Centenarians ‘outliving diseases of old age’


Centenarians have found a way to beat the common diseases of old age, such as cancer and heart disease, research suggests.

The study by King’s College London found they were more likely to die of infections such as pneumonia, unlike younger groups of elderly people.

Researchers said 28% of 100- to 115-year-olds died of “old age” and a fifth of pneumonia. Cancer claimed the lives of fewer than 5% and heart disease fewer than 9%.

The study was based on an analysis of 36,000 death certificates. By comparison, these diseases were the most common reasons for death among the 80- to 84-year-old age group, with cancer responsible for 25% of deaths and heart disease nearly a fifth.

Boost high quality care
Lead researcher Dr Catherine Evans said the findings raised important questions for health and care services.

“Centenarians have outlived death from chronic illness, but they are a group living with increasing frailty and vulnerability to pneumonia and other poor health outcomes.

“We need to plan for healthcare services that meet the ‘hidden needs’ of this group, who may decline rapidly if they succumb to an infection or pneumonia.

“We need to boost high-quality care-home capacity and responsive primary and community health services to enable people to remain in a comfortable, familiar environment in their last months of life.”

The study, published in the journal PLOS Medicine, said this was going to become even more important as the number of centenarians increased.

According to latest Office for National Statistics data, there are more than 13,000 centenarians living in the UK, but by 2066 that number is expected to increase to more than 500,000.

The researchers pointed out that, in the UK, far fewer very old people ended up dying in care homes compared with other European countries, such as the Netherlands and Finland.

Dr Evans added: “Hospital admission in the last weeks of life accounts for a third of the total cost of end-of-life care per patient.”

Source: BBC news

Old and Wise: Why Do Smarter People Live Long


Intelligent people live longer—the correlation is as strong as that between smoking and premature death. But the reason is not fully understood. Beyond simply making wiser choices in life, these people also may have biology working in their favor. Now research in honeybees offers evidence that learning ability is indeed linked with a general capacity to withstand one of the rigors of aging—namely, oxidative stress.

Ian Deary, a psychologist at the University of Edinburgh, has proposed the term “system integrity” for the possible biological link between intelligence and long life: in his conception, a well-wired system not only performs better on mental tests but is less susceptible to environmental onslaughts. Gro Amdam of Arizona State University and the Norwegian University of Life Sciences was intrigued by the idea and last year devised a way to test it in bees.

Honeybees are frequently used as a neurobiological model for learning—they can be trained, using positive or negative reinforcement, to retain information. In Amdam’s experiment, individual bees were strapped into a straw, where they learned to associate an odor with a food reward in a classic Pavlovian conditioning scenario. After only one or two trials, many bees learned to stick out their tonguelike proboscis in anticipation of a sugary droplet. Some bees took a little longer—as in humans, there are quick learners and slower ones.

To simulate aging, the same bees were then placed in plastic tubes and exposed to a high-oxygen environment, a metabolic stress test. All animals need oxygen to breathe, but an overload drives cells to churn out damaging free radicals that break down cell membranes and cause cells to commit suicide, triggering premature aging. The better learners tended to live longer during this ordeal—an average of 58.8 hours, as opposed to the poor learners’ average of 54.6—suggesting they have a more robust antioxidant system, which mops up destructive free radicals.

Amdam suspects that general stress resilience may explain why the quick learners lived longer. In the learning trials, the bees that could stand the stress of being in the straw were able to learn faster that the odor signaled a treat, and the same resilience allowed these bees to better with­stand the stress of being in a high-oxygen environment.

For people, too, Amdam hypothesizes that the ability to handle stress could be a component of system integrity; better overall stress resilience may contribute to both higher IQ scores and longer life. And if scientists can unravel what underlies these biological differences, they might be able to alleviate inborn disparities. “There is an opportunity to help everyone live longer,” Amdam says.

Source: medical webtimes

Low blood sugar tied to ‘hangry’ fights with spouse

We’ve all been “hangry,” so hungry that we become angry at the slightest frustration or provocation. But could low blood sugar make you so hangry you’d abuse your spouse?

In an effort find out, scientists asked married couples to secretly stick pins into a voodoo doll representing their spouses, and blast noise in their spouses’ ears. The results, released Monday in the Proceedings of the National Academy of Sciences (PNAS), does appear to show a link between lower blood sugar and marital spats.

