Family Conflicts, Other Non-Physical Worries Before Cancer Surgery Raise Patients’ Complication Risk

How well patients recover from cancer surgery may be influenced by more than their medical conditions and the operations themselves. Family conflicts and other non-medical problems may raise their risk of surgical complications, a Mayo Clinic study has found. Addressing such quality-of-life issues before an operation may reduce patients’ stress, speed their recoveries and save health care dollars, the research suggests. The study specifically looked at colon cancer patients, and found that patients with a poor quality of life were nearly three times likelier to face serious postoperative complications.

The findings are published in the Journal of Gastrointestinal Surgery.

“We know that quality of life is a very complex thing, but we can now measure it and work with it almost like blood pressure,” says lead author Juliane Bingener, M.D., a gastroenterologic surgeon at Mayo Clinic in Rochester. “We can say, ‘This is good, this is in the normal range, but this one here, that is not good, and maybe we should do something.’”

Quality of life as measured in the study is about more than happiness and how well people feel physically, Dr. Bingener says. It also includes the financial, spiritual, emotional, mental and social aspects of their lives and whether their needs are being met.

Researchers studied 431 colon cancer surgery patients and found that before surgery, 13 percent had a quality of life deficit, defined as an overall quality of life score of less than 50 on a 100-point scale.

Nearly three times as many patients who entered surgery with a quality of life deficit experienced serious post-surgery complications as those with a normal or good quality of life score. Patients with a postoperative complication spent 3.5 days longer in the hospital on average than those who didn’t.

“The question I’m exploring is whether, if we understand before surgery that someone is in the red zone for quality of life, can we do something to help them cope with the new stress that’s going to come, so they’re better equipped to go through surgery?” Dr. Bingener says.

Preventing complications by intervening with behavioral therapy or other assistance would likely cost much less than an ICU stay for an infection after major surgery, Dr. Bingener notes.

Stress can weaken patients’ immune response, putting them at higher risk of infection. A patient’s outlook on life can also influence how active they are in working to recover.

“You have a surgery, you’re lying there in pain, now you wonder, ‘Why should I even get up and walk around? Why do I have to do these deep-breathing exercises? I don’t feel like it.’ You might get pneumonia much faster than somebody who says, ‘Oh, I have to get up. There’s something worth living for, my quality of life is good and I need to get back to that,’” Dr. Bingener says.

The study is part of ongoing work by Mayo to identify and address factors that can influence patients’ recovery from cancer surgery, to help improve their outcomes. Years ago, physicians were just concerned with whether patients survived cancer, because survival was so hard to achieve, Dr. Bingener says. Now, there is growing awareness of the mind’s influence on the body’s health.

“We’re understanding much better now that patients are not just a body with a disease: There’s a whole person with that, and everything plays together,” Dr. Bingener says. “Now that survival is possible, we want to achieve it in a way that preserves normal life for patients as much as possible. And we think that’s probably also the most economical way to go.”

The current study was funded by National Institute of Diabetes and Digestive and Kidney Diseases grant K23DK93553.

The study’s senior author is Heidi Nelson, M.D., a colon and rectal surgeon, the Fred C. Andersen Professor and chair of the Department of Surgery at Mayo Clinic in Rochester.

The research used data from Clinical Outcomes of Surgical Therapy (COST) trial NCCTG 93-46-53, funded by the National Cancer Institute in association with the North Central Cancer Treatment Group. Dr. Nelson was the COST trial’s lead investigator.


Posted in Cancer, Human Behavior: Stress | Leave a comment

Humiliation tops list of mistreatment toward med students

Each year thousands of students enroll in medical schools across the country. But just how many feel they’ve been disrespected, publicly humiliated, ridiculed or even harassed by their superiors at some point during their medical education?

Recently, researchers at Michigan State University were the first to analyze 12 years worth of national survey data from the Association of American Medical Colleges, or AAMC, questioning graduating students about their medical school experience during the clinical portion of their education.

They found that up to 20 percent of students reported some form of mistreatment each year. Additionally, only an average of 31 percent of those who indicated they were mistreated actually reported the incident to faculty or university administrators.

Public humiliation or belittlement topped the list, with sexist remarks and requests to do personal favors coming in second and third, respectively.

The research can be found online in the journal Academic Medicine.

Although the survey definition of mistreatment has evolved over the years, more recently, the meaning has focused on specific behaviors such as being disrespectful or humiliating others, as well as sexual, racial/ethnic, gender and sexual orientation mistreatment.

