Behavioral health

Designing a Health app that Works

April 13th, 2011 | No Comments | Source: Commentary

As the mobile health apps market explodes, health consumers have been inundated with thousands of tools purporting to help them count calories, track work-outs, control diabetes, quit smoking and so forth.

There are nearly 8,000 health-related apps in the iTunes library alone. Of these, about 60% focus on diet, 20% on exercise, 9% on resistance training and 7% on improving sleep. Although the iTunes app store doesn’t publish download counts, the top free health-related app on the Android Market—an exercise monitoring device known as CardioTracker—has been downloaded between 1 million and 5 million times.

With this panoply of new resources a few clicks away, people have begun to wonder, “Do they actually improve health?”

Perhaps not, sadly. At least not yet. For example, a recent study by mobile health app analyst Pamela Culver revealed that a whopping 26% of people who downloaded a health-related app used it just once (in fairness, many of them probably moved-on to another app). Meanwhile, another study revealed that one-third of those who use health apps do not use them as their developers intended. 

Aside from the fact that many health-related apps are as visually appealing as a 1987 version of Super Mario Brothers, there are 2 major reasons why these tools have yet to live-up to their promise. Let’s take a look at them:

Failure to Leverage Clinical Guidelines
A galling problem with many health-related apps is that they do not incorporate tried-and-true methods to positively impact the behavior they supposedly target.

A study by George Washington University professor Lorien Abroms and colleagues recently made this point in spades. Abroms’ team reviewed 47 quit smoking apps that were available through the iTunes library. The apps ranged in price from free to $9.99. Nearly a third of them amounted to calendars which counted days since, or days until a quit date. An equal number of apps functioned to calculate dollars saved or health benefits accrued by kicking the habit. The remainder were an unsavory mash-up of cigarette rationing tools, hypnosis tools and, vey is mir, “virtual cigarettes” that people are supposed to use to pretend they are smoking. (more…)


Subject(s): ,

Those Pesky Tension Headaches

April 12th, 2011 | 6 Comments | Source: Wall Street Journal

Tension headaches are a nearly universal affliction. They are characterized by dull, non-pulsatile discomfort on both sides of the temples and forehead. They typically last for 30-60 minutes, but they can go on for days. Tension headaches affect at least 40% of adults in any given year. Nearly 80% of adults have experienced at least one during the course of their lifetimes.

It’s amazing therefore, that scientists don’t yet understand what causes them.


To be sure, scientists and those who’ve experienced tension headaches know when they tend to occur and what things trigger them.

Tension headaches occur most commonly in the early morning and late afternoon. The morning variety is often triggered by lack of sleep, awkward sleeping positions, hangovers and caffeine withdrawal.

Afternoon tension headaches are triggered by poor posture or airborne irritants in the office, eyestrain from looking at a computer screen all day, teeth grinding, and plain-old everyday stress (see YouTube video, above). The hypoglycemia associated with missed lunches is another culprit, as is excessive caffeine intake.

But What Causes Them?
This is what scientists don’t yet understand. For years, the prevailing theory was that muscle tension, especially in the neck and shoulders, caused tension headaches. That theory has been disproven by studies in which tools that measure muscle contractions revealed no correlation between muscle tension and headaches.

Today, the prevailing belief is that the tension-type headache is caused by abnormalities in parts of the brain that perceive pain. These poorly understood abnormalities render the brain hypersensitive to the inputs it receives (similar mechanisms are also thought to be involved in fibromyalgia, a disorder characterized by diffuse bodily sensations of pain).

Typically, tension headaches sufferers just “bear with them” until they subside, or use OTC pain killers like aspirin, acetaminophen and ibuprofen for quick relief. These drugs usually work, but taking them more than 10 days per month can precipitate so-called “rebound” or “medication-overuse” headaches, which feel like the tension headaches they’re supposed to treat. (more…)


Subject(s): ,

The Sleepy American

April 11th, 2011 | No Comments | Source: ABC News, CBS News, CDC

Sleep deprivation has been linked to motor vehicle accidents, industrial accidents and medical errors. It has also been linked to obesity, diabetes, hypertension, depression, anxiety, reduced problem-solving capacity, memory lapses, an increased risk for the common cold and even premature death.

