at risk of heat-related deaths, is adults over 50 years old--76% of the heat-related deaths in the study period were individuals in this subpopulation. Of the deaths in this group, almost all individuals also showed evidence of pre-existing heart disease. Researchers note that these findings are highly significant given that the population of adults over 50 in Las Vegas is increasing, with more retirees choosing Clark County as a retirement destination.
Only 23% of heat-related deaths occurred in the subpopulation of adults aged 20 to 50 years; interestingly, the most common pre-existing condition for this group was drug and alcohol use. More research is needed to understand how heat is impacting this segment of the population, Bandala noted, because though the number of deaths in this group is comparatively smaller, it is still nearly one-quarter of heat-related deaths in the Las Vegas Valley. Additionally, this subpopulation includes economically active adults.
With more intense, more frequent, and longer lasting heat events projected in the coming years, the research team hopes that the trends identified in this study can assist local decision-makers in taking steps to protect the most vulnerable groups in Las Vegas.
"This research helps us better understand the connection between the climate changes we've experienced in Las Vegas and their impact to public health over the last 35 years," Bandala said. "Ideally, this data analysis will help our community adapt to the changes yet to come."
Limiting warming to 2 degrees C will require emission cuts across entire food system
Feeding 10 billion people and keeping Earth from overheating this century require not only major changes to agriculture, but transformation of the entire food system, according to a new review
International Center for Tropical Agriculture (CIAT)
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Credit: Adriana Varón / CIAT
Agriculture and the food system have long been challenging subjects for climate negotiators at the United Nations' annual gathering to advance the global agenda on climate change. Issues related to mitigation, fiscal responsibility, subsidies, food sovereignty, cultural identity and national agriculture-based economies have long made the topics taboo, says Ana María Loboguerrero, the head of Global Policy Research of the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS), led by the International Center for Tropical Agriculture (CIAT).
Better understanding agriculture and the food system's unique place in climate change - as both drivers of climate change and victims of it - is helping to increase support for climate action. Unfortunately, progress across the food system is lagging, according to a new analysis published in Sustainability by Loboguerrero and CCAFS colleagues. To change this, the researchers are calling for climate change adaptation and mitigation strategies for agriculture to extend to the entire food system.
"If you think about the two-degree increase, efforts need to go beyond the agricultural sector," said Loboguerrero. "This means reducing emissions by stopping deforestation, decreasing food loss and waste, reducing supply chain emissions, and rethinking human diets, if we really want to get on track to that target."
Agriculture is typically lumped together with forestry and land-use to account for about 25 percent of global greenhouse gas emissions. On its own, agriculture accounts for about 10-12 percent of all emissions. But up to one-third of food produced is wasted between the farm and the table. This accounts for another 8 percent of global emissions, and if just 25 percent of this waste could be saved, it would be enough to feed 870 million people a year.
The review found that adoption of emission-reducing practices in agriculture is slow. Even under the most optimistic uptake scenarios, studies have shown that by 2030 these practices will only contribute 21-40 percent of a one-gigaton reduction in carbon dioxide (CO2) emissions, which would be about 1 percent of current annual CO2 emissions. On the other hand, food waste reduction presents such an important opportunity for reducing emissions intensity. Across regions, agricultural production wastes about one-third of food in the production stage. In rich countries, most of the loss comes in the consumption stage.
"Food loss and waste is a big opportunity," Loboguerrero said. "Addressing this issue can reduce emissions intensity, potentially improve global nutrition and boost the bottom line for smallholders, who are hardest hit by losses on the farm."
Another challenge in bringing down emissions from agriculture is the projected growth of meat and dairy production. By 2000, the sector contributed an estimated 18 percent of all human-caused greenhouse gas emissions, when accounting for related deforestation and land-use change as well. Given current trends in population growth and meat consumption, the sector could account for about a quarter of all emissions by 2050.
"Reducing meat and dairy emissions needs to be a priority," said Lini Wollenberg, Flagship Leader of CCAFS' low-emissions development research. "And the good news is that we have lots of options in the pipeline, ranging from low-emissions cattle to meat alternatives. We need more research and development to make some of these options a reality."
