Defensive medicine practiced by vast majority of neurosurgeons

January 30, 2015 – More than three-fourths US neurosurgeons practice some form of defensive medicine–performing additional tests and procedures out of fear of malpractice lawsuits, reports a special article in the February issue of Neurosurgery, official journal of the Congress of Neurological Surgeons.


The rates and costs of defensive medicine by neurosurgeons are especially high in states with high-risk liability environments. “Although ordering extra laboratory tests, imaging studies, etc. was prevalent everywhere, it was even more so in high-risk states,” according to the survey study by Dr. Timothy R. Smith of Northwestern University, Chicago, and colleagues.

Most Neurosurgeons Report Defensive Medicine…

Dr. Smith and colleagues sent a questionnaire regarding defensive medicine to 3,344 Board-certified neurosurgeons. Defensive medicine refers to making medical decisions based on concerns over possible malpractice lawsuits, rather than any expected benefit to the patient. The study assessed the relationship between defensive medicine practice and an objective measure of the “liability risk environment” of the neurosurgeon’s state.

The survey response rate was 31 percent, with 1,026 neurosurgeons responding. Those practicing in states with high-risk liability environments were more likely to respond. Most neurosurgeons correctly perceived their state’s level of liability risk.

Based on the survey responses, “The vast majority of US neurosurgeons participate in some form of defensive medicine,” Dr. Smith and colleagues write. More than 80 percent of surgeons said they had ordered imaging tests solely for defensive reasons, while more than three-fourths reported ordering laboratory tests and making extra referrals for defensive purposes. Up to half said they ordered more medications and procedures out of fear of being sued.

Rates of all of these defensive behaviors were higher for neurosurgeons in high-risk states. This included a 30 percent increase in the likelihood of ordering additional imaging studies for defensive purposes, 40 percent for additional laboratory tests.

…Even More So in States with High Risk of Liability

Nearly half of neurosurgeons in high-risk states said they had stopped performing high-risk procedures because of liability concerns. Nearly one-fourth had stopped performing brain surgery for fear of being sued, while close to 40 percent were considering retirement because of the local liability environment.

Overall, the rate of defensive medicine behaviors increased by 50 percent at each grade of the five-point risk scale. Thus, a neurosurgeon practicing in a state at highest risk of liability would be six times more likely to practice defensive medicine than one in a state at lowest risk.

Neurosurgeons in high-risk states paid almost twice as much in malpractice insurance premiums as those in low-risk states. Across states, most neurosurgeons believed their malpractice coverage was inadequate. Malpractice premiums cost 15 to 20 percent of the neurosurgeons’ annual income.

Neurosurgery–like obstetrics/gynecology and orthopedic surgery–is a specialty with a high risk of costly malpractice claims. Amid ongoing debate over defensive medicine, few studies have focused on the extent of defensive medicine practice among neurosurgeons.

The new survey suggests high rates of defensive medicine practice among neurosurgeons, and finds that these behaviors are related to perceived and actual liability risk by state. “Defensive medicine practices do not align with patient-centered care, and may contribute to increased inefficiency in an already taxed health care system,” Dr. Smith and coauthors conclude.

Click here to read “Defensive Medicine in Neurosurgery: Does State-Level Liability Risk Matter?”

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Article: “Defensive Medicine in Neurosurgery: Does State-Level Liability Risk Matter?” (doi: 10.1227/NEU.0000000000000576) Source

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Posted in Health Care: Ethics, Health Care: Medical Errors | Leave a comment

Sugar-sweetened beverage consumption and age at menarche in a prospective study of US girls

Hum Reprod. 2015 Jan 27. pii: deu349. [Epub ahead of print]

Sugar-sweetened beverage consumption and age at menarche in a prospective study of US girls.

Carwile JL1, Willett WC2, Spiegelman D3, Hertzmark E4, Rich-Edwards J5, Frazier AL6, Michels KB7.


Author information

1Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.

2Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA.

3Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA.

4Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA.

5Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, MA 02115, USA.

6Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA Department of Pediatric Oncology, Dana-Farber/Children’s Hospital Cancer Center, Boston, MA 02115, USA.

7Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA kmichels@research.bwh.harvard.edu.

Abstract

STUDY QUESTION:

Is sugar-sweetened beverage (SSB) consumption associated with age at menarche?

SUMMARY ANSWER:

More frequent SSB consumption was associated with earlier menarche in a population of US girls.

WHAT IS KNOWN ALREADY:

SSB consumption is associated with metabolic changes that could potentially impact menarcheal timing, but direct associations with age at menarche have yet to be investigated.

STUDY DESIGN, SIZE, DURATION:

The Growing up Today Study, a prospective cohort study of 16 875 children of Nurses’ Health Study II participants residing in all 50 US states. This analysis followed 5583 girls, aged 9-14 years and premenarcheal at baseline, between 1996 and 2001. During 10 555 person-years of follow-up, 94% (n = 5227) of girls reported their age at menarche, and 3% (n = 159) remained premenarcheal in 2001; 4% (n = 197) of eligible girls were censored, primarily for missing age at menarche.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Cumulative updated SSB consumption (composed of non-carbonated fruit drinks, sugar-sweetened soda and iced tea) was calculated using annual Youth/Adolescent Food Frequency Questionnaires from 1996 to 1998. Age at menarche was self-reported annually. The association between SSB consumption and age at menarche was assessed using Cox proportional hazards regression.

MAIN RESULTS AND THE ROLE OF CHANCE:

More frequent SSB consumption predicted earlier menarche. At any given age between 9 and 18.5 years, premenarcheal girls who reported consuming >1.5 servings of SSBs per day were, on average, 24% more likely [95% confidence interval (CI): 13, 36%; P-trend: <0.001] to attain menarche in the next month relative to girls consuming ≤2 servings of SSBs weekly, adjusting for potential confounders including height, but not BMI (considered an intermediate). Correspondingly, girls consuming >1.5 SSBs daily had an estimated 2.7-month earlier menarche (95% CI: -4.1, -1.3 months) relative to those consuming ≤2 SSBs weekly. The frequency of non-carbonated fruit drink (P-trend: 0.03) and sugar-sweetened soda (P-trend: 0.001), but not iced tea (P-trend: 0.49), consumption also predicted earlier menarche. The effect of SSB consumption on age at menarche was observed in every tertile of baseline BMI. Diet soda and fruit juice consumption were not associated with age at menarche.

LIMITATIONS, REASONS FOR CAUTION:

Although we adjusted for a variety of suspected confounders, residual confounding is possible. We did not measure SSB consumption during early childhood, which may be an important window of exposure.

WIDER IMPLICATIONS OF THE FINDINGS:

More frequent SSB consumption may predict earlier menarche through mechanisms other than increased BMI. Our findings provide further support for public health efforts to reduce SSB consumption.

STUDY FUNDING/COMPETING INTERESTS:

The Growing up Today Study is supported by grant R03 CA 106238. J.L.C. was supported by the Breast Cancer Research Foundation; Training Grant T32ES007069 in Environmental Epidemiology from the National Institute of Environmental Health Sciences, National Institutes of Health; and Training Grant T32HD060454 in Reproductive, Perinatal and Pediatric Epidemiology from the National Institute of Child Health and Human Development, National Institutes of Health. A.L.F. is supported by the American Cancer Society, Research Scholar Grant in Cancer Control. K.B.M. was supported in part by the National Cancer Institute at the National Institutes of Health (Public Health Service grants R01CA158313 and R03CA170952). There are no conflicts of interest to declare.

Source

Posted in Menstruation, Metabolism, Nutrition: Food: Artificial Sweeteners, Nutrition: Food: Soft Drinks, Nutrition: Food: Sugar, Nutrition: Fructose, Obesity | Leave a comment

Parkinson’s gene linked to lung cancer

Researchers at the Medical College of Wisconsin (MCW), in collaboration with other colleagues of the Genetic Epidemiology of Lung Cancer Consortium (GELCC), have identified a gene that is associated with lung cancer.

