Tuesday, January 27, 2015

Having received a grant to build a collaborative community initiative, collaboration as a management style can help stimulate a healthier and more creative work environment and one in which all involved take ownership of both process and outcomes. But how many businesses are really run in that manner?

 

Building Collaborative Communities

 

By Scott London


In 1995, I was commissioned by the Pew Partnership for Civic Change to study how collaboration was being used in the United States to build and strengthen community. While there are many forms of collaboration, my research focused on one type in particular—the kind carried out by individuals, groups and organizations in the public sphere. This form of collaboration can be described as a process of shared decision-making in which all the parties with a stake in a problem constructively explore their differences and develop a joint strategy for action.




My report on the subject (from which the following essay has been adapted) generated a surprising amount of attention when it appeared. It was widely cited in books and publications and reprinted in several monographs. After concluding the study, I went on to observe and work with collaborative teams across America as well as study community leaders who practice collaboration as part of their community development work.

I found that collaboration can be a powerful alternative to conventional mechanisms for effecting change, such as coalitions, task forces, and commissions. Traditional groups and organizations tend to be structured vertically. Decisions are made at the top and people derive their influence and authority from their positions within the hierarchy. This is especially true in professional organizations where leadership is centralized, the work mission-driven, processes guided by procedures and statutes, and internal communication mostly confined to departments, workgroups, and committees.

Collaborative groups, by contrast, are structured horizontally. Leadership, to the extent that it exists at all, is broadly distributed. Job titles and professional affiliations fade into the background and people derive their influence from having their ears to the ground, from being well-connected in the community, and from being engaged in a multiplicity of projects. Membership usually spans silos and divisions in the community, processes are guided by norms of trust and reciprocity, and communication is more personal, more conversational, more exploratory than in formal settings.

For this reason, collaborative efforts tend to be loosely structured, highly adaptive, and inherently creative. By creating spaces where connections are made, ideas are cross-fertilized, and collective knowledge is developed, collaborative teams generate rich opportunities for innovation. When the right people are brought together in constructive ways and with the appropriate information, they are able to create powerful visions and robust strategies for change.

While collaboration is getting a lot of attention today, especially in the fields of management theory and leadership studies, there is relatively little substantive research on the subject. There is, however, a growing body of literature championing its benefits. In the following pages, I review some of the principal sources in order to better understand: What is collaboration? How does it differ from other models of cooperation? What are the prerequisites and dynamics of effective collaboration? What makes an effective collaborative leader? What are some of the chief dangers and obstacles to successful collaboration? And how do we build more collaborative communities?


WHAT IS COLLABORATION?


As its Latin roots com and laborare suggest, collaboration reduced to its simplest definition means "to work together." The search for a more comprehensive definition leads to a myriad of possibilities each having something to offer and none being entirely satisfactory on its own. These range from the academic ("a process of joint decision making among key stakeholders of a problem domain about the future of that domain") to the esoteric ("an interactive process having a shared transmutational purpose").

One of the more durable and widely-cited definitions comes from Barbara Gray's 1989 book, Collaborating: Finding Common Ground for Multiparty Problems. Gray describes collaboration as "a process through which parties who see different aspects of a problem can constructively explore their differences and search for solutions that go beyond their own limited vision of what is possible."
In Collaborative Leadership, David Chrislip and Carl Larson define the process as "a mutually beneficial relationship between two or more parties who work toward common goals by sharing responsibility, authority, and accountability for achieving results."

Collaboration appeals to people from across the political spectrum, not because it offers everything to everyone—as some of the advocacy literature on the subject seems to suggest—but because it deals with a process, as distinct from a program, agenda, or outcome. Collaboration requires that we look not only at the outcomes of our efforts, whatever they happen to be, but also at the process by which we arrive at those outcomes.

