text:
118th Health Research report 17 DEC 2011
Read Time:53 Minute, 26 Second
Health Technology Research Synopsis
118th Issue Date 17DEC2011
Compiled By Ralph Turchiano
www.vit.bz
www.youtube.com/vhfilm
Editors Top Five:
1. Ecstasy drug produces lasting toxicity in the brain
2. How muscle fatigue originates in the head
3. Recycled thermal cash register receipts spread BPA to other paper products
4. New study supports claim that breast screening may be causing more harm than good
5. Outwit the Grim Reaper by walking faster
1. Low vitamin D levels may contribute to development of Type 2 diabetes
4. Bile acids may hold clue to treat heart disease
5. Smoke and poor diet cause low vitamin C levels in India's elderly population
6. Extreme cold good for exercise recovery
7. Pycnogenol found to improve memory and test scores in college students in new clinical trial
8. Short walk cuts chocolate consumption in half
9. Starch intake may influence risk for breast cancer recurrence
10. Recycled thermal cash register receipts spread BPA to other paper products: ACS podcast
11. Intermittent, low-carbohydrate diets more successful than standard dieting
12. New study supports claim that breast screening may be causing more harm than good
13. Tart cherry juice drinkers gain sleep advantage
14. Women advised to avoid ZEN bust-enhancing supplements because of possible cancer risk
15. Extra weight loss from dietary fibres extracted from seaweed
16. Discordance among commercially-available diagnostics for latent TB infection
17. Brief, high-intensity workouts show promise in helping diabetics lower blood sugar: Study
18. Blue light irradiation promotes growth, increases antioxidants in lettuce seedlings
19. Low iron levels in blood give clue to blood clot risk
20. Study finds increasing atmospheric concentrations of new flame retardants
21. Outwit the Grim Reaper by walking faster
22. Researchers identify phthalates in numeruous medicines and supplements
23. New stats show America's heart health needs improvement
Low vitamin D levels may contribute to development of Type 2 diabetes
Study finds low vitamin D levels associated with higher degrees of insulin resistance
A recent study of obese and non-obese children found that low vitamin D levels are significantly more prevalent in obese children and are associated with risk factors for type 2 diabetes. This study was accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).
High rates of vitamin D deficiency have been found in obese populations and past studies have linked low vitamin D levels to cardiovascular disease and type 2 diabetes. The mechanisms by which obesity and its comorbidities are related to vitamin D deficiency are not fully known. This new study examined associations between vitamin D levels and dietary habits in obese children, and tested whether there were correlations between vitamin D levels and markers of abnormal glucose metabolism and blood pressure.
"Our study found that obese children with lower vitamin D levels had higher degrees of insulin resistance," said Micah Olson, MD, of The University of Texas Southwestern Medical Center in Dallas and lead author of the study. "Although our study cannot prove causation, it does suggest that low vitamin D levels may play a role in the development of type 2 diabetes."
In this study, researchers measured vitamin D levels, blood sugar levels, serum insulin, BMI and blood pressure in 411 obese subjects and 87 control non-overweight subjects. Study participants were also asked to provide dietary information including daily intake of soda, juice and milk, average daily fruit and vegetable intake, and whether or not they routinely skipped breakfast.
"Poor dietary habits such as skipping breakfast and increased soda and juice intake were associated with the lower vitamin D levels seen in obese children," said Olson. "Future studies are needed to determine the clinical significance of lower vitamin D levels in obese children, the amount and duration of treatment necessary to replenish vitamin D levels in these children and whether treatment with vitamin D can improve primary clinical endpoints such as insulin resistance."
Ecstasy drug produces lasting toxicity in the brain
Recreational use of Ecstasy – the illegal "rave" drug that produces feelings of euphoria and emotional warmth – is associated with chronic changes in the human brain, Vanderbilt University investigators have discovered.
The findings, reported online Dec. 5 in the Archives of General Psychiatry, add to the growing evidence that Ecstasy produces long-lasting serotonin neurotoxicity in humans, said Ronald Cowan, M.D., Ph.D., associate professor of Psychiatry.
"Our study provides some of the strongest evidence to date that the drug causes chronic loss of serotonin in humans."
The neurotransmitter serotonin, a critical signaling molecule, has roles in regulating mood, appetite, sleep, learning and memory.
The current study is important, Cowan said, because MDMA (Ecstasy's chemical name) may have therapeutic benefits and is now being tested as a treatment for post-traumatic stress disorder and anxiety associated with cancer.
"It's essential that we understand the risk associated with using Ecstasy," Cowan said. "If news keeps coming out that MDMA is being tested therapeutically and is safe, more people will tend to self-administer the drug. We need to know the dose at which this drug becomes toxic.
"Our studies suggest that if you use Ecstasy recreationally, the more you use, the more brain changes you get."
In the current study, Cowan and colleagues used positron emission tomography (PET) imaging to examine the levels of serotonin-2A receptors in various brain regions, in females who had used Ecstasy (but not in the 90 days prior to imaging) and in females who had never used the drug. They limited their studies to females because previous work has shown gender-specific differences in serotonin receptor levels.
They found that Ecstasy users had increased levels of serotonin-2A receptors and that higher lifetime use of the drug (higher doses) correlated with higher serotonin receptor levels. The findings are consistent with some studies in animal models, with receptor levels increasing to compensate for the loss of serotonin, Cowan said.
Cowan and colleagues reported earlier this year that Ecstasy increased brain activation in three brain areas associated with visual processing, which suggested a loss in brain efficiency. Together, the two studies provide compelling evidence that Ecstasy causes lasting changes in brain serotonin function, Cowan said.
"It's really critical to know whether or not this drug is causing long-term brain damage because millions of people are using it," he said.
The 2010 National Survey on Drug Use and Health estimated that 15.9 million individuals 12 years or older in the United States had used Ecstasy in their lifetime; 695,000 people had used Ecstasy in the month prior to being surveyed.
Cowan is interested in determining the doses of Ecstasy that are toxic, and whether there are genetic vulnerabilities to toxicity. If clinical trials show that the drug has therapeutic benefits, it's critical to know the risks, he said.
How muscle fatigue originates in the head
Researchers from the University of Zurich have now studied in detail what sportsmen and women know from experience: The head plays a key role in tiring endurance performances. They have discovered a mechanism in the brain that triggers a reduction in muscle performance during tiring activities and ensures that one's own physiological limits are not exceeded. For the first time, the study demonstrates empirically that muscle fatigue and changes in the interaction between neuronal structures are linked.
The extent to which we are able to activate our muscles voluntarily depends on motivation and will power or the physical condition and level of fatigue of the muscles, for instance. The latter particularly leads to noticeable and measurable performance impairments. For a long time, the research on muscle fatigue was largely confined to changes in the muscle itself. Now, a joint research project between the University of Zurich and ETH Zurich has shifted the focus to brain research. Headed by neuro-psychologist Kai Lutz from the University of Zurich in collaboration with Urs Boutellier from the Institute of Human Movement Sciences and Sport at ETH Zurich, the researchers discovered neuronal processes for the first time that are responsible for reducing muscle activity during muscle-fatiguing exercise. The third and final part of this series of experiments, which was conducted by Lea Hilty as part of her doctoral thesis, has now been published in the "European Journal of Neuroscience".
Muscle's nerve impulses inhibit motoric area in the brain
In the initial study, the researchers showed that nerve impulses from the muscle – much like pain information – inhibit the primary motoric area during a tiring, energy-demanding exercise. They were able to prove this using measurements in which study participants repeated thigh contractions until they could no longer attain the force required. If the same exercise was conducted under narcotization of the spinal chord (spinal anesthesia), thus interrupting the response from the muscle to the primary motoric area, the corresponding fatigue-related inhibition processes became significantly weaker than when the muscle information was intact.
In a second step, using functional magnetic resonance imaging, the researchers were able to localize the brain regions that exhibit an increase in activity shortly before the interruption of a tiring, energy-demanding activity and are thus involved in signalizing the interruption: the thalamus and the insular cortex – both areas which analyze information that indicates a threat to the organism, such as pain or hunger.
Neuronal system has regulating effect on muscle performance
The third study has now shown that the inhibitory influences on motoric activity are actually mediated via the insular cortex: In tests using a bicycle ergometer, the researchers determined that the communication between the insular cortex and the primary motoric area became more intensive as the fatigue progressed. "This can be regarded as evidence that the neuronal system found not only informs the brain, but also actually has a regulating effect on motoric activity," says Lea Hilty, summing up the current result. And Kai Lutz points to the new research field that now opens up with these results: "The findings are an important step in discovering the role the brain plays in muscle fatigue. Based on these studies, it won't just be possible to develop strategies to optimize muscular performance, but also specifically investigate reasons for reduced muscular performance in various diseases." Prolonged reduced physical performance is a symptom that is frequently observed in daily clinical practice. It can also appear as a side effect of certain medication. However, so-called chronic fatigue syndrome is often diagnosed without any apparent cause.
Bile acids may hold clue to treat heart disease
Heart disease is a major cause of death in industrialised countries, and is strongly associated with obesity and diabetes. Many scientists believe that what links these conditions is a chronic, low-grade inflammation. The current study, published in the scientific journal Cell Metabolism (December 6, 2011), supports that theory by demonstrating that a modified bile acid called INT-777 prevents atherosclerosis, the build-up of fatty plaques in the walls of arteries, and a leading cause of heart disease—and that it does so by exerting an anti-inflammatory effect.
