What's in a name? Psychiatrists' labeling practices may be desensitizing the public

April 9th, 2012 in Psychology & Psychiatry

Does the growing number of psychiatric disorder diagnoses have an effect on people with mental illnesses? According to a new study, as definitions of mental illnesses become broader, people who show signs of depression and other common mental illnesses are less likely to evoke a supportive response from friends and family members as are people with other severe mental disorders. This new study was released in a recent issue of the Journal of Health and Social Behavior.

Author Brea L. Perry studied interviews conducted with 165 individuals with bipolar disorder, schizophrenia, major depression, and other less severe disorders, who were undergoing mental health treatment for the first time. She found that those with more socially-accepted and commonplace mental illnesses, such as depression and mild mood disorders, did not receive strong reactions to their conditions from family members, friends, or others with whom they came in contact. Brea stated that as a result, their support networks may be less willing to take on caregiver responsibilities or to excuse them when their behavior deviates from what is considered normal.

Perry wrote, "Perhaps because so many people are diagnosed and subsequently treated successfully, signs of depression do not alarm friends and family members to the same degree as disorders known to severely affect functioning."

While commonplace mental illnesses such as depression are clearly defined by professionals as legitimate medical conditions, Perry found that the public does not always deem them as justifiable grounds for taking on a "sick" role.

This study also found that diagnosing someone with a severe mental illness that is more outwardly recognizable such as schizophrenia and the manic phase of bipolar disorder can lead to a higher amount of rejection and discrimination by acquaintances and strangers while at the same time creating a stronger social support system among close friends and family.

The author wrote, "Day-to-day emotional and instrumental support is likely to play a critical role in recovery from mental illness."

More information: "The Labeling Paradox: Stigma, the Sick Role, and Social Networks in Mental Illness": http://hsb.sagepub … ull.pdf+html

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Maternal obesity, diabetes associated with autism, other developmental disorders

April 9th, 2012 in Autism spectrum disorders

A major study of the relationships between maternal metabolic conditions and the risk that a child will be born with a neurodevelopmental disorder has found strong links between maternal diabetes and obesity and the likelihood of having a child with autism or another developmental disability.

Conducted by researchers affiliated with the UC Davis MIND Institute, the study found that mothers who were obese were 1-2/3 times more likely to have a child with autism as normal-weight mothers without diabetes or hypertension, and were more than twice as likely to have a child with another developmental disorder.

Mothers with diabetes were found to have nearly 2-1/3 times the chance of having a child with developmental delays as healthy mothers. However, the proportion of mothers with diabetes who had a child with autism was higher than in healthy mothers but did not reach statistical significance.

The study also found that the autistic children of diabetic mothers were more disabled -- had greater deficits in language comprehension and production and adaptive communication -- than were the children with autism born to healthy mothers.

However, the children without autism born to diabetic mothers also exhibited impairments in socialization in addition to language comprehension and production, when compared with the non-autistic children of healthy women. Children without autism of mothers with any of the metabolic conditions displayed mild deficits in problem solving, language comprehension and production, motor skills and socialization.

"Over a third of U.S. women in their childbearing years are obese and nearly one-tenth have gestational or type 2 diabetes during pregnancy. Our finding that these maternal conditions may be linked with neurodevelopmental problems in children raises concerns and therefore may have serious public-health implications," said Paula Krakowiak, a biostatician affiliated with the MIND Institute.

The study, "Maternal metabolic conditions and risk for autism and other neurodevelopmental disorders," is published online today in Pediatrics, the journal of the American Academy of Pediatrics. Its authors said that it is the first study to examine the associations between neurodevelopmental disorders and maternal metabolic conditions not restricted solely to type 2 or gestational diabetes, including obesity and hypertension, which have similar underlying biological characteristics, and to investigate correlations between these conditions and impairments in the skills and abilities of children in specific developmental domains.

More than 60 percent of U.S. women of childbearing age are overweight, 34 percent are obese, and 16 percent have metabolic syndrome. Nearly 9 percent of U.S. women of childbearing age are diabetic, and more than 1 percent of U.S. pregnancies were complicated by chronic hypertension. In California, where the study was conducted, 1.3 percent of women had type 2 diabetes and 7.4 percent had gestational diabetes.

Autism is characterized by impairments in social interaction, communication deficits and repetitive behaviors and often is accompanied by intellectual disability. An estimated 1 in 110 children born today will be diagnosed with autism spectrum disorder, and its incidence appears to be growing. An estimated 1 in 83 U.S. children has another developmental disorder, which includes other disorders resulting in intellectual disability.

The study included 1,004 mother/child pairs from diverse backgrounds enrolled in the Childhood Autism Risks from Genetics and the Environment Study (CHARGE), most of them living in Northern California, with a small subset living in Los Angeles. The children were between 24 and 60 months old, born in California and resided with at least one biological parent who spoke either English or Spanish. There were 517 children who had autism; 172 with other developmental disorders; and 315 were developing normally. The participants were enrolled between January 2003 and June 2010.

The researchers obtained demographic and medical information for the mothers and their children using the CHARGE Study Environmental Exposure Questionnaire, a telephone survey, the study participants' birth files and medical records. The primary metabolic conditions of interest were type 2 diabetes or gestational diabetes.

Women were considered diabetic if the condition was noted in their medical records or if during the telephone surveys they answered yes to the questions "During this pregnancy were you ever told by a physician or nurse that you had gestational diabetes?" or "At any time before you became pregnant were you told by a doctor that you had [type 2] diabetes?" The same wording was used to obtain information about hypertension. BMI was calculated using height and weight prior to pregnancy from medical records or telephone interview.

