The psychology of gold and why it has that allure

(CNN)When you think of the color gold, images of grandeur and extravagance are likely to come to mind.

For millennia, the metal has adorned crowns and hilts of swords. It has been used to enhance paintings and ornaments to increase their value.
That led to the metal being associated with a shining, otherworldly character attributed to the gods in the religions of many different cultures. “Some of these were bodily associations,” the authors write.
The Aztecs described gold as the “excrement of the gods,” while the Incas thought of it as the “sweat of the sun.” In ancient Egypt, gold was considered the “flesh of the gods.” Across cultures, it was a sacred material.
The book goes on to illustrate the importance of gold in health and medicine. Chinese alchemists believed that drinking potable gold in the form of elixirs, eating from gold plates and using gold utensils helped attain longevity.
“Before the 20th century, gold was used to treat conditions as varied as syphilis, heart disease, smallpox and melancholia,” the book notes.
Today, gold compounds are still thought to have some anti-inflammatory effects.

Attracting the eye

The incorruptible nature of gold has an otherworldly allure to it and the reflective quality of the metal gives the impression that it glows from the inside, said Oakley.
When viewed by candlelight, gilded medieval manuscripts, statues and icons in the Eastern Orthodox Church exuded a transcendental quality, glowing as if they were illuminated from the inside.
Human vision can discriminate millions of colors, but it can discriminate trillions of chromatures — colored textures, said Donald Hoffman, professor of cognitive science at University of California, Irvine.
“It is the chromature that targets the human emotions more specifically than uniform color patches,” he said.
Hoffman believes the reason chromatures can target human emotions more specifically than uniform color patches is that they contain far more information than color patches.
He demonstrated the concept with two pictures — a section of brown grizzly bear fur and the same brown color in plain background. When looking at the chromature, our mind can immediately grasp that we are looking at a bear, he explained.
“Evolution would have more success training the emotional system to be wary of the bear fur chromature than to be wary of the uniform color patch of the same average color.”
Similarly, when we look at a gold ring versus a standard patch of uniform color, we see interesting highlights on the ring because the metal is highly reflective.
“Companies are using genetic algorithms to evolve chromatures and target specific emotions they want people to experience with respect to their product or brand. It turns out to be quite powerful,” he adds. For example, “A company might, for instance, want to convey the idea that their product is soft and warm. Then we would start with closeup images of patches of soft things, such as the fur of a rabbit and the down of a goose, and warm things, such as glowing embers of charcoal or a warm sunset,” Hoffman explained.
The same could be applied to evoke emotions linked to gold — how does it make you feel?

A sign of success

In ancient Rome and medieval Europe, sumptuary laws prohibited people from wearing too much gold — or not wearing it at all unless they were from a noble family.
Gold leaf has been used liberally in artwork which hinted at the status of the patron who commissioned it.
All societies value gold and investing in gold has survived for centuries through marketing — even glorified.
“(Gold) carries with it the messaging that you should own it. It is a learned, conditioned response,” said Eiseman — but not so much that it becomes tacky, she adds.
In popular culture, musicians flaunt their gold bling. The underlying message being that they are good at what they do and have amassed a lot of wealth. “In a lot of cultures, the word for money derives from the word for gold. In China, the ideogram for money is the ideogram for gold,” Oakley said.

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Gold continues to be featured heavily in religion and religious rituals alike. It decorates the papal regalia, spires, domes and minarets of temples, churches, monasteries and mosques worldwide.
Golden trophies like Olympic medals, the Nobel Prize, Oscars and Emmys are presented to people who display a unique talent. “The idea is the prize made of a rare material is given to people with display talent as rare as the material,” said Sally Augustin, an environmental and design psychologist.
Psychologically, this results in gold being a color of motivation.
Are you motivated?

Read more: http://www.cnn.com/2017/10/13/health/colorscope-gold-allure/index.html

More than 25 million people dying in agony without morphine every year

Concern over illicit use and addiction is putting morphine out of reach for millions of patients globally who need it for pain relief

More than 25 million people, including 2.5 million children, die in agony every year around the world, for want of morphine or other palliative care, according to a major investigation.

Poor people cannot get pain relief in many countries of the world because their needs are overlooked or the authorities are so worried about the potential illicit use of addictive opioids that they will not allow their importation.

Staring into this access abyss, one sees the depth of extreme suffering in the cruel face of poverty and inequity, says a special report from a commission set up by the Lancet medical journal.

In Haiti, for instance, says the report, there are no nursing homes or hospices for the dying and most have to suffer without pain relief at home.

Patients in pain from trauma or malignancy are treated with medications like ibuprofen and acetaminophen, says testimony from Antonia P Eyssallenne of the University of Miami School of Medicine. Moreover, nurses are uncomfortable giving high doses of narcotics even if ordered to do so for fear of being responsible for the patients death, even if the patient is terminal.

Death in Haiti is cruel, raw, and devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor.

A doctor in Kerala, India, which has a palliative care service, told of the arrival of a man in agony from lung cancer. We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible, said Dr M R Rajagopal.

But when he returned, morphine stocks were out. Mr S told us with outward calm, I shall come again next Wednesday. I will bring a piece of rope with me. If the tablets are still not here, I am going to hang myself from that tree. He pointed to the window. I believed he meant what he said.

The commissions three-year inquiry found that nearly half of all deaths globally 25.5 million a year involve serious suffering for want of pain relief and palliative care. A further 35.5 million people live with chronic pain and distress. Of the 61 million total, 5.3 million are children. More than 80% of the suffering takes place in low and middle-income countries.

Jim Yong Kim, president of the World Bank, said things had to change. Failure of health systems in poor countries is a major reason that patients need palliative care in the first place. More than 90% of these child deaths are from avoidable causes. We can and will change both these dire situations.

Morphine is hard to obtain in some countries and virtually unobtainable in others. Mexico meets 36% of its need, China meets 16%, India 4% and Nigeria 0.2%. In some of the worlds poorest countries, such as Haiti, Afghanistan and many countries in Africa, oral morphine in palliative care is virtually non-existent.

Oral and injectable morphine is out of patent, but costs vary widely and it is cheaper in affluent countries like the USA than in poor countries. A second issue is opiophobia the fear that allowing the drugs to be used in hospitals will lead to addiction and crime in the community.

The world suffers a deplorable pain crisis: little to no access to morphine for tens of millions of adults and children in poor countries who live and die in horrendous and preventable pain, says Professor Felicia Knaul, co-chair of the commission from the University of Miami, calling it one of the worlds most striking injustices.

Knaul says she only realised that many people suffered without pain relief when she was working to improve access to cancer treatment in low-income countries. I was shocked. I had no idea. When people were showing me the data I thought it cant be in this world, she told the Guardian.

She had also experienced the need for morphine herself after a mastectomy for breast cancer. When I woke up I couldnt breathe because the pain was so bad. If they hadnt arrived with the morphine I dont know how I would have got through it. And as a young girl in Mexico, she had to watch her father suffer as he died without pain relief.

I dont think that we have cared enough about poor people who have pain, she said. It doesnt make them live any longer. It doesnt make them more productive. It is simply the human right of not suffering any more pain and we dont care about that for people who are poor.

