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University of Amsterdam study: MRI scans show how ADHD medication affects brain structure in children

19 Aug

The National Institute of Mental Health defined ADHD:

Attention-Deficit/Hyperactivity Disorder
Overview
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
• Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
• Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
• Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Signs and Symptoms
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
In preschool, the most common ADHD symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:
• are more severe
• occur more often
• interfere with or reduce the quality of how they functions socially, at school, or in a job…. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Resources:

What Is Attention Deficit Hyperactivity Disorder?                                         https://wb.md/2NvF1Dx

Attention-Deficit/Hyperactivity Disorder https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml#part_145450

What Is ADHD?                                                                                   https://www.psychiatry.org/patients-families/adhd/what-is-adhd

What is ADHD? https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/ADHD_A_Guide_for_Families/What_is_ADHD.aspx

Lois Zoppi, BA Reviewed by Kate Anderton, B.Sc. (Editor) reported in the Medical Life Sciences News article, MRI scans show how ADHD medication affects brain structure in children:

Attention deficit/hyperactivity disorder (ADHD) affects an increasing number of people worldwide, with an estimated 6.1 million children were living with ADHD in 2016, according to the National Survey of Children’s Health.
Now, MRI scans have revealed that children taking the common medication methylphenidate experience alterations in the distribution of white matter in the brain. This has led to the researchers warning doctors not to over-prescribe the medication and only use it when it is absolutely necessary, as the long-term effects of the medication are not yet known.
Methylphenidate is a stimulant medication commonly prescribed for ADHD and works by blocking norepinephrine and dopamine transporters. Deficits in the prefrontal cortex are associated with ADHD symptoms, and increased dopamine and norepinephrine levels in the prefrontal cortex may have beneficial effects on the condition.
White matter is tissue found in the deepest part of the brain and facilitates quick thinking, learning, co-ordination between different parts of the brain, and the ability to walk and balance. The effects of methylphenidate on white matter, and by extension brain development, is not fully understood….
To chart any changes seen in the participants’ brains, they all underwent an MRI scan one week before their treatment began, and one week after their treatment stopped. Changes were found in the left hemisphere of the brain, with approximately double the rate of fractional anisotropy (nerve fiber density, size, and myelination).
The results suggest that the brain is susceptible to structural changes while it is still developing during childhood and adolescence, with the authors writing:
“The adolescent brain is a rapidly developing system maintaining high levels of plasticity. For instance, the maturation and development of white matter continues well into adulthood.”
“The results show that ADHD medications can have different effects on the development of brain structure in children versus adults. In adult men with ADHD, and both boys and adult men receiving placebo, changes in FA [fractional anisotropy] measures were not present, suggesting that the effects of methyphenidate on brain white matter are modulated by age,” Reneman said.
Reneman warned that they “do not yet know whether these effects are reversible or not and whether they are related to functional or behavioral changes over a longer period of time.”
“What our data already underscores is that the use of ADHD medications in children must be carefully considered until more is known about the long-term consequences of prescribing methylphenidate at a young age,” she said.
The study highlights the key results it produced through its experiments.
“In boys with attention-deficit/hyperactivity disorder (ADHD), four months of treatment with methylphenidate (MPH) was associated with increased white matter fractional anisotropy (FA) after 16 weeks.
“In adult men with ADHD and in both boys and adult men receiving placebo, changes in FA measures were not present, suggesting that the effects of MPH on brain white matter are modulated by age….” https://www.news-medical.net/news/20190815/MRI-scans-show-how-ADHD-medication-affects-brain-structure-in-children.aspx

Citation

Journal reference:
Bouziane, C., et al. (2019). White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder. RSNA Radiology. https://doi.org/10.1148/radiol.2019182528.

Here is the abstract and key results:

Original ResearchFree Access
Neuroradiology
White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder
Cheima Bouziane*, Olena G. Filatova*, Anouk Schrantee, Matthan W. A. Caan, Frans M. Vos, Liesbeth Reneman
* C.B. and O.G.F. contributed equally to this work.
Author Affiliations
Published Online:Aug 13 2019https://doi.org/10.1148/radiol.2019182528
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Abstract
Background
Methylphenidate (MPH) is highly effective in treating attention-deficit/hyperactivity disorder (ADHD). However, not much is known about its effect on the development of human brain white matter (WM).
Purpose
To determine whether MPH modulates WM microstructure in an age-dependent fashion in a randomized double-blind placebo-controlled trial (Effects of Psychotropic Medication on Brain Development–Methylphenidate, or ePOD-MPH) among ADHD referral centers between October 13, 2011, and June 15, 2015, by using diffusion-tensor imaging (DTI).
Materials and Methods
In this prospective study (NTR3103 and NL34509.000.10), 50 stimulant treatment–naive boys and 49 young adult men diagnosed with ADHD (all types) according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria were randomized to undergo treatment with MPH or placebo for 16 weeks. Before and 1 week after treatment cessation, study participants underwent MRI, including DTI. The outcome measure was change in fractional anisotropy (FA), which was assessed in three regions of interest (ROIs), as well as in a voxel-based analysis in brain WM. Data were analyzed by using intention-to-treat linear mixed models for ROI analysis and a permutation-based method for voxel-based analysis with family-wise error correction.
Results
Fifty boys (n = 25 MPH group, n = 25 placebo group; age range, 10–12 years) and 48 men (n = 24 MPH group, n = 24 placebo group; age range, 23–40 years) were included. ROI analysis of FA yielded no main effect of time in any of the conditions. However, voxel-based analysis revealed significant (P < .05) time-by-medication-by-age interaction effects in several association tracts of the left hemisphere, as well as in the lateral aspect of the truncus of the corpus callosum, due to greater increase in FA (standardized effect size, 5.25) in MPH-treated boys. Similar changes were not present in boys receiving a placebo, nor in adult men.
Conclusion
Four months of treatment with methylphenidate affects specific tracts in brain white matter in boys with attention-deficit/hyperactivity disorder. These effects seem to be age dependent, because they were not observed in adults treated with methylphenidate.
© RSNA, 2019
Online supplemental material is available for this article.
Download as PowerPointOpen in Image Viewer
Summary
This randomized clinical trial on the influence of methylphenidate on brain development using diffusion-tensor MRI found fractional anisotropy to increase in specific brain areas of boys with attention-deficit/hyperactivity disorder but not in young adult men or boys receiving a placebo.
Key Results
• ■ In boys with attention-deficit/hyperactivity disorder (ADHD), 4 months of treatment with methylphenidate (MPH) was associated with increased white matter fractional anisotropy (FA) after 16 weeks (standardized effect size of 5.25 at whole-brain voxel-based analysis)
• ■ In adult men with ADHD and in both boys and adult men receiving placebo, changes in FA measures were not present, suggesting that the effects of MPH on brain white matter are modulated by age.
https://pubs.rsna.org/doi/10.1148/radiol.2019182528

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary
http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

Edge Foundation ADHD Coaching Study Full Report
http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

ADHD and College Success: A free guide
http://www.edgefoundation.org/howedgehelps/add-2.html

ADHD and Executive Functioning
http://edgefoundation.org/blog/2010/10/08/the-role-of-adhd-and-your-brains-executive-functions/

Executive Function, ADHD and Academic Outcomes
http://www.helpforld.com/efacoutcomes.pdf

Related:
Louisiana study: Fit children score higher on standardized tests
https://drwilda.com/2012/05/08/louisiana-study-fit-children-score-higher-on-standardized-tests/

Studies: ADHD drugs don’t necessarily improve academic performance
https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome
https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

An ADHD related disorder: ‘Sluggish Cognitive Tempo’
https://drwilda.com/2014/04/12/an-adhd-related-disorder-sluggish-cognitive-tempo/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

University of Washington Health Sciences/UW Medicine study: Scientists can now manipulate brain cells using smartphone

11 Aug

The staff of Mayo Clinic wrote an excellent synopsis about Deep brain stimulation:

Overview
Deep brain stimulation involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that regulate abnormal impulses. Or the electrical impulses can affect certain cells and chemicals within the brain.
The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under your skin connects this device to the electrodes in your brain.
Deep brain stimulation is approved to treat a number of conditions, such as:
• Dystonia
• Epilepsy
• Essential tremor
• Obsessive-compulsive disorder
• Parkinson’s disease
Deep brain stimulation is also being studied as a potential treatment for:
• Addiction
• Chronic pain
• Cluster headache
• Dementia
• Depression (major)
• Huntington’s disease
• Multiple sclerosis
• Stroke recovery
• Tourette syndrome
• Traumatic brain injury
Why it’s done
Deep brain stimulation is an established treatment for people with movement disorders, such as essential tremor, Parkinson’s disease and dystonia, and psychiatric conditions, such as obsessive-compulsive disorder. It’s also approved for use by the Food and Drug Administration to reduce seizures in difficult-to-treat epilepsy.
This treatment is reserved for people who aren’t able to get control of their symptoms with medications…. https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562

Resources:

