Majority of Women Report Sexual Dysfunction After Childbirth

Newswise — Many women notice that their sexual health changes after childbirth, according to researchers from Loyola University Chicago. Loyola researchers have a study underway to determine the extent to which pelvic pain may be related to this change.

“Many women experience physical changes after childbirth. This can lead to significant disability and impaired sexual function,” said Sandi Tenfelde, PhD, RN, APN, study co-investigator, assistant professor and director of the Women’s Health Nurse Practitioner (WHNP) Program, Loyola University Chicago Marcella Niehoff School of Nursing. “We plan to learn more about pelvic pain and its association to reduced sexual function to ultimately improve sexual health for women after childbirth.”

As a woman’s body changes during pregnancy and after the birth of a baby, her sexual function may change as well. The recovery to pre-pregnancy levels of sexual health after childbirth is gradual and varies by individual. Factors that can affect postpartum sexual health include body image and perineal pain related to trauma from childbirth. Despite the high number of women affected by pelvic pain after childbirth, the cause remains unknown. The relationship between postpartum pelvic pain and sexual function also has not been well studied.

Researchers are recruiting women for this study who are between the ages of 21 – 50 and who have delivered a baby in the past year. The study will help clinicians and researchers understand how pregnancy and postpartum changes affect sexual health and quality of life.

Study participants will be seen at Loyola’s Pelvic Floor Clinic in Maywood. They will be recruited from across the Chicago area and from the Wellness Clinic for Mothers at the Loyola Center for Health at Burr Ridge. This was the first multidisciplinary program in the Chicago area to help women recover from pain, injuries and other pelvic floor disorders related to pregnancy and childbirth.

Posted in Human Behavior: Sexuality, Pregnancy | Leave a comment

Forget About the Car Keys, Do You Know When to Take Away Your Parent’s Checkbook?

Newswise — BIRMINGHAM, Ala. – Many Americans have struggled with the thorny issue of suggesting an elderly loved one should give up the car keys, but experts suggest caregivers may also need to be mindful of seniors’ ability to manage their own money.

“Financial capacity has emerged as a key activity of daily living in understanding functional impairment and decline in patients with mild cognitive impairment — or MCI — and dementia,” said Daniel Marson, Ph.D., J.D., professor in the Department of Neurology and director of the Alzheimer’s Disease Center at the University of Alabama at Birmingham. “The capacity to manage one’s own financial affairs is critical to success in independent living. Impairments in financial skills and judgment are often the first functional changes demonstrated by patients with incipient dementia. And breakdowns in financial management skills can be devastating.”

Patients with MCI typically still are functioning in the community with focal memory or other cognitive impairments but are beginning to show initial signs of functional decline. Since 2000, Marson and his group have published a number of empirical studies detailing impairments of financial skills in patients with MCI and Alzheimer’s disease.

At an October symposium organized jointly by the Massachusetts Institute of Technology AgeLab and Transamerica called “Financial Planning in the Shadow of Dementia,” Marson presented five clinical warning signs of financial decline that family members and caregivers of elderly persons should recognize. Marson noted that these warning signs should represent changes from the older person’s prior baseline financial skills.

• Memory lapses, such as forgetting to pay bills or taxes, or paying bills twice.
• Poor organization of financial information flow, where a previously neat desk is now in disarray and disorganized. An individual might be confused about when an activity transpired, and mail might not be opened in a timely manner.
• Math mistakes in everyday life, such as figuring out a tip, balancing a checkbook or needing help with the steps of a calculation.
• Confusion, such as an erosion in the ability to comprehend basic financial concepts.
• Impaired financial judgment, particularly a new interest in get-rich-quick schemes. A classic sign is that the person would not have considered the scheme five years ago and is now listening and interested. Another sign is unrealistic anxiety about personal finances.

In response to these changes, Marson suggests that caregivers can oversee an older person’s checking transactions, contact the bank to detect irregularities such as bills’ being paid twice, or become co-signers on a checking account so that joint signature is required for checks above a certain amount. Online banking and bill-payment services are additional options for families.

In 2009, Marson and his group published a major paper on declining financial capacity in MCI and progression to Alzheimer’s, which involved a tool developed at UAB called the Financial Capacity Instrument. The FCI measures financial skills across 20 tasks, including making investment decisions, understanding a bank statement, balancing a checkbook, paying bills, preparing bills for mailing, and counting coins and currency.

