Pregnancy weight gain, especially in 1st Trimester, may increase a woman’s risk of gestational diabetes
Women who gain excessive weight during pregnancy, especially in the first trimester, may increase their risk of developing diabetes later in their pregnancy, according to a study by the Kaiser Permanente Division of Research that appears online in the current issue of Obstetrics and Gynecology.
Watch a video of the study author explaining her study: http://bit.ly/clLtlZ
The three-year study of 1,145 pregnant women from an ethnically diverse population found that women who gained more weight than is recommended by the Institute of Medicine had a 50 percent increased risk of developing gestational diabetes mellitus, also known as GDM. The association between pregnancy weight gain and gestational diabetes risk was more pronounced among overweight and non-white women. The study included 345 pregnant women with gestational diabetes and 800 pregnant women without gestational diabetes.
Gestational diabetes is defined as glucose intolerance that typically occurs during the second or third trimester of pregnancy. It causes complications in as much as seven percent of pregnancies in the United States. It can lead to early delivery, C-sections and type 2 diabetes, and can increase the child’s risk of developing diabetes and obesity later in life.
This study is among the first to support a direct link between pregnancy weight gain and gestational diabetes risk. Previous research has shown that weight gain before pregnancy and being overweight or obese at the start of pregnancy are risk factors for gestational diabetes. This study was funded by the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases.
The study followed women members of Kaiser Permanente Northern California region and examined their overall rate of pregnancy weight gain up to the time of screening for gestational diabetes (typically between 24-28 gestational weeks), as well as the trimester-specific rates of weight gain compared to the Institute of Medicine’s 2009 guidelines for recommended pregnancy weight gain. Based on a woman’s pre-pregnancy body mass index, the IOM developed the 2009 guidelines for obstetricians to counsel pregnant women on suggested weight gain during pregnancy.
After adjusting for age at delivery, race/ethnicity, previous births, and pre-pregnancy body mass index, the risk of gestational diabetes increased with increasing rates of pregnancy weight gain. Women who exceeded the IOM guidelines for weight gain had a 50 percent increase in the risk of gestational diabetes compared to women who gained within or below the IOM recommendations.
“Health care providers should talk to their patients early in their pregnancy about the appropriate gestational weight gain, especially during the first trimester, and help women monitor their weight gain. Our research shows that weight gain in early pregnancy is a modifiable risk factor for gestational diabetes,” said the study’s lead author Monique Hedderson, PhD, a scientist at the Kaiser Permanente Division of Research. “Randomized studies are needed to determine the feasibility of this early intervention and the best methods to help women meet the IOM recommendations.”
Though the exact mechanism for how excessive weight gain may contribute to gestational diabetes is not known, researchers hypothesize that rapid weight gain early in pregnancy may result in an early increase in insulin resistance that leads to the “exhaustion” of the beta-cells in the pancreas that make and release insulin, which controls the level of glucose in the blood. This could reduce beta-cells’ capacity to secrete adequate levels of insulin to compensate for the insulin resistance induced by the progression of pregnancy and therefore lead to the development of gestational diabetes, researchers said.
A strength of the study is its representative and ethnically diverse population. However, some limitations should be considered. Pre-pregnancy weights were self-reported for most women. However, researchers have no reason to believe that the women who developed gestational diabetes would have misreported their pre-pregnancy weight more than control women and results were similar when looking at the sub-group of women who had a measured pre-pregnancy weight.
This study is part of ongoing research at Kaiser Permanente to understand, prevent and treat gestational diabetes. A recent published Kaiser Permanente study of 16,000 women in Hawaii found that more than 10 percent of women of Chinese and Korean heritage may be at risk for developing gestational diabetes. Another published Kaiser Permanente study of 10,000 mother-child pairs showed that treating gestational diabetes during pregnancy can break the link between gestational diabetes and childhood obesity. That study showed, for the first time, that by treating women with gestational diabetes, the child’s risk of becoming obese years later is significantly reduced.
The study follows other research at Kaiser Permanente regarding healthy weight gain during pregnancy. A recent published Kaiser Permanente study found that obese women who gain more than the recommended amount during pregnancy are much more likely to retain a portion of that weight one year after they give birth. Another published Kaiser Permanente study of 40,000 mother and baby pairs found that women who gained more than 40 pounds during their pregnancies were nearly twice as likely to have a heavy baby.
Assiamira Ferrara, MD, PhD, a research scientist with the Kaiser Permanente Division of Research in Oakland, Calif., is the senior investigator on this study. Erica P. Gunderson, PhD, also with the Kaiser Permanente Division of Research, is an investigator on this study.
Source: Kaiser Permanente
Effort to regenerate injured spinal cords turns to a new model
For more than 400 years, scientists have studied the amazing regenerative power of salamanders, trying to understand how these creatures routinely repair injuries that would usually leave humans and other mammals paralyzed — or worse.
Now, fueled by a highly competitive National Institutes of Health Grand Opportunity grant of $2.4 million, a multi-institutional team of researchers associated with the University of Florida McKnight Brain Institute’s Regeneration Project has begun creating genomic tools necessary to compare the extraordinary regenerative capacity of the Mexican axolotl salamander with established mouse models of human disease and injury.