The commission recommends that all countries put in place a relatively inexpensive package of effective palliative care for end of life conditions that cause suffering, including HIV, cancers, heart disease, injuries and dementia.

One of their most emphatic recommendations, says Knaul, is that immediate-release, off-patent, morphine that can cost just pennies should be made available in both oral and injectable formulations for any patient with medical need. The disparity and access abyss between the haves and have-nots is a medical, public health and moral injustice that can be effectively addressed by the commissions recommendations.

Read more: https://www.theguardian.com/science/2017/oct/12/more-than-25-million-people-dying-in-agony-without-morphine-every-year

How your blood may predict your future health

New research into bloodstream biomarkers aims to unlock the full impact of social status on peoples lifetime health outcomes. The key is exposure to stress

Health is a well-known inequality issue. While ageing is inevitable and most of us will get sick at some point, the rate of your decline is likely to be faster the lower down the socioeconomic ladder you started.

The intriguing thing is, nobody exactly knows why. Tempting though it is to blame the usual suspects poor diet, obesity, smoking they dont account for the whole story.

If you exactly knew somebodys diet, exercise level, smoking habit or alcohol consumption, you would be about 30 to 40% likely to accurately predict how long they are going to live, says Mel Bartley, professor emerita of medical sociology at University College London, who has dedicated her career to understanding the links between society and health. But whats the rest? Thats the big question.

Unpicking the biological connections between external socioeconomic forces and an individuals health is no easy task. But Bartley and others in her field believe important clues can be found in the very lifeblood of a nation.

The idea that measurable biological markers (biomarkers) in the bloodstream can reflect an individuals underlying health status and even offer some kind of prediction of their life expectancy gained popularity in the 1950s, as scientists started searching for tell-tale markers linked to the epidemic of heart disease spreading through the US.

High blood pressure was the obvious one, but they also discovered that the level of bad cholesterol in the bloodstream was a good indicator of risk. By monitoring blood cholesterol levels in healthy people before they show any outward signs of heart disease, doctors can predict who is most at risk. The resulting medical interventions, such as dietary changes and statin drugs, can demonstrably improve those peoples long-term health.

Now, researchers are using the same approach to measure the impact of social status on the body, in the hope of developing policies that can reduce the health toll on societys most deprived section (on average, the poorest people in the UK miss out on more than a decade of life compared with the richest).

One of the most ambitious projects, currently being undertaken by the University of Essexs Institute for Social and Economic Research (ISER), is looking at blood biomarkers from some of the 40,000 UK households taking part in its Understanding Society study, which covers the entire socioeconomic spectrum.

A biomarker is an objective measure of health, explains Professor Meena Kumari, the epidemiologist leading the study along with health economist Dr Apostolos Davillas. These chemicals are like molecular flags: they allow us to see what happens inside people as theyre going through their life course which they themselves might not be so aware of.

According to Kumari, Whats happened historically is that social scientists have tended to measure health in a simple way just asking people: How do you rate your health right now? But we wanted to bring together the biology and the social science.

Published in the journal Scientific Reports, the ISER teams initial analysis focused on measuring the levels of two molecules, fibrinogen and C-reactive protein (CRP), that are produced by inflammation the bodys response to infections, stress and other harmful stimuli. Chronic long-term inflammation is linked to poorer health outcomes including heart disease, diabetes and cancer.

According to Davillas and Kumari, measuring an individuals CRP and fibrinogen levels and matching them against their socioeconomic position starts to reveal the hidden mechanisms connecting social inequality and health. And the missing link appears to be stress.

The impact of chronic stress

When we experience something stressful, we activate the hypothalamic pituitary adrenal axis: a convoluted network involving the brain and the pituitary and adrenal glands. This results in the release of cortisol and other stress hormones such as adrenaline, which have a range of effects on the body.

The complex biological conversation between this stress response and the bodys inflammatory processes actually damps down inflammation in the short term. But this careful balance seems to shift in the face of chronic stress, resulting in more inflammation over time. Thus the levels of CRP and fibrinogen, as markers of chronic inflammation, are a proxy for the impact of long-term stress on a persons body.

CRP
CRP levels at different ages by household income, left, and education. Photograph: Davillas et al/Scientific Reports

For Kumari and Davillass biomarker study, blood samples were gathered from nearly 8,000 adults in the Understanding Society cohort. While CRP and fibrinogen levels increase in all of us as we age, the ISER team found that differences in the levels of CRP and fibrinogen between socioeconomic groups begin to show relatively early in life and on average rise faster and peak sooner in poorer people.

The research shows differences in CRP levels start around 30 years old and peak around the age of 55, Davillas says. Then the gap starts to narrow again theres not so much difference between the lowest and highest socio-economic groups in later life, although of course the social inequalities are still there. People in both groups end up with similar CRP readings by their mid-70s.

The analysis suggested people in lower socioeconomic groups have a demonstrably longer exposure to chronic inflammation with all its knock-on impacts on long-term health even once the team corrected for the usual suspects of health inequality, including diet and smoking. Theres clearly something else at work.

If you ask people about their health, you dont really see differences early in life people tend to become unhealthy later in life, Kumari says. But were starting to see these underlying biomarker differences in people in their 30s; so whats that about?

Fibrinogen
Fibrinogen levels at different ages by household income, left, and education. Photograph: Davillas et al/Scientific Reports

Kumari and Davillas are now considering the causes of chronic stress that might contribute to the patterns they have found, starting with employment or lack of it and the associated issues of poor pay, job insecurity, long hours and the burgeoning gig economy.

You have stressful life events such as bereavement or divorce, but were talking about understanding chronic long-term stresses, Kumari says. One of the things we think about is why is disadvantage stressful? For something like low income, it could be because you dont have the same levels of control over your life. Maybe you can manage it for a little while, but over the long term it becomes a chronic stress. These things are hard to measure and capture.

Bartley agrees more needs to be done to understand the financial causes of stress across society. Debt is deadly for people its the ultimate lack of control, she says. Housing is also a huge issue and it doesnt get researched enough living in poor situations is depressing, especially if youre bringing up children. People in poverty can end up in social isolation, and thats known to be associated with all kinds of unhealthy outcomes.

Changes in policy

Its all very well to be able to measure levels of inflammatory biomarkers, and link them to stress and worse health outcomes but the big question is what to do about it. If its as simple as lowering inflammation, then maybe we should just hand out anti-inflammatory drugs such as aspirin to poorer people?

I dont believe thats the answer, says Bartley. We need to understand what it is about living in a tougher social and economic situation that causes this underlying stress, in order to argue for more effective changes in policy.

From a policy perspective, if you know when health inequalities begin and when they peak, this can help you target these age groups and allocate resources more effectively, says Davillas, pointing to the example of retirement timing. If youre doing a stressful job and this impacts your health more compared to someone in a less stressful occupation, this is an important issue to consider from a public health perspective. Perhaps people in more stressful jobs should retire earlier.

Measuring biomarkers across society could also give researchers a way of monitoring the impact of policy interventions. But to do that effectively will require a lot more data. While the ISER teams findings suggest a link between inflammation, stress and poor health outcomes in the most disadvantaged sectors of society, the study is only a snapshot of biomarker levels in individuals of different ages at one point in time. Whats really needed is detailed, long-term research, monitoring and following people over decades as their lives change.

