Category: Research Findings

Do meta-analyses really offer a bottom line?

For any particular health behavior or condition, the number of research studies is ever-growing. The expansive literature makes it nearly impossible for health practitioners, and even researchers, to stay up-to-date.

Meta-analyses are a type of systematic review that allow for the combination of findings from individual studies in a way that increases statistical power and may thus generate evidence-based ‘bottom lines’ for practice. However, a recent viewpoint in the Journal of the American Medical Association, The Misuse of Meta-Analysis in Nutrition Research, leaves us wondering whether meta-analyses do more harm than good.

Some of the most common flaws discussed in this viewpoint include:

  • The people. Individual studies may include a range in demographic characteristics, like age, sex, race, and ethnicity. While it is typically a good thing to include a variety of people in a single study, trying to compare different study populations can make it more challenging to identify real effects. Think: comparing a study that looked at egg consumption and cholesterol levels in men aged 65 and older to a study looking at women aged 20 – 40 years – there are many other factors that could explain the observed effects.
  • The study design. Although studies may be looking at the relationship between saturated fat and heart disease, they may have used different tools to measure saturated fat intake over varying periods or time or different measures related to heart disease. In addition, some trials may have randomly assigned participants to a group while others followed their natural behaviors over time. This is like trying to compare apples and oranges, although they are both fruit, they are in fact different and it may not be appropriate to try and interpret them together.

Results of meta-analyses matter because they can influence health care policy – either by providing an evidence base for decision-making and/or media headlines prompting public conversation that elevates the priority of a specific condition or behavior. Barnard and colleagues suggest the peer-review process should and could be improved by:

  1. Having content expert editors as well as editors with expertise in meta-analysis techniques
  2. Having authors of the review confirm the appropriateness of the representation of the data with authors of the original report
  3. Having transparent methods and data so that others may reproduce the analysis
  4. Pooling original primary data and not published summary data

 

Sources:                     

Meta-Analysis. Study Design 101. https://himmelfarb.gwu.edu/tutorials/studydesign101/metaanalyses.html

Barnard ND, Willett WC, Ding EL. The Misuse of Meta-analysis in Nutrition Research. JAMA. Published online September 18, 2017. doi:10.1001/jama.2017.12083

The Nutrition Source, Harvard T.H. Chan School of Public Health. Meta-analyses in nutrition research: sources of insight or confusion?

CVS and the role of Pharmacies in the Opioid Crisis

This past week, CVS pharmacy announced another step in their response to the country’s ongoing opioid epidemic. They are expanding medication disposal options, by adding over 700 in store disposal units across the country. They also announced an expanded pharmacist counseling session for those prescribed opioids for the first time, to highlight the risks of addiction and dependence, while answering any patient questions. The CVS Health Foundation has additionally pledged $2 million to support federally qualified community health centers that deliver medication-assisted treatment.

On top of all of this, they have announced that they are limiting the prescription of opioids to seven days for acute prescriptions, limiting daily dose strengths, and requiring that immediate-release formulations of opioids to be used before prescribing extended release options. Not only does this make their practices consistent with recent CDC guidelines, but also as the largest pharmacy in the United States, CVS taking a stronger stance to limit the excess prescribing of opioids could set a precedent in the role that pharmacies play in the opioid crisis.

To combat this epidemic, we need buy in from facets of the medical industry, from individual doctors to health care systems, insurance companies and pharmacies, medication manufacturers and government officials. I commend CVS on their stance to address their role in this crisis, and hope that it serves as a moment of recognizing responsibility for this crisis. If we use evidence based interventions, and partnerships from behavioral health, to medicine, and governmental agencies, we can begin to reduce opioid dependence and addiction, and see a decrease in those lost to overdose.

Sources –

CVS Health Press Release – https://cvshealth.com/thought-leadership/cvs-health-enterprise-response-opioid-epidemic/cvs-health-responds-to-nations-opioid-crisis

CDC Opioid Prescribing Guidelines – https://www.cdc.gov/drugoverdose/prescribing/guideline.html

Could food stamps cause low test scores?

Going without food has serious implications on your health, mood, and if you’re someone who gets hangry, you know that combination of hungry and angry, your social interactions. Research from the University of South Carolina (USC) has recently shown that the effects of hunger might not end there. It could also play a role in the academic performance of students from low-income communities who receive food assistance.

In the state of South Carolina, families receive government food assistance once per month. These benefits are administered in the first ten days of the month. This means that many families can run out of benefits towards the end of the month. When researchers from USC examined math scores of students from families who receive food assistance, they found something interesting. When students take exams on a date far away from when their family received benefits, their test scores are significantly lower than when exams are administered toward the beginning of the month. This can also mean that a child who is tested earlier in the month generally performs better than a child tested toward the end of the month.

It is unclear if this relationship is because of hunger or some third factor; however, we clearly need to give more attention to supporting families with inadequate access to food and resources.

 

Source: http://www.npr.org/2017/09/21/552530614/researchers-examine-links-between-academic-performance-and-food-stamps

Thank you to Dr. Marshall for the fascinating presentation!