What is deep brain stimulation?                 https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/deep-brain-stimulation

Wireless communication with implanted medical devices using the conductive properties of the body https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156009/

Science Daily reported the University of Washington Health Sciences/UW Medicine study, Scientists can now manipulate brain cells using smartphone:

A team of scientists in Korea and the United States have invented a device that can control neural circuits using a tiny brain implant controlled by a smartphone.
Researchers, publishing in Nature Biomedical Engineering, believe the device can speed up efforts to uncover brain diseases such as Parkinson’s, Alzheimer’s, addiction, depression, and pain.
The device, using Lego-like replaceable drug cartridges and powerful bluetooth low-energy, can target specific neurons of interest using drug and light for prolonged periods.
“The wireless neural device enables chronic chemical and optical neuromodulation that has never been achieved before,” said lead author Raza Qazi, a researcher with the Korea Advanced Institute of Science and Technology (KAIST) and University of Colorado Boulder.
Qazi said this technology significantly overshadows conventional methods used by neuroscientists, which usually involve rigid metal tubes and optical fibers to deliver drugs and light. Apart from limiting the subject’s movement due to the physical connections with bulky equipment, their relatively rigid structure causes lesion in soft brain tissue over time, therefore making them not suitable for long-term implantation. Though some efforts have been put to partly mitigate adverse tissue response by incorporating soft probes and wireless platforms, the previous solutions were limited by their inability to deliver drugs for long periods of time as well as their bulky and complex control setups.
To achieve chronic wireless drug delivery, scientists had to solve the critical challenge of exhaustion and evaporation of drugs. Researchers from the Korea Advanced Institute of Science and Technology and the University of Washington in Seattle collaborated to invent a neural device with a replaceable drug cartridge, which could allow neuroscientists to study the same brain circuits for several months without worrying about running out of drugs.
These ‘plug-n-play’ drug cartridges were assembled into a brain implant for mice with a soft and ultrathin probe (thickness of a human hair), which consisted of microfluidic channels and tiny LEDs (smaller than a grain of salt), for unlimited drug doses and light delivery.
Controlled with an elegant and simple user interface on a smartphone, neuroscientists can easily trigger any specific combination or precise sequencing of light and drug deliveries in any implanted target animal without need to be physically inside the laboratory. Using these wireless neural devices, researchers could also easily setup fully automated animal studies where behaviour of one animal could positively or negatively affect behaviour in other animals by conditional triggering of light and/or drug delivery.
“This revolutionary device is the fruit of advanced electronics design and powerful micro and nanoscale engineering,” said Jae-Woong Jeong, a professor of electrical engineering at KAIST. “We are interested in further developing this technology to make a brain implant for clinical applications.”
Michael Bruchas, a professor of anesthesiology and pain medicine and pharmacology at the University of Washington School of Medicine, said this technology will help researchers in many ways.
“It allows us to better dissect the neural circuit basis of behaviour, and how specific neuromodulators in the brain tune behaviour in various ways,” he said. “We are also eager to use the device for complex pharmacological studies, which could help us develop new therapeutics for pain, addiction, and emotional disorders….” https://www.sciencedaily.com/releases/2019/08/190805143525.htm

Citation:

Scientists can now manipulate brain cells using smartphone
Date: August 5, 2019
Source: University of Washington Health Sciences/UW Medicine
Summary:
A team of scientists have invented a device that can control neural circuits using a tiny brain implant controlled by a smartphone. The device could speed up efforts to uncover brain diseases such as Parkinson’s, Alzheimer’s, addiction, depression, and pain.

Journal Reference:
Raza Qazi, Adrian M. Gomez, Daniel C. Castro, Zhanan Zou, Joo Yong Sim, Yanyu Xiong, Jonas Abdo, Choong Yeon Kim, Avery Anderson, Frederik Lohner, Sang-Hyuk Byun, Byung Chul Lee, Kyung-In Jang, Jianliang Xiao, Michael R. Bruchas, Jae-Woong Jeong. Wireless optofluidic brain probes for chronic neuropharmacology and photostimulation. Nature Biomedical Engineering, 2019; DOI: 10.1038/s41551-019-0432-1

Here is the press release from the University of Washington:

NEWS RELEASE

August 5, 2019

For immediate release

Scientists manipulate brain cells using a smartphone

A soft neural implant, capable of delivering multiple drugs and color lights, might speed research on diseases such as Parkinson’s, Alzheimer’s, addiction, depression and pain.

MEDIA CONTACT:
Bobbi Nodell, bnodell@uw.edu, 206.543.7129
Email Facebook Twitter Share

A team of scientists in South Korea and the United States have invented a device that can control neural circuits by using a tiny brain implant managedby a smartphone.
Publishing in Nature Biomedical Engineering, the researchers said the soft neural implant is the first wireless neural device capable of delivering multiple drugs and color lights. The device could speed up efforts to uncover brain diseases, such as Parkinson’s, Alzheimer’s, addiction, depression, and pain.
“The wireless neural device enables chronic chemical and optical neuromodulation that has never been achieved before,” said lead author Raza Qazi, a researcher with the Korea Advanced Institute of Science and Technology and University of Colorado Boulder.
Co-author Michael Bruchas, a professor of anesthesiology and pain medicine and pharmacology at the University of Washington School of Medicine, said this technology will help researchers in many ways.
“It allows us to better dissect the neural circuit basis of behavior, and how specific neuromodulators in the brain tune behavior in various ways,” he said. “We are also eager to use the device for complex pharmacological studies, which could help us develop new therapeutics for pain, addiction and emotional disorders.”
The device uses Lego-like replaceable drug cartridges and powerful bluetooth low-energy to deliver drugs and light to specific neurons of interest.
Resarchers said this technology significantly overshadows conventional neuroscience methods, which usually involve rigid metal tubes and optical fibers. Apart from limiting the subject’s movement due to the physical connections with bulky equipment, their relatively rigid structure causes lesion in soft brain tissue over time, therefore making them not suitable for long-term implantation. Though some efforts have partly mitigate adverse tissue response by incorporating soft probes and wireless platforms, the previous solutions were limited by their inability to deliver drugs for long periods of time as well as their bulky and complex control setups.
To achieve chronic wireless drug delivery, scientists had to solve the critical challenge of exhaustion and evaporation of drugs. The researchers collaborated to invent the neural device, which could allow neuroscientists to study the same brain circuits for several months without worrying about running out of drugs.
These “plug and play” drug cartridges were assembled into a brain implant for mice with a soft and ultrathin probe, the thickness of a human hair, which consisted of microfluidic channels and tiny LEDs, smaller than a grain of salt, for unlimited drug doses and light delivery.
Controlled with an elegant, simple user interface on a smartphone, the device can easily trigger any specific combination or precise sequencing of light and drug deliveries in any implanted target animal without need to be inside the laboratory. Using these wireless neural devices, researchers could also easily setup fully automated animal studies where behavior of one animal could positively or negatively affect behaviour in other animals by conditional triggering of light and/or drug delivery.
“This revolutionary device is the fruit of advanced electronics design and powerful micro and nanoscale engineering,” said Jae-Woong Jeong, a professor of electrical engineering at KAIST. “We are interested in further developing this technology to make a brain implant for clinical applications.”
The researchers at the Jeong group at KAIST, South Korea, develop soft electronics for wearable and implantable devices. The neuroscientists at the Bruchas Lab in Seattle study brain circuits that control stress, depression, addiction, pain and other neuropsychiatric disorders. This collaborative effort among engineers and neuroscientists over three years and tens of design iterations led to the successful validation of this brain implant in freely moving mice.
This work was supported by grants from the National Research Foundation of Korea, the National Institutes of Health, National Institute on Drug Abuse, and Mallinckrodt Professorship.

Resources:

Deep Brain Stimulation                                                   https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Deep-Brain-Stimulation

Ethical Issues in Deep Brain Stimulation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096836/

Deep Brain Stimulation for Mental Illnesses Raises Ethical Concerns https://leapsmag.com/deep-brain-stimulation-mental-illnesses-raises-ethical-concerns/

Ethical Considerations in Deep Brain Stimulation Treatment https://pjb.mycpanel2.princeton.edu/wp/index.php/2016/03/09/ethical-considerations-in-deep-brain-stimulation-treatment/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

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University of Massachusetts – Amherst study: New process discovered to completely degrade flame retardant in the environment

8 Aug

Science Direct reported in Tetrabromobisphenol A:

Abstract
Tetrabromobisphenol A (TBBPA) is one of the most prevalent flame retardants, and is used in plastic paints, synthetic textiles, and electrical devices. Despite the fact that TBBPA is excreted quickly from the body, it is detected in human plasma and milk. Owing to the structural resemblance to thyroid hormones (THs), the thyroid disruption activities of TBBPA have been investigated over the past two decades. Possible action sites are plasma TH binding protein and TH receptors. In experimental animal models, TBBPA exposure induces a decrease in plasma TH levels and a delay of TH-induced metamorphosis in animals. In studies using cell lines, TBBPA shows weak agonist and antagonist activities. These in vitro and in vivo bioassays may be powerful tools for detecting the thyroid system disruption activity of TBBPA. Although recent findings suggest diverse biological effects of TBBPA on the thyroid, reproductive, and immune systems, there is still controversy regarding these effects…. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/tetrabromobisphenol-a and https://www.sciencedirect.com/science/article/pii/B978012801028000249X
Scientists are researching the effects of Tetrabromobisphenol A.

