January 19, 2017
Add one more to the long list of reasons to keep active: A new University of Florida study demonstrates that low levels of physical activity are associated with higher blood sugar among adults who are at a healthy weight. The findings, which appear online ahead of print in the American Journal of Preventive Medicine, may help explain why up to one-third of adults who are slender have prediabetes, a condition that puts them at risk for developing diabetes and other health problems. “We have found that a lot of people who we would consider to be at healthy weight — they’re not overweight or obese — are not metabolically healthy,” said lead investigator Arch G. Mainous III, Ph.D., chair of the department of health services research, management and policy in the UF College of Public Health and Health Professions, part of UF Health. These individuals may have healthy weight obesity, also known as normal weight obesity or “skinny fat.” The condition is characterized as having a body mass index within the normal range, but a high proportion of fat to lean muscle, typically more than 25 percent body fat in males and 35 percent in females. People with healthy weight obesity are more likely to develop metabolic syndrome, which includes increased blood pressure, high blood sugar and abnormal cholesterol levels. Because screening guidelines for prediabetes and diabetes typically focus on adults who are overweight or obese, individuals at a healthy weight who have high blood sugar levels may go undetected. For the UF study, researchers set out to test the hypothesis that a sedentary lifestyle may contribute to metabolic changes that put people who have a healthy weight at risk for prediabetes or diabetes. The team analyzed data from the 2014 Health Survey for England, an annual survey that combines information from personal interviews with lab tests and physical measurements collected by a nurse. The researchers assessed more than 1,000 individuals age 20 and older who had a BMI within the healthy weight range of 18.5 to 24.9 and who did not have a diagnosis of diabetes. Researchers found that participants who reported having a sedentary lifestyle were more likely than their more active counterparts to have a blood glucose level at or above 5.7, which the American Diabetes Association considers prediabetes. Among participants with low activity levels, about one-quarter of all participants and more than 40 percent of adults 45 and older met the criteria for prediabetes or diabetes. “Our findings suggest that sedentary lifestyle is overlooked when we think in terms of healthy weight,” said Mainous, the Florida Blue endowed chair of health administration. “We shouldn’t focus only on calorie intake, weight or BMI at the expense of activity.” Mainous said more research is needed to better understand the health implications of healthy weight obesity as well as how much and what type of activity, whether it is weight-bearing or resistance training, for example, may be most effective at combating metabolic syndrome. The UF study adds to a growing body of research that illustrates the potential negative health effects of low levels of physical activity, Mainous said. “Don’t focus solely on the scale and think you’re OK,” he said. “If you have a sedentary lifestyle, make sure you get up and move.” Study co-authors included Stephen Anton, Ph.D., an associate professor and division chief in the UF College of Medicine’s department of aging and geriatric research and a member of the UF Institute on Aging; and from the department of health services research, management and policy: Rebecca Tanner, M.A., a research coordinator, Ara Jo, M.S., a doctoral student, and Maya Luetke, MSPH, a research coordinator.