Posted in Cognitive Impairment, Dementia, Elder Care | Leave a comment

Moderate coffee consumption may lower the risk of Alzheimer’s disease by up to 20 percent

Drinking 3-5 cups of coffee per day may help to protect against Alzheimer’s Disease, according to research highlighted in an Alzheimer Europe session report published by the Institute for Scientific Information on Coffee (ISIC), a not-for-profit organisation devoted to the study and disclosure of science related to coffee and health.

The number of people in Europe aged over 65 is predicted to rise from 15.4% of the population to 22.4% by 20251 and, with an aging population, neurodegenerative diseases such as Alzheimer’s Disease are of increasing concern. Alzheimer’s Disease affects one person in twenty over the age of 65, amounting to 26 million people world-wide

Recent scientific evidence has consistently linked regular, moderate coffee consumption with a possible reduced risk of developing Alzheimer’s Disease. An overview of this research and key findings were presented during a satellite symposium at the 2014 Alzhemier Europe Annual Congress.

The session report from this symposium highlights the role nutrition can play in preserving cognitive function, especially during the preclinical phase of Alzhemier’s, before symptoms of dementia occur. The report notes that a Mediterranean diet, consisting of fish, fresh fruit and vegetables, olive oil and red wine, has been associated with a reduced risk for development of Alzheimer’s Disease. Research suggests that compounds called polyphenols are responsible for this protective effect, these compounds are also found in high quantities in coffee.

Epidemiological studies have found that regular, life-long moderate coffee consumption is associated with a reduced risk of developing Alzheimer’s Disease with the body of evidence suggesting that coffee drinkers can reduce their risk of developing the disease by up to 20%. A recent paper, suggested that moderate coffee consumption was associated with a lower risk of developing dementia over a four year follow-up period, however the effect diminished over longer follow up period.

Finally, the report explores the compounds within coffee, which may be responsible for this protective effect, identifying caffeine and polyphenols as key candidates. Caffeine helps prevent the formation of amyloid plaques and neurofibrulary tangles in the brain – two hallmarks of Alzheimer’s Disease. In addition to this, both caffeine and polyphenols reduce inflammation and decrease the deterioration of brain cells – especially in the hippocampus and cortex, areas of the brain involved in memory.

Dr. Arfram Ikram, an assistant professor in neuroepidemiology at Erasmus Medical Centre Rotterdam, presented his findings at the symposium. He commented: “The majority of human epidemiological studies suggest that regular coffee consumption over a lifetime is associated with a reduced risk of developing Alzheimer’s Disease, with an optimum protective effect occurring with three to five cups of coffee per day.”

Dr. Iva Holmerova, vice chairperson of Alzheimer Europe, commented: “The findings presented in this report are very encouraging and help to develop our understanding of the role nutrition can play in protecting against Alzheimer’s Disease. Coffee is a very popular beverage enjoyed by millions of people around the world and I’m pleased to know that moderate, lifelong consumption can have a beneficial effect on the development of Alzheimer’s Disease.”

The session report details the key scientific research presented by Dr. Neville Vassallo, Dr. Arfan Ikram and Dr. Astrid Nehlig during a session entitled: Nutrition and Cognitive Function, which took place on the 23rd October in Glasgow, UK. Source

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Few Operations for Epilepsy Despite Their Safety and Efficacy

A study at Sahlgrenska Academy has found that epilepsy surgery is a safe, effective and low-risk procedure. Nevertheless, few Swedes have the operation, and those who are interested may have to wait a long time for presurgical counseling.

The purpose of surgery is to enable a person with severe epilepsy to be free of seizures or to reduce their frequency to the point that (s)he can enjoy better quality of life.

The study at Sahlgrenska Academy was based on the Swedish National Epilepsy Surgery Register, which includes all cases since 1990. The researchers reviewed data for the 865 patients who were operated on at Sweden’s six epilepsy surgery clinics from 1996 to 2010.

Only 3% (25) of the patients suffered lasting complications. A comparison with a previous study showed that the complication rate had trended downward.

The Gothenburg study is one of many that have demonstrated the safety and efficacy of epilepsy surgery. A long-term follow-up study in 2013 based on the Swedish National Epilepsy Surgery Register found that more than 60% of adults were free of seizures 5-10 years after surgery.

Despite the encouraging data, only 50-60 procedures are performed in Sweden every year. Studies show that it takes an average of 20 years for a patient with treatment-resistant epilepsy to be referred for presurgical counseling.

“One possible reason that it takes so long is that doctors may erroneously believe that surgery is a high-risk procedure,” says Johan Bjellvi, a researcher at Sahlgrenska Academy. “Our study has made an important contribution by demonstrating that the risk of complications is very low.”

Another problem is that many patients do not even know that surgery is an option.