Green Sciences Policy Institute provided an overview of retardants:

Flame retardant chemicals are used in commercial and consumer products (like furniture and building insulation) to meet flammability standards. Not all flame retardants present concerns, but the following types often do:
• Halogenated flame retardants (also known as organohalogen flame retardants) containing chlorine or bromine bonded to carbon.
• Organophosphorous flame retardants containing phosphorous bonded to carbon.
For these types of flame retardants:
• Some are associated with health and environmental concerns
• Many are inadequately tested for safety
• They provide questionable fire safety benefits as used in some products
Major uses
The major uses of flame retardant chemicals by volume in the U.S. are:
• Electronics
• Building insulation
• Polyurethane foam
• Wire and cable
Properties of Concern
Organohalogen and organophosphorous flame retardants often have one or more of the following properties of concern. Chemicals with all these properties are considered Persistent Organic Pollutants (POPs) and present significant risks to human health and environment. https://greensciencepolicy.org/topics/flame-retardants/

University of Massachusetts Amherst reported a process to degrade flame retardant.

Science Daily reported in New process discovered to completely degrade flame retardant in the environment:

A team of environmental scientists from the University of Massachusetts Amherst and China has for the first time used a dynamic, two-step process to completely degrade a common flame-retardant chemical, rendering the persistent global pollutant nontoxic.
This new process breaks down tetrabromobisohenol A (TBBPA) to harmless carbon dioxide and water. The discovery highlights the potential of using a special material, sulfidated nanoscale zerovalent iron (S-nZVI), in water treatment systems and in the natural environment to break down not only TBBPA but other organic refractory compounds that are difficult to degrade, says Jun Wu, a visiting Ph.D. student at UMass Amherst’s Stockbridge College of Agriculture and lead author of the paper published in Environmental Science & Technology….
“This research can lead to a decrease in the potential risk of TBBPA to the environment and human health,” says Wu, who began the research at the University of Science and Technology of China in Hefei. At UMass Amherst, Wu works in the pioneering lab of Baoshan Xing, professor of environmental and soil chemistry, corresponding author of the new study and one of the world’s most highly cited researchers….
Among the most common flame retardants that hinder combustion and slow the spread of fire, TBBPA is added to manufactured materials, including computer circuit boards and other electrical devices, papers, textiles and plastics.
Associated with a variety of health concerns, including cancer and hormone disruption, TBBPA has been widely detected in the environment, as well as in animals and human milk and plasma.
Although Wu and Xing’s research breaks new ground in the efforts to develop safe and effective processes to remediate groundwater and soil contaminated with TBBPA, they say more research is needed to learn how to best apply the process.
Their research was supported by grants from the National Natural Science Foundation of China and the USDA-National Institute of Food and Agriculture’s Hatch Program. https://www.sciencedaily.com/releases/2019/08/190808115102.htm

Citation:

New process discovered to completely degrade flame retardant in the environment
New research has potential application to remediate other difficult-to-degrade pollutants
Date: August 8, 2019
Source: University of Massachusetts at Amherst
Summary:
A team of environmental scientists has for the first time used a dynamic, two-step process to completely degrade a common flame-retardant chemical, rendering the persistent global pollutant nontoxic.

Journal Reference:
Jun Wu, Jian Zhao, Jun Hou, Raymond Jianxiong Zeng, Baoshan Xing. Degradation of Tetrabromobisphenol A by Sulfidated Nanoscale Zerovalent Iron in a Dynamic Two-Step Anoxic/Oxic Process. Environmental Science & Technology, 2019; 53 (14): 8105 DOI: 10.1021/acs.est.8b06834

Here is the press release from UMass Amherst:

New Process Discovered to Completely Degrade Flame Retardant in the Environment
UMass Amherst research has potential application to remediate other difficult-to-degrade pollutants
August 8, 2019
Contact: Jun Wu 413-210-2729
AMHERST, Mass. – A team of environmental scientists from the University of Massachusetts Amherst and China has for the first time used a dynamic, two-step process to completely degrade a common flame-retardant chemical, rendering the persistent global pollutant nontoxic.
This new process breaks down tetrabromobisophenol A (TBBPA) to harmless carbon dioxide and water. The discovery highlights the potential of using a special material, sulfidated nanoscale zerovalent iron (S-nZVI), in water treatment systems and in the natural environment to break down not only TBBPA but other organic refractory compounds that are difficult to degrade,says Jun Wu, a visiting Ph.D. student at UMass Amherst’s Stockbridge College of Agriculture and lead author of the paper published in Environmental Science & Technology.
“This is the first research about this dynamic, oxic/anoxic process,” Wu says. “Usually, reduction or oxidation alone is used to remove TBBPA, facilitated by S-nZVI. We combined reduction and oxidation together to degrade it completely.”
Wu emphasizes that “the technique is technically simple and environmentally friendly. That is a key point to its application.”
The research is featured on the cover of ES&T, which is widely respected for publishing papers in the environmental disciplines that are both significant and original.
“This research can lead to a decrease in the potential risk of TBBPA to the environment and human health,” says Wu, who began the research at the University of Science and Technology of China in Hefei. At UMass Amherst, Wu works in the pioneering lab of Baoshan Xing, professor of environmental and soil chemistry, corresponding author of the new study and one of the world’s most highly cited researchers.
“Our research shows a feasible and environmentally friendly process to completely degrade refractory brominated flame retardants in a combined oxic and anoxic system,” Xing says. “This is important for getting rid of these harmful compounds from the environment, thus reducing the exposure and risk.”
Among the most common flame retardants that hinder combustion and slow the spread of fire, TBBPA is added to manufactured materials, including computer circuit boards and other electrical devices, papers, textiles and plastics.
Associated with a variety of health concerns, including cancer and hormone disruption, TBBPA has been widely detected in the environment, as well as in animals and human milk and plasma.
Although Wu and Xing’s research breaks new ground in the efforts to develop safe and effective processes to remediate groundwater and soil contaminated with TBBPA, they say more research is needed to learn how to best apply the process.
Their research was supported by grants from the National Natural Science Foundation of China and the USDA-National Institute of Food and Agriculture’s Hatch Program.

The Environmental Protection Agency (EPA) lists risks in Fact Sheet: Assessing Risks from Flame Retardants https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/fact-sheet-assessing-risks-flame-retardants

Resources:
COMPOUND SUMMARY – Tetrabromobisphenol A https://pubchem.ncbi.nlm.nih.gov/compound/Tetrabromobisphenol-A

Is the flame retardant, tetrabromobisphenol A (TBBPA), a reproductive or developmental toxicant?
Date:
February 18, 2015
Source:
Toxicology Excellence for Risk Assessment
Summary:
Two studies examined the effects of tetrabromobisphenol A (TBBPA) at oral doses of 10,100 or 1000 mg/kg bw/day over the course of 2 generations on growth as well as behavioral, neurological and neuropathologic functions in offspring. https://www.sciencedaily.com/releases/2015/02/150218092044.htm

Global Tetrabromobisphenol-A Market is Evolving with Chemicals and Materials Industry in 2019 | Get Strategic Insights. https://theindustryforecast.com/2019/07/24/global-tetrabromobisphenol-a-insights-market-sp/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

University College London study: People who eat dark chocolate less likely to be depressed

3 Aug

Harvard Health wrote in Chocolate: Pros and cons of this sweet treat:

The reality is that ingredients in cocoa can be healthy, but the high-calorie chocolate bars that contain it aren’t necessarily good for you. Cocoa comes from roasted cacao seeds. It’s high in plant compounds called cocoa flavonoids, which have been shown in studies to have beneficial effects on heart disease risks, as well as on blood flow to the brain. Chocolate is the candy that’s made by adding sugar, milk, and other ingredients to cocoa powder. Those ingredients also add fat and sugar, which counteract some of cocoa’s health benefits.
Cocoa and heart health
The flavonoids in cocoa—specifically catechin, epicatechin, and procyanidins—are thought to help the cardiovascular system by lowering cholesterol, reducing inflammation, and preventing blood clots. When Dr. Ding and his colleagues analyzed the results of 24 studies on the effects of cocoa flavonoids on heart risks, they found that flavonoids reduced blood pressure and unhealthy LDL cholesterol, increased healthy HDL cholesterol, improved blood flow, and lowered insulin resistance (a condition in which the body doesn’t use insulin effectively, which is associated with type 2 diabetes and heart disease).
So far, researchers have only confirmed cocoa’s short-term benefits on heart risks—not the outcomes of lowering those risks. In other words, cocoa flavonoids may counteract the high blood pressure, high cholesterol, and other factors that contribute to a heart attack, but whether they actually prevent one from happening isn’t yet known. “In terms of actual direct heart attack prevention, the jury’s still out,” Dr. Ding says.
Cocoa on the brain
Scientists are also discovering that cocoa may be healthy for the brain. Another team of researchers at Harvard Medical School found that older adults who drank two cups of cocoa a day for 30 days had improved blood flow to parts of their brain needed for memory and thinking.
Another study, this one published in the journal Hypertension in 2012, offers even more direct evidence of cocoa flavonoids’ effects on the brain. Researchers in Italy found that older adults with mild cognitive impairment (mild problems with memory and thinking skills that increase the risk for dementia) who drank high-flavonoid cocoa performed better on tests of mental function and speaking ability than those who drank low-flavonoid cocoa. These studies don’t prove that cocoa can prevent dementia or other kinds of mental decline, but it does appear to play some brain-protective role.
Best cocoa sources
The average dose of flavonoids in the studies Dr. Ding reviewed was 400 milligrams a day. “The problem is, that’s about the equivalent of eight bars of dark chocolate or 30 bars of milk chocolate,” he says. “When you eat these actual chocolate bars, all the calories and sugar come with them.”
To get the health advantages of cocoa flavonoids without the fat and calories, you can buy a more concentrated cocoa product. Some cocoa supplements on the market contain up to 250 milligrams of cocoa flavonoids per serving…. https://www.health.harvard.edu/heart-health/chocolate-pros-and-cons-of-this-sweet-treat

University College London published a study about the effects of dark chocolate on those suffering depression.

Science Daily reported in People who eat dark chocolate less likely to be depressed:

Eating dark chocolate may positively affect mood and relieve depressive symptoms, finds a new UCL-led study looking at whether different types of chocolate are associated with mood disorders.
The study, published in Depression and Anxiety, is the first to examine the association with depression according to the type of chocolate consumed.
Researchers from UCL worked in collaboration with scientists from the University of Calgary and Alberta Health Services Canada and assessed data from 13,626 adults from the US National Health and Nutrition Examination Survey. Participants’ chocolate consumption was assessed against their scores on the Patient Health Questionnaire, which assesses depressive symptoms.
In the cross-sectional study, a range of other factors including height, weight, marital status, ethnicity, education, household income, physical activity, smoking and chronic health problems were also taken into account to ensure the study only measured chocolate’s effect on depressive symptoms.
After adjusting for these factors, it was found that individuals who reported eating any dark chocolate in two 24-hour periods had 70 per cent lower odds of reporting clinically relevant depressive symptoms than those who reported not eating chocolate at all. The 25 per cent of chocolate consumers who ate the most chocolate (of any kind, not just dark) were also less likely to report depressive symptoms than those who didn’t eat chocolate at all. However researchers found no significant link between any non‐dark chocolate consumption and clinically relevant depressive symptoms.
Depression affects more than 300 million people worldwide, according to the World Health Organisation, and is the leading global cause of disability.
Lead author Dr Sarah Jackson (UCL Institute of Epidemiology & Health Care) said: “This study provides some evidence that consumption of chocolate, particularly dark chocolate, may be associated with reduced odds of clinically relevant depressive symptoms…. https://www.sciencedaily.com/releases/2019/08/190802145458.htm

Citation:

People who eat dark chocolate less likely to be depressed
Date: August 2, 2019
Source: University College London
Summary:
Eating dark chocolate may positively affect mood and relieve depressive symptoms, finds a new study looking at whether different types of chocolate are associated with mood disorders.
Journal Reference:
Sarah E. Jackson, Lee Smith, Joseph Firth, Igor Grabovac, Pinar Soysal, Ai Koyanagi, Liang Hu, Brendon Stubbs, Jacopo Demurtas, Nicola Veronese, Xiangzhu Zhu, Lin Yang. Is there a relationship between chocolate consumption and symptoms of depression? A cross‐sectional survey of 13,626 US adults. Depression and Anxiety, 2019; DOI: 10.1002/da.22950

Here is the press release from University College London:

People who eat dark chocolate less likely to be depressed
2 August 2019
Eating dark chocolate may positively affect mood and relieve depressive symptoms, finds a new UCL-led study looking at whether different types of chocolate are associated with mood disorders.
The study, published in Depression and Anxiety, is the first to examine the association with depression according to the type of chocolate consumed.
Researchers from UCL worked in collaboration with scientists from the University of Calgary and Alberta Health Services Canada and assessed data from 13,626 adults from the US National Health and Nutrition Examination Survey. Participants’ chocolate consumption was assessed against their scores on the Patient Health Questionnaire, which assesses depressive symptoms.
In the cross-sectional study, a range of other factors including height, weight, marital status, ethnicity, education, household income, physical activity, smoking and chronic health problems were also taken into account to ensure the study only measured chocolate’s effect on depressive symptoms.
After adjusting for these factors, it was found that individuals who reported eating any dark chocolate in two 24-hour periods had 70 per cent lower odds of reporting clinically relevant depressive symptoms than those who reported not eating chocolate at all. The 25 per cent of chocolate consumers who ate the most chocolate (of any kind, not just dark) were also less likely to report depressive symptoms than those who didn’t eat chocolate at all. However researchers found no significant link between any non‐dark chocolate consumption and clinically relevant depressive symptoms.
Depression affects more than 300 million people worldwide, according to the World Health Organisation, and is the leading global cause of disability.
Lead author Dr Sarah Jackson (UCL Institute of Epidemiology & Health Care) said: “This study provides some evidence that consumption of chocolate, particularly dark chocolate, may be associated with reduced odds of clinically relevant depressive symptoms.
“However further research is required to clarify the direction of causation – it could be the case that depression causes people to lose their interest in eating chocolate, or there could be other factors that make people both less likely to eat dark chocolate and to be depressed.
“Should a causal relationship demonstrating a protective effect of chocolate consumption on depressive symptoms be established, the biological mechanism needs to be understood to determine the type and amount of chocolate consumption for optimal depression prevention and management.”
Chocolate is widely reported to have mood‐enhancing properties and several mechanisms for a relationship between chocolate and mood have been proposed.
Principally, chocolate contains a number of psychoactive ingredients which produce a feeling of euphoria similar to that of cannabinoid, found in cannabis. It also contains phenylethylamine, a neuromodulator which is believed to be important for regulating people’s moods.
Experimental evidence also suggests that mood improvements only take place if the chocolate is palatable and pleasant to eat, which suggests that the experience of enjoying chocolate is an important factor, not just the ingredients present.
While the above is true of all types of chocolate, dark chocolate has a higher concentration of flavonoids, antioxidant chemicals which have been shown to improve inflammatory profiles, which have been shown to play a role in the onset of depression.
Links
• The full paper in Depression and Anxiety
• Dr Sarah Jackson’s academic profile
• UCL Behavioural Science and Health
• UCL Epidemiology & Health Care
• UCL Population Health Sciences
• UCL School of Life and Medical Sciences
• Media coverage
Image
Photo by LongitudeLatitude from Flickr
Media contact
Jake Hawkes
Tel: +44 (0)20 3108 8581
Email: j.hawkes [at] ucl.ac.uk
https://www.ucl.ac.uk/news/2019/aug/people-who-eat-dark-chocolate-less-likely-be-depressed

Dr. Richard Foxx, MD wrote in Can There Really Be Too Much of a Good Thing?

Believe it or not, it is possible to have too much of a good thing—even when it comes to healthy lifestyle choices. Some of the pillars of health, including diet and exercise, can create health problems if they’re overdone. Yes, you really can exercise too much and eat too much of a good thing!
The truth is that we’re always learning more and more about what’s good for us and what isn’t. Furthermore, science is constantly pulling things back and forth in the realm of health. For example, one day,you hear that coffee and eggs are bad for you; the next day, they’re good for your health. But at the end of the day, both coffee and eggs are good for you—if they’re consumed in moderation. Once again, the old adage rings true: “everything in moderation…”

When it comes to health, remember the importance of moderation. Enjoy life, be sensible, and you’ll be rewarded! https://www.doctorshealthpress.com/general-health/healthy-lifestyle-tips-moderation-key-to-healthy-living/

Everything in moderation opines Dr. Wilda.

