Health Tip: If Your Child is Cyberbullied

In this age of social media, parents should be prepared to help kids through episodes of cyberbullying.

The U.S. Federal Trade Commission suggests:

Stay calm and avoid getting angry. Teach your child to ignore the bully and not to respond with more bullying.
Save all messages that show cyberbullying. If it continues, take the evidence to police.
Making sure your child's profile is the one he or she created. If the profile was created by someone your child doesn't know, have the site administrators remove it.

Block the bully's phone number or email address, or delete the bully from a friends list that allows contact.

Researchers reveal how cancer can spread even before a tumor develops

Even before tumors develop, breast cancer cells with a few defined molecular alterations can spread to organs, remain quiet for long periods of time, and then awaken to form aggressive, deadly breast cancer metastasis, says a team of investigators led by researchers at Icahn School of Medicine at Mount Sinai and the University of Regensburg in Germany.

They say their finding, published in two papers in the journal Nature, and conducted in animal models and tested in human samples, now solves the mystery of how breast cancer metastasis forms without a primary tumor in this new model of early dissemination and metastasis. Furthermore, a clinical primary tumor may never develop, investigators say.

The University of Regensburg team had discovered that cancer cells could spread not only from a highly mutated, overtly evolved and pathologically-defined invasive tumors, but also from early stage cancers commonly considered incapable of spreading cells. However, how these early cancer lesions could spawn cells with traits of malignant tumors was unknown.

In two papers published in the journal Nature, and conducted in animal models and tested in human samples, the two teams now have identified the first mechanisms that allow cells to spread early in cancer progression and contribute to metastasis.

In the study from Mount Sinai, two changes in mammary cancer cells -- a switched-on oncogene and a turned-off tumor suppressor -- motivated cells to travel from breast tissue to the lungs and other parts of the body. There, the cells stayed quiet until a growth switch was activated and metastases developed in lungs.

"This research provides insight into the mechanisms of early cancer spread and may shed light into unexplained phenomena -- among them, why as many as 5 percent of cancer patients worldwide have cancer metastases but no original tumor, and most importantly, why it is so difficult to treat cancer that has spread," says the study's senior investigators, Julio A. Aguirre-Ghiso, PhD, Professor of Medicine, Hematology and Medical Oncology, Maria Soledad Sosa, PhD, Assistant Professor of Pharmacological Sciences, and graduate student Kathryn Harper of The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai.

"Biologically, this new model of early metastasis challenges everything we thought we knew about how cancer spreads and forms metastasis. It feels like we are going to have to adjust our ideas about the subject of metastasis," he says. "Our hope is that these findings will reshape the way we think about how metastasis should be treated."

An important finding from the Mount Sinai team is that most early spread cells remain dormant and most chemotherapy and targeted therapies are aimed at those cells that are proliferative. So early spread cancer cells would escape these conventional therapies even if it kills a primary tumor, Dr. Aguirre-Ghiso says. The work also poses new questions on how early spread cancer cells support metastasis development. Do they do it on their own, do they set the soil for later arriving cells from tumors not caught early, or do they cooperate with later arriving cells? This study reveals a new biological mechanism of early dissemination that must be explored to fully understand how to target the seeds of metastasis.

The companion paper headed by Dr. Christoph Klein at the University of Regensburg in Germany, published in the same issue of Nature and co-authored by Dr. Aguirre-Ghiso and members of his team provides additional key mechanistic clues on how early spread is controlled and proof in human cancer cells and tumors of the preclinical findings in this study. Researchers from both teams arrived at their findings independently and then collaborated on the project.

Researchers from both teams studied very early stages of breast cancer including DCIS (ductal carcinoma in situ), a noninvasive breast lesion, since 2-3 percent of women who have been treated for DCIS die of metastasi.In both studies, investigators found that early cancer cell spread is an extension of the normal process of creating a branching tree of breast milk ducts in females. Two major pathways are activated in this ancient process -- p38, a tumor suppressor, and HER2, an oncogene. Switching off p38 and turning on HER2 activates a module of the EMT (epithelial to mesenchymal transition) signaling pathway. EMT promotes movement of cells during embryogenesis and tissue development. The Klein paper also shows that progesterone receptor signaling, which controls branching of the mammary tree, is important for this early spread by regulating cues involved in EMT and growth programs, a mechanism that was hinted in his earlier studies.

As a mammary tree develops, p38, HER2, and EMT are alternatively turned on and off. This, in cooperation with progesterone signaling, allows mammary cells to move through the mammary gland, hollow out a tubular, branching network of milk ducts that flow to the nipple.

"Tweaking these pathways are a normal way of forming hollow branching tubes," Dr. Aguirre-Ghiso says.

But in their experiments, they found that if HER2 is over-activated (not switched off) or mutated, and p38 is permanently turned off, EMT was continually activated, allowing cells to move out of the mammary gland and into the animal's body through the blood.

"We were able to use organoids in three-dimensional cultures, and high resolution imaging directly in the live animal models to actually see these cells enter the blood stream from the mammary tree and travel to the lung, the bone marrow, and other places," he says. "We hadn't thought about oncogenes and tumor suppressors in this way before. This is a new function for these pathways."

John S. Condeelis, PhD, co-Director of the Gruss Lipper Biophotonics Center and its Integrated Imaging Program at Einstein, where the high resolution intravital imaging was performed, noted that "We were surprised to learn that cancer cells from DCIS-like lesions could show such robust dissemination using similar machinery found in tumor cells from invasive carcinoma. This is a new insight with implications beyond our expectations." Also David Entenberg MSc, Director of Technological Development and Intravital Imaging who led the imaging efforts within the same Center said, "A few years ago, it would not have been possible to image these disseminating cells inside a living animal with this level of detail. We're pleased that Einstein's imaging technology could, through this collaboration, contribute to the definitive proof of early dissemination."And while both studies focus on the mechanisms of early dissemination in breast cancer, similar processes could control early dissemination and metastasis in other human cancers, including melanoma and pancreatic cancer. In fact, pancreatic cancer early dissemination has also been linked to an EMT process, Dr. Aguirre-Ghiso says.

Among the critical avenues they are investigating, Mount Sinai researchers are looking for the growth switch that pushes early spread of dormant cancer cells to form metastases. "While our findings add a whole new level of complexity to the understanding of cancer, they also add energy to our efforts to finally solve the big issue in cancer -- stop the metastasis that kills patients," Dr. Aguirre-Ghiso says.

