Dark chocolate’s downsides, courtesy of the FDA

If you’re allergic to milk and you love dark chocolate, how do you know whether you can indulge in a candy bar without having an allergic reaction? That’s what the Food and Drug Administration (FDA) wanted to learn, especially after receiving reports that consumers had harmful reactions after eating dark chocolate.

Milk is a permitted ingredient in dark chocolate, but it is also one of eight major food allergens (substances that can cause reactions that are sometimes dangerous). U.S. law requires manufacturers to label food products that are major allergens, as well as food products that contain major allergenic ingredients or proteins. Allergens contained in a food product but not named on the label are a leading cause of FDA requests for food recalls, and undeclared milk is the most frequently cited allergen. Chocolates are one of the most common sources of undeclared milk associated with consumer reactions.

FDA tested nearly 100 dark chocolate bars for the presence of milk. Earlier this year, the agency issued preliminary findings, and is now releasing more information about its research. The bars tested by FDA were obtained from different parts of the U.S., and each bar was unique in terms of product line and/or manufacturer. Bars were divided into categories based on the statements on the labels.

The bottom line? Unfortunately, you can’t always tell if dark chocolate contains milk by reading the ingredients list. FDA researchers found that of 94 dark chocolate bars tested, only six listed milk as an ingredient. When testing the remaining 88 bars that did not list milk as an ingredient, FDA found that 51 of them actually did contain milk. In fact, the FDA study found milk in 61 percent of all bars tested.

In part, that’s because milk can get into a dark chocolate product even when it is not added as an ingredient. Most dark chocolate is produced on equipment that is also used to produce milk chocolate. In these cases, it is possible that traces of milk may inadvertently wind up in the dark chocolate.

Read ‘May’ as ‘Likely’

To inform consumers that dark chocolate products may contain milk even if not intentionally added, many chocolate manufacturers print “advisory” messages on the label. There’s quite a variety of advisory messages, such as:

  • “may contain milk”
  • “may contain dairy”
  • “may contain traces of milk”
  • “made on equipment shared with milk”
  • “processed in a plant that processes dairy”
  • “manufactured in a facility that uses milk”

FDA found that milk was present in 3 out of every 4 dark chocolate products with one of these advisory statements. Some products had milk levels as high as those found in products that declared the presence of milk.

When the National Confectioners Association (NCA) was asked for its advice, a spokesperson said that “consumers with milk allergies should not consume dark chocolate products that come with advisory statements, since these products may indeed contain milk proteins.”

Another problem is that advisory messages may appear to be conflicting if they are accompanied by dairy-free or vegan statements. “Even a consumer who carefully reads the label may be confused by a statement such as “vegan” (which implies that no animal-derived products were used) along with an advisory—or “may contain” statement—referring to the presence of milk,” says Stefano Luccioli, M.D., a senior medical advisor at FDA.

Not Quite ‘Dairy Free’

In addition to these advisory statements, labels for chocolate bars may make other claims. Some say “dairy-free” or “lactose free,” but FDA found milk in 15% of the dark chocolates with this label. And 25% of dark chocolate products labeled only “vegan” were found to contain milk.

No Message Doesn’t Mean No Milk

You shouldn’t assume that dark chocolate contains no milk if the label does not mention it at all. “Milk-allergic consumers should be aware that 33% of the dark chocolates with no mention of milk anywhere on the label were, in fact, found to contain milk,” says Luccioli.

What Consumers Can Do

  1. Consumers who are sensitive or allergic to milk should know that dark chocolate products are a high-risk food if you’re highly milk-allergic.
  2. Start by checking the ingredients list to see if it includes milk.
  3. Read all the label statements on dark chocolate products and avoid those with an advisory statement for milk, even if these products feature also other (and conflicting) statements, such as “dairy-free” or “vegan”.
  4. View even products with dairy-free claims or without any mention of milk with caution, unless the manufacturer is a trusted source and/or uses dedicated equipment for making milk-free chocolate products.

“The chocolate industry will continue to make every effort to understand the needs of allergic consumers and communicate the potential presence of milk allergens in dark chocolate through advisory labeling,” says Laura Shumow, director of scientific and regulatory affairs at NCA.

