Our Futures Meeting in Central Florida

595 views
521 views

Published on

Central Florida Behavioral Health Network met on June 8-9 at the Manatee County Chamber of Conference and United Way conference center. The aim of this two days is to implement a collection of evidence-based based kernels to achieve population level changes for protection against multiple mental, emotional, behavioral and related disorders. Dr. Dennis Embry from PAXIS presented and consulted with the coalitions

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
595
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Our Futures Meeting in Central Florida

  1. 1. Creating Our Futures: How we can better our world and ourselves A doable plan authored by everyone in this room With Dennis D. Embry, Ph.D. • June 8 and 9, 2011Thursday, June 9, 2011 1
  2. 2. Our Vision & Values Goal 1: Create local, regional and Value 1: Increase national teams to link their wisdom, nurturance of prosociality skills, connections, and knowledge. for persons of all ages. Goal 2: Reduce major indicator of Value 2: Reduce toxic common mental, emotional, influences affecting all ages. behavioral and related health disorders 20% or more in 3 years. Value 3: Increase psychological flexibility Goal 3: Increase every major among people of all ages. indicator of child and youth wellbeing by 20% more in 3 years.Thursday, June 9, 2011 2
  3. 3. Interviewing each other about our futuresThursday, June 9, 2011 3
  4. 4. Thursday, June 9, 2011 4
  5. 5. Your child’s, grandchild’s or child of choice’s suitcase for lifeThursday, June 9, 2011 5
  6. 6. Your child’s, Their friends’ suitcases grandchild’s or child of for life choice’s suitcase for lifeThursday, June 9, 2011 5
  7. 7. What bricks—heavy objects of pain, injury, illness, or problem—do you NOT want in those suitcases?Thursday, June 9, 2011 6
  8. 8. Reporting outThursday, June 9, 2011 7
  9. 9. Ask the suitcase questions of 30 people: some republicans, some democrats, some independents and some who are apolitical.Thursday, June 9, 2011 8
  10. 10. What do you want to happen and not happen for our elders?Thursday, June 9, 2011 9
  11. 11. Bi-directional Wealth and Wellbeing Transfer 5-Year 65-Year Olds OldsThursday, June 9, 2011 10
  12. 12. Bi-directional Wealth and Wellbeing Transfer 5-Year 65-Year Olds Olds Who are living longer though get progressively sicker…Thursday, June 9, 2011 10
  13. 13. Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds Olds Who are living longer though get progressively sicker…Thursday, June 9, 2011 10
  14. 14. Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds Olds Who are living Who are less longer though get and less able… progressively sicker…Thursday, June 9, 2011 10
  15. 15. Bi-directional Wealth and Wellbeing Transfer Requiring more wealth transfer 5-Year 65-Year Olds But elders voting to stop funds to kids Olds Who are living Who are less longer though get and less able… progressively sicker…Thursday, June 9, 2011 10
  16. 16. Thursday, June 9, 2011 11
  17. 17. Our Own Children’s FutureThursday, June 9, 2011 12
  18. 18. Our Own Children’s Future ADHD stealing aggression asthma depression learning disabilities obesity cancer bipolar depression hi-blood pressure heart-disease violence tobacco suicide diabetes alcohol crime drugs dangerous actsThursday, June 9, 2011 13
  19. 19. Thursday, June 9, 2011 14
  20. 20. How many of you know a regular American family with a child with… a mental, emotional or behavioral disorder?Thursday, June 9, 2011 15
  21. 21. How many of you know a regular American family with a child with… a mental, emotional or behavioral disorder? Like a more Like ADHD or Like learning or serious mental Like a serious behavior developmental illness like addictions problems? disorder? bipolar or problem? suicidal actions?Thursday, June 9, 2011 15