Led by Brad Bushman, a professor of communication and psychology at The Ohio State University, the experiment tested a hypothesis about self-control.

The researchers had 107 couples monitor their blood glucose levels with over-the-counter monitors once in the morning and once in the evening for 21 days. Every evening the partners were to privately stick needles into voodoo dolls to indicate how angry they were with their spouses, zero meaning not at all, up to a high of 51.

Even after controlling for a number of variables like overall relationship satisfaction, people with lower glucose levels stuck more pins in the dolls. There was no difference between men and women in how they were affected.

Then Bushman had couples come into his lab to play a simple computer game against each other while sitting in different rooms. In fact, they were playing against a computer and the results were rigged so they’d win and lose about the same number of rounds.

As a punishment for “losing” a round, the victor could play an obnoxious noise — a combination of fingernails on chalkboards and other irritating sounds like an airhorn — into the earphones of the loser at a volume the victor selected, up to about the level of a smoke alarm. (Actually, the computer controlled the noise level.)

Those people with lower glucose levels, and who stuck more pins into the dolls, also tended to blast the noise.

“Thus,” Bushman and colleagues wrote, “low glucose levels might be one factor that contributes to intimate partner violence.”

Many experts believe that self-control can be depleted like a battery, as illustrated in one famous 1998 study: Two groups of hungry people were placed in a room containing a plate of freshly-baked cookies and a plate of radishes. One group was told they could eat cookies, the other told they could eat only radishes. Both groups were then asked to complete a puzzle they didn’t know was unsolvable.

The cookie group worked twice as long on the puzzle. People in the radish group gave up sooner because they had to exercise more self-control to avoid eating the cookies. So there was less willpower left to work on a frustrating puzzle.

A number of factors can deplete self-control, said Brandon Schmeichel, a professor of psychology at Texas A&M University who studies this phenomenon. Performing a task that requires self-control — like not eating a cookie when you really want one, or doing math problems, or filling out your 1040 form — can do it, as can mood, alcohol, and one’s ability to keep your eye on long-term goals, rather than short-term impulses. “That can be difficult to do,” Schmeichel said.

Glucose is a more controversial factor. Proponents argue that the brain uses a lot of energy, especially the pre-frontal cortex that exerts control over our baser instincts and helps us reason. Low glucose can leave the brain low on gas. And being low on gas weakens self-control.

But others point out that some studies suggest self-control is not always limited, and that experiments trying to link low glucose to low self-control are contradictory. Some show an effect, some do not.

Bushman believes there is a cause-effect link and that “aggression starts when self-control stops.”

Professor Florian Lange, a neuroscientist at Hannover Medical School in Germany, praised some parts of the study, but via email said he’s not convinced there’s “a significant role for glucose in self-regulation/self-control.”

A number of other factors could explain the experiment’s results “equally well,” Lange said. For example, he speculated, “who are these violent people having low blood sugar?” he asked.

“Maybe they eat healthier in order to be fit to do extreme sports, an activity they like to pursue because they are more risk-taking,” Lange suggested. “This latter variable could explain why they show more aggression.”

Whether or not low glucose specifically depletes self-control, though, most experts agree that hunger can. As Bushman said, “hungry people are cranky people.”

So, he said, “if you are having a discussion with your spouse about a conflict situation, make sure you’re not hungry.” He advised skipping candy bars and other high-sugar foods, which can spike glucose but lead to a crash. Instead, say, before that last minute tax return debate, eat something nutritious.

source; today

Texas Girl Recovering After Obesity Surgery Switch

Texas pre-teen with rare, medically induced obesity was sedated and on a ventilator late Friday after Cincinnati doctors suddenly had to switch plans during her weight-loss surgery.

Alexis Shapiro, 12, was stable and comfortable but expected to remain in the intensive care unit at Cincinnati Children’s Hospital Medical Center at least through the weekend, said Dr. Thomas Inge and colleagues monitoring the child whose metabolism went haywire after brain surgery two years ago.

“Ultimately, I don’t think this will change her prognosis,” said Inge, who expects Alexis to lose weight and resolve many health problems such as type 2 diabetes and pulmonary issues caused by the condition that sent her weight past 200 pounds on her 4-foot-7 frame.

