16-year-old Niamh McCann is passionate about many things including ballet, the plays of William Shakespeare, the environment and public speaking! Her talk looks at the challenges of the high-functioning end of the Autistic Spectrum for girls. Niamh is a quiet, sensitive girl who studied hard, got good grades and was not one to cause trouble. She researched the reasons why girls on the spectrum are often misdiagnosed or have late diagnoses. Her hope is that through her talk and sharing what she has learnt, all girls on the spectrum will feel freer to embrace who they are and that those who are yet to be diagnosed are not afraid to do so. This talk was given at a TEDx event using the TED conference format but independently organized by a local community.
Contrary to popular belief, many autistic adults are undiagnosed or may not even know they’re autistic. Kip Chow, who was diagnosed as an adult, unpacks two of the main reasons why. Kip Chow is an autistic student dedicated to education, activism, and accessibility as pertaining to neurodiversity. Since discovering that they’re autistic as an adult, they aim to promote understanding and acceptance of autistic folks, especially undiagnosed and multiply marginalized ones. As a result, Kip has served as a panelist and speaker at a couple of student conferences for health care providers in training to address how they should move forward in interacting with autistic and otherwise marginalized patients. This talk was given at a TEDx event using the TED conference format but independently organized by a local community.
Personal construct therapy improves symptoms of depression in women with fibromyalgia CREDIT Chronic Joy Ministry
Fibromyalgia is a rheumatic disease of unknown origin, which is characterized by chronic pain and often accompanied by symptoms of depression. It mainly affects women, and there is no cure, but various treatments can help relieve the symptoms.
Cognitive-behavioural psychological therapy has proven to be a useful tool in this area. Now, a multicentre study involving researchers at the Universitat Oberta de Catalunya (UOC), the University of Barcelona (UB) and the Universidad de Las Américas (UDLA) in Ecuador, and published in open access format in the journal International Journal of Clinical and Health Psychology, has recently proven that another form of psychological therapy, called personal construct therapy, is just as effective in reducing depressive symptoms and improving patients’ quality of life. According to Mari Aguilera, a researcher belonging to the GRECIL interuniversity group, as well as a professor in the Faculty of Psychology and Education Sciences at the UOC and the UB and the co-lead author of the study with the researcher at the Universidad de Las Américas in Ecuador Clara Paz, these results make it possible to “expand the range of effective therapies and increase the flexibility to adapt to each patient’s particular characteristics and needs“.
106 women in a pioneering multicentre study
The study, which was coordinated by the UB full professor of Psychology faculty and the Institute of Neurosciences Guillem Feixas, included 106 women with fibromyalgia and depressive symptoms who were treated in ten different places: two mental health centres and eight primary healthcare centres. The association between fibromyalgia and depression is common in these patients, and appears to work both ways: each one increases the risk and aggravates the characteristics of the other.
The volunteers followed a weekly course of psychological therapy for approximately four months. Half of them received standard cognitive-behavioural therapy, which has already been shown to be moderately effective in this type of patient. The other half followed a treatment based on personal construct therapy – a different approach “focused on people’s identity, how they see themselves, how they see what happens to them and how they see others,” explained Joan Carlos Medina, a member of the Faculty of Psychology and Education Sciences at the UOC, and a researcher at the UB.
The results of the study show that both the therapies reduced symptoms of depression in approximately 60% of the women taking part, and that there were no significant differences between the treatments. Furthermore, they also showed improvements in terms of the disease’s impact on their daily functioning and in terms of pain. In specific terms, approximately one in four patients who received personal construct therapy significantly improved their functioning in the medium term, and one in six experienced reduced pain.
More tools for personalization
“Fibromyalgia has no specific known cause and there is no cure, but a psychological improvement has an impact on physical health,” explained Aguilera. This is particularly important in a disease “which is still questioned by some doctors, and which is often considered less important due to the fact that it mainly affects women,” she added.
The standard cognitive-behavioural therapy “is more interested in how to change behaviour than the reason behind it,” said Aguilera, while personal construct therapy is focused in particular “on how you build your world and what you give meaning to. But it’s not so much about setting them against each other, as seeing whether the two of them can be useful from a different perspective.”
Some studies have shown that personal construct therapy could be useful in treating depression, for example, but apart from a small pilot study, “this is the first time that this type of therapy has been studied and shown to be helpful for fibromyalgia patients,” explained Medina. Having more proven resources means that they can be adapted to the patients’ preferences. “It helps us to personalize treatments, and adapt them better. We have more tools for listening, learning and proposing strategies,” he concluded.
Diabetes is a leading cause of death and disability in the United States, affecting more than 34 million adults and generating $330 billion in annual healthcare expenditures. Excess body weight is one risk factor that increases one’s odds of developing diabetes, and federal guidelines recommend starting screening at age 35 for all overweight adults – defined as those who have a body mass index (BMI) of 25 or higher.
