Women can maintain metabolically healthy obesity through exercise

Women can maintain metabolically healthy obesity through exercise

Exercise may be the best way for obese women to keep heart disease and related metabolic problems at bay, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

Although obesity is a risk factor for diabetes and heart disease, some people who are overweight or obese are able to delay or avoid developing related key risk factors, including prediabetes, high blood pressure and unfavorable cholesterol profiles. This phenomenon is described as metabolically healthy obesity.

"Because it is such a struggle for many people to lose weight, keeping people in a state of metabolically healthy obesity offers one potential avenue for reducing the rate of cardiovascular disease," said the study's primary author, Unab I. Khan, MD, MS, of Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, NY. "Our research identified physical activity as the most important factor in slowing the progression from metabolically healthy to at-risk obesity."

The researchers identified 866 women who fit the metabolically healthy obesity profile from the participants in the Study of Women Across the Nation (SWAN) Study, a multicenter, multiethnic, longitudinal study of women undergoing the menopausal transition. Over the course of the seven-year-long study, the participants' blood pressure, cholesterol and blood sugar levels were measured annually. Participants completed an annual survey regarding their physical activity.

At the end of the study, 373 women - 43 percent of the participants - had progressed to at-risk obesity. The researchers defined at-risk obesity as having at least two risk factors, including high blood pressure, an unfavorable cholesterol profile or prediabetes. Among the women who were metabolically healthy but obese, the authors found that women who had either prediabetes or diabetes were three times more likely to develop other risk factors and progress to being at risk than their counterparts.

"Although an alarming number of the participants developed metabolic risk factors during the study, the results show lifestyle changes can help lower the risk of heart disease and death," Khan said. "This demonstrates the important role exercise plays in protecting women from the adverse health effects of obesity."

Other authors of the study include: D. Wang of Albert Einstein College of Medicine; N. Khalil of Wright State University in Dayton, OH; C.A. Karvonen-Gutierrez and K.Y. Ylitalo of the University of Michigan School of Public Health in Ann Arbor, MI; and N. Santoro of the University of Colorado-Denver School of Medicine in Aurora, CO.

The study, "Progression from Metabolically Benign to At-risk Obesity in Perimenopausal Women: A Longitudinal Analysis of Study of Women Across the Nation (SWAN)," was published online, ahead of print.

The Endocrine Society

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Technology supports diabetic patients and their doctors

Technology supports diabetic patients and their doctors

Diabetes affects about 10% of the population; According to the World Health Organisation (WHO). The disease imposes a huge financial burden on health systems and also leads to early death and poor quality of life. However, patients and health care professionals will now be able to work together and the disease in better and more effective ways.

The reaction-health project, an EU-funded ICT research project that came to completion in February this year has developed an exciting set of tools and technologies that are helping patients with diabetes and their doctors manage the condition better.

RESPONSE project coordinator, Lydia Montandon says: ' the main purpose of reaction was to examine how information and communication technologies (ICT) patients and health care professionals can support in the management of diabetes by providing efficient and scalable tools that can be used in different contexts of health care across Europe. The result is an intelligent service platform that can be used for remote monitoring and therapy management, continuous and tight control of blood glucose levels and other vital signs that are crucial for good diabetes management and insulin therapy easier. '

Learn from patients and healthcare professionals

The response project is concerned patients and health providers since its inception. Patients at the Medical University of Graz in Austria and in primary care patients being treated at the health centre Chorleywood in the United Kingdom have the system use to manage their condition. In each stage the users of the system have given feedback that helped the researchers to design a system that is effective and intuitive.

In the hospital, nurses and doctors both said that the tools used (response GlucoTab ® system) helped to make them better care plans for their patients. The improved on-site documentation and predictions provided by the system meant that they could give more accurate doses of insulin. The result is that glucose levels of patients much more stable in the recommended target range remained. At the health centre, patients used the system to keep a close eye on their symptoms and their vital signs. They could then share these lectures with their doctor or nurse, and were much better able to stay healthy as a result.

That go beyond technology for better health

During the research project the teams developed a number of tools, such as GlucoTab ®, a Tablet PC-based system that doctors and nurses on the best course of treatment for each patient, a smartphone app that allows patients to control their diets, advises and networks of protocols that patients and health care professionals to share lectures from a variety of sensors worn or physically resides on the patient's body. In addition, it has made significant progress in the search for glycaemic control, automatic integration of blood glucose sensors and insulin dosing algorithm developed in the project.

But outside the hi-tech developments, reaction has also looked at the social, economic and legal implications of the technology. In the course of the project, the researchers documented how users and healthcare professionals felt about the technology, in order to better understand what tools like this might make more socially or professionally acceptable. They also studied the legal frameworks in the Member States with regard to privacy and liability. In addition, the reaction was GlucoTab ® system CE marked and can now be used in a clinical routine. The monitoring devices adapted for primary care patients, and gateway also passed safety and EMC tests and have received a CE mark. As a result, the response project has advanced technology for diabetes management much closer to reality.

Finally, the GlucoTab ® system in may 2014 won the price search for man-technology-Interface in the category "economic applications" granted by the Government of the Federal State of Styria.

How 'body clock' dysregulation underlies obesity, diabetes

How 'body clock' dysregulation underlies obesity, diabetes

A team of Texas A&M University System scientists have investigated how "body clock dysregulation" might affect obesity-related metabolic disorders.

The team was led by Dr. Chaodong Wu, associate professor in the department of nutrition and food sciences of Texas A&M's College of Agriculture and Life Sciences, and Dr. David Earnest, professor in the department of neuroscience and experimental therapeutics, Texas A&M Health Science Center.

Study results were published recently on the Journal of Biological Chemistry website.

"Animal sleeping and eating patterns, including those of humans, are subject to a circadian rhythmicity," Earnest said. "And previous studies have shown an association between the dysregulation of circadian or body clock rhythms and some metabolic disorders."

Wu said circadian clocks in peripheral tissues and cells drive daily rhythms and coordinate many physiological processes, including inflammation and metabolism.

