THE LANCET NEUROLOGY: Stroke could cause nearly 10 million deaths annually by 2050, mostly in LMICs, and cost up to US$2 trillion per year, new report warns

Peer-Reviewed Publication

THE LANCET

 

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STROKE IS A MAJOR CAUSE OF DEATH AND DISABILITY, AND ITS GLOBAL IMPACT IS GETTING WORSE. IF CURRENT TRENDS ON STROKE CONTINUE, THE SUSTAINABLE DEVELOPMENT GOALS TARGETS ON NON-COMMUNICABLE DISEASES WILL NOT BE MET.

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CREDIT: THE LANCET

Peer-reviewed / Modelling, Review, and Opinion / People

• New World Stroke Organization-Lancet Neurology Commission forecasts future epidemiological and economic impacts of stroke, identifies evidence-based recommendations for improving the four pillars namely: surveillance, prevention, treatment and rehabilitation.
• Epidemiological analysis projects stroke deaths will increase from 6.6 million in 2020 to 9.7 million in 2050, with an ever-widening gap between low- and middle-income countries (LMICs) and high-income countries (HICs). In 2050, 91% of stroke deaths are projected to be in LMICs compared to 9% in HICs, up from 86% in LMICs and 14% HICs in 2020.
• Economic analysis indicates treatment, rehabilitation, and indirect costs of stroke could more than double from US$891 billion in 2020 to up to US$2.3 trillion in 2050.
• Stroke is highly preventable and treatable through the pragmatic solutions recommended by this Commission.
• Implementing and monitoring all of the Commission’s recommendations, which have a firm evidence base, would lead to a drastic reduction in the global burden of stroke thereby curbing its projected burden.

***Infographics available—see notes to editors***

Unless urgent action is taken, the number of people who die from stroke globally is estimated to increase by 50% by 2050 to 9.7 million deaths per year, with annual costs as high as US$2.3 trillion possible, according to a new report on pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission. The authors’ analysis forecasts growing health and economic impacts from stroke between 2020 and 2050, which will disproportionately affect LMICs. 

Based on a review of evidence-based guidelines, recent surveys, and in-depth interviews with stroke experts around the world, the authors make evidence-based pragmatic recommendations to reduce the global burden, including measures to improve stroke surveillance, prevention, acute care, and rehabilitation.  

The number of people who suffer a stroke, die from, or remain disabled by the condition globally has almost doubled over the past 30 years, with the vast majority of those affected in LMICs, where prevalence of the condition is increasing at a faster rate than in HICs. 

If the current trends continue, one of the World Health Organization’s key Sustainable Development Goals (SDGs) will not be met. SDG 3.4 aims to reduce the 41 million premature deaths from non-communicable diseases – including stroke – by one third by 2030. [1] While achieving these would require US$140 billion in new spending between 2023 and 2030, the financial benefits would outweigh the costs by ten-to-one.

Professor Valery L. Feigin, of Auckland University of Technology, New Zealand, and Commission co-chair, said: “Stroke exerts an enormous toll on the world’s population, leading to the death and permanent disability of millions of people each year, and costing billions of dollars. Precisely forecasting the health and economic impacts of stroke decades into the future is inherently challenging given the levels of uncertainty involved, but these estimates are indicative of the ever-increasing burden we will see in the years ahead unless urgent, effective action is taken.” [2]

Fast-growing burden of disease, mostly affecting LMICs
 
In the new Commission, the authors used the Global Burden of Disease (GBD) study methods [3] to provide estimates of stroke burden between 2020 and 2050 in HICs, LMICs and by major GBD world regions and age.  Taking into account population growth and aging in most countries, their analysis indicates the number of people who die annually from stroke globally will increase by 50%, rising from 6.6 million in 2020 to 9.7 million in 2050. 

The number of stroke deaths in LMICs is projected to rise sharply – widening the gap with HICs – by increasing from 5.7 million in 2020 to 8.8 million in 2050. In contrast, stroke deaths in HICs are estimated to remain largely unchanged at around 900,000 between 2020 and 2050. This indicates that the proportion of global stroke deaths that occur in LMICs will increase from 86% in 2020 to 91% in 2050. 

Professor Jeyaraj Pandian, President-Elect of the World Stroke Organization, one of the lead authors of the Commission, and lead author of The Lancet Regional Health – Southeast Asia journal Series on stroke in Southeast Asia [4] said: “Asia accounted for by far the greatest share of global stroke deaths in 2020 (61%, around 4.1 million deaths) and this is forecast to rise to around 69% by 2050 (around 6.6 million deaths). Though smaller relative to Asia, the number of annual global stroke deaths occurring in Sub-Saharan African countries will rise from 6% in 2020 (403,000) to 8% (765,000) in 2050. We have to closely examine what is causing this increase, including the growing burden of uncontrolled risk factors – especially high blood pressure, and lack of stroke prevention and care services in these regions. Without urgent action, stroke deaths in Southeast Asia, East Asia, and Oceania  could increase by almost 2 million deaths, from 3.1 million in 2020 to potentially 4.9 million in 2050.” [2]

While the global death rate among people aged over 60 years is predicted to fall by 36% (566 deaths per 100,000 in 2020 to 362 per 100,000 in 2050), among those under 60 years it is predicted to fall by less than 25% (13 per 100,000 in 2020 to 10 per 100,000 in 2050). The Commission authors say the lesser reduction among younger people might relate to increasing levels of diabetes and obesity in this age group. 