Researchers want to find ways to tap unused human capacities to treat spinal cord injury, stroke, traumatic brain injury and other neural conditions, according to Edward Scott, Ph.D., principal investigator for the GO grant and director of the McKnight Brain Institute’s Program in Stem Cell Biology and Regenerative Medicine.
“The axolotl is the champion of vertebrate regeneration, with the ability to replace whole limbs and even parts of its central nervous system,” Scott said. “These salamanders use many of the same body systems and genes that we do, but they have superior ability to regenerate after major injuries. We think that studying them will tell us a lot about a patient’s natural regenerative capacities after spinal cord injury and nerve cell damage.”
The issue of what controls organ regeneration was named among the top 25 major questions facing scientists in the next quarter century by Science magazine in 2005, Scott said. With medical science continually adding years to the human lifespan, the importance of “rebuilding and restoring” old tissues and organs is growing. But science had to enter the 21st century to fully explore the use of the highly regenerative axolotl as a model for human disease.
“Only now have new genetic, molecular and cellular technologies as well as scientific knowledge of the salamander, mouse and human genomes and ‘regeneromes’ risen to a level where scientists can compare systemwide responses to injury,” according to Dennis A. Steindler, Ph.D., executive director of UF’s McKnight Brain Institute and a co-investigator on the grant.
“I am extremely hopeful with the discoveries being made in comparative regenerative biology that the questions surrounding cell and tissue regeneration in the human following injury or disease are going to be answered,” Steindler said. “It is going to take broad, multidisciplinary collaborations across a number of scientific fields, but we are making that happen. I think the GO grant shows that these efforts are recognized and valued on a national level.”
GO grants are funded through the American Recovery and Reinvestment Act and are intended to support research with high short-term impact and a high likelihood of enabling growth and investment in biomedical research and health-care delivery.
“NIH Grand Opportunity grants support high-impact projects, which lay the foundation for whole new fields of investigation,” said Naomi Kleitman, Ph.D., repair and plasticity program director at the National Institute of Neurological Disorders and Stroke. “This important model of regeneration is one of several being developed in organisms that can repair themselves, using genetics to find links to mammals. We’ll continue to watch the progress of these exciting studies to ensure that discoveries of genes that promote regeneration are one day applied to improving human health.”
The Regeneration Project is also supported by private foundations such as the Thomas H. Maren Foundation and the Jon L. and Beverly A. Thompson Research Endowment, the UF Office of the Vice President for Research, and an anonymous donor, Steindler said. Enhancing the discovery process are Regeneration Project research fellows — scientists who work across institutes and universities to advance discoveries in tissue and organ regeneration to the clinic.
Even without help, people are capable of a certain degree of regeneration. Humans can regrow fingertips and even more than half of their liver. But they cannot replace whole limbs and restoring parts of their brain and spinal cord is a daunting challenge.
“The axolotl is the highest, most complex organism that can still do this clever trick of completely reconstructing a whole body part in adulthood,” said Arlene Chiu, Ph.D., a scientific adviser for the Regeneration Project and director of New Research Initiatives at Beckman Research Institute of the City of Hope. “I like to think of it in construction terms where we need both the materials such as bricks and beams and the architect’s plans. In regenerative medicine, can we learn where the biological blueprint resides, and understand the basis of restoring and reorganizing many different types of lost cells and tissues? Muscles, bones, nerves and blood vessels all have to be reconstructed at the right time and in the right place, all in perfect coordination with the original biological master plan.
“It may sound like science fiction, but the reality is the salamander is able to do all of these things,” she said. “We are not so far removed that we can’t relate to them, learn from them and try to apply their secrets to improve our capacity to regenerate.”
As discoveries are made, more researchers will begin using the axolotl as a model for exploring regenerative techniques, according to S. Randal Voss, director of the Salamander Genome Project at the University of Kentucky.
“We’ve analyzed genes in common between the axolotl salamander and humans, and found out we share about 90 percent of our genes in a one-to-one sense,” Voss said. “It could be that small but important changes in the way these genes function in an injury environment affect the repair process, but somehow the salamander is able to use these genes for regeneration, while people are not.”
The team has already referenced human and mouse genes with axolotl counterparts.
“We started this with a list of genes in humans and mice that are involved in repair processes and matched them with their counterparts in the axolotl genome,” Scott said. “Ultimately, what makes the axolotl a great model for regeneration is that the model systems we are most familiar with — mice and humans — do not regenerate very well. By comparing how a mammal and a salamander respond to injuries, we can identify genes or proteins that we can now add back to the mammalian system to make it regenerate better.”
Source: University of Florida Health Science Center
Thomson Reuters survey: Most Americans support public option in healthcare reform legislation
but Are Skeptical Healthcare Will Improve in 2010
A majority of Americans support a “public option” in healthcare reform legislation, but most lack confidence that the cost, quality, value or accessibility of medical care will improve in the next year, according to a survey released today by Thomson Reuters.
