Tag Archives: Mayo Clinic

UNC Lineberger Comprehensive Cancer Center study: Will telehealth services become the norm following COVID-19 pandemic?

30 Jul

The Mayo Clinic explained Telehealth in Telehealth: Technology meets health care: See how technology can improve your health care:

What is telehealth?

Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care. These may be technologies you use from home or that your doctor uses to improve or support health care services.

Consider, for example, the ways telehealth could help you if you have diabetes. You could do some or all of the following:

  • Use a mobile phone or other device to upload food logs, medications, dosing and blood sugar levels for review by a nurse who responds electronically.
  • Watch a video on carbohydrate counting and download an app for it to your phone.
  • Use an app to estimate, based on your diet and exercise level, how much insulin you need.
  • Use an online patient portal to see your test results, schedule appointments, request prescription refills or email your doctor.
  • Order testing supplies and medications online.
  • Get a mobile retinal photo screening at your doctor’s office rather than scheduling an appointment with a specialist.
  • Get email, text or phone reminders when you need a flu shot, foot exam or other preventive care.

The goals of telehealth, also called e-health or m-health (mobile health), include the following:

  • Make health care accessible to people who live in rural or isolated communities.
  • Make services more readily available or convenient for people with limited mobility, time or transportation options.
  • Provide access to medical specialists.
  • Improve communication and coordination of care among members of a health care team and a patient.
  • Provide support for self-management of health care.

The following examples of telehealth services may be beneficial for your health care.

Patient portal

Your primary care clinic may have an online patient portal. These portals offer an alternative to email, which is a generally insecure means to communicate about private medical information. A portal provides a more secure online tool to do the following:

  • Communicate with your doctor or a nurse.
  • Request prescription refills.
  • Review test results and summaries of previous visits.
  • Schedule appointments or request appointment reminders.

If your doctor is in a large health care system, the portal also may provide a single point of communication for any specialists you may see.

Virtual appointments

Some clinics may provide virtual appointments that enable you to see your doctor or a nurse via online videoconferencing. These appointments enable you to receive ongoing care from your regular doctor when an in-person visit isn’t required or possible….

Remote monitoring

A variety of technologies enable your doctor or health care team to monitor your health remotely. These technologies include:

  • Web-based or mobile apps for uploading information, such as blood glucose readings, to your doctor or health care team
  • Devices that measure and wirelessly transmit information, such as blood pressure, blood glucose or lung function
  • Wearable devices that automatically record and transmit information, such as heart rate, blood glucose, gait, posture control, tremors, physical activity or sleep patterns
  • Home monitoring devices for older people or people with dementia that detect changes in normal activities such as falls…

https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878

Resources:

What is Telehealth?                                                                                                                https://www.aap.org/en-us/professional-resources/practice-transformation/telehealth/Pages/What-is-Telehealth.aspx

What Is Telehealth?                                                                                                             https://www.goodrx.com/blog/what-is-telehealth/

How Does Telemedicine Work?                                                                                                 https://www.webmd.com/lung/how-does-telemedicine-work#1

Science Daily reported in Will telehealth services become the norm following COVID-19 pandemic?

The onset of the COVID-19 pandemic has broadly affected how health care is provided in the United States. One notable change is the expanded use of telehealth services, which have been quickly adopted by many health care providers and payers, including Medicare, to ensure patients’ access to care while reducing their risk of exposure to the coronavirus.

In an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine, said the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

“The COVID-19 pandemic has resulted in the rapid deregulation of telehealth services. This was done in part by lifting geographical restrictions, broadening patient, health care professional, and services eligibility,” said Royce, the article’s corresponding author. “It is likely aspects of telehealth continue to be part of the health care delivery system, beyond the pandemic.”

The article’s other authors are UNC Lineberger’s Hanna K. Sanoff, MD, MPH, clinical medical director of the North Carolina Cancer Hospital and associate professor in the UNC School of Medicine Division of Hematology, and Amar Rewari, MD, MBA, from the Associates in Radiation Medicine, Adventist HealthCare Radiation Oncology Center in Rockville, Maryland.

Royce said the widespread shift to telehealth was made possible, in part, by three federal economic stimulus packages and the Centers for Medicare and Medicaid Services making several policy changes in March that expanded Medicare recipients’ access to telehealth services.

The policy changes included allowing telehealth services to be provided in a patient’s home. Medicare previously only paid for telehealth services in a facility in nonurban areas or areas with a health professional shortage. Medicare also approved payment for new patient appointments, expanded telehealth coverage to include 80 additional services, allowed for services to be carried out on a wider assortment of telecommunication systems — including remote video communications platforms, such as Zoom — and modified the restrictions of who can provide and supervise care.

While the potential benefits of telehealth have been demonstrated during the pandemic, Royce said they must be balanced with concerns about care quality and safety….                                                                                        https://www.sciencedaily.com/releases/2020/07/200716144727.htm

 

Citation:

Will telehealth services become the norm following COVID-19 pandemic?

Date:      July 16, 2020

Source:  UNC Lineberger Comprehensive Cancer Center

Summary:

Experts address whether the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

Journal Reference:

Trevor J. Royce, Hanna K. Sanoff, Amar Rewari. Telemedicine for Cancer Care in the Time of COVID-19. JAMA Oncology, 2020; DOI: 10.1001/jamaoncol.2020.2684

Here is the press release from UNC Lineberger Comprehensive Cancer Center:

Home / News from Lineberger / Will telehealth services become the norm following COVID-19 pandemic?

Will telehealth services become the norm following COVID-19 pandemic?

July 16, 2020

The onset of the COVID-19 pandemic has broadly affected how health care is provided in the United States. One notable change is the expanded use of telehealth services, which have been quickly adopted by many health care providers and payers, including Medicare, to ensure patients’ access to care while reducing their risk of exposure to the coronavirus.

In an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine, said the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

“The COVID-19 pandemic has resulted in the rapid deregulation of telehealth services. This was done in part by lifting geographical restrictions, broadening patient, health care professional, and services eligibility,” said Royce, the article’s corresponding author. “It is likely aspects of telehealth continue to be part of the health care delivery system, beyond the pandemic.”

The article’s other authors are UNC Lineberger’s Hanna K. Sanoff, MD, MPH, clinical medical director of the North Carolina Cancer Hospital and associate professor in the UNC School of Medicine Division of Hematology, and Amar Rewari, MD, MBA, from the Associates in Radiation Medicine, Adventist HealthCare Radiation Oncology Center in Rockville, Maryland.

Royce said the widespread shift to telehealth was made possible, in part, by three federal economic stimulus packages and the Centers for Medicare and Medicaid Services making several policy changes in March that expanded Medicare recipients’ access to telehealth services.

The policy changes included allowing telehealth services to be provided in a patient’s home. Medicare previously only paid for telehealth services in a facility in nonurban areas or areas with a health professional shortage. Medicare also approved payment for new patient appointments, expanded telehealth coverage to include 80 additional services, allowed for services to be carried out on a wider assortment of telecommunication systems – including remote video communications platforms, such as Zoom – and modified the restrictions of who can provide and supervise care.

While the potential benefits of telehealth have been demonstrated during the pandemic, Royce said they must be balanced with concerns about care quality and safety.

“There is a lot we don’t know about telehealth, and how its rapid adoption will impact our patients,” Royce said. “How will the safety and quality of care be impacted? How will we integrate essential components of the traditional doctor visit, including physical exam, lab work, scans and imaging? Will patients and doctors be more or less satisfied with their care? These are all potential downsides if we are not thoughtful with our adoption.”

He said appropriate oversight of care is critical. There will be a continued need for objective patient assessments, such as patient-reported outcomes, physical examinations and laboratory tests, and to measure care quality and monitor for fraud. There are also a number of standard measures of care quality that can be implemented during the transition to telehealth, including tracking emergency room visits, hospitalizations and adverse events.

Telehealth presents other challenges, as well. Though technology and internet access are now more widely available, they are not universally accessible. Where one lives, their socioeconomic status and comfort level with technology can be barriers to using telehealth services. A reliance on telehealth might lower participation in clinical trials, which can require regular in-person appointments.

“Telehealth can be used to improve access to care in traditionally hard-to-reach populations. However, it is important to acknowledge that if we are not thoughtful in its adoption, the opposite could be true,” Royce said. “For example, will lower socioeconomic groups have the same level of access to an adequate internet connection or cellular services that make a virtual video visit possible? Telehealth needs to be adopted with equity in mind.”

Media Contact: Bill Schaller, bill_schaller@med.unc.edu

 

Mikhail Varshavski wrote in Pros and Cons of Telemedicine & Telehealth:

Advantages of Telemedicine

  1. Higher level of flexibility
  2. Convenience
  3. Reduction of risk for infections
  4. Less waiting time
  5. Better medical support for rural areas
  6. Telehealth is more efficient
  7. Telemedicine can reduce doctor’s shortage
  8. More patients can be treated on average
  9. Information sharing between doctors
  10. Reduction in travel expenses
  11. Lower costs for minor issues
  12. Patients may be more eager to get medical advice
  13. Can give doctors a competitive advantage

 

Problems of Telehealth

  1. Privacy issues
  2. Hacking
  3. Technical problems
  4. No physical examination possible
  5. Doctor’s may have problems to adapt
  6. Excessive consultations
  7. Specific software and training may be needed
  8. Number of wrong diagnoses may increase
  9. Doctors may be sued more often
  10. Varying levels of regulations regarding telehealth
  11. May not be affordable for small doctor’s offices
  12. May not be covered by health insurance yet
  13. Job losses

 

Resources:

Telemedicine Pros and Cons                                                                                     https://healthresearchfunding.org/telemedicine-pros-cons/

What Are the Benefits and Advantages of Telemedicine?                                                    https://www.healthline.com/health/telemedicine-benefits-and-advantages#1

Clinicians see pros, cons to telehealth                                                                                        ‘We’re doing whatever we can to get the service to our folks’                                                http://www.hmenews.com/article/clinicians-see-pros-cons-telehealth

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/

 

 

 

 

 

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National Jewish Health study: African American children respond differently to asthma medications

28 Sep

The Mayo Clinic provides a concise definition of Asthma:

Overview
Asthma attack
Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.
For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.
Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed. https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653

The National Center for Health Statistics has stats on health related issues.

According to the National Center for Health Statistics:

Asthma
Data are for the U.S.
Morbidity
• Number of adults aged 18 and over who currently have asthma: 19.0 million
• Percent of adults aged 18 and over who currently have asthma: 7.7%
Source: Summary Health Statistics Tables for U.S. Adults: National Health Interview Survey, 2017, tables A-2b, A-2c pdf icon[PDF – 137 KB]
• Number of children under age 18 years who currently have asthma: 6.2 million
• Percent of children under age 18 years who currently have asthma: 8.4%
Source: Summary Health Statistics Tables for U.S. Children: National Health Interview Survey, 2017, tables C-1b, C-1c pdf icon[PDF – 99.8 KB]
Physician office visits
• Percent of visits to office-based physicians with asthma indicated on the medical record: 7.1%
Source: National Ambulatory Medical Care Survey: 2016 National Summary Tables, tables 18 pdf icon[PDF – 793 KB]
Emergency department visits
• Percent of visits to emergency departments with asthma indicated on the medical record: 10.1%
Source: National Hospital Ambulatory Medical Care Survey: 2016 Emergency Department Summary Tables, table 13 pdf icon[PDF – 738 KB]
Mortality
• Number of deaths: 3,564
• Deaths per 100,000 population: 1.1
Source: Deaths: Final Data for 2017, Supplemental Tables, tables I-12, I-13 pdf icon[PDF – 2 MB]
https://www.cdc.gov/nchs/fastats/asthma.htm

According to a study by National Jewish Health, African-American children respond differently to different medications for asthma.