The findings are published in American Journal of Human Genetics. Through whole exome sequencing, researchers identified a link between a mutation in PARK2, a gene associated with early-onset Parkinson’s disease, and familial lung cancer.

The researchers sequenced the exomes (protein coding region of the genome) of individuals from a family with multiple cases of lung cancer. They then studied the PARK2 gene in additional families affected by lung cancer.

“While this specific mutation is very rare in the general population, there was a significant association between the PARK2 mutation we studied and the families with multiple cases of lung cancer,” said Donghai Xiong, PhD, assistant professor of pharmacology and toxicology at MCW and the lead author on the paper.

“These results implicate this specific mutation as a genetic susceptibility factor for lung cancer, and provide an additional rationale for further investigations of this gene and this mutation for evaluation of the possibility of developing targeted therapies against lung cancer in individuals with PARK2 variants,” added Ming You, MD, PhD, the Joseph F. Heil Jr. Professor of Oncogenesis at MCW and Director of the MCW Cancer Center. Source

Posted in Cancer: Lung, Genetics, Parkinson's | Tagged | Leave a comment

Heavy drinking in middle-age may increase stroke risk more than traditional factors

Drinking more than two alcoholic beverages daily in middle-age may raise your stroke risk more than traditional factors such as high blood pressure and diabetes, according to new research in the American Heart Association journal Stroke.

In a study of 11,644 middle-aged Swedish twins who were followed for 43 years, researchers compared the effects of an average of more than two drinks daily (“heavy drinking”) to less than half a drink daily (“light drinking”).

The study showed that:

  • Heavy drinkers had about a 34 percent higher risk of stroke compared to light drinkers.
  • Mid-life heavy drinkers (in their 50s and 60s) were likely to have a stroke five years earlier in life irrespective of genetic and early-life factors.
  • Heavy drinkers had increased stroke risk in their mid-life compared to well-known risk factors like high blood pressure and diabetes.
  • At around age 75, blood pressure and diabetes appeared to take over as one of the main influences on having a stroke.

Past studies have shown that alcohol affects stroke risk, but this is the first study to pinpoint differences with age.

“We now have a clearer picture about these risk factors, how they change with age and how the influence of drinking alcohol shifts as we get older,” said Pavla Kadlecová, M.Sc., a statistician at St. Anne’s University Hospital’s International Clinical Research Center in the Czech Republic.

Researchers analyzed results from the Swedish Twin Registry of same-sex twins who answered questionnaires in 1967-70. All twins were under age 60 at the start. By 2010, the registry yielded 43 years of follow-up, including hospital discharge and cause of death data.

Researchers then sorted the data based on stroke, high blood pressure, diabetes and other cardiovascular incidences.

Almost 30 percent of participants had a stroke. They were categorized as light, moderate, heavy or non-drinkers based on the questionnaires. Researchers compared the risk from alcohol and health risks like high blood pressure, diabetes and smoking.

Among identical twin pairs, siblings who had a stroke drank more than their siblings who hadn’t had a stroke, suggesting that mid-life drinking raises stroke risks regardless of genetics and early lifestyle.

The study is consistent with the American Heart Association’s recommended limit of two drinks a day for men and one for women. That’s about 8 ounces of wine (two drinks) for a man and 4 ounces (one drink) for a woman.

Regular heavy drinking of any kind of alcohol can raise blood pressure and cause heart failure or irregular heartbeats over time with repeated drinking, in addition to stroke and other risks.

“For mid-aged adults, avoiding more than two drinks a day could be a way to prevent stroke in later productive age (about 60s),” Kadlecová said.

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Co-authors are Ross Andel, Ph.D.; Robert Mikulik, Ph.D.; Elizabeth Handing, B.A. and Nancy Pedersen, Ph.D. Author disclosures are on the manuscript.

The European Regional Development Fund supported the study.

