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CBT could benefit mental health of children with long-term conditions

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The systematic review used robust methods to bring together and make sense of the best science in this area.

Among a range of findings, the team identified some evidence of the benefits of CBT in inflammatory bowel disease, chronic pain and epilepsy. The research was funded by the National Institute for Health Research (NIHR) and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC).

Long term conditions are common in children. In England, 23% of secondary school age pupils reported that they had a long-term medical illness or disability in a recent survey. Children and young people who have long term conditions are four times more likely to experience feelings of depression, anxiety and other mental health issues than those who are physically healthy.

Study author Dr. Liz Shaw, said: “As well as looking at whether treatments worked for these children, we also included studies that explored the experiences of people giving and receiving the treatments. These studies highlighted the benefits of building good relationships and providing treatments in what feels like a ‘safe space’.”

Fiona Lockhart, Co-investigator from the Biomedical Research Centre Patient & Public Involvement Group at University College London, said: “Children and young people with long-term health conditions face enormous challenges. As well as their physical illness, many of these young people suffer from mental health problems as a consequence of their condition.”

The team also found some benefit from parenting programmes to reduce behavioural problems in children with acquired brain injury and/or cerebral palsy. Further studies showed that children and young people valued treatments that considered a range of needs rather than just focussing on their mental health. The opportunity to meet and build a supportive relationship with people who are managing their long term condition was also seen to help some young people by providing them with a sense of hope for the future and learn skills to manage their physical and mental health.

Study author Dr. Michael Nunns, of the University of Exeter Medical School, said: “The mental health of children and young people is important and offering the best response is vital. When we set out to do this research we were hoping to make recommendations about what works to support children and young people with long term conditions, who are also having difficulties with their mental health. However, we were disappointed in the lack of good quality evidence available to guide treatment decisions for these children.”

Throughout the study, the team worked with a group of children and young people who provided a real-world perspective on the issues they face. They were particularly disappointed in the lack of available research and urged researchers to do something about it. This sentiment was echoed by consultant pediatrician Professor Stuart Logan: ‘The two things that are needed alongside managing a medical condition like this are something to help the family manage and something to help with the children’s emotional problems that so often go alongside these medical conditions. The exciting thing about this project is that it provides researchers with a roadmap for what to do next – we need to work sensibly with parents and children to carefully design treatments and test them in a way that helps us understand whether they actually work.”

The systematic review will be published in Health Technology Assessment. The full title of the paper is: Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses.

Credit: University of Exeter

Partner status influences sexual problems and self-efficacy in survivors of breast cancer

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However, a new study finds that partnered women may fare better than those without a partner. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Breast cancer is the leading cancer diagnosis in women, with more than 266,000 new cases estimated in 2018. More than 70% of these cases occur in women aged older than 50 years. Adjuvant endocrine therapy (AET), such as tamoxifen, is often recommended for postmenopausal women for as long as 10 years after completion of breast cancer treatment as a means to limit the risk of cancer recurrence. Unfortunately, AET has many adverse effects, including sexual problems in the form of vaginal dryness, painful intercourse, and low sexual desire.

Previous studies have associated sexual problems with poor QOL, whereas others have shown that partnered survivors of breast cancer have better QOL than unpartnered survivors. However, this new study is the first known to examine how partner status influences the relationships between sexual problems and self-efficacy for managing sexual problems and QOL domains for postmenopausal survivors of breast cancer taking AET. Its findings suggest that unpartnered postmenopausal women with greater sexual problems or lower self-efficacy may be at a greater risk to experience decreased QOL than partnered women.

Study results appear in the article, “Partner status moderates the relationship between sexual problems and self-efficacy for managing sexual problems and psychosocial quality-of-life for postmenopausal breast cancer survivors taking adjuvant endocrine therapy.”