Planned migration and other hard discussions
The review analyzes some 160 papers across global agriculture and food systems, but focuses primarily on smallholder farming and food supply chains, which sustain as many as 2.5 billion people. Small holders contribute about one-third of global agriculture emissions (or about 3-4 percent of the global total) but smallholders are disproportionately exposed to climate risk.
Many farmers can adapt, provided access to the proper tools. These include technology that can help increase smallholders' access to climate information and markets, insurance schemes that can reduce risk of crop loss, government support including social safety nets, and the implementation of climate-smart agriculture (which seeks to increase smallholder productivity, help farms adapt to climate change and reduce their contribution to climate change).
But desertification, sea-level rise, soil degradation, and other inevitable changes have placed hundreds of millions of people on an irreversible track to migration, even if rapid global action is taken on climate.
"There are some farmers that shouldn't do agriculture at all due to already precarious conditions that do not allow them to ensure a meaningful livelihood, and with climate change, it is going to make it worse," Loboguerrero said. "If that migration is going to happen anyway, then policymakers and planners need to really start thinking about this and how they can work with these migrants to help them find better livelihoods where they migrate."
Back at the negotiation table, Loboguerrero says adaptation - learning to cope with the problem - is a far easier sell than mitigation - reducing emissions - which is often seen as constraining farming options and increasing costs. This is the case for some economies that depend heavily on agriculture. In the long term however, the costs of adaptation will possibly be larger, and reducing emissions now will help reduce the need to adapt.
"There is a lot of tension and you can see it when you go into the negotiations. Some countries don't even want to begin discussions on the mitigation side of things," Loboguerrero said. "Adaptation is something that everyone, however, agrees is necessary. Everyone is keen on discussing adaptation. Some adaptation measures have the co-benefit for mitigation. It's like an entrance to discussing some things at some points that are a little bit taboo in the negotiations."
A combination of insecticides and mite weakens honeybees
University of Bern
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IMAGE: A Varroa destructor mite on the thorax of an experimental Western honeybee, Apis mellifera. view more
Credit: Geoffrey R. Williams
The Western honeybee is the most important managed pollinator globally and has recently experienced unsustainably high colony losses in many regions of the world. Synergistic interactions among stressors are believed to be primarily responsible. Despite the clear negative impact of certain neonicotinoids and the ubiquitous ectoparasitic mite Varroa destructor on exposed honeybees, no data existed to show synergistic effects between these two stressors.
Current data that was collected at the University of Bern and Agroscope, in cooperation with the Auburn University (USA) and Chiang Mai University (Thailand), suggest a novel possible previously overlooked mechanism for recent unsustainably high losses of managed honeybee colonies. The results were published in "Scientific Reports", an Open-Access Journal of "Nature". According to the authors, the study underlines the importance of developing sustainable agro-ecosystem management schemes that incorporate reduced used of neonicotinoids and sustainable solutions for V. destructor mites.
A negative combination
Two stressors having a clear negative impact on the health of honeybees are insecticides and the ubiquitous ectoparasitic mite Varroa destructor. These mites originated from Asia, and have switched hosts from Eastern honeybees Apis cerana to Western honeybees Apis mellifera to become the most serious biotic threat to Western honeybees globally. Similarly, there is evidence for negative impact of widely used neonicotinoid insecticides. However, no data existed so far to show synergistic effects between these two stressors.
In the present work, honeybee colonies exposed to two neonicotinoids (thiamethoxam and clothianidin) via pollen paste feeding, did not affect honeybee worker mass or longevity. However, when in combination with V. destructor infestation, a synergistic negative effect was observed. Whilst a negative synergism was observed for body mass in both summer and autumn, it was only observed for survival 16 weeks post neonicotinoid colony exposure. The revealed results suggest a previously overlooked time-lag effect of neonicotinoid exposure. Because honeybee colonies in temperate regions must produce significant quantities of long-living winter bees to survive, the observed negative synergistic effects on individual winter honeybee longevity are most likely compromising colony survivorship.