“The goal was really to uncover the nature of the problem and better understand what needs to be done to change these experiences,” said Marsha Rappley, dean of the College of Human Medicine at MSU. “The feeling of mistreatment often happens in stressful environments like a clinical setting involving patients, and it’s up to everyone to respond in ways that are respectful.”

Recently, both the AAMC and the American Medical Association have acknowledged that mistreatment is an issue and should be addressed.

“If our students are experiencing these negative feelings, then everyone else is probably feeling uncomfortable as well,” Rappley said, who is also the chair for the AAMC Council of Deans. “Not everything is polite and clean all the time, but if we think of the whole notion of education as treating people respectfully while giving them good feedback on their work, this could help build resiliency in moments where tempers may flare.”

Rappley also said that proper safe reporting mechanisms are needed to ensure that students feel protected when reporting an incident.

“Across the country, med schools continue to look at ways to improve safe reporting practices whether it’s using an ombudsman or implementing an online system,” she said. “We all may be using different approaches, but ultimately it’s about what makes the students feel safe.”

By having serious discussions about specific behaviors that are perceived as disrespectful and offering up tools to help manage conflict and feedback, Rappley said that resident physicians and students could work even better as teams and help each other in intense situations.

“Collectively, we can figure out a solution,” she said.


Posted in Human Behavior: Motivation, Human Behavior: Negativity, Human Behavior: Shame | Leave a comment

Coffee increases prediabetes risk in susceptible young adults

Barcelona, Spain – Tuesday 2 September 2014: Coffee increases the risk of prediabetes in young adults with hypertension who are slow caffeine metabolisers, according to results from the HARVEST study presented at ESC Congress today by Dr Lucio Mos from Italy. People who drank more than three cups of coffee per day doubled their risk of prediabetes.

Dr Mos said: “Lifestyle factors are very important for the prognosis of young people with hypertension. In a previous analysis of HARVEST (Hypertension and Ambulatory Recording VEnetia STudy) we found that coffee was a risk factor for the development of sustained hypertension and that the risk was modulated by the genetic background of the individual. Slow metabolisers of caffeine were at increased risk of hypertension.”(1) ( 2)

He added: “As type 2 diabetes often develops in hypertensive patients at a later stage, in the present study we examined the long term effect of coffee drinking on the risk of developing prediabetes in the participants of HARVEST, a prospective longitudinal study of young subjects screened for stage 1 hypertension.”(3)

HARVEST included 1 180 patients aged 18 to 45 years who had stage 1 hypertension but did not have diabetes. Genotyping of CYP1A2, the enzyme that metabolises caffeine, was performed in 639 patients (4). Prediabetes was defined as fasting plasma glucose between 100 and 125 mg/dL at the final study visit.

The researchers found that 74% of participants drank coffee. Among the coffee drinkers, 87% drank 1-3 cups per day (moderate) and 13% drank more than 3 cups per day (heavy). Analysis of the CYP1A2 genotyping revealed that 42% of participants were fast metabolisers of caffeine and 58% were slow metabolisers.

After 6.1 years, prediabetes was diagnosed in 24% of patients. Moderate coffee drinkers (1-3 cups/day) had a 34% increased risk of developing prediabetes compared to abstainers and heavy drinkers (more than 3 cups/day) had a doubled risk. This association was stronger in patients who were overweight or obese.

However, the risk of prediabetes related to coffee consumption differed according to the CYP1A2 genotyping. The risk of prediabetes associated with coffee intake was increased only in slow caffeine metabolisers, with a hazard ratio of 2.78 (confidence interval 1.32-5.88, p=0.0076) for heavy drinkers. In contrast the risk of prediabetes was not increased significantly among the fast caffeine metabolisers.

Dr Mos said: “Our study shows that drinking coffee increases the risk of prediabetes in young adults with hypertension who are slow caffeine metabolisers. The risk is even greater if these individuals are overweight or obese, and if they are heavy drinkers of coffee.”

He added: “Slow caffeine metabolisers are exposed for a longer time to the detrimental effects of caffeine on glucose metabolism. Thus, the effect of coffee on prediabetes depends on two factors, the amount of daily coffee intake and the individual’s genetic background.”

He continued: “Young-to-middle-age people with hypertension should be aware that coffee consumption may increase their risk of developing diabetes in later life. Genotyping for the CYP1A2 gene polymorphism could help them to better know their risk. Carriers of the slow *1F allele, who are slow caffeine metabolisers, should abstain from drinking caffeinated coffee.”

