Postpartum depression biomarker discovered; could lead to new drugs

Many women suffer from baby blues after giving birth. Some even develop full-blown postpartum depression in the weeks that follow. Monoamine oxidase A, an enzyme responsible for the breakdown of neurotransmitters like dopamine and serotonin, plays an important role in this condition. In comparison to healthy women, women who experience postpartum depression present strongly elevated levels of the enzyme in their brains. This was discovered by a Canadian-German research team including Julia Sacher from the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig. Their findings could help in the prevention of postpartum depression and in the development of new drugs for its treatment.

For most women, the birth of their baby is one of the most strenuous but also happiest days in their lives. However, joy and happiness are often followed by fatigue and exhaustion. The vast majority of women experience a temporary drop in mood for a few days after birth. These symptoms of “baby blues” are not an illness; however, in some cases they can represent early signs of an imminent episode of depression: in 13 percent of mothers, the emotional turmoil experienced after childbirth leads to the development of a full-blown postpartum depression. Postpartum depression is harmful not only to the mother, but also to the baby. It is difficult to treat this condition effectively, as its precise neurobiological causes have remained unidentified to date.

The new study shows that postpartum depression is accompanied by strongly elevated monoamine oxidase A in the brain, particularly in the prefrontal cortex and in the anterior cingulate cortex. In women with postpartum depression, the values recorded were 21 percent higher than those of women who were not plagued by negative feelings after giving birth. Women who did not develop full-blown depression but found themselves crying more often than usual due to depressed mood also presented moderately elevated values.

“Therefore, we should promote strategies that help to reduce monoamine oxidase A levels in the brain, and avoid everything that makes these values rise,” explains Sacher. Such factors include heavy smoking, alcohol consumption and chronic stress, for example when the mother feels neglected and abandoned by her partner and family. “My ultimate goal is to provide women and their families with very concrete lifestyle recommendations that will enable them to prevent postpartum depression,” explains the psychiatrist.

A new generation of long-established drugs could also play an important role in the treatment of postpartum depression in future. Up to now, depressed mothers are mainly given drugs that increase the concentration of serotonin in the brain. However, because monoamine oxidase A breaks down not only serotonin but also other monoamines like dopamine and noradrenaline, a treatment that directly targets monoamine oxidase A could have a higher success rate, particularly in very serious cases: this alternative is provided by selective and reversible monoamine-oxidase- A inhibitors. “The first monoamine oxidase inhibitors often had severe side effects, for example hypertensive crises, which necessitated adherence to a strict diet,” explains Sacher. “However, the new selective and reversible drugs are better tolerated,” she adds. In the next stage of this research involving clinical trials, the scientists intend to test the effectiveness of these reversible monoamine oxidase A inhibitors in the treatment of postpartum depression.

Because the measurement of this enzyme in the brain requires complex technology, it is not suitable for routine testing. Thus, the researchers are also looking for a peripheral marker of this enzyme that can be detected in saliva or blood.

Four years ago, Julia Sacher and her colleagues at the Centre for Addiction and Mental Health CAMH in Toronto already succeeded in showing that, in the first week postpartum, the concentration of the enzyme monoamine oxidase A in the brain is on average 40 percent higher than in women who had not recently given birth. “The monoamine oxidase A values behave in the opposite way to oestrogen levels. When oestrogen levels drop acutely after childbirth, the concentration of monoamine oxidase A rises. This drastic change also influences serotonin levels, known as the happiness hormone,” explains Dr. Sacher. In most women, the values quickly return to normal. In others, they remain raised – and thereby promote the development of depression.

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Rising murder toll of park rangers calls for tougher laws

With poachers responsible for more than half of ranger deaths over the past two years, IUCN, the International Union for Conservation of Nature, and the International Ranger Federation (IRF) call for a toughened stance against wildlife crime globally, marking World Ranger Day celebrated across the globe on 31 July.

Fifty-six rangers have lost their lives in the line of duty in the last 12 months, 29 of whom have been killed by poachers, according to the latest information released today by the International Ranger Federation, which has been monitoring ranger deaths since 2000. Last year’s death toll has reached 102, with poachers and militia responsible for 69 of those deaths.

As more deaths are reported every week and as the figures represent only the confirmed deaths from some 35 countries that voluntarily report to the IRF, the actual number of rangers killed in the line of duty worldwide could be two to three times higher.