Last week, we were excited to have Dr. Laura Marshall discuss her dissertation research with us. Her work looked at the different types of comments posted online under an article for Breitbart and for Huffington Post, both on the subject of healthcare reform. Identity seemed very important to establish in both comments sections with “othering” used as the most common social process, i.e. invalidating a differing opinion typically through name-calling and questioning of intelligence. Main distinctions between the two sets of comments included Breitbart comments focusing on personal responsibility and a distrust of government actions or programs, and Huffington Post comments emphasizing social justice and hopeful solutions.

What is the purpose of these comments sections and, ultimate goal, how can communication professionals utilize them? Dr. Marshall’s theory is that users of comments sections establish identity through “othering,” then seek or offer information within their group, and propose solutions.

An Appetite for Adjectives

How can healthy foods be rebranded to garner interest and uptake, without the use of a master chef? A study this summer looked at the effects of descriptive food labels on the amount of vegetables self-served at lunch. The researchers categorized four different labeling groups:

  1. Basic description (i.e. carrots)
  2. Healthy restrictive (reduced-sodium carrots)
  3. Healthy positive (vitamin-rich carrots)
  4. Indulgent (caramelized carrots)

The vegetables and their recipes remained unchanged regardless of the label type. However, the indulgently labeled vegetables had 25% more people select the vegetable than the basic description, 41% more than in the healthy restrictive, and 35% more than the healthy positive. And when the indulgent label vegetables were selected, the portion size selected was greater than when the vegetable was a basic or healthy positive label.

These findings suggest that how we talk about a food impacts how we interact with it. Once the self-service containers were weighed and paid for, we don’t know how much of that food the individuals ate. Perception seems to play a large role in intent, though, and I am curious to see how health communicators can turn that intent into sustainable action through reframing the perceptions of vegetables and other recommended healthy foods.

http://www.cnn.com/2017/06/19/health/vegetables-indulgent-names-study/index.html

Are You Healthy?

To understand whether or not your healthy, you have to first understand what it means to be healthy. It seems straightforward, but in the modern age, this is a complex question.

We might at first be inclined to think that being healthy means that you don’t have any illness or injury. But is this always true? What if you have an illness that is managed by medication? What if a person has a disability but the disability doesn’t disrupt their daily life? What if you’ve been diagnosed with pre-hypertension but have no symptoms?

Joseph Dumit, Director of Science and Technology Studies and Professor of Anthropology at the University of California, Davis, discusses various changes to our view of health and illness since the rise of the randomized control trial in his book Drugs for Life: How Pharmaceutical Companies Define Our Health (Duke University Press, 2012). He argues “that being at risk for illness is often treated as if one had a disease requiring lifelong treatments, drugs for life” (6).

Dumit discusses a few prediseases in depth, looking at pre-hypertensive, pre-diabetes, and borderline high cholesterol. “Literally, a disease-sounding syndrome is produced by correlating risk factors and naming it in such a way that it becomes common sense to think about treating ‘it’ as a disease in and of itself” (165). Hence, health becomes a matter of risk where we are all bodies constantly at risk of disease. If you have pre-diabetes, are you healthy? How do we understand our health in a risk economy of health?

This intersects interestingly with Donald A. Barr’s claim, in his book Health Disparities in the United States: Social Class, Race, Ethnicity, & Health, that despite investing so much of our economy in health, US health indexes rank rather low; “[p]erhaps, our basic assumption–that more health care will lead, necessarily, to better health–is flawed.”

Hate Crime as a Public Health Concern

Unless you have been living under a rock the past few months you are well aware of the social tension amongst citizens of the United States. Don’t get me wrong, it has never been ideal, but since the election of President Trump, we have been a country far from united.

In the first month following the 2016 election, there were over 1,000 race-related incidents. While the monthly rates have decreased, the overall occurrence of these incidents continues daily. I’m not here to take sides or point fingers, but instead, look at hate crimes from an often overlooked perspective.

The psychological and physiological damage accumulated by those who face routine discrimination is now considered by many as a public health concern in and of itself. Data from the American Psychological Association shows the impact of discrimination and racism can increase rates of chronic stress, depression, and anxiety; while a meta-analysis compiled by Cambridge University has shown it increases rates of the common cold, hypertension, cardiovascular disease and breast cancer.

While data continues to develop, it is now obvious how snide remarks and hateful actions do much more than simply hurt feelings. In times like these, it’s important to take an introspective look and ask what we are doing in response to this climate of hate.

Dr. Martin Luther King Jr. said it best, “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”

Looking at the Hunter-Gatherer Gut

There are anywhere from 10-100 trillion microbes that thrive in the human body. They help maintain normal body conditions, facilitate with digestion, and are really important to our immune systems. Some of these are permanent whereas others are transient. Your own microbiota will change over the course of your life, strongly influenced by diet among other factors. An article published last week in Science magazine says these changes may even have once been seasonal.