FDA is evaluating the study findings and considering options for addressing the issues identified in the study. Further, allergen contamination is included in the preventive and risk-based controls mandated by the FDA Food Safety Modernization Act (FSMA). Under the proposed Preventive Controls for Human Food rule that is scheduled to become final this fall, food manufacturers would be required to implement a food safety plan that identifies safeguards in place to prevent or significantly reduce such hazards as food allergens.

The proposed rule includes provisions to prevent unintended cross-contact between foods that contain allergens and those not intended to contain them. Firms covered by the final rule would have from one to three years after the rule becomes final to comply, depending on the size of the firm.

Milk Detected in Individual Dark Chocolate Products

 Label/Package Statement Total number of dark chocolate products  Number and percent (%) of dark chocolate products testing positive for milk
Milk (or milk-derived component1)  6  6 (100%)
Advisory Statements2 (alone or combined)  59  44 (75%)
Dairy-free or lactose-free3 statements alone  13  2 (15%)
 Vegan statement alone  4 1 (25%)
 No statement regarding milk  12  4 (33%)
 TOTAL  94  57 (61%)
  1. Some examples of milk components include cream, milk fat, and sodium caseinate.
  2. Advisory statements refers to statements regarding the possible presence of milk, such as “may contain milk (or dairy)”, “made on equipment shared with milk,” “processed in a plant that processes dairy”, or “manufactured in a facility that uses milk.” This category also includes “may contain traces” statements, as well as advisory statements combined with either a vegan or dairy-free or lactose statement.
  3. Lactose-free chocolates are grouped with dairy-free products although the statement “lactose-free” does not necessarily indicate that the product is free from milk. This is because lactose is a “milk sugar,” and its removal does not mean that milk proteins are removed as well.

Posted in Nutrition: Allergies, Nutrition: Food: Chocolate, Nutrition: Labeling, Nutrition: Marketing | Leave a comment

Better measurement of Parkinson’s progression in the brain

University of Florida researchers have identified a biomarker that shows the progression of Parkinson’s disease in the brain, opening the door to better diagnosis and treatment of the degenerative disease.

By comparing brain images of Parkinson’s patients to those of a control group over a year, an interdisciplinary team found that an area of the brain called the substania nigra changes as the disease advances. The findings provide the first MRI-based method to measure the disease’s progression, which can inform treatment decisions and aid in identifying new therapies, said UF applied physiology and kinesiology professor David Vaillancourt, Ph.D., one of the study’s authors.

“The Parkinson’s drugs available today help reduce symptoms. They don’t slow the progression of the disease, which is the major unmet medical need,” Vaillancourt said. “We’ve provided a tool to test promising new therapies that could address progression.”

The substania nigra of a Parkinson’s patient has more “free water” – fluid unconstrained by brain tissue, likely because of disease-related degeneration. The new study published in the journal Brain uses diffusion imaging, a type of MRI, to show that free-water levels increase as the disease progresses. The free-water level was also a good predictor of how bradykinesia – the slowness of movement common to Parkinson’s – advanced over the course of the subsequent year.

Because doctors typically diagnose the disease by evaluating patients’ symptoms and how they respond to medication, the indicator could also be useful to distinguish Parkinson’s from similar disorders. That could lead to better clinical trials, Vaillancourt said.

Lead author Edward Ofori, a UF postdoctoral fellow in UF’s College of Health and Human Performance, was joined in the study by UF neurology professor Michael Okun, M.D., medical director of the National Parkinson Foundation; postdoctoral students Peggy Planetta and Roxana Burciu; study coordinator Amy Snyder; Song Lai, Ph.D., human imaging director for UF’s Clinical and Translational Science Institute; and collaborators from Harvard Medical School and Rush University Medical Centre.


Posted in Parkinson's | Leave a comment

Flavored Fruit Drink or Poisonous Cleaning Product? How to Prevent Accidental Poisonings

Newswise — BIRMINGHAM, Ala. – The summer months often mean more time spent at home for kids. While the break from the books can be enjoyable, one University of Alabama at Birmingham child safety expert says there is one important lesson both children and parents still need to learn: how to prevent poisoning.

Every day in the United States, poisonings send more than 300 children to the emergency room and two children die as a result, according to the Centers for Disease Control and Prevention. During the warmer months of the year, when school is out, higher volumes of poisonings have been reported by the American Association of Poison Control Centers.