Resources:

Need Help Managing Your Asthma? https://www.asthma.com/?bing=e_&rotation=71700000038361464&banner=58700004208867532&kw=34938313622&cc=6A9489DC2E35&pid=43700012675028871&gclid=CLygyM2c9OQCFYOngQodxLwFHQ&gclsrc=ds
Asthma: Causes, Symptoms, Diagnosis, Treatment https://www.webmd.com/asthma/what-is-asthma

Asthma | National Heart, Lung, and Blood Institute (NHLBI) https://www.nhlbi.nih.gov/health-topics/asthma

Science Daily reported in African American children respond differently to asthma medications:

African Americans suffer asthma more often and more severely than Caucasian patients. However, clinical trials that have shaped treatment guidelines have included few African Americans. A new report demonstrates a shortcoming of that history. Researchers at National Jewish Health and their colleagues around the nation in the National Heart, Lung & Blood Institute’s AsthmaNet report that African American children respond differently than African American adults and Caucasian adults and children to step-up therapies for inadequately controlled asthma.
“Asthma is a tremendously variable disease,” said Michael Wechsler, MD, professor of medicine at National Jewish Health and first author on the study published in the New England Journal of Medicine. “We need to more closely study subgroups of asthma patients, especially those disproportionately burdened by disease, such as African Americans.”
The researchers evaluated 280 children, ages 5-11, and 294 adolescents/adults of African American ancestry whose asthma was inadequately controlled with low doses of inhaled corticosteroids. Treatment guidelines call for adding a long-acting beta agonist as the preferred step-up therapy. Researchers several medication strategies — adding long-acting beta agonists, increasing inhaled steroids alone and both increasing inhaled steroids and adding long-acting beta agonists.
The researchers measured response by evaluating several factors including exacerbations, asthma control days and lung function.
More adult African Americans responded better to adding long-acting beta agonists (49 percent) versus increasing inhaled steroids alone (28 percent). Caucasians have shown a similar response in previous trials.
However, even numbers of African American children responded better to increasing the dose of inhaled corticosteroids along (46 percent) and adding long-acting beta agonists (46 percent).
“These results indicate that asthma treatment guidelines do not necessarily apply to African American children and that physicians should consider alternatives,” said Dr. Wechsler. “We need to do a better job of understanding how different subgroups respond to asthma treatment….” https://www.sciencedaily.com/releases/2019/09/190927135119.htm

Citation:

African American children respond differently to asthma medications
BARD trial suggests shortcomings in treatment guidelines and demonstrates need for trials of specific subgroups

Date: September 27, 2019
Source: National Jewish Health
Summary:
African Americans suffer asthma more often and more severely than Caucasian patients. However, clinical trials that have shaped treatment guidelines have included few African Americans. A new report demonstrates a shortcoming of that history. Researchers report that African American children respond differently than African American adults and Caucasian adults and children to step-up therapies for inadequately controlled asthma.

Journal Reference:
Michael E. Wechsler, Stanley J. Szefler, Victor E. Ortega, Jacqueline A. Pongracic, Vernon Chinchilli, John J. Lima, Jerry A. Krishnan, Susan J. Kunselman, David Mauger, Eugene R. Bleecker, Leonard B. Bacharier, Avraham Beigelman, Mindy Benson, Kathryn V. Blake, Michael D. Cabana, Juan-Carlos Cardet, Mario Castro, James F. Chmiel, Ronina Covar, Loren Denlinger, Emily DiMango, Anne M. Fitzpatrick, Deborah Gentile, Nicole Grossman, Fernando Holguin, Daniel J. Jackson, Harsha Kumar, Monica Kraft, Craig F. LaForce, Jason Lang, Stephen C. Lazarus, Robert F. Lemanske, Dayna Long, Njira Lugogo, Fernando Martinez, Deborah A. Meyers, Wendy C. Moore, James Moy, Edward Naureckas, J. Tod Olin, Stephen P. Peters, Wanda Phipatanakul, Loretta Que, Hengameh Raissy, Rachel G. Robison, Kristie Ross, William Sheehan, Lewis J. Smith, Julian Solway, Christine A. Sorkness, Lisa Sullivan-Vedder, Sally Wenzel, Steven White, Elliot Israel. Step-Up Therapy in Black Children and Adults with Poorly Controlled Asthma. New England Journal of Medicine, 2019; 381 (13): 1227 DOI: 10.1056/NEJMoa1905560

Here is the press report from National Jewish Health:

NEWS RELEASE 27-SEP-2019
African American children respond differently to asthma medications
BARD trial suggests shortcomings in treatment guidelines and demonstrates need for trials of specific subgroups
NATIONAL JEWISH HEALTH
African Americans suffer asthma more often and more severely than Caucasian patients. However, clinical trials that have shaped treatment guidelines have included few African Americans. A new report demonstrates a shortcoming of that history. Researchers at National Jewish Health and their colleagues around the nation in the National Heart, Lung & Blood Institute’s AsthmaNet report that African American children respond differently than African American adults and Caucasian adults and children to step-up therapies for inadequately controlled asthma.
“Asthma is a tremendously variable disease,” said Michael Wechsler, MD, professor of medicine at National Jewish Health and first author on the study published in the New England Journal of Medicine. “We need to more closely study subgroups of asthma patients, especially those disproportionately burdened by disease, such as African Americans.”
The researchers evaluated 280 children, ages 5-11, and 294 adolescents/adults of African American ancestry whose asthma was inadequately controlled with low doses of inhaled corticosteroids. Treatment guidelines call for adding a long-acting beta agonist as the preferred step-up therapy. Researchers several medication strategies – adding long-acting beta agonists, increasing inhaled steroids alone and both increasing inhaled steroids and adding long-acting beta agonists.
The researchers measured response by evaluating several factors including exacerbations, asthma control days and lung function.
More adult African Americans responded better to adding long-acting beta agonists (49 percent) versus increasing inhaled steroids alone (28 percent). Caucasians have shown a similar response in previous trials.
However, even numbers of African American children responded better to increasing the dose of inhaled corticosteroids along (46 percent) and adding long-acting beta agonists (46 percent).
“These results indicate that asthma treatment guidelines do not necessarily apply to African American children and that physicians should consider alternatives,” said Dr. Wechsler. “We need to do a better job of understanding how different subgroups respond to asthma treatment.”
The researchers also looked at several biological and genetic factors to determine if any could predict treatment response. However, they did not find that any biomarkers or percentage of African American ancestry was associated treatment response.
###
National Jewish Health is the leading respiratory hospital in the nation. Founded 120 years ago as a nonprofit hospital, National Jewish Health today is the only facility in the world dedicated exclusively to groundbreaking medical research and treatment of patients with respiratory, cardiac, immune and related disorders. Patients and families come to National Jewish Health from around the world to receive cutting-edge, comprehensive, coordinated care. To learn more, visit http://www.njhealth.org.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

It is important to seek competent medical advice for the diagnosis or treatment of asthma.

The Mayo Clinic explained the diagnosis of asthma:

Diagnosis

Physical exam

To rule out other possible conditions — such as a respiratory infection or chronic obstructive pulmonary disease (COPD) — your doctor will do a physical exam and ask you questions about your signs and symptoms and about any other health problems.
Tests to measure lung function
You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include:
• Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
• Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings.
Lung function tests often are done before and after taking a medication called a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it’s likely you have asthma.
Additional tests
Other tests to diagnose asthma include:
• Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.
• Nitric oxide test. This test, though not widely available, measures the amount of the gas, nitric oxide, that you have in your breath. When your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels.
• Imaging tests. A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.
• Allergy testing. This can be performed by a skin test or blood test. Allergy tests can identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy.
• Sputum eosinophils. This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin).
• Provocative testing for exercise and cold-induced asthma. In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air.
How asthma is classified
To classify your asthma severity, your doctor considers your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests.
Determining your asthma severity helps your doctor choose the best treatment. Asthma severity often changes over time, requiring treatment adjustments.
Asthma is classified into four general categories:
Asthma classification Signs and symptoms
Mild intermittent Mild symptoms up to two days a week and up to two nights a month
Mild persistent Symptoms more than twice a week, but no more than once in a single day
Moderate persistent Symptoms once a day and more than one night a week
Severe persistent Symptoms throughout the day on most days and frequently at night
More Information
https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc-20369660

Resources:

Asthma: Treatment & Care – WebMD                                http://www.webmd.com/asthma/guide/asthma-treatment-care

Asthma – Management and Treatment | CDC https://www.cdc.gov/asthma/management.html

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/

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Medical University of South Carolina study: How gonorrhea develops resistance to antibiotics

25 Aug

Medline summarized sexually transmitted diseases (STD):

Summary
Sexually transmitted diseases (STDs) are infections that are passed from one person to another through sexual contact. The causes of STDs are bacteria, parasites, yeast, and viruses. There are more than 20 types of STDs, including
• Chlamydia
• Genital herpes
• Gonorrhea
• HIV/AIDS
• HPV
• Syphilis
• Trichomoniasis
Most STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STD, it can cause serious health problems for the baby.
Antibiotics can treat STDs caused by bacteria, yeast, or parasites. There is no cure for STDs caused by a virus, but medicines can often help with the symptoms and keep the disease under control.
Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STDs. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex.
Centers for Disease Control and Prevention https://medlineplus.gov/sexuallytransmitteddiseases.html

Helen Adams reported in Skyrocketing STDs have doctors urging sexually active young people to be tested:

MUSC Health obstetrician and gynecologist Jessica Tarleton has seen a lot in her role as a reproductive infectious disease specialist, but even she is stunned by new STD statistics released by the Centers for Disease Control and Prevention. “A lot of these infections are in young people, very young people.”
This week, the CDC reported there were almost 2.3 million cases of chlamydia, gonorrhea and syphilis in the United States last year….
• Chlamydia is the most common, with more than 1.7 million cases last year.
• Gonorrhea diagnoses rose 67 percent between 2013 and 2017, hitting 555,608 last year.
• Syphilis jumped 76 percent during that same time period, hitting 30,644 cases last year.

Here’s why getting tested matters. A lot of people who have STDs don’t have any symptoms or don’t realize their rashes and other issues are linked to STDs. So if they don’t get tested regularly, the disease can progress. Chlamydia and gonorrhea can cause infertility in women if left untreated. Syphilis can cause neurological problems in both women and men, Tarleton says. And it can do more than that.

“One of the things that’s most upsetting to me is the rate of syphilis we’re seeing in pregnant women, because that can have severe effects on the fetus and baby. Babies can have congenital birth defects, some bone malformations, blindness and deafness. Sometimes it can lead to miscarriage or fetal death in utero. This can happen in moms who don’t know they have it.”

The good news is, all three STDs are treatable with antibiotics, although there is concern that gonorrhea is becoming antibiotic resistant.

So what’s going on? Why is the U.S. seeing a surge in STDs to the point that it’s being called a public health crisis?

Tarleton says part of the problem is some of the people at risk of getting STDs, young people, don’t know enough to worry about them. “Our teenagers are kind of going out unequipped to protect themselves from getting these infections.”

Other factors causing the rise in STDs, cited in a national discussion this week at the CDC’s 2018 STD Prevention Conference, include:

• A lack of funding for prevention programs.
• The opioid epidemic, which is causing some women to trade sex for drugs.
• Methamphetamines and other drugs, which are linked to forced sex, sex for money and sex with people who inject drugs.
• Doctors and patients who are reluctant to talk about STDs….

Tarleton says the best way to prevent STDs is to use condoms. “Condoms are still a very effective way of preventing the spread of sexually transmitted infections. And we want people to take seriously the need for screening and treatment of themselves and their sexual partners. I don’t think the message has been getting out, and it’s becoming a bigger and bigger problem.”
https://web.musc.edu/about/news-center/2018/08/31/skyrocketing-stds-have-doctors-urging-sexually-active-young-people-to-be-tested

Resources:

Your Guide to Sexually Transmitted Diseases                                            https://www.webmd.com/sexual-conditions/guide/sexual-health-stds#1

Sexually Transmitted Diseases                                                     https://www.drugs.com/cg/sexually-transmitted-diseases.html

Symptoms and Signs of Sexually Transmitted Diseases (STDs)
Privacy & Trust Info
Doctor’s Notes on Sexually Transmitted Diseases (STDs) https://www.emedicinehealth.com/sexually_transmitted_diseases/symptom.htm

Sexually Transmitted Diseases (STDs)                                        https://www.cdc.gov/std/default.htm

Science Daily reported in How gonorrhea develops resistance to antibiotics:

Steadily and relentlessly, the bacterium that causes gonorrhea has slipped past medicine’s defenses, acquiring resistance to once-reliable drugs, including penicillin, tetracycline, and ciprofloxacin. These former stalwarts are no longer used to treat the sexually transmitted disease.
In 2010, after some strains of Neisseria gonorrhoeae, the bacterium responsible for gonorrhea, began showing resistance to one of the last remaining classes of antibiotics, the Centers for Disease Control and Prevention began recommending “dual therapy,” meaning that doctors now prescribe two drugs at the same time to fight gonorrhea. Currently, those two drugs are ceftriaxone, a member of the cephalosporin class of antibiotics, and azithromycin.
With fears increasing that gonorrhea could breach these last defenses, the work of researchers like crystallographer Christopher Davies, Ph.D., is crucial.
“We’re looking at a molecular level at the events that have got everybody worried out there in the clinics,” said Davies, a professor in the Department of Biochemistry & Molecular Biology and director of the MUSC Center for Structural Biology.
Davies’ team has just published a paper showing how cephalosporins bind and inactivate a gonococcal protein dubbed penicillin-binding protein 2 (PBP2). Led by postdoctoral fellow Avinash Singh, Ph.D., the researchers showed the protein undergoes key structural changes, including twisting and rolling of a loop to bind the antibiotic, that enhance the reaction with cephalosporins. Without these changes, the protein would react much more slowly with the antibiotic.
Davies explained that all antibiotics work by targeting essential functions in a particular bug. Cephalosporins work by attacking the bacterial cell wall.
Normally, PBP2 moves along the bacterial cell’s cytoplasmic membrane, reaching out into the space between the cytoplasmic membrane and the outer membrane, looking for peptides to bind to. The protein joins peptides together to create a mesh — just like an onion bag at the grocery store, Davies said. But antibiotics jump in to bind to the protein before it can get to a peptide.
“The protein is walking around the membrane layer as normal, but its active site is blocked by antibiotic, so all those potential interactions with the peptide substrate are fruitless,” Davies said.
With the protein out of commission and not building the mesh, holes start to appear in the cell wall. Cytoplasm starts to leak out, and the cell bursts and dies, Davies said.
Yet the resistant strains, which have been identified in Japan, France, Spain and most recently in Canada, evade the lethal action of cephalosporins by preventing the antibiotic from binding to the protein target. How they achieve this is a major focus of Davies’ research.
There are 60-some mutations on the PBP2 protein in the resistant strains of gonorrhea. Davies’ team has identified six mutations that are at the root of the resistance and is looking at how the mutations change the way the protein reacts to antibiotics…. https://www.sciencedaily.com/releases/2019/08/190823140704.htm

Citation:

How gonorrhea develops resistance to antibiotics
Date: August 23, 2019
Source: Medical University of South Carolina
Summary:
As public health officials worry about the emergence of antibiotic-resistant gonorrhea, researchers are tracing how antibiotics bind to a gonococcal protein, information that can help lead to new antimicrobials.