Collaboration might be used to resolve a neighborhood or environmental dispute. It could be a springboard for economic development in a community or region. Or it could be used to promote greater civic participation and involvement. Generally speaking, the process works best when
  • The problems are ill-defined, or people disagree on how the problems are defined
  • Different groups or organizations with a vested interest depend on each other in some way.
  • Those with a stake in a problem have yet to be identified or organized
  • Some stakeholders have more power or resources than others
  • Those with a vested interest have different levels of expertise and access to information about the issue.
  • The problems are often characterized by technical complexity and scientific uncertainty
  • Differing perspectives on the problems lead to conflict or disagreement among the stakeholders
  • Incremental or unilateral efforts to address with the issue have been ineffective
  • Existing processes for addressing the problems have proved unsuccessful
Collaborative endeavors take many forms. Some common varieties include: public-private partnerships (sometimes referred to as social partnerships)—ad hoc alliances between otherwise independent organizations that span both the public and the private sectors; future commissions, also known as search conferences, in which citizens and community leaders analyze trends, develop alternative scenarios of the future, and establish recommendations and goals for the community; interagency collaborations aimed at improving social services to children, families, and other members of a community; online networks designed to link various civic, educational, business, and governmental institutions within a community or region; school-community partnerships designed to foster greater collaboration between secondary schools and key community institutions; networks and coalitions—loosely structured alliances among groups, organizations, and citizens that share a commitment to a particular issue or place; and regional collaboratives where local governments work together to promote economic development and service delivery.


COLLABORATION VS. OTHER MODELS OF COOPERATION


Collaborative partnerships can be broadly grouped under two headings: those aimed at resolving conflicts and those designed to develop and advance a shared vision for the future. In both cases, the process is aimed at carefully defining and, if need be, redefining the issues involved before moving on to solutions.

Collaboration focuses on identifying a common purpose and working toward joint decisions. This distinguishes it from other forms of cooperation that may involve shared interests but are not based on a collectively-articulated goal or vision. "We cannot even begin to agree on how we should act until we have a common definition of the problem," David Mathews writes in Politics for People, "one that reflects an understanding of our own interests, the interests of others, and how the two diverge and converge."

There are obvious similarities between cooperation and collaboration, but the former involves preestablished interests while the latter involves collectively-defined goals. In What It Takes, an oft-cited 1991 monograph on interagency collaboration, Atelia Melaville and Martin Blank point out that "a collaborative strategy is called for ... where the need and intent is to change fundamentally the way services are designed and delivered." Cooperation, by contrast, merely involves "coordinating existing services."

Banding together to work for common goals is not a new idea in politics. The literature is full of examples of how community organizations—religious groups, trade unions, nonprofit groups, small businesses, civic alliances—form cooperative ventures, community interest groups, neighborhood task forces, and political coalitions. But these efforts are rarely collaborative in the strict sense. The goal is to join forces to advance a cause, which is different from collaborating to address a collective problem or develop a joint vision for the future.


THE PREREQUISITES FOR COLLABORATION


For collaboration to be effective, it must be democratic and inclusive. Hierarchies of any kind get in the way of sound decision-making, just as excluding some individuals or groups with a stake in the issue can derail the process. It also requires the involvement of a wide range of community leaders, such as mayors, city council members, nonprofit directors and members of the local school board.

In a series of case studies of successful collaboratives, David Chrislip and Carl Larson point out that each one "involved many participants from several sectors—for example, government, business, and community groups—as opposed to few participants predominantly from one sector." The level of participation required, however, is partly a function of what kind of collaboration is being sought. Clearly, some forms of collaboration—such as interagency partnerships—require only that the relevant stakeholders be included. Chrislip and Larson emphasize that the support of high-level, visible leaders "brought credibility to the effort and was an essential aspect of the success of the endeavor."

According to Barbara Gray, collaboration can only be meaningful if the parties involved are interdependent in some way. "Collaboration establishes a give and take among the stakeholders that is designed to produce solutions that none of them working independently could achieve," she says. In this way, they all depend on each other to produce mutually beneficial solutions.
Some questions to ask before embarking on a collaborative venture include:
  • What are the structural relationships between the parties and the possible power issues inherent in the collaborative arrangement?
  • Is there a clear understanding among all the parties of the respective goals of the other participants?
  • What form of leadership is required to facilitate the process?
  • Does the project have some form of integrating structure, such as a cross-section of steering committees, to facilitate and coordinate decision-making and implementation?
  • Will the project be more effective with a neutral, third-party mediator?
  • Should the media be involved?
  • Does the project have enough time, money, and staff support?

