Culture

People in centenarians' close social networks are often not aware of their thoughts on end-of-life issues, a new Journal of the American Geriatrics Society study reveals.

In the study of 78 centenarians and their primary contacts (proxies), proxies misjudged whether the centenarian thought about end of life in nearly half of cases. Although only few centenarians perceived the end of life as threatening, and approximately one-quarter reported longing for death, proxies overestimated centenarians' reports on the former and underestimated the latter. Proxies reported more centenarian end-of-life planning than centenarians themselves.

"Our findings suggest a lack of communication about end of life between centenarians and the people they count on most," said lead author Dr. Kathrin Boerner, of the McCormack Graduate School of Policy and Global Studies at the University of Massachusetts Boston. "Healthcare professionals should be aware that even among very old adults, discussions about end of life wishes need to be actively encouraged."

Young people who watch one extra junk-food advert a week (over the average of six) consume an additional 350 calories in foods high in salt, sugar, and fat (HFSS) every week (18,000 each year), according to the largest study of its kind in the UK involving over 3,300 teens aged 11 to 19 years.

The study conducted by Cancer Research UK, and being presented at this year's European Congress on Obesity (ECO) in Vienna, Austria (23-26 May), is one of the first to look at online TV viewing in such a systematic fashion, and adds to the growing evidence that TV and streaming adverts can influence young people's unhealthy diet.

The take home message is that "junk food marketing is associated with obesity in young people of all ages, and we know that obesity is linked to at least 13 types of cancer", says Dr Jyotsna Vohra, head of the Cancer Policy Research Centre at Cancer Research UK who led the research. Levels of obesity in teens aged between 12 and 19 years tripled in the USA (5% to 17.6%) between 1980 and 2008. Similarly, in England, around a fifth of children in the last year of primary school (aged 10 to 11), and one in every four adults is obese. Obese children are around five times more likely to become obese adults with a much higher risk of health problems including 13 obesity-related cancers, type 2 diabetes, and cardiovascular disease.

Although the causes of obesity are complex, previous research has found strong links between increases in advertising for fast foods and rates of childhood overweight and obesity. An earlier Cancer Research UK study, also being presented at ECO, showed that teens who report 3 or more hours of commercial screen time (television or streaming) a day are twice as likely to consume large amounts of foods HFSS compared to those who watch less than 3 hours a day.

Regularly eating high calorie food and drink--which usually has higher levels of fat and sugar- increases the risk of becoming overweight or obese. An obese child is more likely to remain obese into adulthood, putting them at risk of cancer, which is the biggest preventable risk after smoking in the UK for the disease.

In this study, Dr Vohra and her Cancer Research UK colleagues investigated the link between HFSS food marketing and unhealthy food and soft drink consumption behaviours among teens in the UK. They started by conducting a qualitative scoping study to explore young people's perceptions of marketing, and the mechanisms linking this with dietary choices. They went on to survey a national sample of 3,348 young people aged 11 to 19 years to further examine the link between marketing and high calorie diets. Participants were asked about their age, gender, ethnicity, socioeconomic status, food and drink consumption, TV and online viewing habits, what HFSS adverts they remembered, brand awareness, and reactions to HFSS ads.

On average, young people watched 21 hours of television a week with adverts, with just over half of this time viewed on streaming platforms. However, obese participants watched significantly more television--around 26 hours (equivalent to one extra advert a week).

On average, young people reported eating almost 30 HFSS food items every week (equivalent to 40-50% of this age group's recommended total calorie intake), but only 16 portions of fruit or vegetables.

Overall, results showed that the more junk food ads young people watched, the more HFSS foods they were eating. All participants were able to recall a favourite HFSS television advert, and were particularly influenced by adverts that were fun, targeted, age appropriate or catchy.

The researchers found that greater familiarity with fast-food marketing was associated with eating more foods HFSS and increased weight, regardless of age and gender. However, those from a more deprived background were more likely to recall HFSS adverts than those who were not. "This combined with their already greater risk of unhealthy weight outcomes suggests that young people from deprived backgrounds would potentially have the most to gain from regulation designed to reduce junk food ad exposure", explains Dr Vohra. Over 40% of participants said they felt pressured to eat unhealthily, and 80% of the 10 food and drink brands young people recalled most frequently had at least one HFSS product in their top sellers.

The authors conclude: "The food industry wouldn't pump hundreds of millions into advertising their products by creating catchy adverts if it didn't get people to eat more. Broadcast regulations in the UK haven't been updated since 2008, and our research shows that the current restrictions clearly aren't working. With today's teens spending more time in front of screens than any other activity apart from sleeping, curbing exposure to junk food ads on streaming platforms as well as TV will be key to helping teens make healthy diet choices and reducing obesity rates."

In 2017, a report by the Obesity Health Alliance found that junk food companies in the UK spend almost 30 times more on advertising (£143 million) than the Government does on healthy eating campaigns (£5 million).

The authors acknowledge that their findings show observational differences rather than evidence of cause and effect. They note some limitations, including that the study is based on a self-reported survey of viewing and eating habits which can lead to problems of recall and could have affected the results.

Despite stereotypes that paint millennials as "all technology, all the time," young people may still prefer curling up with a paper book over their e-reader -- even more so than their older counterparts -- according to a new study from the University of Arizona that explores consumers' psychological perceptions of e-book ownership.