  22. 22. Key messages about mental, emotional & behavioral disorders…Thursday, June 9, 2011 16
  23. 23. Key messages about mental, emotional & behavioral disorders… MEB’s are preventable.Thursday, June 9, 2011 16
  24. 24. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for preventable. MEB prevention is one year.Thursday, June 9, 2011 16
  25. 25. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention preventable. MEB prevention balances is one year. budgets.Thursday, June 9, 2011 16
  26. 26. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business.Thursday, June 9, 2011 16
  27. 27. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business. Effective MEB prevention helps national security.Thursday, June 9, 2011 16
  28. 28. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business. Effective MEB MEB prevention prevention helps helps US global national security. success.Thursday, June 9, 2011 16
  29. 29. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business. MEB prevention Effective MEB MEB prevention saves Social prevention helps helps US global Security & national security. success. Medicare.Thursday, June 9, 2011 16
  30. 30. Key messages about mental, emotional & behavioral disorders… MEB’s are Break-even for MEB prevention MEB prevention preventable. MEB prevention balances improves US is one year. budgets. business. MEB prevention Effective MEB MEB prevention saves Social MEB prevention prevention helps helps US global Security & heals past national security. success. Medicare. inequities.Thursday, June 9, 2011 16
  31. 31. Thursday, June 9, 2011 17
  32. 32. TUV"2003"4-/(560,"2(7-"W0&"#(56)=&"X&*7(0,"" Estimates Possible Benefits of Universal GBG Implementation in First Grade by State Select State: North Carolina 9,222,414 Estimated Total Population 2006 If every cohort of first-graders 36 138,336 Estimated No. of 1st Graders in 2006 Adjust for Percent of 1st Graders Protected by Good 100 100% 138,336 Estimated 1st Graders Reached Behavior Game in the State Adust to reflect average cost per student for education compared to national average 20 100% $8,701 Average Cost Per Student Per Year receives the Good Behavior Game just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in first grade, the Estimated Adjust for Current Impact of Prevalence Population the Good After Adjust for Average Cost of Adjusted Average Annual Average Annual Total Cost of the Problem Estimated Per Year Costs good people of North Carolina will Prevalence Behavior Universal Problem Cost of Behavior With SAVINGS for of Problem Game on 1st Grade Per Child Problem NOT DOING Percent of 1st or Behavior Problem Delivery Per Year Per Child GBG Graders Reached Move slider (or per each save$250 million for Move slider 100% left if think right if think disruption) Child, Adolescent & Adult will less be problem costs effective more Problems each group of kids Total daily disruptions in state $1.0 4,565,095 70000.00% 1,369,528 $0.01 $8,217,171 $5,752,020 before GBG ADHD 3rd Grade 2 7.00% 3000.00% 3.00% $750 $7,262,651 $4,150,086 when they are Oppositional Defiance 3rd Grade 3 5.00% 2700.00% 2.30% $900 $6,225,129 $3,361,570 Adolescent Conduct Disorder 4 14.00% 5600.00% 8.40% $1,400 $27,113,897 $10,845,559 Special Education 1st-Grade 12 5 7.00% 2200.00% 4.80% 500.00% $435 $4,212,822 $1,324,030 Adult Criminal Behavior Serious Adult Drug Addictions 6 7 12.00% 20.00% 1200.00% 800.00% 10.80% 12.00% 45000.00% 4900.00% $4,500 $490 $74,701,553 $13,556,949 $7,470,155 $5,422,779 young adults. Teen/Adult Suicidal Ideations 8 14.00% 