To confirm the developmental diagnoses of the children with autism researchers used the Autism Diagnostic Interview-Revised (ADIR) and the Autism Diagnostic Observation Schedules (ADOS). All of the children were administered the Mullen Sales of Early Learning and the Vineland Adaptive Behavior Scales to assess their cognitive and adaptive development. Spanish-speaking children were administered the tests in Spanish. The participants were then divided into groups of children with autism, developmental disability or normal development.

Among children whose mothers were diabetic during their pregnancies, the study found that the percentage of children with autism born to women with type 2 diabetes or gestational diabetes -- 9.3 percent -- or developmental disability -- 11.6 percent -- was higher than the 6.4 percent of children born to women without these metabolic conditions.

Over 20 percent of the mothers of children with autism or other developmental disability were obese, compared with 14 percent of the mothers of normally developing children.

Approximately 29 percent of the children with autism had mothers with a metabolic condition, and nearly 35 percent of the children with another developmental disorder had mothers with metabolic conditions, compared with 19 percent of the normal children had mothers with a metabolic condition.

The study also examined the link between hypertension and autism or developmental disorder. The prevalence of high blood pressure was low for all groups, but more common among mothers of children with autism or developmental disorder, though the finding did not reach statistical significance.

Analyses of the children's cognitive abilities found that, among the children with autism, children of mothers with diabetes exhibited poorer performance on tests of expressive and receptive language and communication skills of everyday living when compared with the children of non-diabetic mothers. And the presence of any metabolic condition was associated with lower scores on all of the tests among children without autism.

The authors note that obesity is a significant risk factor for diabetes and hypertension, and is characterized by increased insulin resistance and chronic inflammation, as are diabetes and hypertension. In diabetic, and possibility pre-diabetic pregnancies, poorly regulated maternal glucose can result in prolonged fetal exposure to elevated maternal glucose levels, which raises fetal insulin production resulting in chronic fetal exposure to high levels of insulin.

Because elevated insulin production requires greater oxygen use this may result in depleted oxygen supply for the fetus. Diabetes also may result in fetal iron deficiency. Both conditions can adversely affect fetal brain development, the authors said.

"The sequence of events related to poorly regulated maternal glucose levels is one potential biological mechanism that may play a role in adverse fetal development in the presence of maternal metabolic conditions," Krakowiak said.

Maternal inflammation, which accompanies metabolic conditions, may also adversely affect fetal development. Certain proteins involved in cell signaling that are produced by cells of the immune system can cross the placenta from the mother to the fetus and disturb brain development.

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Social stress affects immune system gene expression in monkeys

April 9th, 2012 in Genetics
The ranking of a monkey within her social environment and the stress accompanying that status dramatically alters the expression of nearly 1,000 genes, a new scientific study reports. The research is the first to demonstrate a link between social status and genetic regulation in primates on a genome-wide scale, revealing a strong, plastic link between social environment and biology.

In a comparison of high-ranking rhesus macaque females with their low-ranking companions, researchers discovered significant differences in the expression of genes involved in the immune response and other functions. When a female's rank improved, her gene expression also changed within a few weeks, suggesting that social forces can rapidly influence genetic regulation.

"We were able to use gene expression to classify individuals based on their rank," said Yoav Gilad, PhD, associate professor of human genetics at the University of Chicago Biological Sciences and senior author of the study in the Proceedings of the National Academy of Sciences. "Demonstrating these very plastic and temporal changes was novel and quite interesting."

The research, led by University of Chicago postdoctoral researcher Jenny Tung, was conducted with rhesus macaques housed in groups of five at the Yerkes National Primate Research Center in Atlanta. As in the wild, each group self-organizes into a dominance hierarchy, defined by which individual yields first during competition over food, water and grooming partners. In captivity, dominance is determined by the order of introduction into the group, giving researchers an opportunity to study how changes in rank lead to biological effect.

"In the wild, females would not ordinarily leave the social group they were born into," said Tung, PhD, now an assistant professor of evolutionary anthropology at Duke University. "They inherit their social rank from their mothers. But in this unnatural situation, order of introduction determines rank – the newcomer is generally lower status."

Previous research on rhesus macaques discovered that social rank influenced components of the stress response, brain, and immune system. With gene chip technology for measuring the expression of over 6,000 different genes, Tung, Gilad and colleagues at Yerkes, Emory University, and Johns Hopkins looked for the first time in primates at the effects of social rank on genetic function.

Comparing 49 different female monkeys of different rank revealed significant changes in the expression of 987 genes, including 112 genes associated with immune system function. The result fits with data in monkeys where low rank and chronic stress lead to compromised immune function, and, more loosely, with human studies linking low socioeconomic status and high social stress to elevated disease risk.

The overall genetic "signature" of expression changes was robust enough that researchers could predict an individual monkey's social rank with high accuracy from their gene expression profile alone. That predictive power also enabled an unanticipated second test of whether gene expression would reflect unplanned changes in dominance rank.

"It was a fortunate event in the experiment," Gilad said. "When a couple of animals were removed from cages for various reasons and new ones were introduced to the groups, it turned out to improve the rank of a few monkeys. We could take advantage of this switch and see if our classifier still works."

By analyzing blood samples from these monkeys before and after their move, the researchers were able to use gene expression signatures to correctly predict the change in rank for six of seven monkeys. The result demonstrates that socially-induced gene expression changes are not stable, but can change rapidly in response to changes in social environment.

