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Researchers develop model on how brain reward response may impact anorexia nervosa

Researchers at the University of Colorado Anschutz Medical Campus have found that the brain’s response to taste stimuli is linked to high anxiety and a drive for thinness that could play a role in driving anorexia nervosa.

The study was published last week in the journal JAMA Psychiatry.

The researchers, led by Dr. Guido Frank, MD, associate professor of psychiatry and neuroscience at the University of Colorado School of Medicine, monitored a large group of patients with anorexia nervosa as they tasted sugar during brain imaging.

Dr. Guido Frank, associate professor of psychiatry, is an expert in eating disorders
Dr. Guido Frank, associate professor of psychiatry and neuroscience, is an expert on eating disorders

They found their brain response was higher than those in the control group, representing a biological marker for the illness. At the same time, this brain response was related to high anxiety and less weight gain for those being treated for anorexia nervosa.

Frank found that as these patients restricted their diet, a brain reward circuit associated with the neurotransmitter dopamine becomes more active but also triggers anxiety. This makes food avoidance worse and perpetuates the often deadly disease.

“When you lose weight your brain reward response goes up,” said Frank. “But instead of driving eating, we believe it elevates anxiety in anorexia nervosa, which makes them want to restrict more. This becomes then a vicious cycle.”

Using brain scans, the researchers examined 56 female adolescent and young adults with anorexia nervosa between the ages of 11 and 21 and 52 healthy control participants of the same age. They all learned to associate colored shapes with either getting or not getting a sugary solution. Sometimes when they expected sugar they got nothing, and sometimes when they didn’t expect sugar they received it.

Those with the eating disorder responded more strongly to the unexpected getting or not getting of sugar water, perhaps due to the release of dopamine.

The researchers found that the higher the brain response, the higher the harm avoidance in those with anorexia nervosa was. Harm avoidance is an anxiety measure for excessive worrying and fearfulness. In these patients, it pushes the drive for thinness and furthers body dissatisfaction.

Frank discovered that the higher the brain response, the lower the weight gain during treatment.

This brain reward response acted on the hypothalamus, which stimulates eating, in the anorexia nervosa group. The researchers hypothesized that this could make it possible to override and fend off signals to eat.

“An enhanced dopamine reward system response is an adaptation to starvation,” the study said. “Individuals vulnerable to developing anorexia nervosa could be particularly sensitive to food restriction and adaptations of reward response during the [mid-adolescence] development period.”

According to Frank, anorexia nervosa behavior could alter the brain circuits and impact its taste-reward processing mechanisms. Those who are already worried about shape and weight become even more concerned. And a strong response that says “feed me” might be overwhelming and trigger more food restriction instead of eating.

The study noted that while most people like sweet tasting things, those with eating disorders associate the taste with weight gain and try to avoid it. Frank found that the brain activation among the anorexia group was inversely connected with any pleasant experience of eating sugar.

“Our data raise the possibility that adolescents with anorexia nervosa in this study were negatively conditioned to sweet taste and may have developed an inverse association with dopamine release across the larger (brain) reward circuitry,” the study said.

Frank believes these insights could lead to new treatments for eating disorders.

“I hope we can use these findings to manipulate these biomarkers and design better treatments for this often-deadly disease,” he said.

The study’s coauthors include: Marisa C. DeGuzman, BA, BS; Megan E. Shott, BS; Mark L. Laudenslager, PhD; Brogan Rossi, BS, all from the University of Colorado Anschutz Medical Campus. And Tamara Pryor, PhD, of Eating Disorder Care, Denver, Colorado.

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Researchers find connection between viruses and inflammatory bowel disease

A study led by a University of Colorado Anschutz Medical Campus researcher reveals a key connection between viruses and inflammatory bowel diseases like ulcerative colitis and Crohn’s disease.

Breck Duerkop, PhD, assistant professor of immunology and microbiology at the University of Colorado School of Medicine, and a team of scientists focused on viruses inhabiting bacteria in the intestine known as bacteriophages or simply phages.

Breck Duerkop, PhD, assistant professor of immunology and microbiology at the University of Colorado School of Medicine
Breck Duerkop, PhD, assistant professor of immunology and microbiology at the University of Colorado School of Medicine

“Phage numbers are elevated at the intestinal mucosal surface and increase in abundance during inflammatory bowel disease (IBD), suggesting that phages play an unidentified role in IBD,” said Duerkop, lead author of the study published Monday in the journal Nature Microbiology.

