In The News
New research, published in the journal Biological Psychiatry, investigates the neurobiological mechanisms associated with the ability of individuals with anorexia (AN) to avoid food.
Investigators believe the knowledge of how anorexics are able to resist food may be applied to issues of obesity and over-eating.
In the study, Drs. Christina Wierenga, Walter Kaye, and colleagues discovered new insights on the brain mechanisms that may contribute to the disturbed eating patterns of anorexia.
Researchers examined reward responding in relation to metabolic state (hungry or satiated) in 23 women recovered from AN and 17 healthy women without eating disorder histories (e.g., the comparison group).
Women with active AN weren’t studied to reduce potential confounds related to starvation.
The healthy women, when in a state of hunger, showed increased activity in the part of the brain that motivates the seeking of reward, but the women recovered from AN did not. The recovered women also exhibited increased activation of cognitive control circuitry regardless of metabolic state.
Investigators found that women who have recovered from anorexia nervosa show two related patterns of changes in brain circuit function that may contribute to their capacity to sustain their avoidance of food.
First, hunger does not increase the engagement of reward and motivation circuits in the brain. This may protect people with anorexia from hunger-related urges. Second, they showed increased activation of executive ‘self-control’ circuits in the brain, perhaps making them more effective in resisting temptations.
“This study supports the idea that anorexia nervosa is a neurobiologically-based disorder. We’ve long been puzzled by the fact that individuals with AN can restrict food even when starved. Hunger is a motivating drive and makes rewards more enticing,” said Wierenga.
“These findings suggest that AN individuals, even after recovery, are less sensitive to reward and the motivational drive of hunger. In other words, hunger does not motivate them to eat.”
“This study offers new insights about the brain in AN, which we are using to guide treatment development efforts, and reduce stigma associated with this life-threatening disorder,” added Kaye, professor of psychiatry and director of the Eating Disorder Program at University of California, San Diego.
“Anorexia nervosa is a devastating illness and this study sheds new light on brain mechanisms that may enable people to starve themselves. In identifying these mechanisms, this work may provide circuit-based targets for therapeutics,” commented Dr. John Krystal, editor of Biological Psychiatry.
“But these same circuits and processes seem to be engaged ‘in reverse’ for obesity. Thus, this study may have broad implications for the country’s obesity epidemic as well.”
New research finds that for patients with Parkinson disease, subthalamic nucleus deep brain stimulation (STN DBS) either improves pain or eliminates pain eight years after surgery.
However, a majority of patients will develop new pain, of lesser intensity and mostly musculoskeletal in origins.
The findings are reported online in JAMA Neurology.
Pain is a common non-motor symptom in patients with Parkinson disease and it negatively impacts quality of life.
In the new study, Beom S. Jeon, M.D., Ph.D., of the Seoul National University Hospital, Korea, and coauthors evaluated the long-term effect of STN DBS on pain in 24 patients with Parkinson disease who underwent STN DBS.
Assessments of pain were conducted preoperatively and eight years after surgery.
Of the 24 patients, 16 (67 percent) experienced pain at baseline when not taking their medication and had an average pain score of 6.2, on a scale where 10 was maximal pain.
All baseline pain improved or disappeared at eight years after surgery, according to the results. However, the authors discovered new pain developed in 18 of 24 patients (75 percent) during the eight-year follow-up.
New pain impacted 47 body parts and the average pain score for new pain was 4.4. In most of the patients (11), new pain was musculoskeletal characterized by an aching and cramping sensation in joints or muscles, the authors note.
“We found that pain in PD [Parkinson disease] is improved by STN DBS and the beneficial effect persists after a long-term follow-up of eight years.
In addition, new pain developed in most of the patients during the eight-year follow-up period. We also found that STN DBS is decidedly less effective for musculoskeletal pain and tends to increase over time. Therefore, musculoskeletal pain needs to be addressed independently,” the study concludes.
The new study clarifies that new pain arising years after the procedure is common.
Researchers believe “this underscores the importance of performing future trials with larger cohorts, longer observational periods and standard methods to enable effective interpretation of outcomes. For now, we have learned that STN DBS does not take the ouch out of PD in the long run.”
Source: JAMA Neurology
Breast cancer patients who are given the opportunity to learn stress management techniques early in treatment have been shown to maintain a more positive mood and have an improved quality of life many years down the road, according to a new study published in the journal CANCER, a peer-reviewed journal of the American Cancer Society.
“Because depressive symptoms have been associated with neuroendocrine and inflammatory processes that may influence cancer progression, our ongoing work is examining the effects of stress management on depression and inflammatory biomarkers on the one hand, and disease recurrence and survival on the other,” said Michael Antoni, Ph.D., of the University of Miami.
The study involved 240 women with a new diagnosis of breast cancer. The purpose of the trial was to test the effects of a stress management intervention developed by Antoni.
The findings showed that, compared with patients who attended a one-day seminar of education about breast cancer, those who learned relaxation techniques and new coping skills in a supportive group over 10 weeks experienced improved quality of life and fewer symptoms of depression during the first year of treatment.
Fifteen years have passed since the beginning of the study, and in the latest report, the researchers found that the women who received the stress management intervention still have fewer depressive symptoms and better quality of life.
“Women with breast cancer who participated in the study initially used stress management techniques to cope with the challenges of primary treatment to lower distress,” said lead author and graduate student Jamie Stagl, currently at Massachusetts General Hospital, in Boston.
“Because these stress management techniques also give women tools to cope with fears of recurrence and disease progression, the present results indicate that these skills can be used to reduce distress and depressed mood and optimize quality of life across the survivorship period as women get on with their lives,” she said.
In fact, Stagl noted that breast cancer survivors in the stress management group reported levels of depression and quality of life at the 15-year follow-up that were similar to what is reported by women without breast cancer.
The stress intervention was also found to be beneficial for women of various races and ethnic backgrounds. “This is key given the fact that ethnic minority women experience poorer quality of life and outcomes after breast cancer treatment,” said Stagl.
As survival rates increase for breast cancer, the ability to maintain positive mental health has become increasingly important. The new study suggests the possibility that psychologists and social workers may be able to “inoculate” women with stress management skills early in treatment to help them maintain long-term psychosocial health.
New research suggests that for men, the benefit of exercise goes beyond improving cardiovascular health and controlling weight.
In the study, investigators found that regardless of race, men who exercise more have better erectile and sexual function.
