Body

In a study published in Psycho-Oncology, excess weight was linked with poorer psychosocial health among older adults diagnosed with breast cancer or prostate cancer. The association was not seen in older patients with colon cancer, however.

In the study of 4,159 patients, obesity was consistently associated with a greater burden of symptoms and with experiences of distress among patients with breast or prostate cancer. Few weight-based differences were observed among patients with colon cancer, but this group tended to have significant symptoms and distress regardless of patients' weight.

Across all patients, the most frequent problems related to sleeping, finances, feeling anxious or fearful, pain, feeling down or depressed, managing emotions, and, fear of medical procedures.

"These findings among a large cohort of patients provide insight into the impact of obesity during the cancer care trajectory and can provide guidance in the development and implementation of supportive care services for this 'at-risk' population," the authors wrote.

COLUMBUS, Ohio - Women who choose to shave or wax their pubic hair might not be raising their risk of sexually transmitted diseases (STDs) after all, according to a new study that found no connection between "extreme" grooming and chlamydia or gonorrhea.

Previous research and many media reports have warned women about a connection between pubic hair removal and STDs - but researchers at The Ohio State University wondered how strong that connection was, if it existed at all.

So they devised a study that, unlike previous work in this area, relied on laboratory-confirmed diagnoses of two common STDs. The study included 214 college students, all women.

The researchers examined any possible links between "extreme" grooming - removal of all pubic hair at least weekly in the past year, or at least six times in the past month - and testing positive for chlamydia or gonorrhea. They found no connection. The study appears today (Sept. 4, 2019) in the journal PLOS ONE.

Jamie Luster, the study's lead author and a former graduate student in public health at Ohio State, said she wasn't terribly surprised to find no connection in this study - primarily because there's no clear biological reason to believe that shaving or waxing would lead to increased risk of these common STDs.

The women in the study, who visited an on-campus location at Ohio State for STD testing, completed a questionnaire that asked about their sexual and grooming behaviors. Almost all (98 percent) of the study participants said they had done some grooming, and between 18 and 54 percent were "extreme" groomers, based on the two measures used in the study.

The participants also agreed to allow the researchers to receive the results of their STD tests. About 10 percent of the women had a positive test.

Though this study was small, it's important for women to know that the research in this area is not conclusive, despite what they might see in an internet search on the topic or hear from friends, said Luster, who is now a researcher at the University of Michigan.

The new study highlights the importance of taking actions that are known to reduce the risk of STDs, said Luster and her adviser on the work, Ohio State associate professor of epidemiology Maria Gallo.

The Centers for Disease Control and Prevention estimates about 2.86 million new chlamydia infections and 820,000 new gonorrhea infections occur in the U.S. each year, many in teens and young adults. The agency's prevention recommendations for sexually active people include staying in a long-term mutually monogamous relationship with an STD-free partner and using latex condoms consistently and properly.

Chlamydia and gonorrhea are caused by bacteria, infect both men and women, and can lead to reproductive tract infections that can have lasting damage. Left untreated, both infections can make it more difficult for a woman to become pregnant in the future.

Gallo said this study improves on previous research by carefully taking into account potential confounding factors that include sexual frequency, income, race and age.

"Particularly concerning is that previous work didn't adjust for sexual frequency. It could be that women who were having more sex with more people - and were therefore more likely to contract infections - were more likely to be grooming," Gallo said.

By relying on laboratory-confirmed evidence of STDs, the Ohio State study also improves on previous research, which had relied on participants' self-reports about infections, Luster said.

"Previous research asked participants if they'd ever had a sexually transmitted infection, but didn't measure whether they had one at the time of survey. That makes connecting any current grooming habits to STDs difficult," she said.

Body mass index (BMI) in infants, children and adults is influenced by different genetic factors that change as we age, according to a major new study.

An international consortium of researchers, led by scientists at Imperial College London, the University of Surrey, and the University of Oulu, Finland, discovered that BMI in babies is influenced by a distinct set of genetic variants that play little role in determining weight in later life.

They found, however, that some genetic variants associated with adult BMI start playing a role during childhood from around the age of 4-7 years old - suggesting that the origins of obesity in adults may lie in this critical stage of childhood.

The study, published in Science Advances, raises hopes that it may be possible to intervene at this early age to help to prevent unhealthy weight trajectories in later life.

"Our study shows that nearly 100 genetic variants which increase a person's risk of obesity in adulthood seem to start taking effect at an important stage of childhood development, from the age of around four," said senior author Professor Marjo-Riitta Jarvelin, from Imperial's School of Public Health.

"Environmental factors like the food we eat and our lifestyle have more and more impact on obesity development as we age. These external factors seem to unmask gradually the genetic contributors to obesity that we have from early life, programming development towards an unhealthy direction.

"We have shown that the origins of adult obesity lie in early childhood, and that there are clear windows across the life course which should be better considered in obesity prevention."

The research was conducted as part of the Early Growth Genetics Consortium, which combines data from multiple genome-wide association studies to identify genetic variants implicated in human development.

In total, they analysed measures such as BMI and growth rates from 2 weeks to 13 years of age of more than 22,000 children and compared these to variations in their genetic make-up. This enabled the researchers to identify common genetic variants associated with the peaks and troughs in BMI and their timings in childhood.

BMI (an indicator of body fat) does not follow a linear path through a person's life, but instead has three distinct periods of change. After birth, BMI rises rapidly until the age of nine months, where it peaks before declining again until the age of 5-6 years old, known as 'adiposity rebound point'. BMI then steadily increases until early adulthood.

Previous studies have suggested that adiposity rebound is a key period for determining obesity in later life and the results from the new research now help to explain those findings.

The researchers also discovered a new genetic variant that has an effect on infant BMI, a variation in a region of the genome containing the genes LEPR and LEPROT. In adults this genetic region is involved in controlling the activity levels of a hormone called leptin which is produced by fat cells to reduce appetite. Evidence also suggests that in early life it plays a role in brain development.

This new variant unveiled in the study, does not appear to be associated with adult weight regulation, so its effects may be limited to infancy.

"It suggests there are distinct biological processes driving BMI in infancy compared to later in childhood and into adulthood," said Professor Jarvelin. "We would like to further explore this variation in genetic makeup in infancy to better understand its role in development.