David Schwebel, Ph.D., associate dean for Research in the Sciences in the UAB College of Arts and Sciences and professor in the Department of Psychology, recently published a study in the Journal of Pediatric Psychology that not only suggests ways manufacturers can reduce the risk of accidental poisonings, but how parents can do so as well.

“All of us have dangerous products in our houses,” said Schwebel, who directs UAB’s Youth Safety Lab. “Parents need to be aware that many of these products are packaged in a way that can be misleading. Window cleaner, for example, might look a lot like a drink.”

Besides household cleaners of all kinds, Schwebel says poisons include soaps — both laundry and dishwasher, pesticides, paint, vehicle fluids, lawn care products, lighter fluid, certain types of plants, alcohol, medicines, vitamins, nicotine/cigarettes/e-cigarettes, cosmetics, and personal care products.

To protect kids, Schwebel suggests:
1. Put all poisons out of reach of children or behind locked cabinet doors.
2. Maintain close supervision of young children at all times.
3. Know the number for your local poison-control center.

“Store these poisonous products safely — put them in high places where young children, who are at higher risk, can’t reach,” Schwebel said. “And use cabinet locks if you need to store them in a lower place.”

Schwebel says, in general, teaching kids can also be an effective way to prevent accidents with children, but it cannot be relied on.

“With young children, supervision has to be constant,” he said. “That’s hard to do, I know; but a poisoning can happen very quickly. You need to figure out a way to keep your child safe even when your attention is distracted by something in the oven or if the doorbell rings, for example.”

Posted in Pediatric Health: Accidental Drug Ingestion, Pediatric Health: Injuries | Leave a comment

The first fraction of ejaculate is the most effective for conception: Syst Biol Reprod Med

Sperm in the first fraction of ejaculate are more numerous, move more and present better quality DNA than those lagging behind. This is the conclusion of a study led by the Ginemed fertility clinic, which confirms that while the objective of the first fraction is to fertilise the egg, the second phase is so that no sperm from any other male has a chance to fertilise it.

A study led by the Ginemed Assisted Human Reproduction Clinic analyses the advantages of using fractions of ejaculate separately in in-vitro fertilisation as a way to improve the sample of the semen.

The researchers’ hypothesis was that, comparing the different fractions of semen in an ejaculation, the first would contain sperm with better seminal parameters and could be used as an effective method for selecting sperm prior to fertilisation.

“Ejaculate has always been considered as a whole. However, we believe that it is divided into two quite different phases due to its composition and physiological functions, aimed at achieving two equally important actions in terms of reproduction,” María Hebles, co-director of the reproduction laboratory at the Ginemed Clinic in Seville and lead author of the study, explains to SINC.

The first objective of ejaculate would be to fertilise the egg and the second so that no other male has the opportunity to fertilise it. Therefore, the first fraction is characterised as having protective components such as zinc, whereas the second contains elements that can cause damage to sperm.

However, for their use in assisted reproduction techniques, the liquid is normally collected in a single container, and therefore both phases are mixed together. This could have a detrimental effect on the sperm population,” adds Hebles.

Based on this, the specialists asked 40 participants to collect the ejaculate separately into two containers, one for each phase. They then separated the first and the second phase and studied the characteristics of the sperm in each of them.

Data suggests that the first phase contains an enhanced subpopulation of sperm, with less sperm DNA fragmentation. Therefore, the use of sperm from this fraction can have a positive effect on fertilisation and embryonic development.

“As we were expecting, the sperm from the first fraction of ejaculate were faster moving and the count was higher, and more importantly, they had higher DNA integrity than sperm from the second phase,” says the researcher.

In light of the results, the experts now have a protocol requesting all patients to collect the ejaculate in two fractions, “improving the quality of the sperm used for fertilisation simply and at no cost at all,” Hebles adds.

Ejaculation phases

The fluid expressed during ejaculation is composed of various fragments, shared between a pre-ejaculation phase and the first and the second fraction of the ejaculate. Although there are no definitive studies to this regard, the pre-ejaculatory phase or pre-seminal fluid does not contain sperm; it is a colourless secretion from the Cowper’s glands which is expelled to lower the acidity of the urethra.

On the other hand, the first fraction represents between 15 and 45% of ejaculate volume, is rich in sperm, acid phosphatase, citric acid, magnesium and zinc, which effectively protect the sperm. The second fraction consists of the remaining volume, between 70 and 90% and is composed of secretions from the seminal vesicles rich in reactive oxygen species which have a negative effect on the seminal characteristics.