“Rangers are the guardians of our planet’s most precious natural assets and it’s unnerving to think that every day they go to work, their lives are at risk as a result of human greed and cruelty,” says Julia Marton-Lefèvre, IUCN Director General. “Without solid protection, proper law enforcement and a strong support network for those unsung heroes of conservation, our efforts to protect wildlife are a lost cause. All conservation action should start with supporting those that put their lives on the line to protect nature every day.”

Almost 60% of all rangers killed this year are from Asia, with the majority of those from India. India, Thailand, Kenya and the Democratic Republic of the Congo (DRC) have seen the sharpest increase in ranger deaths caused by poachers in recent years. Areas rich in elephants, rhinos, sandalwood, rosewood and other valuable resources are most affected. In DRC’s Virunga National Park alone, some 140 rangers have been killed in the last 15 years.

“We are extremely concerned that rangers continue to face high levels of violence and are being murdered at an alarming pace,” says Sean Willmore, President of the International Ranger Federation. “Although the world is slowly awakening to their plight, we need to turn this awareness into meaningful action on the ground and make sure that the dangerous work rangers do to protect our valuable wildlife receives the support and respect it deserves. This still remains our challenge.”

The Federation and its charity arm The Thin Green Line Foundation offer equipment and training to rangers and support the families of those who have lost their lives, helping secure health care, education and employment for the widows and children left behind.

“The work of the International Ranger Federation has been crucial in providing rangers with the support that they need to do their job, which today is one of the most dangerous professions in the world,” says Trevor Sandwith, Director of the IUCN Global Protected Areas Programme. “We need to make sure that this support has a strong backing from governments and the international community, and that tougher, more effective laws are put in place to prevent any more tragedies from taking place. Efforts also need to be made to halt the problem at its source where it is being driven by consumer demand.”

In South Africa, which lost more than 1,000 rhinos in 2013, a rhino poacher has recently been sentenced to 77 years in prison — possibly the heaviest penalty handed to wildlife criminals to date.

The extent and impact of illegal wildlife trade and new approaches to combat it, including effective enforcement strategies to combat wildlife poaching and associated crime, will be discussed at the IUCN World Parks Congress 2014 taking place from 12 to 19 November in Sydney, Australia.

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Acupuncture Provides Significant Quality of Life Improvements Among Breast Cancer Patients Taking Drugs to Prevent Recurrence, Penn Study Shows

PHILADELPHIA — Use of electroacupuncture (EA) – a form of acupuncture where a small electric current is passed between pairs of acupuncture needles – produces significant improvements in fatigue, anxiety and depression in as little as eight weeks for early stage breast cancer patients experiencing joint pain related to the use of aromatase inhibitors (AIs) to treat breast cancer. The results of a randomized, placebo-controlled trial examining the intervention led by researchers at the Perelman School of Medicine at the University of Pennsylvania are published online this week in the journal Cancer. The study is the first demonstration of EA’s efficacy for both joint pain relief, as well as these other common symptoms.

The results build upon earlier findings reported in November 2013, showing that EA can decrease the joint pain reported by roughly 50 percent of breast cancer patients taking AIs – the most-commonly prescribed medications to prevent disease recurrence among post-menopausal women with early-stage, hormone receptor positive breast cancer. Despite their efficacy, the joint pain associated with the use of AIs often leads to fatigue, anxiety, depression, and sleep disturbances for these patients, which researchers suggest may cause premature discontinuation of the drug. Previous studies have shown that nearly half of women taking AIs do not complete their recommended course of treatment, and that those who stop taking the drugs or don’t take them as prescribed have a higher chance of dying of both breast cancer and other causes.

“Since many patients experience pain, fatigue, anxiety and depression simultaneously, our results provide an opportunity to offer patients one treatment that may target multiple symptoms,” said lead author Jun Mao, MD MSCE, associate professor of Family Medicine and Community Health in Penn’s Perelman School of Medicine, who directs the Integrative Oncology program in the Abramson Cancer Center. “We see patients every day who are looking for ways to combat some of the side effects of their treatment. What is particularly significant about these new results is that we can now offer more evidence-based treatment and management solutions for these women.

In the eight-week trial, researchers evaluated the short-term effects and safety of EA for AI-related joint pain and other side effects, compared with sham acupuncture (SA – a non-electric, placebo acupuncture where the needles are not actually inserted into the skin), and usual care. The study participants, who were all receiving AI therapy and experiencing joint pain, were randomly assigned to receive EA, SA or usual care. Patient-reported experiences of fatigue and psychological distress, were measured prior to the study, and periodically throughout the duration, with additional follow-up four weeks after treatment.