INT-777 activates a receptor in the membrane of gut cells called TGR5, and in so doing enhances the secretion of a hormone called Glucagon-Like Peptide-1 (GLP-1). GLP-1 is normally induced by feeding, and it stimulates insulin secretion in response to glucose. In earlier work, Profs Kristina Schoonjans and Johan Auwerx of the EPFL's Laboratory of Integrative Systems Physiology (LISP), in collaboration with Prof Roberto Pellicciari of the University of Perugia (Italy) and Intercept Pharmaceuticals (New York, USA), found that they could protect mice fed a high-fat diet from obesity and diabetes by supplementing their food with INT-777.
Anti-diabetic drugs already exist that prolong the activity of GLP-1 in the body. The EPFL group's discovery that INT-777 enhances GLP-1 secretion raised the exciting prospect of combining the two therapeutic approaches for a more effective treatment of diabetes. But how would INT-777 affect any underlying inflammation, and in particular, atherosclerosis?
To find out, LISP members Dr Thijs Pols and Mitsunori Nomura treated mice prone to atherosclerosis with INT-777, and found a significant reduction in plaque formation. Atherosclerotic plaques contain inflammatory cells called macrophages that are generated in the bone marrow. When the bone marrow of the atherosclerosis-prone mice was replaced by bone marrow from either healthy, wild-type mice, or from mice genetically engineered to lack TGR5, the researchers found that only those that received the wild-type marrow showed significantly reduced plaque formation following INT777 treatment. "That was the evidence we needed that it was the anti-inflammatory effect of the compound, acting via TGR5 in bone marrow-derived cells, that accounted for the protective effect," says Dr Schoonjans.
INT777 therefore looks like a promising candidate for the treatment of metabolic syndrome, she says. Unlike some existing anti-diabetes drugs, it is unlikely to have the side-effect of hypoglycaemia, or very low blood glucose, because it only triggers GLP-1 secretion when glucose is in sufficient supply. And though its anti-inflammatory effects are significant, they are moderate, meaning that it would be unlikely to interfere with the normal immune response. The next step will be to devise clinical trials, to test its safety and efficacy in humans.
Smoke and poor diet cause low vitamin C levels in India's elderly population
Up to three quarters of elderly people in parts of India have vitamin C deficiency, a study by the London School of Hygiene & Tropical Medicine found.
Up to three quarters of elderly people in parts of India have vitamin C deficiency, a study by the London School of Hygiene & Tropical Medicine found. Vitamin C is an essential nutrient for human health, playing a role from maintenance and repair of tissues to antioxidant activities. This study is the first ever large screening of vitamin C blood levels in the older Indian population.
Vitamin C deficiency is primarily due to a diet which is low in fruit and vegetables. Vitamin C blood levels can also be depleted by smoking or chewing tobacco and cooking with fuels such as wood crops or dung (used by 70% of the rural population). One of the effects of tobacco and inhaling fumes from home or cooking fires is oxidative stress (which can cause damage to cells) and the body uses vitamin C to combat this.
The study, coordinated by Professor Astrid Fletcher of the London School of Hygiene & Tropical Medicine in collaboration with Aravind Eye Hospital Pondicherry and the All India Institute for Medical Sciences in Delhi, has been published in PloS One.
The research, funded by the Wellcome Trust, highlights marked differences between the study locations in the north and south of the country, although in both regions the percentages of vitamin C deficient people over 60 years of age were extremely high, with 74% in the north and 46% in the south. Only 11% and 26% respectively, met the criteria for adequate levels. Vitamin C levels were also found to vary seasonally, in conjunction with the monsoon months, thought to reflect the lower intake of fruit and vegetables.
The large population-based study involved over 5000 people aged 60 years or over from rural villages and small towns and included interviews about their diet, blood analysis and malnutrition assessments.
Dr Ravindran, principal author of the study said " while much attention has focused on increasing levels of obesity in India, the problem of poor nutrition in the older population has received much less attention even though India has one of the fastest growing older populations. In poor communities, such as in our study, consideration needs to be given to measures to improve the consumption of vitamin C rich foods, and to discourage the use of tobacco and biomass fuels".
Extreme cold good for exercise recovery
Athletes go to great lengths to protect their muscles and recover from exercise-induced muscle damage, but there has been little work to determine what methods are most effective.
Now, a study published in the Dec. 7 issue of the online journal PLoS ONE reports that runners benefit more from whole-body cryotherapy, in which the study participants was exposed to temperatures as cold as -166°F (-110°C), than from exposure to far-infrared radiation or no treatment.
The study, led by Christophe Hausswirth of the National Institute of Sport, Expertise and Performance in Paris, was conducted with nine well trained runners, and each participant tested each recovery method to control for individual differences in muscle damage and recovery.
Overall, the researchers found the whole-body cryotherapy method to be most effective. The first cryotherapy session, conducted one hour after exercise, allowed the runners to recover maximal muscle strength, while the same result took much longer to attain with the other strategies, and three cryotherapy sessions performed over 48 hours post-run accelerated recovery more than the other two methods over the same time period.
According to Dr. Hausswirth, the "whole-body cryotherapy is effective in enhancing post-exercise recovery in well-trained runners, by limiting the maximal force loss and sensations of pain."
Pycnogenol found to improve memory and test scores in college students in new clinical trial
Natural supplement shown to improve mental performance and decrease test anxiety by 17 percent
Dec. 7, 2011 – HOBOKEN, NJ – Keeping your brain in shape…no sweat. Health-conscious consumers may not realize that supplementing a healthy diet is just as important to maintaining mental performance as it is to maintaining six-pack abs. Natural supplements are an easy, effective way to manage mental focus, memory and overall mood. Natural supplement Pycnogenol® (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, was found to significantly enhance mental performance in healthy college students in a recent clinical trial published in Panminerva Medica.
The study was conducted at Pescara University and examined 53 Italian university students, aged 18-27. Students were assigned to a control or test group. The test group was given 100 mg of Pycnogenol® per day, over a period of eight weeks. Students' mental performance was evaluated using cognitive function tests that were carried out by computer-assisted methods. Students' final exam scores were also evaluated. Verbal IQ tests ensured that students recruited for the study demonstrated highly comparable intelligence.
The study found that:
Pycnogenol® effectively enhanced mental performance, including improved sustained attention, memory and mood in students within an eight week period
Students taking Pycnogenol® had higher test scores on university exams than the control group
Alertness and contentedness improved significantly within the Pycnogenol® group and levels of anxiety decreased by 17 percent
"Oxygen-rich blood supply to the brain plays an important role for cognitive function and the improvement of vascular function with Pycnogenol® may be responsible for the beneficial effects found in this study," says Dr. Gianni Belcaro, the lead researcher from Pescara University, Italy.
Results showed that not only did Pycnogenol® decrease test anxiety, but also confirmed Pycnogenol®'s ability to improve mental performance by evaluating students' scores on exams. Researchers suggest that several physiologic contributions of Pycnogenol® may have contributed to the improved cognitive function of investigated students, namely antioxidant potency and blood circulation improvement. While the results are promising they need to be further investigated in a larger population group.
This study confirms previous findings that Pycnogenol® effectively improves cognitive function. Research published in the Journal of Psychopharmacology demonstrated that Pycnogenol® supplementation improved both numerical working memory as well as spatial working memory in Australian senior citizens.
Short walk cuts chocolate consumption in half
A 15-minute walk can cut snacking on chocolate at work by half, according to research by the University of Exeter. The study showed that, even in stressful situations, workers eat only half as much chocolate as they normally would after this short burst of physical activity.
Published in the journal Appetite, the research suggests that employees may find that short breaks away from their desks can help keen their minds off snacking.
In the study, 78 regular chocolate-eaters were invited to enter a simulated work environment, after two days abstinence from chocolate snacking. Two groups were asked to take a brisk 15-minute walk on a treadmill and were then given work to complete at a desk. One group was given an easy, low-stress task, while the other was asked to complete a more demanding job. The other two groups were asked to have a rest before completing the same tasks as the first two groups. Again, half were given an easier and the remainder a more challenging task. Chocolate was available in a bowl on the desk for all participants as they carried out their work.
Those who had exercised before working consumed on average half the amount of chocolate as the others: around 15 grammes, compared with 28 grammes. 15 grammes is equivalent to a small 'treat size' or 'fun size' chocolate bar.
The difficulty of the task made no difference to the amount of chocolate they ate, which suggests that stress did not contribute to their cravings for sweet snacks.
Lead researcher Professor Adrian Taylor of the University of Exeter said: "We know that snacking on high calorie foods, like chocolate, at work can become a mindless habit and can lead to weight gain over time. We often feel that these snacks give us an energy boost, or help us deal with the stress of our jobs, including boredom. People often find it difficult to cut down on their daily treats but this study shows that by taking a short walk, they are able to regulate their intake by half."
Exercise is known to have significant benefits for mood and energy levels and has potential for managing addictions. Professor Taylor and his colleagues at the University of Exeter have previously shown that exercise can curb cravings for chocolate but this is the first study to show a reduction in consumption.
Recycled thermal cash register receipts spread BPA to other paper products: ACS podcast
WASHINGTON, Dec. 7, 2011 — The latest episode in the American Chemical Society's (ACS) award-winning "Global Challenges/Chemistry Solutions" podcast series discusses the discovery of bisphenol A (BPA) in 94 percent of thermal cash register receipts and describes how recycling of those receipts spreads BPA to paper napkins, toilet paper and other paper products.