If we have 30-year-olds with high CRP, we want to know what happens to them five years later, says Bartley. We need to study people over their whole life course to find out if that early high CRP reading is fixed, and does high CRP at age 30 condemn someone to get sicker faster later on or does their health outcome change if they improve their situation and lower their stress levels?

The challenge with this long-term approach is finding ways of measuring biomarkers in large numbers of people across the full spectrum of society. It would be good if we could collect them by some electronic means, instead of having to stick needles in people for blood samples, Bartley speculates. Theres a lot of scope for improvements in technology such as mobile phones, in terms of understanding how society gets under the skin.

The ISER study also highlights another striking issue: the general lack of research focuses on people in midlife a time when life paths can become entrenched.

There are a lot of studies looking at older age groups, because thats when people get sick, and lots involving children because child development is interesting, but theres not a lot going on in the middle of the age span, Kumari says. And yet we found the difference between biomarker levels was biggest in working age groups, where we have the least amount of data.

Understanding the underlying biological pathways will help us to target what it is we should be focusing on. Our data suggest that it might be stress that we need to be thinking about, particularly for working age people. But this is just the beginning theres still a lot to do.

Share your experiences by emailing inequality.project@theguardian.com, or follow the Guardians Inequality Project on Twitter here

Read more: https://www.theguardian.com/inequality/2017/oct/10/how-your-blood-may-predict-your-future-health-biomarkers

Global cost of obesity-related illness to hit $1.2tn a year from 2025

Health bill will be enormous burden without more preventative measures to check worsening epidemic, say experts

The cost of treating ill health caused by obesity around the world will top $1.2tn every year from 2025 unless more is done to check the rapidly worsening epidemic, according to new expert estimates.

Obesity and smoking are the two main drivers behind the soaring numbers of cancers, heart attacks, strokes and diabetes worldwide, grouped together officially as non-communicable diseases. They are the biggest killers of the modern world.

The United States faces by far the biggest treatment bill, with a rise from $325bn per year in 2014 to $555bn in just eight years time, partly because of the high cost of medical care in the US. But all countries are looking at a very steep rise in costs that will be unaffordable for most. In the UK, the bill is set to rise from $19bn to $31bn per year in 2025. The NHS chief executive, Simon Stevens, has already warned that obesity threatens to bankrupt the NHS.

Over the next eight years, the experts say, the US will spend $4.2tn on treating obesity-related disease, Germany will spend $390bn, Brazil $251bn and the UK $237bn if these countries do not do more to try to prevent it.

The new figures come from the World Obesity Federation (WOF), which says there will be 2.7 billion overweight and obese adults by 2025, many of whom are likely to end up needing medical care. That means a third of the global population will be overweight or obese.

The WOFs estimates show adult obesity continuing its steady climb. In 2014, a third of men and women in the US were obese (34%). By 2025 that is predicted to be 41%. In the UK, more than a quarter of adults (27%) were obese in 2014 and that will rise to 34% by 2025. Egypt is predicted to go up from 31% to 37% of adults in the same period, while Australia and Mexico will rise from 28% to 34% if nothing changes.

The annual medical costs of treating the consequences of obesity, such as diabetes and heart disease, is truly alarming, said Prof Ian Caterson, the president of the federation. Continual surveillance by WOF has shown how obesity prevalence has risen dramatically over the past 10 years and with an estimated 177 million adults suffering severe obesity by 2025, it is clear that governments need to act now to reduce this burden on their national economies.

For its new analysis, ahead of World Obesity Day on Wednesday, the federation has for the first time costed in not just cancer, diabetes and heart disease but other harms, including damage to joints which may result in hip and knee replacements and back pain. Thats why the figures are pretty astonishingly high, said Tim Lobstein, its policy director. Some poor countries are already swamped.

Low income countries have healthcare systems that barely manage to cope with childbirth and infectious diseases, and have neither the money nor staff to deal with the epidemic of chronic illness such as cancer and heart disease that is being fuelled by obesity.

For middle income countries we are going to see an enormous impact, said Lobstein. Countries in the Middle East and Latin America where health services are stretched are going to become highly stretched. These are the regions where obesity among children and adults has soared in recent years.

But the increasing costs will be a problem for every country in the world. This is going to be an enormous burden either on the state, the individual or the insurance services which simply wont be able to cope. How high can an insurance premium go? said Lobstein.

Sugary drink taxes are an important measure governments can take, said Johanna Ralston, the federations CEO. Right now there is a big focus on sugar-sweetened beverages, which is fantastic. I think as with tobacco, you want to find something that is tangible that governments can do and is measurable. But it is not enough.

The experts say spending more on treating and preventing obesity will save countries many millions in the long term. Bariatric surgery to reduce the size of the stomach is very effective in reducing appetite, and studies have shown it can reverse type 2 diabetes, dramatically improving peoples chances of a healthy life. But there is not enough treatment available, said Ralston.

One of the reasons is that the consensus that obesity is a disease is only really emerging now, she said. That will also help with the stigma. Bariatric surgery is a fantastic intervention but realistically it will only be for a smallish proportion of the population. It has to be offered in concert with other forms of weight management. Every single individual has to be offered multiple interventions.

Read more: https://www.theguardian.com/society/2017/oct/10/treating-obesity-related-illness-will-cost-12tn-a-year-from-2025-experts-warn

Beyond just birth control: Rollback leaves some women fearful

(CNN)Rachel Jarnagin was on her way to a post-surgical checkup Friday when she heard the news: The Trump administration had rolled back Obamacare’s birth control mandate, opening the door for nearly any employer or insurer with religious or moral convictions against contraceptives to exclude those benefits from their health plans.