While past studies have highlighted the relationship between better erectile function and exercise, African-American men have been underrepresented in this literature.
“The study is the first to link the benefits of exercise in relation to improved erectile and sexual function in a racially diverse group of patients,” said Adriana Vidal, Ph.D., senior author of the study and investigator in the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute and Department of Surgery in Los Angeles.
The research has been published in the Journal of Sexual Medicine.
During the study, nearly 300 individuals self-reported their activity levels which researchers then categorized as sedentary, mildly active, moderately active, or highly active.
The subjects also self-reported their sexual function, including the ability to have erections, orgasms, the quality and frequency of erections, and overall sexual function.
Investigators discovered that men who reported more frequent exercise — a total of 18 metabolic equivalents, or METS, per week — had higher sexual function scores, regardless of race.
MET hours reflect both the total time of exercise and the intensity of exercise.
A total of 18 METS can be achieved by combining exercises with different intensities, but is the equivalent of two hours of strenuous exercise, such as running or swimming, 3.5 hours of moderate exercise, or six hours of light exercise.
Researchers found that men of any ethnicity who exercised less than 18 METS per week, reported lower levels of sexual function. Additional contributors to low sexual function included diabetes, older age, past or current smoking, and coronary artery disease.
Stephen Freedland, M.D., co-author of the study, cautioned that exercise should be tailored for each individual.
“When it comes to exercise, there is no one-size-fits-all approach,” said Freedland, who also serves as co-director of the Cancer Genetics and Prevention Program at Cedars-Sinai.
“However, we are confident that even some degree of exercise, even if less intense, is better than no exercise at all.”
Source: Cedars Sinai-EurekAlert!
Although many smartphone users understand that free apps sometimes share private information with third parties, few are aware of how frequently this occurs.
In a new study, researchers at Carnegie Mellon University discovered that when people learn exactly how many times these apps share that information, they rapidly act to limit further sharing.
Conceptually, application permission manager software gives people control over what sensitive information their apps can access.
In the study, researchers evaluated the benefits of the app by giving 23 smartphone users a daily message, or “privacy nudge,” telling them how many times information such as location, contact lists, or phone call logs had been shared.
Some nudges were alarming. One notable example: “Your location has been shared 5,398 times with Facebook, Groupon, GO Launcher EX, and seven other apps in the last 14 days.”
In interviews, the research subjects repeatedly said the frequency of access to their personal information caught them by surprise.
“4,182 (times) — are you kidding me?” one participant asked. “It felt like I’m being followed by my own phone. It was scary. That number is too high.”
Another participant’s response: “The number (356 times) was huge, unexpected.”
“The vast majority of people have no clue about what’s going on,” said Dr. Norman Sadeh, a professor in the School of Computer Science’s Institute for Software Research.
Most smartphone users, in fact, have no way of obtaining this data about app behavior. But the study shows that when they do, they tend to act rapidly to change their privacy settings.
Researchers examined the efficacy of both app permission managers and privacy nudges in helping people understand and manage privacy settings.
An app permission manager allows smartphone users to decide which apps have access to personal information and sensitive functionality. The study used a permission manager for Android 4.3 called AppOps.
During the first week of the study, app behavior data was collected for 23 people as they used their own Android mobile devices.
In the second week, they were given access to AppOps, and in the third and final phase they received the daily privacy nudges detailing the frequency at which their sensitive information was accessed by their apps.
The researchers found that app permission managers were helpful. When the participants were given access to AppOps, they collectively reviewed their app permissions 51 times and restricted 272 permissions on 76 distinct apps. Only one participant failed to review permissions.
But once the participants had set their preferences over the first few days, they stopped making changes.
When they began getting the privacy nudges, however, they went back to their privacy settings and further restricted many of them. During this phase, which spanned eight days, users collectively reviewed permissions 69 times, blocking 122 additional permissions on 47 apps.
“App permission managers are better than nothing, but by themselves they aren’t sufficient,” Sadeh said.
“Privacy nudges can play an important role in increasing awareness and in motivating people to review and adjust their privacy settings.”
Privacy researchers have struggled to find ways to motivate people to pay attention to online privacy, particularly for mobile devices that gather a great deal of personal information about the user.
Sadeh said when people download an Android app, they are told what information the app is permitted to access, but few pay much attention, and fewer understand the implications of those permissions.
“The fact that users respond to privacy nudges indicate that they really care about privacy, but were just unaware of how much information was being collected about them,” Sadeh said.
The AppOps software was discontinued on later versions of Android. While iPhones do have a privacy manager, it does not tell users how often their information is used or for what purpose and does not nudge users to regularly review their settings.
Nevertheless, being warned about privacy intrusions is still not the answer. This is because given the new types and growing numbers of apps now in circulation, even the most diligent smartphone user is likely to be overwhelmed by the choices for privacy controls.
Sadeh said ultimately, the solution may be personalized privacy assistants — software that learns an individual’s privacy preferences and selectively engages in dialogues with users to help semi-automatically configure many of their settings.
Nevertheless, research along these lines is progressing. Sadeh said his own research shows that it’s possible to predict an individual’s mobile app privacy preferences with over 90 percent accuracy based on their answers to just a few privacy-related questions.
Source: Carnegie Mellon University
Recent findings suggest that the perception of eating disorders as a female problem may be preventing boys and men from seeking help.
About one in eight people with anorexia nervosa is male. This equates to one in 2,000 men, compared with one in 250 women.
Anorexia is one of the four recognized types of eating disorders, with the others being bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified (EDNOS). It has the highest mortality rate of all adolescent psychiatric conditions.
Rates among men are rising, but there is often poor recognition of the signs and symptoms of eating disorders in men, said Dr. Ulla Raisanen of Oxford University, U.K., and her team. As such, true rates may be higher than the official estimates. Some studies suggest that men with anorexia are more likely to engage in obsessive exercise and have more severe psychiatric problems as a result of the condition.
The team interviewed 39 young people aged 16 to 25 with an eating disorder. Of the interviewees, 10 were men. The male respondents had all been slow to realize that they had the potential signs and symptoms of an eating disorder. Crucially, behaviors such as going days without eating, purging, obsessive calorie-counting, exercise, and weighing became entrenched during this time.
Some cited the perception that eating disorders are a women’s problem as one of the main reasons why it took them so long to realize. One said he thought eating disorders only affected “fragile teenage girls”, and another said he thought these disorders were “something girls got”.
