Fruit and vegetable consumption and exercise can directly increase levels of self-reported happiness, according to findings from a new study.
Public health campaigns encourage healthier diets and exercise by virtue of the well-studied link between lifestyle and wellbeing, and will benefit from new findings published by the Journal of Happiness Studies showing that there is also a positive causation from lifestyle to life satisfaction.
This research is the first to identify the causation of happiness, the consumption of fruit and vegetables and exercising are related, rather than generalising a correlation. The researchers, Dr Adelina Gschwandtner (Kent’s School of Economics), Dr Sarah Jewell and Professor Uma Kambhampati (both from the University of Reading’s School of Economics), used an instrumental variable approach to filter out any effect from happiness to lifestyle. This approach revealed that it is the effect of fruit and vegetables and exercising that makes people happy and not the other way round.
The findings show individuals’ ability to delay gratification and apply self-control plays a major role in influencing lifestyle decisions, which in turn has a positive impact on wellbeing. The research also shows that men appear to exercise more, and women eat more fruit and vegetables.
Dr Gschwandtner said: ‘Behavioural nudges that help the planning self to reinforce long-term objectives are likely to be especially helpful in maintaining a healthy lifestyle. If a better lifestyle not only makes us healthier but also happier, then it is a clear win-win situation.’
Professor Kambhampati said: ‘There has been a bigger shift in recent years for healthier lifestyle choices. To establish that eating more fruit and vegetables and exercising can increase happiness as well as offer health benefits is a major development. This may also prove useful for policy campaigns around environment and sustainability.’
A Polish study found that, after a week-long recovery from sleep deprivation, only reaction speed is restored to baseline levels while other functions are still lacking.
The negative impacts of sleep deficiency are well known, and include deficits in attention and memory, increased risk of car accidents, heart problems, and other medical issues. However, while some research has addressed recovery after chronic sleep deprivation, it has been unclear how much time is needed to fully recover from prolonged periods of deficient sleep.
To shed more light on this topic, Jeremi Ochab of the Jagiellonian University in Kraków and colleagues conducted a small study, published in PLOS ONE, with several healthy adults who underwent 10 days of purposeful sleep restriction followed by seven recovery days with unrestricted sleep. Participants completed the study in their normal day-to-day environments, wearing wrist sensors to track sleep and activity. Daily electroencephalography (EEG) monitored their brain activity, and they answered daily questions (Stroop tasks) to measure reaction times and accuracy.
After 7 days of recovery, the participants had not yet returned to their baseline performance on most measures of functioning. These included several EEG measures of brain activity, rest-versus-activity patterns captured by wrist sensors, and accuracy on Stroop tasks. Only their reaction times had recovered to baseline levels.
While the researchers note that it is difficult to compare these results with other studies that employed different methods, the findings contribute new insights into recovery from chronic sleep loss. Future research could include more participants, investigate longer recovery periods, and determine in what order different functions return to normal.
The authors added: “The investigation of the recovery process following an extended period of sleep restriction reveal that the differences in behavioural, motor, and neurophysiological responses to both sleep loss and recovery.”
Histamine from inflammation dampens serotonin levels and antidepressants’ ability to boost them, according to experiments in mice models.
The findings, published in The Journal of Neuroscience add to mounting evidence that inflammation, and the accompanying release of the molecule histamine, affects serotonin, a key molecule responsible for mood in the brain.
Inflammation triggers the release of histamine in the body, increasing blood flow to affected areas to flood them with immune cells. While these effects help the body fight infections, both long-term and acute inflammation is increasingly linked to depression. There is already strong evidence that patients with both depression and severe inflammation are the ones most likely not to respond to antidepressants.
Dr Parastoo Hashemi, Lead Author, Imperial’s Department of Bioengineering, said: “Our work shines a spotlight on histamine as a potential key player in depression. This, and its interactions with the ‘feel-good molecule’ serotonin, may thus be a crucial new avenue in improving serotonin-based treatments for depression.”
Chemical messengers Serotonin is a key target for depression-tackling drugs, and selective serotonin reuptake inhibitors (SSRIs) inhibit the re-absorption of serotonin in the brain, allowing it to circulate for longer and improve mood.
However, although SSRIs bring relief to many who take them, an increasing number of people are resistant to it. This could be due to the specific interactions between chemical messengers, or neurotransmitters, including serotonin and histamine.
With this in mind, researchers set out to investigate the relationship between histamine, serotonin, and SSRIs. They created tiny serotonin-measuring microelectrodes and put them into the hippocampus of the brains of live mice, an area known to regulate mood. The technique, known as fast scan cyclic voltammetry (FSCV), allowed them to measure brain serotonin levels in real time..