Dr Mos concluded: “The results of the HARVEST study suggest that in patients with hypertension, caffeinated coffee should be considered a dietary risk factor for prediabetes. This risk applies especially to slow caffeine metabolisers and to patients who are overweight or obese. Our findings contradict previous epidemiologic studies that have advocated coffee consumption as a means to lower the risk of type 2 diabetes mellitus.”




(1) Palatini P, Ceolotto G, Ragazzo F, Dorigatti F, Saladini F, Papparella I, Mos L, Zanata G, Santonastaso M. CYP1A2 genotype modifies the association between coffee intake and the risk of hypertension. J Hypertens. 2009.;27(8):1594-1601. doi: 10.1097/HJH.0b013e32832ba850.

(2) CYP1A2 is the main enzyme responsible for the metabolism and detoxification of caffeine in the body. Activity of CYP1A2 varies in individuals and depends on the genetic polymorphism they carry. Carriers of the *1F allele (*1A/*1F and *1F/*1F genotypes) are slow caffeine metabolisers and are more exposed to the effects of caffeine. People with the fast *1A/*1A genotype are fast metabolisers and less exposed to caffeine which is rapidly eliminated from the body.

(3) The degree of hypertension is classified into 3 stages. Stage 1 hypertension is defined as a systolic blood pressure of 140 to 159 mmHg and diastolic blood pressure of 90 to 99 mmHg. Prediabetes is defined as having an impaired fasting glucose (fasting glucose of 100 mg/dL), impaired glucose tolerance (two-hour postprandial glucose of 140 mg/dL), or both. The HARVEST study used the former definition. Prediabetes is a precursor of overt type 2 diabetes mellitus and is associated with insulin resistance and an increased risk for cardiovascular disease.

(4) Genotyping of CYP1A2 was performed in just 639 patients because only the four main HARVEST centres participated in the genetic study.


Posted in Coffee, Prediabetes | Leave a comment

Over-hydrating can be lethal, though it rarely happens

Newswise — MAYWOOD, Ill. (Sept. 2, 2014) – The recent deaths of two high school football players illustrate the dangers of drinking too much water and sports drinks, according to Loyola University Medical Center sports medicine physician Dr. James Winger.

Over-hydration by athletes is called exercise-associated hyponatremia. It occurs when athletes drink even when they are not thirsty. Drinking too much during exercise can overwhelm the body’s ability to remove water. The sodium content of blood is diluted to abnormally low levels. Cells absorb excess water, which can cause swelling — most dangerously in the brain.

Hyponatremia can cause muscle cramps, nausea, vomiting, seizures, unconsciousness, and, in rare cases, death.

Georgia football player Zyrees Oliver reportedly drank 2 gallons of water and 2 gallons of a sports drink. He collapsed at home after football practice, and died later at a hospital. In Mississippi, Walker Wilbank was taken to the hospital during the second half of a game after vomiting and complaining of a leg cramp. He had a seizure in the emergency room and later died. A doctor confirmed he had exercise-associated hyponatremia.

And in recent years, there have been more than a dozen documented and suspected runners’ deaths from hyponatremia.

Winger said it’s common for coaches to encourage athletes to drink profusely, before they get thirsty. But he noted that expert guidelines recommend athletes drink only when thirsty. Winger said athletes should not drink a predetermined amount, or try to get ahead of their thirst.

Drinking only when thirsty can cause mild dehydration. “However, the risks associated with dehydration are small,” Winger said. “No one has died on sports fields from dehydration, and the adverse effects of mild dehydration are questionable. But athletes, on rare occasions, have died from over-hydration.”

Winger is co-author of a 2011 study that found that nearly half of Chicago-area recreational runners surveyed may be drinking too much fluid during races. Winger and colleagues found that, contrary to expert guidelines, 36.5 percent of runners drink according to a present schedule or to maintain a certain body weight and 8.9 percent drink as much as possible.

“Many athletes hold unscientific views regarding the benefits of different hydration practices,” Winger and colleagues concluded. Their study was published in the British Journal of Sports Medicine.

Winger is an associate professor in the Department of Family Medicine of Loyola University Chicago Stritch School of Medicine.

Posted in Nutrition: Hydration, Sports Medicine: Injuries | Leave a comment

CT Lung Cancer Screening is Cost Effective: Full Medicare Coverage Should Follow: New Study

Newswise — Reston, Va. (Sept. 2, 2014) – Questions regarding effectiveness, infrastructure and cost effectiveness of low-dose computed tomography (CT) screening of those at high risk for lung cancer have now been answered. Medicare should rapidly provide full national coverage for these exams.