7000% 7.00% $992 $7,684,853 $3,842,427 Total Minimum Estimated Child, Adolescent and Adult Morbibity Costs for Each First Grade Cohort if Nothing is Done New Each Year: $148,975,025 Esimtated Cost of the Good Behavior Game Per First Grader as Behavioral Vaccine (this includes local staff, materials, incentives, training, technical support, and overhead) $62.00 This is less than cost of most childhood disease vaccines. Over the next 10 years, that’s $2.5 Esimtated Cost of Implementing the Good Behavior Game Per Classroom $1,550 Cost per 1st Grade Cohort Based on Percentage of Students Reached: $8,576,845 billion. Return on Investment Net Profit at Start of 2nd Grade Per 1st Grade Cohort: $931,003 11% Net Profit at 6th Grade Per 1st Grade Cohort: $32,517,918 379% The cost? $62 per Net Profit at 12th Grade Per 1st Grade Cohort: $110,701,906 1291% Net Profit at the 29th Year of Life Per 1st Grade Cohort: $247,316,107 2884% first grader. Note: Over a Decade of 1st Grade Cohorts Getting GBG, these numbers would be x10: References: 1 Tingstrom DH, Sterling-Turner HE, Wilczynski SM. The Good Behavior Game: 1969-2002. Behavior Modification 2006;30:225-53. 2 van Lier PAC, Muthen BO, van der Sar RM, Crijnen AAM. Preventing Disruptive Behavior in Elementary Schoolchildren: Impact of a Universal Classroom-Based Intervention. Journal of Consulting & Clinical Psychology 2004;72(3):467-78. 3 Ibid. 4 Ialongo N, Poduska J, Werthamer L, Kellam S. The distal impact of two first-grade preventive interventions on conduct problems and disorder in early adolescence. Journal of Emotional & Behavioral Disorders 2001;9(3):146-60.Thursday, June 9, 2011 5 Bradshaw CP, Zmuda JH, Kellam S, Ialongo N. Longitudinal Impact of Two Universal Preventive Interventions in First 18
  33. 33. Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth Physiological Antecedents Reinforcement Verbal RelationsThursday, June 9, 2011 19
  34. 34. Multi-Inflammatory Threat Reaction Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth Physiological Antecedents Reinforcement Verbal RelationsThursday, June 9, 2011 19
  35. 35. Mood Reward Executive Behavioral Attention Stability Delay Function Competencies Immune- Motor Healing Skills Multi-Inflammatory Threat Reaction Functions Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth Physiological Antecedents Reinforcement Verbal RelationsThursday, June 9, 2011 19
  36. 36. Substance Work Obesity, Early Mental Illness Violence Cancer School Abuse Problems etc Sex Failure Mood Reward Executive Behavioral Attention Stability Delay Function Competencies Immune- STD’s Motor Healing Special Skills Multi-Inflammatory Threat Reaction Functions Ed Major Ecologic Causes of the Dual Inflammatory Threats to Children & Youth Physiological Antecedents Reinforcement Verbal RelationsThursday, June 9, 2011 19
  37. 37. Obesity Conduct Disorders Homicide & Suicide Depression Oppositional/ Addictions ADHD Aggression Self harm ANXIETY R PATH = Risky behaviors or healthThursday, June 9, 2011 20
  38. 38. What are we here?Thursday, June 9, 2011 21
  39. 39. What is a Preventionist? What is the definition? What is a Preventrepreneur? What is the definition?Thursday, June 9, 2011 22
  40. 40. How to save… …OUR futuresThursday, June 9, 2011 23
  41. 41. Thursday, June 9, 2011 24
  42. 42. Thursday, June 9, 2011 25
  43. 43. To change our futures, we must put practical tools in many hands…Thursday, June 9, 2011 26
  44. 44. Increase nurturance of prosociality for persons of all ages This can be individual, family, school and/or community action Reduce toxic influences of all ages This can be at an individual, family, school and/or community level Increase psychological flexibility among people of all ages This can be achieved across settings, as the above. From Biglan, Flay and Embry. Nurturing Environments and the Next Generation of Prevention Research and Practice for the American PsychologistThursday, June 9, 2011 27