The study also found that adult consumers across all age groups perceive ownership of e-books very differently than ownership of physical books, and this could have important implications for those in the business of selling digital texts.

"We looked at what's called psychological ownership, which is not necessarily tied to legal possession or legal rights, but is more tied to perceptions of 'what is mine,'" said lead study author Sabrina Helm, a UA associate professor who researches consumer perceptions and behaviors.

Peoples' sense of psychological ownership is affected by three primary factors: whether they feel like they have control over the object they own, whether they use the object to define who they are, and whether the object helps give them a sense of belonging in society, said Helm, who teaches in the UA's John and Doris Norton School of Family and Consumer Sciences in the College of Agriculture and Life Sciences.

"Psychological ownership is important in people's perception of how they value certain products or services or objects," she said. "In the context of digital products, we thought it would be appropriate to look at how people take ownership of something that's not really there -- it's just a file on your computer or device or in the Cloud; it's more of a concept than an actual thing."

For the study, which is published in the journal Electronic Markets, Helm and her colleagues convened four focus groups in different age ranges: one group of Baby Boomers; one group of members of Generation X; and two groups of millennials. The millennial groups were split into current college students and older millennials.

The researchers moderated discussions with the groups about their feelings surrounding ownership of physical books versus e-books.

The following major themes emerged from the discussions:

--Participants across all age groups reported feeling a constricted sense of ownership of digital books versus physical books, based on the fact that they don't have full control over the products. For example, they expressed frustration that they often could not copy a digital file to multiple devices.

--Along similar lines, many study participants lamented restrictions on sharing e-books with friends, or gifting or selling the books, saying this made e-books feel less valuable as possessions than physical books.

--Participants described being more emotionally attached to physical books, and said they use physical books to establish a sense of self and belonging. Participants across age groups frequently spoke about their nostalgia for certain childhood books. They also talked about experiencing physical books through multiple senses -- describing, for example, the sound, smell and tactile experience of opening a new book, and the ability to highlight or write notes on paper pages. Participants also said they use their physical book collections to express their identity to others who might be perusing their shelves. E-books did not have these associations.

--Minimalists expressed a preference for digital books because they take up less physical space.

--Many participants said the e-book experience feels more like renting than buying.

--While almost everyone expressed strong attachment to physical books, and no one embraced a fully digital reading experience, older consumers, contrary to what one might expect, saw more advantages than younger consumers to reading with an e-reader. They referenced physical benefits that might not be as relevant to younger consumers, like the lightweight nature of e-readers and the ability to zoom in on text.

Understanding differences in how people relate to digital versus physical products is important, especially as digital products become more ubiquitous in various domains of life, Helm said.

"One of the conclusions of our research was that digital books and physical books are entirely different products," she said. "E-books feel like more of a service experience; overall, they seem to offer a more functional or utilitarian experience. You have much more richness if you deal with a physical book, where all your senses are involved."

"Physical books are very special products, and we know that physical books have a lot of meaning for a lot of people," Helm continued, noting that books are one of the earliest objects with which children interact. "Digital reading is still fairly new, digital books are still a fairly new product category, and thinking about ownership in the context of these kinds of products is new for most people."

Based on what the study revealed about people's perceptions of digital ownership, marketers of e-books should consider one of two strategies, Helm said:

They should focus on making the e-reading experience more closely emulate the experience of reading a physical book, which might require making physical changes to e-readers that make it easier to do things like scribble notes in the margins, for example.

They should further distance e-books from physical books and focus on establishing e-books as a unique form of entertainment -- more of a service-based experience that includes features you can't get from a physical book, like an integrated soundscape, for example.

"A lot of participants pointed out that they see digital books as too expensive for what they deliver, because they don't offer the same richness as a physical book; you read them and nothing is left," Helm said. "If we position digital reading in a different way -- as an independent service experience -- consumers might be willing to pay a higher price if there's an obvious added value. If it's different from a physical book, they won't compare it to the physical book anymore, because it's an entirely different form of entertainment."

Helm emphasized that both physical and digital books have their place. "There are just really different values or benefits that we get out of them," she said.

The many threats facing bumblebees can be tested using a "virtual safe space" created by scientists at the University of Exeter.
Bumble-BEEHAVE provides a computer simulation of how colonies will develop and react to multiple factors including pesticides, parasites and habitat loss.

The tool lets researchers, farmers, policymakers and other interested parties test different land management techniques to find out what will be most beneficial for bees. Field experiments can be very timely and costly, so results from Bumble-BEEHAVE can help refine and reduce the number of experiments needed.

Bumble-BEEHAVE - which is freely available online - is a powerful tool that can make predictions, according to a new study.

"We know that pollinator decline is a really big problem for crops and also for wildflowers," said Dr Grace Twiston-Davies, of the Environment and Sustainability Institute at the University of Exeter's Penryn Campus in Cornwall.

"Bumble-BEEHAVE takes into account the many complicated factors that interact to affect bumblebees.

"This provides a virtual safe space to test the different management options."

"It's a free, user-friendly system and we're already starting to work with land managers and wildlife groups on the ground."

Disentangling the many factors that affect bumblebee colonies is incredibly complicated, meaning real-word testing of different methods by land managers is often not feasible.

