Culture

Deaths from cirrhosis rose in all but one state between 1999-2016, with increases seen most often among young adults, a new study shows.

The deaths linked to the end stages of liver damage jumped by 65 percent with alcohol a major cause, adults age 25-34 the biggest victims and fatalities highest among whites, American Indians and Hispanics.

Liver specialist Elliot B. Tapper, M.D., says he's witnessed the disturbing shift in demographics among the patients with liver failure he treats at Michigan Medicine. National data collected by Tapper and study co-author Neehar Parikh, M.D., M.S., confirms that in communities across the country more young people are drinking themselves to death.

The data published in the journal BMJ shows adults age 25-34 experienced the highest average annual increase in cirrhosis deaths -- about 10.5 percent each year. The rise was driven entirely by alcohol-related liver disease, the authors say.

"Each alcohol-related death means decades of lost life, broken families and lost economic productivity," says Tapper, a member of the University of Michigan Division of Gastroenterology and Hepatology and health services researcher at the U-M Institute for Healthcare Policy and Innovation.

"In addition, medical care of those dying from cirrhosis costs billions of dollars."

The rise in liver deaths is not where liver specialists expected to be after gains in fighting hepatitis C, a major liver threat seen often in Baby Boomers. Antiviral medications have set the course to one day eradicate hepatitis C.

Cirrhosis can be caused by a virus like hepatitis C, fatty liver disease or alcohol abuse. The increase in liver deaths highlights new challenges in preventing cirrhosis deaths beyond hepatitis.

"We thought we would see improvements, but these data make it clear: even after hepatitis C, we will still have our work cut out for us," says Tapper.

That mortality due to cirrhosis began increasing in 2009 - around the time of the Great Recession when the economic downturn led to loss of people's savings, homes and jobs - may offer a clue as to its cause.

"We suspect that there is a connection between increased alcohol use and unemployment associated with the global financial crisis. But more research is needed," Tapper says.

Cirrhosis caused a total of 460,760 deaths during the seven-year study period; about one-third were attributed to hepatocellular carcinoma, a common type of liver cancer that is often caused by cirrhosis, researchers found.

In 2016 alone, 11,073 lives were lost to liver cancer which was doubled the number of deaths in 1999.

Researchers studied the trends in liver deaths due to cirrhosis by examining death certificates compiled by the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research project.

"The rapid rise in liver deaths underscores gaps in care and opportunities for prevention," says Parikh, study co-author and liver specialist at Michigan Medicine.

The study's goal was to determine trends in liver disease deaths and which groups have been impacted most across the country. The research showed:

Fewer Asians and Pacific Islanders died of liver cancer.

It is hitting many places especially hard, namely Kentucky, Alabama, Arkansas and New Mexico, where cirrhosis deaths were highest.

A state-by-state analysis showed cirrhosis mortality is improving only in Maryland.

Deaths due to alcohol-related liver disease are entirely preventable, say authors who suggest strategies such as taxes on alcohol, minimum prices for alcohol and reducing marketing and advertising to curb problem drinking. Higher alcohol costs have been linked with decreased alcohol-related deaths.

(Boston)--The desire for unblemished, clear skin permeates all cultures and societies, making the practice of skin lightening to minimize spots and even a skin tone quite common worldwide. Internationally, the use of creams to lighten skin is widespread and widely studied. In the U.S. however, information about use of these creams is sparse.

In what is believed to be the first study of its kind, researchers from Boston University School of Medicine (BUSM) studied the types of people who use these creams, why they use them and how well the creams work. Such information they believe could help doctors advise their patients about which creams are the safest and most effective.

In order to understand characteristics associated with the use of lightening products, researchers surveyed 406 adults with cutaneous hyperpigmentation who had been seen in a U.S.-based dermatology clinic from February 2015 through July 2016. Information was collected about patients' demographics, use of over-the-counter (OTC) or prescription lightening products, their components and perceived benefit. Patients also saw a board-certified dermatologist, for assessment of diagnosis, skin type and disease severity.

Of the more than 400 participates in the study, over 70 percent were born outside the U.S. The most common conditions leading to lightening cream use were melasma (brown to gray-brown patches) and post-inflammatory hyperpigmentation (PIH). Less than half reported subjective improvement in their skin tone and results were even worse for those using OTC creams: only 26.5 percent were satisfied with their results. Among those that did report improvement, the most effective agent was prescription-strength triple-combination cream.

The majority (57.5 percent) of these creams were purchased from U.S. pharmacies, but a significant minority were obtained abroad, from community stores or from friends. According to the researchers these unauthorized creams may contain harmful compounds such as mercury, and they emphasize that not all OTC creams are safe to use without supervision.

