Poisoning among older people with dementia


The November International Psychogeriatrics Article of the Month is entitled “Dementia and intentional and unintentional poisoning in older people: a 10 year review of hospitalization records in New South Wales, Australia” by Rebecca J. Mitchell, Lara A. Harvey, Henry Brodaty, Brian Draper and Jacqueline C. T. Close.

This blog post was written for us by one of the paper’s authors, Rebecca Mitchell.

Older people who have dementia are hospitalized far more commonly than people without dementia. One of the most common reasons that older people with dementia are hospitalized is due to injuries, with poisoning one of the most common types of injury experienced. Some poisonings may be unintentional mistakes, but others are due to a person intentionally trying to harm themselves.

It is not surprising that older people with dementia might experience difficulty with taking different doses of medication on specific days or at specific times. In this study, we wished to identify if older people with dementia had a higher rate of being hospitalised following poisoning than people without dementia and to try to identify commonalities surrounding the circumstances of the poisoning event that would allow us to raise awareness of approaches needed to prevent future poisonings.

Most research that has looked at older people with dementia and poisoning has involved small studies that examined admission at only one or two hospitals. In this study, we were able to examine all hospital admissions following poisoning of older people in the largest state in Australia, New South Wales, and to identify the circumstances of the poisoning event for both people with and without dementia.

Our research found that older people with dementia had double the rate of hospitalisations for unintentional poisoning and one and a half times the rate of hospitalisation for intentional poisoning compared to older people who did not have dementia. We identified that anticholinesterase medications (taken for Alzheimer’s disease), antihypertensive drugs and laxatives were the common medications taken by an older person with dementia when they unintentionally poisoned themselves. The home was the most common location of the poisoning, but unintentional poisoning was 5 times more likely to occur in aged care facilities and at least 4 times more likely to occur in health service facilities compared to intentional poisoning.

As all people age, the number of medications they take generally increase, with around 4 or more medications taken by people aged 60 years and older. It is more common for mistakes with medications to be made, the higher the number of medications that need to be taken. The presence of dementia is only likely to increase the potential for errors to be made and make problems of adherence to a medication regimen more difficult.

The findings of our study suggest that there are opportunities to prevent unintentional poisoning by older people with dementia by improving medication storage options, such as the use of blister packs or Dosette boxes, by getting family members or carers to assist in medication administration and, in the aged care and hospital settings, by ensuring quality use of medicines, and accurate documentation and review regarding polypharmacy.

The full paper “Dementia and intentional and unintentional poisoning in older people: a 10 year review of hospitalization records in New South Wales, Australia” is available free of charge for a limited time here.

The commentary paper “Poisoning among older people with dementia: a wake up call” by Christopher D. Etherton-Beer is also available free of charge here.


Molecular Pathology

Molecular Pathology

Despite slight disbelief that a year has already passed since 2014’s National Pathology Week (where on earth does the time go?!), we at Cambridge University Press are very excited to have another opportunity to join the celebrations of the vital contribution that pathologists make to healthcare in the UK and beyond. Since this year’s National Pathology Week focusses on the increasing role that molecular pathology plays in healthcare, what better time to launch our brand new book ‘Molecular Pathology: A Practical Guide for the Surgical Pathologist and Cytopathology’?

As the editors note in their preface, molecular pathology has now become an integral part of the daily practice of pathologists. This new book contains the essential information practising pathologists will need, starting with an overview of the essential principles of molecular techniques, followed by separate chapters detailing the use of these techniques in particular tissues and organs, and describing recommended treatment plans. Each chapter covers the tests available, their advantages, limitations, and use as diagnostic and prognostic tools, with key learning points at the end of each topic. The book is also packaged with online access to all the text and high-resolution images, hyperlinked references, in-book search and interactive index. With an excellent line-up of international editors (John Bartlett, Canada; Abeer Shaaban, UK; Fernando Schmitt, Luxembourg), we have every confidence that this book will take its place as a state-of-the art handbook on molecular pathology.

What’s more, for National Pathology Week we are very pleased to be able to offer a 20% discount not only on this new Molecular Pathology book, but across our entire portfolio of pathology books at Cambridge University Press using the code NationalPathologyWeek at checkout. We do hope that you will take this chance to check out our range of books and resources for pathologists. If you’re looking for a book on a particular topic and don’t yet see it there, or if you would like to get involved with writing a book yourself, please do get in touch as we’re always looking for new ideas!

-Nisha Doshi, Senior Commissioning Editor, Medicine, Cambridge University Press

Are You Stressed? Do You Suffer from Workplace Anxiety?

Name: Stress

Name: Stress

This year’s stress awareness day bases itself around workplace wellbeing and how this can be beneficial for your business. According to the Health and Safety Executive for Britain, workplace stress is responsible for the loss of 9.9 million working days or 43% of absenteeism and 35% of work related ill health in 2014/15.

In the right amounts, pressure can sustain motivation, and drive personal performance, but if the pressure is too much it can lead to demoralisation and under performance. Certain businesses have take much more criticism than others, indeed the banking industry and other city jobs often being singled out as high pressure environments with alarmingly high suicide rates. Long hours, work overload and highly competitive work relationships can all lead to workplace stress and poor mental health.

Social anxiety can also be a major cause of stress. The need to have a partner, a family, or even a large social media presence with lots of Facebook friends where one can advertise their successful social lives, all trigger stress and anxiety. The idea of maintaining or increasing your social status can create a stressful environment outside of work. Other causes of stress have been attributed to living in a city. Urbanisation with its loud noises, busy streets and general ‘hustle and bustle’ can also lead to higher stress levels.

Stress itself is not a medical diagnosis; however it can lead to depression, anxiety or more severe mental health issues and be a symptom of a more serious condition or disease. Even so, the majority of people do not see stress as a genuine illness and often do not take it seriously. General awareness around its symptoms and consequences can help prevent it from being a gateway to more serious health concerns.

Here you can find a general guide to identifying your personal stress symptoms, and useful tips for managing your stress.

– James Jarvis





Obsessive Compulsive Disorder Awareness Week

11-17 October was OCD awareness week, a week dedicated to educating the general populace about the true nature of obsessive compulsive disorder in order to challenge its relative trivialisation in contemporary culture. However this week kicked off with exactly the type of problematic stereotyping demonstrated in Michelle Mone’s interview on Good Morning Britain which drew a lot of criticism. Watchers were quick to take issue with her self-diagnosis, as well as her description of the disorder as merely reinforcing the trivial stereotype of being neat and organised, even suggesting that this has helped her in business.  What made the whole episode more controversial was that GMB consulted OCD UK about the piece only for their suggested interviewees to be ignored in favour of a more mild option.

The World Health Organisation has actually ranked OCD in the top ten of the most disabling illnesses of any kind, in terms of lost earnings and diminished quality of life. You can see why an enormously successful business woman talking openly about her self-diagnosed ‘struggles’ on TV, whilst simultaneously announcing her upcoming appointment as a baroness was branded as distasteful. Maybe Mone does have a mild form of OCD, and she would be right in speaking out about her own struggles.  However her self-diagnosis makes a lot of what she says seem invalid, especially as OCD is only actually diagnosed when the problem is either ‘causing them overwhelming distress, and/or when their compulsions take so much time that they can’t get to work or school or do the things they want to do in their daily life.’ (Telegraph)

OCD is a severe and specific anxiety disorder characterised by upsetting, unwanted and inappropriate thoughts. Linked to this is the urge to carry out repetitive actions in order to relieve the anxiety created by the unwanted thoughts. These thoughts can range from feeling dirty, irrational fears over your house being burgled, to graphic sexual contemplations. Following this, people suffering from OCD, might wash their hands so compulsively that they spend hours in the shower, or actually damage their skin in the process. For example, someone might check the locks in their house several times to prevent a burglary. Perhaps what is most frustrating for OCD sufferers is the conscious knowledge that what they are doing is irrational, but nonetheless they cannot control the compulsive urge because of the temporary relief it provides.

In response to the Twitter storm, Mone did allude to an OCD spectrum which certainly exists. However this spectrum is much more to do with the different types of OCD that exist. Often not included in the stereotypes and clichés is that OCD can manifest itself as ‘pure O’ as Rose Bretécher has recently spoken out about this particular form of OCD in a series of articles for the Guardian. Within this, people experience disturbing, unwanted obsessions without observable behavioural compulsions. This might be questioning your relationship and the value of your feelings towards another person, your sexual orientation, your religion, or the obsession of doing harm to others. Other parts of the OCD spectrum goes as far as including phobias, hypochondria and panic attacks.

The idea of an OCD spectrum, as well as ‘mild’ and severe cases, means that the line between real and stereotyped OCD behaviours becomes blurred. It’s certainly not helped by celebrities ‘coming out’ about their OCD. Other than Michelle Mone, Paul Hollywood of the Great British Bake Off, recently spoke out  about his problems, which included the compulsive cleaning of his brand new Aston Martin, which to anyone who has recently bought a new car, seems logical rather than obsessive or compulsive.  Even more high profile was David Beckham’s supposed OCD organisation of coke cans in his fridge.  While no one really knows the extent of their condition, the idea of a celebrity coming out about their struggles seems oxymoronic due to their professional success. There will always be that question of what OCD has done to debilitate their careers, and hence a question over the sincerity in their claims. On our TV screens there are mixed portrayals as well.  The Huffington Post has compiled a list of characters from TV shows with ‘OCD’, some are merely yet more stereotypes, however some are extremely accurate and thought provoking (it might be best to avoid Sheldon Cooper’s portrayal from the Big Bang Theory and concentrate more on Michael J Fox’s performance in Scrubs, or Leonardo Di Caprio’s portrayal of Howard Hughes in the Aviator).

So yes, Mone’s interview seemed to reinforce inaccurate stereotypes and quirks of OCD, but is this a case of ‘any publicity is good publicity’? There are no doubts that writers and the general Twittersphere have reacted by posting various articles and facts explaining what OCD really is. The interview from Mone has, at the very least, given OCD awareness week a focal point for discussion. Indeed even this blog post is a consequence of that, and what’s more the whole episode has probably allowed people to educate themselves on the issue. Although people have been quick to condemn Mone and Good Morning Britain, at least people are talking about it, which has saved it from being OCD unawareness week.

-Written by James Jarvis


Rose Bretécher –  http://www.theguardian.com/profile/rose-bretecher

Camilla Tominey – http://www.express.co.uk/comment/columnists/camilla-tominey/612778/Camilla-Tominey-Celebrities-OTT-OCD

Jenni Goodchild – http://www.telegraph.co.uk/news/health/11935833/No-OCD-is-not-all-about-cleaning-and-believe-me-you-dont-wish-you-had-it.html

Linda Blair – http://www.telegraph.co.uk/wellbeing/mood-and-mind/mind-healing–how-do-you-know-if-you-have-ocd-/

Dr. Max Pemberton – http://www.dailymail.co.uk/health/article-3258316/DR-MAX-hate-stars-joke-having-OCD.html

OCD LA http://ocdla.com/ocspectrumdisorders

OCD UK http://www.ocduk.org/ocd; http://www.ocduk.org/good-morning-britain-ocd-feature

Struggling to make Indian Curry…. Early indication of dementia?

shutterstock_139018265 (1)

The September International Psychogeriatrics Article of the Month is entitled “Discriminative power of the advanced activities of daily living (a-ADL) tool in the diagnosis of mild cognitive impairment in an older population” by P. De Vriendt, T. Mets, M. Petrovic and E. Gorus.


This blog post was written for us by one of the paper’s authors, Prof. Dr. Patricia De Vriendt

Struggling to make Indian Curry…. Early indication of dementia?

With a diagnosis of Alzheimer’s dementia (AD) comes an understanding that the affected individual will suffer an inevitable and progressive decline in their functional abilities. In order to identify and treat dementia as early as possible the concept of Mild Cognitive Impairment (MCI) was established. MCI is seen as the intermediate stage between normal aging and AD and is characterized by subjective and objective memory impairments in the absence of functional decline [the loss of ability to perform everyday tasks without assistance]. However, this criterion is controversial since our previous studies and also many other studies showed that mild changes in Activities of Daily Living (ADL) can be present and probably predict conversion to dementia.

The overall issue was whether an evaluation of ADL might underpin the diagnosis of MCI in a valid and reliable way, with an accuracy comparable with cognitive assessment.

For this reason, we hypothesized that an evaluation of ADL should be done on the level of “the advanced (a)-ADL”, encompassing all the most complex activities one can perform, such as using (household) technology, preparing complex dishes, driving, going on holidays, doing sports, practice hobbies, or arts, etc. The a-ADL are considered as the most difficult activities, requiring high level cognitive organization, and accordingly are most vulnerable to early cognitive decline.