"There's a spooky side to this kind of research, in that an individual's social rank is partially determining health status," Tung said. "But there's also a hopeful side. For the seven females that changed ranks, their gene status changed with them. They're not stuck in place, and I think that says something more broadly about the capacity for change."

The researchers also investigated the mechanisms by which social status could influence gene expression. Dominance rank affected signaling of the glucocorticoid "stress hormone" system and the cell composition of blood samples, both of which contributed to changes in gene expression.

Experiments also demonstrated for the first time that social rank influenced the DNA methylation status of many genes, an epigenetic mechanism of transiently turning genes on and off. Genes that changed expression with rank status were more likely to be methylated than unaffected genes, suggesting that this mechanism also plays a role in the social influence on genetic regulation.

"That's a novel mechanism that people haven't considered in primates," Gilad said. "I know that some have been resistant to the possibility of methylation changes on this timescale, but this is a demonstration that this mechanism also matters."

The authors caution that the experiments used monkeys in captivity, and stressed that the relationship between stress and gene regulation in the wild might not look the same. The influence of social factors on human genetics also remains to be tested, and measuring status while controlling for confounding factors in people would be a difficult endeavor, Gilad said. But if social stress does in fact influence human health, the current research provides some optimism.

"An encouraging message to humans is the fact that the effects are plastic, reversible and change on a really large scale when rank changes," Gilad said. "Whatever it is that causes stress through social environment, you might be able to fix."

More information: "Social environment is associated with gene regulatory variation in the rhesus macaque immune system." J. Tung, L. Barreiro, Z. Johnson. et. al. April 9, 2012. PNAS Early Edition. pp. 1-6. DOI: 10.1073/pnas.1202734109

Provided by University of Chicago Medical Center

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Marriage and a high socioeconomic level improve health

April 10th, 2012 in Health

People with a high socioeconomic level have been demonstrated to have better health than the rest of people. Other protective factors against chronic diseases are having higher education, having a job, and the per capita income and welfare in the region of residence.

These are some of the conclusions drawn in a pioneer study conducted at the University of Granada by Kristina Karlsdotter, at the Department of Applied Economics, and supervised by professors José Jesús Martín Martín and María del Puerto López del Amo González. The study also reveals the potential long-term effects that socioeconomic inequalities have on the health of the population at regional level, and the relevance of family when it comes to assess how social inequalities affect population's health.

To carry out this study, the researchers used data from two surveys conducted in Spain: the 2007 Survey on Living Conditions, performed by the Spanish National Statistics Institute, and the 2001 Longitudinal Database of the Andalusian Population conducted by the Institute of Statistics and Cartography of Andalusia and the Spanish National Research Council.

The Higher the Income, the Better the Health

University of Granada researchers have found that the individual income of a person "is positively associated with a good health status". Additionally, education level is statistically associated with health status: the higher the education level, the better the health of the individual according to several health variables: perceived health status –the perception that an individual has on his/her own health status– presence of chronic diseases, and the risk of been granted a temporary/permanent disability pension.

This study reveals the influence of family environment on an individual's health status. Thus, over 30% of variations in an individual's health status are caused by their family environment.

Social relationships are another protective factor against disease, but only in women.

Design of Policies

The authors of this study affirm that the results obtained "are relevant for the design of policies aimed at reducing health inequalities in Spain. The association between health status and the geographical (Autonomous Community, province, city, district) and family environment is very innovative, as well as the association between health status and income and social inequalities. "

This is a pioneer comparative study in Spain on the relationship between individual income, income inequalities, regional and social factors, and health status in people in Spain. This is also the first study to examine how the social environment affects an individual's health status. Finally, this is the first study to analyze the distribution of temporary/permanent disability pensions according to socioeconomic and geographic factors.

More information: Karlsdotter, K; Martín Martín, JJ; López del Amo González, MP (2012). Multilevel analysis of income, income inequalities and health in Spain. Social Science and Medicine. 2012. http://dx.doi.org/ … .2011.12.020

Provided by University of Granada

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Mothers and OCD children trapped in rituals have impaired relationships

April 10th, 2012 in Psychology & Psychiatry

A new study from Case Western Reserve University finds mothers tend to be more critical of children with obsessive-compulsive disorder than they are of other children in the family. And, that parental criticism is linked to poorer outcomes for the child after treatment.

Parent criticism has been associated with child anxiety in the past, however, researchers wanted to find out if this is a characteristic of the parent or something specific to the relationship between the anxious child and the parent.

"This suggests that mothers of anxious children are not overly critical parents in general. Instead they seem to be more critical of a child with OCD than they are of other children in the home," said Amy Przeworski, assistant professor of psychology. She is the lead author of the study, "Maternal and Child Expressed Emotion as Predictors of Treatment Response in Pediatric Obsessive-Compulsive Disorder," in the recent journal, Child Psychiatry & Human Development.

OCD is found in one in 200 children, according to the American Academy of Child and Adolescent Psychiatry. The psychological disorder overcomes individuals with repetitive thoughts that lead to anxiety, which is then acted out in exacting routines or behaviors that can range from foot tapping to eating rituals to school or bedtime preparations.

This research evolved from other studies that found parental criticism is associated with less success in therapy and a relapse of behavior.

"Parents' criticism may be a reaction to the child's anxiety. This research is not blaming the parent for the child's OCD. But it does suggest that the relationship between parents and children with OCD is important and should be a focus of treatment. This means that parents can help children with OCD to get better." Przeworski says.

"OCD sneaks up on the kids and parents," Przeworski says.