The Gothenburg epilepsy surgery team is participating in an EU project to raise awareness and increase the availability of these procedures throughout Europe. One goal is to develop a new classification system for complications of epilepsy surgery.

“If we are going to further minimize the risk of operating, the potential adverse effects must be described in a uniform manner,” Dr. Bjellvi says. “The EU project is designing a website for use by both doctors and patients in 17 countries.”

“Complications of Epilepsy Surgery in Sweden 1996-2010: a Prospective, Population-based Study” was published online by the Journal of Neurosurgery in October.

EPILEPSY FACTS
Epilepsy manifests as seizures, with or without causing convulsions or affecting consciousness. Seizures are due to transient disturbances of the brain’s neural electrical impulses. The cause may be temporary or permanent brain damage but cannot always be determined. Approximately 1% of Swedes are predisposed to experience recurring epileptic seizures. Both drugs and surgical methods are available to relieve the symptoms.

The purpose of surgery is to enable the patient to be free of seizures, to minimize their frequency or to reduce their severity by preventing involvement of larger areas of the brain. Many different procedures are available. Anterior temporal lobectomy is the most common. The purpose of certain other procedures is to limit the diffusion pathways of epileptic activity. Source

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Why do so many seniors with memory loss and dementia never get tested?

ANN ARBOR, Mich. — Despite clear signs that their memory and thinking abilities have gone downhill, more than half of seniors with these symptoms haven’t seen a doctor about them, a new study finds.

University of Michigan researchers and their colleagues say their findings suggest that as many as 1.8 million Americans over the age of 70 with dementia are not evaluated for cognitive symptoms by a medical provider, which in some patients can lead to a failure to uncover modifiable causes of thinking or memory impairment.

The study, published online in Neurology, the medical journal of the American Academy of Neurology, documents a clear lack of clinical testing for seniors with signs of cognitive problems.

Those who were married, and those with the worst levels of dementia symptoms, were more likely to have had their memory and thinking ability evaluated by a primary care doctor, neurologist or psychiatrist. The study included people with mild cognitive impairment through severe dementia, from all causes.

“Early evaluation and identification of people with dementia may help them receive care earlier,” says study author Vikas Kotagal, M.D., M.S., who sees patients at the University of Michigan Health System and is an assistant professor in the U-M Medical School’s Department of Neurology. “It can help families make plans for care, help with day-to-day tasks including observed medication administration, and watch for future problems that can occur. In some instances, these interventions could substantially improve the person’s quality of life.”

Free dementia clinical testing now available to all seniors in Medicare

The data in the study come from before the start of Medicare’s free annual wellness exams for seniors, which began in 2011 under the Affordable Care Act and are required to include a cognitive evaluation.

Even so, says Kotagal, “The results of this study have implications in both primary care and specialty care settings. Recognizing cognitive impairment in older individuals is important, and physicians should explore reasons why dementia has occurred and communicate these findings clearly with patients and family members so that they can take this information with them when they leave the office.”

More about the study population

The study was part of a larger, nationally representative, community-based study called the Health and Retirement Study, based at the U-M Institute for Social Research. From that study, 856 people age 70 and older were evaluated for dementia, including a video interview and standard testing. For each participant, a spouse, child or other person who knew the person well was asked whether the participant had ever seen a doctor for any concerns about memory or thinking.

A total of 297 of the participants met the criteria for dementia. Of those, 45 percent had seen a doctor about their memory problems – and the more severe their issues, the more likely they had had that evaluation. By comparison, 5 percent of those with memory and thinking problems that did not meet the criteria for dementia had been tested by a doctor for those issues, and 1 percent of those with normal memory and thinking skills had undergone testing.

People who were married were more than twice as likely to undergo cognitive evaluations as people who were not married. Why? “It’s possible that spouses feel more comfortable than children raising concerns with their spouse or a health care provider,” said Kotagal. “Another possibility could be that unmarried elderly people may be more reluctant to share their concerns with their doctor if they are worried about the impact it could have on their independence.”

Other demographic factors did not have an effect on whether or not people had cognitive evaluations, including race, socioeconomic status, the number of children and whether children lived close to the parents. “Our results show that the number and proximity of children is no substitute for having a spouse as a caregiver when it comes to seeking medical care for memory problems for a loved one,” Kotagal said.

Next stop: Finding out why

While the study doesn’t answer the question of why people with signs of dementia don’t get tested, Kotagal suggests that many factors may be involved – – some driven by the patient, some by physicians, and others by the nature of our health system.

Many patients and physicians, he says, may perceive that clinical cognitive exams don’t have enough value. But experts have shown that they can improve medical outcomes and help reduce societal costs.