IBD poses significant health burdens worldwide and has inspired intense investigation into the environmental factors causing persistent inflammation of the intestine. Microbial communities are critical in maintaining intestinal health but changes in the composition of these organisms may cause an inflammatory response by the body.

According to Duerkop, most studies looking at how these microbial communities might spark inflammation have focused chiefly on bacteria rather than the viruses residing inside them.

When inflammation occurs, Duerkop found that phage communities change randomly leading to a genetic signature indicative of the inflammatory environment.

“We hypothesize that inflammation or other host defenses alter phage abundances during colitis,” the study said. “Such stresses could produce ecological disturbances in the intestinal environment, driving alterations within the viral community.”

Those disturbances could be the result of the viruses killing off beneficial bacteria in the intestine and allowing for `bad actor’ bacteria to cause inflammation and bowel disease.

The experiments were done with mice.

“What we see in mice is consistent with what we see in humans with IBD,” Duerkop said.

While the mechanics of how these phages operate will require further study, Duerkop said this discovery could lead to new kinds of treatment for these often debilitating diseases.

Clinicians could target certain bacteria with viruses to eliminate bacteria that lead to inflammation. Bacteria could be manipulated to circumvent the development of disease.

“We could promote the growth of good bacteria – a kind of phage therapy,” Duerkop said. “We could perhaps use phages as markers to identify someone predisposed to developing these diseases. While there is clearly more research to do, the potential is very exciting.”

The co-authors include Manuel Kleiner, North Carolina State University; David Paez-Espino of the Department of Energy, Joint Genome Institute; Wenhan Zhu, University of Texas Southwestern Medical Center; Brian Bushnell, Department of Energy, Joint Genome Institute; Brian Hassell, Howard Hughes Medical Institute, University of Texas Southwestern Medical Center; Sebastian E. Winter, University of Texas Southwestern Medical Center; Nikos C. Kyrpides, Department of Energy, Joint Genome Institute; Lora V. Hooper, Howard Hughes Medical Institute, University of Texas Southwestern Medical Center.

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Lifestyle makeover: Wellness center study fuels transformation

With the words “morbidly obese” ringing in her ears and the thrill of crossing a 5K finish line fresh in her mind, Emily Cooley’s eyes stopped short on a Facebook post. The Anschutz Health and Wellness Center (AHWC) needed recruits for a weight-loss study. Having just been counseled by her doctor about the gravity of her weight, Cooley took it as a sign.

Emily Cooley before weight loss
A sense of accomplishment after finishing a 5K helped spur Emily Cooley’s dramatic weight loss.

That was 2-1/2 years ago. Today, the retail manager remains one of the most successful participants to take part in the 170-person study, shedding 80-plus pounds from her 5-foot-7, 240-pound frame and keeping it off, a feat that puts her in a rare group. Only one in five significant weight losers maintain the loss for more than one year, studies show.

“We can generally get individuals to lose weight, or to start exercising, but most are not successful at maintaining either of those two things long-term,” said Danielle Ostendorf, PhD, a physical activity epidemiologist on the University of Colorado Anschutz Medical Campus and recent Colorado School of Public Health graduate who worked on Cooley’s study. “Emily’s a perfect example of doing both things through lifestyle change.”

Turning points

Cooley, 39, who struggled with weight for years, had resigned herself to being a plus-size woman after her second daughter was born. But then her doctor showed her a Body Mass Index chart classifying her as morbidly obese and at risk of serious health problems.

“I want to be here for them, and not just on the sidelines.” – Emily Cooley

“Seeing morbidly obese in black and white freaked me out,” Cooley said. That, coupled with the life-long duty of parenthood, fueled her attitude reversal. “Being a mom definitely changed my perspective about it,” said the wife and mother of 4- and 6-year-old girls. “I want to be here for them, and not just on the sidelines.”

Feeling the satisfaction of finishing a 5K, which she mostly walked with the support of a runner friend, was another trigger. “I was so touched,” said Cooley, who now runs 5Ks with ease and has a BMI of 25 instead of 38. “I had finished it. I had made my goal.”