María Hebles, Mónica Dorado, Miguel Gallardo, Mercedes González-Martínez, Pacual Sánchez-Martín. ‘Seminal quality in the first fraction of ejaculate’. Syst Biol Reprod Med, Early Online: 1-4 2014 DOI: 10.3109/19396368.2014.999390


Posted in Pregnancy, Pregnancy: Birth Control, Pregnancy: Fertility | Leave a comment

Why you are, probably, a horrible person when you drive

Here’s a scenario that should be familiar: You’re driving along on the highway. Suddenly, without signaling, a massive SUV comes barreling into your lane from the right, forcing you to jam on the brakes and swerve out of the way to avoid a collision. “Worthless piece of %$#@,” you yell to this person you don’t know (and who can’t hear you) before embarking on a quest to teach them a lesson by tailgating them for the next two miles.

In his 1950 short, Motor Mania, Goofy plays Mr. Walker, a law abiding, kind, and courteous citizen—until he steps into his car. All of a sudden Mr. Walker undergoes a Hydian transformation, becoming Mr. Wheeler, a reckless, selfish, “uncontrollable monster.” Wrapped in his “personal armor,” Mr. Wheeler screams at other motorists, flies off the handle at the slightest perceived provocation, and through it all still considers himself a good driver.

You are Goofy. You are. But why?

Part of the problem has to do with what psychologists call “deindividuation.” Coined around the same time Motor Mania was released, the word indicates a loss of self-awareness and along with it, individual accountability. This can happen in a number of different scenarios and contexts, but anonymity (perceived or real) is always a key ingredient.

One well known study, conducted by psychologist Philip Zimbardo in 1970, took a group of female students at NYU, gave them hoods, put them in the dark, assigned them numbers to replace their names, and then asked them to administer shocks to other students. Zimbardo found that compared to subjects who were just wearing name tags, the hooded participants were willing to administer twice the level of electric shock (no one was actually shocked) to others.



Posted in Human Behavior: Aggression, Human Behavior: Anger, Human Behavior: Bullying, Human Behavior: Conflict, Human Behavior: Consciousness, Human Behavior: Control, Human Behavior: Emotional Maturity, Human Behavior: Habits, Human Behavior: Impulse, Human Behavior: Rudeness | Leave a comment

If you take the junk out of junk food, is it no longer junk food?

Taco Bell is bidding adiós to artificial colors and flavors. The Mexican-themed fast food chain, along with its corporate sibling, Pizza Hut, said that it will phase out some of its synthetic additives and replace them with alternatives that the company characterizes as simpler and more natural.

“[People are] telling us less is más when it comes to ingredients, so we’re simplifying with natural alternatives and staying true to who we are and what makes us unique,” Taco Bell CEO Brian Niccol said in a press release.

Scheduled for deletion are artificial dye Yellow No. 6, which will be removed from its nacho cheese; Blue No. 1, which will be removed from its avocado ranch dressing; and carmine, a bright red pigment derived from insects, which will be removed from its red tortilla strips. The restaurant will also replace its black pepper flavoring with actual black pepper.

Taco Bell says that it will also eliminate high-fructose corn syrup and unsustainable palm oil by the end of 2015. For its part, Pizza Hut says that it will remove artificial colors and preservatives by the end of July.


Posted in Nutrition: Junk Food | Leave a comment

E-Cigarette Vapor, Even When Nicotine-Free, Found to Damage Lung Cells: American Physiological Society (APS)

Newswise — Bethesda, Md. (May 26, 2015)—Electronic cigarette (e-cig) use has now surpassed traditional cigarette use among middle and high school students, according to the Centers for Disease Control and Prevention. This leaves many parents, public health officials and consumers asking whether e-cigarettes are better or worse for lung health than traditional cigarettes. Now, a team of researchers adds its findings to others that suggest nicotine in any form is damaging to lungs. This new research also suggests that non-nicotine-containing e-cig solutions have a damaging effect on lung health, leading researchers to call for more e-cig research.

The loss of integrity in the lung endothelial cells—the cells that make up the lining of the lungs—can contribute to lung injury and inflammation, but it is unknown what component of cigarette smoke causes lung cells to breakdown. Researchers wrote, “We investigated if nicotine, one of the hundreds of molecules present in [cigarette smoke] extracts, is sufficient to alter lung endothelial barrier function by affecting cytoskeletal regulation,” which is the cell’s internal matrix that supports cell shape and function.