Journal Reference:
Avinash Singh, Joshua Tomberg, Robert A Nicholas, Christopher Davies. Recognition of the β-lactam Carboxylate Triggers Acylation of Neisseria gonorrhoeae Penicillin-Binding Protein 2. Journal of Biological Chemistry, 2019; jbc.RA119.009942 DOI: 10.1074/jbc.RA119.009942

Here is the press release from Medical University of South Carolina:

Researcher works to understand how gonorrhea develops resistance to antibiotics

Leslie Cantu

August 23, 2019

Steadily and relentlessly, the bacterium that causes gonorrhea has slipped past medicine’s defenses, acquiring resistance to once-reliable drugs, including penicillin, tetracycline and ciprofloxacin. These former stalwarts are no longer used to treat the sexually transmitted disease.
In 2010, after some strains of Neisseria gonorrhoeae, the bacterium responsible for gonorrhea, began showing resistance to one of the last remaining classes of antibiotics, the Centers for Disease Control and Prevention began recommending “dual therapy,” meaning that doctors now prescribe two drugs at the same time to fight gonorrhea. Currently, those two drugs are ceftriaxone, a member of the cephalosporin class of antibiotics, and azithromycin.

With fears increasing that gonorrhea could breach these last defenses, the work of researchers like crystallographer Christopher Davies, Ph.D., is crucial.

“We’re looking at a molecular level at the events that have got everybody worried out there in the clinics,” said Davies, a professor in the Department of Biochemistry & Molecular Biology and director of the MUSC Center for Structural Biology.

Davies’ team has just published a paper showing how cephalosporins bind and inactivate a gonococcal protein dubbed penicillin-binding protein 2 (PBP2). Led by postdoctoral fellow Avinash Singh, Ph.D., the researchers showed the protein undergoes key structural changes, including twisting and rolling of a loop to bind the antibiotic, that enhance the reaction with cephalosporins. Without these changes, the protein would react much more slowly with the antibiotic.

Davies explained that all antibiotics work by targeting essential functions in a particular bug. Cephalosporins work by attacking the bacterial cell wall.

Normally, PBP2 moves along the bacterial cell’s cytoplasmic membrane, reaching out into the space between the cytoplasmic membrane and the outer membrane, looking for peptides to bind to. The protein joins peptides together to create a mesh – just like an onion bag at the grocery store, Davies said. But antibiotics jump in to bind to the protein before it can get to a peptide.

“The protein is walking around the membrane layer as normal, but its active site is blocked by antibiotic, so all those potential interactions with the peptide substrate are fruitless,” Davies said.

With the protein out of commission and not building the mesh, holes start to appear in the cell wall. Cytoplasm starts to leak out, and the cell bursts and dies, Davies said.

Yet the resistant strains, which have been identified in Japan, France, Spain and most recently in Canada, evade the lethal action of cephalosporins by preventing the antibiotic from binding to the protein target. How they achieve this is a major focus of Davies’ research.
There are 60-some mutations on the PBP2 protein in the resistant strains of gonorrhea. Davies’ team has identified six mutations that are at the root of the resistance and is looking at how the mutations change the way the protein reacts to antibiotics.

Once researchers understand how the mutations are preventing antibiotics from doing their work, new drugs can be developed, Davies said. Knowing which mutations are important may also allow a diagnostic test to be developed to tell doctors whether a particular patient has a resistant strain and, therefore, which drugs to prescribe.

Davies said it appears that the mutations restrict the protein’s flexibility, preventing the structural changes needed to bind the antibiotic. That triggers a new mystery. If those movements are critical to its job of binding to peptides and building the mesh that keeps the cell wall intact, how can the mutations block the antibiotic but still allow the normal reaction? “This is the most fascinating aspect of our research,” Davies said.

“It’s an essential function, so the mutations can’t change the protein too much. It must be able to discriminate. Discriminating against an antibiotic while still retaining the normal binding and reaction with their substrate is a delicate balancing act they have to negotiate,” he said.

This balancing act might be the reason that antibiotic-resistant gonorrhea hasn’t spread as quickly as anticipated.

“There’s a fitness cost. They don’t function quite as well as their susceptible counterparts, and it’s probably for that reason they’re not spreading as fast as people feared they would,” Davies said.

Although the resistant-type gonorrhea isn’t spreading as quickly as public health officials feared, there have been increases in the number of cases of susceptible gonorrhea, as well as other sexually transmitted diseases.

Gonorrhea diagnoses increased by 67% between 2013 and 2017, according to the CDC.

“We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,” said Gail Bolan, M.D., director of the CDC’s Division of STD Prevention, when it released those figures.

South Carolina has the fourth highest rate of gonorrhea in the U.S., according to an analysis of CDC numbers by Health Testing Centers, a lab testing service.
MUSC infectious disease specialist Eric Meissner, M.D., Ph.D., said it’s not entirely clear why the rates of STDs are increasing.

“We know that there are proven interventions that individuals can use, including regular use of condoms, that markedly reduce the odds of acquiring a sexually transmitted disease. So the rise in STD rates suggests there’s a need for more public health interventions and education,” he said.

Although gonorrhea isn’t fatal, it can cause lifelong problems if left untreated, including infertility and susceptibility to other sexually transmitted diseases, like HIV.

“An important thing for people to know is you can have gonorrhea and not have symptoms, so you can’t rely upon the absence of symptoms alone to provide reassurance that you or your sexual partner do not have gonorrhea,” Meissner said. “Sexually active people at risk for gonorrhea exposure should get regular testing”.

Meanwhile, Davies and his team are continuing their work in the lab. The next step is understanding how the protein can still perform its normal essential function while eluding the antibiotics. The group has some ideas that it will put to the test, he said.

Meissner said antibiotic resistance is concerning to doctors in the clinic.

“Even though the specific strain Dr. Davies is studying is rare, it is important to note that the emergence of resistance in gonorrhea is a real concern,” Meissner said.

About the Author
Leslie Cantu
Keywords: Research
Contact Us 843-792-2300 https://web.musc.edu/about/news-center/2019/08/23/antibiotic-resistant-gonorrhea-research

The Mayo Clinic summarized treatment for STDs:

Diagnosis
Tests
If your sexual history and current signs and symptoms suggest that you have a sexually transmitted disease (STD) or a sexually transmitted infection (STI), laboratory tests can identify the cause and detect coinfections you might also have.
• Blood tests. Blood tests can confirm the diagnosis of HIV or later stages of syphilis.
• Urine samples. Some STIs can be confirmed with a urine sample.
• Fluid samples. If you have open genital sores, your doctor may test fluid and samples from the sores to diagnose the type of infection.
Screening
Testing for a disease in someone who doesn’t have symptoms is called screening. Most of the time, STI screening is not a routine part of health care, but there are exceptions:
• Everyone. The one STI screening test suggested for everyone ages 13 to 64 is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Experts recommend that people at high risk have an HIV test every year.
• Everyone born between 1945 and 1965. There’s a high incidence of hepatitis C in people born between 1945 and 1965. Since the disease often causes no symptoms until it’s advanced, experts recommend that everyone in that age group be screened for hepatitis C.
• Pregnant women. All pregnant women will generally be screened for HIV, hepatitis B, chlamydia and syphilis at their first prenatal visit. Gonorrhea and hepatitis C screening tests are recommended at least once during pregnancy for women at high risk of these infections.
• Women age 21 and older. The Pap test screens for cervical abnormalities, including inflammation, precancerous changes and cancer, which is often caused by certain strains of human papillomavirus (HPV). Experts recommend that women have a Pap test every three years starting at age 21. After age 30, experts recommend women have an HPV DNA test and a Pap test every five years. A Pap test every three years is also acceptable.
• Women under age 25 who are sexually active. Experts recommend that all sexually active women under age 25 be tested for chlamydia infection. The chlamydia test uses a sample of urine or vaginal fluid you can collect yourself.
Some experts recommend repeating the chlamydia test three months after you’ve had a positive test and been treated. Reinfection by an untreated or undertreated partner is common, so you need the second test to confirm that the infection is cured. You can catch chlamydia multiple times, so get retested if you have a new partner.
Screening for gonorrhea is also recommended in sexually active women under age 25.
• Men who have sex with men. Compared with other groups, men who have sex with men run a higher risk of acquiring STIs. Many public health groups recommend annual or more-frequent STI screening for these men. Regular tests for HIV, syphilis, chlamydia and gonorrhea are particularly important. Evaluation for hepatitis B also may be recommended.
• People with HIV. If you have HIV, it dramatically raises your risk of catching other STIs. Experts recommend immediate testing for syphilis, gonorrhea, chlamydia and herpes after being diagnosed with HIV. They also recommend that people with HIV be screened for hepatitis C.
Women with HIV may develop aggressive cervical cancer, so experts recommend they have a Pap test within a year of being diagnosed with HIV, and then again six months later.
• People who have a new partner. Before having vaginal or anal intercourse with new partners, be sure you’ve both been tested for STIs. However, routine testing for genital herpes isn’t recommended unless you have symptoms.
It’s also possible to be infected with an STI yet still test negative, particularly if you’ve recently been infected.
More Information
• STD testing
• Complete blood count (CBC)
• HIV testing
Show More
Treatment
Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) caused by bacteria are generally easier to treat. Viral infections can be managed but not always cured. If you are pregnant and have an STI, getting treatment right away can prevent or reduce the risk of your baby becoming infected.
Treatment for STIs usually consists of one of the following, depending on the infection:
• Antibiotics. Antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Typically, you’ll be treated for gonorrhea and chlamydia at the same time because the two infections often appear together.
Once you start antibiotic treatment, it’s necessary to follow through. If you don’t think you’ll be able to take medication as prescribed, tell your doctor. A shorter, simpler course of treatment may be available.
In addition, it’s important to abstain from sex until seven days after you’ve completed antibiotic treatment and any sores have healed. Experts also suggest women be retested in about three months because there’s high chance of reinfection.
• Antiviral drugs. If you have herpes or HIV, you’ll be prescribed an antiviral drug. You’ll have fewer herpes recurrences if you take daily suppressive therapy with a prescription antiviral drug. However, it’s still possible to give your partner herpes.
Antiviral drugs can keep HIV infection in check for many years. But you will still carry the virus and can still transmit it, though the risk is lower.
The sooner you start treatment, the more effective it is. If you take your medications exactly as directed, it’s possible to reduce your virus count so low that it can hardly be detected.
If you’ve had an STI, ask your doctor how long after treatment you need to be retested. Getting retested will ensure that the treatment worked and that you haven’t been reinfected.
Partner notification and preventive treatment
If tests show that you have an STI, your sex partners — including your current partners and any other partners you’ve had over the last three months to one year — need to be informed so that they can get tested. If they’re infected, they can then be treated.
Each state has different requirements, but most states require that certain STIs be reported to the local or state health department. Public health departments often employ trained disease intervention specialists who can help notify partners and refer people for treatment…. https://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/diagnosis-treatment/drc-20351246

Resources:

What are the treatments for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)? https://www.nichd.nih.gov/health/topics/stds/conditioninfo/treatments

Treatments for Sexually Transmitted Diseases (STDs)                   https://www.webmd.com/sexual-conditions/guide/std-treatments#1

IF YOU ARE AT RISK FOR A SEXUALLY TRANSMITTED DISEASE OR FEEL YOU HAVE ALREADY CONTRACTED AN STD – SEEK MEDICAL ATTENTION.