Huge economic costs, mainly in Asia and Africa

Economic forecasting indicates the combined cost of stroke, including direct costs and loss of income, will rise from US$891 billion per year in 2017 to up to US  $2.31 trillion in 2050. The bulk of these economic impacts are forecast to be felt in Asia and Africa. 

Projections indicate large increases in direct costs and income losses from stroke in middle-income countries and increases in direct costs in HICs. They also forecast increased economic impacts in low-income countries, but their overall share in global costs is likely to remain small, given their overall low share in global population and stroke cases. 

Evidence-based recommendations will greatly reduce the impacts of stroke

To identify key barriers and facilitators to high-quality stroke surveillance, prevention, acute care and rehabilitation, the Commission authors conducted a qualitative analysis of in-depth interviews with 12 stroke experts from six HICs and six LMICs. 

Among the major barriers identified were low awareness of stroke and its risk factors (which include high blood pressure, diabetes mellitus, high cholesterol, obesity, unhealthy diet, sedentary lifestyle, and smoking), and limited surveillance data on stroke risk factors, events, management, and outcomes of stroke. Major facilitators included well-developed stroke organisations and networks that can build capacity for stroke care and research, and universal healthcare providing population-wide access to evidence-based stroke care. 

Based on the findings of the qualitative analysis, the Commission authors make 12 evidence-based recommendations across stroke surveillance, prevention, acute care, and rehabilitation. Key recommendations include: 

• Establishing low-cost surveillance systems to provide accurate epidemiological stroke data to guide prevention and treatment.
• Raising public awareness and action to improve healthy lifestyles and prevent stroke through population-wide use of mobile and digital technologies, such as training and awareness-raising videos and apps.
• Prioritising effective planning of acute stroke care services, capacity building, training, provision of appropriate equipment, treatment and affordable medicines, and adequate resource allocation at national and regional levels.
• Adapting evidence-based recommendations to regional contexts, including training, and support and supervision of community health workers to assist in long-term stroke care.
• Establishing local, national, and regional ecosystems involving all relevant stakeholders to co-create, co-implement and monitor stroke surveillance, prevention, acute care, and rehabilitation.

“One of the most common problems in implementing stroke prevention and care recommendations is the lack of funding. Our Commission recommends introducing legislative regulations and taxations of unhealthy products (such as salt, alcohol, sugary drinks, trans-fats) by each and every government in the world. Such taxation would not only reduce consumption of these products – and therefore lead to the reduction of burden from stroke and major other non-communicable diseases – but also generate a large revenue sufficient to fund not only prevention programmes and services for stroke and other major disorders, but also reduce poverty, inequality in health service provision, and improve wellbeing of the population,” said Prof. Feigin. [2]

Professor Mayowa O. Owolabi, of the University of Ibadan, Nigeria and Commission co-chair said: “Investing in evidence-based measures to reduce the global burden of stroke will deliver benefits that go far beyond health alone. As well as delivering health and economic benefits relating to stroke, many of our recommendations would also facilitate reductions in poverty and inequality and boost local economies.”

He added, “Every member State of the United Nations has committed to meeting the SDGs but at present few countries are on target to achieve SDG 3.4. Stroke is countable, substantially preventable, treatable, and beatable through the pragmatic solutions recommended by this Commission across the four pillars of the stroke quadrangle (surveillance, prevention, acute care, and rehabilitation).  By implementing and monitoring all of the Commission’s recommendations, which have a firm evidence base, the global burden of stroke will be reduced drastically this decade and beyond. Not only will this enable us to meet SDG 3.4, as well as other key SDGs, it will improve brain health and the overall wellbeing of millions of people across the globe now and beyond 2030.”  [2,5]

Professor Sheila Martins, of the Universidade Federal of Rio Grande do Sul, Brazil and President of the World Stroke Organization said: “The gaps in stroke services across the world are catastrophic. We need a drastic improvement today, not in 10 years. World Stroke Organization is committed to support and to accelerate the implementation of these recommendations globally through the WSO Implementation Task Force, with stroke experts to advise the establishment of stroke prevention and care and to contribute with educational programs, and through the Global Stroke Alliance meetings rotating in the world facilitating the discussions between stroke experts and policy makers, giving the technical support to the governments to elaborate national plans for stroke and to include stroke care in the Universal Health Coverage packages.” [2]

NOTES TO EDITORS

The Commission received funding from the World Stroke Organization, Bill and Melinda Gates Foundation, Health Research Council of New Zealand, and National Health & Medical Research Council of Australia and was supported by the National Institutes of Health (USA). It was conducted by researchers from the World Stroke Organization – Lancet Neurology Commission Stroke Collaboration Group. A full list of authors and their institutions is available in the report.