The eating disorder often went unrecognized by friends, family, and teachers, and was often only diagnosed at a crisis point such as being admitted to hospital for self-harming.
The study is published in the journal BMJ Open. The authors write, “Our findings suggest that men may experience particular problems in recognizing that they may have an eating disorder as a result of the continuing cultural construction of eating disorders as uniquely or predominantly a female problem.”
The team also reports that men’s experiences of the health care system were mixed. “They said they often had to wait a long time for specialist referral and had sometimes been misdiagnosed, or, as in one case, told by the doctor ‘to man up.’ They complained of insufficient information about eating disorders targeted specifically at men,” they write.
One participant was given information and advice, but still felt that “I don’t think there’s any real information out there particular for men or any even awareness that it exists.”
The men expressed a strong desire for balanced, gender-tailored information. They felt that gender-blind information reflected wider societal constructions of anorexia as predominantly or only affecting women.
A lack of understanding and training among health professionals may also contribute to delays in diagnosing and treating anorexia among men, in part because men with anorexia might account for symptoms regarding weight and dieting behaviors differently from female sufferers. For example, “unusual behaviors could be misinterpreted as personal choices,” they explain.
But they point out that the study is limited to young people, so does not contribute to an understanding of older people with eating disorders.
“Men with eating disorders are under-diagnosed, under-treated, and under-researched. In order to improve the outlook for men with eating disorders, early detection is imperative,” they state.
Early diagnosis and intervention for anorexia has been shown to prevent the development of long-term, potentially life-threatening, psychiatric issues. Treatment can include psychological and drug interventions as well as dietary advice, but early diagnosis and intervention is important for long-term outcomes.
Another recent study indicated that treatment outcomes in all eating disorders are better for men than women, when remission was measured by a return to healthy weight and relapsing.
“In order to improve prognosis for men with eating disorders, early detection is imperative,” the team writes.
“Primary care clinicians have a key role in recognizing early symptoms. Until information resources are made more appropriate for men with eating disorders, health care providers need to be particularly sensitive to men’s needs in relation to an illness so strongly associated with women.
“Raising awareness of eating disorders more widely in society is also crucial to help men (and women) to recognize and seek help before their symptoms and behaviors become intractable.
“It is important to decouple the experience and self-management of eating disorders from feminized cultural imagery, resources, and clinical practice if we wish to prevent men from dismissing signs and symptoms themselves, and prevent health and other professionals (e.g. teachers) from overlooking signs and symptoms in boys and young men that they may readily recognize as indicative of eating disorders in young women.”
Raisanen, U., & Hunt, K. The role of gendered constructions of eating disorders in delayed help-seeking men: a qualitative interview study. BMJ Open, 9 April 2014 doi: 10.1136/bmjopen-2013-004342
One reason why drinking and driving is so dangerous is that alcohol tends to push a person toward riskier behavior. In a new study, researchers discovered that as blood alcohol levels spike, males, in particular, are more likely to make riskier choices.
In general, people tend to avoid decisions in which the outcomes are uncertain; this is known as “ambiguity aversion.” But psychological scientists Drs. Tadeusz Tyszka, Anna Macko, and Maciej Stańczak from Kozminski University in Warsaw, Poland, found that after people had a few drinks, they were much more willing to bet on a risky choice with unknown odds.
When it comes to driving home, drinkers may find themselves more willing to risk the potential consequences of driving under the influence instead of calling a cab.
For the study, researchers recruited 100 participants — 46 women and 54 men between the ages of 18 and 43 years — from a restaurant bar. Researchers went up to bar customers and asked them if they would be interested in participating in a study on people’s accuracy in guessing their own blood alcohol levels.
Volunteers were then taken to a separate room where they guessed their current blood alcohol concentration (BAC). Their actual BAC was then measured using a breathalyzer.
As a reward for their participation, bar patrons were told that they could win free drink tickets. Each participant was asked to pull a card from one of two jars. One jar contained 15 free drink vouchers and 15 empty cards, so participants were told that the odds of winning were 50/50. The second jar contained 30 coupons, including vouchers good for two free drinks at the bar as well as empty cards. Participants were not told their chances for winning in the “ambiguous-choice” jar.
The findings showed that higher levels of alcohol strongly impacted people’s willingness to bet on the risky ambiguous-choice jar — but only in males. Regardless of blood alcohol levels, women in the study preferred betting on the known 50/50 odds. In men, however, the more drunk they were, the more likely they were to choose the jar with unknown odds.
Overall, when BAC levels in men rose above 1.00 percent (the legal limit to drive in all U.S. states is at least .08 percent), they became more likely to choose the jar with the riskier, unknown odds. The researchers suggest that one reason for this gender difference is that men are more often socialized to see risk-taking as a positive trait.
The study is published in the journal Frontiers in Psychology.
A new paper reports the incidence of diagnosed autism was twice as high for assisted reproductive technology (ART) as non-ART births in a California study.
ART includes a group of complex procedures that are often utilized if a woman does not become pregnant after treatment with medical and surgical techniques. Techniques include intrauterine insemination (IUI), in vitro fertilization and third party assisted ART.
The new study reviewed nearly six million children born in California from 1997 through 2007.
Researchers report, however, that much of the association between ART and autism can be explained by age and education of the mother as well as adverse perinatal outcomes, especially multiple births. After accounting for these factors, the study showed an elevated risk only for mothers ages 20-34.
Notably, the study reported no significant increased risk of autism for women who gave birth to singleton children.
“These results indicate that the higher autism risk may be due mainly to the large numbers of multiple births and complications of pregnancy and delivery among children conceived with ART,” said Dr. Christine Fountain, assistant professor of sociology at Fordham University and affiliated researcher at Columbia University.
Autism impairs social interaction and predisposes children to restrictive and repetitive behaviors. Over the past three decades, California has witnessed a very large spike in autism cases, as have many other areas of the United States.
The study, a large collaboration between researchers at Columbia University, Fordham University, and the Centers for Disease Control and Prevention, was published by the American Journal of Public Health.
The study was based on a massive linkage of different kinds of records from the California Birth Master Files for 1997 through 2007, the California Department of Developmental Services autism caseload for 1997 through 2011, and the Centers for Disease Control and Prevention’s National ART Surveillance System for live births in 1997 through 2007.
