Older Breast Cancer Patients Still Get Radiation Despite Limited Benefit

Newswise — DURHAM, N.C. – Women over the age of 70 who have certain early-stage breast cancers overwhelmingly receive radiation therapy despite published evidence that the treatment has limited benefit, researchers at Duke Medicine report.

The study suggests that doctors and patients may find it difficult to withhold treatment previously considered standard of care, even in the setting of high quality data demonstrating that the advantages are small.

“The onus is on physicians to critically analyze data to shape our treatment recommendations for patients, weighing the potential toxicities of treatment against clinical benefit,” said Rachel Blitzblau, M.D., Ph.D., the Butler Harris Assistant Professor of Radiation Oncology at Duke University Medical Center. Blitzblau was the senior author of a study published online Dec. 8, 2014, in the journal Cancer.

Blitzblau and colleagues launched their inquiry to determine whether clinical practice changed as a result of a large randomized, prospective study first published in 2004 that compared treatment options for women ages 70 and older with early-stage hormone-receptor positive breast cancers. The CALGB 9343 study reported limited benefit for adding radiation therapy plus the drug tamoxifen after lumpectomy among older women.

Specifically, the 2004 study’s 5-year data showed a small but statistically significant reduction in the rate of cancer recurrence; a similar finding was reported again in 2012 with a decade of data. However, the addition of radiation to tamoxifen after surgery did not improve overall survival among the study participants at either of the reporting periods.

“The discussion at the time of the first CALGB report in 2004 was that we should consider omitting radiation for these women, because the small observed benefits might not be worth the side effects and costs,” Blitzblau said, adding that side effects include fatigue, discomfort and changes in the radiated breast tissue, among others.

But little has changed following publication of the study, with about two-thirds of women still getting radiation therapy. Blitzblau and colleagues analyzed cancer treatment patterns from a national health database called the Surveillance, Epidemiology, and End Results (SEER) registry. They found that before the CALGB study results were published in 2004, 68.6 percent of older women who would have been eligible for enrollment in the CALGB trial received radiation therapy. In the five years after the study was first reported, the rate dropped, but only slightly, to 61.7 percent.

“The publication of the trial had only a very small impact on practice patterns,” Blitzblau said. “Our findings demonstrate the potential difficulty of incorporating clinical trial data that involves omitting a treatment that has been considered the standard of care.”

She said physicians might have delayed making practice changes until longer-term data was available; the research team’s analysis did not include results after the 10-year data from CALGB was published in 2012. In addition, she said, there is likely lingering concern among both doctors and patients that reducing treatments may worsen outcomes for older women who have excellent overall health and therefore longer life expectancies.

But Blitzblau said the findings of the current study highlight an important and increasingly difficult challenge for physicians: Striking the right balance between offering effective treatments while also acknowledging the need for more financially efficient medical care.

“It’s important to improve patient and doctor communication to ensure that the right patients are getting the right treatment at the right time,” Blitzblau said. “As we work toward more efficient and evidence-based medical practice in all medical specialties, we will need to understand what processes may be needed to spur change.”

In addition to Blitzblau, study authors include Manisha Palta, Priya Palta, Nrupen A. Bhavsar, and Janet K. Horton.

Posted in Cancer: Breast, Health Care: Medical Errors | Leave a comment

Nearly Half of U.S. Kids Exposed to Traumatic Social or Family Experiences During Childhood

Newswise — Nearly half of all children in the United States are exposed to at least one social or family experience that can lead to traumatic stress and impact their healthy development – be it having their parents divorce, a parent die or living with someone who abuses alcohol or drugs – increasing the risk of negative long-term health consequences or of falling behind in school, suggests new research led by the Johns Hopkins Bloomberg School of Public Health.

The study reports on new data showing the magnitude of these adverse experiences in the child population in the U.S., while also suggesting that training parents, providers and communities to help children with trauma cope and build even basic aspects of resilience may soften the blows and lead to later success, despite the obstacles.

The findings are published in the December issue of the journal Health Affairs.

“This study tells us that adverse childhood experiences are common among U.S. children and, as demonstrated in adult studies, have lifelong impacts that begin early in life,” says study leader Christina D. Bethell, PhD, MPH, MBA, a professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.

For the study, Bethell and her colleagues analyzed data from the 2011-12 National Survey of Children’s Health, a survey of parents of 95,677 children under 17 from throughout the United States. The survey included questions about nine adverse childhood experiences as reported by parents: extreme economic hardship, parental divorce/separation, lived with someone with a drug or alcohol problem, witness or victim of neighborhood violence, lived with someone who was mentally ill or suicidal, witnessed domestic violence, parent served time in jail, treated or judged unfairly due to race/ethnicity and the death of a parent. The survey includes myriad data on family and neighborhood environments and parental well-being in addition to children’s schooling and medical care, and contains some data about child resilience.

The study found that more than 22 percent of children represented in the survey had two or more of these traumatic childhood experiences. Broken down by state, Utah had the lowest number of children experiencing two or more traumatic experiences (16.3 percent) while Oklahoma had the highest (32.8 percent).

