Defying body clock linked to depression and lower wellbeing

June 7, 2021

Science Daily/University of Exeter

People whose sleep pattern goes against their natural body clock are more likely to have depression and lower levels of wellbeing, according to a large-scale new study.

Research led by the University of Exeter, published in Molecular Psychiatry, also found the most robust evidence to date that being genetically programmed to be an early riser is protective against major depression, and improves wellbeing. Researchers suggest this may be because society is set up to be more aligned to early risers, through the standard 9-5 working pattern.

COVID-19 has led to more flexible working patterns and this research may help make the case for more adaptable working habits to suit individuals' needs.

The team built on previous research which mapped 351 genes linked to being an early riser, or a night owl. They used a statistical process called Mendelian Randomisation to examine whether these genes were causally associated with seven mental health and wellbeing outcomes, including major depression, using data on more than 450,000 UK adults from UK Biobank's biomedical database and research resource. As well as the genetic information, participants also completed a questionnaire on whether they were a morning person or an evening person.

The team also developed a new measure of "social jetlag" that measures the variation in sleep pattern between work and free days. They measured this in more than 85,000 UK Biobank participants for whom sleep data was available, via wrist-worn activity monitors. They found that people who were more misaligned from their natural body clock were more likely to report depression and anxiety and have lower wellbeing.

Lead author Jessica O'Loughlin, of the University of Exeter, said: "We found that people who were misaligned from their natural body clock were more likely to report depression, anxiety and have lower wellbeing. We also found the most robust evidence yet that being a morning person is protective of depression and improves wellbeing.

We think this could be explained by the fact that the demands of society mean night owls are more likely to defy their natural body clocks, by having to wake up early for work."

Overall, the research team found that morning people were more likely to be aligned to their natural body clock. They then tested the effect by looking at shift workers, and found that morningness may not be protective for depression in shift workers, meaning morning people who work shifts may not have improved mental health and wellbeing, however, this was inconclusive.

Senior author Dr Jessica Tyrrell, of the University of Exeter, said: "The COVID-19 pandemic has introduced a new flexibility in working patterns for many people. Our research indicates that aligning working schedules to an individual's natural body clock may improve mental health and wellbeing in night owls."

The study is entitled 'Using Mendelian Randomization methods to understand whether diurnal preference is causally related to mental health', and published in Molecular Psychiatry. The research is supported by the Academy of Medical Sciences. The study involved collaborators from King's College London, the University of Colorado Boulder, the University of Manchester and Monash University.

https://www.sciencedaily.com/releases/2021/06/210607202226.htm

How to relax your mind before going to sleep at night.

Guest Post contribution by:David Sheptovitsky, sleepacademy.org

Difficulty falling asleep at night is a common experience for many adults. After a long day of work and caring for your family, you might think falling asleep would be a breeze. This is not the case. Many adults find it difficult to sleep due to their minds running about what they need to accomplish the next day. Thoughts are racing and anxiety is heightened making it much more difficult to relax your mind and have a proper night's sleep. Rather than turning to sleeping pills or other unnatural means to help you fall asleep, focusing on calming your body and relaxing your mind can be the most beneficial way to fall asleep and stay asleep at night after a stressful day. Below are some strategies to help promote relaxation in the mind and body before bed.

Tips to keep in mind before attempting any relaxation strategies:

The ultimate goal of any relaxation strategies before you are going to bed is to lower your heart rate and blood pressure, as well as to enable slow, deep breathing. These factors create an increased sense of well-being. Any strategies you use to promote body and mind relaxation should all create those results. 

While keeping those factors in mind, along with whatever relaxation strategies you choose to do, keeping a balanced sleeping schedule will also be beneficial in creating the best results for falling asleep faster. It is also important to keep in mind these relaxation strategies might take some practice before they are able to work in full effect. Ongoing practices of relaxation techniques are much more effective than short-term use. Lastly, It is important to be aware of what specific exercises work for you. Not all relaxation exercises may be effective for you. Only you know your body best and if you feel like one exercise just isn't cutting it, focusing on a new exercise to relax your mind may be more beneficial.

Relaxation Strategies:

Visualization Exercises:

A way of engaging in your body's natural relaxation process is visualization exercises. These exercises focus on using mental images to create a sense of well-being and promote a stress-free environment for sleeping.

Autogenic Training:  Autogenic training hyper focuses on the heaviness and warmth of each part of your body. The overall idea of this training is to be able to calm different parts of your body at any time. Below are the steps of Autogenic Training:

-       Start with a few minutes of controlled breathing

-       After breathing, focus on a single part of your body. For example your hands. Then say back to yourself “ My hands are very heavy, I am completely calm”. Say this a few times.

-       Then say, “ My hands are very warm, I am completely calm”. Repeat this a few times.

-       Repeat this process as many times as you feel needed, and to as many body parts as you feel needed.

Body Scan: A body scan is a type of meditation that calms different parts of your body. The goal of this exercise is to be able to calm your body parts to promote a relaxed mind. Below are the steps of Body Scan:

-       Start with a few minutes of controlled breathing

-       Focus on a specific body part, for example, your hands. Notice if they hold any tension in your palms or fingers

-       If there is any tension, visualize this tension leaving your hands and body. This can be through mental visualization or through controlled breathing

-       Repeat this process as many times as you feel needed, and to as many body parts as you feel needed.

 Breathing Exercises:

Controlled breathing is one of the body's most basic ways to engage in a state of relaxation. Overall, decreasing the speed of your breathing and focusing on the depths of your breaths can be beneficial in promoting a calm mind and body. These breathing exercises will help you create a stress-free environment that promotes a relaxed mind and body for a good night's rest.

4-7-8 Breathing: This exercise is an advanced breathing exercise. If you are not comfortable holding your breath, this exercise may not be great to promote a stress-free mind. The steps are below as follows:

-       Place your tongue on the roof of your mouth, right behind your top, front teeth. Your tongue will remain here for the duration of the exercise

-       Inhale through your nose for 4 seconds

-       Hold your breath for 7 seconds

-       Exhale through your mouth for 8 seconds

-       Repeat as many times as needed

Diaphragmatic Breathing: This is a much simpler breathing exercise. This technique targets your belly, rather than lungs. This focuses on reducing stress while strengthening your diaphragm. The steps are below as follows:

-       In a lying down position, place one hand on your chest and one hand on your belly, right below your rib cage.

-       Breath in through your nose, and feel your belly push against your hand. You should try to keep the rest of your body as still as possible.

-       While keeping your chest still, tighten your stomach muscles and exhale through your mouth.

-       Repeat as many times as needed

Sleep should be a priority in your life. A good night’s sleep is essential to participate in your daily activities to the fullest of your ability. Trouble falling asleep at night is something commonly struggled with by adults. Stressful days can turn over into stressful, sleepless nights. These exercises above promote relaxation in both your mind and body. Keeping a stress-free mind and body can result in falling asleep quicker, as well as staying asleep longer. Try a few of the practices above and see which relaxation techniques work best for you.

“Relaxation Exercises to Help Fall Asleep.” Sleep Foundation, 18 Dec. 2020, www.sleepfoundation.org/sleep-hygiene/relaxation-exercises-to-help-fall-asleep.

Margarita Tartakovsky, M.S. “12 Ways to Shut Off Your Brain Before Bedtime.” Psych Central, Psych Central, 17 May 2016, psychcentral.com/lib/12-ways-to-shut-off-your-brain-before-bedtime#6. 

'Prescription' to sit less, move more advised for mildly high blood pressure and cholesterol

June 2, 2021

Science Daily/American Heart Association

Physical activity is the optimal first treatment choice for adults with mild to moderately elevated blood pressure and blood cholesterol who otherwise have low heart disease risk. About 21% of adults in the US with mild to moderately raised blood pressure and 28-37% of those with mild to moderate elevated cholesterol levels may be best served by a prescription for lifestyle-only treatment, which includes increasing physical activity.

A "prescription" to sit less and move more is the optimal first treatment choice for reducing mild to moderately elevated blood pressure and blood cholesterol in otherwise healthy adults, according to the new American Heart Association scientific statement published today in the American Heart Association's journal Hypertension.