Source

Posted in Alcohol, Stroke | Leave a comment

The top 5 reasons you need fat in your diet

Newswise — IFT Past President Roger Clemens, DrPh, CFS, explains why it’s important to incorporate fats in our diets in this IFT Food Facts video. Dr. Clemens emphasizes needing a balance of fats and exercise to help our body function at its highest level and reduce the risk of diseases such as cardiovascular disease.

1. Energy: Fat provides a highly-concentrated form of energy. One gram of fat gives you nine calories of energy, which is over twice that provided by carbohydrates or protein.
2. Organs Need a Cushion: A cushion of fat helps protect organs from injury and holds them in place.
3. Cell Structure: Whether it is hair, skin or your eyes, fats make up part of the membrane that surrounds each cell of the body and without them the rest of the cell can’t function.
4. Immune Function: Without good fats in our diet, immune function becomes partially impaired and our bodies are susceptible to foreign invaders such as bacterial and viral infections.
5. Nutrient Transport: Vitamin A, D, E and K are fat soluble vitamins and need fat to help the body transport, store, and absorb them.

Source: Roger Clemens, DrPh, CFS

About IFT
Founded in 1939, the Institute of Food Technologists is committed to advancing the science of food. Our non-profit scientific society—more than 17,000 members from more than 95 countries—brings together food scientists, technologists and related professionals from academia, government, and industry. For more information, please visit ift.org.

Posted in Nutrition: Fat | 2 Comments

After heart attacks, most don’t get enough statins

(Reuters Health) – In the U.S., less than a third of older heart “event” patients being discharged from the hospital get the recommended high-intensity statins, according to a new study that looked at prescriptions filled.

National guidelines from the American College of Cardiology and American Heart Association say the majority of patients should be on a high-dose statin following a serious heart disease-related event like heart attack or bypass surgery.

“It appears that there’s tremendous reticence in prescription of statin therapy,” said lead author Dr. Robert S. Rosenson of the Icahn School of Medicine at Mount Sinai in New York.

“Whatever the dose of statin people were taking when they came to the hospital was the dose they went out on, the acute event didn’t change it,” he told Reuters Health. “This is very disappointing.”

The authors studied a random sample of Medicare beneficiaries ages 65 to 74 who filled a statin prescription after having a heart attack or bypass surgery between 2007 and 2009.

Of more than 8,000 people who filled a statin prescription after one of these events, only 27 percent of the first post-discharge prescriptions were for “high-intensity” statins, such as 40 to 80 milligrams of atorvastatin (Lipitor) or 80 milligrams of simvastatin (Zocor). More

 

 

Posted in Heart Disease: Heart Attack, Statins | 2 Comments

Telomere-lengthening procedure turns clock back years in human cells

Researchers at the Stanford University School of Medicine have developed a new procedure to increase the length of human telomeres. This increases the number of times cells are able to divide, essentially making the cells many years younger. This not only has useful applications for laboratory work, but may point the way to treating various age-related disorders – or even muscular dystrophy.

Telomeres are the caps at the ends of our chromosomes that protect the DNA code of the genome. Linked to aging and disease, they are 8,000 to 10,000 nucleotides long in young people, but this decreases as we age (a nucleotide is an organic molecule that is a subunit of nucleic acids DNA and RNA). The researchers have found a way to lengthen a telomere by 1,000 nucleotides, which Dr. Helen Brau, professor of microbiology and immunology at Stanford, says is the equivalent of “many years of human life.”

Telomeres shorten each time a cell divides and at a certain point, when they reach a critical length, the cell can no longer divide and will die. Their limited lifespan means that growing cells in laboratories can be tricky, given there can only be so many cell doublings before they give up the ghost.

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Because added fructose is a principal driver of type 2 diabetes, guidelines need to be challenged

Rochester, MN, January 29, 2015 – Recent studies have shown that added sugars, particularly those containing fructose, are a principal driver of diabetes and pre-diabetes, even more so than other carbohydrates. Clinical experts writing in Mayo Clinic Proceedings challenge current dietary guidelines that allow up to 25% of total daily calories as added sugars, and propose drastic reductions in the amount of added sugar, and especially added fructose, people consume.

