Socioeconomic factors affect response to depression treatment

Cross-college collaboration highlights importance of patients’ home environments

April 15, 2022

Science Daily/University of Cincinnati

Patients seeking treatment for depression who have lower income and education and those who are members of minority populations tend to have worse treatment outcomes even when receiving equal access to treatment, according to new research from the University of Cincinnati.

Led by Jeffrey Mills, PhD, and Jeffrey Strawn, MD, the UC cross-college collaborative research was recently published in the journal Psychiatric Services.

Strawn, professor in the Department of Psychiatry and Behavioral Neuroscience in UC's College of Medicine and a UC Health adolescent psychiatrist, said that previous research has concluded that people seeking treatment for depression with lower income and less education have worse outcomes because of a lack of access to quality health care, but it is hard to isolate socioeconomic factors as they are often intertwined.

The research team analyzed data from a very large clinical trial known as CO-MED that enrolled 665 patients seeking treatment for depression. In the randomized trial, all patients had the same access to treatment without differences due to health insurance or income.

Study results

After controlling for sex, age and treatment type following 12 weeks of antidepressant medication treatment in the study, the team's analysis found patients who were non-white improved 11.3% less compared to white patients. Those who were unemployed saw 6.6% less improvement compared to employed patients. Compared to patients in the 75th percentile of income distribution, patients having income at the 25th percentile reduced improvement by 4.8%.

Strawn noted the findings are still preliminary, but he was particularly interested to find that patients without a college degree had 9.6% less improvement compared to college graduates.

"We think about these things in terms of access, we think about them in terms of income inequality, and I realize that education does track with those, but just having a college degree while controlling for all of these other factors still had a significant impact," said Strawn.

The researchers also examined the effect of the combination of socioeconomic factors, since the individual factors are often correlated, Mills said. Patients who were non-white, unemployed with no degree and had income in the 25th percentile had 26% less improvement compared to patients who were white, employed with a college degree and had income in the 75th percentile.

Mills said that the findings do not negate the fact that a lack of access makes an impact on treatment outcomes, but it does show the importance of including a patients' home environment when analyzing the effectiveness of treatment.

"If you're going home to a wealthy neighborhood with highly educated parents or spouse, then you're arguably in a much better environment for the treatment to be effective than if you're going to a poor neighborhood with other problems," said Mills, professor of economics in UC's Carl H. Lindner College of Business.

Strawn said other research suggests patients in resource-poor environments may be affected by greater chronic variable stress, meaning high stress in a pattern that is intermittent and difficult to predict. Other studies suggest chronic variable stress has a worse effect on patients than chronic sustained stress that is more steady, he said.

"So this is, 'I was able to pay my rent this month, but I'm not sure that I will be able to next month. And I have a job right now, but I don't know that I will next month,'" Strawn said. "So it's just the impact of all those things as well as maybe having relatives or kids who have fewer educational resources or other job-related stress, or potentially other health problems, and you're still running into those same barriers in terms of access and cost and support there."

Research application

The study findings have the potential to impact clinical trials by designing studies that pay better attention to socioeconomic variables that may have been previously overlooked, Strawn said.

"When we don't control for these variables, which we often do not in our clinical trials because of differences in populations, we may miss detecting an effective treatment because its effect is obscured," Strawn said. "So it can potentially jeopardize our treatment development by not accounting for these factors."

Strawn said those treating patients every day can use the knowledge from the study in a more straightforward approach. While removing barriers of access to treatment is important, he said clinicians must also acknowledge that a patient's socioeconomic environment may be affecting their ability to get better with treatment when measuring progress and crafting future treatment plans.

Mills said the research also has important implications when crafting and implementing economic policy, such as the recently passed infrastructure bill or ongoing discussions on the minimum wage. The impact of a policy on an individual's socioeconomic environment, and subsequently their mental health, is not typically considered, he said.

"Someone employed at a higher wage has a chance to improve their socioeconomic status and environment, and so they're definitely less likely to get mental health problems," he said. "If people with higher socioeconomic status do get mental health problems, what we're showing is they're more likely to improve if they get treatment."

Team science

In the past, two researchers with different specialties in different colleges within a university may have never worked together on research like this, but the collaboration shows the benefit of what is called team science, a transdisciplinary approach to research.

Strawn explained that traditional multidisciplinary research often looks like a psychiatrist, a neurologist and a psychologist all within the College of Medicine working together on a project. While that has its place, team science works across disciplines and involves completely separate sets of expertise, concepts and approaches.

"We think of multidisciplinary as being kind of the fruit salad where you have your grapes and your bananas, but everything is still distinct," Strawn said. "And then you have your transdisciplinary, where things are really blended and it's difficult to tell whose contributions are whose. That's probably more like the fruit smoothie of disciplinary integration. I think that's hopefully what we've achieved."

Mills said he has previously seen colleagues expected to closely collaborate who never published a paper together because their skill sets were too similar and they did not need each other to move forward. Alternatively, Mills and Strawn have interest in each other's field and bring varying, complementary skill sets to the research.

"It's further than just multidisciplinary, because if I get together with my colleagues, we still have had very similar training. We use the same jargon, we have similar ideas," Mills said. "There's not the same cross pollination in stepping out of your field and thinking about other topics and giving each other ideas and concepts that you may not have thought about."

Moving forward, the researchers want to continue the research by combining data from other depression trials to produce more powerful results with a larger dataset.

https://www.sciencedaily.com/releases/2022/04/220415112155.htm

High cardiovascular risk is associated with symptoms of depression

Improving cardiovascular health might help prevent the onset of depression in the elderly, researchers say

April 13, 2022

Science Daily/PLOS

Cardiovascular risk factors are associated with an increased risk of depression in older adults, according to a new study published April 13 in the open-access journal PLOS ONE by Sandra Martín-Peláez of University of Granada, Spain, and colleagues.

Cardiovascular disease and depression are thought to be closely related due to similar risk factors, including inflammation and oxidative stress. Although it has been shown that depression could be a risk factor for developing cardiovascular disease, studies analyzing the potential impact of cardiovascular health on developing depression are scarce.

In the new study, the researchers used data from an ongoing 6-year multi-center randomized trial in Spain which analyzes the effect of a Mediterranean Diet on men aged 55-75 and women aged 60-75 with overweight or obesity. 6,545 individuals with no cardiovascular or endocrine disease at baseline were included in the current analysis. A cardiovascular risk score according to the Framingham-based REGICOR function was calculated for each person, dividing participants into low (LR), medium (MR), or high/very high (HR) cardiovascular risk groups. Depressive status was gauged using a questionnaire at baseline and after 2 years of follow-up.

At baseline, women in the HR group showed higher odds of depressive status than LR women (OR 1.78 95% CI 1.26-2.50). In addition, among all participants with baseline total cholesterol below 160 mg/mL, MR and HR individuals showed higher odds of depression than LR (MR: OR 1.77 95% CI 1.13-2.77; HR: OR 2.83 95% CI 1.25-6.42). On the contrary, among participants with total cholesterol of 280 mg/mL or higher, MR and HR individuals had a lower risk of depression than LR (MR: OR 0.26 95% CI 0.07-0.98; HR: OR 0.23 95% CI 0.05-0.95). After two years, during which time all individuals were instructed to follow a Mediterranean Diet as part of the trial, participants, on average, decreased their depressive status score, with the greatest decreases seen for MR and HR participants with high baseline cholesterol levels.

The authors conclude that high and very high cardiovascular risk are associated with depressive symptoms, especially in women, and that the role of other factors, such as adherence to the Mediterranean Diet, deserves further research.

The authors add: "High cardiovascular risk, especially in women, is associated with symptoms of depression in the elderly."

https://www.sciencedaily.com/releases/2022/04/220413141551.htm

Babies exposed to cannabis in the womb may be at risk for obesity, high blood sugar

Both CBD and THC put children at risk despite CBD being marketed as having health benefits

March 31, 2022

Science Daily/The Endocrine Society

Cannabis use among pregnant women is on the rise and may be associated with negative health outcomes in children, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology and Metabolism.

A 2016 study in Colorado revealed that up to 22% of pregnant women had detectable levels of cannabinoids in their body. Women who use cannabis, both tetrahydrocannabinol (THC) and cannabidiol (CBD), during pregnancy could be putting their child at risk for low birth weight and behavioral problems. Exposure to cannabinoids may also increase the child's future risk of obesity and high blood sugar.

Part of CBD's popularity is that it is marketing as being "nonpsychoactive," and that consumers can reap health benefits from the plant without the high. CBD is advertised as providing relief for anxiety, depression and post-traumatic stress disorder. It is also marketed to promote sleep.

"We found that cannabis use during pregnancy was linked to increased fat mass percentage and fasting glucose levels in 5-year-old children," said Brianna Moore, Ph.D., of the Colorado School of Public Health in Aurora, Colo. "We would encourage women to refrain from using any cannabis while pregnant or breastfeeding to minimize adverse health effects in the offspring."