Bad people are disgusting, bad actions are angering

A person's character, more so than their actions, determines whether we find immoral acts to be 'disgusting,' according to new research in Psychological Science, a journal of the Association for Psychological Science.

"We wanted to know why moral transgressions can be disgusting even when they don't involve the kinds of things that typically disgust us, like body products, insects, and rotting foods," says psychological scientist and study co-author Hanah Chapman of Brooklyn College, the City University of New York. "We found that what drives moral disgust seems to be the character of the transgressor -- who they are more so than what they do."

The worse someone's character is, says Chapman, the more disgusting people typically find them to be.

The research was prompted by differing findings regarding how our judgments of moral violations evoke specific emotional responses: anger and disgust.

Anger and disgust are often felt together when we think about someone else's wrongdoing, but the emotion that predominates can shape how we act. Previous work by first author Roger Giner-Sorolla of the University of Kent had shown that violating taboos is likely to elicit disgust, while violating people's rights tends to elicit anger. But work by Chapman and others had shown that people sometimes report disgust more so than anger in response to acts that violate a person's rights.

Giner-Sorolla and Chapman decided to collaborate and test the idea that focusing on a person's bad character might be what leads us to feel of disgust in response to harm and other rights violations.

In an online study, 87 American adults read and evaluated two scenarios. In one scenario, a man finds out that his long-term girlfriend has cheated on him and he beats her. In the other scenario, a man finds out that his long-term girlfriend has cheated on him and he beats the girlfriend's cat.

The participants evaluated the nature of the act, rating which act was more immoral, which act should be punished more severely, and which act deserves more blame. They also evaluated the nature of the two men, responding to questions gauging which man was more likely to be sadistic and which man was more likely to be empathetic.

Using both photos of facial expressions and verbal descriptions, the participants rated their relative disgust and anger.

In regards to the act itself, people tended to judge the act of beating the cat as less morally wrong than beating the girlfriend. But they tended to judge the moral character of the man who beat the cat as worse than that of the man who beat his girlfriend.

And the emotion ratings indicated that such negative character evaluations were associated with greater disgust, but not greater anger.

In two additional studies, participants read a series of different moral scenarios that varied according to whether the main character wanted to hurt someone (a sign of bad character, regardless of the outcome) and whether someone was actually hurt. In line with the first study, when the main character wanted to hurt someone, participants reported feeling disgust more than anger, even when no actual harm was done. And when the character caused harm unintentionally, participants reported more anger than disgust.Overall, the findings suggest that we tend to feel more disgust when we judge someone to be a "bad person," but we tend to feel more anger when we evaluate someone's "bad actions."

Despite these overall trends in the data, the researchers note that the findings were complex and warrant further investigation.

Ultimately, the research "can help us understand why we feel these emotions," says Giner-Sorolla. And it shows "that two scholars with opposing ideas can get together and work out a way to resolve them."

Blocking hormone activity in mosquitoes could help reduce malaria spread

Disruption of hormone signaling in mosquitoes may reduce their ability to transmit the parasite that causes malaria, according to a new study published in PLOS Pathogens. The findings suggest a potential new approach to combat spread of the disease.

Malaria kills about 500,000 people every year. A person can become infected when bitten by a female mosquito that carries the Plasmodium parasite in its saliva, allowing the microbe to enter the person's bloodstream. Efforts to reduce infection have relied heavily on insecticides that kill malaria-spreading mosquitoes, but the insects are rapidly becoming resistant to these chemicals.

In the new study jointly led by Flaminia Catteruccia and Caroline Buckee of the Harvard T. H. Chan School of Public Health, Boston, Lauren Childs, Francisco Cai, Evdoxia Kakani and colleagues investigate a potential alternative to insecticides. Instead of killing mosquitoes, their method targets the ability of the bloodsuckers to transmit malaria.

To test this method, the researchers exposed adult Anopheles gambiae females, the dominant malaria-spreading mosquitoes in sub-Saharan Africa, to a type of chemical known as DBH. DBH targets the activity of the steroid hormone known as 20-hydroxyecdysone, which plays a role in several biological processes in mosquitoes.

The scientists found that DBH shortens mosquito lifespan, reduces the number of mosquito eggs produced and laid, prevents successful mosquito mating, and blocks development of the Plasmodium parasite.

To further explore the potential of hormone targeting as a malaria control tactic, the researchers fed their experimental results into a mathematical model of the mosquito life cycle. The results suggest that applying DBH to bed nets or spraying it indoors could potentially reduce malaria transmission as effectively as insecticides.

Western' maternal diet appears to raise obesity risk in offspring

Diet composition around the time of pregnancy may influence whether offspring become obese, according to a new study using animal models at The Scripps Research Institute (TSRI).

"Your diet itself matters, not just whether you are gaining excess weight or developing gestational diabetes," said TSRI Associate Professor Eric Zorrilla, who led the study in collaboration with Tim R. Nagy of the University of Alabama at Birmingham and Barry E. Levin of the Veterans Affairs (VA) Medical Center of East Orange, New Jersey, and Rutgers University.

In fact, the researchers found that giving females a typical American, or Western, diet appeared to set the next generation up for lifelong obesity issues.

This work was published recently in the American Journal of Physiology and featured in APSselect, a collection of the best research papers from all journals published by the American Physiological Society.

It's Not Just about Weight

The researchers made this discovery by studying two lines of rats, one selectively bred to be obesity-resistant to a high-fat diet and one bred to be unusually vulnerable. Rats from each group were fed either a diet with the same overall fat, saturated fat, carbohydrate and protein levels as a typical Western diet, or a lower-fat, higher-grain control diet.

The scientists found that female rats given a Western diet in the weeks leading up to pregnancy, during pregnancy and during nursing had offspring more prone to obesity at birth, during early adolescence and -- many months later -- through adulthood. This occurred even if the mothers themselves did not overeat and maintained a healthy weight, body fat and insulin status.

Zorrilla said the results were surprising because, whereas previous studies had shown that overweight mothers were more likely to have overweight offspring, the new findings suggest that diet alone can make a difference independent of weight gain.

The Western diet seemed to set in motion a metabolic "program" that lasted throughout the rat's life. Although these rats slimmed down during puberty and early adulthood, they still showed a lower basal metabolic rate (less energy expended at while rest) and higher food intake during that time, which led to a return of obesity in mid-adulthood.