Their logic is based on a study conducted with the Hadza community in Tanzania. These hunter-gatherers have a diet that must be much closer to that of our earliest ancestors, rooted in foraging as opposed to agriculture. The Hadza suffer much less from digestive illness–Chron’s, colitis, colon cancer–than do modern Westerners. Though the pattern of gut microbes found have yet to be more seriously researched, there seems to be health benefits of eating seasonally. Some scientists are tentatively naming this synchronization of food ingested and microbes in the gut a biorhythm of sorts.

This is certainly not the first time the hunter-gatherer diet has been looked to for inspiration. The Paleo Diet fad/trend is based in this vein of thought. It’s rich in natural proteins and fats, carbs from fruits and roots, and eliminates dairy, grains, and the cheap highly processed foods that so conveniently line our grocery stores. It has its critics certainly, but it would be interesting to see if the Paleo dieter’s microbiota is more similar to that of the Hadza.

As research in this field continues, it’ll be interesting to see how parallels in diet and its effects on the gut will continue to inform our favorite apt saying: You are what you eat.

 

Ebola vaccine-preliminary trials

Ebola is a severe virus disease that spreads to humans from wild animals (often those found in rain forests), and can then be transmitted from human to human. The virus will onset between 2 to 21 days of exposure, and can cause fever, muscle pain, headaches and sore throats, followed by vomiting, diarrhea, impaired kidney/liver function, and bleeding. Though there are treatments, and re-hydration helps, there is as of yet no cure or licensed treatment to neutralize the virus.

In March of 2014, the World Health Organization recognized an outbreak of Ebola in West Africa–the largest one to date, and fatal in an estimated 40% of cases. It spread quickly in both rural and urban communities. The CDC reported, as of April 2016, 11,325 deaths.

An article published in The Lancet-an infectious disease academic journal- this month says that this outbreak “highlighted the need for a safe, effective vaccine with a rapid onset of protection”. A phase 1 study (the stage of vaccine development in which a vaccine is administered to what is considered a small group of adults) was completed in June of 2015 and demonstrated some success. Nearly 500 participants finished the study, which lasted 360 days, and most of them showed promising amounts of lasting immunity starting about two weeks into the study. The study was led by scientists at the World Health Organization.

Of course, the study was just short of a year, and in a relatively small sample size, so there is future research to be done. Still, the potential protection offered by a successful vaccine is an exciting thought.

Sources-

World Health Organization: http://www.who.int/mediacentre/factsheets/fs103/en/

Lancet article: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30313-4/fulltext

CDC, Infectious Disease Adviser

Why our perception of beauty is skewed

My friend asked me last night, seemingly out of the blue, “Do you ever wonder why stores separate their plus size clothes?”

The truth is, it didn’t cross my mind until she asked it. But I haven’t stopped thinking about it since because, really,  it seems like a classic microagression–a small, perhaps mundane but not insignificant–manner by which to separate people who lie outside of what, at some point, became considered the norm. Not that it should matter, but a 2016 VCU article cited data claiming that over 60% of women in the US wear clothes that are plus or extended sized. Another article notes that plus size women account for 28% of the clothing market (Binkley, 2013). With an affected population that substantial, it’s even more glaring how insensitive we can be.

A 2016  article published in Body Image links anti-fat attitudes, body shaming, self-compassion, and fat-talk in female college students. They found that internalizing body-shaming led to engaging in fat-talk, among other negative anti-fat attitudes. They found the converse to be true as well–that self-compassion leads to better psychological well-being and less engagement with objectification and self-denigration. The health education and communication implication of all this, is to promote self-compassion (Webb, 2016).  It isn’t hard to imagine that segregated stores don’t play into a healing cycle very well.

Though there has been a recent movement for models to that match all body types, the retail industry still largely caters to a frankly thinner than average body type. Consider the last mannequin you saw that wasn’t unrealistically proportioned. I can’t recall a single one…

One article says these social pressures, among others like harsh lighting and narrow spaces in dressing rooms,  are driving plus-sized women to opt towards online shopping (Money, 2017).  Despite some small successes, Money says, men and women of size “are clearly tired of limited options and unwelcome shopping experience”.

The thing is, it wasn’t a question out of the blue. She had gone shopping with her cousin. It should have been a fun  outing– bonding, enjoying rare time together, catching up and picking out clothes for each other. Instead, they parted ways near the entrance of the store.

References:

Binkley, Christina (2013, June 12), “On plus side: New fashion choices for size 18,” The Wall Street Journal, Retrieved from http://online.wsj.com/news/articles/SB100014241278873 23949904578540002476232128.

Money, C. N. (2017). Do the Clothes Make the (Fat) Woman: The Good and Bad of the Plus-Sized Clothing Industry. Siegel Institute Ethics Research Scholars, 1(1), 1.

Webb, J. B., Fiery, M. F., & Jafari, N. (2016). “You better not leave me shaming!”: Conditional indirect effect analyses of anti-fat attitudes, body shame, and fat talk as a function of self-compassion in college women. Body image, 18, 5-13.

http://www.hercampus.com/school/vcu/problems-womens-plus-size-clothing