"The current American Heart Association guidelines for diagnosing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks. The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity," said Bethany Barone Gibbs, Ph.D., FAHA, chair of the statement writing group and associate professor in the department of health and human development and clinical and translational sciences at the University of Pittsburgh in Pittsburgh, Pennsylvania.

An estimated 21% of U.S. adults, about 53 million, have systolic (top number) blood pressure between 120-139 mm Hg or diastolic (bottom number) blood pressure between 80-89 mm Hg; both values are abnormally high. Individuals in this range who have an otherwise low risk of heart disease or stroke meet the American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline criteria for lifestyle-only treatment for elevated blood pressure.

Likewise, the scientific statement authors estimate that 28% of U.S. adults, or about 71 million, have an LDL cholesterol score above 70 mg/dL and otherwise meet criteria for low risk of heart disease or stroke. These people would meet the 2018 AHA/ACC Cholesterol Treatment Guidelines criteria for lifestyle-only treatment. Lifestyle changes highlighted in the blood pressure and cholesterol guidelines include increased physical activity, weight loss, improving diet, stopping smoking and moderating alcohol intake.

"Increasing physical activity can help lower blood pressure and cholesterol, along with many other health benefits." Gibbs said. Physical activity also has benefits beyond cardiovascular health, including a decreased risk of some cancers, improved bone, brain and mental health, and better sleep.

Increasing physical activity results in clinically meaningful reductions in systolic and diastolic blood pressure, typically an average reduction of 3 or 4 mm Hg. Similar improvements are seen with blood cholesterol. For example, increased physical activity typically decreases LDL cholesterol by 3 to 6 mg/dL.

The statement highlights research concluding that physically active people have a 21% lower risk of developing cardiovascular disease and a 36% lower risk of death from cardiovascular diseases compared to those who are not physically active.

To improve health, the U.S. Department of Health and Human Services 2018 Physical Activity Guidelines for Americans suggest individuals participate in either a cumulative 150 minutes of moderate intensity aerobic exercise, or 75 minutes of vigorous aerobic activity weekly plus two or more strength training sessions each week.

However, there is no minimum amount of time to receive benefits from physical activity. "Every little bit of activity is better than none," said Gibbs. "Even small initial increases of 5 to 10 minutes a day can yield health benefits."

The statement provides suggestions for clinicians to provide exercise "prescriptions" such as patient counselling, incorporating health behavior professionals (e.g., health coaches) and connecting patients to local resources like community centers to help meet their physical activity needs.

According to the statement, prescribing exercise includes:

• Screening patients about physical activity at every interaction, as recommended by the American College of Sports Medicine's 'Exercise is Medicine' campaign. Clinicians can ask patients to report their physical activity with a few questions or by using a wearable device.

• Providing ideas and resources for supporting patients to improve and sustain regular physical activity;

• Meeting patients where they are by exploring activities that the patient enjoys and provide ideas for early success; and

• Encouraging and celebrating small increases in physical activity, such as walking more or taking the stairs.

"In our world where physical activity is increasingly engineered out of our lives and the overwhelming default is to sit -- and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus -- the message that we must be relentless in our pursuit to 'sit less and move more' throughout the day is more important than ever," said Gibbs.

https://www.sciencedaily.com/releases/2021/06/210602091419.htm

Overweight or obesity worsens liver-damaging effects of alcohol

June 1, 2021

Science Daily/University of Sydney

Led by the University of Sydney's Charles Perkins Centre, the study looked at medical data from nearly half a million people and found having overweight or obesity considerably amplified the harmful effects of alcohol on liver disease and mortality.

"People in the overweight or obese range who drank were found to be at greater risk of liver diseases compared with participants within a healthy weight range who consumed alcohol at the same level," said senior author and research program director Professor Emmanuel Stamatakis from the Charles Perkins Centre and the Faculty of Medicine and Health.

"Even for people who drank within alcohol guidelines, participants classified as obese were at over 50 percent greater risk of liver disease."

The researchers drew upon data from the UK Biobank -- a large-scale biomedical cohort study containing in-depth biological, behavioural, and health information from participants in the United Kingdom (UK).

According to the researchers, this is one of the first and largest studies looking at increased adiposity (overweight or obesity) and level of alcohol consumption together, in relation to future liver disease.

Information was examined from 465,437 people aged 40 to 69 years, with medical and health details collected over an average of 10.5 years.

The findings were published in the European Journal of Clinical Nutrition.

Lead author Dr Elif Inan-Eroglu, a postdoctoral research fellow with the Charles Perkins Centre, said the results suggest people carrying excess weight may need to be more aware of risks around alcohol consumption.

"With the most recent data suggesting two in three people -- or 67 percent of the Australian population are in the overweight or obesity range, this is obviously a very topical issue."

Key findings 

The researchers reviewed data on participants classified as overweight/obese based on their body mass index (BMI) and waist circumference, self-reported alcohol consumption according to UK alcohol guidelines, and liver disease incidence and liver disease as cause of death.

BMI is based on both weight and height. A BMI of over 25 denotes overweight, and over 30 denotes obesity. For waist circumference, researchers used the World Health Organization (WHO) classification: normal (<80 cm for women, <94 cm for men), overweight (>80 cm for women, >94 cm for men), and obese (>88 cm for women, >102 cm for men).

The level of risk was given a number called a 'hazard ratio'. The higher the number than 1, the higher the risk.

- People who drank above UK alcohol guidelines had, compared to within guideline drinkers: 

o A nearly 600 percent higher risk of being diagnosed with alcoholic fatty liver disease (5.83 hazard ratio). 

o A nearly 700 percent higher risk of death caused by alcoholic fatty liver disease (6.94 hazard ratio).

- People with overweight or obesity who drank within or above alcohol guidelines had over 50 percent greater risk of developing liver disease compared to normal weight participants who consumed alcohol at the same level.

https://www.sciencedaily.com/releases/2021/06/210601100701.htm

'Good' bacteria show promise for clinical treatment of Crohn's disease, ulcerative colitis

May 28, 2021

Science Daily/University of North Carolina Health Care

A new study published in Nature Communicationsdemonstrates that a consortium of bacteria designed to complement missing or underrepresented functions in the imbalanced microbiome of inflammatory bowel disease (IBD) patients, prevented and treated chronic immune-mediated colitis in humanized mouse models. The study's senior author, Balfour Sartor, MD, Midget Distinguished Professor of Medicine, Microbiology and Immunology, Co-Director of the UNC Multidisciplinary IBD Center, said the results are encouraging for future use treating Crohn's disease and ulcerative colitis patients.

"The idea with this treatment is to restore the normal function of the protective bacteria in the gut, targeting the source of IBD, instead of treating its symptoms with traditional immunosuppressants that can cause side effects like infections or tumors," Sartor said.

The live bacteria consortia, called GUT-103 and GUT-108, were developed by biotech firm Gusto Global. GUT-103 is comprised of 17 strains of bacteria that work together to protect and feed each other. GUT-108 is a refined version of GUT-103, using 11 human isolates related to the 17 strains. These combinations permit the bacteria to stay in the colon for an extended amount of time, as opposed to other probiotics that are not capable of living in the gut and pass through the system quickly.

GUT-103 and GUT-108 were given orally three times a week to "germ-free" mice (no bacteria present) that had been specially developed and treated with specific human bacteria, creating a humanized mouse model. The therapeutic bacteria consortia worked by addressing upstream targets, rather than targeting a single cytokine to block downstream inflammation responses, and reversed established inflammation.

"It also decreased pathobionts -- bacteria that can cause harm -- while expanding resident protective bacteria, and produced metabolites promoting mucosal healing and immunoregulatory responses," Sartor said. "Simply put -- the treatment increased the good guys and decreased the bad guys."

Because of the robust results seen in this study, and the need for more alternative therapies for Crohn's disease, Sartor would like to see GUT-103 and GUT-108 studied in Phase 1 and 2 clinical trials in the future. He plans to continue his work with Gusto Global to further explore uses of the bacterial consortia.

https://www.sciencedaily.com/releases/2021/05/210528114008.htm

Waking just one hour earlier cuts depression risk by double digits

May 28, 2021

Science Daily/University of Colorado at Boulder

Waking up just one hour earlier could reduce a person's risk of major depression by 23%, suggests a sweeping new genetic study published May 26 in the journal JAMA Psychiatry.