An actuarial cost-benefit analysis by Milliman, Inc., published in the August issue of American Health and Drug Benefits, shows that use of United States Preventive Services Task Force (USPSTF) lung cancer screening recommendations in high-risk Medicare beneficiaries is cost effective.

• This latest Milliman analysis echoes a 2012 study published in Health Affairs that found low-dose CT lung cancer screening is cost effective in high-risk commercially-insured people.

National Lung Screening Trial data presented to the National Institutes of Health confirmed that the test is cost effective — particularly compared to other screening programs.

• Other published data show that the test is more cost effective than automobile seatbelts/airbags.

“CT lung cancer screening is cost-effective and significantly reduces lung cancer deaths. Published results show no undue or lasting patient anxiety from the screening process. It is time for Medicare to cover CT lung cancer screening,” said Ella Kazerooni, M.D., FACR, chair of the American College of Radiology (ACR) Lung Cancer Screening Committee and ACR Thoracic Imaging Panel.

Significant lung cancer screening infrastructure is growing. The ACR Lung Cancer Screening Center program helps ensure these exams are provided safely and effectively. Lung-RADS standardizes CT lung cancer screening reporting and management, aids lung CT interpretation and supports outcomes monitoring.

The Affordable Care Act requires private insurers to cover medical procedures that receive a grade of “B” or higher from the USPSTF without a co-pay. The ACA does not specify that Medicare beneficiaries receive full coverage for these services. CT lung cancer screening is deemed an Essential Health Benefit, covered by many private health insurers, while Medicare beneficiaries have lesser access to these exams and increased risk of lung cancer death due to lack of coverage.

“Lung cancer is the nation’s leading cancer killer, annually taking more lives than breast, prostate and colon cancer combined. CT lung cancer screening could save up to 30,000 people each year. Medicare needs to help doctors save lives by fully covering these exams,” said Kazerooni.

1. July 2013 Black/Pinsky presentation to National Institutes of Health. CT lung cancer screening is cost-effective – particularly compared to breast and colon cancer screening – and requires fewer people to be screened to save a life. The official NLST cost-effectiveness paper has yet to be published.

2. S. Feig. Cost-Effectiveness of Mammography, MRI, and Ultrasonography for Breast Cancer Screening (Table 1 on page 881). Also, data presented at 2009 Radiological Society of North America meeting showed that mammography is more cost-efficient than seatbelts/airbags. As CT lung cancer screening cost-effectiveness is comparable or better to breast and colorectal cancer screening, it is more cost-effective than car seatbelts/airbags.

Posted in Cancer: Lung | Leave a comment

Most costly hospital condition? Most cannot name it.

SAN DIEGO–(BUSINESS WIRE)–While diseases like Ebola, flesh-eating bacteria, and MRSA have quickly cemented their place in America’s consciousness, a disease that kills more than 258,000 Americans every year continues to fall short in recognition and awareness: sepsis.

In a recent study conducted by Harris Poll on behalf of Sepsis Alliance in June 2014, only 44 percent of Americans had ever even heard of sepsis. The survey polled 2,100 U.S. adults 18+ and discovered that women (47 percent) were more likely than men (40 percent) to have heard of sepsis, as were those 35 years or older (48 percent) versus those younger than 35 (35 percent).

A similar survey in 2013 found an identical percentage of Americans recognizing sepsis, confirming that most American adults are not familiar with sepsis, despite a 2013 statistical brief from a division of the U.S. Department of Health and Human Services that singled out sepsis as being the most expensive health condition to treat, costing America’s healthcare system over $20 billion every year.

For the first time, the Sepsis Alliance survey asked those Americans that had heard of sepsis where they heard about it. Twenty-five percent of respondents recalled learning about sepsis from news and entertainment programs, while 15 percent recalled learning from medical professionals. Thirteen percent of respondents became familiar with sepsis after knowing someone who had sepsis or having it themselves.

“It was surprising to learn that a quarter of the respondents who knew about sepsis had learned about it through news and entertainment programs,” said Thomas Heymann, Executive Director of Sepsis Alliance. “The new Sepsis Alliance survey demonstrates the power of the media and the important role it can play in helping raise awareness of this disease.”

CDC Director Highlights the Need to Raise Awareness

Sometimes referred to as blood poisoning, sepsis is the body’s often-deadly response to infection. The U.S. Centers for Disease Control and Prevention (CDC) has reported that sepsis cases have increased in the U.S. from 621,000 in the year 2000 to 1,141,000 in 2008. When these cases are spotted and treated early with fluids and antibiotics, thousands of lives can be saved, resulting in billions being saved in healthcare costs.