Recent data published in the CDC’s Morbidity and Mortality Weekly Report, while not cutting new ground in this area, has helped to quantify the extent of the problem among Americans, as well as its impact on car crashes. The news is not good.

According to the CDC report, between 50 and 70 million US adults suffer from chronic sleep deprivation and related disorders. Those estimates came from a study which found that 35% the nearly 75,000 adult participants in a 12-state sleep study reported getting less than 7 hours of sleep per night. Nearly 40% of these people claimed to doze off inadvertently at least once a day.

Furthermore, people who averaged less than 7 hours were more likely to nod-off while driving a car. Overall, nearly 5% of respondents said they had fallen asleep while driving during the last year. According to the CDC, this phenomenon causes 1,550 highway deaths and 40,000 injuries per year.

The numbers are probably higher than this, according to Allan Pack, who directs the Center for Sleep at University of Pennsylvania. “Most of us believe that there are a lot more fall asleep crashes than reported,” he said in an interview. “It’s probably not reported accurately because a number of states don’t even having a ‘falling asleep while driving’ tick in the box when reporting a car crash.” (more…)



Medicaid to Fund ‘Stay-Healthy’ Incentive Programs

April 7th, 2011 | 1 Comment | Source: CMS, Medical News Today

In recent years, scientists have shown that financial incentives can drive short-term behavioral changes that are associated with improved health; things like losing weight and quitting cigarettes, for example. The rewards in these studies include direct cash incentives, gift cards and so on.

Recently, the Centers for Medicare and Medicaid Services announced plans to leverage this strategy with a $100 million initiative that permits states to offer incentives to Medicaid enrollees for adopting healthy behaviors.

Called a “demonstration program,” the CMS initiative is designed to figure out which strategies produce long-term behavioral changes. It should also help CMS determine the extent to which special populations (like adults with disabilities or children with special needs) can participate in the program, the level of satisfaction with the program, and the administrative costs incurred by State agencies that administer the program.

The program is funded by the new health care law (known as the Affordable Care Act). It invites each state to submit one proposal . Grant Applications are due to CMS by May 2, 2011. There are no state cost-sharing requirements.

According to CMS, the proposals must be “comprehensive, evidence-based, widely available, and easily accessible.” When states prepare their proposals, CMS recommends that they rely on evidence-based research which can be found in documents like the Guide to Community Preventive Services, the Guide to Clinical Preventive Services, and the National Registry of Evidence-based Programs.

“Keeping people healthy is an important goal of the Affordable Care Act,” HHS Secretary Kathleen Sebelius said in a press release. “One way to reach that goal is to encourage all Americans to make better choices about diet, exercise and smoking to avoid potentially disastrous outcomes down the road like heart disease, cancer or diabetes.” (more…)


Subject(s): ,

Self-Injury Videos on YouTube

March 29th, 2011 | No Comments | Source: LA Times, MedPageToday, Pediatrics

Millions of people watch YouTube videos depicting teens injuring and cutting themselves, according to a new study. The authors conclude that the videos may serve to legitimize the behaviors as acceptable, even normal.

To assess the scope and accessibility of self-injury videos on the Internet, Stephen Lewis of the University of Guelph, and colleagues searched YouTube for keywords like “self-harm,” and “self-injury.”

They found that the top 100 most frequently viewed videos were watched more than 2.3 million times. Ninety-five percent of the viewers were female. Their average age was 25, although Lewis’ group suspects their actual average age was lower, since some YouTube viewers provide restricted content only to older viewers.

Typically, the videos contained graphic images of cutting, embedding and burning. Many of the videos contained statements of despair or images of sad or crying people. About 42% of the videos neither encouraged nor discouraged self-injury. An additional 26% denounced the behavior, while 23% gave a mixed message and 7% actually encouraged people to perform the depicted behavior.

Most of the videos contained no warnings or viewing restrictions. Viewers tended to rate these videos highly (an average score of 4.61 out of 5). Self-harm videos were identified as “favorites” over 12,000 times. (more…)


Subject(s): ,

A New Way to Treat Panic Attacks

March 25th, 2011 | 3 Comments | Source: J. Psychiatric Res., Wall Street Journal

Panic attacks are characterized by a racing heart, copious sweating, rapid breathing and feelings of impending doom and loss of control. Approximately 15% of adults have experienced a panic attack. A stressful event like a final exam or a big presentation typically precipitates the episode.