"And recent scientific observations suggest that disruption of circadian clock regulation plays a key role in the development of metabolic diseases, including obesity and diabetes," he noted.

He said this study affirms that eating unhealthy foods causes health problems and that it's much worse to eat unhealthy foods at the wrong time. It also indicates that "time-based treatment may provide better management of metabolic diseases.

"To promote human health, we need not only to eat healthy foods, but also more importantly to keep a healthy lifestyle, which includes avoiding sleeping late and eating at night," he said.

Wu and Earnest said while previous studies using mice with genetic mutation of the removal of core clock genes has indicated that specific disruption of circadian clock function alters metabolism or produces obesity, the mechanism remained unknown. As key components of inflammation in obesity, macrophages, which are immune cells, contain cell-autonomous circadian clocks that have been shown to gate inflammatory responses.

"Our hypothesis was that overnutrition causes circadian clock dysregulation, which induces pro-inflammatory activity in adipose tissue. This then worsens inflammation and fat deposition, leading to systematic insulin resistance," Wu said.

To test the hypothesis, the team conducted experiments with "reporter mice" in which the circadian rhythmicity of various types of cells could be monitored by looking at their reporter activity. Accordingly, the reporter mice were put on a 12-hour light-dark cycle and were fed a high-fat diet. Additional reporter mice were fed a low-fat diet and served as controls. In this set of experiments, the team was able to characterize the effects of a high-fat diet on circadian clock rhythmicity and inflammatory responses in immune cells, or macrophages.

To further define a unique role for circadian clock dysregulation in metabolic disorders, the team conducted "bone marrow transplantation" experiments, through which the rhythmicity of circadian clocks was disrupted only in a specific type of immune cells. After high-fat diet feeding, the transplanted mice were used for collection of blood and tissue samples. A number of physiological and immunological assays also were performed on the mice.

Earnest said results showed that during obesity, that is when mice were fed a high-fat diet, the rhythmicity of circadian clocks in immune cells of fat tissue is dysregulated by a prolonged rhythmic period. This is, in turn, is linked to increased accumulation of immune cells in fat tissue and decreased whole-body insulin sensitivity.

"Animals on a high-fat diet display metabolic problems associated with obesity," Earnest said. "The problems are worsened in animals whose circadian clocks in immune cells are disrupted."

Earnest and Wu said the study will help those involved in human health and nutrition better understand the underlying mechanisms related to obesity and diabetes.

Women with diabetes 'less likely to breastfeed'

Women with diabetes 'less likely to breastfeed'

Breastfeeding is considered beneficial for both mother and baby. Breast milk is believed to give infants the nutrients they need, while breastfeeding has been associated with a lower risk of breast and ovarian cancers. But new research suggests that women diagnosed with diabetes before or during pregnancy are less likely to initiate or continue breastfeeding their newborns, compared with women without diabetes.

The research team, led by Dr. Reena Oza-Frank of the Center for Perinatal Research at Nationwide Children's Hospital in Columbus, OH, recently published their findings in the journal Public Health Nutrition.

Past research has indicated that infants born to women with diabetes during pregnancy, known as gestational diabetes, are more likely to develop hypoglycemia (low blood sugar) immediately after birth, as well as type 2 diabetes or obesity later in life. But Dr. Oza-Frank says breastfeeding can help reduce such risks.

The team set out to see whether pre-pregnancy diabetes or gestational diabetes influence breastfeeding initiation or the overall duration a mother breastfeeds.

For their study, the researchers looked at data from the 2009-2011 Pregnancy Risk Assessment Monitoring Program (PRAMS) - a surveillance project of the Centers for Disease Control and Prevention (CDC).

Women with pre-pregnancy or gestational diabetes are less likely to initiate or continue breastfeeding their newborns, research suggests.

Of almost 73,000 women, the researchers identified 8.8% who had gestational diabetes and 1.7% who had pre-pregnancy diabetes.

In order to ensure that any differences in breastfeeding initiation or continuation could be attributed solely to diabetes, the team accounted for 16 influential factors, including age, income and ethnicity.

They found that women with gestational diabetes and those without diabetes were equally as likely to start breastfeeding. However, women with gestational diabetes were more likely to breastfeed for at least 2 months less than healthy women.

Women with pre-pregnancy diabetes were less likely to start breastfeeding than those with gestational diabetes or without diabetes, but those who did breastfeed continued to do so for approximately the same duration as women with gestational diabetes.

Commenting on the team's findings, Dr. Oza-Frank says:

"We found that women with pre-pregnancy diabetes had the lowest breastfeeding initiation and continuation rates. However, women with gestational diabetes also had low continuation rates.

This study indicates that women with pre-pregnancy diabetes need additional support both initiating and continuing breastfeeding, and women with gestational diabetes need additional support continuing breastfeeding."

The researchers also found that 30% of women with pre-pregnancy diabetes said their illness and medication use deterred them from breastfeeding, indicating that diabetes and its treatment has a direct influence on women's breastfeeding decisions.

Many of the women with diabetes said they simply did not want to breastfeed or felt that they could not supply enough milk for their infants - reasons that were also cited among women without diabetes.

Dr. Oza-Frank says that women with pre-pregnancy or gestational diabetes could have their breastfeeding concerns put to rest by having prenatal education about how their illness may influence their infant's health and how breastfeeding may help reduce these risks.

"Breastfeeding intention is often the strongest predictor of breastfeeding initiation, and by establishing intent early in pregnancy, successful initiation is more likely," she adds. "Lactation consultants are an excellent resource and support for breastfeeding moms both immediately after delivery and beyond."

The researchers plan to further their research in this field by assessing exclusive breastfeeding rates for up to 6 months among women with pre-pregnancy and gestational diabetes. They also plan to look at the women's breastfeeding patterns in the first year of their infant's life, as well as the introduction of bottle-feeding and solid foods.

Earlier this year, Medical News Today reported on a study from Ohio State University, which suggested that the benefits of breastfeeding are "overstated."