“Sepsis is devastating to patients and their families. This survey tells us that there is much more work needed to raise awareness,” said Dr. Tom Frieden, Director of the CDC. “CDC is committed to protecting patients by increasing sepsis awareness, enhancing prevention and early detection, and improving treatment.”

September is Sepsis Awareness Month

Sepsis Alliance announced the results of this survey as the official start of Sepsis Awareness Month. During the month of September, Sepsis Alliance, volunteers, and health organizations across the country are combining their efforts to raise sepsis awareness. World Sepsis Day will take place on September 13, 2014, and Sepsis Alliance will be hosting its annual Sepsis Heroes event in New York City on September 18, 2014. Sepsis Alliance has also released a calendar of events to help individuals find and participate in events happening across the country.

“We have a record number of partners participating in this year’s Sepsis Awareness Month,” added Heymann, “but these survey results prove there is still a lot of work that needs to be done. Increasing awareness in the general public is essential in helping people advocate for their own health care, stopping this deadly disease in its tracks.”

Abbreviated Methodology

This survey was conducted online within the United States by Harris Poll on behalf of Sepsis Alliance from June 19-23, 2014 among 2,100 adults ages 18 and older. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables, please contact Sepsis Alliance at 619-232-0300.

About Sepsis Alliance

Sepsis Alliance is the leading nonprofit patient advocacy organization in the U.S. promoting awareness of sepsis. Sepsis Alliance’s mission is to save lives by raising awareness of sepsis as a medical emergency. The organization hosts national events, distributes information, and conducts training and education of sepsis and its devastating effects. Sepsis Alliance also provides support by giving people affected by sepsis a forum to share information. Sepsis Alliance is registered as a 501(c)(3) charitable organization, and is a founding member of the Global Sepsis Alliance. For more information on Sepsis Alliance, please visit

About Nielsen & The Harris Poll

On February 3, 2014, Nielsen acquired Harris Interactive and The Harris Poll. Nielsen Holdings N.V. (NYSE: NLSN) is a global information and measurement company with leading market positions in marketing and consumer information, television and other media measurement, online intelligence and mobile measurement. Nielsen has a presence in approximately 100 countries, with headquarters in New York, USA and Diemen, the Netherlands. For more information, visit

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Online social networking may be addictive, literally

Addiction. 2014 Aug 29. doi: 10.1111/add.12713. [Epub ahead of print]

Craving Facebook? Behavioral addiction to online social networking and its association with emotion regulation deficits.

Hormes JM1, Kearns B, Timko CA.

Author information

1Department of Psychology, University at Albany, State University of New York, Social Sciences 399, 1400 Washington Avenue, Albany, NY 12222.



To assess disordered online social networking use via modified diagnostic criteria for substance dependence, and to examine its association with difficulties with emotion regulation and substance use.


Cross-sectional survey study targeting undergraduate students. Associations between disordered online social networking use, internet addiction, deficits in emotion regulation, and alcohol use problems were examined using univariate and multivariate analyses of covariance.


A large University in the Northeastern United States.


Undergraduate students (n=253, 62.8% female, 60.9% white, age M=19.68, SD=2.85), largely representative of the target population. Response rate was 100%.


Disordered online social networking use, determined via modified measures of alcohol abuse and dependence, including DSM-IV-TR diagnostic criteria for alcohol dependence, the Penn Alcohol Craving Scale, and the CAGE screen, along with the Young Internet Addiction Test, Alcohol Use Disorders Identification Test, Acceptance and Action Questionnaire-II, White Bear Suppression Inventory, and Difficulties in Emotion Regulation Scale.


Disordered online social networking use was present in 9.7% (n=23; 95% Confidence Interval [5.9, 13.4]) of the sample surveyed, and significantly and positively associated with scores on the Young Internet Addiction Test (p<.001), greater difficulties with emotion regulation (p=.003), and problem drinking (p=.03).


The use of online social networking sites is potentially addictive. Modified measures of substance abuse and dependence are suitable in assessing disordered online social networking use. Disordered online social networking use seems to arise as part of a cluster of symptoms of poor emotion regulation skills and heightened susceptibility to both substance and non-substance addiction.


Posted in Human Behavior: Addictive, Human Behavior: Social Media, Pediatric Health: Social Networking | Leave a comment

Do you heel strike or are you a forefoot runner?