"If we can explain what is happening in early life, then we can start to understand why some people become obese and some people don't even though they are eating the same amount of calories. This may allow us to tackle the risk factors that are leading to the obesity epidemic."

Dr Sylvain Sebert from the University of Oulu added: "We are hopeful that the next international efforts we are running will help further tackling the early risk of obesity."

It's not just fake news. As social networks have become bigger players in shaping opinions about partisan elections, new research suggests that subtle differences in the way the networks are organized can have profound effects on voting outcomes.

The work, reported Wednesday, Sept. 4, in the journal Nature, relied on a mathematical analysis to explain a phenomenon the researchers call "information gerrymandering," saying the structure of a social network can sway the outcome of a vote toward one political party, even if both parties are equal in size and have the same amount of influence.

"Twitter, Facebook, those networks are organized by who you follow, and who follows you," said Alexander Stewart, a mathematical biologist at the University of Houston and corresponding author for the paper. "That affects both the information people are exposed to, and the way they make decisions."

People draw information from various sources in making decisions, the researchers said, but that information "can be constrained by social networks and distorted by zealots and automated 'bots'." The result? The network can promote one party without seeming to, or make people less likely to compromise and more likely to deadlock.

Does Information Flow Freely?

It's not about whether an individual chooses to talk only with people who share their views, Stewart said. "But we should be paying attention to the overall structure of these social networks, to whether information overall has the ability to flow freely."

That will require a better understanding of the algorithms governing social media. "People should have the ability to choose what content they want to see, but if the algorithm is inducing bias, we need to know that," he said. "Even if that's not intentional, you still need to be aware."

The analysis drew on data produced by a voter game designed to study information flow and was then confirmed through the study of real-world datasets, including online political discussions.

Stewart said the researchers wanted to address how the organization of social networks affects decision-making. "People increasingly use social networks to get their news, and along with reading news, they see what other people think about that news," he said. "That raises concerns about not only the spread of false news but about bubbles, where people are exposed to a biased set of viewpoints."

Purple vs. Yellow

The game worked like this: Groups of people were divided into teams, dubbed Yellow and Purple. (Testing showed most people have no intrinsic preference for one color over the other.). Working with coauthor David Rand at the Massachusetts Institute of Technology and colleagues, the team conducted more than 100 online experiments with more than 2,500 human subjects.

Your followers, and the people you follow on social media, comprise a real-world influence network; the game duplicated that. "It's like we built a tiny, simplified version of Twitter," Stewart said.

The game was structured to reward both party loyalty and compromise - if your party won with 60% of the votes or more, each party member received $2. If members of your party compromised to help the other party reach 60% of the votes, each member received 50 cents. If no party won, the game was deadlocked and no one was paid.

Researchers showed decisions of individual voters - or players, in the game - are shaped by what information they receive via the influence network. People convinced their party will win have no incentive to compromise. If they think the other side has more votes, players are more likely to compromise.

"When one party can use the network to convince more members of the other side that they need to compromise, that party has a huge advantage." Stewart said. The researchers called that "information gerrymandering," demonstrating that decision-making can be influenced even when the game is superficially fair, depending on what message people receive through their networks.

The stakes are far higher than winning a few dollars. "Our analysis provides an account of the vulnerabilities of collective decision-making to systematic distortion by restricted information flow," the researchers wrote. "Our analysis also highlights a group-level social dilemma: Information gerrymandering can enable one party to sway decisions in its favor, but when multiple parties engage in gerrymandering the group loses its ability to reach consensus and remains trapped in deadlock."

ARLINGTON, Va., September 4, 2019 -- A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides recommendations on the use of radiation therapy to treat patients diagnosed with pancreatic cancer, including when radiation treatments are appropriate, as well as the optimal dosing, timing and fractionation for these treatments. The guideline, which also outlines strategies to prevent and mitigate common side effects of pancreatic radiation therapy, is published online in Practical Radiation Oncology, the clinical practice journal of ASTRO.

Despite being the 11th most common cancer diagnosed among U.S. adults, pancreatic cancer is the third leading cause of cancer death, with an estimated 45,570 deaths and 56,770 new diagnoses in 2019. The five-year relative survival rate for pancreatic cancer is 9%, which is among the lowest for any cancer type. Multiple factors underlie these high mortality rates: the disease is very aggressive compared to other cancers, symptoms can be vague, and screening is difficult. More than half of diagnoses occur after the cancer has metastasized, when the five-year relative survival rate drops to 2.9%.

The ASTRO guideline covers four main areas: (1) the use of radiation in pre-surgical, post-surgical, definitive and palliative treatment settings; (2) stereotactic versus conventional radiation therapy; (3) technical aspects of radiation therapy; and (4) mitigating common side effects. It emphasizes a patient-centered approach that integrates patients' values and preferences into treatment decisions and also stresses the importance of multidisciplinary consultations, planning and follow-up.

Standard treatment for localized pancreatic cancer, or disease that has not spread outside of the pancreas, involves surgery to remove the tumor, combined with radiation and/or chemotherapy prior to surgery and/or following surgery to target potential residual disease. More than 80% of patients are diagnosed with tumors that have spread beyond the pancreas and cannot be removed surgically, however, and even patients who undergo surgery face local and distant recurrence rates of 50-90%.

Recent breakthroughs including new systemic therapies and the emergence of stereotactic radiation have driven significant changes in pancreatic cancer treatment, which led ASTRO to develop its first guideline on this topic. "Historically, very high rates of distant metastatic disease with pancreas cancer have overshadowed its tendency to recur locally. In the past several years, newer systemic therapies are proving to be more effective at controlling this cancer when it spreads, and fewer people are dying from distant disease. This makes treatments like radiation to manage local disease more meaningful," explained Manisha Palta, MD, co-chair of the guideline task force and a radiation oncologist at Duke University.

Recommendations for Radiation Therapy for Pancreatic Cancer Patients

The guideline first presents indications for radiation therapy in the adjuvant, neoadjuvant and definitive settings. It delineates between conventionally fractionated and stereotactic radiation therapy, providing the first clinical guidance on the newer, shorter-course approach. "One thing this guideline offers that hasn't been available previously is context about the current status of ablative radiotherapy such as stereotactic body radiation therapy (SBRT) and where it might be useful for patients with pancreatic cancer," said Dr. Palta.