In sum, information about all of the 5,926,251 live births, including 48,865 infants conceived with ART and 32,922 cases of autism diagnosed by the Department of Developmental Services were involved in the study which compared births originated using ART with births originated without ART for incidence of autism diagnosis.
“This study of the relationship between ART and autism is the largest to date,” said Dmitry Kissin, M.D., M.P.H., health scientist in CDC’s Division of Reproductive Health.
“The results indicate that reducing multiple births during ART may be beneficial for decreasing the risk of autism.”
Dr. Peter Bearman, Cole Professor of the Social Sciences and the lead investigator at Columbia University said, “While the risk of ART with respect to autism appears to be largely modifiable by restricting the procedure to single-embryo transfer, more research is needed to understand the precise mechanisms by which ART and autism are linked.”
Source: Columbia University/EurekAlert!
Emerging research suggests the installation of alcohol ignition interlock devices could prevent nearly 60,000 deaths.
Researchers at the University of Michigan Injury Center and the University of Michigan Transportation Research Institute studied the impact of installing these alcohol ignition interlock devices in all newly purchased vehicles over a 15-year period.
Investigators conclude that the country could avoid 85 percent of crash deaths attributable to alcohol-involved motor vehicle crashes during the 15-year implementation period.
That would mean saving more than 59,000 lives, the team reports in a paper published online in the American Journal of Public Health.
Another 1.25 million non-fatal injuries would also be prevented, they calculate, as the nation would see a reduction of 84 to 89 percent.
Societal economic benefits from the ‘SMART’ automobile includes the saving of $343 billion over 15 years. In fact, the cost of installing the devices would be recouped after just three years.
“We knew our modeling would yield significant results, but the sheer numbers of preventable fatalities and serious injuries were surprising. Our analysis clearly demonstrates the significant public health benefit and societal cost savings associated with including alcohol ignition interlock devices as standard equipment in all new cars,” said lead-author Patrick Carter, M.D.
This is the first study in the United States that models the impact of a universal policy installing alcohol interlocks on all new vehicles sold in the U.S.
The report was based on two national data sets used frequently in analyses of motor vehicle crashes: the Fatality Analysis Reporting System; and the National Automotive Sampling System’s General Estimates System data sets (2006-2010).
Researchers found that younger drivers would benefit the most from the new safeguard.
Though the injury prevention benefit was apparent for all ages, drivers who are closes to the legal drinking age would likely be the most significant beneficiaries of alcohol interlocks.
Among drivers age 21 to 29 years, 481,103 deaths and injuries would be prevented, nearly 35 percent of total deaths and injuries for all age groups. Drivers less than 21 years old who engaged in drinking while driving would also benefit substantially, with 194,886 deaths and injuries potentially prevented.
“It is often difficult to penetrate these age groups with effective public health interventions and policies to prevent drinking and driving,” says Carter.
“By capitalizing on recent technological advancements that make alcohol-detecting sensors seamless to the driver and applying such technology more broadly to all newly built vehicles, we can actually have a substantial injury prevention impact among traditionally hard-to-reach high-risk populations.”
The estimated injury prevention impact was derived first by modeling the proportion of the alcohol-related crashes that are preventable for all vehicles less than one year old and then repeating the analysis for each year of a projected 15-year time-frame.
Cost savings were determined by applying existing crash-induced injury cost metrics.
Source: University of Michigan
As the obesity epidemic spreads across America, new public policies seek to incorporate environmental solutions as a method to improve health.
However, the value or efficacy of the interventions are often obscure.
New health policies include banning sodas from school vending machines, building walking paths and playgrounds, adding supermarkets to food deserts and requiring nutritional labels on restaurant menus.
These population based solutions attempt to stem the increase the obesity, but which of these changes actually make an impact?
The new interventions are often called “natural experiments” as they compare people’s calorie consumption or physical activity levels before and after a policy or environmental change.
Or, they may compare the target group against a similar group of people not affected by that change. But not all natural experiments are created equal.
“Rigorous science is needed to evaluate these natural or quasi-experiments,” said Amy Auchincloss, Ph.D., an associate professor at the Drexel University School of Public Health.
Auchincloss was a member of a research team that authored a new study published online ahead of print in Obesity Reviews: “Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments.”
The review was led by Stephanie Mayne, a doctoral student supervised by Auchincloss, and also co-authored by Yvonne Michael, Sc.D., an associate professor and associate dean for academic and faculty affairs in the Drexel University School of Public Health.
The Drexel team reviewed the state of the science on this topic, evaluating the results and methods of all previous such studies published in the medical literature, in particular:
- Which policies and built environment changes have been evaluated via natural- or quasi-experiments and what are the results from these studies?
- Are there issues of concern with the studies’ design, including methods of assessment?
- What are the limitations of these studies and areas where additional science is needed?
Researchers say this is the first review that has examined the use of natural- or quasi-experiments to evaluate the efficacy of policy and built environment changes on obesity-related outcomes (body mass index, diet, or physical activity).
The review identified certain types of interventions that are more successful than others in improving obesity-related outcomes, and identified areas where more research is needed to draw conclusions about obesity-related outcomes:
Changes with strong impacts were ones that improved the nutritional quality of foods:
- trans-fat bans;
- sugary food and beverage availability limits;
- higher-fat food availability limits.
Changes that had smaller or no impacts in the research to date included:
- nutritional information requirements;
- supermarkets built in underserved areas.
Researchers did observe that some changes had stronger health impacts. These included infrastructure improvements that encourage walking and cycling (active transportation). Furthermore, they found long-term studies were more effective in identifying the interventions that had a meaningful impact.
Investigators recommend additional research to look at physical activity effects (not just use of amenities) for built environment changes including:
- park improvements;
- active transportation infrastructure.
The researchers noted that a common shortcoming in many studies is that they only measured process outcomes such as food purchases or use of bike/transit infrastructure, rather than measuring the desired health outcomes, such as weight loss.
“Research suggests that people will use new amenities like bike shares, and limit purchases of unhealthy foods in specific contexts like schools,” said Mayne. “But it is less clear whether these changes translate into overall improvements in diet and physical activity.”
Likewise, only a few studies directly assessed impacts on BMI or weight; thus, the authors concluded that evidence is lacking on whether environmental and policy modifications are successful in maintaining healthy weight or reducing excess weight.