After placing the microelectrodes, they injected half the mice with lipopolysaccharide (LPS), an inflammation-causing toxin found in some bacteria, and half the mice with a saline solution as a control.
Within minutes of LPS injection, brain serotonin levels dropped, whereas they remained the same in control mice, demonstrating the rapid action of inflammatory responses on the brain and serotonin. Since LPS cannot cross the blood-brain barrier, it could not cause the drop in serotonin. The inflammatory response triggered histamine in the brain which directly inhibited the release of serotonin by attaching to inhibitory receptors.
To counter this, the researchers administered SSRIs to the mice, but they were much less able to boost serotonin levels than in control mice. They posited that this is because the SSRIs directly increased the amount of histamine in the brain, cancelling out its serotonin boosting action.
The researchers then administered histamine reducing drugs alongside the SSRIs to counter histamine’s inhibitory effects, and saw serotonin levels rise back to control levels. This appears to confirm the theory that histamine directly dampens serotonin release in the mouse brain. These histamine reducing drugs cause a whole-body reduction in histamine and are distinct from antihistamines taken for allergies, which block histamine’s effects on neurons.
A new molecule of interest More work is needed before progressing to human studies. However, it is not currently feasible to use microelectrodes to make similar measurements in human brains, so the researchers are now looking at other ways to get a snapshot of the brain by looking at other organs which use serotonin and histamine, like the gut.
A new study has helped researchers understand the experiences of people who withdraw from clinical cancer trials.
Cancer clinical trials (CCTs) provide patients with an opportunity to receive experimental drugs, tests, and/or procedures that may lead to remissions. Such opportunities can be a great benefit for those who took part, but there is little known of the experiences of participants who withdraw from CCTs.
To address this, a first-of-its-kind study from the University of Pennsylvania School of Nursing (Penn Nursing) was conducted to better understand the post-trial needs of these patients and define responsible transitions when patients exit CCTs.
“Understanding the post-trial needs of patients with cancer and their families represents a measure of ethical respect of the many contributions that patients with cancer make to advancing our scientific knowledge and finding treatments that save lives,” said the study’s lead researcher, Connie M Ulrich, the Lillian S Brunner Chair in Medical and Surgical Nursing, professor of nursing, professor of medical ethics and health policy.
The study revealed three important areas:
Patients exiting CCTs feel intense symptoms, emotions, and awareness that their life spans are short and options seem limited.
The limited discussions with patients who are exiting on their immediate post-trial care needs can result in many feeling that there is no clear path forward.
Good communication that deliberately includes attention to post-trial needs throughout the CCT is needed to help scared and disappointed patients navigate their next steps.
Medical students who experienced mistreatment during medical school were more likely to become exhausted or disengaged, have less empathy, and have career regret, a new study has revealed.
Among a large national sample of trainees, the 22.9% of respondents who reported mistreatment on the Association of American Medical Colleges’ Medical School Year 2 Questionnaire (Y2Q) had higher exhaustion and disengagement scores on the Graduation Questionnaire (GQ) 2 years later, reported Liselotte Dyrbye, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues writing in JAMA Network Open.
Furthermore, of those who had experienced mistreatment, 18.8% reported career regret on the GQ.
Conversely, medical students who experienced a better environment more likely to:
Have lower exhaustion scores: for each 1-point increase on the Y2Q, there was a 0.05 reduction in exhaustion score Report lower disengagement scores on the GQ: for each 1-point increase on the Y2Q, there was a 0.04 reduction in disengagement score Further, reports of having positive interactions with faculty on the Y2Q were associated with higher empathy scores on the GQ. For each 1-point increase, there was a rise of 0.02 in empathy score. Positive student-to-student interactions were linked to having lower odds of career regret during the last year of medical school.
“The potential protective effect of positive experiences within the learning environment may provide insight into strengths that organizations can amplify to mitigate burnout, decline in empathy, and career choice regret among their students,” wrote Dyrbye and colleagues.
The team noted the opportunity for potential interventions. “Although the most effective approaches to addressing mistreatment of learners remain elusive, the frequency of mistreatment varies between educational programs, suggesting there are likely to be levers within the control of the organisation that adequate commitment, leadership, infrastructure, resources, and accountability can lead to a meaningful reduction in mistreatment.”
Average age of the respondents was 28 years, 52% were women, 72.8% were single, and 91% reported having no dependents. The study also found that older medical students reported higher disengagement scores, and that women reported lower exhaustion (by 0.27 points) and disengagement (by 0.47 points) scores on the GQ.