The psychology professor, who specializes in anxiety disorders, says some parents become concerned when their children show some early warning signs for OCD:

• Rigidity in a child, with things routinely done or said in exactly the same way or order.
• Asking for reassurance many times in the day.
• Repetition of a task from tapping the foot, checking on the stove, washing hands that the child cannot stop when asked.
• Routines that have prescribed patterns or are excessive lengthy: An example is a two-hour shower or raw and chapped hands that look like the child is wearing red gloves.
• Bedtime or dinner rituals, where there is a prescribed order for eating food, placement of food on the plate, etc.
• Temper tantrums where the child goes beyond being stubborn but has anxiety associated with them.
• Children want symmetry in appearance or things around them.

Parents initially may think it is a phase, a habit or stubbornness. Over time, the behaviors become so exacting that the child and family members have to act in prescribed ways. Parents may end up criticizing the child in an effort to get them to drop obsessive-compulsive behaviors.

The researchers videotaped interviews with 62 mother-child pairs just before the child's OCD treatment began. Children either had medication, therapy, a combination of the two, or a placebo. The children were between the ages of 7 and 17.

Because most mothers bring their children for treatment appointments, the researchers focused on the mother's view of their children. Mothers were asked to give a five-minute description of their relationship with the child with OCD and the mother's relationship with the sibling closest in age to the child with OCD. The researchers asked the children to describe their relationships with their mothers and fathers.

The researchers examined the presence of criticism and emotional over-involvement (over-protection or excessive self-sacrificing) in these descriptions. The tone of the OCD child and parent tended toward criticism, they said. The other sibling received more loving expressions. Parent criticism was associated with poorer child functioning after treatment.

Przeworski said treatment of OCD has good results, but many times parents misjudge these rigid routines as stubbornness or "just going through a phase" until the behavior takes over family life. Then parents realize the behavior requires therapy.

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uok? Text messages - even automated ones - can soothe the disconnected soul

April 10th, 2012 in Psychology & Psychiatry
Text messages in cognitive behavior therapy can make people feel less isolated.

(Medical Xpress) -- Text messaging often gets a bad rap for contributing to illiteracy and high-risk behavior such as reckless driving. But a social welfare professor at the University of California, Berkeley, has found an upside to texting, especially for people who feel stressed out, isolated and alone.

Adrian Aguilera, a clinical psychologist who treats many low-income Latinos for depression and other mental disorders, said his patients report feeling more connected and cared for when they receive text messages asking them to track their moods, reflect on positive interactions, and take their prescribed medications.

“When I was in a difficult situation and I received a message, I felt much better. I felt cared for and supported. My mood even improved,” reported one Spanish-speaking patient in Aguilera’s cognitive behavior therapy group at San Francisco General Hospital.

The project began in 2010 when Aguilera developed a customized “Short Message Service (SMS)” intervention program, with the help of UCSF psychologist Ricardo Munoz,  in which Aguilera’s patients were sent automated text messages prompting them to think and reply about their moods and responses to positive and negative daily interactions.

 The psychologists published the results of the project last year in the journal, Professional Psychology: Research and Practice. Aguilera has since been awarded a $75,000 grant from the Robert Wood Johnson Foundation.

“We are harnessing a technology that people use in their everyday lives to improve mental health in low-income, under-served communities,” said Aguilera, whose passion for addressing mental health issues among the poor was sparked while growing up in a Mexican immigrant community in Chicago.

Recent statistics bear out Aguilera’s outreach strategy. The 2011 Pew Research Center’s Internet & American Life Project survey found that African American and Latino mobile phone owners send and receive more text messages than do Caucasians.

Of the 2,277 adult cell phone users surveyed by the Pew Foundation, the most active senders and receivers of text messages (at least 50 messages a day) were non-whites, earned incomes below $30,000 and did not graduate from high school.

Aguilera came up with the texting idea when he realized that many of his patients had difficulty applying the skills they learned in therapy to their daily lives, possibly because of the many stressors they routinely faced. They could not afford laptops, electronic tablets or smart phones, but most had a basic cellular phone and a prepaid monthly plan.

“The people I wanted to impact directly didn’t have as much access to computers and the Internet,” Aguilera said. “So I thought about using mobile phones to send text messages to remind them to practice the skills covered in therapy sessions.”

The feedback from patients offers new insight into the human need for regular contact or check-ins for mental health professionals, even if only through automated technology, Aguilera said.

While the text-messaging sessions are designed to last only a certain number of weeks, about 75 percent of the patients requested that they continue receiving the messages. When the program stopped for a week due to technical problems, some really noticed the difference.

“When it stopped, I missed it,” the patient reported. “My life is so crazy, I need a reminder to think about how I feel.”

Provided by University of California - Berkeley

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Overcoming obsessive-compulsive disorder: Researcher pioneers treatment that tackles sufferers' fears and doubts

April 10th, 2012 in Psychology & Psychiatry

Did I remember to lock the back door? Did I turn off the stove? Were the lights still on when I left the house this morning? Such minor doubts are part our daily mental chatter. But for the over 650,000 Canadians who suffer from obsessive compulsive disorder (OCD), thoughts along these lines can lead to compulsive checking — a potentially debilitating behaviour that keeps the sufferer locked in an endless cycle of fear and doubt.

For Concordia University's Adam Radomsky, a professor in the Department of Psychology and the Director of the Centre for Clinical Research in Health at Concordia, finding a viable treatment for these individuals is driving research freshly funded by the Canadian Institutes for Health Research (CIHR). Based on previous work conducted with colleagues at the University of British Columbia and the University of Reading in the United Kingdom, Radomsky is now testing a novel approach to treatment for compulsive checking that could just mean vast improvements in the quality of life of countless individuals.