The study of 840,000 people, by researchers at University of Colorado Boulder and the Broad Institute of MIT and Harvard, represents some of the strongest evidence yet that chronotype -- a person's propensity to sleep at a certain time -- influences depression risk.

It's also among the first studies to quantify just how much, or little, change is required to influence mental health.

As people emerge, post-pandemic, from working and attending school remotely -- a trend that has led many to shift to a later sleep schedule -- the findings could have important implications.

"We have known for some time that there is a relationship between sleep timing and mood, but a question we often hear from clinicians is: How much earlier do we need to shift people to see a benefit?" said senior author Celine Vetter, assistant professor of integrative physiology at CU Boulder. "We found that even one-hour earlier sleep timing is associated with significantly lower risk of depression."

Previous observational studies have shown that night owls are as much as twice as likely to suffer from depression as early risers, regardless of how long they sleep. But because mood disorders themselves can disrupt sleep patterns, researchers have had a hard time deciphering what causes what.

Other studies have had small sample sizes, relied on questionnaires from a single time point, or didn't account for environmental factors which can influence both sleep timing and mood, potentially confounding results.

In 2018, Vetter published a large, long term study of 32,000 nurses showing that "early risers" were up to 27% less likely to develop depression over the course of four years, but that begged the question: What does it mean to be an early riser?

To get a clearer sense of whether shifting sleep time earlier is truly protective, and how much shift is required, lead author Iyas Daghlas, M.D., turned to data from the DNA testing company 23 and Me and the biomedical database UK Biobank. Daghlas then used a method called "Mendelian randomization" that leverages genetic associations to help decipher cause and effect.

"Our genetics are set at birth so some of the biases that affect other kinds of epidemiological research tend not to affect genetic studies," said Daghlas, who graduated in May from Harvard Medical School.

More than 340 common genetic variants, including variants in the so-called "clock gene" PER2, are known to influence a person's chronotype, and genetics collectively explains 12-42% of our sleep timing preference.

The researchers assessed deidentified genetic data on these variants from up to 850,000 individuals, including data from 85,000 who had worn wearable sleep trackers for 7 days and 250,000 who had filled out sleep-preference questionnaires. This gave them a more granular picture, down to the hour, of how variants in genes influence when we sleep and wake up.

In the largest of these samples, about a third of surveyed subjects self-identified as morning larks, 9% were night owls and the rest were in the middle. Overall, the average sleep mid-point was 3 a.m., meaning they went to bed at 11 p.m. and got up at 6 a.m.

With this information in hand, the researchers turned to a different sample which included genetic information along with anonymized medical and prescription records and surveys about diagnoses of major depressive disorder.

Using novel statistical techniques, they asked: Do those with genetic variants which predispose them to be early risers also have lower risk of depression?

The answer is a firm yes.

Each one-hour earlier sleep midpoint (halfway between bedtime and wake time) corresponded with a 23% lower risk of major depressive disorder.

This suggests that if someone who normally goes to bed at 1 a.m. goes to bed at midnight instead and sleeps the same duration, they could cut their risk by 23%; if they go to bed at 11 p.m., they could cut it by about 40%.

It's unclear from the study whether those who are already early risers could benefit from getting up even earlier. But for those in the intermediate range or evening range, shifting to an earlier bedtime would likely be helpful.

What could explain this effect?

Some research suggests that getting greater light exposure during the day, which early-risers tend to get, results in a cascade of hormonal impacts that can influence mood.

Others note that having a biological clock, or circadian rhythm, that trends differently than most peoples' can in itself be depressing.

"We live in a society that is designed for morning people, and evening people often feel as if they are in a constant state of misalignment with that societal clock," said Daghlas.

He stresses that a large randomized clinical trial is necessary to determine definitively whether going to bed early can reduce depression. "But this study definitely shifts the weight of evidence toward supporting a causal effect of sleep timing on depression."

For those wanting to shift themselves to an earlier sleep schedule, Vetter offers this advice:

"Keep your days bright and your nights dark," she says. "Have your morning coffee on the porch. Walk or ride your bike to work if you can, and dim those electronics in the evening."

https://www.sciencedaily.com/releases/2021/05/210528114107.htm

Parasites as fountains of youth: Study finds infected ants live much longer

Life expectancy of tapeworm-infected worker ants is significantly higher than that of their uninfected nest-mates and resembles that of ant queens

May 27, 2021

Science Daily/Johannes Gutenberg Universitaet Mainz

Ant workers that are infected with a tapeworm live much longer than their uninfected nest-mates. Parasitic infections are usually harmful to their hosts, but there are some exceptions. According to the results of a multi-year scientific study, ants of the species Temnothorax nylanderi show exceptionally high survival rates when infected with a tapeworm. "The lifespan of the infected ants is significantly prolonged. According to our observations, such workers have a survival rate similar to that of queens," said Professor Susanne Foitzik of Johannes Gutenberg University Mainz (JGU), leader of the study. Queens of this species can live for up to 20 years, while female workers rarely reach the age of two. Among possible explanations for this extended lifespan are the change in the physiology of infected ants caused by the parasites and the fact that infected workers are better supplied with food.

Social care in the nest linked to longer life

In the case of ants, there is a stark divergence in lifespan between female castes. Many ant queens can survive for several decades. They spend almost all their lives safely in the nest where they are cared for by the workers, their daughters. In contrast, ant workers live for only a few weeks or months or, in rare cases, a few years. The infertile workers carry out all tasks in the nest, starting in brood care and progressing to riskier activities outside the colony as they grow older, such as foraging for food. The high life expectancy of queens is due to their low mortality rate, which is attributable to the high levels of social care they receive, their safe environment, and the activation of physiological repair mechanisms.

These factors may also contribute to the extremely high survival rates of Temnothorax-nylanderi workers infected with a tapeworm. This species of ant is common in Central Europe and forms small colonies on the forest floor, inside acorns or wooden branches. The insects are relatively small, with a body length of just two to three millimeters. They serve as an intermediate host for the tapeworm Anomotaenia brevis, whereby a single ant can be infected by up to 70 parasitic larvae. The parasites survive in the hemolymph, the body fluid of insects. Their complex life cycle is completed once they have been ingested by a woodpecker that feeds on the ants.

The research team led by Professor Susanne Foitzik looked at the long-term consequences of the parasitic infection by collecting ant colonies from forests around Mainz and observing them in the laboratory. "We tracked the survival rate of the workers and queens in both infected and uninfected ant colonies over three years, until more than 95 percent of the uninfected workers had died," explained Foitzik. At that point, over half of the infected workers were still alive -- exhibiting a survival rate practically identical to that of the long-lived queens. "It is quite extraordinary that a parasite can trigger such a positive change in its host. This lifespan extension is very unusual," emphasized the JGU-based evolutionary biologist.

Infected workers differ in appearance, behavior, and physiology

The infected ants are easily distinguished from their brown nest-mates due to their lighter, yellow color, an effect that results from their cuticle being less pigmented. They are also less active and receive enhanced care from other workers in the nest. "The infected insects get more attention and are fed, cleaned, and looked after better. They even benefit from slightly more care than the nest's queen," explained Professor Susanne Foitzik. The tests also revealed that infected ants have metabolic rates and lipid levels similar to those of younger ants. It would seem that these ants remain in a permanent juvenile stage as a result of the infection. This is likely down to both the tapeworm larvae altering the expression of ant genes that affect aging and to the parasites' release of proteins containing antioxidants into the ants' hemolymph.

Even though the mystery of their long life has not yet been fully resolved, the behavior of the infected ants themselves does not seem to be the decisive factor. The research team, which included scientists from the Max Planck Institute for Biology of Ageing and Tel Aviv University, found no evidence that the insects actively beg for better care. However, chemical signals on the cuticle of infected ants were found to elicit more attention of their nest-mates. "The infected insects live a life of luxury, but the fact that they receive more social care cannot alone account for their prolonged lifespan," concluded Foitzik. The scientists will undertake further research in order to identify the factors, particularly on the molecular and epigenetic level, behind the infected workers death-defying attributes.

https://www.sciencedaily.com/releases/2021/05/210527150134.htm

Silver attacks bacteria, gets 'consumed'

Impacts of antibacterial interactions on silver affect applications

May 25, 2021

Science Daily/American Institute of Physics

For millennia, silver has been utilized for its antimicrobial and antibacterial properties. Although its use as a disinfectant is widely known, the effects of silver's interaction with bacteria on the silver itself are not well understood.