Instead of the gastric bypass operation and procedure to cut part of her vagus nerve they expected to perform, Inge and his crew had to adjust their plans because Alexis’ liver was bigger and fattier than anticipated. Instead, they performed a sleeve gastrectomy to remove up to 80 percent of her stomach.

He said it wasn’t a medical complication, but a clinical decision to alter plans. Doctors knew her liver was large, but couldn’t tell how difficult it would be to manipulate it until they got into surgery.

“It’s not disappointing at all,” Inge told reporters. “Our goal is do to a safe operation under circumstances that are not always 100 percent predictable.”

Alexis’ parents, Jenny and Ian Shapiro, agreed.

“Yes, unexpected. But it’s OK,” Jenny Shapiro told NBC News in an email Friday. “We are OK with it. And it was what’s best for her.”

The Cibolo, Texas, couple backed out of the press conference Friday because they had signed a contract with the television show “The Doctors,” which plans to air a segment about Alexis in April.

In a statement, they expressed gratitude to the thousands of people who have sent cards and emails and raised more than $84,000 for the family since NBC News first reported the story in December.

“We are appreciative of all of the prayers and thoughts of all of the people who have shown support of us over recent months and we will continue to be focused on Alexis getting better,” they wrote.

“We have an exclusive contractual relationship with the guest and her family which is being honored by the family,” Marc Grossmann, a senior publicist with The Doctors, said in an email. Show officials would not disclose whether or how they compensated the family to stop talking to other media.

Inge said doctors will wait to see how Alexis responds to the surgery before deciding whether to go ahead with the gastric bypass and vagus nerve operations. Patients sometimes lose less weight with the sleeve procedure than with gastric bypass, Inge said. However, it’s very common to perform bypass surgery after a sleeve gastrectomy, he added.

“I think she will have a new normal,” Inge said. “The new normal for her will be at a healthier weight perhaps with less damaging conditions.”

Alexis will remain hospitalized for about a week and could return to Texas in two weeks.

Source: NBC news


Why happiness is healthy

You might call it a sense of well-being, of optimism or of meaningfulness in life, although those could also be treated as separate entities. But whatever happiness is, we know that we want it, and that is just somehow good.

We also know that we don’t always have control over our happiness. Research suggests that genetics may play a big role in our normal level of subjective well-being, so some of us may start out at a disadvantage. On top of that, between unexpected tragedies and daily habitual stress, environmental factors can bring down mood and dry up our thirst for living.

Being able to manage the emotional ups and downs is important for both body and mind, said Laura Kubzansky, professor of social and behavioral sciences at Harvard School of Public Health.

“For physical health, it’s not so much happiness per se, but this ability to regulate and have a sense of purpose and meaning,” Kubzansky said.

Why be happy?

Many scientific studies, including some by Kubzansky, have found a connection between psychological and physical well-being.

It’s not as simple as “you must be happy to prevent heart attacks,” of course. If you have a good sense of well-being, it’s easier to maintain good habits: Exercising, eating a balanced diet and getting enough sleep, researchers said. People who have an optimistic mindset may be more likely to engage in healthy behaviors because they perceive them as helpful in achieving their goals, Kubzansky said.

Lower blood pressure, normal body weight and healthier blood fat profiles were also associated with a better sense of well-being in this study.

For now these studies can only show associations; they do not provide hard evidence of cause and effect. But some researchers speculate that positive mental states do have a direct effect on the body, perhaps by reducing damaging physical processes. For instance, another of Kubzansky’s studies found that optimism is associated with lower levels of inflammation.

If what you mean by happiness is specifically “enjoyment of life,” there’s newer evidence to support that, too. A recent study in the Canadian Medical Association Journal found that people ages 60 and older who said they enjoyed life less were more likely to develop disability over an eight-year period. Mobility was also related to enjoyment of life. This study does not prove that physical problems are caused by less enjoyment of life, but suggests a relationship.

Where happiness comes from: genes + environment
There is substantial evidence that genetics play a big role in happiness, according to Nancy Segal, psychologist at California State University, Fullerton, and author of “Born Together — Reared Apart.”

Research has shown that identical twins tend to have a similar level of happiness, more so than fraternal twins. And in identical twins, one twin’s happiness is a better predictor of the other twin’s current or future happiness than educational achievement or income, Segal said.

“If you have happy parents and happy children, I think that people usually assume it’s because the children are modeling the parents,” she said. “But that’s not really so. You need to make the point that parents pass on both genes and environments.”