Researchers found that children with two or more adverse experiences were more than 2.5-times more likely to repeat a grade in school as well as be disengaged in school, compared to those without any traumatic experiences, and after adjusting for confounding factors such as race, income and health status. Children with these experiences were also much more likely to have a wide range of chronic health problems, including asthma, ADHD, Autism Spectrum Disorders, obesity and other health and risk factors. Children with adverse childhood experiences were also less likely than those without to live in a protective home environment and have mothers who were healthy.

The news isn’t all bad: Among children with two or more adverse experiences who already have a chronic condition requiring regular doctor visits, those who had learned and showed even the one aspect of resilience evaluated in the study were 1.5-times more likely to be engaged in school and nearly half as likely to repeat a grade in school compared to those who had not learned this skill.

Also a positive: Children and families who received quality health care from a doctor who knows, listens to and ensures children’s whole health care needs are met and coordinated did better than those who did not.

Bethell says that parents and children can be taught to recognize and reduce the biologic, emotional and psychological impact of traumatic stress, bounce back when faced with a challenge, and to develop a habit of hope instead of despair. Some of the most promising methods involve simple breathing techniques as well as so-called “trauma-informed” care and community approaches growing in popularity all across the country.

“Adverse childhood events don’t automatically have to have long-term traumatic impacts for children,” Bethell says. “To recognize trauma in children requires widespread awareness and skills-building among adults interacting with children at all levels. Efforts to support children, families and communities, so they can create a culture that supports safe, stable and nurturing relationships, hold great promise. Rapid innovation and studies documenting best methods and their impact are called for now. Supporting and teaching the adults in children’s lives to learn to heal from trauma and learn resilience themselves may be the most effective strategy to implement immediately.”

Posted in Domestic Violence, Mental Health: Abuse, Mental Health: PTSD | Leave a comment

Cervical Cancer: FDA Approval of Nonavalent HPV Vaccine Adds New Eradication Tool

Newswise — CHICAGO, IL (Dec. 10, 2014)—The Food and Drug Administration’s approval of a nonavalent vaccine against the human papillomavirus (HPV) represents another important step in the eradication of cervical cancer, according to the Society of Gynecologic Oncology (SGO).

It is estimated that the seven “high-risk” HPV types found in the nonavalent vaccine can potentially prevent over 90 percent of cervical cancers and a similarly high number of other HPV-associated cancers of the vulva, vagina, anus, penis, and some head and neck cancers.

“As the healthcare providers for women who suffer from cervical and lower genital tract cancers, members of the SGO have always been advocates for the primary prevention of cervical and other HPV-related cancers,” said SGO President Richard R. Barakat, MD. “Vaccination against HPV is a powerful way to eliminate these cancers.”

SGO reiterates its strong support for vaccination of adolescent girls and boys, including the routinely recommended age group of 11 to 12 year olds, the group in which these vaccines have been found to be most effective. Also, SGO recommends that women undergo cervical cancer screening as recommended by guidelines.

In 2014, the American Cancer Society estimated that 12,360 women would be diagnosed and 4,020 women would die from cervical cancer in the United States. “HPV vaccination should result in a significant decline in these numbers, but it is critical that physicians urge parents to take advantage of the rare opportunity to prevent cancer through a simple vaccine,” Dr. Barakat said.

Girls and boys already on a vaccine schedule should continue to get vaccinated.

Posted in Cancer: Cervical, HPV | Leave a comment

How to Avoid Foods That Trigger Migraines During the Holiday Season

Newswise — Certain foods and drinks can trigger migraine in many people, and those who suffer from migraines need to be especially careful to avoid these triggers as they attend holiday celebrations. With this in mind, the American Migraine Foundation and its Chair, David W. Dodick, MD, FRCP (C), FACP, want to help people with migraine avoid these potential triggers, so that they can better enjoy the season. Dr. Dodick is also Professor of Medicine at the Mayo Clinic College of Medicine (Scottsdale, AZ).

“This is the season in which many people overindulge in things that can trigger attacks of migraine,” said Dr. Dodick. “It’s important to think through food and beverage choices, to help reduce the risk of having a migraine attack.”

Dr. Dodick and the Foundation offer the following tips, which can also be found on http://www.americanmigrainefoundation.org/resources-and-links/spotlight-on-tis-the-season/, along with a wealth of other consumer-friendly tips on reducing migraine risk while enjoying the holidays:

• Skipping or missing meals is a much more common trigger of migraine than any particular food, so be sure to eat regularly during the day. That’s three meals … don’t skip breakfast!

• Avoid eating within a few hours of bedtime or drinking caffeinated beverages after early afternoon.

• Identify potential dietary triggers. Start keeping a migraine diary now, and see if you can identify particular foods that are followed by a migraine attack at least half of the time you eat them. Avoid those foods, especially during the holidays when stress and other holiday factors may make you more susceptible to attacks.

• Red wine is a common migraine trigger for some people, so opt for white wine or another beverage instead, unless you discover that these others are also migraine triggers for you. And because alcohol and dehydration can trigger migraines, be sure to drink in moderation. Alternating a glass of water with an alcoholic beverage will help.