For instance, knowing that a stroke or vascular issues in the brain caused dementia means patients can work to control risk factors like blood pressure that might otherwise cause it to keep worsening.

The next steps in research on this topic are to find out why patients don’t get tested, and what parts of the diagnostic process are most valuable to patients and caregivers. Source

Posted in Alzheimer's, Cognitive Impairment, Dementia, Elder Care | Leave a comment

Detectable, pre-cancerous state in the blood identified

Boston, MA. Wednesday, November 26, 2014 — Researchers from the Broad Institute of MIT and Harvard, Harvard Medical School, and Harvard-affiliated hospitals have uncovered an easily detectable, “pre-malignant” state in the blood that significantly increases the likelihood that an individual will go on to develop blood cancers such as leukemia, lymphoma, or myelodysplastic syndrome. The discovery, which was made independently by two research teams affiliated with the Broad and partner institutions, opens new avenues for research aimed at early detection and prevention of blood cancer. Findings from both teams appear this week in the New England Journal of Medicine.

Most genetic research on cancer to date has focused on studying the genomes of advanced cancers, to identify the genes that are mutated in various cancer types. These two new studies instead looked at somatic mutations – mutations that cells acquire over time as they replicate and regenerate within the body – in DNA samples collected from the blood of individuals not known to have cancer or blood disorders.

Taking two very different approaches, the teams found that a surprising percentage of those sampled had acquired a subset – some but not all – of the somatic mutations that are present in blood cancers. These individuals were more than ten times more likely to go on to develop blood cancer in subsequent years than those in whom such mutations were not detected.

The “pre-malignant” state identified by the studies becomes more common with age; it is rare in those under the age of 40, but appears with increasing frequency with each decade of life that passes, ultimately appearing in more than 10% of those over the age of 70. Carriers of the mutations are at an overall 5% risk of developing some form of blood cancer within five years. This “pre-malignant” stage can be detected simply by sequencing DNA from blood.

“People often think about disease in black and white – that there’s ‘healthy’ and there’s ‘disease’ – but in reality most disease develops gradually over months or years. These findings give us a window on these early stages in the development of blood cancer,” said Steven McCarroll, senior author of one of the papers. McCarroll is an assistant professor of genetics at Harvard Medical School and director of genetics at the Broad’s Stanley Center for Psychiatric Research. Benjamin Ebert, an associate member of the Broad and associate professor at Harvard Medical School and Brigham and Women’s Hospital, is the senior author of the other paper.

The mutations identified by both studies are thought to originate in blood stem cells, and confer a growth-promoting advantage to the mutated cell and all of its “clones” – cells that derive from that original stem cell during the normal course of cell division. These cells then reproduce at an accelerated rate until they account for a large fraction of the cells in a person’s blood. The researchers believe these early mutations lie in wait for follow-on, “cooperating” mutations that, when they occur in the same cells as the earlier mutations, drive the cells toward cancer. The majority of mutations occurred in just three genes; DNMT3A, TET2, and ASXL1.

“Cancer is the end-stage of the process,” said Siddhartha Jaiswal, a Broad associated scientist and clinical fellow from Massachusetts General Hospital who was first author of Ebert’s paper. “By the time a cancer has become clinically detectable it has accumulated several mutations that have evolved over many years. What we are primarily detecting here is an early, pre-malignant stage in which the cells have acquired just one initiating mutation.”

The teams converged on these findings through very different approaches. Ebert’s team had hypothesized that, since blood cancers increase with age, it might be possible to detect early somatic mutations that could be initiating the disease process, and that these mutations also might increase with age. They looked specifically at 160 genes known to be recurrently mutated in blood malignancies, using genetic data derived from approximately 17,000 blood samples originally obtained for studies on the genetics of type 2 diabetes.

They found that somatic mutations in these genes did indeed increase the likelihood of developing cancer, and they saw a clear association between age and the frequency of these mutations. They also found that men were slightly more likely to have mutations than women, and Hispanics were slightly less likely to have mutations than other groups.

Ebert’s team also found an association between the presence of this “pre-malignant” state, and risk of overall mortality independent of cancer. Individuals with these mutations had a higher risk of type 2 diabetes, coronary heart disease, and ischemic stroke as well. However, additional research will be needed to determine the nature of these associations.

In the related paper, McCarroll’s team discovered the phenomenon while studying a different disease. They, too, were looking at somatic mutations, but they were initially interested in determining whether such mutations contributed to risk for schizophrenia. The team studied roughly 12,000 DNA samples drawn from the blood of patients with schizophrenia and bipolar disorder, as well as healthy controls, searching across the whole genome at all of the protein-coding genes for patterns in somatic mutations.