However, Asian, Hispanic, and Black Americans are at increased risk for diabetes at lower weights and younger ages than white Americans. In a new study published in the Annals of Internal Medicine, a team of physician-scientists at the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC) sought to reduce racial and ethnic disparities in diabetes diagnosis. The team used statistical modelling to determine the BMI levels and age at which the prevalence of diabetes in racial and ethnic minority populations in the United States is equivalent to the prevalence of diabetes in white Americans considered at risk of diabetes. The team’s findings suggest that screening Asian, Hispanic, and Black Americans for diabetes at lower BMI and younger ages than white Americans has the potential to reduce the rate of undiagnosed diabetes in these groups and as a result, improve health equity in diabetes care.
“The simplicity of a single screening threshold for all Americans is alluring, but it is deeply inequitable,” said senior author Dhruv Kazi, MD, MSc, MS, associate director of the Smith Center and associate professor of medicine at Harvard Medical School. “Our findings suggest that Asian, Hispanic, and Black Americans may need to get screened at lower BMI or younger ages than white Americans. If the current thresholds are universally applied, without accounting for differential risk in racial/ethnic groups, clinicians may underdiagnose diabetes in Asian, Hispanic, and Black Americans. On the other hand, applying a more tailored approach may allow reduce rates of undiagnosed diabetes and produce population wide improvements in diabetes care.”
Kazi and colleagues used a long-running, nationally representative survey from the Centers for Disease Control and Prevention called the National Health and Nutrition Examination Survey (NHANES) to examine the prevalence of diabetes by race/ethnicity, body mass index (BMI), and age. Then, the scientists used regression modelling to determine the BMI at which the prevalence of diabetes in 35-year-old Asian Americans, Black Americans and Hispanic Americans, respectively, is equivalent to the prevalence of diabetes in 35-year-old white Americans with a BMI of 25 kg/m2.
“We found that a more equitable approach would be to offer screening starting at a BMI of 20kg/m2 to Asian Americans ages 35 to 70, and at 18.5 kg/m2 in Hispanic and Black Americans in this age group,” said first author Rahul Aggarwal, MD, an internal medicine resident at BIDMC. “We also found that among individuals from racial and ethnic minority populations with overweight or obesity, it would be equitable to offer diabetes screening starting in the early 20s rather than waiting till they are 35 years old. Delayed diagnosis and inadequate treatment of diabetes can produce catastrophic consequences, jeopardizing one’s heart, kidney, eyes, and limbs. But it doesn’t affect all of us equally – there are striking disparities that are largely the legacy of structural racism. Fixing the health disparities for Americans with diabetes will require a range of strategic investments in health care and efforts to reduce structural inequities. Making screening more equitable is a place to start, as it ensures that individuals with diabetes can receive preventive care and treatment in a timely manner and avert the most catastrophic consequences of diabetes.”
Young adults who were at risk of food insecurity had an increased incidence of diabetes 10 years later, according to a Washington State University study.
While previous research has associated food insecurity with a range of health issues including diabetes, obesity and hypertension, this study showed a connection over time, suggesting a causal relationship.
In the study, published in theJournal of Nutrition, researchers analyzed data on nearly 4,000 people from the National Longitudinal Study of Adolescent to Adult Health. They found that adults ages 24-32 who said they’d been worried about food running out in the last year showed a greater incidence of diabetes, either through blood glucose tests or self-reports, at ages 32-42, compared to those who did not report food insecurity risk.
“When we look at the data 10 years later, we do see this separation in the prevalence of diabetes: those that experienced risk of food insecurity at young adulthood are more likely to have diabetes in middle adulthood,” said Cassandra Nguyen, the study’s lead author and an assistant professor with WSU’s Institute for Research and Education to Advance Community Health or IREACH.
While the study could not identify the exact reason for this connection, previous research has shown that food-insecure households often have diets with lower nutritional values.
“Eating according to the dietary guidelines tends to cost more money, and it may cost more time,” said Nguyen. “It’s not always accessible to households that have limitations such as transportation to sources of lower-cost, nutritionally dense food.”
Nguyen added that people experiencing food insecurity can also get caught in a negative reinforcing cycle: when food insecurity is associated with a diet that contributes to disease risk, which then creates additional health care expenses, stressing a household’s economic resources and deepening food insecurity.
The study did not reveal differences among race or ethnicity, but the authors noted that the numbers of minorities in the sample may be too low to show a pattern.
For future work, the research team plans to investigate food insecurity risks and health issues within American Indian and Alaska Native populations. These communities are often left out of annual reports on food insecurity, which means they may be overlooked when reforms are made to food assistance programs and policies. Nguyen recently led a review of 30 studies that found food insecurity estimates in Native populations varied widely, but even the lowest estimate far exceeds the prevalence among non-Hispanic white adults.
Interventions – such as SNAP, the Supplemental Nutrition Assistance Program, it’s educational component SNAP-Ed and EFNEP, the Expanded Food and Nutrition Education Program – have been shown to be effective in improving diet and health, Nguyen said. But to benefit from them, people have to be counted first.
“It’s really important to ensure that individuals who are experiencing food insecurity are able to be identified and that they have resources made available to them to be able to break the cycle,” she said.
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