• Practice healthy eating habits: In addition to not skipping meals, limit your intake of processed foods, sodium, sugar, and caffeinated and carbonated drinks.

“Knowing your food triggers and planning in advance can increase your enjoyment of holiday activities with fewer migraine attacks,” said Dr. Dodick. “If you don’t know whether you have food triggers, we suggest trying to eliminate specific dietary foods and beverages, such as red wine, processed meats, nuts, chocolate, aged cheese, monosodium glutamate, and gluten-containing foods, to see if they are causing migraine attacks. If these attacks decrease, introducing these items back one at a time can identify the culprit(s), should they exist. Not everyone with migraine has food triggers, but for those with these triggers, avoiding them can often mean fewer migraine attacks.”

For more information on migraine food triggers and how to identify them, see Migraine Management – Migraine Food Triggers.

The American Migraine Foundation recently redesigned its site (www.americanmigrainefoundation.org) to include a range of resources, including a new monthly “Spotlight,” where migraine sufferers and the public can turn for more detailed information about living with and managing many aspects of migraine. “Spotlight” will change topics approximately once a month. The current Spotlight is “’Tis the Season for Holiday Headaches,” a feature packed with information on how people with migraine can help reduce the likelihood that activities during the winter holidays will trigger more frequent migraine attacks. In addition to the subject discussed above, the site includes articles on “Seasonal Triggers of Migraines,” “Migraine and Sleep During the Holidays,” “Tips for Managing Stress During the Holidays,” and “’Tis the Season for Major Migraines” (an article covering a range of potential holiday-related migraine triggers), as well as useful links.

ABOUT MIGRAINE

Some 36 million Americans live with migraine, more than have asthma and diabetes combined. An estimated three to seven million Americans live with chronic migraine, a highly disabling neurological disorder. Migraine can be extremely disabling and costly, accounting for more than $20 billion in direct (e.g. doctor visits, medications) and indirect (e.g. missed work, lost productivity) expenses each year in the United States.

ABOUT THE AMERICAN MIGRAINE FOUNDATION

The American Migraine Foundation is a non-profit foundation supported by the American Headache Society and generous donors dedicated to the advancement of migraine research. Its mission is to support innovative research that will lead to improvement in the lives of those who suffer from migraine and other disabling headaches. www.americanmigrainefoundation.org is the companion website to the American Headache Society (www.americanheadachesociety.org), the professional services organization for the world’s foremost clinicians and researchers working in migraine.

Posted in Headaches: Migraines | Leave a comment

Mental Illness Is the Wrong Scapegoat After Mass Shootings

Newswise — In the shadow of the two year anniversary of one of the worst mass shootings in American history, at Sandy Hook Elementary School, an extensive new study by two Vanderbilt University researchers challenges common assumptions about gun violence and mental illness that often emerge in the aftermath of mass shootings.

When a mass shooting occurs there seems to be a familiar narrative that untreated mental illness is the primary cause for the terrifying act. But a new study published in the American Journal of Public Health by Dr. Jonathan Metzl and Kenneth T. MacLeish finds that an isolated focus on mental illness is misguided.

“Gun discourse after mass shootings often perpetuates the fear that ‘some crazy person is going to come shoot me,’” said Metzl, the study’s lead author. “But if you look at the research, it’s not the ‘crazy’ person you have to fear.”

MENTALLY ILL NOT VIOLENT
In the article, “Mental Illness, Mass Shootings and the Politics of American Firearms,” Metzl and MacLeish analyzed data and literature linking guns and mental illness over the past 40 years. They found that despite societal pre-conceived notions, most mentally ill people are not violent.

“Fewer than 5 percent of the 120,000 gun-related killings in the United States between 2001 and 2010 were perpetrated by people diagnosed with mental illness,” they write.

FOUR MYTHS ARISE AFTER MASS SHOOTINGS
Their research uncovered four central myths that arise in the aftermath of mass shootings:

(1) Mental illness causes gun violence
(2) Psychiatric diagnosis can predict gun crime before it happens
(3) U.S. mass-shootings “prove” that we should fear mentally ill loners
(4) Because of the complex psychiatric histories of mass-shooters, gun control “won’t prevent” mass shootings

They stress that all four of these are incorrect, though understandable assumptions.

“Our research finds that across the board the mentally ill are 60 to120 percent more likely than the average person to be the victims of violent crime rather than the perpetrators.”

MISDIRECTED BLAME
Metzl and MacLeish find that the focus on mental illness after horrific, yet statistically rare, mass shootings misdirects people from the bigger issues tied to preventing gun deaths in the U.S.

“There are 32,000 gun deaths in the United States on average every year and people are far more likely to be shot by relatives, friends or acquaintances than they are by lone violent psychopaths,” said Metzl.

“We should set our attention and gun policies on the everyday shootings, not on the sensational shootings because there we will get much more traction in preventing gun crime.”

MENTAL SCREENING CANNOT PREDICT GUN CRIME
The presumed link between mental illness and gun violence has led to calls for mental health screening for gun owners. But the authors find that psychiatric diagnosis is in and of itself not predictive of violence.