Sustainable solutions required
"Beekeepers in many regions of the world face losses of their colonies, which are far too high", says Prof. Peter Neumann of the Institute of Bee Health at the University of Bern, co-author and president of COLOSS. Due to the present evidence for interactions between insecticides and mites, the authors stress the importance of developing sustainable agro-ecosystem management and varroa-management schemes. "Reduced usage of insecticides and sustainable solutions for V. destructor mites in agriculture and beekeeping are urgently required", adds Dr. Lars Straub, first author and Post-Doc at the Institute of Bee Health
IMAGE: Providers need more clear guidance on whether a patient who has suffered from STEMI heart attack should recover in the intensive care unit, a new University of Michigan study in... view more
Credit: Michigan Medicine
A trip to an intensive care unit can be more than twice as costly as a stay in a non-ICU hospital room, but a new study finds intensive care is still the right option for some vulnerable patients after a severe heart attack.
The difficulty lies in determining which people are best served in the ICU while they recover.
The new Michigan Medicine (University of Michigan) research, published in The BMJ, found ICU admission was associated with improved 30-day mortality rates for patients who had a STEMI heart attack and weren't clearly indicated for an ICU or non-ICU unit.
"For these patients who could reasonably be cared for in either place, ICU admission was beneficial," says lead author Thomas Valley, M.D., M.Sc., an assistant professor of internal medicine at Michigan Medicine, who cares for patients in the intensive care unit.
But Valley cautions against simply continuing to send nearly everyone to the ICU.
"ICU care is a treatment just like any medication," Valley says. "Providers need to know whether it's right for an individual person just like we try to do with a prescription drug."
The researchers analyzed Medicare data from more than 100,000 patients hospitalized with STEMI, or ST-elevation myocardial infarction, a dangerous heart attack that requires quick opening of the blocked blood vessel to restore blood flow. Those patients were hospitalized at 1,727 acute care hospitals across the U.S. in a nearly two-year period from January 2014 to October 2015, and most were sent to the ICU after treatment.
"A lot of the focus is on getting these people to the cardiac catheterization lab as soon as possible to open up the blood vessel, but less is known about what you do after that," Valley says.
Current U.S. guidelines don't address whether to send patients to the ICU, while European guidelines recommend the ICU.
Valley says providers could use more clear guidance on how to make these decisions.
In this study, the mortality rate was 6.1% lower after 30 days for those admitted to their hospital's ICU. Valley says the surprising results--in the face of other studies that show ICU overuse--demonstrate that ICU care is misdirected.
'An important debate in cardiology'
This study addresses an important issue in ICU care, says Michael Thomas, M.D., an assistant professor of internal medicine who runs the Cardiac ICU at Michigan Medicine's Cardiovascular Center.
"At Michigan Medicine, all of our STEMI patients are admitted to the Cardiac ICU," says Thomas, who was not involved with the BMJ paper. "However, knowing where to send these patients after STEMI is an important debate in cardiology right now."
"Some recent studies suggest many patients don't need ICU level of care and that it wastes resources. But before we pull back from this model, we need to understand this problem more fully," he says.
Across the nation, 75% of STEMI heart attack patients are sent to the ICU, most of the time after reperfusion treatment in the cath lab to open up the blocked vessel.
ICU vs. non-ICU care
People recovering from a STEMI are some of the very sick patients ICUs were originally designed for, so providers may not even think about disrupting the longtime status quo, Valley says.
"The historical thinking was, 'Why not send everyone to the ICU?' Now, we see that there are risks associated," Valley says. "For example, in the ICU, you're more likely to have a procedure, whether you need it more or not.
"We must also consider the risk of infection, sending someone to a unit full of really sick patients who might have C. diff or other serious infections."
The sleep quality as people are recovering from their heart attacks may also be lower in the ICU, because patients are given such close nursing care, Valley says.
That's necessary for the sickest patients, but it might be disruptive to those people on the bubble who could be getting better rest on a regular floor, he says.