The announcement struck close to home: Jarnagin, 30, had an ovary removed because of endometriosis just over a week ago and was prescribed hormonal birth control to keep the disorder in check. Endometriosis is an often-painful condition in which uterine tissue grows outside the uterus.
“My doctor told me, ‘Unless we start you on birth control to manage it, there’s no guarantee that you won’t get endometriosis on the other ovary and lose it, too,'” said Jarnagin, who works at a bath and beauty store in Denver. “It’s a necessity for me.”
    Her reaction to the administration’s decision: “I deserve to have affordable medications for a condition that I have no control over. I have always been an advocate for access to health care, and it’s frustrating that I may have to fight or pay more for health care that I’ve already do.”
    Much of the controversy over providing contraception to women centers on its use for family planning. But many medical conditions also require the use of hormonal birth control methods.
    “I saw this announcement, and it made me really angry,” said Jarnagin’s older sister, Allison Phipps, 32. “Endometriosis is a very common problem. My mom had it when she was 27 and had a portion of both of her ovaries removed. I might even have it, because many women don’t even know it’s there until the symptoms start.”
    Phipps herself was on the pill for 11 years and believes it might have protected her from developing the condition that has plagued the women in her family.
    “Personally, that’s why it’s important to me for birth control to be covered,” said Phipps, who works as an art director in Denver, “but I also believe it’s very important to women as a family planning method.
    “I remember when I was in college and having to pay for it,” she said. “For a generic mini pill, it was $30 a month, and with no job and student loans, that was a big deal. That was ramen noodle packages for a month.”
    Phipps, like many women, took to social media to express outrage, often using the hashtag #HandsoffmyBC.
    Jennifer Lawson, 43, a best-selling author and blogger from San Antonio, used the hashtag to share how she used birth control in her youth to control excruciating cramps.
    Her cramps, she wrote in an email, were “so severe they made me physically sick. A doctor put me on birth control pills to help and it made a big difference. I still had cramps and nausea but they were finally manageable to the point that I wasn’t missing days of school and falling behind in life.”
    Children’s book author Jessie Talbot had an even stronger reaction. “If I didn’t have BC, I’d be dead now,” she posted.
    “My issues came to an abrupt end when I got a hysterectomy 17 years ago,” Talbot said in an interview. “The birth control helped for a while but there was actually too much wrong for it to save the day. At least I had that option at the time.”
    Atlanta interactive designer Deb Nilsen has polycystic ovary syndrome, a hormonal imbalance often treated with birth control. If left untreated, it can lead to serious health issues such as heart disease and diabetes.
    “I think that the idea of the rollback on birth control is ridiculous and shortsighted,” Nilsen posted on Facebook. “Women like me, who have PCOS, typically do not have regular cycles and take birth control in order to get a period and not to prevent pregnancy. If a woman with PCOS doesn’t have access to birth control, I think it could be a risk factor for her.”
    None of these reactions comes as a surprise to Dr. Anne Davis, an OB-GYN in New York who serves as consulting medical director for the nonprofit Physicians for Reproductive Health. After the 2016 election, she says, she heard women warning each other that their access to birth control might dwindle once the president-elect took office.
    But worry is much different from reality.
    Friday, Davis was fitting an intrauterine device for a patient who has a condition that makes it medically dangerous to have more children. “I asked her if she’d seen the news,” Davis said. “She told me that she saw it and it was really hard for her not to cry.”
    Just a decade ago, says Davis, most women in her practice never considered using an IUD. “I would tell them, ‘Your insurance isn’t going cover it, and it’s 800 bucks.’ And people just shrugged their shoulders and said, ‘Well, I don’t have 800 bucks.’ It was completely out of reach financially for most of my patients.”
    One of those patients, she recalls, used a condom for contraception but, due to accidents, ended up having an abortion, and then another.
    “After the Obamacare mandate, she was able to get an IUD,” Davis said. “Years later, she’s planning a family, in a place and time in her life where she can support children. It was a sea change for her.”

    See the latest news and share your comments with CNN Health on Facebook and Twitter.

    What’s next for women who find themselves reliant on birth control for their medical conditions?
    “People are feeling deeply unsettled,” Davis added. “They don’t know what’s going to happen.”
    Lawson, the author and blogger, said, “No employer knows me well enough to decide what is or isn’t acceptable for myself, my daughter, or anyone else. And they shouldn’t have to know me well enough because it’s none of their business.”
    Lawson says she no longer has to take birth control pills but would be terrified of how the Trump decision would affect her if she were still suffering as she did when she was younger.
    “But just because it doesn’t affect me personally doesn’t mean I will stop fighting for those who it will negatively impact,” Lawson said. “We’re in this together. Or at least, we should be.”

    Read more: http://www.cnn.com/2017/10/06/health/women-react-trump-birth-control-mandate-bn/index.html

    ‘Western society is chronically sleep deprived’: the importance of the body’s clock

    The 2017 Nobel prize for medicine was awarded for the discovery of how our circadian rhythms are controlled. But what light does it shed on the cycle of life?

    The cycle of day and night on our planet is age-old and inescapable, so the idea of an internal body clock might not sound that radical. In science, though, asking the questions why? and how? about the most day-to-day occurrences can require the greatest leaps of ingenuity and produce the most interesting answers.

    This was the case for three American biologists, Jeffrey Hall, Michael Rosbash and Michael Young, who earlier this week were awarded the Nobel in medicine or physiology, for their discovery of the master genes controlling the bodys circadian rhythms.

    The first hints of an internal clock came as early as the 18th century when the French scientist Jean-Jacques dOrtous de Mairan noticed that plants kept at a steady temperature in a dark cupboard unexpectedly maintained their daily rhythm of opening and closing their leaves. However, De Mairan himself concluded this was because they could sense the sun without ever seeing it.

    It was only when Hall, Rosbash and Young used fruit flies to isolate a gene that controls the rhythm of a living organisms daily life that scientists got the first real glimpse at our time-keeping machinery that explains how plants, animals and humans adapt their biological rhythm so that it is synchronised with the Earths revolutions, the Nobel prize committee said.

    Using fruit flies, the team identified a period gene, which encodes a protein within the cell during the night which then degrades during the day, in an endless feedback cycle.

    Prof Robash, 73, a faculty member at Brandeis University in Waltham, Massachussetts, said that when his paper was published in the 1980s he had no grandiose thoughts about the importance of the discovery. During the intervening years, the picture has changed.

    Its [now] pretty clear that it has its fingers in all kinds of basic processes by influencing an enormous fraction of the genome, he said.

    Scientists discovered the same gene exists in mammals and that it is expressed in a tiny brain area called the suprachiasmatic nucleus, or SCN. On one side, it is linked to the retina in the eye, and on the other side it connects to the brains pineal gland, which pumps out the sleep hormone melatonin.

    Modern lifestyles may no longer be constrained by sunrise and sunset, but light remains one of the most powerful influences on our behaviour and wellbeing. This realisation has fuelled a sleep hygiene movement, whose proponents point out that bright lights before bedtime and spending the whole day in a dimly lit office can dampen the natural circadian cycle, leaving people in a continual mental twilight dozy in the morning, and too alert to fall asleep promptly at night.

    Rosbash welcomes this new awareness. Its been overlooked for a long time as a real public health problem, he said. All of western society is a little bit sleep deprived and, when I say a little bit, I mean chronically.

    There is growing evidence that this decoupling from the natural circadian cycle can have long-term health consequences much more far-reaching than tiredness.

    At first, it was assumed that the brains master clock was the bodys only internal timekeeper. In the past decade, though, scientists have shown that clock genes are active in almost every cell type in the body. The activity of blood, liver, kidney and lung cells in a petri dish all rise and fall on a roughly 24-hour cycle. Scientists have also found that the activity of around half our genes appear to be under circadian control, following undulating on-off cycles.

    In effect, tiny clocks are ticking inside almost every cell type in our body, anticipating our daily needs. This network of clocks not only maintains order with respect to the outside world, but it keeps things together internally.

    Virtually everything in our body, from the secretion of hormones, to the preparation of digestive enzymes in the gut, to changes in blood pressure, are influenced in major ways by knowing what time of day these things will be needed, said Clifford Saper, a professor of neuroscience at Harvard Medical School. The most common misconception is that people think that they do not have to follow the rules of biology, and can just eat, drink, sleep, play, or work whenever they want.

    This discovery explains why jet lag feels so grim: the master clock adapts quickly to changing light levels, but the the rest of your body is far slower to catch up and does so at different speeds.

    Jet lag is so awful because youre not simply shifted, but the whole circadian network is not aligned to each other, said Prof Russell Foster, chair of circadian neuroscience at the University of Oxford. If you were completely aligned but just five hours shifted you wouldnt feel so crappy.