  45. 45. The “Bible” of Prevention Virtually every mental, emotional, behavioral and related physical illness is preventable— not just manageable by rather simple things everyone can do. Imagine that as many people knew what these simple things were as people who know who Lady Gaga is.Thursday, June 9, 2011 28
  46. 46. What is nurturing? At home? At school? At work? At church or temple? In the community or politics? In the media?Thursday, June 9, 2011 29
  47. 47. What is prosociality? At home? At school? At work? At church or temple? In the community or politics? In the media?Thursday, June 9, 2011 30
  48. 48. Now, the learning game or fast factsThursday, June 9, 2011 31
  49. 49. Your wisdom: How do we teach/grow prosocialty?Thursday, June 9, 2011 32
  50. 50. Reinforcement Reinforcement Adult Behavior & for “Good” for “Bad” coercion the Matching In one hour of school, In one hour of school, Law how often do peers how often do peers How often might adults reinforce the “good” in reinforce the “bad” in The probability of human in authority exert behavioral choice school? school? perceived threats of “matches” this saturation How often by adults How often by adults coercion in school, at formula in the classroom, at school? at school? home, or in the home and community, How often at home or How often at home or community in a single and Matching Law works day? community in a day? community in a day? for all vertebrate creaturesThursday, June 9, 2011 33
  51. 51. Reinforcement Reinforcement Adult Behavior & for “Good” for “Bad” coercion the Matching In one hour of school, In one hour of school, Law how often do peers how often do peers How often might adults reinforce the “good” in reinforce the “bad” in The probability of human in authority exert behavioral choice school? school? perceived threats of “matches” this saturation How often by adults How often by adults coercion in school, at formula in the classroom, at school? at school? home, or in the home and community, How often at home or How often at home or community in a single and Matching Law works day? community in a day? community in a day? for all vertebrate creaturesThursday, June 9, 2011 33
  52. 52. Reinforcement Reinforcement Adult Behavior & for “Good” for “Bad” coercion the Matching In one hour of school, In one hour of school, Law how often do peers how often do peers How often might adults reinforce the “good” in reinforce the “bad” in The probability of human in authority exert behavioral choice school? school? perceived threats of “matches” this saturation How often by adults How often by adults coercion in school, at formula in the classroom, at school? at school? home, or in the home and community, How often at home or How often at home or community in a single and Matching Law works day? community in a day? community in a day? for all vertebrate creaturesThursday, June 9, 2011 33
  53. 53. Reinforcement Reinforcement Adult Behavior & for “Good” for “Bad” coercion the Matching In one hour of school, In one hour of school, Law how often do peers how often do peers How often might adults reinforce the “good” in reinforce the “bad” in The probability of human in authority exert behavioral choice school? school? perceived threats of “matches” this saturation How often by adults How often by adults coercion in school, at formula in the classroom, at school? at school? home, or in the home and community, How often at home or How often at home or community in a single and Matching Law works day? community in a day? community in a day? for all vertebrate creaturesThursday, June 9, 2011 33
