April 8, 2011
NIH Podcast Episode #0131
Balintfy: Welcome to episode 131 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health – the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode how dollars spent on high-quality preschool pays dividends later; two stories on brain activity patterns: one related to dyslexia, the other with anxiety; and an interview with NIH Director, Dr. Francis Collins on the obesity epidemic and future obesity research. But first, this news update. Here’s Craig Fritz.
Fritz: Researchers funded by the National Institute on Aging have confirmed one gene variant and have identified several others that may be risk factors for late-onset Alzheimer’s disease. The investigators studied DNA samples from more than 56,000 people and analyzed shared data sets to detect gene variations. Scientists say new technologies are allowing them to look at subtle genetic differences among large groups of study participants. By comparing people diagnosed with Alzheimer’s with people free of symptoms, researchers are now able to discern elusive genetic factors that may contribute to disease risk. Until recently, only one gene variant was confirmed as a significant risk factor for late-onset Alzheimer’s. However, research conducted over the last two years has discovered four additional gene factors that increase risk and four other gene factors that may be related to the disease.
A study funded by the Eunice Kennedy Shriver National Institute of Child Health And Human Development has found that progesterone, a naturally occurring hormone, reduced the rate of preterm birth by 45 percent among one category of at risk women. In 2008, over 12 percent of children born in the United States were preterm, meaning they were born before the 33rd week of pregnancy. The women in the study had a short cervix, which is known to increase the risk for preterm birth. The study also found that infants born to women who had received progesterone were less likely to develop a breathing complication. Infants born preterm are at high risk of early death and long term health and developmental problems.
For this NIH News Update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news . Coming up, what parts of the brain are involved in dyslexia and anxiety, plus details from the NIH Director on an obesity research plan, plus how a preschool program produces long-term economic payoff. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
High-quality preschool program produces long-term economic payoff
Balintfy: In 2007, analysis of an intensive early childhood program showed greater college attendance and lower crime and depression. Now a cost-benefit analysis of that program finds 4- to 11-dollars worth in benefits for every dollar spent on these kinds of programs. Britt Ehrhardt files this report.
Ehrhardt: New analysis shows that an early education program generates economic benefits far greater than the cost of the program.
Griffin: The researchers evaluated the effectiveness of the Chicago Public Schools federally funded Child-Parent Centers, or CPCs.
Ehrhardt: Dr. James Griffin, is with the Eunice Kennedy Shriver National Institute of Child Health and Human Development. He explains that CPC facilities are staffed by certified teachers, offer instruction in reading and math, as well as educational field trips. The centers provide meals and health screening for children ages 3 through 9, and skills training for parents.
Griffin: The study results strongly suggest that the program produced lasting economic benefits, even for children who completed only part of the program.
Ehrhardt: Dr. Griffin says researchers found four to eleven dollars worth of economic benefits for each dollar spent on the program. Benefits included increased earning power, once the children become adults. Benefits also included reduced costs to society, for example less special education and less interaction with the judicial system.
Griffin: So projected over lifetime, what they found is the children who attended the program at age three, at age 26, the return was nearly $11 for every dollar spent.
Ehrhardt: Griffin explains how researchers analyzed data from more than 1,500 children, now adults, who participated in the program.
Griffin: Researchers surveyed study participants and their parents and analyzed their education, employment, criminal justice, and child welfare records for the participants through age 26.
Ehrhardt: Some groups of children benefited even more than others.
Griffin: So, for example, for children who lived in the highest poverty neighborhoods, the returns were four to 10 times higher than children living in less disadvantaged areas.
Ehrhardt: Boys, children from high-risk homes, and those who started the program at a younger age benefitted even more than others.
Griffin: Overall, the size of the study and the nature of the program suggest these results can be generalized to other settings. And, more importantly, these findings add a significant weight to the idea that investing in early childhood education has returns for the individuals and for society.
Ehrhardt: This cost-benefit analysis was conducted by researchers at the University of Minnesota, Minneapolis and the Chicago Public Schools system. For more information on early education and this study, visit www.nichd.nih.gov. This is Britt Ehrhardt at the National Institutes of Health, Bethesda, Maryland.