[1] https://www.who.int/data/gho/data/themes/topics/sdg-target-3_4-noncommunicable-diseases-and-mental-health 
[2] Quote direct from author and cannot be found in the text of the Article.
[3] Previous estimates of the burden of stroke, done by the Global Burden of Disease study (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31694-5), forecasted health impacts until 2040. However, the Commission authors say effective long-term healthcare planning requires projections for at least the next three decades. 
[4] The Lancet Regional Health – Southeast Asia journal Series on stroke in Southeast Asia will be available via www.thelancet.com/series/Stroke-Southeast-Asia at 23:30 UK time on Monday 9 October. For embargoed access to the Series please contact The Lancet press office. 
[5] Owolabi MO, Leonardi M, Bassetti C, et al. Global synergistic actions to improve brain health for human development. Nat Rev Neurol 2023; 19: 371–83.

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com  
 

IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: www.thelancet.com/commissions/global-burden-stroke

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JOURNAL

The Lancet Neurology

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission

ARTICLE PUBLICATION DATE

9-Oct-2023

COI STATEMENT

VLF states that the free Stroke Riskometer app and PreventS-MD webapp are owned and copyrighted by AUT Ventures, which is owned by his employer, Auckland University of Technology (Auckland, New Zealand). VLF has no financial relationship with the apps, but AUT Ventures intends to commercialise PreventS-MD via its social enterprise business, for which VLF serves as chief scientific advisor. PreventS-MD was not involved in any aspect of the design, conduct, analysis, or content of this Commission. GAF has received grants from Novartis, consulting fees from CSL Behring, and honoraria from Astellas and Bayer; has served on data safety monitoring boards, data-monitoring committees, and steering committees for Pharmagenesis and Boehringer Ingelheim; and is a nonexecutive director of the UK National Institute for Health and Care Excellence and a trustee of Health Services Research UK. DCG has received travel support from the World Federation for Neurorehabilitation and Conventus Travel, and is a past president of the World Federation for Neurorehabilitation. WH has participated on data safety monitoring boards for IFS Institut für anwendungsorientierte Forschung und klinische Studien and Imperical College, London, and is a past president of the World Stroke Organization. GJH has received consultation fees from Janssen Research and Development, Bristol Myers Squibb, and Bayer, and has participated on data safety monitoring boards for Janssen Research and Development. PL has received honoraria from Pfizer, Boehringer Ingelheim, and RAPID-AI iSchemaView; has received travel support from Angels–Boehringer Ingelheim; has participated on data safety monitoring boards and steering committees for Pfizer and Janssen; and is the president of the Chilean Stroke Association and vicepresident of the Iberoamerican Stroke Society. BN has received honoraria for serving on data safety monitoring boards work for Simbec-Orion. TP is a member of the Data Safety Monitoring Board for a publicly funded trial in Germany, with public grant money paid to his institution. AR has received honoraria from the University of Texas at Austin (Austin, TX, USA) and Medical College of Virginia (Richmond, VA, USA), and travel support from Fiji National University. PNS is a leader or member of advisory boards for Medtronic and the Angels Initiative (funded by Boehringer-Ingelheim). DY has served as consultant for the Athersys, Johnson & Johnson, Medtronic, Rapid Medical, Gravity Medical Technology, Guidepoint Global, Poseydon, Vascular Dynamics, Royal Caribbean Cruises, and Stryker; holds stocks or stock options in Athersys, Poseydon, and Rapid Medical; has received honoraria payments from Emory University (Atlanta, GA, USA); and is founder and global co-chair of the Society for Vascular and Interventional Neurology’s Mission Thrombectomy. All other authors declare no competing interests.

 

International team of scientists says identifying some foods as addictive could shift attitudes, stimulate research

Fralin Biomedical Research Institute scientist joins colleagues from three continents in calling for a global rethink of food choices

Peer-Reviewed Publication

VIRGINIA TECH

 

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RESEARCHERS FROM THE UNITED STATES, BRAZIL, AND SPAIN JOINED IN AN ANALYSIS OF ULTRA-PROCESSED FOOD PUBLISHED IN THE OCT. 10 SPECIAL EDITION OF THE BRITISH MEDICAL JOURNAL, STATING THERE IS CONVERGING AND CONSISTENT SUPPORT FOR THE VALIDITY AND CLINICAL RELEVANCE OF FOOD ADDICTION. 

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CREDIT: CLAYTON METZ/VIRGINIA TECH

Researchers from the United States, Brazil, and Spain, including scientists with the Fralin Biomedical Research Institute at VTC, published an analysis in a special edition of the British Medical Journal with a timely and controversial recommendation: It’s time for an international shift in the way we think about ultra-processed food.