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

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Michigan Medicine – University of Michigan study: One in 100 new mothers go on to long-term opioid painkiller use; risk rises with size of Rx

28 Jul

American Pregnancy posted, Using Narcotics For Pain Relief During Childbirth:

Using Narcotics for Pain Relief During Labor: Types & Side Effects
Many women end up relying on some type of method to reduce the physical pain of childbirth. As you prepare for labor, it is important to become familiar with the pain medications that are available, how they work, their risks and their benefits.
The method you choose for pain relief will depend on your personal preference, your health care provider’s recommendation, and the availability of medications at your birthing facility.
What are Opiates?
Opiates are a type of analgesic given to relieve pain. When used during childbirth, opiates are considered the first option after natural methods for pain relief such as labor in water, deep breathing, and massage.
Opiates are given in small doses and usually administered during the early stages of labor in an attempt to avoid potential side effects for both the mother and baby.
What are the advantages of using opiates during childbirth?
Opiates offer pain relief and do not interfere with a woman’s ability to push during labor. Unlike an epidural, an opiate does not numb the pain; it instead helps to take some“edge” off of the pain. Opiates can help reduce anxiety and improve the mother’s ability to cope with painful contractions.
What are the potential side effects of opiates?
Mothers can experience the following side effects:
• Nausea
• Vomiting
• Itching
• Dizziness
• Sedation
• Decreased gastric motility
• Loss of protective airway reflexes
• Hypoxia due to respiratory depression
How will the opiates affect my baby?
Opiates cross the placenta during labor and can produce the following side effects in the baby:
• Central nervous system depression
• Respiratory depression
• Impaired early breastfeeding
• Altered neurological behavior
• Decreased ability to regulate body temperature
For these reasons, your baby might need other medication to counteract the effects of the opiate. Naloxone is a medication given in small doses that can reverse the respiratory depression that opiates can cause in a baby. It is usually given intravenously and its effects can be seen within a few minutes and can last up to 2 hours.
What types of opiates are used during childbirth?
The most frequently used narcotic medications are:
• Morphine
• Stadol
• Fentanyl
• Nubain
• Demerol
Demerol:
Demerol is a popular choice for pain relief during labor. Demerol alters how the mother recognizes the pain she is experiencing by binding to the receptors found in the central nervous system.
The advantages of Demerol include:
• Can be given by injection into the muscle, the vein or by a Patient Controlled Analgesia (PCA) pump
• Fast-acting – starts working in less than 5 minutes
How can Demerol affect me and my baby?
Demerol can cause drowsiness, nausea, vomiting, respiratory depression, and maternal hypotension (low blood pressure). If injected within 2-4 hours of delivery, Demerol has been found to cause breathing difficulties in some babies.
Morphine:
In recent years, morphine has not been routinely used as a method of pain relief during labor because it has been found to depress the baby’s ability to breathe.
Stadol:
Stadol has been found to relieve pain when given in the first stage of labor. This narcotic is considered more potent than Demerol. It is usually given intravenously in small doses, usually 1 to 2 mg.
The advantages of using Stadol include:
• Starts working in less than five minutes
• Is a sedative
• Has minimal fetal effects
• Causes minimal nausea
How can Stadol affect me and my baby?
Stadol can cause the mother to have respiratory depression, dizziness, and dysphoria (a state of feeling unwell and unhappy). Stadol can cause respiratory depression in the baby.
Fentanyl:
Fentanyl is a synthetic opiate that provides mild to moderate sedation. The advantages of using Fentanyl include:
• Begins working quickly (although, usually only lasts 45 minutes)
• Minimal sedation
• Minimal fetal effects
How can Fentanyl affect me and my baby?
You and your baby can experience some sedation and/or nausea. According to Danforth’s Obstetrics and Gynecology, babies born to mothers who used Fentanyl to relieve pain during labor were less likely to need naloxone (medication to help with breathing) than babies born to mothers who used Demerol.
Nubain:
Nubain is an opiate agonist-antagonist comparable to morphine. The advantages of using Nubain include:
• Begins working within 5 minutes of administration
• Minimal nausea
• Minimal fetal effects
How can Nubain affect me and my baby?
Nubain can cause the mother to have sedation and dysphoria (a state of feeling unwell and unhappy)…. https://americanpregnancy.org/labor-and-birth/narcotics/

A University of Michigan study found that some mothers go on to long-term use of opioid painkillers.

Science Daily reported in One in 100 new mothers go on to long-term opioid painkiller use; risk rises with size of Rx:

Nearly half of American women having a baby in the last decade received a prescription for a powerful opioid painkiller as part of their birth experience, a new study shows.
And one or two in every hundred were still filling opioid prescriptions a year later — especially those who received birth-related opioid prescriptions before the birth, and those who received the largest initial doses.
In a study of records from more than 308,000 women who gave birth from 2008 to 2016, researchers from the University of Michigan find the percentage of women filling opioid prescriptions in the days and months after giving birth declined over time. This may have resulted from growing awareness of the broader national epidemic.
But they note that there is still ample room for providers to adopt effective pain control strategies — for both vaginal and Caesarean births — that don’t include giving new mothers opioid pills if other pain treatments work for them.
Writing in JAMA Network Open, U-M obstetrician and health services researcher Alex Friedman Peahl, M.D., and her colleagues explore opioid prescribing to women with private insurance who hadn’t received opioids for a year before delivering. They limited the study to women who didn’t suffer major birth complications or have any other procedures in the year after a birth.
“Overall, we see rates of opioid persistence higher than previously documented for women having C sections, at about two percent,” says Peahl. “For women who delivered vaginally, one-quarter received opioid prescriptions, although current guidelines call for a step-wise approach to pain management, starting with non-narcotic medications such as ibuprofen and acetaminophen. One percent of vaginal birth mothers were still receiving opioids months later.”
Peahl and her colleagues hope their findings bolster efforts by national groups to help birth care teams adopt opioid-sparing pain care methods. Birth care at Von Voigtlander Women’s Hospital, part of the U-M academic medical center Michigan Medicine, already includes such approaches.
Peahl says she tells her birthing patients, “Pain after birth is like a mountain: once you’re at the peak, it is harder to get down. Using non-narcotic pain medications before opioids can help better manage your pain by preventing you from reaching that peak.”
Alternatives to opioids
Peahl’s experience treating birth pain with fewer opioids extends back to her training in Rhode Island, where birthing women once routinely went home from the hospital with prescriptions for 20 to 40 opioid painkiller pills. Then, the state legislature passed a limit of 20 pills for acute pain prescriptions, and she worked with the birth team where she trained to develop alternate pain care approaches.
Using long-lasting opioids for the height of birth pain as part of an epidural, and reserving oral opioids for “breakthrough” post-birth pain, is possible, says Peahl.
Acetaminophen, and non-steroidal anti-inflammatory drugs such as ibuprofen can provide effective pain relief in the days after birth, Peahl says, especially if women receive education during birth preparation about their proper use. She recently presented data at a conference showing such an approach can reduce post-discharge opioid painkiller use.
A team of U-M obstetric clinicians also recently published a paper in the American Journal of Obstetrics & Gynecology that laid out the case for opioid-sparing approaches to pain care after C-section births. Such an approach, called Enhanced Recovery After Surgery or ERAS, has already risen in popularity for other OB/Gyn procedures such as hysterectomy… https://www.sciencedaily.com/releases/2019/07/190726111025.htm

Citation:

One in 100 new mothers go on to long-term opioid painkiller use; risk rises with size of Rx
Date: July 26, 2019
Source: Michigan Medicine – University of Michigan
Summary:
Nearly half of American women having a baby in the last decade received a prescription for a powerful opioid painkiller as part of their birth experience, a new study shows. And one or two in every hundred were still filling opioid prescriptions a year later — especially those who received birth-related opioid prescriptions before the birth, and those who received the largest initial doses.

Journal Reference:
Alex F. Peahl, Vanessa K. Dalton, John R. Montgomery, Yen-Ling Lai, Hsou Mei Hu, Jennifer F. Waljee. Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women. JAMA Network Open, 2019; 2 (7): e197863 DOI: 10.1001/jamanetworkopen.2019.7863

Here is the press release from University of Michigan:

Kara Gavin

July 26, 2019 11:15 AM

1 in 75 New Moms Go on to Long-Term Opioid Painkiller Use
Examination of post-birth pain care patterns over time finds declines in opioid prescribing, but opportunities for more non-opioid-based care.