Worldwide, approximately one in ten adults has type 2 diabetes, with the number of individuals afflicted by the disease across the globe more than doubling from 153 million in 1980 to 347 million in 2008. In the United States, 29 million adults (one in eleven) have type 2 diabetes and another 86 million (more than one in three) have pre-diabetes.

“At current levels, added-sugar consumption, and added-fructose consumption in particular, are fueling a worsening epidemic of type 2 diabetes,” said lead author James J. DiNicolantonio, PharmD, a cardiovascular research scientist at Saint Luke’s Mid America Heart Institute, Kansas City, MO. “Approximately 40% of U.S. adults already have some degree of insulin resistance with projections that nearly the same percentage will eventually develop frank diabetes.”

The net result of excess consumption of added fructose is derangement of both overall metabolism and global insulin resistance say the authors. Other dietary sugars not containing fructose seem to be less detrimental in these respects. Indeed, several clinical trials have shown that compared to glucose or starch, isocaloric exchange with fructose or sucrose leads to increases in fasting insulin, fasting glucose, and the insulin/glucose responses to a sucrose load. “This suggests that sucrose (in particular the fructose component) is more harmful compared to other carbohydrates,” added Dr. DiNicolantonio. Dr. DiNicolantonio and his co-authors, James H O’Keefe, MD, Saint Luke’s Mid America Heart Institute, Kansas City, MO, and Sean C. Lucan, MD, MPH, MS, a family physician at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, examined animal experiments and human studies to come to their conclusions.

Data from recent trials suggest that replacing glucose-only starch with fructose-containing table sugar (sucrose) results in significant adverse metabolic effects. Adverse effects are broader with increasing baseline insulin resistance and more profound with greater proportions of added fructose in the diet.

The totality of the evidence is compelling to suggest that added sugar, and especially added fructose (usually in the form of high-fructose corn syrup and table sugar), are a serious and growing public health problem, according to the authors.

The 2010 Dietary Guidelines for Americans say it is acceptable for some people to consume up to 19% of calories from added sugars, and the Institute of Medicine permits up to 25% of total calories from added sugars. In contrast, the World Health Organization recommends that added sugars should make up no more than 10% of an entire day’s caloric intake, with a proposal to lower this level to 5% or less for optimal health. Such levels would be more in line with what the authors would recommend and similarly restrictive to existing American Heart Association (AHA) recommendations–to consume no more than six teaspoons (24 grams) of sugar per day for women and no more than nine teaspoons (36 grams) of sugar per day for men.

While fructose is found naturally in some whole foods like fruits and vegetables, consuming these foods poses no problem for human health. Indeed, consuming fruits and vegetables is likely protective against diabetes and broader cardiometabolic dysfunction, explained DiNicolantonio and colleagues. The authors propose that dietary guidelines should be modified to encourage individuals to replace processed foods, laden with added sugars and fructose, with whole foods like fruits and vegetables. “Most existing guidelines fall short of this mark at the potential cost of worsening rates of diabetes and related cardiovascular and other consequences,” they wrote.

The authors also think there should be incentives for industry to add less sugars, especially fructose-containing varieties, to food-and-beverage products. And they conclude that at “an individual level, limiting consumption of foods and beverages that contain added sugars, particularly added fructose, may be one of the single most effective strategies for ensuring one’s robust future health.” Source

Posted in Diabetes, Nutrition: Food: Sugar, Nutrition: Fructose, Obesity | Leave a comment

Global warming won’t mean more stormy weather: Toronto study

TORONTO, ON – A study led by atmospheric physicists at the University of Toronto finds that global warming will not lead to an overall increasingly stormy atmosphere, a topic debated by scientists for decades. Instead, strong storms will become stronger while weak storms become weaker, and the cumulative result of the number of storms will remain unchanged.