This problem prompted the Exeter scientists to create the BEEHAVE (honeybees) and Bumble-BEEHAVE computer models.
Bumble-BEEHAVE can simulate the growth, behaviour and survival of six UK bumblebee species living in a landscape providing various nectar and pollen sources to forage on.

"The Bumble-BEEHAVE model is a significant step towards predicting bumblebee population dynamics," said Professor Juliet Osborne, who leads the BEEHAVE team.

"It enables researchers to understand the individual and interacting effects of the multiple stressors affecting bumblebee survival and the feedback mechanisms that may buffer a colony against environmental stress, or indeed lead to spiralling colony collapse.

"The model can be used to aid the design of field experiments, for risk assessments, to inform conservation and farming decisions and for assigning bespoke management recommendations."

Professor Osborne and team won the BBSRC Social Innovator of the Year 2017 award for creating the BEEHAVE models.

"We really hope that researchers and landowners will use the model and give us feedback so we can improve it further in future" said model developer Dr Matthias Becher.

The new study, published in the Journal of Applied Ecology, is entitled: "Bumble-BEEHAVE: a systems model for exploring multifactorial causes of bumblebee decline at individual, colony, population and community level."

Successful weight loss maintainers have different behavioural and physiological responses to food than people with obesity and their lean counterparts, according to new research by the University of Birmingham and the University of Amsterdam being presented at this year's European Congress on Obesity (ECO) in Vienna, Austria (23-26 May).

The findings indicate that a reduced physiological response to highly palatable foods such as pizza, and reduced sensitivity towards "winning" foods, may help explain why some individuals are able to successfully lose weight in the long-term.

Obesity costs the global economy around US$2 trillion a year, and risk factors linked to poor diet contribute to more disease than unsafe sex, alcohol, drugs, and tobacco use combined. There has been much research into how our food environment and neurobiology can lead to overeating. For example, highly palatable foods such as pizza and chocolate trigger signals in the brain that give a feeling of pleasure and reward. These cravings contribute to overeating. But little is known if these responses to food cues support weight-loss maintenance.

In this study, Leonie Balter from the University of Birmingham's School of Psychology in the UK and colleagues looked at saliva production and heart rate following exposure to pizza in different weight groups (average age 29.5 years). The team, from the Suzanne Higgs' Eating Behaviour Research Group, compared the responses of three groups-successful weight-loss maintainers who previously had obesity (20 participants), individuals with current obesity (25), and never-overweight lean individuals (20)

They found that individuals with obesity had a heightened salivation and heart rate response following presentation of the pizza, whilst the salivation and heart rate of successful weight-loss maintainers decreased, and lean individuals were unresponsive.

Participants also completed cognitive tasks to objectively measure their motivation to win and avoid losing food and money in a computerised task. Participants had to figure out the meaning of a symbol by trial-and-error. On each trial they choose one of two figures. The figure either meant that they won food, lost food, won money, or lost money. After a while participants learned what a specific symbol meant, and their ability to win or avoid different rewards was measured.

Compared to the lean and obese groups, the ability of the weight loss maintainers to learn the meaning of the symbol was less affected by food "wins" and more affected by food "losses". These data may suggest that explicit food rewards have less value for weight loss maintainers.

The findings add to knowledge about the factors that might predict successful weight loss maintenance. The authors conclude: "Our findings reveal a marked difference in physiological reactivity to food depending on weight-loss history. The results suggest that explicit food rewards have less value for weight loss maintainers. Further longitudinal research is needed to determine whether reduced physiological response to palatable (high calorie) food and sensitivity to food rewards may be predictive of individuals that can successfully restrict food intake."

This is an observational study, so no firm conclusions can be drawn about cause and effect and the authors point to several limitations, including that the current study included a small sample size and results must therefore be replicated in a bigger group of people.

DURHAM, N.C. -- When the malaria-causing Plasmodium parasite first slips into the human bloodstream, injected by the bite of an infected mosquito, it does not immediately target red blood cells.

Instead, it seeks refuge inside the liver and rapidly reproduces, copying itself as many as 30,000 times in the span of 48 hours.

After building strength in numbers, the parasite leaves the liver and escapes into the blood stream, invading red blood cells and triggering the devastating disease.

The battle against malaria usually focuses on either helping people evade infected mosquitos or developing strategies to kill the parasite after it raids red blood cells. But a team of Duke University researchers wants to take a different tactic -- disrupting the parasite while it lurks inside the liver.

In a new study, the team shows that the Plasmodium parasite tricks liver cells into pumping out a protein called aquaporin-3, and then steals the protein for itself. Using an inhibitor to disable aquaporin-3 curtails the parasite's ability to reproduce inside the liver, the researchers report in PLOS Pathogens.

"This parasite found a way to manipulate the host's liver cells to make it favorable for this replication event," said Emily Derbyshire, an assistant professor of chemistry at Duke. "This suggests that maybe we can develop drugs to try to target the host to prevent malaria."

After arriving at the liver, Plasmodium forces its way into liver cells, stealing a bit of the cell membrane to form a small pouch inside the cell. This pouch, called a vacuole, provides a safe harbor while the parasite grows and divides, stealing nutrients and proteins from the host cell along the way.