"This primarily descriptive study highlights important aspects in those who use lightening products," explained corresponding author Neelam Vashi, MD, assistant professor of dermatology at Boston University School of Medicine and director of the Boston University Cosmetic and Laser Center at Boston Medical Center. "More than half of our responders were not satisfied with their OTC creams, reporting that it did not improve their hyperpigmentation."

Approximately half of the sample population, all of which had cosmetically bothersome hyperpigmentation, had tried OTC lightening agents, with the vast majority consulting a clinician during the course of their treatment. "This indicates a very large group of patients that dermatologists have the ability to educate and counsel, advising on proper application and side effects from inappropriate use of lightening agents."

Alternative schooling programs could deliver greater learning outcomes for young people who are struggling at school, according to University of South Australia researcher, Dr Thomas Stehlik.

In a paper presented at the Education and New Developments 2018 Conference in Budapest in June, Dr Stehlik says that the growing not-school movement is challenging the confines of traditional schooling because the one-size-fits-all solution for modern education is not working.

"Compulsory schooling is considered a basic responsibility of civil society, yet for many young people, school is a narrow experience that can restrict their potential," Dr Stehlik says.

"We need to start looking at education from the perspective of the student.

"The not-school movement is all about encouraging different educational initiatives and practices that 'think outside the box' to provide young people with positive education experiences that they enjoy."

Including all educational programs that occur outside of the school environment, the not-school movement covers activities from art-based initiatives to home schooling. Often unstructured and informal, not-school learning can be delivered by adult educators, youth workers, community developers and parents.

Echoing the findings of Australia's 2018 Gonski Report, Dr Stehlik says that today's mass approach to education is outdated and despite long-term calls for change, little change has occurred.

"Young people have different individual learning needs and talents, but when we try and fit everyone under the same standard schooling model, it doesn't work," Dr Stehlik says.

"Different educational experiences can provide options for those who do not respond well in traditional school environments, including alternative career and post-school pathways; as well as contributing to an improved sense of identity and wellbeing.

"Just think of the gap year. One in four young Australians take a gap year post-secondary schooling; it's essentially formal time out of study, yet is looked upon positively as a means to gaining real world experience."

Dr Stehlik says that Australia needs to think more broadly about how we deliver education, particularly given the growing demand for innovation and creativity and other '21st Century skills' that by definition require unconventional teaching approaches.

"Given the increased use of flexible and online learning methodologies, it is surprising that more alternatives to face-to-face classroom teaching are not being considered," Dr Stehlik says.

"Innovation is considered critical for the sustained success business, but this starts with education. If we're not being inclusive of those young people who do not fit the convention, we could be overlooking a whole sector of creative and alternative thinkers.

"We know that one educational size does not fit all. It's time to ask ourselves 'What else can we do?'"

The paper is based on a chapter of Dr Stehlik's new book, Educational Philosophy for 21st Century Teachers, published by Palgrave Macmillan, which provides an in-depth analysis and review of alternative education options and questions our current approach to schooling and the traditions upon which it is based.

FINDINGS

In a small study of military personnel who had suffered head trauma and had reported memory and mood problems, UCLA researchers found brain changes similar to those seen in retired football players with suspected chronic traumatic encephalopathy, a degenerative brain disease linked to repeated blows to the head.

BACKGROUND

Chronic traumatic encephalopathy, or CTE, occurs in people who have had multiple head injuries. Recent studies and headlines have focused on former football players who exhibited symptoms such as depression, confusion and mood swings. In later stages, CTE can lead to symptoms of Alzheimer's disease and other forms of dementia. Currently, CTE can only be diagnosed after death, when examination of brain tissue reveals clumps of a protein called tau, which kills brain cells.

To aid in diagnosing CTE in living individuals, UCLA researchers are studying a molecular tracer, called FDDNP, which binds with tau as well as another abnormal protein called amyloid. The tracer, given intravenously, shows up in brain scans, pointing to the location and extent of abnormal proteins in the brain.

Previously, UCLA researchers used the tracer to study the brains of 15 former NFL players with memory and mood problems. In that study, the pattern of abnormal protein distribution in living patients was consistent with the tau distribution seen in autopsy-confirmed CTE cases.

METHOD

For the current study, which builds upon the earlier research, seven military personnel (five veterans and two in active duty) who had suffered mild traumatic brain injuries and had memory or mood complaints underwent neuropsychiatric evaluations. They had brain scans after being injected with FDDNP, the molecular tracer. The results were compared to those of the 15 previously studied football players, as well as 24 people with Alzheimer's dementia and 28 people without cognitive problems, for comparison.