Expert guidance

The AHWC study, funded by the National Institutes of Health and led by the School of Medicine’s Victoria Catenacci, MD, helped keep her motivated through guidance, support and resources, from

Emily with family
Being around as long as possible for her family served as Emily Cooley’s “why” for losing weight.

the latest diet research to top-of-the-line fitness facilities, Cooley said. While working with a nutritionist, she learned she was absent-mindedly drinking calories, swallowing as many as 600 in a large frappe for breakfast and 300 in a large Coke for lunch.

Once her diet counseling changed things, Cooley was eating fewer calories all day than she generally consumed before noon.

Initially, Cooley was disappointed when she was placed in the “delayed-exercise” group during the study, spending the first six months on dieting only while her counterparts had exercise and diet training from the start. But now she sees the chance placement as luck. “I was focusing on only one big change at a time.”

Once exercise was added to her routine, Cooley had already dropped 50 pounds, making working out easier and less painful, she said. Participants’ exercise routines were ramped up slowly, from 20 minutes three times a week to 60 minutes five times a week, which Cooley and Ostendorf also suspect helped prevent burnout and injury, two threats that often sabotage overzealous new exercisers.

Powerful goals

Motivation, commitment and “SMART goals” set regularly along the way led to Cooley’s success, Ostendorf said, referring to Specific goals that are Measurable, Attainable, Realistic and Timely. “It could be: I want to lose 10 pounds in two months, or I want to lower my blood pressure 5 mm/Hg in six months,” she said.

Cooley largely uses a regular race plan for keeping on track, setting 5K and 10K dates with friends she’s met along the way throughout the year. “Then I tell my girls I have to go to the gym, so I can be strong for my race,” she said.

Setting an example for her daughters remains a big motivator for Cooley, who often hears: “Good job, Mommy!” and who walked a 5K with her 6-year-old this summer. Higher energy and better moods are other benefits, Cooley said, who has now set a lofty goal of completing a marathon this spring. “I just want to prove that I can.”

Curbing an epidemic: weight-loss star offers tips

With 70 percent of Americans overweight or obese, and their burgeoning waistlines costing the medical system as much as $190 billion annually, the Anschutz Health and Wellness Center’s research and promotion of weight loss helps curb an epidemic. Here are a few of study participant Emily Cooley’s tricks for success:

Be consistent.

“I will have one cheat meal once in a while, but then I get right back on track. I don’t do cheat weekends or cheat vacations anymore.”

Track exercise and calories.

“I still use MyFitnessPal. If I don’t, I underestimate what I eat.”

Have a powerful “why.”

“I can’t be morbidly obese. I have two little girls.”

Set consistent goals.

“I always have a race planned with friends; that helps keep me motivated.”

Make it fun.

“We make it a girls’ day out and do something like brunch after the race.”

Surround yourself with support.

“It just makes sense to have friends with the same goals.”

Plan.

For exercise: “I lay out my workout clothes the night before. And I have two alarms: a wake-up alarm nearby, and a get-out-of-bed alarm farther away.”

For diet: “I always have things like Clif bars or trail mix with me, so I don’t get caught out with nothing.”

Make it easy.

“My gym is only 10 minutes away.”

Forget the guilt.

“I used to feel guilty about taking time away from the girls. Now I realize if I’m not a healthy mom, I can’t be the best mom.”

Just do it.

“It’s never too late to lose weight.”

 

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CU Anschutz awarded $8 million to refine and expand research cooperative focused on end-of-life and palliative care

The University of Colorado Anschutz Medical Campus received an $8 million, five-year continuation grant from the National Institute for Nursing Research (NINR), part of the National Institutes of Health, to refine and expand the Palliative Care Research Cooperative Group (PCRC).

Jean Kutner, MD,MSPH, professor of medicine
Jean Kutner, MD, MSPH, professor of medicine.

As the nation’s first research cooperative group focused on end-of-life and palliative care research, the PCRC was established in 2010 with initial funding from the NINR/NIH, and now includes close to 450 members and a growing network of over 150 clinical sites across the nation.