However, women and older medical students had higher empathy scores compared with their male peers (0.74 points and 0.05 points, respectively).
The researchers observed that conflicting findings on burnout among women in medicine have been reported. For example, a longitudinal cohort study of resident physicians across specialties in the US found that female residents were “more likely to develop burnout and have worsening in the severity of their emotional exhaustion between the second and third year of training compared with male residents, even after controlling for various forms of mistreatment.”
Limitations of their own study, the researchers noted, included unestablished differences between the exhaustion, disengagement, and empathy scale measures that were used in the questionnaires; and the varying response rates between questionnaires: 55.5% for the Y2Q and 81.5% for the GQ.
A US study showed that adults with atopic dermatitis (AD) had a higher burden of disease than those with other chronic diseases. Even mild dermatitis can negatively affect quality of life (QoL), increasing risk of anxiety, depression, and suicide.
Persistent itching and skin pain can disrupt sleep, leading to poor work or study performance. In moderate to severe disease, oozing, crusting lesions can lead to stigmatisation social isolation. More adults are affected than previously thought, with some 16.5 million adults in the US estimated to have AD.
In a study of 1278 patients using the US web-based Growth from Knowledge (GfK) panel, 60.1% had mild disease, 28.9% had moderate AD, and 11% had severe AD. Patients with more severe disease had higher scores on the dermatology life quality index and on the hospital anxiety and depression scale (HADS) when compared with controls.
This indicates “a worse impact on quality of life and an increased likelihood of anxiety or depression,” the researchers wrote in the Journal of Investigative Dermatology. “Our study confirms the high prevalence and disease burden of atopic dermatitis in this population.”
Quality of life threatened A pair of studies in patients from the GfK panel reinforce these findings. The first, with 602 patients, showed that AD carried a “profound” disease burden, based on a comparison of patient-oriented AD measures between patients with and without AD. Those with moderate and severe AD had lower mean mental health scores compared with those who had mild disease, and lower QoL compared with patients with other chronic disorders.
“We recommend that clinicians incorporate QoL assessments in clinical practice to determine disease burden, identify patients requiring step-up treatment of their skin disease, and potentially screen for patients with mental health disturbance,” wrote Jonathan I Silverberg, MD, PhD, MPH, of George Washington University, and colleagues in the Annals of Allergy, Asthma and Immunology.
A subsequent study in 2137 patients from the GfK Knowledge Panel found that 40% of patients with AD had a higher prevalence of anxiety or depression in the previous 12 months compared with 17.5% of adults without AD. The researchers concluded that anxiety and depression were driven primarily by disease severity, and were heavily underdiagnosed.
Breaking the ‘vicious cycle’ AD can be life-threatening in some patients, warned the authors of a systematic review and meta-analysis of AD studies. The combination of pruritus, visible skin lesions, social isolation, depression, and anxiety likely sets up a “vicious cycle,” according to the authors.
The investigators found a positive and significant association between AD in adulthood and depression, anxiety, and suicidal ideation, regardless of where the patients lived. And while only a few studies examined the risk of completed suicide, the majority showed a positive association, the authors said. A positive association between AD and depression in children was also identified.
They advised that “depression, anxiety, and suicidal ideation should be considered by doctors when treating patients with AD,” adding: “Because AD disease improvement appears to reduce these risks, this should be a priority.”
Better systemic and topical AD therapies are improving the QoL of patients. “It is important to recognise that improvement of AD often results in improvements in symptoms of depression and anxiety, as these mental health symptoms are caused or worsened by the AD,” Dr Silverberg told MedPage Today. “We already have data for dupilumab and the JAK inhibitors that show improvements of HADS scores and other patient-reported outcome measures of mental health.”
Robert Sidbury, MD, MPH, of the University of Washington School of Medicine in Seattle said, “relatively recent literature suggests screening for depression is particularly important for kids with AD, especially those with severe disease.”
AD affects children of all ages, including the very young, and more than 50% of children with AD are diagnosed by age 1 year, he noted.”Dupilumab has been the most effective new available therapy to date by far,” Dr Sidbury told MedPage Today. “Pipeline drugs, particularly the JAK inhibitors like upadacitinib show tremendous promise.”
Giving the means to quit smoking to patients with depression could save as many as 125 000 lives over the next 80 years, researchers estimate. This number could be as high as 203 000 if people with depression who are not yet in mental health care settings are included.