IMPACT

The location and quantity of the tracer in the brains of the military personnel were similar to that seen in retired football players and distinct from the distribution patterns seen in people with Alzheimer's disease or in healthy individuals.

Larger studies using FDDNP and brain scans in people at risk for chronic traumatic encephalopathy are needed to confirm the usefulness of FDDNP as a diagnostic tool. The ability to diagnose chronic traumatic encephalopathy in living individuals would help scientists observe the progression of the disease, develop treatments and quantify the scope of CTE among different populations, such as military veterans.

AUTHORS

Dr. Gary Small, a professor of psychiatry and biobehavioral sciences at UCLA and director of the Longevity Center at UCLA's Semel Institute for Neuroscience and Human Behavior, is the study's senior author. Co-first authors are Drs. Stephen Chen and Prabha Siddarth, both of UCLA. Other authors are Jorge Barrio, Natacha Emerson, Chris Giza, Sung-Cheng Huang, Jie Liu, Jacqueline Martinez, David Merrill, Nagichettiar Satyamurthy and Koon-Pong Wong, all of UCLA; Robert Fitzsimmons of Fitzsimmons Law Offices in Wheeling, West Virginia; Julian Bailes of the University of Chicago's Pritzker School of Medicine; and Bennet Omalu of UC Davis.

JOURNAL

The study appears in the July 17 Journal of Alzheimer's Disease.

Research by King's College London has found that local authorities across England have failed to prioritise palliative and end of life care, despite the health care challenges posed by a rapidly ageing population.

The research, published today in the journal Palliative Medicine, is based on an analysis of the Health and Wellbeing Strategies of 150 local authorities across England, which found that only 4 per cent cited end of life care as a priority.

Palliative care is defined as the active total care of patients whose disease is not responsive to curative treatment, with the control of pain, of other symptoms, and of psychological, social and spiritual problems paramount.

The goal of palliative care is to achieve the best possible quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness.

As the population ages, the need for effective palliative care strategies that are fit for purpose has never been greater - research suggests that the demand for palliative care will increase by 42%* by 2040.

To understand how England's 152 local authorities - whose regional Health and Wellbeing Boards are responsible for improving health and care - prioritise end of life care, researchers systematically analysed their Health and Wellbeing Strategies published from 2012 onwards. In two areas neighbouring Health and Wellbeing Boards developed a joint strategy, making the total number of strategies analysed 150.

Specific measures linked to end of life care were assessed, including; the level of prioritisation of end of life care; whether end of life care was referenced within a specific clinical context - such as in relation to cancer or dementia; whether a target for improvement was identified; and whether a specific intervention for improving end of life care was present.

Researchers found that of the 150 strategies identified, end of life care was mentioned in just over half 78 (52 per cent) and prioritised in only six (4 per cent).

In 43 of the 78 strategies, end of life care was mentioned in connection with specific medical conditions, with ageing and dementia the most cited.

The King's team also found that there was a sparse use of evidence in relation to end of life care, particularly with respect to the effectiveness of interventions. With budgets for specialist palliative care services ranging from £51.83 to £2,329 per patient per annum across England, being able to provide robust evidence about the effectiveness of treatments could have a bearing both on provision and budgets.

Lead author Dr Katherine Sleeman, from King's College London's Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation said: 'This is the first study to systematically analyse content relating to end of life care within local health care strategies and provides a comprehensive national picture of priorities and plans.

"What we found is that while half of Health and Wellbeing Strategies mention end of life care, few prioritise it, and none cite evidence for effective interventions This is concerning, especially as end of life care has been highlighted as a priority for policy makers nationally and internationally.

'This research highlights the large variations in the prioritisation of palliative and end of life care across England and underscores the need for greater scrutiny of local health and care strategies to avoid the unintended creation of a palliative care post code lottery.'

Antarctica is not as isolated from the rest of the world as scientists have thought, new research reveals, with potential for drifting plastics to create problems in the continent in future and new species to colonise there as the climate warms.

The research reported today in Nature Climate Change by an international, multidisciplinary team of scientists including Professor Jon Waters from the University of Otago's Zoology Department and led by former PhD student Dr Ceridwen Fraser, shows kelp had drifted 20,000km to reach the Antarctica - making it the longest known biological rafting event ever recorded.

To get there, the kelp - which drifted all the way from the Kerguelen Islands in the Southern Indian Ocean - had to pass through barriers created by polar winds and currents that were, until now, thought to be impenetrable.

DNA samples taken from the kelp revealed it had drifted from the Kerguelen Islands and another specimen from South Georgia. This meant the routes they took to reach Antarctica must have been tens of thousands of kilometres long.