Brain activity pattern signals ability to compensate for dyslexia
Balintfy: One thing that can hinder learning is dyslexia. Dyslexia is a brain-based type of learning disability that specifically impairs a person's ability to read. The disorder varies from person to person, but common characteristics include difficulty with spelling and rapid visual-verbal responding, and this is despite the person having normal intelligence. Wally Akinso reports that researchers now see where brain activity happens for those who can compensate for their dyslexia.
Akinso: Brain scans of dyslexic teens showed a pattern of brain activity when compared to scans of teens that were unable to compensate for their dyslexia according to a Eunice Kennedy Shriver National Institute of Child Health and Human Development study.
Miller: The key aspect of the project really had to do with whether the collected brain measures could provide insight above and beyond behavior measures that tell us about a person's reading skills.
Akinso: Dr. Brett Miller is a Health Scientist Administrator at the NICHD.
Miller: In addition to these behavioral test the reading, and language skills that were taking when they came in. The researchers also had the adolescents complete some reading related task while monitoring brain activity.
Akinso: The researchers used two types of brain imaging technology to conduct their study. The first, functional MRI which depicts oxygen use by brain areas involved in a particular task or activity. The second, diffusion tensor magnetic resonance imaging (DTI), maps the brain's wiring, revealing connections between brain areas. Dr. Miller explains what researchers found when teens were scanned using the functional MRI.
Miller: The functional MRI or the fMRI scans of the adolescents without dyslexia just as a contrast point. Essentially those that were reading normally showed strong brain activation pattern on the left side of the brain when completing the reading task inside the MRI scanner. To contrast that those individuals who had dyslexia, their brain scans revealed relatively weak activation patterns on the left side of the brain in regions that are commonly activated during reading. But what's of particular note here is that in the case of the adolescents with dyslexia who later were able to compensate for their disability, these individuals showed strong activation in the right hemisphere; inferior frontal gyrus.
Akinso: The adolescents who would later compensate for their dyslexia showed a pattern of increased activity in the brain region known as the inferior frontal gyrus, an area on the right side of the head, slightly below and behind the temple. Similarly, DTI scans of the brain also revealed stronger connections in the right side according to Dr. Miller.
Miller: The DTI scans for the group that was able to compensate for their reading disability showed a strong network of connections again of the right side for a region called the superior longitudinal fasiculus.
Akinso: The superior longitudinal fasiculus is a network of neural fibers linking the front and rear of the brain. The fibers are involved in the processing of visual aspects of text. This brain area governs the ability to halt an ongoing activity. The adolescents were shown pairs of printed words, and asked to identify pairs that rhymed. Dr. Miller says the individuals with dyslexia that didn't compensate for their disability had continued difficulty in a range of reading and language measures.
Miller: They didn't show the same pattern of this right hemisphere activation in the inferior frontal gyrus and nor did they have the strong pattern of connectivity in the superior longitudinal fasculus. More generally they showed relatively weak activation at least compared to individuals without dyslexia and the reading related regions of the left hemisphere.
Akinso: Dr. Miller says their findings suggest that brain imaging may help determine when a treatment is likely to be effective or which patients are most susceptible to risks. For more information on this study, visit www.nichd.nih.gov. More on dyslexia can be found at www.ninds.nih.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Brain activity patterns in anxiety-prone people suggest deficits in handling fear
Balintfy: Another brain study is looking at anxiety. Anxiety as a personality trait appears to be linked to the functioning of two key brain regions involved in fear and its suppression; this is according to a National Institute of Mental Health-funded study. Cherry Graziosi reports that differences in how these two regions function and interact may help explain the wide range of symptoms seen in people who have anxiety disorders.
Graziosi: Anxiety disorders are characterized by an excessive, irrational dread of everyday situations. At any given time 30 percent of the population will suffer from some form of anxiety. To better understand the disorder and how to treat it, the National Institute of Mental Health has conducted a study focusing on two parts of the brain, the amygdale and the ventral prefrontal cortex. Dr. Sonia Bishop of the University of California Berkeley helped design the study.