  54. 54. Oodles of TootlesThursday, June 9, 2011 34
  55. 55. PeaceBuilders School-Community Reinforcement Study Positive Peer-to-Peer Social Home Notes Notes Competence ViolenceThursday, June 9, 2011 35
  56. 56. What if these SAME notes were everywhere?Thursday, June 9, 2011 36
  57. 57. What if these SAME notes were everywhere?Thursday, June 9, 2011 37
  58. 58. FREE DOWNLOAD Embry, D. D., & Biglan, A. (2008). Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review, 39. Free download at www.paxis.orgThursday, June 9, 2011 38
  59. 59. What is a kernel? Is the smallest unit of scientifically proven behavioral influence. • Is indivisible; that is, removing any part makes it inactive. Produces quick easily measured change that can grow much bigger change over time. Can be be used alone OR combined with other kernels to create new programs, strategies or policies. • Are the active ingredients of evidence-based programs.Thursday, June 9, 2011 39
  60. 60. Relational Antecedent Reinforcement Physiological Frame Kernel Kernel Kernel Kernel Changes Creates verbal Happens BEFORE Happens AFTER the biochemistry of relations for the the behavior behavior behavior behavior Embry, D. D., & Biglan, A. (2008). Evidence-Based Kernels: Fundamental Units of Behavioral Four Types of Kernels Influence. Clinical Child & Family Psychology Review, 39.Thursday, June 9, 2011 40
  61. 61. Beat the Timer Antecedent Kernel Happens BEFORE the behaviorThursday, June 9, 2011 41
  62. 62. Powerful economics of scale inherent in this approach Multi-Level Model for Public Health Prevention Outcomes B Developme ntal sta Birth Childhood ges Adolescence Ad ulthood Low Intensity Multiple Hi reach Fa m Sc ilie h els Settings O ools s lev rg an A Co iat io ach m ns mu nit ies /re /re gio ns C sity en Int High Intensity Low reachThursday, June 9, 2011 42
  63. 63. Thursday, June 9, 2011 43
  64. 64. Why not invite disadvantaged teens to select their most life values? Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.Thursday, June 9, 2011 44
  65. 65. Why not invite disadvantaged teens to select their most life values? Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.Thursday, June 9, 2011 44
  66. 66. Why not invite disadvantaged teens to select their most life values? Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.Thursday, June 9, 2011 44
  67. 67. Why not invite disadvantaged teens to select their most life values? Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Affirmation: Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.Thursday, June 9, 2011 44
  68. 68. Thursday, June 9, 2011 45
  69. 69. 15.0% 6.0% 10.0% 4.0% 5.0% 2.0% 0.0% 18.0% Wisconsin Wisconsin 40.0% 16.0% 35.0% Youth Who Smoked During the Last 30 Days 14.0% Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder Baseline Reward and Reminder 30.0% 45.0% 12.0% 18.0% Wyoming Wyoming 25.0% 40.0% 16.0% 10.0% 35.0% 14.0% 20.0% 8.0% 30.0% 12.0% 15.0% 6.0% 25.0% 10.0% 10.0% 4.0% 20.0% 8.0% 5.0% 15.0% 2.0% 6.0% 0.0% 10.0% 4.0% 5.0% 18.0% 2.0% United States United States 0.0% 40.0% 16.0% 18.0% 35.0% Wisconsin 14.0% Wisconsin 40.0% 16.0% 30.0% 35.0% 12.0% 14.0% 30.0% 25.0% 12.0% 10.0% 25.0% 10.0% 20.0% 8.0% 20.0% 8.0% 15.0% 6.0% 15.0% 6.0% 10.0% 10.0% 4.0% 4.0% 5.0% 5.0% 2.0% 2.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 0.0% 1995 1997 1999 2001 2003 2005 2007 1995 1997 1999 2001 2003 2005 2007 = Trend = Wyoming = Wisconsin =United States Why not publicize and reward clerks and stores for not selling tobacco or alcohol to minors if…Embry, D. D. and A. Biglan (2009). Reward and Reminder: An Environmental Strategy for Population-Level Prevention. National Registry of Effective Programs and Practices, Substance Abuse and Mental Health Administration.Thursday, June 9, 2011 46