THE DYNAMICS OF COLLABORATION


The process of collaboration is rarely simple and straight-forward. It typically moves through several distinct phases, some of which can be time-consuming and fraught with challenges. Generally speaking, the process begins with an analysis of the situation and a diagnosis of the key issues involved. It moves on to a definition of the fundamental mission or desired outcome. The participants then articulate a common vision and work out a plan and a timetable for meeting their goals. It most cases, the process concludes with an assessment of the outcomes and a review of lessons learned.

Barbara Gray describes it as a three-phase process. The first phase, which she calls the prenegotiation or problem-setting phase, is often the most difficult. Six issues need to be addressed at this stage: 1) the parties must arrive at a shared definition of the problem, including how it relates to the interdependence of the various stakeholders; 2) the parties must make a commitment to collaborate; 3) other stakeholders need to be identified whose involvement may be necessary for the success of the endeavor; 4) the parties have to acknowledge and accept the legitimacy of the other participants; 5) the parties must decide what type of convener or leader can bring the parties together; and 6) the parties must determine what resources are needed for the collaboration to proceed.

During the second phase, the parties identify the interests that brought them to the table, determine how they differ from the interests of others, set directions and establish shared goals. Gray calls this the direction-setting phase. It is characterized by six essential steps: 1) establishing ground rules; 2) setting the agenda; 3) organizing subgroups, especially if the number of issues to be discussed is large or the number of stakeholders exceeds a dozen or so people; 4) undertaking a joint information search to establish and consider the essential facts of the issue involved; 5) exploring the pros and cons of various alternatives; and 6) reaching agreement and settling for a course of action.

The final step of the collaborative process is the implementation phase during which 1) participating groups or organizations deal with their constituencies; 2) parties garner the support of those who will be charged with implementing the agreement; 3) structures for implementation are established; and finally 4) the agreement is monitored and compliance is ensured.

Collaborative ventures obviously vary a great deal and not all of them can or want to follow this general framework. Much will depend on the nature of the endeavor, the number of people or parties involved, the time-frame, and the resources at hand.


COLLABORATIVE LEADERSHIP


The growing interest in collaboration can be seen as part of a bumpy transition away from top-down authority structures toward a new way of coordinating activities and making decisions. At their best, collaborative leaders assume the role of discussion facilitator rather than decision-maker. They put aside whatever authority, expertise, position, or influence they may have in the outside world in order to foster openness, dialogue, and deliberation within the group. The collaborative leader is one whose primary goal is to convene, energize, facilitate and sustain the process over time.

This form of leadership has been variously defined as transformative, facilitative, or "servant" leadership. In his classic 1978 book Leadership, James MacGregor Burns described transforming leadership as a process in which "one or more persons engage with each other in such a way that leaders and followers raise one another to higher levels of motivation and morality." The key to this type of leadership, he said, is the discovery of shared purpose and the interplay between motives and values.

James Svara, in his book Facilitative Leadership in Local Government, expanded on this notion, saying that collaborative leaders "stress empathetic communication, think in 'win-win' terms rather than seeing their interests in conflict with those of others, and use synergism to make the whole greater than the sum of the parts."

A number of theorists stress that one reason collaboration works as well as it does is that it empowers participants and creates a sense of ownership and "buy-in" within the group. When decisions are reached, they are the products group's own efforts. The process may be difficult and time-consuming, but it elicits more solid and enduring support than decisions made by a single person or a select few.

Collaborative leaders understand this intuitively. They move the process along by sharing inspiring visions, focusing on results, strengthening relationships, being open and inclusive, bringing out the best in others, and celebrating achievement. Collaborative leadership is not a specific set of activities. It means playing whatever role is necessary to bring about real change and lasting impact in the community. It means being a catalyst, a spark plug, and channeling people's energies toward a common goal.