"What we found interesting was that you sometimes see the same thing in humans, when a kid goes through a growth spurt," said study first author Jen Frihauf, who recently completed her PhD through the University of California, San Diego, while working in the Zorrilla lab at TSRI.

The researchers also spotted an interesting difference in the effects of the Western diet between the obesity-vulnerable and obesity-resistant lines: in females, the diet impaired the reproduction of the obesity vulnerable lines. Significantly fewer of females were able to reproduce, and those that did reproduce had fewer offspring. "This wasn't the focus of the study, but it supports the idea that a Western diet promotes infertility in mothers vulnerable to diet-induced obesity," said Zorrilla.

The researchers also identified elevated levels of several molecules, such as insulin and hormones called leptin and adiponectin, starting at birth in both the Western diet and genetically vulnerable offspring. This hormone profile may serve as an early biomarker for detecting obesity risk.The Takeaway for Moms: Better Nutrition

Research is ongoing into which aspects of a Western diet trigger these effects -- and the molecular changes in the offspring responsible for them. Zorrilla said the findings should raise awareness of the importance of a healthy pre- and post-natal diet. For example, doctors may want to discuss nutrition with all women who are pregnant or are planning to become pregnant, not just those already overweight.

"Doctors often use weight gain as a hallmark of a healthy pregnancy," said Frihauf. "But we realized there was something going on in utero that wasn't detectable in the mother's weight."

Frihauf added that few pregnant women, even in the United States, eat a high-fat, high-sugar diet all day, every day. "We're not trying to tell pregnant women not to occasionally splurge on a piece of cake," she said.

Studies have also shown that paternal diet, through "epigenetic" mechanisms that control how genes are expressed, can affect obesity risk in offspring, added Zorrilla, so nutritional information may be valuable for potential fathers as well.

In addition to Zorrilla, Nagy, Levin and Frihauf, the study, "Maternal Western Diet Increases Adiposity Even in Male Offspring of Obesity-Resistant Rat Dams: Early Endocrine Risk Markers," was authored by Éva M. Fekete, previous of TSRI and now at The University of Wisconsin-Madison.

This study was supported by the National Institutes of Health (grants R01DK-070118, R01DK-30066, R01DK-076896, F31DA026708-01A2, R21DK-077616, P30DK-056336 and P30DK-079626) and the Research Service of the VA.

Researchers uncover why morning people should not work at night

It has been known for a long time that early risers work less efficiently at night than night owls do. But researchers from the Higher School of Economics and Oxford University have uncovered new and distinctive features between the night activities of these two types of individuals. At night, early risers demonstrate a quicker reaction time when solving unusual attention-related tasks than night owls, but these early risers make more mistakes along the way.

Sleep deprivation and a relative increase in the time spent awake negatively impact the brain's attention system. Nicola Barclay and Andriy Myachykov conducted a study that is the first experiment investigating the influence of sleep deprivation on people with different chronotypes. Specifically, the researchers found out how an increase in time spent awake affects the attention system of early risers and night owls. The study is available in the journal Experimental Brain Research.

Twenty-six volunteers (13 male, 13 female) with an average age of 25 participated in the study. Participants were required to stay awake for 18 hours, from 8:00 a.m. to 2:00 a.m., and adhere to their normal routine. At the beginning and end of their time spent awake, the participants completed an Attention Network Test (ANT) and a Morningness-Eveningness Questionnaire to help assess their chronotype.

The researchers did not find any important differences between the results of the ANT test the early birds and night owls completed in the morning, but the evening test showed a more pronounced contrast. The early birds completed tests quicker than the night owls, which was a rather unexpected and contradictory outcome, though the researchers did find an explanation for this. This may have been because of the different approaches the two groups took towards managing the task. Evening people tended to take a more serious approach when it came to tasks requiring more time and attention during their favorite hours, i.e., in the late evening or at night. 'To deal with the most difficult test -- resolving a conflict of attention -- it was necessary not only to concentrate on the main visual stimulus, but at the same time to ignore accompanying stimulus that distract from the core task,' Andriy Myachykov explains. Completion of this task requires increased concentration. 'An interesting fact is that although night owls spent more time finishing than early birds, their accuracy in completing the task was higher,' the researcher added.

Overall, the evening people turned out to be slower but more efficient compared to the early risers, according to the second ANT taken at 2:00 a.m. after 18 hours of being awake. 'On the one hand, it's known that night owls are more efficient in the late hours, but how this influences the speed and accuracy with which attention-related tasks are completed remains unclear. Our study demonstrated how night owls working late at night "sacrifice" speed for accuracy,' explained Andriy Myachykov.

The results of this study could challenge the education system and human resources management in certain areas. For pilots, air traffic controllers, drivers, etc., attention, the ability to deal with large sets of data, and reaction time are all very important. During emergencies, these features could play a vital role. The results of this study could also be very useful for people who work night shift.

Cellular reprogramming slows aging in mice

Scientists have rolled back time for live mice through systemic cellular reprogramming, according to a study published December 15 in Cell. In mice carrying a mutation leading to premature aging, reprogramming of chemical marks in the genome, known as epigenetic marks, reduced many signs of aging in the mice and extended their lifespan on average from 18 weeks to 24.

The study suggests that epigenetic changes drive the aging process, and that those changes may be malleable. "We did not correct the mutation that causes premature aging in these mice," says lead investigator Juan Carlos Izpisua Belmonte, a professor in the Salk Institute of Biological Science's Gene Expression Laboratory. "We altered aging by changing the epigenome, suggesting that aging is a plastic process."

This is the first report in which cellular reprogramming extends lifespan in a live animal. Previous efforts resulted in mice that either died immediately or developed extensive tumors. The Salk team used a partial cellular reprogramming approach that did not cause tumors or death. "We were surprised and excited to see that we were able to prolong the lifespan by in vivo reprogramming," says co-first author Pradeep Reddy.

Cellular reprogramming turns an adult cell, such as a skin cell, into an induced pluripotent stem (iPS) cell. IPS cells have high proliferation rates and are not yet specialized to perform functions, such as being part of the skin. Reprogramming involves inducing the expression of four factors, called Yamanaka factors, in cells. The factors must be expressed for 2 to 3 weeks for cells to reach pluripotency.