We set out to study this issue by developing and validating a new advanced (a)-ADL tool, based on the International Classification of Functioning, Disability and Health framework (ICF), evaluating high-level activities. Taking each participant as their own reference, we calculated a global Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), based on the number of activities performed and the severity and causes of the functional problem.

The study published as ‘paper of the month’ evaluated the discriminative power of the a-ADL tool in order to establish diagnostic accuracy.

Based upon clinical evaluation and a set of global, cognitive, mood, and functional assessments, 150 community-dwelling participants (average age 80.3 years) were included and diagnosed as (1) cognitively healthy participants (n = 50); (2) patients with a-MCI (n = 48), or (3) mild to moderate AD (n = 52). The a-ADL tool was not a part of the clinical evaluation.

The a-ADL tool was able to detect the diagnostic distinction between cognitively healthy older persons, patients with a-MCI, and patients with AD. Both the a-ADL-DI and the a-ADL-CDI – of interest in this population – showed promising results and differed significantly between the groups; in contrast, the a-ADL-PDI did not.

What is the take home message of this research?

The a-ADL tool showed a good ability to distinguish normal and pathological cognitive aging. Its discriminative power for underlying causes of limitations is an advantage. Concluding, the evaluation of a-ADL, when administered in a systematic and scientific way, enables the diagnosis of MCI and – moreover – is experienced as less invasive by the patients. In the same time, this evaluation offers directions for clinical treatment, rehabilitation, advice and coaching.


The full paper “Discriminative power of the advanced activities of daily living (a-ADL) tool in the diagnosis of mild cognitive impairment in an older population” is available free of charge for a limited time here.

The commentary paper “A useful development in measuring activities of daily living” by David Ames is also available free of charge here.

What does Tu Youyou’s Nobel Prize mean for Traditional Chinese Medicine?

Earlier this month China won its first Nobel Prize for Medicine, prompting Prime Minister Li Keqiang to boldly state that Tu Youyou’s prize ‘embodies the enormous contributions of Traditional Chinese Medicine (TCM) to human health’. For ‘TCM’, this seems like a huge win, years of doubt and scepticism swept under the carpet. In fact the Nobel committee explicitly honoured Tu for her sophisticated extraction and development of the antimalarial ingredient – this process was far removed from TCM practices and completely ‘western’ in method and execution. The discovery of the qinghao plant within a 4th century text, from which Artemisinin is extracted, was indeed inspired, but having an idea does not win you a Nobel Prize.

What is important to remember is that Tu tapped into the most likely part of Chinese medicine to produce results. To some extent, her prize does vindicate TCM’s use of herbal remedies. Even then, some herbal injections in China mixed with antibiotics have proved disastrous in terms of side effects, suggesting that without proper research, herbal remedies still remain dangerous. In any case the use of naturally occurring chemicals that can effectively treat illnesses is a well-established practice worldwide and is by no means exclusive to TCM. This prize is arguably a perfect example of pharmacognosy – ‘the study of the physical, chemical, biochemical and biological properties of drugs, drug substances or potential drugs or drug substances of natural origin as well as the search for new drugs from natural sources’ – importantly this involves the isolation of these useful chemicals from plants.

Despite all this, supporters of TCM are taking it further, and asserting that other aspects of Chinese medicine might also be valid. This includes the wider beliefs of human bodies being made of the five elements, and the idea of ‘qi’ and ‘yin and yang’. This type of pseudoscience benefits from the fact that TCM is an umbrella term for many ancient Chinese medicinal practices. In this case, a vindication in the herbal arm of the ‘science’ represents a vindication of the entire TCM body. Obviously this seems an illogical argument; indeed Tu in a recent interview illustrated this when responding to a question about other efforts during the 1960s in China to find a cure for malaria – “There was a team of acupuncture specialists who were trying to cure patients in quarantine centres. Obviously that didn’t work“.

The idea of applying rigorous evidence-based methods is unacceptable to institutionalised TCM. As Professor Zhang Gongyao has said, ‘researchers have been refusing to conform to the “Western norm of science” in their lab results, for it is thought to be “unsuitable” for TCM’. One example is that the researchers of TCM have no interest in eliminating the placebo effect, which may constitute a large part of TCM’s ‘effectiveness’. There are also claims that standard research methods aren’t applicable to TCM, because treatment must differ for each individual. Not included in this is the alleged frequent doctoring of results in studies, and poor experimental technique (Aeon).

TCM causes so much controversy due to its emotive history. At the turn of the century, China seemed destined for reform. Traditional medicine came in for especially harsh criticism. Its theories were vague, its outcomes dubious, and most of all it was “unscientific”. The Qing dynasty and later the Nationalists would however find it difficult to displace and ran into stiff opposition. Its status was then given a massive boost with the arrival of the Communist party. Mao would adopt it under his brand of ideology despite his own lack of faith. In a conversation with his physician Mao told him, “I personally do not believe in it. I don’t take Chinese medicine.”

FreeImages.com/Sebastian Strobl Chinese Pharmacy in Singapore

FreeImages.com/Sebastian Strobl
Chinese Pharmacy in Singapore

TCM is in fact a relatively new term and was coined in the 1950s under Mao before being institutionalised for practical and propagandistic reasons. China was (and still is) a vast country, with very few trained doctors and a lot more ‘trained’ TCM physicians, it simply made sense to continue TCM to care for the majority of the populace. In terms of propaganda, Mao set about creating academies that aimed to integrate Chinese and Western medicine. In 1952, the president of the Chinese Medical Association said that, “This One Medicine, will possess a basis in modern natural sciences, will have absorbed the ancient and the new, the Chinese and the foreign, all medical achievements—and will be China’s New Medicine!” The idea that TCM could form the basis of an alternative system of medicine was a powerful piece of ideology, and valuable currency in the cold war era. Whilst several other Chinese traditions were cast overboard during the revolutions, TCM was allowed to survive.

It was TCM’s endurance that accounts for its popularity today. Virtually every other aspect of traditional Chinese culture was shattered by Mao, during the convulsions of the 1960s. An entire generation or more was lost, and that hole within society still echoes through contemporary society. Belief in TCM is a comforting national myth, connecting a proud past with new belief in the present. For the Chinese, the West might have invented modern medicine, but they have something just as good, if not better. Such pride is demonstrated in one ethno-graphic illustration of TCM, some believe that ‘the reason Westerners don’t believe in TCM is that it only works on Chinese bodies.’

What’s more TCM’s claims of being ‘natural’ are highly appealing in a country where everything from dumplings to baby milk has proved toxic (Telegraph). What’s more TCM is also popular because of the poor image of its ‘modern’ counterpart.  Chinese conventional hospitals are filled with poorly paid doctors who are overworked and resented or attacked by patients (FT).  In addition drugs are often more expensive than TCM and the administration is suspect to huge amounts of corruption (TIME).  Going to a Chinese hospital with its long queues, several fees and general disregard for comfort can be a fairly traumatic experience (Harvard Blog). With such deficiencies in conventional health care coupled with TCM as a source of national pride, it is not surprising that it still gains such a large amount of traction in modern Chinese society. Its apparent vindication by a western institution in the Nobel Committee might provide it with further encouragement.

Li Keqiang’s statement should thus be taken with a pinch of salt. Tu’s research was, at best, TCM that benefited from western scientific techniques. After all the Artemisinin had to be isolated, and was by no means necessarily effective without extraction and isolation. This demonstrates Chinese Medicine has its obvious merits in its ancient Pharmacopeia. There is no reason why mining ancient texts for clues about plants with real medical value is not a fruitful avenue for research. However the idea that TCM should continue unchallenged is wrong, and ultimately dangerous, both for the animals and people suffering from the industry. Historically, its revival was based on propaganda and politics, not on scientific fact. Thanks to this warped history and failures in China’s conventional hospital administration, TCM has remained stubborn.

Chairman Mao. Photo: Tauno Tõhk / 陶诺. Used under CreativeCommons.

Chairman Mao. Photo: Tauno Tõhk / 陶诺. Used under CreativeCommons.

This prize may only serve to reignite debate, but discussion fuels research. The issue has piqued international interest in TCM and perhaps we will see new discoveries soon – especially if the Chinese government throws money at this kind of R&D again. Zhao Haiyu, Assoc. Professor at Chinese Academy of Chinese Medical Sciences has suggested what the future holds for TCM – “Tradition is our source of inspiration, and modern technology takes it further. They don’t go against each other. They go hand in hand with each other.”

References/further reading

Hannah Beech


Peter Foster


Nectar Gan


Marta Hanson


Ashish Jha


Ian Johnson


Alan Levinovitz


James Palmer


Tom Phillips


Patti Waldmeir




Rethinking Mental Health in Latin America – via Global Health, Epidemiology and Genomics

Rethinking Mental Health v02 FINAL

Mental health disorders are a huge burden for health systems, particularly in low and middle income countries. A new research hub based in Sao Paulo and Lima is exploring the opportunity to use technology to tackle these disorders.

In 2010, mental and substance use disorders were responsible for the greatest number of years of life lost to ill health worldwide.(1) In 2012, the World Health Assembly officially recognised the major contribution of mental disorders to the global non-communicable disease burden.(2) It urged member states to develop a coordinated and comprehensive response towards mental health treatment through their health and social sectors. Worldwide a large treatment gap exists for mental health disorders, particularly in low and middle income countries (LMICs). Insufficient financial resources in LMICs results in inadequate numbers of trained personnel, and a high proportion of patients who do not receive care; 76-85% of people with severe mental health conditions do not receive treatment.(3)

The Latin American Treatment and Innovation Network in Mental Health (LATIN-MH) is a regional hub for research and training in mental health, based in Lima (CRONICAS), Sao Paulo, Chicago and London. Its aim is to find innovative solutions to address the treatment gaps that exist in mental health care. Although undoubtedly a difficult challenge, at CRONICAS we believe that to develop sustainable mental health interventions, health systems must adapt to scarce resources and health inequities, effectively building upon the existing context. We see LATIN-MH as a “disruptive innovation”: a new product that transforms and adds to traditional ones. This innovation is driven by three pillars: (i) building capacity to achieve sustainability, (ii) developing strategic interdisciplinary partnerships, and (iii) integrating effective mental health treatment into primary care and community health systems.

LATIN-MH combines the innovative use of task shifting and technology to address the mental health treatment gap. Task shifting at the level of healthcare providers and patients’ self-management has been successfully shown to increase child survival rates and maternal health.(4) Furthermore, the growing implementation of e-health and m-health interventions has played an important role in changing unhealthy habits or lifestyles.(5)

Our research component is centred on assessing the feasibility of using a technologically driven nurse assisted intervention (CONEMO) for people with co-morbid depression and diabetes/hypertension to reduce symptoms of depression. The intervention is a 6-week programme based on behavioural activation, an approach which works by engaging patients in activities that improve their mood. Implementing this smartphone application shifts tasks to nurses and smartphones by taking advantage of the huge mobile phone penetration in the region.(6) This is hugely important in settings where staff shortages exist. At the same time, the project builds research capacity within Peru and Brazil by providing a framework for hands-on mentoring and training for junior investigators who will form part of the new cohort of public health researchers. The success of the intervention is currently being evaluated.

We hope that this model will be sustainable and will help improve the management of mental health in the long-term in order to overcome the barriers preventing us from achieving universal access to mental health care and improved population mental wellbeing.

CRONICAS Center of Excellence in Chronic Diseases, supported by the National Heart, Lung, and Blood Institute’s Global Health Initiative under the contract ‘Global Health Activities in Developing Countries to Combat Non-Communicable Chronic Diseases’.

1. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet (London, England). 2013;382(9904):1575-86.
2. WHO (World Health Organisation). The global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. Geneva: WHO, 2012.
3. WHO (World Health Organisation). 10 facts on mental health 2014 [cited 2015]. Available from: http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/.
4. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. The Cochrane database of systematic reviews. 2010(3):Cd004015.
5. WHO (World Health Organisation). mHealth: New horizons for health through mobile technologies: second global survey on eHealth. Geneva: WHO, 2011.
6. GSMA Intelligence. The Mobile Economy; Latin America 2014. London: 2014.