“We know that with global warming we’ll get more evaporation of the oceans,” said Frederic Laliberte, a research associate at U of T’s physics department and lead author of a study published this week in Science. “But circulation in the atmosphere is like a heat engine that requires fuel to do work, just like any combustion engine or a convection engine.”

The atmosphere’s work as a heat engine occurs when an air mass near the surface takes up water through evaporation as it is warmed by the Sun and moves closer to the Equator. The warmer the air mass is, the more water it takes up. As it reaches the Equator, it begins to ascend through the atmosphere, eventually cooling as it radiates heat out into space. Cool air can hold less moisture than warm air, so as the air cools, condensation occurs, which releases heat. When enough heat is released, air begins to rise even further, pulling more air behind it producing a thunderstorm. The ultimate “output” of this atmospheric engine is the amount of heat and moisture that is redistributed between the Equator and the North and South Poles.

“By viewing the atmospheric circulation as a heat engine, we were able to rely on the laws of thermodynamics to analyze how the circulation would change in a simulation of global warming,” said Laliberte. “We used these laws to quantify how the increase in water vapour that would result from global warming would influence the strength of the atmospheric circulation.”

The researchers borrowed techniques from oceanography and looked at observations and climate simulations. Their approach allowed them to test global warming scenarios and measure the output of atmospheric circulation under warming conditions.

“We came up with an improved technique to comprehensively describe how air masses change as they move from the Equator to the poles and back, which let us put a number on the energy efficiency of the atmospheric heat engine and measure its output,” said Laliberte.

The scientists concluded that the increase in water vapour was making the process less efficient by evaporating water into air that is not already saturated with water vapour. They showed that this inefficiency limited the strengthening of atmospheric circulation, though not in a uniform manner. Air masses that are able to reach the top of the atmosphere are strengthened, while those that can not are weakened.

“Put more simply, powerful storms are strengthened at the expense of weaker storms,” said Laliberte. “We believe atmospheric circulation will adapt to this less efficient form of heat transfer and we will see either fewer storms overall or at least a weakening of the most common, weaker storms.”

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The findings are reported in the paper “Constrained work output of the moist atmospheric heat engine in a warming climate” published January 30 in Science. The work was supported by grants from the Natural Sciences and Engineering Research Council of Canada. Source

Posted in Environmental Health: Climate | Leave a comment

Landmark study to track ‘pioneer’ generation of transgender children

Marlo Mack’s son was 3 years old when he told her very adamantly that he was not a boy, but a girl.

Unsure what to do, Mack went in search of answers. She found little information online, her pediatrician knew nothing about transgender children, and even a psychologist who specialized in child identity issues couldn’t answer her questions. Mack quickly learned there was almost no research that could help her determine whether to allow her son to live as a girl, or tell her what might happen if she did.

“It’s like stepping into the abyss,” said Mack, who uses a pseudonym to protect her child’s identity. “There are almost no resources out there.”

A new study by Kristina Olson, a University of Washington assistant professor of psychology, aims to provide insight that could help parents like Mack. The study’s initial results, which are being published soon in Psychological Science, involved 32 transgender children ages 5 to 12 from around the U.S. who are living as their identified gender in all aspects of their lives and in supportive environments.

The paper, believed to be the first ever to focus on this group of children, is intended to launch the first large-scale, nationwide, longitudinal study of transgender children in the United States. Its co-authors are Nicholas Eaton at Stony Brook University and Aidan Key of Gender Diversity, a Seattle organization that provides training and runs support groups for families of gender-nonconforming children.

The research is part of the broader TransYouth Project, an initiative based out of the UW’s Social Cognitive Development Lab that seeks to engage collaborators nationwide to better understand gender development in gender-nonconforming youth. Mack’s child is participating in the research, and Olson ultimately hopes to recruit more than 100 children; families can sign up through the project’s website.

Olson embarked on the project a year ago, partly out of her interest in how children think about social groups, but also because she’d witnessed the challenges of a close friend with a transgender child.