The researchers studied urine samples from 103 pregnant women, 15% of whom had detectable levels of cannabinoids (such as THC and CBD) in their urine. These mothers' 5-year-old children had higher fat mass and fasting glucose levels compared to children who were not exposed to cannabis during pregnancy.

"More studies are needed to understand how exposure to different cannabinoids during pregnancy may impact the offspring," Moore said.

https://www.sciencedaily.com/releases/2022/03/220331101458.htm

Personality traits are associated with well-being and satisfaction in life after work

As we experience the Great Resignation, new findings could inform efforts to support older adults after retirement

March 30, 2022

Science Daily/PLOS

A new study has identified novel associations between older adults' personality traits, the routes they took to leave their jobs, and their well-being after exiting the workforce. Dusanee Kesavayuth of Kasetsart University in Bangkok, Thailand, and colleagues present these findings in the open-access journal PLOS ONE on March 30, 2022.

As the world's population of older adults grows, communities and policy makers are increasingly interested in the well-being of those leaving the labor market. Researchers have begun to explore how different exit paths -- mandatory retirement versus voluntary retirement, for instance -- may be associated with subsequent life satisfaction. But few studies have addressed how such associations may vary depending on people's personality traits.

To help clarify, Kesavayuth and colleagues analyzed data from more than 2,000 adults aged 50 to 75 who participated in the British Household Panel Survey. The dataset included assessment of participants' "Big Five" personality traits -- a standard evaluation of personality -- and subsequent life satisfaction after participants left their jobs, whether voluntarily or not, without plans to begin working again.

Statistical analysis of the data uncovered associations between the routes people took to exit their jobs and their subsequent satisfaction with life, income, and leisure. However, these associations did indeed vary according to their personality traits.

For example, the trait of conscientiousness was linked to increased satisfaction with leisure time for older adults who underwent mandatory retirement, and to increased life satisfaction for people who became unemployed. The authors suggest that conscientiousness might act as a "psychological buffer," with conscientious individuals being more proactive in finding new fulfilling life patterns.

Among people who retired early, extraversion was linked to lower satisfaction with life, income, and leisure. However, for people who stopped working due to ill health or caregiving demands, extraversion was linked to higher satisfaction with leisure time. The authors speculate that extraverts might miss social relationships at work, but might also be motivated to find sociable, rewarding hobbies.

Associations were also found for the traits of agreeableness, openness, and neuroticism. These associations do not confirm any causal relationships between the various factors, and proposed explanations can only be speculative at this stage. However, the findings could help guide targeted interventions and policies to boost the well-being of aging adults. Such efforts could be especially relevant during the current mass exodus of workers from the labor force in the context of the COVID-19 pandemic.

The authors add: "Our study uncovered associations between the routes people took to exit their jobs and their subsequent satisfaction with life, income, and leisure. These associations varied according to people's personality traits. Conscientious individuals were more proactive in finding new fulfilling life patterns."

https://www.sciencedaily.com/releases/2022/03/220330141408.htm

Exercise may reduce depression symptoms, boost effects of therapy

March 30, 2022

Science Daily/Iowa State University

Exercising for half an hour may reduce symptoms of depression for at least 75 minutes post-workout and amplify the benefits of therapy, according to two new studies led by researchers at Iowa State University.

"A lot of previous research on the effects of exercise on mental health, in general, have used very broad measures of wellbeing. What we were interested in, specifically, is: how does acute exercise -- that is, one session of exercise in a day -- influence the primary symptoms of depression," said Jacob Meyer, a professor of kinesiology at ISU and the lead-author of both publications.

For the first study, the researchers recruited 30 adults who were experiencing major depressive episodes. The participants filled out electronic surveys immediately before, half-way-through and after a 30-minute session of either moderate-intensity cycling or sitting, and then 25-, 50- and 75-minutes post-workout. Those who cycled during the first lab visit came back a week later to run through the experiment again with 30-minutes of sitting, and vice versa.

Each survey included standard questions and scales used to measure symptoms of depression and several cognitive tasks, including the Stroop test; participants responded to the color of a particular font rather than the word itself (e.g., indicating red when they saw the word 'blue' in red ink).

The researchers then used the survey data to track any changes in three characteristics of major depressive disorder: depressed mood state (e.g., sad, discouraged, gloomy), anhedonia (i.e., difficulty experiencing pleasure from activities previously enjoyed) and decreased cognitive function (e.g., difficulty thinking, juggling multiple pieces of information at once).

During the cycling experiment, participants' depressed mood state improved over the 30 minutes of exercise and consistently up to 75 minutes afterward. The improvement to anhedonia started to drop off at 75 minutes post-exercise, but still was better than the participants' levels of anhedonia in the group that did not exercise.

As for cognitive function, participants who cycled were faster on the Stroop test mid-exercise but relatively slower 25- and 50-minutes post-exercise compared to participants in the resting group. Meyer said more research is needed to understand the variation.

"The cool thing is these benefits to depressed mood state and anhedonia could last beyond 75 minutes. We would need to do a longer study to determine when they start to wane, but the results suggest a window of time post-exercise when it may be easier or more effective for someone with depression to do something psychologically or cognitively demanding," said Meyer.

He said that could include giving a presentation, taking a test -- or going to therapy.

"Can we synergize the short-term benefits we know that happen with exercise and the clear long-term benefits with therapy to deliver the most effective overall intervention?" asked Meyer.

As part of the effort to answer that question, Meyer and his research team conducted a separate pilot study.

Half of the ten participants exercised on their own (e.g., cycled, jogged, walked) for 30 minutes at a pace they considered moderate intensity, which the researchers also verified with Fitbit data, before signing into an hour of virtual, cognitive behavior therapy each week. The other participants simply continued in their day-to-day activities prior to their therapy sessions.

At the end of the eight-week intervention program, participants in both groups showed improvements, but those who exercised before talking with a therapist had more pronounced reductions in symptoms of depression.

The researchers said the results indicate exercise could help amplify the benefits of therapy for adults with depression.

"With such a small group, we did not perform formal statistical testing, but the results are promising," said Meyer. "Overall, the pilot study showed people were interested and would stick with the combined approach, and that exercise seemed to have some effects on depression and a couple of the mechanisms of therapy."

One of those mechanisms relates to the relationship between a client and therapist. If someone feels a connection with their therapist, Meyer said, there's a higher chance they'll continue going to therapy and the sessions likely will have greater impact.

In the pilot study, participants who exercised before the cognitive behavior therapy session reported a quicker and stronger connection with their therapists. The researchers said the findings suggest exercise may be priming or "fertilizing" the brain to engage with more emotionally challenging work that can happen during therapy.

The researchers said they hope to expand on the innovative studies in the coming years to better understand how exercise could be incorporated into an effective treatment or intervention for people experiencing chronic depression.

https://www.sciencedaily.com/releases/2022/03/220330101735.htm

Exercise holds even more heart health benefits for people with stress-related conditions

Study underscores the brain’s role in deriving cardiovascular benefits from physical activity

March 24, 2022

Science Daily/American College of Cardiology

Regular physical activity had nearly doubled the cardiovascular benefit in individuals with depression or anxiety, compared with individuals without these diagnoses, according to a study presented at the American College of Cardiology's 71st Annual Scientific Session.

The research findings add to mounting evidence that exercise improves cardiovascular health by helping to activate parts of the brain that counteract stress. Overall, the study found that people who achieved the recommended amount of physical activity per week were 17% less likely to suffer a major adverse cardiovascular event than those who exercised less. These benefits were significantly greater in those with anxiety or depression, who had a 22% risk reduction vs. a 10% risk reduction in those without either condition.

"The effect of physical activity on the brain's stress response may be particularly relevant in those with stress-related psychiatric conditions," said Hadil Zureigat, MD, postdoctoral clinical research fellow at Massachusetts General Hospital and the study's lead author. "This is not to suggest that exercise is only effective in those with depression or anxiety, but we found that these patients seem to derive a greater cardiovascular benefit from physical activity."

Rates of both depression and anxiety have risen during the COVID-19 pandemic, and heart disease remains the leading cause of death in the U.S. The study findings underscore the important role of exercise in maintaining heart health and reducing stress, according to the researchers.

For the study, researchers analyzed health records of more than 50,000 patients in the Massachusetts General Brigham Biobank database. Just over 4,000 of the patients had suffered a major adverse cardiovascular event, which included experiencing a heart attack, having chest pain caused by a blocked artery or undergoing a procedure to open a blocked artery in the heart.