Recommendations on the indications of radiation therapy for pancreas cancer are as follows:

In the adjuvant/post-operative setting, conventionally fractionated radiation is recommended conditionally for patients with high-risk features such as positive lymph nodes and margins following surgical resection. SBRT is recommended only if the patient is enrolled in a clinical trial/data registry.

In the neoadjuvant/pre-operative setting, conventionally fractionated radiation therapy or SBRT is recommended conditionally following chemotherapy for patients with resectable disease. Neoadjuvant chemotherapy plus radiation (either conventional or stereotactic) is conditionally recommended following systemic therapy for select patients with borderline resectable disease.

For patients with locally advanced disease (who are not candidates for surgery), systemic chemotherapy followed by either chemoradiation or SBRT is recommended conditionally as an option for definitive treatment.

Recommendations also address:

optimal dosing and fractionation for different subgroups of patients;

sequencing of radiation with systemic chemotherapies in adjuvant, neoadjuvant and definitive settings;

simulation and setup strategies, such as image guidance and patient-specific motion management;

techniques for treatment planning and delivery, including a strong recommendation for the use of modulated radiation therapy to deliver treatment; and

treatment in the palliative setting, including a strong recommendation for palliative radiation therapy to either the primary tumor or select metastatic sites to help relieve the patient's pain and other symptoms.

Mitigating Side Effects

The guideline also addresses ways to mitigate side effects related to pancreatic radiation, whether given alone or with chemotherapy. While the side effects from radiation therapy depend on how the radiation is administered, the most common toxicities include fatigue and digestive/gastrointestinal effects such as nausea, vomiting and diarrhea.

The guideline strongly recommends that patients who undergo radiation treatments for pancreatic cancer be given prophylactic anti-nausea medicines. It also conditionally recommends the use of antacid or acid-reducing medications.

Dr. Palta explained how these medications are used preventatively with radiation: "If we know that certain side effects tend to occur with a relatively modest or high frequency - such as nausea and stomach pain - there are medications we can give to patients prior to treatment to help mitigate those side effects."

Future Directions

The guideline comments on emerging and upcoming trial reports that will add to the evidence on stereotactic radiation and other aspects of pancreatic cancer treatment, and which subsequently will shape future clinical practice and guideline updates.

"Any patient who is diagnosed with pancreatic cancer deserves to have a multidisciplinary evaluation, where she or he can have nuanced conversations about the benefits and risks of different types of treatment based on the most current information available. It's also essential that any patient who might be an appropriate candidate for radiation have access to a radiation oncologist who can provide perspective on the pros and cons of treatment, so that the patient can make an informed decision," said Dr. Palta. "This is a rapidly evolving field and some potentially practice-changing studies that are not included in this guideline may become available in the relatively near-term future."

About the Guideline

The guideline was based on a systematic literature review of 179 articles published from May 2007 through January 2017. The 14-member task force included a multidisciplinary team of radiation oncologists from a variety of practice settings, a medical physicist, a medical oncologist, a surgical oncologist, a radiation oncology resident and a patient representative. The guideline was developed in collaboration with the American Society of Clinical Oncology (ASCO) and the Society of Surgical Oncology (SSO), who provided representatives and peer reviewers.

ASTRO's clinical guidelines are intended as a tool to promote appropriately individualized, shared decision-making between physicians and patients. None should be construed as strict or superseding the appropriately informed and considered judgments of individual physicians and patients.

PROVIDENCE, R.I. [Brown University] -- By comparing needles and syringes to disease-carrying mosquitoes, an innovative mathematical model of how the Hepatitis C virus spreads is offering scientists new perspectives on how best to prevent its proliferation.

The insights offered by the model are of particular importance in the context of the nation's opioid epidemic and the related Hepatitis C virus outbreaks among people who inject drugs.

"Mathematical models like this give us new perspectives on complicated phenomena, like the spread of Hepatitis C virus in the community of people who inject drugs," said Brandon Ogbunu, an assistant professor in Brown University's Department of Ecology and Evolutionary Biology and senior author on the study. "It gives us a picture of the different knobs and levers that determine this phenomenon. Looking at needles like mosquitoes can give us a different lens on interventions and prevention measures."

The model and findings were published on Wednesday, Sept. 4, in the journal Proceedings of the Royal Society Interface.

Hepatitis C is a blood-borne viral infection that can cause serious liver damage, yet the symptoms can take decades to appear, which is why it is called a "silent epidemic," Ogbunu said. Hepatitis C virus has, for decades, been spread among communities of people who inject drugs.

The research team included numerous parameters in its mathematical model, including the number of new people who inject drugs, the rate of people who inject drugs entering treatment for substance use disorder, the number of new needles used each day, and the rates of discarding infected and uninfected needles.

By inserting different values into the model, Ogbunu and his team found that simply removing used needles doesn't reduce the spread of Hepatitis C. Instead, it's important to replace infected needles with new ones or change the ratio of infected to uninfected needles. He said this finding has implications for harm reduction agencies, suggesting the importance of adding screening for Hepatitis C virus and other blood-borne diseases to needle exchange programs and the additional value of safe consumption spaces that expressly halt needle sharing.

Since the opioid epidemic tends to affect populations that are less urban and less connected to existing harm reduction resources than previous injection drug epidemics, harm reduction agencies and policymakers need to adapt new methods to reach new communities, Ogbunu said.

And more research is needed to better understand these communities of people who inject drugs, he added.

"In the case of these modern opioid outbreaks, we really need data on the sharing networks," Ogbunu said. "What is injection drug use as a social phenomenon? How are people actually sharing needles?"

He said that comparing the spread of Hepatitis C virus to that of mosquito-borne malaria can spark creative ideas to reduce transmission -- such as creating needles and syringes that cannot harbor viruses, similar to genetically engineered mosquitoes that cannot spread malaria.

Ogbunu will continue his research by studying how people who inject drugs share needles and what aspects of the sharing networks foster or hinder the spread of blood-borne diseases.

He added that because no one knows what epidemics the future holds, mathematical models like this one -- which can compare new pathogens to well-studied diseases -- could provide insight into how microbes spread, even if the microbes are quite different biologically.