“Seeing how little scientific information there was, basically nothing for parents, was hard to watch,” Olson said. “Doctors were saying, ‘We just don’t know,’ so the parents have to make these really big decisions: Should I let my kid go to school as a girl, or should I make my kid go to school as a boy? Should he be in therapy to try to change what he says he is, or should he be supported?”

Olson’s study sought to determine how deeply held a participant’s gender identity was, or whether transgender children were, as others have suggested, confused or simply pretending to be the opposite gender. The research combined the children’s own self-reporting about gender with tests that assessed the speed at which they associated with various concepts of male and female.

The study found that participants’ responses were indistinguishable from those of two control groups, suggesting that “this identity is a deeply held one.”

The findings are likely to be controversial. The notion that prepubescent children can be legitimately transgender has been met with skepticism in the public realm. And some experts believe the best approach for gender-variant children is not to allow them to live as the “opposite” gender, but to instead try to help them be comfortable with their biological gender.

But growing numbers of doctors, parents and mental health professionals are advocating that children be permitted to live as their identified gender. The attitude shift is motivated at least in part by the often tragic outcomes for transgender people. Forty-one percent of transgender people attempt suicide, compared with 4.6 percent among the general population, and transgender adults face staggeringly high rates of unemployment, poverty, discrimination and homelessness.

The risks to transgender children were driven starkly home by the Dec. 28 death of Ohio transgender teen Leelah Alcorn. The 17-year-old committed suicide after posting an online letter saying her conservative Christian parents isolated her and refused to allow her to transition from male to female.

Key, who helped to develop questions and assisted with recruitment for Olson’s study, said he’s met parents of transgender children as young as 5 years old who have significant anxiety and depression, even suicidal impulses.

“Families are searching for information,” he said. “Nobody wants a child to say, ‘I wish I were dead’ when they’re 6 years old.”

Key said previous research and treatment have been hampered by a fear that allowing children to transition to their expressed gender will track them into becoming transgender adults. Rather than forcing children to live as their assigned gender, Key said, allowing simple measures such as using a different name or altering their hair makes them feel validated and supported.

“Then if that child were to change their mind, they would just change back,” he said.

Key expects Olson’s research will affirm what parents he works with have discovered — that embracing their children’s identities leads to happier, healthier young adults.

“The evidence is there in the lives of their children,” he said. “The research is struggling to catch up. That’s why Kristina’s work is so powerful.”

Olson hopes to follow the children in her initial study into adulthood to observe how the support they have received influences their development and whether it translates into more positive outcomes than in today’s transgender adults.

“We have absolutely no idea what their lives will look like, because there are very few transgender adults today who lived as young kids expressing their gender identity,” Olson said. “That’s all the more reason why this particular generation is important to study. They’re the pioneers.”

Mack started a podcast, How to Be a Girl, and a blog to chronicle her experiences with her daughter and share information with other parents. She hopes Olson’s work will ultimately help parents like her determine how likely their children are to remain fixed in their gender identities.

“That’s the 64-million-dollar question,” she said. “That’s what everybody wants to know.”

Source

 

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

The common pesticide that may increase ADHD risk

A commonly used pesticide may alter the development of the brain’s dopamine system — responsible for emotional expression and cognitive function – and increase the risk of attention deficit hyperactivity disorder in children, according to a new Rutgers study.


The research published Wednesday in the Journal of the Federation of American Societies for Experimental Biology (FASEB), by Rutgers scientists and colleagues from Emory University, the University of Rochester Medical Center, and Wake Forest University discovered that mice exposed to the pyrethroid pesticide deltamethrin in utero and through lactation exhibited several features of ADHD, including dysfunctional dopamine signaling in the brain, hyperactivity, working memory, attention deficits and impulsive-like behavior.

These findings provide strong evidence, using data from animal models and humans, that exposure to pyrethroid pesticides, including deltamethrin, may be a risk factor for ADHD, says lead author Jason Richardson, associate professor in the Department and Environmental and Occupational Medicine at Rutgers Robert Wood Johnson Medical School and a member of the Environmental and Occupational Health Sciences Institute (EOHSI).

