Science Says

Aims/Hypothesis: Early recognition of those at high risk for diabetes as well as diabetes itself can permit preventive management, but many Americans with diabetes are undiagnosed. We sought to determine whether routinely available outpatient random plasma glucose (RPG) would be useful to facilitate the diagnosis of diabetes.

Methods: Retrospective cohort study of 942,446 U.S. Veterans without diagnosed diabetes, ≥3 RPG in a baseline year, and ≥1 primary care visit/year during 5-year follow-up. The primary outcome was incident diabetes (defined by diagnostic codes and outpatient prescription of a diabetes drug).

Results: Over 5 years, 94,599 were diagnosed with diabetes [DIAB] while 847,847 were not [NONDIAB]. Baseline demographics of DIAB and NONDIAB were clinically similar, except DIAB had higher BMI (32 vs. 28 kg/m2) and RPG (150 vs. 107 mg/dl), and were more likely to have Black race (18% vs. 15%), all p<0.001. ROC area for prediction of DIAB diagnosis within 1 year by demographic factors was 0.701, and 0.708 with addition of SBP, non-HDL cholesterol, and smoking. These were significantly less than that for prediction by baseline RPG alone (≥2 RPGs at/above a given level, ROC 0.878, p<0.001), which improved slightly when other factors were added (ROC 0.900, p<0.001). Having ≥2 RPGs ≥115 mg/dl had specificity 77% and sensitivity 87%, and ≥2 RPGs ≥130 mg/dl had specificity 93% and sensitivity 59%. For predicting diagnosis within 3 and 5 years by RPG alone, ROC was reduced but remained substantial (ROC 0.839 and 0.803, respectively).

Conclusions: RPG levels below the diabetes “diagnostic” range (≥200 mg/dl) provide good discrimination for follow-up diagnosis. Use of such levels–obtained opportunistically, during outpatient visits–could signal the need for further testing, allow preventive intervention in high risk individuals before onset of disease, and lead to earlier identification of diabetes.

Rhee MK, Ho YL, Raghavan S, et al. Random plasma glucose predicts the diagnosis of diabetes. PLoS One. 2019;14(7):e0219964. Published 2019 Jul 19. doi:10.1371/journal.pone.0219964.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of Abstract, Introduction, Research Design and Methods, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6641200/.

Chronic stress is a major underlying origin of the top leading causes of death, globally. Yet, the mechanistic explanation of the association between stress and disease is poorly understood. This stems from the inability to adequately measure stress in its naturally occurring state and the extreme heterogeneity by inter and intraindividual characteristics. The growth and availability of digital technologies involving wearable devices and mobile phone apps afford the opportunity to dramatically improve measurement of the biological stress response in real time. In parallel, the advancement and capabilities of artificial intelligence (AI) and machine learning could discern heterogeneous, multidimensional information from individual signs of stress, and possibly inform how these signs forecast the downstream consequences of stress in the form of end-organ damage. The marriage of these tools could dramatically enhance the field of stress research contributing to impactful and empowering interventions for individuals bridging knowledge to practice, and intervention to real-world use. Here we discuss this potential, anticipated challenges, and emerging opportunities.

Goodday SM, Friend S. Unlocking stress and forecasting its consequences with digital technology. NPJ Digit Med. 2019;2:75. Published 2019 Jul 31. doi:10.1038/s41746-019-0151-8.

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Sections of the Abstract, Introduction, Defining Stress, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668457/

Background: This research is an investigation into the role of expert quotes in health news, specifically whether news articles containing a quote from an independent expert are less often exaggerated than articles without such a quote.

Methods: Retrospective quantitative content analysis of journal articles, press releases, and associated news articles was performed. The investigated sample are press releases on peer-reviewed health research and the associated research articles and news stories. Our sample consisted of 462 press releases and 668 news articles from the UK (2011) and 129 press releases and 185 news articles from The Netherlands (2015). We hand-coded all journal articles, press releases and news articles for correlational claims, using a well-tested codebook. The main outcome measures are types of sources that were quoted and exaggeration of correlational claims. We used counts, 2x2 tables and odds ratios to assess the relationship between presence of quotes and exaggeration of the causal claim.

