Saturday, March 21, 2015

Sleep apnea and severe maternal-infant morbidity/mortality in the United States - Five fold increase in mortality!


Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009.

Abstract

STUDY OBJECTIVES: 

A recent trend in increasing rates of severe maternal morbidity and mortality despite quality improvements has been noted. The goal of this study is to estimate the national prevalence of obstructive sleep apnea (OSA) in pregnant women and examine associations between OSA and pregnancy-related morbidities, including in-hospital maternal mortality.

DESIGN: 

A retrospective, cross-sectional analysis.

SETTING: 

A nationally representative sample of maternal hospital discharges from 1998-2009.

PATIENTS OR PARTICIPANTS: 

The analytic sample included 55,781,965 pregnancy-related inpatient hospital discharges.

INTERVENTIONS: 

N/A.

MEASUREMENTS AND RESULTS: 

The Nationwide Inpatient Sample (NIS) database was used to identify hospital stays for women who were pregnant or gave birth. Among these women, we determined length of hospital stay, in-hospital mortality, and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify OSA and other outcome measures. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between OSA and each outcome. The overall rate of OSA was 3.0 per 10,000; however, the rate climbed substantially from 0.7 in 1998 to 7.3 in 2009, with an average annual increase of 24%. After controlling for obesity and other potential confounders, OSA was associated with increased odds of pregnancy-related morbidities including preeclampsia (OR, 2.5; 95% CI, 2.2-2.9), eclampsia (OR, 5.4; 95% CI, 3.3-8.9), cardiomyopathy (OR, 9.0; 95% CI, 7.5-10.9), and pulmonary embolism (OR, 4.5; 95% CI, 2.3-8.9). Women with OSA experienced a more than fivefold increased odds of in-hospital mortality (95% CI, 2.4-11.5). The adverse effects of OSA on selected outcomes were exacerbated by obesity.

CONCLUSIONS: 

Obstructive sleep apnea is associated with severe maternal morbidity, cardiovascular morbidity, and in-hospital death. Targeted interventions may improve pregnancy outcomes in this group.

KEYWORDS: 

maternal mortality obstructive sleep apnea preeclampsia  pregnancy pulmonary embolus

Monday, March 16, 2015

How about some good news....Basketball players defend Kenosha cheerleader targeted by bully!

How about some news about what is good in kids today! JR

Basketball players defend Kenosha cheerleader targeted by bully

KENOSHA -- A student being bullied at a Lincoln Middle School basketball game caught the attention of the basketball players. They walked off the court to come to defend her. 
This is where it all happened for Desiree Andrews.  As she was being bullied from the stands, a few boys on the team said enough's enough, and that's where this bullying situation turned her life around.
 
Desiree Andrews no longer walks to class alone.  Students have been drawn to her after a situation that could have taken away this pretty smile.
 
"The kids in the audience were picking on Dee, So we all stepped forward," said Chase Vazquez, Lincoln Middle School basketball player.
 
Andrews has Down syndrome.  These three boys were in the middle of a game when they heard something upsetting directed at one of their cheerleaders, a girl who dances to her own beat.
 
“So when I heard they were talking about her like, it kind of like made me mad," said Miles Rodriguez, Lincoln Middle School basketball player.
Basketball players stepped to action, walked off the court, and told the bully to stop.
“It’s not fair when other people get treated wrong because we’re all the same. We’re all created the same. God made us the same way," said Scooter Terrien, Lincoln Middle School basketball player.
Dee and the boys are now eighth graders and last night, played their last game in the gymnasium that they have affectionately dedicated to their friend.
We asked Desiree Andrews: “Are they calling it something special?"

An Essential Audio and Written Article on Ataxia and Cerebellar Disorders.



This is a very important informative piece for anyone with ataxia or other cerebellar dysfunction...or living with or educating someone with ataxia...Thanks to Dr. Schmahmann from a specialist and a parent.

My favorite quotes:

"...the cerebellum really has just one job: It takes clumsy actions or functions and makes them more refined. "It doesn't make things. It makes things better," Schmahmann says.'

"But during that time doctors and developmental health experts still didn't know why Jonathan was having so much trouble. And that turned out to be a good thing, says his father, Richard. "Not knowing what the diagnosis was we said, 'Well, let's assume he can do everything,' " he says."