  • Fatigue: Compared with usual care, patients receiving EA had a greater reduction in the fatigue score at week eight and the effect was maintained at week 12. On average, patients reported a 2.0 point reduction in fatigue on the Brief Fatigue Inventory, an instrument designed to assess fatigue severity on a numerical scale ranging from 0-10.
  • Anxiety: By week 12, patients receiving EA reported a significant improvement in their anxiety score, whereas patients receiving SA did not. On average, patients in the EA group reported a 2.2 point reduction in anxiety on the Hospital Anxiety and Depression Scale (HADS) compared to the usual care group.
  • Depression: Patients in both EA and SA groups reported a significant improvement in HADS-Depression scores (2.4 points and 2.0 points, respectively) compared with the usual care group by week eight. The effects of both EA and SA on depression were maintained at week 12.

“Our study provides a novel understanding of how fatigue, sleep and psychological distress relate to pain in patients with AI-related joint pain. More importantly, we found that acupuncture helped reduce these symptoms and the effects persisted for at least four weeks following treatment,” said Mao. “There is a small but growing body of literature showing that acupuncture is effective for the management of pain, fatigue, anxiety and depression. However, studies with larger sample sizes and longer follow-up periods are needed to provide more in-depth knowledge about how these treatments, combined with usual care, are improving quality of life for our patients.”

In addition to Mao, other Penn authors on the study are John Farrar, MD, PhD, Angela DeMichele, MD, MSCE, Sharon Xie, PhD, Jarcy Zee, and Christina Seluzicki. The study was supported with grants from the National Institutes of Health (R21 AT004695, K23 AT004112).

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Calorie restriction with resveratrol key to kick-starting cell health

GAINESVILLE, Fla. — When it comes to staying healthy, it’s a cell-eat-cell world.

As cells age, damaged proteins and lipids accumulate within them. Impaired cell parts can send free radicals into the body, and dysfunctional proteins and lipids may break down DNA within cells, causing them to become toxic. Cells usually clean up their own damage through a “housekeeping” process called autophagy. But as the body ages and in people with certain diseases, cells’ ability to do this housekeeping becomes less efficient. That means it may be harder for people to recover from cardiac events such as heart attack or other illnesses.

University of Florida researchers have found that combining calorie restriction with a supplement of resveratrol, an antioxidant found in the skin of red grapes, dark chocolate and blueberries, could kick-start this housekeeping process, helping heart cells recover from damage, according to a study in rats published in the journal Free Radical Biology and Medicine.

“The damaged proteins and lipids remain inside cells, eventually making them toxic,” said lead author Debapriya Dutta, who earned her doctorate from the University of Florida and is now a postdoctoral researcher at the University of Illinois at Urbana-Champaign. “We wanted to see whether an increase in autophagy would remove such damaged cellular components and make the cells healthy again.”

In an earlier study published in the journal Autophagy, Dutta and UF researcher Christiaan Leeuwenburgh, showed that increasing the housekeeping process protected cardiac cells from cell death. In their current study, the researchers wanted to test interventions that could improve autophagy in the heart. They further investigated whether the improved process helped protect rats’ heart cells against induced stress.

To study this, the researchers restricted the calorie intake of one group of 26-month-old rats — approximately equivalent to a 65-year-old human — by 20 percent over a period of six weeks. Another group received only the resveratrol supplement. A third group received both the calorie-restricted diets and the resveratrol.

“Only the group with caloric restriction plus a higher dose of resveratrol induced autophagy,” said Leeuwenburgh, who is also chief of the division of the biology of aging in the University of Florida Institute on Aging.

The researchers think the combination of resveratrol and calorie restriction promotes the role of a protein called mTOR, which regulates cell growth, proliferation and survival, though the researchers say they need to further investigate exactly why the combination of interventions was more effective than either just calorie restriction or just resveratrol.

Leeuwenburgh compares cells unable to clean themselves of damaged parts to smoldering houses.

“If you’re older and you have a sudden stress condition, the smoking homes become fires,” Leeuwenburgh said. “A little bit of smoke is okay, but if they’re not removed quickly, the smoke will turn into a fire, and the cell will start releasing proteins that will cause the breakdown of other apparently functional proteins and DNA in the cell, leading to cell demise and ultimately, organ dysfunction.”

That also means cells may not be able to react as well to the onset of diseases, especially in older adults. Aggregations of plaque within neurons contribute to Alzheimer’s disease, for example. But the plaque could be alleviated by spurring autophagy, which could help clean out the plaque, the researchers said. Increasing the cleaning process could also help cells protect themselves against inflammatory diseases and cancer.