“Survivors of breast cancer, particularly those on aromatase inhibitors, often have unaddressed sexual concerns, and healthcare providers aren’t asking about them,” says Dr. JoAnn Pinkerton, NAMS executive director. “In this study, postmenopausal, unpartnered women were the most vulnerable to having quality-of-life issues and also sense-of-self affected by unaddressed sexual problems.”

Credit: The North American Menopause Society (NAMS)

Study: Cholesterol in eggs tied to cardiac disease, death

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Research that tracked the diets, health and lifestyle habits of nearly 30,000 adults across the country for as long as 31 years has found that cholesterol in eggs, when consumed in large quantities, is associated with ill health effects, according to Katherine Tucker, a biomedical and nutritional sciences professor in UMass Lowell’s Zuckerberg College of Health Sciences, who co-authored the analysis. The study was published in the Journal of the American Medical Association.

The study results come as egg consumption in the country continues to rise. In 2017, people ate an average of 279 eggs per year, compared with 254 eggs in 2012, according to the U.S. Department of Agriculture.

Current U.S. Dietary Guidelines for Americans do not offer advice on the number of eggs individuals should eat each day. The guidelines, which are updated every five years, do not include this because nutrition experts had begun to believe saturated fats were the driving factor behind high cholesterol levels, rather than eggs, according to Tucker. However, prior to 2015, the guidelines did recommend individuals consume no more than 300 milligrams of cholesterol a day, she said.

One large egg contains nearly 200 milligrams of cholesterol, roughly the same amount as an 8-ounce steak, according to the USDA. Other foods that contain high levels of cholesterol include processed meats, cheese and high-fat dairy products.

While the new research does not offer specific recommendations on egg or cholesterol consumption, it found that each additional 300 milligrams of cholesterol consumed beyond a baseline of 300 milligrams per day were associated with a 17 percent higher risk of cardiovascular disease and an 18 percent higher risk of death.

Eating several eggs a week “is reasonable,” said Tucker, who noted they include nutrients beneficial to eye and bone health. “But I recommend people avoid eating three-egg omelets every day. Nutrition is all about moderation and balance.”

Research results also determined that study participants’ exercise regimen and overall diet quality, including the amount and type of fat they consumed, did not change the link between cholesterol in one’s diet and risk of cardiovascular disease and death.

“This is a strong study because the modelling adjusted for factors such as the quality of the diet,” Tucker said. “Even for people on healthy diets, the harmful effect of higher intake of eggs and cholesterol was consistent.”

Credit: University of Massachusetts Lowell

Female cannabis users underrepresented in health research, study reveals

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In a review of scientific literature over a number of years, Ian Hamilton from the University of York’s Department of Health Sciences found that the majority of research reflects the experience of male cannabis users, with very limited information on how women react to the drug.

They also found that there was little research on cannabis psychosis in countries where cannabis use is high.

Research tends to be focused in America, Europe and Australia, missing the impact of the drug in Africa, Asian and the Middle East, where very little is known about the number of people that develop cannabis psychosis.

Ian Hamilton said: “Across the world governments are opening up access to cannabis for health or recreation. This means that it is important that people have access to information about the risks as well as benefits of using cannabis.

“Cannabis psychosis is one risk which can have a devastating effect on an individual and their family. Building on previous research from the University of York, we reviewed the evidence linking cannabis to psychosis and identified two significant problems.

“One such problem relates to gender bias. The research we looked at predominantly includes men and not women; this could link to a wider problem with the lack of female scientists in addiction research also.

“The other issue relates to the geographical spread of addiction research; we are missing a large population size in not focusing study in areas outside of America, Europe and Australia.

“We could gain much more knowledge on the risk of cannabis psychosis by including other countries and cultures.”

The study suggests that more attention needs to be on who is at risk of cannabis psychosis as well as the health implications of taking the drug. This research has to include more women and countries across Asia, Africa and the Middle East, the researchers argue.

Ian Hamilton added: “We need to accept that cannabis psychosis is about more than genetics or biology but is affected by social factors such as where and how young people grow up and the problems they experience as they develop.”

