Recalled experiences surrounding death: More than hallucinations?

Global scientific team publishes consensus statement and new guidelines

April 12, 2022

Science Daily/NYU Langone Health / NYU Grossman School of Medicine

Scientific advances in the 20th and 21st centuries have led to a major evolution in the understanding of death. At the same time, for decades, people who have survived an encounter with death have recalled unexplained lucid episodes involving heightened consciousness and awareness. These have been reported using the popular -- yet scientifically ill-defined -- term "near-death experiences."

A multidisciplinary team of national and international leaders, led by Sam Parnia, MD, PhD, director of Critical Care and Resuscitation Research at NYU Grossman School of Medicine, have published "Guidelines and Standards for the Study of Death and Recalled Experiences of Death," a multi-disciplinary consensus statement and proposed future directions in the Annals of the New York Academy of Sciences.Thisstudy, which examined the accumulated scientific evidence to date, represents the first-ever, peer-reviewed consensus statement for the scientific study of recalled experiences surrounding death.

The researchers on the study represent many medical disciplines, including the neurosciences, critical care, psychiatry, psychology, social sciences and humanities, and represent many of the world's most respected academic institutions including Harvard University, Baylor University, University of California Riverside, University of Virginia, Virginia Commonwealth University, Medical College of Wisconsin, and the Universities of Southampton and London.

Among their conclusions:

1. Due to advances in resuscitation and critical care medicine, many people have survived encounters with death or being near-death. These people -- who are estimated to comprise hundreds of millions of people around the world based on previous population studies -- have consistently described recalled experiences surrounding death, which involve a unique set of mental recollections with universal themes.

2. The recalled experiences surrounding death are not consistent with hallucinations, illusions or psychedelic drug induced experiences, according to several previously published studies. Instead, they follow a specific narrative arc involving a perception of: (a) separation from the body with a heightened, vast sense of consciousness and recognition of death; (b) travel to a destination; (c) a meaningful and purposeful review of life, involving a critical analysis of all actions, intentions and thoughts towards others; a perception of (d) being in a place that feels like "home," and (e) a return back to life.

3. The experience of death culminates into previously unidentified, separate subthemes and is associated with positive long-term psychological transformation and growth.

4. Studies showing the emergence of gamma activity and electrical spikes -- ordinarily a sign of heightened states of consciousness on electroencephalography (EEG) -- in relation to death, further support the claims of millions of people who have reported experiencing lucidity and heightened consciousness in relation to death.

5. Frightening or distressing experiences in relation to death often neither share the same themes, nor the same narrative, transcendent qualities, ineffability, and positive transformative effects.

"Cardiac arrest is not a heart attack, but represents the final stage of a disease or event that causes a person to die," lead author Parnia explains. "The advent of cardiopulmonary resuscitation (CPR) showed us that death is not an absolute state, rather, it's a process that could potentially be reversed in some people even after it has started.

"What has enabled the scientific study of death," he continues, "is that brain cells do not become irreversibly damaged within minutes of oxygen deprivation when the heart stops. Instead, they 'die' over hours of time. This is allowing scientists to objectively study the physiological and mental events that occur in relation to death."

So far, the researchers say, evidence suggests that neither physiological nor cognitive processes end with death and that although systematic studies have not been able to absolutely prove the reality or meaning of patients' experiences and claims of awareness in relation to death, it has been impossible to disclaim them either.

"Few studies have explored what happens when we die in an objective and scientific way, but these findings offer intriguing insights into how consciousness exists in humans and may pave the way for further research," Parnia adds.

https://www.sciencedaily.com/releases/2022/04/220407100956.htm

Psilocybin rewires the brain for people with depression

April 11, 2022

Science Daily/University of California - San Francisco

Psilocybin fosters greater connections between different regions of the brain in depressed people, freeing them up from long-held patterns of rumination and excessive self-focus, according to a new study by scientists at UC San Francisco and Imperial College London.

The discovery points toward a general mechanism through which psychedelics may be acting therapeutically on the brain to alleviate depression and possibly other psychiatric conditions that are marked by fixed patterns of thinking.

Scientists analyzed fMRI brain scans from nearly 60 people who had participated in two psilocybin trials. In the first one, all the participants had treatment-resistant depression and knew they were being given psilocybin. In the second one, the participants were depressed but not as severely, and they were not told whether they had been given psilocybin or a placebo that turned out to be escitalopram, an SSRI antidepressant. In addition to the drugs, all the participants received the same type of psychotherapy.

The scans, which were done before and after treatment, showed the psilocybin treatment reduced connections within brain areas that are tightly connected in depression, including the default mode, salience, and executive networks, and increased connections to other regions of the brain that had not been well integrated.

Participants were also less emotionally avoidant and their cognitive functioning got better. The improvement in their depressive symptoms correlated with changes to their brains, and these changes lasted until the study ended three weeks after the second psilocybin dose. No such changes were seen in the brains of those who received escitalopram, suggesting that psilocybin acts differently on the brain than SSRIs.

Psilocybin and other serotonergic psychedelics like ayahuasca affect 5-HT2A receptors, which are plentiful in brain networks that become overactive in depression. One hypothesis is that the drugs briefly disrupt these connections, giving them a chance to reform in new ways in the ensuing days and weeks.

"In previous studies we had seen a similar effect in the brain when people were scanned whilst on a psychedelic, but here we're seeing it weeks after treatment for depression, which suggests a carry-over of the acute drug action," said Robin Carhart-Harris, PhD, who directs the Neuroscape Psychedelics Division at UCSF and is the senior author of the study, which appears April 11, 2022, in Nature Medicine.

"We don't yet know how long the changes in brain activity seen with psilocybin therapy last, and we need to do more research to understand this," said Carhart-Harris, who is the Ralph Metzner Distinguished Professor of Neurology, Psychiatry, and Behavioral Sciences and a member of the UCSF Weill Institute for Neurosciences. "We do know that some people relapse, and it may be that after a while their brains revert to the rigid patterns of activity we see in depression."

The authors caution that while these findings are encouraging, patients with depression should not attempt to self-medicate with psilocybin. The trials took place under controlled, clinical conditions, using a regulated dose formulated in a laboratory, and involved extensive psychological support before, during, and after dosing.

But the study points to a mechanism that, if it holds up, may explain both how psilocybin helps to alleviate depression and potentially other debilitating psychiatric conditions.

"For the first time we find that psilocybin works differently from conventional antidepressants -- making the brain more flexible and fluid, and less entrenched in the negative thinking patterns associated with depression," said David Nutt, DM, head of the Imperial Centre for Psychedelic Research. "This supports our initial predictions and confirms psilocybin could be a real alternative approach to depression treatments."

https://www.sciencedaily.com/releases/2022/04/220411113727.htm

Research helps provide scientific framework for psilocybin use in therapeutic settings

April 11, 2022

Science Daily/Oregon State University

A new paper by an Oregon State University-led research team provides a scientific framework to help shape the rollout of a program in Oregon that will legally permit the use of psilocybin for therapeutic reasons.

Oregon voters approved a ballot measure in 2020 to allow use of psilocybin, the hallucinogenic compound found in some magic mushrooms, in therapeutic settings, becoming the first state to do so. Preliminary clinical trial data has shown psilocybin has potential to address mental health issues including depression, anxiety and PTSD.

The state created an advisory board to recommend how to roll out a safe and equitable system for psilocybin use. The Oregon Health Authority in February released draft rules crafted by the advisory board. They are expected to be finalized in the next year.

Jessie Uehling, a mycologist at Oregon State University who studies fungi and their applications that benefit humanity, was appointed last year by Gov. Kate Brown to the advisory board. Her involvement with the board made her realize the need for the recently published paper in the journal Fungal Biology.

"There was not a synthesis of all the information about psilocybin that an entity like the advisory board or any other state- or federal-level group would need to make decisions that are informed by science," said Uehling, an assistant professor who has a doctoral degree in genetics and genomics and a master's in mycology.

She, along with researchers in Mexico and several universities in the U.S., set out to change that. The paper they just published provides an overview of the biology, diversity and history of psilocybin-containing fungi.