Written by Honor Whiteman

How online games can help diabetic patients make healthier choices

How online games can help diabetic patients make healthier choices

Type 2 diabetes is a chronic disease of global importance. Because of the fear that comes with the long term physical degenerative processes, people with the disease often do not actively search for information about the health risks. According to a new study in the Journal of Consumer Research, modern technologies such as interactive games and virtual reality platforms can help people with Type 2 diabetes to check their health and make better choices on a regular basis.

"Our findings to light up the unrealised power of information information and communication technologies as social platforms," write authors Kelly Tian (University of Wyoming), Pookie Sautter, Derek Fisher (both New Mexico State University), Sarah Fischbach (University of Hawaii at Manoa), Cuauhtemoc Luna-Nevarez (Sacred Heart University), Kevin Boberg, Jim Kroger (both New Mexico State University), and Richard Vann (University of Wyoming).

The authors find that when people engage in interactive social platforms that can build and hosting online therapeutic communities, they are the people who daily empathy for living with chronic illness. Such as the online therapeutic communities have been developed, players are peers who mentor each other in making better choices about their health.

For companies interested in the financing of grants that support for health care, the study results support the need for creation of therapeutic Community involvement promote online communities where Visual platforms and markets for new technologies. The authors point also need a patient education reform and the design and distribution of information related to a chronic disease such as Type 2 diabetes.

"Emerging bio-health companies that develop products could also benefit from monitoring so that customer input characterized in their product designs," the authors conclude. "Patient visions of how these features help can ease trauma and life enhancing Show the power of the therapeutic community."

Kelly Tian, Pookie Sautter, Derek Fisher, Sarah Fischbach, Cuauhtemoc Luna-Nevarez, Kevin Boberg, Jim Kroger and Richard Vann. "Transform health care: Empowering therapeutic communities through technology-Enhanced stories." Journal of Consumer Research: August 2014.

University of Chicago Press journals

Advance can offer a fast and cost-effective way to identify safe replacements for BPA

Advance could offer a fast and cost-effective way to identify safe replacements for BPA

Numerous studies have linked exposure to bisphenol A (BPA) in plastic, receipt paper, toys, and other products with various health problems from poor growth to cancer, and the FDA has been supporting efforts to find and use alternatives. But are these alternatives safer? Researchers reporting in the Cell Press journal Chemistry & Biology have developed new tests that can classify such compounds ' activity with great detail and speed. The advance could offer a fast and cost-effective way to identify safe replacements for BPA.

Millions of tons of BPA and related compounds are produced each year. "I think it is fair to say that many of these analogs BPA have not been thoroughly tested, yet they are used in everyday plastics such as water bottles, baby bottles, and the lining or canned goods." says lead author Dr. Fabio Stossi or Baylor College of Medicine.

BPA and BPA analogs belong to a class of compounds called endocrine disruptors, so named because they can interfere with the body's endocrine, or hormonal, system. Using their newly developed assays on living cells, Dr. Stossi and his colleagues characterized how alpha and beta estrogen analogs affect different BPA 18 receptors, which are the primary targets of this class of chemicals. Their studies were conducted using high throughput microscopy and automated image analysis in different cell line models, with varying exposures to BPA analogs

The investigators were able to record and analyze massive data sets related to BPA analogs. "The high throughput approach that we've refined during the past several years can simultaneously quantify what these compounds are doing to a wide range of processes such as protein levels, nuclear trafficking, DNA binding, protein interactions, transcription, cell cycle, and proliferation," says senior author Dr. Michael a. Mancini, or Baylor and the Texas A&M Health Science Center Institute of Biosciences and Technology (IBT). "The results showed us that various BPA analogs increased or decreased certain receptor activities, while others were specific receptor; clearly, the various analogs BPA can have unique properties. "

The investigators found that many BPA analogs have inhibitory effects on the beta form of the estrogen receptor, a less well studied steroid receptor that has tumor fighting properties. Many analogs also acted to stimulate the alpha form of the estrogen receptor or they had mixed inhibitory and stimulatory effects. Determining precisely how these effects influence human health will require additional research. "These studies represent a breakthrough in our ability to focus precious resources on those endocrine disrupting chemicals or analogs and other BPA greatest concern," says coauthor Dr. Cheryl Walker of the IBT.

The scientists note that there are likely many more BPA-like compounds that can be found in products and in the environment. The widely applicable technologies used in the study will enable investigators to rapidly test such compounds for any unexpected or undesirable properties.

Defining Mechanisms or Estrogenic Bisphenol A Analogs through High Throughput Microscopy-Based Contextual Assays, Fabio Stossi, Michael j. Baker, Felicity j. Ashcroft, Jane e. Lamerdin, Jonathan s. Melnick, Reid t. Powell, Radhika d. Dandekar, Maureen g. Mancini, Cheryl l. Walker, John k. Westwick, Michael a. Mancini, Chemistry & Biology, DOI: 10.1016/j. chembiol. 2014.03.013, published online May 2014.

Cell Press

PKD patients who receive kidney transplants may have a reduced risk of cancer

PKD patients who receive kidney transplants may have a reduced risk of cancer

Patients with some form of kidney disease may have a reduced risk of cancer compared to patients with other kidney diseases, according to a study appearing in an upcoming issue of the journal of the American Society of Nephrology (JASN).

Polycystic kidney disease (PKD) is a disorder of the kidney by given by families in which many form of cysts in the kidneys, causing them to be extended. It has thought to have cancer-like properties, but cancer risk has never been compared between PKD patients and others with kidney disease. Cancer risk is also increased in people who have received a kidney transplant, due to the Immunosuppressive medications they should take.

James b. Wetmore, MD, MS (University of Kansas Medical Center) and his colleagues, the first study cancer risk in kidney transplant recipients with PKD research and compare their risk for those of other kidney-transplant recipients.

The team analyzed data from the National Cancer Institute Cancer transplant Match study, which information on all solid organ transplant recipients in the United States, as well as population-based data from 15 American Cancer Registries. For PKD receivers, the researchers compared to overall cancer risk to those in the general population. They also compared cancer cases in PKD versus non-PKD kidney-transplant recipients. The analysis included 10,166 kidney-transplant recipients with PKD and 107,339 without it.