Results: Overall, 99.1% of the UK press releases and 84.5% of the Dutch press releases contain at least one quote. For the associated news articles these percentages are: 88.6% in the UK and 69.7% in the Netherlands. Authors of the study are most often quoted and only 7.5% of UK and 7.0% of Dutch news articles contained a new quote by an expert source, i.e. one not provided by the press release. The relative odds that an article without an external expert quote contains an exaggeration of causality is 2.6.

Conclusions: The number of articles containing a quote from an independent expert is low, but articles that cite an external expert do contain less exaggeration.

Bossema FG, Burger P, Bratton L, et al. Expert quotes and exaggeration in health news: a retrospective quantitative content analysis. Wellcome Open Res. 2019;4:56. Published 2019 Jul 8. doi:10.12688/wellcomeopenres.15147.2.

This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sections of the Abstract, Introduction, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619368/#ref-24

Background: Some individuals with autism find it challenging to use and understand language in conversation, despite having good abilities in core aspects of language such as grammar and vocabulary. This suggests that pragmatic skills (such as understanding implied meanings in conversation) are separable from core language skills. However, it has been surprisingly difficult to demonstrate this dissociation in the general population. We propose that this may be because prior studies have used tasks in which different aspects of language are confounded.

Methods: The present study used novel language tasks and factor analysis to test whether pragmatic understanding of implied meaning, as part of a broader domain involving social understanding, is separable from core language skills. 120 adult participants were recruited online to complete a 7-task battery, including a test assessing comprehension of conversational implicature.

Results: In confirmatory analysis of a preregistered model, we compared whether the data showed better fit to a two-factor structure (including a “social understanding” and “core language” factor) or a simpler one-factor structure (comprising a general factor). The two-factor model showed significantly better fit.

Conclusions: This study supports the view that interpreting context-dependent conversational meaning is partially distinct from core language skills. This has implications for understanding the pragmatic language impairments reported in autism.

Wilson AC, Bishop DVM. If you catch my drift...: ability to infer implied meaning is distinct from vocabulary and grammar skills. Wellcome Open Res. 2019;4:68. Published 2019 Jul 10. doi:10.12688/wellcomeopenres.15210.2.

This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sections of the Abstract, Introductions, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589929/

Relationship problems among school children can lead to bullying situations. In this regard, it should be noted that, among healthy lifestyle habits, sports practice (non-competitive) promotes responsibility and improves coexistence. The objective of the present study was to analyze the incidence of the frequency of practice of healthy physical activity on the risks of students directly involved in school bullying (harasser and victim) by gender. The participants of the study were 1,248 students of Compulsory Secondary Education with ages between 11 and 18 (M = 14.42, SD = 1.43), being 50.8% males. The results of the study indicated that students who practiced physical activity in the recommended frequency rated as healthy, at least four or more times per week, had higher values in the indicators of aggressiveness than students who practiced with a lower frequency, appreciating a greater relationship between both variables in male rather than in female students. The study will make progress in preventive and intervention programs whose central axis is the promotion of physical activity and healthy sport (non-competitive) among students involved in situations of bullying. Likewise, teacher training in the recognition of bullying is considered a priority, providing them with guidelines for action.

Méndez I, Ruiz-Esteban C, Ortega E. Impact of the Physical Activity on Bullying. Front Psychol. 2019;10:1520. Published 2019 Jul 2. doi:10.3389/fpsyg.2019.01520.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614442/.

Introduction: The Dutch Pharmacogenetics Working Group (DPWG) indicated a list of actionable genotypes that affect patients’ response to more 50 drugs; these drugs which show variable effects based on patients’ genetic traits were named as pharmacogenetics (PGX) drugs. Preemptive genetic testing before using these drugs may protect certain patients from serious adverse reactions and could help in avoiding treatment failures. The objectives of this study include identifying the rate of PGX drug usage among Dutch population, estimating the level of users who carry the actionable genotypes and determining the main genes involved in drug’s effect variability.