January 13, 2017
Walking across the University of Florida’s Health Science Center campus, Adam Woods cites a sobering statistic. “By 2050, the U.S. population over the age of 65 will double,” he says. “We’re simply not set up as a society to house and treat an exponential growth of dementia patients. Economically, our healthcare system is unable to absorb that impact.” Woods is an assistant professor of clinical and health psychology in the College of Public Health and Health Professions as well as the assistant director of UF’s Center for Cognitive Aging and Memory. He is looking at ways to delay the onset of dementia, or just preventing people from getting it all together. Besides the obviously devastating diagnosis for a patient and their loved ones, there are the cold hard facts of caring for someone with dementia: the astronomical financial costs involved. According to a 2015 report by the NIH’s National Institute on Aging, in the last five years of life, total health care spending for people with dementia was more than a quarter of a million dollars per person, 57 percent more than the costs associated with death from other diseases, including cancer and heart disease. “Half the expenses of long-term care for dementia patients comes from the family, and the other half comes from taxpayers,” Woods said. “If we can delay the onset of dementia by just one year, it would save the U.S. hundreds of millions of dollars annually.” How are Woods and his team at UF looking for ways to delay dementia? By partnering with Arizona State University and the University of Miami on research pertaining to Augmenting Cognitive Training in Older Adults, or more informally, the ACT Grant. Woods is the principal investigator on the $6 million, multisite clinical trial. “The primary goal is to evaluate how pairing a form of non-invasive electrical brain stimulation, known as transcranial direct current stimulation, with cognitive training may enhance the brain's neurocognitive function in our participants and potentially slow or prevent onset of dementia,” Woods said. “We teach the participants a series of ‘brain games’ while they undergo brain stimulation. Using state-of-the-art brain imaging methods, we look at how the participants’ brains are impacted by the training games and brain stimulation that we ask them to do over a three-month period. The research question is, can this type of brain training and stimulation slow down the brain’s aging? The study involves 360 participants. Researchers conduct a series of initial scans for a baseline image, again after three months, and finally after one year. The question they’re trying to answer: Do our cognitive training therapies help delay the onset of dementia, or can we prevent a person from getting dementia altogether? Woods and his team work closely with UF Research Computing, home of HiPerGator, the state of Florida’s first supercomputer. At the start of the study, Woods purchased 100 cores on HiPerGator to process the participants’ brain scans and analyze the data. Handling all of three sites’ participant scans on the Gainesville campus makes sense for both ease of analysis and cost savings. “In the ‘old’ days (five years ago) we used to process the data – all of these brain images – ourselves,” Woods said. “The costs involved, of tying up staff to handle the data processing, and of dedicating a computer for months on end, was staggering. With HiPerGator, we can use the cores purchased to have multiple scans produced simultaneously. Plus, doing all of the study sites' scans and data processing on our supercomputer means we have an efficient way to produce study findings at each stage of our research.” Woods’ past sponsored research includes awards from the National Science Foundation and the National Institutes of Health, with focuses on stroke, sarcopenia (loss of muscle tissue during the aging process), and preventing disabilities in older persons. “For me, this has always been about novel ways to help people,” Woods said. “Let’s figure out, at a mechanistic level, but then let’s use this knowledge and do some real good. Aging is relevant to everyone. Some diseases impact 1 percent of the population, others impact 5 percent. But aging, God willing, affects all of us. We start aging from the moment we are born … even before.”
January 12, 2017
Emotions tend to run high in hospitals, and patients or patients’ loved ones can be rude to medical professionals when they perceive inadequate care. But berating your child’s doctor could have harmful — even deadly — consequences, according to new research. The findings by University of Florida management professor Amir Erez and doctoral student Trevor Foulk reinforce their prior research that rudeness has “devastating effects on medical performance,” Erez said. A Johns Hopkins study estimated that more than 250,000 deaths are attributed to medical errors in the U.S. annually—which would rank as the third-leading cause of death in the U.S., according to statistics from the Centers for Disease Control and Prevention. Some errors could be explained by a doctor’s poor judgment due to a chronic lack of sleep. Those types of circumstances, according to prior research from Erez and Foulk, account for about 10 to 20 percent of the variance in practitioner performance. The