"This study shows that Antarctica is not as biologically isolated as previously thought - by demonstrating that rafting biological material can cross Southern Ocean barriers to reach the shores of Antarctica," Professor Waters explains.

The research changes the way scientists think about Southern Ocean oceanography, where storms can play a big role moving drifting material. The findings have important implications for the science of ocean drift that is used to track plastics, aeroplane crash debris and other floating material across our seas.

"The results suggest that Antarctica won't be immune from drifting plastics that are increasingly a problem in the world's marine ecosystems," Professor Waters says.

"It also highlights the potential for new species to colonise Antarctica as the climate warms."

Lead author Dr Fraser, a former University of Otago PhD student now based at the Australian National University, says the finding shows living plants and animals can reach Antarctica across the ocean, with temperate and sub-Antarctic marine species probably bombarding Antarctic coastlines all the time.

"We always thought Antarctic plants and animals were distinct because they were isolated, but this research suggests these differences are almost entirely due to environmental extremes, not isolation," Dr Fraser says.

The new research also shows Antarctica's ecosystems could be more vulnerable to global warming than previously suspected, she says.

"Parts of Antarctica are among the fastest warming places on Earth. If plants and animals get to Antarctica fairly frequently by floating across the ocean, they will be able to establish themselves as soon as the local environment becomes hospitable enough."

The study builds on a previous Marsden-funded project led by Professor Waters together with Dr Fraser. The basic knowledge generated by the original Marsden study made this new study possible.

Researchers have conducted one of the largest surveys of people's first memories, finding that nearly 40 per cent of people had a first memory which is fictional.

Current research indicates that people's earliest memories date from around three to three-and-a-half years of age. However, the study from researchers at City, University of London, the University of Bradford and Nottingham Trent University found that 38.6 per cent of a survey of 6,641 people claimed to have memories from two or younger, with 893 people claiming memories from one or younger. This was particularly prevalent among middle-aged and older adults.

To investigate people's first memories the researchers asked participants to detail their first memory along with their age at the time. In particular, participants were told that the memory itself had to be one that they were certain they remembered. It should not be based on, for example a family photograph, family story, or any source other than direct experience.

From these descriptions the researchers then examined the content, language, nature and descriptive detail of respondents' earliest memory descriptions, and from these evaluated the likely reasons why people claim memories from an age that research indicates they cannot be formed.

As many of these memories dated before the age of two and younger, the authors suggest that these fictional memories are based on remembered fragments of early experience - such as a pram, family relationships and feeling sad - and some facts or knowledge about their own infancy or childhood which may have been derived from photographs or family conversations.

As a result, what a rememberer has in mind when recalling these early memories is a mental representation consisting of remembered fragments of early experience and some facts or knowledge about their own childhood, instead of actual memories.

Over time, such mental representations come to be recollectively experienced when they come to mind and so for the individual they quite simply are 'memories' with content strongly tied to a particular time. In particular, fictional very early memories were seen to be more common in middle-aged and older adults and about 4 in 10 of this group have fictional memories for infancy. The study is published in the journal Psychological Science.

Dr Shazia Akhtar, first author and Senior Research Associate at the University of Bradford said:

"We suggest that what a rememberer has in mind when recalling fictional improbably early memories is an episodic-memory-like mental representation consisting of remembered fragments of early experience and some facts or knowledge about their own infancy/childhood.

"Additionally, further details may be non-consciously inferred or added, e.g. that one was wearing nappy when standing in the cot. Such episodic-memory-like mental representations come, over time, to be recollectively experienced when they come to mind and so for the individual they quite simply are 'memories' which particularly point to infancy."

Professor Martin Conway, Director Centre for Memory and Law at City, University of London and co-author of the paper, said:

"In our study we asked people to recall the very first memory that they actually remembered, asking them to be sure that it wasn't related to a family story or photograph. When we looked through the responses from participants we found that a lot of these first 'memories' were frequently related to infancy, and a typical example would be a memory based around a pram.

"For this person, this type of memory could have resulted from someone saying something like 'mother had a large green pram'. The person then imagines what it would have looked like. Over time these fragments then becomes a memory and often the person will start to add things in such as a string of toys along the top.

"Crucially, the person remembering them doesn't know this is fictional. In fact when people are told that their memories are false they often don't believe it. This partly due to the fact that the systems that allow us to remember things are very complex, and it's not until we're five or six that we form adult-like memories due to the way that the brain develops and due to our maturing understanding of the world."

SEATTLE (July 17, 2018) -- A large prospective study has found that sexual and physical abuse in childhood and adolescence is associated with a greater risk of endometriosis diagnosed during adulthood. The study found that women reporting severe-chronic abuse of multiple types had a 79 percent increased risk of laparoscopically-confirmed endometriosis.