A minority of affected people, perhaps as many as 2% of adults, have full-blown panic disorder, which is characterized by frequent attacks, often in the absence of an obvious trigger, and by behaviors designed to avoid situations that might precipitate an attack. In extreme cases, affected individuals shut-out social interactions altogether to avoid the possibility that they might have a panic attack.

Physicians tend to reserve drugs like SSRIs (newer antidepressants) and sedatives to prevent recurrent panic attacks, but the drugs seem to work in no more than two-thirds of affected individuals, at best. As an alternative, many clinicians use cognitive-behavioral therapy to treat the symptoms of panic attacks. In this approach, individuals learn to control and live with that horrible sense of doom during an attack. When behavioral therapy works, people gain confidence that the unpleasant sensations are temporary and not overly harmful.

What’s New
For decades, a cornerstone of the behavioral approach to panic disorder has involved breathing deeply, usually into a paper bag. This exercise is thought to help people calm down by focusing on something benign, non-threatening and controllable.

Now, a pair of studies by Alicia Meuret and colleagues at SMU suggests that the exact opposite approach to breathing, one that involves taking slow, shallow breaths, may be better.

Meuret’s group tested a ginned-up version of “slower, shallower breaths” in which patients adjusted their breathing to correspond with a series of tones produced by an audiotape, and checked their physiological responses with a gadget called a capnometer. (more…)



Dietary Fiber and Mortality

March 21st, 2011 | No Comments | Source: Archives Int. Medicine, LA Times, USNews, Wall Street Journal

Scientists have proven that dietary fiber lowers the risk of coronary artery disease, diabetes and certain cancers. Surprisingly however, they had yet to show that fiber could impact overall mortality. Now apparently, they have done just that. 

A research team led by Yikyung Park of the National Cancer Institute has published a study showing that high fiber intake is indeed associated with longer survival.

To reach these conclusions, Park’s group looked at data from nearly 400,000 men and women between the ages of 50 and 71 using the AARP Diet and Health Study. They assessed dietary fiber intake with a questionnaire that had been administered at the beginning of the 9-year study. They excluded people with diabetes, heart disease and most cancers, as well as those who reported extremely high daily fiber intake.

After controlling for smoking, exercise and body weight, the researchers showed that dietary fiber intake was associated with a reduced risk of death in both sexes.

Specifically, people in the highest quintile for fiber consumption (29.4 grams per day for men and 25.8 grams for women) were 22% less likely to die from all causes than those in the lowest quintile (12.6 grams per day for men and 10.8 for women). Women were 34-59%, and men were 24-56%  less likely to die from heart, respiratory and infectious diseases, in particular. Fiber consumption was associated with a lower risk of dying from cancer in men (who are prone to get cancers thought to be reduced by dietary fiber intake) but not in women.

Interestingly, the type of fiber consumed made a huge difference in this study. Participants who consumed fiber from grains, like oatmeal, brown rice and cornmeal experienced all the benefits. In this study at least, fiber derived from vegetables, fruits and beans did not reduce mortality. (more…)



Personalized Medicine for the Treatment of Alcoholism

March 16th, 2011 | 1 Comment | Source: Am. J. Psychiatry, Wall Street Journal

Genetic factors predispose people to alcoholism. That’s why the children of alcoholics are four times more likely to develop drinking problems, and the sons of alcoholic fathers are at even greater risk. And that’s why kids who are born to alcoholic parents and then raised by non-drinking parents have the same risk for alcoholism as if they had been raised by their biologic parents.

This is not to say that one, or even a handful of genes are responsible for the disease. The number is clearly far higher than that. Genes that predispose to alcoholism affect diverse physiological functions ranging from those involved with alcohol metabolism to those governing the behavioral response to rewards and pleasure. Some genes linked primarily to depression have even been linked to alcoholism.

The explanation for this multi-gene etiology is that diverse social and environmental factors can interact with genetically programmed mechanisms in complex ways, all of which end-up precipitating the syndrome.

Gene Links to Alcoholism: A Sampler
The “Asian Flush” genes are perhaps the best understood in this regard. Fully one third of all people of East Asian descent are born with a genetic deficiency that causes their cheeks, and often their necks, arms and trunk to turn sunburn-red after consuming even small amounts of alcohol. This “Asian Flush” syndrome is often associated with nausea, headache and tachycardia, distasteful symptoms which act collectively to deter people from drinking alcohol. The result: very few affected individuals become alcoholics.