What’s more, there seems to be a certain level of happiness that individuals have generally, to which they usually gravitate, Segal said. That level depends on the person, and the situations he or she is in.

Even if genetics has a big influence, though, that doesn’t mean anyone is biologically stuck being unhappy, she said. It might take more work if your baseline mood is low, but certain therapies have proven useful for elevating psychological well-being.

The environment is still quite important for psychological well-being, too, Kubzansky said.

“To say to someone, ‘Don’t worry, be happy,’ is kind of not looking at the whole picture of, what are the environmental constraints on things they can do?” Kubzansky said.

Source: cnn

Will you die in 5 years? New ‘death test’ predicts

Scientists were astonished to find they could predict which healthy people are at most risk of death by studying four key biomarkers in the body

A ‘Death Test’ which predicts the chance of a healthy person dying from any medical condition in the next five years has been developed by scientists.

Researchers said they were ‘astonished’ to discover that a simple blood test could predict if a person was likely to die – even if they were not ill.

They found that the levels of four ‘biomarkers’ in the body, when taken together, indicated a general level of ‘frailty’.

People whose biomarkers were out of kilter were five times more likely to die with five years of the blood test.

“What is especially interesting is that these biomarkers reflect the risk for dying from very different types of diseases such as heart disease or cancer. They seem to be signs of a general frailty in the body,” said Dr. Johannes Kettunen of the Institute for Molecular Medicine in Finland.

“We believe that in the future these measures can be used to identify people who appear healthy but in fact have serious underlying illnesses and guide them to proper treatment.”

A biomarker is a biological molecule found in blood, body fluids, or tissues that may signal an abnormal process, a condition, or a disease.

The level of a particular biomarker may indicate a patient’s risk of disease, or likely response to a treatment. For example, cholesterol levels are measured to assess the risk of heart disease.

Most current biomarkers are used to test an individual’s risk of developing a specific condition. There are none that accurately assess whether a person is at risk of ill health generally, or likely to die soon from a disease.

Blood samples from over 17,000 generally healthy people were screened for more than a hundred different biomarkers and those people monitored over five years
In that time 684 people died of a range of illnesses and diseases, including cancer and cardiovascular disease. Scientists discovered that those people all had similar levels of four biomarkers.

Those were albumin, alpha-1-acid glycoprotein, citrate and the size of very-low-density lipoprotein particles which are linked to liver and kidney function, inflammation and infection, energy metabolism and vascular health.
One in five participants with the highest biomarker scores died within the first year of the study.

Estonian researchers made the initial link in a cohort of 9,842 people but were so sceptical about the results that they asked Finnish scientists to repeat the experiment on a further 7,503.

Research professor Markus Perola of the Institute for Health and Welfare, Finland said they were not expecting to be able to replicate the findings and were amazed when they were identical.

Prof Perola said: “It was a pretty amazing result. First of all we didn’t really believe it. It was astonishing that these biomarkers appeared to actually predict mortality independent of disease.

“These were all apparently healthy people but to our surprise it appears these biomarkers show an undetected frailty which people did not know they had.”

Researchers claim that in the future a test could flag up high-risk individuals in need of medical intervention who show no symptoms of any disease.

“If the findings are replicated then this test is surely something we will see becoming widespread,” added Prof Perola.

“But at moment there is ethical question. Would someone want to know their risk of dying if there is nothing we can do about it?”

Dr Kettunen added: “Next we aim to study whether some kind of connecting factor between these biomarkers can be identified.

Source: Telegraph

7 Reasons Vegetarians Live Longer

There’s nothing wrong with eating meat if you’re doing so in moderation (I for one, will never give up the occasional cheeseburger), but research does show that vegetarians tend to be healthier overall, and even live longer.

Now there’s another health perk vegetarians can boast about. A new study published in the journal JAMA Internal Medicine looked at data from seven clinical studies and 32 other studies published between 1900 and 2013 where participants kept a vegetarian diet and found that vegetarians have lower blood pressure compared to people who eat meat.

Here are some other reasons vegetarians may outlive meat-lovers.

1. Low blood pressure: In the latest study, researchers found that not only do vegetarians have lower blood pressure on average, but that vegetarian diets could be used to lower blood pressure among people who need an intervention.