    It is also helps explain the extensive range of health risks experienced by shift workers, who are more likely to suffer from heart disease, dementia, diabetes and some cancers. Theyre having to override their entire biology, said Foster.

    Obesity is also more common among those with irregular sleep patterns. Sapers team has found that animals that dont get enough sleep, but keep their circadian pattern, do not gain weight. But when they are placed on a 20-hour light-dark cycle, they eat more impulsively and develop glucose intolerance.

    I would suggest that for humans, staying up late, watching video screens with high levels of blue light and eating high fat foods, is potentially a major cause of obesity and diabetes, said Saper.

    Evidence is also emerging that our risk of acute illness rises and falls with a predictable regularity. People are 49% more likely to suffer a stroke between 6am and 12 noon than at any other time of the day and a similar pattern is true for heart attacks. This is linked to a circadian rise in blood pressure in the early morning, which happens even if youre lying in bed not doing anything.

    As a result, it makes sense to take certain blood pressure medications first thing, before getting out of bed. By contrast, cholesterol is made more rapidly by the liver at night. So, statins, which lower cholesterol, work best if taken before going to bed.

    Foster said that a failure to consider the circadian influence in past animal experiments may even have led to promising drug candidates being shelved. Toxicity can change from 20% to 80% depending on the time of the day you test a drug, he said.

    As the impact of scientific advance slowly trickles down, the medical profession and society at large are waking up to the power of the biological clock.

    A paper last year showing that jet lag impairs baseball performance, prompted some professional sports teams to take on circadian biologists as consultants on schedules for training and travel. The US Navy has altered its shift system to align it with the 24-hour clock, rather than the 18-hour day used in the old British system. Schools are experimenting with later school days, better aligned with the teenage body clock, which runs several hours later than that of adults.

    As circadian rhythms have journeyed from obscure corner of science to part of the zeitgeist, companies are launching an increasing number of products on the back of a new anxiety around sleep and natural cycles. This is the western world; if somebody can make a buck theyre going to try to do it, said Rosbash.

    The 73-year-old, who describes his own relationship with sleep as borderline problematic, prefers low- tech remedies, however.

    I havent quite figured out how to do better, he said. I try not to take sleep medication. I dont drink alcohol too late in the evening, I read a good book. The common sense things, I think they help.

    Read more: https://www.theguardian.com/science/2017/oct/06/western-society-is-chronically-sleep-deprived-the-importance-of-the-bodys-clock

    ‘World’s heaviest woman’ dies

    (CNN)Eman Abdul Atti, once believed to be the “world’s heaviest woman,” died on Monday due to complications from heart disease and kidney dysfunction, according to a statement from Burjeel Hospital in Abu Dhabi, the United Arab Emirates.

    The 37-year old Egyptian woman weighed 1,102 pounds (500 kg), her family reported, prior to undergoing weight reduction surgery at Saifee Hospital in Mumbai in March.
    All signs looked positive immediately following the surgery for Eman, who had lost more than 200 pounds prior to the operation.
      “She is very happy, she started dancing in her bed,” Dr. Muffazal Lakdawala, the surgeon who performed her laparoscopic sleeve gastrectomy operation, told CNN in March. “Her smile has come back.” The procedure involves removing part of the stomach so that only a “sleeve,” roughly the size and shape of a banana, is left behind, along with the muscle that controls emptying food into the intestine.
      On September 9, Eman celebrated her 37th birthday.

      Early difficulties

      Eman’s family said Eman had weighed 11 pounds (5 kg) at birth and suffered from thyroid problems since she was a child. The thyroid gland produces hormones that help regulate metabolism. By fifth grade, she’d stopped going to school because she’d begun to have difficulties moving and walking.
      For the past two decades, Eman has barely left her room, her family reported. She suffered a stroke and, unable to move or communicate, her weight increased to more than 1,000 pounds. Her health deteriorated rapidly.
      Her sister created a social media campaign last year and Lakdawala responded by offering to help. His proposed three-and-a-half year plan including two operations to help her reduce her weight to less than 220 pounds (100kg).
      Eman overcame a number of hurdles to reach what her family had hoped to be a life-saving surgery in Mumbai, including an initial refusal to grant her a visa because of her inability to get to the embassy in person. After surmounting that problem with the help of an Indian minister, she then faced the difficulty of boarding an airplane.
      Egypt Air specially adapted a cargo plane to transport her to India.
      Following the surgery, Lakdawala said her kidney function had improved.
      “She has done well post-surgery,” he told CNN in March. At that time, he intended for her to lose another 155 to 175 pounds (70 to 80 kg) within the next couple of months. The plan was to then send her home to Egypt and schedule a second surgery for next year.

      See the latest news and share your comments with CNN Health on Facebook and Twitter.

      Eman was later transferred to Burjeel Hospital in Abu Dhabi. There, her condition was managed by a medical team of more than 20 doctors in different specialties.
      However, her heart and kidneys could no longer function.
      Her family expressed appreciation for the care provided by Burjeel Hospital and the support of the people of the UAE, according to the hospital statement. “Our prayers and heartfelt condolences go out to her family,” Burjeel Hospital staff said in the statement.

      Read more: http://www.cnn.com/2017/09/25/health/heaviest-woman-dies-bn/index.html

      Hedonism is good for your health

      I think I might be a hedonist. Are you imagining me snorting cocaine through $100 notes, a glass of champagne in one hand, the other fondling a stranger’s firm thigh? Before you judge me harshly, I know hedonism has a bad reputation, but it might be time to reconsider.

      What if, instead of a guaranteed one-way road to ruin, hedonism is good for your health? If we think of hedonism as the intentional savouring of simple pleasures — like playing in fallen leaves, moments of connection with friends, or cuddling the dog — then it probably is. Seeking and maximising these kinds of pleasures can boost our health and well-being.
      So where do our ideas of hedonism come from and how can we harness hedonism to improve our health and quality of life?

        The popular view of hedonism

        In broad terms, a hedonist is someone who tries to maximise pleasure and minimise pain. Jordan Belfort (played by Leonardo DiCaprio) in The Wolf of Wall Street is probably the popular idea of the quintessential hedonist, where his extreme wealth allows him to indulge his insatiable hunger for all things pleasurable.
        Hedonism Bot from Futurama is another character exquisitely in touch with things that provide pleasure.
        We find these characters so compelling because they seem to reject the sensible, responsible way to live. They indulge their carnal appetites in ways we daren’t, with scant regard for consequences. We wait for their liver to rebel or their life to come crashing down around them, as of course it must.
        But this kind of behaviour is better termed debauchery — extreme indulgence in bodily pleasures and especially sexual pleasures — rather than hedonism.
        Hedonism has its philosophical roots as far back as Plato and Socrates, but ancient Greek philosopher Epicurus is often credited with articulating an early brand of hedonism based not on a life of untamed appetites, but on moderate pleasures and respect for others.
        Today there are multiple views on what hedonism is. This is largely due to some highly nuanced philosophical arguments about how we should conceptualise pleasure.

        What is pleasure?