They found that the somatic mutations were concentrated in a handful of genes; the scientists quickly realized that they were cancer genes. The team then used electronic medical records to follow the patients’ subsequent medical histories, finding that the subjects with these acquired mutations had a 13-times elevated risk of blood cancer.

McCarroll’s team conducted follow-up analyses on tumor samples from two patients who had progressed from this pre-malignant state to cancer. These genomic analyses revealed that the cancer had indeed developed from the same cells that had harbored the “initiating” mutations years earlier.

“The fact that both teams converged on strikingly similar findings, using very different approaches and looking at DNA from very different sets of patients, has given us great confidence in the results,” said Giulio Genovese, a computational biologist at the Broad and first author of McCarroll’s paper. “It has been gratifying to have this corroboration of each other’s findings.”

Jaiswal will be presenting the findings on December 9 at the American Society of Hematology Annual Meeting in San Francisco.

All of the researchers involved emphasized that there is no clinical benefit today for testing for this pre-malignant state; there are no treatments currently available that would address this condition in otherwise healthy people. However, they say the results open the door to entirely new directions for blood cancer research, toward early detection and even prevention.

“The results demonstrate a way to identify high-risk cohorts – people who are at much higher than average risk of progressing to cancer – which could be a population for clinical trials of future prevention strategies,” McCarroll said. “The abundance of these mutated cells could also serve as a biomarker – like LDL cholesterol is for cardiovascular disease – to test the effects of potential prevention therapies in clinical trials.”

Ebert agrees:

“A new focus of investigation will now be to develop interventions that might decrease the likelihood that individuals with these mutations will go on to develop overt malignancies, or therapeutic strategies to decrease mortality from other conditions that may be instigated by these mutations,” he said.

The researchers also say that the findings show just how important it is to collect and share large datasets of genetic information: both studies relied on DNA samples collected for studies completely unrelated to cancer.

“These two papers are a great example of how unexpected and important discoveries can be made when creative scientists work together and with access to genomic and clinical data,” said Broad deputy director David Altshuler, one of Ebert’s co-authors. “For example, Steve’s team found stronger genetic relationships to cancer than they have yet found for the schizophrenia endpoint that motivated their original study. The pace of discovery can only accelerate if researchers have the ability to apply innovative methods to large datasets.” Source

Posted in Cancer: Leukemia, Cancer: Lymphoma, Cancer: Myelodysplastic Syndrome | Leave a comment

How insomnia can kill you

A persistent lack of sleep will land you in an early grave.

That is the conclusion of a 40-year study examining the long-term effects of sleepless nights.

Persistent insomnia – for six years or more – was linked to a 58 per cent increased risk of death, scientists at the University of Arizona found.

It was also linked to higher levels of inflammation in the blood, which is linked to heart disease, diabetes, obesity, cancer, dementia and depression.

Insomnia – difficulty falling asleep, staying asleep, or waking too early – is a common medical complaint.

Chronic insomnia means disrupted sleep that occurs at least three nights per week and lasts at least three months.

The U.S. researchers analysed data from a long running respiratory study, the Tucson Epidemiological Study of Airway Obstructive Disease, which began in 1972 and has followed participants for decades.

They found that unlike intermittent insomnia, chronic insomnia that lasted for at least six years was associated with mortality.

  • Disrupted sleep at least three nights a week for six years can kill
  • Chronic insomnia was associated with a 58 per cent increased risk of death
  • Also linked to higher levels of inflammation in the blood
  • Inflammation in blood is responsible for most chronic illnesses
  • These include heart disease, diabetes, dementia, cancer and depression More

Posted in Insomnia, Sleep, Sleep Apnea | Leave a comment

Minimally invasive disc surgery is a pain in the neck

Hamilton, ON (Nov. 26, 2014) – McMaster University researchers have found that current evidence does not support the routine use of minimally invasive surgery to remove herniated disc material pressing on the nerve root or spinal cord in the neck or lower back.

In comparing it with open surgery, they found that while minimally invasive surgery for cervical or lumbar discectomy may speed up recovery and reduce post-operative pain, it does not improve long-term function or reduce long-term extremity pain.

Minimally invasive surgery for discectomy also requires advanced technical expertise and may be associated with increased risks of neurologic injury, incidental damage to the outer covering of the brain and spinal cord, and further surgery.

