Posted on Rheumatoid arthritis

Rheumatoid arthritis increases health care costs, harms mental health

Rheumatoid Arthritis

Patients with rheumatoid arthritis spend some $3,000 more than unaffected people per year on medical expenses. The study is the first comprehensive look at the economic and humanistic burden of rheumatoid arthritis. Credit Srijita Chattopadhyay/Ole Miss Digital Imaging Services

A University of Mississippi-led comprehensive study of a disorder affecting 4.27 million Americans nationwide reveals just how significant its burdens are on patients’ financial well-being and quality of life.    

Patients with rheumatoid arthritis, an inflammatory disorder that causes joint pain and reduces mobility, spend an average of $3,383 more per year on healthcare expenses compared to those without the disorder, according to a study published in ACR Open Rheumatology, the journal of the American College of Rheumatology.

“This chronic disease requires ongoing medication,” stated Yinan Huang, assistant professor of pharmacy administration and research assistant professor in the Research Institute of Pharmaceutical Sciences. Huang is the lead author of the study.

“Patients face higher out-of-pocket costs for prescription medications compared to the general population, and their mental and physical health-related quality of life is usually lower than that of the general population. All these factors played a role in motivating us to proceed with this project.”

Huang, along with co-authors Jieni Li, a research assistant professor at the University of Houston, and Sandeep Krishna Agarwal, an associate professor of rheumatology at the Baylor College of Medicine, analyzed data from the Medical Expenditure Panel Survey from 2018 to 2020. Their aim was to understand the challenges and needs of those suffering from the disorder.

About 40% of rheumatoid arthritis patients’ medical expenses were prescription medication, highlighting how steep the cost of managing this illness can be, Li said.  

“It’s a shock for both of us to see that RA patients spend so much on their prescriptions,” Li said. “We all knew that there are new RA treatments like biologics and that those are expensive for the patient, but not to this extent.” 

Huang said a better understanding of the disease can help develop more support systems, policies, and more nuanced care for the population.

“We want to provide solid data to the healthcare communities about the overall comprehensive burden facing this vulnerable group of patients,” she said. “From the financial perspective, I would like to see more focus on the prescription medication-related costs.  

“Some intervention needs to be taken to increase access to treatment because of the costs.” 

Rheumatoid arthritis affects over 18 million people worldwide, with about 70% of those patients being women and 55% being over the age of 55, according to the World Health Organization. This systemic autoimmune disease most commonly affects the joints, but it may also damage the skin, lungs, heart, and eyes.

“If not treated properly, it can result in disability,” she stated. “Arthritis, including RA, is a leading cause of disability in the United States, according to the Centers for Disease Control.”

Besides health care and medication costs, patients with rheumatoid arthritis are also more likely to need daily support to go about their lives. This could be mobility devices such as wheelchairs or walkers, in-home help or other accommodations.  

“From a quality-of-life, humanistic perspective, we all know the burden is huge on these patients,” Li said. “They suffer from limited mobility as well as pain, and so they are more likely to seek these supports. 

“When looking at treatments, we should also consider this factor in the future. What supports (does) this patient have?” 

To treat rheumatoid arthritis better, health care workers must first understand the disease, the researchers said. The next step of their study will include comparing the severity of rheumatoid arthritis pain among patients to determine who is most affected by the disease.  

“These days, people are discussing individualized, personalized care,” Li said. “From the study’s objective, we want to provide more for RA patients.” 

Posted on Diabetes, Diet

Ultra-processed foods pose huge dangers for people with diabetes

Researchers found ultra-processed foods, even diet ones, bring distinct risks for people with diabetes.
Researchers found that ultra-processed foods, even diet ones, bring distinct risks for people with diabetes.

A team of researchers in nutritional sciences, kinesiology, and health education at the University of Texas at Austin has found that eating more ultra-processed foods—from diet sodas to packaged crackers to certain cereals and yoghurts—is closely linked with higher blood sugar levels in people with Type 2 diabetes.

In a recent paper published in the Journal of the Academy of Nutrition and Dietetics, the team describes how, more than just the presence of sugar and salt in the diet, consuming more ultra-processed foods loaded with additives can lead to higher average blood glucose levels over several months, as measured by HbA1C.