Sixty percent of survey respondents said they believe a public option should be included in final healthcare reform legislation. Only about one in five, however, believes the cost, quality or value of care will improve in the next 12 months. Twenty-three percent said they expect access to care to improve.
The results are from a telephone survey of 2,999 households conducted from November 9-17 — a segment of the Thomson Reuters PULSE Healthcare Survey, the largest and longest-running survey of its kind. Each year, PULSE polls more than 100,000 U.S. households about healthcare behaviors, attitudes and utilization.
Here are the key findings:
– 18 percent of survey respondents said they expect to spend less on healthcare a year from now.
– 21 percent believe the quality of care will improve in the next 12 months.
– 18 percent believe the value of care delivered will be better in a year.
– 23 percent believe it will be easier for people to receive the care they need a year from now.
– 60 percent of Americans believe a public option should be included in final healthcare legislation. There are sharp divisions, however, along party lines: 86 percent of Democrats support the public option versus 57 percent of Independents and 33 percent of Republicans.
The survey is nationally representative and the margin of error is 1.8 percent.
Source: Thomson Reuters
Rate of confirmed AIDS in prison 2.5 times the rate in the U.S. general population
On December 31, 2008, a reported 20,606 state prisoners and 1,538 federal prisoners were HIV positive or had confirmed AIDS, the Bureau of Justice Statistics (BJS) in the Office of Justice Programs, U.S. Department of Justice, announced.
At yearend 2008, an estimated 5,672 inmates in state and federal prisons had confirmed AIDS, down from 5,762 in 2007. In 2007, about 43 per 10,000 prison inmates were estimated to have confirmed AIDS, compared to 17 per 10,000 persons in the general population.
At yearend 2008, the reported number of state and federal inmates who were HIV positive or had confirmed AIDS totaled 22,144. Among states reporting data in both 2007 and 2008, there was an increase of 145 inmates with HIV/AIDS. Of the state and federal inmates who were HIV positive or had confirmed AIDS, a reported 20,231 were men and 1,913 were women. Between 2007 and 2008, the percentage of male inmates with HIV/AIDS remained stable at 1.5 percent, while the percentage of female inmates with HIV/AIDS decreased slightly from 2.1 percent to 1.9 percent.
Florida (3,626), New York (3,500) and Texas (2,450) reported the largest number of HIV/AIDS cases. While these three states account for 24 percent of the total state custody population, together they account for 46 percent of HIV/AIDS cases in state prison. New York continues to report large decreases (down 450) in the number of HIV/AIDS cases. Notable increases between 2007 and 2008 were in California (up 246), Missouri (up 169) and Florida (up 166).
Between 1995 and 2006 the number of state inmates who died from AIDS-related causes decreased 85 percent from 1,010 to 155. Continuing the downward trend, 120 state inmates died from AIDS-related causes in 2007. Among federal inmates, 13 died from AIDS-related causes in 2008, up from 10 in 2007.
During 2008, a total of 24 states reported testing all inmates for HIV at admission or sometime during custody. Among these 24 states, 23 tested at admission, five tested while in custody, and six tested upon release. Fifty states and the federal system tested inmates if they had HIV-related symptoms or if they requested an HIV test. Forty-two states and the federal system tested inmates after they were involved in an incident in which an inmate was exposed to a possible HIV transmission, and 18 states and the federal system tested inmates who belonged to specific high-risk groups.
The report, HIV in Prisons, 2007-08 (NCJ 228307), was written by BJS statistician Laura M. Maruschak and intern Randy Beavers. Following publication, the report can be found at http://www.ojp.usdoj.gov/bjs/abstract/hivp08.htm.
Source: Office of Justice Programs – U.S. Department of Justice
Military study shows prevention of Novel A/H1N1 virus infection is vaccine-type and age-dependent
Both Live, Attenuated Influenza Vaccine (LAIV) and Trivalent Inactivated Vaccine (TIV) provide Protection against novel A/H1N1, especially against severe disease
Immunization with either live attenuated influenza vaccine (LAIV, also known as FluMist®), or trivalent inactivated influenza vaccine (TIV), appears to offer a protection (~ 45%) against the novel A/H1N1 virus, the cause of the present influenza pandemic. However, the benefit was largely attributed to the youngest age group. The finding emerges from an evaluation of medical encounters and seasonal influenza immunization of U.S. military service members.
As reported today in a Late-Breaker presentation at the 58th annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH), seasonal influenza vaccination also appears to offer higher protection against severe disease requiring hospitalization (~ 62%, 95% confidence interval [CI], 14% to 84%) than against milder infections that can be treated on an outpatient basis (~ 42%, 95% CI, 29% to 53%).
“The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” comments Col. (Ret.) Jose L. Sanchez, MD, MPH, of the Armed Forces Health Surveillance Center (AFHSC) in Silver Spring, Maryland.