THE LIMITATIONS OF COLLABORATION


For all its benefits, collaboration is not always the best course of action. The process is fraught with dangers and inherent limitations. It is notoriously time-consuming and is not suitable for problems that require quick and decisive action, for example. Power inequalities among the parties often thwart the process. The norms of consensus and joint decision-making sometimes require that the common good take precedence over the interests of a few. It can break down in groups that are too large. And the process is meaningless when participants lack the power to implement final decisions.

The literature is full of examples of poorly executed collaborations that failed to yield substantive results, ran out of funding, failed to garner enough interest or support from the leadership of the community, or stalled because of irreconcilable differences between stakeholders. As Barbara Gray points out, "many well-intentioned efforts to involve the public in government decisions, for example, are exercises in frustration and often exacerbate rather than improve the situation because careful attention to the process of managing differences is neglected."

Some of the circumstances under which it is best not to collaborate include: 1) when one party has unchallenged power to influence the final outcome; 2) when the conflict is rooted in deep-seated ideological differences; 3) when power is unevenly distributed; 4) when constitutional issues are involved or legal precedents are sought; and when a legitimate convener cannot be found. But when groups are aware of the limitations of the process and are able to work around them, they can do great things.


THE PROMISE OF COLLABORATION


Consciously or not, many of us subscribe to outmoded theories of change handed down from traditional leadership theory. We believe that influence occurs as a direct result of force exerted from one person to another. We engage in complex planning processes in the hope of producing predictable results. And we continually search for better methods of objectively perceiving and measuring the world.

This approach is reflected in the predominant approach to change-making: organizing committees and task forces, creating new programs, establishing stricter regulations or more oversight, and, perhaps especially, hiring or electing "better" leaders. But the realities of public life today are dynamic and complex and no longer lend themselves to mechanistic solutions. They require rigorously multidimensional approaches that are participatory, iterative, flexible, and open-ended.

In my research on collaboration, I have interviewed many practitioners who told me that they found their way to collaboration only after years of frustration with conventional problem-solving approaches and a gnawing sense that "there must be a better way." They stressed that traditional mechanisms for bringing about change are often exasperating, time-consuming, and ineffective.

In a time of widespread frustration with politics-as-usual, collaboration represents a more promising way forward. "What has moved so many people to take on this hard work of collaboration," write Daniel Kemmis and Matthew McKinney in Collaboration and the Ecology of Democracy, "has been the widespread perception that, in all too many cases, the existing governing framework was proving itself incapable of getting the job done. To put it bluntly, the problems that people expected the government to solve were not getting solved."

Building collaborative communities means finding new and better ways to work together. We need to create spaces where people can find each other, share ideas, and discover common ground. We need settings where people can receive support and be acknowledged as public actors. And we need contexts in which people can begin to imagine and act from a new sense of possibility.

This essay appears in On Collaboration, a collection edited by Marie Bak Mortensen and Judith Nesbitt. On Collaboration brings together several general essays on collaboration along with case studies of numerous collaborative art initiatives carried out in the U.K. under the auspices of Tate. (London: Tate, December 2012).

Thursday, January 22, 2015

Want to combat fatigue, stress, malaise, and a droll mood? The cure - according to a NY Times story of a Scandinavian Journal of Medicine in Sports published study - may be as simple as taking a daily lunchtime stroll. And why not....it also helps burn calories and improves cardiovascular health!


  Well - Tara Parker-Pope on Health

The Benefits of a Lunch Hour Walk



To combat afternoon slumps in enthusiasm and focus, take a walk during the lunch hour.

A new study finds that even gentle lunchtime strolls can perceptibly — and immediately — buoy people’s moods and ability to handle stress at work.

It is not news, of course, that walking is healthy and that people who walk or otherwise exercise regularly tend to be more calm, alert and happy than people who are inactive.

But many past studies of the effects of walking and other exercise on mood have focused on somewhat long-term, gradual outcomes, looking at how weeks or months of exercise change people emotionally.

Fewer studies have examined more-abrupt, day-to-day and even hour-by-hour changes in people’s moods, depending on whether they exercise, and even fewer have focused on these effects while people are at work, even though most of us spend a majority of our waking hours in an office.