Researchers first assessed the rates of major coronary events among patients who reported in a questionnaire that they exercise at least 500 metabolic equivalent (MET) minutes per week -- aligning with the ACC and American Heart Association primary prevention guideline recommendation of at least 150 minutes of moderate intensity exercise per week -- with those who exercise less. MET-minutes are a unit of exercise that represents the amount of energy expended during various activities. The analysis revealed that people who got at least 500 MET-minutes or more per week were 17% less likely to suffer an adverse cardiovascular event.

They then analyzed how this pattern played out among patients who had a diagnosis of depression or anxiety compared with those who did not have depression or anxiety. This second analysis revealed that patients with depression derived more than double the benefit from exercise in terms of reduced cardiovascular risk compared with people who did not have depression. A similar benefit of exercise was found for patients with anxiety.

The research expands upon previous studies by the research team that used brain imaging to determine how exercise improves cardiovascular health by helping to keep the brain's stress response in check. Individuals with depression or anxiety have higher stress-related neural activity and a higher risk of cardiovascular disease.

"When one thinks about physical activity decreasing cardiovascular risk, one doesn't usually think of the brain," Zureigat said. "Our research emphasizes the importance of the stress-related neural mechanisms by which physical activity acts to reduce cardiovascular risk."

Even though the study used 500 MET-minutes as a cutoff for the analysis, researchers noted that previous studies show people can reduce their heart disease risk even if they do not achieve the recommended amount of physical activity. Even a little bit of regular physical activity can make a difference in terms of cardiovascular risk.

"Any amount of exercise is helpful, particularly for those with depression or anxiety," Zureigat said. "Not only will physical activity help them feel better, but they will also potently reduce their risk of cardiovascular disease. It can be hard to make the transition, but once achieved, physical activity allows those with these common chronic stress-related psychiatric conditions to hit two birds with one stone."

https://www.sciencedaily.com/releases/2022/03/220324104415.htm

Cases of cognitive decline in older people more than double in ten years

March 24, 2022

Science Daily/University College London

The researchers set out to see if there had been an increase in the numbers of older people who were reporting their first concerns about memory loss or cognitive decline to their doctor and what their chances of developing dementia were after consultation.

The study, published today in Clinical Epidemiology, looked at data from more than 1.3m adults aged between 65 and 99 years old, taken between 2009 and the end of 2018. The researchers identified 55,941 adults who had spoken to their GP about memory concerns and 14,869 people who had a record of cognitive decline.

For every 1,000 people that were observed for one year in 2009, there was one new case of cognitive decline being recorded. By 2018, for every 1,000 people that were observed for one year, there were three new cases of cognitive decline being recorded.

Lead author and PhD candidate Brendan Hallam (UCL Epidemiology & Health Care) said: "This is an important study which sheds new light on how prevalent memory concerns and cognitive decline are among the older generation in the UK and how likely these symptoms might progress to a dementia diagnosis.

"The study showed that while memory concern rates had remained stable, incidence of cognitive decline, a step beyond memory concern, had more than doubled between 2009 and 2018.

"There has been a drive in the past decade to encourage people to seek help earlier from their doctors if they are worried about their memory and we found that among those over 80, women and people living in more deprived areas were more likely to have a record of memory concern or cognitive decline, and their symptoms were more likely to progress to dementia diagnosis."

The study also showed that within three years of following up a person from the date when the doctor reported a memory concern, 46% of people would go on to develop dementia. For people with cognitive decline, 52% would go on to develop dementia.

Co-author, Professor Kate Walters (UCL Epidemiology & Health Care) explained: "People who have been noted in their health records as having concerns about their memory are at just under 50% chance of developing dementia within the next three years."

Brendan Hallam also outlined "Memory concerns and cognitive decline are not only hallmark symptoms of dementia, but they also predict a high risk of developing dementia. It is important for GPs to identify people with memory concerns as soon as possible to deliver recommendations to improve memory and allow timely diagnosis of dementia."

The authors note one potential limitation of the present study is the potential variations in which GPs record memory concerns and memory decline. They also say more research is needed to better understand the discrepancy between rates of memory symptoms and cognitive decline in the general population and those recorded in primary care.

https://www.sciencedaily.com/releases/2022/03/220324104459.htm

Lipid and glucose levels at age 35 associated with Alzheimer's disease

Study has implications for delaying or lowering risk

March 23, 2022

Science Daily/Boston University School of Medicine

Living your best life at 35, ignoring cholesterol and glucose levels, may impact your chances of getting Alzheimer's disease (AD) later in life. According to researchers from Boston University School of Medicine (BUSM), lower HDL (high-density cholesterol) and high triglyceride levels measured in blood as early as age 35 are associated with a higher incidence of AD several decades later in life. They also found that high blood glucose measured between ages 51-60 is associated with risk of AD in the future.

"While our findings confirm other studies that linked cholesterol and glucose levels measured in blood with future risk of Alzheimer's disease, we have shown for the first time that these associations extend much earlier in life than previously thought," explains senior author Lindsay A. Farrer, PhD, chief of biomedical genetics at BUSM.

The researchers believe that although high LDL has been consistently associated with AD risk in many previous studies, the link between HDL and AD was inconclusive, perhaps because most studies examining these relationships were conducted in persons who were 55 years and older at baseline.

This study was conducted using data obtained from participants of the Framingham Heart Study who were examined in approximately four-year intervals throughout most of their adult lives. Correlations of AD with multiple known risk factors for cardiovascular disease and diabetes (including HDL, LDL, triglycerides, glucose, blood pressure, smoking, and body mass index) were measured at each exam and during three age periods during adulthood (35-50, 51-60, 61-70).

The researchers found that lower HDL (the good cholesterol) is predictive of AD in early (35-50 years) and middle (51-60 years) adulthood and that high glucose in the blood (a precursor of diabetes) during mid-adulthood is also predictive of AD "These findings show for the first time that cardiovascular risk factors, including HDL which has not been consistently reported as a strong risk factor for AD, contribute to future risk of AD starting as early as age 35," says first and corresponding authorXiaoling Zhang, MD, PhD, assistant professor of medicine at BUSM.

According to the researchers, careful management of these factors starting in early adulthood can lower one's risk of cardiovascular disease and diabetes, as well as Alzheimer's."Intervention targeting cholesterol and glucose management starting in early adulthood can help maximize cognitive health in later life," adds Farrer.

Farrer also points out, "the unique design and mission of the Framingham Heart Study, which is a multi-generation, community-based, prospective study of health that began in 1948, allowed us to link Alzheimer's to risk factors for heart disease and diabetes measured much earlier in life than possible in most other studies of cognitive decline and dementia."

https://www.sciencedaily.com/releases/2022/03/220323101236.htm

Married mothers who earn more than their husbands take on an even greater share of the housework

Married couples may be trying to compensate for deviating from the entrenched gender norm of 'male breadwinner'

March 31, 2022

Science Daily/University of Bath

While new mothers frequently take on a greater share of housework than their spouses, this effect is even more pronounced in mothers who earn more than fathers, new research from the University of Bath shows.

Rational economic theory suggests parenthood and the resulting income and time pressure should lead to a more efficient sharing of household chores. However, the study of more than 6,000 heterosexual North American married households revealed this is not the case.

"Of course, we understand why specialized division of labour exists, but there is no reason for this specialization to be gender-specific. Traditional division has been conventionally explained by men earning more and working longer hours and has a certain logical appeal," said Dr Joanna Syrda of the University's School of Management.

"However, I found that the gender housework gap actually gets bigger for mothers who earned more than their spouses -- the more they earned over their partner, the more housework they did," she said.

Syrda said the findings might indicate that traditional gender identity norms -- the notion of the 'male breadwinner' and its association with masculinity -- are so entrenched that couples may try to compensate for a situation where wives earn more than their husbands. She said she was interested to find the effect was stronger in married couples than in unmarried cohabiting parents.

"Married couples that fail to replicate the traditional division of income may be perceived -- both by themselves and others -- to be deviating from the norm. What may be happening is that, when men earn less than women, couples neutralise this by increasing traditionality through housework -- in other words, wives do more and husbands do less as they try to offset this 'abnormal' situation by leaning into other conventional gender norms," she said.

Syrda noted that the economic argument for mothers taking on a greater share of household chores was to free their higher-earning (male) partner up to focus on work and maximise the household's standards of living.

"We would therefore expect the balance of domestic labour to shift as more women enter the workforce, work longer hours and gain higher salaries -- but that has not been the case! So, we need to look beyond economic theory to this traditionalising effect and couples following traditional gender norms," Syrda said.

Syrda said it was important to recognise that there are some childcare tasks where women have an obvious advantage. However, she noted that the research is about housework defined as 'time spent cooking, cleaning, and doing other work around the house'.

"Therefore, it doesn't necessarily follow that this should lead to gender-specific housework division -- if the wife is the relatively higher earner, transition to parenthood shouldn't result in a more traditional division of domestic labour as this wouldn't improve the household's overall quality of life. But this study suggests this is not the case."