The researchers exposed mice and both human and mouse cells to cigarette smoke and e-cigarette solution that either contained nicotine or was nicotine-free. Their findings shed light on how cigarette smoke damages the lungs and point directly to nicotine as the cause. “Nicotine has dose-dependent deleterious pulmonary effects that result in loss of lung endothelial barrier function, acute lung inflammation and decreased lung endothelial cell proliferation,” they wrote. The effects of nicotine were seen both in cigarette smoke and in e-cig solutions that contained nicotine.

Interestingly, nicotine-free e-cig solutions were also found to include lung-harming substances, such as acrolein. This substance, which is present in both e-cig solution and vapor, has been shown to damage the lungs by attacking the molecules that hold endothelial cells together.

“The increased use of inhaled nicotine via e-cigarettes, especially among the youth, prompts increased research into the effects on health. This research reports that components found in commercially available e-cigarette solutions and vapors generated by heating them may cause lung inflammation,” said lead researcher Irina Petrache, PhD. “The effects described characterize short-term effects of e-cig exposures. Whereas studies of long-term effects await further investigations, these results caution that e-cigarette inhalation may be associated with adverse effects on lung health.”

The article “Endothelial disruptive pro-inflammatory effects of nicotine and e-cigarette vapor exposures” is published ahead of print in the American Journal of Physiology—Lung Cellular and Molecular Physiology. Read the full article.


Posted in Cancer: Lung, E-cigarettes | Leave a comment

Lassa Fever Confirmed in Death of U.S. Traveler Returning from Liberia

The CDC and the New Jersey Department of Health have confirmed a death from Lassa fever which was diagnosed earlier today in a person returning to the United States from Liberia.

The patient traveled from Liberia to Morocco to JFK International Airport on May 17th.

The patient did not have a fever on departure from Liberia, did not report symptoms such as diarrhea, vomiting, or bleeding during the flight, and his temperature was taken on arrival in the U.S. and he did not have a fever at that time.

On May 18th, the patient went to a hospital in New Jersey with symptoms of a sore throat, fever and tiredness.

According to the hospital, he was asked on the 18th about his travel history and he did not indicate travel to West Africa.

The patient was sent home the same day and on May 21st returned to the hospital when symptoms worsened.

The patient was transferred to a treatment center prepared to treat viral hemorrhagic fevers.

Samples submitted to CDC tested positive for Lassa fever early this morning.

Tests for Ebola and other viral hemorrhagic fevers were negative. The patient was in appropriate isolation when he died there this evening.

Lassa fever is a viral disease common in West Africa but rarely seen in the United States.

There has never been person-to-person transmission of Lassa fever documented in the United States.

The New Jersey case is the sixth known occurrence of Lassa fever in travelers returning to the United States since 1969, not including convalescent patients. The last case was reported in Minnesota in 2014.

Although Lassa fever can produce hemorrhagic symptoms in infected people, the disease is different from Ebola, which is responsible for the current outbreak in West Africa. In general, Lassa fever is less likely to be fatal than Ebola (approximately 1% case fatality rate for Lassa vs approximately 70% case fatality rate for Ebola without treatment) and less likely to be spread from person to person. However, some Lassa patients develop severe disease, as the patient in New Jersey did.

In West Africa, Lassa virus is carried by rodents and transmitted to humans through contact with urine or droppings of infected rodents. In rare cases it can be transmitted from person to person through direct contact with a sick person’s blood or bodily fluids, through mucous membrane, or through sexual contact. The virus is not transmitted through casual contact, and patients are not believed to be infectious before the onset of symptoms. About 100,000 to 300,000 cases of Lassa fever, and 5,000 deaths related to Lassa fever, occur in West Africa each year.

CDC is working with public health officials to generate a list of people who had contact with the patient. Those identified as close contacts of the patient will be monitored for 21 days to see if symptoms occur.

Updates will be provided as the investigation continues.

For additional information about Lassa fever see the CDC website at http://www.cdc.gov/vhf/lassa.

Posted in Infectious Diseases: Lassa Fever | Leave a comment

Your brain is what you eat

Debilitating brain disorders are on the rise-from children diagnosed with autism and ADHD to adults developing dementia at younger ages than ever before.