        It might help to think of pleasure simply as a subjective state of enjoyment. This is a broad perspective, but one easily applied to our everyday lives. So, a lover’s caress gives me pleasure, but so can a piece of music, laughing with friends, or simply sitting still in a comfy chair after a frantic day.
        Just as different experiences can bring a similar shiver of pleasure, the same experience can conjure a range of responses — from extreme pleasure to definite displeasure — in different people.
        There is no single stimulus that elicits exactly the same response in everyone all the time: pleasure is an interaction between the stimulus and the perceiver.
        If you close your eyes and think about a time you experienced a tingle of pleasure, chances are you’re remembering a sexual experience, or something delicious you’ve eaten. Perhaps the memory is of a very good glass of wine, or those last 50 metres of a long, satisfying run.
        And these are good things, right? Sexual pleasure is linked with health and well-being. For example, women who say they are satisfied with their sex life score higher on measures of psychological well-being and vitality. A regular glass of wine is said to have a protective effect against dementia and heart disease, perhaps due to its antioxidant flavonoids. And everyone knows the advantages of physical fitness.
        Well, these activities are good … until they’re not. Many of the things that commonly give us pleasure can also be used in risky or harmful ways.

        When pleasure becomes a problem

        Dependence, addiction, bingeing and compulsive consumption can be thought of as risky or harmful uses of otherwise pleasurable experiences, like using alcohol and other drugs, doing exercise and having sex.
        It can be difficult to pin down the point at which a previously pleasurable behaviour becomes problematic. But, somewhere between enjoying an occasional beer and needing a drink before getting out of bed each morning, we’ve passed the tipping point.
        At this stage though, pleasure is no longer the motivation, nor the result, of the behaviour. The uncontrollable “hunger” has wiped the pleasure away and the best we can hope for is relief. Without pleasure, the behaviour is no longer a hedonic one.
        The single-minded pursuit of one intense pleasure at the expense of other aspects of life that bring meaning and pleasure is also counterproductive to living a rich and enjoyable life. This puts it well outside Epicurus’ idea of moderate pleasures and self-control.

        Let’s be rational about hedonism

        So, when we need to make the mortgage or rent and keep our complex lives on track, what might a modern hedonist’s life look like?
        A practical definition might be someone who tries to maximise the everyday pleasures while still balancing other concerns. I’ll call this a kind of “rational hedonism”. In fact, Epicurus emphasised a simple, harmonious life without the pursuit of riches or glory.
        Maximising pleasure, unlike with debauchery or addiction, need not take the form of more, bigger, better. Instead, we savour everyday pleasures. We relish them while they’re happening, using all our senses and attention, actively anticipate them, and reflect on them in an immersive way.
        So, if my morning coffee gives me pleasure, I might pause and relish it while I drink it: inhale the fragrance of it fully and focus on the nuanced warm, smoky, bitter deliciousness of it. I should fully attend to the warmth of it in my hands, to the feeling of it in my mouth, and to the cascade of sensations and flavours it delivers.
        Not only that, in the morning, before my coffee, I can anticipate it. I can think how lovely it will be. And later, as I go about my day, I can pause and think about that coffee, about just how warm and good it was, how it smelled and tasted.
        In other words, I can immerse myself in these moments, in the anticipation, in the drinking itself, and in the remembering, and bring all my attention to them. This kind of savouring results in a totally different, and richer, experience than if I absent-mindedly gulp down the coffee while dodging traffic and talking on the phone.
        The act of savouring intensifies the pleasure we extract from simple things and delivers greater satisfaction from them. One study found that spending a little time savouring the anticipation before eating chocolate led participants to eat less chocolate overall.
        And attention seems to be key to the link between pleasurable feelings and well-being.

        How do we benefit from hedonism?

        A state of pleasure is linked with reducing stress. So when we feel pleasure, our sympathetic nervous system — that fight or flight response we experience when we feel threatened — is calmed. First of all, the stimulus arouses us, then if we appraise the situation as safe, we have “stress-terminating responses“, which we experience as relaxation or stress relief.
        Studies show pleasurable emotions are associated with broader and more creative thinking, and a range of positive outcomes including better resilience, social connectedness, well-being, physical health, and longevity. So, pleasure might not only help us to live more enjoyably, but longer.

        Hedonism for health and well-being

        Maximising everyday pleasures can be used in therapy and shows promise as an intervention for depression.
        One study of school children showed focusing on pleasurable daily events, in this case recording them in a diary, reduced depressive symptoms, and the effect was maintained three months later.
        Focusing on the pleasurable aspects of healthy foods can also be a more effective way to eat more of them than focusing on how “healthy” they are. Similar approaches are likely to be effective with exercise and other behaviours associated with health benefits.
        What we know about the benefits of this kind of rational hedonism is likely to grow from here. We have only just begun to explore the therapeutic value of shifting focus to fully attend to and maximise pleasure.
        We do know that interventions encouraging individuals to focus on pleasurable experiences are associated with increased self-reported well-being.

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        Promoting well-being in older adults is a particularly promising area. Savouring pleasure is linked to resilience in older adults and positive emotions can help to offset the ill-effects of loneliness. Plus, regardless of physical health status, the ability to savour is associated with higher levels of satisfaction with life.
        And savouring can be taught. One study, looked at the effects of an eight week program promoting savouring for a group of community dwelling adults aged 60 and above. The program reduced depression scores, physical symptoms and sleep problems, and increased psychological well-being and satisfaction with life.
        In the meantime, we should defiantly shake off the idea that pleasure is slightly shameful or frivolous and become early adopters of this rational kind of hedonism. We can think of Epicurus, and intentionally savour the simple pleasures we have learned to overlook.

        Read more: http://www.cnn.com/2017/09/12/health/hedonism-partner/index.html

        Benefits of water: Are you getting enough fluids to stay healthy?

        (CNN)Water is known as the elixir of life, with good reason. Every system in your body needs it to survive.

        This feature is part of CNN Parallels, an interactive series exploring ways you can improve your health by making small changes to your daily habits.
        “Water regulates our body temperature, keeps our joints lubricated, helps prevent infections and delivers nutrients to our cells,” said registered US dietitian and CNN contributor Lisa Drayer. “Additionally, our kidneys and liver work hard to get rid of toxins in our bodies, and they depend on water to do their job.”
        Water makes up about 60% of your body’s weight, and although you can survive without food for weeks, dehydration can kill you within days or even hours, depending on the temperature and your environment.
          Dehydration means more water is moving out of your body’s cells than into them. And as this happens, it’s not just water that you lose. Small amounts of electrolytes critical to cell function and energy, such as sodium and potassium, are lost along with the water.
          You’re constantly losing water and electrolytes throughout the day via breath, sweat, urine and bowel movements, so even mild dehydration can exhaust you and affect many of your body’s daily functions.