"For years, the best way to treat compulsive checking in OCD sufferers has been through a difficult therapeutic process known as exposure and response prevention, or ERP" explains Radomsky. "By facing their worst fears repeatedly until their anxiety declines, patients learn to diffuse their hypervigilant checking responses — in theory." In practise, however, this type of treatment often results in patients quickly discontinuing the therapy. "Refusal rates for ERP are unacceptably high, which is why we need to develop a new and refined treatment that specifically works for compulsive checking."

Radomsky's treatment builds on previous research which found that individuals with OCD who compulsively checked certain aspects of their surroundings did so because of an inflated sense of perceived responsibility. "If I don't turn off the stove, the house will burn down", is a plausible thought that can quickly devolve into an obsessive cycle of checking and re-checking, and can even result in an inability to leave the house. Yet, as proved by Radomsky's previous research, performing these seemingly senseless repetitions actually results in a loss of confidence.

By modifying the patient's inflated feelings of personal responsibility and reducing predictions of seriousness of anticipated misfortunes, the cycle can be turned the around. By placing the emphasis on how people think rather than on what they do, Radomsky's new approach targets people's faulty beliefs about how responsible they think they are, about their own memories, and about the dangers that they perceive. The progress of the proposed treatment takes the patient from exercises in normalizing inflated responsibility, through restoring confidence in memory, all the way to reducing self-doubt and guilt, hopefully leaving patients with new insights into how they perceive themselves, and the world around them.

Developed in the lab, Radomsky's research is set to show real promise in the field. "For me and my team," says Radomsky, "this work will capitalize on all of our previous experimental research and lead us to testing a new intervention based on our previous findings. It's our hope that this work will lead to a more substantial test of the treatment, which in turn could influence how people treat OCD in Montreal, in Canada and beyond."

More information: The study paper was published in Cognitive and Behavioral Practice.

Provided by Concordia University

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U.S. spends too little on public health initiatives: report

April 10th, 2012 in Health
Just $251 per person goes annually toward programs to prevent costly chronic diseases.

(HealthDay) -- The United States needs to spend more on its chronically underfunded public health system and use that money more efficiently, according to an Institute of Medicine report released Tuesday.

The United States spends more on health than any other nation -- nearly $2.5 trillion in 2009 -- but has lower scores on life expectancy, infant survival and other indicators of population health than other wealthy nations, according to the report.

Public health department initiatives, services and expertise can help prevent or decrease rates of chronic diseases that account for the bulk of rising U.S. health spending, the authors report.

However, only 3.1 percent of U.S. health spending went to government-administered public health in 2009, according to the U.S. Centers for Medicare and Medicaid's National Health Expenditure Accounts. That works out to $251 per person in public health spending, compared with $8,086 per person in medical care spending.

The report calls for the U.S. Department of Health and Human Services to establish new goals for life expectancy and per-person health spending. The hope is that setting targets will motivate public health and medical care professionals to work together to maximize the value of health spending, and that public health skills and knowledge are used to address some of the biggest issues facing the larger health care system, such as the unnecessary use of medical procedures.

To achieve efficient use of public health dollars, the report recommended that the U.S. National Prevention, Health Promotion, and Public Health Council -- created by the Affordable Care Act -- should establish the minimum level of public health services every community should receive from its state and local health departments.

In addition, the council should create an expert panel to determine how much money is needed for every public health department to provide at least these minimum services, and to determine the proportion of federal health spending that needs to be spent in public health and medical care in order to get better value, the report said.

"Developing and implementing strategic population-based efforts to improve our health as a nation will increase the quality of life and productivity of Americans at the same time that it will contribute to moderating the expense of the clinical care system," report committee chair Dr. Marthe Gold, a professor and chair of the department of community health and social medicine at City College of New York, said in a National Academies news release.

"The country's failure to maximize the conditions in which people can be healthy continues to take a growing toll on the economy and on society. As the backbone of the health system, public health departments could help communities and other partners engage in efforts and policies that lead to better population health," Gold said.

More information: The U.S. Department of Health and Human Services has more about public health service agencies.

Copyright © 2012 HealthDay. All rights reserved.

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Zip code as important as genetic code in childhood obesity

April 10th, 2012 in Health

Nearly 18 percent of U.S. school-aged children and adolescents are obese, as the rate of childhood obesity has more than tripled in the past 30 years. The prevalence of obesity puts children at greater risk of developing heart disease, type 2 diabetes, stroke and other illnesses, and of suffering severe obesity as adults. New study results indicate that where a child lives, including factors such as the neighborhood's walkability, proximity to higher quality parks, and access to healthy food, has an important effect on obesity rates. Researchers found that children living in neighborhoods with favorable neighborhood environment attributes had 59 percent lower odds of being obese.

"Obesogenic Neighborhood Environments, Child and Parent Obesity: The Neighborhood Impact on Kids Study" was published in a special theme issue of the American Journal of Preventive Medicine. Led by Brian Saelens, PhD, of Seattle Children's Research Institute, this is among the first neighborhood environment studies to look at a combination of nutrition and physical activity environments and to assess children and their parents. It is also among the largest studies of its kind to use objective geographic information system (GIS) data to examine the physical activity and healthy food option attributes of a neighborhood related to obesity.