But a medical revolution is underway that can solve this problem: Astonishing new research is revealing that the health of your brain is, to an extraordinary degree, dictated by the state of your microbiome – the vast population of organisms that live in your body and outnumber your own cells ten to one.

What’s taking place in your intestines today is determining your risk for any number of brain-related conditions.

In Brain Maker, Dr. Perlmutter explains the potent interplay between intestinal microbes and the brain, describing how the microbiome develops from birth and evolves based on lifestyle choices, how it can become “sick,” and how nurturing gut health through a few easy strategies can alter your brain’s destiny for the better.

With simple dietary recommendations and a highly practical program of six steps to improving gut ecology, Brain Maker opens the door to unprecedented brain health potential.

“Dr. Perlmutter’s book is among those rare and exciting exceptions: information so empowering, so enlightening, and presented so clearly and concisely that the reader emerges far better off for the reading experience. Put this book on your short list of must-reads for health and nutrition.”—William Davis, MD, author of Wheat Belly

“The research in Brain Maker was a revelation to me. And it will be to you as well. And, most importantly, you don’t have to wait for this information to become mainstream. You can ensure your brain health-and that of your family-by following the practical program outlined here.”—Christiane Northrup, MD, author of Women’s Bodies, Women’s Wisdom and Goddesses Never Age

“The single most important medical innovation in the 21st century is making the link between the gut and the little bugs that live there and nearly every chronic disease – from autism to depression, from asthma to autoimmune disease, from diabetes to dementia. Brain Maker is a game changer. For the first time, this brilliant scientist doctor connects the dots and teaches us why we need to tend our inner garden (our microbiome) and provides a radical but simple plan to reset, reboot, and renew your microbiome. This book shouldn’t be called Brain Maker, it should be called Health Maker.”—Mark Hyman, MD, author of The Blood Sugar Solution

Source: Amazon

Posted in Brain, Brain Fitness, Brain Fog, Microbiome, Nutrition, Nutrition is Medicine, Nutrition: Dietitians, Nutrition: Diets, Nutrition: Gut | Leave a comment

Narcissism’s definition is changing

In the past two years the study of narcissism has gotten a face-lift. The trait is now considered to have two distinct dimensions: admiration seeking and rivalry. Subsequent studies, including a recent look at actors, revealed a more nuanced picture of personality than did past work. The actors, for instance, want admiration more than most people but tend to be less competitive than the average Joe—they may crave the spotlight, but they will not necessarily push others out of the way to get it.

The new understanding of narcissism started with a 2013 paper in the Journal of Personality and Social Psychology that identified narcissism’s two dimensions. “Previous theories and measures of narcissism dealt with this trait as a unitary construct, mixing up agentic aspects—assertiveness, dominance, charm—with antagonistic aspects—aggressiveness and devaluation of others,” says Mitja Back of the University of Münster in Germany, the study’s primary author. Lumping both aspects together made narcissistic behavior confounding.

Studying hundreds of healthy subjects, Back’s team found that traits related to narcissism clustered into two categories, with both facets of narcissism serving to maintain a positive self-image. Self-promotion draws praise, whereas self-defense demeans others to fend off criticism. Admiration seeking and rivalry each have different effects on body language, relationship health and personality.


Posted in Human Behavior: Egoism, Human Behavior: Narcissism | Leave a comment

How commuting may increase burnout risk

Newswise — Commuting length, distance, and means are stress factors that can lead to burnout, says Annie Barreck of the University of Montreal’s School of Industrial Relations. “A correlation exists between commuting stress factors and the likelihood of suffering from burnout. But their importance varies according to the individual, the conditions in which their trips take place, and the place where the individual works,” she explained. Barreck will present her research today at the 83rd congress of the Association francophone pour le savoir (ACFAS).

Barreck’s work compares rural and urban regions of Quebec in terms of their commuting patterns, including types of transport used (car, subway, bus, bike, etc.) and links these patterns to the three dimensions of burnout: emotional burnout, cynicism and professional efficacy. The study involved 1,942 people, aged between 17 and 69, working at 63 organizations in Quebec. Data was collected through Canada’s SALVEO survey. Burnout symptoms were ascertained through the Maslah Burnout Inventory General Survey. The findings show that there is a significant link between commuting (i.e. the trip between home and work) and the presentation of the symptoms professional burnout.