“We wanted to understand the impact of different types of foods on blood sugar control in people with Type 2 diabetes,” said Marissa Burgermaster, assistant professor of nutritional sciences at UT and the senior author of the study. “Our findings showed that individuals who consumed more ultra-processed foods had poorer blood sugar control, while those who included more minimally processed or unprocessed foods in their diet had better control.”

The researchers examined the diet recalls and scored them against three widely used indexes that look at the overall quality or nutrition in a person’s diet. Still, those tools were not associated with blood glucose control. Instead, how many grams of ultra-processed food the participants ate or drank was linked to worse control, and a correspondingly better control occurred in participants who ate more whole foods or foods and drinks with minimal processing.

Recent studies have indicated that eating more ultra-processed foods is linked to higher rates of cardiovascular disease, obesity, sleep disorders, anxiety, depression and early death. Ultra-processed foods are typically higher in added sugars and sodium. Still, the researchers concluded that the A1C increases were not about merely added sugar and sodium, or they would have correlated with the tools that measure overall nutritional quality in the diet. Synthetic flavours, added colours, emulsifiers, artificial sweeteners and other artificial ingredients may be in part to blame, hypothesized Erin Hudson, a graduate student author of the paper, and this would suggest that dietary guidelines may need to begin to place more emphasis on ultra-processed foods.

Posted on Autism

Research highlights key challenges and opportunities in transitioning autistic individuals into adulthood

Adults with ADHD are at increased risk for developing dementia
The Autism Transitions Research Project has released new findings that underscore critical challenges and opportunities in transitioning autistic youth into adulthood.

The Autism Transitions Research Project, funded by the Health Resources and Services Administration and led by Drexel University’s A.J. Drexel Autism Institute, has released new findings that highlight critical challenges and opportunities in transitioning autistic youth into adulthood. With approximately 1.2 million autistic individuals expected to reach adulthood in the coming decade, these insights are crucial for shaping future research and services.

The study titled “Challenges and Opportunities in Transitioning Autistic Individuals into Adulthood” was led by Anne M. Roux, a research scientist and director at the Policy Impact Project in the Autism Institute’s Policy and Analytics Center, along with a multidisciplinary team.

The study identifies critical barriers that hinder successful transitions for autistic individuals, including delays in diagnosis and access to services, long waitlists, and an over-reliance on care partners to provide daily support and navigate complex service systems. Funded through the Autism Transitions Research Project grant under principal investigator Lindsay Shea DrPH, the study also emphasizes the importance of cultural considerations and responsiveness, as well as the inclusion of autistic individuals in the development of transition services.

Key findings include:

  • Significant delays in diagnosis and access to transition services exacerbate challenges for autistic youth and their families.
  • There is a critical need for peer navigation support and tailored services for marginalized groups, such as those with intersecting identities.
  • Disparities in service availability across geographic locations.
  • Difficulty accessing essential benefits programs, like Supplemental Security Income, and need to revise benefits programs that reinforce poverty.

Participants in nine focus groups—which included autistic young adults, care partners, and professionals—emphasized the need for research focusing on the efficacy of transition services, the impact of system performance on outcomes, and the need for transformation in service ecosystems.

“This research reflects the perspectives of those most impacted by transition challenges and offers a pathway to more inclusive and effective solutions,” said Roux. “We must prioritize autistic perspectives and account for cultural differences when designing transition services and supports.”

The study’s recommendations include developing population-level research to assess system performance, improving service delivery for marginalized groups, and transforming the complexity of service ecosystems to better support successful transitions for all autistic youth across differing life experiences.

Posted on Autism

Increased autism symptoms linked to Y chromosome

Research offers new explanation for greater ASD risk among males
Research offers a new explanation for a greater possibility of autism among males.

 Increased probability for autism appears to be linked to the Y chromosome, a Geisinger study found, offering a new explanation for the greater prevalence of autism in males. T

Autism is a neurodevelopmental condition characterized by impaired social interaction and communication and restricted and repetitive patterns of behaviour, interests and activities. AAutism is nearly four times more prevalent among males than females, but the reason for this disparity is not well understood.

One common hypothesis involves the difference in sex chromosomes between males and females—typical females have two X chromosomes, while typical males have one X and one Y chromosome.

“A leading theory in the field is that protective factors of the X chromosome lower autism in females,” said Matthew Oetjens, Ph.D., assistant professor at Geisinger’s Autism & Developmental Medicine Institute.