Medicare has requirements for what constitutes ICU care, such as high nurse staffing levels and access to lifesaving care.
"Because of Medicare requirements, ICUs tend to be more similar across hospitals than non-ICUs," Valley says.
"Perhaps some hospitals can take care of patients anywhere, while others really need to use the ICU at high rates in order to provide safe care."
A clear benefit for some, increased cost for others
Valley says these data show a clear benefit of ICU care for vulnerable patients, as opposed to non-STEMI patients studied who did not have a significant difference in mortality rates with or without ICU admission.
"Physicians might look at STEMI patients and wonder, 'Do they really need the ICU? Could it harm them? Is it a good use of resources?'" Valley says.
Valley, a member of U-M's Institute for Healthcare Policy and Innovation, has previously found ICU overuse occurred for less critical patients hospitalized for a flare-up of chronic obstructive pulmonary disease (COPD) or heart failure. In that study, ICU admission dramatically increased cost of care without an increased survival benefit.
The next step, according to Valley, is to determine what is beneficial about the ICU for those patients who benefit from it. He says that could lead to hospitals adopting some ICU care practices on non-ICU floors.
Valley hopes making non-ICU floors more similar to the ICU in some ways could improve outcomes while reducing cost of care and infection risk
Home exercise program reduces rate of falling in at-risk seniors
University of British Columbia
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An in-home exercise program reduced subsequent falls in high-risk seniors by 36 per cent, according the results of a 12-month clinical trial published today in the Journal of the American Medical Association.
The study, conducted by UBC faculty of medicine researchers in partnership with the clinical team at the Falls Prevention Clinic at Vancouver General Hospital, found a reduction in fall rate and a small improvement in cognitive function in seniors who received strength and balance training through the clinical trial.
"When we think about falls we often think about loss of muscle strength and poor balance," said Dr. Teresa Liu-Ambrose, principal investigator at the Vancouver Coastal Health Research Institute and professor in the department of physical therapy at the University of British Columbia. "However, the ability to remain upright and not fall is also dependent on cognitive abilities--calculating how far to lift your foot to get over a curb, making a decision as to when to cross the road, and paying attention to your physical environment while you are having a conversation."
Falls increase risk of injury and loss of independence for older adults. Exercise is a widely recommended fall prevention strategy, but whether it can reduce subsequent falls in those who have previously fallen is not well established.
The study involved 344 adults aged 70 and older who had been referred to the Falls Prevention Clinic following a fall that had resulted in a visit to a medical facility, such as an emergency room. Participants had a history of falls, with an average of three prior falls per person, and generally had symptoms of frailty and limited mobility.
The study had participants perform a set of balance and resistance training exercises in the comfort of their homes, using simple equipment such as free weights, a minimum of three times per week. Over the course of six months, a physical therapist made five home visits to prescribe exercises and ensure that exercises were done properly. For those who completed the program, the results were notable. Participants were less likely to experience repeat falls, and as a secondary benefit, they improved in some markers of cognitive function.
Falls in older adults are the third-leading cause of chronic disability. According to the Public Health Agency of Canada, 20 to 30 per cent of Canadian seniors suffer falls each year, and falls are the leading cause of hospitalization for adults over age 65.
"It is well known that exercise benefits older people in general, but what was special about this study group was that they are at very high risk for losing their independence--they had both mobility and cognitive impairments and another fall may mean the inability to live in their own homes. Many already had difficulty navigating public spaces independently," said Liu-Ambrose, who holds a Canada Research Chair in Physical Activity, Mobility, and Cognitive Neuroscience.
"Older adults who experience falls that require medical attention falls are medically complex and at high risk for both morbidity and mortality, and we demonstrated that exercise is a practical and cost-effective intervention that can improve older peoples' outcomes after a significant fall," she added.
Liu-Ambrose and her team at the Centre for Hip Health and Mobility are now looking at whether the exercise program resulted in reduced health care utilization and medical cost savings in this high-risk population.