“Even the overwhelming majority of psychiatric patients who fit the profile of recent U.S. mass shooters – gun-owning, angry, paranoid white men – do not commit crimes,” Metzl and MacLeish write.

“Basing gun crime-prevention efforts on the mental health histories of mass shooters risks building ‘common evidence’ from ‘uncommon things,’ all while giving mental health providers the untenable responsibility of preventing the next massacre.”

SIGNS TO PREDICT GUN VIOLENCE
The authors detail how focusing solely on mental illness ignores those factors that do predict gun violence more broadly:

• Drug and alcohol use
• History of violence
• Access to firearms
• Personal relationship stress

“People are far more likely to be shot by relatives, friends, enemies or acquaintances than they are by lone violent psychopaths,” according to Metzl and MacLeish’s research.

MENTAL HEALTH SYSTEMS
The authors argue in the paper that lawmakers and voters should pay much more attention to mental health systems such as access to mental health care, medication and health insurance.

“In a way it is a failure of the system often that becomes represented as a failure of the individual,” said Metzl.

RACE, GENDER AND GUN ANXIETY
The authors also delve into to the ways that responses to mass shootings reflect cultural anxieties about race and gender.

“The rhetoric in which people are accumulating guns in the present day has a lot to do with the fear of the unknown stranger. ‘Somebody could come attack me or my family, so we need to protect ourselves.’ And that rhetoric is most common among suburban white men,” said Metzl.

The authors uncover how the political and racial strife in the 1960’s led some African Americans to push for their constitutional right to own and carry guns, while some white Americans at the time, including the National Rifle Association, pushed for stricter gun control laws.

“Reading the gun rights statements of the Black Panthers and other black power groups in the 1960’s is almost exactly the same as the Tea Party today,” said Metzl. “Both groups argued that they’re protecting themselves from government tyranny and have a constitutional right as individuals to bear arms,” said Metzl.

Yet Metzl adds that in the 60s, American society rushed to pathologize “black culture” while restricting gun rights, while in the present day our narratives locate the problem on individual white brains while at the same time encouraging further gun ownership.

Metzl and MacLeish teach at the The Center for Medicine, Health and Society at Vanderbilt, an innovative multidisciplinary center that studies the social and societal dimensions of health and illness. Its scholarship, teaching and wide-ranging collaborative projects explore medicine and science in a wide array of cultural contexts, while at the same time fostering productive dialogue across disciplinary boundaries.

The paper will publish in the February issue of the American Journal of Public Health.

Posted in Human Behavior: Violence | Leave a comment

Live Trees and Scented Candles Hijack the Holidays for Allergy Sufferers

Newswise — The many smells and tastes of the holidays that get so many in a festive mood can sicken others, thanks to allergic reactions. But with some seasonal savvy, allergy sufferers can breathe easy this festive time of year.

“The dust from the boxes and on the decorations that have been packed away in dank basements or dusty attics is triggering reactions in my allergy and asthma patients,” said Rachna Shah, MD, affiliate faculty member at Loyola Chicago Stritch School of Medicine and allergist at Gottlieb Memorial Hospital.

The holidays are supposed to be some of the happiest times of the year. But popular seasonal items, such as fresh trees, scented air fresheners and live plants make the holidays miserable for many.

Here are Dr. Shah’s top five tips for easy breathing this holiday season:

1. Clean The Tree – Artificial or real, a tree can cause allergy problems. “A tree that is moldy increases the spore counts in the home exponentially after just a few days, triggering reactions and illness,” says Dr. Shah. “Some have found relief by spraying down the tree with water to remove mold and then limiting the amount of time the tree is indoors to 12 days or less.”

The clean fragrance from the live balsam, fir and pine trees is pleasing, but it can aggravate respiratory conditions. “No variety of live tree is less allergenic than any other,” says Dr. Shah. “Artificial is the best if you have allergies.” The scent of a freshly cut tree as well as elements of its care can wreak havoc on your airways and nasal passages. “The water in the tree holder also grows stagnant and collects mold, which is detrimental to those with allergies,” Dr. Shah says. Decorations used to adorn the tree may also be dusty, scented or carry irritants. If you choose an artificial tree, make sure the branches, as well as decorations, are dry and moisture-free. “Artificial trees and holiday decorations can grow mold if they get wet, as they often do in humid basements or attics,” she warns.

2. Prepare for Parties – Bring your own treats, especially for kids, at social gatherings where allergenic foods may be plentiful and an only option. “Those with egg, nut or dairy allergies especially can play it safe and enjoy the parties if they know what they are eating and drinking,” says Dr. Shah. “Communicating in advance with the host can help avoid illness.”

3. Pamper the Pet – Dogs and cats spend more time indoors during the winter months and often bring allergens in with them from their trips outdoors, contaminating the environment for those with sensitive respiratory systems. “Have your dog and cat groomed more often to remove dander and hair,” says Shah. HEPA filters also help filter pet hair of all kinds as well.

4. Relax – “Anxiety has been shown to increase asthma symptoms,” says Dr. Shah. “Use relaxation methods such as deep breathing, meditation or yoga to maintain control during the holiday hustle-bustle.”