Bottom Line: Higher proportions of patients in the United States and Canada filled opioid prescriptions after surgery compared with Sweden. This analysis examined differences in rates of opioid prescriptions filled after low-risk surgical procedures (laparoscopic removal of the gallbladder or appendix, arthroscopic knee meniscus surgery and breast excision) among 129,000 patients in the United States, 84,000 patients in Canada and 9,800 in Sweden. The authors report the proportion of patients who filled an opioid prescription within the first seven days after being discharged from the hospital was 76.2% in the United States, 78.6% in Canada and 11.1% in Sweden. The average dose of opioids for most surgical procedures was highest in the United States. Limitations of the study include a lack of information about pain experiences of patients after surgery so the quality of pain treatment across counties couldn't be examined.

Authors: Mark D. Neuman, M.D., M.Sc., University of Pennsylvania Perelman School of Medicine, Philadelphia, and coauthors

(doi:10.1001/jamanetworkopen.2019.10734)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

While the vast majority of the 1.8 billion people infected with the TB bacterium never experience active disease, an estimated 5 to 15 percent do develop full-blown infections--roughly half of them within 18 months of exposure.

Why do some people develop overt disease soon after infection, while others harbor silent infections for decades and remain apparently healthy?

It's a question that has continued to mystify microbiologists, infectious disease specialists and public health experts on the forefront of the fight against TB, which continues to claim more lives globally than any other infectious pathogen.

Now, a study by scientists from Harvard Medical School, Brigham and Women's Hospital, the Broad Institute of MIT and Harvard, Socios en Salud in Peru and other institutions offers an answer: Some of the risk for early disease progression is driven by several gene variants, at least one of which controls key immune functions.

The research, published Aug. 21 in Nature Communications, is believed to be the first large-scale study to explore the genetic underpinnings of early TB progression among people living in the same households with confirmed active and latent infections. This was a particular strength of the study, the research team said, because it ensured a meaningful and direct comparison allowing scientists to distinguish between infected progressors and infected non-progressors.

To be sure, researchers added, this is not the whole story, and more genes will likely be uncovered as drivers of early disease progression. These genes, they said, are likely spread across many areas of the genome, as is the case with other disorders such as cardiovascular disease or diabetes--multifactorial diseases that arise from mutations in multiple genes and are influenced by environmental and lifestyle factors.

Early progression to active TB disease soon after infection with the bacterium is physiologically different from late-onset disease, which develops after years or decades of dormancy, typically as a result of aging or immunosuppression.

Scientists have long suspected that immune system factors drive the progression from latent TB infection to overt disease, hypothesizing that people whose immune systems fail to mount a swift defense progress to overt disease soon after infection.

The study, which involved people infected with TB in Lima, Peru, pinpoints the precise genetic region that interferes with immune control and leads to early progression. In doing so, the research confirms the role of gene-mediated immunity in disease development after TB infection. Additionally, the study points to the different genetic basis for early versus late-onset TB, underscoring how fundamentally different the two forms of the disease are.

"The purpose of our study was to characterize genetic differences between people who develop TB soon after they have been infected and those who do not progress to overt disease," said study co-senior investigator Megan Murray, professor in the Department of Global Health and Social Medicine in the Blavatnik Institute at Harvard Medical School. "Our results indicate that early TB progression is a highly heritable trait and one that is genetically distinct from TB reactivation after years of dormancy."

Understanding the genetic mechanisms behind early disease progression could inform the development of interventions such as vaccines or drugs that prevent people from developing the disease after infection, said Soumya Raychaudhuri, professor of medicine at Harvard Medical School, a clinician at Brigham and Women's Hospital and a member of the Broad Institute.

Moreover, the findings could lead to the design of tests that could help clinicians determine who is at risk for early progression, Raychaudhuri added.

The researchers started out by examining publicly available whole-genome data sets of Peruvian people. They homed in on tiny areas of the DNA known as single-nucleotide polymorphisms, or SNPs (pronounced "snips"). Each SNP represents a difference of a single nucleotide--or a single letter in the genomic alphabet. SNPs can alter the function of genes, as well as the regulatory sequences in which they are found. To enhance the accuracy of their analysis, the researchers identified SNPs specific to Peruvian populations, adapting their genotyping tests to reflect this population-specific variation.

Next, the investigators obtained DNA samples from more than 2,000 people with active TB infections and 2,000 people who lived in the same households who also were infected with TB but had no active disease. To confirm that the apparently disease-free housemates had, indeed, been infected with TB, the researchers screened them using a standard TB skin test, blood tests and X-ray imaging of the lungs to check for the presence of TB in the body. The researchers repeated these tests at two, six and 12 months. This approach allowed the scientists to compare genetic risk among individuals who shared the same environment and had the same or very similar disease exposures.

The analysis traced the epicenter of susceptibility to a region on chromosome 3 involved in regulating the expression of ATP1B3, a protein known to influence the function of immune cells called monocytes, which have critical functions in innate immunity ranging from detecting the presence of viral and bacterial invaders to the detection and destruction of defective or infected cells.

The researchers hypothesize that the gene variant interferes with the expression of the protein that regulates monocyte function, interfering with the immune cells' ability to perform key functions, thus boosting the risk for early TB progression.

There were associations suggestive of early progression with other areas of the genome in the region of the human leukocyte antigen complex, which encodes proteins that are a key part of the immune system. This complex is involved in distinguishing human proteins from those of foreign intruders such as bacteria and viruses.

"The risk regions that we identified may play a vital role in the immune responses for TB progression, but they may not be the end of the story," said lead author Yang Luo, a research scientist and instructor in medicine at Harvard Medical School and Brigham and Women's.

Many more DNA regions driving susceptibility to early disease progression are likely to be found as the sizes of genetic samples and related studies continue to increase, Luo added.

"There may be lots of other alleles with weaker effects spread around the genome," Raychaudhuri said. For comparison, genetic variation appears to account for 28 percent of cases of Crohn's disease. Genome-wide association studies have identified around 200 alleles that contribute to this variation in genetic risk of Crohn's, the researchers said.

Infections, especially chronic infectious diseases, play out in highly distinct phases, the team said, and the new study identifies some of the genetic drivers behind one of these phases.

"We believe our analysis is the first step on a long journey," Raychaudhuri said. "A journey toward identifying new ways to intervene at these distinct stages and developing strategies that either optimize host immunity or interfere with the pathogen's fitness."

Major depressive disorder – referred to colloquially as the ‘black dog’ – has been identified as a genetic cause for 20 distinct diseases, providing vital information to help detect and manage high rates of physical illnesses in people diagnosed with depression.