Study: Cholesterol in eggs tied to cardiac disease, death
UMass Lowell expert stresses moderation, balance in daily diet
University of Massachusetts Lowell
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LOWELL, Mass. - The risk of heart disease and death increases with the number of eggs an individual consumes, according to a UMass Lowell nutrition expert who has studied the issue.
Research that tracked the diets, health and lifestyle habits of nearly 30,000 adults across the country for as long as 31 years has found that cholesterol in eggs, when consumed in large quantities, is associated with ill health effects, according to Katherine Tucker, a biomedical and nutritional sciences professor in UMass Lowell's Zuckerberg College of Health Sciences, who co-authored the analysis. The study was published in the Journal of the American Medical Association.
The study results come as egg consumption in the country continues to rise. In 2017, people ate an average of 279 eggs per year, compared with 254 eggs in 2012, according to the U.S. Department of Agriculture.
Current U.S. Dietary Guidelines for Americans do not offer advice on the number of eggs individuals should eat each day. The guidelines, which are updated every five years, do not include this because nutrition experts had begun to believe saturated fats were the driving factor behind high cholesterol levels, rather than eggs, according to Tucker. However, prior to 2015, the guidelines did recommend individuals consume no more than 300 milligrams of cholesterol a day, she said.
One large egg contains nearly 200 milligrams of cholesterol, roughly the same amount as an 8-ounce steak, according to the USDA. Other foods that contain high levels of cholesterol include processed meats, cheese and high-fat dairy products.
While the new research does not offer specific recommendations on egg or cholesterol consumption, it found that each additional 300 milligrams of cholesterol consumed beyond a baseline of 300 milligrams per day was associated with a 17 percent higher risk of cardiovascular disease and an 18 percent higher risk of death.
Eating several eggs a week "is reasonable," said Tucker, who noted they include nutrients beneficial to eye and bone health. "But I recommend people avoid eating three-egg omelets every day. Nutrition is all about moderation and balance."
Research results also determined that study participants' exercise regimen and overall diet quality, including the amount and type of fat they consumed, did not change the link between cholesterol in one's diet and risk of cardiovascular disease and death.
"This is a strong study because the modeling adjusted for factors such as the quality of the diet," Tucker said. "Even for people on healthy diets, the harmful effect of higher intake of eggs and cholesterol was consistent."
Physical inactivity proved risky for children and pre-teens
Researchers from UNIGE have shown that children lose their motivation to participate in physical activities in PE classes at school from the age of 9
Université de Genève
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Cardio-respiratory capacity in children has dropped by 25% in 20 years, according to a study by the University of Adelaide in Australia. There are multiple reasons for this, from the social environment and the decreasing number of play areas to a more academic approach towards teaching physical education and the spread of new technologies. But at what age do children lose the desire to exercise? Researchers from the University of Geneva (UNIGE), Switzerland, followed 1,200 Geneva pupils, aged 8 to 12, for two years. The team found out that from the age of 9, the positive reasons for exercising - it's fun and good for your health - begin to be replaced by more displaced incentives: to get a good mark or improve your image with others. These results, which are published in the journal Psychology of Sport and Exercise, call for a more detailed analysis of how PE is taught in schools to counter physical inactivity leading to a sedentary lifestyle from an early age.
Society today is characterized by an increasingly sedentary way of life and a decline in physical activity, which is reflected in the growing number of overweight children (16% of children aged 6 to 12 in Switzerland). In an earlier study, UNIGE researchers noted that the recommendations issued by the World Health Organisation (WHO) for the amount of exercise undertaken by school-age children were not being met, namely: children should be active for at least 50% of the time devoted to physical education lessons in primary school. In reality, they move on average only 38% of the time. And as children grow older, the percentage drops. Why?