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

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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/

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Lancet study: High intake of dietary fiber and whole grains associated with reduced risk of non-communicable diseases

16 Jan

The Mayo Clinic wrote in Dietary fiber: Essential for a healthy diet:

What is dietary fiber?
Dietary fiber, also known as roughage or bulk, includes the parts of plant foods your body can’t digest or absorb. Unlike other food components, such as fats, proteins or carbohydrates — which your body breaks down and absorbs — fiber isn’t digested by your body. Instead, it passes relatively intact through your stomach, small intestine and colon and out of your body.
Fiber is commonly classified as soluble, which dissolves in water, or insoluble, which doesn’t dissolve.
• Soluble fiber. This type of fiber dissolves in water to form a gel-like material. It can help lower blood cholesterol and glucose levels. Soluble fiber is found in oats, peas, beans, apples, citrus fruits, carrots, barley and psyllium.
• Insoluble fiber. This type of fiber promotes the movement of material through your digestive system and increases stool bulk, so it can be of benefit to those who struggle with constipation or irregular stools. Whole-wheat flour, wheat bran, nuts, beans and vegetables, such as cauliflower, green beans and potatoes, are good sources of insoluble fiber.
The amount of soluble and insoluble fiber varies in different plant foods. To receive the greatest health benefit, eat a wide variety of high-fiber foods.
Benefits of a high-fiber diet
A high-fiber diet:
• Normalizes bowel movements. Dietary fiber increases the weight and size of your stool and softens it. A bulky stool is easier to pass, decreasing your chance of constipation. If you have loose, watery stools, fiber may help to solidify the stool because it absorbs water and adds bulk to stool.
• Helps maintain bowel health. A high-fiber diet may lower your risk of developing hemorrhoids and small pouches in your colon (diverticular disease). Studies have also found that a high-fiber diet likely lowers the risk of colorectal cancer. Some fiber is fermented in the colon. Researchers are looking at how this may play a role in preventing diseases of the colon.
• Lowers cholesterol levels. Soluble fiber found in beans, oats, flaxseed and oat bran may help lower total blood cholesterol levels by lowering low-density lipoprotein, or “bad,” cholesterol levels. Studies also have shown that high-fiber foods may have other heart-health benefits, such as reducing blood pressure and inflammation.
• Helps control blood sugar levels. In people with diabetes, fiber — particularly soluble fiber — can slow the absorption of sugar and help improve blood sugar levels. A healthy diet that includes insoluble fiber may also reduce the risk of developing type 2 diabetes.
• Aids in achieving healthy weight. High-fiber foods tend to be more filling than low-fiber foods, so you’re likely to eat less and stay satisfied longer. And high-fiber foods tend to take longer to eat and to be less “energy dense,” which means they have fewer calories for the same volume of food.
• Helps you live longer. Studies suggest that increasing your dietary fiber intake — especially cereal fiber — is associated with a reduced risk of dying from cardiovascular disease and all cancers…. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983

See, Dietary fiber: Why do we need it? https://www.medicalnewstoday.com/articles/146935.php

Science Daily reported: High intake of dietary fiber and whole grains associated with reduced risk of non-communicable diseases

People who eat higher levels of dietary fibre and whole grains have lower rates of non-communicable diseases compared with people who eat lesser amounts, while links for low glycaemic load and low glycaemic index diets are less clear. Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fibre a day, according to a series of systematic reviews and meta-analyses published in The Lancet.
The results suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least. Eating fibre-rich foods also reduced incidence of coronary heart disease, stroke, type 2 diabetes and colorectal cancer by 16-24%. Per 1,000 participants, the impact translates into 13 fewer deaths and six fewer cases of coronary heart disease.
In addition, a meta-analysis of clinical trials suggested that increasing fibre intakes was associated with lower bodyweight and cholesterol, compared with lower intakes.
The study was commissioned by the World Health Organization to inform the development of new recommendations for optimal daily fibre intake and to determine which types of carbohydrate provide the best protection against non-communicable diseases (NCDs) and weight gain.
Most people worldwide consume less than 20 g of dietary fibre per day. In 2015, the UK Scientific Advisory Committee on Nutrition recommended an increase in dietary fibre intake to 30 g per day, but only 9% of UK adults manage to reach this target. In the US, fibre intake among adults averages 15 g a day. Rich sources of dietary fibre include whole grains, pulses, vegetables and fruit….
The researchers included 185 observational studies containing data that relate to 135 million person years and 58 clinical trials involving 4,635 adult participants. They focused on premature deaths from and incidence of coronary heart disease, cardiovascular disease and stroke, as well as incidence of type 2 diabetes, colorectal cancer and cancers associated with obesity: breast, endometrial, esophageal and prostate cancer. The authors only included studies with healthy participants, so the findings cannot be applied to people with existing chronic diseases.
For every 8g increase of dietary fibre eaten per day, total deaths and incidence of coronary heart disease, type 2 diabetes and colorectal cancer decreased by 5-27%. Protection against stroke, and breast cancer also increased. Consuming 25g to 29g each day was adequate but the data suggest that higher intakes of dietary fibre could provide even greater protection.
For every 15g increase of whole grains eaten per day, total deaths and incidence of coronary heart disease, type 2 diabetes and colorectal cancer decreased by 2-19%. Higher intakes of whole grains were associated with a 13-33% reduction in NCD risk — translating into 26 fewer deaths per 1,000 people from all-cause mortality and seven fewer cases of coronary heart disease per 1,000 people. The meta-analysis of clinical trials involving whole grains showed a reduction in bodyweight. Whole grains are high in dietary fibre, which could explain their beneficial effects.
The study also found that diets with a low glycaemic index and low glycaemic load provided limited support for protection against type 2 diabetes and stroke only. Foods with a low glycaemic index or low glycaemic load may also contain added sugars, saturated fats, and sodium. This may account for the links to health being less clear…. https://www.sciencedaily.com/releases/2019/01/190110184737.htm

Citation:

High intake of dietary fiber and whole grains associated with reduced risk of non-communicable diseases
Date: January 10, 2019
Source: The Lancet
Summary:
Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fiber a day, according to a series of systematic reviews and meta-analyses.

Andrew Reynolds et al, Carbohydrate quality and human health: a series of systematic reviews and meta-analyses, The Lancet (2019). DOI: 10.1016/S0140-6736(18)31809-9

Here is the press release from the Lancet:

The Lancet: High intake of dietary fiber and whole grains associated with reduced risk of non-communicable diseases
People who eat higher levels of dietary fiber and whole grains have lower rates of non-communicable diseases compared with people who eat lesser amounts, while links for low glycemic load and low glycemic index diets are less clear
THE LANCET
People who eat higher levels of dietary fibre and whole grains have lower rates of non-communicable diseases compared with people who eat lesser amounts, while links for low glycaemic load and low glycaemic index diets are less clear. Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fibre a day, according to a series of systematic reviews and meta-analyses published in The Lancet.
The results suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least. Eating fibre-rich foods also reduced incidence of coronary heart disease, stroke, type 2 diabetes and colorectal cancer by 16-24%. Per 1,000 participants, the impact translates into 13 fewer deaths and six fewer cases of coronary heart disease.
In addition, a meta-analysis of clinical trials suggested that increasing fibre intakes was associated with lower bodyweight and cholesterol, compared with lower intakes.
The study was commissioned by the World Health Organization to inform the development of new recommendations for optimal daily fibre intake and to determine which types of carbohydrate provide the best protection against non-communicable diseases (NCDs) and weight gain.
Most people worldwide consume less than 20 g of dietary fibre per day. In 2015, the UK Scientific Advisory Committee on Nutrition recommended an increase in dietary fibre intake to 30 g per day [1], but only 9% of UK adults manage to reach this target. In the US, fibre intake among adults averages 15 g a day [2]. Rich sources of dietary fibre include whole grains, pulses, vegetables and fruit.
“Previous reviews and meta-analyses have usually examined a single indicator of carbohydrate quality and a limited number of diseases so it has not been possible to establish which foods to recommend for protecting against a range of conditions,” says corresponding author Professor Jim Mann, the University of Otago, New Zealand.
“Our findings provide convincing evidence for nutrition guidelines to focus on increasing dietary fibre and on replacing refined grains with whole grains. This reduces incidence risk and mortality from a broad range of important diseases.” [3]
The researchers included 185 observational studies containing data that relate to 135 million person years and 58 clinical trials involving 4,635 adult participants. They focused on premature deaths from and incidence of coronary heart disease, cardiovascular disease and stroke, as well as incidence of type 2 diabetes, colorectal cancer and cancers associated with obesity: breast, endometrial, oesophageal and prostate cancer. The authors only included studies with healthy participants, so the findings cannot be applied to people with existing chronic diseases.
For every 8g increase of dietary fibre eaten per day, total deaths and incidences of coronary heart disease, type 2 diabetes and colorectal cancer decreased by 5-27%. Protection against stroke, and breast cancer also increased. Consuming 25g to 29g each day was adequate but the data suggest that higher intakes of dietary fibre could provide even greater protection.
For every 15g increase of whole grains eaten per day, total deaths and incidences of coronary heart disease, type 2 diabetes and colorectal cancer decreased by 2-19%. Higher intakes of whole grains were associated with a 13-33% reduction in NCD risk – translating into 26 fewer deaths per 1,000 people from all-cause mortality and seven fewer cases of coronary heart disease per 1,000 people. The meta-analysis of clinical trials involving whole grains showed a reduction in bodyweight. Whole grains are high in dietary fibre, which could explain their beneficial effects.
The study also found that diets with a low glycaemic index and low glycaemic load provided limited support for protection against type 2 diabetes and stroke only. Foods with a low glycaemic index or low glycaemic load may also contain added sugars, saturated fats, and sodium. This may account for the links to health being less clear.
“The health benefits of fibre are supported by over 100 years of research into its chemistry, physical properties, physiology and effects on metabolism. Fibre-rich whole foods that require chewing and retain much of their structure in the gut increase satiety and help weight control and can favourably influence lipid and glucose levels. The breakdown of fibre in the large bowel by the resident bacteria has additional wide-ranging effects including protection from colorectal cancer.” says Professor Jim Mann. [3]
While their study did not show any risks associated with dietary fibre, the authors note that high intakes might have ill-effects for people with low iron or mineral levels, for whom high levels of whole grains can further reduce iron levels. They also note that the study mainly relates to naturally-occurring fibre rich foods rather than synthetic and extracted fibre, such as powders, that can be added to foods.
Commenting on the implications and limitations of the study, Professor Gary Frost, Imperial College London, UK, says, “[The authors] report findings from both prospective cohort studies and randomised controlled trials in tandem. This method enables us to understand how altering the quality of carbohydrate intake in randomised controlled trials affects non-communicable disease risk factors and how these changes in diet quality align with disease incidence in prospective cohort studies. This alignment is seen beautifully for dietary fibre intake, in which observational studies reveal a reduction in all-cause and cardiovascular mortality, which is associated with a reduction in bodyweight, total cholesterol, LDL cholesterol, and systolic blood pressure reported in randomised controlled trials… There are some important considerations that arise from this Article. First, total carbohydrate intake was not considered in the systematic review and meta-analysis… Second, although the absence of association between glycaemic index and load with non-communicable disease and risk factors is consistent with another recent systematic review, caution is needed when interpreting these data, as the number of studies is small and findings are heterogeneous. Third, the absence of quantifiable and objective biomarkers for assessing carbohydrate intake means dietary research relies on self-reported intake, which is prone to error and misreporting. Improving the accuracy of dietary assessment is a priority area for nutrition research. The analyses presented by Reynolds and colleagues provides compelling evidence that dietary fibre and whole grain are major determinants of numerous health outcomes and should form part of public health policy.”
###
NOTES TO EDITORS
Peer-reviewed / Meta-analysis and systematic review / People
This study was funded by the Health Research Council of New Zealand, the WHO, the Riddet Centre of Research Excellence, the Healthier Lives National Science Challenge, the University of Otago, and the Otago Southland Diabetes Research Trust. It was conducted by researchers from the University of Otago, the Riddet Centre of Research Excellence, and the University of Dundee.
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com
[1] Scientific Advisory Committee on Nutrition https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf
[2] https://www.ucsfhealth.org/education/increasing_fiber_intake/
[3] Quote direct from author and cannot be found in the text of the Article.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Although, there are minimum suggested daily minimum requirements, one should not overdue the daily intake of fiber.

Lauretta Claussen wrote in the SFGATE article, What Is Maximum Fiber Intake Per Day?

Too Much Fiber
Though fiber is beneficial, there is some risk of negative side effects from eating too much. Excessive amounts of fiber can bind with certain minerals such as calcium, iron, zinc and magnesium, interfering with absorption, warns the University of Maryland Medical Center. However, there is no upper limit set for how much fiber one can safely consume daily. Achieving dangerous levels from food intake alone would be difficult, and would most likely come as a result of excessive fiber supplement use.
Intestinal Problems
Though it is difficult to eat too much fiber, there is a risk of intestinal side effects from eating too much fiber at one sitting. Stomach cramps, gas and bloating can all occur when a dramatic fiber intake occurs suddenly. Once the natural bacteria in the digestive system gets accustomed to a high-fiber diet, these symptoms will likely subside.
Recommended Levels
The average American diet contains far too little fiber. Older children and adults should consume 20 to 35 grams of fiber daily, though most only get approximately 10 to 15. If you find you need to increase your daily fiber, do so slowly– over six to eight weeks– in order to avoid side effects. Drinking at least eight glasses of water daily will also help reduce the risk of negative side effects…. https://healthyeating.sfgate.com/maximum-fiber-intake-per-day-7061.html

The key concept is moderation.