In the podcast, Kurunthachalam Kannan, Ph.D., explains that manufacturers produce more than 8 billion pounds of BPA worldwide every year. Research links BPA with certain harmful health effects. BPA has been used in plastic water bottles, the lining of food cans and a variety of other products. But how much do non-food sources contribute to BPA exposure? BPA coats the surfaces of thermal receipts, where it acts as a developer for the printing dye. To see whether this source of BPA was a concern, the researchers analyzed hundreds of samples of thermal cash register receipts and 14 other paper types from the U.S., Japan, Korea and Vietnam.
They found BPA on 94 percent of all the receipts. The only receipts with that were BPA-free were those from Japan, which phased out this use of BPA in 2001. BPA was in most of the other types of paper products, with tickets, newspapers and flyers having the highest concentrations. But these levels still paled in comparison to BPA on receipts, which the study said are responsible for more than 98 percent of consumer exposure to BPA from paper. The researchers estimate that receipts contribute about 33.5 tons of BPA to the environment every year in the U.S. and Canada. They note that handling of paper products can contribute up to 2 percent of the total daily BPA exposures in the general population, and that fraction can be much higher in occupationally exposed individuals.
Starch intake may influence risk for breast cancer recurrence
SAN ANTONIO — Researchers have linked increased starch intake to a greater risk for breast cancer recurrence, according to results presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.
"The results show that it's not just overall carbohydrates, but particularly starch," said Jennifer A. Emond, M.S., a public health doctoral student at the University of California, San Diego. "Women who increased their starch intake over one year were at a much likelier risk for recurring."
Researchers conducted a subset analysis of 2,651 women who participated in the Women's Healthy Eating and Living (WHEL) Dietary Intervention Trial, a plant-based intervention trial that enrolled about 3,088 survivors of breast cancer. WHEL researchers studied breast cancer recurrence and followed the participants for an average of seven years.
The subset analysis involved an examination of how changes in carbohydrate intake influenced breast cancer recurrence. "The WHEL dietary trial, even though it focused on fruits and vegetables, fiber and fat, didn't really have a specific carbohydrate goal," Emond said.
She and her colleagues obtained carbohydrate intake information from multiple 24-hour dietary recalls at baseline and at one year. In an annual phone interview, participants reported everything they had eaten during the last 24 hours.
At baseline, carbohydrate intake was 233 grams per day. Results showed that women whose cancer recurred had a mean increase in carbohydrate intake of 2.3 grams per day during the first year, while women whose cancer did not recur reported a mean decrease of 2.7 grams per day during the first year.
Starches were particularly important, Emond said. Changes in starch intake accounted for 48 percent of the change in carbohydrate intake. Mean change in starch intake during the first year was 𔃂.1 grams per day among women whose cancer recurred vs. 𔃆.7 grams per day among women whose cancer did not recur.
When change in starch intake during one year was grouped into quartiles of change, the rate of an additional breast cancer event was 9.7 percent among women who decreased their starch intake the most during one year, compared with an event rate of 14.2 percent among women who increased their starch intake the most during one year.
The change in starch intake was "independent of dietary changes that happened in the intervention arm," Emond said. "It is independent of more global changes in diet quality."
After stratifying patients by tumor grade, Emond and colleagues found that the increased risk was limited to women with lower-grade tumors.
These results indicate a need for more research on dietary recommendations that consider limited starch intake among women with breast cancer.
Intermittent, low-carbohydrate diets more successful than standard dieting
Present possible intervention for breast cancer prevention
SAN ANTONIO — An intermittent, low-carbohydrate diet was superior to a standard, daily calorie-restricted diet for reducing weight and lowering blood levels of insulin, a cancer-promoting hormone, according to recent findings.
Researchers at Genesis Prevention Center at University Hospital in South Manchester, England, found that restricting carbohydrates two days per week may be a better dietary approach than a standard, daily calorie-restricted diet for preventing breast cancer and other diseases, but they said further study is needed.
"Weight loss and reduced insulin levels are required for breast cancer prevention, but [these levels] are difficult to achieve and maintain with conventional dietary approaches," said Michelle Harvie, Ph.D., SRD, a research dietician at the Genesis Prevention Center, who presented the findings at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.
Harvie and her colleagues compared three diets during four months for effects on weight loss and blood markers of breast cancer risk among 115 women with a family history of breast cancer. They randomly assigned patients to one of the following diets: a calorie-restricted, low-carbohydrate diet for two days per week; an "ad lib" low-carbohydrate diet in which patients were permitted to eat unlimited protein and healthy fats, such as lean meats, olives and nuts, also for two days per week; and a standard, calorie-restricted daily Mediterranean diet for seven days per week.
Data revealed that both intermittent, low-carbohydrate diets were superior to the standard, daily Mediterranean diet in reducing weight, body fat and insulin resistance. Mean reduction in weight and body fat was roughly 4 kilograms (about 9 pounds) with the intermittent approaches compared with 2.4 kilograms (about 5 pounds) with the standard dietary approach. Insulin resistance reduced by 22 percent with the restricted low-carbohydrate diet and by 14 percent with the "ad lib" low-carbohydrate diet compared with 4 percent with the standard Mediterranean diet.
"It is interesting that the diet that only restricts carbohydrates but allows protein and fats is as effective as the calorie-restricted, low-carbohydrate diet," Harvie said.
She and her colleagues plan to further study carbohydrate intake and breast cancer. This study was funded by the Genesis Breast Cancer Prevention Appeal (www.genesisuk.org).
New study supports claim that breast screening may be causing more harm than good
Research: Possible net harms of breast cancer screening: Updated modelling of Forrest report
A new study published on bmj.com today supports the claim that the introduction of breast cancer screening in the UK may have caused more harm than good.
Harms included false positives (abnormal results that turn out to be normal) and overtreatment (treatment of harmless cancers that would never have caused symptoms or death during a patient's lifetime). This may be because the cancer grows so slowly that the patient dies of other causes before it produces symptoms, or the cancer remains dormant or regresses.
It shows that the harms of screening largely offset the benefits up to 10 years, after which the benefits accumulate, but by much less than predicted when screening was first started.
The Forrest report in 1986, which led to the introduction of breast cancer screening in the UK, estimated the number of screened and unscreened women surviving each year over a 15-year period. Costs and benefits were measured in quality adjusted life years or QALYs (a combined measure of quantity and quality of life) but it omitted harms.
It suggested that screening would reduce the death rate from breast cancer by almost one third with few harms and at low cost.
Since the Forrest report, the harms of breast cancer screening have been acknowledged. So, researchers at the University of Southampton set out to update the report's survival estimates by combining the benefits and harms of screening in one single measure.
The results are based on 100,000 women aged 50 and over surviving by year up to 20 years after entry to the screening programme.
Inclusion of false positives and unnecessary surgery reduced the benefits of screening by about half. The best estimates generated negative net QALYs for up to eight years after screening and minimal gains after 10 years.
After 20 years, net QALYs accumulate, but by much less than predicted by the Forrest report.
The authors say more research is needed on the extent of unnecessary treatment and its impact on quality of life. They also call for improved ways of identifying those most likely to benefit from surgery and for measuring the levels and duration of the harms from surgery. From a public perspective, the meaning and implications of overdiagnosis and overtreatment need to be much better explained and communicated to any woman considering screening, they add.
However, the continuing uncertainty surrounding the extent of overtreatment is apparent in a study of French women published on bmj.com last month, which put overdiagnosis of invasive breast cancer due to screening at around 1%.
Tart cherry juice drinkers gain sleep advantage
New research suggests red hot super fruit may be a natural sleep aid
LANSING, Mich. — Americans seeking a better night's sleep may need to look no further than tart cherry juice, according to a new study in the European Journal of Nutrition. 1 An international team of researchers found that when adults had two daily glasses of tart cherry juice, they slept 39 minutes longer, on average, and had up to 6 percent increase in overall sleep efficiency (significantly less non-sleep time in bed), compared to when they drank a non-cherry, fruit cocktail.
In a study conducted at Northumbria University, twenty healthy adults drank two servings of tart cherry juice concentrate (30mL of 100% pure Montmorency juice concentrate per serving, diluted in a half pint of water; provided by CherryActive, Sunbury, UK) or a non-cherry fruit drink for seven consecutive days at a time – one serving when they woke up, and another before bed. The researchers tracked participant's sleep habits, and after drinking the cherry juice, they found significant improvements in sleep behaviors, most notably longer sleep time, less daytime napping and increased overall sleep efficiency (the ratio of time spent in bed to time spent sleeping) compared to when they drank the non-cherry juice drink.
The researchers attribute the sleep benefits to the melatonin content of the red Super Fruit – a powerful antioxidant critical for sleep-wake cycle regulation. Each serving of the tart cherry juice concentrate was estimated to contain the equivalent of 90 – 100 tart cherries, providing a significant level of melatonin in the juice and ultimately in the bodies of the participants.
Previous research has supported the benefits of tart cherries as a sleep aid – a potentially wide-reaching benefit since nearly one-third of all Americans suffer from sleep disturbances affecting their health and wellbeing, according to the Centers for Disease Control and Prevention. 2,3 Currently, Americans spend more than $84 million on over-the-counter sleep aids each year, leaving many searching for cost-effective ways to help manage their conditions. 4 While more research is necessary before medical professionals turn to cherries as a sole treatment for sleep disorders, the scientists conclude that tart cherry juice concentrate could be a viable "adjunct intervention for disturbed sleep across a number of scenarios."