Nearly half of American women having a baby in the last decade received a prescription for a powerful opioid painkiller as part of their birth experience, a new study shows.
And one or two in every hundred were still filling opioid prescriptions a year later – especially those who received birth-related opioid prescriptions before the birth, and those who received the largest initial doses.
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In a study of records from more than 308,000 women who gave birth from 2008 to 2016, researchers from the University of Michigan found the percentage of women filling opioid prescriptions in the days and months after giving birth declined over time. This may have resulted from growing awareness of the broader national epidemic.
But they note that there is still ample room for providers to adopt effective pain control strategies – for both vaginal and caesarean births – that do not include giving new mothers opioid pills if other pain treatments work for them.
In the new issue of JAMA Network Open, U-M obstetrician and health services researcher Alex Friedman Peahl, M.D., and her colleagues explore opioid prescribing to women with private insurance who had not received opioids for a year before delivering. They limited the study to women who did not suffer major birth complications or have any other procedures in the year after a birth.
“Overall, we saw rates of opioid persistence higher than previously documented for women having c-sections, at about 2%,” says Peahl. “For women who delivered vaginally, one-quarter received opioid prescriptions, although current guidelines call for a step-wise approach to pain management, starting with non-narcotic medications such as ibuprofen and acetaminophen. One percent of vaginal birth mothers were still receiving opioids months later.”
Peahl and her colleagues hope their findings bolster efforts by national groups to help birth care teams adopt opioid-sparing pain care methods. Birth care at Von Voigtlander Women’s Hospital, part of the U-M academic medical center Michigan Medicine, already includes such approaches.
Peahl says she tells her birthing patients, “Pain after birth is like a mountain: once you’re at the peak, it is harder to get down. Using non-narcotic pain medications before opioids can help better manage your pain by preventing you from reaching that peak.”
Alternatives to opioids
Peahl’s experience treating birth pain with fewer opioids extends back to her training in Rhode Island, where birthing women once routinely went home from the hospital with prescriptions for 20 to 40 opioid painkiller pills. Then, the state legislature passed a limit of 20 pills for acute pain prescriptions, and she worked with the birth team where she trained to develop alternate pain care approaches.
Using long-lasting opioids for the height of birth pain as part of an epidural, and reserving oral opioids for “breakthrough” post-birth pain, is possible, says Peahl.
Acetaminophen, and non-steroidal anti-inflammatory drugs such as ibuprofen can provide effective pain relief in the days after birth, Peahl says, especially if women receive education during birth preparation about their proper use. She recently presented data at a conference showing such an approach can reduce post-discharge opioid painkiller use.
A team of U-M obstetric clinicians also recently published a paper in the American Journal of Obstetrics & Gynecology that laid out the case for opioid-sparing approaches to pain care after c-section births. Such an approach, called Enhanced Recovery After Surgery or ERAS, has already risen in popularity for other OB/Gyn procedures such as hysterectomy.
Building on surgical opioid studies
Peahl, a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation (IHPI), teamed up with IHPI members from the Michigan Opioid Prescribing and Engagement Network for the new study. Senior author Jennifer Waljee, M.D., M.P.H., M.S., helped Peahl adopt an approach already used to study opioid prescriptions after inpatient surgery.
Using IHPI-purchased data, they looked at women who filled an opioid prescription in the immediate week before giving birth, up to the third day afterward. This allowed them to include women whose doctors wrote a prescription to have on hand before they went to the hospital.
They defined persistent use as those women who filled at least one more opioid prescription within three months of delivering, and another up to a year after delivering. In addition to excluding women with prior opioid use and those in treatment for substance abuse, the study left out women who had any sort of medical procedure within a year of having a baby, including readmission for additional surgical procedures, and women whose birth hospitalization lasted more than a month.
“The silver lining in these data is that we see drops of several percentage points in the filling of initial prescriptions over time, although nearly 24% of women who delivered vaginally in 2016, and nearly 73% of those who had a c-section, still had these pills on hand,” says Peahl.
Women most at risk of persistent use
While the researchers could not tell from the data how many opioid pills the women actually took, they note that unused pills can pose a risk of their own. Excess opioids can be misused by others, diverted for illicit sale, or discovered by curious children.
Looking more closely at the data, they showed that risk of opioid persistence was higher in certain groups of women. Women who had their babies in their teens or early 20s, and those who had more medical issues at the time of birth, especially diagnoses related to pain or mental health, had higher rates of persistence. So did mothers in the South and Midwest and women who used tobacco during pregnancy.
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But the biggest factors – and the one that health care providers can actually modify – was the size of the initial prescription for opioids that the women filled and the timing of when that prescription was given. The larger the vial, the more likely they were to refill multiple prescriptions in the months after giving birth. Similarly, women who filled prescriptions prior to birth were more likely to develop new persistent use.
This is similar to what Waljee and her colleagues have seen in surgical patients, which has led them to create prescribing guidelines for surgical teams that are based on what patients say they actually needed to take for pain control. The guidelines for c-sections published on the Michigan-OPEN site recommend that women receive between zero and 20 five-milligram oxycodone tablets or the equivalent.
Next steps
Peahl and her colleagues are currently contacting new mothers who received opioid painkillers to find out how many pills they took out of the total number they were prescribed and given. This could inform more evidence-based recommendations in the near future. They are also assessing the impact of a new ERAS protocol that was launched on July 8, which includes more robust patient education and shared decision making about opioid prescriptions at the time of discharge.
They also hope to study Medicaid data on a national level, expanding on the single-state analysis others have done. And, they hope to study data on the half of women who could notbe included in the current study because they had received opioid prescriptions in the year before they had their baby.
“No matter which way they deliver, women should be able to get up and spend time with their new baby,” says Peahl. “Pain, and the effects of pain control medications, should not get in the way of their birth experience and bonding with their infant.”
In addition to Peahl and Waljee, the study’s authors include Vanessa K. Dalton, M.D., John R. Montgomery, M.D., Yen-Ling Lai and Hsou Mei Hu. Peahl, Dalton, and Waljee are members of IHPI. The study was funded by Peahl’s IHPI NCSP fellowship.
DOI: 10.1001/jamanetworkopen.2019.7863

Nancy D. Campbell, PhD wrote in When Should Screening and Surveillance Be Used during Pregnancy?

Ethics in the kinds of risky situations described above is not a mere preoccupation with abstract principles—nor should ethics be understood as limited to technical details. Ethics is practical, often arising as a result of specific cases with particular histories of harm and injustice. Enjoined to do no harm, physicians arguably have a duty to reduce harm and certainly to provide care that does not coerce, stigmatize, or criminalize.
Physicians share responsibility to ensure access to the full range of reproductive health care and drug treatment for their patients who need it. Physicians also share with drug-using pregnant women responsibility to bring about healthy births and humane treatment for all concerned—mothers, babies, and children. Ensuring access to the full range of evidence-based drug treatment should be considered part of these affirmative duties. Biomedical surveillance should be conducted only for clinical purposes having to do with ensuring access to and delivering quality health care. Just because we have surveillance technology does not mean we should use it against the very women who need to be enrolled in caring for their infants. “Mom” is part of the cure, and compassionate care demands that surveillance be judiciously used in therapeutic spaces…. https://journalofethics.ama-assn.org/article/when-should-screening-and-surveillance-be-used-during-pregnancy/2018-03

Resources:

Prescription opioids during pregnancy https://www.marchofdimes.org/pregnancy/prescription-opioids-during-pregnancy.aspx

Using Narcotics For Pain Relief During Childbirth               https://americanpregnancy.org/labor-and-birth/narcotics/

Opioid use during pregnancy                                                      https://www.mayoclinic.org/opioid-use-during-pregnancy/art-20380741/in-depth/art-20380741
Doctors’ responsibility in opioid crisis                              http://cmajnews.com/2016/11/18/doctors-responsibility-in-opioid-crisis-cmaj-109-5359/

Untangling the medical ethics of prescribing opioids                                            https://www.ama-assn.org/delivering-care/ethics/untangling-medical-ethics-prescribing-opioids

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Kaiser Permanente study: More women using cannabis daily before and during pregnancy, research finds

20 Jul

The Ontario Ministry of Children and Youth Services explained why healthy babies are important. “Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy teenagers and healthy adults.” http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/index.aspx
Science Daily reported in Women, particularly minorities, do not meet nutrition guidelines shortly before pregnancy:

Black, Hispanic and less-educated women consume a less nutritious diet than their well-educated, white counterparts in the weeks leading up to their first pregnancy, according to the only large-scale analysis of preconception adherence to national dietary guidelines.
The study, published in the Journal of the Academy of Nutrition and Dietetics and led by the University of Pittsburgh Graduate School of Public Health, also found that, while inequalities exist, none of the women in any racial and socioeconomic group evaluated achieved recommendations set forth by the Dietary Guidelines for Americans.
Healthy maternal diets have been linked to reduced risks of preterm birth, fetal growth restriction, preeclampsia and maternal obesity.
“Unlike many other pregnancy and birth risk factors, diet is something we can improve,” said lead author Lisa Bodnar, Ph.D., M.P.H., R.D., associate professor and vice chair of research in Pitt Public Health’s Department of Epidemiology. “While attention should be given to improving nutritional counseling at doctor appointments, overarching societal and policy changes that help women to make healthy dietary choices may be more effective and efficient.”
Bodnar and her colleagues analyzed the results of questionnaires completed by 7,511 women who were between six and 14 weeks pregnant and enrolled in The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be, which followed women who enrolled in the study at one of eight U.S. medical centers. The women reported on their dietary habits during the three months around conception.
The diets were assessed using the Healthy Eating Index-2010, which measures 12 key aspects of diet quality, including adequacy of intake for key food groups, as well as intake of refined grains, salt and empty calories (all calories from solid fats and sugars, plus calories from alcohol beyond a moderate level).
Nearly a quarter of the white women surveyed had scores that fell into the highest scoring fifth of those surveyed, compared with 14 percent of the Hispanic women and 4.6 percent of the black women. Almost half — 44 percent — of black mothers had a score in the lowest scoring fifth…. https://www.sciencedaily.com/releases/2017/03/170317082514.htm

See, https://drwilda.com/tag/pregnancy/

Science Daily reported in More women using cannabis daily before and during pregnancy:

The number of women using cannabis in the year before they get pregnant and early in their pregnancies is increasing, and their frequency of use is also rising, according to new data from Kaiser Permanente.
The research, published July 19, 2019, in JAMA Network Open, examined self-reported cannabis use among 276,991 pregnant women (representing 367,403 pregnancies) in Northern California over 9 years and found that cannabis use has increased over time.
From 2009 to 2017, the adjusted prevalence of self-reported cannabis use in the year before pregnancy increased from 6.8% to 12.5%, and the adjusted prevalence of self-reported cannabis use during pregnancy increased from 1.9% to 3.4% (rates were adjusted for demographics). Annual rates of change in self-reported daily, weekly, and monthly-or-less cannabis use increased significantly, though daily use increased most rapidly.
Among women who self-reported cannabis use during the year before pregnancy, the proportion who were daily users increased from 17% to 25%, and weekly users increased from 20% to 22%, while monthly-or-less users decreased from 63% to 53% during the study period. Similarly, among women who self-reported cannabis use during pregnancy, the proportion who were daily users increased from 15% to 21%, and weekly users from 25% to 27%, while monthly users decreased from 60% to 52%.
“These findings should alert women’s health clinicians to be aware of potential increases in daily and weekly cannabis use among their patients,” said lead author Kelly Young-Wolff, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research. “The actual numbers are likely higher, as women may be unwilling to disclose their substance use to a medical professional.”
In addition, the prevalence of daily and weekly cannabis use may have risen even further in the past year and a half following legalization of cannabis for recreational use in California in 2018, Young-Wolff said.
The data come from women’s initial prenatal visits at Kaiser Permanente in Northern California, which usually take place at around 8 weeks gestation, and do not reflect continued use throughout pregnancy. Investigators were unable to differentiate whether self-reported cannabis use during pregnancy occurred before or after women were aware that they were pregnant.
While the current findings are based on women’s self-reporting, the results are supported by the Kaiser Permanente research team’s December 2017 JAMA Research Letter showing an increase in prenatal cannabis use via urine toxicology testing. In this newer study, the authors focus on trends in frequency of use in the year before and during pregnancy.
Some women may use cannabis during pregnancy to manage morning sickness, the authors noted. The authors’ previous work published in JAMA Internal Medicine in 2018 found women with severe nausea and vomiting in pregnancy were nearly 4 times more likely to use cannabis during the first trimester of pregnancy.
Women may get the impression from cannabis product marketing and online media that cannabis use is safe during pregnancy, said Young-Wolff. However, there is substantial evidence that exposure to cannabis in pregnancy is associated with having a low-birthweight baby, and the American College of Obstetricians and Gynecologists recommends women who are pregnant or contemplating pregnancy discontinue cannabis use because of concerns about impaired neurodevelopment and exposure to the adverse effects of smoking….
More research is needed to offer women better, specific advice, said study senior author Nancy Goler, MD, an obstetrician/gynecologist and associate executive director of The Permanente Medical Group.
“There is an urgent need to better understand the effects of prenatal cannabis exposure as cannabis becomes legalized in more states and more widely accepted and used,” Dr. Goler said. “Until such time as we fully understand the specific health risks cannabis poses for pregnant women and their fetuses, we are recommending stopping all cannabis use prior to conceiving and certainly once a woman knows she is pregnant….”
https://www.sciencedaily.com/releases/2019/07/190719173602.htm

Citation:

More women using cannabis daily before and during pregnancy, research finds
Current advice is to avoid cannabis exposure during pregnancy
Date: July 19, 2019
Source: Kaiser Permanente
Summary:
The number of women using cannabis in the year before they get pregnant and early in their pregnancies is increasing, and their frequency of use is also rising, according to new data.

Journal Reference:
Kelly C. Young-Wolff, Varada Sarovar, Lue-Yen Tucker, Amy Conway, Stacey Alexeeff, Constance Weisner, Mary Anne Armstrong, Nancy Goler. Self-reported Daily, Weekly, and Monthly Cannabis Use Among Women Before and During Pregnancy. JAMA Network Open, 2019; 2 (7): e196471 DOI: 10.1001/jamanetworkopen.2019.6471

Here is the press release from Kaiser Permanente:

July 19, 2019

More women using cannabis daily before and during pregnancy
Current advice from Kaiser Permanente is to avoid cannabis exposure during pregnancy.
OAKLAND, Calif. — The number of women using cannabis in the year before they get pregnant and early in their pregnancies is increasing, and their frequency of use is also rising, according to new data from Kaiser Permanente.
The research, published July 19, 2019, in JAMA Network Open, examined self-reported cannabis use among 276,991 pregnant women (representing 367,403 pregnancies) in Northern California over 9 years and found that cannabis use has increased over time.
From 2009 to 2017, the adjusted prevalence of self-reported cannabis use in the year before pregnancy increased from 6.80% to 12.50%, and the adjusted prevalence of self-reported cannabis use during pregnancy increased from 1.95% to 3.38%. Annual rates of change in self-reported daily, weekly, and monthly-or-less cannabis use increased significantly, though daily use increased most rapidly.
Among women who self-reported cannabis use during the year before pregnancy, the proportion who were daily users increased from 17.1% to 25.2%, and weekly users increased from 20.4% to 22.0%, while monthly-or-less users decreased from 62.7% to 53.1% during the study period. Similarly, among women who self-reported cannabis use during pregnancy, the proportion who were daily users increased from 14.6% to 20.9%, and weekly users from 25.1% to 27.4%, while monthly users decreased from 60.3% to 51.8%.
“These findings should alert women’s health clinicians to be aware of potential increases in daily and weekly cannabis use among their patients,” said lead author Kelly Young-Wolff, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research. “The actual numbers are likely higher, as women may be unwilling to disclose their substance use to a medical professional.”
In addition, the prevalence of daily and weekly cannabis use may have risen even further in the past year and a half following legalization of cannabis for recreational use in California in 2018, Young-Wolff said.
The data come from women’s initial prenatal visits at Kaiser Permanente in Northern California, which usually take place at around 8 weeks of pregnancy, and do not reflect continued use throughout pregnancy. Investigators were unable to differentiate whether self-reported cannabis use during pregnancy occurred before or after women were aware that they were pregnant.
While the current findings are based on women’s self-reporting, the results are supported by the Kaiser Permanente research team’s December 2017 JAMA Research Letter showing an increase in prenatal cannabis use via urine toxicology testing. In this newer study, the authors focus on trends in frequency of use in the year before and during pregnancy.
Some women may use cannabis during pregnancy to manage morning sickness, the authors noted. The authors’ previous work published in JAMA Internal Medicine in 2018 found women with severe nausea and vomiting in pregnancy were nearly 4 times more likely to use cannabis during the first trimester of pregnancy.
“Women may get the impression from cannabis product marketing and online media that cannabis use is safe during pregnancy,” said Young-Wolff. “However, there is substantial evidence that exposure to cannabis in pregnancy is associated with having a low-birthweight baby, and the American College of Obstetricians and Gynecologists recommends women who are pregnant or contemplating pregnancy discontinue cannabis use because of concerns about impaired neurodevelopment and exposure to the adverse effects of smoking.”
“There is still much that is unknown on the topic, including what type of cannabis products pregnant women are using and whether the health consequences differ based on mode of cannabis administration and frequency of prenatal cannabis use,” Young-Wolff noted.
More research is needed to offer women better, specific advice, said study senior author Nancy Goler, MD, an obstetrician-gynecologist and associate executive director of The Permanente Medical Group.
“There is an urgent need to better understand the effects of prenatal cannabis exposure as cannabis becomes legalized in more states and more widely accepted and used,” Dr. Goler said. “Until such time as we fully understand the specific health risks cannabis poses for pregnant women and their fetuses, we are recommending stopping all cannabis use prior to conceiving and certainly once a woman knows she is pregnant.”
The study was supported by a grant from the National Institute on Drug Abuse.
Young-Wolff and Kaiser Permanente Division of Research colleague Lindsay Avalos, PhD, MPH, have received a new 5-year grant from NIDA to support further research on maternal cannabis use during pregnancy. They plan to study whether prenatal cannabis use is associated with increased risk of adverse maternal, fetal, and neonatal outcomes using data from urine toxicology testing, self-reported frequency of prenatal cannabis use, and mode of cannabis administration. They will also test whether legalization of cannabis for recreational use in 2018 and local regulatory practices (such as retailer bans) are associated with variation in prenatal cannabis use.
Additional authors were Constance Weisner, DrPH, MSW; Varada Sarovar,;Lue-Yen Tucker; Mary Anne Armstrong; and Stacey Alexeeff, PhD, of the Kaiser Permanente Northern California Division of Research; and Amy Conway, MPH, of the Kaiser Permanente Northern California Early Start Program.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 12.3 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.