“These kinds of diseases aren’t solely due to a lack of autophagy. There are so many factors that come into play,” said Dutta, who was the paper’s lead author. “But if you increased autophagy for many of these pathologies, it can help the body fight the disease.”

Dutta said the next steps are to test autophagy-enhancing treatments in different disease models, eventually starting clinical trials including the combination of weight loss and resveratrol, exercise and other natural compounds such as papaya.

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Religious children less able to distinguish fantasy from reality

If you expose your child to Moses, Muhammad or Matthew the Apostle, are they at a disadvantage?

According to new research from Boston University, young children with a religious background are less able to distinguish between fantasy and reality compared with their secular counterparts.

In two studies, 66 kindergarten-age children were presented with three types of stories – realistic, religious and fantastical. The researchers then queried the children on whether they thought the main character in the story was real or fictional.

While nearly all children found the figures in the realistic narratives to be real, secular and religious children were split on religious stories. Children with a religious upbringing tended to view the protagonists in religious stories as real, whereas children from non-religious households saw them as fictional.

Although this might be unsurprising, secular and religious children also differed in their interpretation of fantasy narratives where there was a supernatural or magical storyline.

“Secular children were more likely than religious children to judge the protagonist in such fantastical stories to be fictional,” wrote the researchers.

“The results suggest that exposure to religious ideas has a powerful impact on children’s differentiation between reality and fiction, not just for religious stories but also for fantastical stories.”

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More than 5 fruit and veg servings have no additional effect: BMJ

New research backs the five-a-day target for fruit and vegetables, but suggests eating more may have no added benefits.

An analysis of 16 worldwide studies suggested that for every portion of fruit and vegetables consumed, there was a lower risk of premature death.

But after five portions a day, there was no further impact, researchers report in The BMJ.

There have been calls to up the quota to seven-a-day, to prolong lives.

Current NHS guidance is to eat at least five portions of fruit and vegetables a day. Most people manage about four.

The new analysis looked at 16 studies in the US, Asia and Europe involving more than 833,000 people, of whom about 56,000 died during the follow-up period.

Researchers in the US and China found eating more fruit and vegetables was linked with a lower risk of dying from any cause, particularly from cardiovascular disease.

The average risk of death fell by about 5% for every extra serving of fruit and vegetables, up to five servings a day, but not beyond.

“This analysis provides further evidence that a higher consumption of fruit and vegetables is associated with a lower risk of all-cause mortality, particularly cardiovascular mortality,” said the team, led by Prof Frank Hu, of Harvard School of Public Health, in Boston, US.

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Eating tree nuts results in ‘modest decreases’ in blood fats and sugars, survey finds

Eating tree nuts appears to help reduce two of the five markers for metabolic syndrome, a group of factors that raise the risk for heart disease and other health problems such as diabetes and strokes, a new research paper says.

The paper found a “modest decrease” in blood fats known as triglycerides and blood sugars among people who added tree nuts to their diets compared to those who ate a control diet.

The paper, by Dr. John Sievenpiper, a physician and researcher in the Clinical Nutrition and Risk Factor Modification Centre of St. Michael’s Hospital, was published today in the journal BMJ Open.

Dr. Sievenpiper said he believes this is the first systematic review and meta-analysis examining all of the collective evidence of randomized clinical trials on the effect of tree nuts on metabolic syndrome. After screening 2,000 articles published in peer-reviewed journals, he found 49 randomized control trials with 2,000 participants.

A person is considered to have metabolic syndrome if he or she has three of the following risk factors: low levels of “good” cholesterol; high triglycerides; high blood pressure; high blood sugar; extra weight around the waist.

Dr. Sievenpiper said the biggest reductions in triglycerides and blood glucose were seen when tree nuts replaced refined carbohydrates rather than saturated fats. He said there was no adverse impact on the other risk factors for metabolic syndrome or weight gain, even though nuts are high in calories. Nuts also have a high fat content, but it’s good, or unsaturated, fat.

Tree nuts are such things as almonds, Brazil nuts, cashews, chestnuts, coconuts, hazelnuts, pecans, macadamia nuts, walnuts, pine nuts and pistachios. They do not include peanuts, which are legumes.

In the randomized control studies, patients ate about 50 grams of nuts a day or about 1-1/2 servings. One serving of tree nuts is about ¼ cup or 30 grams. He said that people in North America consume on average less than one serving a day, so this is one way they can adapt their diets to take advantage of the metabolic benefits.