A key value of a natural experiment is that it can narrowly focus on the direct impact of a change in policy or infrastructure on an affected population — making natural experiments an important way to check on what kinds of public policies and investments make real-world impacts on health, and to what degree.
The authors concluded that more natural experiments are needed to strengthen the evidence base about obesity-related policies and interventions.
Source: Drexel University
A new study from the University of Texas at Austin attributes men’s preferences for women with a curvy backside to prehistoric influences.
The study, published in Evolution and Human Behavior, investigated men’s preferences for women with a “theoretically optimal angle of lumbar curvature,” a 45.5 degree curve from back to buttocks, which allowed women to better support, provide for, and carry out multiple pregnancies.
“What’s fascinating about this research is that it is yet another scientific illustration of a close fit between a sex-differentiated feature of human morphology — in this case lumbar curvature — and an evolved standard of attractiveness,” said the study’s co-author Dr. David Buss, a University of Texas Austin psychology professor.
“This adds to a growing body of evidence that beauty is not entirely arbitrary, or ‘in the eyes of the beholder’ as many in mainstream social science believed, but rather has a coherent adaptive logic.”
The research, led by UT alumnus Dr. David Lewis, now a Bilkent University psychologist, consisted of two studies.
The first looked at vertebral wedging, an underlying spinal feature that can influence the actual curve in women’s lower backs.
The researchers asked about 100 men to rate the attractiveness of several manipulated images displaying spinal curves ranging across the natural spectrum. The researchers found that men were most attracted to images of women exhibiting the hypothesized optimum of 45 degrees of lumbar curvature.
“This spinal structure would have enabled pregnant women to balance their weight over the hips,” Lewis said. “These women would have been more effective at foraging during pregnancy and less likely to suffer spinal injuries.
“In turn, men who preferred these women would have had mates who were better able to provide for fetus and offspring, and who would have been able to carry out multiple pregnancies without injury.”
The second study addressed the question of whether men prefer this angle because it reflects larger buttocks, or whether it really can be attributed to the angle in the spine itself.
Approximately 200 men were presented with groups of images of women with differing buttock size and vertebral wedging, but maintaining a 45.5-degree curve. Men consistently preferred women whose spinal curvature was closer to optimum regardless of buttock size, according to the study’s findings.
“This enabled us to conclusively show that men prefer women who exhibit specific angles of spinal curvature over buttock mass,” said the study’s co-author Dr. Eric Russell, a visiting researcher from University of Texas Arlington.
The researchers note that this preference evolved over thousands of years, and it won’t disappear over night.
“This tight fit between evolutionary pressures and modern humans’ psychology, including our standards of attractiveness, highlights the usefulness that an evolutionary approach can have for expanding our knowledge not just of the natural sciences, but also the social sciences,” Lewis said.
Source: University of Texas at Austin
iMAGE Credit: The University of Texas at Austin
New research has found that suspending teens from school for using marijuana is likely to lead to more marijuana use among their classmates.
The study, conducted by researchers at the University of Washington and in Australia, found that counseling was a more effective means of combating marijuana use.
The researchers also found that, while enforcing anti-drug policies is a key factor in whether teens use marijuana, the way schools respond to those who violate those policies matters greatly.
The new study compared drug policies at schools in Washington State and Victoria, Australia, to determine how they affected marijuana use by students.
The researchers said the results startled them. They found that students attending schools with suspension policies for illicit drug use were 1.6 times more likely than their peers at schools without such policies to use marijuana in the next year.
Moreover, that was the case with the student body as a whole, not just those who were suspended, according to the study’s findings.
“That was surprising to us,” said co-author Dr. Richard Catalano, a professor of social work and co-founder of the Social Development Research Group at the University of Washington’s School of Social Work. “It means that suspensions are certainly not having a deterrent effect. It’s just the opposite.”
By contrast, the study found that students attending schools with policies of referring students who use marijuana to a school counselor were almost 50 percent less likely to use marijuana.
Other ways of responding to policy violators, such as sending them to educational programs, expelling them, or calling the police, were found to have no significant impact on marijuana use, according to the study’s findings.
Data used in the new research came from the International Youth Development Study, an initiative started in 2002 to examine behaviors among young people in Washington and Victoria.
The two states were chosen since they are similar in size and demographics, but differ considerably in their approaches to drug use among students, researchers said. Washington schools are more likely to suspend students, call police or require offenders to attend education or cessation programs, the researchers note, while Victoria schools emphasize an approach that favors counseling.
Researchers surveyed more than 3,200 seventh- and ninth-graders and nearly 200 school administrators in both 2002 and 2003. Students were asked about their use of marijuana, alcohol, and cigarettes, and also about their schools’ drug policies and enforcement.
In both survey years, marijuana use was higher among Washington students than those in Victoria, the researchers said. Almost 12 percent of Washington ninth-graders had used marijuana in the past month, compared with just over nine percent of Victoria ninth-graders, according to the study’s findings.
The researchers were initially interested in teens’ use of alcohol and cigarettes, according to Catalano. But after Washington legalized recreational marijuana use for adults in 2012, the researchers decided to take a closer look at the data to determine how legalization might influence students in Washington versus their counterparts in Australia, where pot remains illegal.
Research has shown a consistent link between increased access to marijuana and higher rates of self-reported use by adolescents, the study notes. In Washington and Colorado, where recreational marijuana use by adults was also legalized in 2012, school systems have new responsibilities to educate students about marijuana and respond effectively when teens are caught using it, Catalano said.
“To reduce marijuana use among all students, we need to ensure that schools are using drug policies that respond to policy violations by educating or counseling students, not just penalizing them,” he said.
The study was published in the American Journal of Public Health.
Source: University of Washington
A new study has found unexpected gender differences among teenagers who watch music videos on television.
The study, conducted at the Catholic University of Leuven in Belgium, found that sexually active youth of both genders think their peers are also sexually active after watching music TV.
But the study also found that when girls and boys perceive males in music videos as being sexually active, it makes boys watch more music TV, and girls watch less.
The study, published in Springer’s journal Sex Roles, notes that watching music videos is a popular pastime of European and American teenagers. The videos, however, are often criticized for having too much sexual content, for objectifying women and for promoting a recreational view of sexual activities. They also have been linked to teenagers becoming sexually active earlier in life, according to the researchers.