As antibiotic-resistant bacteria become more and more prevalent, silver has seen steep growth in its use in things like antibacterial coatings. Still, the complex chain of events that lead to the eradication of bacteria is largely taken for granted, and a better understanding of this process can provide clues on how to best apply it.

In Chemical Physics Reviews, by AIP Publishing, researchers from Italy, the United States, and Singapore studied the impacts an interaction with bacteria has on silver's structure.

When monitoring the interaction of silver nanoparticles with a nearby E. coli culture, the researchers found the silver undergoes several dramatic changes. Most notably, the E. coli cells caused substantial transformations in the size and shape of the silver particles.

It is often assumed the silver stays unmodified in this process, but the work done by the team shows this not to be true.

The electrostatic interaction between the silver and the bacteria causes some of the silver particles to dissolve as it releases ions to penetrate the bacterial cells. This dissolution modifies the shape of the silver particles, shrinking and rounding them out from triangular shapes into circles.

These effects are even more pronounced if the E. coli cells are pretreated with a molecule to increase the permeability of their membranes before they meet the silver.

"It seems from this study that silver is 'consumed' from the interaction," said Guglielmo Lanzani, one of the authors on the paper and director of the Center for Nano Science and Technology of IIT-Instituto di Tecnologia.

Fortunately, this "consumption" likely does not impact silver's antimicrobial properties, because the effect is so small.

"We think this does not affect the efficiency of the biocidal process and, due to the tiny exchange of mass, the lifetime is essentially unlimited," said Giuseppe Paternò, a researcher at IIT and co-author of the study. "The structural modifications, however, affect the optical properties of the metal nanostructures."

Direct investigations of processes like these are difficult, because laboratories are controlled environments that cannot fully capture the complexities of a biological setting of bacterial cells.

Nevertheless, the group is planning further experiments to explore the chemical pathways that lead to the structural changes in silver. They hope to uncover why silver works better than other materials as an antibacterial surface, and why bacterial membranes are particularly vulnerable to silver, while other cells remain less affected.

https://www.sciencedaily.com/releases/2021/05/210525113726.htm

Evacuating under dire wildfire scenarios

May 24, 2021

Science Daily/University of Utah

In 2018, the Camp Fire ripped through the town of Paradise, California at an unprecedented rate. Officials had prepared an evacuation plan that required 3 hours to get residents to safety. The fire, bigger and faster than ever before, spread to the community in only 90 minutes.

As climate change intensifies, wildfires in the West are behaving in ways that were unimaginable in the past -- and the common disaster response approaches are woefully unprepared for this new reality. In a recent study, a team of researchers led by the University of Utah proposed a framework for simulating dire scenarios, which the authors define as scenarios where there is less time to evacuate an area than is required. The paper, published on April 21, 2021 in the journal Natural Hazards Review, found that minimizing losses during dire scenarios involves elements that are not represented in current simulation models, among them improvisation and altruism.

"The world is dealing with situations that exceed our worst case scenarios," said lead author Thomas Cova, professor of geography at the U. "Basically we're calling for planning for the unprecedented, which is a tough thing to do."

Most emergency officials in fire-prone regions develop evacuation plans based on the assumptions that wildfires and residents will behave predictably based on past events. However, recent devastating wildfires in Oregon, California and other western states have shown that those assumptions may no longer hold.

"Wildfires are really becoming more unpredictable due to climate change. And from a psychological perspective, we have people in the same area being evacuated multiple times in the past 10 years. So, when evacuation orders come, people think, 'Well, nothing happened the last few times. I'm staying,'" said Frank Drews, professor of psychology at the U and co-author of the study. "Given the reality of climate change, it's important to critically assess where we are and say, 'Maybe we can't count on certain assumptions like we did in the past.'"

How to predict the unprecedented

The framework allows planners to create a dire wildfire scenario -- when the lead time, defined as the time before the fire reaches a community to respond, is less than the time required to evacuate. The authors developed a scoring system that categorizes each scenario as routine, dire, very dire or extremely dire based on many different factors.

One big factor affecting the direness is the ignition location, as one closer to a community offers less time than one farther away. A second major factor is the wildfire detection time. During the day, plumes of smoke can cue a quick response, but if it starts at night when everyone is asleep, it could take longer to get people moving. Officials may delay their decisions to avoid disrupting the community unnecessarily, but a last-minute evacuation order can cause traffic jams or put a strain on low-mobility households.

Alert system technologies can create dire circumstances if residents do not receive the warning in time due to poor cellphone coverage or low subscription rates to reverse 911 warning systems. If the community has many near misses with wildfire, the public's response could be to enact a wait-and-see approach before they leave their homes.

Using a dire scenario dashboard, the user assigns various factors an impediment level -- low, minor or major -- that can change at any point to lessen or increase a situation's direness.

"Usually when we run computer simulations, nothing ever goes wrong. But in the real world, things can get much worse half-way through an evacuation," said Cova. "So, what happens when you don't have enough time? The objective switches from getting everyone out to instead minimizing casualties. It's dark."

"More people began working remotely from home during the pandemic, which then led to them moving out of large cities into rural areas," explained assistant professor Dapeng Li of the South Dakota State University Department of Geography and Geospatial Sciences, a co-author and U alumnus who helped develop the computer simulations. "These rural communities typically have fewer resources and face challenges in rapidly evacuating a larger number of residents in this type of emergency situation."

Reducing dire scenarios

Simulating dire wildfire scenarios can improve planning and the outcomes in cases where everything goes wrong. For example, creating fire shelters and safety zones inside of a community can protect residents who can't get out, while reducing traffic congestion for others who can evacuate. During the 2018 Camp Fire, people improvised temporary refuges in parking lots and community buildings. Modeling could help city planners construct permanent safety areas ahead of time.

A common human response during wildfires are improvisations and creative thinking, which are difficult to model but can be literally lifesaving. For example, during the 2020 Creek Fire in California, a nearby military base sent a helicopter to rescue trapped campers. Another crucial component is individuals helping others, such as people giving others rides or warning neighbors who missed the official alert. During the Camp Fire, Joe Kennedy used his bulldozer to singlehandedly clear abandoned cars that were blocking traffic.

"It is very common for families and neighbors to assume a first responder role and help each other during disasters," said Laura Siebeneck, associate professor of emergency management and disaster science at the University of North Texas and co-author of the study. "Many times, individuals and groups come together, cooperate, and improvise solutions as needed. Though it is difficult to capture improvisation and altruism in the modeling environment, better understanding human behavior during dire events can potentially lead to better protective actions and preparedness to dire wildfire events."

Studying and modeling dire scenarios is necessary to improve the outcomes of unprecedented changes in fire occurrence and behavior. This study is the first attempt to develop a simulation framework for these scenarios, and more research is needed to incorporate the unpredictable elements that create increasingly catastrophic wildfires.

https://www.sciencedaily.com/releases/2021/05/210524161657.htm

Narcissism linked to aggression in review of 437 studies

Study found relationship 'across the board' all over the world

May 25, 2021

Science Daily/Ohio State University

A comprehensive analysis of 437 studies from around the world provides the best evidence to date that narcissism is an important risk factor for both aggression and violence, researchers said.

The link between narcissism and aggression was found for all dimensions of narcissism and for a variety of types of aggression. Results were similar regardless of gender, age, whether they were college students, or country of residence.

And, to have an impact, narcissism doesn't have to be at levels so high as to be pathological. Findings showed that even when narcissism was within what is considered a normal range, higher levels were linked to aggression.

"It is a pretty straightforward message: Narcissism is a significant risk factor for aggressive and violent behavior across the board," said Brad Bushman, co-author of the study and professor of communication at The Ohio State University.