The study, published today in CMAJ Open, was led by Nathan Evaniew, a physician who is a research fellow in orthopedics and a PhD student in health research methodologies at McMaster’s Michael G. DeGroote School of Medicine.

“Surgeons already perform open discectomies through relatively small incisions. Selecting the right patients and providing technically adequate nerve-root decompression are probably the most important determinants of long-term outcomes,” said Evaniew. “So, we were not surprised to find that outcomes are essentially the same between minimally invasive and open discectomies.”

People affected by symptomatic neck and lower back spinal disc diseases make up at least five per cent of the population and they suffer with pain, disability and loss of income. For carefully selected patients who fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results, said Evaniew.

Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less morbid, but they require specialized equipment and may involve increased risks for technical complications, he added.

Evaniew and his colleagues performed a meta-analysis of previous studies to examine the effects of minimally invasive versus open surgery on functional outcomes, pain, complications and reoperations among patients undergoing cervical or lumbar discectomy.

They searched the MEDLINE, Embase and Cochrane Library databases for reports of relevant randomized controlled trials and reviewed four trials involving 431 patients in the cervical discectomy group, and 10 trials involving 1,159 patients in the lumbar discectomy group.

“Many spinal surgery procedures are known to have difficult learning curves, and surgeons embarking on minimally invasive surgical techniques should obtain specialized training to minimize complications,” the authors write. “Conventional open techniques for spinal surgery are themselves technically demanding, and minimally invasive techniques are likely even more challenging.”

In addition to concluding that current research evidence does not support the routine use of minimally invasive surgery for cervical or lumbar discectomy, the researchers also found an overall lack of high-quality research, which suggests further well-designed trials are needed. Source

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Why middle managers are unhappy

In ascending order of importance, here’s the litany of their unhappiness.

9. Their distinctiveness is not valued or appreciated. Diversity is talked about but rarely practiced.

8. They see the organization as inefficient and ineffective. Many organizations are guilty of wasting money, making poor decisions, and resisting innovation — in other words, failing to correctly apply resources to enable employees to succeed.

7. They’re overworked. Many organizations will tell employees that they think it’s important to have work-life balance but then assign too large workload for anyone to handle effectively. The inconsistency between what’s said and what really happens creates significant frustration.

6. They don’t believe that if they raise an issue it will be addressed. They tend to feel helpless and with no advocate. They feel that their opinions do not matter.

This is a symptom of the more fundamental feeling:

5. They don’t feel valued or appreciated.  To a large extent they feel that they are taken advantage of.

Worse,

4.  They feel they are treated unfairly compared with others. They believe others get better pay or opportunities, while all they get is a grossly unfair share of the workload.

 3. Their work lacks meaning and purpose. When people feel that they accomplish something worthwhile, they have pride in what they do and commitment increases. But these employees feel that they are lost in hollow, throwaway jobs that make very little difference. More

Posted in Human Behavior: Fairness, Human Behavior: Happiness, Human Behavior: Leadership, Workplace Issues | Leave a comment

Pain drug compliance detectable by doctors with new method

Newswise — CHICAGO, Nov. 25, 2014 — Assuring appropriate drug theory is important for effective pain management, and a new study published in The Journal of Pain reported that use of a short compliance checklist by clinicians can best identify individuals most likely to misuse prescription pain medications.

The Journal of Pain is the peer-review publication of the American Pain Society (APS, www.americanpainsociety.org).

Researchers at Brigham and Women’s Hospital developed and validated a brief self-administered compliance checklist for long-term opioid therapy in patients with chronic pain. Currently, there are no widely accepted assessments for monitoring ongoing opioid therapy adherence, and few studies have attempted to link self-report variables with objective evidence of prescription drug misuse.

For the study, a 12-item Opioid Compliance Checklist was repeatedly administered to 157 patients taking opioids for chronic pain who participated in the investigation and were followed for six months.

Results showed that five items best predicted subsequent aberrant drug behaviors. They are:
• Lost or misplaced medications
• Ran out of pain medication early
• Missed scheduled doctor appointments
• Used any illegal or unauthorized substances
• Not been completely honest about personal drug use

Data collected on the sample of patients with chronic pain suggest these five items may be useful in identifying potential for drug misuse and in determining appropriateness of continued treatment.

“We were surprised at how powerfully a brief checklist that reflects how patients comply with parts of an opioid agreement can predict future misuse of opioids,” stated lead author, Robert Jamison, PhD, professor, Departments of Anesthesiology and Psychiatry, Brigham and Women’s Hospital.

About the American Pain Society
Based in Chicago, the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organization. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and others. For more information on APS, visit www.americanpainsociety.org.