"Both physical and sexual abuse were associated with endometriosis risk, with abuse severity, chronicity, and accumulation of types of abuse each associated with increasing risk in a dose-response manner," said Dr. Holly R. Harris, assistant member of Epidemiology in Fred Hutch's Public Health Sciences Division. She is lead author of an embargoed article scheduled to appear July 17 in the journal, Human Reproduction.

Abuse has been associated with chronic pelvic pain, uterine fibroids, and hypertension in previous studies, but this report - which used data collected from 60,595 women within the Nurses' Health Study II from 1989 to 2013 - is the first to show an association between childhood abuse and laparoscopically-confirmed endometriosis. Study highlights include:

More than 3,000 cases of laparoscopically-confirmed endometriosis were diagnosed during 24 years of follow-up.

21 percent of all women reported having experienced some level of both child/adolescent physical and sexual abuse.

32 percent reported child/adolescent physical abuse only.

12 percent reported child/adolescent sexual abuse only.

Compared to those reporting no physical or sexual abuse, the risk of endometriosis was greater among those who experienced severe physical abuse or severe sexual abuse.

There was a 79 percent higher risk of laparoscopically-confirmed endometriosis for women reporting severe-chronic abuse of multiple types.

There was a stronger association between early life abuse and pain-associated endometriosis (versus endometriosis diagnosed in the absence of pain).

"A growing body of literature suggests that early traumatic experiences affect production of stress hormones and inflammatory responses, and these contribute to chronic pelvic pain and other pain syndromes. Our findings suggest that similar mechanisms may be involved in the association between early abuse and endometriosis diagnosed during adulthood. We need an increased focus on the potential underlying biological mechanisms to fully understand these relationships," Harris said. "This study adds to the growing evidence that abuse during childhood/adolescence is not rare and can have multiple consequences for lifelong health and wellbeing."

The study population was primarily white female nurses between the ages of 25 to 42 at baseline who were participants in the Nurses' Health Study II, which began in 1989 with 116,429 women. Participants receive follow-up questionnaires every two years.

July 17, 2018 - Professional baseball players who score higher on a test of hand-eye coordination have better batting performance - particularly in drawing walks and other measures of "plate discipline," reports a study in the July issue of Optometry and Vision Science, the official journal of the American Academy of Optometry. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Batters with better eye-hand visual motor reaction time [EH-VMRT] appear to be more discerning in deciding to swing at pitches as compared [to those with] poorer visual-motor reaction time," according to the study, led by Daniel M. Laby, MD, of the Sports and Performance Vision Center, State University of New York College of Optometry.

The results suggest that measuring hand-eye coordination might be helpful in player selection, and raise the possibility that EH-VMRT training might lead to improved batting performance. Dr. Laby's coauthors were David G. Kirschen, OD, PhD, of Southern California College of Optometry, Fullerton; Usha Govindarajulu, PhD, of SUNY College of Optometry; and Paul DeLand, PhD, of California State University, Fullerton.

Players with Faster Hand-Eye Coordination May Be More Selective at Bat

Using a portable testing system, the researchers measured EH-VMRT in 450 professional baseball players during three Major League Baseball spring training seasons. The participants played for six MLB teams and their affiliated minor league teams; 105 were classified as major-league players and 435 as minor-leaguers.

The relationship between EH-VMRT and statistical measures of batting performance was analyzed. The study focused on measures of "plate discipline" - for example, how often the players drew walks (bases on balls) or swung at pitchers in the strike zone. In contrast to traditional statistics like batting average, these measures are more dependent on the batter's own ability, with little if any influence by the abilities of the defensive players.

One of three test EH-VMRT modes, called the Proactive score, was chosen as the best single descriptor of hand-eye coordination. The players' average Proactive score was 9.28 seconds, with a range from about 5.80 to 15.75 seconds.

The Proactive score was significantly correlated with measures of plate discipline. For players in the top versus bottom one-fifth (quintile) of Proactive scores, there was a 22 percent difference in the walk rate. Players with the fastest hand-eye coordination drew a walk every 10.1 times at bat (on average), compared to every 13.1 times for those with the slowest hand-eye coordination.

Players in the top quintile also swung at better pitches: they were six to seven percent more likely to swing at pitches in the strike zone and to swing at fastballs (rather than curveballs or other "off-speed" pitches) in the strike zone. "One could hypothesize that faster EH-VMRT allows the batter an opportunity to be selective in which pitches he ultimately decides to swing at," Dr. Laby and coauthors write. "These timing differences may result in higher rates of swinging at pitches and a lower likelihood to gain a base on balls."