After adjusting for demographic differences between kidney recipients with PKD PKD patients and other recipients, were 16% less chance of developing cancer than others who received a kidney transplant. Compared with the general population, was total cancer risk increased by 48% in PKD receivers, while overall cancer risk in non-PKD recipients increased 86%.

The findings indicate that PKD patients who receive transplants not a higher risk of cancer than other kidney-recipients. In fact, their risk of cancer may be lower. "The reason for the reduced risk is uncertain, but some factor or factors in PKD patients-either inherent to the disease process itself or in connection with the care patients receive PKD-is associated with lower risks of cancer," said Dr. Wetmore. "Further study is required to determine how PKD can affect cancer development."

Dr. Wetmore speculated that PKD certain anti-neoplastic defense mechanisms that provide protection against the development of cancer can cause. Alternatively, it may be that PKD patients, who often aware that they have a progressive condition and who are therefore usually receive close medical care for many years or decades, participate in other healthy behaviors that prevent cancer.

Understanding of the functioning of Taxol could lead to better drugs

Understanding of the functioning of Taxol could lead to better drugs

University of California, Berkeley, scientists have discovered the extremely subtle effect that the prescription drug Taxol has cells that it is one of the most widely used anticancer agents in the world.

The details, which the drug interference with the normal function of microtubules, part of the cell skeleton, could help in designing better drugs, or in improving Taxol and other drugs known to disturb the functioning of the microtubules.

The findings are reported in the journal cell.

"Efforts towards understanding this better chemotherapeutics are very important, because there are some differences microtubule in cancer cells versus normal cells that maybe we can exploit," said principle Author Eva Nogales, a biophysicist, UC Berkeley professor of molecular and cell biology and senior faculty scientist at Lawrence Berkeley National Laboratory (LBNL). "We are not there yet, but this is the kind of analysis we need to get there."

Taxol, originally extracted from the bark of the Pacific Hangul:, is one of the most commonly used medicines against solid tumors, and is a front-line drug for the treatment of ovarian cancer and advanced breast. The drug is known to bind to microtubules and freeze them essentially in place, which prevents the chromosomes to separate them when a cell divides. This will kill dividing line cells, particularly cancer cells, which are known for the rapid proliferation.

Nogales, a Howard Hughes Medical Institute researcher, has been working on microtubules since she was a doctoral student in England in the early 1990s, using techniques such as x-ray scattering and cryoelectron microscopy to study influence of Taxol and other anticancer agents on the microtubules. Later, during her postdoctoral work on LBNL with Ken Downing, she was the first to discover exactly where Taxol binds the basic building block, called tubulin, microtubule polymer.

Microtubules are of the cell skeleton

Work by many scientists around the world have shown the microtubule network within cells called the cytoskeleton, very different from stiff animal skeletons. Microtubules are polymer by amalgamation of filaments that are constantly growing and shrinking, and in doing so push and pull things around the cell, including the chromosomes. Scientists call this dynamic instability. The microtubules also offer a highway for the transport of the cell organelles and other packages around the cell.

Tubulin, microtubules, the basic structural unit is a complex of two proteins-alpha and beta tubulin. Tubulin units stack up a on top of another to align with other comics strips that form and then zip up to form a hollow tube, the microtubules.

"The cytoskeletal protein Tubulin in microtubules, assembles, that itself is absolutely essential to the life of every eukaryotic cell, which is why it has become a prime target of anticancer agents to," said Nogales. "It's amazing how microtubules probe and try new things almost random, but there is a level of control built into the cell that ultimately makes sense for this chaos, and the cell survives and flourishes."

Microtubules grow their free end about 1 micron per minute by continually adding more tubulin (about 20 tubulin molecules per second). But if they stop growing, they quickly peel apart as the skin of a banana, releasing tubulin for recycling in other microtubules. This peeling, or depolymerization, takes place on up to 15 micrometres per minute, or about 300 tubulin molecules falling off per second, Nogales said.

Microtubules are as compressed springs

Nogales has now discovered why microtubules as quickly peel apart. When they assemble, are put under intense pressure, but the strips tubulin bending and pulling apart prevented by the growing cap of tubulin in the end. Once growing stops and that Cap disappears, rips the understated tension the microtubule from each other.

The tension is created when the tubulin complex, which has a small energy molecule called GTP (Guanosine triphosphate) attached, and the GTP is hydrolysed in GDP ((III) calcium Guanosine diphosphate changes). This chemical reaction encrypts, compresses the alpha and beta subunits, much like compacted vertebrae, keep the tubulin stack under tension, as long as the microtubule on its end is growing.

"It had proposed that tubulin was to be limited, but nobody had it turned out to be," said Nogales. "What we have seen is that if GTP hydrolysis occurs, the tubulin structure gets stuck in a tense situation, like a compressed spring. The subunits end are to hold the whole thing together. "

If growth stops, the tension is released, and quickly Peel the strips apart.

"This work represents an important step forward on an issue with a long history," wrote Tim Mitchison in a commentary in the same issue of cell. Mitchison, a professor of Harvard University in systems biology, was the first to recognize the importance of GTP hydrolysis in destabilizing microtubules. The model proposed by Nogales and her team, he added, "offers our first glimpse in (the) mechanism destabilization."

Nogales also found that Taxol itself is inserted into the protein tubulin and prevent the compaction of the alpha and beta subunits, so no excitement builds. As a result, even if the microtubule stops growing, remains intact, basically frozen in place, peel apart, or depolymerize, and its normal function.

"Taxol reverses the effects of GTP hydrolysis," she said.

Nogales and her team discovered these structural changes by pushing the limits of cryoelectron microscopy, a technique in which samples are frozen and probed with a high-powered electron beam. They now have a resolution sufficient to details smaller than 5 angstroms (a tenth of a nanometer), which about the size of five hydrogen atoms is reached. While most information to date about the structure of tubulin in the microtubule has come from the study of artificial, flat sheets of aligned strips tubulin, Nogales was able to probe three dimensional microtubules frozen in their natural state, with and without Taxol bound to tubulin. This comparison showed clearly the effect that taxol has on microtubule structure.