"The liver stage is a checkpoint, a bottleneck, where it goes from a few dozen parasites to many thousands of parasites, which are released from the liver into the blood where it is amplified into hundreds of billions of parasites," said Peter Agre, Director of the Johns Hopkins Malaria Research Institute, who was not involved in the study.

"If we could put out the forest fire when it is the smallest possible little campfire, that would be a potential therapeutic breakthrough," said Agre, who won the 2003 Nobel Prize in Chemistry for the discovery of aquaporins.

But studying the liver stage in the lab is notoriously difficult. To infect liver cells, researchers must first isolate Plasmodium from the salivary glands of infected mosquitos where it only exists in small numbers.

Dora Posfai, a graduate student in the department of molecular genetics and microbiology at Duke, spent three-hour stretches dissecting infected mosquitos under a microscope, using a small needle to cut out their salivary glands and extract the parasites hidden inside.

After infecting human liver cells with the parasite, Posfai and Sandeep Dave, a professor of medicine in the Duke School of Medicine, used RNA sequencing to comb through all 20,000 genes in the human genome, searching for genes that are switched on in infected liver cells.

The team decided to investigate the role of one protein that they found in greater numbers called aquaporin-3 (AQP-3), a channel protein that sits astride cell membranes and plays a key role in shuttling water and nutrients into and out of the cell.

Liver cells do not normally produce AQP-3, instead relying on other types of aquaporin for water transport. But after infection with Plasmodium, the liver cells started producing the protein in droves.

The team used fluorescence imaging to track where all the new AQP-3 proteins were going -- and followed them straight to the vacuole membrane surrounding all the rapidly replicating Plasmodium cells.

"This is the first time we have seen upregulation of a human protein that is then trafficked to the vacuole membrane just to help the parasite," Derbyshire said.

When Posfai exposed the liver cells to an AQP-3 inhibitor called auphen, which blocks nutrients from passing through the port formed by aquaporin, she found the numbers of parasites decreased substantially.

"This is a great proof-of-principle that you can develop small molecules to fight Plasmodium in the liver, and one could now have a campaign looking specifically for inhibitors against this protein," Derbyshire said.

Barring the Plasmodium parasite from reproducing in the liver could not only help treat malaria before the onset of symptoms, but also side-step the development of drug-resistant strains by targeting proteins in the host cells rather than in the rapidly evolving parasite.

"We do have medicines for treating malaria in the blood, but we don't have good medicines for treating it in the liver," Agre said. "Knowing a new, important target like AQP-3 could lead to the discovery of new medicines."

The traditional diet of people in Mediterranean countries has been linked to numerous health benefits and has been shown to cut the risk of obesity. Although popular elsewhere, this healthy eating pattern is relatively new to the USA. New research being presented at this year's European Congress on Obesity (ECO) in Vienna, Austria (23-26 May) uses geospatial techniques to identify which US states have the greatest adherence to this Mediterranean-style of eating. Western and northeastern coastal areas of the USA including California, New Jersey, New York City, and Massachusetts lead the nation following this healthier eating pattern, while residents of the South and East North Central states such as Arkansas, Louisiana, Alabama, and Michigan are least likely to adopt the Mediterranean-style diet.

The Mediterranean diet is rich in fruits, vegetables, nuts, whole grains, and olive oil. It's low in red meat and other saturated fats, and it contains few processed foods or refined sugars. This eating pattern has well known health benefits, including reduced mortality and lower risk of chronic conditions such as cancer, diabetes, and heart disease.

Current dietary guidelines reveal that around three-quarters of Americans do not eat enough vegetables, fruit, and dairy, and most exceed the recommendations for added sugars, saturated fats, and salt. The estimated annual healthcare costs of obesity-related illness are a staggering US$190 billion or a fifth of annual medical spending in the USA. Increased adoption of the Mediterranean diet could help reverse this public health crisis, but little is known about the popularity of this dietary pattern across the USA.

In this study, researchers led by Professor Meifang Chen from California State University, Los Angeles investigated adherence to the Mediterranean diet among almost 21,000 adults (aged 45 or older) from 48 contiguous states and Washington DC taking part in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. The study is tracking stroke incidence and mortality from an ethnically and demographically diverse sample of the US population.

Participants completed detailed food questionnaires at the start of the study, and the researchers calculated a Mediterranean diet adherence (MD) score for each participant based on the types of food they ate--ranging from 0-9, with a higher score showing greater adherence. The researchers used geospatial and hot spot analysis to see the geographical distribution and pattern of Mediterranean diet adoption across study areas. Modelling was also used to identify factors associated with high adherence.

The average MD score was 4.36, and almost half (46.5% of participants) closely followed the Mediterranean Diet. The researchers found that higher Mediterranean diet adherence clusters were mainly located in the western and northeastern coastal areas including Californian, Pennsylvania, New Jersey, New York City, Connecticut, and Massachusetts; whereas lower adherence clusters were largely seen in South and East North Central regions such as Arkansas, Louisiana, Alabama, Georgia, North Carolina, Michigan and the northern area of Indiana (see map).

Further analyses showed that, irrespective of geographical location, people who live in socioeconomically disadvantaged, rural, minority neighborhoods with smaller populations are least likely to follow this 'healthier' diet pattern. Being older, black, not a current smoker, having a college degree and above, an annual household income of US$75,000 or more, exercising at least four times a week, and watching less than 4 hour of TV a day were each linked with a higher likelihood of eating the Mediterranean-style diet.