Faster EH-VRMT values were also associated with more years playing in the major leagues. Further analysis suggested that the differences in plate discipline were related to hand-eye coordination, rather than major league experience.

While there was a large difference between the fastest and slowest EH-VRMT groups, there was comparatively little difference within the middle quintiles. For players, moving from this middle group into the top quintile would make little difference in terms of plate discipline, but moving out of the bottom quintile could have a major impact. A few studies have addressed the ability to improve EH-VRMT by training - however, more research is needed to see if hand-eye coordination training can have a lasting effect on batting ability.

The researchers note that the statistical correlations between EH-VRMT and batting performance are low - likely reflecting the many other factors contributing to batting success. Yet they point out "the very large and statistically significant difference" between the top and bottom EH-VRMT groups and their plate discipline abilities. Dr. Laby and colleagues conclude: "These findings may be important in player selection as well as identification of players who may possibly benefit from an intervention to improve eye-hand visual-motor reaction time."

Click here to read "The Hand-eye Coordination of Professional Baseball Players: The Relationship to Batting"

DOI: 10.1097/OPX.0000000000001239

New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

Omega 3 is a type of fat. Small amounts of omega 3 fats are essential for good health, and they can be found in the food that we eat. The main types of omega 3 fatty acids are; alpha­linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is normally found in fats from plant foods, such as nuts and seeds (walnuts and rapeseed are rich sources). EPA and DHA, collectively called long chain omega 3 fats, are naturally found in fatty fish, such as salmon and fish oils including cod liver oil.

Increased consumption of omega 3 fats is widely promoted globally because of a common belief that that it will protect against heart disease. There is more than one possible mechanism for how they might help prevent heart disease, including reducing blood pressure or reducing cholesterol. Omega 3 fats are readily available as over-the-counter supplements and they are widely bought and used.

A new Cochrane systematic review, published today in the Cochrane Library, combines the results of seventy-nine randomised trials involving 112,059 people. These studies assessed effects of consuming additional omega 3 fat, compared to usual or lower omega 3, on diseases of the heart and circulation. Twenty-five studies were assessed as highly trustworthy because they were well designed and conducted.

The studies recruited men and women, some healthy and others with existing illnesses from North America, Europe, Australia and Asia. Participants were randomly assigned to increase their omega 3 fats or to maintain their usual intake of fat for at least a year. Most studies investigated the impact of giving a long-chain omega 3 supplement in a capsule form and compared it to a dummy pill. Only a few assessed whole fish intake. Most ALA trials added omega 3 fats to foods such as margarine and gave these enriched foods, or naturally ALA-rich foods such as walnuts, to people in the intervention groups, and usual (non-enriched) foods to other participants.

The Cochrane researchers found that increasing long-chain omega 3 provides little if any benefit on most outcomes that they looked at. They found high certainty evidence that long-chain omega 3 fats had little or no meaningful effect on the risk of death from any cause. The risk of death from any cause was 8.8% in people who had increased their intake of omega 3 fats, compared with 9% in people in the control groups.

They also found that taking more long-chain omega 3 fats (including EPA and DHA), primarily through supplements probably makes little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities. Long-chain omega 3 fats probably did reduce some blood fats, triglycerides and HDL cholesterol. Reducing triglycerides is likely to be protective of heart diseases, but reducing HDL has the opposite effect. The researchers collected information on harms from the studies, but information on bleeding and blood clots was very limited.

The systematic review suggests that eating more ALA through food or supplements probably has little or no effect on cardiovascular deaths or deaths from any cause. However, eating more ALA probably reduces the risk of heart irregularities from 3.3 to 2.6%. The review team found that reductions in cardiovascular events with ALA were so small that about 1000 people would need to increase consumption of ALA for one of them to benefit. Similar results were found for cardiovascular death. They did not find enough data from the studies to be able to measure the risk of bleeding or blood clots from using ALA.

Increasing long-chain omega 3 or ALA probably does not affect body weight or fatness.

Cochrane lead author, Dr. Lee Hooper from the University of East Anglia, UK said: "We can be confident in the findings of this review which go against the popular belief that long-chain omega 3 supplements protect the heart. This large systematic review included information from many thousands of people over long periods. Despite all this information, we don't see protective effects.

"The review provides good evidence that taking long-chain omega 3 (fish oil, EPA or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause. The most trustworthy studies consistently showed little or no effect of long-chain omega 3 fats on cardiovascular health. On the other hand, while oily fish is a healthy food, it is unclear from the small number of trials whether eating more oily fish is protective of our hearts.