This post was originally posted on the Global Health, Epidemiology and Genomics blog – read more at: http://journals.cambridge.org/gheg

A smartphone test for delirium assessment in hospital


The August International Psychogeriatrics Article of the Month is entitled “Development of a smartphone application for the objective detection of attentional deficits in delirium” by Zoë Tieges, Antaine Stíobhairt, Katie Scott, Klaudia Suchorab, Alexander Weir, Stuart Parks, Susan Shenkin and Alasdair MacLullich.

Delirium is a sudden disruption in consciousness and cognition marked by an inability to focus and sustain attention. People with delirium can also experience psychotic symptoms such as terrifying hallucinations and delusions. Delirium is extremely common, affecting around one in eight hospital patients. It can occur at any age but is particularly common in older patients in hospital, where it is often mistaken for dementia. Delirium tends to develop after infection or surgery, or as a result of drug side-effects, and has serious consequences: it affects how long patients stay in hospital and future mental and physical well-being, and increases the risk for future dementia and death.

The first step towards improving treatment and subsequent health outcomes of patients with delirium is accurate detection of the syndrome. Yet up to three-quarters of delirium is undetected. Part of the problem is that delirium is difficult to recognise, with some features similar to those in other conditions such as dementia and depression. Most available delirium tests discriminate inadequately between delirium and dementia, rely on subjective judgements, and require trained personnel. It is evident that new ways of easily and accurately detecting delirium are needed.

Researchers at the Edinburgh Delirium Research Group and LLHW Centre for Cognitive Ageing and Epidemiology (CCACE), at the University of Edinburgh, have previously developed an electronic method for measuring delirium using simple visual attention tests, which were implemented on a purpose-built device known as ‘Delbox’. The rationale for this method is that patients with dementia will perform better because they are able to focus their attention for longer periods than patients with delirium. This is exactly what the researchers found.

The team have taken this approach one step further by developing a software application (‘DelApp’) for smartphones based on the Delbox, in collaboration with the Medical Devices Unit in Glasgow (NHS Greater Glasgow & Clyde). The DelApp incorporates a brief arousal assessment, a visual test and a graded counting task to measure inattention. The patient is asked to count a short sequence of circles shown on the smartphone screen. The DelApp takes a few minutes.

The researchers studied the feasibility and validity of the DelApp. First, 20 older hospital patients were tested with both Delbox and Delapp, showing comparable performance on both tests. Patient feedback was overall positive and suggested that the DelApp was acceptable to them. Secondly, the DelApp was pilot tested in 156 selected older patients split in three groups (delirium, dementia, and no delirium/no dementia). The delirium group performed more poorly compared to dementia and no delirium/no dementia groups. The DelApp not only showed good diagnostic performance, but also appeared to capture the severity of delirium as measured with a validated delirium severity scale.

In conclusion, this study showed the initial feasibility and validity of using a smartphone test for delirium assessment in hospital. The DelApp test appears to be objective and easy to use at the patient’s bedside. It requires little training, which may be particularly useful for non-experts.

The research team is developing the DelApp further and will confirm the clinical effectiveness of the test in larger trials with blinded raters.

The full paper “Development of a smartphone application for the objective detection of attentional deficits in delirium” is available free of charge for a limited time here.

The commentary paper “Bringing delirium into the 21st century: will physicians get the app out?” by Kenneth Rockwood is also available free of charge here.

People Might Be Living Longer, But They’re Also Sicker Longer

A study researched all major diseases in 188 countries and found that while people are living longer, they are also sicker longer.

While life expectancy has increased,  because of improvements in general health and substantial developments towards curing and fighting diseases like tuberculosis and malaria, healthy life expectancy has not increased as fast.

The study was published in The Lancet journal and was headed by Theo Vos, a professor at the Institute of Health Metrics and Evaluation at the University of Washington told Reuters, “The world has made great progress in health, but now the challenge is to invest in finding more effective ways of preventing or treating the major causes of illness and disability.”

The study took into consideration chronic ailments like heart and lung diseases, diabetes, disabilities, and injuries and other detractors from quality of life. The study found that global life expectancy rose by 6.2 years, from 65.3 in 1990 to 71.5 in 2015, while healthy life expectancy only rose by 5.4 years. However, the study also found that there were a lot of difference between countries in terms of both healthy life expectancies and in rates of change.

For instance, Nicaraguans and Cambodians have seen an increase from 1990 of 14.7 and 13.9 years while Bostwana and Belize saw a decline of 1.3 years. Japan had the highest of highest life expectancy at 73.4 years while Lesotho had the world’s lowest at 42 years.

Only One Flu Shot? Maybe!

Can you imagine not having to get a flu shot every season? Apparently two independent teams of doctors have been imagining the same thing.

The two independent research groups have released findings that this could be a reality someday.

It has been notoriously difficult to formulate a vaccine against all forms of influenza for a number of reasons. One thing that makes the virus so difficult is that influenza is a shape shifter that can, and does, mutate and change quickly and repeatedly. This means that even if a person develops immunity through an earlier year’s flu shot, he might not be immune to the latest strain of the virus.

A large portion of the human immune response to the flu is directed against a portion of the protein hemagglutinin called the hemagglutinin head. In the last twenty years scientists discovered that some people were able to fight a large swath of flus because their immune systems could develop antibodies that targeted the hemagglutinin stem. Even so though, the human immune system still often cannot keep up with the rapidly mutating stem. This could be partially due to the fact that the stem is hidden while the head is exposed.

Knowing this, the two independent research teams took two different approaches to almost identical notions. With idea to help the body create more stem-specific antibodies in order to help battle more types of influenza, each team decided to focus exclusively on the hemagglutinin stem. Their idea was to create stem-only antigens to incorporate into vaccines, effectively ignoring the hemagglutinin head.

This proved a very difficult task, “Flu is a very large virus with lots of parts. It’s very hard to build a small piece without screwing things up,”  Andrew Ward told the Los Angeles Times a structural biologist at Scripps Research Institute. In order to create a stable molecule and not disrupt the response they wished-for for the antibodies, they could not have a single atom out of place.

Incredibly, the two teams were able to create stable molecules and were able to use them to create vaccines which they tested on mice and monkeys and mice and ferrets respectively. They were both able to elicit certain protection in varying degrees.

This, by no means, means that a universal flu vaccine will be available in the short term. However, it paves the way for a type of booster shot that could be available at some point in the future and more protection against the flu than current shots, which only can protect against 3 or 4 strains, says Ward.

Clinical Infectious Disease has a Second Edition!

Clinical Infectious Disease

Clinical Infectious Disease

My goal in designing this text has been to provide a user-friendly but comprehensive Infectious Disease reference for the busy clinician. Positioned in size between the various pocket guides and huge encyclopedic references, our book allows for a convenient but thorough review of an Infectious Disease topic.

We include the traditional syndrome-oriented and organism-oriented chapters, but, keeping the bedside clinician in mind, I have included chapters on many specific topics that are often difficult to research. For example, the chapter on Esophageal Infections includes such diverse etiologies as CMV, Herpes Simplex, Candida, tuberculosis and trypanosomes. Again, Recreational Water Exposure considers infections related to activities such as swimming, boating and hot tubs, and includes a huge variety of infections, helpfully organized, ranging from hot tub folliculitis and Seabather’s eruption to vibriosis and cryptosporidial gastroenteritis.

Additional interesting and important differential diagnoses characterize chapters on Sexually-Transmitted Enteric Infections, Splenic Abscess, Iliopsoas Abscess, Myelitis, Diabetes and Infection, Infection in the Alcoholic, Infections in the Elderly and Infected Implants. The chapter on Bioterrorism provides syndromic comparisons among these critically important infections, exploring presentations such as fulminant pneumonia, sepsis with hemorrhage, and skin lesions, and the chapter is enhanced by spectacular images of patients, skin lesions and radiographic studies.

This edition also includes two new chapters, on  Probiotics and Biologic therapies, which are increasingly important in the Infectious Disease realm. My continuing goal is to provide a practical and authoritative guide for the clinician dealing with the fascinating world of Infectious Diseases.

-Dr. David Scholossberg

Better Diet Quality may Improve Cognition in Children

Author: Eero Haapala

A recent Finnish study shows that better diet quality is related to better cognitive performance among 6–8 year old children. The results published in the British Journal of Nutrition are part of the Physical Activity and Nutrition in Children (PANIC) Study conducted at the University of Eastern Finland. The study investigated the relationships of the Baltic Sea type and the Dietary Approaches to Stop Hypertension (DASH) dietary patterns to cognition in a population based sample of 428 children aged 6–8 years. Stricter adherence to the Baltic Sea type and the DASH dietary patterns, indicated by a higher consumption of vegetables, fruit and berries, fish, whole grain products, and a lower consumption of red meat, was associated with better cognitive performance. Of the components of these dietary patterns particularly higher consumption of vegetables, fruit and berries and fish and a lower consumption of red meat was related to better cognition. The associations of dietary patterns with cognition were stronger in boys than in girls. In conclusion, a poorer diet quality was associated with worse cognition in children and the relationship was stronger in boys than in girls.

This article is freely available for two weeks via the following link: journals.cambridge.org/bjn/panic

Source: Better Diet Quality may Improve Cognition in Children « Journals in the News « Cambridge Journals Blog

Do Video Games Cause Violent Behavior? More Then 200 Academics Think Not

The APA recently released findings that stated there while there was not a “single” cause for aggression; violent video games can play a role. The APA set up a team to go over studies and papers that were published on the subject between 2005 and 2013.

The paper reports, “The research demonstrates a consistent relation between violent video game use and increases in aggressive behaviour, aggressive cognitions and aggressive affect, and decreases in pro-social behaviour, empathy and sensitivity to aggression.”


The research for the paper was done primariliy though meta-analysis. It looked at the results of a number, hundreds, of studies and tried to find patterns and parallels. “While there is some variation among the individual studies, a strong and consistent general pattern has emerged from many years of research that provides confidence in our general conclusions,” said task force chairman Mark Appelbaum.

However, the research team’s findings have not been met with open arms. A group of more than 200 academics made up of “media scholars, psychologists and criminologists” have released an open letter to the APA opposing the findings. They suggest that the methodology of the study is inherently unsound. Much of the surveyed papers and studies that the APA used have not been peer reviewed, the open letter criticizes the methodology of the taskforce’s study and findings.

The notion that violent video games may cause aggression is a strongly contested one. It has historically been a scapegoat for violent behavior particularly in adolescents and teens. And while people don’t deny an effect of games, many deny the correlation between violent video games and outright violence:

“I fully acknowledge that exposure to repeated violence may have short-term effects – you would be a fool to deny that – but the long-term consequences of crime and actual violent behaviour, there is just no evidence linking violent video games with that,” says Dr Mark Coulson, one of the signatories of the letter told BBC. “If you play three hours of Call of Duty you might feel a little bit pumped, but you are not going to go out and mug someone.”

The rating system for video games can also be tricky. The US goes by the Entertainment Software Rating Board (ESRB) and begins with “eC” (Early Childhood) and progresses to “AO” (Adults 18+ Only). The rating system however has been controversial from the beginning with critics saying that the ESRB has gotten more lax on their “M” (Mature) rating and the games have gotten progressively more violent without receiving an AO rating.

In the letter to the APA the writers acknowledged that youth violence is currently “at a 40-year low” and that the “statistical data are simply not bearing out this concern and should not be ignored.”

The letter ends with a striking call for better data and research, “Policy statements based on inconsistent and weak evidence are bad policy and over the long run do more harm than good, hurting the credibility of the science of psychology.” With an overwhelming number of signatories, their message should not be ignored.

Turns Out Birth Order Might Not Mean Much

In a curious turn of events, according to a new study by a University of Illinois study birth order actually has no significant effect on personality or intelligence between siblings. The study analyzed 377,000 high school students and its head researcher is calling it the biggest look at the relationship between personality and birth order in history.

Strobist: SB-800 camera right with Honl 5 inch snoot aimed at girl. SB-800 with 8 inch shoot aimed at boy. Both at 1/2 power.

Strobist: SB-800 camera right with Honl 5 inch snoot aimed at girl. SB-800 with 8 inch shoot aimed at boy. Both at 1/2 power.

The study was published in the Journal of Research in Personality and has established that while first-borns statistically have a one-point IQ advantage over their younger siblings the difference is “statistically significant but meaningless.”

The lead researcher, Brent Roberts, stated, “In some cases, if a drug saves 10 out of 10,000 lives, for example, small effects can be profound. But in terms of personality traits and how you rate them, a .02 correlation doesn’t get you anything of note. You are not going to be able to see it with the naked eye. You’re not going to be able to sit two people down next to each other and see the differences between them.”