Dr. Sanchez and colleagues conducted a case control analysis of influenza-related medical encounter data of U.S. military service members, compared to a control group of personnel with acute, non-respiratory illnesses. For the period of April-October 2009, a total of 1,205 cases of pandemic H1N1 2009 infections were reported, of which 966 (80%) were among males and more than one-half (58%) were among those younger than 25 years. The overall vaccine effectiveness (VE) for service members was found to be 45% (95% confidence interval [CI], 33% to 55%). Immunization with prior season’s TIV (VE=37%; 95% CI, 23% to 49%) as well as LAIV (VE=22%; 95% CI, 1% to 38%), were found to be protective.
Interestingly, and unexpectedly, the investigators observed a U-shaped relationship of VE with age stratification. VE was high in the youngest (< 25 yo) and oldest (> 39 yo) service members (50% and 55% respectively), while there was noVE for those 25 to 39 years of age.
“These data highlight the need for concise, timely assessments of influenza vaccine effectiveness against the new A/H1N1 as well as seasonal strains,” notes Thomas Wellems, MD, PhD, president of ASTMH. “Although the United States military constitutes a highly immunized population that may not be generalizable to civilians, it offers unique cohorts of at-risk individuals that can be studied in randomized clinical trials. We look forward to further data from this population.”
“These findings suggest that while prior season’s influenza vaccine may not prevent infection or developing illness once infected, it certainly appears to protect against more severe outcomes. We may also be seeing a cross-protective effect resulting from natural influenza infections and/or prior influenza immunization in the military setting,” says Dr. Sanchez. “This may play a role in conferring a certain degree of ‘immunological priming.”
“Continued timely assessment of influenza vaccine effectiveness among military personnel is a top priority for us at the AFHSC. At the very least, our results will assist health officials in the military and Department of Defense in guiding future policy on seasonal and novel A/H1N1 vaccine use among military service members and dependents,” Dr. Sanchez concludes.
Source: The American Society of Tropical Medicine and Hygiene
Survey shows that Americans lack significant knowledge of age-related vision problems
Macular degeneration and glaucoma among the top areas Americans have the most misunderstanding according to the American Optometric Association
It’s a fact of life that eyes change with age, and baby boomers – Americans born between 1946 and 1964 – are at the stage when many are affected by vision problems. Despite the prevalence of Americans affected by these changes, a new survey from the American Optometric Association (AOA) shows a concerning lack of public knowledge and misunderstanding regarding age-related eye diseases and conditions.
According to the AOA’s American Eye-Q® survey, which assesses public knowledge and understanding of issues related to eye and visual health, only 18 percent of Americans know that macular degeneration is the leading cause of blindness in adults 65 years of age and older, and less than a quarter of all Americans understand the effects of glaucoma. Even more concerning, 89 percent of Americans incorrectly believe that glaucoma is preventable, when in fact it is only treatable if caught early.
Americans who are 40 years of age or older have probably noticed changes in vision. Difficulties seeing clearly for reading and close work are among the most common problems adults develop between the ages of 41 to 60. According to the Eye-Q® survey, top concerns about the effects of vision problems include not being able to live independently, cited by 45 percent; not being able to see loved ones, 21 percent; being unable to read, 20 percent and losing the ability to drive, 11 percent.
“When left undetected and untreated, many age-related eye diseases can damage your vision permanently,” said Mark Wilkinson, O.D., Chair of the AOA’s Vision Rehabilitation Section. “The good news is that most people can preserve their vision with proper treatment, so the key is early detection.”
Age-related vision disorders baby boomers and seniors should be aware of include:
– Age-related macular degeneration (AMD) – an eye disease that causes loss of central vision. Activities like reading, driving, watching TV and recognizing faces all require clear central vision.
– Diabetic retinopathy – a condition occurring in people with diabetes, which causes progressive damage to the retina, the light-sensitive lining at the back of the eye. If left untreated, it can cause blindness.
– Cataracts – a cloudy or opaque area in the clear lens of the eye. Usually cataracts develop in both eyes, but one may be worse than the other. Cataracts can cause a decrease in contrast sensitivity, a dulling of colors and increased sensitivity to glare.
– Glaucoma – a group of eye diseases characterized by damage to the optic nerve resulting in peripheral vision loss. People at higher risk of developing glaucoma include those with a family history of the disease, older adults, African-Americans and Hispanics.
– Dry eye – a condition where there is an insufficient amount of tearsor a poor quality of tears to lubricate and nourish the eye. Tears contribute to clear vision and the health of the front surface of the eye.
– Retinal detachment – tearing or separation of the retina from the underlying tissue. This can be caused by trauma to the eye or head, health problems due to advanced diabetes, and inflammatory disorders of the eye.
The good news is the majority of the American Eye-Q® survey respondents (92 percent) understand that visiting an eye doctor on a regular basis for comprehensive eye exams can help reduce the risk of developing age-related vision problems. The bad news is that respondents were less aware that avoiding smoking (40 percent) and eating a low-fat, low-salt diet (30 percent) can also reduce age-related vision problems.
“Some common warning signs of age-related vision problems include fluctuating vision, seeing floaters or flashes of light, loss of side vision and seeing distorted images,” said Dr. Wilkinson. “However, often patients with eye diseases do not have recognizable symptoms until the conditions are quite advanced, so regular comprehensive eye exams are essential for baby boomers and seniors.”