effects of rudeness, Erez said, account for more than 40 percent. “[Rudeness] is actually affecting the cognitive system, which directly affects your ability to perform,” Erez said. “That tells us something very interesting. People may think that doctors should just ‘get over’ the insult and continue doing their job. However, the study shows that even if doctors have the best intentions in mind, as they usually do, they cannot get over rudeness because it interferes with their cognitive functioning without an ability to control it.” In a previous study, Erez and Foulk examined the effects of rudeness from a colleague or authority figure on individual medical professionals. This study analyzed team performance and the effects rudeness has when it comes from a patient’s family member. In the new study, 39 neonatal intensive care unit teams (two doctors and two nurses) from Israel simulated five scenarios where they treated infant medical mannequins for emergency situations such as severe respiratory distress or hypovolemic shock. An actress playing the baby’s mother scolded certain teams while the control groups experienced no rudeness. Erez and Foulk found that the teams that experienced rudeness performed poorly compared to the control groups. The teams that encountered rudeness were deficient in all 11 of the study’s measures, including diagnostic accuracy, information sharing, therapy plan, and communication, over the course of all five scenarios showing that the negative effects last the entire day. To combat the effect of rudeness, the researchers included “interventions” for selected teams. Some teams participated in a pre-test intervention which consisted of a computer game based on a cognitive-behavioral attention modification method intended to raise the threshold of the participants’ sensitivities to anger and aggression. Other teams participated in the post-test intervention, which consisted of team members writing about the day’s experience from the perspective of the baby’s mother. Erez and Foulk found no difference in the performances of the control groups and the teams that played the computer game. The teams recognized the mother’s rudeness —both midway and after the simulation — but were not affected by it. “It’s really shocking how well it worked,” Erez said. “They were basically immunized from the effects of rudeness.” Conversely, the post-test intervention, which research has shown to be extremely successful for victims of trauma, actually had a negative effect on teams. “What is really concerning is that, at midday, these teams recognized the mother was rude to them,” Erez said. “But at the end of the day, they did not. So not only did it not work, but it caused them to not recognize rudeness later.” Considering the researchers’ findings and the large number of deaths attributed to medical errors, teaching medical professionals to handle rudeness more effectively should be a priority for the medical community. “In the medical field, I don’t think they take into account how social interactions affect them,” said Erez, “but it’s something they’re starting to pay attention to. The purpose of this research was to identify what’s going on here. Now that we’ve found serious effects, we need to find more realistic interventions.” Dr. Arik Riskin, a professor of Neonatology at the Technion, Israel Institute of technology, and Peter Bamberger, a professor of management at Tel Aviv University in Israel, also collaborated on this research. The study, “Rudeness and Medical Team Performance,” appears in the January issue of Pediatrics.
January 11, 2017
Nudging people toward better behavior through policy can be effective, but can face resistance if people feel their autonomy is threatened. Despite advances in neuroscience and genetics that raise questions about the limitations of free will, people hold strongly to their sense of autonomy, according to a study by University of Florida marketing professor Joe Alba and post-doctoral student Yanmei Zheng. Alba’s and Zheng’s work, co-authored with Cornell University professor and former UF marketing Ph.D. student Stijn van Osselaer, is not an analysis of whether free will exists, but rather an examination of our impressions of free will, and the implications of those impressions on opinions regarding policy. “It’s a ripe question because developments in the sciences seem to throw more and more challenges to the notion that we have free will,” Alba said. Alba and Zheng conducted a series of experiments in which participants were asked to gauge an individual’s personal control in a variety of situations. In one experiment, Alba and Zheng compared responses based on four behaviors: obesity, shoplifting, financial fraud, and drunk driving. The study found that people were more likely to accept obesity as a consequence resulting outside the individual’s control (perhaps based on a poor metabolism) than the other three behaviors—despite the fact that the authors included similar genetic and environmental forces in each scenario. Similar findings were present in the study’s other experiments. The study found, for the most part, that people believe free will—even in the face of significant physical constraints—would prevent them from engaging in unethical behavior. “When we pose questions