Bishop: We were interested in trying to look at people who were kind of highly vulnerable to see what's different about the way in which these processes work in those individuals to try and understand the pathway into high risk anxiety disorders.
Graziosi: The researchers assessed the level of anxiety of each participant by having their brain activity recorded through functional MRI screening while being re-exposed to different types of fear scenarios. She explains that the amygdale region of the brain, which is involved in responding strongly to dangerous or threatening stimuli, can be over responsive.
Bishop: What we also found is that this other region of the brain, the ventral frontal cortex, which has previously been associated with extinction, which is how quickly you can get over your fears once danger has passed, we found that this is actually involved in people's ability to down regulate or decrease them even before danger has passed.
Graziosi: Dr. Bishop says the study is ongoing, but the goal is to be able to predict which individuals will respond to cognitive therapies and which will respond to drug therapies. Additionally, Dr. Bishop says another aim is that researchers might eventually be able to develop online training courses that can let people look to see if they are at a high risk for anxiety disorders. To learn more about anxiety disorders and this study, visit www.nimh.nih.gov. I'm Cherry Graziosi, National Institutes of Health, Bethesda, Maryland.
Balintfy: The NIH Director’s perspective on obesity research plans; that’s next on NIH Research Radio.
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New strategic plan for NIH obesity research seeks to curb epidemic
Balintfy: In 2008, obesity-related medical costs were an estimated $147 billion. Today, more than one-third of adults in the United States and nearly 17 percent of the nation’s children are obese. This increases a person’s chance of developing many health problems, including type 2 diabetes, heart disease, high blood pressure, fatty liver disease, and some cancers. To combat the obesity epidemic, the National Institutes of Health is encouraging diverse scientific investigations through a new Strategic Plan for NIH Obesity Research. To talk about the plan, and obesity research, we hear from NIH Director, Dr. Francis Collins. Dr. Collins, what are some of the factors involved when it comes to obesity and obesity research?
Collins: It’s way too simplistic to say, well, people should just eat less and exercise more. That isn’t gonna solve the problem. There are many other factors that are we partly aware of, but need to know more about. A very interesting one is what exactly is the role of the microbes, that live in our gut; the Microbiome Project is aiming to look at that.
And it’s clear there’s evidence that there’s a difference in the microbes in the presence of obesity, as opposed to in … to somebody who’s lean. And if we understood that a little better, we might be able to do something along the lines of giving a probiotic, and that would assist weight loss. That’s an entirely possible future outcome. We’re not there yet.
Certainly social networks play a role here. It’s been very clearly demonstrated that obesity is something which is influenced, by the networks that we’re all part of. And if your own close circle of friends and family are afflicted by this problem, you’re more likely to be, also. And we need to understand how that works. There’s a whole question of the built environment. And whether the way in which our increasingly urban society has been set up, discourages people, from the kinds of activities that might prevent obesity.
All of those things together makes a very complicated landscape, but it’s not an impossible landscape for us, I think, with very rigorous research, to begin to understand and to develop on the basis of that understanding, new ideas about interventions to help people who are struggling with obesity to be successful.
Balintfy: How does NIH fit into the obesity question?
Collins: The National Institutes of Health is the largest supporter of biomedical research in the world. Our mission is to conduct basic science to understand how life works and how disease occurs. But then also, based on that understanding, to develop clinical implementations that will reduce the likelihood of people falling ill. Obesity is an enormous problem in terms of public health. It is threatening to take the gains in longevity, that have been so prominent in the U.S. over the course of the past many decades, and begin to reverse them. Some people say this may be the first generation where the children don’t live as long as their parents. Because of obesity and all the things that come along with that, especially diabetes. We need to do something about that.
If the NIH has its mission to try to promote human health, obesity is right in the middle of that. So of all the organizations you can think of, probably NIH appears on that very short list of the most important ones to tackle this problem. And we embrace that. And aim to try to live up to that responsibility by promoting excellent science that gives rigorous results that then can be applied to the public.
Balintfy: What are some of the areas of obesity that may be explored?
Collins: I think there are a lot of new areas, certainly the whole question of the neurological connections to obesity, the role of the brain, how it is that the brain is part of this pathway that relates to hunger and satiety. We still have a lot to figure out.