So, for the new study, which was published in the Scandinavian Journal of Medicine and Science in Sports this month, researchers at the University of Birmingham and other universities began by recruiting sedentary office workers at the university.

Potential volunteers were told that they would need to be available to walk for 30 minutes during their usual lunch hour three times a week.

Most of the resulting 56 volunteers were middle-aged women. It can be difficult to attract men to join walking programs, said Cecilie Thogersen-Ntoumani, the study’s lead author and now a professor of exercise science at Curtin University in Perth, Australia. Walking may not strike some men as strenuous enough to bother with, she said. But she and her colleagues did attract four sedentary middle-aged men to the experiment.

The volunteers completed a series of baseline health and fitness and mood tests at the outset of the experiment, revealing that they all were out of shape but otherwise generally healthy physically and emotionally.

Dr. Thogersen-Ntoumani and her colleagues then randomly divided the volunteers into two groups, one of which was to begin a simple, 10-week walking program right away, while the other group would wait and start their walking program 10 weeks later, serving, in the meantime, as a control group.

To allow them to assess people’s moods, the scientists helped their volunteers to set up a specialized app on their phones that included a list of questions about their emotions. The questions were designed to measure the volunteers’ feelings, at that moment, about stress, tension, enthusiasm, workload, motivation, physical fatigue and other issues related to how they were feeling about life and work at that immediate time.

A common problem with studies of the effect of exercise on mood, Dr. Thogersen-Ntoumani said, is that they rely on recall. People are asked to remember hours or days after the fact how exercise made them feel. Given how fleeting and mysterious our emotions can be, recalled responses are notoriously unreliable, Dr. Thogersen-Ntoumani said.

Instead, she and her colleagues wanted in-the-moment assessments from people of how they felt before and after exercise. The phone app questions provided that experience, she said, in a relatively convenient form.

Then the first group began walking. Each volunteer was allowed to walk during one of several lunchtime sessions, all of them organized by a group leader and self-paced. Slower walkers could go together, with faster ones striding ahead. There was no formal prescribed distance or intensity for the walks. The only parameter was that they last for 30 minutes, which the volunteers had said would still allow them time to eat lunch.

The groups met and walked three times a week.

Each workday morning and afternoon during the first 10 weeks, the volunteers in both groups answered questions on their phones about their moods at that particular moment.

After 10 weeks, the second group began their walking program. The first group was allowed to continue walking or not as they chose. (Many did keep up their lunchtime walks.)

Then the scientists compared all of the responses, both between groups and within each individual person. In other words, they checked to see whether the group that had walked answered questions differently in the afternoon than the group that had not, and also whether individual volunteers answered questions differently on the afternoons when they had walked compared with when they had not.

The responses, as it turned out, were substantially different when people had walked. On the afternoons after a lunchtime stroll, walkers said they felt considerably more enthusiastic, less tense, and generally more relaxed and able to cope than on afternoons when they hadn’t walked and even compared with their own moods from a morning before a walk.

Although the authors did not directly measure workplace productivity in their study, “there is now quite strong research evidence that feeling more positive and enthusiastic at work is very important to productivity,” Dr. Thogersen-Ntoumani said. “So we would expect that people who walked at lunchtime would be more productive.”

As a pleasant, additional outcome, all of the volunteers showed gains in their aerobic fitness and other measures of health at the completion of their 10 weeks of walking.

But, tellingly, many said that they anticipated being unable to continue walking after the experiment ended and a few (not counted in the final tally of volunteers) had had to drop out midway through the program. The primary impediment to their walking, Dr. Thogersen-Ntoumani said, had been “that they were expected by management to work through lunch,” suggesting that management might wish to acquaint themselves with the latest science.

Tuesday, January 20, 2015

A British Journal of Sports Medicine posting indicates that "Group Walking" boosts overall health, according to MedPage Today. It may be that while walking itself has health benefits, doing so with friends or co-workers increases frequency, duration and distance while allowing the trek to simply be more fun.

  Medpage Today


Endocrinology 0 Comments

Group Walking Seems to Boost Overall Health

Meta-analysis indicates reductions in blood pressure, body fat, and total cholesterol.