Women advised to avoid ZEN bust-enhancing supplements because of possible cancer risk
No clinical trials and no evidence of long-term safety, say authors
Women who use bust-enhancing dietary supplements containing the mycoestrogen zearalenone (ZEN), a naturally occurring toxin that widely contaminates agricultural products, could be increasing their risk of breast cancer. That is the warning from breast health experts in a paper published online ahead of print publication in the January issue of IJCP, the International Journal of Clinical Practice.
"No clinical trials have been published on the use of potent oestrogens like ZEN in bust-enhancing products and their use should be discouraged because of the lack of evidence of their long-term safety" says Professor Ian Fentiman, consultant breast surgeon at Guy's and St Thomas' NHS Foundation Trust, London.
The use of ZEN to increase bust size is just one of the key concerns raised by the review focussing on the affects of ZEN and its derivatives on the human reproductive system and breast cancer. It also included the use of ZEN to fatten up livestock, its use in hormone replacement therapy and oral contraceptives, its links with premature puberty and its possible effects on breast cancer.
"ZEN is a toxic non-steroidal mycoestrogen produced by fungi that widely contaminates agricultural products, such as crops, eliciting oestrogenic responses by mimicking the female sex hormones" explains Professor Fentiman.
Using ZEN in animal feed has been associated with a wide range of reproductive anomalies in livestock, including diminished fertility and infertility, reduced litter size and smaller offspring and negative effects on the reproductive organs.
International studies have suggested links between consumption of ZEN-fed animals and products and precocious (early) puberty in young females.
These include an epidemic of premature breast development and early puberty in Puerto Rico, linked to dairy and meat products, and studies from Hungary and Italy where female children with precocious puberty had increased ZEN levels in their serum.
"In fact the European Union has banned using ZEN to fatten up cattle, a technique used in the USA since 1969, because of its links with precocious puberty" says Professor Fentiman.
"Recently it has been suggested that some ZEN derivatives can increase the growth of hormone-dependent breast tumours. It has also been reported that, depending on the dose, ZEN can either promote or prevent breast cancer. So the jury on whether its links with breast cancer are positive or negative is well and truly out at this stage."
The authors drew a number of conclusions from their review:
There is a lack of information on the human metabolism of ZEN and disagreement on the mechanisms of ZEN oestrogenic action in human tissue.
The presence of this mycoestrogen in cereals, milk, and meat, and the possibility of ZEN involvement in the development of new breast tumours, warrant further investigation.
Future studies should investigate the effects of ZEN on the growth stimulation of hormone-dependent cancers and identify the key genes that promote hormone-dependent cancers.
ZEN promotes programmed cell death and reduces the proliferation of cancer cells when administered at certain doses.
Although ZEN is a common diet toxic mycoestrogen, the potential risk to human health appears to only occur when it is absorbed in concrete concentrations or over a long period of time.
A molecular biomarker of dietary exposure to ZEN and its derivatives will allow the detection and control of harmful food intake.
The interaction of ZEN with anti-oestrogens and anticancer agents and antioxidants requires further investigation.
Extra weight loss from dietary fibres extracted from seaweed
A new research project conducted at the Faculty of Life Sciences (LIFE), University of Copenhagen, shows that dietary fibres from brown algae boost the sensation of satiety, thereby making people eat less and lose more weight.
Previous studies have shown that a fibre-rich diet makes it easier to maintain weight, and now a new PhD project documents that dietary fibres from brown algae, the so-called alginates, are excellent at creating an 'artificial feeling of fullness' in the stomach:
– Over a three-year period, we have studied the effect of taking different alginate doses. We are able to demonstrate that the healthy subjects who took alginates and were also allowed to eat as much as they wanted felt less hungry and ate less than the subjects not drinking fibre drinks with alginates, says PhD student Morten Georg Jensen, who arrived at the findings with his colleagues.
Gel fills up the stomach
The 12-week study included 96 overweight men and women. 48 subjects drank a specially designed drink with alginates three times daily before each main course as a supplement to an energy-reduced diet. The other 48 subjects drank a placebo drink without alginates.
Greater weight loss with alginates
The 80 subjects who completed the study achieved a far larger weight loss with alginate treatment than those drinking a similar drink without alginates.
On average, the subjects in the seaweed fibre drink group lost 1.7 kg more than those in the placebo group. According to the researchers, this weight loss is primarily due to a decrease in body fat percentage:
– A probable explanation of the weight loss is that the alginates form a gel in the stomach which strengthens the gastrointestinal satiety signals to the brain because the gel takes up space in the stomach. The overweight subjects thus ate less than usual, says PhD student Morten Georg Jensen.
Counterweight to junk food
The growing obesity epidemic requires research and the development of new dietary measures to counter the easy 24/7 access to enormous quantities of energy-rich food:
– Eating more than you burn results in a body energy imbalance, which may lead to weight gain in the long term. It is therefore crucial that new dietary measures improve appetite control and limit our food intake, says Morten Georg Jensen.
The researchers hope that the research findings may pave the way for new treatment options for the overweight. In collaboration with the biotech company S-biotek, the researchers have developed the special fibre drink with alginates which the subjects drank. No such fibre drink is as yet available on the market.
Primarily palm seaweed
Seaweed covers a wide range of marine macroalgae which can be classified into three groups: brown algae (Phaephycecae), green algae (Chlorophyta) and red algae (Rhodophyta). The researchers have studied fibres from brown algae, primarily palm seaweed.
Discordance among commercially-available diagnostics for latent TB infection
In populations with a low prevalence of tuberculosis (TB), the majority of positives with the three tests commercially available in the U.S for the diagnosis of TB are false positives, according to a new study.
"We compared commercially available tests for latent tuberculosis infection (LTBI) in a diverse population with a low LTBI prevalence," said James Mancuso, MD, DrPH, of the Walter Reed Army Institute of Research Preventive Medicine Residency Program. "Our results suggest that in low-prevalence populations, most positive results obtained with these tests are false positives."
The findings were published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
The cross-sectional study involved 2,017 military recruits at Fort Jackson, South Carolina, who completed a risk factor questionnaire and underwent testing with the 3 tests: 1) tuberculin skin test (TST), 2) the interferon gamma release assays (IGRAs) QuantiFERON®-TB Gold In-Tube test (QFT-GIT) and 3) the TSPOT® TB test (T-Spot). The Battey Skin Test (BST) was also administered to assess the impact of non-tuberculosis mycobacteria (NTM) reactivity on test discordance.
The specificities of TST, QFT-GIT, and T-Spot were not significantly different. Of 88 subjects with a positive test, 68 (77%) were positive to one test, 10 (11.4%) were positive to two tests, and only 10 (11.4%) were positive to all three tests. Bacille Calmette Guerin vaccination, tuberculosis prevalence in country of birth,and Battey skin test reaction size were associated with TST positive, IGRA negative test discordance, supporting evidence that NTM sensitization can cause false positive TST results. Greater quantitative test results and higher TB risk strata were associated with increased concordance between tests.
"Our data support a high proportion of false positives with any of these three tests in a low- prevalence population," added Dr. Mancuso, "as 77 percent of our subjects had positive results with only one test. Lower quantitative results were associated with a smaller risk for TB exposure and single positive tests, and lower risk for TB exposure was associated with decreasing test agreement."
There were some limitations to the study, including the lack of a gold standard for determining the presence of M. tuberculosis infection and administrative restrictions that resulted in an increased proportion of inadequate blood draws and TST reading times, which were slightly shorter than optimal.
"Low positive predictive value (PPV) is a well-known issue with the TST, and risk stratification is recommended to guide interpretation of the test," concluded Dr. Mancuso. "Our study suggests that risk stratification may also increase the PPV and reduce the number of false positives with the IGRAs. In accordance with the CDC's recommendation, people at minimal risk of TB infection should not be targeted for LTBI testing, regardless of which test is used."
Brief, high-intensity workouts show promise in helping diabetics lower blood sugar: Study
Researchers at McMaster University have found that brief high intensity workouts, as little as six sessions over two weeks, rapidly lower blood sugar levels in type 2 diabetics, offering a potential fix for patients who struggle to meet exercise guidelines.
The small proof-of-principle study, conducted on eight diabetics, appears in the latest edition of the Journal of Applied Physiology.
It found that a total of 30 minutes of high-intensity intermittent exercise per week, involving a total time commitment of 75 minutes, lowered 24-hour blood sugar concentrations, reduced blood sugar spikes after meals, and increased skeletal muscle mitochondrial capacity, a marker of metabolic health.
"These findings are intriguing because they suggest that exercising very strenuously for short periods of time, may provide many of the same health benefits as traditional exercise training," says Martin Gibala, professor in the Department of Kinesiology at McMaster and supervising author of the study. "This is the first study to show that intense interval training may be a potent, time-efficient strategy to improve glycemic regulation in people with type 2 diabetes."
Current guidelines from the Canadian Diabetes Association call for 150 minutes of moderate to vigorous exercise per week—twice the training time commitment of study participants—which can be tough to manage for many people including those with diabetes, adds Gibala.
He is quick to point out that larger studies are needed to comprehensively examine the potential benefits of this type of training, especially compared to traditional exercise guidelines.
For the study, researchers gave each volunteer a baseline exam to test blood sugar over a 24-hour period, assess fitness levels and take biopsies of thigh muscle to measure proteins linked to health status.
Each workout involved riding a stationary bike for 10 bouts of 60 seconds at roughly 90 percent of maximal heart rate, with one minute between each burst of exercise. The routine also included a warm up and cool down such that each training session lasted 25 minutes in total.