Addressing Age-Related Vision Problems
The American Eye-Q® survey also revealed that respondents age 55 and older are taking steps to address their age-related vision problems. Thirty three percent said they limit their night driving; 27 percent use brighter lights; 24 percent use wetting eye drops or artificial tears and 18 percent purchase or request items in large print.
Adding certain nutrients to one’s diet every day – either through foods or supplements – can help preserve vision and prevent age-related eye diseases.
The AOA recommends the following eye-healthy nutrients and foods:
– Lutein and zeaxanthin: Colorful fruits and vegetables such as broccoli, spinach, kale, corn, green beans, peas, oranges and tangerines
– Essential fatty acids: Fatty fish like tuna, salmon, or herring;
whole-grain foods; chicken and eggs
– Vitamin C: Fruits and vegetables, including oranges, grapefruit, strawberries, papaya, green peppers and tomatoes
– Vitamin E: Vegetable oils, such as safflower or corn oil; almonds and pecans; sweet potatoes and sunflower seeds
– Zinc: Extra-lean red meat, poultry, liver, shellfish, milk, baked beans and whole grains
Dealing with Vision Loss
Comprehensive eye exams are important for Americans of all ages, but become especially important later in life when more Americans develop age-related conditions and begin taking medications more frequently. The AOA recommends that adults over age 60 have a comprehensive eye examination by an optometrist once a year or more frequently if a doctor recommends it.
For patients with age-related vision loss, a specialized examination by an optometrist who treats vision impairment is a critical first step in the care process that focuses on maintaining and/or regaining independence and maximizing useful remaining vision. Prescribed treatment options commonly include specialized reading spectacles, spectacle-mounted telescopes, hand-held magnifiers and telescopes, therapeutic filters, specialized contact lenses, field enhancement treatments, and video magnification technology that both enlarge and enhance the contrast of reading materials.
There also are numerous other assistive products that can help with daily activities for people who have vision impairment, such as large-type books, magazines, and newspapers, books-on-tape, talking wristwatches, self-threading needles, and more. To learn more about vision rehabilitation and available treatment options, talk to an optometrist.
For additional information about aging eyes or to find a doctor of optometry in your area, please visit www.aoa.org.
About the survey:
The fourth annual American Eye-Q® survey was created and commissioned in conjunction with Penn, Schoen & Berland Associates (PSB). From May 21 – 24, 2009, using an online methodology, PSB interviewed 1,000 Americans 18 years and older who embodied a nationally representative sample of U.S. general population. (Margin of error at 95 percent confidence level.)
Source: American Optometric Association
Poll finds Americans very concerned about exposure to toxic chemicals
Voters want the EPA to be given more power to regulate chemicals
A poll conducted in August by Lake Research Partners found Americans very concerned with how chemicals are regulated for consumer use in the U.S. The findings come as overhaul of the 1976 Toxic Substances Control Act (TSCA) will be introduced soon in both Houses of Congress.
Voters are concerned that, under TSCA, chemicals in existence prior to 1976 were grandfathered in to be used and produced in the U.S. without testing or regulation. (87 percent were somewhat or very concerned). Eighty percent of voters were concerned that the EPA was unsuccessful in banning asbestos under current law. Eighty-four percent were concerned that the EPA has mandated testing of barely 200 out of the over 80,000 on the market since 1976.
“Voters across almost all demographic and political groups said that regulations on chemicals were not strong enough,” said pollster Celinda Lake. “People definitely are not confident about how chemicals are currently regulated, but they’re ready to give the EPA authority to protect consumers.”
Hundreds of recent scientific studies associate chemicals like bisphenol A (BPA) and phthalates, which are used in baby bottles, pacifiers, canned foods and toys, with a variety of chronic diseases, including diabetes, asthma, increased risk of certain types of cancer and infertility.
“The public is aware of a growing body of science linking common chemicals to chronic diseases and they’re waking up to the fact that the existing law isn’t working,” says Andy Igrejas, director of the Safer Chemicals, Healthy Families coalition. “Americans are doing their best to shop smart, but we can’t protect our families without help, and without strong reforms to put common sense limits on toxic chemicals.”
Majorities of Democrats, Independents and Republicans say they would support legislation that would take toxic chemicals off the market if they have been detected in babies at birth or in infants, and exposure to other known toxic chemicals, such as formaldehyde, that have been extensively studied, will be reduced to the maximum extent possible.
The poll was commissioned by the Safer Chemicals, Healthy Families coalition and has a margin of error of +/- 3.1 percent. The poll was conducted among 1,000 registered voters nationwide Aug. 25 to 31, 2009. More detailed poll results available at www.saferchemicals.org.
Source: Safer Chemicals, Healthy Families coalition
Nine leading research teams selected to study how digital games improve players health
Researchers seek to discover how interactive video games can be designed to improve physical activity, prevention behaviors and self-management of chronic conditions
The Robert Wood Johnson Foundation (RWJF) announced more than $1.85 million in grants for research that will offer unprecedented insight into how digital games can improve players’ health behaviors and outcomes. With funding from RWJF’s Health Games Research national program, nine research teams across the country will conduct extensive studies to discover, for example, how the popular dance pad video game Dance Dance Revolution might help Parkinson’s patients reduce the risk of falling, how Wii Active might be most effectively implemented in high schools to help overweight students lose weight, how a mobile phone game with a breath interface might help smokers quit or reduce their tobacco use, or how facial recognition games might be designed to help people with autism learn to identify others’ emotions.