Syrda said the study -- "Gendered Housework: Spousal Relative Income, Parenthood and Traditional Gender Identity Norms" -- is important for the understanding of a prime source of conflict for many married couples. She pointed to research from the U.S. Institute of Family Studies that found the most common area of contention among spouses with children to be chores and responsibilities, highlighting the clash between the traditional division of labour and the modern reality of high-earning, working mothers.

Syrda said that previous research showed that the transition to parenthood brought more of a change to the division of labour in couples than any other event, like getting married or having more children. At the same time, her research showed that this appears to strengthen norms regarding gender-typical behaviour or even shift individual gender role attitudes.

"This is important, because how couples divide the increased domestic workload after becoming parents will be an important determinant of earnings inequalities between women and men over the course of their lives -- a pattern once settled upon is often difficult to renegotiate. And these norms may be passed to their children," she said.

Syrda reflected that one expectation of the 'gender revolution' of the 1960s and 1970s was that women's increased level of employment and earnings would be accompanied by men's greater participation in domestic activities.

"Sadly, however, it looks like married men and women -- especially married parents -- have still not equalised the level of housework they perform, leading many of us to wonder how to restart this 'stalled revolution'?" she said.

https://www.sciencedaily.com/releases/2022/03/220331101532.htm

One in four women experience domestic violence before age 50

Governments are not on track to meet global targets to eliminate violence against women and girls

March 24, 2022

Science Daily/McGill University

Over one in four women (or 27 per cent) experience intimate partner violence before the age of 50, according to a worldwide analysis led by researchers from McGill University and the World Health Organization. The largest of its kind, the analysis covers 366 studies involving more than 2 million women in 161 countries.

"Intimate partner violence against women -- which includes physical and sexual violence by husbands, boyfriends, and other partners -- is highly prevalent globally," says McGill University Professor Mathieu Maheu-Giroux, a Canada Research Chair in Population Health Modeling.

According to the finding published in The Lancet, one in seven women (or 13 per cent) experienced intimate partner violence within the last year of the study period between 2000 and 2018. The analysis also found high levels of violence against young women, estimating that 24 per cent of those between the ages of 15 to 19 experienced domestic violence in their lifetime.

While the numbers are alarming the true scale of violence is likely even higher, the researchers say, noting that the studies were based on self-reported experiences. Given the stigmatized nature of the issue, women can be hesitant to report their experiences, they explain.

High-income countries reported lower rates of domestic violence

The researchers found regional variations, with high-income countries having lower prevalence of both lifetime and past year violence. The lifetime prevalence among women aged 15 to 49 was highest in Africa, South Asia, and parts of South America. The regions with the lowest estimated lifetime domestic violence against women were Central Asia and Central Europe.

The proportion of women who experienced intimate partner violence in the last year was around 5 per cent for North America, Europe, and Asia Pacific. In regions of Africa, this number was as high as 15 per cent to 30 per cent.

Canada among countries with lowest rates of domestic violence

"While Canada is among the top 30 countries with the lowest rates of intimate partner violence, it's still a problem that affects 1 in 25 women," notes Professor Maheu-Giroux. "Some provinces in Canada are looking at different ways to address domestic violence. In Quebec, for example, the government approved a pilot project in 2021 to create a special court for victims of domestic and sexual violence," he adds.

Calls to strengthen response in pandemic rebuilding efforts

"Overall, our research shows that governments are not on track to meet global targets to eliminate violence against women and girls. An important takeaway is that even in some high-income countries the prevalence of intimate partner violence is relatively high, which calls for investment in prevention at local and global levels," says Maheu-Giroux.

"In Québec alone, we witnessed a wave of 17 intimate partner feminicides in 2021 -- the most extreme consequence of intimate partner violence and the highest number in more than a decade," he says.

Globally, the problem is likely to have been further exacerbated by the COVID-19 pandemic, the researchers explain. There's an urgent need to strengthen the public health response to intimate partner violence, and ensure it's addressed in post-COVID-19 rebuilding efforts, they conclude.

https://www.sciencedaily.com/releases/2022/03/220324143806.htm

Rising parental expectations linked to perfectionism in college students

March 31, 2022

Science Daily/American Psychological Association

Rising parental expectations and criticism are linked to an increase in perfectionism among college students, which can have damaging mental health consequences, according to new research published by the American Psychological Association.

Researchers analyzed data from more than 20,000 American, Canadian and British college students. They found that young people's perceptions of their parents' expectations and criticism have increased over the past 32 years and are linked to an increase in their perfectionism.

"Perfectionism contributes to many psychological conditions, including depression, anxiety, self-harm and eating disorders," said lead researcher Thomas Curran, PhD, an assistant professor of psychological and behavioral science at the London School of Economics and Political Science.

Study co-author Andrew P. Hill, PhD, a professor of sport and exercise psychology at York St John University, added that "the pressure to conform to perfect ideals has never been greater and could be the basis for an impending public health issue."

Perfectionism often becomes a lifelong trait and prior research has shown that perfectionists become more neurotic and less conscientious as they get older. Perfectionism also can perpetuate through generations, with perfectionist parents raising perfectionist children.

Curran and Hill previously found that three types of perfectionism were increasing among young people in the U.S., Canada and the United Kingdom. They suspected that one cause might be that parents are becoming more anxious and controlling, so they analyzed the findings of other published studies in two meta-analyses for this latest piece of research, which published online in the journal Psychological Bulletin.

The first meta-analysis included 21 studies with data from more than 7,000 college students. Parental expectations and criticism had moderate associations with self-oriented and other-oriented perfectionism and a large association with socially prescribed perfectionism.

Self-oriented perfectionism involves perfectionist standards about the self. Other-oriented perfectionism is perfectionism turned outward, where someone expects others to be perfectionist. Socially prescribed perfectionism is the perception that other people and society require perfection. The three types of perfectionism overlap and can exacerbate the effects of each other in negative ways.

Parental expectations had a larger impact than parental criticism on self-oriented and other-oriented perfectionism, so parental expectations may be more damaging than parental criticism.

"Parental expectations have a high cost when they're perceived as excessive," Curran said. "Young people internalize those expectations and depend on them for their self-esteem. And when they fail to meet them, as they invariably will, they'll be critical of themselves for not matching up. To compensate, they strive to be perfect."

Self-oriented perfectionism was higher for American college students than Canadian or British students, possibly because of more intense academic competition in the U.S.

"These trends may help explain increasing mental health issues in young people and suggest this problem will only worsen in the future," Hill said. "It's normal for parents to be anxious about their children, but increasingly this anxiety is being interpreted as pressure to be perfect."

The second meta-analysis included 84 studies conducted between 1989 and 2021 with a total of 23,975 college students. Parental expectations, criticism and their combined parental pressure increased during those 32 years, with parental expectations increasing at the fastest rate by far.

"The rate of increase in young people's perceptions of their parents' expectations is remarkable," up an average 40% compared with 1989, Curran said.

The studies were conducted in the U.S., Canada and the United Kingdom, so the findings can't be generalized to other cultures. The research is correlational, so it can't prove that rising parental expectations or criticism caused an increase in perfectionism among college students, only that there is a link between them. However, the research suggests troublesome changes over time, according to the researchers.

So what are parents supposed to do? "Parents are not to blame because they're reacting anxiously to a hyper-competitive world with ferocious academic pressures, runaway inequality and technological innovations like social media that propagate unrealistic ideals of how we should appear and perform," Curran said.

"Parents are placing excessive expectations on their children because they think, correctly, that society demands it or their children will fall down the social ladder," Curran added. "It's ultimately not about parents recalibrating their expectations. It's about society -- our economy, education system and supposed meritocracy -- recognizing that the pressures we're putting on young people and their families are unnecessarily overwhelming."

Parents can help their children navigate societal pressures in a healthy way by teaching them that failure, or imperfection, is a normal and natural part of life, Curran said. "Focusing on learning and development, not test scores or social media, helps children develop healthy self-esteem, which doesn't depend on others' validation or external metrics," he said.

https://www.sciencedaily.com/releases/2022/03/220331101501.htm

Treatment for substance use reduces depression for many adolescents and young adults with both problems

When adolescents with substance use problems and depression are treated for substance use, about a third also have early improvements in depression

March 29, 2022

Science Daily/Elsevier

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that, among youth with substance use and depression, a significant proportion show early improvements in depression during their treatment for substance use. Youth who are using cannabis less frequently prior to treatment and those without conduct disorder are more likely to experience early depression improvement.

"The combination of alcohol or cannabis use and depression is a significant problem in adolescents and young adults. In addition to the negative outcomes associated with substance use, like automobile accidents and academic problems, those with both conditions tend to have longer episodes of depression, more substance-related problems, and, most importantly, an increased risk for suicidal behavior," said lead author John Curry, PhD, Professor Emeritus in the Department of Psychiatry & Behavioral Sciences at Duke University, Durham, NC. "Yet there is no standard approach to treating them, and they are often treated in two separate systems of care."