The study was led by Sophie Kjaervik, a graduate student in communication at Ohio State. It was published yesterday (May 24, 2021) in the journal Psychological Bulletin.

"The link we found between narcissism and aggression was significant -- it was not trivial in size," Kjaervik said. "The findings have important real-world implications."

The researchers combined and analyzed data from many studies to provide a comprehensive view of this research area. In this meta-analysis, they examined data from 437 independent studies with a total of 123,043 participants.

Narcissism is characterized by an overblown sense of self-importance, Bushman said. The key component of narcissism is entitlement. Narcissism also has two peripheral components: grandiose (those with high self-esteem) and vulnerable (those with low self-esteem). The study found all of these components were linked to aggression.

Narcissism was related to all forms of aggression measured in the studies the researchers analyzed, including physical, verbal, bullying, direct or indirect, and displaced onto innocent targets.

"Individuals who are high in narcissism are not particularly picky when it comes to how they attack others," Kjaervik said.

Findings showed that narcissism was linked to online cyberbullying, as well as bullying offline.

"That's a highly important finding now that we live in an online world," she said.

People higher in narcissism were not only more likely to lash out in anger, but were also more likely to be "cold, deliberate and proactive" in their aggression, Bushman said.

People high in narcissism were more likely than others to be aggressive whether they were provoked or not, the study found. But the risk for aggression was significantly higher when they felt provoked, such as being ignored or insulted.

The researchers were somewhat surprised to find that the link between narcissism and violence was nearly as strong as its link with less serious forms of aggression. Violence is more rare than and is generally more difficult to predict than lesser forms of aggression, Bushman said. In this study, violence was defined as aggression intended to cause physical harm such as injury or death.

But these results are consistent with research suggesting that narcissism might be a risk factor for extremely violent acts such as mass shootings, he said.

One argument could be that the narcissism-aggression link would be more likely to occur in individualistic countries, like the United States, where people emphasize their personal rights. But the analysis found that narcissism and aggression were related even in more collectivist countries.

And findings were similar whether the research participants were college students or a more general population.

It might be tempting to think these results apply only to people who are "narcissists," but that would be wrong, Bushman said.

For one, you can't separate people into those who are narcissists and those who are not. Nearly everyone has some degree of narcissism, even though only a minority have levels high enough to be called pathological.

Findings in this study suggest that higher levels of narcissism are related to more aggression even before it reaches pathological levels.

"All of us are prone to being more aggressive when we are more narcissistic," Bushman said.

One thing that clearly stood out in the analysis, he said, was how people high in narcissism respond when they feel threatened.

"Our results suggest provocation is a key moderator of the link between narcissism and aggression," Bushman said.

"Those who are high in narcissism have thin skins, and they will lash out if they feel ignored or disrespected."

https://www.sciencedaily.com/releases/2021/05/210525084324.htm

Taking more steps daily may lead to a longer life

May 20, 2021

Science Daily/American Heart Association

Taking more steps per day, either all at once or in shorter spurts, may help you live longer, according to preliminary research to be presented at the American Heart Association's Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference 2021. The meeting is virtual, May 20-21, and offers the latest science on population-based health and wellness and implications for lifestyle.

Walking is one of the safest and easiest ways to improve fitness and health including heart health. The American Heart Association's fitness guidelines for adults recommend at least 150 minutes per week of moderate or 75 minutes of vigorous physical activity, or a combination of both. Popular fitness apps and step counters make it easy to count steps, so researchers used a wearable step counting device to compare the effects of uninterrupted bouts of steps (10 minutes or longer) to occasional short spurts, such as climbing the stairs and general daily activities throughout the day.

"Technological advances made in recent decades have allowed researchers to measure short spurts of activity. Whereas, in the past we were limited to only measuring activities people could recall on a questionnaire," said lead study author Christopher C. Moore, M.S., a Ph.D. student in epidemiology at the University of North Carolina at Chapel Hill. "With the help of wearable devices, more research is indicating that any type of movement is better than remaining sedentary."

From 2011-2015, 16,732 women wore a waist step counter that measured their daily steps and walking patterns for four to seven days. The women were all over age 60 (average age of 72; mostly non-Hispanic white women) and were participants in the Women's Health Study, a large, national study of heart disease, cancer and other long-term disease prevention.

The researchers divided the total number of steps for each study participant into two groups: 1) 10 minutes or longer bouts of walking with few interruptions; and 2) short spurts of walking during regular daily activities such as housework, taking the stairs, or walking to or from a car. In follow-up, they tracked deaths from any cause for an average of six years, through December 31, 2019.

Researchers found:

• Overall, 804 deaths occurred during the entire study period of 2011-2019.

• Study participants who took more steps in short spurts lived longer, regardless of how many steps they had in longer, uninterrupted bouts. The benefits leveled off at about 4,500 steps per day in short spurts.

• Compared to no daily steps, each initial increase of 1,000 steps per day was associated with a 28% decrease in death during the follow-up period.

• A 32% decrease in death was noted in participants who took more than 2,000 steps daily in uninterrupted bouts.

A prior analysis of the same women reported that those who took 4,500 steps per day had a significantly lower risk of death compared to the least active women. "Our current results indicate that this finding holds even for women who did not engage in any uninterrupted bouts of walking. Taking 2,000 or more additional steps during bouts was associated with further benefits for longevity," Moore said.

"Older adults face many barriers to participating in structured exercise programs, so some may find it more convenient and enjoyable to increase everyday walking behaviors, like parking slightly further from their destination or doing some extra housework or yardwork," Moore said.

Since all study participants were older and mostly non-Hispanic white women, more research is needed to determine if the results apply to men, younger women and people from diverse racial and ethnic groups.

https://www.sciencedaily.com/releases/2021/05/210520145353.htm

Study raises new alarm over long-term exposure to second-hand smoke

Researchers measure chronic exposure in mice over 10 months

May 19, 2021

Science Daily/Oregon Health & Science University

Chronic exposure to second-hand smoke results in lower body weight and cognitive impairments that more profoundly affects males, according to new research in mice led by Oregon Health & Science University.

The study published today in the journal Environmental Health Perspectives.

"The hope is that we can better understand these effects for policymakers and the next generation of smokers," said lead author Jacob Raber, Ph.D., professor of behavioral neuroscience in the OHSU School of Medicine. "Many people still smoke, and these findings suggest that that the long-term health effects can be quite serious for people who are chronically exposed to second-hand smoke."

The research examined daily exposure of 62 mice over a period of 10 months. Researchers used a specially designed "smoking robot" that went through a pack of cigarettes a day in ventilated laboratory space at OHSU. The longest previous study of this kind lasted three months.

"Nobody has done this, ever. This study is unique," Raber said. "It really gives you the ability to look at long-term effects."

"This study more accurately replicates the human experience by daily exposing mice to cigarette smoke," added senior author Glen Kisby, Ph.D., professor of pharmacology at Western University of Health Sciences in Lebanon, Oregon.

Second-hand smoke is already considered a risk factor for dementia in people, but the new study put the theory to the test.

Researchers first divided mice into two groups -- one wild-type and one expressing the human tau protein, important in Alzheimer's-like dementia. Starting in April of 2018, they exposed mice to cigarette smoke for 168 minutes a day, then conducted behavioral and cognitive testing. They also examined lung and brain tissue.

Key findings:

• Smoke harms 'healthy' mice. Researchers theorized that second-hand smoke would be especially harmful for mice with the human tau protein. However, "we actually found the opposite," Raber said. In many of the behavioral and cognitive tests -- including swimming speeds and migrating through a maze -- wild-type mice were more affected than human tau mice after both groups were exposed to second-hand smoke.

• Smoke especially harms males. Researchers discerned a clear sex-related difference in cognition, with clearly discernable changes in the hippocampus region of the brain among males compared to females.

• Loss in body weight. Researchers found lower body weights in wild-type mice following second-hand smoke compared with human tau mice. Further, they also noticed that males were disproportionately impacted by a loss in body weight compared to females.

• Brain changes: Researchers discovered more profound changes in metabolic pathways, which are linked chemical reactions, in the brains of wild-type males than females. Researchers also found more profound effects in the brains of wild-type than the human tau mice.