The authors conclude: "Given the skyrocketing obesity rates in the USA over the past few decades, identifying and promoting obesity-modifying dietary approaches is a top priority. Our study identifies and characterises locations and at-risk populations across the USA where Mediterranean diet promoting interventions and policies might have the greatest effect in combating the obesity."

The authors note some limitations, including that the MD score was calculated based on self-reported dietary intake data, which might not accurately represent participants' food consumption. For instance, inaccurate recall of food intake, or a tendency towards social desirability resulting in individuals over-reporting healthy food intake, and underreporting unhealthy food intake can't be ruled out. They also note that dietary intake data was only assessed once at the start of the study, so the stability of the dietary pattern is unknown. Lastly, the study represented only two racial groups (non-Hispanic white and black) and mid- to old-age populations, so the findings might not be generalisable to younger generations and other racial groups.

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims.

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit - but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

These patients also had significantly lower out-of-pocket costs.

"Given our findings in light of the national opioid crisis, state policymakers, insurers, and providers may want to review current policies and reduce barriers to early and frequent access to physical therapists as well as to educate patients about the potential benefits of seeing a physical therapist first," said lead author Dr. Bianca Frogner, associate professor of family medicine and director of the University of Washington Center for Health Workforce Studies.

Frogner said individuals in all 50 states have the right to seek some level of care from a physical therapist without seeking a physician referral, however, many do not take advantage of this option. She said this may be because some insurance companies have further requirements for payment.

About 80 percent of adults experience back pain at some point during their lifetime, according to the National Institutes of Health.

Currently, patients with low-back pain are given painkillers, x rays and, in some cases, told to rest, said Frogner. She said said seeing a physical therapist first and given exercise is a more evidence-based approach.

Using an insurance claims dataset provided by the Health Care Cost Institute, the researchers reviewed five years of data of patients newly diagnosed with low back pain who had received no treatment in the past six months. The claims were based in six states: Washington, Wyoming, Alaska, Montana, Idaho and Oregon.

The research involved the UW School of Medicine in Seattle and The George Washington University in Washington, D.C.

"This study shows the importance of interprofessional collaboration when studying complex problems such as low-back pain. We found important relationships among physical therapy intervention, utilization, and cost of services and the effect on opioid prescriptions," said Dr. Ken Harwood, lead investigator for The George Washington University.

Compared with fiscal austerity measures currently being implemented in Brazil, the maintenance of social protection could result in a reduction in childhood mortality by 8.6% in 2030, according to simulations published this week in PLOS Medicine by Davide Rasella of the Universidade Federal da Bahia, Brazil, and colleagues.

Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of austerity measures, including proposed cuts to the Bolsa Familia Programme (BFP) and the Estrategia Saude da Familia (ESF), two major programs with an impact on childhood mortality. Rasella and colleagues developed a microsimulation model, projecting the effects of poverty, BFP, and ESF on child health in all 5,507 Brazilian municipalities for the period 2017-2030.

Compared with reducing the coverage provided by BFP and ESF due to fiscal austerity, the maintenance of their levels of social protection would lead to a child mortality rate 8.6% lower [95% confidence interval: 6.9%-10.2%] in 2030, the study estimated. Avoidable childhood deaths would be approximately 20,000 lower and avoidable childhood hospitalisations up to 124,000 lower between 2017 and 2030 under maintenance of social protection. Under various simulations, which varied the length of the economic crisis and the amount of cuts, childhood mortality was still affected. The research also showed that poorer municipalities would be disproportionately impacted.

"Our study suggests that reduced coverage of poverty-alleviation and primary care programmes may result in a substantial number of preventable child deaths and hospitalizations in Brazil," the authors say. "These austerity measures will disproportionately impact child mortality in the poorest municipalities, disrupting previous trends of reducing inequality in child health outcomes."

Cutbacks to social programmes in Brazil could lead to more avoidable childhood hospitalisations and deaths compared to maintaining current funding.

The findings come from new research, published this week in the journal PLOS Medicine and led by researchers at Imperial College London and Universidade Federal da Bahia in Brazil.

Using statistical models to simulate future outcomes, the researchers found that childhood mortality rates could be 8.6 per cent lower by 2030 if investments in two major social programmes were protected when compared with austerity measures currently being proposed.

The team also found that these austerity policies disproportionately affect the poorest areas of the country.

Brazil is the eighth largest economy in the world, but since 2015 a deep economic crisis has increased poverty and the government has introduced austerity measures substantially reducing funding for social programmes. .

These include proposed reductions to two major programmes known to reduce childhood mortality: the Bolsa Familia Programme (BFP) and the Estrategia Saude da Familia (ESF) - Brazil's main poverty-alleviating welfare programme and primary healthcare service.

The BFP was launched in 2003 and in 2016 was estimated to cover 25 per cent of Brazilian families, providing funds to poor families, vulnerable individuals, and pregnant women. The ESF delivers community-based healthcare services to families including vaccination, child healthcare services, treatment of simple conditions, and chronic disease management. Existing evidence demonstrates these programmes have led to large improvements in health - especially for children.