Assessing risk factors between depression* and 925 diseases, a study from the Australian Centre for Precision Health at the University of South Australia found a causal relationship between depression and a range of respiratory, heart and digestive diseases including: asthma, coronary heart disease, high cholesterol, oesophagitis, gastroenteritis, E. coli infections, and urinary system disorders.

UniSA researcher, Anwar Mulugeta, says understanding the relationship between depression and other diseases can reduce the incidence of comorbidities – the presence of one or more additional conditions occurring with a primary condition – and improve the lives of millions of people worldwide.

“Data shows that people living with serious mental diseases, like depression, have much higher rates of physical illness than those in the general population,” Mulugeta says.

“But until now, these studies have been complicated by the possibility of other confounding factors, or even reverse causation where the physical condition is assumed to cause depression.

“This research puts the ‘chicken and egg’ conundrum to rest, showing that depression causes disease, rather than only the other way around.

“Importantly, this research signals that an individual diagnosed with depression should now also be screened for a defined set of possible comorbidities, enabling much better clinical management and significantly improved outcomes.”

Published in Molecular Psychiatry, the study is the first to use MR-PheWAS analyses to screen for a causal link between depression and a range of diseases. MR-PheWAS is a method that uses genetic data to explore causal associations between a risk factor (depression) and a range of disease outcomes. In this study, researchers assessed data from 337,536 UK Biobank participants to confirm the range of diseases affected by depression.

This study was led by Professor Elina Hyppönen, Director of the Australian Centre for Precision Health, who says appreciating the link between depression and distinct comorbidities has important implications for individuals, practitioners and policymakers.

“Today, nearly half of the population is estimated to experience a mental health condition in their lifetime,” Prof Hyppönen says.

“Understanding the connections between depression and other diseases is critical to ensure people with depression receive the support they require. The more we can look at the individual patient as a whole, the better their outcomes are likely to be.

“Our results suggest that it is important to look beyond the obvious, and that we need to screen and effectively manage depression-related comorbidities if we want to minimise the longer-term negative implications on health.

“It’s also important to focus on diet and encourage healthy lifestyles in this context. It was concerning to see that depression was associated with multiple inflammatory and even haemorrhagic gastro-intestinal complications, which may be due to side effects from medications used to treat depression, or even due to the greater occurrence of e-coli infections, both of which could be prevented.

“Through this study we provide critical evidence to help navigate the complexities of depression and its comorbidities, with the ultimate goal of delivering customer-centric treatment strategies for people suffering from this debilitating disease.”

In one of the most substantial studies of a skin health supplement, BioCell Collagen®, was found to visibly reduce common signs of skin aging, including lines and wrinkles, within 12 weeks of daily use. The findings reported in this randomized, double-blind, placebo-controlled clinical trial included a measurable improvement in signs of aging in women, represented by increased skin elasticity, reduction of crow's feet, and improvement in depth and number of fine lines and wrinkles. The full findings of the peer-reviewed study are published in the September/October issue of Alternative Therapies in Health and Medicine and posted on PubMed. A summary of the research findings was presented in June 2019 during the annual meeting of the American Society for Nutrition.

"Findings from a clinical trial of this magnitude show how BioCell Collagen's naturally-occurring matrix of hydrolyzed collagen type II, chondroitin sulfate and hyaluronic acid can address the loss of collagen in skin associated with aging," said Alexander Schauss, PhD, a co-author of the study. "This landmark research is especially encouraging for women who are seeking safe and effective options for meeting their skin health and appearance goals, including those who are considering or already using cosmetic procedures to address skin aging."

BioCell Collagen is a clinically tested branded dietary ingredient proven to promote active joints, youthful-looking skin, and healthy connective tissues. The study evaluated the use of BioCell Collagen among 128 women, aged 39-59. All participants entered the study with visible signs of facial aging.

Study participants were split into an intervention group or placebo group by randomized assignment. Over the course of 12 weeks, the intervention group supplemented twice daily with BioCell Collagen® 500 mg capsules composed of a naturally occurring matrix of hydrolyzed collagen type-II (? 300 mg), chondroitin sulfate (? 100 mg), hyaluronic acid (? 50 mg).

Throughout the study, the intervention and placebo group were under a uniformed, simplified skincare routine. Participants' skin was visually graded monthly to determine the intervention's efficacy, measurements of facial lines and wrinkles, definition of crow's feet lines and wrinkles, level of skin texture and smoothness, and skin tone.

For the 113 participants completing the study, dietary supplementation (1g/day) of BioCell Collagen:

Increased skin collagen content by 12%

Significantly reduced facial lines and wrinkles in women

Reduced the width of crow's feet and wrinkles compared to placebo

Improved skin elasticity in women compared to placebo

No adverse reactions were reported during the study. Participants surveyed at the sixand twelve-week marks reported a positive perception of the supplement effectiveness.

"We are very excited about the publication of our largest study to date, which further supports the efficacy and safety of our flagship dietary ingredient BioCell Collagen as a key component to a healthy aging routine," said Suhail Ishaq, president of BioCell Technology.

"With age, levels of collagen and hyaluronic acid in the skin decline which, over time, result in visible signs of skin aging such as wrinkles and sagging skin. Because of their healthy aging capabilities, collagen and hyaluronic acid are becoming increasingly popular supplements for a range of applications, including cosmetics and dietary supplements. Yet not all collagen and hyaluronic acid ingredients are created equal It's important for consumers to look to ingredients that can provide multidimensional skin nutrition support and are supported by human clinical trials, like the new study on BioCell Collagen," said Dr. Schauss.

"Those who are considering procedures to address signs of aging in skin should know their options. This substantive study adds to a body of evidence and years of study that show how the dietary supplement ingredient BioCell Collagen can be used as part of a skin health routine for people who are looking for more subtle and natural improvements in their appearance," said Ishaq.

BioCell Collagen® is available as a stand-alone product; or as a primary ingredient in many formulations worldwide from leading dietary supplement brands.

In the first large study to examine the diagnosis of dementia in older Americans over time, researchers found the vast majority never meet with a dementia specialist and are instead overwhelmingly diagnosed and cared for by non-specialists.