  70. 70. What is a behavioural vaccine? It is a simple procedure (a kernel or a recipe of kernels) that, when used repeatedly, reduce morbidity and mortality and/or increase wellbeing or health. Such behavioural vaccines can become cultural practices. Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines." Journal of Community Psychology 32(5): 575.Thursday, June 9, 2011 47
  71. 71. Key message by showing clear visual results 30% Why not help Percentage with Psychosis at 12 months 27.5% our serious 24% at-risk 18% This cost $12 to children with 12% achieve omega-3 to prevent 6% 4.9% psychosis? 0% Amminger, G. P., M. R. Schafer, et al. (2010). Omega-3 Placeo "Long-Chain {omega}-3 Fatty Acids for See p.214, IOM Report Psychosis Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch Gen Psychiatry 67(2): 146-154.Thursday, June 9, 2011 48
  72. 72. Reduced  Felony  Violent  Offences  Among  Prisoners   with  recommended  daily  amounts  of  vitamins,  minerals  and  essen=al  fa>y   acids 1.00 Ratio of Disciplinary Incidents Supplementation/Baseline Placebo  -­‐10.1% Ac=ve  -­‐37.0%  p  =  ns 0.75  p  ‹  0.005 Active 0.50 Placebo Error bars drawn at 2 standard errors to indicate 0.25 95% confidence interval 0 Before supplementation During supplementation UK  maximum  security  prison  -­‐  338  offences  among  172  prisoners  over  9  months  treatment  in  a  compared  to  9   months  baseline.   Gesch  et  al.    Br  J  Psychiatry  2002,  181:22-­‐28Thursday, June 9, 2011 49
  73. 73. Cardiovascular  mortality  risk  and  LC  n-­‐3  in  =ssues 200 150 100 rdiovascular  mortality  /100,000 50 0 15 25 35 45 55 65 85 75 %  n-­‐3  HUFA-­‐PL  Thursday, June 9, 2011 50
  74. 74. Cardiovascular  mortality  risk  and  LC  n-­‐3  in  =ssues 200 US  Military 150 100 rdiovascular  mortality  /100,000 50 0 15 17 25 35 45 55 65 85 75 %  n-­‐3  HUFA-­‐PL  Thursday, June 9, 2011 50
  75. 75. Cardiovascular  mortality  risk  and  LC  n-­‐3  in  =ssues 200 US  Military 150 100 2  gm/  d  LC  n-­‐3 rdiovascular  mortality  /100,000 50 0 15 17 25 35 45 45 55 65 85 75 %  n-­‐3  HUFA-­‐PL  Thursday, June 9, 2011 50
  76. 76. Low  Plasma  DHA  at  Baseline  Predicts  Greater  Risk  of  Future  Suicide  A>empts Cox  propor=onal  hazard  ra=o=0.29,    p<0.002 1.0 Inpatient Discharge 0.8 Survival  Probability 0.6 0.4 High  DHA    (n=16) Low    DHA    (n=17) 0.2 (median  split  of  plasma  phospholipid  %  fa1y  acids) 0 0 200 400 600 800 Time  to  First  Suicide  A1empt  (days) Suble>e,  Hibbeln  et  al  Am  J  Psychiatry  2006;163:  1100-­‐1102  Thursday, June 9, 2011 51
  77. 77. Low maternal omega-3 consumption from seafood and suboptimal verbal IQ among their children 34 32 30 28 - UK , 8y 26 III r = 0.97 Percentage of children with 24 r2 = 0.95 F=27.2 p<0.02. low verbal IQ, WISC 22 20 18 16 14 0 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40 0.45 0.50 0.55 0.60 - Estimated omega 3 fatty acids from seafood (en %) Mother at 32 wk gestation Hibbeln et al, Lancet 2007: 369: 578-585Thursday, June 9, 2011 52
  78. 78. More  fish  meals  in  Swedish  15  year  olds  and  be>er   school  grades    (n  =  9,448) 50 45 40 35 Increase in child grade score (95% CI) 30 25 20 15 10 5 REF 0 < = > one one one Fish meals per week Kim et al Acta Paediatr. 2010; 99 (1) :72-7.Thursday, June 9, 2011 53
  79. 79. More  fish  meals  in  Swedish  15  year  olds  and  be>er   school  grades    (n  =  9,448) 50 45 40 35 Increase in child grade score (95% CI) 30 25 20 15 10 5 REF REF 0 < = > one one one ES HS COL Fish meals per week Parent Education Kim et al Acta Paediatr. 2010; 99 (1) :72-7.Thursday, June 9, 2011 53
