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People over 40 with type 1 diabetes and COVID-19 are more likely to be hospitalized

People with diabetes are at higher risk for COVID-19-related complications, especially if they are over the age of 40.

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Adults with type 1 diabetes need to be extra cautious of COVID-19 as they are more likely to be hospitalized and die, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

People with diabetes are at higher risk for COVID-19-related complications, especially if they are over the age of 40. Children with COVID-19 rarely develop severe respiratory symptoms and often remain asymptomatic. In contrast, adults experience respiratory symptoms of varying severity, with older adults and those with diabetes at higher risk of acute respiratory distress syndrome and death.

“Our study shows people over 40 with type 1 diabetes have worse outcomes from COVID-19 than children and young adults. Children and young adults experienced milder disease and a better prognosis,” said Carla Demeterco-Berggren, M.D., Ph.D., of the University of California San Diego in San Diego, Calif. “These findings indicate the need for age-tailored treatments, immunization and clinical management of individuals affected by type 1 diabetes and COVID-19. Public health recommendations, including wearing masks and getting vaccinated, need to be followed by all to reduce the risk of contracting COVID-19.”

The researchers studied data from 767 patients with COVID-19 and type 1 diabetes from 56 diabetes clinics across the U.S. Fifty-four percent were 18 or younger, 32% were 19-40 years old and 14% were over 40. The study found patients over 40 were seven times more likely to be hospitalized with COVID-19 compared to the younger group. No patients from the 18 and under group died, while three died from the over 40 age group and two died from the 19-40 age group.

People with diabetes and COVID-19 who were 40 and older were more likely to experience adverse outcomes such as death, diabetic ketoacidosis or severe hypoglycemia. This group also had a significantly higher prevalence of obesity, hypertension or cardiovascular disease and chronic kidney disease when compared to the younger groups.

“The goal of our study is to prevent poor COVID-19 outcomes for adults with type 1 diabetes and to highlight the need to base health care decisions on data as the COVID-19 pandemic evolves,” said Demeterco-Berggren.

Other authors of the study include: Osagie Ebekozien of the T1D Exchange in Boston, Mass. and the University of Mississippi School Medical Center in Jackson, Miss.; Saketh Rompicherla of the T1D Exchange; Laura Jacobsen of the University of Florida in Gainesville, Fla.; Siham Accacha and Mary Pat Gallagher of NYU Langone in New York, N.Y.; Todd Alonso of the University of Colorado in Aurora, Colo.; Berhane Seyoum of Wayne State University in Detroit, Mich.; Francesco Vendrame of the University of Miami in Miami, Fla.; Sonya Haw of Grady Hospital in Atlanta, Ga.; Marina Basina and David M. Maahs of Stanford University in Stanford, Calif.; and Carol J. Levy of the Icahn School of Medicine at Mount Sinai in New York, N.Y.

The manuscript, “Age and Hospitalization Risk in People with Type 1 Diabetes and COVID-19: Data from the T1D Exchange Surveillance Study,” was published online, ahead of print.

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Telling people they might lose motivates more than telling them they might win, research shows

How managers choose to frame problems directly influences employees’ motivation to speak up at work. For managers, this is an insightful approach for building more open and collaborative teams.

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Athletes say they hate to lose more than they love to win. New research finds the same sentiment is shared in organizations.

A Virginia Tech researcher and his colleagues discovered that when managers frame work problems as a potential loss, employees are more likely to take action than when those problems are framed as potential gains. The research also revealed that when the potential loss impacts a larger group, employees are more likely to take action in the form of speaking up to a supervisor in hopes of finding a solution. The findings were recently published in the Journal of Applied Psychology.

For managers, this research suggests that framing work problems as potential losses can influence employees to speak up more.

“Employee voice occurs when suggestions are made to improve organizational functioning,” said Phil Thompson, associate professor in the Pamplin College of Business Department of Management. “From an organizational perspective, the positive outcomes of employee voice include improved performance, effectiveness, and workplace safety. From an employee level, speaking up is positively related to creativity, innovation, engagement, and ethical behavior.”

At its core, this research shows that how managers choose to frame problems directly influences employees’ motivation to speak up at work. For managers, this is an insightful approach for building more open and collaborative teams.