2. Lower risk of death: A 2013 study of more than 70,000 people found that vegetarians had a 12% lower risk of death compared with non-vegetarians. With none of the saturated fat and cholesterol that clogs arteries, vegetarians may be at a lower risk for chronic diseases overall.

3. Better moods: A 2012 study randomly split participants into a three diets: all-meat allowed, fish-only, and vegetarian no-meat. The researchers found that after two weeks, the people on the vegetarian diet reported more mood improvements than those on the other two diets.

4. Less chance of heart disease: Another 2013 study of 44,000 people reported that vegetarians were 32% less likely to develop ischemic heart disease.

5. Lower risk of cancer: Researchers at Loma Linda University in California studied different versions of the vegetarian diet and cancer risk among people at a low risk for cancer overall and discovered that a vegetarian diet may have protective benefits. Although the study is not the final say on the matter, vegans had the lowest risk for cancers, specifically cancers most common among women, like breast cancer.

6. Lower risk of diabetes: Studies have shown that vegetarians are at a lower risk for developing diabetes. While the diet won’t cure the disease, it can lower an individual’s risk by helping them maintain weight and improve blood sugar control.

7. Less likely to be overweight: Research shows that vegetarians tend to be leaner than their meat-eating counterparts, and that they also tend to have lower cholesterol and body mass index (BMI). Some data suggests that a vegetarian diet can help with weight loss and be better for maintaining a healthy weight over time.

People who don’t eat vegetarian can still be very healthy, and a vegetarian diet comes with its own health risks. For instance, research has also shown that vegetarians are at a higher risk for iron deficiencies, and some experts question whether children who are raised vegetarian get the right amount of nutrients for their growing bodies. Making sure you get the right amount of nutrients is important, and keeping your physician in the loop about your eating habits can make sure you’re meeting all the requirements for good health.

Source: health and Time

Why city life may be bad for you

When it comes to getting people to be more active, much of the attention is focused on the improving sports facilities, encouraging people to join the gym or lambasting schools for not doing enough PE.

But could another crucial factor be the way neighbourhoods are designed?

The Royal Institute of British Architects (RIBA) thinks so.

The organisation has carried out an analysis of the nine major cities in England – Birmingham, Bristol, Leeds, Liverpool, London, Manchester, Newcastle, Nottingham and Sheffield – to explore this.

Its researchers looked at housing density and the availability of green spaces.

The least active areas – deprived parts of Birmingham, Newcastle and London – had twice the housing density and 20% less green space than the most active places.

This is important.

Nearly 60% of people living in these cities do not do the recommended levels of activity.

But, crucially, three quarters said they would be happy to walk more and get outside in the fresh air if their local environment was more suitable, according to a poll cited by RIBA.

People cited safer streets and more attractive green spaces as two key factors.

RIBA has published the findings as it wants councils to take note.

Under the shake-up of the NHS last year, local government was given responsibility for public health.

So RIBA president Stephen Hodder said he wanted councils to ensure public health becomes an important part of the planning process.

“It’s vital that planners and developers take the lead and ensure healthier cities,” he added.

To be fair, this is already happening in many places.

Health impact assessments have become a crucial part of the process.

But as always – for councils which have seen their funding cut dramatically in recent years – it comes down to money.

One of the examples of good practice cited by RIBA in its report was the re-development of the Brownfield Estate, an inner-London housing estate.

It under-went a major £7m building programme with money invested from a variety of public and private sources.

The project saw the walk-ways between flats become “green grids” lined with grass and trees, while play areas were created across the site.

Another scheme highlighted was the creation of a natural play area with climbing frames, a water foundation and wetland on a disused field in the former mining town of Huthwaite in north Nottinghamshire.

Once empty, the area is now packed with children (when the weather permits).

But this project was only possible because the area was given over £200,000 of lottery money.

Source: BBC News

Sibling relationships tied to children’s vocabulary skills

siblingsIn large families, young kids can’t always get a lot of individual attention from parents – but healthy interactions with an older sibling might help compensate for that, a new study suggests.

How older children interact with their siblings is tied to the younger children’s development, Canadian researchers found.

“The idea is that here is this effect of being in a large family where you don’t get that many resources, but if you get an older sibling that’s really attuned to your needs that would be a modifying effect,” Jennifer Jenkins told Reuters Health.