The authors detail that there are hundreds of fungal species belonging to at least seven genera that are capable of producing psilocybin. Further, they discuss how many psilocybin-producing fungi have deadly poisonous lookalikes which grow in similar locations in natural habitats.

They also focus on how Indigenous people around the world have historically used the compound for sacred traditions in part because they say these cross-disciplinary insights need to be published, citable and publicly available.

While indirect evidence of hallucinogenic mushroom rituals dates back thousands of years in Northern Africa and Spain; its use, for hundreds of years, still persists in Mexico. Rules governing how these mushrooms are used among Indigenous Mexican groups has resulted in safe consumption for centuries, the researchers note. These rules include being guided by an elder or shaman, not mixing alcohol, medicine or drugs and discouraging travel for a week after the ceremony.

"These mushrooms and their traditions constitute a unique biocultural heritage whose use by Western society must be based on their respect and conservation," said Roberto Garibay-Orijel, a researcher at the Universidad Nacional Autónoma de México and co-author of the paper.

He said it's important that the paper emphasizes that the species of mushroom only found in Mexico, and strains from Indigenous territories in Mexico, are protected by the Nagoya protocol, an international agreement that prohibits their use for commercial purposes without the consent of their ancestral owners.

Recent Western, medicalized psilocybin trials have been designed to mirror the guided experience used by Indigenous groups. The trials have confirmed the importance of preparation and setting when using psilocybin-producing fungi.

There are currently more than 60 psilocybin clinical trials overseen by the National Institutes of Health. Preliminary data suggest psilocybin therapies are effective in treating major depressive disorder, obsessive-compulsive disorder, smoking cessation and alcoholism.

Results of psilocybin ingestion outside of clinical trials have found an increased connection to nature, enhanced creativity, greater enjoyment of music and increased positive mood.

Meanwhile, cities across the U.S. are decriminalizing psilocybin and Washington is considering a measure similar to Oregon's that would legalize psilocybin for therapeutic reasons.

"Society is having this moment right now where fungi are being appreciated for being really cool," Uehling said. "But they are also really powerful and some can be deadly. So we really need to better understand them through scientific research and proceed with safety as a first priority."

https://www.sciencedaily.com/releases/2022/04/220411101254.htm

Exercise may protect brain volume by keeping insulin and BMI levels low

April 13, 2022

Science Daily/American Academy of Neurology

Studies have shown that exercise helps protect brain cells. A new study looking at the mechanisms involved in this relationship suggests that the role exercise plays in maintaining insulin and body mass index levels may help protect brain volume and thus help stave off dementia. The research is published in the April 13, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"These results may help us to understand how physical activity affects brain health, which may guide us in developing strategies to prevent or delay age-related decline in memory and thinking skills," said study author Géraldine Poisnel, PhD, of Inserm Research Center in Caen, France. "Older adults who are physically active gain cardiovascular benefits, which may result in greater structural brain integrity."

In contrast, researchers found that the relationship between exercise and the metabolism of glucose in the brain was not affected by insulin or body mass index (BMI) levels. Reduced glucose metabolism in the brain can been seen in people with dementia.

The study involved 134 people with an average age of 69 who had no memory problems. The people filled out surveys about their physical activity over the past year. They had brain scans to measure volume and glucose metabolism. Information was gathered on BMI and insulin levels as well as cholesterol, blood pressure and other factors.

People with the most physical activity had a higher total volume of grey matter in their brains than people with the least amount of physical activity, with an average of about 550,000 cubic millimeters (mm³) compared to about 540,000 mm³. When researchers looked only at areas of the brain affected by Alzheimer's disease, they found the same results.

Those with the most activity also had a higher average rate of glucose metabolism in the brain than those with the least amount of activity.

Higher physical activity was not associated with how much amyloid plaque people had in their brains. Amyloid plaque is a marker for Alzheimer's disease.

Poisnel said more research is needed to understand the mechanisms behind these relationships. "Maintaining a lower BMI through physical activity could help prevent disturbed insulin metabolism that is often seen in aging, thus promoting brain health," Poisnel said.

The study does not prove that exercise protects brain volume. It only shows an association.

A limitation of the study is that people reported their own physical activity, so they may not remember it accurately.

https://www.sciencedaily.com/releases/2022/04/220413161810.htm

Maladaptive daydreaming may be a better diagnosis for some than ADHD

April 12, 2022

Science Daily/Ben-Gurion University of the Negev

Maladaptive daydreaming (MD) may be a better diagnosis for some people than ADHD, according to a new study by Ben-Gurion University of the Negev researchers, in collaboration with the University of Haifa. MD is a condition whereby people slip into involved highly detailed and realistic daydreams that can last hours at the cost of normal functioning. It has not yet been recognized as a formal psychiatric syndrome. However, Dr. Nirit Soffer-Dudek of the Consciousness and Psychopathology Laboratory in the Department of Psychology at BGU is one of the foremost experts on the condition and is hoping to get MD added to the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM VI), by promoting rigorous research on the subject.

"Some individuals who become addicted to their fanciful daydreams experience great difficulty in concentrating and focusing their attention on academic and vocational tasks, yet they find that an ADHD diagnosis and the subsequent treatment plan does not necessarily help them. Formally classifying MD as a mental disorder would enable psychological practitioners to better assist many of their patients," says Dr. Soffer-Dudek.

Previous studies had found high levels of ADHD in those also presenting with MD, thereby raising the question of whether MD was separate from ADHD. In the current study, published recently in the Journal of Clinical Psychology, doctoral candidate Ms. Nitzan Theodor-Katz, together with Dr. Soffer-Dudek and their colleagues from the University of Haifa, assessed 83 adults diagnosed with ADHD for inattention symptoms, MD, depression, loneliness, and self-esteem. Of those, about 20% met the proposed diagnostic criteria for MD, with significantly higher rates of depression, loneliness, and lowered self-esteem, compared to those with ADHD that did not meet criteria for MD.

"Our findings suggest that there is a subgroup of those diagnosed with ADHD who would benefit more from a diagnosis of MD," says Dr. Soffer-Dudek.

https://www.sciencedaily.com/releases/2022/04/220412141107.htm

Certain personality traits associated with cognitive functioning late in life

People high in conscientiousness, low in neuroticism, less likely to develop mild cognitive impairment

April 11, 2022

Science Daily/American Psychological Association

People who are organized, with high levels of self-discipline, may be less likely to develop mild cognitive impairment as they age, while people who are moody or emotionally unstable are more likely to experience cognitive decline late in life, according to research published by the American Psychological Association.

The research, published in the Journal of Personality and Social Psychology, focused on the role three of the so-called "Big Five" personality traits (conscientiousness, neuroticism and extraversion) play in cognitive functioning later in life.

"Personality traits reflect relatively enduring patterns of thinking and behaving, which may cumulatively affect engagement in healthy and unhealthy behaviors and thought patterns across the lifespan," said lead author Tomiko Yoneda, PhD, of the University of Victoria. "The accumulation of lifelong experiences may then contribute to susceptibility of particular diseases or disorders, such as mild cognitive impairment, or contribute to individual differences in the ability to withstand age-related neurological changes."

Individuals who score high in conscientiousness tend to be responsible, organized, hard-working and goal-directed. Those who score high on neuroticism have low emotional stability and have a tendency toward mood swings, anxiety, depression, self-doubt and other negative feelings. Extraverts draw energy from being around others and directing their energies toward people and the outside world. They tend to be enthusiastic, gregarious, talkative and assertive, according to Yoneda.

To better understand the relationship between personality traits and cognitive impairment later in life, researchers analyzed data from 1,954 participants in the Rush Memory and Aging Project, a longitudinal study of older adults living in the greater Chicago metropolitan region and northeastern Illinois. Participants without a formal diagnosis of dementia were recruited from retirement communities, church groups, and subsidized senior housing facilities beginning in 1997 and continuing to the present. Participants received a personality assessment and agreed to annual assessments of their cognitive abilities. The study included participants who had received at least two annual cognitive assessments or one assessment prior to death.