Posted in Back Pain, Health Care: Compliance, Pain, Painkillers | Leave a comment

Why Do People with Autism See Faces Differently?

Newswise — The way people with autism spectrum disorder (ASD) gather information – not the judgement process itself – might explain why they gain different perceptions from peoples’ faces, according to a new study from Hôpital Rivière-des-Prairies and the University of Montreal. “The evaluation of an individual’s face is a rapid process that influences our future relationship with the individual,” said Baudouin Forgeot d’Arc, lead author of the study. “By studying these judgments, we wanted to better understand how people with ASD use facial features as cues. Do they need more cues to be able to make the same judgment?”

The study was conducted in collaboration with a team from the Hôpital Robert-Debré in Paris, who recruited 71 individuals, including a control group (n=38) and an ASD group (n=33), without intellectual disabilities. The group was divided into aged-matched subgroups: children (mean age 10 years) and adults (mean age 33 years) The researchers presented 36 pairs of photographic and synthetic images to the participants, and evaluated their social judgment by asking them to indicate which emotionally neutral faces appeared “kind” to them.

When photographic images of neutral faces were presented, the judgment of ASD participants was mixed compared to participants in the control group – the choices of the ASD participants were not predictable from one subject to another. However, the researchers found no difference between the groups when participants were presented with synthetic images, which were nevertheless created based on the characteristics of the photographic images previously shown. Moreover, when the synthetic image pairs contained less useful judgment clues (less pronounced facial features), the results for the two groups were influenced in the same way by this difficulty.

The identical results of the two groups when they viewed synthetic images suggest that it is not the judgment process itself that is different: judging whether a person seems “kinder” than another can be accomplished similarly in participants with or without ASD. However, the differences observed when they viewed photographic images suggest that the way they gather information about people’s faces is critical.

“We now want to understand how the gathering of cues underpinning these judgments is different between people with or without ASD depending on whether they are viewing synthetic or photographic images. Ultimately, a better understanding of how people with ASD perceive and evaluate the social environment will allow us to better interact with them,” said Forgeot d’Arc.

About the study
Baudouin Forgeot d’Arc is a researcher at the Institut universitaire en santé mentale de Montréal and the Hôpital Rivière-Des-Prairies He is a affiliated with the Centre d’excellence en troubles envahissants du développement at the University of Montreal and is an assistant clinical professor at the university’s Faculty of Medicine.
His French collaborators (Franck Ramus, Aline Lefebvre, Delphine Brottier, Tiziana Zalla, Sanaa Moukawane, Frédérique Amsellem, Laurence Letellier, Hugo Peyre, Marie-Christine Mouren, Marion Leboyer, and Richard Delorme) are researchers at the École normale supérieure (Paris, France), the Hôpital Robert-Debré (Paris, France), and the INSERM U955 (Créteil, France).
The University of Montreal is officially known as Université de Montréal.

Reference: Forgeot d’Arc, B., Ramus, F., Lefebvre, A., Brottier, D., Zalla, T., Moukawane, S., Amsellem, F., Letellier, L., Peyre, H., Mouren, M. C., Leboyer, MDelorme, R. (2014). Atypical Social Judgment and Sensitivity to Perceptual Cues in Autism Spectrum Disorders. J Autism Dev Disord. Epub ahead of print. Pubmed

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Pleasure at Another’s Misfortune Is Evident in Children as Young as Two

Newswise — They say there is no joy like the joy at another’s misfortune, but at what age do we already know how to feel and express it?

Until now, researchers believed that children didn’t develop such a sophisticated emotion until the age of seven, but a new study conducted at the University of Haifa found evidence of schadenfreude in children as young as two.

“The study strengthened the perception that schadenfreude is an evolutionary mechanism that develops within us as we cope with situations of inequality,” said Prof. Simone G. Shamay-Tsoory, of the University of Haifa’s Psychology Department, who led the study.

Schadenfreude is an emotion of joy in the face of someone else’s misfortune, and it can be rooted in jealousy, competitiveness, or sometimes even hatred. According to one theory, schadenfreude is an evolutionary mechanism that develops as a result of competition over limited resources, for example, the struggle between two siblings over their parents’ attention. This mechanism, which develops at an early age, turns later on into a mechanism that enables us to feel pleasure at another’s misfortune even when there is no competition for resources.

Until now, the prevailing assumption among researchers was that children younger than 7 years old are not emotionally developed enough to have such feelings. This study, conducted by Prof. Shamay-Tsoory, along with Dorin Ahronberg-Kirschenbaum of the University of Haifa’s School of Education, and Nirit Bauminger-Zviely of Bar Ilan University, sought to determine whether such an emotion exists even earlier, at ages 2 to 3.