Resources:

Minimum Daily Fiber Requirements                               https://healthyeating.sfgate.com/minimum-daily-fiber-requirements-4436.html

Fiber: How Much Is Too Much?                                   https://www.everydayhealth.com/hs/guide-to-daily-fiber/too-much-fiber/

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American Society of Nephrology study: Sugar-sweetened beverage pattern linked to higher kidney disease risk

30 Dec

Kerry Torrens, nutritional therapist wrote in The truth about sugar:

The instant ‘lift’ we get from sugar is one of the reasons we turn to it at times of celebration or when we crave comfort or reward. However, even those of us without a sweet tooth may be eating more than we realise because so many everyday processed foods, from cereals and bread to pasta sauce and soups contain sugar…. http://www.bbcgoodfood.com/howto/guide/truth-about-sugar
There are many medical reasons for reducing sugar in one’s diet. The issue for many reduced or sugar free products is can palates educated to the taste of sugar adapt to a different option?

An American Society of Nephrology study reported that a sugar-sweetened beverage pattern was linked to a higher risk of kidney disease.

Science Daily reported in Sugar-sweetened beverage pattern linked to higher kidney disease risk:

Higher collective consumption of sweetened fruit drinks, soda, and water was associated with a higher likelihood of developing chronic kidney disease (CKD) in a community-based study of African-American adults in Mississippi. The findings, which appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), contribute to the growing body of evidence pointing to the negative health consequences of consuming sugar-sweetened beverages.
Certain beverages may affect kidney health, but study results have been inconsistent. To provide more clarity, Casey Rebholz PhD, MS, MNSP, MPH (Johns Hopkins Bloomberg School of Public Health) and her colleagues prospectively studied 3003 African-American men and women with normal kidney function who were enrolled in the Jackson Heart Study.
“There is a lack of comprehensive information on the health implications of the wide range of beverage options that are available in the food supply,” said Dr. Rebholz. “In particular, there is limited information on which types of beverages and patterns of beverages are associated with kidney disease risk in particular.”
For their study, the investigators assessed beverage intake through a food frequency questionnaire administered at the start of the study in 2000-04, and they followed participants until 2009-13.
Among the 3003 participants, 185 (6%) developed CKD over a median follow-up of 8 years. After adjustment for confounding factors, consuming a beverage pattern consisting of soda, sweetened fruit drinks, and water was associated with a higher risk of developing CKD. Participants in the top tertile for consumption of this beverage pattern were 61% more likely to develop CKD than those in the bottom tertile.
The researchers were surprised to see that water was a component of this beverage pattern that was linked with a higher risk of CKD. They noted that study participants may have reported their consumption of a wide variety of types of water, including flavored and sweetened water. Unfortunately, the investigators did not collect information about specific brands or types of bottled water in the Jackson Heart Study.
In an accompanying editorial, Holly Kramer, MD, MPH and David Shoham, PhD (Loyola University Chicago) noted that the findings hold strong public health implications. “While a few select U.S. cities have successfully reduced SSB [sugar sweetened beverage] consumption via taxation, all other municipalities have resisted public health efforts to lower SSB consumption,” they wrote. “This cultural resistance to reducing SSB consumption can be compared to the cultural resistance to smoking cessation during the 1960s after the Surgeon General report was released. During the 1960s, tobacco use was viewed as a social choice and not a medical or social public health problem….” https://www.sciencedaily.com/releases/2018/12/181228091642.htm

Citation:

Sugar-sweetened beverage pattern linked to higher kidney disease risk
Date: December 28, 2018
Source: American Society of Nephrology
Summary:
In a study of African-American men and women with normal kidney function, a pattern of higher collective consumption of soda, sweetened fruit drinks, and water was associated with a higher risk of developing kidney disease.
Journal Reference:
Casey M. Rebholz, Bessie A. Young, Ronit Katz, Katherine L. Tucker, Teresa C. Carithers, Arnita F. Norwood, Adolfo Correa. Patterns of Beverages Consumed and Risk of Incident Kidney Disease. Clinical Journal of the American Society of Nephrology, 2018; CJN.06380518 DOI: 10.2215/CJN.06380518

Here is the press release from American Society of Nephrology:

PUBLIC RELEASE: 27-DEC-2018
Sugar-sweetened beverage pattern linked to higher kidney disease risk
AMERICAN SOCIETY OF NEPHROLOGY
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• In a study of African-American men and women with normal kidney function, a pattern of higher collective consumption of soda, sweetened fruit drinks, and water was associated with a higher risk of developing kidney disease.
Washington, DC (December 27, 2018) — Higher collective consumption of sweetened fruit drinks, soda, and water was associated with a higher likelihood of developing chronic kidney disease (CKD) in a community-based study of African-American adults in Mississippi. The findings, which appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), contribute to the growing body of evidence pointing to the negative health consequences of consuming sugar-sweetened beverages.
Certain beverages may affect kidney health, but study results have been inconsistent. To provide more clarity, Casey Rebholz PhD, MS, MNSP, MPH (Johns Hopkins Bloomberg School of Public Health) and her colleagues prospectively studied 3003 African-American men and women with normal kidney function who were enrolled in the Jackson Heart Study.
“There is a lack of comprehensive information on the health implications of the wide range of beverage options that are available in the food supply,” said Dr. Rebholz. “In particular, there is limited information on which types of beverages and patterns of beverages are associated with kidney disease risk in particular.”
For their study, the investigators assessed beverage intake through a food frequency questionnaire administered at the start of the study in 2000-04, and they followed participants until 2009-13.
Among the 3003 participants, 185 (6%) developed CKD over a median follow-up of 8 years. After adjustment for confounding factors, consuming a beverage pattern consisting of soda, sweetened fruit drinks, and water was associated with a higher risk of developing CKD. Participants in the top tertile for consumption of this beverage pattern were 61% more likely to develop CKD than those in the bottom tertile.
The researchers were surprised to see that water was a component of this beverage pattern that was linked with a higher risk of CKD. They noted that study participants may have reported their consumption of a wide variety of types of water, including flavored and sweetened water. Unfortunately, the investigators did not collect information about specific brands or types of bottled water in the Jackson Heart Study.
In an accompanying editorial, Holly Kramer, MD, MPH and David Shoham, PhD (Loyola University Chicago) noted that the findings hold strong public health implications. “While a few select U.S. cities have successfully reduced SSB [sugar sweetened beverage] consumption via taxation, all other municipalities have resisted public health efforts to lower SSB consumption,” they wrote. “This cultural resistance to reducing SSB consumption can be compared to the cultural resistance to smoking cessation during the 1960s after the Surgeon General report was released. During the 1960s, tobacco use was viewed as a social choice and not a medical or social public health problem.”
In an accompanying Patient Voice editorial, Duane Sunwold explained that he is a patient with CKD who changed his eating and drinking patterns to put his disease in remission. As a chef, he offers a number of recommendations to fellow patients trying to decrease their consumption of sugar-sweetened drinks.
###
Study co-authors include Bessie Young, MD, MPH, Ronit Katz, PhD, Katherine Tucker, PhD, Teresa Carithers, PhD, RD, LD, Arnita Norwood, PhD, MPH, RD, and Adolfo Correa, MD, PhD, MPH.
Disclosures: The authors reported no financial disclosures.
The article, entitled “Patterns of Beverages Consumed and Risk of Incident Kidney Disease,” will appear online at http://cjasn.asnjournals.org/ on December 27, 2018, doi: 10.2215/CJN.06380518.
The accompanying editorial, entitled “The Millennial Physician and the Obesity Epidemic: A Tale of Sugar Sweetened Beverages,” will appear online at http://cjasn.asnjournals.org/ on December 27, 2018.
The Patient Voice editorial, entitled “Diet and Risk for Developing Kidney Disease,” will appear online at http://cjasn.asnjournals.org/ on December 27, 2018.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 20,000 members representing 131 countries. For more information, please visit http://www.asn-online.org or contact the society at 202-640-4660.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

The Harvard T. H. Chan School of Public Health reported about the effects of sugary drinks in Soft Drinks and Disease.

According to the Chan School:

Soft drinks are the beverage of choice for millions of Americans, but sugary drinks increase the risk of type 2 diabetes, heart disease, and other chronic conditions.
• People who consume sugary drinks regularly—1 to 2 cans a day or more—have a 26% greater risk of developing type 2 diabetes than people who rarely have such drinks. (46)
• A study that followed 40,000 men for two decades found that those who averaged one can of a sugary beverage per day had a 20% higher risk of having a heart attack or dying from a heart attack than men who rarely consumed sugary drinks. (47) A related study in women found a similar sugary beverage–heart disease link. (48)
• A 22-year-long study of 80,000 women found that those who consumed a can a day of sugary drink had a 75% higher risk of gout than women who rarely had such drinks. (49) Researchers found a similarly-elevated risk in men. (50)
• Dr. Frank Hu, Professor of Nutrition and Epidemiology at Harvard School of Public Health, recently made a strong case that there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. (51)…. https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/soft-drinks-and-disease/

Each individual should consult competent medical professionals about their individual dietary needs.

Resources:

Diabetes Myths                                                                                  http://www.diabetes.org/diabetes-basics/myths/

Does Eating Sugar Cause Diabetes?                         https://www.webmd.com/diabetes/video/kahn-eating-sugar-cause-diabetes

Diabetes                                                                                         https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444

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

Dr. Wilda says this about that ©

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COMMENTS FROM AN OLD FART©
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Stanford Medicine study: Older fathers associated with increased birth risks, study reports

8 Nov

Typically, older mothers are the subject of risk factor analysis for pregnancy after 35. The Mayo Clinic staff wrote in Pregnancy after 35: Healthy moms, healthy babies:

Understand the risks
The biological clock is a fact of life, but there’s nothing magical about age 35. It’s simply an age at which various risks become more discussion worthy. For example:
• It might take longer to get pregnant. You’re born with a limited number of eggs. As you reach your mid- to late 30s, your eggs decrease in quantity and quality. Also, older women’s eggs aren’t fertilized as easily as younger women’s eggs. If you are older than age 35 and haven’t been able to conceive for six months, consider asking your health care provider for advice.
• You’re more likely to have a multiple pregnancy. The chance of having twins increases with age due to hormonal changes that could cause the release of multiple eggs at the same time. The use of assisted reproductive technologies — such as in vitro fertilization — also can play a role.
• You’re more likely to develop gestational diabetes. This type of diabetes, which occurs only during pregnancy, is more common as women get older. Tight control of blood sugar through diet and physical activity is essential. Sometimes medication is needed, too. Left untreated, gestational diabetes can cause a baby to grow significantly larger than average — which increases the risk of injuries during delivery. Gestational diabetes can also increase the risk of premature birth, high blood pressure during pregnancy, and complications to your infant after delivery.
• You’re more likely to develop high blood pressure during pregnancy. Research suggests high blood pressure that develops during pregnancy is more common in older women. Your health care provider will carefully monitor your blood pressure and your baby’s growth and development. You will need more frequent obstetric appointments and you might need to deliver before your due date to avoid complications.
• You’re more likely to have a low birth weight baby and a premature birth. Premature babies, especially those born earliest, often have complicated medical problems.
• You might need a C-section. Older mothers have a higher risk of pregnancy-related complications that might lead to a C-section delivery. An example of a complication is a condition in which the placenta blocks the cervix (placenta previa).
• The risk of chromosome abnormalities is higher. Babies born to older mothers have a higher risk of certain chromosome problems, such as Down syndrome.
• The risk of pregnancy loss is higher. The risk of pregnancy loss — by miscarriage and stillbirth — increases as you get older, perhaps due to pre-existing medical conditions or fetal chromosomal abnormalities. Research suggests that the decrease in the quality of your eggs, combined with an increased risk of chronic medical conditions such as high blood pressure and diabetes, could increase your risk of miscarriage. Ask your health care provider about monitoring your baby’s well-being during the last weeks of pregnancy.
While further research is needed, studies suggest that men’s ages at the time of conception — the paternal age — also might pose health risks for children…. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy/art-20045756

Stanford Medicine studied the risk factors associated with older fathers.