5. Never Use Scented Candles or Home Fragrance Oils – The popularity of home fragrance products and scented specialty candles reaches a peak during the holidays – and so do allergies. Unplug the electric scent distributors and take a pass on the potpourri simmering pots. “Far from creating an inviting home, the fragrance aggravates the sinuses and respiratory system so sufferers can’t breathe,” Dr. Shah said.

6. Avoid Real Poinsettias and Fresh Floral Arrangements – “The moist soil encourages the growth of mold. And if there is mold in your house, you are breathing mold spores,” Dr. Shah said. This causes air passageways to swell, which restricts airflow. It can even cause skin rashes.

7. Keep the Humidity in Check – Warm and cool air humidifiers are up and running in many homes now that the cold, dry air is here. “Get a gauge and keep the humidity no higher than 48 to 50 percent,” Dr. Shah said. “Too much humidity encourages the growth of mold, which triggers allergic reactions.”

8. Store Holiday Decorations in Large Plastic Tubs – Save yourself some sneezes next year by purchasing large resealable plastic tubs to store decorations. Dust them occasionally during the year.

Posted in Allergies, Asthma | Leave a comment

Dehydration and diabetes: new research

Newswise — BUFFALO, N.Y. — Some drugs used to treat diabetes mimic the behavior of a hormone that a University at Buffalo psychologist has learned controls fluid intake in subjects. The finding creates new awareness for diabetics who, by the nature of their disease, are already at risk for dehydration.

Derek Daniels’ paper “Endogenous Glucagon-Like Peptide-1 Reduces Drinking Behavior and Is Differentially Engaged by Water and Food Intakes in Rats,” co-authored with UB psychology graduate students Naomi J. McKay and Daniela L. Galante, appears in this month’s edition of the Journal of Neuroscience.

The hormone, GLP-1, works in the body to increase the release of insulin, functioning the same way as many common injectable treatments for diabetes. Extensive research has already established GLP-1’s role in the control of food intake, but the new study’s authors say there was a profound absence of literature on its role in fluid intake.

“Naomi picked this up early on in her graduate work and published two other papers before this one showing GLP-1 decreases fluid intake in ways that weren’t appreciated before,” said Daniels, whose lab studies the neurobiology of ingestive behaviors, like thirst and dehydration.

A downloadable photo of Daniels is available here: http://www.buffalo.edu/news/releases/2014/12/023.html.

When GLP-1 binds to receptors in the body it sends a signal to the brain that decreases fluid intake.
“We blocked that signaling,” said McKay. “In doing so, we found an elevation in water intake.”

But what sounds like straightforward behavioral pharmacology is a bit tricky when measuring incremental increases in a rat’s fluid intake, especially when working with units of volume as small as the segments of time that measure computer processing speeds. Rats consume fluid in nanolitres, and since filling a teaspoon requires nearly 5 million nanolitres, researchers use a lickometer to study licking patterns.
“Licking patterns can give us hints about why rats drink more or less after an experimental manipulation,” said Daniels. “In this study, we found that the rats were probably drinking more because they were feeling less full from the drinking.”

Lickometers measure the number of times a rat’s tongue touches an electrical port. In doing so, the rat unknowingly completes an electrical circuit at the same time the port dispenses water. Each completed circuit is one lick. The lack of any sensation protects the integrity of the count. The number of licks are tracked and then translated into a given volume of fluid.

“Clearly what we’re seeing, not just in this paper, but in all three papers, is that these substances decrease drinking behavior,” said Daniels. “But we’re not saying people shouldn’t use these drugs to treat diabetes, and we’re not saying they are ineffective tools for the treatment of diabetes. However for populations already at risk for dehydration it may be something we want to be more concerned about.”

These conclusions arise from what Daniels says is “a reverse-engineering approach or a reverse drug discovery approach.”
“Normally, it’s the basic research that informs the applied research. Basic research tells us what drugs to try for treating a disease. But in this case, we’ve used the drug and the clinical relevance to learn more about basic abilities of the body and how the body functions,” said Daniels.

Funding for the study came from The National Institutes of Health, an American Psychological Association dissertation award and the Mark Diamond Research Fund of the Graduate Student Association at the University at Buffalo for McKay.

Posted in Diabetes, Nutrition: Hydration | Leave a comment

Why Keeping the Weight Off Over the Long Term is So Hard

Newswise — SILVER SPRING, MD: A new report combining perspectives from a range of obesity experts identifies genetic, epigenetic and neuro-hormonal differences between individuals as one of the key challenges associated with weight loss and long-term weight control. The authors, led by Paul MacLean, PhD, and Rena Wing, PhD, reinforce that maintaining weight loss over the long term can be a major challenge. They recommend a number of novel approaches to improve obesity therapeutics, including more emphasis on an individualized approach to weight-loss treatments and maintenance, and the integration of physiology and behavioral psychology to identify effective and sustainable interventions.

“Despite advancements in our understanding of obesity, weight regain after weight loss remains the most substantial problem in obesity treatment – with both the body and the mind conspiring against individual efforts to maintain weight loss,” said Dr. MacLean, co-chair of the National Institutes of Health (NIH) working group who authored the report, “Innovative Research to Improve Maintenance of Weight Loss,” published in the January 2015 issue of the journal Obesity. “There are many differences in individuals ranging from genetic to behavioral that lead some to do well on one approach, whereas others do not. Therefore, what works for a friend or coworker may be very different from a weight-loss program that’s most effective and sustainable for you over the long term.”