Researchers at USC, Johns Hopkins and the University of Washington used Medicare data to track dementia diagnoses of nearly a quarter of a million people over five years. The team found 85% of individuals first diagnosed with dementia were diagnosed by a non-dementia specialist physician, usually a primary care doctor, and an "unspecified dementia" diagnosis was common.

One year after diagnosis, less than a quarter of patients had seen a dementia specialist. After five years, the percent of patients had only increased to 36%.

The study, which also found the use of dementia specialty care was particularly low for Hispanic and Asian patients, was published today in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

"Dementia specialists are more familiar with subtypes of dementia and may be less likely, for example, to misdiagnose Lewy body dementia as Alzheimer's disease and wrongly prescribe antipsychotic medications to patients," said co-author Julie Zissimopoulos, director of the Aging and Cognition program at the USC Schaeffer Center for Health Policy & Economics.

Differences in diagnosis and follow-up care

Using a large Medicare dataset, researchers examined the types of physicians that diagnose dementia, what dementia subtype diagnoses were initially provided and how they changed over time, the extent to which individuals accessed specialty care and how it varied by gender, race and ethnicity.

They found that, among those diagnosed by a non-dementia specialist, 33% of patients were given a diagnosis that lacked a specific type of dementia, compared to 22% of patients diagnosed by a specialist. Diagnoses of Alzheimer's disease among patients who saw a specialist within the first year of diagnosis were higher at 42% compared to 29% among those who did not see a specialist. Dementia specialists include neurologists, psychiatrists, neuropsychiatrists and geriatricians.

"Without identification of dementia type, patients and their families are potentially missing out on important discussions about care and managing this diagnosis with other chronic conditions, as well as information about clinical trials," Zissimopoulos explained.

The team also found Hispanic and Asian patients were less likely to have a follow-up visit about the diagnosis compared to white and African-American patients. Approximately 37% of Hispanics and 40% of Asians with an initial diagnosis had no follow-up care within the first year of diagnosis, compared to whites and African Americans who each had a rate of about 33%.

The research team said more study is needed to identify factors driving these differences, such as severity at diagnosis, complexity of the care and barriers or differences in seeking care from specialists.

The importance of dementia subtypes

There are many different types of dementia, including Alzheimer's disease, vascular dementia and frontotemporal dementia. Study authors say that more accurate identification of dementia type may lead to better treatment for symptoms, enhance knowledge of medications that may worsen symptoms, inform disease progression over time and encourage advance care planning.

Identifying dementia subtypes can also assist in developing and evaluating new drugs and gaining access to effective treatments when they become available.

"While the study shows that specialists seem to be able to identify the subtype better, what we're really interested in is whether that leads to better health and financial outcomes," Zissimopoulos said. "If in the future these diagnoses are going to be handled in large part by non-dementia specialists, they may need better training and tools."

An aging population, a rapidly growing toll

The toll of Alzheimer's disease and other dementias is high and rapidly growing as the population ages. Dementia affects approximately 7 million America and is projected to grow to nearly 12 million over the next 20 years, driven by an aging population and increased life expectancy. The research team pointed to a recent Alzheimer's Association survey that found only half of seniors are being assessed for dementia despite the fact that screenings are now reimbursable services.

Market factors may also drive dementia specialist health care use. For example, the research team found 3.9 neurologists for every 100,000 residents in the zip codes of beneficiaries who never saw a dementia specialist in the first year after diagnosis. In contrast, they found 5 neurologists for every 100,000 residents among beneficiaries who had a specialist visit. The researchers note that low rates of dementia specialist care are consistent with recent findings about regional U.S. neurologist shortages.

The study authors explain that their results don't answer the question of whether or not increasing use of dementia specialist health care should be a policy goal. They say use of specialist services may increase health care costs and, without enough evidence that they improve health outcomes, they may not be a cost-effective approach to dementia care.

"Non-specialists and specialists may be complementary in dementia diagnosis and care," Zissimopoulos said. "General practioners and other nondementia specialists play an important role in screening because often they are the first point of contact, while specialists are key to making finer distinctions across dementia subtype."

The researchers say the study's findings will aid in efforts to improve diagnosis -- especially among patients and families not receiving timely post-diagnostic care or dementia specialist care -- and inform efforts to better target resources to physicians and improve the preparation necessary to link patients to appropriate new treatments as they become available.

A traumatic brain injury is often easily suspected and can be confirmed and treated if necessary following an injury using a blood analysis, but scientists are reporting that even one mild blast to the brain can cause very subtle but permanent damage as well. Urine analysis taken within one week of a mild to traumatic brain injury also can provide faster diagnosis and treatment for such injuries.

"We're finding that even a mild blast can cause long-term, life-changing health issues," said Riyi Shi, a professor of neuroscience and biomedical engineering in Purdue University's Department of Basic Medical Sciences. "The individual appears to be fine, and it's difficult to tell if you just look at a person. But the fact is that these types of hits are multiplied over years and often ignored until someone reaches an age when other factors come into play. Identifying and treating these incidents sooner can help mitigate issues later in life."

A study led by Shi reports that checking the urine within seven days following such an injury, even a mild injury with no immediately obvious symptoms, could be less invasive, faster and help reduce the risk of long-term health issues including Parkinson's disease.

"Even at one day post injury, a simple urine analysis can reveal elevations in the neurotoxin acrolein. The presence of this "biomarker" alerts us to the injury, creating an opportunity for intervention," said Shi, who has appointments in Purdue's College of Veterinary Medicine and Weldon School of Biomedical Engineering. "This early detection and subsequent treatment window could offer tremendous benefits for long-term patient neurological health."

The research paper, titled "Acrolein-mediated Alpha-synuclein Pathology Involvement in the Early Post-injury Pathogenesis of Mild Blast-induced Parkinsonian Neurodegeneration," was published in July in the Journal of Molecular and Cellular Neuroscience.

"Most people have heard that traumatic brain injuries are linked to Parkinson's, Alzheimer's and other neurodegenerative diseases, dating back as far as to Muhammad Ali and even earlier," Shi said. "The seriousness of this relationship is readily apparent; however, we want to, for the first time, implement a mechanism or protocol capable of connecting brain injuries to these diseases. We can accomplish this by testing for acrolein, which is well-researched and already recognized as a very important pathological factor in Parkinson's disease. This study establishes a solid link between the two and opens the door for faster treatments utilizing acrolein urine tests during the days following a traumatic episode."