Health Games Research is supported by an $8.25 million grant from RWJF’s Pioneer Portfolio, which funds innovative projects that may lead to breakthrough improvements in the future of health and health care. The national program, which conducts, supports, and disseminates research to improve the quality and impact of health games, is headquartered at the University of California, Santa Barbara. It is directed by Debra Lieberman, Ph.D., communication researcher in the university’s Institute for Social, Behavioral, and Economic Research and a leading expert in the research and design of interactive media for learning and health behavior change. The grants were awarded under the program’s second funding round to strengthen the evidence base in this emerging field.
“Digital games are interactive and experiential, and so they can engage people in powerful ways to enhance learning and health behavior change, especially when they are designed on the basis of well-researched strategies,” said Lieberman. “The studies funded by Health Games Research will provide cutting-edge, evidence-based strategies that designers will be able to use in the future to make their health games more effective.”
The nine research teams, chosen from among 185 proposals, each have been awarded between $100,000 and $300,000 to lead one- to two-year studies of digital games that engage players in physical activity and/or motivate them to improve how they take care of themselves through healthy changes in lifestyle; prevention behaviors; cognitive, social or physical skills; chronic disease self-management; and/or adherence to a medical treatment plan. Studies will focus on diverse population groups that vary by race and ethnicity, health status, income level, and game-play setting, with age groups ranging from elementary school children to 80-year-olds. The research teams will study participants’ responses to health games played on a variety of platforms, such as video game consoles, computers, mobile phones and robots.
“The pace of growth and innovation in digital games is incredible, and we see tremendous potential to design them to help people stay healthy or manage chronic conditions like diabetes or Parkinson’s disease. However, we need to know more about what works and what does not — and why,” said Paul Tarini, team director for RWJF’s Pioneer Portfolio. “Health Games Research is a major investment to build a research base for this dynamic young field. Further, the insights and ideas that flow from this work will help us continue to expand our imagination of what is possible in this arena.”
The nine grant recipients are:
Children’s Hospital of Philadelphia (Philadelphia, PA) Reward Circuitry, Autism and Games that Teach Social Perceptual Skills -- tests effects of facial perception games on the brain activity and facial perception skills of 8- to 12-year-old children who have been diagnosed with an autism spectrum disorder (ASD). Children with ASD tend to have difficulty perceiving and interpreting facial expressions and recognizing a person’s identity by observing their face. The games used in the study challenge them to notice subtle differences in faces and expressions and give them opportunities to rehearse these skills and receive feedback on their performance. Behavioral testing and use of functional Magnetic Resonance Imaging (fMRI) of players’ brains before and after playing the games for 50 hours over the course of eight weeks will help the researchers determine how the games influence facial perception skills and how the brain changes in response to these game experiences.
George Washington University (Washington, DC) Active-Adventure: Investigating a Novel Exergaming Genre in Inner City School Physical Education Programs – compares physical, psychological and behavioral effects of three activities: (1) playing Winds of Orbis, a video game that involves an upper and lower body workout as the player moves in order to control a character’s movements in the game; (2) playing Dance Dance Revolution, a popular video game that provides a lower body workout as players dance on a pad that detects their dance steps; and (3) engaging in traditional physical education activities at school. Study participants are inner-city African-American and Hispanic students from grades 1-8 who are randomly assigned to the three groups. The study examines various outcomes such as their enjoyment of the activities, attitudes toward physical activity, amount of exercise and number of calories burned.
Georgetown University (Washington, DC) Wii Active Exergame Intervention for Low-Income African-American Obese and Overweight Adolescents – assigns obese and overweight urban high school students to (1) play the Wii Active competitively after school with the goal of lowering their body mass index (BMI), (2) play the Wii Active cooperatively in a team after school with the goal of helping each other reduce their BMI, or (3) play with no access to Wii Active after school (control condition). The seven-month field experiment examines physiological, social and cognitive outcomes of participants in all three groups to determine whether those who play Wii Active are more physically active; lose more weight; develop greater self-esteem; have more friends; and have better memory, attention and other cognitive skills than those assigned to the control group. The study also examines whether competitive or cooperative game play influences these outcomes the most.
Long Island University (Brooklyn, NY) Dance Video Game Training and Falling in Parkinson’s Disease – compares the use of a commercially available dance pad video game, Dance Dance Revolution, to two traditional treatment options that help people with Parkinson’s Disease reduce their risk of falling by increasing their balance, strength, endurance, motor coordination and visual-motor integration. The two traditional treatments are rhythmic stepping and treadmill training with music. The researchers assess balance, motor function, reaction time and self-confidence to evaluate the game in comparison to the two traditional treatments. They also use functional Magnetic Resonance Imaging (fMRI) to observe participants’ brain activity.