The NIH Working Group report summarizes the results from a recent conference and includes various perspectives from experts in integrative physiology, genetics, endocrinology, and behavioral and cognitive sciences.

The report is accompanied by a commentary in Obesity by research and treatment pioneers and TOS past presidents, George Bray, MD, of Pennington Biomedical Research Center and Thomas Wadden, PhD, of the University of Pennsylvania. In their commentary, Drs. Bray and Wadden called individualized weight-loss strategies “promising,” highlighting it as the most important issue identified by the working group to bridge the divide between basic and clinical sciences and better target obesity treatments.

“In all weight loss trials, whether behavioral, dietary, exercise or pharmacological, some individuals lose a great deal of weight, others an average amount, and some even gain weight,” they say in their response.

Drs. Bray and Wadden go further to call the area of personalized treatment an “essential focus” that should be combined with political and societal actions to change our food and activity environments, which currently exacerbate the struggle for most people who are trying to lose weight and keep it off.

“Personalized medicine is not a new idea; it is one that is applied and encouraged across many areas of medicine. Why not apply it to obesity treatment?” said Chris Ochner, PhD, TOS Public Affairs co-chair and Assistant Professor of Pediatrics and Psychiatry at the Icahn School of Medicine at Mount Sinai. “Weight loss is not a sprint; it’s a marathon.”

Working group co-chair Dr. Wing also stresses that current treatment approaches to improving maintenance of weight loss often do not adequately counter the many physiological and behavioral changes that occur when a person loses weight.

“Development of more effective approaches to weight-loss maintenance requires the integration of physiological and behavioral perspectives and a more concerted collaboration between basic and clinical researchers,” she said.

TOS agrees that collaboration between physiological and behavioral researchers is needed to advance the science behind individualized treatments and develop better weight-maintenance strategies. In 2013, the Society launched the Bio-Behavioral Research Section to encourage greater research into the complex interactions between biological, behavioral and environmental factors that influence obesity. The Section, led by Chair Myles Faith, PhD, of the University of North Carolina at Chapel Hill, strives to bridge people, ideas and methodologies from distinct scientific “silos.”

“Understanding individual differences in treatment response requires expertise in biology and behavior,” Faith said. “Seasoned clinicians, who are keenly observing and working to harness the strengths of individual patients every day, are an integral piece of the puzzle. Individual responses to treatment are at the scientific ‘heart’ of the matter for understanding weight-loss maintenance.”

The NIH working group report in full seeks to identify barriers to successful weight loss, review strategies that have been previously employed to improve success, and recommend novel solutions that could be investigated in future long-term weight control studies. In addition to more personalized weight-loss strategies, the authors recommend further exploration into the following areas to improve weight-loss maintenance:
• Pharmacological strategies to counter the physiological changes that occur after weight loss, which require adjustments to the drug development process (e.g. pairing different medications or combining medication and behavioral approaches).
• New ways to improve adherence to physical activity programs.
• Foods engineered to maximize palatability and satiation to improve long-term adherence to a lower-calorie diet.
• Strategies to decrease the perceived reward value of foods and increase impulse control.
• Technologies (e.g. smart phones, tablets, GPS) and social networking to keep individuals engaged and goal-oriented.

Find the full report online in Obesity here and the Bray/Wadden commentary here.

# # #

This article can be republished in part or in full with attribution to The Obesity Society.

About The Obesity Society
The Obesity Society (TOS) is the leading professional society dedicated to better understanding, preventing and treating obesity. Through research, education and advocacy, TOS is committed to improving the lives of those affected by the disease. For more information visit: www.Obesity.org. Connect with us on social media: Facebook, Twitter and LinkedIn.

Posted in Human Behavior: Willpower, Obesity, Weight Cycling | Leave a comment

Moms of Food-Allergic Kids Need Dietician’s Support

Newswise — ARLINGTON HEIGHTS, Ill. (December 18, 2014) – Discovering your child has a severe food allergy can be a terrible shock. Even more stressful can be determining what foods your child can and cannot eat, and constructing a new diet which might eliminate entire categories of foods.

According to a new study published in the Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI), providing parents with detailed, individual advice from a dietician is a key component of effective food allergy care.

“We know getting a food allergy diagnosis can be confusing and scary,” said dietician Carina Venter, PhD, lead author of the study. “We set out to explore what information and support mothers of kids with food allergies require and value from a dietary consultation. What we found is mothers want dieticians to help them ensure their child will be safe, and guide them through the process of creating a nutritionally complete diet. They also want to maintain normality for their child and promote independence.”

Focus groups were conducted in the United Kingdom with 17 mothers of food allergic kids who sought dietary advice at an allergy clinic. According to most of the mothers, the time immediately after diagnosis was the most anxious for them as they found the process daunting. They felt that over time, with the help of dieticians, they grew to understand their child’s food allergy and how to cope with new information and the new dietary guidelines for their families.