Link discovered between clusters of 'broken hearts' and massive natural disasters

Link discovered between clusters of 'broken hearts' and massive natural disasters

Dramatic spikes in cases of Takotsubo cardiomyopathy, also called broken heart syndrome, were found in two states after major natural disasters, suggesting the stress of disasters as a likely trigger, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session. Authors call for greater awareness among emergency department physicians and other first responders.

Takotsubo cardiomyopathy, or broken heart syndrome, is a disorder characterized by a temporary enlargement and weakening of the heart muscle, which is often triggered by extreme physical or emotional stress - for example, being in a car accident or losing a child or spouse. Previous international studies have also linked broken heart syndrome to natural disasters, including the 2004 earthquake in Japan. This is the first U.S. study to examine the geographic distribution of the condition in relation to such catastrophes.

Researchers at the University of Arkansas identified 21,748 patients diagnosed with primary cases of broken heart syndrome in 2011 using a nationwide hospital discharge database. After mapping the cases by state, Vermont and Missouri emerged as having the highest rate of cases, with 380 cases per million residents in Vermont and 169 per million in Missouri. Most states had fewer than 150 cases per million residents. New Hampshire and Hawaii had the lowest rate of the disease that year.

The rate of broken heart cases in Vermont in 2011 was more than double most other states. This was the same year that Tropical Storm Irene pummeled the state with heavy rain and wind, causing the most devastation Vermont has experienced since the Great Flood of 1927. Similarly, researchers found broken heart syndrome at a rate of 169 cases per million in Missouri in 2011, the same year a massive tornado ripped through Joplin, Mo., demolishing neighborhoods and killing at least 158 people.

"Despite the seemingly increasing number of natural disasters we have, there is limited data about how it might affect the heart," said Sadip Pant, M.D., internist at the University of Arkansas for Medical Sciences, and lead investigator of the study. "Our findings suggest two disasters, one in Vermont and one in Missouri, might have been possible triggers for the clustering of Takotsubo cardiomyopathy cases in these regions."

Patients with broken heart syndrome often complain of chest pain and shortness of breath, symptoms that mimic those of a heart attack, which can delay diagnosis. In addition, biomarkers in the blood and changes on electrocardiogram can raise suspicions of possible heart attack. While broken heart syndrome typically resolves within a month or two, in the acute scenario it can result in serious complications such as heart failure, life-threatening arrhythmias and stroke. Previous studies by the same group found that as many as one in four patients with broken heart syndrome have some form of arrhythmia and 1 to 7 percent suffer cardiac arrest. Many patients are diagnosed in the cath lab when doctors see there are no blockages in the artery, or imaging reveals changes in the shape of the heart that are characteristic of broken heart syndrome.

"By and large, it is a very reversible form of cardiomyopathy, but in the acute phase these patients need to be monitored closely to be sure they are stable and to prevent and manage problems," Pant said, adding that the impetus for the study was the increasing number of cases and a desire to find out what might trigger clusters of broken heart syndrome. "It's also something that emergency doctors and medical personnel need to be aware of as they are often on the frontlines seeing patients after disaster strikes."

Episodes are thought to be driven by the sympathetic response and surges of adrenaline in the body, similar to the well-known fight-or-flight reaction. This leads to depressed function of the apex and middle segment of the heart and increased contractility of the base producing a balloon-like appearance.

"It's a perfect example of our brain-heart connection," Pant said. "The emotional stress we have in our brain can lead to responses in the heart, and not much is known about this condition."

Of course everyone's threshold for stress is different. There were other natural disasters in 2011. Pant said that because these events occur more frequently in some parts of the country, residents in these regions may have adapted to and experienced less stress during such occurrences; whereas in places like Vermont, where natural disasters are relatively rare, people may be more susceptible to extreme stress when a disaster hits particularly hard.

Hospital admissions for broken heart syndrome have been on the rise, but it is unknown whether the growing numbers are due to clinicians being more aware of the condition, especially since a reimbursement billing code was established for it in 2006, or if there is a true increase in its incidence. Either way, Pant says it is important to identify potential triggers.

Takotsubo cardiomyopathy got its name because the abnormal shape of the heart resembles a Japanese octopus fishing pot (tako=octopus, tsubo=pot). Pant says more research is needed to further explore the pathophysiological basis and management of this disease.

Guidance for evacuees in disaster zones inspired by ant colonies

Guidance for evacuees in disaster zones inspired by ant colonies

An escape route mapping system based on the behavior of ant colonies could give evacuees a better chance of reaching safe harbor after a natural disaster or terrorist attack by building a map of showing the shortest routes to shelters and providing regular updates of current situations such as fires, blocked roads or other damage via the smart phones of emergency workers and those caught up in the disaster.

Koichi Asakura of Daido University in Nagoya and Toyohide Watanabe of the Nagoya Industrial Science Research Institute in Japan have carried out successful simulations of the construction of navigational maps using this approach and report details in the International Journal of Knowledge and Web Intelligence. Following a major earthquake, tsunami, typhoon or other disaster it is crucial for those affected, including emergency workers, to obtain and share accurate and timely information about the situation as it unfolds. Lives can only be saved if evacuation to safe areas and shelters is not stymied by blocked roads, fires and other problems.

The team's new system has two key features: First it utilizes the smart phones that are now ubiquitous across cities as networked, mobile sensors that can feed information back to emergency centers. The second feature exploits our understanding of the behavior of an ant colony. This provides a way to determine whether or not particular problems are recent or not, just as individual ants use pheromone trails, and the concentration changes in those pheromones to assess how recently a colony member left a particular signal and so find the optimal routes to and from the nest via food supplies. By using this approach to analyze the data from myriad smart phones as evacuees head for shelter, it is possible to build an active navigational map using the phones' GPS and other tools.