 


  • by Yen Chen Liu MD
    Contributing Writer


Participating in a walking group may dramatically improve overall health with little to no adverse effect, U.K. researchers reported.

A systemic review and meta-analysis of 42 studies found participants of group walking showed significant reduction in mean differences for systolic blood pressure, resting heart rate, body fat, body mass index (BMI), and total cholesterol, according to Sarah Hanson, a PhD candidate, and Andy Jones, PhD, of Norwich Medical School.

"Walking groups are effective and safe with good adherence and wide ranging health benefits," they wrote online in the British Journal of Sports Medicine. "They could be a promising intervention as an adjunct to other healthcare, or as a proactive health-promoting activity."

The study looked at 5,145 citations in seven electronic databases, clinical trial registers, grey literature, and reference lists in English language up to November 2013 and identified 42 studies. The eligibility criteria included adults participating in group walking outdoors with outcome directly attributable to the walking intervention.

A total of 1,843 participants walked in outdoor walking groups with at least 1,488 hours of provision and a total of 74,023 hours of participant walking time. Participants involved in this study were from 14 different countries and had a wide range of long-term conditions, including arthritis, dementia, diabetes, fibromyalgia, obesity/overweight, mental health issues, and Parkinson's disease.

The levels of walking were varied in duration and intensity, ranging from 168 to 8,580 minutes of walking over a period of 3 weeks to 1 year, with intensity ranging from self-selected and low to brisk walking and high-intensity intervals. Mean adherence, where stated, was 75%.

The meta-analysis showed statistically significant reductions in mean difference for:
  • Systolic blood pressure: -3.72 mm Hg (95% CI minus 5.28-minus 2.17)
  • Diastolic blood pressure: -3.14 mm Hg (95% CI minus 4.15-minus 2.13)
  • Resting heart rate: -2.88 bpm (95% CI minus 4.13-minus 1.64)
  • Body fat: -1.31% (95% CI minus 2.10-minus 0.52)
  • BMI: -0.71 kg/m2 (95% CI minus 1.19-minus 0.23)
  • Total cholesterol: -0.11 mmol/L (95 CI minus 0.22-minus 0.01)
Moreover, the analysis identified significant mean increases in VO2max of 2.66 mL/kg/min (95% CI 1.67-3.65) and SF-36 (physical functioning) score 6.02 (95% CI 0.51-11.53).

However, the authors pointed out that "the evidence was less clear for other outcomes such as waist circumference, fasting glucose, SF-36 (mental health), and serum lipids such as high-density lipids."

For adverse effects, one study described a fall with a brief absence from the walking program, while another reported a calf injury. In one study in participants with Parkinson's disease, one person experienced exercise-induced hypotension after intense uphill walking in hot weather; four fell on roots and wet ground. Otherwise, the authors stated that there were no injuries, or there was no reference to adverse effects.

The research had some limitations, specifically the analysis of studies in English only. Also, there was no information on walking dose in many of the studies so the authors could not perform an analysis of dose-responses.

Still, the results further demonstrated the dramatic impact walking groups can have on overall health, the authors stated, and are in line with previous research.

A 2013 meta-analysis found that interventions to promote walking in groups boosted physical activity.

Looking specifically at blood pressure, a population survey-based study demonstrated that a reduction of 2 mm Hg in diastolic blood pressure could lower coronary heart risk by 6% and stroke and trans-ischemic attacks by 15%.

A more recent study noted that a reduction of 2 mm Hg in systolic blood pressure could reduce stroke mortality by 10% and mortality from vascular causes in a middle-age population by 7%. That study also suggested a persistent reduction in average blood pressure could decrease large numbers of premature deaths and stroke. Hanson and Jones suggested that outdoor walking groups could be an example of such a practicable method.

This study was supported by the Centre for Diet and Activity Research (CEDAR), the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust.

Hanson and Jones disclosed no relevant relationships with industry.

Wednesday, January 14, 2015

While most understand the risk of self prescribing medication, a new study finds that more than 10% of patients prescribed aspirin by their doctor to prevent heart attack or stroke should not have been prescribed the medication. The risk of bleeding, for them, outweigh the benefits.