"This systematic review did find moderate evidence that ALA, found in plant oils (such as rapeseed or canola oil) and nuts (particularly walnuts) may be slightly protective of some diseases of the heart and circulation. However, the effect is very small, 143 people would need to increase their ALA intake to prevent one person developing arrhythmia. One thousand people would need to increase their ALA intake to prevent one person dying of coronary heart disease or experiencing a cardiovascular event. ALA is an essential fatty acid, an important part of a balanced diet, and increasing intakes may be slightly beneficial for prevention or treatment of cardiovascular disease."

A simple instruction to change your thinking as mealtime approaches can help cut calories, according to new research from the University of Tübingen, Germany. By encouraging study participants to concentrate on different types of information when planning their meal, the experimenters saw portion sizes shift. Adopting a health-focused mindset produced better outcomes than focusing on pleasure or the desire to fill up. These new findings were presented this week at the annual meeting of the Society for the Study of Ingestive Behavior, an international conference of experts on eating research.

"Daily food intake is highly dependent on the portion sizes we select," explained Stephanie Kullmann, lead investigator on the project. "The rise in obesity since the 1950s has directly paralleled increasing portion sizes. We are finding that switching an individual's mindset during pre-meal planning has the potential to improve portion control."

In recent experiment, the researchers learned that lean individuals can be encouraged to make healthier food choices by adopting a 'health-focused mindset'. Brain scans showed how this approach can trigger activity in the prefrontal cortex, which is linked to self-control and future meal planning. Their latest study demonstrates how a shift in mindset might assist individuals who are overweight or obese.

Study participants ranged from normal weight to obese. They were told to focus their mindset on either the health effects of food, expected pleasure, or their intention to stay full until dinner time, while choosing their portion size for lunch. Additionally, in a control condition they chose their actual portion size for lunch without any mindset instruction. Compared to the control condition (no mindset instruction), participants in all weight categories selected smaller portions when prompted to think about health. By contrast, those who adopted the fullness mindset took larger portions. In pleasure mindset condition, obese participants selected larger portions than normal-weight participants. This tendency correlated with a heightened response in a taste-processing region of the brain. In the fullness mindset, obese persons showed blunted brain responses in regions for reward and physiological regulation.

"This influence of pre-meal mindset on food choices may contribute to the vicious cycle we observe in obesity," said Kullmann. "Focusing on food for pleasure leads to bigger servings and increased brain responses to food reward, whilst the sensation of fullness is perceived as less satisfying."

The encouraging message from this study is people of all weights responded positively to a healthy mindset instruction, suggesting that this approach should be considered in strategies for healthy weight management. The findings also suggest that advertising healthy food options as "tasty" might be counterproductive because this has the potential to induce a pleasure mindset, which leads to the selection of larger serving sizes in individuals who are struggling with their weight.

Anyone lost in a desert hallucinating mirages knows that extreme dehydration discombobulates the mind. But just two hours of vigorous yard work in the summer sun without drinking fluids could be enough to blunt concentration, according to a new study.

Cognitive functions often wilt as water departs the body, researchers at the Georgia Institute of Technology reported after statistically analyzing data from multiple peer-reviewed research papers on dehydration and cognitive ability. The data pointed to functions like attention, coordination and complex problem solving suffering the most, and activities like reacting quickly when prompted not diminishing much.

"The simplest reaction time tasks were least impacted, even as dehydration got worse, but tasks that require attention were quite impacted," said Mindy Millard-Stafford, a professor in Georgia Tech's School of Biological Sciences.

Less fluid, more goofs

As the bodies of test subjects in various studies lost water, the majority of participants increasingly made errors during attention-related tasks that were mostly repetitive and unexciting, such as punching a button in varying patterns for quite a few minutes. There are situations in life that challenge attentiveness in a similar manner, and when it lapses, snafus can happen.

"Maintaining focus in a long meeting, driving a car, a monotonous job in a hot factory that requires you to stay alert are some of them," said Millard-Stafford, the study's principal investigator. "Higher-order functions like doing math or applying logic also dropped off."

The researchers have been concerned that dehydration could raise the risk of an accident, particularly in scenarios that combine heavy sweating and dangerous machinery or military hardware.

Millard-Stafford and first author Matthew Wittbrodt, a former graduate research assistant at Georgia Tech and now a postdoctoral researcher at Emory University, published their meta-analysis of the studies in the latest edition of the journal Medicine & Science in Sports & Exercise.

It can happen quickly

There's no hard and fast rule about when exactly such lapses can pop up, but the researchers examined studies with 1 to 6 percent loss of body mass due to dehydration and found more severe impairments started at 2 percent. That level has been a significant benchmark in related studies.

"There's already a lot of quantitative documentation that if you lose 2 percent in water it affects physical abilities like muscle endurance or sports tasks and your ability to regulate your body temperature," said Millard-Stafford, a past president of the American College of Sports Medicine. "We wanted to see if that was similar for cognitive function."