The system circumvents the problem that would be almost inevitable during a disaster that closed circuit television (CCTV) cameras would be unreliable whereas sufficient numbers of wireless communication devices might remain active for sufficient time given a large enough number of service providers and communication towers spread widely across the disaster area. The next step will be to develop an ad hoc mobile networking system so that evacuees can themselves access these active maps rather than the present system that provides advice to emergency services for guiding evacuees. Such a network might also circumvent the problem of service provider outages by allowing individual smart phones to create a local network.

"Construction of navigational maps for evacuees in disaster areas based on ant colony systems" in Int. J. Knowledge and Web Intelligence, 2014, 4, 300-313

Federal costs could be lower by extending terrorism insurance program

Federal costs could be lower by extending terrorism insurance program

Federal spending after future terrorist attacks on the United States may be higher if the nation's terrorism risk insurance program is allowed to expire, according to a new RAND Corporation study.

The analysis finds that in a terrorist attack with losses up to $50 billion, the federal government would spend more helping to cover losses than if it had continued to support a national terrorism risk insurance program.

In the wake of the terrorist attacks of Sept. 11, 2001, terrorism risk insurance quickly became either unavailable or very expensive. Congress reacted by passing the Terrorism Risk Insurance Act, which provides an assurance of government support after a catastrophic attack. This has helped keep terrorism risk insurance affordable for businesses.

The program will expire at the end of this year and Congress is considering the appropriate government role in terrorism insurance markets.

"One important dimension of the debate about whether to reauthorize the act is its impact on government spending," said Tom LaTourrette, lead author of the study and senior physical scientist at RAND, a nonprofit research organization. "If, as many expect, allowing the program to expire causes a sharp decline in the number of businesses with terrorism coverage, we find that the federal government could spend billions more in disaster assistance after an attack than it would with the program in place."

The act creates an incentive for a functioning private terrorism insurance market through the promise of government support for losses that exceed a specified amount. This keeps terrorism insurance available with essentially no government spending unless terrorism losses reach catastrophic levels. Without the program, terrorism insurance would become less available and more attack losses would go uninsured, increasing demand for disaster assistance, said LaTourrette, who wrote the report with Noreen Clancy.

For simulated attacks with losses ranging from $14 billion to $26 billion, the RAND study estimates that the federal government would spend from $1.5 billion to $7.2 billion more without the program than with it.

The federal government makes no net expenditures through the program until the insured loss reaches at least $27.5 billion. For comparison, at current terrorism insurance coverage rates, an attack equivalent to the 9/11 attacks would have an insured loss of about $30 billion today. Taxpayers would therefore only contribute through the program in an attack comparable in magnitude to the 9/11 attacks, which is the second most costly insurance event in United States history, exceeded only by Hurricane Katrina.

When considering both disaster assistance and spending through the program, the impact of the program on federal spending reverses when total losses exceed about $50 billion. For losses below this amount, the federal government would pay more without the program; for larger losses, the federal government could pay less without the program, according to the study.

The study, "The Impact on Federal Spending of Allowing the Terrorism Risk Insurance Act to Expire," can be found at http://www.rand.org. The report is the second in a series about reauthorizing the Terrorism Risk Insurance Act.

Support for the study was provided by the property-casualty insurance industry and major business groups. Contributors included the American Insurance Association, Chubb & Son, The Financial Services Roundtable, Liberty Mutual Insurance Group, The NAREIT Foundation, National Association of Mutual Insurance Companies, National Council on Compensation Insurance, Property Casualty Insurers Association of America, The Real Estate Roundtable Education and Research Foundation, Reinsurance Association of America, and the Willis Group.

Research for the study was conducted within the RAND Center for Catastrophic Risk Management and Compensation, part of the RAND Justice, Infrastructure and Environment division.

RAND Corporation

Nutrition programmes should shift from treatment to prevention to meet African needs, new research shows

Nutrition programmes should shift from treatment to prevention to meet African needs, new research shows

Nutrition programmes by foreign donors in Africa are generally focused on treatment and technical solutions, like vitamin and mineral supplementation. But African researchers and policy makers ask for community-based interventions to prevent, rather than only remedy, nutritional problems. They also want Africa to take charge of research priorities to beat malnutrition and hunger. These are the findings of the two-year EU-funded SUNRAY ('Sustainable nutrition research for Africa in the years to come') project, which will be published in PLOS Medicine.

"In Benin, for example, international agencies implement programmes intended to solve acute malnutrition. However, the real malnutrition problem in the country is chronic malnourishment," said Dr. Eunice Nago Koukoubou of the Université d'Abomey-Calavi in Benin. According to demographic and health surveys in this West-African country, the prevalence of stunting among children aged less than 5 years increased from 25% (1990) to 45% (2011). Nearly one out of three of these children suffered from the severe form. While malnutrition rates are in decline globally, most African countries lag behind.

African researchers also warn that the current nutrition research agenda is driven mainly by funding bodies from outside Africa. They call for additional efforts to promote cross-African networking of researchers, as well as interactions between researchers and policymakers.

"Africa needs to take charge of research priorities if it is to beat hunger and malnutrition. African research is mostly descriptive and generates too little new evidence. Most of it is driven by a donor-defined agenda and performed in collaboration with researchers from developed countries, while collaboration within Africa remains very poor," added Nago Koukoubou.

If donor countries and organisations, including the European Union, want to beat food insecurity and malnutrition, they need to change their approach. That is the conclusion of the coordinator of the SUNRAY project, Prof. Patrick Kolsteren of the Institute of Tropical Medicine (ITM) in Antwerp:

"We need to shake up nutritional research in Africa and turn it upside down," said Prof. Kolsteren. "Currently, researchers from developed countries search African partners for joint research based on funding and research priorities defined outside Africa. Instead, the research agenda should be based on needs identified within the continent. Calls for research proposals of donors should match this agenda."