To date, however, there has been little evidence on how the economic crisis, austerity measures, and reducing the coverage of such social programmes, could affect children's health in middle income countries such as Brazil.

In the latest paper, researchers developed a statistical model to measure the projected effects of the economic crisis, poverty, as well as the impact of reductions to these two programmes on child health in all 5,507 Brazilian municipalities for the period 2017-2030.

Their simulations revealed that maintaining coverage from social protection programmes led to a child mortality rate up to 8.6 per cent lower in 2030, when comparing to lower coverage under austerity measures.

In addition, their simulations revealed that maintaining coverage of the BFP and ESF reduced avoidable childhood deaths by nearly 20,000 and avoidable childhood hospitalisations were up to 124,000 lower between 2017 and 2030, compared to austerity. They also found that the country's poorer municipalities would be impacted most.

Professor Christopher Millett, from Imperial's School of Public health and author of the study, said: "It is clear that these programmes have a hugely beneficial impact on the health of Brazilian children.

"We urge policy makers in Brazil to protect child health and well-being by reversing proposed austerity measures affecting these important social programmes."

Dr Davide Rasella, from Universidade Federal da Bahia, added: "Our study suggests that reduced coverage of poverty-alleviation and primary care programmes may result in a substantial number of preventable child deaths and hospitalizations in Brazil.

"These austerity measures will disproportionately impact child mortality in the poorest municipalities, halting important progress made in Brazil in reducing inequality in child health outcomes."

Researchers have identified a new inherited neurodevelopmental disease that causes slow growth, seizures and learning difficulties in humans.

Writing in the journal eLife, the team reveals that this disease is caused by a recessive mutation in CAMK2A - a gene that is well known for its role in regulating learning and memory in animals. The findings suggest that dysfunctional CAMK2 genes may contribute to other neurological disorders, such as epilepsy and autism, opening up potential new avenues for treating these conditions.

"A significant number of children are born with growth delays, neurological defects and intellectual disabilities every year across the world," explains senior author Bruno Reversade, Research Director at the Institute of Medical Biology and Institute of Molecular and Cell Biology, A*STAR, Singapore, who supervised the study. "While specific genetic mutations have been identified for some patients, the cause remains unknown in many cases. Identifying novel mutations would not only advance our understanding of neurological diseases in general, but would also help clinicians diagnose children with similar symptoms and/or carry out genetic testing for expecting parents."

The team's research began when they identified a pair of siblings who demonstrated neurodevelopmental delay with frequent, unexplained seizures and convulsions. While the structure of their bodies developed normally, they did not gain the ability to walk or speak. "We believed that the children had novel mutations in CAMK2A, and we wanted to see if this were true," says Reversade.

The fully functional CAMK2A protein consists of multiple subunits. Using a genomic technique called exome sequencing, the team discovered a single coding error affecting a key residue in the CAMK2A gene that prevents its subunits from assembling correctly.

Moving their studies into the roundworm Caenorhabditis elegans, the scientists saw that this mutation disrupts the ability of CAMK2A to ensure proper neuronal communication and normal motor function. This suggests that the mutation is indeed the cause of the neurodevelopmental defects seen in the siblings.

To the best of the team's knowledge, this new disorder represents the first human disease caused by inherited mutations on both copies of the CAMK2A gene. In addition, another report* published recently identified single-copy mutations on both CAMK2A and CAMK2B that caused intellectual disabilities as soon as the mutations occurred. "We would like to bring these findings to the attention of those working in the area of paediatric genetics, such as clinicians and genetic counsellors, as there are likely more undiagnosed children with similar symptoms who have mutations in their CAMK2A gene," explains co-first author Franklin Zhong, Research Scientist in Reversade's lab at A*STAR.

"Neuroscientists working to understand childhood brain development, neuronal function and memory formation also need to consider this new disease, since CAMK2A is associated with these processes. In future, it would be interesting to test whether restoring CAMK2A activity can bring therapeutic benefit to patients with this condition, as well as those with related neurological disorders."

CAMBRIDGE, Mass. - A study by MIT researchers has uncovered a new way of telling how well people are learning English: tracking their eyes.

That's right. Using data generated by cameras trained on readers' eyes, the research team has found that patterns of eye movement -- particularly how long people's eyes rest on certain words -- correlate strongly with performance on standardized tests of English as a second language.

"To a large extent [eye movement] captures linguistic proficiency, as we can measure it against benchmarks of standardized tests," says Yevgeni Berzak, a postdoc in MIT's Department of Brain and Cognitive Sciences (BCS) and co-author of a new paper outlining the research. He adds: "The signal of eye movement during reading is very rich and very informative."

Indeed, the researchers even suggest the new method has potential use as a testing tool. "It has real potential applications," says Roger Levy, an associate professor in BCS and another of the study's co-authors.

The paper, "Assessing Language Proficiency from Eye Movements in Reading," is being published in the Proceedings of the 16th Annual Conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies. The authors are Berzak, a postdoc in the Computational Psycholinguistics Group in BCS; Boris Katz, a principal research scientist and head of the InfoLab Group at MIT's Computer Science and Artificial Intelligence Laboratory (CSAIL); and Levy, who also directs the Computational Psycholinguistics Lab in BCS.