“Dieticians understand the social and emotional, as well as nutritional issues that accompany food allergies,” said allergist Gailen Marshall, MD, PhD, ACAAI Fellow and Editor-in-Chief of Annals of Allergy, Asthma and Immunology. “They have the most complete information about how to undertake an elimination diet and how to begin being the kind of detective a parent often has to be in these situations. There’s a clear value for parents of food-allergic kids to meet with a dietician as they have a very specific expertise to offer.”

For more information about treatment of food allergies and to locate an allergist in your area, visit AllergyAndAsthmaRelief.org.

About ACAAI
The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest and Twitter.

Posted in Allergies, Milk Allergy, Nutrition: Allergies, Nutrition: Allergies: Gluten, Nutrition: Allergies: Nut, Nutrition: Dietitians, Parenting | Leave a comment

Research Correlates Female Representation on Boards with Firm Financial Performance

Newswise — Research by Kris Byron, PhD, department chair and associate professor of management at the Martin J. Whitman School of Management at Syracuse University, examines female board representation’s effect on firm financial performance. The paper, titled “Women on Boards and Firm Financial Performance: A Meta-Analysis,” was recently accepted for publication in the Academy of Management Journal. The co-author was Corinne Post (Lehigh University).

By aggregating results from 140 studies examining the relationship between firms’ financial performance and female board representation, Byron and Post found that having women on boards of directors is positively related to accounting returns. This relationship is more positive in countries that have stronger shareholder protections, which the researchers say could be due to the fact that shareholder protections can motivate boards to use the varied experience, knowledge and values each member brings to the board.

The results also suggest why this may be the case. Firms with more female directors tend to have boards that make stronger efforts to monitor the firms and to ensure that they are executing the right strategy.

The study also suggests that the societal context may determine how investors evaluate firms when they have female directors. In countries with high gender equality, there was a positive relationship between female board representation and market performance; in countries with low gender parity, a negative relationship.

About the Whitman School
The Martin J. Whitman School of Management at Syracuse University was established as the College of Business Administration in 1919. In 1920, it was only the 16th collegiate business school in the nation to be accredited by the AACSB. Today, the Whitman School of Management includes programs in accounting, entrepreneurship, finance, management, marketing, real estate, retail management and supply chain management. In any given year, the Whitman School is home to nearly 2,000 doctoral, graduate and undergraduate students.

Posted in Business, Human Behavior: Bias, Human Behavior: Gender Differences | Leave a comment

The Dementia that is NOT Alzheimer’s Disease

Newswise — Lewy body dementia (LBD) — a complex, challenging and surprisingly common brain disease — is often misdiagnosed as its “cousin,” Alzheimer’s disease. And that could lead to devastating results.

According to the Lewy Body Dementia Association (LBDA), accurate and early diagnosis is critical because people with LBD typically have sensitivities to medication, and many drugs prescribed for Alzheimer’s can be very harmful to those with LBD.

Although, LBD is the second most common cause of progressive dementia it is not well recognized by physicians, especially primary care and general health care providers.

“While the symptoms of LBD may be similar to Alzheimer’s and Parkinson’s disease, the treatment strategy is more challenging because fewer medications can be used safely,” warns Howard I. Hurtig, M.D., Chair, Department of Neurology, Pennsylvania Hospital, and member of the LBDA Scientific Advisory Council. “I cannot overemphasize the need to avoid medications that can worsen the symptoms of LBD. Every patient with this disease and their caregivers should be familiar with the list of acceptable and forbidden drugs.”

Is it Alzheimer’s or LBD?
These two diseases share some clinical and biological similarities that can make them difficult for many physicians to distinguish. Dementia experts are more experienced at differentiating between dementia types. Alzheimer’s disease affects cognitive function, including making new experiences into memories. The disorder in LBD affects different aspects of cognition, such as problem solving and complex reasoning and movement.

LBDA has just issued a new brochure — Lewy Who? Recognizing when it’s not Parkinson’s or Alzheimer’s Disease — that offers a symptom comparison chart that can help clarify the confusion. It can be downloaded from the LBDA.org website.

A Different Diagnosis
Lewy body dementia, which affects 1.4 million Americans, refers to two related diagnoses: dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD). Both DLB and PDD are considered Lewy body dementias. With DLB, cognitive (thinking) symptoms appear before Parkinson–like movement problems. With PDD, disabling cognitive symptoms do not develop until more than a year after movement problems begin.

LBD is characterized by an abnormal build up of Lewy bodies (alpha-synuclein protein deposits) in the areas of the brain that regulate behavior, memory, movement and personality. The most prominent symptoms of Parkinson’s disease affect motor abilities. Alzheimer’s disease primarily affects areas of the brain involving learning and memory. A specialist like a neurologist, geriatric psychiatrist or a neuropsychologist may be needed to distinguish the symptoms and provide an accurate diagnosis.