Michigan State University (East Lansing, MI) Buddy Up! Harnessing Group Dynamics to Boost Motivation to Exercise. Research has found that people will work harder with a partner in a strenuous physical task than when working alone, especially if the partner is moderately better at the task. This study provides a virtual partner that engages in exercises with participants on the Eye Toy: Kinetic camera-based video game. College-age study participants are randomly assigned to engage in Eyetoy: Kinetic exercises either with a virtual partner or alone. Characteristics of the partner are varied to see which are most effective at improving endurance and exercise time.
Michigan State University (East Lansing, MI) Short-Term and Long-Term Effectiveness of Exergames for Young Adults – investigates effects of the Mount Olympus game, a 3D fantasy role-playing game that requires players to move their upper and lower body in order to control their character’s movements throughout the world of the game. Overweight and inactive college students participate in the study, which randomly assigns them either to play Mount Olympus or to use a motivational Web site designed to promote and support physical activity. The study examines the extent to which each media activity meets individuals’ needs for competence, autonomy and social relatedness, and how meeting these needs may motivate engagement in the activity. More engagement is expected to lead to more physical activity in daily life and therefore to more weight loss and better health outcomes.
Teachers College, Columbia University (New York, NY) Lit: A Game Intervention for Nicotine Smokers – develops and evaluates a smoking reduction game delivered on a mobile phone. The game is intended to be an alternative to smoking with the goal of reducing or eliminating tobacco use in players’ lives. The game involves breathing into a microphone to control gameplay and is coupled with sound, color, images, challenges and feedback to mimic the stimulant and relaxant effects of smoking. Effects will be evaluated through emotional response and physiological measures (electroencephalogram (EEG), heart rate, galvanic skin response) and compared to subjects after smoking or after playing the game in lieu of smoking. If successful, the game will emulate the effects of smoking as a replacement therapy for smokers who want to quit.
University of California, San Francisco (San Francisco, CA) A Video Game to Enhance Cognitive Health in Older Adults. As people age, they lose some of their ability to sustain their attention and to focus their attention on their main task while ignoring distractions. This study aims to improve these and other related cognitive skills by using a driving game in which players practice paying attention to relevant information, such as traffic signs, and ignoring irrelevant information, such as billboards. The study monitors brain activity with electroencephalogram (EEG) recordings and observes eye position and game performance in younger adults (ages 18 to 30) and older adults (ages 60 to 80) before and after six weeks of game play. The study assesses changes in cognitive ability, brain activity and transfer of game-related skills to similar cognitive operations and activities that take place in daily life.
University of Southern California (Los Angeles, CA) Robot Motivator: Towards Adaptive Health Games for Productive Long-Term Interaction – examines the influence of virtual social characters on people’s motivation to exercise. Study participants ages 60 and older are randomly assigned to exercise by following the lead of either (1) an embodied character, which is a human-looking robot that demonstrates exercises right there in the room with them or (2) an animated presentation of the same robot on a television screen. The study investigates the role of physical embodiment and social presence on participants’ motivation to engage and persist in exercise and physical activity.
Source: Robert Wood Johnson Foundation’s Health Games Research
World Trade Center responders plagued with asthma
Reported Asthma in 9/11 Responders 2X Greater Than General Population
Responders to the 2001 World Trade Center (WTC) terrorist attacks, who were exposed to caustic dust and toxic pollutants following the 9/11 disaster, suffer from asthma at a rate more than twice that of the general US population, according to new research presented at CHEST 2009, the 75th annual international scientific assembly of the American College of Chest Physicians (ACCP).
As many as 8 percent of the workers and volunteers who engaged in rescue and recovery, essential service restoration, and cleanup efforts in the wake of 9/11 reported experiencing post-9/11 asthma attacks or episodes, compared with 4 percent of the general population. Furthermore, the lifetime prevalence of asthma in WTC responders was marked by a dramatic increase from 3 percent pre-9/11 to a high of 16 percent in each of the years from 2005 through 2007.
“Although previous WTC studies have shown significant respiratory problems, this is the first study to directly quantify the magnitude of asthma among WTC responders compared with the general US population,” said Hyun Kim, ScD, Instructor of Preventive Medicine at Mount Sinai School of Medicine (MSSM), New York, NY, and lead author of the analysis which uses data obtained from the federally-funded World Trade Center Medical Monitoring and Treatment Program. “Six years out from 9/11, the World Trade Center Program was still observing responders affected by asthma episodes and attacks at more than double the percentage of people not exposed to World Trade Center dust.”
WTC Study Details
In the multi-center clinical study, researchers from the MSSM-coordinated WTC Program reported on health-related findings of 20,843 WTC responders who received an initial medical screening examination during the program’s first 5-1/2 years of existence, from July 2002 through December 2007. Asthma outcomes assessed were the following: (1) prevalence of asthma episodes/attacks reported by responders to have occurred during the previous 12 months, and (2) lifetime asthma prevalence, as measured by participants reporting having ever been told by a physician that they had asthma. Results were compared with the US National Health Survey Interviews (NHIS) adult sample data for the year 2000 (pre-9/11) and years 2002 through 2007.