like, ‘Why wouldn’t you behave in this way under these physical constraints?’” said Alba, “they start to appeal to their nonphysical mind or to their superior soul. So they’ll have noncorporeal (non-physical) explanations of their decisions.” The findings support the philosophy of libertarian paternalism, an idea that blends organizational intervention with people’s desire for freedom of choice, as a guide for policy makers. Considering the study’s findings of people’s steadfast belief in free will, Alba said policy makers must be careful to not threaten autonomy, even if it is for the public good. Alba cites New York City’s efforts to ban the sale of 16-plus-ounce sugary drinks in 2014. Although studies have linked sugary drinks to obesity, the ban was overturned by the New York State Court of Appeals. “[Policy makers] want to create contingencies in the environment for people to behave in a better way,” Alba said. “But people don’t like being manipulated. So the dilemma for the policy maker is how do I get people to behave better without them feeling their autonomy is threatened? That’s a hard problem to solve. Because once people detect that you’re putting constraints on them—even though you’re doing it for their own good—they rebel against it.” Alba said the subtle nudges of libertarian paternalism provide a potential solution to this dilemma. A classic example of libertarian paternalism is the “opt-in vs. opt-out” arrangement where, for example, a company enrolls an employee in its 401K program unless the employee expressly exempts himself or herself. The situation blends the company’s intention of doing what’s best for the employee while still allowing the employee the freedom to say no. “When you cast doubts on the existence of free will, you shake people’s worldview,” Alba said. “The notion that we don’t have free will is not only counterintuitive but also threatening to people’s notions of their essence.” The study, “Belief in Free Will: Implications for Practice and Policy,” appears in the December issue of the Journal of Marketing Research.
December 22, 2016
An international group of researchers associated with the World Health Organization has published its final report on the Ebola vaccine trial in Guinea, finding that the vaccine is a safe and effective way to prevent Ebola infection. Researchers at the University of Florida have played an integral role in the vaccine trial’s execution, finding that it is 100 percent effective at preventing Ebola when given 10 or more days prior to exposure to the deadly virus. The study findings were published today (Dec. 22) in The Lancet. “The goal was to estimate the vaccine efficacy from a phase III randomized vaccine trial,” said Ira Longini, a professor in the department of biostatistics at the UF College of Public Health and Health Professions and the College of Medicine and director of the UF Center for Statistics and Quantitative Infectious Diseases. The 2014 Ebola virus outbreak was by far the largest and most lethal Ebola outbreak ever recorded. Transmission occurred primarily in three West African countries: Liberia, Sierra Leone, and Guinea. According to the Centers for Disease Control and Prevention, the virus infected nearly 29,000 people in the region, with more than 11,000 deaths occurring due to the disease. Longini, who is also a member of UF’s Emerging Pathogens Institute, was a key figure in the design of the Ebola vaccine trial and the analysis of its statistical data. The trial was called “Ebola ça suffit!” and it was the first successful phase III trial for an Ebola vaccine. Having successfully completed phase III indicates it has been tested on hundreds of subjects and proven both safe and effective. Natalie Dean, a postdoctoral researcher in the department of biostatistics, worked with Longini on both the design and analysis of the vaccine trial. Trial participants were organized into 117 clusters, of which 70 clusters received the vaccine immediately and 47 clusters received it 21 days later. Disease takes several days – even weeks – to develop following Ebola infection, yet there were zero cases among vaccines more than 10 days after any cluster received the vaccination. Those in immediately vaccinated clusters who were not vaccinated still received protection, thanks to the trial design – known as a “ring vaccination” trial. This type of trial creates clusters around contacts of people who have contracted the pathogen, as well as contacts of contacts, since these people are at a higher risk of contracting disease. Since the immediately vaccinated participants reduced the number of infections, those ineligible for vaccination within immediate clusters benefitted from herd immunity. According to the report, vaccinating only 52.1 percent of the participants was still 70.1 percent effective in preventing the spread of Ebola. The Ebola vaccine – rVSV-ZEBOV – is not available for sale. The WHO has collected a stockpile as a safeguard, just in case another Ebola outbreak occurs. “We are now helping WHO replicate this experience for all emergency infectious disease threats through the Research and Development Blueprint for Action to prevent Epidemics at WHO,” Longini said. “This includes the design and analysis plans for Zika vaccine trials.”
WEEKLY NEWS: January 19, 2017