Methods: Usage of PGX drugs over 2011–2017 by the insured population (an average of 11.4 million) in outpatient clinics in Netherlands was obtained from the publically available GIP databank. The data of 45 drugs were analyzed and their interactions with selected pharmacogenes were estimated. Frequency of actionable genotypes of 249 Dutch parents was obtained from the public database: Genome of Netherlands (GoNL), to identify the pattern of genetic characteristics of Dutch population.

Results: Over a 7 year period, 51.3 million exposures of patients to PGX drugs were reported with an average of 5.3 exposures per each drug user. One quarterof the exposures (12.4 million) are predicted to be experienced by individuals with actionable genotypes (risky exposures). Up to 60% of the risky exposures (around 7.5 million) were related to drugs metabolized by CYP2D6. SLCO1B1, and CYP2C19 were also identified among the top genes affecting response of drugs users (involved in about 22 and 12.4% of the risky exposures, respectively). Cardiovascular medications were the top prescribed PGX drug class (43%), followed by gastroenterology (29%) and psychiatry/neurology medications (15%). Women use more PGX drugs than men (55.8 vs. 44.2%, respectively) with the majority (84%) of users in both sexes are above 45 years.

Conclusion: PGX drugs are commonly used in Netherlands. Preemptive panel testing for CYP2D6, SLCO1B1, and CYP2C19 only could be useful to predict 95% of vulnerable patients’ exposures to PGX drugs. Future studies to assess the economic impact of preemptive panel testing on patients of older age are suggested.

Alshabeeb MA, Deneer VHM, Khan A, Asselbergs FW. Use of Pharmacogenetic Drugs by the Dutch Population. Front Genet. 2019;10:567. Published 2019 Jul 2. doi:10.3389/fgene.2019.00567.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614185/

Objectives: To explore if short term, high dose vitamin D supplementation is safe and improves balance in persons with Parkinson's disease (PD).

Methods: A pilot randomized, double-blind intervention trial to measure the effects of 16 weeks of high dose vitamin D (10,000 IU/day) on balance as well as other motor and non-motor features of PD. We measured balance, gait, strength, falls, cognition, mood, PD severity, and quality of life before and after 16 weeks of high dose vitamin D supplementation or placebo. All participants also received 1000 mg calcium once daily.

Results: Fifty-one randomized participants completed sixteen weeks of high dose vitamin D supplementation or placebo. The intervention resulted in a rise in serum concentrations of vitamin D (25-OH) (30.2 ng/ml to 61.1 ng/ml) and was well tolerated with no serious adverse events. Serum vitamin D (25-OH) levels rose steadily and did not suggest a leveling off at the end of the 16 weeks. There was not an improvement in the primary endpoint, balance as measured by the Sensory Organization Test (p = 0.43). A post hoc analysis examining treatment effects in younger (ages 52–66) versus older (ages 67–86) participants found a significant improvement in the SOT of 10.6 points in the younger half of the cohort (p = 0.012).

Conclusions: Short term, high dose vitamin D supplementation appears safe in persons with PD, but did not significantly improve balance as measured with the Sensory Organization Test in this pilot study population. A post hoc analysis suggests that vitamin D may have potential for improving balance in a younger population with PD. High dose vitamin D supplementation in PD needs further study especially in light of new research suggesting that mega doses and even moderate doses (as low as 4000IU a day) may increase falls in an older populations.

Hiller AL, Murchison CF, Lobb BM, O'Connor S, O'Connor M, Quinn JF. A randomized, controlled pilot study of the effects of vitamin D supplementation on balance in Parkinson's disease: Does age matter?. PLoS One. 2018;13(9):e0203637. Published 2018 Sep 26. doi:10.1371/journal.pone.0203637.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157857/