Researchers used GIS to assess Seattle and San Diego area neighborhoods' nutrition and physical activity environments. Nutrition environments were defined based on supermarket availability and concentration of fast food restaurants. Physical activity environments were defined based on environmental factors related to neighborhood walkability and at least one park with more or better amenities for children. Kids that lived in neighborhoods that were poorer in physical activity and nutrition environment had the highest rates of obesity—almost 16 percent—in the study. This figure is similar to the national average. On the flip side, only eight percent of children were obese in neighborhoods where physical activity and nutrition environments were positive.

"People think of childhood obesity and immediately think about an individual's physical activity and nutrition behaviors, but they do not necessarily equate obesity with where people live," said Dr. Saelens, who is also a professor of pediatrics at the University of Washington. "Everyone from parents to policymakers should pay more attention to zip codes because they could have a big impact on weight."

Fast food may not be as easy to come by in the Seattle area, based on the study. There were 3,474 fast food locations in San Diego County, as compared to 1,660 in King County, Wash. On a county-level block group average basis, San Diego had 2.0 fast food locations per block group, and King County had 1.1.

Numerous national health organizations have identified neighborhood environment and built environment, including healthy food and physical activity opportunities, as important factors in childhood obesity, including the Institute of Medicine and the Centers for Disease Control and Prevention. "Our data support recommendations from these groups that we need to change our environments to make them more supportive of physical activity and nutrition," said Saelens.

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Personality, habits of thought and gender influence how we remember

April 10th, 2012 in Psychology & Psychiatry
University of Illinois researchers Sanda, left, and Florin Dolcos studied how personality, gender, and emotion-regulation strategies appear to influence the recall of emotional personal memories. Credit: L. Brian Stauffer

We all have them – positive memories of personal events that are a delight to recall, and painful recollections that we would rather forget. A new study reveals that what we do with our emotional memories and how they affect us has a lot to do with our gender, personality and the methods we use (often without awareness) to regulate our feelings.

The study appears in Emotion, a journal of the American Psychological Association.

"We're looking at traits that are associated with the way that people process the emotional world and the way that they respond to it," said University of Illinois psychology professor Florin Dolcos, who conducted the study with postdoctoral researcher Sanda Dolcos and University of Alberta postdoctoral researcher Ekaterina Denkova. "We wanted to look not only at how personality traits might influence what and how people remember, but also to examine how that impacts their (subsequent) emotional state."

Previous studies of personality and its relationship to autobiographical memory have tended to focus only on women and only on negative memories, Florin Dolcos said. They do this because women are more likely than men to be diagnosed with emotional disorders such as depression or anxiety, which are associated with an increased focus on negative emotions.

Previous studies have found that people with high neuroticism – the tendency to focus on negative emotions, particularly in times of stress – also "are more disposed to become ill with affective disorders like depression and anxiety-related problems," Dolcos said. But these studies have not looked at differences between men and women, the relationship between positive and negative memories, the frequency with which individuals recall specific memories and the vividness of their memories, he said.

Nor have most such studies examined the strategies people use to regulate their emotions when calling to mind positive and negative autobiographical memories. Such strategies include suppression (trying to blunt or hide negative emotions) and reappraisal (trying to adopt a new perspective on unpleasant memories).

The new study examined all these variables, and the findings offer a first hint of the complex interplay of factors that contribute to mood in healthy young men and women.

The researchers used questionnaires and verbal cues to assess personality and to elicit more than 100 autobiographical memories in each of 71 participants (38 of them women). Their analysis revealed that both men and women who were high in extroversion (gregarious, assertive, stimulus-seeking) tended to remember more positive than negative life events. Men who were high in neuroticism tended to recall a greater proportion of negative memories than men who were low in neuroticism, while women who were high in neuroticism tended to return to the same negative memories again and again, a process called rumination.

Rumination is known to be associated with depression, Florin Dolcos said.

"Depressed people recollect those negative memories and as a result they feel sad," he said. "And as a result of feeling sad, the tendency is to have more negative memories recollected. It's a kind of a vicious circle."

None of the study subjects had been diagnosed with depression or other emotional disorders, but, as might be expected, both male and female participants were likely to experience a lower mood after recalling negative autobiographical memories. (Positive memories generally preceded a more positive mood, but the association was indirect and mediated by extroversion, the researchers reported.)

The most pronounced differences between men and women involved the effects of the emotional strategies they used when recalling negative autobiographical memories. Men who engaged in reappraisal, making an effort to think differently about their memories, were likely to recall more positive memories than their peers, while men who used suppression, trying to tamp down their negative emotional responses, saw no pronounced effect on the recall of positive or negative memories. In women, however, suppression was significantly associated with the recall of negative memories and with a lower mood afterward.

"I think that the most important thing here is that we really need to look concomitantly at sex- and personality-related differences and to acknowledge that these factors have a different impact on the way we record our memories, on what we are doing with our memories, and later, how what we are doing with our memories is impacting our emotional well-being," said Sanda Dolcos.

The findings are instructive for both men and women, she said. Being more outgoing, interrupting rumination and using reappraisal seems to work best for men and women as a strategy for dealing with negative memories and cherishing the positive ones, she said.