“When managers say, ‘If we don’t get this done, not only will you lose the $5,000 bonus, but everybody in this work group is going to lose a $5,000 bonus,’ it magnifies an employee’s motivation to act in a proactive way,” said Thompson. “This suggests that framing work problems as what will be collectively lost – compared to what can be individually lost – makes employees want to speak up more.”

Thompson was part of a research team led by Jeffery Thomas and Jonathan Booth from The London School of Economics and Mark Bolino from Oklahoma University. Together they analyzed responses from nearly 2,000 full-time employees, MBA students, and employee-supervisor pairs for their experience in situations where work problems were framed as either a gain or a loss. Across three different studies, framing something as a loss yielded employees to voice a work suggestion more.

For example, a manager dealing with a reputational crisis of their team, such as a product quality issue, can frame the problem in a way to spark helpful employee suggestions on how to resolve the issue. For example, instead of saying “if this product has great quality, our company will look really good” a manager saying “if this product is not up to quality standards, our reputation will be damaged” carries more weight for the team. When this reputational risk is shared by everyone, employees are more willing to step forward to help the problem.

In the first study, participants were asked to think about a problem at work that was significant for them. From there, they were randomly assigned to write about the potential losses or gains from that problem. They were also asked to indicate how likely they were to talk about these problems to their supervisor. Participants who reflected on their potential losses showed a 16 percent higher willingness to speak up compared to those who focused on the potential gains.

When it came to the MBA students, they read a fictional performance review scenario where a workplace problem was described. They then rated how willing they would be to speak up about that scenario if they were in the situation. One example suggested that the entire team might fall short of its goals if an issue was not addressed. This specific scenario yielded the most likelihood of speaking up 35 percent more than the scenario’s suggesting that only they would miss their goal, supporting the research’s findings that an employee is more likely to speak up when the loss impacts more people.

The third study looked at employee-supervisor pairings to understand how these relationships play out in the real world. Using pairings from across three industries, employees reported a workplace problem they encountered and their supervisor rated how often that employee spoke up on the job. While the first two studies involved hypothetical scenarios, this real-world evidence showed that employees were 8-10 times more likely to speak up when issues were framed as a potential collective loss compared with a potential collective gain. 

“This research is really geared toward managers so they can facilitate and understand how and why their employees will speak up,” said Thompson. “You can talk about the issue, but it always ends in terms of how we frame things.” 

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Yoga practice could reduce blood pressure in people with obesity

People who practiced yoga had a significant decrease in blood pressure, with systolic blood pressure lowered by an average of 4.35 mmHg and diastolic blood pressure by 2.06 mmHg.

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Practicing yoga could help people with overweight or obesity improve their cardiometabolic health, according to a study in the open-access journal PLOS Global Public Health by Widya Wasityastuti from the University of Edinburgh, Scotland, and colleagues.

Yoga is a popular form of exercise around the world, and is a gentle and accessible form of exercise for many people. To better understand the potential health benefits of yoga, the authors of this study performed a meta-analysis, examining 30 studies of yoga for its cardiometabolic benefits. They focused on studies which examined outcomes for blood pressure, lipid profiles, glucose homeostasis, markers of inflammation, and measures of antioxidants, and those which examined people with body-mass index over 23 for Asian countries, and 25 for other countries, indicating that participants had overweight or obesity. Of the 30 studies considered, 23 were conducted in Asian countries, while the remaining studies were from the United States, Germany, and Australia.

Across the 30 studies and a total of 2,689 participants, the authors found that people who practiced yoga had a significant decrease in blood pressure, with systolic blood pressure lowered by an average of 4.35 mmHg and diastolic blood pressure by 2.06 mmHg. They also found modest beneficial effects on low- and high-density lipoproteins, types of cholesterol that have been linked to an increased risk of stroke. 

The authors note that the studies analyzed were not specifically recruiting people with obesity, and there was no dose-response measured, so it is unknown how much yoga is needed to produce these effects, though the studies they analyzed favored practice of at least 180 minutes per week.

The studies also focused heavily on Asian participants, and practitioners with comorbidities were excluded from analysis. Finally, it’s important to note that due to the nature of this study, causality cannot be confirmed here despite the correlations found.