Participants who scored either high on conscientiousness or low in neuroticism were significantly less likely to progress from normal cognition to mild cognitive impairment over the course of the study.

"Scoring approximately six more points on a conscientiousness scale ranging 0 to 48 was associated with a 22% decreased risk of transitioning from normal cognitive functioning to mild cognitive impairment," said Yoneda. "Additionally, scoring approximately seven more points on a neuroticism scale of 0 to 48 was associated with a 12% increased risk of transition."

Researchers found no association between extraversion and ultimate development of mild cognitive impairment, but they did find that participants who scored high on extraversion -- along with those who scored either high on conscientiousness or low in neuroticism -- tended to maintain normal cognitive functioning longer than others.

For example, 80-year-old participants who were high in conscientiousness were estimated to live nearly two years longer without cognitive impairment compared with individuals who were low in conscientiousness. Participants high in extraversion were estimated to maintain healthy cognition for approximately a year longer. In contrast, high neuroticism was associated with at least one less year of healthy cognitive functioning, highlighting the harms associated with the long-term experience of perceived stress and emotional instability, according to Yoneda.

Additionally, individuals lower in neuroticism and higher in extraversion were more likely to recover to normal cognitive function after receiving a previous diagnosis of mild cognitive impairment, suggesting that these traits may be protective even after an individual starts to progress to dementia. In the case of extraversion, this finding may be indicative of the benefits of social interaction for improving cognitive outcomes, according to Yoneda.

There was no association between any of the personality traits and total life expectancy.

Yoneda noted that the findings are limited due to the primarily white (87%) and female (74%) makeup of the participants. Participants were also highly educated, with nearly 15 years of education on average. Future research is necessary on more diverse samples of older adults and should include the other two of the big five personality traits (agreeableness and openness) to be more generalizable and provide a broader understanding of the impact of personality traits on cognitive processes and mortality later in life, she said.

https://www.sciencedaily.com/releases/2022/04/220411101359.htm

Loss of neurons, not lack of sleep, makes Alzheimer’s patients drowsy

Reviving 'awake neurons' could be the solution to their sleepiness

April 4, 2022

Science Daily/University of California - San Francisco

The lethargy that many Alzheimer's patients experience is caused not by a lack of sleep, but rather by the degeneration of a type of neuron that keeps us awake, according to a study that also confirms the tau protein is behind that neurodegeneration.

The study's findings contradict the common notion that Alzheimer's patients sleep during the day to make up for a bad night of sleep and point toward potential therapies to help these patients feel more awake.

The data came from study participants who were patients at UC San Francisco's Memory and Aging Center and volunteered to have their sleep monitored with electroencephalogram (EEG) and donate their brains after they died.

Being able to compare sleep data with microscopic views of their post-mortem brain tissue was the key to answering a question that scientists have been pondering for years.

"We were able to prove what our previous research had been pointing to -- that in Alzheimer's patients who need to nap all the time, the disease has damaged the neurons that keep them awake," said Grinberg, a neuropathologist who, along with psychiatrist Thomas Neylan, MD, is a senior author on the study, which appears in the April 4, 2022 issue of JAMA Neurology.

"It's not that these patients are tired during the day because they didn't sleep at night," noted Grinberg. "It's that the system in their brain that would keep them awake is gone."

The opposite phenomenon occurs in patients with other neurodegenerative conditions, such as progressive supranuclear palsy (PSP), who were also included in the study. Those patients have damage to the neurons that make them feel tired, so they are unable to sleep and become sleep deprived.

Grinberg's team developed the hypothesis that Alzheimer's patients were having trouble staying awake, after discovering a set of neurons that keep us awake and that are affected in Alzheimer's from the onset of the disease.

"You can think of this system as a switch with wake-promoting neurons and sleep-promoting neurons, each tied to neurons controlling circadian rhythms," said Joseph Oh, a medical student and one of the lead authors. "Finally, with this post-mortem tissue, we've been able to confirm that this switch, which is known to exist in model animals, also exists in humans and governs our sleep and awake cycles."

"Extremely Smart Neurons" Disrupted by Tau Proteins

Oh describes these neurons as "extremely smart" because they can produce an array of neurotransmitters and can excite, inhibit, and modulate other nerve cells.

"It's a small number of neurons but their computational capabilities are incredible," Oh said. "When these cells are affected by disease, it can have a huge effect on sleep."

To determine what's contributing to the degradation of these neurons in Alzheimer's, the researchers looked at the brains of 33 patients with Alzheimer's, 20 with PSP, and 32 volunteers who'd had healthy brains through the end of life.

The team measured the amounts of two proteins often associated with the neurodegenerative process -- beta amyloid and tau. Which of the two is more involved in disrupting sleep has been a long-disputed question, with most researchers crediting the sleep problems to beta-amyloid accumulation.

During sleep, the brain clears out the beta amyloid that accumulates during the day. When we can't sleep, it builds up. So, Neylan said, since the PSP patients never sleep, she expected to see lots of the protein in their brains.

"But it turns out that they have none," he said. "These findings confirm with direct evidence that tau is a critical driver of sleep disturbances."

In patients with PSP, said Grinberg, this understanding turned the treatment paradigm on its head.

"We see that these patients can't sleep because there is nothing telling the "awake" neurons to shut down," she said. "Now, rather than trying to induce these people to sleep, the idea is to shut down the system that's keeping them awake."

Clinical Trial is Giving Patients Hope

That idea is currently being tested in a clinical trial of patients with PSP, using a treatment that specifically targets the overactive 'awake' system that keeps these patients from sleeping. This approach contrasts with the traditional trial-and-error treatment with sleep medications.

At the helm of that trial is Christine Walsh, PhD, the study's other lead author, who has also worked on the study for a decade. Noting that PSP and Alzheimer's are at opposite ends of the sleep-disturbance spectrum, she said she expects the research to lead to new ways of treating sleep disturbances driven by neurodegeneration.

Treatments for Alzheimer's could be adjusted depending on the patient's needs, bumping up the "awake" system while tamping down the "sleep" system, said Walsh, who along with Grinberg, is a member of the UCSF Weill Institute for Neurosciences.

The PSP trial is still underway, and Walsh is highly optimistic that this new approach will have better results than current medications for people with either condition. Based on the findings of the study published today, she said, "We're even more hopeful that we can actually make a difference in the lives of these patients."

https://www.sciencedaily.com/releases/2022/04/220404120516.htm

Half of older adults now die with a dementia diagnosis, up sharply

More awareness and more detailed health records may explain rise; end-of-life care shifting as diagnoses allow for more advance planning

April 1, 2022

Science Daily/Michigan Medicine - University of Michigan

Nearly half of all older adults now die with a diagnosis of dementia listed on their medical record, up 36% from two decades ago, a new study shows.

But that sharp rise may have more to do with better public awareness, more detailed medical records and Medicare billing practices than an actual rise in the condition, the researchers say.

Even so, they note, this offers a chance for more older adults to talk in advance with their families and health care providers about the kind of care they want at the end of life if they do develop Alzheimer's disease or another form of cognitive decline.

The study, published in JAMA Health Forum by a University of Michigan team, uses data from 3.5 million people over the age of 67 who died between 2004 and 2017. It focuses on the bills their providers submitted to the traditional Medicare system in the last two years of the patients' lives.

In 2004, about 35% of these end-of-life billing claims contained at least one mention of dementia, but by 2017 it had risen to more than 47%. Even when the researchers narrowed it down to the patients who had at least two medical claims mentioning dementia, 39% of the patients qualified, up from 25% in 2004.

The biggest jump in the percentage of people dying with a dementia diagnosis happened around the time Medicare allowed hospitals, hospices and doctors' offices to list more diagnoses on their requests for payment.

But around this same time, the National Plan to Address Alzheimer's Disease also went into effect, with a focus on public awareness, quality of care and more support for patients and their caregivers.