Provided by University of Illinois at Urbana-Champaign

"Personality, habits of thought and gender influence how we remember." April 10th, 2012. http://medicalxpress.com/news/2012-04-personality-habits-thought-gender.html

Researchers use brain-injury data to map intelligence in the brain

April 10th, 2012 in Neuroscience

A new study found that specific structures, primarily on the left side of the brain, are vital to general intelligence and executive function (the ability to regulate and control behavior). Brain regions that are associated with general intelligence and executive function are shown in color, with red indicating common areas, orange indicating regions specific to general intelligence, and yellow indicating areas specific to executive function. Credit: Aron Barbey

Scientists report that they have mapped the physical architecture of intelligence in the brain. Theirs is one of the largest and most comprehensive analyses so far of the brain structures vital to general intelligence and to specific aspects of intellectual functioning, such as verbal comprehension and working memory.

Their study, published in Brain: A Journal of Neurology, is unique in that it enlisted an extraordinary pool of volunteer participants: 182 Vietnam veterans with highly localized brain damage from penetrating head injuries.

"It's a significant challenge to find patients (for research) who have brain damage, and even further, it's very hard to find patients who have focal brain damage," said University of Illinois neuroscience professor Aron Barbey, who led the study. Brain damage – from stroke, for example – often impairs multiple brain areas, he said, complicating the task of identifying the cognitive contributions of specific brain structures.

But the very focal brain injuries analyzed in the study allowed the researchers "to draw inferences about how specific brain structures are necessary for performance," Barbey said. "By studying how damage to particular brain regions produces specific forms of cognitive impairment, we can map the architecture of the mind, identifying brain structures that are critically important for specific intellectual abilities."

The researchers took CT scans of the participants' brains and administered an extensive battery of cognitive tests. They pooled the CT data to produce a collective map of the cortex, which they divided into more than 3,000 three-dimensional units called voxels. By analyzing multiple patients with damage to a particular voxel or cluster of voxels and comparing their cognitive abilities with those of patients in whom the same structures were intact, the researchers were able to identify brain regions essential to specific cognitive functions, and those structures that contribute significantly to intelligence.

"We found that general intelligence depends on a remarkably circumscribed neural system," Barbey said. "Several brain regions, and the connections between them, were most important for general intelligence."

These structures are located primarily within the left prefrontal cortex (behind the forehead), left temporal cortex (behind the ear) and left parietal cortex (at the top rear of the head) and in "white matter association tracts" that connect them. (Watch a video about the findings.)

The researchers also found that brain regions for planning, self-control and other aspects of executive function overlap to a significant extent with regions vital to general intelligence.

The study provides new evidence that intelligence relies not on one brain region or even the brain as a whole, Barbey said, but involves specific brain areas working together in a coordinated fashion.

"In fact, the particular regions and connections we found support an emerging body of neuroscience evidence indicating that intelligence depends on the brain's ability to integrate information from verbal, visual, spatial and executive processes," he said.

The findings will "open the door to further investigations into the biological basis of intelligence, exploring how the brain, genes, nutrition and the environment together interact to shape the development and continued evolution of the remarkable intellectual abilities that make us human," Barbey said.

Provided by University of Illinois at Urbana-Champaign

"Researchers use brain-injury data to map intelligence in the brain." April 10th, 2012. http://medicalxpress.com/news/2012-04-brain-injury-intelligence-brain.html

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Robert Karl Stonjek

New treatment trial for bipolar disorder

April 11th, 2012 in Psychology & Psychiatry

Applying mild electrical currents to the brain has been shown to be an effective treatment for depression. But could the treatment also benefit people with bipolar disorder?

Transcranial Direct Current Stimulation (tDCS) is a safe, non-invasive technique that involves the passing of a very weak direct current into the brain through electrodes on the scalp. Patients remain awake and alert during the procedure.

The largest randomised controlled trial of tDCS ever undertaken, conducted by the University of New South Wales (UNSW) and the Black Dog Institute, recently confirmed the treatment’s significant antidepressant effects.

Now the researchers believe tDCS can improve the day-to-day functioning for people with bipolar disorder, by improving the way they think.

“One of the other things our research showed is that tDCS improves performance on cognitive tasks. Even a single session of tDCS improved people’s thinking speeds,” said research team leader Professor Colleen Loo, from UNSW’s School of Psychiatry.

“This is significant for bipolar disorder because individuals with the illness frequently show deficiencies in their day-to-day functioning, which affects their ability to form relationships, and hold down a job.”

The researchers are currently recruiting participants for the trial, due to begin in Sydney next month.

“We are expecting that tDCS will improve participants’ thinking by ‘normalising’ brain activity in the specific regions of the brain responsible for cognitive tasks,” said Dr Donel Martin, postdoctoral researcher and clinical neuropsychologist.

Following the study, which is sponsored by the US-based Brain & Behavior Research Foundation, further research is planned to develop a therapeutic treatment for people with bipolar disorder.

More information: http://www.blackdo … disorder.cfm

Provided by University of New South Wales

"New treatment trial for bipolar disorder." April 11th, 2012. http://medicalxpress.com/news/2012-04-treatment-trial-bipolar-disorder.html

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Adolescent expectations of early death predict young adult socioeconomic status

April 10th, 2012 in Health

(Medical Xpress) -- Adolescents' expectations of an early death can predict their economic futures more than a decade later, according to a new study from the UNC Gillings School of Global Public Health.

Individuals who did not expect to live to age 35 had lower levels of educational attainment and lower personal earnings as young adults when compared to individuals who expected longer lives. Even after controlling for characteristics such as violence involvement, drug use, parental education and neighborhood poverty, those who perceived a short life expectancy were 73 percent more likely to have only a high school education than those who expected long lives.

The study suggests that low perceived survival expectations reported early in life may be a marker for worse health trajectories later in life. Screening for these perceptions in early life, along with other psychosocial characteristics, may assist in the identification of youth at risk of giving up on education and careers.