Credit: University of York

Weak upper and lower body physical performance associated with depression and anxiety

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A new study from Singapore now links physical performance with mental health and emotions, suggesting that weak upper and lower body fitness can cause more serious depression and anxiety in midlife women. Results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Although several studies have previously linked depression in midlife women with self-reported low physical activity, this new study is the first known (even in Western populations) to evaluate objective measures of physical performance in relation to depression and anxiety in premenopausal, perimenopausal, and postmenopausal women.

Depression and anxiety are prevalent symptoms experienced by midlife women. This latest study of more than 1,100 women aged 45 to 69 years found, in fact, that 15% of participants, especially those of younger age, reported depression and/or anxiety. Because depression can cause disability, reduced quality of life, mortality, and heart disease, the researchers felt it was important to identify potentially modifiable risk factors that could reduce morbidity and mortality.

The researchers observed significant associations of objective physical performance measures with depression and anxiety. Specifically, they found that weak upper body strength (handgrip strength) and poor lower body strength (longer duration to complete the repeated chair stand test) were associated with elevated depression and/or anxiety symptoms. Future trials will be needed to determine whether strengthening exercises that improve physical performance might similarly help reduce depression and anxiety in midlife women.

Findings were published in the article “Objective measures of physical performance associated with depression and/or anxiety in midlife Singaporean women.”

“Strength training has been shown to lead to a significant reduction in depressive symptoms,” says Dr. JoAnn Pinkerton, NAMS executive director. “Both strength training and aerobic exercise appear to improve depression, possibly as a result of increased blood flow to the brain or improved coping with stress from the release of endorphins such as norepinephrine and dopamine.”

Credit: The North American Menopause Society (NAMS)

Study could lead to ‘cognitive therapy in your pocket’

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The study, “Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based Psychiatric Hospital Program,” was published in the journal Behavior Therapy. It shows the potential effectiveness of CBM-I when combined with cognitive behaviour therapy (CBT) in an acute psychiatric setting. It also points the way for adapting this therapeutic approach for use outside the hospital.

The lead researcher of the study is Courtney Beard, PhD, director of McLean’s Cognition and Affect Research and Education (CARE) Laboratory.

Beard described CBM-I as a “class of interventions designed to shift people’s interpretations of ambiguous situations in either a more positive or more negative way.” She explained that “CBM-I tries to address interpretation bias, a mental habit that is implicated in many mental disorders.”

To do this, individuals undergoing CBM-I treatment can be presented with a series of word association questions that address everyday situations.

For example, the CBM-I task may show a patient a situation about a person yawning during their conversation. Then the patient is asked whether that person is “tired” or “bored.” The individual who answers “tired” is told the response is “correct,” and “bored” is incorrect. Through repetition, this type of CBM-I therapy helps the person reframe or reassess these daily ambiguous situations.

“People face countless interactions like this every day in their lives,” Beard said. “If you have a tendency to jump to a threatening or negative conclusion, it can have a huge impact on how you’re feeling and on what you do and how you react. You can get stuck in a cycle that can maintain anxiety or depression.”

For their study, Beard and her colleagues developed and implemented CBM-I to augment CBT-based treatment in a partial hospital setting. They presented patients with word-sentence associations that encouraged patients to endorse positive interpretations and reject negative interpretations.

Study results showed that CBM-I was practical and acceptable to acute psychiatric patients. Many stated that CBM-I bolstered their primary CBT-based care. The study also found that that the word association exercises were successful in helping reframe potentially negative situations.

Based on these results, Beard and her team are moving forward with a National Institute of Mental Health-backed study to develop a smartphone version of CBM-I.

“With the smartphone app, we can offer CBM-I to many more people at one time,” Beard said. “With the app, they can practice new skills, create healthy mental habits, and stop automatically jumping to negative conclusions. And they can do it on demand.”