“There is converging and consistent support for the validity and clinical relevance of food addiction,” said Ashley Gearhardt, the article’s corresponding author and a psychology professor at the University of Michigan. “By acknowledging that certain types of processed foods have the properties of addictive substances, we may be able to help improve global health.”

While people can give up smoking, drinking, or gambling, they can’t stop eating, said co-author Alexandra DiFeliceantonio, assistant professor at the Fralin Biomedical Research Institute. The challenge, and the open and controversial question, is defining which foods have the most potential for addiction and why.

Their work was published Oct. 10 in Food For Thought, a special edition of the British Medical Journal, a high-impact publication and one of the world’s oldest medical journals.

DiFeliceantonio is also associate director of the Fralin Biomedical Research Institute’s Center for Health Behaviors Research and an assistant professor in the Department of Human Nutrition, Foods, and Exercise in the College of Agriculture and Life Sciences at Virginia Tech.

Not all foods have the potential for addiction, the researchers said. 

“Most foods that we think of as natural, or minimally processed, provide energy in the form of carbohydrate or fat – but not both,” DiFeliceantonio said.

Researchers gave the example of an apple, salmon, and a chocolate bar. The apple has a carbohydrate to fat ratio of roughly 1-to-0, while the salmon has a ratio of 0-to-1. In contrast, the chocolate bar has a carbohydrate to fat ratio of 1-to-1, which appears to increase a food’s addictive potential.

“Many ultra-processed foods have higher levels of both. That combination has a different effect on the brain,” DiFeliceantonio said. Researchers also called for more study into the role of food additives used in industrial processing. Key takeaways from the analysis include:

• Behaviors around ultra-processed food, which are high in refined carbohydrates and added fats, may meet the criteria for diagnosis of substance use disorder in some people. Those behaviors include less control over intake, intense cravings, symptoms of withdrawal, and continued use despite such consequences as obesity, binge eating disorder, poorer physical and mental health, and lower quality of life.
• This global health challenge needs to consider geographic differences. In a review of 281 studies from 36 different countries, researchers found ultra-processed food addiction is estimated to occur in 14 percent of adults and 12 percent of children. In some countries, ultra-processed foods are a needed source of calories. Even within high-income countries, food deserts and other factors could limit access to minimally processed foods. People facing food insecurity are more reliant on ultra-processed foods, and therefore more likely to demonstrate food addiction, researchers noted.
• Viewing some foods as addictive could lead to novel approaches in the realm of social justice, clinical care, and public policy. Policies implemented in Chile and Mexico – taxes, labelling, and marketing – are associated with decreases in caloric intake and purchases of foods high in sugar, saturated fat, and salt, for example. And in the United Kingdom, a salt-reduction program was associated with a decline in deaths from stroke and coronary artery disease.

The co-authors represent international expertise on food addiction, nutrition physiology, gut-brain reward signaling, food policy, behavioral addiction, and eating disorders. They call for more study and science surrounding ultra-processed foods,

“Given how prevalent these foods are -- they make up 58 percent of calories consumed in the United States -- there is so much we don’t know.” DiFeliceantonio said. 

The researchers call for more study into such areas as: how complex features of ultra-processed foods combine to increase their addictive potential; better defining which foods can be considered addictive; differences among countries and communities, including disadvantaged communities; the value of public-health messaging; and clinical guidelines for preventing, treating, and managing addiction to ultra-processed foods.

In addition to Gearhardt and DiFeliceantonio, authors include Nassib B. Bueno, a professor at Universidade Federal de Alagoas in Brazil; Christina A. Roberto, associate professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine; and Susana Jiménez-Murcia and Fernando Fernandez-Aranda, both professors in the Department of Clinical Psychology at the University Hospital of Bellvitge in Spain.

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JOURNAL

BMJ

DOI

10.1136/bmj-2023-075354 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Social, clinical, and policy implications of ultra-processed food addiction

ARTICLE PUBLICATION DATE

10-Oct-2023

COI STATEMENT

Authors have read and understood BMJ policy on declaration of interests and declare that CAR receives funding from Bloomberg Philanthropies to support her research on soda taxes.

 

Comprehensive new Canadian guideline for skeletal health and fracture prevention

Peer-Reviewed Publication

CANADIAN MEDICAL ASSOCIATION JOURNAL

A comprehensive guideline from Osteoporosis Canada aims to help primary care professionals deliver care to optimize skeletal health and prevent fractures in postmenopausal females and males who are age 50 years and older. It is published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221647.

With 25 recommendations and 10 good practice statements, this update to the 2010 guideline contains sections on exercise, nutrition, fracture risk assessment, treatment and more, reflecting advances in risk assessment, and nonpharmacologic and pharmacologic management of osteoporosis.

