Richest and poorest people in Toronto hospitalized for different reasons

Researchers who examined the income levels of patients at central Toronto hospitals found that people in the highest and lowest income brackets are being hospitalized for different reasons and that different hospitals serve different income groups.

More wealthy patients received same-day surgeries than low-income patients. In contrast, more low-income patients were hospitalized for mental health issues, visited emergency departments for non-urgent issues and remained in acute care hospital beds while waiting to be transferred to more appropriate levels of care in the community such as nursing homes.

This report will enable many Toronto hospitals and health care stakeholders to see the socioeconomic profile of patients for the first time, said Dr. Rick Glazier, one of the lead authors of the study.

Once they have that information, they can see whether patient outcomes are linked to incomes, he said. This also gives them the opportunity to tailor care to the needs of their current patient population and to work with others to plan health services appropriate for the community.

"We want a universal health care system that helps everyone be healthy, regardless of how much money they earn," said Dr. Glazier, a researcher at the Centre for Research on Inner City Health at St. Michael's Hospital and a senior scientist at the Institute for Clinical Evaluative Sciences. "But until we actually look at social differences among patients, it's impossible to say if hospital care is equitable or if hospitals have the proper resources to respond to the patients they serve."

Dr. Glazier said the statistics point to the social causes of disease and strains on the health system.

"Very low-income people are using the parts of the health care system that are in greatest crisis," he said. "It's all the more reason to think broadly about what keeps people healthy in the first place. What health supports do wealthy groups enjoy that those with lower incomes lack? Access to primary health care, the ability to pay for healthy foods and medicines and to live in a healthy place where you can receive home care if you need it? We think that addressing upstream areas like these will likely make an impact on hospital use."

The researchers examined data on all patients admitted between 2008 and 2010 to 20 hospitals in the Toronto Central Local Health Integration Network.

They found hospitals fell into three categories: those, including St. Michael's, who treat high-income and low-income patients in the same numbers; those who treat mainly low-income patients; and those who treat mainly high-income patients. In all of the hospitals surveyed, middle-income patients were served the least.

Among their other findings: 

• In almost every hospital, surgical patients had higher incomes than medical patients
• More wealthy patients than poor patients had day surgery.
• More low-income patients than high-income patients were admitted for mental health services at almost every hospital
• Patients designated as waiting for "alternate level of care," meaning they occupy an acute hospital bed but do not require the intensity of resources or services provided in that setting, were more likely to have low incomes than high incomes. In most of the hospitals, ALC patients had lower incomes than the hospital's overall patient population
• Overall, more low-income patients visited emergency departments than high-income patients for non-urgent reasons

Provided by St. Michael's Hospital

"Richest and poorest people in Toronto hospitalized for different reasons." June 4th, 2012.http://medicalxpress.com/news/2012-06-richest-poorest-people-toronto-hospitalized.html

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Robert Karl Stonjek

Genetics, rapid childhood growth and the development of obesity

A 38-year longitudinal study of New Zealanders suggests that individuals with higher genetic risk scores were more likely to be chronically obese in adulthood, according to a report published in the June issue of Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

Obesity is capable of being inherited and genome-wide association studies (GWASs) have started to uncover the molecular roots of heritability by identifying multiple single-nucleotide polymorphisms (SNPs) associated with higher adult body mass index (BMI), the authors write in their study background.

"In this study, we asked how SNPs with replicated GWAS evidence for association with adult BMI relate to growth across the first four decades of life and to adult obesity in a birth cohort followed up prospectively from birth through 38 years of age," Daniel W. Belsky, Ph.D., of Duke University, Durham, N.C., and colleagues write in the study background.

Study participants were members of the Dunedin Multidisciplinary Health and Development Study, an investigation of health and behavior in a complete birth cohort. The 1,037 study members (52 percent were male) were born between April 1972 and March 1973 in Dunedin, New Zealand. Assessments were performed every few years starting at birth until 38 years.