Beard stated that the app could be particularly helpful for individuals who have just been discharged from a treatment program. “They can use it during the month transition period after they leave the hospital, which is a risky and challenging time for them,” she said.

Beard sees great promise for app-based CBM-I therapy. “It quickly shows people what their brain is doing,” she explained. “The patient sees hundreds of situations in a short amount of time. So, they see how often they jumped to a negative conclusion, and that can be very powerful. It’s kind of like cognitive therapy in your pocket–but a little different and a lot faster.”

Credit: McLean Hospital

One change can make diet more planet friendly

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“We found that making one substitution of poultry for beef resulted in an average reduction of dietary greenhouse gases by about a half,” said lead study author Diego Rose, PhD, professor and director of nutrition at Tulane University.

Rose will present the research at Nutrition 2019, the American Society for Nutrition annual meeting, held June 8-11, 2019 in Baltimore.

“To our knowledge, this is the only nationally representative study of the carbon footprint of individually chosen diets in the U.S.,” said Rose. “We hope this research will raise awareness about the role of the food sector in climate change and the sizable impact of a simple dietary change.”

The new study is based on diet information from more than 16,000 participants in the 2005-2010 National Health and Nutrition Examination Survey. A portion of this survey asked participants to recall all the foods they consumed in the previous 24 hours. The researchers used this information to determine which foods had the highest greenhouse gas emissions and to calculate a carbon footprint for each individual diet.

They found that the 10 foods with the highest impacts on the environment were all cuts of beef and that about 20 percent of participants reported consuming one of these high-carbon foods. Using simulation, the researchers calculated a new carbon footprint for each diet by replacing beef with the closest related poultry product. For example, a broiled beef steak was replaced with broiled chicken and ground beef with ground turkey. Each substitution was performed only one time for each person that consumed one of the high-carbon foods.

Animal foods are known to contribute more to greenhouse gas emissions than plant foods. Ruminant animal foods such as beef and lamb have particularly high carbon footprints because cows and sheep also release methane gas.

“Our simulation showed that you don’t have to give up animal products to improve your carbon footprint,” said Rose. “Just one food substitution brought close to a 50% reduction, on average, in a person’s carbon footprint.”

The researchers plan to expand this research, which focused on dietary greenhouse gas emissions, to include other environmental impacts such as water use.

Although not the subject of this study, they point out that food waste and overeating also increase the carbon footprint of our diet. Thus, in addition to eating low-carbon foods, better meal planning and eating of leftovers can also help reduce carbon footprint.

Diego Rose will present this research on Monday, June 10, from 12:15 – 12:30 p.m. in the Baltimore Convention Center, Room 317 (abstract). Contact the media team for more information or to obtain a free press pass to attend the meeting.

Credit: American Society for Nutrition

EWG: Nitrate pollution of US tap water could cause 12,500 cancer cases each year

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For the groundbreaking study, published today in the journal Environmental Research, EWG scientists estimated the number of cancer cases in each state that could be attributed to nitrate contamination of public water systems, largely caused by farm runoff containing fertilizer and manure. They also estimated the costs of treating those cases at up to $1.5 billion a year.

“Nitrate contamination of drinking water is a serious problem, and especially severe in the nation’s farm country,” said Olga Naidenko, Ph.D., EWG senior science advisor and one of the study’s authors. “Now, for the first time, we can see the staggering consequences of this pollution.”

The current federal drinking water standard for nitrate, set in 1962, is 10 parts per million, or ppm. Yet several well-regarded epidemiological studies have linked nitrate in drinking water with cancer and other serious health issues at levels less than one-tenth of the legal limit. Earlier this year, the Environmental Protection Agency suspended plans to reevaluate its outdated nitrate standard.

Four-fifths of EWG’s estimated cases were occurences of colorectal cancer, with ovarian, thyroid, kidney and bladder cancer making up the rest. Nitrate in tap water has also been linked with serious neonatal health issues. EWG estimated that nitrate pollution may be responsible for as many as 2,939 cases of very low birth weight; 1,725 cases of very preterm birth; and 41 cases of neural tube defects.