In Canada, there are more than 2 million people living with osteoporosis, defined as bone mineral density (BMD) at a level below peak bone mass, which increases risk of fracture. Fractures usually occur after a fall and can affect the hip, wrist, arm and spine, in particular.

"We are hopeful that this Canadian guideline will empower health care professionals and patients to have meaningful discussions on the importance of skeletal health and fracture prevention to preserve mobility and autonomy across adulthood," says Dr. Suzanne Morin, lead author and chair of the guideline steering committee.

The guideline is based on the latest evidence and included patient partners in developing the recommendations.

Key points:

• Prior fracture is a strong risk predictor of subsequent fracture (particularly in the subsequent 12–24 months); however, other risk factors are also important to identify individuals who would benefit from pharmacotherapy.
• The management of osteoporosis should be guided by the patient's risk of fracture based on clinical assessment, including risk for falls, and using a validated fracture risk assessment tool.
• Exercise, nutrition, fall prevention and pharmacotherapy are key elements of the management strategy for fracture prevention, and should be individualized.
• Clinicians and patients should collaborate in developing care plans that consider patients' priorities and preferences.

The guideline emphasizes key components to ensuring bone health and contains several recommendations for patients, including the following:

Exercise

• Balance and functional training at least twice a week to reduce the risk of falls
• Progressive resistance training at least twice a week, including exercises targeting abdominal and back extensor muscles

"Create a plan to do balance, functional, and strength training twice a week or more to prevent falls and fractures and improve functioning and quality of life," advises Dr. Lora Giangregorio, a coauthor and chair of the Exercise Working Group. "Progress the difficulty of the exercise program over time and monitor your progress."

Nutrition

• For people who meet the recommended dietary allowance for calcium with a variety of calcium-rich foods, no supplementation to prevent fractures is needed.
• Follow Health Canada's recommendation on vitamin D for bone health: 600 IU/d (age 51–70 yr) and 800 IU/d (age > 70 yr) for males and females.

Fracture risk assessment

• A clinical assessment for osteoporosis and fracture that includes identifying risk factors and assessing for signs of undiagnosed vertebral fracture(s). This includes BMD testing in postmenopausal females and males who are
  • aged 50–64 years with a previous osteoporosis-related fracture or ≥ 2 clinical risk factors OR
  • aged ≥ 65 years with 1 clinical risk factor for fracture OR
  • aged ≥ 70 years

Pharmacotherapy is an important component of fracture prevention management and should be individualized.

Other guidelines

A guideline from the Canadian Task force on Preventive Health Care published in spring 2023 based on randomized controlled trials (RCTs) recommends risk assessment–first screening for the primary prevention of fragility fractures in females aged 65 years and older using the Fracture Risk Assessment Tool without BMD. The task force guideline recommends against screening younger females and males of any age. The Osteoporosis Canada guideline differs as it included a range of studies in addition to RCTs and several studies included men. The new guideline recommends screening in men and younger women, in contrast to the task force guideline.

"Identification and appropriate management of skeletal fragility in Canadians can reduce fractures, and preserve mobility, autonomy and quality of life in this population," says Dr Morin.

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JOURNAL

Canadian Medical Association Journal

DOI

10.1503/cmaj.221647 

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update

Mental health issues in Latinx middle schoolers may increase risk of sleep problems, obesity and unhealthy behaviors

New study suggests depression or other mental health issues as early as age 13 can set the stage for heart disease and stroke years later

Peer-Reviewed Publication

GEORGE WASHINGTON UNIVERSITY

WASHINGTON (Oct. 10, 2023)--Latinx kids who experienced depression, anxiety or other mental health issues in middle school had a greater chance of developing sleep problems, unhealthy weight gain and sedentary behavior in high school, according to a study out today.

 

The research, led by a team at the George Washington University, suggests that unhealthy behaviors linked to mental health issues may start early in life and trigger obesity, high blood pressure, diabetes and other serious health problems.

 

“Our study suggests signs of depression or anxiety in Latinx kids can set up a cycle that leads to weight gain, an unhealthy diet, and inactivity by the high school years,” Kathleen M. Roche, a professor of prevention and community health at the GW Milken Institute School of Public Health, said. “If such problems are not addressed early on they can set the stage for adult diseases like heart disease and stroke.”

 

Latinx high school students are 50% more likely to be obese compared to white youth and are at much higher risk of developing diabetes, according to the U.S. Department of Health and Human Services. And researchers know that mental health issues can trigger many unhealthy behaviors such as overeating high-fat comfort food and a sedentary lifestyle.

 

Roche and her colleagues studied data from 547 Latinx middle school students in suburban Atlanta. The vast majority of students in the sample were U.S. citizens. The students were, on average, age 13 at the time of the first survey and 17 at the time of the most recent survey.

 

Researchers asked the students questions about their diet, sleep patterns and physical activity. They also had youth report on their mental health symptoms such as depression and anxiety.