The Salk team used partial reprogramming, which induced expression of Yamanaka factors for just 2 to 4 days. Cells do not reach pluripotency. Rather, a cell that starts off as a skin cell remains a skin cell. But signs of age-associated dysfunction in the cell diminish. In this study, partial reprogramming of cells in vitro reduced DNA damage accumulation and restored nuclear structure. "These changes are the result of epigenetic remodeling in the cell," says Izpisua Belmonte.

Epigenetic marks, which change over a lifetime in response to environmental changes, regulate and protect the genome. Some marks turn on specialized functions, such as skin cell machinery in a skin cell, and turn off mechanisms that aren't needed, such as liver cell machinery. "During aging, marks are added, removed, and modified," says co-first author Alejandro Ocampo. "It's clear that the epigenome is changing as we get older."

The team induced expression of Yamanaka factors in all cells of the organism using their partial reprogramming approach. Several organs improved. For instance, tissue from skin, spleen, kidney and stomach all had improved appearance when inspected under a microscope. The cardiovascular system, which often fails and causes early death in these prematurely aging mice, also showed improvements in structure and function. "It is difficult to say specifically why the animal lives longer," says co-first author Paloma Martinez-Redondo. "But we know that the expression of these factors is inducing changes in the epigenome, and those are leading to benefits at the cellular and organismal level."

The team also tested applications of partial reprogramming in models of injury in mice. In this study, partial reprogramming enhanced the regeneration of muscle tissue and beta cells in the pancreas following injury.

Next steps will involve learning more about how the epigenome changes during partial reprogramming. "We need to go back and explore which marks are changing and driving the aging process," says Izpisua Belmonte.

Heavy Drinking Can Harm the Aging Brain

As people age, the harmful effects of heavy drinking can take a toll on key brain functions, such as memory, attention and learning, a new study shows.

Researchers led by Adam Woods, of the University of Florida's department of aging and geriatric research, asked 31 men and 35 women to complete a series of comprehensive brain tests.

The volunteers were divided into groups based on their level of alcohol intake: heavy drinkers, moderate drinkers or non-drinkers.

About 53 percent of the study group had a lifetime history of some period of alcohol dependence, the team said, and 21 were considered current heavy drinkers.

The test results of the latter group were compared to the results of the 45 non-drinkers and moderate drinkers. Woods' team tracked brain functions such as attention, learning, memory, motor function, verbal function and thinking speed.

The study found that older people who were heavy drinkers had lower scores on tests of so-called cognitive function -- worse learning skills, memory and motor function.

A lifetime history of alcohol dependence was also linked with worse learning, memory and motor function, the researchers reported. These people also had reductions in their attention or executive function (which includes reasoning and working memory), regardless of their age, the findings showed.

"It is not surprising that lifetime alcohol dependence would have long-term adverse effects on cognition [thinking], nor is it surprising that heavy alcohol use in older adults would also be associated with worse cognition," said Dr. Marc Gordon, chief of neurology at Zucker Hillside Hospital in Glen Oaks, N.Y. He reviewed the new findings.

Dr. Gisele Wolf-Klein directs geriatric education at Northwell Health in Great Neck, N.Y. She agreed with Gordon that "the findings should not come as a surprise, since it is well known that alcohol at any age, from birth to death, is toxic for brain cells."

And she pointed out that the effects of heavy drinking may be especially hazardous for the elderly, many of whom are taking several medications.

"Medication regimens can be negatively affected by the use of alcohol," Wolf-Klein said. For this and other reasons, "use of alcohol is better avoided altogether in older adults -- or at least reported and discussed openly with their primary care doctors," she said.

Yoga Called Good Medicine for High Blood Pressure

Yoga may help reduce blood pressure in people who are at risk for developing hypertension, a new study finds.

"Patients with pre-hypertension [slightly elevated blood pressure] are likely to develop hypertension [high blood pressure] unless they improve their lifestyle," said study author Dr. Ashutosh Angrish. He is a cardiologist at Sir Gangaram Hospital in Delhi, India.

"Both pre-hypertension and high blood pressure increase the risk of heart attack, stroke and heart failure," Angrish added.

The new study included 60 people who had slightly elevated blood pressure but were otherwise healthy. The participants were randomly assigned to either practice hatha yoga while also making conventional lifestyle changes, or to just make the lifestyle changes (the "control" group). The lifestyle changes included moderate aerobic exercise, eating a healthier diet and quitting smoking.

The yoga group, average age 56, received yoga instruction for a month and then did the activity at home. It included stretching, controlled breathing and meditation for one hour a day. The average age of the control group participants was 52, according to the researchers.

After three months, those in the yoga group had notable decreases in blood pressure, while those in the control group did not, the investigators found.

Blood pressure is made up of two numbers. The top number is called systolic pressure. This measures the pressure in the arteries when blood is pumped from the heart. The bottom number -- diastolic pressure -- measures the pressure between heartbeats. Blood pressure is expressed in millimeters of mercury (mm Hg).

Angrish and his colleagues found that people in the yoga group had 24-hour diastolic blood pressure and night diastolic blood pressure decreases of about 4.5 mm Hg, and 24-hour average arterial pressure decreases of about 4.9 mm Hg.

"Although the reduction in blood pressure was modest, it could be clinically very meaningful because even a 2 mm Hg decrease in diastolic blood pressure has the potential to decrease the risk of coronary heart disease by 6 percent and the risk of stroke and [mini-stroke] by 15 percent," Angrish said.

"Our research suggests that patients with pre-hypertension should be advised to practice hatha yoga for one hour daily. It may prevent the development of hypertension and in addition give a sense of well-being," he added in a news release from the European Society of Cardiology.

The findings were presented Wednesday at the annual meeting of the Cardiological Society of India, in Kochi. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

Cushioned Shoe Inserts Won't Guard Against Injury

The millions who run, walk or play sports may think shoe inserts that cushion the foot can help prevent injuries. But a new review challenges that notion.

Only orthotics, which are actually molded to a person's foot, seem to be able to do that job, Australian researchers reported.

"There appears to be little merit in using shock-absorbing insoles for the prevention of injury, while there is some evidence that foot [orthotics] are effective for the prevention of some injuries like stress fractures and shin pain," said review author Daniel Bonanno. He is a lecturer in podiatry in the College of Science, Health, and Engineering at La Trobe University in Melbourne.

However, Bonanno noted that the studies the researchers evaluated weren't done well, so whether cushioned inserts are worthless is still an open question.

"Given that the majority of studies included in our review weren't well-designed trials, better-quality research on this topic is needed to better inform consumers and clinicians as to whether foot [orthotics] or shock-absorbing insoles can be used to decrease injury risk," he said.