If you have no idea what that question means this wearable probably isn’t for you. RunScribe is aiming for serious running geeks who want to nerd out over exactly how, where and when their feet connect with the ground — and use that data to improve their running technique and (hopefully) avoid injury.

Running has been a popular target for fitness focused wearables up to now, with fitness bands and running-focused smartwatches mushrooming forth as forerunners of the nascent wearables category. But as more and more generic fitness bands crop up, an appetite for greater specialism is likely to gather momentum.  So enter RunScribe: a device that attaches to the back of your running shoe in order to be well-placed to figure out exactly how you are running.

The data its motion sensors capture is stored locally on flash memory during each run and synced to a cloud service after — visualised via various granular charts and graphs — allowing the athlete to do a deep data dive analysis of their gait. (A top tier of the service — called runScribe Science — will even give the user access to the raw sensor data captured by the device.)


Posted in Fitness: Running | Leave a comment

How action movies make you fat

Is television making us fat? An increasing amount of research shows an association between TV viewing and higher food consumption and a more sedentary lifestyle. Now, a new Cornell University study points out that not all TV is alike. Some TV programs might lead people to eat twice as much as other programs! “We find that if you’re watching an action movie while snacking your mouth will see more action too!” says Aner Tal, Ph.D. lead author on the new article just published in the Journal of the American Medical Association: Internal Medicine. “In other words, the more distracting the program is the more you will eat.”

In the study, conducted by researchers at the Cornell Food and Brand Lab, 94 undergraduates snacked on M&Ms, cookies, carrots and grapes while watching 20 minutes of television programming. A third of the participants watched a segment of the action movie The Island, a third watched a segment from the talk show, the Charlie Rose Show, and a third watched the same segment from The Island without sound.

“People who were watching The Island ate almost twice as many snacks – 98% more than those watching the talk show!” says co-author Brian Wansink, author of Slim by Design (forthcoming) and Professor and Director of the Cornell Food and Brand Lab. “Even those watching “The Island” without sound ate 36% more.” People watching the more distracting content also consumed more calories, with 354 calories consumed by those watching The Island (314 calories with no sound) compared to 215 calories consumed by those watching the Charlie Rose Show.

“More stimulating programs that are fast paced, include many camera cuts, really draw you in and distract you from what you are eating. They can make you eat more because you’re paying less attention to how much you are putting in your mouth,” explains Tal. Because of this, programs that engage viewers more might wind up being worse for their diets!

So what can you do to avoid overeating during your favorite chase scene? The researchers suggest pre-plating or pre-portioning your TV snacks instead of bringing out a whole bag of chips or box of cookies. Wansink notes that the best solution is to bring out the healthy munchable snacks, like carrots. “The good news,” says Wansink “is that action movie watchers also eat more healthy foods, if that’s what’s in front of them. Take advantage of this!”


Posted in Human Behavior: Habits, Human Behavior: Sedentary, Nutrition: Junk Food, Obesity, Pediatric Health: TV Watching | Leave a comment

Dietary-quality gap between rich, poor widening: Harvard study

The quality of the U.S. diet showed some modest improvement in the last decade in large measure because of a reduction in the consumption of unhealthy trans fats, but the gap in overall diet quality widened between the rich and the poor.

An unhealthy diet is closely linked to cardiovascular disease, diabetes and some cancers. Eating a healthy diet is an important part of the strategy to prevent adverse health outcomes. Evaluating population trends in diet quality is important because it can offer guidance for public health policy.

The authors used the Alternate Healthy Eating Index 2010 (AHEI-2010) to investigate trends in diet quality in the U.S. adult population from 1999 to 2010 using a sample of 29,124 adults from the National Health and Nutrition Examination Survey (NHANES). A higher AHEI-2010 score indicated a more healthful diet. The index’s components were scored from 0 to 10. For fruits, vegetables, whole grains, nuts and legumes, long-chain omega-3 fats and polyunsaturated fatty acids (PUFAs), a higher score corresponded to higher intake. For trans fat, sugar-sweetened beverages and fruit juices, red and/or processed meat and sodium, a higher score corresponded to lower intake. The authors used a recently updated index, the Healthy Eating Index 2010 (HEI-2010) for further analysis.