Further studies will be needed to understand whether yoga can provide similar benefits to other populations, as well as people with co-morbidities such as diabetes or heart disease.

The authors suggest that while more high-quality trials are needed, the meta-analysis supports potential benefits of yoga for cardiometabolic health in people with overweight and obesity.

The authors summarize: “Our review suggests that yoga may offer a helpful additional option for improving some aspects of cardiometabolic health in adults with overweight or obesity, particularly blood pressure.”

They add: “Yoga is often seen mainly as a wellbeing practice, but our findings suggest it may also support certain cardiometabolic health outcomes in adults with overweight or obesity.”

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Stress, BMI, and hormones linked to earlier puberty in girls

Higher levels of key steroid hormones—combined with elevated stress and body mass index (BMI)—are associated with earlier onset of puberty in girls.

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Higher levels of key steroid hormones—combined with elevated stress and body mass index (BMI)—are associated with earlier onset of puberty in girls, according to a new study at Columbia University Mailman School of Public Health.

The findings are published in The Journal of Clinical Endocrinology & Metabolism.

 Elevated prepuberty urinary levels of glucocorticoids, androgens, and progesterone were strongly linked to accelerated breast development (thelarche). Girls with high glucocorticoid levels alongside high BMI and stress entered puberty an average of seven months earlier than peers with lower levels.

“While stress and BMI have long been recognized as independent predictors of puberty, few studies have examined how they interact with a girl’s hormones,” said Lauren Houghton, PhD, assistant professor of Epidemiology at Columbia Mailman School, and first author. “Our findings challenge conventional research that has largely focused on estrogen and body size, highlighting instead the role of stress and androgens – typically thought of as male hormones– in shaping pubescent development.”

The strongest associations were observed for progesterone, androgens, and glucocorticoids, indicating that multiple hormonal pathways—not just estrogen—play a critical role in the timing of puberty.

For example:

  • Higher glucocorticoid, androgen, and progesterone metabolites were associated with earlier onset of puberty
  • Elevated androgens and progesterone were also linked to a longer duration of puberty
  • Estrogen metabolites were associated with delayed onset, not acceleration
  • The effects of hormones on puberty timing were significantly modified by BMI and stress levels.

 Notably, the associations were consistent regardless of family history of breast cancer.

“Our objective was to identify the full set of hormonal patterns linked to accelerated puberty and test whether BMI and stress modify this relationship,” said Houghton, who is also assistant professor at the Herbert Irving Comprehensive Cancer Center at Columbia. “We predicted that girls with elevated BMI and stress would experience the earliest onset—and that the stress response shifts during this key time for girls.”

The researchers drew on data from the LEGACY Girls Study, a cohort of 1,040 girls ages 6 to 13 recruited across the U.S. States and Canada. Participants were followed every six months with clinical assessments, questionnaires, and biospecimen collection.

The analysis included 327 girls who were at the pre-puberty stage at baseline and provided urine samples at least one year before the onset of puberty. Houghton and colleagues measured a comprehensive panel of steroid metabolites using first-morning urine samples and tracked puberty development using validated clinical scales.

Mothers of the girls completed an Internalizing Composite Scale, which includes subscales for anxiety, depression, and other at-risk status. They also provided information on girls’ family history of all cancers as well as on pregnancy and infancy, including birth weight and their child’s race and ethnicity. Trained research staff measured height and weight twice every 6 months. 

“Unlike prior research, this study simultaneously examined hormonal patterns, BMI, and psychosocial stress—captured through standardized behavioral assessments—within the same cohort,” said senior author Mary Beth Terry, PhD, professor of Epidemiology at Columbia Mailman School, and the Herbert Irving Cancer Center, and Silent Spring Institute.  “Interestingly, we also learned that the associations were consistent regardless of family history of breast cancer.”

The findings may help explain the ongoing trend toward earlier puberty and point to actionable prevention strategies, observed the authors.

 “Stress-reducing interventions and healthy lifestyle changes may help delay early puberty and improve long-term health outcomes,” said Houghton. ‘Because early puberty is linked to increased breast cancer risk later in life, the results have important implications for both pediatric care and public health.”

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