As public health advertisements move online, it becomes possible to run inexpensive randomized-controlled trials (RCTs) thereof. Here we report the results of an online RCT to improve food choices and integrate exercise into daily activities of internet users. People searching for pre-specified terms were randomized to receive one of several professionally developed campaign advertisements or the “status quo” (ads that would otherwise have been served). For 1-month pre-intervention and post-intervention, their searches for health-promoting goods or services were recorded. Our results show that 48% of people who were exposed to the ads made future searches for weight loss information, compared with 32% of those in the control group—a 50% increase. The advertisements varied in efficacy. However, the effectiveness of the advertisements may be greatly improved by targeting individuals based on their lifestyle preferences and/or sociodemographic characteristics, which together explain 49% of the variation in response to the ads. These results demonstrate that online advertisements hold promise as a mechanism for changing population health behaviors. They also provide researchers powerful ways to measure and improve the effectiveness of online public health interventions. Finally, we show that corporations that use these sophisticated tools to promote unhealthy products can potentially be outbid and outmaneuvered.

Yom-Tov E, Shembekar J, Barclay S, Muennig P. The effectiveness of public health advertisements to promote health: a randomized-controlled trial on 794,000 participants [published correction appears in NPJ Digit Med. 2018 Aug 16;1:38]. NPJ Digit Med. 2018;1:24. Published 2018 Jun 27. doi:10.1038/s41746-018-0031-7.

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6550260/

Background: Reducing diet costs may lead to the selection of energy-dense foods, such as refined grains or foods high in added sugars and/or fats, which can lower overall dietary quality. We examined the longitudinal association between the monetary value of the diet (MVD) and the overall dietary quality across sex, race and income groups.

Methods and findings: Longitudinal data from 1,466 adult urban participants from Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used. Healthy Eating Index–2010 (HEI–2010) and Mean Adequacy Ratio (MAR) were computed and a national food price database was used to estimate MVD. Multiple linear regression analyses were conducted linking annual rates of change (Δ) in MVD to ΔHEI-2010 and ΔMAR, stratifying by sex, race and income groups. Among key findings, ΔHEI-2010 was comparable across socio-demographic groups, while ΔMAR was higher among women and individuals above poverty. Adjusting for key covariates, ΔMVD was positively associated with both ΔHEI-2010 and ΔMAR, and with a consistently stronger association among individuals above poverty, specifically for the total proteins and empty calories components of HEI-2010 and several nutrient adequacy ratios (NARs: vitamins C, E, B-6 and Zinc). ΔMVD-ΔMAR association was stronger in women, mainly influenced by ΔMVD’s positive associations with B-vitamins, copper, calcium, magnesium and phosphorus NARs. ΔMVD-Δvitamin D NAR’s positive relationship was stronger among Whites, while ΔMVD-Δvitamin B-12 NAR’s association was stronger among African-Americans.

Conclusions: In sum, a potential increase in MVD may have a stronger impact on dietary quality among urban adult women and above-poverty individuals.

Beydoun MA, Fanelli-Kuczmarski MT, Poti J, et al. Longitudinal change in the diet's monetary value is associated with its change in quality and micronutrient adequacy among urban adults. PLoS One. 2018;13(10):e0204141. Published 2018 Oct 12. doi:10.1371/journal.pone.0204141.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of the Abstract, Introduction, Methods, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193582/

Keeping commitments to others can be difficult, and we know that people sometimes fail to keep them. How does a speaker’s ability to keep commitments affect children’s practical decisions to trust and their epistemic decisions to learn? An amassing body of research documents children’s trust in testimonial learning decisions, which can be moved in the face of epistemic and moral evidence about an agent. However, other bases for trust go largely unexplored in this literature, such as interpersonal reasons to trust. Here, we investigated how direct bids for interpersonal trust in the form of making commitments, or obligations to the listener, influence a range of decisions toward that agent. We found that 3- and 4-year-olds’ (N = 75) practical decisions to wait and to share were moved as a function of a person’s commitment-keeping ability, but epistemic decisions to learn were not. Keeping one’s commitments may provide children with interpersonal reasons to trust, reasons that may function in ways distinct from the considerations that bear on accepting a claim.

Pesch A, Koenig MA. Varieties of trust in preschoolers' learning and practical decisions. PLoS One. 2018;13(8):e0202506. Published 2018 Aug 20. doi:10.1371/journal.pone.0202506.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101396/