Although smoking rates have declined in recent generations in some countries, smoking -- and exposure to second-hand smoke -- remains widespread in much of the world. The World Health Organization estimates 1.5 to 1.9 billion people worldwide will be smokers in 2025.

"Long-term exposure to second-hand smoke triggers detrimental changes," Raber said. "Based on our study, it seems that males might be more susceptible than females. People should take that into consideration."

https://www.sciencedaily.com/releases/2021/05/210519080435.htm

Alcohol problems severely undertreated

Heavy drinkers see doctors regularly, but few receive treatment for disorder

May 17, 2021

Science Daily/Washington University School of Medicine

Some 16 million Americans are believed to have alcohol use disorder, and an estimated 93,000 people in the U.S. die from alcohol-related causes each year. Both of those numbers are expected to grow as a result of heavier drinking during the COVID-19 pandemic.

Yet, in a new study involving data from more than 200,000 people with and without alcohol problems, researchers at Washington University School of Medicine in St. Louis found that although the vast majority of those with alcohol use disorder see their doctors regularly for a range of issues, fewer than one in 10 ever get treatment for drinking.

The findings are published in the June issue of the journal Alcoholism: Clinical & Experimental Research.

Analyzing data gathered from 2015 through 2019 via the National Survey on Drug Use and Health, the researchers found that about 8% of those surveyed met the current criteria for alcohol use disorder, the medical diagnosis for those with an addiction to alcohol. Of these people who met the criteria, 81% had received medical care in a doctor's office or spent time in a hospital or clinic during the previous year. But only 12% reported they had been advised to cut down on their drinking, 5% were offered information about treatment, and 6% received treatment, some of whom were not referred by their doctors but sought out treatment on their own.

"It's not that these people aren't in the health-care system," said first author Carrie M. Mintz, MD, an assistant professor of psychiatry. "But although they see doctors regularly, the vast majority aren't getting the help they need."

Mintz and her colleagues evaluated data from 214,505 people. The researchers first wanted to learn whether people with alcohol use disorder had access to health care and if they did, whether they had been screened about their alcohol use; they were considered to have been screened if their doctors simply had asked how much they drink. The researchers also evaluated whether people with drinking problems had been advised to cut down on drinking, had received additional information about treatment, or had received treatment or counseling.

The researchers found that although most people with alcohol use disorder had access to health care and although 70% reported they had been asked about alcohol use, that's where the care stopped.

"Some primary care doctors may not feel comfortable telling patients they should cut down on drinking, prescribing medication to help them cut back or referring them to treatment because they don't specialize in treating alcohol misuse; but the result is that many people who need treatment aren't getting it," said senior author Laura Jean Bierut, MD, the Alumni Endowed Professor of Psychiatry. "We used to see the same thing with smoking, but when physicians became educated about smoking and learned that many of their patients wanted to quit or cut back, doctors began offering more treatment, and more people were able to quit. We think the same thing may be possible with alcohol."

Among treatments that could be prescribed are the FDA-approved medications naltrexone, acamprosate and disulfiram, as well as psychotherapy and mutual-aid approaches, such as the 12-step program used by Alcoholics Anonymous.

"Alcohol use disorder is a chronic disease, but compared to other chronic diseases, it's wildly untreated," Bierut said. "For example, two-thirds of patients with HIV and 94% of patients with diabetes receive treatment, compared with only 6% of people with alcohol use disorder."

The researchers noted that during the pandemic, alcohol sales in the U.S. increased by 34%. Consequently, they expect that as the country emerges from COVID-19 and returns to normal, the number of people with alcohol use disorder will have climbed.

"We know alcohol use and misuse have increased during the pandemic," Mintz said. "It seems there has been a shift toward heavier drinking. Plus, many doctor's offices, AA groups and other support groups were shut down for a period of time, so we would hypothesize that even the relatively small percentage of people in treatment may have declined during the past year."

Mintz, C, Hartz S, Fisher S, Ramsey A, Geng E, Grucza R, Bierut L. A cascade of care for alcohol use disorder: using 2015-2019 National Survey on Drug Use and Health data to identify gaps in past 12-month care. Alcoholism: Clinical & Experimental Research, published online May 16, 2021.

https://www.sciencedaily.com/releases/2021/05/210517144730.htm

###

What Is Telemedicine In Healthcare?

Guest post by John Mullen Training COR

*We do not endorse guest posts. For informational purposes only.

Telemedicine is a novel new way of getting you healthy without having to see the doctor in person. Offering you innovative solutions and twenty-four-hour access to your medical records and results, you have the best opportunity to meet with your doctor and talk about your concerns without stepping outside your house. That offers great benefit to those who suffer from anxiety and fear of getting sick during the pandemic.

Using Technology

 Technology is your friend when using telemedicine. By using the app or the patient portal, you can talk to your doctor quickly. You also have access to your complete set of files and full knowledge of what is going on with your health. In addition to that, you have an easier time understanding your lab results, medication, and notes from the doctor. 

You also have the chance to speak with your doctor freely through text or call them from your phone. That saves time and frustration because you can call them anytime, no matter what location you find yourself in.  It will work when your parked and waiting for the kids at school, at home, or if you are walking somewhere. The service is around the clock, so you never go without professional help should you need it. When you need instant urgent care telemedicine options, service anytime is what you need. 

A Virtual Appointment

The way telemedicine works for an appointment is that you call your doctor's office like usual, and then on the day of your appointment, they will call you on your phone when it's time. If you are using video calling, you will be able to see them, and the same is true with Skype. 

That option works better for people because they don't have to go to the doctor's office in person. It helps them retain their schedule, and it's more convenient, which is something they appreciate. It also works for people stuck in areas that make it hard to get to the doctor or people who are not well enough to make the trip to the doctor. Those at risk with the pandemic can't leave the house either but still need medical help. This system was put in place with them in mind. 

Try Telemedicine

It’s easy to have appointments virtually instead of in person. It’s easier on you, your car, and your time. It also helps the doctor help you medically. Insurance isn't a problem; there are no hidden fees; it is the perfect way to see a doctor when you need assistance during this pandemic. 

Long term use of prescription meds for insomnia not linked to better quality sleep

No difference between those who did and didn't take these drugs for 1-2 years

May 11, 2021

Science Daily/BMJ

Long term use of prescription meds for insomnia doesn't seem to improve disturbed sleep in middle-aged women, suggests research published in the online journal BMJ Open.

There was no difference in sleep quality or duration between those who did and didn't take these meds for 1 to 2 years, the findings show.

Disturbed sleep -- difficulty falling and/or staying asleep and waking early -- is common. An estimated 9 million adults in the US alone say they take prescription meds to try and get a good night's sleep.

Poor quality sleep is associated with ill health, including diabetes, high blood pressure, pain and depression, and various drugs are prescribed to induce shut-eye.

These include benzodiazepines, Z-drugs which include zolpidem, zaleplon and eszopiclone, as well as other agents mostly intended for other conditions (off label use), such as quelling anxiety and depression.

The clinical trial data indicate that many of these drugs work in the short term (up to 6 months), but insomnia can be chronic, and many people take these drugs for longer, say the researchers.

They therefore wanted to assess the effectiveness of drugs used to tackle insomnia over the long term among an ethnically diverse group of middle aged women who developed sleep disorders.

The women were all part of the Study of Women's Health Across the Nation (SWAN), a long term multicentre study looking at biological and psychosocial changes arising during the menopause. The women's average age was 49.5 and around half were white.

Sleep disturbances were defined as difficulty falling asleep, frequent awakening, and waking up early and rated on a 5-point scale, ranging from no difficulty on any night (1) to difficulty on 5 or more nights of the week (5), reported during an average of 21 years of monitoring.

Sleep disturbances, as measured on the ratings scale, were compared among those who did and didn't take prescription meds to improve their sleep after 1 and 2 years.

Some 238 women who started using medication to tackle insomnia during the monitoring period were matched with 447 women who didn't take these drugs.

Both groups of women reported difficulty falling asleep on 1 out of every 3 nights, waking frequently on 2 out of 3 nights, and waking up early on 1 in every 3 nights of the week. More than 70% of women in both groups reported disturbed sleep at least 3 times a week.