The illusion of continuity

The study delves into a phenomenon about reading that we may never notice, no matter how much we read: Our eyes do not move continuously along a string of text, but instead fix on particular words for up to 200 to 250 milliseconds. We also take leaps from one word to another that may last about 1/20 of a second.

"Although you have a subjective experience of a continuous, smooth pass over text, that's absolutely not what your eyes are doing," says Levy. "Your eyes are jumping around, mostly forward, sometimes backward. Your mind stitches together a smooth experience. ... It's a testimony to the ability of the mind to create illusions."

But if you are learning a new language, your eyes may dwell on particular words for longer periods of time, as you try to comprehend the text. The particular pattern of eye movement, for this reason, can reveal a lot about comprehension, at least when analyzed in a clearly defined context.

To conduct the study, the researchers used a dataset of eye movement records from work conducted by Berzak. The dataset has 145 students of English as a second language, divided almost evenly among four native languages -- Chinese, Japanese, Portugese, and Spanish -- as well as 37 native English speakers.

The readers were given 156 sentences to read, half of which were part of a "fixed test" in which everyone in the study read the same sentences. The video footage enabled the research team to focus intensively on a series of duration times -- the length of time readers were fixated on particular words.

The research team called the set of metrics they used the "EyeScore." After evaluating how it correlated with the Michigan English Test (MET) and the Test of English as a Foreign Language (TOEFL), they concluded in the paper that the EyeScore method produced "competitive results" with the standardized tests, "further strengthening the evidence for the ability of our approach to capture language proficiency."

As a result, the authors write, the new method is "the first proof of concept for a system which utilizes eye tracking to measure linguistic ability."

Sentence by sentence

As the researchers see it, the current study is just one step on a longer journey of exploration about the interactions of language and cognition.

As Katz says, "The bigger question is, how does language affect your brain?" Given that we only began processing written text within the last several thousand years, he notes, our reading ability is an example of the "amazing plasticity" of the brain. Before too long, he adds, "We could actually be in a position to start answering these questions."

Levy, for his part, thinks that it may be possible to make these eye tests about reading more specific. Rather than evaluating reader comprehension over a corpus of 156 sentences, as the current study did, experts might be able to render more definitive judgments about even smaller strings of text.

"One thing that we would hope to do in the future that we haven't done yet, for example, is ask, on a sentence-by-sentence basis, to what extent can we tell how well you understood a sentence by the eye movements you made when you read it," Levy says. "That's an open question nobody's answered. We hope we might be able to do that in the future."

The United States is increasingly diverse ethnically and racially. Studies have shown that for young people, simply being around peers from different ethnic and racial backgrounds may not be enough to improve attitudes toward and relationships with other groups. Instead, children and adolescents also need to value spending time and forming relationships with peers from diverse groups. A new study examined how friends in middle school affect each other's attitudes about interacting with peers of different ethnicities and races, finding that they influence each other's racial and ethnic views significantly.

The study was done by researchers at the University of Michigan and the University of California-Irvine. It appears in Child Development, a journal of the Society for Research in Child Development.

"Success in engaging and forming friendships with people from diverse ethnic and racial groups is an important kind of social competence, and one that is especially relevant given today's pervasive racial tensions," explains Deborah Rivas-Drake, associate professor of psychology and education at the University of Michigan, who led the study. "Our results point to a system in which adolescents prefer to befriend more open-minded peers and, in turn, influence one another on intergroup relations. Taken together, our research suggests that such attitudes may be contagious."

The study collected information from 524 ethnically diverse students in grades 6, 7, and 8 who attended a middle school in the midwestern United States. The students filled out surveys asking them about their friends in school and their attitudes toward diversity--how they felt about interacting with peers from different ethnic and racial groups.

The researchers found that students who had more positive attitudes about interacting with peers from other ethnic and racial groups were most likely to be friends with students who shared the same attitudes. Students with more positive attitudes were less likely to select friends of the same race and ethnicity than those with less positive attitudes. And students' attitudes became more similar to their friends' over time.

The study also found that students who expressed positive beliefs about interacting with peers from other ethnic and racial groups reaped benefits: They were more sought after as friends than those with less positive attitudes toward diversity and they reported more friends from groups other than their own.

"Many schools, like the one we studied, are encouraging not just awareness of difference but also empathy and the ability to take others' perspectives," notes Robert Jagers, former associate professor of education and psychology at the University of Michigan and incoming vice president for research at the Collaborative for Academic, Social, and Emotional Learning (CASEL), who coauthored the study. "Our research highlights the importance of peers in this process and their role in helping shape students' beliefs about diversity."

Since the study was carried out in a school that was ethnically and racially heterogeneous, the authors caution that their findings may not be replicable in schools that are less diverse. In addition, the study did not ask students about where they lived or their socioeconomic status, which could play a role in students' decisions to associate with peers who are similar to themselves.

Lifetime risks of developing Alzheimer's disease dementia vary considerably by age, gender and whether any signs or symptoms of dementia are present, according to a new study published online by Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

According to the authors, these are the first lifetime risk estimates for Alzheimer's that take into account what are believed to be biological changes in the brain that occur 10 to 20 years before the well-known memory and thinking symptoms appear. These early changes, prior to overt clinical symptoms, are referred to as preclinical Alzheimer's disease. This designation is currently only for research use until more scientific evidence is produced to determine if it can accurately predict the progression to symptoms.