The end-of-life care that patients with dementia received changed somewhat overtime, including a drop in the percentage who died in a regular hospital bed or a ICU bed, or who had a feeding tube in their last six months. The percentage who received hospice services rose dramatically, from 36% to nearly 63%, though the authors note this is in line with a national trend toward more hospice care by the late 2010s.

"This shows we have far to go in addressing end-of-life care preferences proactively with those who are recently diagnosed, and their families," said Julie Bynum, M.D., Ph.D., senior author of the study and a professor of geriatric medicine at Michigan Medicine. "Where once the concern may have been underdiagnosis, now we can focus on how we use dementia diagnosis rates in everything from national budget planning to adjusting how Medicare reimburses Medicare Advantage plans."

https://www.sciencedaily.com/releases/2022/04/220401122152.htm

Most older adults want to 'age in place' but many haven't taken steps to help them do so

From home safety and accessibility, to social support, community services and paid in-home help, National Poll on Healthy Aging shows varied preparation

April 13, 2022

Science Daily/University of Michigan

The vast majority of people over 50 say it's important that they keep living in their current homes for as long as possible. But a new poll shows many of them haven't planned or prepared for "aging in place," and a sizable percentage might have a hard time paying for in-home help.

The pandemic's toll on older adults, especially those in nursing homes and other long-term care facilities, has brought the issue of living independently at home into the national spotlight. So have policy proposals around changing the ability of Medicare and Medicaid to pay for virtual care and in-home help.

But the new findings from the National Poll on Healthy Aging suggest many people in their 50s, 60s and 70s need to do more to modify their homes or plan for services they may need if they want to avoid or delay needing to move. The poll also shows differences in aging-in-place readiness among the 28% of older adults who told the poll that they live alone.

The poll is based at U-M's Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan's academic medical center.

In all, 88% of people between the ages of 50 and 80 said it was very or somewhat important to them that they live in their homes as long as possible. But only 15% said they've given a lot of consideration to how their home may need to be modified as they age, while 47% have given it little or no thought.

Meanwhile, 48% of those who live alone said they don't have someone in their lives who could help them with personal care such as bathing and dressing if needed, compared with 27% of those who live with others.

As for hiring help, 19% of older adults are very confident they could afford to pay someone to help with household chores, grocery shopping, personal care or managing their finances. On the other hand, nearly two-thirds of those who called their current physical or mental health status fair or poor said they were not confident or not very confident that they could afford to pay for such help.

"The pandemic's impact on older adults, and policy proposals about home-based services at the federal and state level, mean this is a topic of immediate importance," said Sheria Robinson-Lane, assistant professor at the U-M School of Nursing and IHPI member who worked with the poll team on the report. "Especially for those without as much social support, or with more health needs, it's important to take a proactive approach and plan for the future now."

Poll director Preeti Malani, U-M Medical School infectious disease professor also trained in geriatrics, said that older adults should explore with their health care providers and local social service agencies the kinds of support available to them, and talk with loved ones about their goals.

"Taking steps to understand what's available in the community, through the national Eldercare Locator, the Area Agency on Aging that serves your region, nonprofit organizations and other sources could help older adults be more prepared," she said.

"Family members can help encourage older adults to find out what's available, to invest in home improvements, and to aid them in installing safety devices and technologies that can help keep them aging in place. Think of it as a positive investment toward current safety and future independence -- that can help older adults get past the temptation to put it off for another day."

More findings

The poll finds that 1 in 5 older adults had moved in the past five years. About half of those who moved said they had moved to a home that was easier to get around, while half also said their new home was smaller.

Wherever they live now, 34% said their home definitely has the necessary features that would let them age in place, and 49% said they had at least one 'smart home' device.

But the poll drilled down to ask about specific features and technologies. While 88% had a main-floor bathroom and 78% had a bedroom on the main floor, which could reduce the need to climb stairs and reduce fall risk, fewer older adults had other features.

For instance, 32% said they had grab bars in the bathroom, and less than 10% had safety-focused technologies such as alarms on their stoves or personal emergency response systems. Only 7% said they had a barrier-free shower, and 9% said that it was difficult to use the main rooms in their home because of clutter or large amounts of possessions there.

"AARP research consistently shows that the majority of older adults want to stay in their homes and communities for as long as possible," said Indira Venkat, vice president of consumer insights at AARP. "Unfortunately, most houses weren't built to support the needs of people across the many stages of life. The best way to continue living in the home you love is to plan ahead and make changes that will accomodate your needs today and in the future."

In late 2021, AARP published a report on the preferences of adults over 18 about their future home and community circumstances, including the ability to age in place.

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI, and administered online and via phone in January and February 2022 among nearly 2,277 older adults ages 50-80. The sample was subsequently weighted to reflect the U.S. population.

Poll: https://www.healthyagingpoll.org/reports-more

https://www.sciencedaily.com/releases/2022/04/220413203139.htm

How to reduce loneliness: Meaningful activities can improve health, well-being

April 6, 2022

Science Daily/Penn State

Free time is sometimes idealized, but research shows free time can sometimes be unhealthy by increasing loneliness. A new Penn State study demonstrated that engaging in meaningful, challenging activities during free time can reduce people's loneliness and increase their positive feelings.

An international team of researchers including John Dattilo -- professor of recreation, park, and tourism management at Penn State -- has been studying how to increase leisure and reduce loneliness during the pandemic among both international college students and older adults.

Across two different studies, the researchers found that people who had meaningful, challenging experiences were less lonely -- even when higher levels of social contact and support were not available.

"There is a well-known saying: 'Time flies when you are having fun,'" said Dattilo. "The unspoken corollary is that time drags when you are bored. Our research shows that both of these ideas are true. By engaging in meaningful activities during free time that demand focus, people can reduce loneliness and increase momentary happiness."

Loneliness and the pandemic

Despite -- or perhaps in part because of -- technology that can connect people anywhere at any time, previous research has shown that loneliness has increased over recent decades.

Loneliness touches people of all ages, from children to young adults to older adults. The COVID-19 pandemic, which caused many people to alter their social behavior to prevent the spread of disease, exacerbated the problem of loneliness around the world.

"Loneliness is very connected to our health," Dattilo explained. "Psychological, emotional, and cognitive health are all challenged when people are lonely. Loneliness is associated with depression and other mental health challenges."

"Troublingly," continued Dattilo, "there is a loneliness epidemic. And while the COVID-19 pandemic has increased loneliness for many people, the silver lining is that the pandemic has also exposed the scope of the loneliness problem. Anything we can do as a society to reduce loneliness should improve health and happiness for people everywhere."

In a new article that appears in Leisure Sciences, the researchers explored loneliness among international university students in Taiwan. The same research team also published an article about reducing loneliness among nursing home residents late in 2021.

Prior research has shown that loneliness among international university students is common around the world. International students are removed from their social networks and live in a different culture, often one that speaks a different language. Typically, international students can prevent loneliness by participating in social activities to receive 'social support,' the sense that they are cared for by the people with whom they socialize. During the pandemic, however, many group-based activities and social gatherings have been cancelled or prohibited.

Additionally, the researchers identified that the online social opportunities that became available in the pandemic may be less accessible to international students because of language and cultural differences.

Flow reduces loneliness 

According to the researchers, reduced loneliness is associated with engaging in enjoyable activities that require both concentration and skill.

"When people become engrossed in what they are doing, they enter a state that is called 'flow,'" Dattilo explained. "Flow can be achieved by engaging in mental or physical activities that we value and that require us to concentrate fully to use our skills."

For people to achieve a state of flow, an activity must require a good deal of their skill but not be so difficult that it seems impossible. Additionally, it must demand concentration to execute and be meaningful to the participant. Artistic endeavors like playing the piano or painting can induce flow. So can physical activities like skiing or chopping wood, along with mental tasks like writing or storytelling. What induces flow differs from person to person based on individual skills and values.

"When we enter a state of flow, we become absorbed and focused, and we experience momentary enjoyment," Dattilo continued. "When we leave a state of flow, we are often surprised by how much time has passed."

People with extensive free time -- like college students who are locked down during a pandemic, or people who live in a nursing home -- can achieve flow when they engage in activities they find to be meaningful. In this way, time passes quickly for them, their life has meaning, and their experience of loneliness is reduced, according to the researchers.