Birth order has been a fixture of fascination and often is linked closely with fate; firstborns are meant to be controlling and ambitious, middle children are meant to be wayward and rebellious and oft overlooked, and the youngest are coddled, bratty, and babied. The firstborn traditionally has the most weight on his shoulders and inherits the most of the family’s fortune or tribulations. For decades, scientists have been studying the effects of birth order on family dynamics and individual personalities from early 20th Century Austrian psychiatrist Alfred Adler to pop phycology parenting books on how to raise each child based on their place in the family.

The study controlled for a few factors, most notably family size, socio-economic status, and gender and arrived at a .02 correlation between birth order and personality and a .04 correlation between birth order and intelligence.

This shockingly low number goes against almost all previous studies and hypotheses regarding personality and intelligence relative to birth order.

It’s tempting to credit and blame a child’s personality traits, characteristics, and fate on birth order. The reality however is so much more complex; each child’s character and fate are based on biology and environment and encompass hundreds of thousands choices in and out of his control. The study’s co-author, Rodica Damian, sums it up nicely, “Birth order probably should not influence your parenting because it’s not meaningfully related to your kid’s personality or IQ.”




Community social cohesion may help improve child and adolescent mental health and behaviour

Have you ever borrowed a cup of sugar from a neighbour? Would you trust them to keep an eye on your child while playing outside? New research indicates that the degree of social cohesion, or ‘neighbourliness’, of a community may have long-term consequences for children’s mental health and social adjustment.

The neighbourhood environment has well-documented effects on individual health and wellbeing, including mental health. Living in an unsafe or unstable neighbourhood can lead to adverse health outcomes including depression, anxiety, and substance use. On the other hand, cohesive neighbourhoods (those which provide social support, trust, and a sense of community among residents) are thought to contribute positively to residents’ mental health.

In a new study published in Psychological Medicine, researchers at the University of Ottawa and University College London examined patterns of neighbourhood cohesion across childhood (from toddlerhood to preadolescence), and linked these patterns to several different mental health and behavioural outcomes in early adolescence (age 12-15).

Living in low-cohesion neighbourhoods throughout childhood, they found, was associated with increased anxious and depressive symptoms, as well as greater social aggression (e.g., malicious gossip, excluding peers) in adolescence. Declining neighbourhood cohesion from early to late childhood was associated with greater symptoms of hyperactivity, whereas improvements in neighbourhood cohesion were associated with reduced hyperactivity and social aggression. Those in highly cohesive neighbourhoods in early childhood were more likely to engage in prosocial behaviour.

These results suggest that efforts to improve community social cohesion may help improve child and adolescent mental health and behaviour. Higher social cohesion may increase a child’s level of interaction with teachers and other adults in the community, as well as with other neighbourhood children, all of which may contribute to advances in social and emotional development.

The full paper, published in Psychological Medicine, “Trajectories of childhood neighbourhood cohesion and adolescent mental health: evidence from a national Canadian cohort” by M. Kingsbury, J. B. Kirkbride, S. E. McMartin, M. E. Wickham, M. Weeks and I. Colman is can be viewed here free of charge until 31st August 2015 .

Do higher vitamin E levels have a protective effect on pulmonary condition in Cystic Fibrosis?

The  July Nutrition  Paper of the Month is entitled ‘Vitamin E intake, The affect of  levels and pulmonary function in children and adolescents with cystic fibrosis’

Cystic fibrosis (CF) is a life-threating genetic disorder, characterised by chronic pulmonary inflammation that causes a gradual, progressive decline in pulmonary function, partly due to oxidative stress. Most patients have pancreatic insufficiency, leading to intestinal malabsorption of fat and fat-soluble vitamins. Therefore, lifelong treatment with fat-soluble vitamins such as vitamin E has become standard care.

It has been suggested that higher vitamin E levels, expressed as serum α-tocopherol levels, have a protective effect on pulmonary condition in CF. However, serum α-tocopherol levels are compromised during a pulmonary exacerbation and recover with resolution of the inflammation. Likewise, chronic pulmonary inflammation may reduce levels, and the suggested association between vitamin E levels and pulmonary function might be secondary.

Whether current recommendations for vitamin E supplementation are optimal for preventing deficiency and whether higher serum α-tocopherol levels have beneficial effects on pulmonary function are subjects of debate. The present paper studied the association between vitamin E intake (dietary intake plus prescribed supplementation), the coefficient of fat absorption and chronic inflammation on serum α-tocopherol levels, and the long-term effect of both serum α-tocopherol levels and chronic inflammation on pulmonary function in paediatric patients with CF.


In our study sample, we found no clear effect of vitamin E intake, the coefficient of fat absorption or chronic inflammation on serum α-tocopherol levels. Moreover, patients with CF received vitamin E supplementation at half the CF-specific recommended dosage; nevertheless, serum α-tocopherol levels were normal.

Furthermore, we found that chronic inflammation was inversely associated with pulmonary function and we found no association between serum α-tocopherol levels and pulmonary function. Paradoxically, we even found an overall trend towards a lower pulmonary function in those with higher serum α-tocopherol levels.


Our results suggest that the CF-specific vitamin E recommendations are higher than necessary to prevent deficiencies. Therefore, vitamin E dosages of 50% of the recommendations could be used, at least initially. We found no evidence that higher serum α-tocopherol levels had protective effects on pulmonary function in paediatric patients with CF. Moreover, the finding of higher serum α-tocopherol levels in patients with lower pulmonary function casts doubt on the hypothesis that vitamin E has therapeutic benefits.

This paper is freely acvailablke via the following link for one month: journals.cambridge.org/ns/jul15

Authors: Janna W. Woestenenk, Nancy Broos, Rebecca K. Stellato, Hubertus G. M. Arets, Cornelis K. van der Ent and Roderick H. J. Houwen

Nutrition Society Paper of the Month

Each month a paper is selected by one of the Editors of the five Nutrition Society Publications (British Journal of Nutrition, Public Health Nutrition, Nutrition Research Reviews, Proceedings of the Nutrition Society and Journal of Nutritional Science). This paper is freely available for one month.

Does Parkinson’s Disease Begin in Your Stomach?

While the cause of Parkinson’s disease, the progressive impairment of neurons in the area of the brain called the substantia nigra, is known it is still unclear why some people and not others develop the degenerative disease. New evidence discovered by Aarhus University and Aarhus University Hospital may have made some significant strides towards answering why some people develop Parkinson’s disease.

Aarhus University and hospital are now reporting that their new research may indicate that Parkinson’s disease starts in the gastrointestinal tract and spreads the vagus nerve to the brain. Their study is primarily based on new information where they discovered that patients that had the entire vagus nerve severed did not develop Parkinson’s disease.

“Our study shows that patients who have had the entire vagus nerve severed were protected against Parkinson’s disease. Their risk was halved after 20 years. However, patients who had only had a small part of the vagus nerve severed were not protected. This also fits the hypothesis that the disease process is strongly dependent on a fully or partially intact vagus nerve to be able to reach and affect the brain,” explains postdoc at Aarhus University Elisabeth Svennson. She explains that during 1970-1995 severing the vagus nerve was a very common method to treat ulcers and that their study surveyed 15,000 patients who had had undergone this treatment.

Svennson also goes on to say that many Parkinson’s disease patients suffer from stomach problems well before symptoms of the disease start to show, “Patients with Parkinson’s disease are often constipated many years before they receive the diagnosis, which may be an early marker of the link between neurologic and gastroenterologic pathology related to the vagus nerve.”

Previously it has been very difficult to offer preventative measures to people for Parkinson’s disease. The new research presented in Annals of Neurology could be a helpful tool to recognize risk factors and ultimately prevent the disease altogether.

“Now that we have found an association between the vagus nerve and the development of Parkinson’s disease, it is important to carry out research into the factors that may trigger this neurological degeneration, so that we can prevent the development of the disease. To be able to do this will naturally be a major breakthrough,” said Elisabeth Svensson.

This is the first time that the connection between the gut and the brain in Parkinson’s disease has been tested in an epidemiological study in humans. This is great and exciting news for those affected by Parkinson’s disease and will hopefully prove very fruitful in the future.




Writing well is important: The value of a science-based approach

The Reader's Brain How Neuroscience Can Make You a Abetter Wrtier

No matter what initially drew you to medicine, you most likely failed to picture yourself spending a hefty portion of your time writing. But, if you entered academic medicine, writing ends up occupying a significant amount of your time. Universities require us to bring in a stream of funding, which requires us to write grant proposals. In the US, only one of every seven proposals researchers write receive funding—and this statistic excludes the highly competitive and prestigious R01 awards offered by the National Institutes of Health (NIH). In addition, to first obtain funding, researchers usually need at least one publication as evidence of expertise in the area their proposal targets. Once you obtain funding, you face still greater pressure to produce a stream of publications that demonstrate you’re making progress in achieving your grant’s specific aims. Moreover, most universities tie job offers and promotions to your publications and papers you present at meetings. In short, in academic medicine, writing is inescapable—and integral to your success.

However, few researchers or clinicians understand the advantages of writing well in a now-competitive environment. A well-written proposal or manuscript increases your odds in receiving funding or getting published. Why? Three of the top seven reasons why journal reviewers and editors reject manuscripts include poor focus, organization, and writing (1). In addition, poor writing ranks fourth in the ten most common reasons why Respiratory Care rejects papers (2). Writing also figured in the top reasons why reviewers rejected manuscripts for a conference, slated for subsequent publication in Academic Medicine (3).

In addition, academic medicine often requires writers to generate reader-friendly lay summaries or recommendations for practice that the general public understands. UK-based journals, including The Lancet-, BMJ­-, and Nature-affiliated journals, place particular emphasis on writing articles comprehensible to a general audience, not just subject-matter experts. In the US, the NIH favors research proposals that contain some outreach to the general public. In NIH-funded Clinical and Translational Science Institutes, including the one in which I teach at the University of Florida, we include in our courses for fellows and faculty instruction on reaching lay readers and writing reader-friendly prose.

All these demands bring us to the nub of a rather vexing problem. The handful of publications on writing in medicine contain advice on tackling the rhetorical and content challenges of each section of a proposal or manuscript. A few others have bravely struck out into territory normally claimed by English studies faculty—the components of readable sentences. However, neither approach tells, say, a gastroenterologist how she can identify a problematic sentence or avoid burying important data. The how-to-get-published advice helps you dodge common errors in study design, data analysis and reporting, and the handling of introductions and discussions (1, 4, 5). Other resources included now-dead URLs featuring writing advice on avoiding passive voice and wordiness. But, while most researchers might grasp why passive voice is something to be avoided along with verbosity, few of us know how to recognize when we use either—let alone how to avoid using them.

The first brave foray into giving researchers advice on writing well in academic medicine appeared in Gopen and Swan’s 1990 article on scientific writing (6). Their work tackled examples of academic prose, used linguistics to examine the challenges poor writing throws at its readers, and offered guidance on handling sentence-level challenges. That article represented a quiet milestone on the science of writing, which should have begun a decades-long series of studies on psycholinguistics and its valuable insights into how writers need to write to accommodate the challenges words and sentences pose to our readers’ brains. Instead, however, to use Hamlet’s dying words, the rest is silence.

This silence is particularly ironic, given our growing knowledge of how the reading brain processes written language. Gopen and Swan’s work focused on how words, sentence structure, and connections between sentences impact writing. Their 1990 article used dramatic “before” and “after” versions of scientific writing to demonstrate how to make easily readable even the most complex information. In addition, they established a valuable precedent in recognizing that, as researchers, we are data-driven. Provide a researcher or clinician with data-driven methods for improving their writing, and you’re speaking to us via a conduit we understand.

I spent nearly two decades using research on reading drawn from psycholinguistics and neuroscience to understand reading in multimedia documents before I realized its value to creating a methodology in creating principles for writing. In English studies, every book on writing seeks to be the last word on the subject. In science, you realize that your research can only begin or add to conversations on your subject. My book, The reader’s brain: How neuroscience can make you a better writer uses empirical data to begin a much-needed conversation and research on the connection between writing and the reading brain. One student claimed these methods enabled her to become a full professor and dean within a decade of taking my course via her hefty list of grants and peer-reviewed publications. I hope others in medicine find it as useful—and that considerable conversation and debate ensue.

–Yellowlees Douglas

  1. D.W., Byrne. (1998). Publishing your medical research paper. What they don’t

teach in medical school. Baltimore: Lippincott Williams & Wilkins.