The PCRC addresses national research priorities in end-of-life and palliative care by enhancing the quality and efficiency of research. The PCRC exists to lead, catalyze, and empower a community of investigators who are developing an evidence base to ensure high quality care and optimal well-being for persons with serious illness and their caregivers. The PCRC is a vibrant, interdisciplinary research community committed to advancing rigorous palliative care science and improving care for people with serious illness.

“The PCRC has developed key resources and infrastructure that are facilitating conduct of high quality palliative care research and fostering an interdisciplinary community of investigators,” said Jean Kutner, MD, MSPH, professor of medicine at the University of Colorado School of Medicine and PCRC Co-Chair.

Christine Ritchie, MD, MSPH, professor of medicine at the University of California San Francisco, Co-Chair of PCRC, and Director of the PCRC Investigator Development Center, describes the PCRC as a community of learners. “In a field as new as palliative care with substantial research needs, it is critical for new and seasoned investigators alike to be learning cutting-edge research methods and strategies to answer complex questions faced by those with serious illness and their caregivers.”

“Palliative care research has grown by leaps and bounds. The PCRC helps ensure we conduct the most rigorous science that can inform our clinical practice to improve the lives of patients and their caregivers,” said Kathryn Pollak, PhD, professor of Population Health Sciences at Duke University, Co-Chair of PCRC, and Director of the PCRC Clinical Studies/Methodology Core.

Information about the PCRC is available on the PCRC website: http://palliativecareresearch.org/.

Funding for the PCRC is provided by the NINR (UC4NR012584, U24NR014637, and U2CNR014637-6).

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Online course focuses on opioid prescription guidelines

The Center for Health, Work & Environment, at the Colorado School of Public Health, and the Colorado Consortium for Prescription Drug Abuse Prevention have released an online course that educates healthcare professionals in Colorado about the latest opioid prescription guidelines and best practices for treating patients in pain. Originally developed in 2012, the updated course, “The Guidelines and Tools for Improving Pain Management: Opioid Stewardship,” has been redesigned to reflect current federal, state, and professional association guidelines, incorporate new research, and provide guidance about how to treat specific populations including workers and pregnant patients.

More than 2,800 people have taken the previous version of the course and 90 percent say that they have applied what they learned in the training in their healthcare practice.

“We are starting to bend the curve on the opioid epidemic and have better guidelines for improving the management of patients’ pain,” said Lee Newman, MD, MA, director of the Center for Health, Work & Environment and professor at the University of Colorado (CU) Anschutz Medical Campus. “This new, self-paced course brings practitioners and their staff up to date with practical advice from experts right here in Colorado.”

Working together, teams at the center and the consortium have combined their collective expertise into this course. Their goal is to ensure that healthcare workers in Colorado stay informed about how to provide excellent patient care, help patients manage their pain safely and effectively, and curb opioid misuse in their communities.

“Providers truly are on the frontlines of the opioid crisis. Getting them the latest, most accurate information will lead to safer prescribing practices and more effective treatment for patients,” said Robert Valuck, PhD, RPh, director of the Colorado Consortium for Prescription Drug Abuse Prevention and professor at the CU Anschutz Medical Campus.

Every member of a care team can enroll in this course. The audience ranges from physicians and nurses to dentists and pharmacists. The online, self-paced format is designed to appeal to busy health professionals, especially those in rural communities. More than a quarter of past participants are from rural areas. Learners can review materials and complete assignments at their own pace wherever they are located in the state, whether that is in a small mountain town or a major city in Colorado.

“Courses like this will help us reach providers where they are, allowing them to gain vital knowledge in a way that fits into their busy schedules,” said Valuck.

Reversing the opioid epidemic sweeping across Colorado and the nation will be no easy feat. But experts from the center and the consortium believe that educating healthcare providers about evidence-based, nonaddictive ways to manage patients’ pain is a big step in the right direction.

Guest Contributor:  Avery Artman, Colorado School of Public Health

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College of Nursing accepted into first cohort of State Innovation Model of whole-person care

Sheridan Health Services, owned and operated by the CU College of Nursing, was accepted into the Colorado State Innovation Model (SIM), a federally funded, governor’s office initiative that helps primary care providers deliver whole-person care.

It is one of 24 practices in Denver County to participate in SIM and was part of the first cohort that completed its work in March, and one of 11 practices in Arapahoe County to be accepted into the federally funded, governor’s office initiative.