  80. 80. More  fish  meals  in  Swedish  15  year  olds  and  be>er   school  grades    (n  =  9,448) 50 45 40 35 Increase in child grade score (95% CI) 30 25 20 15 10 5 REF REF REF 0 < = > one one ES HS COL M F one Fish meals per week Parent Education Kim et al Acta Paediatr. 2010; 99 (1) :72-7.Thursday, June 9, 2011 53
  81. 81. Be>er  Standard  Test  Score  in  Children   When  Moms  ate  Fish  in  Pregnancy dropped out n=2,454 remained n=7,081 12 Standardized Assessment Test Score 11 10 9 8 Children- age 7 7 6 Mean  (SD) p<0.0009 5 ANOVA-­‐intake   4 and  reten=on   3 2 1 0 None 1-340g/w >340g/w None 1-340g/w >340g/w Maternal seafood consumption in pregnancy ALSPAC cohort Hibbeln et al, The Lancet 17 Feb 2007Thursday, June 9, 2011 54
  82. 82. Teacher-­‐rated  ADHD  symptoms Reduction in ADHD-related Symptoms DSM Combined-type DSM Hyperactivity DSM Inattention Conners Global Index CG Emotional Lability CG Restless-Impulsive Conners Index Social Problems Perfectionism Anxiety Hyperactivity Placebo (N=52) Active (N=50) Cognitive Problems Opposition -0.15 0 0.15 0.30 0.45 0.60 Treatment Effect Size (Mean change 0-3m / Pooled Baseline SD) Richardson  and  Montgomery  2005Thursday, June 9, 2011 55
  83. 83. Homicide mortality and availability of linoleic acid (en%) Combined Australia, United Kingdom, Canada Argentina and USA data from 1961-2000 r = 0.93 1985 10 r2 = 0.86 F = 583 USA p<1 X10 -40 8 Homicide mortality /100,000 6 1988 1999 1961 4 1961 Argentina 2000 2000 1961 UK 2 Canada 2000 1961 1961 Australia 0 0 2 4 6 8 10 Linoleic acid (en%) [from 12 seed oils as en% of all commodities available for food consumption] f=y0+a*exp(b*x) y0 = -1.98207a = 2.14258 b = 0.203595 Hibbeln et al, Lipids 2004; 23: 1207-1213Thursday, June 9, 2011 56
  84. 84. Essential Fats: Metabolism and Dietary SourcesThursday, June 9, 2011 57
  85. 85. Essential Fats: Metabolism and Dietary Sources Omega-3 20:5n-3, eicosapentaenoic acid, EPA Seafood Breast milk (DHA) 22:6n-3, docosahexaenoic acid, DHA (brain, retina, testis)Thursday, June 9, 2011 57
  86. 86. Essential Fats: Metabolism and Dietary Sources Omega-3 18:3n-3 alfa-linolenic acid, ALA Flax ~ Canola Leaf plants FADS 1-2 20:5n-3, eicosapentaenoic acid, EPA Seafood Breast milk (DHA) 22:6n-3, docosahexaenoic acid, DHA (brain, retina, testis)Thursday, June 9, 2011 57
  87. 87. Essential Fats: Metabolism and Dietary Sources Omega-6 Omega-3 18:2n-6 linoleic acid, 18:3n-3 alfa-linolenic acid, LA - Competition - ALA Flax ~ Canola Leaf plants FADS 1-2 20:4n-6, arachidonic acid 20:5n-3, eicosapentaenoic acid, AA EPA Seafood Breast milk (DHA) 22:6n-3, docosahexaenoic acid, 22:5n-6 DPA n-6 DHA (brain, retina, testis)Thursday, June 9, 2011 57
  88. 88. Essential Fats: Metabolism and Dietary Sources Omega-6 Omega-3 18:2n-6 linoleic acid, 18:3n-3 alfa-linolenic acid, LA - Competition - ALA Flax ~ Canola Leaf plants FADS 1-2 20:4n-6, arachidonic acid 20:5n-3, eicosapentaenoic acid, AA EPA Seafood Breast milk (DHA) 22:6n-3, docosahexaenoic acid, 22:5n-6 DPA n-6 DHA (brain, retina, testis)Thursday, June 9, 2011 57
  89. 89. DHA dietary deficiency impairs synapse development Adequate Deficient Hippocampal DHA 6.6 ± 0.7% 0.5 ± 0.1% Fatty Acids DPAn-6 0.4 ± 0.1% 4.7 ± 0.1% Cao et al. J. Neurochem. 2009Thursday, June 9, 2011 58
  90. 90. DHA dietary deficiency impairs synapse development Adequate Deficient Hippocampal DHA 6.6 ± 0.7% 0.5 ± 0.1% Fatty Acids DPAn-6 0.4 ± 0.1% 4.7 ± 0.1% Synapes in Hippocampal Neurons 30 µm Mother mice fed adequate of deficient diets, embryo neurons harvested day 18 Cao et al. J. Neurochem. 2009Thursday, June 9, 2011 58

×