Social support from friends and acquaintances is a primary way that people reduce loneliness. For many people, however, obtaining adequate social support can be challenging. Though the researchers found that students with high levels of social support were less lonely, they found that flow was even more important to reducing loneliness. Helping people achieve flow can reduce loneliness in situations where social support is insufficient. More importantly, it can reduce loneliness for people in any situation.

Encouraging flow for everyone 

Some activities never induce flow, while other activities may or may not, depending on the individual. According to Dattilo, there is nothing wrong with watching television, but, typically, it does not help people enter a state of flow because they are unlikely to experience any challenges. Additionally, different people find different activities meaningful and enjoyable. Nursing home residents are unlikely to enjoy playing bingo if they did not enjoy similar games when they were younger, said Dattilo.

"Learning which activities might enable someone to enter a state of flow requires asking questions and listening," said Dattilo. "People tend to thrive on healthy engagement and challenge. My collaborators and I hope that this research will help people live fuller, happier, healthier lives."

https://www.sciencedaily.com/releases/2022/04/220406132430.htm

Firefighters with PTSD likely to have relationship problems

PTSD interferes with ability to regulate emotions, causing relationship fallout

April 4, 2022

Science Daily/University of Houston

For firefighters, every day can be an emergency, rushing into flames and disasters as others can only hope to rush out. And make no mistake, it takes a toll. Exposure to such traumatic events throughout their careers places these first responders at heightened risk for the development of post-traumatic stress disorder (PTSD), and new research from the University of Houston First Responder Program, indicates that PTSD means trouble for their intimate relationships.

"Individuals experiencing PTSD symptoms often experience interpersonal problems and relationship stress, and this may be due to emotion regulation difficulties," reports Anka Vujanovic, associate professor of psychology and director of the UH First Responder Program and the Trauma and Stress Studies Center in the Journal of Aggression, Maltreatment & Trauma. "Negative alterations in cognition and mood were especially relevant to emotion regulation difficulties and relationship satisfaction."

The paper's lead author is Donald A. Godfrey, a doctoral student in the lab of Julia Babcock, professor of psychology and co-director of the Center for Couples Therapy at UH. The study examined the association between PTSD symptoms, couple relationship satisfaction and emotion regulation difficulties among 188 firefighters who completed an online questionnaire.

"To our knowledge, no prior research has examined the role of emotion regulation difficulties in the association between PTSD symptoms and relationship satisfaction," said Godfrey. "This study was the first to identify these associations among firefighters."

Difficulty regulating emotion also appears to have negative effects on couple intimacy, as individuals who report heightened emotion regulation difficulties demonstrated heightened fear of being controlled by their partners and avoidance of closeness. Their partners reported decreased perception that they would be open to emotional dialogue.

"Results indicated that PTSD symptom severity was negatively associated with relationship satisfaction and positively associated with emotion regulation difficulties," wrote Godfrey.

The findings highlight the importance of understanding associations between PTSD and interpersonal functioning among firefighters.

"Emotion regulation difficulties may offer a path for clinically targeting PTSD symptoms and relationship functioning among firefighters," said Babcock.

https://www.sciencedaily.com/releases/2022/04/220404150127.htm

Intense exercise while dieting may reduce cravings for fatty food

April 21, 2022

Science Daily/Washington State University

In a study that offers hope for human dieters, rats on a 30-day diet who exercised intensely resisted cues for favored, high-fat food pellets.

The experiment was designed to test resistance to the phenomenon known as "incubation of craving," meaning the longer a desired substance is denied, the harder it is to ignore signals for it. The findings suggest that exercise modulated how hard the rats were willing to work for cues associated with the pellets, reflecting how much they craved them.

While more research needs to be done, the study may indicate that exercise can shore up restraint when it comes to certain foods, said Travis Brown, a Washington State University physiology and neuroscience researcher.

"A really important part of maintaining a diet is to have some brain power -- the ability to say 'no, I may be craving that, but I'm going to abstain,'" said Brown, corresponding author on the study published in the journal Obesity. "Exercise could not only be beneficial physically for weight loss but also mentally to gain control over cravings for unhealthy foods."

In the experiment, Brown and colleagues from WSU and University of Wyoming put 28 rats through a training with a lever that when pressed, turned on a light and made a tone before dispensing a high-fat pellet. After the training period, they tested to see how many times the rats would press the lever just to get the light and tone cue.

The researchers then split the rats into two groups: one underwent a regime of high-intensity treadmill running; the other had no additional exercise outside of their regular activity. Both sets of rats were denied access to the high-fat pellets for 30 days. At the end of that period, the researchers gave the rats access to the levers that once dispensed the pellets again, but this time when the levers were pressed, they only gave the light and tone cue. The animals that did not get exercise pressed the levers significantly more than rats that had exercised, indicating that exercise lessened the craving for the pellets.

In future studies, the research team plans to investigate the effect of different levels of exercise on this type of craving as well as how exactly exercise works in the brain to curb the desire for unhealthy foods.

While this study is novel, Brown said it builds on the work of Jeff Grimm at Western Washington University who led the team that first defined the term "incubation of craving" and has studied other ways to subvert it. Brown also credited Marilyn Carroll-Santi's research at University of Minnesota showing that exercise can blunt cravings for cocaine.

It is still an unsettled research question as to whether food can be addictive in the same way as drugs. Not all foods appear to have an addictive effect; as Brown pointed out, "no one binge eats broccoli." However, people do seem to respond to cues, such as fast-food ads, encouraging them to eat foods high in fat or sugar, and those cues may be harder to resist the longer they diet.

The ability to disregard these signals may be yet another way exercise improves health, Brown said.

"Exercise is beneficial from a number of perspectives: it helps with cardiac disease, obesity and diabetes; it might also help with the ability to avoid some of these maladaptive foods," he said. "We're always looking for this magic pill in some ways, and exercise is right in front of us with all these benefits."

https://www.sciencedaily.com/releases/2022/04/220421094049.htm

Got food cravings? What's living in your gut may be responsible

April 20, 2022

Science Daily/University of Pittsburgh

Eggs or yogurt, veggies or potato chips? We make decisions about what to eat every day, but those choices may not be fully our own. New University of Pittsburgh research on mice shows for the first time that the microbes in animals' guts influence what they choose to eat, making substances that prompt cravings for different kinds of foods.

"We all have those urges -- like if you ever you just feel like you need to eat a salad or you really need to eat meat," said Kevin Kohl, an assistant professor in the Department of Biology in the Kenneth P. Dietrich School of Arts and Sciences. "Our work shows that animals with different compositions of gut microbes choose different kinds of diets."

Despite decades of speculation by scientists about whether microbes could influence our preferred diets, the idea has never been directly tested in animals bigger than a fruit fly. To explore the question, Kohl and his postdoc Brian Trevelline (A&S '08), now at Cornell University, gave 30 mice that lacked gut microbes a cocktail of microorganisms from three species of wild rodents with very different natural diets.

The duo found that mice in each group chose food rich in different nutrients, showing that their microbiome changed their preferred diet. The researchers published their work today in the Proceedings of the National Academy of Sciences.

While the idea of the microbiome affecting your behavior may sound far-fetched, it's no surprise for scientists. Your gut and your brain are in constant conversation, with certain kinds of molecules acting as go-betweens. These byproducts of digestion signal that you've eaten enough food or maybe that you need certain kinds of nutrients. But microbes in the gut can produce some of those same molecules, potentially hijacking that line of communication and changing the meaning of the message to benefit themselves.

One such messenger will be familiar to anyone who's had to take a nap after a turkey dinner: tryptophan.

"Tryptophan is an essential amino acid that's common in turkey but is also produced by gut microbes. When it makes its way to the brain, it's transformed into serotonin, which is a signal that's important for feeling satiated after a meal," Trevelline said. "Eventually that gets converted into melatonin, and then you feel sleepy."