For their study, researchers gathered information three times over the course of a year from 515 Belgian teenagers between the ages of 12 and 15. The kids were asked how much music television they watched, how sexually active they were, and how sexually active they thought their peers were.
The researchers found that watching sexual music videos only had an effect on the sexual behavior of teenage boys, but not girls. They said they believe this behavior is influenced by the sexual scripts of music videos, which tend to show men taking a more active role in any sexual interaction.
Watching music videos definitely had an influence on how sexually active boys and girls thought peers of the same sex were, the researchers reported. It made them believe that many of their friends were also sexually active — even though this might not be true.
This, in turn, made the boys watch even more of this kind of television, according to the study’s findings. Girls, on the other hand, stopped watching this kind of television.
The researchers speculate that this might be a type of defense reaction on the part of girls who believe that many male peers are sexually active. The girls also may be rejecting media content that tends to portray girls as sexual objects, the researchers hypothesized.
“Regarding the influence of music television exposure on sexual behavior, our findings suggest that increased sexual activities may be triggered by media use among boys, but not among girls,” said co-author Eline Frison.
“As the portrayal of women as objects of lust reflects patriarchal values, media images that support this type of male dominance may provoke resistance in female viewers. This is especially valid among those who view such activity as a threat because of the high sexual activity rates of male peers.”
Researchers have developed a new scoring method to help identify which older people are at greater risk for developing mild cognitive impairment (MCI), a condition that can eventually lead to full dementia.
“Our goal is to identify memory issues at the earliest possible stages,” said study author Ronald C. Petersen, M.D., Ph.D., of the Mayo Clinic in Rochester, Minn., and a member of the American Academy of Neurology.
“Understanding what factors can help us predict who will develop this initial stage of memory and thinking problems, called mild cognitive impairment, is crucial, because people with MCI have an increased risk of developing dementia.”
The study, published in the journal Neurology, recruited 1,449 participants, aged 70 to 89, who did not have current memory and thinking problems. At the beginning of the study and at visits every 15 months for an average of 4.8 years, subjects underwent memory and thinking tests. During the study period, 401 people, or 28 percent, developed MCI.
The scoring system took into account factors such as years of education, history of stroke or diabetes, and smoking. Researchers also factored in information gathered at the clinic visit, such as participants’ scores on tests of cognition as well as any reported symptoms of depression and anxiety.
All factors were assigned a score based on how much they contributed to the risk of developing thinking problems. For instance, people who were diagnosed with diabetes before the age of 75 were given an extra 14 points, while those with 12 or fewer years of education were given two points.
Among women, the group with the lowest risk had scores of less than 27 and the highest had scores of more than 46. For both men and women, those in the highest risk group were seven times more likely to develop mild cognitive impairment than those in the lowest group.
The biggest contributors to mild cognitive impairment were age, heart health risk factors, depression and anxiety disorders, and memory or functional abilities, which were all identified at the start of the study.
The APOE gene, which has been linked to a higher risk of dementia in previous studies, was determined to be only a moderate risk factor in the current study.
“This risk scale may be an inexpensive and easy way for doctors to identify people who should undergo more advanced testing for memory issues or may be better candidates for clinical trials,” said Petersen.
Source: American Academy of Neurology
A new study has found that students who are older when they start kindergarten are more likely to drop out of school and commit serious crimes as teenagers.
Additionally, this negative outcome is significantly more likely for children from disadvantaged backgrounds, according to a researcher from Duke University.
“This research provides the first compelling evidence of a causal link between dropout and crime. It supports the view that crime outcomes should be considered in evaluating school reforms,” said lead author Dr. Philip J. Cook, a professor in Duke’s Sanford School of Public Policy.
“Dropouts are greatly over-represented in prison, so we know there is a strong association between dropping out and crime,” he continued.
“But to establish causation requires an experiment. My analysis takes advantage of nature’s experiment associated with birth date.”
The study compared North Carolina public school students born 60 days before and 60 days after the school cutoff date. At the time of the study, North Carolina children had to turn five by Oct. 16 to be eligible to enter kindergarten that year, according to the researchers.
Previous studies have established that children born just after the school-entry cutoff date, who enter school “old for grade,” perform better academically than their younger classmates.
As a result, a growing number of parents have delayed enrolling their children whose birthdays fall shortly before the cutoff date, seeking to gain academic and social advantages, the researcher notes. Known as “academic redshirting,” this delay is more common for boys than girls and for whites than African-Americans.
In addition to performing better academically, Cook’s study found old-for-grade students were one-third less likely to engage in delinquent behavior while still in school.
“Up until the 16th birthday, it is all positive,” Cook said. “They are doing better, relative to their classmates, by every measure. It makes sense, because they are more mature.”
But after age 16, the picture shifts, according to Cook’s research. The old-for-grade students are more likely to drop out and be convicted of a felony before age 20.
The explanation for the seeming contradiction lies in the age at which students may legally withdraw from school, which is 16 in North Carolina, he noted.
“If they were born before the cutoff date, they have just 19 months between their 16th birthday and graduation to be tempted to drop out,” Cook said. “If they were born just after and enter school later, they have 31 months, and for some of them, it is an irresistible temptation.”
“It’s human nature,” he added. “For a lot of adolescents, high school is a drag.”
Among the old-for-grade students, the likelihood of dropping out and being convicted of a serious crime is 3.4 times greater for those born to an unwed mother and 2.7 times greater for those whose mothers were high school dropouts, according to the study’s findings.
Policymakers should take notice, Cook said.
“Even something as crude as a regulation that requires a kid stay in school to a fixed age, whether he wants to or not, has a considerable effect on criminal activity,” he said.
Rather than tie when kids can drop out to an age, states might consider requiring completion of a certain grade or a specified number of years in school, he said.
“People say there is no point keeping a kid in school who doesn’t want to be there because he won’t learn anything and he’ll be disruptive,” Cook said. “My findings suggest that intuitive argument is not entirely correct.”
“Even students who would rather drop out can benefit from staying in school when they are required to do so,” he concluded. “Otherwise they are prime candidates for recruitment into a life of crime.”
The study was published in the American Economic Journal-Applied Economics.
Source: Duke University
News consumers have only themselves to blame for the negative news phenomenon, find researchers in a new study, as the results show that it’s actually consumer buying habits that are driving the negative press.
The study, conducted by Professor Jill McCluskey from Washington State University and a team from the University of Leuven in Belgium, is among the first to investigate a negative news bias from the consumer, or demand side; previous studies have focused mainly on the supply side by examining media output.