Participants showed improved blood sugar levels even though they did not lose weight during the short two-week study.
"The improved glycemic control may be linked to changes in the subjects' muscles, such as an improved ability to clear glucose from the blood after meals", says Gibala. "We need to conduct further research to identify the mechanisms behind these results."
Blue light irradiation promotes growth, increases antioxidants in lettuce seedlings
Treated seedlings are healthier, more vigorous after transplanting
IMAGE:This image shows morphology of red leaf lettuce plants treated with a white fluorescent lamp (FL), blue (B), red (R), and blue+red (BR) LED lights 17 days after sowing (DAS)….
ABIKO, JAPAN—The quality of agricultural seedlings is important to crop growth and yield after transplantation. Good quality seedlings exhibit characteristics such as thick stems, thick leaves, dark green leaves, and large white roots. Scientists have long known that plant development and physiology are strongly influenced by the light spectrum, which affects seedling structure. Raising seedlings irradiated with blue light has been shown to increase crop yield after planting because of the high accumulation of phenolic compounds. Although most studies with blue light only or blue mixed with red light have indicated that blue light-containing irradiation produces higher plant biomass, recent research has suggested that yield and crop quality could be improved by controlling light quality.
Researchers from Japan's Central Research Institute of Electric Power Industry premiered a study in HortScience that determined the effects of raising seedlings with different light spectra—such as with blue, red, and blue + red LED lights—on seedling quality and yield of red leaf lettuce plants. Photosynthetic pigments, polyphenols, and antioxidant activity of lettuce seedlings treated with different light spectra were also determined.
The team performed experiments in which pregerminated seeds of red leaf lettuce were subjected to various light treatments using blue and red light for one week. At the end of the light treatment (17 days after sowing), the leaf area and shoot fresh weight of the lettuce seedlings treated with red light increased by 33% and 25%, respectively, and the dry weight of the shoots and roots of the lettuce seedlings treated with blue-containing LED lights increased by greater than 29% and greater than 83% compared with seedlings grown under a white fluorescent lamp. The shoot/root ratio and specific leaf area of plants irradiated with blue-containing LED lights decreased.
At 45 days after sowing (DAS), higher leaf areas and shoot fresh weight were obtained in lettuce plants treated with blue-containing LED lights. "The total chlorophyll contents in lettuce plants treated with blue-containing and red lights were less than that of lettuce plants treated with florescent light; the chlorophyll a/b ratio and carotenoid content increased under blue-containing LED lights", the researchers wrote. Polyphenol contents and the total antioxidant status were greater in lettuce seedlings treated with blue-containing LED lights than in those treated with florescent light at 17 DAS.
The scientists concluded that raising seedlings treated with blue light promoted the growth of lettuce plants after transplanting. "This is likely because of high shoot and root biomasses, a high content of photosynthetic pigments, and high antioxidant activities in the lettuce seedlings before transplanting. The compact morphology of lettuce seedlings treated with blue LED light would be also useful for transplanting", noted corresponding author Kazuhiro Shoji.
Low iron levels in blood give clue to blood clot risk
People with low levels of iron in the blood have a higher risk of dangerous blood clots, according to research published in the journal Thorax today. A study of clotting risk factors in patients with an inherited blood vessel disease suggests that treating iron deficiency might be important for preventing potentially lethal blood clots.
Each year, one in every 1,000 people in the UK is affected by deep vein thrombosis – blood clots that form in the veins. These can cause pain and swelling, but can also be fatal if the clot is dislodged and travels into the blood vessels of the lungs. Although some risk factors for blood clots are recognised, such as major surgery, immobility and cancer, often there is no clear reason for the blood clot.
To look for new risk factors for blood clots, scientists at Imperial College London studied patients with hereditary haemorrhagic telangiectasia (HHT). HHT is an inherited disease of the blood vessels, the main symptoms of which are excessive bleeding from the nose and gut. Previous research by the same group had found that HHT patients have a higher risk of blood clots, but the reason for this was unclear.
"Most of our patients who had blood clots did not have any of the known risk factors ," said the paper's lead author Dr Claire Shovlin, from the National Heart and Lung Institute at Imperial College London and an honorary consultant at Imperial College Healthcare NHS Trust. "We thought that studying people with HHT might tell us something important about the wider population."
Dr Shovlin and her team analysed blood from 609 patients reviewed at the HHT clinic at Hammersmith Hospital from 1999 to 2011, to look for differences between the patients who had blood clots and those who did not. Many of the patients had low iron levels because of iron lost through bleeding. The researchers found that low levels of iron in the blood were a strong risk factor for blood clots. Patients who took iron supplements did not have higher risk, suggesting that treatment for iron deficiency can prevent blood clots.
"Our study shows that in people with HHT, low levels of iron in the blood is a potentially treatable risk factor for blood clots," Dr Shovlin said. "There are small studies in the general population which would support these findings, but more studies are needed to confirm this. If the finding does apply to the general population, it would have important implications in almost every area of medicine."
Iron deficiency anaemia is thought to affect at least 1 billion people worldwide. The association with blood clot risk might not have been found before because the iron levels demonstrating the link fluctuate during the day, and other markers of iron deficiency can be spuriously high if other medical conditions are present. Consistent timing of blood samples, as in this study, is therefore important for establishing correlations with health outcomes.
The link between iron levels and blood clots appears to be dependent on factor VIII – a blood protein which promotes normal clotting. High levels of factor VIII in the blood are also a strong risk factor for blood clots, and low iron levels were strongly associated with higher levels of factor VIII. The gene encoding factor VIII has sites where iron-binding proteins can bind, making it plausible that iron levels could regulate the factor VIII gene, and that this might be the mechanism for the link.
"We can speculate that in evolutionary terms, it might be advantageous to promote blood clotting when your blood is low in iron, in order to prevent further blood loss," Dr Shovlin said.
Study finds increasing atmospheric concentrations of new flame retardants
BLOOMINGTON, Ind. — Compounds used in new flame-retardant products are showing up in the environment at increasing concentrations, according to a recent study by researchers at Indiana University Bloomington.
The study, published in the journal Environmental Science & Technology, reports on concentrations of two compounds measured in atmospheric samples collected in the Great Lakes region between 2008 and 2010. Authors are doctoral student Yuning Ma, Assistant Research Scientist Marta Venier and Distinguished Professor Ronald A. Hites, all of the IU School of Public and Environmental Affairs.
The chemicals — 2-ethylhexyl tetrabromobenzoate, also known as TBB; and bis(2-ethylhexyl) tetrabromophthalate, or TBPH — are used to reduce flammability in such products as electronic devices, textiles, plastics, coatings and polyurethane foams.
They are included in commercial mixtures that were introduced in recent years to replace polybrominated diphenylethers (PBDEs), widely used flame retardants that have been or are being removed from the market because of their tendency to leak from products into the environment.
"We find that the environmental concentrations of these compounds are increasing rather rapidly," Hites said. "It's rare to find that concentrations of any compound are doubling within a year or two, which is what we're seeing with TBB and TBPH."
The researchers measured concentrations of TBB and TBPH in 507 air samples collected at six locations on the shores of the Great Lakes. The samples were collected by the Integrated Atmospheric Deposition Network, a joint U.S.-Canada project, conducted by IU researchers, to monitor airborne toxic chemicals that are deposited in the Great Lakes.
The results constitute the first self-consistent data set that shows environmental concentrations of TBB and TBPH increasing relatively rapidly. Previous studies have found the compounds in sewage sludge in California, marine mammals in Hong Kong and household dust and furniture foam in the U.S.
As would be expected, the IU researchers found the largest concentrations of TBB and TBPH in atmospheric samples collected in urban areas: Chicago and, especially, Cleveland. But the compounds were also detected in about half the samples from remote sites at Sleeping Bear Dunes and Eagle Harbor in Michigan and Point Petre in Ontario, Canada. They also were detected at rural Sturgeon Point, N.Y.
TBPH was detected more frequently and in higher concentrations than TBB. The concentrations are similar to those reported previously by Hites and Venier for PBDEs at the Great Lakes sites, suggesting the newer-generation flame retardants may be replacing their predecessors in the environment.
Outwit the Grim Reaper by walking faster
How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over
Men aged 70 and older can elude the Grim Reaper by walking at speeds of at least 3 miles (or 5km) an hour, finds a study in the Christmas issue published on bmj.com today.
The authors say that for the first time they have estimated the speed at which the Grim Reaper usually walked: about 1.8 miles per hour. He never walked faster than 3 miles per hour.
The Grim Reaper is a well known mythological and literary figure who personifies death. To assess his role in mortality and walking speed, a team of researchers based at Concord Hospital in Sydney, Australia analysed the walking patterns of 1,705 men aged 70 and over who were participating in The Concord Health and Ageing in Men Project (CHAMP).
The men lived in the inner city and suburbs of Sydney and they were recruited from January 2005 to June 2007. The CHAMP study included a high proportion of immigrants and only 50% of the participants were born in Australia, 20% were born in Italy and the other main countries of birth were Great Britain, Greece and China.
The researchers assessed participants' walking speed at baseline and survival over the five-year study period.
A total of 266 deaths were observed during the follow-up. The results show that their average walking speed was 0.88 metres per second (m/s). No men with walking speeds of 1.36 m/s (3 miles or 5km per hour) or above had contact with the Grim Reaper.
The authors conclude that the results support their theory "that faster speeds are protective against mortality because fast walkers can maintain a safe distance from the Grim Reaper."