Children with higher genetic risk scores (GRSs) had higher BMIs at every age assessed from age 3 through 38 years. Children at high genetic risk were 1.61 to 2.41 times more likely to be obese in their second, third and fourth decades of life and were 1.90 times more likely to be chronically obese across more than three assessments compared with children at low genetic risk, according to study results.

Adiposity rebound, when children begin to gain body fat after losing it during early childhood, occurred earlier in development and at higher BMI for children at higher genetic risk, the results indicate.

Higher genetic risk also predicted faster growth and increased obesity risk in children with normal-weight and overweight parents, the study results note. The authors comment that the GRS contributed "independent and additive information" to the prediction of children's growth and their risk for obesity in adulthood beyond the family history information.

"Thus, the results present compelling evidence that SNPs identified in GWASs of adult BMI and other obesity-related phenotypes predispose to more rapid growth in childhood, leading to increased risk for obesity in adulthood, and provide information not forthcoming from a simple analysis of family history," the authors conclude.

In an editorial, Jose R. Fernandez, Ph.D., of the University of Alabama at Birmingham, writes: "This study provides clear evidence regarding the role of biological risk attributed to the development of obesity and suggests that genetic risk for obesity affects fat accumulation through accelerated growth in early childhood."

Fernandez continues: "Further insights and implications of the study, however, cause concern as much as they fascinate. Given that the associations identified were independent of parental body mass index, the findings from Belsky et al may imply a degree of genetic determinism that challenges overall public health recommendations worldwide in a simple question: What about the role of the environment across the life span?"

"Attempting to translate the findings from Belsky and colleagues to clinical practice would be naïve at this point when more research is clearly needed to fully understand the genetic basis of many complex traits. ... Until we know more, and perhaps after we know more, preventive behaviors should be each individual's priority so that we all achieve the best health possible regardless of genetic profiles. Without taking this approach, we might risk the mistake of allowing genetic predisposition to become genetic determinism," Fernandez concludes.

More information: Arch Pediatr Adolesc Med. 2012;166[6]:515-521. 
Arch Pediatr Adolesc Med. 2012;166[6]:576-577. 

Provided by JAMA and Archives Journals

"Genetics, rapid childhood growth and the development of obesity." June 4th, 2012.http://medicalxpress.com/news/2012-06-genetics-rapid-childhood-growth-obesity.html

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Robert Karl Stonjek

Japan 'diet glasses' fool wearers into eating less

Goggles that trick the wearer into thinking the plain snack in their hand is a chocolate cookie, or make biscuits appear larger have been unveiled in Japan, offering hope to weak-willed dieters everywhere.

Researchers at the University of Tokyo have developed devices that use computer wizardry and augmented reality to fool the senses and make users feel more satisfied with smaller -- or less appealing -- treats.

On one device goggle-mounted cameras send images to a computer, which magnifies the apparent size of the cookie in the image it displays to the wearer while keeping his hand the same size, making the snack appear larger than it actually is.

In experiments, volunteers consumed nearly 10 percent less when the biscuits they were eating appeared 50 percent bigger.

They ate 15 percent more when cookies were manipulated to look two-thirds of their real size.

Professor Michitaka Hirose at the university's graduate school of information science and technology said he was interested in how computers can be used to trick the human mind.

"How to fool various senses or how to build on them using computers is very important in the study of virtual reality," he told AFP.

Hirose said standard virtual reality equipment that attempts to cater to complex senses like touch often results in bulky equipment.

But he said using one or more senses to fool the others was a way around this problem.

"Reality is in your mind," he said.

In another project, Hirose's team developed a "meta cookie", where the headgear uses scent bottles and visual trickery to fool the wearer into thinking the snack they are eating is anything but a plain biscuit.

Users can set the device to their favourite taste so they think they are eating a chocolate or strawberry-flavoured cookie.

Hirose says experiments so far have shown 80 percent of subjects are fooled.

The team has no plans as yet to commercialise their invention, but would like to investigate whether people wanting to lose weight can use the device.

(c) 2012 AFP

"Japan 'diet glasses' fool wearers into eating less." June 4th, 2012.http://phys.org/news/2012-06-japan-diet-glasses-wearers.html

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Robert Karl Stonjek