SIM will support a total of three practice cohorts, which run through July 2019. About 1,847 SIM providers in cohorts 1-2 deliver care during 3,342,018 annual patient visits.

“SIM providers in these cohorts must focus on the entire patient, which means addressing mind, body and
mental wellness,” said Donna Lynne, lieutenant governor and chief operating officer, who has many years of leadership experience in the health care sector. “That complete approach to health is what makes the SIM initiative is so valuable. Patients get the care they need when they need it, and providers learn how to succeed with new payment models. It’s a great example of meaningful reform in our state.”

Patients interviewed by SIM staff notice and appreciate the work done by practices. “It’s powerful for me, as a patient, to land somewhere I feel well taken care of,” said Mary Catherine Conger, a patient at Roaring Fork Family Practice, during a SIM podcast (https://bit.ly/2nzuieO).

Whole-person care

Colorado was the only state (out of 11 selected for a SIM model test award) to focus on integrated behavioral and physical health care supported by public and private payers as its primary goal. The initiative helps providers progress along an integrated care path continuum that can start with referrals and could lead to colocation of behavioral and physical health professionals in primary care settings. Integrated care improves patient outcomes, reduces health care costs, and enhances provider morale.

The efforts also benefit providers. “I partner with the providers to achieve my goals and improve the quality of my life. My family appreciates the continuity between dentistry, pharmacy, primary care, and behavioral health,” said Sally Daigle, a patient who is also the Board President and Mayor Pro-Tem of Sheridan.

SIM launched with 100 practice sites in 2016, added 155 practices in 2017 and will help about 25 percent of the state’s primary care sites and four community mental health centers deliver whole-person care. The state will receive $65 million from the Centers for Medicare and Medicaid Services (CMS) to implement this model for health care innovation, which is expected to save or avoid $126.6 million in health care costs for CMS, with a 1.95 return on investment during its four-year time frame.

Learn more at the SIM website. See how integrated care improves health.

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New Paid Parental Leave Policy effective July 1, 2018

Dear CU Anschutz faculty and staff,

I’m writing to let you know about exciting changes to the university’s Parental Leave Policy.

Effective July 1, 2018, university staff and 12-month faculty (including research faculty and PRAs) will be eligible for four consecutive weeks (160 hours) of paid leave within one year of the birth, adoption or foster placement of a child. Only employees who are already on a continuous block of leave for a qualifying event as of July 1, 2018, OR who have a qualifying event that occurs after July 1, 2018, may receive the paid leave portion of this new benefit.

The campus policy including eligible job classifications can be found here.

Supporting our employees and preparing our campuses for the needs of the current and future workforce is a priority, and this policy change is being made by CU administration in response to Staff Council and Faculty Assembly input. Paid Parental Leave was identified as a benefit that would support employees as they grow their families, and we are very pleased to be able to respond to this need.  Much work and cross-campus collaboration went into this policy change, and demonstrates CU’s commitment to our employees and their needs.

Parental Leave basics:

  • Under current policy, 12-month faculty who have worked for 12 consecutive months in a 50 percent or greater appointment and university staff may take either 12 weeks or six consecutive months of unpaid parental leave (depending on job classification). Pay is received using a combination of vacation, sick leave and (in the case of birth parents) short-term disability, if available. ​
  • Under the new policy, 160 consecutive hours (four weeks) of this leave will be paid by the university – separate from an employee’s accrued sick and annual leave pay.

Parental leave polices will not change for nine-month faculty (who currently receive a more generous parental leave benefit) and for classified staff. CU administration is working with the State to potentially extend the program to classified staff in the future.

The original communication, CU System Policy, Denver | Anschutz Campus Policy FAQs and information on applying can be found here: http://www.ucdenver.edu/about/departments/HR/ResourcesforHRBusinessPartners/Pages/leave.aspx

Details on the revised CU System policy can be found on the Office of Policy and Efficiency’s website (click “Draft PDF”).

For questions about parental leave, CU Anschutz faculty and staff may email HR.ParentalLeave@ucdenver.edu.

To apply for parental leave, please complete the Parental Leave Request form. You will need to log in with your credentials in order to apply.

Best,

Carolyn Brownawell
Associate Vice Chancellor & Chief Human Resources Officer
CU Denver ǀ Anschutz Medical Campus

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