Science Daily reported in Older fathers associated with increased birth risks, study reports:

A decade of data documenting live births in the United States links babies of older fathers with a variety of increased risks at birth, including low birth weight and seizures, according to a new study by researchers at the Stanford University School of Medicine.
The data even suggest that the age of the father can sway the health of the mother during pregnancy, specifically her risk for developing diabetes.
“We tend to look at maternal factors in evaluating associated birth risks, but this study shows that having a healthy baby is a team sport, and the father’s age contributes to the baby’s health, too,” said Michael Eisenberg, MD, associate professor of urology.
Data from more than 40 million births showed that babies born to fathers of an “advanced paternal age,” which roughly equates to older than 35, were at a higher risk for adverse birth outcomes, such as low birth weight, seizures and need for ventilation immediately after birth. Generally speaking, the older a father’s age, the greater the risk. For example, men who were 45 or older were 14 percent more likely to have a child born prematurely, and men 50 or older were 28 percent more likely to have a child that required admission to the neonatal intensive care unit.
Still, these numbers aren’t reason to drastically change any life plans, as the risks are still relatively low, Eisenberg said. He compared the increased risks to buying lottery tickets. “If you buy two lottery tickets instead of one, your chances of winning double, so it’s increased by 100 percent,” he said. “But that’s a relative increase. Because your chance of winning the lottery started very small, it’s still unlikely that you’re going to win the lottery. This is a very extreme example, but the same concept can be applied to how you think about these birth risks.”
Instead, Eisenberg sees the findings as informational ammunition for people planning a family and hopes that they will serve to educate the public and health officials.
A paper describing the study will be published online Nov. 1 in the The British Medical Journal. Eisenberg is the senior author. Resident physician Yash Khandwala, MD, is the lead author…. https://www.sciencedaily.com/releases/2018/11/181101133759.htm

See, Pregnancy at Dr. Wilda https://drwilda.com/tag/pregnancy/

Citation:

Older fathers associated with increased birth risks, study reports
Date: November 1, 2018
Source: Stanford Medicine
Summary:
A decade of data documenting live births in the United States links babies of older fathers with a variety of increased risks at birth, including low birth weight and seizures, according to a new study.

Infants of older fathers are at greater risk of birth complications
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4595 (Published 01 November 2018) Cite this as: BMJ 2018;363:k4595
Linked research
Association of paternal age with perinatal outcomes
Paternal factors in preconception care: the case of paternal age
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4466 (Published 31 October 2018) Cite this as: BMJ 2018;363:k4466

Here is the press release from Stanford Medicine:

Older fathers associated with increased birth risks

From the data of more than 40 million births, scientists at Stanford have linked paternal age to birth risks, and even risks to the mother’s health.
A decade of data documenting live births in the United States links babies of older fathers with a variety of increased risks at birth, including low birth weight and seizures, according to a new study by researchers at the Stanford University School of Medicine.
The data even suggest that the age of the father can sway the health of the mother during pregnancy, specifically her risk for developing diabetes.
“We tend to look at maternal factors in evaluating associated birth risks, but this study shows that having a healthy baby is a team sport, and the father’s age contributes to the baby’s health, too,” said Michael Eisenberg, MD, associate professor of urology.
Data from more than 40 million births showed that babies born to fathers of an “advanced paternal age,” which roughly equates to older than 35, were at a higher risk for adverse birth outcomes, such as low birth weight, seizures and need for ventilation immediately after birth. Generally speaking, the older a father’s age, the greater the risk. For example, men who were 45 or older were 14 percent more likely to have a child born prematurely, and men 50 or older were 28 percent more likely to have a child that required admission to the neonatal intensive care unit.
Still, these numbers aren’t reason to drastically change any life plans, as the risks are still relatively low, Eisenberg said. He compared the increased risks to buying lottery tickets. “If you buy two lottery tickets instead of one, your chances of winning double, so it’s increased by 100 percent,” he said. “But that’s a relative increase. Because your chance of winning the lottery started very small, it’s still unlikely that you’re going to win the lottery. This is a very extreme example, but the same concept can be applied to how you think about these birth risks.”
Instead, Eisenberg sees the findings as informational ammunition for people planning a family and hopes that they will serve to educate the public and health officials.
A paper describing the study was published online Nov. 1 in the British Medical Journal. Eisenberg is the senior author. Resident physician Yash Khandwala, MD, is the lead author.
Increased risks at 35
Back in 2017, Eisenberg published a study showing that the number of older men fathering children was on the rise. Now, about 10 percent of infants are born to fathers over the age of 40, whereas four decades ago it was only 4 percent.
“We’re seeing these shifts across the United States, across race strata, across education levels, geography — everywhere you look, the same patterns are being seen,” Eisenberg said. “So I do think it’s becoming more relevant for us to understand the health ramifications of advanced paternal age on infant and maternal health.”
Having a better understanding of the father’s biological role will be obviously important for the offspring, but also potentially for the mother.
Eisenberg and his colleagues used data from 40.5 million live births documented through a data-sharing program run by the Centers for Disease Control and Prevention and the National Center for Health Statistics. The researchers organized the information based on the fathers’ age — younger than 25; 25 to 34; 35 to 44; 45 to 55; and older than 55 — and controlled for a variety of parameters that might skew the association between the father’s age and birth outcomes, such as race, education level, marital status, smoking history, access to care and the mother’s age.
The data suggested that once a dad hits age 35, there’s a slight increase in birth risks overall — with every year that a man ages, he accumulates on average two new mutations in the DNA of his sperm — but birth risks for infants born to fathers of the subsequent age tier showed sharper increases.
Compared with fathers between the ages of 25 and 34 (the average age of paternity in the United States), infants born to men 45 or older were 14 percent more likely to be admitted to the NICU, 14 percent more likely to be born prematurely, 18 percent more likely to have seizures and 14 percent more likely to have a low birth weight. If a father was 50 or older, the likelihood that their infant would need ventilation upon birth increased by 10 percent, and the odds that they would need assistance from the neonatal intensive care unit increased by 28 percent.
“What was really surprising was that there seemed to be an association between advanced paternal age and the chance that the mother would develop diabetes during pregnancy,” said Eisenberg. For men age 45 and older, their partners were 28 percent more likely to develop gestational diabetes, compared with fathers between 25 and 34. Eisenberg points out that possible biological mechanisms at play here are still a bit murky, but he suspects that the mother’s placenta has a role.
Beyond correlation
Moving forward, Eisenberg wants to look into other population cohorts to confirm the associations between age and birth risks, as well as begin to decode some of the possible biological mechanisms.
“Scientists have looked at these kinds of trends before, but this is the most comprehensive study to look at the relationship between the father’s age and birth outcomes at a population level,” said Eisenberg. “Having a better understanding of the father’s biological role will be obviously important for the offspring, but also potentially for the mother.”
Other Stanford co-authors of the study are professor of obstetrics and gynecology Valerie Baker, MD; professor of pediatrics Gary Shaw, DrPH; professor of pediatrics David K. Stevenson, MD; and professor of biomedical data, Ying Lu, PhD.
Eisenberg is a member of Stanford Bio-X, the Stanford Child Health Research Institute and the Stanford Cancer Institute.
Stanford’s Department of Urology also supported the work.
By HANAE ARMITAGE
Hanae Armitage is a science writer for the medical school’s Office of Communication & Public Affairs. Email her at harmitag@stanford.edu. http://med.stanford.edu/news/all-news/2018/10/older-fathers-associated-with-increased-birth-risks.html

There are benefits and cautions for those becoming parents after 35.

Dinah Wisenberg Brin wrote in the CNBC article Older-Parent Families: Advantages and Disadvantages:

Beyond the retirement and college-planning decisions, middle-aged parents may be caring for their own frail, elderly parents at the same time they’re raising preschoolers, a potentially costly prospect that points to another issue: No built-in support network of youthful grandparents who can babysit during parental getaways. CFP Kahler knows this first hand.
“Our childcare bill is as much as our airfare bill,” he says. Trading childcare with other families can defrays the costs, though, he adds.
The age factor similarly can make it difficult for middle-age parents to find willing and able guardians to name in their wills. Lindsay recalls a former client couple in their 40s with young children who had trouble completing their estate planning because they had only older siblings and no one willing to be named as guardians.
“Sometimes it just comes down to making the best decision out of a number of poor alternatives,” Kahler says. “It may mean sending them out of state to someone, you may be looking to nieces and nephews who could potentially raise a child.”
Older-parent families can face other advantages and disadvantages, as well.
“I think my kids will need less therapy than if I’d had kids in my 20s,” Kahler jokes. On the other hand, he notes there are costs associated with the care of an aging body. “I tell my kids, `The horsey can only go up and down the hallway a couple of times before the horsey runs out of gas.’ ” https://www.cnbc.com/id/44378785

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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Washington State University study: BPA replacements in plastics cause reproductive problems in lab mice

16 Sep

Brent A. Bauer, M.D. of the Mayo Clinic provides a concise description of bisphenol A (BPA):

What is BPA, and what are the concerns about BPA?
Answer From Brent A. Bauer, M.D.
BPA stands for bisphenol A. BPA is an industrial chemical that has been used to make certain plastics and resins since the 1960s.
BPA is found in polycarbonate plastics and epoxy resins. Polycarbonate plastics are often used in containers that store food and beverages, such as water bottles. They may also be used in other consumer goods.
Epoxy resins are used to coat the inside of metal products, such as food cans, bottle tops and water supply lines. Some dental sealants and composites also may contain BPA.
Some research has shown that BPA can seep into food or beverages from containers that are made with BPA. Exposure to BPA is a concern because of possible health effects of BPA on the brain, behavior and prostate gland of fetuses, infants and children. Additional research suggests a possible link between BPA and increased blood pressure.
However, the Food and Drug Administration (FDA) has said that BPA is safe at the very low levels that occur in some foods. This assessment is based on review of hundreds of studies.
The FDA is continuing its review of BPA, including supporting ongoing research. In the meantime, if you’re concerned about BPA, you can take these steps to reduce your exposure:
• Use BPA-free products. Manufacturers are creating more and more BPA-free products. Look for products labeled as BPA-free. If a product isn’t labeled, keep in mind that some, but not all, plastics marked with recycle codes 3 or 7 may be made with BPA.
• Cut back on cans. Reduce your use of canned foods since most cans are lined with BPA-containing resin.
• Avoid heat. The National Institute of Environmental Health Sciences, part of the National Institutes of Health, advises against microwaving polycarbonate plastics or putting them in the dishwasher, because the plastic may break down over time and allow BPA to leach into foods.
• Use alternatives. Use glass, porcelain or stainless steel containers for hot foods and liquids instead of plastic containers….. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/bpa/faq-20058331

A Washington State University study found there could be problems with some replacements to BPA plastics.

Science Daily reported in BPA replacements in plastics cause reproductive problems in lab mice:

Twenty years ago, researchers made the accidental discovery that the now infamous plastics ingredient known as bisphenol A or BPA had inadvertently leached out of plastic cages used to house female mice in the lab, causing a sudden increase in chromosomally abnormal eggs in the animals. Now, the same team is back to report in the journal Current Biology on September 13 that the array of alternative bisphenols now used to replace BPA in BPA-free bottles, cups, cages, and other items appear to come with similar problems for their mice….

The new findings were uncovered much as before as the researchers again noticed a change in the data coming out of studies on control animals. Again, the researchers traced the problem to contamination from damaged cages, but the effects this time, Hunt says, were more subtle than before. That’s because not all of the cages were damaged and the source of contamination remained less certain.
However, she and her colleagues were able to determine that the mice were being exposed to replacement bisphenols. They also saw that the disturbance in the lab was causing problems in the production of both eggs and sperm.
Once they got the contamination under control, the researchers conducted additional controlled studies to test the effects of several replacement bisphenols, including a common replacement known as BPS. Those studies confirm that replacement bisphenols produce remarkably similar chromosomal abnormalities to those seen so many years earlier in studies of BPA.
Hunt notes that the initial inadvertent exposure of their animals was remarkably similar to what might happen in people using plastics in that the exposure was accidental and highly variable. Not all of the animals’ cages were damaged, and so the findings differed among animals in different cages.
She adds that — although determining the levels of human exposure is difficult — their controlled experiments were conducted using low doses of BPS and other replacement bisphenols thought to be relevant to exposure in people using BPA-free plastics.
These problems, if they hold true in people as has been shown in the case of BPA, will carry over to future generations through their effects on the germline. The researchers showed that, if it were possible to eliminate bisphenol contaminants completely, the effects would still persist for about three generations… https://www.sciencedaily.com/releases/2018/09/180913113940.htm

Citation:

BPA replacements in plastics cause reproductive problems in lab mice
Date: September 13, 2018
Source: Cell Press
Summary:
Twenty years ago, researchers made the accidental discovery that BPA had leached out of plastic cages used to house female mice in the lab, causing an increase in chromosomally abnormal eggs. Now, the same team is back to report that the array of alternative bisphenols now used to replace BPA in BPA-free bottles, cups, cages, and other items appear to come with similar problems for their mice.
Journal Reference:
Tegan S. Horan, Hannah Pulcastro, Crystal Lawson, Roy Gerona, Spencer Martin, Mary C. Gieske, Caroline V. Sartain, Patricia A. Hunt. Replacement Bisphenols Adversely Affect Mouse Gametogenesis with Consequences for Subsequent Generations. Current Biology, 2018; DOI: 10.1016/j.cub.2018.06.070

Here is the press release from Washington State University:

WSU researchers see new plastics causing reproductive woes of old plastics
September 13, 2018

BPA has long been used in bottles, cups, medical and dental devices, and as coatings for food-can linings and cash register receipts.
By Eric Sorensen, WSU News

Washington State University researchers have found that plastic products meant to replace the chemical bisphenol A, or BPA, are also causing genetic abnormalities in mice.

The discovery is a déjà vu moment for Patricia Hunt, who 20 years ago linked abnormalities in egg chromosomes to BPA released by a harsh detergent used on her lab’s mouse cages. This time, she saw reproductive defects in control animals housed in plastic cages made with BPA alternatives.