Jenkins is the study’s senior author and the Atkinson Chair of Early Child Development and Education at the University of Toronto.

Previous research had found that children from large families tend to score lower on vocabulary, IQ and other academic tests, compared to those from smaller families.

“That’s been pretty well examined that the larger the family, the less good the child’s skill in language and IQ,” Jenkins said. “It’s really thought of as a resource dilution.”

For example, if a couple has a second child, the attention they spent on their first child will then be split among both kids.

She cautioned that whatever effect a large family may have on a child is small, however.

To see whether an older sibling can possibly fill in for some of that diluted attention, the researchers used data from an existing trial that included families from Toronto with 385 young children who had a sibling at least four years older.

Mothers and older siblings were scored on how they interacted with the younger child.

For example, the researchers scored whether the older sibling or mother were sensitive to the younger sibling’s abilities and gave positive feedback.

The younger sibling’s vocabulary was also tested by having the child point to an object’s picture after its named was said out loud.

The researchers found that children with many siblings tended to score lower on the vocabulary test, compared to those who had smaller families.

Children from large families whose older siblings scored higher during the interaction, however, tended to score higher on the test than those whose older brother or sister scored lower during the interaction.

The association between an older sibling’s so-called cognitive sensitivity and the younger child’s score remained strong even when the researchers also accounted for traits that might have influenced the results, such as gender and age.

While the overall association may be small, Jenkins said many traits that are associated with similar cognitive delays are of a similar size.

“It’s multiple and multiple accumulating influences,” she said. “I think all of these small influences are worth paying attention to.”

Jenkins said the next step would be to develop a trial to test a program that encourages older siblings to have better interactions with their younger brothers and sisters to see if that improves the younger siblings’ cognitive abilities.

That, she said, would also help show that the older sibling’s interactions cause better outcomes in their younger brothers and sisters instead of just showing that the two are somehow linked – as this study does.

The study also has some limitations, including not knowing what kind of interactions the younger children’s other siblings have with each other.

Jenkins and her colleagues write in the journal Pediatrics on Monday that it’s also possible that the association is reversed and that the younger child’s abilities influence the type of interactions their older siblings have with them.

“Siblings really play this very strong role in how kids come out,” Jenkins said. “I’d like people to think about those sibling relationships a little bit more and then how to strengthen them.”

Source: Reuters


How meditation helps overcome addictions

Rehabilitation therapies that use meditation are likely to have a higher success rate when it comes to helping trying to overcome addiction. This is the conclusion of a new survey of animal and human studies by a computer scientist who used a computational model of addiction, a literature review and an in silico experiment. The findings of the survey — by computer scientist Yariv Levyof the University of Massachusetts Amherst, neuroscience researcher Jerrold Meyer, and computer scientist Andrew Barto — has been published in the latest issue of the journal Frontiers in Psychiatry. “Our higher-level conclusion is that a treatment based on meditation-like techniques can be helpful as a supplement to help someone get out of addiction. We give scientific and mathematical arguments for this,” said Levy, who was a doctoral student when he undertook the survey.

According to Levy, the survey aimed to use learnings from existing animal and human studies to better understand addiction and seek new approaches to treatment. The researchers explored the allostatic theory, which describes changes in the brain’s reward and anti-reward systems and reward set points as substance misuse progresses. They used two existing computational models, one pharmacological and a more behavioural-cognitive model for the study. The allostatic theory says that when someone takes a drug he or she stresses the reward system and it loses its equilibrium state. “We smoke one cigarette and go out, come back in again, and out with another cigarette, always trying to return to equilibrium,” Levy says. “The reward system tries to change its structure with neural adaptations to get back to equilibrium. But if I continue to smoke, even with such adaptations, I can’t make it back. Equilibrium is broken as long as I continue to smoke.”

As the reward system is stressed, the anti-reward system steps in and says, “I’ll try to help,” and the person enters what is known as an allostatic state. Other brain structures are affected by the addictive substance, impairing the addict’s evaluation of drug use compared to other reinforcers, Levy said. To bind the two theories and test how they could work together in silico, the authors follow three virtual case studies, each representing a different trajectory of allostatic state during escalation of cigarette smoking. “This investigation provides formal arguments encouraging current rehabilitation therapies to include meditation-like practices along with pharmaceutical drugs and behavioural counseling,” the authors wrote.

Source: Oman daily Observer