  1. Pierson, David J. (2004). The top 10 reasons why manuscripts are not accepted for publication. Respiratory care, 49(10), 1246-1252. PMid:15447812
  2. Bordage, Georges. (2001). Reasons reviewers reject and accept manuscripts: the strengths and weaknesses in medical education reports. Academic Medicine, 76(9), 889-896. PMid:11553504
  3. Provenzale, James M. (2007). Ten principles to improve the likelihood of publication of a scientific manuscript. American Journal of Roentgenology, 188(5), 1179-1182. PMid:17449755
  4. Browner, Warren S. (1998). Publishing and presenting clinical research. Baltimore: Lippincott Williams & Wilkins.
  5. Gopen, George D, & Swan, Judith A. (1990). The science of scientific writing. American Scientist, 550-558.

Your Brain on Books: Studies Show Reading Causes Measurable Changes in the Brain

It turns out your brain on books might look a lot better, or at least more connected, than your brain not on books. A number of recent studies have found that reading can cause significant quantifiable changes in brains.

A study from Emory University looked at specifically how reading increased connectivity in particular networks in the brain. The study scanned 19 participants’ brains over 19 days: before, during, and after they read 1/9 of the novel Pompeii by Robert Harris. The scans done during the time that the participants were reading the novel show significantly more connectivity in three independent networks in the brain.

Two of these networks almost immediately showed less activity once the reading was finished. The third network however continued to show connectivity, demonstrating reading’s lasting impact on the brain.

But Emory isn’t the only one figuring out how reading changes the brain. Carnegie Mellon scientists created a six-month daily reading program where they scanned participants’ brains before and after. The participants’ grey matter, the region of the brain that processes information, increased dramatically from before and after the six month reading program. The more you read, the easier it may be for your brain to process information and understand the world around you.

Further down South, Washington University in St. Louis also used brain scans to figure out how reading can affect the way we think. Their studies found that the kind of “deep reading” that can sometimes happen when we lose ourselves in a book can actually make new neural pathways in our brains. We create a mental synthesis of our experiences with the protagonists’ and put ourselves in his shoes while reading. For example, when we read about a character moving between places the part of our brain that is associated with spatial scenes is activated. We see ourselves moving between places with the character.

That reading can be transformative seems intuitive. But that its transformative powers are now quantifiable seems almost like a work of science fiction, one that I’d love to read. Just like the body needs be exercised and stretched, so too does the brain…. Another excuse to curl up with some strong coffee and a big new book!





Victims of childhood bullying at higher risk of cardiovascular disease in later life « King’s College London


People who experienced bullying in childhood are more likely to be overweight and show higher levels of blood inflammation in later life, finds new research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London. This puts them at higher risk of heart attack and various age-related conditions, including type-2 diabetes, according to the study authors. 

The findings are based on data from the British National Child Development Study (NCDS), a long-term study of all children born in England, Scotland and Wales during one week in 1958. The study, published today in Psychological Medicine, includes 7,102 children whose parents provided information on their child’s exposure to bullying when they were aged 7 and 11. Measures of blood inflammation and obesity were obtained from information and samples collected when participants were aged 45.

Professor Louise Arseneault
, senior author from the IoPPN at King’s College London, said: ‘Our research has already shown a link between childhood bullying and risk of mental health disorders in children, adolescents and adults, but this study is the first to widen the spectrum of adverse outcomes to include risks for cardiovascular disease at mid-life. Evidently, being bullied in childhood does get under your skin.’

Researchers found that 26 per cent of women who had been occasionally or frequently bullied in childhood were obese at the age of 45, compared to 19 per cent of those who had never been bullied. A second measure of abdominal fat was calculated by dividing waist measurements by hip size (waist-hip ratio). Both men and women who suffered childhood bullying showed greater waist-hip ratio at 45 years old than non-bullied participants. Findings remained significant when controlling for childhood risk factors including parental social class, participants’ BMI and psychopathology and also key adult variables such as social class, smoking, diet and exercise.

Frequent bullying in childhood also led to higher levels of inflammation at mid-life in men and women. Researchers found that 20 per cent of those who had been frequently bullied, compared to 16 per cent of those who had never been bullied, had C-reactive protein (CRP) levels of more than 3mg/L. High CRP levels increase risk of heart disease by promoting atherosclerosis, a condition where arteries become clogged up by fatty substances. Those who were frequently bullied in childhood also had raised levels of fibrinogen, a protein which promotes the formation of blood clots.

Bullying is characterised by repeated hurtful actions by other children, where the victim finds it difficult to defend themselves. In the NCDS, 28 per cent of participants were bullied occasionally in childhood and 15 per cent were bullied frequently. These figures are consistent with prevalence rates of childhood bullying victimisation today.

Professor Louise Arseneault said: ‘Bullying is a part of growing up for many children from all social groups. While many important school programmes focus on preventing bullying behaviours, we tend to neglect the victims and their suffering. Our study implies that early interventions in support of the bullied children could not only limit psychological distress but also reduce physical health problems in adulthood.’

Dr Andrea Danese, a co-author from the IoPPN at King’s, said: ‘Taking steps to tackle obesity and high blood inflammation is important because both can lead to serious and potentially life-threatening conditions, such as type-2 diabetes and cardiovascular disease.

‘The effects of being bullied in childhood on the risk for developing poor health later in life are relatively small compared to other factors. However, because obesity and bullying are quite common these days, tackling these effects may have a real impact.’

He added: ‘The main focus of prevention for age-related disease has traditionally been on unhealthy adult behaviours, such as smoking, physical inactivity, and poor diet. These are clearly important but our research highlights the need to trace the roots of these lifelong risk trajectories back to psychosocial experiences in childhood.’

This research was funded by the British Academy and the Royal Society.

via King’s College London –Victims of childhood bullying at higher risk of cardiovascular disease in later life

The full paper, published in Psychological Medicine, “Bullying victimization in childhood predicts inflammation and obesity at mid-life: a five-decade birth cohort study” by  R. Takizawa, A. Danese, B. Maughan and L. Arseneault is can be viewed here free of charge until 15th July 2015 .


Pregnant women lack guidance on iodine intake levels

Pregnant women are not getting enough information about the need to include iodine in their diets, despite high awareness of general advice for pregnancy nutrition.

While 96% of pregnant women surveyed by researchers were aware of general nutritional recommendations for pregnant women, only 12% were aware of iodine-specific advice.

The study, published in the British Journal of Nutrition, estimated the median intake of iodine during pregnancy was 190 micrograms (ug) per day, with 74% consuming less than the World Health Organisation (WHO) recommended intake of 250ug daily.

Iodine is required for the production of thyroid hormones, which are crucial for fetal development with links between iodine deficiency and developmental impairments.

Dr Emilie Combet, who led the reserch at the University of Glasgow, said: “Women aren’t receiving the message about the importance of iodine in pregnancy, meaning they cannot make informed choices to ensure they get the amount they require.”

Iodine deficiency affects 1.9 billion people globally and is the most preventable cause of intellectual disability. The UK is ranked 8th in a list of iodine-deficient countries in the world.

The main sources of iodine-rich foods are seafood and dairy products, and in some countries iodine-fortified salt or bread. In the UK, the Reference Nutrient Intake (RNI) for adults is 140ug per day, with no proposed increment for pregnant and lactating women.

Unborn children and young infants are entirely reliant on their mother for iodine supply, making babies and pregnant or lactating mothers the most vulnerable groups of the population.

At present there is no recommendation for routine iodine supplementation in the UK unlike folic acid and Vitamin D, or routine testing in pregnancy that would reflect iodine levels, as there is with iron.

The study surveyed 1,026 women across the UK who were pregnant or mothers of children aged up to 36 months. Participants were asked about their awareness of nutritional guidelines and completed a food frequency questionnaire.

Knowledge of iodine-rich foods was low, with 56% unable to identify any iodine-rich food and the majority wrongfully believing dark green vegetables and table salt had high levels. Most, 84% were unaware that iodine from diet is important for the healthy development of the unborn baby, and only 11% had heard about iodine from a healthcare professional.

Dr Combet said: “Iodine is crucial during pregnancy and the first months of life, to ensure adequate brain development, but achieving over 200ug a day of iodine through diet requires regular consumption of iodine-rich foods such as milk and sea fish. Not everyone will have the knowledge, means or opportunity to achieve this.

“There is an ongoing debate as to whether there should be some form of fortification of food with iodine. Iodine-fortified salt is common in other countries, but using salt as the delivery method has raised concerns since it is perceived to clash with public health messaging around reducing salt intake to combat high blood pressure. However, other countries have demonstrated that both measures could be held simultaneously. We need to work toward a solution.

“The most important issue to come from this study, however, was the lack of awareness of the important role iodine plays in fetal development and how to consume adequate levels of this essential mineral. This is something that needs to be addressed. Our current Yorkhill Children Charity – funded project us developing tools and resources for health care professionals and women either pregnant or planning a pregnancy.”

This paper is freely available for 2 weeks

Related links

Dr Emilie Combet: researcher profile

Media enquiries: stuart.forsyth@glasgow.ac.uk / 0141 330 4831

Cardiovascular risk factors extremely high in people with psychosis « King’s College London

Extremely high levels of cardiovascular risk factors have been found in people with established psychosis, with central obesity evident in over 80 per cent of participants, in a study by researchers from the NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust (SLaM) and King’s College London.

In the largest study of its kind in the UK, drawing on a sample of more than 400 outpatients with psychosis, it was discovered that nearly half of the sample were obese (48 per cent), with a body mass index (BMI) of 30 or more. Additionally, nearly all women and most men had a waist circumference above the International Diabetes Federation’s (IDF) threshold for central obesity. According to this measure 83 per cent of patients were centrally obese: 95 per cent of females and 74 per cent of males. Central obesity refers to excessive fat around the stomach and abdomen, to the extent that it is likely to have a negative impact on health.

The majority of participants tested (57 per cent) met the IDF’s criteria for metabolic syndrome, which is a cluster of biochemical and physiological abnormalities associated with the development of heart disease, stroke and type-2 diabetes. A fifth met the criteria for diabetes and 30 per cent showed a higher risk of going on to develop diabetes.

Although cardiovascular risk factors are common in psychosis, this UK study reports some of the highest rates worldwide, reinforcing the need to incorporate weight and cardiovascular risk assessment and management into the routine care of people with psychosis.

Data was collected as part of the NIHR-funded IMPaCT trial and the study took place within community mental health teams in five mental health NHS Trusts in urban and rural locations across England.

The study, published in Psychological Medicine, also identified lifestyle choices likely to add to cardiovascular risk, with 62 per cent of the sample reported to be smokers, greatly in excess of the general UK population smoking rates of 20 per cent. Lack of exercise was also commonplace, with only 12 per cent of participants engaging in high intensity physical activity.

Dr Fiona Gaughran, senior author from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, and the National Psychosis Unit at SLaM, said: ‘We already know that diagnosis of a psychotic illness such as schizophrenia or bipolar disorder is associated with a reduced life expectancy of between 10 to 25 years. This mortality gap is largely due to natural causes, including cardiac disease. The worryingly high levels of cardiovascular risk shown in our study indicate that a much greater emphasis on physical activity is needed for those with severe mental illnesses, as well as a more significant focus on supporting attempts to quit smoking.

‘While previous research has demonstrated that people gain weight on starting anti-psychotics, our study of people who have had psychosis for nearly 16 years on average found no difference in the rates of cardiovascular risk between the various different anti-psychotic medications. Research is urgently needed into the best ways to reduce existing cardiovascular risk in people with psychosis, prevent weight gain and promote healthy lifestyles in the early stages of the illness.’

The research paper summarises independent research funded by the National Institute for Health Research (NIHR) under its IMPaCT Programme Grant (Reference Number RP-PG-0606-1049).

via King’s College London –Cardiovascular risk factors extremely high in people with psychosis


The full paper, published in Psychological Medicine, “Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial” by P. Gardner-Sood, J. Lally, S. Smith et al. is published open access and can be viewed here.

Cambridge launch new open access journal – Global Health, Epidemiology and Genomics

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Cambridge unveils new Open Access journal – Global Health, Epidemiology and Genomics (GHEG)

Cambridge University Press is delighted to announce a major new open access journal, Global Health, Epidemiology and Genomics (GHEG), dedicated to publishing and disseminating research that addresses and increases understanding of global and population health issues through the application of population science, genomics and applied technologies.