 

They found that even after adjusting for confounding factors, kids who had more depression, anxiety and other internalizing mental health symptoms were more likely to be sedentary, to report more sleep problems and an unhealthy diet, and to be overweight or obese just four years later. These are all risk factors that can lead to cardiovascular disease in young adulthood.

 

The findings represent a sobering reminder that teens, even those in middle school, can suffer from mental health issues that continue into the high school years and may also set in motion health problems like obesity.

 

At the same time, the research also points to a solution: Roche says that prompt mental health treatment may help teens stop overeating and get involved in physical activities such as soccer or another sport.

 

“Just telling a kid to get out and move probably isn’t going to motivate a teen who is sad or distressed,” Roche said. “Depression and anxiety makes it much harder to get off the couch and move.”

 

Previous research conducted by Roche in 2020 shows that when Latinx adolescents reported having a family member who was deported or detained under US immigration policy they had a high risk of reporting suicidal thoughts, early alcohol use and risky behavior. In addition, she and her colleagues published research in 2022 showing that Latinx adolescents who took on more childcare responsibility during the COVID-19 pandemic reported significant increases in symptoms of depression and anxiety and experienced increased problem behavior such as conduct disorder and aggression. 

 

This latest study adds to such findings by showing that mental health problems that surface during middle school may have enduring impacts on physical health well into the later high school years, Roche said.

 

The findings of such research indicate a critical need for increased health and social services that can help ease the mental distress faced by Latinx teens. Roche says parents, teachers and health professionals should be alert to symptoms of mental health problems and arrange for treatment that can keep teens stay active and healthy.

 

The study, “Mental Health During Early Adolescence and Later Cardiometabolic Risk: A Prospective Study of US Latinx Youth,” was published Oct. 10 in the Journal of Adolescent Health.

 

-GW-

 

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JOURNAL

Journal of Adolescent Health

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Mental Health During Early Adolescence and Later Cardiometabolic Risk: A Prospective Study of US Latinx Youth

ARTICLE PUBLICATION DATE

10-Oct-2023

Estimates of major depressive disorder and treatment among adolescents by race and ethnicity

JAMA Pediatrics

Peer-Reviewed Publication

JAMA NETWORK

About The Study: During the first full calendar year of the pandemic, approximately 1 in 5 adolescents had major depressive disorder, and less than half of adolescents who needed treatment had any mental health treatment, according to this analysis of nationally representative survey data of 10,000 U.S. adolescents. Adolescents in racial and ethnic minority groups, particularly Latinx, experienced the lowest treatment rates.

Authors: Michael William Flores, Ph.D., M.P.H., of the Cambridge Health Alliance in Cambridge, Massachusetts, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamapediatrics.2023.3996)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Embed this link to provide your readers free access to the full-text article 

 https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2023.3996?guestAccessKey=7e91dca7-ffb0-4673-9b51-c9cbc632dfbf&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=100923

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JOURNAL

JAMA Pediatrics

 

Researchers find pre-Columbian agave plants persisting in Arizona landscapes

Peer-Reviewed Publication

OXFORD UNIVERSITY PRESS USA

 

IMAGE: 

AGAVE PHILLIPSIANA

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CREDIT: WENDY HODGSON/ANNALS OF BOTANY

A new paper in the Annals of Botany, published by Oxford University Press, reveals that researchers have found unaltered agave plant species cultivated by several early cultures including the Hohokam people, a large Native American group in the Southwest that existed between 300 and 1500 CE.

Agave plants have been of great economic and social importance in the Americas for at least 9,000 years. Before people cultivated corn, agave plants were one of their main carbohydrate sources. Archaeological research indicates the Hohokam increased agricultural potential by building terraces for agave dry farming. Agricultural features such as terraces and rock piles were especially characteristic of this culture’s farming practices with the increase of dense, aggregated populations. While crops native to the Americas (corn/maize, peanuts, potatoes, tomatoes, etc.) are common around the world today, virtually all these plants have been modified extensively by European colonists and their descendants.

Since the 1980s, concurrent with archaeological explorations, Desert Botanical Garden research staff continue to document and study agaves throughout Arizona and the Southwest and northern Mexico. Their work resulted in the rediscovery and naming of five of the six known agave species that represent remnant populations of plants domesticated and farmed by pre-contact peoples in today’s Arizona landscape: Agave murpheyi, Agave delamateri, Agave phillipsiana, Agave sanpedroensis, Agave verdensis and Agave yavapaiensis. Although once grown on a large scale, some clones of these agaves have continued to persist through the centuries still within ancient, constructed fields in today’s modern landscape from southern Arizona north to the Grand Canyon.

These pre-contact domesticated agaves are morphologically distinct from Southwest U.S. and northern Mexico wild agaves and Mesoamerican wild and domesticated species. The remnant clones present a rare opportunity to examine plant species that are virtually unchanged since they were last cultivated prehistorically.