“Fifty grams of nuts can be easily integrated into a diet as a snack or as a substitute for animal fats or refined carbohydrates,” Dr. Sievenpiper said.

The U.S. Food and Drug Administration has granted tree nuts a qualified health claim for cardiovascular disease risk reduction. Tree nuts are also recommended as part of the Mediterranean, Portfolio and DASH (Dietary Approaches to Stop Hypertension) diets for cardiovascular disease prevention and management based on their ability to reduce bad cholesterol.

This study received funding from the International Tree Nut Council Nutrition Research and Education Foundation and the Canadian Institutes of Health Research.

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Sugar-sweetened beverages impair kids’ memory: USC researcher

7/29/2014, Seattle, WA. Research to be presented at the Annual Meeting of the Society for the Study of Ingestive Behavior (SSIB), the foremost society for research into all aspects of eating and drinking behavior, finds that daily consumption of beverages sweetened with high-fructose corn syrup or sucrose can impair the ability to learn and remember information, particularly when consumption occurs during adolescence. Both adult and adolescent rats were given daily access to sugar-sweetened beverages that mirror sugar concentrations found in common soft drinks. Adult rats that consumed the sugar-sweetened beverages for one month performed normally in tests of cognitive function; however, when consumption occurred during adolescence the rats were impaired in tests of learning and memory capability.

The lead author, Dr. Scott Kanoski from the University of Southern California, says, “It’s no secret that refined carbohydrates, particularly when consumed in soft drinks and other beverages, can lead to metabolic disturbances. However, our findings reveal that consuming sugar-sweetened drinks is also interfering with our brain’s ability to function normally and remember critical information about our environment, at least when consumed in excess before adulthood”. In addition to causing memory impairment, adolescent sugar-sweetened beverage consumption also produced inflammation in the hippocampus, an area of the brain that controls many learning and memory functions. “The hippocampus is such a critical brain region for memory function”, says Kanoski. “In many ways this region is a canary in the coal mine, as it is particularly sensitive to insult by various environmental factors, including eating foods that are high in saturated fat and processed sugar.”

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Why eating regular meals helps weight control: a new reason

7/29/2014, Seattle, WA. Our brain’s response to the sight of food appears to be driven more by how low our blood sugar level is at the moment than our upbringing or genetics, researchers said at the annual meeting of the Society for the Study of Ingestive Behavior. “The finding suggest our brains have a way to override our genetic inheritance, upbringing and habits to respond to our immediate nutritional needs,” said Dr. Ellen Schur, associate professor of medicine at the University of Washington.

In the study, Schur and UW Medicine colleagues at Harborview Medical Center, used brain scans to compare how appetite centers in the brains of identical twins responded to images of high- and low-calorie foods. The scans, called functional magnetic resonance imagers (fMRI), detect differences in the activity in different brain centers by measuring changes in blood flow

Studies of identical twins have shown that genetics and upbringing play a major role in a person’s body weight regulation. In this study, the researchers wanted to determine what role inherited similarities in brain function had on appetite. In the study, the researchers hypothesized that because identical twins have nearly identical genetic inheritance their brain appetite centers would react similarly when the twins were shown the images of high- and low-calorie foods. To test their hypothesis, the researchers enrolled 21 pairs of identical (monozygotic) twins who had been raised together. The twins were first fed a standardized breakfast, and 3.5 hours later they underwent a baseline fMRI brain scan.

After the first scan, they were fed a filling meal of macaroni and cheese, calibrated to satiate their appetites. The twins then had a second fMRI during which they were shown photographs of non-fattening foods, such as fruits and vegetables, and fattening foods, such as pizza and french fries.

Changes in blood flow measured by the fMRI were used to assess how the activity of key appetite-regulating centers in their brains changed in response to the images. Afterwards, the twins were offered to eat what they would like from a buffet. How much they ate from the buffet was recorded.

At regular intervals during the experiment the twins were asked to rate their feelings of hunger, fullness and satisfaction, using a standardized scale, and blood samples were taken to measure blood glucose levels and levels of regulatory hormones, such as insulin, leptin and ghrelin.

The researchers found the twin pairs gave similar responses when asked to rate their appetite before and after meals, had similar hormonal responses, and even ate similar amounts from the buffet — findings that suggest these responses were influenced by their shared upbringing and genetics. That did not seem to be the case with brain activation in response to the food images, however, when response tended to be greater in the twin with lower blood glucose levels.

