Rheumatoid Arthritis? Your pet can keep you active and help with some symptoms.
Many people report that marijuana or marijuana extracts such as Sativex (nabiximols) are effective for multiple sclerosis symptoms. This video reviews some of the clinical trials, and I share experience with my own patients.
Significant weight loss and insulin independence drive improvement in general health measures for patients with type 2 diabetes
A new analysis from the STAMPEDE trial shows that over the course of five years, patients who had bariatric and metabolic surgery to treat uncontrolled type 2 diabetes reported greater physical health, more energy, less body pain, and less negative effects of diabetes in their daily lives, compared with patients who had medical therapy alone for their diabetes.
Long-term changes in psychosocial and emotional quality of life measures were not significantly different between the surgical and medical groups. The research was published in the Annals of Surgery.
“Chronic diseases, such as severe obesity and diabetes, can negatively affect quality of life,” said Ali Aminian, M.D., director of Cleveland Clinic’s Bariatric & Metabolic Institute and lead author of the study. “It is important to study the effects of different treatments on the well-being of patients in their daily lives.”
The Cleveland Clinic-led STAMPEDE study (Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently) was the first randomized controlled clinical trial that compared head-to-head bariatric surgery with intensive medical therapy for the treatment of type 2 diabetes in patients with poorly controlled diabetes and obesity.
The trial initially involved 150 participants, who were divided into three groups: 1) Fifty patients received intensive medical therapy only, including counseling and medications; 2) Fifty patients underwent Roux-en-Y gastric bypass surgery and received medical therapy; 3) Fifty patients underwent sleeve gastrectomy and received medical therapy. Effectiveness was gauged by the percentage of patients who achieved blood sugar control, defined in this study as HbA1c level of less than or equal to 6.0 percent – a more aggressive target than the American Diabetes Association’s guidelines. HbA1c is a standard laboratory test that reflects average blood sugar over three months.
The study’s initial results showed that metabolic surgery is superior to medical therapy alone for achieving weight loss and diabetes control with less reliance on anti-diabetic medications. The five-year results showed that the benefits of metabolic surgery persist over time.
This current study looked at 104 STAMPEDE trial participants: 1) Twenty-six patients who received intensive medical therapy only; 2) Forty-one patients who underwent Roux-en-Y gastric bypass surgery and received medical therapy; 3) Thirty-seven patients who underwent sleeve gastrectomy and received medical therapy.
The 104 patients were asked to answer two generic health-related quality of life questionnaires (the RAND 36-Item Health Survey and European QoL 5-Dimensions) and a diabetes-specific questionnaire at the beginning of the trial, and then on an annual basis following enrollment. Those three questionnaires were chosen to assess how surgical or medical treatment of obesity and diabetes may affect key elements of quality of life.
The results show that over the course of five years, the 78 patients in the surgical groups had significantly better scores on physical functioning, more energy, less body pain, and improved general heath scores compared with the 26 patients in the medical therapy group. The diabetes questionnaire looked at 12 various aspects of life in patients who have type 2 diabetes, such as maintaining a diet, going on vacation, planning meals or eating out with others, and family life. Over five years, data show that diabetes has less negative impact on quality of life in the metabolic surgery groups compared with the medical therapy group.
“Patients with long duration of diabetes tend to have poor quality of life, especially when they develop microvascular complications like eye and kidney diseases,” said Sangeeta Kashyap, M.D., co-investigator involved with the trial and an endocrinologist at Cleveland Clinic’s Endocrinology & Metabolism Institute. “When diabetes is coupled with obesity, the impact on lower quality of life can be related to the mechanical effects of obesity as well, which leads to poor mobility and bodily pain. Significant weight loss and insulin independence following metabolic surgery drive the improvement in general health measures and quality of life for patients with type 2 diabetes,” said Dr. Kashyap.
“Our findings suggest that psychological well‐being needs may require more attention in metabolic surgical patients,” said Dr. Aminian. “As part of our multidisciplinary approach to weight management at Cleveland Clinic, our patients have appointments with psychologists before and after surgery. The study results highlight that we may need greater emphasis on that aspect of the treatment, such as identification of psychosocial and emotional factors before surgery that can predict outcomes of surgery, as well as continuous psychosocial support after surgery.”
More long-term research is needed to continue to gather feedback directly from patients on the effects of metabolic surgery on their quality of life.