Earlier studies have shown that some of these young people will show significant improvement in depression during treatment for substance use alone, suggesting that if that improvement is sustained, they may not need additional depression treatment. Based on this evidence, the researchers tested an adaptive approach in which everyone received substance use treatment. Yet, if they were still depressed after a month, they would receive additional depression treatment either with the same therapist or in the community.

"This approach allowed us to examine two different approaches to depression treatment for youth with substance use," said Dr. Curry. "We also wanted to discover what proportion of the youth would have an early depression response during substance use treatment and what factors predicted it."

Across two sites, a sample of 95 youths between the ages of 14 and 21 with alcohol or cannabis use and depressive symptoms received up to 12 sessions of cognitive behavior therapy (CBT) for substance use over 14 weeks. Before treatment, they completed measures of psychiatric diagnoses, alcohol or cannabis use, and severity of depression. Early depression response was defined as a 50% reduction in symptoms by week 4 of treatment. Those without early depression response were randomized to add either CBT for depression with the same therapist or depression treatment in the community.

Thirty-five participants (37%) demonstrated early depression response. Predictors of early depression response were lower frequency of cannabis use at baseline and lack of a conduct disorder diagnosis. No other variables -- including demographic characteristics, severity of depression, or other psychiatric diagnoses -- were predictors. Frequency of drinking, heavy drinking, and cannabis use declined over the full course of treatment for all participants. Among those without early depression response, depression improved significantly with either additional CBT or community treatment, with no difference between treatments.

"This treatment study emphasizes the importance of recognizing the heterogeneity of youth with substance use and co-occurring disorders such as depression, including the different trajectories of their responses to treatment," said lead author Yifrah Kaminer, MD, MBA, Professor Emeritus of Psychiatry at the University of Connecticut, Storrs, CT. "An important finding is that the level of cannabis use affects the trajectory of change in depression during treatment. Additional examination of potential biological markers or other predictors of treatment response is of paramount importance for developing cost-effective interventions."

Additional analyses will examine the course of depression and substance use after treatment, and whether the young people whose depression responded to substance use treatment continue to remain less depressed. Given the relatively small sample, it will be important to replicate the study's findings in other samples. Future research is needed to investigate the factors that underlie the relationship between substance use and depression over time.

https://www.sciencedaily.com/releases/2022/03/220329114730.htm

One in four children who have suffered a minor head injury is liable to suffer from chronic post-concussion syndrome

The long term consequences of mild head injury in children is underdiagnosed

March 28, 2022

Science Daily/Tel-Aviv University

A new study by Tel Aviv University, Kaplan Medical Center and Shamir Medical Center (Assaf Harofeh) found that one in four children (25.3%) who have been discharged from the emergency room after a mild head injury are misdiagnosed and continue to suffer from persistent post-concussion syndrome for many years. This syndrome includes chronic symptoms such as forgetfulness, memory problems, sensitivity to light and noise, ADHD and even psychological problems and, instead of receiving treatment for the syndrome, they are mistakenly diagnosed as suffering from ADHD, sleep disorders, depression, etc. The misdiagnosis leads to treatment that is not suited to the problem, thus causing the children prolonged suffering.

The study was led by Prof. Shai Efrati of the Sagol Center for Hyperbaric Medicine and Research at Tel Aviv University and Shamir Medical Center (Assaf Harofeh), Dr. Uri Bella and Dr. Eli Fried of Kaplan Medical Center, and Prof. Eran Kotzer of Shamir Medical Center. The results of the study were published in the journal Scientific Reports.

"The objective of our study was to determine how many children in Israel suffer from persistent post-concussion syndrome," says Dr. Fried of Kaplan Medical Center. "The children participating in the study arrived at the emergency room with mild head trauma and, after staying overnight for observation or being sent for a CAT scan of the head, they were discharged to go home."

Prof. Efrati of Tel Aviv University states: "Persistent post-concussion syndrome is a chronic syndrome that results from micro damage to the small blood vessels and nerves, which may appear several months after the head injury, and therefore is often misdiagnosed as attention deficit disorders, sleep disorders, depression, etc. There are cases where children report headaches and are diagnosed as suffering from migraines or, for example, children who report difficulty concentrating and the doctor prescribes Ritalin. Unfortunately, these children continue to suffer for many years from various disorders and, instead of treating the real problem, which is the syndrome, they receive treatments that usually do not solve the problem."

The study examined 200 children who suffered from a head injury and who were released from the emergency room after the need for medical intervention was ruled out. The researchers tracked the subjects for a period between six months and three years from their date of discharge and found that about one in four children released from the emergency room suffered from the chronic syndrome.

"It should be understood that the consequences of brain injury during childhood continue throughout life," says Dr. Uri Bella, Director of the Pediatric Emergency Room at the Kaplan Medical Center. "Loss of any brain function will prevent the child from realizing his or her potential in education and in social life."

Unlike damage to large arteries and noticeable damage to brain tissue, with a minor head injury, the damage is to the small blood vessels and neurons -- and it is not detected on CAT scans of the head or on regular MRIs. Diagnosis of the syndrome requires long-term monitoring of the manifestation of symptoms as well as the use of imaging and functional tests of the brain. According to the researchers, the alarming findings demonstrate that changes in the approach are needed to be monitoring and treating these children.

"The purpose of an emergency room diagnosis is to determine whether the child suffers from a severe brain injury that requires immediate medical intervention," adds Prof. Eran Kotzer, Director of the Emergency Rooms at the Shamir Medical Center. "Unfortunately, the way most medical systems operate today, we miss long-term effects and do not continue to monitor those children who leave the emergency room without visible motor impairment."

"Treatment for a wide range of disorders will change if we know that the cause of the new problem is a brain injury," concludes Prof. Efrati. "Proper diagnosis of the cause is the first and most important step in providing appropriate treatment for the problem."

https://www.sciencedaily.com/releases/2022/03/220323101226.htm

Maternal socialization, not biology, shapes child brain activity

Probing reward-related processing in children of depressed moms

March 23, 2022

Science Daily/Elsevier

Children of mothers with clinical depression are at three times greater risk to develop depression themselves than are their low-risk peers. Researchers are working to understand the neural underpinnings of the risk, and some studies have shown altered brain processing of reward in at-risk children as young as 6. An outstanding question remains as to whether children with a maternal history of depression have a biological predisposition to blunted neural reward responding or whether it depends more on social factors. Now, new work finds those dampened responses depended on maternal feedback, suggesting the latter.

The study appears in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.

Researchers have long observed changes in brain activity associated with depression in adults, particularly in a brain area called the ventral striatum (VS), which is associated with motivation, pleasure, and goal-directed behaviors. Similarly, several studies have shown striatal responses to rewarding experiences are blunted in adolescent children of depressed parents, which predicts later development of depression. However, more recent work shows that these brain changes can emerge long before the teenage years, when the risk for depression typically increases.

For the current study, lead author Judith Morgan, PhD, at the University of Pittsburgh, Pennsylvania, USA, recruited 49 children aged 6 to 8 without a history of psychiatric illness. Half the kids' mothers had a history of clinical depression, and half had no psychiatric history. To measure reward-related brain activity, children played a video game in which they guessed which of two doors contained a hidden token while they underwent functional magnetic resonance imaging (fMRI).

Depression may disrupt parents' capacity for emotional socialization, a process by which kids learn from their parents' reactions to their emotional responses. Positive socialization responses include acknowledgment, imitation, and elaboration, whereas negative or emotionally dampening parental responses may be dismissive, invalidating, or punitive.

Mothers participating in the study completed an extensive questionnaire designed to measure parental emotional socialization by presenting a dozen situational vignettes of children's displays of positive emotions and collecting parents' reactions to them. Strikingly, children with a maternal history of depression were more likely to have reduced reward-related brain activity in the VS, but only if their mothers reported less enthusiastic and more dampening responses to their children's positive emotions, the researchers found.

"In our study, mothers' own history of depression by itself was not related to altered brain responses to reward in early school-age children," said Dr. Morgan. "Instead, this history had an influence on children's brain responses only in combination with mothers' parenting behavior, such as the ability to acknowledge, imitate, or elaborate on their child's positive emotions."

"This is hopeful news as interventions geared at coaching parents to encourage positive emotions in their children may have a powerful impact on child reward-related development, especially for families of children who may be at greater risk because of a family history of depression," Dr. Morgan added.

Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, said,

"This important work provides a great example of how clinical neuroscience can reveal neural mechanisms underlying depression and discover new links that may explain why one person has depression and another does not. These links take us beyond clinical observation and therapy alone to open new avenues (such as parenting interventions) for prevention that can promote resilience and wellness."

https://www.sciencedaily.com/releases/2022/03/220323101221.htm

One in three children with disabilities globally have experienced violence in their lifetimes

March 23, 2022

Science Daily/Columbia University's Mailman School of Public Health

Children and adolescents (aged 0-18 years) with disabilities experience physical, sexual, and emotional violence, and neglect at considerably higher rates than those without disability, despite advances in awareness and policy in recent years. This is according to a systematic review of research involving more than 16 million young people from 25 countries conducted between 1990 and 2020. The study provides the most comprehensive picture of the violence experienced by children with disabilities around the world. The findings are published in The Lancet Child & Adolescent Health.

Young people with mental illness and cognitive or learning disabilities (e.g., attention deficit hyperactivity disorder and autism) are especially likely to experience violence, and overall, children with disabilities are more than twice as likely to experience violence compared to those without disabilities, which can have a serious and long-lasting impact on their health and wellbeing.

The findings highlight the urgent need for collaborative efforts by governments, health and social care workers, and researchers to raise awareness of all forms of violence against children with disabilities and to strengthen prevention efforts, according to the authors.

"Children with disabilities face unacceptably high levels of violence worldwide," says Dr. Ilan Cerna-Turoff in the Department of Environmental Health Sciences at Columbia University Mailman School of Public Health, who co-led the study. "Governments face a challenging time in which resources are spread thin in responding to the COVID-19 pandemic and economic and social change. We know that violence prevention leads to better development indicators for our societies. Now, more than ever, violence prevention is a worthy and important investment to secure a better future. Moreover, all people deserve the right to live in a world in which they are safe from violence. Protecting children with disabilities from violence is a fundamental aspect of social justice and equity."

An estimated 291 million children and adolescents have epilepsy, intellectual disability, vision impairment, or hearing loss -- representing about 11 percent of the total child and adolescent population globally. Many more have other physical and mental disabilities. The vast majority of children with disabilities -- more than 94 percent -- live in LMICs where multiple risks converge. Inadequate systems of social protection and access to support, stigma, discrimination, and a lack of information about disability contribute to the higher levels of violence experienced by children with disabilities. This can be further exacerbated by poverty and social isolation. The unique challenges faced by children with disabilities, such as the inability to verbalise or defend themselves, can also make them a target of violence.

In 2012, a systematic review published in The Lancet estimated that more than a quarter of children with disabilities in high-income countries experienced violence and that their odds of experiencing violence were more than three times higher than their non-disabled peers.

This new analysis includes a larger number of studies from a wider geographical area, more types of violence (e.g., peer bullying and intimate partner violence), and a wider range of disabilities (physical limitations, mental disorders, cognitive or learning disabilities, sensory impairments and chronic diseases), as well as using updated methods. It provides current global estimates of violence against children with disabilities, up to September 2020. The new estimates suggest that one in three children with disabilities are survivors of violence and that they are twice as likely to experience violence as non-disabled children.

The researchers did a systematic review and meta-analysis of all observational studies measuring violence against children with disabilities published in 18 English language databases and three regional Chinese databases between 1990 and 2020. Data were analysed for 98 studies involving over 16.8 million children (aged 0-18 years), including 75 studies from high-income countries and 23 studies from seven low-income and middle-income countries.

Analysis of data from 92 studies looking at prevalence found that the overall rates of violence varied by disability and were slightly higher among children with mental disorders (34 percent) and cognitive or learning disabilities (33 percent) than for children with sensory impairments (27 percent), physical or mobility limitations (26 percent), and chronic diseases (21 percent).

The most commonly reported types of violence were emotional and physical, experienced by about one in three children and adolescents with disabilities. The estimates suggest that one in five children with disabilities experience neglect and one in ten have experienced sexual violence.

The study also draws attention to high levels of peer bullying, with almost 40 percent of children with disabilities estimated to have experienced bullying by their peers. In-person bullying (physical, verbal, or relational acts, such as hitting and kicking; insults and threats; or social exclusion) is more common (37 percent) than cyberbullying (23 percent).

In general, children with disabilities living in low-income countries experienced higher rates of violence than those in high-income countries -- possibly as a result of limited access to prevention and support services, lower levels of legal protection, and attitudes and norms that stigmatize people with disabilities and lead to greater social tolerance for violence. A further challenge is that we continue to face gaps in information on low-income and middle-income countries, especially in Southeast and Central Asia and Eastern Europe.

"Violence against children with disabilities is preventable. These children must be given the right life chances now, said co-lead author Dr. Zuyi Fang from Beijing Normal University in China. "The UN Sustainable Development Goals aim to end all forms of violence against children by 2030. Achieving this will require political leaders, practitioners, and researchers to work together to implement what we already know works to prevent violence such as evidence-based parenting interventions, while developing and evaluating effective community, school-based, and on-line interventions that target specific forms of violence."

Writing in a linked Comment, Dr. Tania King from the University of Melbourne in Australia, who was not involved in the study, notes that it is possible that there has been an escalation in rates of violence against children with disability since the COVID-19 pandemic, adding that, "Article 19 of the United Nations Convention on the Rights of the Child, endorsed by many countries around the world, enshrines the rights of children to be protected from violence. As the number of children with disability continues to grow worldwide, we must establish the systems and processes to protect them from violence. Better services and support for children with disability will reduce many of the risk factors that underpin their increased experiences of violence. The imperatives to act are many: they are economic, as the damage wrought by violence is costly. The imperatives are social -- society has much to gain by improving inclusion of those with disability. But importantly the imperatives are moral -- it is unacceptable for current society to tolerate such rates of violence among children with disability."

https://www.sciencedaily.com/releases/2022/03/220322145741.htm

Eating two servings of avocados a week linked to lower risk of cardiovascular disease

March 30, 2022

Science Daily/American Heart Association

Eating two or more servings of avocado weekly was associated with a lower risk of cardiovascular disease, and substituting avocado for certain fat-containing foods like butter, cheese or processed meats was associated with a lower risk of cardiovascular disease events, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Avocados contain dietary fiber, unsaturated fats especially monounsaturated fat (healthy fats) and other favorable components that have been associated with good cardiovascular health. Clinical trials have previously found avocados have a positive impact on cardiovascular risk factors including high cholesterol.

Researchers believe this is the first, large, prospective study to support the positive association between higher avocado consumption and lower cardiovascular events, such as coronary heart disease and stroke.

"Our study provides further evidence that the intake of plant-sourced unsaturated fats can improve diet quality and is an important component in cardiovascular disease prevention," said Lorena S. Pacheco, Ph.D., M.P.H., R.D.N., lead author of the study and a postdoctoral research fellow in the nutrition department at the Harvard T.H. Chan School of Public Health in Boston. "These are particularly notable findings since the consumption of avocados has risen steeply in the U.S. in the last 20 years, according to data from the U.S. Department of Agriculture."

For 30 years, researchers followed more than 68,780 women (ages 30 to 55 years) from the Nurses' Health Study and more than 41,700 men (ages 40 to 75 years) from the Health Professionals Follow-up Study. All study participants were free of cancer, coronary heart disease and stroke at the start of the study and living in the United States. Researchers documented 9,185 coronary heart disease events and 5,290 strokes during more than 30 years of follow-up. Researchers assessed participants' diet using food frequency questionnaires given at the beginning of the study and then every four years. They calculated avocado intake from a questionnaire item that asked about the amount consumed and frequency. One serving equaled half of an avocado or a half cup of avocado.

The analysis found:

• After considering a wide range of cardiovascular risk factors and overall diet, study participants who ate at least two servings of avocado each week had a 16% lower risk of cardiovascular disease and a 21% lower risk of coronary heart disease, compared to those who never or rarely ate avocados.

• Based on statistical modeling, replacing half a serving daily of margarine, butter, egg, yogurt, cheese or processed meats such as bacon with the same amount of avocado was associated with a 16% to 22% lower risk of cardiovascular disease events.

• Substituting half a serving a day of avocado for the equivalent amount of olive oil, nuts and other plant oils showed no additional benefit.

• No significant associations were noted in relation to stroke risk and how much avocado was eaten.

The study's results provide additional guidance for health care professionals to share. Offering the suggestion to "replace certain spreads and saturated fat-containing foods, such as cheese and processed meats, with avocado is something physicians and other health care practitioners such as registered dietitians can do when they meet with patients, especially since avocado is a well-accepted food," Pacheco said.

The study aligns with the American Heart Association's guidance to follow the Mediterranean diet -- a dietary pattern focused on fruits, vegetables, grains, beans, fish and other healthy foods and plant-based fats such as olive, canola, sesame and other non-tropical oils.

"These findings are significant because a healthy dietary pattern is the cornerstone for cardiovascular health, however, it can be difficult for many Americans to achieve and adhere to healthy eating patterns," said Cheryl Anderson, Ph.D., M.P.H., FAHA, chair of the American Heart Association's Council on Epidemiology and Prevention.