The findings suggest that while genetics and upbringing play a big role in how much we weigh and how much we normally eat, our immediate response to food in the environment is driven by our bodies need for nutrition at the time, Schur said. “Just looking at pictures of high-calorie foods when we are hungry strongly engages parts of the brain that motivate us to eat.” The study’s findings might help explain why eating regular meals helps people keep their weight under control, she said.

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The Journal of Human Trafficking: Addressing A Global Human Rights Crisis

Routledge is proud to announce the upcoming launch of the Journal of Human Trafficking, a scholarly journal taking an interdisciplinary approach to a highly complex human rights issue. The Journal of Human Trafficking enters its first volume year in 2015 under Editor-in-Chief Rochelle L. Dalla, PhD of the University of Nebraska, Lincoln.

“Human trafficking” has come to represent more than just the transit of its victims, covering instead a wide range of abuses with ties to child welfare, migration, smuggling, prostitution, gender roles, alongside myriad aspects of globalization. As such, human trafficking research has grown incredibly diffuse, a barrier to progress that the Journal of Human Trafficking challenges by providing a centralized scholarly resource for the growing ranks of concerned parties. Topics of interest include (but are not limited to):

• pre-trafficking circumstances/conditions
• recruitment
• experiences of varied types of exploitation
• resistance
• re-integration
• research methods
• popular representations of human trafficking
• rehabilitation & care for victims
• prevention
• prosecution of traffickers
• public policy
• intervention & rescue

“The idea behind this was born out of the realization that there was a need for a journal that could serve as a central, international and interdisciplinary repository for the most up to date and comprehensive work, research, policy, and issues focused on human trafficking,” says Donna Sabella, PhD, RN, Director of Global Studies & the Office of Human Trafficking at Drexel University and an Associate Editor of the Journal of Human Trafficking. “Having such a resource is invaluable to those wanting to learn more, to those working in the field, and to those who have information to share.”

The Journal of Human Trafficking is seeking submissions from academics, researchers, and practitioners covering a wide variety of subject areas, such as anthropology, criminology, family studies, social work, sociology, international relations, law, medicine, psychology, gender studies, political science, and public policy, among others.
While the journal is research-focused, it carries the potential to open up much-needed lines of dialogue between academics and practitioners as a unified venue for perspectives on theory, applied research, and practical understanding.

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Here’s what the phone unlocking bill means, and how it affects our future

Early last year, it became illegal to unlock your handset for use on other carriers unless your provider directly gives you the permission to do so. Thanks to moves from the Senate and House this month, legislation to remove this restriction is just a presidential signature away from passing; it’s not a permanent solution, but at least it’s a step in the right direction for consumer freedom.

Many mobile operators in the United States add restrictions to every phone they sell. These “locks” prevent you from being able to use your phone on other networks. If you put an AT&T SIM inside a locked T-Mobile phone, the only phone calls you’ll be able to make will be to 911. This lock also applies to international carriers, so travelers will be hit with extensive roaming fees for data, text messages and phone calls.

The vast majority of US carriers have policies that, under specific conditions, will grant you a code to unlock your device. This usually only happens when you’re a long-term customer in good standing who has a valid reason for unlocking it (such as military service or lengthy international trips). Problem is, these operators are still in charge and they can decide whether or not they want to give you the code.

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Concussion symptoms overlap with neck injuries, making diagnosis a tough call

BUFFALO, N.Y. – Athletes and others reporting cognitive difficulties after a head injury are usually diagnosed as having had a concussion. But is it really a concussion? A new study published by University at Buffalo medical faculty finds that many of the same symptoms are common to concussions and to injuries to the neck and/or balance system, known collectively as cervical/vestibular injuries.

The research was based on responses about symptoms from 128 patients – some of whom were professional athletes – who were being treated at UB’s Concussion Management Clinic in the School of Medicine and Biomedical Sciences.

It was published online ahead of print last week in the Clinical Journal of Sport Medicine.

The purpose of the study was to determine how to distinguish between concussion injury and neck injury, based on symptoms.

“Based on our research, we conclude that some patients who have been told they’ve suffered a concussion, and whose symptoms persist for several months may actually have suffered a neck injury, rather than a concussion, or in addition to a concussion,” says John J. Leddy, MD, clinical professor in the UB Department of Orthopaedics and senior author.

He embarked on the study based on his experience as director of the UB Concussion Management Clinic.

“I’d seen enough patients in our clinic, some previously diagnosed with post-concussion syndrome, who continued to experience symptoms even after passing our treadmill test, which indicates full recovery from concussion,” says Leddy, who sees patients through UBMD, the physician practice plan of the UB medical school.