The study examined how people tend to use information from news articles to enhance their well-being and avoid losses. Their model analyzed how much happiness consumers obtained from choosing either bad or good news.
The findings showed greater individual benefit from reading the bad news.
In general, this tendency creates a public preference for negative news stories, McCluskey said. “Newspapers act on this demand by reporting more bad news to attract readers and sell more papers.”
The researchers built their model on an economic theory suggesting that as a person’s wealth increases, the impact of each additional dollar diminishes.
“When you are very poor and hungry, for example, each dollar is worth a lot as it helps you buy enough food to eat,” McCluskey said. “But once you have more money and can count on regular meals, it’s the losses that will affect you more. In terms of happiness and well-being, a $1,000 loss will affect you more than a $1,000 windfall.”
The same idea applies to information appearing in newspapers, the Internet, TV, or radio. In their model, the researchers assessed the benefits or drawbacks people get from consuming a good or service — in this case, positive and negative news stories. Their findings reveal a strong human tendency to avoid risk.
McCluskey said consumers read good news to discover personal benefits from a positive event, such as an event that would improve their own income or welfare.
Reading about the success of a Fortune 500 company, for example, might help one decide to invest in their stock. Reading bad news, however, provides information on how to avoid a negative event or loss to one’s well-being. In other words, reading bad news helps consumers avoid making bad choices.
“Food scares are a good illustration as they are widely covered by the media,” McCluskey said. To protect their health, “people choose to avoid the suspected food, such as beef during the Mad Cow scare, or spinach with the E.coli outbreaks.”
Over time, news consumers, either consciously or subconsciously, continue to choose newspapers with more negative reporting. In response, news outlets take advantage of that risk aversion to maximize their profits.
Reading bad news can certainly create negative consequences of its own, however. For example, some people become depressed from reading too much bad news or develop an exaggerated fear of risk.
Bad news can also lead to extended responses to a negative event. “Even after the E. coli scare was over, people still wouldn’t buy spinach. There can be a lot of impact on growers and wasted food with these scares,” McCluskey said.
The study is published in the journal Information Economics and Policy.
Source: Washington State University
Looking at visual cues associated with overweight or obese people can influence a person’s sense of smell, according to a new study. The more a person is turned off by an obese image, the worse he or she will tend to rate a particular scent.
The findings suggest that the extent of negative bias toward overweight and obese people may be greater than previously thought. Surprisingly, people with higher BMIs tended to be more critical of other heavier people, as higher-BMI participants gave scents a lower rating when scent samples were matched with an obese or overweight individual.
“You wouldn’t think that not liking someone’s weight could then be seen in a totally different sensory modality, which makes us think, ‘How else is weight stigma affecting our lives that we don’t even know about?'” said Dr. A. Janet Tomiyama, an assistant professor of psychology at the University of California, Los Angeles (UCLA).
Tomiyama conducted the research with Angela Incollingo-Rodriguez, a UCLA doctoral student in psychology, and Dr. Andrew Ward, a professor of psychology at Swarthmore College.
“This is the first step in proving that the consequences of weight stigma could be very widespread in ways that we don’t even know,” Tomiyama said.
Lead author Incollingo-Rodriguez added that while some people are overtly biased, others are more subtle about it and may not even be aware that they harbor negative feelings toward heavy people.
“There are no checks and balances on weight stigma in the way you would see with racism, sexism, or homophobia,” Tomiyama said.
In two related studies, participants were shown one of two sets of images. Both sets contained photographs of different people — half who were visibly overweight or obese, and half who were normal weight or thin — along with a series of “distractor” objects.
Along with each image, subjects were asked to smell a container of lotion tinted with a different food coloring. Although all of the scent samples were actually fragrance free, the researchers wanted to see whether participants would perceive them to have different smells, and whether their reactions could be associated with the pictures they were viewing at the same time.
With each visual image, a researcher placed the scent sample under the participant’s nose. Participants were asked to rate each scent on a scale from one to 11.
The researchers found that when overweight or obese people were on the screen, participants gave worse ratings to the scent samples, while photos of average-sized or thin people tended to trigger higher ratings.
The link between visual stimuli and sense of smell is well-established: Prior research has connected the perception of negative odors to feelings of disgust.
“Right now, we only have a couple of ways to measure implicit attitudes, such as an implicit-association test measure,” Incollingo-Rodriguez said. “We wanted to see if looking at something you find unappealing or unpleasant could influence how you evaluate a smell that has nothing to do with weight.
“This shows that something is happening implicitly, and we may have tapped into a new methodology for assessing people.”
She said weight bias can affect people’s everyday lives in many different ways, including how they are treated in social situations, the quality of medical care they receive, and hiring and promotion decisions.
“It also undermines people’s motivation to diet and exercise,” Incollingo Rodriguez said. “If anything, stigma is a barrier to these lifestyle changes that people commonly use to lose weight.”
The findings are published by the International Journal of Obesity.
Taking a brief nap after studying — instead of participating in other activities — can significantly increase retention of the information just learned, according to a new study at Saarland University.
“Even a short sleep lasting 45 to 60 minutes produces a five-fold improvement in information retrieval from memory,” says Professor Axel Mecklinger, Ph.D.
“The control group, whose members watched DVDs while the other group slept, performed significantly worse than the nap group when it came to remembering the word pairs. The memory performance of the participants who had a power nap was just as good as it was before sleeping, that is, immediately after completing the learning phase.”
During the study, the researchers focused mostly on the role of the hippocampus, the part of the brain where memories are consolidated. In the hippocampus, previously learned information is transferred into long-term memory storage.
“We examined a particular type of brain activity, known as ‘sleep spindles,’ that plays an important role in memory consolidation during sleep,” explains Sara Studte, a graduate biologist specializing in neuropsychology. A sleep spindle is a short burst of rapid oscillations in the electroencephalogram (EEG).
The greater the number of sleep spindles in a person’s brain, the better he or she will remember newly acquired information. New information is essentially given a label, making it easier to recall that information at some later time.
“We suspect that certain types of memory content, particularly information that was previously tagged, is preferentially consolidated during this type of brain activity,” says Mecklinger.
In an effort to rule out the possibility that the study subjects only recall the learned items due to a feeling of familiarity, the researchers used the following trick: participants were asked to learn not only 90 single words, but also 120 word pairs, in which the word pairs were essentially meaningless.