One doctor explained the difference between the two products.

Shock-absorbing cushion inserts are sold in shoe stores and drugstores for anywhere from $10 to over $100. Foot orthotics are only available at specialty stores and from foot doctors. They can cost from $200 to $400, but the cost can sometimes be offset by insurance if they are treating an existing condition, said Dr. Robert Glatter, an emergency room physician at Lenox Hill Hospital in New York City.

"There are a lot of insole products being sold on the market that advertise having a shock-absorbing quality," Glatter said.

"Insoles may reduce shock, but have no significant arch, and thus do not provide adequate support," he added. "That said, combining shock-absorbing qualities with adequate support [orthotics] may ultimately be the answer."

For most people who engage in moderate physical activity or sports, investing in foot orthotics may not be necessary. But someone who suffers from foot or back problems may benefit from using them, Glatter said.

In the study, Bonanno and his colleagues analyzed 11 trials that evaluated orthotics and seven trials that evaluated shock-absorbing insoles.

The main findings of the review were that foot orthotics seemed to help prevent overall injuries, shin pain and some stress fractures of the foot and leg. Shock-absorbing insoles, however, did not.

Specifically, foot orthotics reduced the risk of overall injury by 28 percent, while they cut the chances of a stress fracture by 41 percent. However, they did not lower the incidence of tendon or muscle injuries, or knee and back pain, the researchers said.

Shock-absorbing insoles didn't lessen the risk of any type of injury. And one trial suggested they might even increase the risk of injury, the review found.

What You Need to Know When Prescribed an Opioid Painkiller

There are a number of questions you should ask if a doctor or other health care provider prescribes opioid painkillers such as Oxycontin, Vicodin, codeine and morphine, the U.S. Food and Drug Administration says.

While approved to treat certain kinds of acute and chronic pain, opioids can have serious side effects, and the United States is in the mist of an opioid overuse epidemic.

First, ask why you need the medication, is it right for you, and are there non-opioid options?

If your health care provider thinks an opioid painkiller is the best choice, ask the doctor to prescribe the lowest dose and the smallest quantity. Find out when to call to follow-up with the health care provider on how well the opioid is working, as well as when and how to stop or taper off use of the drug, the FDA said in a news release.

To reduce the risk of side effects, take the medication exactly as prescribed. If you still have pain, call your health care provider. Do not take an extra dose.

Learn about serious side effects, such as excessive sleepiness or a craving for more of the medication, so you and your family will know when to call a doctor or go to the hospital. Ask your pharmacist if your prescription comes with a medication guide, which are paper handouts that come with many prescription medicines and provide detailed information.

"Tell your health care provider about any history you have had with substance misuse or addiction to drugs or alcohol and if you have a history of smoking cigarettes. You should also tell your health care provider if anyone in your family has had a problem with substance misuse, alcoholism or drug addiction," the FDA said.

"It is also very important that you tell your health care provider about all of the medicines you are taking, especially those prescribed to treat anxiety, sleeping problems, or seizure. Even medicines you take only occasionally could interact with the opioid pain medicine. Ask your health care provider about possible interactions," the FDA advised.

It's a good idea to keep opioids locked up to prevent youngsters from accidentally taking them or from other people stealing them. Never share opioids with other people. What's safe for you could lead to an overdose for someone else.

"You should discuss with your doctor whether you should also receive a prescription for naloxone, a drug that can reverse the effects of an opioid overdose and could save lives. In many cases, it makes sense to be prepared for potential problems by keeping naloxone in your home," the FDA said.

According to federal health officials, the United States is in the grip of an unprecedented opioid epidemic. More people died from drug overdoses in 2014 (the most recent statistics available) than in any year on record. And the majority of drug overdose deaths -- more than six out of 10 -- involved an opioid.

Smartphones, Tablets and Weight Gain in Teens

Teens glued to their tablet, smartphone or computer for hours on end may be more likely to become obese, a new study suggests.

Those who used screen devices for five or more hours daily were twice as likely to drink more sugary beverages and engage in too little physical activity, the researchers found.

As a result, these teens showed a 43 percent increased risk of obesity compared with kids who don't use smartphones or tablets at all. But the study did not prove that high use of these technologies caused obesity risk to rise.

"Parents should be cautious with their kids in terms of how much they're using these devices, especially if you see your child on them several hours a day," said study lead author Erica Kenney. "It is something to keep an eye on and be concerned about, because it could be having an effect on their health."

Kids using a screen device for that amount of time is not that uncommon, Kenney, a research fellow with the Harvard T.H. Chan School of Public Health in Boston, and her co-author found.

One of every five U.S. teenagers spends more than five hours a day on smartphones, tablets, computers and video games, the researchers discovered. By comparison, only 8 percent of kids watch more than five hours a day of TV.

"We know kids are shifting their time away from TV and onto these other devices," Kenney said.

Previous studies have linked excessive TV viewing with increased consumption of sugary drinks, fast foods, sweets and salty snacks -- all leading to a higher risk of obesity, the study authors said.

Kenney decided to see whether this risk also applied to kids who've ditched TV for screen devices.

The study relied on data drawn from the 2013 and 2015 waves of the Youth Risk Behavior Surveillance System, a regular youth survey conducted by the U.S. Centers for Disease Control and Prevention. Researchers reviewed responses from almost 25,000 teens in grades 9 through 12.The results regarding excess TV viewing agreed with earlier findings, the researchers said. Teens who watched five or more hours of TV daily were nearly three times as likely to drink sugary beverages daily and 78 percent more likely to become obese, compared with kids who didn't watch TV.

But those bad habits also appeared to transfer over when kids used smartphones, tablets or computers. Five or more hours of screen device time every day was linked to a doubled risk of drinking sugary beverages and getting too little exercise every day, and a 74 percent increased risk of poor sleep.

Kids tend to snack too much while using electronic devices, explained Stephanie Schiff, a registered dietitian with Northwell Health's Huntington Hospital in Huntington, N.Y.

"If kids are playing video games on the computer while they're eating, they sometimes don't register an end to their hunger," Schiff said. "Eating can become mindless rather than mindful, and they may not realize they are actually full."

In addition, a more insidious process tied to screen use could be influencing their food choices, Kenney said.

"A lot of the literature on TV and diet and TV and obesity risk really suggests the key factor driving these associations is exposure to advertising for unhealthy things that kids nag their parents to get in the supermarket," she said. "We do know in recent years a lot of the money towards marketing foods and beverages has shifted more towards marketing on social media and video games and things like that."