          Hydration and your health

          You could quickly become constipated as your colon steals water from your stool to keep your digestive system moving. Urine will become darker; prolonged dehydration can also crystallize salts and minerals in urine, possibly leading to the formation of painful kidney stones.
          Because dehydration can often be mistaken for hunger, you might gain weight as you try to satisfy your body’s needs. Fortunately, the opposite is also true if you’re hydrated.
          “If you are looking to lose weight, water can help you shed pounds,” Drayer said. “Drinking a glass of water before a meal can fill you up a bit and help you eat fewer calories at a meal.”
          If you suffer from migraines, studies show that a lack of fluids might easily trigger an episode. Headaches are also likely to last longer if you’re low on fluids. In addition, dehydration can leave you unable to concentrate, cause short-term memory problems and leave you feeling moody and anxious.
          “When you’re well-hydrated, your sleep quality is better, your cognition is better, you function better, your mood is better, the list goes on,” said Douglas Casa, CEO of the University of Connecticut’s Korey Stringer Institute, which studies athletic performance — another area that benefits from drinking enough fluids.
          “We did a study on people who were mildly dehydrated, which can happen within just 30 minutes of exercise,” Casa said, “and we found mood was compromised in both men and women.”

          Signs of dehydration

          The signs of dehydration differ by age group. Infants and young children may not be able to recognize their need for fluids, so it’s critical to provide frequent fluid intake and keep an eye out for symptoms of dehydration: irritability or lethargy, no tears when crying, no wet diapers for as little as three hours, a dry mouth and tongue, sunken eyes and cheeks, and a shrinking of the soft spot on top of head.
          Adults show much different signs of dehydration, including fatigue, dizziness, confusion, less-frequent urination and extreme thirst, but the latter has one exception: the elderly. Older adults may not feel thirsty but can still be dehydrated.
          That’s why one of the best ways to tell whether you’re lacking fluids is by the color of your urine.
          “The morning is the best time to get a global sense of your hydration status,” Casa advised. “If your urine looks more like apple juice instead of lemonade, then you’re dehydrated. On the flip side, the need to urinate throughout the day is a sign that you’re well-hydrated.”

          Additional causes of dehydration

          A lack of fluids is not the only cause of dehydration. Certain blood pressure and diuretic medications can increase urination, as can diabetes that has not been diagnosed or isn’t well controlled.
          A sudden and extreme episode of diarrhea or vomiting can remove a large amount of fluids in a short amount of time. Add a high fever, and you could be in trouble quickly. Upping fluid intake, preferably fluids fortified with electrolytes, is critical.
          Sweating due to hot, humid conditions or extreme physical activity is another sure way to become quickly dehydrated. Athletes and those who work outside have to be especially careful to avoid heat injuries including muscle cramps, heat exhaustion and seizures.
          Hypovolemic shock, in which low blood volume causes a drop in oxygen and blood pressure, is the most serious form of dehydration and can be life threatening.

          The many sources of water

          What’s the best way to stay hydrated? Drinking plain water, of course, can’t be beat. It’s readily available and has zero calories.
          But what if, like many Americans, you don’t like the taste of water? Drayer suggests adding fruit or vegetables, such as lemons, berries and orange or cucumber slices, to enhance the flavor.
          The National Academies of Medicine recommends a little over 11 cups (2.7 liters) of fluids a day for the average woman and 15 1/2 cups (3.7 liters) for men. Though that may sound difficult to achieve, the fluids can come from many sources besides water, including food.
          “I often remind people that broth-based soup, as well as other beverages including tea, coffee and milk, count towards your daily fluid intake,” Drayer added. “Also vegetables including cucumbers, lettuce, celery and tomatoes and fruits including watermelon, cantaloupe and strawberries.”
          “Why don’t Americans like to drink water? Because we are conditioned to expect high levels of sweetness in everything,” said renowned nutritionist Dr. Walter Willett, professor of nutrition and epidemiology at Harvard T.H. Chan School of Public Health.
          “And that has led to a lot of problems,” he added. “High levels of sugar have adverse metabolic effects, and the amounts we get in beverages today is so huge that it is one of our major health issues.”
          Willett, who is also a professor of medicine at Harvard Medical School, has published over 1,700 research papers and reviews on lifestyle risk factors for chronic disease.
          “You might say we are malhydrated, because we drink so much soda and fruit juice and other sugar-sweetened beverages, and by that I mean we drink beverages that harm our health,” he said. “Even energy drinks and vitamin waters, most are loaded with sugar and not worth the use.”

          Calculate your fluids

          To help people make better choices about their fluid intake, the American Society for Clinical Nutrition’s Beverage Guidance Counsel created a “pitcher” of liquids to illustrate at a glance how much of each fluid is considered best for optimal health. Though it was created in 2006, Willett, who served on the council, said the guidance holds true today.

          The vast majority of your daily fluid intake should come from water. In this illustration, a person on a 2,200-calorie diet would drink about 50 fluid ounces of water a day, which is just over 6 cups (1.4 liters). Another 28 fluid ounces, which is 3½ cups or just over 700 milliliters, could come from coffee or tea.
          “There are health benefits to coffee. Studies show it can help with diabetes and has some modest cardiovascular benefits,” Willett said. “It’s a mild antidepressant. In fact, studies show about a 50% lower risk of suicide of with three to four cups of coffee a day.
          “Tea has about a third the amount of caffeine as coffee, so you’re much less likely to have sleep problems,” he added, “but we don’t see as many health benefits for tea as coffee.”
          The next choice in the fluid pyramid is skim milk, also sold as 1% milk, as well as soy or other unsweetened alternatives such as almond milk. For adults who wish to add that beverage to their diet, the maximum amount per day would be two cups (almost 500 milliliters).
          “Milk is really complicated area because it comes along with saturated fat,” Willett said, “and even low-fat milk is high in calories. Up to two servings a day is fine, but going beyond that is excessive.”
          Level four in the diagram includes diet sodas, teas and other beverages with non-calorie artificial or natural sweeteners such as aspartame, sucralose and stevia. Because there is growing evidence that these drinks might contribute to weight gain, Willett says they should be seen as an “occasional treat.” They are listed in the pitcher as no more than 16 ounces a day (2 cups or almost 500 milliliters); keep in mind that a typical can of soda is 12 ounces.
          Then come alcohol, whole fat milk, sports drinks, vitamin enhanced waters and fruit and vegetable juices. Yes, even fruit and veggie drinks are capped at 4 ounces a day.
          “Fruit juices are cautionary because they contain about the same amount of sugar as soda,” Willett said. “Orange juice has nutritional value, apple juice much less, so we recommend choosing orange over apple juice.”
          Alcoholic beverages are complicated, he added. “There are definite protective health benefits against heart disease for both sexes, but for women, even a half a drink a day can raise the risk of breast cancer. So if you’re not at risk for heart disease, there’s no benefit in preventing it, so there’s no reason to drink,” he said. That’s why alcohol is listed on Willet’s diagram as zero fluid ounces toward your daily amount.
          The last category is reserved for sugar- or high fructose corn syrup sweetened beverages such as regular soda, lemonade and fruit drinks. Willett says those get a ‘”thumbs down” because they provide no nutritional value and plenty of calories.

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          Taken as a whole, Willett said, the pitcher recommendations should come as a wake up call for anyone looking to quench their thirst.
          “The most important message is the source of the hydration,” he said. “Beverages can cause real harm. People are not dying of dehydration in America, so choosing beverages other than water and other healthy sources has major health implications.”

          Read more: http://www.cnn.com/2017/09/27/health/benefits-of-water-and-fluids/index.html

          People are living longer, but violent deaths are on the rise

          (CNN)Conflict, terrorism and gun violence are claiming more lives around the world now than a decade ago, according to a new study published Thursday in the health journal The Lancet.