 

Medical News Today -


1 in 10 patients inappropriately prescribed aspirin to prevent first heart attack, stroke

 
Last updated:


More than 10% of patients in the US receiving low-dose daily aspirin to prevent a first heart attack or stroke are likely to have been prescribed the medication inappropriately.
 
 
pill in open hand
1 in 10 Americans are inappropriately prescribed daily aspirin to prevent a first heart attack or stroke.
 
 
This was the conclusion of a new study published in the Journal of the American College of Cardiology, led by a team at Baylor College of Medicine in Houston, TX.

The researchers note that as aspirin is also available over the counter, it is possible that inappropriate use may be higher than their figure suggests because of patients medicating themselves against the risk of primary cardiovascular events.

In May 2014, the Food and Drug Administration (FDA) advised Americans against the general use of aspirin for primary prevention and they also recently denied a request to market the drug for such use.
To decide what constitutes inappropriate prescribing of daily aspirin for preventing a first heart attack or stroke, the researchers evaluated guidelines from organizations like the American Heart Association and the US Preventative Services Task Force.

Study analyzed large nationwide patient sample of aspirin use


From the published guidelines, the researchers determined that daily aspirin use would be inappropriate in patients whose 10-year cardiovascular risk was under 6%.

They then used this rule to analyze data on a nationwide sample of 69,000 patients receiving aspirin for primary cardiovascular disease prevention. The sample came from the National Cardiovascular Disease Registry Practice Innovation and Clinical Excellence (PINNACLE) Registry.

The patients in the sample were attending 119 practices when they were prescribed aspirin between January 2008 and June 2013. The researchers excluded patients who had already experienced a cardiovascular event - such as heart attack or stroke - or who were affected by heart conditions like atrial fibrillation.

The analysis showed nearly 12% of patients in the nationwide sample probably should not have been prescribed aspirin to prevent primary cardiovascular disease.

The team found that inappropriate use of prescribed aspirin was higher among women than men (17% versus 5%). Patients prescribed aspirin inappropriately were also on average about 16 years younger than those receiving it appropriately, they note.

However, they also found that inappropriate use fell from 14% in 2008 to 9% in 2013.
In addition, the researchers found the rate of inappropriate prescribing varied among practices, ranging from 0-72% of patients receiving aspirin for primary prevention.

In people who do not meet guidelines, risk of bleeding outweighs potential benefits


There is no evidence, note the authors, that aspirin reduces the risk of a first stroke or heart attack in people who have no history of cardiovascular events and a low risk of developing disease. However, it is linked to raised risk bleeding in the gut or stomach and of hemorrhagic strokes.

First author Dr. Ravi S. Hira, a cardiology researcher at Baylor College of Medicine, says doctors must think about whether the potential for bleeding outweighs the potential benefits of aspirin in patients who do not meet the guidelines, adding:

"Since aspirin is available over the counter, patient and public education against using aspirin without a medical provider's recommendation will also play a key role in avoiding inappropriate use."

In an editorial published with the study, Freek W.A. Verheugt - a professor of cardiology at the the Heart and Lung Center and chairman of the Department of Cardiology at Onze Lieve Vrouwe Gasthuis, both of the University Medical Centre of Nijmegen in the Netherlands - says:
"Major coronary events are reduced 18% by aspirin, but at the cost of an increase of 54% of major extracranial bleeding. Each two major coronary events have shown to be prevented by prophylactic aspirin at the cost of one major extracranial bleed. Yet, primary prevention with aspirin is widely applied."
In August 2014, Medical News Today reported a study that suggested daily aspirin could be an effective way to avoid recurrent blood clots in patients with venous thromboembolism - blood clots in the veins - who are unable to have anticoagulant therapy.

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Monday, January 5, 2015

In the beginning there was exercise. And it begat the 7-Minute Workout. And now, newly begot, there is the 1-Minute Workout made up of three 20 seconds of interval training. Reporting on a number of studies, the N.Y. Times concludes it's better to be in shape, than not.