No surprises: the bigger the city, the more stressful the commute, at least for people travelling by car. “People commuting towards rural areas, or even suburban areas, feel less stressed out,” Barreck said, the finding coming as no surprise to her either. She did however note that passengers are more likely to be stressed out than drivers. “Carpooling reduces the passenger commuters’ sense of control, which causes them more stress before they’ve even arrived at work,” she said.

However, people commuting towards rural areas are not entirely spared: those who take long trips in public transit feel less effective in the workplace. “Public transit implies bus or train connections, and as rural regions are less well served, the risk of unforeseeable and uncontrollable delays is increased, causing stress that is carried over into the workplace,” Barreck explained. The opposite is true for transit users in major urban areas: the variety of types and times of service means they’re less likely to have symptoms of burnout.

Biking is also a mixed bag that is determined by the profile of the area the commuter is working in. Commuting by bike in the suburbs is particularly stressful. “Cyclists in the suburbs have a lesser sense of control than cyclists in the city,” Barreck explained. “Cyclists and walkers in the city have access to safety features such as cycle paths and pedestrian crossings, which increases their sense of control over their commute. Meanwhile, as businesses have been leaving city centres over the past 20 years, car traffic continues to increase in the suburbs. In the country, cyclists and walkers use quiet country roads, which are comparatively less stressful and offer a greater sense of control.”

Commuting doesn’t have to contribute to burnout. “The effects of the duration of a commute on a person’s mental health vary according to the type of transport used and the profile of the area where the person works,” Barreck said. Her findings show that the risk of burnout increases significantly when a commute lasts more than 20 minutes. In Quebec, it takes an average of 32. Above 35 minutes, all employees are at increased risk of cynicism toward their job. Barreck believes this should lead employers to adopt flexible commuting arrangements. “Managing employee commuting flexibly would increase employee efficiency and moreover enable organisations to attract or retain workers. In the current context of skill shortages, employers have everything to gain from facilitating the mental health of their employees,” she said.

Pending approval of the researcher, this is an unofficial, courtesy translation of a document originally issued in French. The University of Montreal is officially known as Université de Montréal.


Commute for life: A survival guide to commuting, or -How to manage work, family, health and travel-and stay sane!

Are commuting patterns a good indicator of urban spatial structure? [An article from: Journal of Transport Geography]

Posted in Burnout, Human Behavior: Stress, Human Behavior: Work Ethic | Leave a comment

Frailer older patients at higher risk of readmission or death after discharge from hospital: Canadian Medical Association Journal

Frailer older patients are at higher risk of readmission to hospital or death within 30 days after discharge from a general internal medicine ward, but health care professionals can assess who is at risk using the Clinical Frailty Scale, according to a study in CMAJ (Canadian Medical Association Journal)

Readmission within 30 days after hospital discharge is common and also costly for the health care system. Identifying at-risk patients and addressing the factors contributing to readmission can help reduce recurrences. However, current tools are not able to predict accurately who might be at risk of readmission.

Researchers assessed whether the Clinical Frailty Scale can help predict readmission or death within 30 days after hospital discharge in a group of 495 patients at 2 Alberta hospitals. The Clinical Frailty Scale, an easy-to-use tool developed several years ago, can be used at the bedside by physicians and other health care professionals to determine frailty. The scale measures difficulty in daily living activities with mild frailty (score of 5) corresponding to difficulty with 1 or more complicated daily living activities such as finances, shopping, meal preparation and housework. Moderate frailty (score of 6) indicates difficulty in bathing, dressing or climbing stairs. Severe frailty (score of 7) means a patient is physically or mentally dependent on someone for 3 or more daily living activities.

Of the patients enrolled in the study, half were women, and the median age was 64 years. One-third of the patients (162) were frail, with a score of 5 or higher on the Clinical Frailty Scale in the week before admission to hospital. Within 30 days after discharge, 85 patients (17%) were readmitted or had died. Compared with nonfrail patients, frail patients were at greater risk of readmission or death within 30 days (24% v. 14%), especially those with moderate or severe frailty (31% v. 14%). Inclusion of frailty assessments improved the prediction of post-discharge outcomes, leading the authors to suggest that this assessment be included in discharge planning procedures to help identify patients at highest risk of poor transition from hospital to home.