In their study, Trevelline and Kohl also showed that mice with different microbiomes had different levels of tryptophan in their blood, even before they were given the option to choose different diets -- and those with more of the molecule in their blood also had more bacteria that can produce it in their gut.

It's a convincing smoking gun, but tryptophan is just one thread of a complicated web of chemical communication, according to Trevelline. "There are likely dozens of signals that are influencing feeding behavior on a day-to-day basis. Tryptophan produced by microbes could just be one aspect of that," he said. It does, however, establish a plausible way that microscopic organisms could alter what we want to eat -- it's one of just a few rigorous experiments to show such a link between the gut and the brain despite years of theorizing by scientists.

There's still more science to do before you should start distrusting your food cravings, though. Along with not having a way to test the idea in humans, the team didn't measure the importance of microbes in determining diet compared to anything else.

"It could be that what you've eaten the day before is more important than just the microbes you have," Kohl said. "Humans have way more going on that we ignore in our experiment. But it's an interesting idea to think about."

And it's just one behavior that microbes could be tweaking without our knowledge. It's a young field, Kohl points out, and there's still lots to learn.

"I'm just constantly amazed at all of the roles we're finding that microbes play in human and animal biology," Kohl said.

https://www.sciencedaily.com/releases/2022/04/220420151540.htm

New study reveals that healthy plant-based diets are associated with a lower risk of developing diabetes

April 10, 2022

Science Daily/Diabetologia

New research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) finds that the consumption of healthy plant-based foods, including fruits, vegetables, nuts, coffee, and legumes, is associated with a lower risk of developing type 2 diabetes (T2D) in generally healthy people and support their role in diabetes prevention.

The study was conducted by Professor Frank Hu and colleagues at the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA, and aimed to identify the metabolite profiles related to different plant-based diets and investigate possible associations between those profiles and the risk of developing T2D.

A metabolite is a substance used or produced by the chemical processes in a living organism and includes the vast number of compounds found in different foods as well as the complex variety of molecules created as those compounds are broken down and transformed for use by the body. Differences in the chemical makeup of foods means that an individual's diet should be reflected in their metabolite profile. Recent technological advances in the field of high-throughput metabolomics profiling have ushered in a new era of nutritional research. Metabolomics is defined as the comprehensive analysis and identification of all the different metabolites present within a biological sample.

Over 90% of diabetes cases are the type 2 form, and the condition poses a major threat to health around the world. Global prevalence of the disease in adults has more than tripled in less than two decades, with cases increasing from around 150 million in 2000 to over 450 million in 2019 and projected to rise to around 700 million in 2045.

The global health burden of T2D is further increased by the numerous complications arising from the disease, both macrovascular, such as cardiovascular disease, and microvascular, which damage the kidneys, the eyes, and the nervous system. The diabetes epidemic is primarily caused by unhealthy diets, having overweight or obesity, genetic predisposition, and other lifestyle factors such as a lack of exercise. Plant-based diets, especially healthy ones rich in high quality foods such as whole grains, fruits, and vegetables, have been associated with a lower risk of developing T2D but the underlying mechanisms involved are not fully understood.

The team conducted an analysis of blood plasma samples and dietary intake of 10,684 participants from three prospective cohorts (Nurses' Health Study, Nurses' Health Study II and Health Professionals Follow-up Study). Participants were predominantly white, middle-aged (mean age 54 years), and with a mean body mass index (BMI) of 25.6kg/m2.

Study participants completed food frequency questionnaires (FFQs) which were scored according to their adherence to three plant-based diets: an overall Plant-based Diet Index (PDI), a healthy Plant-based Diet Index (hPDI), and an Unhealthy Plant-Based Diet Index (uPDI). Diet indices were based on that individual's intake of 18 food groups: healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee); unhealthy plant foods (refined grains, fruit juices, potatoes, sugar-sweetened beverages, and sweets/desserts); and animal foods (animal fats, dairy, eggs, fish/seafood, meat, and miscellaneous animal-based foods). The team distinguished between healthy and unhealthy plant foods according to their association with T2D, cardiovascular disease, certain cancers, and other conditions, including obesity and high blood pressure.

The researchers tested blood samples taken back in late 1980s and 1990s in the early phase of the three studies mentioned above to create metabolite profile scores for the participants, and any cases of incident T2D during the follow-up period of the study were recorded. Analyses of these data together with the diet index scores enabled the team to find any correlations between metabolite profile, diet index, and T2D risk.

The study found that compared with participants who did not develop T2D, those who were diagnosed with the disease during follow-up had a lower intake of healthy plant-based foods, as well as lower scores for PDI and hPDI. In addition, they had a higher average BMI, and were more likely to have high blood pressure and cholesterol levels, use blood pressure and cholesterol drugs, have a family history of diabetes, and be less physically active.

The metabolomics data revealed that plant-based diets were associated with unique multi-metabolite profiles, and that these patterns differed significantly between the healthy and unhealthy plant-based diets. In addition, metabolite profile scores for both the overall plant-based diet and the healthy plant-based diet were inversely associated with incident T2D in a generally healthy population, independent of BMI, and other diabetes risk factors, while no association was observed for the unhealthy plant-based diet. As a result, higher metabolite profile scores for PDI and hPDI indicated both closer adherence to those diets and having a lower risk of developing T2D.

Further analysis revealed that after adjusting for levels of trigonelline, hippurate, isoleucine, a small set of triacyglycerols (TAGs), and several other intermediate metabolites, the association between plant-based diets and T2D largely disappeared, suggesting that they might play a key role in linking those diets to incident diabetes. Trigonelline, for example, is found in coffee and has demonstrated beneficial effects on insulin resistance in animal studies, while higher levels of hippurate are associated with better glycaemic control, enhanced insulin secretion and lower risk of T2D. The team suggest that these metabolites could be investigated further and may provide mechanistic explanations of how plant-based diets can have a beneficial effect on T2D risk.

Professor Hu explains: "While it is difficult to tease out the contributions of individual foods because they were analysed together as a pattern, individual metabolites from consumption of polyphenol-rich plant foods like fruits, vegetables, coffee, and legumes are all closely linked to healthy plant-based diet and lower risk of diabetes."

The authors conclude: "Our findings support the beneficial role of healthy plant-based diets in diabetes prevention and provide new insights for future investigation…our findings regarding the intermediate metabolites are at the moment intriguing but further studies are needed to confirm their causal role in the associations of plant-based diets and the risk of developing type 2 diabetes."

Since they only collected blood samples at one point in time, the authors also believe that long-term repeated metabolomics data are needed to understand how dietary changes relate to changes in metabolome, thereby influencing T2D risk.

https://www.sciencedaily.com/releases/2022/04/220410110753.htm

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Women were less likely to return to work after a severe stroke

April 21, 2022

Science Daily/American Heart Association

According to new research, about one third of people who had a large vessel (severe) ischemic stroke, treated with mechanical clot removal, resumed work three months after stroke treatment. However, women were about half as likely to return to work after a severe stroke compared to men, according to the study published today in Stroke, the peer-reviewed, flagship journal of the American Stroke Association, a division of the American Heart Association.

A stroke due to a blockage in a large blood vessel is an indicator of a severe stroke and the potential for continuing loss of function, which makes it less likely people will return to work. According to the American Heart Association, while ischemic stroke accounts for 87% of strokes in the United States, large vessel occlusions only account for approximately 24% -- 46% of ischemic strokes.

Endovascular therapy (mechanical clot removal) and clot-busting medications are now a standard treatment for select patients with severe stroke. Endovascular therapy involves threading a slim catheter through a vessel in the leg to mechanically remove a clot blocking a brain vessel. In 2018, the American Heart Association stroke treatment guidelines were updated to recommend mechanical clot removal for select stroke patients to improve the odds of functional recovery.

"Returning to work after a severe stroke is a sign of successful rehabilitation. Resuming pre-stroke levels of daily living and activities is highly associated with a better quality of life," said Marianne Hahn, M.D., lead study author and a clinician scientist in the department of neurology at Johannes Gutenberg University in Mainz, Germany. "In contrast to most return-to-work studies, we included a large cohort of only people treated with mechanical clot removal; they are a subgroup of stroke patients at high risk for severe, persisting deficits."