Global Health, Epidemiology and Genomics is the Press’s second Open Access journal in the field of global health, joining Global Mental Health which launched in 2014. Spanning both non-communicable and communicable diseases, GHEG will specifically integrate epidemiology, genomics and related technological advances in the global health context. Topics relevant to GHEG will include studies, methods and resources relating to global population health, disease aetiology, variation in disease susceptibility, drug resistance and surveillance, health care and health care systems, pharmacogenomics and stratified medicine, as well as the challenges of implementing new developments into clinical practice and the community, globally. In addition to more traditional Original Research and Review Articles, GHEG will support submission of Resources and Analyses that provide a framework for integrating and facilitating genomics and global health studies.

The Editor-in-Chief of GHEG is Dr Manjinder Sandhu, head of the Global Health Group based at the University of Cambridge and the Wellcome Trust Sanger Institute. The international Editorial team includes recognised leaders in global health, epidemiology and genomics from around the world who have taken a lead in shifting attention and action to global health and populations, as well as a wider Editorial Board that will reflect and emphasize the broad scope of the field.

Dr Sandhu said, “I am committed to making GHEG an innovative, engaging and practical resource for the global health research community through which we can publish new scientific research, exchange ideas within and across our related disciplines and share resources to facilitate efforts to increase our understanding of human health and shape effective disease management worldwide.”

Professor Alex Brown, Deputy Director of the South Australia Health & Medical Research Institute (SAHMRI) and one of the journal’s Associate Editors commented, “I am delighted to be involved with GHEG, an exciting venture which recognises the relevance and importance of the work being undertaken in the field of global health, epidemiology and genomics and the widespread benefits to be gained by applying technological advances and innovations to research into population health including within disadvantaged population groups. By facilitating discussion and encouraging the sharing of resources GHEG looks to actively support contributions in these areas.”

Katy Christomanou, Publishing Director for STM Journals at Cambridge University Press, added, “This launch affirms our long-term commitment in the global health field and reflects our strong investment in maintaining and extending our successful presence in this area. We are highly enthusiastic at the prospect of working alongside such an outstanding editorial team.”

Global Health, Epidemiology and Genomics will be hosted on Cambridge’s industry-leading platform, Cambridge Journals Online (CJO). The Journal will benefit from a range of the latest author services including article level usage metrics and Altmetric data. In addition, for articles submitted during 2015 and 2016, Cambridge University Press will waive all article processing charges.

For more information please visit the journal website: journals.cambridge.org/gheg

Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma?


The April International Psychogeriatrics Article of the Month is entitled “Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma?” by Maria Landqvist Waldö, Lars Gustafson, Ulla Passant and Elisabet Englund.

Despite all attempts to develop clinical diagnostic criteria with high specificity and sensitivity early diagnosis in FTD remains a challenge, even for the experienced clinician. The patients may present with a wide range of symptoms that often mimic other psychiatric disorders and initial psychiatric diagnoses are common. Psychotic symptoms are known to be prominent symptoms in several neurodegenerative diseases including AD and DLB, and have previously been thought to be quite rare in FTD. There are indications that a high prevalence of psychotic symptoms seems to be associated with specific molecular and genetic subgroups of FTD, but as this has not been adequately studied we examined prevalence of psychotic symptoms and possible correlations to brain pathology in FTD. Furthermore we evaluated clinical diagnostic accuracy as well as family history in our cohort of 97 neuropathologically diagnosed FTD cases.

We found that psychotic symptoms were present at some time during the course of dementia in 32% of our cases. There were no significant differences in gender, age at onset or disease duration between patients with and without psychotic symptoms. The most common type of psychotic symptoms was paranoid ideas (20.6%) followed by hallucinations and delusions (17.5%) in equal measure. There was a strong significant correlation between psychotic symptoms and predominantly right-sided brain degeneration.

We could see a trend with more frequent psychotic symptoms in tau-negative cases, however not statistically significant. Psychotic symptoms were particularly common in the cases with FUS pathology and in those without identified brain protein pathology.

The majority of patients received other first diagnoses than FTD, often psychiatric diagnoses. The patients with an initial psychiatric diagnosis were significantly younger than patients with other first diagnoses. About 80% patients where subsequently diagnosed with FTD and among these the median time from symptom onset until diagnosis was 4 years with median disease duration of 7.5 years, however with large variations. A clinical diagnosis of psychosis was almost exclusively given to tau-negative cases.

This is one of the largest studies aimed at assessing the prevalence of psychotic symptoms in FTD and relating them to neuropathology. Compared to many other studies we found a higher prevalence of psychotic symptoms. A correlation between psychotic symptoms and right-sided predominant pathology has been suggested earlier, but to our knowledge never shown in such a large neuropathological study. Although previous studies have found differences in the prevalence of psychotic symptoms between tau-positive and tau-negative cases, we did not find any significant differences between the groups. We identified two groups with particular high prevalence of psychotic symptoms: the FUS pathology cases and those with no identified protein pathology. Our FUS cases share many features with previous reports of this specific group such as young age at onset, no heredity for dementia and prominent neuropsychiatric symptoms. Interestingly, the cases from the group without specific protein pathology also display prominent psychiatric symptoms.

Read the full paper “Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma” by Maria Landqvist Waldö, Lars Gustafson, Ulla Passant and Elisabet Englund

Read the commentary paper “Commentary on:  in frontotemporal dementia: a diagnostic dilemma?” by John T. O’Brien

Dodo bird verdict given new life by psychosis therapy study | The University of Manchester

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A study by researchers at The University of Manchester and the University of Liverpool has examined the psychological treatment of more than 300 people suffering from psychosis, showing that, whatever the therapy, it is the relationship between the patient and therapist which either improves or damages wellbeing.

The research relates to one of the more controversial ideas in psychotherapy research – the Dodo bird conjecture.  Named after a bird in Alice’s Adventures in Wonderland which sent several characters on a race and then declared them all winners, this conjecture states that all types of psychotherapy, even though often appearing to be very different from each other, are equally beneficial to patients.

In this case, the research showed that it is the quality of the relationship between the therapist and patient which causes improvement and not the different techniques employed in the two therapies that were compared.

Many studies have looked at types of talking treatment which can help people recover from psychotic episodes.  These include cognitive behavioural therapy (CBT) and family therapy. High quality research uses a comparison group which also receives some kind of less structured treatment, for example supportive counselling or befriending.

Surprisingly, patients in these comparison groups often benefit from the comparison treatment as much as those receiving the specific, targeted therapies (CBT or family therapy). Both groups who receive a psychosocial treatment fare much better than those offered only medication and usual care.

The researchers explored in depth the causative effect of the ‘therapeutic alliance’ or relationship of trust between patient and psychologist when schizophrenia patients were treated during a trial of this kind.

Lucy Goldsmith, a PhD candidate from The University of Manchester’s Institute of Brain, Behaviour and Mental Health, carried out the research in collaboration with the researchers who had carried out the original trial: Manchester professors Shôn Lewis and Graham Dunn, and Liverpool professor Richard Bentall. She said: “The quality of the therapeutic relationship has been linked to outcomes before, but we wanted to see whether the it really causes the changes in wellbeing occurring during therapy.

“Does successful treatment make patients feel well disposed towards their therapist or is the relationship actually at the heart of whether therapy succeeds?”

By using already established rating systems of these relationships and taking data from the earlier study of 308 patients, the researchers found that a good level of therapeutic alliance had a beneficial impact on wellbeing, but where the relationship was poor, the treatment could actually be damaging.

“The implications are that trying to keep patients in therapy when the relationship is poor is not appropriate,” Lucy said.  “More effort should be made to build strong, trusting and respectful relationships, but if this isn’t working, then the therapy can be detrimental to the patient and should be discontinued.

“The study clearly shows that the two types of therapy are equally beneficial to the patient – as long as the trust, shared goals and mutual respect between client and psychologist are in place.”

The paper, ‘Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis,’ was published in the journal, Psychological Medicine.

via Dodo bird verdict given new life by psychosis therapy study | The University of Manchester.

The paper, “Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis” has been published gold Open Access, and can be found using this link. 


The importance of Youth Mental Health

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Find out the Guest Editors’ (Mary Cannon and John Lyne) response to questions about youth mental health following a recent special issue in Irish Journal of Psychological Medicine.

What is Youth Mental Health?

Youth Mental Health refers to mental health among adolescents and young adults. The time period covered by the term “youth mental health” typically ranges between 15-25 years of age though some would advocate that this should extend from 12-30 years. Youth mental health focuses on the well-being of young people, and aims to ensure that young people transition between childhood and adulthood with positive mental health. With this in mind a recently published issue of the Irish Journal of Psychological Medicine provided a focus on mental health during this youth phase of people’s lives.

Why highlight the Youth Mental Health agenda?

It is now recognised that many so-called “adult” mental health difficulties have their origins during adolescence and young adulthood. An illness prevention focus has been very effective in reducing the prevalence of some illnesses, such as heart attacks and cancers, however similar strategies have lagged behind in the field of mental health. Appropriate help for young people early in their lives has the potential to reduce later mental health morbidity. However, despite the high levels of mental health issues among young people, services for this age-group remain fragmented and difficult to access.  The delivery of tailored youth-friendly services could help address this need and is a particular focus of youth mental health advocates.

Why publish this special issue now?

This Special Issue follows on from the adoption of Youth Mental Health as the official annual theme by the College of Psychiatry of Ireland in 2013. Several annual Youth Mental Health Research conferences have been held in Ireland since 2011, establishing Ireland as one of the leading international countries in the field of youth mental health. This special issue aims to harness the large amount of research activity in this area in Ireland and internationally.

What does the issue include?

Scientific papers were contributed by several high profile national and international researchers. New data papers are included which report the prevalence of mental disorders among young Irish adults. Risk and protective factors for mental illness in young people and the importance of early intervention in psychosis and bipolar disorder are also addressed.  Editorials and perspective pieces by experts in the field address the challenges in providing seamless care during transition from childhood to adulthood, and give examples of youth services developed in United Kingdom, Canada and Ireland. Overall this special issue brings together high quality research which highlights that youth mental health should be prioritised on health policy agendas.


Read the full contents of the special issue free of charge here for a limited time period

If you are using a mobile device please click here to view the issue


Variability in estimating the self-awareness of memory deficits


The March International Psychogeriatrics Article of the Month is entitled ‘Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease’ by Johann Lehrner, Sandra Kogler, Claus Lamm, Doris Moser, Stefanie Klug, Gisela Pusswald, Peter Dal-Bianco, Walter Pirker and Eduard Auff

As the world population ages, we face sharp rises in prevalence rates for neurodegenerative diseases. In order to minimize entailing individual and societal burdens, early diagnosis is becoming increasingly important. Efforts to enable early recognition of impending cognitive decline led to the development of the concept of Mild Cognitive Impairment (MCI), which describes a transitional stage between normal age-related memory decline and dementia. Yet, not all individuals diagnosed with MCI can be considered as being in a prodromal phase of dementia. Accordingly, ongoing research is now focusing on the identification of (a) those individuals with MCI who are most likely to convert to dementia and (b) asymptomatic individuals in a pre-MCI stage. Yet, which early markers are available for their identification?

With some evidence pointing towards a connection between low memory awareness – an inability to (fully) recognize memory deficits – and subsequent memory decline, awareness measures bear potential as an important marker of underlying dementia pathologies. However, as research in this field is defined by inconsistencies, this hypothesis needs further investigation.

We therefore used data concerning our patients’ subjective memory appraisals and objective memory performance to create an awareness index, which allowed us to compare levels of awareness (and frequencies of memory overestimation) across healthy elderly people and patients with varying degrees of memory impairment. Our question was whether our approach would reveal characteristic awareness differences similar to prior research.

As expected, our findings suggest that self-awareness of memory deficits decreases as cognitive deficits – especially memory deficits – increase. Accordingly, the highest rate of overestimation of memory function was found among patients suffering from Alzheimer’s disease (63%), followed by amnestic MCI patients without and with Parkinson’s disease (46%, 38%), while patients with cognitive deficits other than memory (non-amnestic MCI) showed a tendency towards underestimation of memory function. Our analyses further revealed considerable between-group overlaps in awareness scores and strong influences of non-cognitive factors such as depression.

The main implication of our study is that memory awareness reflects objective deterioration to some extent, but that there is considerable inter-individual variability in awareness. It is this variability which gives rise to the question whether differences in awareness are predictive of future conversion to dementia.

We hold the view that research in this field is important insofar as awareness measures are of high practical relevance: As opposed to biomarkers and neuroimaging technologies, which are of restricted availability in primary care settings, both measures of subjective memory complaint and objective memory performance provide easily, time- and cost efficiently accessible sources of information. Moreover, they count among the standard repertoire of diagnosis in MCI and other dementia-related diseases. Researchers could use these data to further explore the diagnostic and predictive validity of awareness measures. We hope that our work inspires further research concerning memory awareness and strongly welcome any comments and remarks.