Contacts
Jan Greene
janice.x.greene@kp.org
510-891-3653
Kerry Sinclair
ksinclair@webershandwick.com
310-710-0321

Humans have free will and are allowed to choose how they want to live. What you do not have the right to do is to inflict your lifestyle on a child. So, the responsible thing for you to do is to get birth control for yourself and the society which will have to live with your poor choices. Many religious folks are shocked because moi is mentioning birth control, but most sluts have few religious inklings or they wouldn’t be sluts. A better option for both sexes, if this lifestyle is a permanent option, is permanent birth control to lessen a contraception failure. People absolutely have the right to choose their particular lifestyle. You simply have no right to bring a child into your mess of a life. I observe people all the time and I have yet to observe a really happy slut. Seems that the lifestyle is devoid of true emotional connection and is empty. If you do find yourself pregnant, please consider adoption.

Let’s continue the discussion. Some folks may be great friends, homies, girlfriends, and dudes, but they make lousy parents. Could be they are at a point in their life where they are too selfish to think of anyone other than themselves, they could be busy with school, work, or whatever. No matter the reason, they are not ready and should not be parents. Birth control methods are not 100% effective, but the available options are 100% ineffective in people who are sexually active and not using birth control. So, if you are sexually active and you have not paid a visit to some agency, then you are not only irresponsible, you are Eeeevil. Why do I say that, you are playing Russian Roulette with the life of another human being, the child. You should not ever put yourself in the position of bringing a child into the world that you are unprepared to parent, emotionally, financially, and with a commitment of time. So, if you find yourself in a what do I do moment and are pregnant, you should consider adoption.
Children need stability and predictability to have the best chance of growing up healthy.

Children will have the most success in school if they are ready to learn. Ready to learn includes proper nutrition for a healthy body and the optimum situation for children is a healthy family. Many of society’s problems would be lessened if the goal was a healthy child in a healthy family.

Unless there was a rape or some forcible intercourse, the answer to the question is a woman who gets preggers with a “deadbeat dad” a moron – is yes.

Learn more about prenatal and preconception care.
http://www.nichd.nih.gov/health/topics/preconceptioncare/Pages/default.aspx
http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

 

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American Orthopaedic Society for Sports Medicine study: Over-conditioning kills: Non-traumatic fatalities in football is preventable

13 Jul

@Life360 discussed the dangers of participating in sports in The Hidden Dangers of Competitive Sports:

I think Wall identifies the real danger of sports on your health — long-term injuries. While we’re most likely to think of sprains and broken bones, teens are able to recover from those well; it’s damages that affect growth which should be of more concern.
We can all agree that sports nurture a positive discipline for exercise, but it’s easy for that regiment to go too far. Personally, I’ve seen competitive sports spur unhealthy habits. In high school, I was on the wrestling team in the winter and rowing team in the spring. Since weight is such an important issue with both of those sports, I was encouraged to watch what I ate very carefully. While my coaches never suggested making unhealthy changes to my diet, there is often an unspoken pressure for young athletes to do so. That’s not to say that wrestling and rowing are bad sports (in fact, I’d argue the opposite), but in a competitive atmosphere, even high school kids can take things too seriously. Eating disorders from sports isn’t all that uncommon.
Though I’ve only discussed the cons of high school athletics, I still think the positives — both physical and mental — outweigh the negatives. But I think both young athletes and their parents should be aware of the dangers, and understand when to realize that they’re taking sports too seriously. https://www.life360.com/blog/the-hidden-dangers-of-competitive-sports/

American Orthopaedic Society for Sports Medicine released a study which examined the dangers of over-conditioning.

Science Daily reported in Over-conditioning kills: Non-traumatic fatalities in football is preventable:

Most non-traumatic fatalities among high school and college football athletes do not occur while playing the game of football, but rather during conditioning sessions which are often associated with overexertion or punishment drills required by coaches and team staff, according to research presented today at the American Orthopedic Society for Sports Medicine Annual Meeting. The research was presented by Dr. Barry P. Boden of The Orthopaedic Center, Rockville, Md.

Football is associated with the highest number of fatalities of any high school or college sport, but the number of traumatic injuries incurred while playing football have declined significantly since the 1960s.
However, the annual number of non-traumatic fatalities has stayed constant with current rates that are two to three times higher than traumatic fatalities.
Heat and sickle cell trait fatality rates were compared pre- and post-implementation of the NCAA football acclimatization model in 2003 and sickle cell screening policies implemented in 2010, respectively.
Boden and his team reviewed 187 non-traumatic football fatalities that occurred between 1998 and 2018. The researchers obtained information from extensive internet searches, as well as depositions, investigations, autopsies, media and freedom of information reports.
Of the 187 fatalities, more than half (52 percent) were due to cardiac issues; 24 percent were caused by heat; and five percent from asthma.
“The majority of deaths occurred outside of the regular season months of September through December, with the most common month for fatalities being August,” Boden reported.
Boden said many of the fatalities had three issues in common: the conditioning sessions were supervised by the football coach or strength and conditioning coach; irrationally intense workouts and/or punishment drills were scheduled; and an inadequate medical response was implemented…. https://www.sciencedaily.com/releases/2019/07/190713103944.htm

Citation:

Over-conditioning kills: Non-traumatic fatalities in football is preventable
Date: July 13, 2019
Source: American Orthopaedic Society for Sports Medicine
Summary:
Most non-traumatic fatalities among high school and college football athletes do not occur while playing the game of football, but rather during conditioning sessions which are often associated with overexertion or punishment drills required by coaches and team staff, according to new research.

Here is the press release from American Orthopaedic Society for Sports Medicine:

July 13, 2019
Over-conditioning kills: Non-traumatic fatalities in football is preventable

by American Orthopaedic Society for Sports Medicine

Most non-traumatic fatalities among high school and college football athletes do not occur while playing the game of football, but rather during conditioning sessions which are often associated with overexertion or punishment drills required by coaches and team staff, according to research presented today at the American Orthopedic Society for Sports Medicine Annual Meeting. The research was presented by Dr. Barry P. Boden of The Orthopaedic Center, Rockville, Md.
Football is associated with the highest number of fatalities of any high school or college sport, but the number of traumatic injuries incurred while playing football have declined significantly since the 1960s.
However, the annual number of non-traumatic fatalities has stayed constant with current rates that are two to three times higher than traumatic fatalities.
Heat and sickle cell trait fatality rates were compared pre- and post-implementation of the NCAA football acclimatization model in 2003 and sickle cell screening policies implemented in 2010, respectively.
Boden and his team reviewed 187 non-traumatic football fatalities that occurred between 1998 and 2018. The researchers obtained information from extensive internet searches, as well as depositions, investigations, autopsies, media and freedom of information reports.
Of the 187 fatalities, more than half (52 percent) were due to cardiac issues; 24 percent were caused by heat; and five percent from asthma.
“The majority of deaths occurred outside of the regular season months of September through December, with the most common month for fatalities being August,” Boden reported.
Boden said many of the fatalities had three issues in common: the conditioning sessions were supervised by the football coach or strength and conditioning coach; irrationally intense workouts and/or punishment drills were scheduled; and an inadequate medical response was implemented.
The average annual rate of heat-related fatalities remained unchanged at the collegiate level pre- and post-implementation of the NCAA football acclimatization model in 2003. The average annual number of sickle cell trait deaths in collegiate football declined 58 percent after the 2010 NCAA sickle cell screening policies were implemented. At the high school level, where there are no sickle cell guidelines, the number of sickle cell fatalities increased 400 percent since 2010.
The football acclimatization model implemented by the NCAA in 2003 has failed at reducing exertional heat-related fatalities at the collegiate level. Sickle cell trait screening policies adopted by the NCAA in 2010 have been effective at reducing fatalities in college athletes and similar guidelines should be mandated at the high school level.
“Conditioning-related fatalities are preventable by establishing standards in workout design, holding coaches and strength and conditioning coaches accountable, ensuring compliance with current policies, and allowing athletic health care providers complete authority over medical decisions,” Boden reported.

Explore further
Athletes with sickle cell traits are at more risk to collapse: here’s why
More information: http://www.sportsmed.org/aossmimis/me … AM2019-Abstracts.pdf
Provided by American Orthopaedic Society for Sports Medicine

Faye Reid wrote in Moderation And Fitness | What Is The Balance?

The fact of the matter is that while an extreme and explosive shred workout is a great thing, it becomes useless without moderation. Regardless of what your goals are, sustainability has to at least be somewhere in your priority list. Whether you are training for a sports match, a competition, or for summer, one would generally want to be able to get back into the gym after completing such a goal. But where one trains with ferocity without moderation, injuries and burn-outs leave a fitness career with an early death.
The most important ingredients to a good training regime can all by injected with a healthy dose of moderation to ensure sustainability and longevity…. https://www.myprotein.com/thezone/training/moderation-and-fitness-what-is-the-balance/

The choicest pleasures of life lie within the ring of moderation.
Benjamin Disraeli

The Sports Concussion Institute has some great information about concussions http://www.concussiontreatment.com/concussionfacts.html

Resources:

Concussions
http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Concussion
http://www.emedicinehealth.com/concussion/article_em.htm

Concussion – Overview
http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

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