To begin with, sleep disturbance ratings were similar between the two groups of women. Those taking prescription meds for their sleep problems had average scores for difficulty falling asleep, waking up frequently, and for waking up early of 2.7, 3.8, and 2.8 respectively.

This compares with equivalent ratings of 2.6, 3.7, and 2.7, respectively, for those not taking prescription meds to get a good night's sleep.

After 1 year, average ratings among those taking the meds were 2.6, 3.6, and 2.8, respectively. The equivalent average scores among those not using prescription meds for their sleep problems were 2.3, 3.5, and 2.5, respectively.

None of the 1 year changes was statistically significant nor did they differ between the two groups. And after 2 years there were no statistically significant reductions in sleep disturbances among those taking prescription meds compared with those who didn't.

This is an observational study, and as such can't establish cause, only correlation. What's more, around half of the women were current or former smokers and 1 in 5 were moderate to heavy drinkers, both of which may affect sleep quality.

Information collected on prescription meds was also collected only at annual or biennial study visits, and there may have been intermittent or periods of no use between visits, say the researchers. Nor were there any objective measures of sleep quality.

Nevertheless, conclude the researchers: "Sleep disturbances are common and increasing in prevalence. The use of sleep medications has grown, and they are often used over a long period, despite the relative lack of evidence from [randomised controlled trials]."

These drugs may work well in some people with sleep disturbances over several years, but the findings of this study should give pause for thought to prescribing clinicians and patients thinking about taking prescription meds for sleep disturbances in middle age, they add.

https://www.sciencedaily.com/releases/2021/05/210511201131.htm

Sleep disorders tally $94.9 billion in health care costs each year

May 7, 2021

Science Daily/Massachusetts Eye and Ear Infirmary

Sleep disorders are associated with significantly higher rates of health care utilization, conservatively placing an additional $94.9 billion in costs each year to the United States health care system, according to a new study from researchers at Mass Eye and Ear, a member hospital of Mass General Brigham.

In their new analysis, published in the Journal of Clinical Sleep Medicine, the researchers found the number of medical visits and prescriptions filled were nearly doubled in people with sleep disorders such as sleep apnea and insomnia, compared to similar people without. Affected patients were also more likely to visit the emergency department and have more comorbid medical conditions.

Costly medical care for sleep disorder patients 

The researchers sought out to determine the true diagnostic prevalence of sleep disorders and how expensive these conditions were to the health care system. They examined differences in health expenditures in similar patients with and without a sleep disorder diagnosis, as determined by their ICD-10 diagnosis code. The study included data from a nationally-representative survey of more than 22,000 Americans called the 2018 Medical Expenditure Panel Survey, which is administered by the Department of Health and Human Services' Agency for Healthcare Research and Quality.

They found 5.6 percent of respondents had at least one sleep disorder, which translated to an estimated 13.6 million U.S. adults. This likely represents a significant underestimate, according to the authors, as insomnia alone is felt to conservatively affect 10 to 20 percent of the population. These individuals accumulated approximately $7,000 more in overall health care expenses per year compared to those without a sleep disorder -- about 60 percent more in annual costs. This equates to a conservative estimate of $94.9 billion in health care costs per year attributable to sleep disorders.

The analysis revealed that patients with sleep disorders attended more than 16 office visits and nearly 40 medication prescriptions per year, compared to nearly 9 visits and 22 prescriptions for those without a sleep disorder. The study did not quantify non-health care related costs, but the authors noted it can be assumed that more doctors' appointments means more time off from work, school or other social obligations, not to mention decreased productivity associated with symptoms, only exacerbating costs to society.

Sleep disorders raise risk for other conditions 

Sleep disorders can take a toll on health and quality of life in numerous ways. Individuals with certain sleep disorders experience decrease daytime functionality related to sleepiness, mental fog and an increased risk of motor vehicle accidents, for instance. Obstructive sleep apnea is one of the most common sleep disorders and if untreated, can increase risk for neurocognitive issues, such as difficulty concentrating and mood disorders, as well as cardiovascular conditions including heart attacks, strokes, high blood pressure and irregular heart rhythms.

Getting a proper diagnosis at the sign of asleep problem can lead to an effective treatment for a sleep disorder.

"Fortunately, studies have demonstrated that treating certain sleep disorders effectively reduces health care utilization and costs. Therefore, sleep issues should not be ignored. Greater recognition of sleep disorders and an early referral to a sleep specialist are essential," said Dr. Huyett. "Your sleep is important, and if there's an issue with your sleep, seek help for it."

https://www.sciencedaily.com/releases/2021/05/210507160008.htm

Mental health may play big role in recovery after a heart attack

Psychological distress found to double the risk of subsequent cardiac events in younger adults

May 6, 2021

Science Daily/American College of Cardiology

Young and middle-aged adults who reported severe psychological distress -- such as depression or anxiety -- after suffering a heart attack were more than twice as likely to suffer a second cardiac event within five years compared with those experiencing only mild distress, according to a study presented at the American College of Cardiology's 70th Annual Scientific Session.

The study is the first to comprehensively assess how mental health influences the outlook for younger heart attack survivors, according to the researchers. The researchers also tracked inflammatory markers that appear to have a role in increasing cardiovascular risk among people experiencing distress. The findings align with previous studies focusing on older adults, bolstering the evidence for mental health as an integral part of a person's recovery after a heart attack.

"Our findings suggest that cardiologists should consider the value of regular psychological assessments, especially among younger patients," said Mariana Garcia, MD, a cardiology fellow at Emory University in Atlanta and the study's lead author. "Equally importantly, they should explore treatment modalities for ameliorating psychological distress in young patients after a heart attack, such as meditation, relaxation techniques and holistic approaches, in addition to traditional medical therapy and cardiac rehabilitation."

The researchers analyzed health outcomes in 283 heart attack survivors between the ages of 18 and 61, with an average age of 51 years. Study participants completed a series of validated questionnaires measuring depression, anxiety, anger, perceived stress and posttraumatic stress disorder within six months of their heart attack. Based on these questionnaires, the researchers established a composite score of psychological distress for each participant and grouped patients based on experiences of mild, moderate and high distress.

Within five years after their heart attack, 80 of the 283 patients suffered a subsequent heart attack or stroke, were hospitalized for heart failure or died from cardiovascular causes. These outcomes occurred in nearly half (47%) of patients experiencing high distress compared to 22% of those experiencing mild distress.

Previous studies suggest inflammation is one mechanism through which psychological distress may lead to heart problems. In the new study, patients who experienced high distress were also found to have higher levels of two inflammatory markers -- interleukin-6 and monocyte chemoattract protein-1 -- in their blood during rest and after mental stress. These markers, which increase during times of mental stress, are known to be associated with plaque buildup in the arteries and adverse cardiac events.

"It is thought that those who have had a heart attack may be particularly vulnerable to plaque rupture as a result of these inflammatory mechanisms at play," Garcia said. "The association we found was independent of known cardiovascular risk factors and suggests mechanisms involving systemic inflammation in response to stress may be implicated in the likelihood of a subsequent cardiac event."

The researchers also found that patients with high distress were more often Black, female and from a disadvantaged socioeconomic background and were more likely to smoke or have diabetes or high blood pressure.

"This finding highlights the importance of socioeconomic status in regard to higher distress and raises important questions about the role of race, sex and other factors," Garcia said.

The researchers plan to further investigate how socioeconomic and demographic factors may influence mental health among people who suffer a heart attack at a young age. Recent studies have suggested younger adults, especially women, account for an increasing proportion of the heart attacks occurring each year in the U.S., Garcia said, underscoring the importance of improving outcomes in this population.

"Outreach to the community has led to increased awareness of traditional heart disease risk factors and focus on things like diet and exercise, but many people, particularly younger people, may not be aware of the importance of mental health," Garcia said. "Our study offers a strong message to people recovering from a heart attack that ameliorating psychological distress is equally important."