"We desperately need strategies to improve intake of AHA-recommended healthy diets -- such as the Mediterranean diet -- that are rich in vegetables and fruits," said Anderson, who is professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego. "Although no one food is the solution to routinely eating a healthy diet, this study is evidence that avocados have possible health benefits. This is promising because it is a food item that is popular, accessible, desirable and easy to include in meals eaten by many Americans at home and in restaurants."

The study is observational, so a direct cause and effect cannot be proved. Two other limitations of the research involve data collection and the composition of the study population. The study analyses may be affected by measurement errors because dietary consumption was self-reported. Participants were mostly white nurses and health care professionals, so these results may not apply to other groups.

https://www.sciencedaily.com/releases/2022/03/220330103250.htm

Burst of accumulated zinc shows how the mineral boosts immune function, suggesting ways to improve health

In mice, zinc helps thymus of the immune system regrow and immune-cell recovery after bone marrow transplant

March 31, 2022

Science Daily/Fred Hutchinson Cancer Research Center

Zinc's immune-boosting properties are well-established, but scientists haven't known exactly how it works. In a new study published online March 25 in the journal Blood, Fred Hutchinson Cancer Research Center scientists reveal two ways the mineral supports immunity and suggest how it could be used to improve health.

Using mice, the team discovered that zinc is needed for the development of disease-fighting immune cells called T cells and prompts regeneration of the thymus, the immune organ that produces T cells.

"This study adds to our knowledge of what zinc is actually doing in the immune system and suggests a new therapeutic strategy for improving recovery of the immune system," said senior author Dr. Jarrod Dudakov, an immunologist at Fred Hutch.

The study also revealed that an experimental compound that mimics zinc's action in this organ works even better than the natural mineral to promote immune recovery.

"We are now looking into how zinc may fit in with our other discoveries of how the immune system repairs itself and could eventually lead to therapies to improve immune function for people who receive a blood stem cell transplant for a blood cancer or people with chronic immune decline that accompanies aging," Dudakov said.

Thymic regeneration and immune function, and zinc

Previously, Dudakov and his team have outlined the molecular pathways and cell types that govern how the immune system's thymus repairs itself after injury. Such treatments could improve vaccine efficacy and hasten thymic regeneration after stressors like chemotherapy, blood stem cell transplant and radiation exposure.

Dudakov began studying zinc a few years ago when Dr. Lorenzo Iovino, the study's first author and a research associate at Fred Hutch, joined Dudakov's lab. Since the scientists knew that low levels of zinc are linked to fewer infection fighting T cells and a shrunken thymus, where T cells develop, Dudakov and Iovino explored how to supplement with zinc in mouse models where the immune system is damaged.

Iovino, who's also a blood stem cell transplant physician, had shown in a previous study that zinc could boost immune recovery in patients undergoing stem-cell transplants for the blood cancer multiple myeloma.

But the study didn't explain why zinc was helping.

Zinc is critical for T-cell development and thymic regeneration

As in humans, Iovino and Dudakov found that the thymuses of mice deprived of dietary zinc shrink and produce notably fewer mature T cells, even after as little as three weeks of a no-zinc diet. Iovino was able to show that without zinc, T cells cannot fully mature.

He also found that zinc deficiency slows recovery of T-cell numbers after mice receive immune-destroying treatments akin to those given to patients about to receive a blood stem cell transplant.

Conversely, extra zinc speeds this process, and T cells recover faster than normal. The team saw a similar result in a mouse model of blood stem cell transplant.

"So we had a consistent result of a better reconstitution of the thymus and also a better reconstitution of T cells in the peripheral blood after zinc supplementation," Iovino said. "But we still didn't know how exactly zinc was working."

Iovino discovered that it was the change in zinc levels around cells that release a key regenerative factor that seemed to kick off the thymus' renewal processes. T cells accumulate zinc as they develop, but release it after a damaging event -- like a burst of radiation -- kills them off.

Cells use a molecule called GPR39 to sense a change in external zinc, and Iovino found that an experimental compound that mimics rising external zinc levels by stimulating GPR39 could also promote renewal factor release and thymic regeneration.

"What we think is going on is, as you give zinc supplementation, that gets accumulated within the developing T cells. It gets stored and stored and stored, then the damage comes along and the zinc is released," Dudakov said. "Now you have more zinc than you normally would, and it can instigate this regenerative pathway. With the experimental compound we can just directly target GPR39 and basically get the same effect without any of that pretreatment."

Getting to the clinic

There's still a lot to learn before they can turn their findings to therapeutic strategies, the scientists said.

Transplant patients already receive mineral supplements, so if extra zinc were to be incorporated into their treatment regimens, it would be important to make sure that anyone receiving it is truly zinc-deficient. Iovino thinks many patients might be, but right now there isn't a good test to assess this. He's currently working on developing one, which would first be used to help researchers determine whether patients' zinc status correlates with immune recovery after blood stem cell transplant.

Dudakov will pursue GPR39-stimulating compounds as therapies to improve thymic recovery after acute injuries like pre-transplant radiation. The team is currently screening similar compounds to find any that may be more effective.

He and Iovino are also working to determine whether such compounds could help with thymic regeneration in other settings. Unfortunately, our thymuses also slowly shrink and reduce their T-cell output as we age. Dudakov and Iovino would also like to know whether this chronic degeneration could be slowed by boosting the organ's regenerative processes.

"Our lab is continuing to piece together the molecular players that contribute to thymus regrowth," Dudakov said. "Ultimately, we aim to develop therapies that trigger natural regeneration and restore immune health."

https://www.sciencedaily.com/releases/2022/03/220331185359.htm

Good hydration may reduce long-term risks for heart failure

Serum sodium levels may help identify adults with a greater chance of experiencing heart disease

March 29, 2022

Science Daily/NIH/National Heart, Lung and Blood Institute

Staying well-hydrated may be associated with a reduced risk for developing heart failure, according to researchers at the National Institutes of Health. Their findings, which appear in the European Heart Journal, suggest that consuming sufficient amounts of fluids throughout life not only supports essential body functioning but may also reduce the risk of severe heart problems in the future.

Heart failure, a chronic condition that develops when the heart does not pump enough blood for the body's needs, affects more than 6.2 million Americans, a little more than 2% of the population. It is also more common among adults ages 65 and older.

"Similar to reducing salt intake, drinking enough water and staying hydrated are ways to support our hearts and may help reduce long-term risks for heart disease," said Natalia Dmitrieva, Ph.D., the lead study author and a researcher in the Laboratory of Cardiovascular Regenerative Medicine at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.

After conducting preclinical research that suggested connections between dehydration and cardiac fibrosis, a hardening of the heart muscles, Dmitrieva and researchers looked for similar associations in large-scale population studies. To start, they analyzed data from more than 15,000 adults, ages 45-66, who enrolled in the Atherosclerosis Risk in Communities (ARIC) study between 1987-1989 and shared information from medical visits over a 25-year period.

In selecting participants for their retrospective review, the scientists focused on those whose hydration levels were within a normal range and who did not have diabetes, obesity, or heart failure at the start of the study. Approximately 11,814 adults were included in the final analysis, and, of those, the researchers found 1,366 (11.56%) later developed heart failure.

To assess potential links with hydration, the team assessed the hydration status of the participants using several clinical measures. Looking at levels of serum sodium, which increases as the body's fluid levels decrease, was especially useful in helping to identify participants with an increased risk for developing heart failure. It also helped identify older adults with an increased risk for developing both heart failure and left ventricular hypertrophy, an enlargement and thickening of the heart.

For example, adults with serum sodium levels starting at 143 milliequivalents per liter (mEq/L) -- a normal range is 135-146 mEq/L -- in midlife had a 39% associated increased risk for developing heart failure compared to adults with lower levels. And for every 1 mEq/L increase in serum sodium within the normal range of 135-146 mEq/L, the likelihood of a participant developing heart failure increased by 5%.

In a cohort of about 5,000 adults ages 70-90, those with serum sodium levels of 142.5-143 mEq/L at middle age were 62% more likely to develop left ventricular hypertrophy. Serum sodium levels starting at 143 mEq/L correlated with a 102% increased risk for left ventricular hypertrophy and a 54% increased risk for heart failure.

Based on these data, the authors conclude serum sodium levels above 142 mEq/L in middle age are associated with increased risks for developing left ventricular hypertrophy and heart failure later in life.

A randomized, controlled trial will be necessary to confirm these preliminary findings, the researchers said. However, these early associations suggest good hydration may help prevent or slow the progression of changes within the heart that can lead to heart failure.

"Serum sodium and fluid intake can easily be assessed in clinical exams and help doctors identify patients who may benefit from learning about ways to stay hydrated," said Manfred Boehm, M.D., who leads the Laboratory of Cardiovascular Regenerative Medicine.