To do this, the researchers set up 35 groups comprising a mother, her child, and a friend of the child who is the same age. The groups were subjected to two situations.

The first was an “equal” situation, in which the mother encouraged the children to play together, ignored them for two minutes, and then began to read a book aloud to herself for two minutes. After those two minutes, the mother was told to take a glass of water that was on the table and pour it by “accident” on the book. In the second, “unequal” situation, after the first two minutes the mother took the child that wasn’t hers on her lap and began reading the book aloud to him or her. Here, too, after two minutes, the mother spilled the cup of water on the book.

The researchers found that when the unequal situation was brought to an end, the mother’s own child showed visible signs of happiness, as expressed by jumping up and down, clapping his hands, or rolling on the floor. By contrast, when the water was spilled while the mother was reading the book to herself, there were no similar reactions. According to the researchers, the “misfortune” that made the children happy was the fact that their peer had stopped hearing the story, which strengthens the theory that schadenfreude is a social development that is a reaction to inequality.

During the study the researchers also found evidence of jealousy that expressed itself by children trying to force themselves between their mother and the book, or playing with their mother’s hair while the mother was reading the book to their friend. These expressions were stronger than the expressions of schadenfreude, which upholds the findings of previous studies that show jealousy is a stronger emotion than schadenfreude.

Apparently, therefore, the emotion of schadenfreude is embedded in children far earlier than previously thought. “Social comparisons, in which we compare what we have to what others have, as well as emotions of justice, develop at a very early age and constitute positive evolutionary mechanisms to cope with inequitable situations,” said Prof. Shamay-Tsoory. “Because social-comparison reactions are linked to character traits like self-esteem and altruism, it’s possible that people who think less of themselves are more likely to suffer from feelings of schadenfreude.”

Posted in Human Behavior: Schadenfreude | Leave a comment

Post-concussion severity predictable via a protein

PHILADELPHIA – New Penn Medicine research has found that elevated levels in the blood of the brain-enriched protein calpain-cleaved αII-spectrin N-terminal fragment, known as SNTF, shortly after sports-related concussion can predict the severity of post-concussion symptoms in professional athletes. The complete findings were released today in the Journal of Neurotrauma.

This new study builds on previous research from this group showing that elevated blood levels of SNTF on the day of a mild traumatic brain injury treated in the emergency room predicted those patients who would go on to suffer diffuse axonal injury and long-term cognitive dysfunction.

“We extended this biomarker research to the domain of professional sports to test its merit as an objective and rapid way to determine players’ severity of brain injury,” says lead author, Robert Siman, PhD, Research Professor of Neurosurgery at Penn. “This blood test may aid neurobiologically-informed decisions on suitability for return to play following a sports-related concussion.”

The study, conducted in collaboration with Henrik Zetterberg, MD, PhD and Kai Blennow, MD, PhD, of the Sahgrenska Academy at University of Gothenburg, Sweden, and their colleagues, enrolled 288 players in the top Swedish professional ice hockey league. Each of the 28 players who suffered a concussion during the first half of the 2012-2013 season received serial blood draws and was evaluated daily for symptom resolution using the latest guidelines for treatment of sports concussions. Eight of the concussed players were symptom-free within a few days of their injury, but 20 of the players had persistent post-concussion symptoms requiring they be withheld from play six days or longer. An additional 45 players were evaluated during the preseason, 17 of whom were also tested before and after a concussion-free training game.

Compared to those players who were not concussed, or whose concussion symptoms resolved rapidly, the researchers found an increase in the blood SNTF concentration from one hour up to 144 hours post-concussion in those players experiencing persisting post-concussion symptoms. SNTF is a protein that is present at undetectable levels in healthy human brains, but is produced under conditions where nerve cells are traumatized and begin to die. Concussions that lead to lasting brain dysfunction cause SNTF to accumulate in vulnerable long axon tracts of the brain, and its blood elevation is a measure of this diffuse axonal injury.

“These results show that SNTF has promise as a blood biomarker for sports-related concussion and beyond. High blood levels of SNTF appear to identify acute brain damage that corresponds with persisting symptoms after concussion. These observations lend further support to the growing awareness that concussion is not trivial, since it can induce permanent brain damage in some individuals,” agree Siman and senior author, Douglas H. Smith, MD, professor of Neurosurgery and director of the Center for Brain Injury and Repair at Penn. Source

Posted in Concussions, Sports Medicine: Injuries, Sports Medicine: Injuries: Concussion | Leave a comment