Garcia cautioned that causation cannot be proven with an observational study and noted the possibility of recall bias among people with more severe disease, since psychological distress was self-reported in this study. While the study's sample size was relatively small, it did demonstrate a robust association using a prospective design.

https://www.sciencedaily.com/releases/2021/05/210506105433.htm

Too much, too little sleep linked to elevated heart risks in people free from disease

Sleep should be assessed along with other factors that increase heart disease

May 5, 2021

Science Daily/American College of Cardiology

People who clock six to seven hours of sleep a night had the lowest chance of dying from a heart attack or stroke when compared with those who got less or more sleep, according to a study being presented at the American College of Cardiology's 70th Annual Scientific Session. This trend remained true even after the research team accounted for other known conditions or risk factors for heart disease or stroke.

The study, according to researchers, is the first to explore the association between baseline cardiovascular risk and duration of sleep and adds to mounting evidence that sleep -- similar to diet, smoking and exercise -- may play a defining role in someone's cardiovascular risk.

"Sleep is often overlooked as something that may play a role in cardiovascular disease, and it may be among the most cost-effective ways to lower cardiovascular risk," said Kartik Gupta, MD, resident, Division of Internal Medicine, Henry Ford Hospital in Detroit and lead author of the study. "Based on our data, sleeping six to seven hours a night is associated with more favorable heart health."

For the study, Gupta and his team included data from 14,079 participants in the 2005-2010 National Health and Nutrition Examination Survey. Participants were followed for a median duration of 7.5 years to determine if they died due to heart attack, heart failure or stroke. Those surveyed were 46 years old on average, half were women and 53% were non-white. Less than 10% of participants had a history of heart disease, heart failure or stroke.

Researchers divided participants into three groups based on answers to a survey question about their average length of sleep -- less sleep (seven hours). Researchers then assessed participants' atherosclerotic cardiovascular disease (ASCVD) risk scores and levels of C-reactive protein (CRP), a key inflammatory marker known to be associated with heart disease.

The ASCVD risk score, which accounts for age, gender, race, blood pressure and cholesterol, is widely used to predict how likely someone is to have a heart attack or stroke or die from atherosclerosis, a hardening of the arteries, in the next 10 years. An ASCVD risk score less than 5% is considered low risk.

While the median ASCVD risk was 3.5% among all participants, there was a U-shape relationship based on sleep duration such that participants with six to seven hours had the lowest risk. The median 10-year ASCVD risk among people with less than six, six to seven and more than seven hours of sleep were 4.6%, 3.3% and 3.3%, respectively.

"Participants who slept less than six hours or more than seven hours had a higher chance of death due to cardiac causes. ASCVD risk score was, however, the same in those who sleep six to seven hours versus more than seven hours," Gupta said, adding that the ASCVD risk score may not adequately capture elevated cardiac risk in this subgroup and that results are perhaps stronger for participants sleeping less than six hours a night.

Levels of CRP, a protein made in the liver that rises when there is inflammation in the body, were also higher in participants with longer or shorter durations of sleep.

"Participants who sleep less or more than six to seven hours have higher ASCVD risk scores, which is likely driven by heightened inflammation as measured by CRP, which was found to be higher among those who had less or more sleep," Gupta said, adding that CRP levels were only collected at the start of the study. "The effect of sleep probably accrues over time; it takes time for the damage to happen."

According to the researchers, unlike some risk factors for heart disease that can't be changed, such as age or genetics, sleep habits can be adjusted and should be routinely asked about during medical visits.

"It's important to talk about not only the amount of sleep but the depth and quality of sleep too. Just because you are lying in bed for seven hours doesn't mean that you are getting good quality sleep," Gupta said, adding that this study is limited to sleep quantity, not quality or how well or deeply someone sleeps. For example, sleep apnea, which is a sleep disorder that results in frequent awakenings, is increasingly associated with cardiovascular disease.

The amount of sleep found to be favorable to heart health in this study differs slightly from national recommendations by the National Sleep Foundation and the American Academy of Sleep Medicine, which recommend most adults get seven to nine hours or seven or more hours of sleep a night, respectively. But, as Gupta explains, individuals were limited to choosing hour blocks (six, seven or eight hours, for example) when noting sleep time.

More research is needed to further validate these results.

https://www.sciencedaily.com/releases/2021/05/210505090300.htm

Circadian rhythm research could turn early birds into night owls

May 4, 2021

Science Daily/American Institute of Physics

How body clocks work could lead to science that can turn an early bird into a night owl or vice versa as well as other advances, like helping crops grow all year long.

In Applied Physics Reviews, by AIP Publishing, scientists at Penn State report on their work advancing knowledge about circadian rhythms, the natural process that governs sleep and waking patterns in humans, animals, and plants.

Researchers have identified a set of genes, called clock genes, that control these rhythms. But a more complicated network of genes than previously known appears related to circadian rhythms. More fully understanding this network is key to understanding how the rhythms work and could potentially be changed.

The authors detail a statistical model they are using to help identify all the genes involved in this network. With the help of scientists from other disciplines, they hope to fully understand how these genes work together to make one person more productive in the early morning while another thrives in the middle of the night.

Doing so could lead to the creation of medicines that would help someone who is naturally a day person but required to work nights, or one who struggles to be productive first thing in the morning.

"If we understand the gene for a night owl, we can develop a drug to activate that gene for an early bird who has to live a lifestyle like a night owl," said author Rongling Wu, director of the Center for Statistical Genetics at Penn State.

There are also possible health benefits. Disrupted circadian rhythms have been linked to health issues including depression, anxiety, weight gain, and cardiovascular disease.

And while most people probably think of circadian rhythms in humans, plants and animals have them, too. A breakthrough in understanding the clock-gene network could help increase crop production.

For example, wheat, which tends to "rest" during the middle of the day, could be modified to grow all day long and be harvested more quickly. Or a crop that does not grow well in northern areas with less daylight and colder temperatures could have genes altered to make it ignore those conditions.

"We can increase our production," Wu said. "If we can activate the correct gene, we can use all of that time. But we need to bring together different researchers from other fields to better understand such a complex problem."

https://www.sciencedaily.com/releases/2021/05/210504112602.htm

Short-term exposure to air pollution may impede cognition; Aspirin could help

May 3, 2021

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

Exposure to air pollution, even over the course of just a few weeks, can impede mental performance, according to a new study led by researchers at Columbia University Mailman School of Public Health. However, these adverse effects were lessened in people taking nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin. The study is among the first to explore short-term air pollution exposures and the use of NSAIDs to mitigate their effects. The results are published in the journal Nature Aging.

Examples of events that would increase someone's exposure to air pollution over the short term could include forest fires, smog, second-hand cigarette smoke, charcoal grills, and gridlock traffic.

The researchers examined the relationship between exposures to fine particulate matter (PM2.5) and black carbon, a component of PM, and cognitive performance in 954 older white males from the Greater Boston Area enrolled in the Normative Aging Study. They also explored whether taking NSAIDs could modify their relationships. Cognitive performance was assessed using the Global Cognitive Function (GCF) and Mini-Mental State Examination (MMSE) scales. Air pollution levels were obtained from a site in Boston.

Elevated average PM2.5 exposure over 28 days was associated with declines in GCF and MMSE scores. Men who took NSAIDs experienced fewer adverse short-term impacts of air pollution exposures on cognitive health than non-users, though there were no direct associations between recent NSAID use and cognitive performance. The researchers postulate that NSAIDs, especially aspirin, may moderate neuroinflammation or changes in blood flow to the brain triggered by inhaling pollution.

"Despite regulations on emissions, short-term spikes in air pollution remain frequent and have the potential to impair health, including at levels below that usually considered hazardous," says senior author Andrea Baccarelli, MD, PhD, chair of the Department of Environmental Health Sciences. "Taking aspirin or other anti-inflammatory drugs appears to mitigate these effects, although policy changes to further restrict air pollution are still warranted."

The link between long-term PM exposure and impaired cognitive performance in the aging population is well-established. Reported effects include reduced brain volume, cognitive decrements, and dementia development. Air pollution has also been associated with poor cognition of children and adults. Until now, however, little was known about the effects of short-term exposure to air pollution.

The researchers say future studies should investigate the specific effects of chemical components of air pollution on cognitive performance, exposure sources in the environment, and whether cognitive impairments due to short-term air pollution exposures are transient or persistent. Randomized clinical trials of NSAID use are needed to validate their protective effects.

https://www.sciencedaily.com/releases/2021/05/210503135611.htm