The study, led by the Yale School of Public Health, shows the potential benefits that smoking cessation could have in a population suffering disproportionately from tobacco-related disease and death. Smokers with depression already find it harder to quit, and experience more negative withdrawal symptoms if they do, including increased depression. The study is also the first to estimate the population health effects of integrating smoking cessation treatments with standard mental health care. Using more than a decade of data from the National Survey on Drug Use and Health, the researchers made a model to project the effectiveness of smoking-cessation treatments into the future. They assessed how the benefits varied based on different rates of treatment adoption over the next 80 years.
Simulating the health benefits reveals that, at least 32 000 deaths could be prevented by 2100 if a significant number of patients with depression adopted any kind of cessation treatment. Assuming 100% mental health service utilisation and pharmacological cessation treatment, the number of potential lives saved could rise to 203 000.
“We’ve known for a long time that people with depression smoke more than the general population, and that mental health care settings often don’t have cessation treatment as part of standard care. Our study asks: what is that missed opportunity? What do we have to gain when mental health care and smoking cessation treatment are fully integrated,” said lead author and assistant professor Jamie Tam, PhD. The findings are published in the American Journal of Preventive Medicine.
Such high benefits would be a best-case scenario, the researchers cautioned. Even so, the model’s results match public health experts’ long-standing predictions of the results of smoking-cessation treatment becoming a routine part of mental health care. The findings show that even less-optimal cessation treatments would greatly impact both quality and length of life for patients living with depression.
“Beyond reducing the risk of early death, smoking cessation improves quality of life and increases productivity,” Tam added. “Decision makers should remove barriers to mental health care and smoking cessation treatments for people with mental health conditions.”
The researchers concluded that while existing treatments, such as nicotine replacement therapy, varenicline, and bupropion, can raise cessation rates by nearly 60%, in the future there would be even larger health gains if there were better cessation treatments.
Employee wellbeing in healthcare is reflected in patient satisfaction, and a new study found that a heavy workload, even positive challenges such as learning new things are experienced as increased stress.
Researchers from the Department of Psychology at the University of Jyväskylä in Finland explored how the staff of a healthcare district experienced increasing job demands, and how wellbeing at work was linked to these demands. The study also clarified whether the demands on employees were reflected in patient satisfaction.
More than a thousand employees took part in the study and evaluated their experiences in a survey measuring intensified job demands, work exhaustion, and work engagement. Additionally, nearly a thousand patients of the healthcare district evaluated their treatment by the healthcare staff.
In line with expectations, healthcare staff’s experiences of greater time pressure and workload were associated with greater exhaustion. An especially high risk of exhaustion was seen in those working in emergency care and nurses.
Additionally, experience of increased job planning demands shared by the working community was associated with greater exhaustion and lower customer satisfaction. This was particularly evident in the staff of leadership services.
“A surprising observation was that none of the intensification demands was positively connected with work engagement,” said Senior Lecturer Mari Huhtala. “In the light of previous studies, employees may find some demands such as learning new things positive challenges, especially when the demands are reasonable. However, this was not the case with the studied healthcare employees. It is possible the general workload in healthcare has led to these positive challenges being experienced as additional stress as well.”
Research data for the study were collected using an electronic survey in the third quarter of 2019. The study will continue in the third quarter of 2021 with the collection of follow-up data.
Journal information: Huhtala, M., et al. (2021) Intensified job demands in healthcare and their consequences for employee well‐being and patient satisfaction: A multilevel approach. Journal of Advanced Nursing. doi.org/10.1111/jan.14861.
Researchers at the University of South Australia are warning that high levels of body fat can add to the risk of dementia and stroke.
Having examined grey brain matter from about 28 000 people, the reseachers’ study demonstrated that increased body fat incrementally leads to increased atrophy of grey matter in the brain, resulting in greater risk of declining brain health. Obesity is a major and growing issue worldwide; World Health Organization data shows that more than 1.9 billion adults are overweight, with 650 million being obese.
The lead researcher, Dr Anwar Mulugeta of UniSA, said the findings add to the growing number of issues known to be associated with being overweight or obese.
“Obesity is a genetically complex condition characterised by the excessive body fat,” Dr Mulugeta said. “Commonly linked to cardiovascular disease, type 2 diabetes, and chronic inflammation (a marker of dementia), obesity currently costs Australia’s economy about $8.6 billion dollars each year.
“While the disease burden of obesity has increased over the past five decades, the complex nature of the disease means that not all obese individuals are metabolically unhealthy, which makes it difficult to pinpoint who is at risk of associated diseases, and who is not.
“Certainly, being overweight generally increases your risk for cardiovascular disease, type 2 diabetes, and low-grade inflammation, but understanding the level of risk is important to better direct supports.