Article adapted by Medical News Today from original press release. Source:

Institute of Tropical Medicine Antwerp

Life changing HIV/STI prevention program in Haiti is saving lives

Life changing HIV/STI prevention program in Haiti is saving lives

New research from the University of Toronto shows that a little training can go a long way in a desperate situation.

Carmen Logie, assistant professor in the Factor-Inwentash Faculty of Social Work, demonstrated that marginalized and displaced women in Leogane, Haiti, can measurably impact mental and sexual health behaviours in their village. Leogane was at the epicentre of a 2010 earthquake that displaced entire populations and led to the collapse of business, social and health infrastructure throughout the country.

"By bringing women together for six educational sessions in a space for them to build connections and share their stories, public health improved significantly," explained Logie. "Sexual health awareness and practices increased significantly and rates of depression in the community dropped 20 per cent."

Logie visited Leogane six times between 2011-2012 training eight displaced women living in tents to become health workers. These eight health workers helped implement the program with help from 200 other displaced women.

Logie's educational sessions took a holistic approach that addressed sexual and mental health, healthy relationships and coping with trauma.

"By the end of the program participants had increased HIV and STI knowledge, increased condom use in the community and decreased depression rates from 33 to 13 per cent," says Logie.

Logie is planning to replicate the program in other parts of Haiti, integrating HIV testing and treatment as well as a micro-finance component to encourage citizens to build social and financial capital. She is also planning to adapt and pilot-test the program with displaced women in South Sudan.

Logie says the public needs to know about post-disaster situations and the long-lasting effect they can have on the poverty and health of survivors.

"We can empower internally displaced persons and build their capacity to be part of the solution and deliver whatever necessary help the situation calls for," says Logie. "There are 27 million internally displaced persons around the world living in tents and tent cities so we hope we can apply this concept elsewhere."

Obama administration announces additional assistance to Californians impacted by drought

Obama administration announces additional assistance to Californians impacted by drought

Agriculture Secretary Tom Vilsack joined President Barack Obama in Fresno, Calif., today to announce that the U.S. Department of Agriculture (USDA) will provide additional assistance to help farmers, ranchers and residents affected by severe drought in California. At President Obama's direction, USDA has made implementation of the 2014 Farm Bill livestock disaster assistance programs a top priority and plans to have the programs available for sign up by April 15, 2014.

"President Obama and I will continue to do everything within our power to support California farmers, ranchers and families living in drought-stricken areas. This assistance, coupled with other aid being made available across government, should provide some relief during this difficult time," said Vilsack. "Thanks to the newly-signed Farm Bill, we are now able to offer long-awaited livestock disaster assistance, which will provide needed stability for California livestock producers impacted by drought."

USDA has declared 54 counties in California as primary natural disaster areas due to drought. Additional USDA resources announced for California and other drought-stricken states today include:

$100 million in livestock disaster assistance for California producers. The 2014 Farm Bill contains permanent livestock disaster programs including the Livestock Forage Disaster Program, which will help producers in California and other areas recover from the drought. At President Obama's direction, USDA is making implementation of the disaster programs a top priority and plans to have the programs available for sign up in 60 days. Producers will be able to sign up for the livestock disaster programs for losses not only for 2014 but for losses they experienced in 2012 and 2013. While these livestock programs took over a year to get assistance out the door under the last Farm Bill - USDA has committed to cut that time by more than 80 percent and begin sign-up in April. California alone could potentially receive up to $100 million for 2014 losses and up to $50 million for previous years. $15 million in targeted conservation assistance for the most extreme and exceptional drought areas. This includes $5 million in additional assistance to California and $10 million for drought-impacted areas in Texas, Oklahoma, Nebraska, Colorado and New Mexico. The funding is available through the Environmental Quality Incentives Program (EQIP) administered by USDA. The assistance helps farmers and ranchers implement conservation practices that conserve scarce water resources, reduce wind erosion on drought-impacted fields and improve livestock access to water. $5 million in targeted Emergency Watershed Protection (EWP) Program assistance to the most drought impacted areas of California to protect vulnerable soils. EWP helps communities address watershed impairments due to drought and other natural occurrences. This funding will help drought-ravaged communities and private landowners address watershed impairments, such as stabilizing stream banks and replanting upland sites stripped of vegetation. $60 million has been made available to food banks in the State of California to help families that may be economically impacted by the drought. The U.S. Department of Agriculture (USDA) is providing help to food banks through The Emergency Food Assistance Program (TEFAP). 600 summer meal sites to be established in California's drought stricken areas. The U.S. Department of Agriculture (USDA) is working with the California Department of Education to target efforts to expand the number of Summer Food Service Program meal sites this summer. There are expected to be close to 600 summer meal sites throughout the drought stricken areas. $3 million in Emergency Water Assistance Grants for rural communities experiencing water shortages. U.S. Department of Agriculture (USDA) is making $3 million in grants available to help rural communities that are experiencing a significant decline in the quality or quantity of drinking water due to the drought obtain or maintain water sources of sufficient quantity and quality. These funds will be provided to eligible, qualified communities by application through USDA-Rural Development's Emergency Community Water Assistance Grants (ECWAG). California state health officials have already identified 17 small community water districts in 10 counties that are at risk of running out of water in 60-120 days. This number is expected to increase if current conditions persist.

Today's announcements build on other recent USDA efforts to help farmers, ranchers, and forest landowners mitigate the impacts of drought. Last week, USDA announced $20 million in Environmental Quality Incentives Program (EQIP) funds for agricultural conservation enhancements on key agricultural lands in California1. These enhancements include irrigation efficiency, cover crops, orchard pruning, and protection of grazing lands. USDA also announced $15 million in Conservation Innovation Grants2 (CIG) in available funding to state and local governments, Tribes, universities, businesses and agricultural producers. These grants are dedicated to stimulating the development and adoption of innovative conservation approaches and technologies, including those that will help communities adapt to drought and climate change.

USDA also announced last week the establishment of regional Climate Hubs across the country that will help farmers, ranchers and communities get the information and data they need to make informed decisions around a changing climate3. One center was established at the University of California, Davis.