“The symptoms for both conditions are so nonspecific that it’s really hard to make a diagnosis based on them,” Leddy continues, “so we had to find another way to discriminate between them.”

To determine which of the respondents had probably sustained a concussion and which more likely had a neck injury, the UB researchers used the graded treadmill test developed by Leddy and co-author Barry Willer, PhD, UB professor of psychiatry.

“The treadmill test helps us make a first delineation between what I call physiologic concussion and other possible causes of cognitive symptoms,” says Leddy.

“Because a concussion is a brain injury, we thought that cognitive symptoms would be more likely associated with concussions,” he says. “Surprisingly, that didn’t turn out to be the case. People who have had neck injuries can also have problems with concentration and with memory. They feel like they’re in a fog, which is exactly what people report after concussion.”

Symptoms reported by both groups were headache, dizziness, blurred vision, poor concentration and memory deficits.

Patients in both groups filled out a detailed questionnaire concerning their symptoms. These responses were then correlated to their treadmill test results.

“Then we did some sophisticated statistical analysis,” says Leddy. “Even when we looked at the data in multiple ways, there was really no way to separate out the two groups based on their symptom patterns alone.”

Determining which condition a patient has experienced is critical, Leddy explains, because courses of treatment are very different.

“The treatment for a neck injury is actually to be more active, to do physical and vestibular therapy, to have a more active intervention, whereas after a concussion, exercise must begin slowly and incrementally after a period of rest,” he says.

Leddy notes that more research should be done on larger samples concerning concussion and neck injury.

In the meantime, he says, patients who think they’ve had a concussion and whose symptoms have not diminished after several months, should instead be examined for neck and vestibular injury by a sports medicine physician, a neurologist or a physiatrist, a specialist in rehabilitation medicine.

“I think a lot of practitioners listen to the symptoms and just chalk it up to concussion,” he adds, “but if they also examined the neck in these people, they might discover that a neck injury is involved and that’s a treatable problem.”

Physical symptoms specific to neck injuries include tenderness, neck spasms, reduced motion and reduced perception of where the head is in relation to the body, Leddy explains.

Co-authors with Leddy and Willer are John G. Baker, PhD, UB Department of Nuclear Medicine; Asim Merchant, MD and Jason Matuszak, MD, of the UB Department of Family Medicine; John Picano, an MD candidate at UB and Daniel Gaile, PhD, of the UB Department of Biostatistics.
- See more at: http://www.buffalo.edu/news/releases/2014/07/040.html#sthash.F3EA2Ksm.dpuf

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

Weekday heart attacks still getting quicker treatment at hospitals

(Reuters Health) – People who arrive at the hospital with a heart attack during business hours are more likely to survive than those who show up on weeknights, weekends or holidays, according to a new study.

Rates of death in the hospital are very low overall, at just over 4 percent, the researchers found. But some life-saving treatments can take longer to get to patients during off hours, which makes care less than optimal, they write.

It was actually surprising how similar quality of care seemed to be for working hours and after hours in the hospital, and even for balloon angioplasty, there was only a difference of 16 minutes, said study author Dr. Jorge F. Saucedo of the NorthShore University Health System in Evanston, Illinois.

In the most severe heart attacks, a blood vessel in the heart is completely blocked. Using a catheter to thread a balloon into the blocked artery can immediately restore blood flow.

In the new study, which included more than 50,000 severe heart attacks between 2007 and 2010 in the U.S., patients who arrived at the hospital during work hours took an average of 56 minutes to have angioplasty, the balloon procedure. For those who arrived on nights or weekends, the average wait time was 72 minutes.

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Informal Child Care Significantly Impacts Rural Economies, MU Study Finds

COLUMBIA, Mo. – The child care industry has grown significantly in recent years, contributing considerably to the national economy through job creation and increased opportunities for parents to work. However, little knowledge exists of the size and economic impact of child care, especially informal child care, on rural economies. Now, University of Missouri researchers have studied the child care sector in Kansas, particularly in rural areas, and have found that informal child care services create a large economic impact in the state.

Tom Johnson, a professor in the MU Truman School of Public Affairs, found that the informal child care industry created more than 128,000 jobs and added about $971.5 million in total value to the state of Kansas in 2005. Informal child care services include unlicensed facilities, unreported day care services run from homes, and child care performed for trade rather than money. Johnson says the scale of the informal child care industry reveals the importance of child care to the economy, particularly economies in rural areas.