The energy-adjusted average AHEI-2010 score increased from 39.9 in 1999- 2000 to 46.8 in 2009- 2010. Reduced trans fat intake accounted for more than half of this improvement. Scores increased by 0.9 points for sugar-sweetened beverages and fruit juice reflecting decreased consumption. Score increases of 0.7 points for whole fruit, 0.5 points for whole grains, 0.5 points for PUFAs and 0.4 points for nuts and legumes reflected increased consumption. A decrease in scores for sodium reflected greater consumption. Having a lower body mass index (BMI) also was associated with dietary improvement. Diet quality scores in the high-socioeconomic status (SES) group, associated with both income and education, were consistently higher than in the lower-SES groups and that gap widened over time from 3.9 points in 1999-2000 to 7.8 points in 2009-2010.

“Our study suggests that the overall dietary quality of the U.S. population steadily improved from 1999 through 2010. This improvement reflected favorable changes in both consumers’ food choices and food processing, especially the reduction of trans fat intake, that were likely motivated by both public policy and nutrition education. However, overall dietary quality remains poor, indicating room for improvement and presenting challenges for both public health researchers and policy makers. Furthermore, substantial differences in dietary quality were seen across levels of SES, and the gap between those with the highest and lowest levels increased over time.”

Author: Dong D. Wang, M.D., M.Sc., of the Harvard School of Public Health, Boston, and colleagues.

(JAMA Intern Med. Published online September 1, 2014. doi:10.1001/jamainternmed.2014.3422.


Posted in Health Care: Disparities, Human Behavior: Bias, Nutrition, Poverty | Leave a comment

Rapid 50-cent sickle cell test

Within minutes after birth, every child in the U.S. undergoes a battery of tests designed to diagnose a host of conditions, including sickle cell disease. Thousands of children born in the developing world, however, aren’t so lucky, meaning many suffer and die from the disease each year.

A.J. Kumar hopes to put a halt to at least some of those deaths.

A Post-Doctoral Fellow in Chemistry and Chemical Biology working in the lab of George Whitesides, the Woodford L. and Ann A. Flowers University Professor, Kumar and colleagues, including other co-authors, have developed a new test for sickle cell disease that provides results in just 12 minutes and costs as little as 50 cents – far faster and cheaper than other tests. The test is described in a paper published this week in the Proceedings of the National Academy of Sciences.

“The tests we have today work great, they have a very high sensitivity,” Kumar said. “But the equipment needed to run them costs in the tens of thousands of dollars, and they take hours to run. That’s not amenable to rural clinics, or even some cities where the medical infrastructure isn’t up to the standards we see in the U.S. That’s where having a rapid, low-cost test becomes important and this paper shows such a test can potentially work.”

When run against more than 50 clinical samples – 26 positive and 26 negative – the new test showed good sensitivity and specificity for the disease, Kumar said, so the early evidence is promising, but additional testing will be needed to determine whether the test is truly accurate enough to use in the field.

The test designed by Kumar is deceptively simple, and works by connecting two ideas scientists have understood for decades.

The first is the notion that blood cells affected by the disease are denser than normal cells, and the second is that many polymers, when mixed in water, automatically separate into layers ordered by density.

Conventional methods to separate cells by density relied on layering liquids with different density by hand. The insight, arrived at by Charles Mace (now at Tufts) and Kumar, was that the self-forming layers could be used to separate cells, such as red blood cells, by density.

“When you mix the polymers with water, they separate just like oil and water,” he said. “Even if you mix it up, it will still come back to those layers.”

It wasn’t until a chance meeting with Dr. Thomas Stossel, however, that Kumar believed the technology might have a real impact on sickle cell disease.

“Initially, we started off working on malaria, because we thought when parasites invaded the cells, it would change their density,” he said. “But when I met Tom Stossel on a panel at the Harvard Medical School, he said, ‘You need to work on sickle cell.’ He’s a hematologist by training and has been working with a non-profit in Zambia for the past decade, so he’s seen the need and the lack of a diagnostic tool.”

When Kumar and colleagues ran tests with infected blood, their results were unmistakable. While healthy red blood cells settled in the tubes at specific levels, the dense cells from blood infected with sickle cell settled in a band significantly lower. The band of red cells could clearly be seen by eye.

Just showing that the test worked, however, wasn’t enough.

“We wanted to make the test as simple as possible,” Kumar explained. “The idea was to make it something you could run from just a finger prick. Because these gradients assemble on their own, that meant we could make them in whatever volume we wanted, even a small capillary tube.”

The design the team eventually settled on is barely larger than a toothpick. In the field, Kumar said, running the test is as simple as uncapping the tube, pricking a patient’s finger and allowing the blood to wick into the tube.