Positive motivations decline as the child grows older
The UNIGE researchers tracked 1,200 Geneva pupils aged 8 to 12 for two years. The children had to complete a questionnaire every six months to measure their motivation levels according to a seven-point scale based on different motivational controls related (or not) to practising the actual activity: enjoyment, learning, health, grades, satisfying other people, integration, avoiding guilt or shame, and so forth. "Our results showed for the first time that there is a sharp drop in positive motivations for physical activity (with good motivational qualities), such as pleasure or health, over a child's time at primary school from age 9 onwards", explains Julien Chanal, a researcher in the Psychology Section of UNIGE's Faculty of Psychology and Educational Sciences (FPSE). "And we've never observed this decline at such a young age!" On the other hand, motivations considered counterproductive (with poor motivational qualities) - such as undertaking the activity to get a good grade or to send a positive image to one's classmates - increase as a child gets older. "It's true that harmful motivations do also mean that a child is physically active but these motivational qualities are only positive in the short term, which is counter-productive for a child's physical development. In fact, we know that if children are motivated by good reasons when they're young, then they'll remain active when they're adults", continues Chanal. But what can be done to fight against the early decline of positive motivations?
Reforming education to increase physical activity
Given that nine years is a crucial age to establish good, healthy and long term physical activity, the way PE is taught at primary school needs to be analysed, since compulsory education is the only place where every child can be reached. "In recent decades," says Chanal, "PE teaching has changed enormously. Classes are more academic, with children learning about rules, motor functioning, mutual support, etc." But this approach has a direct cost for the child since it reduces the actual time dedicated to moderate to vigorous physical activity, which is already rare outside school.
The UNIGE researchers are now working with the Haute École Pédagogique in the canton of Vaud (HEP Vaud) on teaching physical education in primary classes. The aim is to develop autonomy and cooperation among pupils, and to work on the curriculum, course structure and teacher involvement to help them keep or boost their positive motivations for physical education. "Now that children don't move as much as before outside school, it's vital that the periods earmarked for PE maximize the time they spend moving", adds Chanal. "This is especially the case since, once again, we fall below the standards prescribed by the WHO. Their recommendation is 150 minutes of physical education per week, while students in Geneva only have 135 minutes available, or three periods of 45 minutes each." Teaching physical education has an important role to play in this new global health problem, which affects children at a younger age.
researchers caution against expecting exercise to act as a panacea for humans.
"A very important part of this research is that the mice were not forced to exercise - any physical activity was voluntary. If children are interested, they should be encouraged to do any exercise they want, but this research does not reveal how different activities might affect the brains of children with ASD," said Koyama.
Fitness for the mind
About a decade ago, small trials in children began showing that regular exercise could improve the social difficulties and repetitive behaviors common in ASD. Although many studies investigated how exercise can make large-scale changes to already healthy brains or postpone age-related neurodegeneration, there were no studies on the fine-tuned changes that exercise might make in brains with ASD.
Although the brains of healthy children naturally prune away redundant connections between neurons as they age, a defining feature of the brains of people with ASD is too many connections.
The results from the mouse model study indicate that exercise may somehow activate the brain's normal pruning processes.
"Exercise likely enhanced the contrast between active and inactive neuronal connections so that the weak ones could be more easily targeted for removal," said Koyama.
A gym for mice
ASD model mice display lifelong behaviors of neurodevelopmental difference: They interact less with new mice, they groom themselves repetitively, and they take longer to start eating when in a new environment, a sign of anxiety.
Researchers placed a running wheel in the corner of the ASD model mice's cages so they could run as much as they wished. Mice had access to the wheel from the time they were four weeks old until eight weeks old. Mice are adults at eight weeks old.
"Part of the variability of our data is that we could not give all mice the same amount of exercise. Some mice may have exercised just a little, some may have exercised very intensely," said Koyama.
Despite wide variation between individual mice, overall, ASD model mice that could exercise showed behavior that was similar to healthy mice after just 30 days of access to the running wheel.
Cellular studies for a closer look
Researchers performed additional experiments to look inside the brains of ASD model mice.
Specifically, researchers focused on a structure called mossy fibers in the hippocampus, an area of the brain thought to be important for memory and a source of new neurons (neurogenesis) in adults. Individual neurons can be connected to dozens of mossy fibers sent out by other neurons.
Immune cells called microglia change brain structure by engulfing and digesting less active synapses, which is why they are sometimes referred to as "the brain's garbage collectors."