The Geisinger research team, led by Dr Oetjens and Alexander Berry, PhD, staff scientist, sought to determine the effects of the X and Y chromosomes on autism risk by examining ASD diagnoses in people with an abnormal number of X or Y chromosomes, a genetic condition known as sex chromosome aneuploidy.

The team analyzed genetic and autism diagnosis data on 177,416 patients enrolled in the Simons Foundation Powering Autism Research (SPARK) study and Geisinger’s MyCode Community Health Initiative. They found that individuals with an additional X chromosome had no change in ASD risk, but that those with an extra Y chromosome were twice as likely to have an ASD diagnosis. This suggests a risk factor associated with the Y chromosome instead of a protective factor associated with the X chromosome.

“While these may seem like two sides of the same coin, our results encourage us to look for autism risk factors on the Y chromosome instead of limiting our search to protective factors on the X chromosome,” Dr. Berry said. “However, further research is needed to identify the specific risk factor associated with the Y chromosome.”

Posted on Patient Talk

Echoes in the brain: Why today’s workout could fuel next week’s bright idea

The everyday effects of sleep, exercise, heart rate and mood — both good and bad — could linger in our brains for over two weeks, according to a pioneering study
According to a pioneering study, the everyday effects of sleep, exercise, heart rate and mood — both good and bad — could linger in our brains for over two weeks.

In a rare, longitudinal study, researchers from Aalto University and the University of Oulu tracked one person’s brain and behavioural activity for five months using brain scans and data from wearable devices and smartphones. 

‘We wanted to go beyond isolated events,’ says research leader Ana Triana. ‘Our environment and experiences constantly shape our behaviour and mental states. Yet, we know little about the response of brain functional connectivity to environmental, physiological, and behavioural changes on different timescales, from days to months.’ 

The study discovered that our brains don’t react to daily life in short, isolated bursts. Instead, brain activity changes in response to sleep patterns, physical activity, mood, and respiration rate over several days. This implies that even a workout or a restless night from last week could still impact your brain — and consequently your attention, thinking, and memory — well into next week.

The research also revealed a strong link between heart rate variability, which measures the heart’s adaptability, and brain connectivity, particularly during rest. This suggests that activities that affect our body’s relaxation response, such as stress management techniques, could influence the wiring of our brains even when we are not actively focusing on a task. The study also found that physical activity has a positive impact on the interaction between different brain regions, potentially affecting memory and cognitive flexibility. Furthermore, even small changes in mood and heart rate had lasting effects for up to fifteen days.

The study goes beyond a snapshot.

The research is unusual because few brain studies involve detailed monitoring over days and weeks. ‘The use of wearable technology was crucial’, says Triana. ‘Brain scans are useful tools, but a snapshot of someone lying still for half an hour can only show so much. Our brains do not work in isolation.’

Triana was the subject of the research, being monitored as she went about her daily life. Her dual role as both lead author and study participant added complexity but also provided firsthand insights into how to best maintain research integrity during several months of personalized data collection.

‘At the beginning, it was exciting and a bit stressful. Then, routine settles in, and you forget,’ says Triana. Qualitative data from mood surveys complemented data from the devices and twice-weekly brain scans. 

The researchers identified two distinct response patterns: a short-term wave lasting under seven days and a long-term wave of up to fifteen days. The short-term wave reflects rapid adaptations, such as how the focus is impacted by poor sleep, but it recovers quickly. The long wave suggests more gradual, lasting effects, particularly in areas tied to attention and memory.

Single-subject studies offer opportunities for improving mental health care.

The researchers hope their innovative approach will inspire future studies that combine brain data with everyday life to help personalise mental health treatment. 

‘We must bring data from daily life into the lab to see the full picture of how our habits shape the brain, but surveys can be tiring and inaccurate,’ says study co-author, neuroscientist and physician Dr Nick Hayward. ‘Combining concurrent physiology with repeated brain scans in one person is crucial. Our approach gives context to neuroscience and delivers very fine detail to our understanding of the brain.’ 

The study is also a proof-of-concept for patient research. Tracking brain changes in real-time could help detect neurological disorders early, especially mental health conditions where subtle signs might be missed.

“Linking brain activity with physiological and environmental data could revolutionize personalized healthcare, opening doors for earlier interventions and better outcomes,” says Triana.