A treatment involving electrical nerve stimulation helped women with fibromyalgia in a recent clinical trial. The findings are published in Arthritis & Rheumatology.
Fibromyalgia is characterized by pain and fatigue, particularly during physical activity. Transcutaneous electrical nerve stimulation (TENS) delivers electrical currents through the skin to activate nerve pathways in the body that inhibit pain.
In this trial, TENS resulted in significant improvements in movement-related pain and fatigue compared with placebo or no TENS.
The TENS treatment was given along with standard treatments for fibromyalgia. Thus, it can provide people with a tool to help manage pain and fatigue without taking additional pain medications.
“TENS is available over the counter, is inexpensive, and is safe and easy to use,” said senior author Kathleen A. Sluka, PT, PhD, FAPTA, of the University of Iowa. “It can provide a self-management option for people with chronic pain, particularly fibromyalgia, to provide an additional level of pain relief.
Autistic people need extra help in going green say researchers behind a new study which argues for a more inclusive environmental agenda.
Climate action movements are gathering extraordinary pace due to international campaigners like Greta Thunberg, whose autism has been well documented. Being autistic has been used to explain and celebrate, but also diminish and denigrate, her activism.
Thunberg, for example, reports that being autistic is a psychological “gift” and “superpower” that underpins her environmental attitudes and behaviours. This has fuelled speculation – in the media and the general public – that autistic personality traits are intrinsically linked to environmentalism. But, until now, there was no investigation to test the autistic aspect of the so-called ‘Greta Thunberg Effect’.
Now a new study from the universities of Bath, Cardiff, Essex, and King’s College London, in the Journal of Environmental Psychology, suggests that autistic personality traits are unrelated to environmental attitudes. In contrast they can be linked to lower engagement in pro-environmental green behaviours.
Reflecting on their findings based on data from over 2,000 people in the UK and US, they discuss several reasons why people with autistic traits might face challenges going green. This includes sensory challenges that can act as a barrier to using noisy and crowded public transport, as well as issues over changing diet to reduce meat consumption.
The researchers conclude that autism spectrum conditions can present obstacles for pro-environmental action and are calling for greater support for people with autism and mental health conditions as well as more research on the topic.
Practical support might include adapting cognitive behavioural therapy, which is commonly used to facilitate behaviour change in people with mental health conditions, to support pro-environmental behaviours. They suggest it is also important to consider early environmental education for families and teachers supporting children with neurodevelopmental and metal health conditions.
Dr Punit Shah, Associate Professor of Psychology at the University of Bath and the GW4 Neurodevelopmental Neurodiversity Network, explained: “The ‘Greta Thunberg Effect’ has powerfully emerged in recent years, with many focussing on her autism diagnosis to explain her environmental activism.
“Intuitively, the speculation between autism and environmentalism has resonated with the public, including autistic adults who helped co-produce our new research. We also know from research that interests in animals, nature, and the environment, are widely reported by autistic individuals, which enhances their subjective wellbeing and life satisfaction.
“However, our findings show the link between autism and environmentalism is not clear cut. Given our results, we strongly recommend a move away from ‘Thunberg-driven’ autism-based narratives, whether positive or negative, of recent advances in climate policy.
Emily Taylor, lead author of the article said: “Our research is some of the first on how neurodevelopmental or mental health conditions may influence environmental attitudes and behaviour, and climate change beliefs. We focussed on autistic traits, but many other psychological differences and difficulties are likely to be associated with barriers to personal action on climate change. For instance, those with anxiety, or high levels of stress more generally, may be unable to move towards pro-environmental behaviours, for example using public transport, and have difficulty sustaining any changes they make.
“We need to think harder about supporting people to manage stress and mental health difficulties, which might then give them the cognitive resources to direct towards engaging in green behaviours. Mental health and environmental science are often thought about separately, but greater coherence – in terms of research and policy – will be crucial for both people’s mental wellbeing and the environment.”
Dr Shah added: “The United Nations recently called for a ‘disability-inclusive’ approach to climate action. Although there is some understanding of how ‘physical’ health impairments are linked to difficulties with engagement in environmental behaviours, there is little understanding of how ‘mental’ health problems or ‘hidden disabilities’ may have the same effect.
“Based on our findings, we speculate that the psychological and financial support required for autistic people and people with other mental health conditions to engage in pro-environmental activities is underestimated and must be a focus in the future – for a fairer, more inclusive environmental agenda.”