“Millions of Americans are being involuntarily exposed to nitrate, and they are also the ones paying the heavy costs of treating contaminated tap water,” said Alexis Temkin, Ph.D., a toxicologist at EWG and primary author of the study. “But the federal government is not doing enough to protect Americans from tap water contamination.”

EWG scientists estimate the level at which there would occur no adverse health effects from nitrate in drinking water to be 0.14 milligrams per liter – equivalent to parts per million. That level, 70 times lower than the EPA’s legal limit, represents a one-in-one-million risk of cancer.

Credit: Environmental Working Group

Unhealthy gut promotes spread of breast cancer

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An unhealthy, inflamed gut causes breast cancer to become much more invasive and spread more quickly to other parts of the body, new research from the University of Virginia Cancer Center suggests.

Melanie Rutkowski, PhD, of UVA’s Department of Microbiology, Immunology and Cancer Biology, found that disrupting the microbiome of mice caused hormone receptor-positive breast cancer to become more aggressive. Altering the microbiome, the collection of microorganisms that live in the gut and elsewhere, had dramatic effects in the body, priming cancer to spread.

“When we disrupted the microbiome’s equilibrium in mice by chronically treating them antibiotics, it resulted in inflammation systemically and within the mammary tissue,” she said. “In this inflamed environment, tumour cells were much more able to disseminate from the tissue into the blood and to the lungs, which is a major site for hormone receptor-positive breast cancer to metastasize.”

Hormone Receptor-Positive Breast Cancer
Most breast cancers — 65 percent or more — are hormone receptor positive. That means their growth is fueled by a hormone, either estrogen or progesterone. The good news is that these types of cancers are likely to respond well to hormone therapy.

Predicting whether such cancers will spread beyond the breast to other parts of the body (a process called metastasis) is a major challenge within the field, and is primarily driven by clinical characteristics at the time of diagnosis. Early metastasis is affected by a variety of factors, Rutkowski explained. “One of them is having a high level of [immune] cells called macrophages present within the tissue,” she said. “There have also been studies that have demonstrated that increased amounts of the structural protein collagen in the tissue and tumour also lead to increased breast cancer metastasis.”

Having an unhealthy microbiome prior to breast cancer increased both, and the effect was powerful and sustained. “Disrupting the microbiome resulted in long-term inflammation within the tissue and the tumour environment,” Rutkowski said. “These findings suggest that having an unhealthy microbiome, and the changes that occur within the tissue that are related to an unhealthy microbiome, may be early predictors of invasive or metastatic breast cancer. Ultimately, based upon these findings, we would speculate that an unhealthy microbiome contributes to increased invasion and a higher incidence of metastatic disease.”

Maintaining a Healthy Microbiome
While Rutkowski used powerful antibiotics to disrupt the mice’s natural gut bacteria, she emphasized that antibiotics are not dangerous and should not be avoided by women with breast cancer or anyone who needs them to treat infections. Mice, after all, are not people, and substantially more research needs to be done to define whether an association exists between chronic antibiotics usage and cancer outcome. For this study, the antibiotics were only a means to an end, a simple way to create a long-term imbalance to the microbiome, similar to what individuals may experience with chronically unhealthy microbiomes. The effect was far, far more exaggerated than would occur in a person taking a normal course of antibiotics, or even multiple rounds.

Thanks in part to Rutkowski’s research, doctors eventually may be able to manipulate the microbiome to benefit patients with breast cancer. But the key message, for now, Rutkowski said, is the importance of a healthy microbiome. The finding adds to the growing evidence demonstrating that a healthy microbiome is vital for many aspects of good health.

While she is a cancer researcher rather than a medical doctor, Rutkowski noted there are things that are generally accepted to promote a healthy microbiome. “A healthy diet, high in fiber, along with exercise, sleep — all of those things that contribute to positive overall health,” she said. “If you do all of those things, in theory, you should have a healthy microbiome. And that, we think, is very much associated with a favourable outcome in the long term for breast cancer.”