In the research study, a urine analysis tested for an increased elevation of acrolein or oxidative stress within one week following a neurological injury.

"What's important is that urine tests can be performed much easier than blood tests or other more invasive medical procedures currently available," Shi said. "And it has been shown that individuals who experience brain injuries are three times more likely than their age-matched peers to develop neurological disease. If we can establish a protocol to routinely test urine following a traumatic brain injury, we can improve treatment options earlier and potentially offer better long-term outcomes."

More than 500,000 people in the U.S. are currently living with Parkinson's disease, and another 50,000 people are diagnosed with this neurodegenerative disorder every year, according to the National Institutes of Health.

A video about the link between acrolein and Parkinson's disease based on Shi's research is available here.

The research was funded in part by the National Institutes of Health, the Indiana State Department of Health, and the Indiana CTSI Collaboration in Biomedical Translational Research Pilot Program.

Shi's work aligns with Purdue's Giant Leaps celebration, acknowledging the university's global advancements in health as part of Purdue's 150th anniversary. This is one of the four themes of the yearlong celebration's Ideas Festival, designed to showcase Purdue as an intellectual center solving real-world issues.

The technology is patented through the Purdue Office of Technology Commercialization. Contact otcip@prf.org. for more information.

The research dovetails with the goals of a recently formed Purdue Institute for Integrative Neuroscience, at Purdue's Discovery Park. The institute spans 25 departments and includes around 100 faculty engaged in neuroscience-related research.

PHILADELPHIA -- Patients in the United States and Canada are seven times as likely as those in Sweden to receive a prescription for opioid medications after surgery, according to a new multi-institutional study led by researchers from Penn Medicine. Though the United States and Canada had similar prescription rates, patients in the U.S. were prescribed a much higher dosage - as measured by the total morphine milligram equivalents (MME). The findings were published today in JAMA Network Open.

To compare international opioid prescribing rates after surgery, researchers analyzed data on four frequently performed procedures: surgery to remove the appendix, surgery to remove the gallbladder, a minimally invasive procedure to treat a torn meniscus cartilage in the knee and a procedure to remove a breast lump.

Within seven days of discharge, about 75 percent of the patients in the United States and Canada filled an opioid prescription, compared to just 11 percent of the patients in Sweden. By the one-month mark, nearly half of U.S patients had received high-dose opioid prescriptions (i.e., prescriptions totaling more than 200 MME) - nearly double the rate in Canada (25 percent) and nine times higher than the rate in Sweden (5 percent).

"Our findings reveal stark differences in prescribing practices across the three countries and suggest real opportunities to encourage more judicious use of opioids before and after surgery for patients in the United States and Canada," said the study's corresponding author Mark D. Neuman, MD, an associate professor of Anesthesiology and Critical Care and Chair of the Penn Medicine Opioid Task Force. "While innovative strategies, like enhanced recovery protocols, have helped to reduce the number of prescribed opioids, it's clear that we need to continue to identify ways to improve prescribing practices in the United States and Canada."

Opioids, such as codeine, tramadol and morphine, are routinely prescribed for postoperative pain management in many countries. However, recent research suggests that overprescribing opioid medications for short-term pain may be widespread in the United States. The excessive prescribing can increase the risk of drug diversion, new long-term opioid use and the development of opioid use disorder. In the last decade, opioid overdose deaths have significantly increased in countries across the world, including the United States and Canada - which have the highest opioid use per capita in the world.

While the use of opioids varies in countries worldwide, there has been little research - until now - that characterizes the international disparities in opioid use for specific indications, such as pain relief after surgery. In their analysis, researchers examined data from more than 220,000 cases - ranging from 2013 to 2016 - to identify differences in the percentage of opioid prescriptions filled within seven and 30 days of the procedures, as well as the quantity and types of opioids dispensed. They specifically sought patients who shared similar characteristics, including age and medical history, and who had not received an opioid in the 90 days prior to the surgery.

Researchers found that at least 65 percent of patients in the United States and Canada filled an opioid prescription in the first seven days after each procedure. In Sweden, the prescribing rate didn't exceed 20 percent for any of the procedures. Meanwhile, the average dosage of the initial prescription in the United States was 247 MME -much higher than the dosage dispensed in Sweden (197) and Canada (169). In addition to the disparities in prescribing rate and dosage, researchers also identified a significant variation in the types of opioid medication prescribed. For example, codeine and tramadol accounted for 58 percent of the postoperative prescriptions dispensed in Canada and 45 percent of the prescriptions in Sweden, but just 7 percent of prescriptions in the United States. In the United States, hydrocodone and oxycodone were the most commonly dispensed opioid medications.

"Our findings point to systematic differences in practitioners' approaches to opioid prescribing, public attitudes regarding the role of opioids in treating pain and broader structural factors related to drug marketing and regulation," said Dr. Karim Ladha, a clinician-scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and co-author of the study.

Picture a woman in her 60s, in the hospital after a heart attack or a hip replacement. As her hospital stay nears its end, her care team prepares her for the next step in her recovery, which might include time in a nursing home or rehabilitation facility, care at home or regular therapy appointments.

But a new study reveals that if the patient has traditional Medicare coverage, her post-hospital care will probably cost far more than it would have for an identical patient with private insurance.

And despite the difference in cost, both patients have about the same clinical ending - as measured in their odds of ending up back in the hospital again, the study shows.

The new findings, made by a University of Michigan team, suggest that the Medicare system spends far more than it probably needs to on post-hospital care. That spending is about $60 billion a year.

The researchers say that changes to Medicare's post-hospital care payment structure, to bring it closer to that used by private insurance, might save taxpayer dollars while still giving patients the care they need to recover and avoid a repeat hospital stay.

As elected officials and presidential candidates put forth proposals to expand Medicare, the new study also offers insight into a major source of potential cost if any of those proposals become law. It also shows the importance of developing guidelines to help clinicians choose appropriate post-hospital options for each patient.

Comparing costs

The new analysis, published in the September issue of the journal Health Affairs, used four years' worth of data from more than 25,000 patients across Michigan whose hospitals take part in a statewide effort called the Michigan Value Collaborative.

Funded by Blue Cross Blue Shield of Michigan, MVC pools data from patients who have different forms of insurance and finds ways to improve quality and value.