Researchers examined data from the German Stroke Registry -- Endovascular Treatment Study Group. The analysis included more than 600 men and women (28% women), ages 18- to 64-years-old who had a large vessel ischemic stroke between 2015 and 2019.

All study participants were employed prior to their stroke and were treated with mechanical thrombectomy. More than half of the study participants also received intravenous thrombolysis (clot-busting medication).

Researchers compared the people who returned to work 90 days after being treated with mechanical thrombectomy to those who did not resume work. After accounting for age, sex, health conditions, type and severity of stroke, and treatment characteristics, the analysis found:

• About one-third of the stroke survivors resumed work three months later.

• The amount of persistent functional deficits after stroke was the main reason people were not able to return to work.

• Women were 58% less likely to return to work three months after mechanical thrombectomy compared to men.

• Individuals who were treated with both mechanical thrombectomy and intravenous thrombolysis were almost twice as likely to return to work compared to the individuals who had undergone mechanical thrombectomy only.

"After examining the data further, we also found that women in our cohort were younger at the time of their stroke, were more likely to be non-smokers and were more likely to have no existing significant disability when discharged from the hospital compared to the men in our study. Despite having more of these favorable characteristics for return to work, we did not observe a higher re-employment rate among women before considering these differences," Hahn said.

The researchers noted further study is needed to explain the discrepancy between men and women re-entering the workforce after a major stroke. More intensive and supportive vocational rehabilitation programs may be valuable to help women return to work.

"There is more to re-employment after mechanical thrombectomy than functional outcomes," Hahn said. "Targeted vocational and workplace rehabilitation interventions have been shown to improve rates of return to work. And previous studies have also found that returning to work is associated with increased well-being, self-esteem and life satisfaction."

The study authors believe their findings may be transferable to other countries with similar health care and rehabilitation systems. However, confirmation and in-depth analyses of national policies are necessary to explain the observation since there may be differences, such as social services and benefits, which have been shown to influence return to work.

The study was limited in that the data lacked detailed information about types of jobs and available employment opportunities. The German Stroke Registry does not include social determinants of health, and whether an individual was re-employed at the same job or working full- or part-time. Researchers noted these limitations may help explain and play a role in whether people returned to work after a severe stroke.

In the U.S., stroke is the fifth leading cause of death and a leading cause of disability, according to the latest data from the American Heart Association. To recognize stroke symptoms requiring immediate medical attention, the American Stroke Association recommends everyone remember the acronym F.A.S.T. for Face drooping, Arm weakness, Speech difficulty, Time to call 9-1-1.

https://www.sciencedaily.com/releases/2022/04/220421094107.htm

Women's earnings drop after childbirth

April 20, 2022

Science Daily/Cornell University

When U.S. couples have their first child, mothers' earnings still drop substantially relative to fathers', and new Cornell University research demonstrates the stubborn, decades-old pattern isn't changing despite broad increases in other aspects of gender equality.

The research indicates the relative drop in the earnings of mothers cuts across all education levels. The COVID-19 pandemic may lock the income imbalance in place as mothers who pulled back to care for children face worse hiring prospects and wage penalties as they seek to restart their work lives.

An article on the research, "Change and Variation in U.S. Couples' Earnings Equality Following Parenthood," was published March 22 in Population and Development Review. The research was conducted by sociologists Kelly Musick of the Cornell Jeb E. Brooks School of Public Policy, Pilar Gonalons-Pons of the University of Pennsylvania and Christine Schwartz of the University of Wisconsin, Madison.

"The gender revolution has stalled, and women remain economically vulnerable," Musick said, noting the country is an outlier among wealthy nations in offering no mandated paid leave following childbirth, no system of subsidized childcare and scant public support for working families.

The study is one of the first to assess changes over time in within-family earnings inequality, tracking what happened to the incomes of couples over a full 10 years. The researchers used detailed survey results and administrative tax records that provide long-run data on earnings, birth and marriage dates and key characteristics such as education.

The researchers analyzed a period of about 30 years, from the 1980s through the 2000s. They found a brief period in the 1980s when wives became less financially dependent on their husbands after parenthood. Wives' earnings share dropped 13 percentage points following the first birth in the 1980s, relative to 10 percentage points in the 2000s. That modest change held largely true no matter the education or income level of the husband and wife.

Musick said the similarities by education were something of a surprise because disparities -- especially among those with and without a college degree -- have grown in other aspects of family life over this time period. "Across groups, wives become more financially dependent on their husbands after parenthood," the researchers concluded, a worrying sign particularly in the U.S., where divorce remains common and policy support for families is weak.

"The pandemic puts into sharp relief the pitfalls of our fend-for-yourself approach to managing work and family," Musick said. The pandemic also creates an opening for policymakers to build a stronger "infrastructure of care" and the success of that effort will shape gender inequalities in work and family in the decades to come, she said.

https://www.sciencedaily.com/releases/2022/04/220420151611.htm

Study finds 48 percent of young adults struggled with mental health in mid-2021

April 13, 2022

Science Daily/University of California - San Francisco

About half of young adults had mental health symptoms during the pandemic and more than a third of those were unable to access mental health therapy, a new UC San Francisco study found.

The study, published today in the Journal of Adolescent Health, used Household Pulse Survey (HPS) data from the U.S. Census Bureau to determine the prevalence of anxiety and/or depression symptoms in a sample of 2,809 adults ages 18-25 years. The data, collected in June through early July 2021, also included rates of mental health service utilization and unmet need for mental health therapy.

Forty-eight percent of young adults reported mental health symptoms and, among those with symptoms, 39% used prescription medications and/or received counseling, while 36% reported unmet counseling need. Female, Hispanic and uninsured young adults had the greatest unmet need, though these trends were not statistically significant.

The "unmet need" figures were a bit surprising, said Sally Adams, PhD, RN, specialist in UCSF's Division of Adolescent and Young Adult Medicine.

"Given that only about one third of those with symptoms received care, we might have expected to see closer to two-thirds reporting unmet need," said Adams. "It could be that the people with symptoms who didn't report unmet need either didn't think their symptoms were serious enough for treatment or feared the stigma of needing mental health services."

While the rates of mental health symptoms in this study are high, they are a decline from a CDC study that found 63% of young adults were experiencing depression or anxiety a year earlier in June 2020.

Nonetheless, the consistent findings of significant mental health struggles among young adults highlight the importance of addressing barriers to care for this group, such as cost, stigma and confidentiality concerns, the authors wrote.

There is also a need to improve the size, distribution, and capacity of the mental health workforce, noted Charles Irwin Jr., MD, UCSF professor of pediatrics.

"Despite the development of virtual platforms for providing mental health services, the current need for services far exceeds the capacity to provide them," he said

Identification and treatment of mental health symptoms are crucial for promoting young adults' present and future well-being across the life course, wrote the authors.

https://www.sciencedaily.com/releases/2022/04/220413104206.htm

Teens more likely to disengage from school after police stops

Psychological distress after police stops includes anxiety, anger and depression

April 4, 2022

Science Daily/American Psychological Association

Teens who are stopped by the police are more likely to report greater disengagement from school the next day, and racial and ethnic minority youth reported more invasive police encounters than white youth, according to research published by the American Psychological Association.

In the study, 387 adolescents aged 13 to 17 (50% white, 32% Black and 18% other ethnic-racial minority) completed daily online diary entries over 35 days. The youth were students in five public school districts in Pittsburgh where district leaders were concerned about racially disparate juvenile justice court referrals. Half of the participants attended schools where low-income students were in the majority.

The researchers analyzed more than 13,000 diary entries. Youth who reported being stopped by the police were more likely to report disengagement from school the next day (skipping all or some classes, not staying focused, etc.). Students who were stopped also were more likely to report psychological distress, including anxiety, anger and depression. The research was published online in Developmental Psychology.