These electronic devices also share TV's ability to glue kids to a couch, Schiff said.

"Years ago, kids would play in the playground at recess or come home after school and play in their yards or on the sidewalk," Schiff said. "That play has been replaced to an extent by video games, Facebook, YouTube and texting.

"It's not a surprise that childhood obesity is on the rise, since to some extent virtual games have replaced real-time play and interaction, and physical activity has been relegated to fingers and thumbs," she continued.

Kenney recommends getting advice on ways to limit screen time if your child is using smartphones or tablets more than a couple hours a day.

"If they're regularly on these devices for long periods of time, you maybe want to talk with your pediatrician about strategies for how to cut back a little bit," she said.

Health Tip: Who Needs a Flu Shot?

 Debating whether to get a flu shot? With few exceptions, most people will benefit and a few in particular really need the vaccine.

The U.S. Centers for Disease Control and Prevention says these people are at greatest risk of flu and should get the shot:

Children between the ages of 6 months and 4 years, and seniors aged 50 and older.
People with a chronic illness, such as diabetes, asthma, cardiovascular disease or kidney disease. Also, anyone with a suppressed immune system.
Pregnant women.
Children on aspirin therapy.
Anyone living in a nursing home or long-term care facility.
People who work in a health-care setting.
People who live with young children or older adults.
People who are obese.
People of Alaskan or American Indian descent.
Culled from medplus

A Lengthy, Stable Marriage May Boost Stroke Survival

Stroke patients may have better odds of surviving if they're in a long-term stable marriage, a new study suggests.

Researchers found that among more than 2,300 stroke sufferers, those who'd been "continuously" married had a better chance of surviving -- versus both lifelong singles and people who'd been divorced or widowed.

The long-term marrieds' outlook was better even compared to people who'd gotten remarried after divorcing or losing a spouse.

The reasons for the findings aren't completely clear, and the study doesn't prove a cause-and-effect relationship. But researchers said the study highlights the potential importance of "social support" in stroke recovery.

"This implies that the support of a lifelong partner has benefits," said Dr. Ralph Sacco, a professor of neurology at the University of Miami and a past president of the American Heart Association.

A spouse can give emotional support, he said, as well as help with day-to-day basics -- such as eating a healthy diet and remembering to take medications.

"People sometimes consider it 'nagging,' but it can help," said Sacco, who wasn't involved in the study.

"What we don't know," he added, "is whether other forms of social support might have similar benefits."

In a previous study, Sacco and his colleagues did find that older stroke patients who had friends generally fared better than those who were socially isolated.But it's not clear whether friendships directly aided people's stroke recovery. And no one knows whether unmarried stroke patients would live longer if they joined a support group, for example.

Those are important questions, according to Matthew Dupre, one of the researchers on the new study.

It's known that "social support" can help people stick with their medication regimens or change unhealthy habits, said Dupre, an associate professor of community and family medicine at Duke University in Durham, N.C.

So it's possible that unmarried stroke patients could benefit from resources that connect them with other people, according to Dupre.

"More research is needed, though, to know the full implications of our findings, and to identify possible avenues of intervention," he said.

The findings, reported Dec. 14 in the Journal of the American Heart Association, are based on 2,351 U.S. adults who'd suffered a stroke. Their health was followed for about five years after the stroke, on average.

During that time, 1,362 people died -- leaving just under 1,000 survivors. Among those who survived, 42 percent were in a stable marriage with their first spouse. That compared with 31 percent among patients who died.

Overall, Dupre's team found, lifelong singles were 71 percent more likely to die than stroke patients in a stable marriage.

Much of that disparity seemed to be explained by "psychosocial factors," the researchers said -- including depression symptoms and a lack of children or other close relationships.

It wouldn't be surprising, Sacco said, if depression were a key reason that unmarried people tend to fare more poorly after a stroke.Depression is common after stroke, and it's been shown to be a predictor of stroke outcomes," he said. "Depression needs to be recognized and treated."

Dr. Paul Wright, chief of neurology at North Shore University Hospital in Manhasset, N.Y., agreed.

He said stroke patients at his center are routinely screened for depression. But the new findings, he said, suggest that unmarried patients may need closer attention in general -- including extra help with lifestyle changes that can improve their outlook.

"We may need to bring them in for follow-up earlier, and start monitoring them more closely," Wright said.

Lifelong singles were not the only ones at higher risk in this study. People who'd been divorced or widowed were more likely to die after their stroke -- particularly if they'd lost more than one marriage.

Patients who'd been divorced or widowed more than once were about 40 percent more likely to die than those in stable marriages. And those who were currently remarried fared no better.

Certain practical factors, such as income and access to health insurance, seemed to explain part of the risk -- but not all of it.

"It may be that patients with a history of marital instability experienced more severe and debilitating strokes -- and in turn have fewer economic resources and social support to use toward their recovery," Dupre said.

For now, Sacco suggested that stroke survivors "reach out and interact with other people" if they feel isolated. Many hospitals have support groups, he said -- as do organizations such as the American Heart Association/American Stroke Association.

People could also try community or church organizations, or even online groups, Sacco said -- though, he added, "we don't know whether computer connections can replace face-to-face human connection."

Wright agreed that unmarried stroke survivors should reach out for help. But in reality, he added, many do not -- so their family members should be proactive.

1. "Be the 'nudge' who makes sure they're taking care of themselves, even if they say they're OK," Wright said.

When Buying a Christmas Tree, Think Safety First

choosing the precise Christmas tree is a a laugh culture for lots families, but it's vital to consider fireplace protection while redecorating for the vacations, a pediatricians' institution advises.

folks that opt for an synthetic tree should make sure it's fireplace-resistant. This must be mentioned on its label, in step with the yankee Academy of Pediatrics.

in case you're shopping for a stay Christmas tree for your private home, the institution recommends the following precautions:

pick out a fresh tree. Many human beings look for bushes that are a sure length or shape, but it's also essential to make sure it is not dried out. Dry timber may turn out to be a hearth hazard. A fresh tree is green and its needles don't wreck or drop off its branches easily. The trunk of a sparkling tree is also sticky.
Trim the trunk. cutting some inches off the trunk of the tree exposes fresh wood. This allows the tree to soak up water extra correctly and keep away from drying out.
Water the tree. make certain to preserve the tree-stand full of water. bushes in heated homes can dry out quick.
cautiously keep in mind tree placement. Christmas timber should no longer be close to fireplaces, radiators or portable warmers. timber must no longer block doorways. instead, they have to be positioned faraway from high-traffic areas.