The researchers here believe that providing protection to these newly uncovered agave species is particularly relevant today because of increased interest and research in the surviving wild relatives of contemporary crops. This is particularly true of plants that occupy hot, dry environments, where climate change has rendered such plants more attractive for agricultural development.

“It is hoped that our work, made more fruitful as a result of input from archaeologists and Indigenous Peoples, will foster our understanding of today’s landscapes as legacies of past human activities, rather than pristine environments,” said the paper’s lead author, Wendy Hodgson. “Pre-contact peoples were superb agriculturists, selecting, domesticating, and cultivating crops in the arid Southwest. We have the rare opportunity to study how and what kinds of agaves ancient farmers grew, especially significant today when there is a need to explore the benefits of growing drought adapted crops using sustainable agroecological methods.”

The paper, “Pre-contact Agave Domesticates – Living Legacy Plants in Arizona’s Landscape,” is available (at midnight EST on October 10th) at: https://academic.oup.com/aob/article-lookup/doi/10.1093/aob/mcad113

To request a copy of the study, please contact:
Daniel Luzer 
daniel.luzer@oup.com

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JOURNAL

Annals of Botany

DOI

10.1093/aob/mcad113 

METHOD OF RESEARCH

Content analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Pre-contact Agave Domesticates – Living Legacy Plants in Arizona’s Landscape

ARTICLE PUBLICATION DATE

10-Oct-2023

 

Food taxes, farm subsidies and GM crops: new ‘how-to’ guide launched for tailor-made food policies

First of its kind sourcebook provides step-by-step guide to ensure food and agriculture policies have the best chance of success according to national and local contexts

Reports and Proceedings

THE ALLIANCE OF BIOVERSITY INTERNATIONAL AND THE INTERNATIONAL CENTER FOR TROPICAL AGRICULTURE

 

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THE BOOK COMPILES DOZENS OF FRAMEWORKS AND APPROACHES FOR DESIGNING FOOD AND AGRICULTURE POLICIES, SUCH AS REFORMING FARM SUBSIDIES, WATER POLICIES, FOOD SAFETY REGULATIONS AND TAXES.

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CREDIT: ALLIANCE OF BIOVERSITY INTERNATIONAL AND THE INTERNATIONAL CENTER FOR TROPICAL AGRICULTURE (CIAT), AND THE INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE (IFPRI)

October 10, WASHINGTON D.C. – A new tool will help governments customise food and agriculture policies based on country-level circumstances to increase their effectiveness at improving diets, adapting to changing climate and protecting natural resources.

The Political Economy and Policy Analysis (PEPA) Sourcebook is the first to compile dozens of frameworks and approaches for designing food and agriculture policies, such as reforming farm subsidies, water policies, food safety regulations and taxes.

The authors from the Alliance of Bioversity International and the International Center for Tropical Agriculture (CIAT), and the International Food Policy Research Institute (IFPRI) believe the guide fills a gap in understanding of how national political climates and economy-wide drivers can influence the success or failure of a specific policy.

It comes as the European Union reconsiders its flagship Farm to Fork Strategy, while governments across the Global South respond to the threat of rice and wheat shortages exacerbated by the war in Ukraine, including bans on rice exports and approvals of GM crops.

“Food and agriculture policies often focus on products or technologies, without paying enough attention to the broader economic and social implications at the national level,”

said Jonathan Mockshell, co-lead author and senior agricultural economist at Alliance Bioversity-CIAT.

“Coherent and effective policies must be tailored to meet national and societal needs. As governments grapple with the global food crisis, the PEPA Sourcebook provides a comprehensive resource that makes sense of the crowded field of approaches, frameworks and tools.”

The PEPA sourcebook, produced as part of the CGIAR Research Initiative on National Policies and Strategies (NPS), provides a six-step guide to help development practitioners, researchers, and policymakers answer critical questions, such as “what works, where, and how?” and “what are the drivers of reform policies?”

The process starts with identifying the policy problem, examining specific questions related to the policy area, and determining the relevant frameworks and analytical tools to apply, based on those included in the sourcebook. The fourth step is to gather data, focusing on why the problem persists, before compiling the insights to inform policy design and finally,  packaging the evidence for policymakers.

The sourcebook features frameworks and tools that can be applied to the macro level to factor historical contexts and prevailing national conditions into food and agriculture policies.

It also includes meso-level analysis to guide the development of rules and incentives that underpin policies. And micro-level frameworks focused on the individual can help identify winners and losers of policy reforms to shape mitigation or safety net measures.

“The solutions to tricky issues like food security and sustainable agriculture are currently hotly contested, resulting in divergent special interest coalitions and fragmented policies,”

said Danielle Resnick, co-lead author and senior research fellow at IFPRI.

“The PEPA Sourcebook provides systematic guidance for answering questions related to food and nutrition, land and water, and climate and ecology to maximise the chance of effective policies.”