While further study is needed to determine how accurate and effective the test may be, Kumar said stopping even a few sickle-cell-related deaths would represent a victory.

“The best way to state it is in terms of the actual problem,” he said. “About 300,000 children are born every year with sickle cell disease, and the vast majority – about 80 to 90 percent – are in either Africa or India, where for the most part, they aren’t going to get access to the current screening tests.

“There were studies recently that showed in sub-Saharan Africa, between 50 and 90 percent of the children born with sickle cell disease die before the age of 5,” he continued. “Whereas in the U.S. people don’t die from this disease as children, they can still live a full life. So my hope is that if this test is effective, it can make some small dent in those numbers.”


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Frail surgery patients spend longer in hospital, more likely to die

Am J Surg. 2014 Jul 27. pii: S0002-9610(14)00333-X. doi: 10.1016/j.amjsurg.2014.05.022. [Epub ahead of print]

Prevalence of frailty and its association with mortality in general surgery.

Hewitt J1, Moug SJ2, Middleton M3, Chakrabarti M4, Stechman MJ5, McCarthy K6; Older Persons Surgical Outcomes Collaboration.

Author information

1Cardiff University, University Hospital, Llandough, Cardiff CF64 2XX, UK. Electronic address:

2University of Glasgow, Royal Alexandra Hospital, Corsebar Road, Paisley PA2 9PN, UK.

3School of Medicine, Cardiff University, Cardiff, UK.

4West of Scotland Rotation, Royal Alexandra Hospital, Corsebar Road, Paisley PA2 9PN, UK.

5University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.

6North Bristol NHS Trust, Frenchay Park Road, Bristol BS16 1LE, UK.



We assessed the prevalence of frailty in an older acute general surgical population and its correlation with length of hospital stay, readmission to hospital, and 30- and 90-day mortality.


In 3 acute surgical admission units, we assessed consecutive participants aged over 65 years with general surgical conditions. We measured the prevalence of frailty using a 7-point frailty score. We measured length of hospital stay, readmission to hospital, and mortality at both 30 and 90 days.


We studied 325 participants with an average age of 77.3 years 8.2 (standard deviation), 185 (57%) women. There were 88 (28%) participants who were classified as being mildly, moderately, or severely frail. The frail group spent longer in hospital (7.6 days, 95% confidence interval [CI] 6.1 to 9.2 vs 11.1, 95% CI 7.2 to 15.0; P = .03). They also were more likely to die at both 30 and 90 days (adjusted odds ratio [OR] 4.0, 95% CI 1.1 to 15.2, P = .04; OR 3.0, 95% CI 1.3 to 7.4, P = .02). Readmission to hospital did not differ (OR 1.1, 95% CI .5 to 2.3).


Over 1 in 4 people were frail. These individuals spent longer in hospital and were more likely to die.


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E-cigarettes are a source of thirdhand nicotine exposure

Nicotine Tob Res. 2014 Aug 30. pii: ntu152. [Epub ahead of print]

Electronic Cigarettes Are a Source of Thirdhand Exposure to Nicotine.

Goniewicz ML1, Lee L2.

Author information

1Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA

2Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA.



Substances remaining on the surfaces in areas where people have smoked contribute to thirdhand exposure. Nicotine from tobacco smoke has been shown to react with oxidizing chemicals in the air to form secondary pollutants, such as carcinogenic nitrosamines. While previous studies have demonstrated thirdhand exposure to nicotine from tobacco smoke, none has investigated whether nicotine from electronic cigarettes (e-cigarettes) can also be deposited on various surfaces.


Three brands of e-cigarettes were refilled with varying nicotine concentrations. We released 100 puffs from each product directly into an exposure chamber. Surface wipe samples were taken from five indoor 100cm2 surfaces (window, walls, floor, wood, and metal) pre and post release of vapors. Nicotine was extracted from the wipes and analyzed using gas chromatography.


Three of four experiments showed significant increases in the amount of nicotine on all five surfaces. The floor and glass windows had the greatest increases in nicotine, on average by a factor of 47 and 6, respectively (p < .05). The average amount of nicotine deposited on a floor during each experiment was 205 μg/m2, and varied from limit of quantitation to 550 μg/m2.


This study indicates that there is a risk of thirdhand exposure to nicotine from e-cigarettes. Thirdhand exposure levels differ depending on the surface and e-cigarette brand. Future research should explore the potential risks of thirdhand exposure to carcinogens formed from nicotine released from e-cigarettes.


Posted in E-cigarettes, Smoking, Third-hand Smoke | Leave a comment