“There’s growing evidence that many of these common replacements are not safe,” said Hunt, a professor in WSU’s School of Molecular Biosciences and lead author of a study in the latest Current Biology. “We stumbled on an effect yet again. This is a more stable plastic but it induced similar effects on the process of making eggs and sperm. Importantly, when we tested the chemicals in controlled experiments, we got similar results for each of them.”

BPA has long been used in bottles, cups, medical and dental devices, and as coatings for food-can linings and cash register receipts. After Hunt and other researchers began tying BPA exposure to developmental defects in numerous animal species, the U.S. Food and Drug Administration banned it in baby bottles and children’s drinking cups. The Washington legislature has also limited its use.
Hunt and her colleagues say mice exposed to the common BPA replacement bisphenol S, or BPS, underwent changes in the way the germ cells in their testes and ovaries copy and splice DNA while producing sperm and eggs. Both sexes had problems getting DNA to recombine correctly, leading to a reduction in viable sperm and an increase in abnormal eggs. Hunt and her colleagues had similar results with the replacements BPF, BPAF, and diphenyl sulfone.

“These findings add to growing evidence of the biological risks posed by this class of chemicals,” Hunt and her colleagues write.

Problems in the male germline lasted several generations after the initial exposure.
In addition to risking human reproductive health, the replacement plastics can also be compromising the integrity of biological research.

“It’s now becoming almost impossible to run experiments without contamination,” said Hunt, called the “accidental toxicologist” by Scientific American magazine. “And it’s not that I live under my own black cloud. It’s that I have a super sensitive system. A germ line is like the canary in the coal mine. As soon as something hits, we see it. Other investigators in my facility don’t see it but it doesn’t mean that it doesn’t impact their research.”

Hunt’s WSU colleagues in the research are Tegan Horan, a research intern and the paper’s first author, as well as scientific assistants Hannah Pulcastro and Crystal Lawson and former postdoctoral fellows Mary Gieske and Caroline Sartain. Joining them are Roy Gerona and Spencer Martin of the University of California, San Francisco.
The study was funded by the National Institutes of Health.
Media contact:
Patricia Hunt, professor, WSU School of Molecular Biosciences, 509-335-4954, pathunt@wsu.edu

The question is whether there are safe plastics.

Timothy Banas wrote in the Livestrong.com article, Which Plastic Containers Can I Safely Use?

Type 1: Polyethylene Teraphthalate – Do Not Reuse
You commonly find Type 1 plastic in bottles for juices, salad dressing, water, vegetable oil and mouthwash. Peanut butter and pickle jars often contain type 1 plastic as well. Polyethylene teraphthalate is light-weight, clear and smooth; its manufacturers intend it for a single use only.
While it does not contain bisphenol A or phthalates, it does contain antimony, a possible human carcinogen. Also, harmful bacteria can build up in it as you reuse it. Polyethylene teraphthalate containers may have the symbol “PET” on them.

Type 2: High-Density Polyethylene – Safe
Milk containers, detergent bottles, freezer bags and plastic grocery bags often contain high-density polyethylene, a relatively stiff plastic. Type 2 plastic neither contains bisphenol A nor phthalates. It is not known to contain other harmful chemicals. High-density polyethylene containers may have the symbol “HDPE” on them.
Type 3: Polyvinyl Chloride – Contains Phthalates
Polyvinyl chloride contains phthalates that can cause reproductive problems in animals and humans. Type 3 plastic can be plasticized or unplasticized; the former is clear and flexible, the latter is more rigid. Food containers commonly made with polyvinyl chloride include fruit juice bottles, cooking oil bottles and clear food packaging. Plasticized PVC pipes and siding contain phthalates as well. Polyvinyl chloride containers may have the symbol “V” on them.
Type 4: Low-Density Polyethylene – Safe
Frozen foods packaging and condiment squeeze bottles often contain Type 4 plastic because it is flexible and resistant to solvents. Type 4 plastic does not contain any known harmful chemicals. Low-density polyethylene containers may have the symbol “LDPE” on them.
Type 5: Polypropylene – Safe
Polypropylene containers do not leach harmful chemicals into foods or liquids. They commonly contain yogurt, medicine, drinks, ketchup and medicines. Type 5 plastic is flexible, hard and semi-transparent and has high resistance to solvents. Polypropylene containers may have the symbol “PP” on them.
Type 7: Polycarbonate
You should avoid type 7 plastic containers because they may contain bisphenol A that leaches into their contents. Type 7 plastics often have the symbol “PC” or “Other” on them. You will find polycarbonate plastics in 3- and 5-gallon water-cooler bottles; hard, plastic reusable water bottles; and to-go coffee mugs. Manufacturers use polycarbonate for these purposes because it is virtually shatter-proof…. https://www.livestrong.com/article/158674-which-plastic-containers-can-i-safely-use/

The Washington State University research indicates that this list may have to be studied further to determine safety.

Resources:

Safe Plastic Numbers (Guide)                                             http://www.babygreenthumb.com/p-122-safe-plastic-numbers-guide.aspx

Pots, Pans, and Plastics: A Shopper’s Guide to Food Safety https://www.webmd.com/food-recipes/features/cookware-plastics-shoppers-guide-to-food-safety#1

Which Plastics Are Safe?                                                  https://www.care2.com/greenliving/which-plastics-are-safe.html

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Mayo Clinic study: Suicide attempt a stronger predictor of completed suicide than previously thought

24 Sep

People of all ages may have feelings of profound sadness, loss, and depression. There is no one on earth, despite what the ads attempt to portray, who lives a perfect life. Every life has flaws and blemishes; it is just that some cope better than others. For every person who lives to a ripe old age, during the course of that life they may encounter all types of loss from loss of a loved one through death, divorce or desertion, loss of job, financial reverses, illness, dealing with A-holes and twits, plagues, pestilence, and whatever curse can be thrown at a person. The key is that they lived THROUGH whatever challenges they faced AT THAT MOMENT IN TIME. Woody Allen said something like “90% of life is simply showing up.” Let moi add a corollary, one of the prime elements of a happy life is to realize that whatever moment you are now in, it will not last forever and that includes moments of great challenge. A person does not have to be religious to appreciate the story of Job. The end of the story is that Job is restored. He had to endure much before the final victory, though.

Science Daily reported in Suicide attempt a stronger predictor of completed suicide than previously thought:

While a prior history of suicide attempt is one of the strongest predictors of completed suicide, a Mayo Clinic study finds it is more lethal than previously known.

Researchers find that suicide risk was nearly 60 percent higher than previously reported when based on a population-based cohort focusing on individuals making first lifetime attempts and including those whose first attempts were fatal. This risk was dramatically higher for attempts using firearms. The population sample was identified through the Rochester Epidemiology Project.

“We hoped to address the shortcomings of earlier studies by including two groups previously overlooked by other studies,” says J. Michael Bostwick, M.D., a psychiatrist on Mayo Clinic’s Rochester campus and the lead author of the study published in the American Journal of Psychiatry. “Our study enrolled individuals whose first-ever suicide attempt presented to medical attention. Not only did we include those who survived this initial attempt, but we also included those who died on their first attempt and ended up on the coroner’s slab rather than in the emergency room. These are large groups that have been routinely ignored in calculation of risk.” Since suicide is one of the 10 most common causes of death in the U.S., it is a major public health concern. The study found that nearly 60 percent of people who attempted suicide died on their first attempt….                                                                                                                                https://www.sciencedaily.com/releases/2016/09/160912161259.htm

Citation:

Suicide attempt a stronger predictor of completed suicide than previously thought

Date:         September 12, 2016

Source:     Mayo Clinic

Summary:

While a prior history of suicide attempt is one of the strongest predictors of completed suicide, a new study finds it is more lethal than previously known.

Journal Reference:

  1. J. Michael Bostwick, Chaitanya Pabbati, Jennifer R. Geske, Alastair J. McKean. Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew. American Journal of Psychiatry, 2016; appi.ajp.2016.1 DOI: 10.1176/appi.ajp.2016.15070854

Here is the press release from the Mayo Clinic:

  • By Duska Anastasijevic

Suicide attempt a stronger predictor of completed suicide than previously thought

September 12, 2016

ROCHESTER, Minn. — While a prior history of suicide attempt is one of the strongest predictors of completed suicide, a Mayo Clinic study finds it is more lethal than previously known.

Researchers find that suicide risk was nearly 60 percent higher than previously reported when based on a population-based cohort focusing on individuals making first lifetime attempts and including those whose first attempts were fatal. This risk was dramatically higher for attempts using firearms. The population sample was identified through the Rochester Epidemiology Project.

“We hoped to address the shortcomings of earlier studies by including two groups previously overlooked by other studies,” says J. Michael Bostwick, M.D., a psychiatrist on Mayo Clinic’s Rochester campus and the lead author of the study published in the American Journal of Psychiatry. “Our study enrolled individuals whose first-ever suicide attempt presented to medical attention. Not only did we include those who survived this initial attempt, but we also included those who died on their first attempt and ended up on the coroner’s slab rather than in the emergency room. These are large groups that have been routinely ignored in calculation of risk.”

Since suicide is one of the 10 most common causes of death in the U.S., it is a major public health concern. The study found that nearly 60 percent of people who attempted suicide died on their first attempt.

“Almost no other study in the literature includes individuals who die on that first attempt,” Dr. Bostwick adds. “A large part of the reason that such a high proportion of the total suicides occurred on first attempt can be attributed to firearm usage. The results show that it is a 140 time more likely for firearms to cause suicide, compared to all other methods. That means nearly three-fourths of all deaths at first suicide attempt were caused by using firearms. This shows that guns are, unfortunately, but not surprisingly, remarkably effective.”

The study also revealed that the male-female ratio was higher (1.7-to-1) among those making their attempts than what other studies previously purported. Older age in men also is associated with higher suicide risk. Nearly one-third of men over 65 in the study killed themselves.

MEDIA CONTACT: Duska Anastasijevic, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

The Rochester Epidemiology Project diagnostic index was searched electronically to identify 1,490 Olmsted County residents whose first suicide attempt came to medical attention between Jan. 1, 1986, and Dec. 31, 2007. The study included 555 males and 935 females followed for three to 25 years.

While the study confirmed previous findings that the risk decreased in survivors given a follow-up psychiatry appointment, the vast majority of survivors, irrespective of gender, killed themselves within a year after the index attempt. This underscores how important it is that survivors have psychiatric follow-up scheduled after the first attempt and how the first year following a suicide attempt is a critical window for a repeat fatal attempt.

Other authors include: Alastair J. McKean, M.D. and Jennifer R. Geske, M.S., of Mayo Clinic, and Chaitanya Pabbati, M.D., Department of Psychiatry, University of California, San Diego;

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or http://newsnetwork.mayoclinic.org/.

What Should You Do if You Know Someone Who Thinking About Suicide?

If you are thinking of suicide or you know someone who is thinking about suicide, GET HELP, NOW!!!! The Suicide Prevention Resource Center http://www.sprc.org/basics/roles-suicide-prevention has some excellent advice about suicide prevention http://www.sprc.org/basics/roles-suicide-prevention

Resources:

Suicide Prevention
http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

Teen Suicide Overview
http://www.teensuicidestatistics.com/

Teen’s Health’s Suicide
http://kidshealth.org/teen/your_mind/feeling_sad/suicide.html

American Academy of Adolescent Psychiatry http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Teen_Suicide_10.aspx

Suicide Prevention Resource Center
http://www.sprc.org/basics/roles-suicide-prevention

Teen Depression
http://helpguide.org/mental/depression_teen.htm

Jared Story.Com
http://www.jaredstory.com/teen_epidemic.html

CNN Report about suicide                                                                                                     http://www.cnn.com/2009/LIVING/10/20/lia.latina.suicides/index.html

American Foundation for Suicide Prevention
http://www.afsp.org This group is dedicated to advancing the knowledge of suicide and the ability to prevent it.

A\VE – Suicide Awareness\Voices of Education
http://www.save.org SA\VE offers information on suicide prevention. Call (800) SUICIDE

About.Com’s Depression In Young Children                                                                http://depression.about.com/od/child/Young_Children.htm

Psych Central’s Depression In Young Children                                          http://depression.about.com/od/child/Young_Children.htm

Psychiatric News’ Study Helps Pinpoint Children With Depression
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106034

Family Doctor’s What Is Depression?
http://familydoctor.org/familydoctor/en/diseases-conditions/depression.html

WebMD’s Depression In Children
http://www.webmd.com/depression/guide/depression-children

Healthline’s Is Your Child Depressed?
http://www.healthline.com/hlvideo-5min/how-to-help-your-child-through-depression-517095449

Medicine.Net’s Depression In Children                                                                http://www.onhealth.com/depression_in_children/article.htm

If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.

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

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Case Western Reserve University study: Fungus in humans identified as key factor in Crohn’s disease

22 Sep

Heathline describes Crohn’s disease:

Crohn’s disease is a type of inflammatory bowel disease (IBD) in which an abnormal immune system response causes chronic inflammation in the digestive tract. Crohn’s is often confused with ulcerative colitis, a similar IBD that only affects the large intestine.