The Super-Short Workout and Other Fitness Trends


Credit Brandon Thibodeaux for The New York Times, Willie Davis for The New York TImes and Buda Mendes/Getty Images

The big story in exercise science this year was the super-short workout. 
 
In one particularly useful study from May, scientists found that three brief sessions per day of interval-style exercise — consisting of one minute of brisk walking followed by another minute of strolling, repeated six times — allowed people at risk of diabetes to control their blood sugar better than a continuous 30-minute walk. 

Just as important, these short “exercise snacks,” as the scientists called the condensed sessions, were more popular with the study’s participants than the single, longer walk, the scientists reported. They liked finishing quickly.

That sentiment likewise explains the popularity of the “Scientific 7-Minute Workout,” which I first wrote about in 2013 and updated this fall with an advanced version and a related app. Similarly, many of you were intrigued by a July study detailing how running as little as five minutes a day might add years to someone’s life span. “Most people can fit in five minutes a day” of exercise, one of the study’s authors told me.

But should even that time commitment seem excessive, scientists obligingly developed and tested a one-minute workout this year, with three 20-second intervals of very hard exercise leading to robust improvements in the endurance and health of the study’s overweight, out-of-shape volunteers. 

There is naturally a catch to such truncated workouts, however. In each of these studies, the exertion involved was intense. The volunteers panted and strained, albeit briefly. Their strenuous exercise seemed to invoke “more potent” physiological responses than gentler activity, one of the researchers involved in the exercise-snacking study said. 

A nifty June study helps to explain why. In that experiment, mice that were pushed to run hard on running wheels developed distinctly different biochemical responses within their muscle cells than other animals and these differences translated into larger, healthier muscles. The study’s lesson, its lead author concluded, is that sometimes you need to “get out of your body’s comfort zone.” But only, thankfully, for a minute or five. 

While studies showing how little exercise you can complete and still become healthier, stronger and fitter may be — let’s be honest — among the most beguiling exercise news of the year, many other fitness-related themes emerged in 2014, as a look back through this year’s Phys Ed columns reminded me. 

Scientists advanced, for instance, our understanding of the effects of exercising — and not exercising — on the mind and brain. Several different studies found that exercise significantly improves the brain health of people with a genetic predisposition to Alzheimer’s disease and also, encouragingly, lessens healthy, middle-aged people’s risks of suffering from what one scientist described to me as “a C.R.S. problem,” or Can’t Remember Stuff. 

Another study explored how exercise can improve mood, with Swedish researchers showing that, in mice, a substance produced abundantly in the bodies of both mice and men during exercise crosses the blood-brain barrier and buffers brains against stress and depression

And, in perhaps the most novel exercise-neuroscience experiment this year, researchers explored how sitting may affect the brain, by having one group of rats remain sedentary while others ran. The sedentary rats soon displayed changes in the shape and function of certain neurons in their brains, while the running rats showed no such changes. The neurons involved play a role in how well the body regulates blood pressure, so the researchers concluded that not exercising had remodeled the animals’ brains in ways that undermined their health. 

Meanwhile, plenty of other studies this year underscored how wide-ranging the benefits of exercise really are. In various experiments, physical activity was found to lessen and even reverse the effects of aging on human skin; protect against age-related vision loss; improve creativity; lower people’s risk of developing heart disease even if they had multiple risk factors for the condition; increase the numbers of good bacteria in athletes’ guts; raise exercisers’ pain tolerance; and alter, in desirable ways, how our DNA works

Being in good shape also, in a sense, keeps us young, according to a large-scale study published in October. Fit people were biologically younger than others of the same chronological age, the study concluded, and generally lived longer. “There is a huge benefit,” the study’s senior author told me, “larger than any known medical treatment, in improving your fitness level to what is expected for your age group or, even better, to above it.”

But the benefits of exercise are not limitless, as science gently reminded us this year. Working out spurs many people to gain weight, primarily in the form of body fat, a pitiless but important October study showed. It also can be harmful to the teeth, if the exercise is prolonged and strenuous. And if practiced in a gym, exercise may expose us to more indoor pollution than many of us might have expected. 

Luckily, this exposure will be minimal for those of us embracing the one-minute workout.