Runners' brains may be more connected, research shows

if you're thinking about taking over running as your New 12 months's decision and nevertheless want some convincing, keep in mind this: MRI scans monitor that persistence runners' brains have more useful connectivity than the brains of greater sedentary individuals.

college of Arizona researchers in comparison brain scans of younger person move country runners to teenagers who do not engage in normal bodily hobby. The runners, ordinary, showed more useful connectivity -- or connections among awesome brain regions -- within numerous regions of the mind, including the frontal cortex, which is essential for cognitive features inclusive of making plans, selection-making and the capacity to switch attention between tasks.

although extra studies is needed to determine whether or not these bodily differences in mind connectivity bring about differences in cognitive functioning, the cutting-edge findings, posted within the magazine Frontiers in Human Neuroscience, help lay the foundation for researchers to higher understand how workout impacts the brain, specially in young adults.

UA walking expert David Raichlen, an companion professor of anthropology, co-designed the take a look at with UA psychology professor Gene Alexander, who studies brain getting old and Alzheimer's sickness as a member of the UA's Evelyn F. McKnight mind Institute.

"one of the matters that drove this collaboration became that there has been a latest proliferation of studies, over the past 15 years, which have shown that bodily pastime and exercise could have a beneficial effect at the mind, but most of that paintings has been in older adults," Raichlen said.

"This query of what's happening inside the brain at more youthful a while hasn't surely been explored in a good deal intensity, and it's important," he said. "not best are we interested in what is taking place in the brains of young adults, however we realize that there are matters which you do across your lifespan that could effect what happens as you age, so it's crucial to apprehend what's taking place in the mind at those more youthful a long time."

along with their colleagues, Raichlen and Alexander compared the MRI scans of a group of male pass usa runners to the scans of young person males who hadn't engaged in any kind of organized athletic pastime for as a minimum a yr. participants have been more or less the equal age -- 18 to 25 -- with comparable body mass index and educational levels.

The scans measured resting country purposeful connectivity, or what goes on in the brain whilst members are conscious but at relaxation, now not accomplishing any precise challenge.

The findings shed new mild at the effect that running, as a particular form of exercising, may additionally have on the brain.

preceding research have shown that activities that require exceptional motor control, which include playing a musical tool, or that require high stages of hand-eye coordination, such as playing golfing, can alter mind structure and feature. however, fewer research have checked out the outcomes of more repetitive athletic activities that do not require as tons particular motor control -- which include jogging. Raichlen's and Alexander's findings propose that those forms of activities may want to have a similar impact.

"those activities that humans do not forget repetitive virtually involve many complex cognitive functions -- like making plans and selection-making -- that may have results on the mind," Raichlen stated.

considering that purposeful connectivity often seems to be altered in growing old adults, and especially in people with Alzheimer's or different neurodegenerative sicknesses, it is an vital degree to bear in mind, Alexander stated. And what researchers analyze from the brains of teenagers should have implications for the viable prevention of age-associated cognitive decline in a while.

"one of the key questions that these outcomes increase is whether or not what we're seeing in teenage

Study Shows How Zika Attacks Infant Brain

Scientists from the U.S. Centers for Disease Control and Prevention report that the mosquito-borne virus can replicate itself thousands of times in both fetal brain cells and the placentas of pregnant women. Levels of Zika's genetic material were about 1,000 times higher in the infants' brains than in the placentas, the researchers noted.

Not only that, the virus can persist for more than seven months, which may explain why some babies who appeared normal at birth later developed symptoms of microcephaly, the researchers said. The most common birth defect associated with Zika, microcephaly leaves infants with too small heads and underdeveloped brains.

"Our findings show that Zika virus can continue to replicate in infants' brains even after birth, and that the virus can persist in placentas for months -- much longer than we expected," said study author Julu Bhatnagar, lead of the molecular pathology team at the CDC's Infectious Diseases Pathology Branch.

"We don't know how long the virus can persist, but its persistence could have implications for babies born with microcephaly and for apparently healthy infants whose mothers had Zika during their pregnancies," Bhatnagar said. "More studies are needed to fully understand how the virus can affect babies."

In all, the research team tested tissues from 52 patients with suspected Zika infection; 44 pregnant women and eight infants who had microcephaly and later died.

In their study, published Dec. 13 in the Emerging Infectious Diseases journal, the scientists also discovered that the virus appears to gain entry to the fetal brain through a type of migratory immune cells in the placenta known as Hofbauer cells.

Meanwhile, a report released last Friday showed that the tragedy of hundreds of babies born with devastating birth defects linked to the Zika virus is no longer confined to Brazil.

Colombia is now also experiencing a surge in infant microcephaly cases.

A team led by Margaret Honein, of the U.S. Centers for Disease Control and Prevention, reported that between January and November of 2016, there were 476 cases of microcephaly in Colombia, a fourfold increase from the same period in 2015.

There were nine times as many cases of microcephaly in July 2016 than in July 2015, the researchers said.

And because Colombia's surveillance of birth defects relies on voluntary reporting, the new data "likely underestimates the actual prevalence of birth defects, including those defects associated with Zika virus infection during pregnancy," Honein's team said.

The study also found that the peak in cases of microcephaly in Colombia occurred about six months after the highest number of new Zika infections were reported. This suggests that the greatest risk for Zika-related microcephaly likely arises in the first half of pregnancy -- especially the first trimester and early in the second trimester.According to the latest figures from the CDC, there have so far been 32 cases of Zika-related birth defects to live-born infants in the 50 U.S. states and the District of Columbia.

However, there's also some good news on Zika in the United States: the CDC has declared that the state of Florida is now free of the Zika virus.

But, Texas officials, who recently reported a suspected case of local infection, said last week that they have identified four more cases of suspected locally transmitted Zika virus in Cameron County, near the border with Mexico.

Anesthetic cream best for relieving vaccination pain in infants

For toddlers beneath age 1 12 months, lidocaine cream, combined with a small quantity of sugar given by way of mouth and infant soothing, can assist relieve pain from ordinary vaccinations, in keeping with a look at in CMAJ (Canadian clinical association journal).