“A word pair might, for example, be ‘milk-taxi.’ Familiarity is of no use here when participants try to remember this word pair, because they have never heard this particular word combination before and it is essentially without meaning. They therefore need to access the specific memory of the corresponding episode in the hippocampus,” said Mecklinger.
“A short nap at the office or in school is enough to significantly improve learning success. Wherever people are in a learning environment, we should think seriously about the positive effects of sleep.”
Source: Saarland University
A new diet, known by the acronym MIND, has been found to significantly reduce a person’s risk of developing Alzheimer’s disease (AD), even when the diet is not strictly followed, according to new research published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
The MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, both of which have been found to reduce the risk of cardiovascular conditions, including hypertension, heart attack and stroke.
The diet was developed by nutritional epidemiologist Martha Clare Morris, Ph.D., of Rush University in Chicago, and her colleagues.
According to the study findings, the MIND diet was able to lower the risk of AD by as much as 53 percent in participants who strictly adhered to the diet, and by about 35 percent in those who followed it fairly well.
“One of the more exciting things about this is that people who adhered even moderately to the MIND diet had a reduction in their risk for AD,” said Morris, a Rush professor, assistant provost for Community Research, and director of Nutrition and Nutritional Epidemiology.
“I think that will motivate people.”
The diet is based on information accrued from years’ worth of past research about which foods and nutrients have positive and negative effects on the functioning of the brain over time. This is the first study to relate the MIND diet to Alzheimer’s disease.
For the study, the MIND diet was compared with the two other diets. People with high adherence to the DASH and Mediterranean diets also had reductions in AD — 39 percent with the DASH diet and 54 percent with the Mediterranean diet — but got insignificant benefits when they only loosely followed either diet.
The MIND diet labels 15 dietary components: 10 “brain-healthy food groups” — green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine — and five unhealthy groups such as red meats, butter and stick margarine, cheese, pastries, and sweets, and fried or fast food.
To follow the MIND diet, a person should eat at least three servings of whole grains, a salad and one other vegetable every day — along with a glass of wine — snack most days on nuts, eat beans every other day or so, eat poultry and berries at least twice a week, and eat fish at least once a week.
However, a person should limit consumption of the designated unhealthy foods, especially butter (less than one tablespoon a day), cheese, and fried or fast food (less than a serving a week for any of the three), to have a real shot at avoiding the devastating effects of AD, according to the study.
Berries are the only fruit included in the MIND diet. “Blueberries are one of the more potent foods in terms of protecting the brain,” Morris said, and strawberries have also performed well in past studies of the effect of food on cognitive function.
AD, which takes a devastating toll on cognitive function, is not unlike heart disease in that there appear to be “many factors that play into who gets the disease,” including behavioral, environmental and genetic components, Morris said.
“With late-onset AD, with that older group of people, genetic risk factors are a small piece of the picture,” she said. Research has shown that what we eat may play a significant role in determining who gets AD and who doesn’t, Morris added.
The findings also suggest that the longer a person adheres to the MIND diet, the less risk a person will have of developing AD. “You’ll be healthier if you’ve been doing the right thing for a long time,” Morris added.
Source: Rush University Medical Center
A new project levers the ubiquity of mobile technology to improve depression screening among pregnant and new mothers.
Researchers from the University of Illinois believe the use of tablet computers will foster universal screening for perinatal depression at public health clinics. Investigators call the use of mobile technology to screen for depression — mHealth technology.
“We’ve talked to clinicians at other sites, and the mHealth technology is a no-brainer — it’s easy, people are comfortable with it, it’s faster and it’s paperless — there are so many great things about it,” said principal investigator Karen M. Tabb Dina, a professor of social work.
“But clinics across the country are struggling with how to implement universal screening, and from what we’ve learned, they’re implementing it without getting staff feedback first.”
Early in the project, focus groups were held with Public Health staff members to gain their perspectives about the clinic’s paper-based screening system and the possibility of using technology to overcome language barriers and other obstacles.
A paper on the project will be published in a forthcoming issue of the journal General Hospital Psychiatry, says Tabb Dina, the lead author.
Dina is also the principal investigator for Identifying Depression through Early Assessment, a multidisciplinary project that is exploring the prevalence of perinatal depression among women in Brazil and the U.S.
Perinatal depression — which begins during pregnancy or up to a year after childbirth — may affect up to 20 percent of women worldwide. Some recent studies suggested that the disease might be twice as prevalent among low-income women.
Under a 2008 Illinois law, clinics and hospitals that provide prenatal care, labor, and delivery services are required to screen women for perinatal depression.
Champaign-Urbana Public Health District alone, serves about 3,100 pregnant women and postpartum women each month. The District administers a depression questionnaire at least once during each client’s pregnancy and again after delivery.
“The paper-based screenings are great if you complete them and score them immediately, but sometimes there’s a little bit of delay, which can be a barrier if you have to find the client later,” said Brandon Meline, director of maternal and child health management at Public Health.
“We have a pretty transient population, so we try to get everything done — education, interventions, and referrals — while the client is here.”
The tablets are equipped with electronic versions of the Edinburgh Postnatal Depression Scale, a 10-item questionnaire commonly used by clinics.
Currently, Public Health provides the paper form in English, French, and Spanish, although it frequently treats clients who speak other languages, such as Korean, Mandarin, and Turkish.
The variety of ethnic groups and languages has been a challenge as women who rely upon their partners to help them complete the forms may be reluctant to disclose their symptoms, say the researchers.
Because the software provides the questionnaire in numerous languages, clients can complete the screening in the language they are most comfortable using. And audio technology enables even women with poor literacy skills to complete the screening independently, Tabb Dina said.
“Most of our moms come in with smartphones, so they’re savvy to the use of mobile technology and touch-screen functionality,” said Meline, adding that data will not be stored on the tablets but in the clinic’s electronic medical records system.
Still, the movement to a mobile, digital environment comes with a riskof privacy and security issues.
“One of the main concerns that clinicians had was that the tablets could get lost, broken, or stolen,” said doctoral student Maria Pineros-Leano, who analyzed the focus group data and is the lead author on a related paper published online recently by the journal Family Practice.
“We’re considering bright covers or protectors, so that even if a tablet falls on the floor it’s unlikely to break.”
Source: University of Illinois