Researchers identify phthalates in numeruous medicines and supplements
(Boston) –Researchers from Boston University's Slone Epidemiology Center (SEC), in collaboration with Harvard School of Public Health, have found numerous prescription and over-the-counter drugs and supplements use certain chemicals called phthalates as inactive ingredients in their products. The findings appear on-line in Environmental Health Perspectives.
Phthalates such as dibutyl phthalate (DBP) and diethyl phthalate (DEP) are used as inactive ingredients in FDA-approved medications where they may serve a variety of functions. Most commonly, they are used in the coating of a drug product to target the delivery of the active ingredients to a specific area of the gastrointestinal tract, or manage their release over time. Some phthalates, including DBP have been identified as causing adverse developmental and reproductive effects in laboratory animals. Limited human studies have suggested a possible association of DBP and DEP with male reproductive health outcomes.
Using a combination of resources, the researchers were able to identify over 100 drug and dietary supplement products that indicated they contained phthalates, including 50 prescription, 40 over-the-counter (OTC) and 26 dietary supplement products with labels that listed DEP or DBP, of which nine contained DBP. In addition, a large number of product labels listed phthalate polymers that are considered to be of little or no known toxicity but which are often used in combination with other phthalates.
"Given the thousands of orally-ingested products on the market (prescription, OTC and dietary supplements), it is difficult to know exactly how many contain phthalates. However, it is informative and important to identify the specific drug products that have included phthalates in their formulations," said lead author Kathy Kelley, MPH, RPh, a research pharmacist at BU's SEC.
According to the researchers, the potential health effects of human exposure to these phthalates through medications are unknown and warrant further investigation. "The present findings should assist researchers in conducting the necessary studies of potential risk of phthalates in human populations, but such efforts are limited by the lack of centralized, comprehensive, and publically-available information on the presence of phthalates in the full range of prescription, OTC and dietary supplement products," added Kelley.
The researchers recommend that future studies should pay particular attention to the amount of phthalate, specifically DBP, used in each dosage form so that estimates of exposure from medications and supplements can be quantified
New stats show America's heart health needs improvement
America's heart and blood vessel health is far from ideal, according to data in the American Heart Association's "Heart Disease and Stroke Statistical Update 2012," published in Circulation: Journal of the American Heart Association.
The update provides insight into our less than ideal cardiovascular health. For example, obesity continues to be a major problem for many Americans. More than 67 percent of U.S. adults and 31.7 percent of children are overweight or obese. Over the past 30 years, the prevalence of obesity in children has increased from 4 percent to more than 20 percent.
The American Heart Association defines ideal cardiovascular health based on seven health factors: smoking status, weight, physical activity, healthy diet, cholesterol, blood pressure and fasting glucose levels, as well as the absence of a diagnosis of heart or blood vessel disease.
Based on that definition, the new data shows that 94 percent of U.S. adults have at least one and 38 percent have at least three of the seven factors at "poor" levels. Half of U.S. children 12 to 19 years old meet four or fewer criteria for ideal cardiovascular health.
Between 1971 and 2004, our average calorie consumption has increased by 22 percent in women (from 1,542 to 1,886 kcal/d) and by 10 percent in men (from 2,450 to 2,693 kcal/d). Many of these increased calories come from consuming more carbohydrates, particularly starches, refined grains and sugars; larger portion sizes and calories per meal as well as consuming more sugar-sweetened beverages, snacks, commercially prepared meals (especially fast food) and high-calorie foods.
Burning those calories is also an increasing challenge – 33 percent of adults engage in no aerobic leisure-time physical activity. Furthermore, in 2009, among adolescents in grades nine through 12, 29.9 percent of girls and 17 percent of boys had not engaged in 60 minutes of moderate-to-vigorous physical activity — the recommended amount for good health — even once in the previous seven days.
There is some good news in the update — the death rate from cardiovascular diseases (CVD — all diseases of the heart and blood vessels) fell 30.6 percent from 1998 to 2008, possibly due to better treatments for heart attacks, congestive heart failure and other acute conditions.
The stroke death rate fell 34.8 percent during that time period, dropping it from the third to the fourth leading cause of death. While the drop in ranking is mostly driven by decreases in the number of stroke deaths, likely due to better treatment options for acute stroke, reclassifying some respiratory diseases into one category also played a role.
For example, deaths from chronic obstructive pulmonary disease (COPD), bronchitis and pneumonia are now grouped under the larger category, "respiratory diseases."
Unfortunately, other statistics in the update illustrate America's continued cardiovascular disease burden:
Cardiovascular diseases accounted for one in every three deaths in the United States in 2008; more than 2,200 Americans die of cardiovascular diseases every day ― an average of one death every 39 seconds.
The cost of cardiovascular care and treatment increased over $11 billion from 2007 to 2008.
The direct and indirect cost of CVD and stroke in the United State for 2008 was an estimated $297.7 billion.
"By monitoring health, as well as disease, the update provides information essential to public health initiatives, patient care and for people to take personal responsibility for their health ― and for their lives," said Véronique L. Roger, M.D, M.P.H., lead author of the update and professor of medicine and epidemiology at the Mayo Clinic College of Medicine in Rochester, Minn.
The American Heart Association has set a goal for America — to improve the cardiovascular health of all Americans by 20 percent and reduce deaths from cardiovascular diseases and stroke by 20 percent by 2020. "If we're to reach this goal, we'll need to engage every segment of the population to focus on improved health behaviors," said Donald Lloyd-Jones, M.D., an author of the statistical update and chair of the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine in Chicago.
"In particular, more children, adolescents and young adults will need to learn how to improve and preserve their ideal levels of health factors and health behaviors into older ages. Moving people who are at poor health to make small changes in their behavior and reach intermediate health is a step in the right direction that can make a big difference," said Lloyd-Jones.
These reports are done with the appreciation of all the Doctors, Scientist, and other
Medical Researchers who sacrificed their time and effort. In order to give people the
ability to empower themselves. Without the base aspirations for fame, or fortune. Just honorable people, doing honorable things.
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BMI's March edition of the Acoustic Lounge series boasted a provocative lineup of soul, folk and Latin-tinged artists poised for a breakthrough. The March 3 showcase, held at Genghis Cohen in Hollywood, featured singer/songwriters Nettie Rose, Ignacio Val, Duane' Neillson and Richard Harris. BMI's Acoustic Lounge takes place the first Monday of each month, is free and open to the public.


You are here: Manchester Confidential › Food & Drink › Seafood.
Written by Neil Sowerby. Published on January 22nd 2015.
WHEN was the last time you left a restaurant clutching a carrier bag containing six yellow-fin bream skeletons? Or indeed any combination of fish heads and bones, enough to make a huge vat of home stock? And all for free? I thought not. But when your hosts have been in the fishmongery trade for a century and a half they understand a fish lover's needs.
Excellent, friendly service and cooking that doesn't distract you from the main reason for being there – spanking fresh fish.
It helps when the restaurant is situated behind one of the Greater Manchester's best fish shops. Heaton Moor's Easy Fish Company may not have the high profile – or quite the range – of Out Of The Blue in Chorlton, but it is still a piscatorially inspirational spot to find in a suburban parade of shops. It was Steve Pilling, restaurateur and long-time customer of the Leving family's wholesale operation, who suggested they set up in retail in a dilapidated former Co-op next to his Damson restaurant.
They moved in four years ago, adding a simple cafe, which last September was transformed into the 30-cover Easy Fish Restaurant with a new kitchen team on board and, of course, access to the freshest fish out front, marshalled by son of the family Charlie. Without hesitation he scooped my gratis bagful out of the filleted bone bin and then cleaned me a gleaming squid (which I paid a modest sum for) to take home, too.
I was feeling as mellow as a rope-grown mussel by this point after an exceedingly fish-filled lunch, accompanied by a bottle of peachy-with-a-hint-of-salt single vineyard Finca de Arantei Albariño 2013. Half of it had gone by the time we'd slurped our oysters down. The temptation at just 12.5 per cent alcohol and £23 was to order a second bottle, but we resisted. We also resisted encore de huitres, which were a gorgeous gulp of the briny shallows.
Like the rest of the wine list, the Albarino, a perfect seafood white, is from Gatley-based Boutinot. All the wines are available from the shop (without the restaurant mark-up) alongside the fresh fish array and many other non-fishy North West products from the Cheshire Smokehouse to Great North Pies.
The Atlantic oysters came from further afield. We had three each for £4.95, with shallot and red wine vinegar and horseradish in creme fraiche to accompany. Oysters feature, too, on an attractive sounding £39.25 signature sharing platter that ticks most cold seafood boxes, while a whole grilled lobster will set you back £34.25, but we were keen to check out dishes on the list that really seemed to be pushing the boat out (sic).
Well, my companion's roasted Mediterranean fish soup with rouille-smeared toasts (£4.75) didn't really set sail. Substantial, a mite crabshell-driven, it was just OK. I landed luckier with my pan-seared Scallops starter (£8.95). The nutty little bivalves marry well with bacon or black pudding; here a less assertive meatiness came from a ballotine of roast chicken confit flavoured with garlic and lemon thyme. A tomato relish added a lovely sharpness.
This was accomplished cooking coming from a minnow-sized kitchen slotted in at the rear of a blue-painted, slightly four square dining area. More was to follow with our mains. We were never going to settle for a token steak or veggie Thai green curry with fish this good.