As USDA begins implementing disaster assistance programs, producers should record all pertinent information of natural disaster consequences, including:

Documentation of the number and kind of livestock that have died, supplemented if possible by photographs or video records of ownership and losses; Dates of death supported by birth recordings or purchase receipts; Costs of transporting livestock to safer grounds or to move animals to new pastures; Feed purchases if supplies or grazing pastures are destroyed; Crop records, including seed and fertilizer purchases, planting and production records; Pictures of on-farm storage facilities that were destroyed by wind or flood waters; and Evidence of damaged farm land.

For more information about today's announcements, visit the USDA drought resource page at http://www.usda.gov/drought.

40% of minors in Lorca suffer post-traumatic stress a year after earthquake

40% of minors in Lorca suffer post-traumatic stress a year after earthquake

Spanish researchers have analysed the impact of the Lorca catastrophe by the percentage of minors suffering post-traumatic stress. Results reveal that 55% of young people displayed this disorder a month on from the earthquake and 40% were still suffering a year later.

On 11 May 2011, Lorca suffered an earthquake measuring 5.1, preceded by another of 4.5, which killed nine people and caused significant material damage.

Two experts from the University of Murcia compared the prevalence of post-traumatic stress disorder (PTSD) on the population of minors in the region in its acute phase (one month after the quake) and as a chronic condition (one year later).

"The analysis indicates that 55% of the minors suffered from post-traumatic stress one month after the earthquake, while after one year this had decreased to 40%", as Concepción López Soler, researcher from the University of Murcia and co-author of the study with Juan José López García, explained to SINC.

The results, published in the journal Gaceta Sanitaria, reveal that 75% of the minors presented re-experiencing symptoms (recurrent thoughts, nightmares and physiological manifestations) after one month and 60% after one year.

In addition, a month later, 42% suffered from avoidance of anything related to the tragedy (memory disturbances, emotional blockage) and 24% after one year. 51% also displayed hyperarousal (sleeping difficulties, irritability and concentration problems) after a month and 38% a year later.

The authors argue that post-traumatic reactions generally tend to disappear over time. "After the earthquake new mental health resources were implemented to assist people with severe post-traumatic stress", stresses López Soler.

Primary school pupils in their 3rd and 6th year in educational centres from the municipal area were asked for their voluntary participation in this study. One month after the earthquake the level of PTSD was assessed in 495 minors and in 374 after one year.

"It is important to highlight that the younger age groups and girls are more sensitive to developing these symptoms, which coincides with the results of other studies", the Murcian researcher points out. "Young girls in particular are a special risk group."

Among the younger students, 54% of girls showed symptoms of post-traumatic stress compared to 39% of boys.

The evaluation was carried out using the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-IV-TR), using the Child PTSD Symptom Scale (CPSS) questionnaire which was developed to evaluate the post-traumatic stress in minors after an earthquake in Northridge (Los Angeles, USA) in 1994.

Stress after trauma

"Natural disasters create a sense of loss of personal safety and endangered survival among the population", adds López Soler. Earthquakes are one of the disasters which cause the greatest psychological disturbances in the population and PTSD is the reaction most associated with adverse conditions.

"With previous earthquakes, the affected population has been quite variable", she states. Three years after the Turkey earthquake in 1999, the prevalence of PTSD was 59%; 18 months after the earthquake in Kashmir (between India and Pakistan), it was 64.8% and ten months after the disaster in L'Aquila (Italy) in 2009, it was greater than 60%.

In comparison with other studies, the prevalence of PTSD is somewhat lower, which according to the authors can be understood to be due both to the lesser intensity of the earthquake and its consequences, and swift normalisation of the environment.

Some children are more resilient than others to post-traumatic stress

Some children are more resilient than others to post-traumatic stress

Children exhibit a range of responses to traumatic events such as natural disasters, with some suffering acute traumatic reactions that resolve over time and others experiencing long-term symptoms of post-traumatic stress. Identifying factors that may help predict which youths are at greater risk of more serious disorders and which are likely to be more resilient following a traumatic event can help determine the care and services needed, according to an article in Journal of Child and Adolescent Psychopharmacology (JCAP), a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is part of a special issue on pediatric traumatic stress that is available on the JCAP website.

In the article "Resilience and Trajectories of Post-traumatic Stress Among Youth Exposed to Disaster," Carl Weems, PhD and Rebecca Graham, University of New Orleans, LA, compare post-traumatic stress (PTS) symptoms among children exposed to both hurricanes Katrina and Gustav and describe the different risk factors and coping styles associated with resiliency to PTS.

Guest Editors Judith Cohen, MD, Drexel University, Philadelphia, PA, and Michael Scheeringa, MD, Tulane University, New Orleans, LA, emphasize the importance of recognizing the similarities and differences in how children and adults react to traumatic events, and the effect that family dynamics and caregivers can have on treatment strategies and their outcomes in the Journal's Editorial.

In another article, authors Richard Meiser-Stedman, PhD, et al., MRC Cognition & Brain Sciences Unit, Cambridge, U.K., and King's College and King's College Hospital, London, caution against using certain cognitive strategies aimed at blocking trauma-related memories in adults and adolescents in the article entitled "Thought Control Strategies and Rumination in Youth with Acute Stress Disorder and Post-traumatic Stress Disorder Following Single-Event Trauma."

In "Perceived Parenting Change and Child Posttraumatic Stress Following a Natural Disaster," Vanessa Cobham, PhD and Brett McDermott, MD, University of Queensland, Brisbane, Australia, identify a link between specific parenting practices and increased risk for PTS symptoms among the children in a household following a natural disaster.

Harold S. Koplewicz, MD, Editor-in-Chief of JCAP, and President, Child Mind Institute, New York, NY, states that there is a "palpable shift in the profession towards considering even sub-threshold PTS symptoms a worthy target of intervention in kids who have experienced a possible traumatic event, such as natural disaster or violence. Even children who do not meet specific criteria in terms of how they response to trauma may warrant care - and this care can be helpful. This work is of particular importance in light of recent school shootings and natural disasters."