Researchers used molecular genetics and fluorescent imaging techniques to identify which mossy fibers were most active and saw that microglia spared those active synapses, while removing the less active ones nearby.
Researchers also connected microglia to synaptic pruning in healthy mice. Juvenile mice without ASD were given medication to prevent normal microglia activity. After just five days of medication, researchers detected significant differences in the density of brain synapses between mice whose microglia were inhibited and their unmedicated peers.
Although the causes of ASD are an area of active research, Koyama's research team states that the reversible aspects of ASD and the connection between exercise and microglia should also receive continued attention.
Exercise fine-tunes brain's connections, eases autism spectrum disorder in mouse model
University of Tokyo
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Researchers at the University of Tokyo have studied how exercise can change the structure of mouse brains modeling autism spectrum disorder. Researchers specifically looked at connections between neurons in the... view more
Credit: Photo by Ryuta Koyama, CC-BY.
A mouse model of autism has revealed how exercise changes the structure of the brain by eliminating the excess connections between neurons characteristic of autism spectrum disorder (ASD). After one month of voluntary running on a wheel, behavioral differences disappeared and structural differences in ASD model mice's brains were reduced.
"Voluntary exercise can be a safe, drug-free way to improve overall health and now we have a better understanding of how exercise can positively change brain structure in ASD," said Associate Professor Ryuta Koyama, who led the research team at the University of Tokyo.
This research study was performed in mice and researchers caution against expecting exercise to act as a panacea for humans.
"A very important part of this research is that the mice were not forced to exercise - any physical activity was voluntary. If children are interested, they should be encouraged to do any exercise they want, but this research does not reveal how different activities might affect the brains of children with ASD," said Koyama.
Fitness for the mind
About a decade ago, small trials in children began showing that regular exercise could improve the social difficulties and repetitive behaviors common in ASD. Although many studies investigated how exercise can make large-scale changes to already healthy brains or postpone age-related neurodegeneration, there were no studies on the fine-tuned changes that exercise might make in brains with ASD.
Although the brains of healthy children naturally prune away redundant connections between neurons as they age, a defining feature of the brains of people with ASD is too many connections.
The results from the mouse model study indicate that exercise may somehow activate the brain's normal pruning processes.
"Exercise likely enhanced the contrast between active and inactive neuronal connections so that the weak ones could be more easily targeted for removal," said Koyama.
A gym for mice
ASD model mice display lifelong behaviors of neurodevelopmental difference: They interact less with new mice, they groom themselves repetitively, and they take longer to start eating when in a new environment, a sign of anxiety.
Researchers placed a running wheel in the corner of the ASD model mice's cages so they could run as much as they wished. Mice had access to the wheel from the time they were four weeks old until eight weeks old. Mice are adults at eight weeks old.
"Part of the variability of our data is that we could not give all mice the same amount of exercise. Some mice may have exercised just a little, some may have exercised very intensely," said Koyama.
Despite wide variation between individual mice, overall, ASD model mice that could exercise showed behavior that was similar to healthy mice after just 30 days of access to the running wheel.
Cellular studies for a closer look
Researchers performed additional experiments to look inside the brains of ASD model mice.
Specifically, researchers focused on a structure called mossy fibers in the hippocampus, an area of the brain thought to be important for memory and a source of new neurons (neurogenesis) in adults. Individual neurons can be connected to dozens of mossy fibers sent out by other neurons.
Immune cells called microglia change brain structure by engulfing and digesting less active synapses, which is why they are sometimes referred to as "the brain's garbage collectors."
Researchers used molecular genetics and fluorescent imaging techniques to identify which mossy fibers were most active and saw that microglia spared those active synapses, while removing the less active ones nearby.
Researchers also connected microglia to synaptic pruning in healthy mice. Juvenile mice without ASD were given medication to prevent normal microglia activity. After just five days of medication, researchers detected significant differences in the density of brain synapses between mice whose microglia were inhibited and their unmedicated peers.
Although the causes of ASD are an area of active research, Koyama's research team states that the reversible aspects of ASD and the connection between exercise and microglia should also receive continued attention.
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