A separate, colloquially named “tipsy gene” makes affected individuals feel completely bombed after just a drink or two. As many as 20% of the US population has the tipsy gene. It too seems to protect people from becoming alcoholics.

By contrast, a gene variant for the DRD2 dopamine receptor in the brain causes people to feel downright euphoric after drinking, probably because it alters the way the brain’s reward circuits respond to alcohol. Some (but not all) studies have shown this gene variant to be present in a disproportionate number of alcoholics, drug addicts and cigarette smokers. (more…)


Subject(s): ,

Kids, Energy Drinks Don’t Mix

March 8th, 2011 | No Comments | Source: MedPageToday, Pediatrics

Energy drinks represent the fastest growing segment of beverage sales in the US, with revenues predicted to surpass $9 billion this year. Children, teens and young adults consume at least half of all energy drinks.

Is there a problem with this? Perhaps so, according to the results of a new study. Many energy drinks contain high levels of unregulated ingredients and therefore could pose a health risk to the younger folks who consume them so avidly.

To review the effects and adverse consequences of energy drink consumption among children, adolescents, and young adults, Sara Seifert, of the University of Miami, and colleagues searched PubMed and Google for an assortment of terms including “energy drink,” “sports drink,” “guarana,” “caffeine,” “taurine,” “diabetes,” and “poison control center.” They reviewed the articles they found as well as manufacturer Web sites for product information.

The review suggested that 30-50% of young people consume energy drinks in the US, although there is considerable variation in the types of drinks consumed and the frequency with which they are consumed.

The adverse consequences of energy drink consumption, as documented by the scientists’ review, can be divided into 3 categories: caffeine overdoses, organ system dysfunction and interactions with drugs. Let’s review these briefly:

Caffeine Overdoses
Nearly half of the 5,448 caffeine overdoses in 2007 involved people who were 19 years old or less, the scientists reported. They weren’t able to determine which cases were caused by the consumption of energy drinks, but suggested that it is substantial.

Energy drinks typically contain between 70-80 mg of caffeine per 8-oz. serving, or about 3 times as much as is found in most cola drinks. Since energy drinks are classified as dietary supplements rather than food, producers aren’t required to specify the caffeine content on the label, or the amounts of other ingredients which could add more caffeine. (more…)


Subject(s): ,

Exercise a Brain-Booster for the Elderly

March 7th, 2011 | 4 Comments | Source: LA Times, MedPageToday, PNAS

Aerobic exercise reduces the risk of cardiovascular disease, stroke and diabetes…and it may improve memory in elderly adults as well, a new study has found.

The study was carried out by Arthur Kramer of the University of Illinois Urbana-Champaign, and colleagues.

The scientists knew that as people age, a part of the brain known as the hippocampus shrinks by 1-2% per year. They also knew that this phenomenon is associated with impaired memory and an increased risk for dementia. In addition, they were aware of previous studies which had shown that (1)the hippocampus is larger in physically fit adults, (2)aerobic exercise increases blood flow to the hippocampus, and that (3)in animals, aerobic exercise reduces the loss of hippocampal volume and preserves memory.

It remained for Kramer’s group to determine whether aerobic exercise could reverse age-related shrinkage of the hippocampus in humans.

To study the matter, the scientists randomized 120 men and women in their mid-60s to either a program involving walking 3 times-a-week for a year, or to a stretching (non-aerobic) program. The first group walked around a track for 40 minutes per session.  All participants gave blood samples and underwent spatial memory tests and MRI scans at study onset, halfway through the study, and at the end of the study.

The scientists found that the aerobic exercisers had a 2% increase in hippocampal volume, whereas the control (stretching) group lost 1.4% of their hippocampal volume. In addition, the aerobic exercisers performed better on spatial memory exercises at the end of the study. They also had increased blood levels of BDNF, a chemical that is synthesized in the brain and is involved with memory and learning. (more…)



We just want the site to look nice!
  • Comment Policy

    Pizaazz encourages the posting of comments that are pertinent to issues raised in our posts. The appearance of a comment on Pizaazz does not imply that we agree with or endorse it.

    We do not accept comments containing profanity, spam, unapproved advertising, or unreasonably hateful statements.

Contact us if interested