The full paper “Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease” is available free of charge for a limited time here.

The commentary on the paper, “Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease” is also available free of charge here.

Are men with moustaches more likely to carry nasal bacteria?

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This paper discusses the results of an investigation concentrating on men with and without a moustache, to explore whether having facial hair may lead to an increase in nasal Staphylococcus aureus (S aureus) colonisation.

S. aureus can be considered as a serious public health issue. It can cause a range of illnesses, from minor skin infections to life-threatening diseases such as pneumonia, meningitis, and food poisoning, although the presence of S. aureus does not always indicate infection.

The anterior nares (nostrils) are where S. aureus resides in human beings, and it has been shown that nasal carriers of S aureus have an increased risk of acquiring an infection with this pathogen. Despite antibiotic therapy, nasal infections occur frequently in hospitalised patients, often with severe consequences.  In order to fully address this public health problem, it is important to understand whether the presence of a moustache effects the colonisation of nasal infections.

To test this hypothesis the researchers took men who had been wearing a moustache for at least one year and compared them to the participants in the control group who had shaved the hair in this region daily over the previous year. None of the participants had been hospitalised or treated with antibiotics in the previous three months nor were they smokers or had any previous respiratory infections in the past.

The study group consisted of 118 adult men with a moustache and 123 men without a moustache, all of whom gave samples from their right nasal cavity for the study of cytology and the left nasal for microbiology testing.

The results of the swab testing indicated that nasal Staphylococcus aureus carriage is similar in men with (19.5%) and without (20.3%) a moustache.

As a moustache is situated at the entrance to the nostrils, some bacterial contamination might be possible, especially in nasal S aureus carriers. Nevertheless, this study indicated that nasal S aureus carriage is similar in men with and without a moustache. The carrier rate of S aureus observed here is comparable to those rates reported in the literature. Therefore, having a moustache does not increase the risk of S aureus colonisation in the nose.

The full paper, published in The Journal of Laryngology & Otology, “Effect of a moustache on nasal Staphylococcus aureus colonisation and nasal cytology results in men” by E. Soylu, I. Orhan, A. Cakir, A. Istanbullu, G. Altin, R. Yilmazer and O. F. Calim can be viewed free of charge here for a limited period.

A provisional consensus clinical and research definition for Agitation in cognitive disorders

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The January International Psychogeriatrics Article of the Month is entitled ‘Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition’ by Jeffrey Cummings, Jacobo Mintzer, Henry Brodaty, Mary Sano et al.

Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome.

Agitation is a common clinical manifestation of many neuropsychiatric disorders. It is a frequent manifestation of Alzheimer’s disease (AD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and other dementia but also occurs in schizophrenia, bipolar illness, and depression. While agitation may include aggressive behaviors, it is not identical to aggression, and agitation can occur without aggression (e.g. pacing, rocking, repetitious mannerisms).

The International Psychogeriatric Association (IPA) formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs.

The ADWG implemented a transparent process that included nearly 1,000 survey respondents and engaged the memberships of the IPA, IPA affiliates, and other organizations involved in the care and research of neuropsychiatric disorders in patients with cognitive impairment. The group used a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process.

An initial survey provided valuable insights from those involved in the care of agitated patients, and key elements of the definition were identified. Of the items listed as possible behaviors to be included in a definition of agitation, the following were endorsed by at least 50% of the respondents: pacing, aimless wandering, verbal aggression, constant unwarranted requests for attention or help, hitting others, hitting self, pushing people, throwing things, general restlessness, screaming, resistiveness, hurting self, hurting others, tearing things or destroying property, shouting, and kicking furniture. This information guided the elements included in the definition by the ADWG.

Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as “strongly agree” or “somewhat agree” (68–88% across elements). A majority of the respondents also agreed that the definition is appropriate for clinical and research applications.

The development of a provisional definition of agitation is the first step in advancing a research agenda for the definition. Not all elements were unanimously endorsed; a consensus was achieved on all aspects of the definition. Validity studies using other agitation assessments, reliability of the application of the definition, usefulness in clinical trials, usefulness in non-pharmacologic research, and real-world application in clinical and healthcare settings will lead to refinements and adjustments that will enhance the definition and advance the study of neuropsychiatric syndromes in cognitive impairment disorders.


The full paper “Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition” has been published Open Access and is available here.

The commentary on the paper, “Defining agitation in the cognitively impaired–a work in progress” is also available free of charge here.

A looming danger…

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This paper reports on four paediatric patients who presented with a loom band associated foreign body in the nose over a 7-day period at a district general hospital in Scotland. The patients were two three-year old and two four-year old children with either loom bands or the S-shaped hooks in their noses.

There has been a surge in the popularity of loom bands amongst children in recent months. These small rubber bands, which can be woven together to make colourful bracelets and necklaces, have become the world’s most popular toy. Foreign bodies in paediatric nasal and aural cavities are a common presentation to ENT units across the country. Whilst most are removed without incident, foreign bodies in nasal passages represent a potential risk for inhalation, leading to airway obstruction.

Two of the cases resulted in the item being removed with local anaesthetic and forceps, and in one case, forceps without anaesthetic. In the fourth case, the hook was originally visible deep within the nasal passage, but partial inhalation into the posterior nasal passage meant that the hook was no longer visible. Whilst waiting for a senior medical review, the patient was observed to choke.  After examination, it was assumed that the patient had ingested the foreign body and after a short period of observation, the patient was released.

Although the four cases presented were resolved without the need for general anaesthetic, the ever-soaring prevalence and popularity of loom bands necessitates a degree of caution and vigilance from parents, retailers and manufacturers alike.

The authors said, “Foreign body airway obstructions in children are potentially avoidable, life-threatening events. The case series presented reflects a poor public understanding of the complications of inhaled foreign bodies in children and limited hazard advertising by the manufacturers of loom bands. There is a great urgency to rectify this in light of the ever-increasing popularity and availability of loom bands.”


 The full paper, published in The Journal of Laryngology & Otology, “Loom bands and young children – a tragedy waiting to happen?” by I R M Bohler, C Douglas and S Ansari, can be viewed free of charge here for a limited period.

Pregnant women are exceeding weight gain guidelines

Mums-to-be are advised to watch their “overall food intake and takeaway consumption” following the results of a new study on the health behaviours and psychological well-being of pregnant women in Ireland.

The findings published in the scientific journal Public Health Nutrition reveal that almost two-thirds (62.5%) of women in Ireland exceed the recommended levels* of weight gain during pregnancy.

According to the study, pregnant women who report eating “a little more food” during their pregnancy are 60% more likely to gain excessive weight over the course of their pregnancy than those women who report eating “about the same” as before they became pregnant. It also shows that women who report eating “a lot more food” during their pregnancy are twice as likely to exceed weight gain guidelines.

The study identifies “increased food intake and takeaway consumption” as two key drivers of weight gain during pregnancy. To conduct the study researchers at University College Dublin and the National Maternity Hospital examined four health behaviours of almost 800 pregnant women: food intake, physical activity, sleep and smoking. They also assessed additional dietary behaviours including the frequency of takeaway and fried food consumption and the number of snacks eaten per day.

The findings show that foreign nationals living in Ireland are almost twice as likely as women born in Ireland to gain excessive weight over the course of their pregnancy.

“Excessive weight gain during pregnancy has significant implications for infant growth and obesity, with potential implications for later adult health,” says Fionnuala McAuliffe, Professor of Obstetrics and Gynaecology at UCD School of Medicine & Medical Science, University College Dublin, and the National Maternity Hospital, Holles Street, Dublin, who co-authored the study.

“With these findings, public health campaigns can be better designed to target the types of dietary changes required to bring weight gain during pregnancy into line with the recommended guidelines.”

Women who were overweight before they became pregnant were also shown to be the most likely to gain excessive weight during their pregnancy. This matches findings from many other studies in this area. “To our knowledge, this is the first study to find an independent association between consumption of takeaway meals and weight gain during pregnancy,” says Dr Emily Heery of the UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, the lead author of the study. 53% of the women who took part in the study were first time mums-to-be, 30% were foreign nationals, and almost half (47%) had obtained at least a degree qualification. Over half (55%) of the women had private health insurance.

The article is freely available until 27 February 2015.

– Dr Emily Heery

How to measure mood in nutrition research

The January Nutrition Society Paper of the Month is from Nutrition Research Reviews  and is entitled “’How to Measure Mood in Nutrition Research”.

Mood is widely assessed in nutrition research, usually with rating scales. We have been researching the effects of food on mood for over twenty years, which has highlighted concerns about how mood is measured, one result of which is this review; we have been working on it intermittently ever since.

From early on, we had serious concerns because the mood effects of food are often fragile and hard to replicate, yet many foodstuffs are marketed and consumed on the assumption that they affect mood, at least by being pleasurable, and perhaps also by having functional effects on the nervous system. One of the striking but hard to substantiate claims made repeatedly since the 1960s was that sugar has drug-like effects by artificially elevating mood, followed by a rebound ‘sugar blues’ requiring further consumption of sugar. Consequently, we have largely focused on sucrose in our research.

There are some basic problems with how mood is measured. The questionnaires used to rate mood have not always been shown to be sensitive to relatively rapid ‘transient’ changes in mood because they were designed to compare mood over different days or weeks, as in the study of depression.  It is therefore possible that nutrition research often fails to detect mood effects of food that actually exist.

Another difficulty is that the use of different rating scales in different combinations, given at different times, in different experimental designs, propagates inconsistent and uncertain results. Mood rating can be affected by many aspects of an experiment other than the food given, and generally research participants should be blind to the experimental manipulation.

There are other more theoretical difficulties: It is commonly assumed that mood is what mood scales measure, most often arousal, and positive versus negative mood; It is also often assumed that rated mood is an unproblematic measure of experienced subjective mood, which is in turn related to underlying physiological condition. So for instance rating oneself aroused means you feelaroused and are aroused by measures such as skin conductance and heart rate. In reality, rated mood, phenomenological mood and physiological state are correlated with each other, but can vary separately and be affected by different causes. For instance, it is possible for mood ratings to change without there being an underlying conscious experience of change. As well as improving methods of rating mood, there is a need for a better theory of how mood and mood rating work. This review along with an earlier paper in Neuroscience and Biobehavioral Reviews is our attempt to improve practice in the assessment and understanding of mood in nutrition research.

– Professor Richard Hammersley

This paper is freely available for one month via the following link: journals.cambridge.org/ns/Jan15

Common mental disorders prevalent in UK military « King’s College London

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Symptoms of anxiety and depression appear to be twice as frequent in the UK military as in the general working population, according to research carried out at the King’s Centre for Military Health Research (KCMHR), King’s College London and published in Psychological Medicine.

The study compared data from over 7,000 personnel serving in the UK Armed Forces with 7,000 people from the general population identified as being in employment from the Health Survey for England. Both surveys used the General Health Questionnaire (GHQ) and it was found that symptoms of common mental disorders (CMD) (i.e. anxiety and depression), appeared to be twice as frequent in the military as in the general working population. In fact, 18% of men and 25% of women serving in the Armed Forces reported symptoms of CMD compared to 8% of men and 12% of women in the general working population.  This difference was apparent at both time points of the study, 2003 and 2008.

Lead author, Dr Laura Goodwin from KCMHR said ‘This is the first formal comparison of common mental disorders between the serving military and the general working population. Whilst symptoms of common mental disorders appear to be twice as common in the military after accounting for age, gender and social class, there is more to be done to understand these differences.’

The researchers had previously found that there is a tendency for over reporting of symptoms of anxiety and depression in occupational studies aimed at specific groups such as police, teachers and social workers. The Health Survey for England was a population study in which an individual’s occupation was not the main focus, which is likely to have had some effect on the results.

One way it was a considerable improvement on earlier research was that previous studies have all been forced to compare different measures of CMD, which is a major limitation, whereas in this study all participants completed the same questionnaire, the GHQ. Also, some previous surveys have included individuals who are unemployed and those with long-term health problems and disabilities and these groups are more likely to report symptoms of depression and anxiety, so this comparison of military employees with only those in employment from the general population is a fairer like-for-like comparison.

The survey included questions such as whether the subject felt they were ‘playing a useful part in things’, and military respondents were almost three times more likely to disagree with this statement than the general population at both time points. On the other hand, the smallest difference between the military and general population was found for the statement ‘felt constantly under strain’.