In just over a month, 9% of the youth (34 students) were stopped by police -- including school-assigned police officers -- which is a "shockingly high" number for such a short period, said lead researcher Juan Del Toro, PhD, a research associate at the University of Pittsburgh. The rate of police stops didn't vary significantly across racial or ethnic groups, but Black and other ethnic-racial minority students reported more intrusive interactions when they were frisked by police.

"Police officers use their own discretion to decide which people to stop and frisk in their aim to reduce crime," Del Toro said. "However, many of these practices result in racial disparities in policing and stop-and-frisks."

Students who reported disengagement from school were no more likely to be stopped by the police the next day, "which helps refute common stereotypes that only 'bad kids' are stopped by the police," Del Toro said.

Youth who reported psychological distress from police stops were more likely to disengage from school the following day. The cumulative negative effects of police stops could have long-term consequences for youth, including lower grades, lower standardized test scores and a lower likelihood of college admission, Del Toro said.

Prior research has found that youth of color are perceived as less innocent and more like adult criminals than their white peers, and aggressive policing has been linked to reduced test scores and school attendance for Black boys. In New York City, Black and Latino males between the ages of 14 and 24 account for only 5% of the city's population, but represented 38% of the reported police stops in recent years, according to a 2019 New York Civil Liberties Union report. Black and Latino people also were more likely to be frisked and to experience force from New York City police than white people.

Police officers should receive more training on how to interact with children and teens in a less confrontational manner, Del Toro said. There also should be increased funding for community efforts to help local youth feel more autonomous and competent at school and in their daily lives.

https://www.sciencedaily.com/releases/2022/04/220404093008.htm

Drug use severity in adolescence affects substance use disorder risk in adulthood

April 1, 2022

Science Daily/NIH/National Institute on Drug Abuse

People who reported multiple symptoms consistent with severe substance use disorder at age 18 exhibited two or more of these symptoms in adulthood, according to a new analysis of a nationwide survey in the United States. These individuals were also more likely, as adults, to use and misuse prescription medications, as well as self-treat with opioids, sedatives, or tranquillizers. Published today in JAMA Network Open, the study is funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

While use of alcohol, cannabis, or other drugs is common among adolescents, previous studies have suggested that most teens reduce or cease drug use as they enter adulthood. However, this study indicates that adolescents with multiple symptoms of substance use disorder -- indicating higher severity -- do not transition out of symptomatic substance use.

"Screening adolescents for drug use is extremely important for early intervention and prevention of the development of substance use disorder," said Nora Volkow, M.D., director of NIDA. "This is critical especially as the transition from adolescence to adulthood, when brain development is still in progress, appears to be a period of high risk for drug use initiation." Dr. Volkow further discusses the findings and implications of this study in a related commentary.

Researchers in this study argue that key knowledge gaps currently hinder the initiation of screening, diagnosis, prevention, and treatment efforts for teens with substance use disorders. For example, previous methods evaluating persistence of substance use disorder tended to treat substance use disorder as one broad category, without looking at severity. They also failed to account for the possibility of polysubstance use, whereby individuals may use multiple drugs or switch the types of drugs they use as they grow older.

The NIDA-funded Monitoring the Future Panel study at the University of Michigan-Ann Arbor helped close this research gap by examining substance use behaviors and related attitudes among 12th graders through their adulthood in the United States. Since 1976, the study has surveyed panels of students for their drug use behaviors across three time periods: lifetime, past year, and past month. In this study, researchers looked primarily at a subgroup of 5,317 12th graders first evaluated between 1976 and 1986, who were followed with additional surveys at two-year, then five-year intervals for up to 32 years, until they reached age 50. Among the respondents, 51% were female and 78% were white.

The research team examined the relationship between substance use disorder symptom severity at age 18 and prescription drug use, prescription drug misuse, and substance use disorder symptoms up to age 50 in these individuals.

To measure severity of substance use disorder symptoms in adolescence, researchers recorded the number of substance use disorder symptoms that participants reported in response to initial survey questions. These questions were based on criteria for alcohol, cannabis, and "other drug" use disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The researchers categorized substance use disorder symptoms into five levels of severity: exhibiting no symptoms, one symptom, two to three symptoms, four to five symptoms, and six or more symptoms. Symptoms included, but were not limited to, substance use resulting in a failure to fulfill major role obligations and repeating substance use even when dangerous to health.

Approximately 12% of surveyed teens indicated "severe" substance use disorder, defined by this study as reporting six or more symptoms. Among this group, more than 60% exhibited at least two symptoms of substance use disorder in adulthood -- an association found across alcohol, cannabis, and other drug use disorders. By comparison, roughly 54% of teens reporting two to three symptoms -- indicative of "mild" substance use disorder -- had two or more substance use disorder symptoms in adulthood. Higher severity of substance use disorder symptoms at age 18 also predicted higher rates of prescription drug misuse in adulthood.

Overall, more than 40% of surveyed 18-year-old individuals reported at least two substance use disorder symptoms (across all substances). More than half of the individuals who were prescribed and used opioids, sedatives, or tranquilizers as adults also reported two or more symptoms at age 18. This finding underlines the importance of strategies to increase safety and properly assess a potential history of substance use disorder symptoms when prescribing controlled medications to adults.

"Teens with substance use disorder will not necessarily mature out of their disorders, and it may be harmful to tell those with severe symptoms that they will," said Dr. Sean Esteban McCabe, senior author of this study and director of the Center for the Study of Drugs, Alcohol, Smoking and Health at University of Michigan. "Our study shows us that severity matters when it comes to predicting risk decades later, and it's crucial to educate and ensure that our messaging to teens with the most severe forms of substance use disorder is one that's realistic. We want to minimize shame and sense of failure for these individuals."

The authors note that more research is needed to uncover potential neurological mechanisms and other factors behind why adolescents with severe substance use disorder symptoms are at increased risk of drug addiction and misuse in adulthood. Characterizing possible causes of more severe substance use disorder could help improve understanding of vulnerability to chronic substance use and help make prevention and treatment strategies more effective.

https://www.sciencedaily.com/releases/2022/04/220401122203.htm

Antidepressants are not associated with improved quality of life in the long run

Among people with depression, those using antidepressants over the long term had no better physical or mental health

April 20, 2022

Science Daily/PLOS

Over time, using antidepressants is not associated with significantly better health-related quality of life, compared to people with depression who do not take the drugs. These are the findings of a new study published this week in the open-access journal PLOS ONE by Omar Almohammed of King Saud University, Saudi Arabia, and colleagues.

It is generally well known that depression disorder has a significant impact on the health-related quality of life (HRQoL) of patients. While studies have shown the efficacy of antidepressant medications for treatment of depression disorder, these medications' effect on patients' overall well-being and HRQoL remains controversial.

In the new study, the researchers used data from the 2005-2015 United States' Medical Expenditures Panel Survey (MEPS), a large longitudinal study that tracks the health services that Americans use. Any person with a diagnosis of depression disorder was identified in the MEPS files. Over the duration of the study, on average there were 17.47 million adult patients diagnosed with depression each year with two years of follow-up, and 57.6% of these received treatment with antidepressant medications.

Use of antidepressants was associated with some improvement on the mental component of SF-12 -- the survey tracking health-related quality of life. However, when this positive change was compared to the change in group of people who were diagnosed with depressive disorder but did not take antidepressants, there was no statistically significant association of antidepressants with either the physical (p=0.9595) or mental (p=0.6405) component of SF-12. In other words, the change in quality of life seen among those on antidepressants over two years was not significantly different from that seen among those not taking the drugs.

The study was not able to separately analyze any subtypes or varying severities of depression. The authors say that future studies should investigate the use of non-pharmacological depression interventions used in combination with antidepressants.

The authors add: "Although we still need our patients with depression to continue using their antidepressant medications, long-term studies evaluating the actual impact for pharmacological and non-pharmacological interventions on these patients' quality of life is needed. With that being said, the role of cognitive and behavioral interventions on the long term-management of depression needs to be further evaluated in an efforts to improve the ultimate goal of care for these patients; improving their overall quality of life."

https://www.sciencedaily.com/releases/2022/04/220420151555.htm