Neuroscience is going forward in very interesting ways, in lots of other applications, and obesity is one where I think we could gain a lot, by applying some of those new technologies that really lay out the details of pathways and how they work in the brain. And how they influence other activities in the body.
The whole area of behavioral and social science, which I think is increasingly seen as an important investment for NIH, obviously fits in this circumstance.
For myself, I will tell you my own little anecdote. Having found out a year-and-a-half ago that I was at higher risk for diabetes, than I thought I was, on the basis of some genetic tests, that was a motivator to take seriously that there are some risks to my own future that I could do something about.
And for whatever reason, that woke me up and caused me to take some actions that I probably should have taken anyway. I am 25 pounds lighter than I was a year-and-a-half ago when I was tipping over into that zone of BMI, where you don’t want to be. And, actually it wasn’t that hard to accomplish that, once I made up my mind. I had to give up honey buns; that was tough. And you know those muffins that are like about as big as your entire face? Well, I had to give those up, too.
But it’s that question of how do you go from having actionable information to taking the action. Which is what behavioral and social science research is focused on, for obesity, for cigarette smoking, for lots of other activities. It’s a central part of what we need to know more about, in this situation.
Balintfy: Dr. Collins, what do you hope will change because of the Strategic Plan for NIH Obesity Research?
Collins: This new plan lays out a bold blueprint of where obesity research could go. I hope it will recruit additional investigators to come and work in this field, ‘cause we need the best and the brightest on such a tough problem. And I hope it will inspire people who look at the list of opportunities, maybe some of which they hadn’t thought about, and think to themselves, “Yeah, I could do that. I could work on that.” That’s what strategic plans are really all about, I think. To take a whole bunch of smart people, uh, look at the needs of the field, lay out the landscape of opportunity, in a way that then looks like something the scientific community can embrace and get together and work on and make real progress.
Balintfy: How can the public get involved in obesity research?
Collins: Well, much of the strategic plan is devoted to interventions that will have to be tested. Initially in controlled trials. And we will need people to be willing to participate in those, to sign up, to take part in that kind of research. Which can be a very meaningful experience, uh, for patients who decide that this is something they want to do. You learn a lot in the process, and you have a chance to contribute to new knowledge that may benefit both yourself and future generations.
And then, once we have some ideas about interventions that do seem to work in that situation, then there will be an effort to try to generalize them. One of the things that we now have available that may help are networks of HMOs that actually collectively have access to millions of patients. And which are very important in terms of next step laboratories for testing out interventions for something like obesity, to see whether they work in a much more real world situation.
So individuals who are part of those HMOs at Kaiser, for instance, or Geisinger or Mayo, or Marshfield, increasingly have the opportunity also to participate in research studies that are somewhat different. They really are the real world, but you may be asked to say whether you’re willing to participate in a study where you might get randomized to this intervention or that one, and then we’re going to see what works best in that situation.
There’s a lot of knowledge that needs to be derived. A lot of it has to depend upon the good will and the willingness of people in the public to take part. But this is an exceptional opportunity for building that kind ‘a knowledge and building a healthier society.
Balintfy: What about resources that are available for the public now?
Collins: Well, everybody on the web seems to have a magic solution to obesity. But most of them, frankly, aren’t based upon much in the way of scientific evidence. We at NIH like to believe, that we are a very good resource for people who are looking for evidence, of interventions that work.
The National Library of Medicine, with all of the resources it provides, in terms of publicly-accessible information about health, would be a very good place, to go. Certainly many of the NIH Institutes also support educational materials about important public health matters. And obesity is certainly one of those. So one could certainly go to the NIH homepage and simply search under ‘obesity’ and you’d get a wealth of information from various sources that is based on science and likely to be quite helpful.
Balintfy: Thank you very much Dr. Francis Collins. For more from the NIH Director on Strategic Plan for NIH Obesity Research, including a video interview, visit www.obesityresearch.nih.gov. For now, that’s it for this episode of NIH Research Radio. Please join us again on Friday, April 22 when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Best to reach me by email—my address is email@example.com. I'm your host, Joe Balintfy. Thanks for listening.
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