“Although we can’t change genetic susceptibility to ADHD, there may be modifiable environmental factors, including exposures to pesticides that we should be examining in more detail,” says Richardson.

Attention deficit hyperactivity disorder most often affects children, with an estimated 11 percent of children between the ages of 4-17- about 6.4 million – diagnosed as of 2011. Boys are three to four times more likely to be diagnosed than girls. While early symptoms, including an inability to sit still, pay attention and follow directions, begin between the ages of 3 to 6, diagnosis is usually made after the child starts attending school full time.

Importantly, in this study, the male mice were affected more than the female mice, similar to what is observed in children with ADHD. The ADHD-like behaviors persisted in the mice through adulthood, even though the pesticide, considered to be less toxic and used on golf courses, in the home, and on gardens, lawns and vegetable crops, was no longer detected in their system.

There is strong scientific evidence that genetics plays a role in susceptibility to the disorder, but no specific gene has been found that causes ADHD and scientists believe that environmental factors may also contribute to the development of the behavioral condition.

Using data from the Centers for Disease Control, National Health and Nutrition Examination Survey (NHANES) the study analyzed health care questionnaires and urine samples of 2,123 children and adolescents. Researchers asked parents whether a physician had ever diagnosed their child with ADHD and cross-referenced each child’s prescription drug history to determine if any of the most common ADHD medications had been prescribed. Children with higher pyrethroid pesticide metabolite levels in their urine were more than twice as likely to be diagnosed with ADHD.

Young children and pregnant women may be more susceptible to pesticide exposure because their bodies do not metabolize the chemicals as quickly. This is why, Richardson says, human studies need to be conducted to determine how exposure affects the developing fetus and young children.

“We need to make sure these pesticides are being used correctly and not unduly expose those who may be at a higher risk,” Richardson says. Source

Posted in ADHD, Environmental Health: Pesticides | Tagged | Leave a comment

Edmonton may build an ice-skating highway through town

Considering most rinks are circular, ice skating doesn’t seem like an especially good way to actually get somewhere other than where you started. But if a young Canadian gets his way, that could change.


He’s suggested building something he calls the Freezeway, a 6.8-mile skating lane through Edmonton, Alberta, for residents and tourists who want to commute on ice. You may laugh, but Matt Gibbs has given this a lot of thought—he first proposed the idea two years ago in his masters thesis in landscape architecture at the University of British Columbia in Vancouver.

For his thesis, Gibbs focused on ways “to make winter cities more livable, in particular how can we diversify transportation options, focus on active transportation, as well as social activity.”

The idea for the Freezeway was prompted in part when he found a comment by Tooker Gomberg, who, as a city councillor in the 1990s suggested the city crack open the fire hydrants, let the water freeze, and watch residents skate around town. Gibbs’ riff on the idea (which he found “delightful”) is more refined, and presented in a way that seems like something that could actually happen. More

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Why is IBM planning to sequence the microbiomes of food ingredients to prevent outbreaks earlier?

Our food system is by no means bulletproof when it comes to pathogens. In just the past year, the United States saw major outbreaks of listeria in caramel apples and salmonella in nut butters, and the Centers for Disease Control and Prevention (CDC) estimates that 48 million Americans suffer from some kind of food-borne diseases annually.


Meanwhile, food-borne illness results in $9 billion in medical costs and another $75 billion in contaminated food that’s recalled and tossed out every year. Regulatory agencies have acknowledged that more needs to be done.

One strategy comes from IBM, which announced on Thursday that it’s partnering with Mars on a project called the Sequencing the Food Supply Chain Consortium. Their goal, which will likely take at least three years to accomplish, is to sequence the makeup of various foods and then enter that information into a database. The thinking is that if they can establish, at the molecular level, what a given ingredient is supposed to look like, systems can be put into place to catch brewing problems before contaminated foods make it to your table.

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Posted in Microbiome, Nutrition: Food Safety | 1 Comment