The researchers looked at 6,591 relevant studies for their comparison, then narrowed them down to 33 papers with scientific criteria and data comparable enough to do metadata analysis. They focused on acute dehydration, which anyone could experience during exertion, heat and/or not drinking as opposed to chronic dehydration, which can be caused by a disease or disorder.

One day to lousy

How much fluid loss adds up to 2 percent body mass loss?

"If you weigh 200 pounds and you go work out for a few of hours, you drop four pounds, and that's 2 percent body mass," Millard-Stafford said. And it can happen fast. "With an hour of moderately intense activity, with a temperature in the mid-80s, and moderate humidity, it's not uncommon to lose a little over 2 pounds of water."

"If you do 12-hour fluid restriction, nothing by mouth, for medical tests, you'll go down about 1.5 percent," she said. "Twenty-four hours fluid restriction takes most people about 3 percent down."

And that begins to affect more than cognition or athletic abilities.

"If you drop 4 or 5 percent, you're going to feel really crummy," Millard-Stafford said. "Water is the most important nutrient."

She warned that older people can dry out more easily because they often lose their sensation of thirst and also, their kidneys are less able to concentrate urine, which makes them retain less fluid. People with high body fat content also have lower relative water reserves than lean folks.

Don't overdo water

Hydration is important, but so is moderation.

"You can have too much water, something called hyponatremia," Millard-Stafford said. "Some people overly aggressively, out of a fear of dehydration, drink so much water that they dilute their blood and their brain swells."

This leads to death in rare, extreme cases, for example, when long-distance runners constantly drink but don't sweat much and end up massively overhydrating.

"Water needs to be enough, just right," Millard-Stafford said.

Also, she warned that while salt avoidance may be good for sedentary people or hypertension patients, whoever sweats needs some salt as well, or they won't retain the water they drink.

Hormones that signal the body's state of hunger and fullness could be the key to new treatments for drug and alcohol addiction. That is the consensus of an expert panel convened this week at the annual meeting of the Society for the Study Ingestive Behavior, the leading international research conference on food and fluid intake. Gut hormones have received considerable attention from scientists seeking to understand overeating and obesity, which led the panelists to discover that those hormones are also involved in addiction. They expressed optimism about the potential for rapid progress toward new addiction treatments, since several drugs that affect these hormones are already approved or in the FDA pipeline.

"Hormones from the gut act in the brain to modulate dopamine signaling, which controls decisions to seek out rewards," explained Dr. Mitchell Roitman, University of Illinois-Chicago neuroscientist. That explains how food and water become more or less rewarding based on a person's state of hunger, fullness, or thirst. Since drugs like cocaine and alcohol act on those same dopamine circuits in the brain, gut hormones could potentially turn their rewarding effects up or down in the same fashion.

Ghrelin, a hunger hormone released by the stomach, can influence the reward value of alcohol much like it increases the reward value of food, according to new data shared by panelist Dr. Lorenzo Leggio, leader of a joint team from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA). The NIAAA/NIDA team has demonstrated that ghrelin promotes alcohol seeking in people with alcohol use disorder. More recently, they have also studied rats genetically insensitive to ghrelin, an approach that further supports a role of the ghrelin system in alcohol seeking.

Other gut hormones like GLP-1 and amylin are released during eating to tell the brain when a person has had enough. In animal studies reported by several of the panelists, medications that enhance the action of those hormones reduce the rewarding effects of drugs and alcohol. In one study led by Dr. Elisabet Jerlhag of the University of Gothenberg in Sweden, treating rats with a compound that mimics amylin significantly reduced alcohol-seeking, even in rats selectively bred for excess alcohol consumption. Dr. Heath Schmidt of the University of Pennsylvania's Perelman Medical School, reported similar effects of GLP-1 analogs in reducing rats' cocaine seeking.

All members of the panel were optimistic about the potential for new therapies to help people battling addiction. "These results provide strong rationale for clinical trials of GLP-1 analogs for people seeking addiction treatment," said Schmidt. "Medications affecting GLP-1 and amylin are already FDA approved for Type II diabetes and obesity. These drugs could be re-purposed for treating drug craving and relapse."

Currently substance abuse disorders are one of most common and expensive chronic health problems. In just the United States, more than 21 million adults require treatment for alcohol or illicit drug abuse, according to government statistics. Behavioral therapy is the standard treatment approach, but persistent cravings lead to high relapse rates. There are at present only a few medications approved to help manage cravings, and they are not effective for all people. The panelists concluded that data from animal experiments and preliminary trials in humans all support the gut hormone system as a prime target for novel treatments.