A tranche of exquisitely flaky roasted cod (£15.95, main image) came with an oniony red wine sauce and a smoked Applewood and bacon potato hash that was less in your face than expected. Similarly, the pan-fried sea bass (£15.25) accompaniment, chestnut and redcurrant spring roll, which my cynical companion suggested was using festive leftovers. It was quite superfluous; the dish got its oomph from a butternut and sage squash puree and slick of salsa verde.
All in all, though, specialist inland fish restaurants are as rare as a toothless shark. Livebait and Fish! made the attempt and failed in Manchester city centre. Out in Lancashire the growth of Jocelyn Neve's Seafood Pub Company empire has been a success story, in part due to canny sourcing by her dad, Fylde Coast legend Chris. I can't for the life of me see why the hit and miss Oyster and Otter near Blackburn scooped Lancashire Life's Restaurant of the Year in 2014, but I'm glad fish is being given its head.
And so to my big surprise in Heaton Moor. Excellent, friendly service and cooking that doesn't distract you from the main reason for being there – spanking fresh fish. Easy does it – as they say.
All scored reviews are unannounced, impartial, paid for by Confidential and completely independent of any commercial relationship.
The Easy Fish Restaurant, 117 Heaton Moor Road, Heaton Moor, SK4 4HY. 0161 442 0823.
I love Easyfish. A local gem. My tip would be to stick to the simple dishes on the menu, such as fish and chip plus the moules and frites. They are consistently fresh and always fantastic. Avoid the more complex dishes on the menu, as they often disappoint, with too many frills for my liking, distracting from the fish. In fact, I would love Easyfish to include, funnily enough, more fish on the menu. Especially simply dishes or classics, such as fish pie, fish cakes, kedgeree, fish curry, skate wings with capers etc...However those are minor gripes, as Easyfish is the best place I've found to eat fish in Greater Manchester.
Anyone know who is Head Chef here? Food looks great!
Steve green ex head chef at earle amongst others when i visited. Was very good.
Saffron shared this on Facebook on January 22nd 2015.
"Occasionally a writer places [sic] after his or her own words, to indicate that the language has been chosen deliberately for special effect, especially where the writer's ironic meaning may otherwise be unclear"
There's some right nitpicking nits on here!
Excellent wines, specials are always fantastic, not sure I have ever managed to get to dessert as starters and mains are so generous. Great food at sensible prices, carry on doing what you do...Best restaurant in Heaton's and gives Didsbury something to think about..
Manchester is in Lancashire you know.


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Home › I Love You Necklace Initial I Love You Sign Language Necklace Personalized Gifts
I Love You Necklace Initial I Love You Sign Language Necklace Personalized Gifts
17 / A - $17.00 USD 17 / B - $17.00 USD 17 / C - $17.00 USD 17 / D - $17.00 USD 17 / E - $17.00 USD 17 / F - $17.00 USD 17 / G - $17.00 USD 17 / H - $17.00 USD 17 / I - $17.00 USD 17 / J - $17.00 USD 17 / K - $17.00 USD 17 / L - $17.00 USD 17 / M - $17.00 USD 17 / N - $17.00 USD 17 / O - $17.00 USD 17 / P - $17.00 USD 17 / Q - $17.00 USD 17 / R - $17.00 USD 17 / S - $17.00 USD 17 / T - $17.00 USD 17 / U - $17.00 USD 17 / V - $17.00 USD 17 / W - $17.00 USD 17 / X - $17.00 USD 17 / Y - $17.00 USD 17 / Z - $17.00 USD 24 / A - $17.00 USD 24 / B - $17.00 USD 24 / C - $17.00 USD 24 / D - $17.00 USD 24 / E - $17.00 USD 24 / F - $17.00 USD 24 / G - $17.00 USD 24 / H - $17.00 USD 24 / I - $17.00 USD 24 / J - $17.00 USD 24 / K - $17.00 USD 24 / L - $17.00 USD 24 / M - $17.00 USD 24 / N - $17.00 USD 24 / O - $17.00 USD 24 / P - $17.00 USD 24 / Q - $17.00 USD 24 / R - $17.00 USD 24 / S - $17.00 USD 24 / T - $17.00 USD 24 / U - $17.00 USD 24 / V - $17.00 USD 24 / W - $17.00 USD 24 / X - $17.00 USD 24 / Y - $17.00 USD 24 / Z - $17.00 USD 28 / A - $17.00 USD 28 / B - $17.00 USD 28 / C - $17.00 USD 28 / D - $17.00 USD 28 / E - $17.00 USD 28 / F - $17.00 USD 28 / G - $17.00 USD 28 / H - $17.00 USD 28 / I - $17.00 USD 28 / J - $17.00 USD 28 / K - $17.00 USD 28 / L - $17.00 USD 28 / M - $17.00 USD 28 / N - $17.00 USD 28 / O - $17.00 USD 28 / P - $17.00 USD 28 / Q - $17.00 USD 28 / R - $17.00 USD 28 / S - $17.00 USD 28 / T - $17.00 USD 28 / U - $17.00 USD 28 / V - $17.00 USD 28 / W - $17.00 USD 28 / X - $17.00 USD 28 / Y - $17.00 USD 28 / Z - $17.00 USD
I love you skeleton hand, and initial necklace.
Skeleton hand I love you charm is 36mm(1 3/8") x 25mm(1")
Comes on thin brass curb chain.
Closes with A lobster claw clasp.
Choose the length, and initial you prefer during checkout.

redpajama_set_name: RedPajamaCommonCrawl


A study by Artprice finds that the Chinese art market is the largest in the world — but only in terms of auctions. The misleading news bite is telling in other ways, though. The Chinese domestic auction market is growing so quickly in part because Western auction houses like Christie's and Sotheby's have failed to dominate even while the Chinese collector community has grown hugely.
The reason that the standard international auction houses haven't been able to take full advantage of this growth is both because of Chinese government restrictions on the Western auction houses and difficulties adapting to the specifics of the Chinese market. The Chinese secondary market has the benefit of thousands of years of artifacts, treasures and art celebrities for auction fodder, and while contemporary art is popular in China, the work largely moves in the primary market, through commercial galleries.
This means a surplus of auction material and a downplaying of the market for living artists' work as compared to the Western markets (particularly in the US). The primary market wasn't counted in Artprice's study, and thus China comes out totally on top. It's looking like it'll stay that way too, as Chinese auction houses like China Guardian and Poly Auctions, the equivalents of Christie's and Sotheby's, gain domestic traction that will be hard to shake.
Local operators are also better suited to acting in China's admittedly harsh political climate. Take for an object lesson Christie's troubles in auctioning off one of the 18th century bronze fountain heads originally from Beijing's Summer Palace. Despite the fact that the auction house was selling the piece from the private collection of Yves Saint Laurent, Chinese buyers interfered with a sale that they felt was unjust and immoral — the piece should go back to China. Rest assured, China Guardian and Poly won't have the same problems.


I dragged myself out of bed well before dawn, blearily noting the silence outside my window. It seemed even the neighboring rooster, who'd spent more than an hour crowing the previous afternoon, was still asleep. I, however, had better things to do: this was my day to visit Angkor Wat.
was a good sport and agreed to pose for me.
After a hurried breakfast, I greeted Mr. Thorn, who'd picked me up at the Siem Reap airport the day before, hopped in the back of his tuk-tuk and off we went. I closed my eyes and breathed deeply as we tore down dirt roads in the dark. The pre-dawn air was lovely, the omnipresent Cambodian dust tamped down by an overnight rain and the sweltering heat of the Southeast Asian sun still an hour or two beyond the horizon.
The noisy confusion and fluorescent lights at the entrance to Angkor Archaeological Park jolted me halfway back to reality as I purchased my ticket, and I climbed back into the tuk-tuk a little more alert. I watched the fog that hovered above the surface of the moat running parallel to the road, guiding us toward the entrance to Angkor Wat itself as the nighttime shadows began to lift, nudged back by the first fingers of dawn creeping over the landscape.
break in the clouds over Angkor Wat.
Wading through the masses of tourists and salespeople, I eventually settled down on the steps of one of the libraries that flank the main causeway, watching light slowly seep into the sky around Angkor's unmistakable triple silhouette. A bank of clouds from the night's rain lingered, hovering above and behind the temple, and it quickly became apparent that it wasn't going to clear before the sun was well into the sky. The photographers around me grumbled about missing a typically stunning Angkor Wat sunrise but I was oddly unperturbed, content to absorb the feeling of being nearly 9,000 miles from home, standing in the midst of a complex ordered built by a 12th-century king.
As the sun crept higher in the sky and deeper into the cloud bank, I made my way into the enclosure around the temple itself, marveling at the beauty of the bas-relief devatas guarding it and their apsara cousins, seemingly poised to begin a dance. After a climb up dauntingly steep steps with a railing so rickety I felt safer not holding onto it, I wandered one of the towers as the sun burned through the remaining clouds, sending hazy light spreading over the city surrounding the temple as sunbeams found their way through gaps in the sandstone to dance over the carvings lining the tower corridors.
A trio of apsaras at the base of one of the towers, with another tower at left.
Sunlight slowly seeping into the tower corridors.
The view over one of the tower balconies, with the Angkor balloon just visible among the treetops.
I could happily have spent all morning in that one small corner of the 150-some-odd square mile complex that is the archaeological park, but I eventually pulled myself away to find Mr. Thorn and make our way to Angkor Thom and the Bayon.
The Bayon was perhaps my favorite of the sites I visited at Angkor, although it was also the most crowded. The serene smiles of the huge faces carved into the stone make for a peaceful setting, and I curled up in as quiet a spot as I could find to write some postcards before moving onto Angkor Thom city itself.