According to the Crohn’s & Colitis Foundation of America, about 1.4 million Americans have Crohn’s disease or ulcerative colitis. Of those, about 700,000 have Crohn’s. In the years between 1992 and 2004, there was a 74 percent increase in doctor’s office visits due to Crohn’s disease. In 2004, Crohn’s disease was the cause of 57,000 hospitalizations.

Who Gets Crohn’s Disease

Anyone can develop Crohn’s disease or ulcerative colitis. However, IBDs are usually diagnosed in young adults between the ages of 15 and 30. Children are twice as likely to be diagnosed with Crohn’s as ulcerative colitis. Boys develop IBDs at a slightly higher rate than girls.

In the United States, males and females get Crohn’s at about the same rate. Caucasians and Ashkenazi Jews develop Crohn’s at a higher rate than other ethnicities. The highest rates occur in Canada. In general, people who live in higher latitudes are more likely to develop Crohn’s than those in lower latitudes. When relocating from a low-latitude to a high-latitude region, the risk of developing Crohn’s matches that of the high-latitude region within a single generation.

In Crohn’s disease, the immune system mistakenly attacks healthy bacteria in the GI tract. Chronic inflammation causes thickening of the intestinal wall, which triggers the symptoms. The exact reason this occurs is not clear, but there is a hereditary factor. According to the Crohn’s & Colitis Foundation of America, between 5 and 20 percent of people who have an IBD have a first-degree relative with one. The risk is higher in Crohn’s than ulcerative colitis, and higher when both parents are affected.

There may also be an environmental element. Rates of Crohn’s are higher in developed countries, urban areas, and northern climates. Stress and diet may worsen Crohn’s, but neither is thought to cause the disease. It’s likely that Crohn’s is caused by a combination of factors….      http://www.healthline.com/health/crohns-disease/facts-statistics-infographic#2

See, Epidemiology of the IBD          http://www.cdc.gov/ibd/ibd-epidemiology.htm

Bret Lashner, MD of the Cleveland Clinic describes the symptoms of Crohn’s disease:

Signs and Symptoms

Patients with new-onset Crohn’s disease usually present with inflammatory-type symptoms, with such as diarrhea, abdominal pain, fever, fatigue, stomatitis, anal fissures, and weight loss. The abdominal pain usually is insidious, is in the right lower quadrant, occurs soon after eating, and may be associated with a tender inflammatory mass. When the inflammatory process affects the large bowel, there may be hematochezia, but bleeding is much less common in Crohn’s disease patients than in ulcerative colitis patients. Extra-intestinal manifesations of disease, such as peripheral arthritis, axial arthritis, and erythema nodosum also may be presenting features. Cigarette smoking is seen much more commonly in Crohn’s disease patients (upwards of 50% of patients) compared to an unaffected adult population.

As Crohn’s disease becomes more advanced, strictures and fistulas may develop (Figure 1)4. Patients with strictures often present the obstructive symptoms, such as severe abdominal pain, distension, bloating, and vomiting. Patients who develop fistulas, or perforating-type complications, may present with perianal fistulas and abscesses, ventral wall drainage, pneumaturia, or intra-abdominal or retroperitoneal abscesses. Children with extensive small bowel involvement with their Crohn’s disease can present with growth retardation and delayed puberty. Interestingly, nutritional support can reverse some of manifestations of growth retardation….              http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/crohns-disease/

See, Crohn’s Disease            https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/crohns-disease/Pages/overview.aspx

Science Daily reported in Fungus in humans identified for first time as key factor in Crohn’s disease:

A Case Western Reserve University School of Medicine-led team of international researchers has for the first time identified a fungus as a key factor in the development of Crohn’s disease. The researchers also linked a new bacterium to the previous bacteria associated with Crohn’s. The groundbreaking findings, published on September 20th in mBio, could lead to potential new treatments and ultimately, cures for the debilitating inflammatory bowel disease, which causes severe abdominal pain, diarrhea, weight loss, and fatigue….

Both bacteria and fungi are microorganisms — infinitesimal forms of life that can only be seen with a microscope. Fungi are eukaryotes: organism whose cells contain a nucleus; they are closer to humans than bacteria, which are prokaryotes: single-celled forms of life with no nucleus. Collectively, the fungal community that inhabits the human body is known as the mycobiome, while the bacteria are called the bacteriome. (Fungi and bacteria are present throughout the body; previously Ghannoum had found that people harbor between nine and 23 fungal species in their mouths.)

The researchers assessed the mycobiome and bacteriome of patients with Crohn’s disease and their Crohn’s-free first degree relatives in nine families in northern France and Belgium, and in Crohn’s-free individuals from four families living in the same geographic area. Specifically, they analyzed fecal samples of 20 Crohn’s and 28 Crohn’s-free patients from nine families and of 21 Crohn’s-free patients of four families. The researchers found strong fungal-bacterial interactions in those with Crohn’s disease: two bacteria (Escherichia coli and Serratia marcescens) and one fungus (Candida tropicalis) moved in lock step. The presence of all three in the sick family members was significantly higher compared to their healthy relatives, suggesting that the bacteria and fungus interact in the intestines. Additionally, test-tube research by the Ghannoum-led team found that the three work together (with the E. coli cells fusing to the fungal cells and S. marcescens forming a bridge connecting the microbes) to produce a biofilm — a thin, slimy layer of microorganisms found in the body that adheres to, among other sites, a portion of the intestines — which can prompt inflammation that results in the symptoms of Crohn’s disease.

This is first time any fungus has been linked to Crohn’s in humans; previously it was only found in mice with the disease. The study is also the first to include S. marcescens in the Crohn’s-linked bacteriome. Additionally, the researchers found that the presence of beneficial bacteria was significantly lower in the Crohn’s patients, corroborating previous research findings….                     https://www.sciencedaily.com/releases/2016/09/160920151435.htm

Citation:

Fungus in humans identified for first time as key factor in Crohn’s disease

Date:         September 20, 2016

Source:     Case Western Reserve University

Summary:

A fungus has been identified as a key factor in the development of Crohn’s disease, an international team of researchers has identified for the first time.

Journal Reference:

  1. G. Hoarau, P. K. Mukherjee, C. Gower-Rousseau, C. Hager, J. Chandra, M. A. Retuerto, C. Neut, S. Vermeire, J. Clemente, J. F. Colombel, H. Fujioka, D. Poulain, B. Sendid and M. A. Ghannoum. Bacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn’s Disease. mBio, September 2016 DOI: 10.1128/mBio.01250-16

Here is the press release from Case Western Reserve School of Medicine:

Case Western Reserve-Led International Team Identifies Fungus in Humans for First Time as Key Factor in Crohn’s Disease

Novel Finding Opens Door for Potential Treatment

September 20, 2016

A Case Western Reserve University School of Medicine-led team of international researchers has for the first time identified a fungus as a key factor in the development of Crohn’s disease. The researchers also linked a new bacterium to the previous bacteria associated with Crohn’s. The groundbreaking findings, published on September 20th in mBio, could lead to potential new treatments and ultimately, cures for the debilitating inflammatory bowel disease, which causes severe abdominal pain, diarrhea, weight loss, and fatigue.

“We already know that bacteria, in addition to genetic and dietary factors, play a major role in causing Crohn’s disease,” said the study’s senior and corresponding author, Mahmoud A Ghannoum, PhD, professor and director of the Center for Medical Mycology at Case Western Reserve and University Hospitals Cleveland Medical Center “Essentially, patients with Crohn’s have abnormal immune responses to these bacteria, which inhabit the intestines of all people. While most researchers focus their investigations on these bacteria, few have examined the role of fungi, which are also present in everyone’s intestines. Our study adds significant new information to understanding why some people develop Crohn’s disease. Equally important, it can result in a new generation of treatments, including medications and probiotics, which hold the potential for making qualitative and quantitative differences in the lives of people suffering from Crohn’s.”

Both bacteria and fungi are microorganisms – infinitesimal forms of life that can only be seen with a microscope. Fungi are eukaryotes: organism whose cells contain a nucleus; they are closer to humans than bacteria, which are prokaryotes: single-celled forms of life with no nucleus. Collectively, the fungal community that inhabits the human body is known as the mycobiome, while the bacteria are called the bacteriome. (Fungi and bacteria are present throughout the body; previously Ghannoum had found that people harbor between nine and 23 fungal species in their mouths.)

The researchers assessed the mycobiome and bacteriome of patients with Crohn’s disease and their Crohn’s-free first degree relatives in nine families in northern France and Belgium, and in Crohn’s-free individuals from four families living in the same geographic area. Specifically, they analyzed fecal samples of 20 Crohn’s and 28 Crohn’s-free patients from nine families and of 21 Crohn’s-free patients of four families. The researchers found strong fungal-bacterial interactions in those with Crohn’s disease: two bacteria (Escherichia coli and Serratia marcescens) and one fungus (Candida tropicalis) moved in lock step. The presence of all three in the sick family members was significantly higher compared to their healthy relatives, suggesting that the bacteria and fungus interact in the intestines. Additionally, test-tube research by the Ghannoum-led team found that the three work together (with the E. coli cells fusing to the fungal cells and S. marcescens forming a bridge connecting the microbes) to produce a biofilm – a thin, slimy layer of microorganisms found in the body that adheres to, among other sites, a portion of the intestines – which can prompt inflammation that results in the symptoms of Crohn’s disease.

This is first time any fungus has been linked to Crohn’s in humans; previously it was only found in mice with the disease. The study is also the first to include S. marcescens in the Crohn’s-linked bacteriome. Additionally, the researchers found that the presence of beneficial bacteria was significantly lower in the Crohn’s patients, corroborating previous research findings.

“Among hundreds of bacterial and fungal species inhabiting the intestines, it is telling that the three we identified were so highly correlated in Crohn’s patients,” said Ghannoum. “Furthermore, we found strong similarities in what may be called the ‘gut profiles’ of the Crohn’s-affected families, which were strikingly different from the Crohn’s-free families. We have to be careful, though, and not solely attribute Crohn’s disease to the bacterial and fungal makeups of our intestines. For example, we know that family members also share diet and environment to significant degrees. Further research is needed to be even more specific in identifying precipitators and contributors of Crohn’s.”

In addition to Ghannoum, other Case Western Reserve University investigators equally contributing to the study are Pranab Mukherjee, Chris Hager, Jyotsna Chandra, Mauricio Retuerto, and Hisashi Fujioka. Other members of the study team are from France and Belgium, as well as the Icahn School of Medicine at Mt. Sinai in New York City.

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The research was supported by National Institutes of Health grants R01DE024228 to MAG and PKM, RO1DE17846, the Oral HIV AIDS Research Alliance (OHARA, BRS-ACURE-S-11-000049-110229) to MAG and a Cleveland Digestive Diseases Research Core Center (DDRCC) Pilot and Feasibility project (supported by NIH/NIDDK P30 DK097948) to MAG, and R21EY021303 and R21AI074077 to PKM. Funding from the European Community’s Seventh Framework Programme (FP7-2007-2013) under HEALTH-F2-2010-260338-ALLFUN, the Programme Hospitalier de Recherche Clinique du Ministère des Affaires Sociales, de la Santé et de la Ville PHRC 1918, 2011 Candigène, France, to B.S. the UEG Research Prize 2009 to JFC

For more information about Case Western Reserve University School of Medicine, please visit: http://case.edu/medicine.

About Case Western Reserve University School of Medicine

Founded in 1843, Case Western Reserve University School of Medicine is the largest medical research institution in Ohio and is among the nation’s top medical schools for research funding from the National Institutes of Health. The School of Medicine is recognized throughout the international medical community for outstanding achievements in teaching. The School’s innovative and pioneering Western Reserve2 curriculum interweaves four themes–research and scholarship, clinical mastery, leadership, and civic professionalism–to prepare students for the practice of evidence-based medicine in the rapidly changing health care environment of the 21st century. Nine Nobel Laureates have been affiliated with the School of Medicine.

Annually, the School of Medicine trains more than 800 MD and MD/PhD students and ranks in the top 25 among U.S. research-oriented medical schools as designated by U.S. News & World Report’s “Guide to Graduate Education.”

The School of Medicine’s primary affiliate is University Hospitals Case Medical Center and is additionally affiliated with MetroHealth Medical Center, the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, and the Cleveland Clinic, with which it established the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in 2002. case.edu/medicine.

Media Contact(s):

Marc Kaplan
Associate Dean, Marketing and Communications
The School of Medicine
Case Western Reserve University
Office: 216-368-4692
Marc.Kaplan@case.edu

The Mayo Clinic offers the following advice:

Treatment for Crohn’s disease usually involves drug therapy or, in certain cases, surgery. There is currently no cure for the disease, and there is no one treatment that works for everyone. Doctors use one of two approaches to treatment — either “step-up,” which starts with milder drugs first, or “top-down,” which gives people stronger drugs earlier in the treatment process.

The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. It is also to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission…..                                   http://www.mayoclinic.org/diseases-conditions/crohns-disease/basics/treatment/con-20032061

As with any medical condition, consult competent medical professionals.

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