Fluids are essential for a range of bodily functions, including helping the heart pump blood efficiently, supporting blood vessel function, and orchestrating circulation. Yet many people take in far less than they need, the researchers said. While fluid guidelines vary based on the body's needs, the researchers recommended a daily fluid intake of 6-8 cups (1.5-2.1 liters) for women and 8-12 cups (2-3 liters) for men. The Centers for Disease Control and Prevention also provides tips to support healthy hydration.

https://www.sciencedaily.com/releases/2022/03/220329114701.htm

Men with high blood pressure have a biased recognition of other people’s anger

March 31, 2022

Science Daily/University of Konstanz

Men with high blood pressure have a biased recognition of other people's anger, as shown in a new study.

Hypertension is a disease. However, in the majority of cases, there is no clear medical explanation, referred to as "essential hypertension." Could psychological factors play a role? In this context, Konstanz biological health psychologists Alisa Auer and Professor Petra Wirtz conducted a study in male participants over several years together with colleagues from Konstanz (Germany) and Switzerland. The researchers wanted to better understand the psychobiosocial mechanisms in hypertension, since previous work in this area has left many questions open.

In an article published in the Annals of Behavioral Medicine on 22nd March 2022, they show that compared to a healthy control group, men with essential hypertension more often recognized angry expressions when they looked into the faces of others. In addition, this anger recognition bias seems to contribute to blood pressure increases over time if someone tends to frequently and intensively experience anger. This tendency is called "trait anger."

Recognition of mixed emotions

In their study in 145 hypertensive and normotensive men, researchers presented different pictures of people who were angry. However, the pictures did not just display anger alone, but combined anger with one of three other emotions: fear, happiness, and sadness. The background for this approach is that, in everyday life, people's faces rarely show just one emotion. Mixed emotions are more prevalent. Each of the computer-morphed pictures showed two emotions with varying affect intensities. Participants were asked which emotion they saw in the pictures.

"Hypertensive men recognized anger more often than any other emotion," Alisa Auer says. "So, they overrated anger displayed in other people's faces as compared to our healthy control group." Petra Wirtz adds: "Overrating anger displayed by other persons seems to affect whether high 'trait anger' contributes to blood pressure increases over time." Hence, interpersonal factors seem to play a role in essential hypertension. The expectation of associations between hypertension and social aspects was one of the reasons why the study was supported by the Cluster of Excellence "Centre for the Advanced Study of Collective Behaviour."

Improving treatment of essential hypertension 

Auer and Wirtz hope that their results will be examined and confirmed by other researchers. "Then, a next step would be to offer people with essential hypertension a more targeted support," says Alisa Auer, who is currently completing her doctorate in Psychology. Auer is thinking of "therapeutic treatments that address a person's perception of social environments in order to protect them from other people´s anger."

Such therapeutic interventions would be important, because blood pressure lowering medication only treats the consequences of hypertension, but does not address potential causes. In addition, hypertension is one of the major risk factors for cardiovascular disease. In 2020, as in previous years, the Federal Statistical Office (Destatis) listed cardiovascular disease as the leading cause of death in Germany. "338,001 deaths, or more than one third of all deaths (34%), can be attributed to cardiovascular disease," Destatis reports. Cardiovascular disease is especially deadly for older people: 93% of those who died of cardiovascular disease were 65 years or older.

What about women? The researchers hope that future studies will include women. Since women may possibly differ in their emotion recognition from men and as fewer women suffer from hypertension, the study initially focused on men.

https://www.sciencedaily.com/releases/2022/03/220331121236.htm

Classification of 16 adult sleep patterns based on large-scale sleep analysis

Expectations for application in sleep health checkups and sleep medicine

March 31, 2022

Science Daily/Japan Science and Technology Agency

A research group found that the human sleep patterns could be classified into 16 types by combining ACCEL, their original machine learning algorithm for sleep-wake classification, the dimension reduction method and the clustering method. The acceleration data of approximately 100,000 people in the UK Biobank were analyzed in detail, and some life-style-related patterns and insomnia-like patterns were reported.

In recent years, the number of people worldwide who are dissatisfied or anxious about their sleep has been increasing due to the diversification of lifestyles. Simple sleep measurement and quantitative understanding of individual sleep patterns are very important not only in the field of healthcare but also from the medical perspective, such as in the diagnosis of sleep disorders.

A research group of The University of Tokyo led by Professor Hiroki Ueda (also a Riken team leader) and Machiko Katori, and Assistant Professor Shoi Shi (RIKEN) used ACCEL(1), an original machine learning algorithm developed by their research laboratory, to determine sleep and waking states based on arm acceleration and converted the acceleration data of approximately 100,000 people in the UK Biobank(2) into sleep data, which was then analyzed in detail. They found that the sleep patterns of these 100,000 people could be classified into 16 different types.

The research group first focused on the arm acceleration data of approximately 100,000 people in the UK Biobank. This data was obtained from men and women in their 30s to 60s, mainly in the UK, who were measured for up to 7 days using wristband-type accelerometers. Using an algorithm (ACCEL) they had developed in 2022, the research group generated sleep data(3) for approximately 100,000 people from the acceleration data. The obtained sleep data were converted into 21 sleep indicators, and then, using dimension reduction(4) and clustering(5) methods, the sleep patterns were classified into 8 different clusters. These included clusters related to "social jet lag" and clusters characterized by mid-onset awakenings and considered insomnia, enabling the extraction of clusters related to lifestyles and to sleep disorders. Next, in order to examine sleep patterns associated with sleep disorders in more detail, the research group focused on 6 of the 21 sleep indicators, including sleep duration and intermediate waking time, which are known to be closely related to sleep disorders. By applying the same analysis to data where one indicator deviated significantly from general sleep (data in the upper 2.28th percentile or higher or the lower 2.28th percentile or lower (6) in the overall distribution), they were able to classify the data into 8 clusters. These included clusters related to morning-types and evening-types. They also identified several clusters associated with insomnia, and were able, along with the clustering using the entire dataset, to classify 7 types of sleep patterns associated with insomnia.

Thus, by analyzing sleep on a large scale, they have revealed the landscape of human sleep phenotype. This study has made it possible to quantitatively classify clusters related to lifestyle such as "social jet lag" and morning/evening types, which are usually difficult to determine with short-term PSG measurements(7), In addition, detailed analysis of outlier and classification of sleep patterns revealed 7 clusters related to insomnia. These clusters are classified based on new indicators differing from conventional methods, and are expected to be useful in the construction of new methods in terms of diagnosing insomnia and proposing treatment methods.

These results were obtained through the "Ueda Biological Timing Project," ERATO Program funded by the Japan Science and Technology Agency (JST). In this project, JST develops "systems biology that contributes to understanding human beings," using sleep-wake rhythms as a model system, and aims to understand in human sleep-wake behavior the "biological time" information that extends from molecules to individual humans living in society.

Notes:

(1) ACCEL : An original sleep determination algorithm developed by the research team. For details, refer to the following paper. "A jerk-based algorithm ACCEL for the accurate classification of sleep-wake states from arm acceleration" DOI: 10.1016/j.isci.2021.103727

(2) UK Biobank: A large research database containing genetic and health information on approximately 500,000 British participants. This study uses acceleration data for approximately 100,000 people as well as the linked gender and age data.

(3) Sleep data: Time-series data with intervals of 30 seconds labeled as sleeping or waking. PSG measurement uses diverse data measured by specialist technicians to create sleep data. In this study, sleep data was obtained by applying ACCEL to accelerometers.

(4) Dimension reduction method: A method to reduce the number of dimensions of data. This makes it possible to extract important information from the data and to capture the characteristics of the data. In this study, UMAP (Uniform Manifold Approximation and Projection) is used.

(5) Clustering method: A method of classifying data into clusters based on similarities among the data. There are two types of clustering methods: supervised clustering, which uses correct data for clustering, and unsupervised clustering, which does not. In this study, the unsupervised clustering method, DBSCAN (Density-Based Spatial Clustering of Applications with Noise) is used.

(6) Upper and lower percentiles:?The value in any given percent when the values are arranged in descending order is called the upper percentile. Conversely, the value in any given percent when the values are listed in ascending order is called the lower percentile. For instance, data above the upper 2.28th percentile or below the lower 2.28th percentile in normal distribution refers to data deviating from the mean by more than twice the standard deviation (2SD).

(7) Polysomnography (PSG): In PSG measurements, multiple electrodes and sensors are attached to the examinee to measure brain waves, eye movements, respiratory status, and electrocardiogram status. It is currently the most accurate measurement method used to determine human sleep patterns. It is also used to diagnose sleep disorders.

https://www.sciencedaily.com/releases/2022/03/220331101543.htm