WTC Study Results
In the general population, the prevalence of asthma episodes and/or attacks in the previous 12 months remained relatively constant at slightly less than 4 percent throughout the period from 2000 to 2007. In contrast, among WTC responders, while fewer than 1 percent recalled asthma episodes or attacks during the year 2000, that percentage increased to 8 percent, and then remained constant, through the period from 2005 to 2007. WTC responders were 2.3 times more likely to report asthma episodes/attacks that had occurred during the previous 12 months when compared with the general population of the United States. Additionally, the increase in lifetime prevalence of asthma among responders undergoing their initial program screening any time during the study period grew from a reported 3 percent for (pre-9/11) diagnoses to 13 percent in 2002. The lifetime prevalence of asthma subsequently rose through the years to plateau at 16 percent from 2005 through 2007.
“It is important to note that this report focused on findings from baseline or initial visit examinations,” said Philip J. Landrigan, MD, MSc, Ethel H. Wise Professor and Chair of MSSM’s Department of Preventive Medicine, and principal investigator of the WTC Program Data and Coordination Center. “Where the data shows an increasing percentage of responders reporting asthmatic episodes, rising to double that seen in the general population, it is clearly vital that we continue to track responders’ health and look further into the medical outcomes of this population.”
Of the study’s rescue and recovery workers, 86 percent were men; 59 percent were Caucasian; and the average duration of work at WTC sites was 80 days. The study followed uniformed and other law enforcement and protective service workers (42 percent), as well as construction workers and other responders who had engaged in paid and volunteer WTC-related rescue and recovery, essential service restoration, and/or debris removal and cleanup efforts.
“Asthma and other chronic lung conditions remain a significant burden for rescue and recovery workers responding to the attacks on the World Trade Center,” said Kalpalatha Guntupalli, MD, FCCP, President of the American College of Chest Physicians. “The significant chronic health problems associated with the World Trade Center attacks only reinforces the need for stronger disaster preparedness plans, as well as long-term medical follow-up for 9/11 responders and individuals who respond to disaster-related events.”
Source: American College of Chest Physicians
National survey findings: Americans are concerned about heart health, but not proactive enough to prevent it
Trends in Reducing Heart Disease Risk Are Headed in Wrong Direction
Recent research indicates that despite decades of progress, fewer Americans are now considered “low risk” for heart disease compared to years past. Adding fuel to the fire, a new study is making headlines with the alarming statistic that 7 in 10 obese teens already have at least one risk factor for heart disease. To help educate families about prevention, the Preventive Cardiovascular Nurses Association (PCNA) has released findings from a new national consumer survey and launched a campaign to educate families about heart disease, the leading cause of death in the U.S.
The national survey revealed that more than three in five (61%) Americans incorrectly believe that the processes related to heart disease do not begin until adulthood. Alarmingly, fewer than four in ten (38%) correctly surmise that people should be concerned about living a heart-healthy lifestyle beginning in childhood and continuing throughout every life stage.
Research on reducing heart disease risk clearly shows that a more comprehensive approach to being heart-healthy is key. According to a study published in the journal Circulation in September, despite the success of past heart disease awareness and education campaigns, the recent trend toward reducing cardiovascular risk is now going in reverse. The vast majority (92%) of Americans are still at risk, primarily because of the rise in obesity.
“This is a wake up call for parents and their children in particular,” says Laura Hayman, Ph.D., RN, a member of the PCNA Board of Directors and a leading researcher on obesity and cardiovascular disease in children, adolescents, and families. “Some strides have been made; however, since more and more children are currently overweight, they are more likely at risk for obesity-related conditions later in life such as hypertension and type 2 diabetes.”
Statistics from a newly released Canadian study echo Dr. Hayman’s concerns about the link between the ever-present obesity epidemic and heart disease risk — particularly among teens. The findings, presented in October at the Canadian Cardiovascular Congress, showed that among a sample of 14 and 15 year old students, rates of high blood pressure, high cholesterol, and obesity were unusually high and increasing over time.
Research has found that when children learn about heart-healthy eating habits, it can strongly influence their behavior to reduce heart disease risk later in life. Yet, according to the PCNA survey, less than one-third of Americans follow a diet that is healthy for their heart. Also, seven in ten (70%) would not want their kids to adopt their eating habits because they do not think they set a good example when it comes to food choices (26%) or some of the time they eat food that is not healthy (44%).
“We are at a critical juncture,” explains Hayman. “It is imperative for parents to lead by example with an all encompassing heart-healthy lifestyle, making the necessary changes both in diet and physical activity.”
Since the PCNA survey found that the majority of Americans are at risk of heart disease due to some lifestyle factor, such as being overweight or having high cholesterol, small incremental changes in diet and physical activity can have a lasting healthy effect. To help parents learn how to make important lifestyle changes and become better role models for their children, to help reduce their risk of heart disease in the future, PCNA has launched a national education campaign called “Family at Heart.”
www.FamilyatHeart.org
Source: Preventive Cardiovascular Nurses Association