The researchers suggest that a variety of factors may contribute to readmission to hospital.

“Although frailty or vulnerability before becoming ill may affect outcomes after discharge, patients in hospital may also experience an acquired, transient period of risk for adverse events that is harmful in addition to the stress of the acute illness,” writes Dr. Finlay McAlister, University of Alberta, with coauthors. “This ‘post-hospital syndrome’ is a multidimensional construct that incorporates sleep deprivation, cognitive stress, poor nutrition and physical pain. Patients who are already frail before hospital admission may be more sensitive to the stresses of this syndrome and at higher risk of readmission and poor outcomes.”

The Clinical Frailty Scale can be a useful tool for health care professionals to identify patients at high risk of readmission and provide support to lessen the likelihood of readmission.


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Motherhood permanently alters the brain and its response to hormone therapy later in life

Hormone therapy (HT) is prescribed to alleviate some of the symptoms of menopause in women. Menopausal women are more likely to be diagnosed with Alzheimer’s disease but not other forms of dementia, and HT has been prescribed to treat cognitive decline in post-menopausal women with variable degrees of effectiveness. New research by Dr. Liisa Galea, at the University of British Columbia, suggests the form of estrogens used in HT and previous motherhood could be critical to explain why HT has variable effects. Research in women, and Dr. Galea’s research in animals, shows that one form of estrogens, called estradiol, which is the predominant form of estrogens in young women, had beneficial effects, while estrone, which is the predominant form of estrogens in older women, did not. Furthermore, the effects of estrone also depended on whether the rats had experienced motherhood: estrone-based HT impaired learning in middle-aged rats that were mothers, while it improved learning in rats that were not. Dr. Galea’s latest results were presented at the 9th Annual Canadian Neuroscience Meeting, on May 25th 2015 in Vancouver British Columbia.

“Our most recent research shows that previous motherhood alters cognition and neuroplasticity in response to hormone therapy, demonstrating that motherhood permanently alters the brain” says Dr. Liisa Galea.

Dr. Liisa Galea is interested in how hormones affect brain and behaviour. Hormone therapy (HT) has been shown to have variable effects on brain function and Dr. Galea noted that one factor that had not received much attention was the form of estrogens used in HT. There are three forms of estrogens: estradiol, estrone and estriol. Estradiol is the most potent of estrogens, and it is the predominant form in young women, while estrone is a weaker estrogen and is the predominant form in post-menopausal women. A systematic review of the published scientific literature indicates that estradiol-based HT may have more beneficial effects, while estrone-based HTs may have more detrimental effect on cognition and dementia risk in women.

Dr. Galea studied how two forms of estrogens, estradiol and estrone, affect neuroplasticity, which is how neural pathways in the brain change in response to various factors. Her studies focused on a specific brain region, called the hippocampus, which has important roles in memory and spatial ability, such as navigational skills. Both forms of estrogens increased the production of new cells in a part of the hippocampus called the dentate gyrus in young females. However, only chronic estradiol, but not chronic estrone, significantly increased the survival of these new neurons, and increased the expression of zif268, a protein involved in neuroplasticity.

Chronic estradiol, but not chronic estrone, also improved performance of young female rats in a behavioural test called the water maze. The water maze is a test of memory and orientation in which rats must find a submerged platform in water that they cannot see; they must instead rely on cues located around them to orient themselves and swim to the platform. Rats receiving estradiol based HT found the platform significantly better that rats receiving estrone-based HT.

Finally, Dr. Galea’s previous research had shown that motherhood causes changes in the architecture of connections in the hippocampus, so her team investigated whether the different forms of estrogens could have different effects on rats that had experienced motherhood once (primiparous rats) and on those who had not (nulliparous rats). They found that estrone-based HT improved learning in middle-aged nulliparous rats, but impaired learning in primiparous rats of the same age. These primiparous rats also showed a reduction in neurogenesis and zif268, a protein involved in neuroplasticity in the hippocampus.

As estrone is a component of the most common form of HT prescribed for women in the US, these findings could have implications for the treatment of age-related neurodegenerative disorders in women.

“Hormones have a profound impact on our mind. Pregnancy and motherhood are life-changing events resulting in marked alterations in the psychology and physiology of a woman. Our results argue that these factors should be taken into account when treating brain disorders in women” concludes Dr. Liisa Galea.


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