The prevalence of this research-only stage of the Alzheimer's continuum, known as preclinical Alzheimer's disease, in the U.S. has been estimated at nearly 47 million people in a previous study. An example from this newly published report is of a 70-year-old male who has just amyloid, but no signs of neurodegeneration and no memory loss, has a lifetime risk of 19.9 percent. But, if he also had neurodegeneration in addition to amyloid, the lifetime risk rises to 31.3 percent. If, in addition, he had mild cognitive impairment (MCI) plus amyloid plus neurodegeneration, the risk rises to 86 percent.

"What we found in this research is that people with preclinical Alzheimer's disease dementia may never experience any clinical symptoms during their lifetimes because of its long and variable preclinical period," said Ron Brookmeyer, Ph.D., from the UCLA School of Public Health, Los Angeles. "The high mortality rates in elderly populations are also an important factor as individuals are likely to die of other causes."

Brookmeyer provides an example of a 90-year-old female with amyloid plaques having a lifetime risk of Alzheimer's disease of only 8.4 percent, compared to a 65-year-old female with amyloid plaques who has a lifetime risk of 29.3 percent. The lower lifetime risk for the 90-year-old versus the 65-year-old is explained by the shorter life expectancy of the older person.

That same 65-year-old female with amyloid plaques has a 10-year risk of Alzheimer's disease dementia of 2.5 percent. Lifetime risks for females are generally higher than males because they live longer. Brookmeyer and his co-author Nada Abdalla, M.S., also of UCLA, state that the lifetime and 10-year risks provide an indication of the potential that someone will develop Alzheimer's disease dementia based on their age and screenings for amyloid deposits, neurodegeneration and presence or absence of MCI or any combination of those three. For men and women, having the combination of all three puts them at the highest risk of developing Alzheimer's disease.

"Just as there are risk predictors for whether you might have a heart attack, it will be important in the future to measure the likelihood that someone will develop Alzheimer's disease," said Maria Carrillo, Ph.D., Alzheimer's Association chief science officer. "In the future, when treatments are available, this would be helpful, especially for people in the stages before the clinical symptoms appear. For example, those people with the highest 10-year risk of getting Alzheimer's dementia would be high priority to volunteer for clinical trials evaluating Alzheimer's medications or other therapies."

After reviewing the existing scientific literature, including some of the largest longitudinal studies available that have measured biomarkers with data from thousands of people, (e.g., The Mayo Clinic Study of Aging) the authors created a computerized mathematical model to ascertain how likely a person would progress in the continuum of the disease. They based their calculations on the transition rates from the published studies and from U.S. death rates data based on age and gender. They acknowledge that future studies looking at transition rates need to be in ethnically diverse populations and also need to consider whether genetic variants such as the Apolipoprotein (APOE) ?4, which puts people at much higher likelihood for developing Alzheimer's disease, would affect the lifetime risk estimates. And future studies will need to be based on research that is more conclusive than the current scientific literature about risk in relation to early biomarkers like presence of amyloid decades before symptoms appear.

"There are still many things to consider when assessing the value of screening people for Alzheimer's disease biomarkers. Lifetime risks will help in formulating screening guidelines to identify those who would be most helped by screening, especially in the preclinical stage," the authors conclude.

The model used in this study differs from the recently announced NIA-AA Research Framework Towards a Biological Definition of Alzheimer's Disease. Under the framework, if a person does not have amyloid plaques, then they do not have Alzheimer's pathology. Amyloid is one of the biomarkers along with tau tangles considered to be hallmark of Alzheimer's disease. In this model, two of the states of progression (state 3 which is neurodegeneration alone and state 6 which is MCI and neurodegeneration alone) do not include amyloid and would not be considered Alzheimer's under the research framework.

Portland State University researchers who published an article three years ago in the New England Journal of Medicine about the presence of previously undiscovered forms of formaldehyde in e-cigarette vapor revisited their research and found that formaldehyde risks were even higher than they originally thought.

The 2015 study by PSU chemistry professors David Peyton, Robert Strongin, James Pankow and others revealed that e-cigarette vapor can contain the new forms of formaldehyde at levels five to 15 times higher than the formaldehyde in regular cigarettes. The chemicals were detected when the vaping device used in their experiments was set at the high end of its heat settings.

Formaldehyde is a known carcinogen. Unlike gaseous formaldehyde, the newly discovered compounds are bound to particulates in the e-cigarette aerosols, enabling them to be deposited more deeply in the lungs than gaseous formaldehyde.

The 2015 study drew criticism from e-cigarette advocates, who said that the high settings would produce an unpleasant taste and therefore would be avoided by the vast majority of people who use e-cigarettes.

In their new study, published in Scientific Reports, Peyton and Strongin found that both gaseous formaldehyde and the new formaldehyde compounds were detectable at levels above OSHA workplace limits even when e-cigarettes were operated at lower, more commonly used heat settings. Strongin said this raises concerns about the overall risks of e-cigarette use.

"In 2016, more than 9 million Americans were current e-cigarette users, including more than 2 million U.S. middle and high school students," he said. "It is thus concerning if even a minority of users cannot properly control e-cigarette-derived intake of formaldehyde and related toxins."