One of the frameworks included in the sourcebook is the Kaleidoscope Model (KM), developed by Resnick and colleagues by analysing policy processes related to food security in Zambia.

The framework was used to evaluate policy reforms related to agricultural input subsidies and vitamin A fortification. It uncovered key political and cultural insights, such as core beliefs underpinning subsidy programs about the effectiveness of market delivery systems and the government’s role in agricultural input supply, which later changed with the emergence of e-voucher technology. Similarly, beliefs and biases based on rumours hindered the vitamin A fortification of maize meal.

The PEPA Sourcebook was launched during a webinar for policymakers, researchers and practitioners on Tuesday, October 10.

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About the Alliance of Bioversity International and CIAT

The Alliance of Bioversity International and the International Center for Tropical Agriculture (CIAT) delivers research-based solutions that harness agricultural biodiversity and sustainably transform food systems to improve people’s lives. Alliance solutions address the global crises of malnutrition, climate change, biodiversity loss, and environmental degradation.

With novel partnerships, the Alliance generates evidence and mainstreams innovations to transform food systems and landscapes so that they sustain the planet, drive prosperity, and nourish people in a climate crisis. The Alliance is part of CGIAR, a global research partnership for a food-secure future.

https://alliancebioversityciat.org

 

About IFPRI

The International Food Policy Research Institute (IFPRI), a CGIAR Research Center established in 1975, provides research-based policy solutions to sustainably reduce poverty and end hunger and malnutrition. IFPRI's strategic research aims to foster a climate-resilient and sustainable food supply; promote healthy diets and nutrition for all; build inclusive and efficient markets, trade systems, and food industries; transform agricultural and rural economies; and strengthen institutions and governance. The Institute's regional and country programs play a critical role in responding to demand for food policy research and in delivering holistic support for country-led development.

www.ifpri.org.

 

About the CGIAR Research Initiative on National Policies and Strategies (NPS)

 

CGIAR launched the CGIAR Research Initiative on National Policies and Strategies (NPS) with national and international partners to build policy coherence, respond to policy demands and crises, and integrate policy tools at national and subnational levels in countries in Africa, Asia, and Latin America. CGIAR centers participating in NPS are The Alliance of Bioversity International and the International Center for Tropical Agriculture (Alliance Bioversity-CIAT), International Food Policy Research Institute (IFPRI), International Livestock Research Institute (ILRI), International Water Management Institute (IWMI), International Potato Center (CIP), International Institute of Tropical Agriculture (IITA), and WorldFish.

https://www.cgiar.org/initiative/national-policies-and-strategies/

Former RCMP officer wins $10K pot-rolling discrimination case

Robin Hayes was ejected from a Port Alberni pub for rolling cannabis cigarettes to treat his PTSD.

Jeremy Hainsworth
3 days ago

A former RCMP officer was barred from a Port Alberni pub for rolling joints.

A former RCMP officer ejected from a Vancouver Island pub for rolling pot to treat his post-traumatic stress disorder (PTSD) has been awarded a $10,000 human rights complaint settlement.

In her newly released B.C. Human Rights Tribunal decision, Amber Prince found Robin Hayes visited the Creekers Pub near his home in Port Alberni, part of the Ocean Marina Hotel, in May 2019.

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There, Prince said, on Feb. 26 and May 6, 2019, Hayes was rolling cannabis cigarettes in the pub to smoke outside.

Hayes has a prescription for medical cannabis to treat his PTSD related to his years of work as an RCMP officer.

Hayes said the pub denied him a service and did not accommodate his needs as a person with PTSD. Prince agreed, saying the pub, its owner and manager discriminated against Hayes in the area of services based on mental disability.

On both occasions, manager Colby McMeekin told Hayes that he was not allowed to prepare cannabis in the pub and that he had to leave for doing so.

On May 6, 2019, McMeekin also told Hayes he was permanently barred from the pub for preparing cannabis.

On June 7, 2019, Hayes filed a complaint against McMeekin, Dean Johnson and Johnson’s company.

Those respondents said they did not eject and bar Hayes for preparing cannabis but because he was rude and belligerent.

Prince accepted Hayes’ evidence that he has PTSD and that it is recognized as a disability under the B.C. Human Rights Code.

The respondents claimed Hayes could have prepared his cannabis in advance or used a bathroom.

“I accept Mr. Hayes’ evidence that he prepares his medical cannabis in real time to meet his disability related needs,” Prince said. “As such, I accept that Mr. Hayes prepared his cannabis at the pub to meet his disability related needs.”

As such, Prince ruled: “I find that Mr. Hayes’ mental disability was a factor in the respondents’ ejecting and barring him from the pub.”

The respondents also claimed they did not allow rolling cannabis in the pub in order to maintain a safe environment. Prince said they had not made a connection between the two things.

“Mr. Hayes was stigmatized as doing something offensive, illicit, and wrong because he is prescribed and uses cannabis to treat his disability,” the tribunal said.

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