“In general, child care is much more expensive in rural areas than in urban areas,” Johnson said. “This is because people in rural areas often have to travel long distances to find child care services. Add the cost of travel to the potential wages many parents do not earn because they spend so much time travelling to and from child care facilities, and the total cost creates a large impediment to working parents.”

Johnson says that due to these high costs of child care in rural areas, policymakers would be advised to facilitate increased access to child care services in rural areas.

“Increased access to child care in rural areas, whether it is informal services or formal services from licensed providers, has the potential to create a large, positive impact on rural economies,” Johnson said. “Parents with affordable child care will have more opportunities to work, generating more income for families and creating a more diverse economy.”

Johnson says that rural economies do not exist in a vacuum, and anything that is positive for rural economies should be reflected back to urban economies in a positive manner as well.

Johnson also is the Frank Miller Professor of Agricultural and Applied Economics in the MU College of Agriculture, Food, and Natural Resources. This study was co-authored by Eun-Young Choi, a former doctoral student at MU, and will be published in the Journal of Regional Analysis and Policy.

Posted in Pediatric Health: Day Care | Leave a comment

Non-endoscopic migraine surgery provides significant symptom relief

A revised version of a surgical procedure to treat severe chronic migraine headaches led to significant symptom relief more than 90 percent of the time in patients treated at Massachusetts General Hospital (MGH).  Physicians from the MGH Division of Plastic and Reconstructive Surgery report that more than half of 35 patients treated with the non-endoscopic procedure – all of whom had headaches associated with compression of craniofacial nerves – reported complete symptom relief a year later.  The team’s paper has received advance online publication in the journal Plastic and Reconstructive Surgery.

“We confirmed that surgery through standard incisions used for cosmetic procedures can be very effective in treating some of the most severe cases of chronic migraine,” says William G. (Jay) Austen, Jr., MD, chief of Plastic and Reconstructive Surgery at MGH, who led the study.  “While the earlier version of this procedure used an endoscope, not every patient is a candidate for endoscopic surgery, and not every surgeon has access to or experience with the equipment.  We hope that this may increase the availability of this treatment.

Surgical treatment of migraine headaches was developed by Cleveland plastic surgeon Bahman Guyuron, MD, who had observed that some patients receiving cosmetic procedures of the forehead also had relief of migraine symptoms.  Several studies by Guyuron and other investigators have supported the hypothesis that compression of the trigeminal and other craniofacial nerves can be an important trigger for migraine symptoms in some patients.  The temporary symptom relief some patients experience through injections of botulinum toxin (Botox), which would release pressure from overactive muscles, further supports the theory.

Although Guyuron’s original version of this procedure almost always used an endoscope to access and remove muscles contracting around specific nerves, the MGH team and other investigators have focused on developing ways to access migraine trigger points – specific sites of nerve compression that differ from patient to patient – through open incisions used in several cosmetic procedures.

Patients included in the current study all had chronic migraines that had been confirmed by a full neurological exam and had not responded to standard medical therapies.  Previous symptom relief from treatment with Botox or nerve blocks, which would support a role for nerve compression, was required for inclusion in the study. Trigger points were identified based on patients’ symptoms and histories, including response to previous procedures; and surgery was performed to free those sites from compressing muscles, connective tissue, blood vessels or bony structures.

The study analyzed a total of 43 procedures performed on 35 patients. Of those procedures, 90.1 percent resulted in symptom resolution – defined as a greater than 50 percent improvement in the frequency, duration and severity of migraine pain.  Complete elimination of migraine symptoms was produced by 51.3 percent of successful procedures; 28.2 percent resulted in a greater than 80 percent improvement, and 20.5 percent produced a 50 to 80 percent improvement.

Austen stresses that selecting the appropriate patients for this procedure – including preliminary evaluations by a neurologist specializing in migraines – is essential.  “We’re still at the early stages of developing this concept and are now conducting a prospective study to find better ways of evaluating which patients we can help.  We need to develop more evidence that this approach will be successful in the hands of surgeons at many different centers.  No one is claiming that this is a cure for migraines, but the results of our study and others clearly indicate that this procedure can make a big difference in the lives of the right patients.”

Austen is an associate professor of Surgery at Harvard Medical School. Co-authors of the paper are Lisa Gfrerer, MD, lead author; Daniel Maman, MD, and Oren Tessler, MD, all of the MGH Division of Plastic and Reconstructive Surgery. The manuscript version of the report is currently available here.

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Posted in Headaches: Migraines | Leave a comment