          Deaths caused by war and terrorism spiked after 2006, with 150,500 reported in 2016 — a 143% increase from 10 years earlier. These fatalities occurred largely as a result of conflicts in North Africa and the Middle East, the researchers noted.
          Worldwide, gun deaths also climbed during the same period: In 2016, firearm suicide fatalities reached 67,500 and firearm assault casualties rose to 161,000, increases of 4.3% and 5.7%, respectively, from 2006.
            Guns may be the direct cause of more deaths, but the there was an overall 3% decrease in fatalities caused by self-harm during the decade ending in 2016, the study indicated.
            The Global Burden of Disease study, an annual assessment of health trends, provides worldwide and national estimates on more than 330 diseases, causes of death and injuries in 195 countries and territories. The study, coordinated by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, requires assistance from more than 2,500 researchers around the globe.
            One of several sunny spots in the report: Worldwide, people are living longer.

            Life expectancy on the rise

            Generally, male life expectancy was lower than female from 1970 through 2016. Currently, the average global life expectancy for women is 75.3 years, while men can expect to see 69.8 years on the planet. Life expectancy for both sexes combined is 72.5 years.
            By contrast, global life expectancy combined was 58.4 years in 1970 and 65.1 in 1990. In 2000, the combined expectancy was 66.8 years, and in 2005, it was 68.4 years.
            Of all the nations, Japan boasts the highest life expectancy at 83.9 years (a combined figure for both sexes), while people living in the Central African Republic can expect only 50.2 years, a global low.
            Several countries have seen recent large increases in life expectancy, far beyond expectations for their levels of development.
            These countries include Ethiopia, where life expectancy in 2016 was 64.7 years for men and 66.5 for women; the Maldives (77.6 years for men and 81.3 years for women); Nepal (69.7 years for men and 71.9 years for women); Niger (60.6 years for men and 62.8 years for women); Portugal (77.8 years for men and 84.0 years for women); and Peru (77.8 years for men and 81.6 years for women).
            These “exemplar” nations may offer insight into which policies are most successful for accelerating health progress, the study authors noted.

            Children reach a milestone

            “In 2016, for the first time in modern history, fewer than 5 million children under age 5 died in one year, as compared to 1990 when 11 million died,” Christopher Murray, a co-author of the report and director of the Institute for Health Metrics and Evaluation, wrote in an email. In 1970, 16.4 million deaths were recorded for this age group.
            Last year, lower respiratory infections, neonatal preterm birth complications and neonatal encephalopathy due to birth asphyxia and trauma were the most common causes of fatality for children under 5. Combined, these three causes resulted in 1.80 million deaths in 2016.
            Overall, there was what researchers described as a “profound” shift toward deaths at older ages: a 178% increase in deaths among people 90 to 94 and a 210% increase among those older than 95.
            In 2016, there were 1.7 million stillbirths worldwide. The rates decreased substantially between 1970 and 2016, from 41.5 stillbirths per 1,000 live births to just 13.1 per 1,000.
            This decrease occurred against a backdrop of increasing live births around the globe; in 2016, 128.8 million livebabies were born, compared with 114.1 million in 1970.
            Finland had the lowest rate of stillbirths at 1.1 per 1,000 live births, while South Sudan had the highest rate, at 43.4 per 1,000. Central sub-Saharan Africa’s stillbirths, which exceeded 23 per 1,000 live births in 2016, rank as the highest regional rates on the globe.

            Taking aim at early death

            A key measure of health is mortality — particularly at younger ages — and so avoiding early death from any cause is a key goal of health systems worldwide, noted the researchers.
            Early death is most often caused by diseases of various stripes.
            In 2016, noncommunicable diseases contributed 72.3% to the total number of deaths around the globe — 54.7 million — with 19.3% of deaths caused by communicable, maternal, neonatal and nutritional diseases. Injuries, including those incurred by violence, accounted for 8.4% of all deaths.
            “Population growth does not inherently mean there will be more deaths — it depends on a number of factors,” Mohsen Naghavi, a study co-author and a professor of global health at the Institute for Health Metrics and Evaluation, wrote in an email.
            “We provide total counts of death, death rates by age, and age-standardized rates of death to tease out what component of change in deaths comes from a population increasing in size over time, the ageing of populations, and true change at each age,” Naghavi wrote.
            Ischemic heart disease — a condition that restricts blood flow throughout the body — caused 9.48 million deaths in 2016, an increase of 19% since 2006. It ranked as the leading cause of early mortality in all regions of the globe, apart from low-income countries.
            In the poorest nations, the leading cause of early death was lower respiratory infections, including pneumonia and other bronchial conditions. Combined, these resulted in 2.38 million deaths, a decrease of 8.2% since 2006. Diabetes caused 1.43 million deaths globally last year, an increase of 31.1% since 2006.
            Deaths from infectious diseases have decreased since 2006, but HIV/AIDS claimed 1.03 million lives in 2016 (a 45.8% decrease since 2006), while 719,500 people died from malaria (a 25.9% decrease) and 1.21 million died from tuberculosis (a 20.9% decrease) last year.
            Dengue, a mosquito-borne infection that can lead to a fatal hemorrhagic fever, increased sharply over the decade — by 81.8% — and caused 37,800 deaths in 2016. Extensively drug-resistant tuberculosis, which caused 10,900 deaths in 2016, also showed increasing rates throughout the past decade, rising by 67.6% since 2006.

            ‘Triad of troubles’

            Nearly one in every five deaths is linked to a poor diet, the report revealed. Diets lacking in whole grains, fruit, nuts and seeds and fish oils while providing too much salt were the most common dietary risk factors, the authors noted.
            As a result, high blood glucose, high blood pressure, high body mass index and high total cholesterol were among the top 10 leading risk factors for death for men and women globally.
            Nations and people are likely to tackle — or at least attempt to tackle — those diseases that kill at high rates, Murray noted, since death is a powerful motivator. “But, we’ve been much less motivated to address issues leading to illnesses,” he said
            Tobacco, which caused 7.1 million deaths across the globe in 2016, is another issue leading to illness.
            Another factor that sometimes lacks attention from policy-makers is mental illness, which in many cases contributes to disability.
            “Mental illnesses tend not to discriminate based on income,” Theo Vos, a study co-author and professor of global health at the Institute for Health Metrics and Evaluation, wrote in an email.
            “In 2016, 1.1 billion people were living with mental health and substance use disorders,” he noted. “Major depressive disorders ranked in the top 10 causes of years lived with disability in all but four countries worldwide.”
            Those four nations are American Samoa, Philippines, Myanmar and Indonesia.
            “There is considerable overlap between mental health disorders and substance use disorders,” Vos wrote. “People suffering from both types of disorders present considerable extra challenges to health services as one problem can interfere with the successful treatment of the other.”

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            Overall, the National Institutes of Health-funded study reveals a portrait of a globe precariously balanced between health successes and health failures — with some of the latter being intractable yet avoidable.
            “A ‘triad of troubles’ — obesity, conflict, and mental illness, including substance use disorders — poses a stubborn and persistent barrier to active and vigorous lifestyles,” Murray wrote.

            Read more: http://www.cnn.com/2017/09/14/health/global-gun-deaths-rise-study/index.html