Story Source: Materials provided by University of Virginia Health System.
Note: Content may be edited for style and length.

Journal Reference: 1. Claire Buchta Rosean, Raegan R Bostic, Joshua C. M. Ferey, Tzu-Yu Feng, Francesca N Azar, Kenneth S Tung, Mikhail G Dozmorov, Ekaterina Smirnova, Paula D. Bos, Melanie R Rutkowski. Pre-existing commensal dysbiosis is a host-intrinsic regulator of tissue inflammation and tumor cell dissemination in hormone receptor-positive breast cancer. Cancer Research, 2019; canres.3464.2018 DOI: 10.1158/0008-5472.CAN-18-3464

Pizza Pizza Adds Plant-Based Protein Options to the Menu

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Starting today, Pizza Pizza customers can order the Super Plant Pizza and customize their orders with two all new plant-based toppings (CNW Group/Pizza Pizza Limited)

Canadians looking for more flexibility and plant-based options when it comes to their pizza orders need to look no further. Today, Pizza Pizza announced the launch of their new Super Plant Pizza, the first plant-based protein topping recipe available on the menu.  The latest innovation by the iconic Canadian brand is in response to the growing trend and consumer demand for more plant-based and environmentally responsible options. The new menu items will be available in all traditional Pizza Pizza restaurants across Canada.

“The pizza landscape in Canada is continuously evolving and we have always been an innovation leader at the forefront,” said Paul Goddard, CEO, Pizza Pizza.  “The launch of the Super Plant Pizza with our plant-based protein options is an exciting moment in our brand history and one that we are very proud of.  We will continue to create flexible options to suit all dietary preferences as we look to the future.”

The new Super Plant Pizza recipe is a delicious combination of flavours and is available on any crust, including their newest crust innovation, Cauliflower Crust. The recipe includes:  homestyle Italian tomato sauce, mozzarella cheese, and is topped with plant-based pepperoni and plant-based chorizo crumble.  For a truly vegan experience, customers are also able to order dairy-free vegan cheese.

“Most people personalize their pizza and consumers want options; that’s something we’ve continually offered consumers, putting quality and great taste at the forefront of introducing new options,”  said Alyssa Huggins, Vice President, Marketing, Pizza Pizza. “With the launch of the Super Plant Pizza and the plant-based protein options we are responding to our customers’ ever-changing needs, namely the flexitarian movement, but also growth in consumers identifying as vegan or vegetarian.”

The plant-based protein options have been made available through a strategic partnership with Yves Veggie Cuisine (plant-based pepperoni) and Field Roast Grain Meat Co., owned by Greenleaf Foods, SPC (plant-based chorizo crumble).  Both brands are proven leaders in the plant-based protein space and offer a unique flavour in all their products.

Since 1967, Pizza Pizza has been a leader in Canada’s quick-service restaurant industry with notable firsts and innovations. The company was among the first in the pizza category to eliminate non-natural trans-fats and artificial colours and flavours from its menu. Pizza Pizza is also known for the introduction of a time guarantee on delivery, the invention of the insulated pizza delivery bag, as well as the implementation of a centralized call centre and iconic 967-1111 phone number.

For more information, visit www.pizzapizza.ca.

About Pizza Pizza Limited
For more than 50 years, Pizza Pizza Limited has been guided by a vision of “Always the best food, made especially for you”, with a focus on quality ingredients, customer service, continuous innovation and community involvement. With more than 750 locations across Canada, the company is Canada’s pizza pioneer and a quick-service restaurant leader, operating two banners – Pizza Pizza and Pizza 73 – that deliver quality food choices, diverse menus and exciting promotions for all tastes, lifestyles and budgets. Visit www.pizzapizza.ca and www.pizza73.com for more information.

SOURCE Pizza Pizza Limited
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