"In the United States, disparities in morbidity and mortality are closely linked to differences in education and income," said Quynh Nguyen, PhD, the study's lead author and recent graduate from the UNC Gillings School of Global Public Health. "So improving the survival perceptions of adolescents may, in the long run, help decrease health disparities."

The study findings were published online April 3 in the journal Social Science & Medicine.

While previous studies had linked anticipation of an early death to risk behaviors in adolescence, this is the first study to show perceived survival as a predictor of socioeconomic status among adults ages 24 to 32, a time in the human life span when socioeconomic status typically is more stabilized.

"People who have fatalistic beliefs about the future may set fewer goals, seek less guidance and attempt fewer solutions to their problems," Nguyen said. "The creation of environments that allow for healthy youth development - schools with resources and neighborhoods low in poverty and crime - could play an important role in raising survival expectations."

The study compared data collected from 19,000 adolescents in 1994-1995 to follow-up data collected from the same respondents 13 years later. One in seven adolescents in grades 7 through 12 reported perceiving a 50-50 chance or less of living to age 35. The cohort was part of the National Longitudinal Study of Adolescent Health (Add Health),  conducted by the Carolina Population Center and funded by the National Institutes of Health and 23 other federal agencies and foundations.

More information: http://www.science … 953612001116

Provided by University of North Carolina at Chapel Hill

"Adolescent expectations of early death predict young adult socioeconomic status." April 10th, 2012. http://medicalxpress.com/news/2012-04-adolescent-early-death-young-adult.html

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New research supports youth with mood and anxiety disorders

April 11th, 2012 in Psychology & Psychiatry

75% of mental illnesses emerge by age 25. Mood and anxiety disorders are among the most common conditions, yet there is little support for youth in this age group. A new study from Lawson Health Research Institute shows that may no longer be the case.

Dr. Elizabeth Osuch, Lawson researcher and a psychiatrist at London Health Sciences Centre, heads up the First Episode Mood and Anxiety Program (FEMAP), a treatment and clinical research program geared specifically to youth ages 16-26. Traditionally, youth can only access these specialized services through a physician referral, but FEMAP allows potential patients to refer themselves. Dr. Osuch believes this could help professionals to better connect with those at risk, and to intervene before the young person's development is impacted.

In a new study released last month in Early Intervention in Psychiatry, FEMAP could be a valuable alternative. After reaching out to local secondary schools, medical centres, and community agencies to raise awareness, FEMAP's health care delivery research study enrolled 93 patients in their first year. Each participated in an interview and questionnaire to assess the severity of their symptoms, their level of functional impairment and their demographic information.

Results showed that 67% of patients referred themselves. More importantly, almost 71% had received some mental health treatment in the past, but still showed severe symptoms of depression and/or anxiety, and substantial functional impairment. This suggests that outreach and easy access can help meet the needs of the youth population, such as that provided through FEMAP's direct access and age-specific program.

"It is our belief that adolescents and young adults should not meet any obstacles when they reach out for mental health care because the odds are just too high. If a young person has to wait 6 to 12 months to get the mental health care they need that could ruin a semester or year of school or their early work life," says Dr. Osuch. "That would have a seriously detrimental effect on their developmental trajectory and that's why we at FEMAP wanted to see if easier access would be an appropriate and useful model for youth mental health care delivery. Our findings suggest that it is."

Provided by Lawson Health Research Institute

"New research supports youth with mood and anxiety disorders." April 11th, 2012. http://medicalxpress.com/news/2012-04-youth-mood-anxiety-disorders.html

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Nonsurgical method to measure brain pressure shows promise

April 11th, 2012 in Medical research
If confirmed with further research, new technique could offer alternative to drilling into skull.

(HealthDay) -- A new nonsurgical method for monitoring brain pressure might help improve treatment of head injury patients, according to a new study.

Head injuries, including concussions, and brain tumors can lead to increased pressure inside the skull, which can crush brain tissue or cut off the brain's blood supply.

Monitoring brain pressure can help doctors determine the best treatment for these patients. However, this requires drilling a hole in the skull so it is done only in the most serious cases. Risks include infection or damage to the brain, study co-author George Verghese, a distinguished professor of electrical engineering at MIT, said in an institute news release.

This new method is much less invasive and may enable doctors to measure brain pressure in patients who have milder head injuries, but would benefit from close monitoring, the MIT researchers said.

"It's still at the validation stage. To convince people that this works, you need to build up more [data] than we currently have," Verghese said.

They developed a technique based on a computer model of how blood flows through the brain. The researchers found that they can calculate brain pressure from two less-invasive measurements: arterial blood pressure and an ultrasound measurement of how quickly blood flows through the brain.

This approach enables changes in brain pressure to be monitored over time so that doctors can detect problems that might develop gradually, the researchers said.

They describe the technique in the April 11 issue of the journal Science Translational Medicine.

"It's a holy grail of clinical neurosurgery to find a noninvasive way to measure (brain) pressure," James Holsapple, chief of neurosurgery at Boston Medical Center, said in the news release. "It would be a big step if we could get our hands on something reliable."

He said the MIT technique shows promise and added that the next major step is to incorporate the technology into a system that's easy for hospital staff to use and that can record data over many hours or days.

More information: The Brain Injury Association of America has more about brain injury treatment.

Copyright © 2012 HealthDay. All rights reserved.

"Nonsurgical method to measure brain pressure shows promise." April 11th, 2012. http://medicalxpress.com/news/2012-04-nonsurgical-method-brain-pressure.html

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