About Lewy Body Dementia Association
The Lewy Body Dementia Association (LBDA) is a 501(c)(3) nonprofit organization dedicated to raising awareness of Lewy body dementias (LBD), promoting scientific advances, and supporting people with LBD, their families and caregivers. LBD, a complex disease that can present with a range of physical, cognitive, and behavioral symptoms, is a “family disease.” It dramatically affects not only the person diagnosed but also the primary caregiver. A national health organization, LBDA supports all those affected by Lewy body dementias through outreach, education and research. To learn more about LBD and LBDA, please visit lbda.org/lewywho.

Posted in Alzheimer's, Cognitive Impairment, Elder Care, Lewy Body Dementia | Leave a comment

Early Exposure to Antidepressants Affects Adult Anxiety and Serotonin Transmission

Newswise — About 15 percent of women in the United States suffer from anxiety disorders and depression during their pregnancies, and many are prescribed antidepressants. However little is known about how early exposure to these medications might affect their offspring as they mature into adults.

The answer to that question is vital, as 5 percent of all babies born in the U.S. – more than 200,000 a year – are exposed to antidepressants during gestation via transmission from their mothers.

Now, a UCLA team has studied early developmental exposure to two different antidepressants, Prozac and Lexapro, in a mouse model that mimics human third trimester medication exposure. They found that, although these serotonin-selective reuptake inhibiting antidepressants (SSRIs) were thought to work the same way, they did not produce the same long-term changes in anxiety behavior in the adult mice.

The mice exposed to Lexapro had permanent changes in serotonin neurotransmission and were less anxious as adults than the mice exposed to Prozac, said study senior author Anne M. Andrews, professor of psychiatry and chemistry and biochemistry and the Richard Metzner Endowed Chair in Clinical Neuropharmacology at the Semel Institute for Neuroscience & Human Behavior and California NanoSystems Institute.

“This was quite surprising, since these medications belong to the same drug class and are believed to work by the same mechanism. The implications of these findings are that with additional investigation, it may be possible to identify specific antidepressants that are safer for pregnant women,” Andrews said. “It’s important to recognize that major depressive disorders and anxiety disorders are serious medical conditions that often require therapeutic intervention. Prescribing the safest medication for mother and child is paramount.”

The results of the six-year study appear early online Dec. 19, 2014 in the peer-reviewed journal Neuropsychopharmacology.

SSRIs like Prozac and Lexapro act by blocking the actions of a protein called the serotonin transporter, which removes the neurotransmitter serotonin from the signaling space between neurons. Andrews and her team also studied mice that had been genetically engineered to have a reduction or absence of serotonin transporters in the brain. They were able to compare early antidepressant exposure to permanent reductions in serotonin transporter function.

Genetic reductions in serotonin transporters are thought to be a risk factor, particularly when combined with stressful life experiences, for developing anxiety and mood disorders. And in fact, the genetically engineered mice Andrews studied showed more anxiety as adults.

“It might be possible that when mothers are treated for depression or anxiety during pregnancy that certain SSRIs may promote resilience to developing these disorders in children later in life,” Andrews said. “However, it will take much more research for us to understand whether this is true and whether certain SSRIs may be better at promoting these effects.”

Going forward, Andrews and her team plan to investigate the effects of early exposure to antidepressants on the architectures of serotonin neurons. Based on the current findings, they suspect that early exposure to Lexapro may alter the way serotonin neurons innervate brain regions involved in mood and anxiety behavior. They also plan to investigate other SSRIs such as Paxil and Zoloft.

“Current antidepressant therapies are ineffective in treating anxiety and depression in large numbers of patients, and advances in predicting individual responses are hindered by difficulties associated with characterizing complex influences of genetic and environmental factors on serotonergic transmission in humans,” the study states. “Highly controlled animal models, such as those studied here, represent avenues by which to identify factors potentially influencing behavioral domains associated with emotion-related disorders.”

The research was funded by the National Institute of Mental Health (MH064756, MH086108), the Brain and Behavior Research Foundation, the Shirley and Stefan Hatos Foundation, and the UCLA Weil Endowment Fund.

Andrews works as a consultant for Forest Laboratories, now Actavis, developers of Lexapro. Neither Forest Laboratories nor Actavis consulted on or funded this study.

Posted in Antidepressants, Human Behavior: Anxiety, Serotonin | Leave a comment

Listeria-tainted caramel apples have killed five in the midwest

Five people have died and 21 others have been hospitalized in a listeria outbreak linked to caramel apples, federal health officials said today.

A total of 28 people infected with listeria have been reported from 10 states, according to a statement from the U.S. Centers for Disease Control. Eleven of the cases are in the Midwest: five in Missouri, four in Minnesota and two in Wisconsin.

The CDC warned consumers not to eat any pre-packaged, commercially-produced caramel apples, including those with other toppings such as nuts, chocolate or sprinkles, until more information is available. A recall, however, has not been issued as of Friday afternoon.

Of the 28 victims, 26 were hospitalized and five of those people died, the CDC said, adding that listeriosis contributed to at least four of the deaths. Nine of the cases involved a pregnant woman or her newborn infant and three were among otherwise healthy children aged 5 to 15 years, the CDC said. According to the studies, 83% of the ill people interviewed reported eating commercially produced prepackaged caramel apples. More

Posted in Nutrition: Food Safety | Leave a comment