The new study, funded by the National Institutes of Health's National Institute on Aging, focuses on MVC data from people in their 60s. It included people below and above age 65, the age of Medicare eligibility who have either traditional Medicare coverage or BCBSM plans called PPOs, which cover about 20 percent of all Michigan residents.

The researchers used statistical techniques that allowed them to make 'apples to apples' comparisons of post-hospital care use and costs between the two groups.

The study focused on the use and the cost of post-hospital care received at home, in skilled nursing facilities and at inpatient and outpatient rehabilitation facilities. It included those hospitalized for six common reasons: heart attack, heart failure, cardiac bypass surgery, stroke, hip replacement and colon surgery.

For almost every condition and every form of post-hospital care, there was significantly more spending for Medicare patients than privately insured patients. Post-hospital spending was more than double for hip replacement patients covered by Medicare than for privately insured patients. It was two-thirds more for Medicare participants who had had heart bypass surgery.

Yet the differences in the percentage of patients who received any post-hospital care were relatively small. Instead, the largest differences were in the amount of spending among those who were prescribed care after hospitalization.

And despite this excess spending, the two groups had similar rates of readmission to the hospital within 90 days of leaving - a measure of how well a patient's recovery has gone.

"This shows that providers are making similar clinical decisions about what to do regarding post-hospital care for both types of patients, but that Medicare is far more permissive regarding the volume of services delivered and therefore the costs," says Scott Regenbogen, M.D., M.P.H., lead author of the paper, co-director of MVC and chief of colorectal surgery at Michigan Medicine, U-M's academic medical center. "The only exception was stroke, where overall spending was similar between the two groups -- most likely because the clinical indications for stroke rehabilitation are so much more clear than in the other five conditions."

Change already starting

Regenbogen and his colleagues, including senior author Edward C. Norton, Ph.D., a U-M health economist, point out that Medicare covers post-hospital care provided within time-defined windows, while private insurance often sets coverage by day of overnight stay or outpatient or home visit. Private plans, working with the employers that pay for them, can set limits on exactly what they'll cover, or set co-pays to try to keep patients from using less-needed services.

They also note that the Centers for Medicare and Medicaid Services, which oversees the Medicare system, has started to work to incentivize more judicious use of post-acute care in Medicare through the introduction of alternative payment models.

For instance, it has established 'bundled payment' programs that pay hospitals a set amount for the entire range of care that a hip or knee replacement patient needs including post-hospital care. And Accountable Care Organizations are financially rewarded - and sometimes penalized - based on the total cost of care in and out of the hospital for the traditional Medicare patients who see the ACO's participating physicians.

More about the study

The new study grew out of the MVC team's general observations about the costs of post-acute care for patients with different forms of insurance whose hospitals take part in the consortium.

But in order to make a true comparison, the team had to peel away the layers of differences between the groups of patients, so that they were clinically similar and prices of services were standardized. This included were not on Medicare for reasons such as kidney failure or disability that would have kept them off of private insurance before the age of 65,

The same approach could help researchers study differences between pre- and post-Medicare groups for other purposes.

A new study looking at incidence of disease data nationwide from 2000 to 2016 found a shift in obesity-associated cancers (OACs) to younger individuals. Typically, these cancers are diagnosed at higher rates among people older than 65. The most notable findings pertain to increases in these OACs among non-Hispanic Black and Hispanic women and men for whom certain cancers increased by 200-400%.

The study, "Changes in Age Distribution of Obesity-Associated Cancers," was recently published in JAMA Network Open. It was conducted by a team at Case Western Reserve University School of Medicine and the Case Comprehensive Cancer Center. The team includes Siran Koroukian, Weichuan Dong, and Nathan Berger. Koroukian and Berger are faculty with the School of Medicine and members of the Case Comprehensive Cancer Center. Berger is also an oncologist at Seidman Cancer Center at University Hospitals Cleveland Medical Center.

Data were used from more than six million incident cancer cases from the Surveillance Epidemiology and End Results (SEER) database, recognized as an authoritative source for U.S. cancer statistics. The SEER is administered by National Institute of Health's National Cancer Institute.

"We were struck by the shift in obesity-associated cancers to people in the 20 to 49 age group, but most notably to those in the 50 to 64 age range," said Koroukian. "Keep in mind that the population aged 50 to 64 increased in number by nearly 52% in that time frame, so the absolute numbers of people affected by these changes are substantial. It also is notable that the percent increase of obesity-associated cancer cases was highest among non-Hispanic Black and Hispanic women and men."

Researchers point out that many of the people 50 to 64 years of age with cancers diagnosed in the years from 2000 to 2016 are now cancer survivors, and many will be part of incoming Medicare cohorts or are now covered by Medicare. It also is likely that these individuals will be covered by Medicaid, given the financial burden of cancer care. Thus, obesity-associated cancers have both a public health and public finance impact.

"We all know that public health education efforts are important to address the impact of obesity on individuals' health and quality of life," said Berger. "This analysis of the SEER data proves the point at a population level, with dramatic findings for the Black and Hispanic communities. Public health practitioners and officials are wise to continue and even increase efforts to inform people about the adverse consequences of obesity, and support individuals and communities in changing behaviors that contribute to obesity."

Obesity-associated cancers included in this study include cancers of the colon and rectum (combined as colorectal), female breast, uterus, ovary, gallbladder and other biliary organs, esophagus, stomach, liver and intrahepatic bile duct, pancreas, kidney and renal pelvis, thyroid, and multiple myeloma. Cancers not included in the OAC grouping (including lung cancer, melanoma, and brain cancers) are referred to as non-OACs.

Researchers broke out the number of cases by specific types of cancer, stratified by age, gender and race. Specific types of OACs were dramatically higher in some populations and the contrast between the groups was striking, notably: the number of all OACs considered collectively in people aged 50 to 64 increased by 25% in non-Hispanic white women and nearly 200% in Hispanic men. For non-OACs considered collectively, among non-Hispanic white men aged 50 to 64, the increase was nearly 10%, while for Hispanic women, all non-OACs increased by nearly 100%.

Some of the greatest increases were observed in uterine cancer among Hispanic women, and in liver and thyroid cancers across all sex and race/ethnicity strata.

"Additional research is needed to ascertain the stage of cancer at which these cancers were diagnosed in various populations," said Koroukian. "Unfortunately, cancers diagnosed in younger people tend to be found at later stages of the disease, contributing to poor prognosis and premature mortality."