“In this study, we investigated the causal relationships of individuals within three metabolically different obesity types* – unfavourable, neutral and favourable – to establish whether specific weight groups were more at risk than others.”
These three obesity subtypes are:
‘unfavourable’ – people who tend to have fat around their lower torso and abdominal area. These people have a higher risk of type 2 diabetes and heart diseases.
‘favourable’ – people who have have wider hips but a lower risk of type 2 diabetes and heart diseases.
‘neutral’ – people who have relatively low or very low risk of the cardiometabolic diseases.
Dr Mulugeta continued, “Generally, the three obesity subtypes have a characteristic of higher body mass index, yet, each type varies in terms of body fat and visceral fat distribution, with a different risk of cardiometabolic diseases.
“We found that people with higher levels of obesity especially those with metabolically unfavourable and neutral adiposity subtypes had much lower levels of grey brain matter, indicating that these people may have compromised brain function which needed further investigation.
“However, we did not find conclusive evidence to link a specific obesity subtype with dementia or stroke. Instead, our study suggests the possible role of inflammation and metabolic abnormalities and how they can contribute to obesity and grey matter volume reduction.”
The study analysed the genetic data of up to 336 000 individual records in the UK Biobank, along with self-reported information and linked hospital and death register records to connect dementia and stroke.
It found that, in middle to elderly age groups (37-73), grey brain matter decreased by 0.3 percent for every extra 1 kg/m2, which is equivalent of an extra 3 kg of weight for persons of average height (173 cm).
Senior investigator Professor Elina Hyppönen, Director of UniSA’s Australian Centre for Precision Health based at SAHMRI, said keeping to a healthy weight is important for general public health.
“It is increasingly appreciated that obesity is a complex condition, and that especially excess fat which is located around the internal organs have particularly harmful effects on health,” Prof Hyppönen said.
“Here, we used the individuals’ genetic and metabolic profiles to confirm different types of obesity. In practice, our findings very much support the need to look at the type of obesity when assessing the type of likely health impact.
“Even in a relatively normal weight individual, excess weight around the abdominal area may be a cause of concern.”
Investigators at Sanford Burnham Prebys have discovered that a certain protein circulating in blood could be a potential biomarker for schizophrenia. The activity of this protein, present in both the brain and blood, affects neural connections in human brains and is uniquely imbalanced in people with schizophrenia.
The study, an international collaboration among groups at Yokohama City University Graduate School of Medicine in Japan and the Department of Psychiatry at Harvard Medical School in Belmont, Massachusetts, was recently published in PNAS.
“This study examined the activity of CRMP2, a protein found in the brain (called a ‘cytoskeletal protein’) that regulates how neurons make connections with each other,” said co-senior author of the study Evan Y Snyder, MD, PhD, director of the Center for Stem Cells and Regenerative Medicine at Sanford Burnham Prebys. “CRMP2 also happens to be expressed in lymphocytes in the blood and can therefore be readily sampled in people by doing nothing more than a simple venipuncture.
“There was an abundance of CRMP2 levels in samples from people with schizophrenia compared to people without the disorder. We also saw structural abnormalities in the dendrites of neurons that could potentially be disabling because dendrites play an important role in receiving impulses from other nerve cells in the brain.”
In previous research, most people were found to maintain an even proportion of the two forms of CRMP2: its active, non-phosphorylated form and its inactive, phosphorylated form. Postmortem brain tissue and then blood samples from people with schizophrenia were examined and compared these levels to those in people without the disorder.
The findings indicated that the amount of active CRMP2 was too high in people with schizophrenia and, at least in young people with schizophrenia, was not balanced by an appropriate amount of increased inactive CRMP2. That imbalance between active and inactive CRMP2 could account for some dysfunctions in neural connections.
Testing blood for high levels of active CRMP2, along with low levels of inactive CRMP2, could support schizophrenia diagnosis.
“Schizophrenia can be challenging to diagnose early on or in young patients for a number of reasons,” explained Dr Snyder. “Pairing a blood test with psychiatric and neurobehavioral exams could help doctors distinguish schizophrenia from other conditions that have somewhat similar symptomologies, such as the manic phase of bipolar disorder or other behavioral, personality, or thought disorders.
“Our results were most striking in people under the age of 40, and even more so in people under the age of 30. An early diagnosis could improve the clinical management of affected individuals as well as accelerate the development of new therapeutic options,” Dr Snyder added.
As a next step, the researchers want to delve into the molecular biology of the disease to discover the ‘regulator’ that balances most people’s CRMP2 levels. They also want to conduct a larger, multi-centre clinical study that compares schizophrenia with other psychiatric disorders, which would include participants from more ethnicities and age groups.