The Terrace of the Elephants, the South Gate entrance and parts of the Preah Pithu Group aside, Angkor Thom city itself was my least favorite part of the day and didn't have as much of an impact on me as the other sites I visited, but I'm still glad I took some time to wander through one of the major sites in the archaeological park.
One of the Bayon's many face towers.
My favorite of the face towers - I wrote my postcards sitting near this guy.
When I arrived at Ta Prohm, the last site I visited, I felt as if I had stepped into some sort of Eden. The shade from the surrounding jungle and the cool morning air retained by the stone protected most of the complex from the sweltering midday heat. Despite being another of Angkor's most popular sites and full of camera-wielding tourists, Ta Prohm seemed to instill a sense of awe in most of its visitors and the hush that filled the temple was a welcome change from the chaos of Angkor Thom. With its crumbling corridors and overgrown doorways, it was easy to wander Ta Prohm wrapped in a sense of solitude, absorbing the feeling of peace that seemed to float through the air. As I climbed back into Mr. Thorn's tuk-tuk, I faced backward to watch first the temple and then the jungle treetops for as long as I could before turning around to watch the dusty road as we headed back to the vibrant, noisy reality of Siem Reap.
The last photo I got before my camera battery died, taken by a kind French couple who waited for or asked numerous other tourists to step out of one side or the other of the frame to get the perfect shot.
N.B.: My camera battery gave up its battle with the Cambodian heat not long after I arrived at the Bayon, which is why there are no photos of Angkor Thom city or Ta Prohm. (Advice: take a spare or two! This was the only place on my Thailand-Cambodia trip that I could have used one.) I was a little disappointed not to be able to photograph Ta Prohm for myself, but there's no lack of stunning photos of nearly every part of Angkor Archaeological Park available in books, prints and online. One thing that surprised me a little was the lack of English-speaking tourists, at least that I heard. The few fellow tourists I spoke with, either to take their photo or ask them to take mine, were French-speaking, although most tourists I encountered in nearby Siem Reap were native English speakers.
While planning this trip, I debated for a long time over whether or not to include this small piece of Cambodia and Angkor Wat on my itinerary, since it meant a harried beginning to my trip, but I'm very glad I decided to go. Thai temples are lovely, but I got a lot more out of my day among the stones at Angkor than I did my afternoon amidst the opulence of Bangkok's Wat Phra Kaew.
of keeping Bangkok predictably hot and sticky.
I am not a hot weather person. Growing up in the temperate climate of Southern California, I was spoiled by summers that maxed out at about 27ºC and winters where temperatures of less than 10ºC were shocking. After an uncomfortable season or two on the U.S.' East Coast in college, I adapted to winters involving below-freezing temperatures without much trouble. I even, to some degree, learned to enjoy the cold that made spring seem all the sweeter once it finally arrived. Extreme heat, however, I stayed as far away from as possible. If I had a choice between bundling into a coat and baking in a tank top, I'd almost always choose the former - or the latter with a heavy dose of air-conditioning.
So while planning my April jaunt to Southeast Asia earlier this year, I expected to be pretty darn uncomfortable throughout the majority of my trip. April is the region's hottest month, meaning there are few places where the high is likely to be below 30ºC (or, really, more like 33°) and nighttime lows don't bring much relief.
By the time I got into the taxi that would take me to my hostel near Siam Square, every inch of my skin was coated with a fine sheen of sweat that felt like it had been there since the day I was born. I walked into my hostel room and whimpered when I saw the request not to set the thermostat any lower than 23ºC - as hot as I was, 20º sounded like it might, possibly, after several hours, be cool enough. But I'd come to Southeast Asia wanting to experience it as it is (as much as possible for a blonde-haired, blue-eyed farang), so I set the thermostat for the prescribed 23º and eventually cooled off enough to fall asleep.
Several days later I had crossed the border into Cambodia, where the intensity of the sun made Bangkok look like a nice, shady park in comparison. To me, Siem Reap didn't feel as sticky as Bangkok had, but it was several degrees hotter and lacked Bangkok's thick smog to cut the beating of the sun's rays. The clearest indication of the difference came during my one and only day at Angkor Wat. Throughout my time in Thailand, as long as I charged my camera battery each night, I didn't have a problem; in Cambodia, the heat was so intense that my battery started sputtering three hours after I arrived at Angkor and died less than an hour after that. (Angkor Wat tip: Take extra camera batteries!) I spent the little time I had in Siem Reap sweaty and flushed, but - just like in Bangkok - didn't really care.
After Siem Reap, I headed back into Thailand, this time North to Chiang Mai, where the first day of Songkran was winding down as I arrived. For those of you who are unfamiliar with your Theravada Buddhist holidays, Songkran is the Thai festival that celebrates the Lunar New Year in mid-April. The rituals surrounding the New Year have to do with the bathing of living spaces, Buddha images and monks and making merit or paying tribute to elders...but for all intents and purposes, what it's really become is a nation-wide water fight lasting from one to three days (or more!), depending on where you are. And, as most of the travel blogosphere will tell you, Chiang Mai is the place to be for Songkran.
One thing I did notice about my reaction to the heat while I was in Chiang Mai was that I was no longer wishing I could set the air-conditioning down to 20°, as I had that first night in Bangkok. In fact, I often found myself setting it at 25°, or even shutting it off altogether. The same was true when I reached Koh Lanta, one of the Southern islands on the Andaman Sea side. The humidity there was especially brutal, so I kept the air-conditioning on at night to cut through it and set the fan on low to keep the air moving around the bed and blow the few mosquitoes that found their way into my bungalow away, but I found myself setting the thermostat to 25° or higher and still needing to bundle into my sweater to sleep. What was happening to me?!
Back in Sydney, I arrived toward the end of April to find that it had been raining for a week and would continue for most of the next. It wasn't particularly cold, but I was freezing. I wore layers of sweats and two pairs of socks. I huddled in bed at night, shivering until I warmed up enough to fall asleep. I drank copious amounts of tea and coffee, clutching at the mug until every remnant of warmth had faded. When the temperature dropped to 15° at night - a temperature I had greeted with a sigh of relief in Tasmania when my visit coincided with Sydney's 40°+ February heat wave - I whimpered and briefly considered adding a third pair of socks. After a month of this, I decided it was official: Thailand and Cambodia had smashed my internal thermostat to pieces. In two weeks of steamy weather, Southeast Asia had not only overridden my lifelong aversion to temperatures above 24° degrees, it had me longing for them.
While I've gotten a bit better in the three months since my return (read: I don't start staring wistfully at the heater until it drops to 22°, rather than 25°), I still find myself craving heat at temperatures I used to think were ideal and sighing in relief when I step into the bright Sydney sun, rather than looking for a patch of shade. I imagine that I'll continue to shift back toward "normal" until I'm once again grumbling at 30° temperatures, but it may be a while. Or maybe I should just head back to Thailand or Siem Reap...at this point, I'm getting kind of sick of wearing two pairs of socks.


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How scorpio deals with lost love
Scorpio Behavior When in Love!
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They become this standard you compare everyone else too. Most the time everyone else falls short. Kirsten is the author of But Before You Leave , a book of poetry about the experiences we struggle to put into words. Do not make it contingent on their acceptance of you or their feelings for you.
All that matters is that you are happy with the person you are becoming. All that matters is that you like yourself, that you are proud of what you are putting out into the world.
BREAKUPS AND SCORPIO
You are in charge of your joy, of your worth. You get to be your own validation.
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Traits of a Scorpio Man in Love and the Dos and Don'ts of Dating Him.
Scorpio's Behavior Is Influenced by an Emotional Nature.
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Here's How Your Ex Deals With Your Breakup, Based On Their Zodiac Sign | Thought Catalog.
Scorpio Behavior When in Love | LoveToKnow?
Breakups and Scorpio.
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Scorpio in Love
They can be both the center of attention at a party and very introverted behind closed doors. They know deception hurts more. Aries is attracted to Scorpio with a passion they can't quite understand, mostly because it's lasting, and Aries' isn't used to feeling enthusiastic about a partner for more than a few days OK, months? That's being generous.
Aries & Scorpio Relationship Is Tumultuous & Intriguing, So Good Luck
So what is it that makes them stay for Scorpio? Is it that Scorpio stare, or the way they can't quite figure out what's going on behind those deep, dark eyes? Well, it's all of that, but there's a lot more to it. To really understand the attraction, you have to look at a few underlying factors. Aries is ruled by Mars, the planet of the warrior and of physical strength.
Scorpio is ruled by Pluto, the planet of power, and of physical impulse.
Both of these planets have a lot of force behind them, but because Mars is overt and Pluto is subdued, the interplay is tricky as hell. Mars goes directly after what it wants. It's opinionated, it's extroverted, and it's direct.
Zodiac Signs That Make Perfect Couples
Pluto goes after what it wants by digging for information, by discovering what the object of their affection desires, and by promising them that, not directly, but through subtle psychological warfare. When an Aries goes after a Scorpio, they don't realize that they're playing the same game, but by two completely different sets of rules.
They'll know that a Scorpio wants them, but they won't understand why it's taking them so long, and being that they love to dominate a scenario, it'll drive them insane that with all their brute force, someone else seems to have all the power to actually make something happen.
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Scorpio is one of the most profound and mysterious signs of the zodiac, and a They want to immerse and lose themselves in that love, drown in it, and be.
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