"Vaccinations cause acute misery for both babies and their mother and father, contributing to vaccination avoidance," states Dr. Anna Taddio, a pharmacist and senior accomplice scientist on the health center for unwell children (SickKids) and professor, Leslie Dan faculty of Pharmacy, college of Toronto, Toronto, Ontario. "however, there are gaps in understanding approximately what is the high-quality way to relieve pain throughout vaccination."

To address this gap, researchers conducted a randomized controlled trial inclusive of 352 healthful babies from 3 pediatric outpatient clinics, together with 7 health practitioner practices, who acquired scheduled vaccinations of their first year of existence. The babies were randomized to one of four companies: placebo control; video guidance to mother and father on how to soothe their toddler; video plus oral sugar solution; and video, oral sugar answer and lidocaine applied to the pores and skin.

"We found that, while used constantly in the course of vaccine injections in the first yr of existence, most effective liposomal lidocaine mixed with parental video training and orally administered sucrose showed a gain on acute ache when in comparison with placebo, video by myself, and video and sucrose collectively," wrote the authors.

"The outcomes of regular ache control at the development of preprocedural anxiety (fear), hypersensitive reaction to ache and compliance with destiny vaccination warrant future research," they endorse.

How hearing loss can change the way nerve cells are wired

it is iciness, and your head is filled up from the cold or flu. the whole thing sounds muffled.

If this has ever passed off to you, you can have experienced conductive hearing loss, which takes place whilst sound cannot tour freely from the outer and middle ear to the inner ear. other commonplace reasons consist of ear infections in children, or a build-up of earwax in older adults.

Even quick-term blockages of this type can lead to amazing adjustments inside the auditory gadget, altering the behavior and shape of nerve cells that relay information from the ear to the brain, in line with a new university at Buffalo study.

The studies, published on line Dec. 1 inside the journal of Neuroscience, checked out what came about while mice had their ears surgically blocked for a length of 3 days to over every week, dampening hearing.

"We wanted to understand what occurs on the brainstem, inside the cells coming from the ear," says Matthew Xu-Friedman, PhD, the lead researcher and an companion professor of organic sciences in UB's university of Arts and Sciences. "What we saw is that a few substantial changes do occur within a few days.

"what's nevertheless uncertain, however, is whether or not the cells go back to their normal state while acoustic situations go back to regular. We see in our studies that the cells do appear to ordinarily bounce back, but we do not yet realize whether they completely recover."

A smaller 'gas tank'

The modifications the studies group located needed to do with neurotransmitters -- chemical substances that help ship signals from the ear to the brain.

In mice whose ears were blocked, cells inside the auditory nerve commenced to use their supplies of neurotransmitter more freely. They depleted their reserves of those chemical substances swiftly on every occasion a brand new auditory sign got here in, and that they decreased the amount of space in the cells that housed sac-like systems called vesicles -- organic garage tanks in which neurotransmitter chemical compounds are saved.

"whilst it's quiet, the needs at the auditory nerve cells are not as brilliant," Xu-Friedman says. "So it makes feel that you might see these modifications: You now not want as plenty neurotransmitter, so why spend money on lots of storage? if you're not that energetic, you don't need a large gasoline tank. And you are now not as afraid to dissipate what you have got. that is one conceivable reason for what we discovered."

The adjustments in cellular structure and behavior have been the other of what Xu-Friedman group's noticed in a preceding study that placed mice in a always noisy surroundings. In that venture -- confronted with an strangely high level of noise -- the mice's auditory nerve cells started to save money their sources, conserving materials of neurotransmitter whilst growing the storage capacity for the chemical substances.

"It looks like these results are two facets of the identical coin, and that they might be the first guidelines of a fashionable rule that nerve cells modify their connections based on how active they're," Xu-Friedman says.

Many questions stay

within the more latest observe, cellular adjustments commenced to opposite themselves when the mice's ears had been unplugged.

"when you undo the treatment, the cells begin to cross again to what they have been like before," Xu-Friedman says. "but, it's not clear that they completely recover, so we want to do more research to look if that's the case."

He additionally desires to examine what occurs while cells are exposed to conductive listening to loss time and again again, as takes place in some small children.

"when she changed into younger, my daughter had ear infections continuously. It appeared like she would get one whenever she had a chilly," Xu-Friedman says. "I have no idea what this did to her hearing, whether there are lasting outcomes from this repeated plugging of the ears, or whether or not any affects are transient. If the nerve 

Social isolation may lead to poor survival rates in breast cancer patients

Examining the link between loneliness and breast cancer
Recent studies have shown that loneliness and lack of social connections increase the risk of premature death.

In fact, some studies have suggested that social isolation and living alone increase the risk of mortality by as much as 29 and 32 percent, respectively.

Researchers led by Dr. Candyce Kroenke, of the Kaiser Permanente Division of Research in Oakland, CA, set out to examine the link between social isolation and breast cancer survival rates.

Dr. Kroenke and team investigated the medical records of 9,267 women with breast cancer.

The median follow-up period was 10.6 years, during which 1,448 cancer recurrences and 1,521 deaths were recorded. Of the 1,521 deaths, 990 were from breast cancer.

Scientists wanted to see how the patients' survival is affected by their social networks within 2 years from the diagnosis.

The research findings were published in the journal Cancer.

Isolated women 60 percent more likely to die from breast cancer
The results indicate that having an extended social network significantly increases the survival rates of breast cancer survivors.

Socially isolated women had a 40 percent higher risk of recurrence and a 60 percent higher risk of dying from breast cancer than socially integrated women.

Additionally, women living in isolation had a 70 percent higher risk of dying from any cause, compared with their socially integrated counterparts.

However, not all social ties are equally beneficial to everyone. Some types of social relationships held different results, depending on age, race/ethnicity, and country of origin.

For instance, non-white women who had strong ties with their family and relatives were less likely to die from breast cancer, whereas older white women were less likely to die from breast cancer if they had a spouse.

Older white and Asian women were more likely to have a lower recurrence and mortality rate if they had strong community ties.

Overall, the correlations proved to be stronger in patients with stages 1 and 2 breast cancer.

Dr. Kroenke explains the contribution of the study, noting that it sheds light on specific breast cancer outcomes."It is well established that larger social networks predict lower overall mortality in healthy populations and in breast cancer patients, but associations with breast cancer-specific outcomes like recurrence and breast cancer mortality have been mixed," says Dr. Kroenke.

Additionally, the study highlights complex differences between various kinds of social ties.