The researchers suggest that differences in the prevalence of symptoms of depression and anxiety in this extensive study could be explained by the frequency and intensity of stressful events experienced by military personnel and that military life requires extended periods spent away from family and friends, for training and exercises as well as for deployment.

Professor Nicola Fear, KCMHR concludes: ‘This highlights that symptoms of depression and anxiety are common in the Armed Forces, in fact, they are more common than alcohol misuse or post-traumatic stress disorder (PTSD).  The findings draw attention to the need for Defence Medical Services to continue to focus on identifying and treating depression and anxiety in addition to PTSD.’

Paper reference: Goodwin, L. et al. ‘Are common mental disorders more prevalent in the UK serving military compared to the general working population?’ published in Psychological Medicine DOI: http://dx.doi.org/10.1017/S0033291714002980

via King’s College London – Common mental disorders prevalent in UK military.

International Psychogeriatrics – Special issue on Young Onset Dementia

International Psychogeriatrics
has published a special issue on Young Onset Dementia, guest edited by Raymond Koopmans and Tor Rosness.

The rising prevalence of dementia includes an increase of people with Young Onset Dementia (YOD). Studies have scrutinized the literature and documented distinct differences in traits between younger and older persons with dementia in several areas such as medical treatment, physical activity, functional level, activities of daily living, comorbidity, risk profiles, and caregiver distress. However, the cut-off of 65 years is arbitrary and there is still no consensus on if a diagnosis of dementia has to be made before the age of 65 years or if it is sufficient that the first symptoms are detected before the age of 65 years?

YOD is being steadily recognized as an important psychosocial and medical health problem with specific-age-related adverse consequences for both these younger persons and their families, however, many countries lack specific plans in their dementia strategies and do not offer any specific form of services or support for this group of individuals. Therefore the International Psychogeriatric Association (IPA) established a taskforce on YOD. The idea of composing a special issue on YOD was raised during The Hague meeting in 2011, and the issue consists partially of papers that have been presented during the symposia and workshop-meetings of the taskforce.

The YOD special issue provides an overview of important topics including unmet needs of carers, different clinical approaches to YOD diagnoses, needs of children with YOD parents, and medical treatment of behavioral symptoms of YOD patients.

We are offering limited time free access to the articles from this issue – simply register using our short form, using the code IPGYOD2

Socio-economic inequalities in diet in UK adults

The December Nutrition Society Paper of the Month is from British Journal of Nutrition and is entitled “Socio-economic dietary inequalities in UK adults: an updated picture of key food groups and nutrients from national surveillance data”.

Study written in the British Journal of Nutrition found that those higher up on the socio-economic ladder are generally healthier and are less likely to be obese, and what people eat varies across different social groups.  It’s a reasonable assumption that these two phenomena are connected, but in the UK social inequalities in diet have not been comprehensively assessed in recent years.  While plenty of studies have documented socioeconomic differences in fruit and vegetable consumption, less is known about other food groups and nutrients, including fish and processed meat.  We also need to better understand the extent to which inequalities in diet differ across different indicators of socioeconomic position such as income, education and occupation.  This matters because unless we can understand the social and economic pattern of diet we will struggle to find the right strategies to improve public health for everyone.

Our study examined foods and nutrients eaten in a nationally-representative sample of 1491 UK adults stratified by socioeconomic position (SEP).  Data came from the rolling programme of the National Diet and Nutrition Survey 2008-2011. We calculated average intakes of five foods and nutrients across three indicators of SEP: equivalised household income, occupational social class, and highest educational qualification. The choice of foods and nutrients for this study was informed by the Scientific Advisory Committee on Nutrition’s (SACN) 2008 report on the nutritional status of the British population. This report expressed concern over whether people in the UK were eating enough fruit, vegetables and oily fish; and whether they were eating too much red and processed meat, sugar and saturated fat.

We found that, not only did the sample as a whole not meet recommended intakes, those of a lower SEP fared the worst.  For the food groups, the least educated adults ate 128grams a day less fruit and vegetables than the most educated; the lowest occupational class consumed 26grams a day more red and processed meat than those in higher managerial occupations; and the highest income group were four times more likely than the lowest to have consumed any oily fish.  The amount of calories from sugars (non-milk extrinsic sugars) was around two percentage points higher in the lower SEP groups. No pattern of saturated fat consumption was found for any of the socio-economic indicators.

So, what does this mean for action to tackle health inequalities?  Our study provides up-to-date evidence about specific food groups  that are of concern for public health nutrition, and is a reminder of the importance of monitoring dietary trends in a time of entrenched and rising inequality. It also adds important detail in terms of how different aspects of life experience and social position can affect what we eat. For instance, income or occupation may affect our material ability to access a healthy diet, or education may equip us to make healthier choices. When developing policies and interventions to tackle unhealthy diet, it is vital to take into account these different aspects of our lives.

This paper is freely available for one month via the following link: journals.cambridge.org/ns/dec14

Calorie-focused thinking when it comes to obesity may mislead and harm public health

Perhaps not all calories are created equal. A new paper, co-authored by Saint Luke’s Mid America Heart Institute cardiovascular research scientist James J. DiNicolantonio, PharmD, challenges the prevailing belief that all consumed calories—regardless of their sources—are equivalent, and that focusing on calories is a good thing.

Primarily authored by Sean C. Lucan, M.D., M.P.H., M.S., Department of Family and Social Medicine, Albert Einstein College of Medicine, the paper is titled “How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative,” and is being published in the journal Public Health Nutrition.

The paper discusses various problems with the idea that “a calorie is a calorie,” and with the primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus—paying more attention to the foods from which the consumed calories derive—and on the metabolic changes that result from consuming foods of different types. In particular, Lucan and DiNicolantonio consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases (e.g. nuts, olive oil, oily fish, whole milk), and supportive of starchy and sugary replacements, which are likely detrimental.

The idea that “a calorie is a calorie” implies that any two different foods, which have equivalent amounts of potential energy, will produce identical biological effects with regard to body weight/body fatness when consumed. By this thinking, a calorie’s worth of salmon, olive oil, white rice, or vodka would each be equivalent and expected to have the same implications for body weight and body fatness.

But a calorie’s worth of salmon, which is largely protein, and a calorie’s worth of olive oil, which is purely fat, have very different biological effects than a calorie’s worth of white rice, a refined carbohydrate, or a calorie’s worth vodka, mostly alcohol—particularly with regard to body weight/body fatness. In fact, studies in humans have shown that calorie-providing proteins, fats, carbohydrates, and alcohol each have substantially different effects on a variety of physiologic pathways and hormones relevant to perceived fullness, subsequent food consumption, weight maintenance, and body composition.

The paper specifically discusses the harmful effects of rapidly absorbable carbohydrates—sugars and refined starches, such as white rice and foods consisting substantively of white flour. These foods cause blood sugar and insulin to rise quickly, which then causes a rapid drop in blood sugar. The result is food cravings, particularly for something sweet.

“The fact is that some calories will squelch a person’s appetite and promote energy utilization, while others will promote hunger and energy storage,” DiNicolantonio said. “So while some calories send messages to the brain and body that say ‘I’m full and ready to move,’ other calories are send messages that says ‘I’m still hungry and just want to lie down on the couch.’ Not all calories are the same, and in order to promote healthy weight and better health, we need to take special note of the calories we are choosing to consume.”

Lucan and DiNicolantonio stress in their paper that public health should work primarily to support the consumption of whole/minimally processed foods—which help protect against obesity-promoting energy imbalance and metabolic dysfunction—and not continue to promote calorie-directed messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases.

Read the full article here until 24th December 2014.

Posted on behalf of Dr James DiNicolantonio,  Saint Luke’s Mid America Heart Institute

Male sexual orientation influenced by genes

Results of a five-year study of 409 independent pairs of homosexual brothers in 384 families find that genetics play a key role in male sexual orientation. Alan Sanders, M.D., a psychiatrist who studies behavioral genetics at NorthShore University HealthSystem Research Institute, was the principal investigator of the molecular genetics study that scanned the entire human genome to search for evidence of genetic links to variation in sexual orientation in men.

“We found two strong links in chromosome 8 and chromosome Xq28, which supports that this is not a one-gene, one-trait scenario,” said Dr. Sanders. “These genetic variations contribute to the development of the important psychological trait of male sexual orientation.

The new evidence “is not proof but it’s a pretty good indication” that genes on the two chromosomes have some influence over sexual orientation.”

Participants in the study were gay men with at least one living gay brother (full brothers, half brothers or fraternal twins). They were asked to provide DNA samples through blood or saliva and to complete a questionnaire about their sexual and personal history and that of immediate family members. The study was funded by the US National Institutes of Health from the National Institute for Child Health and Human Development.

“Understanding the origins of sexual orientation enables us to learn a great deal about sexual motivation, sexual identity, gender identity and sex differences,” Dr. Sanders added.

The full paper, “Genome-wide scan demonstrates significant linkage for male sexual orientation”, which is published in Psychological Medicine can be read free of charge for a limited time here.

Explore the online archive of AGMG

AGMG cover-1
Cambridge University Press and Twin Research and Human Genetics (TRHG) are proud to announce the release of the online archive of AGMG, the predecessor journal to TRHG. AGMG was the official journal of the International Society for Twin Studies (ISTS) from 1952-1998 when TRHG took over this role. However, both journals have always had a wider interest in the field of human genetics.

Twins can provide unique and powerful opportunities to study genetic and environmental factors that make people differ in how they look, behave and how healthy they are. Monozygotic [identical] twins share all their genetic variation and dizygotic [non-identical] twin pairs, on average, share about 50% of their genetic variation. Both types of twin pairs often but not always share similar pre- and post-natal environments as well. Having twins participate in these studies helps to continue important research for common human conditions such as diseases, health, and behaviors, leading to advances in science, medicine and future potential therapies.

Much effort has gone into creating this digitised archive and making it available online to the research community because we believe that many of the classic papers published in AGMG reveal the academic foundations of the subject and still have relevance today. Below is a link to the 20 most cited papers from the AGMG archive to demonstrate the wide scope of interest. We encourage you to explore and enjoy this fascinating resource.

View the 20 most-cited papers from the AGMG archive here .

The papers cover a wide spectrum of topics and include the following articles:

  • Population-Based Twin Registries: Illustrative Applications in Genetic Epidemiology and Behavioral Genetics from the Finnish Twin Cohort Study (1990)
  • Resting Metabolic Rate in Monozygotic and Dizygotic Twins (1985)
  • Causes of Variation in Drinking Habits in a Large Twin Sample (1984)
  • The Vanishing Twin (1982)


DMPHP Special Issue on Ebola

ebola blog pic
Accurate knowledge regarding Ebola is critical and pertinent for practicing physicians and clinicians given the current risk of hazardous global outbreak and epidemic. Disaster Medicine and Public Health Preparedness has launched a special issue, Ebola Virus and Public Health, to surround the public, medical professionals and media with necessary knowledge in this critical societal moment.

As part of this special issue, the journal has published A Primer on Ebola for Clinicians. The primer was prepared by Dr. Eric Toner, internist and emergency physician, as well as Amesh A. Adalja and Thomas V. Inglesby (all of the University of Pittsburgh Medical Center). The primer discusses the history, epidemiology, microbiology, clinical manifestations, biosafety, prevention, treatment and experimental vaccines to offer an informative and inclusive background on the Ebola virus for clinicians.

The scale of the uncontrolled outbreak in Western Africa makes further exportation to other parts of the world an unfortunate possibility (as citizens across the globe have already witnessed, with cases appearing in Europe and the United States). Those who serve at the frontlines of emergency medicine, critical care, infectious diseases and infection control are in high need and demand, and in some cases, high risk. The primer provided by the UPMC professionals offers clear and concise information on the fundamentals of the virus, including its diagnosis, treatment and control. The public and media are especially apt to benefit from the clear and accurate information provided by the primer, as the popularity of social media makes misinformation about Ebola easily (and rapidly) sharable, believed and misattributed.

The DMPHP Special Edition on Ebola has been designed from the outset to be a conduit for operational and policy level information that will improve outcomes and decision making, and to ensure that this information is available to all practitioners.

As such, published contributions will go online immediately after appropriate review and placed chronologically to ensure a ready historical track for future review and debate. The Special Edition will be made available to everyone in the field as well as at the policy level decision makers worldwide.

View the special issue contents here free of charge. More articles will be added as soon as they become available online.

The SDMPH have released press releases on some of these papers- you can view these by using the links below:

Volunteer guidelines for clinicians in the ebola epidemic
A Primer on Ebola for Clinicians
Special issue on Ebola




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