 JR


A Man's Incomplete Brain Reveals Cerebellum's Role In Thought And Emotion




Since his birth 33 years ago, Jonathan Keleher has been living without a cerebellum, a structure that usually contains about half the brain's neurons.
This exceedingly rare condition has left Jonathan with a distinctive way of speaking and a walk that is slightly awkward. He also lacks the balance to ride a bicycle.
But all that hasn't kept him from living on his own, holding down an office job and charming pretty much every person he meets.
"I've always been more into people than anything else," Jonathan tells me when I meet him at his parents' house in Concord, Mass., a suburb of Boston. "Why read a book or why do anything when you can be social and talk to people?"

Jonathan's Brain Scans

These are brain MRI scans of Jon Keleher (A,B) compared to a control person (C,D) of the same age.
Brain Scans
Jonathan is also making an important contribution to neuroscience. By allowing scientists to study him and his brain, he is helping to change some long-held misconceptions about what the cerebellum does. And that, in turn, could help the hundreds of thousands of people whose cerebellums have been damaged by a stroke, infection or disease.
For decades, the cerebellum has been the "Rodney Dangerfield of the brain," says Dr. Jeremy Schmahmann, a professor of neurology at Harvard and Massachusetts General Hospital. It gets no respect because most scientists only know about its role in balance and fine motor control.
You can learn a lot about that role by watching someone who's been pulled over for drunken driving, Schmahmann says. "The state trooper test is a test of cerebellar function. So the effect of alcohol on cerebellar function is identified by everybody who's ever done walking a straight line or touching their finger to the nose."
But Schmahmann and a small group of other scientists have spent decades building acase that the cerebellum does a lot more than let people pass a sobriety test.

Wednesday, March 11, 2015

Concussions detectable on the sidelines in children as young as 5

A vision test that can be done on sidelines to detect concussions was shown effective in children as young as 5 years old.

New research from the NYU Langone Concussion Center finds that a simple eye test, which can be administered in less than two minutes, can effectively diagnose a concussion and help determine whether a student athlete as young as 5 years old should return to a game.
The new study, published online in the Journal of Neuro-Ophthalmology, was conducted on 89 NCAA athletes and a younger subset of 243 youth athletes under age 17, and shows how the eye test, known as the King-Devick test, could help mitigate the problems that face concussion diagnosis in youth sports.
Study author Steven Galetta, MD, the Philip K. Moskowitz, MD Professor and Chair of Neurology at NYU Langone Medical Center, says the test can easily be administered on the sidelines by parents and non-health care professionals when athletic trainers and doctors are not available to monitor sidelines at youth sports games.
"Our findings in children and collegiate athletes show how a simple vision test can aid in diagnosis of concussion at all levels of sport," says Dr. Galetta, who is also a professor of ophthalmology at NYU Langone. "Adding the King-Devick test to the sideline assessment of student athletes following a head injury can eliminate the guesswork for coaches and parents when deciding whether or not a student should return to play."
As part of the King-Devick test, athletes read numbers off of three pieces of paper while being timed with a stopwatch. A worsened performance from a baseline reading suggests a concussion has occurred.
"Given that concussions may cause devastating short- and long-term cognitive effects, tools like vision testing that can objectively diagnose a concussion are critical," says Laura Balcer, MD, co-director of the NYU Langone Concussion Center, and a professor of neurology, ophthalmology and population health at NYU Langone.
Some sideline tests only measure cognition and balance, but visual testing is rarely performed, despite longstanding evidence that vision is commonly affected by concussion, according to a review article published by Dr. Galetta and Dr. Balcer in the March 3 print issue of Journal of Neuro-Ophthalmology. Previous research suggests about 50 percent of the brain's pathways are tied to vision.
The King-Devick test was developed in 1976 by optometrists Dr. Alan King and Steven Devick. Previous studies have looked at the test for neurological conditions that can affect vision like multiple sclerosis, before the researchers began testing it on athletes.
While earlier studies by the NYU Langone researchers looked at the King-Devick test on college athletes, this is the first to administer the test in children.
For the new study, researchers recruited 243 male and female athletes between the ages of 5 and 17 years old participating in a local youth hockey and lacrosse leagues, and 89 athletes who played these sports at the collegiate level. All of them underwent a baseline King-Devick test before the start of the sports season.
As part of the test, participants read numerical on cards from left to right as quickly as possible. Times for all three reading cards are added together, and then that number is compared with the baseline score: higher testing times suggest a worsening of performance consistent with a concussion.
All the student athletes were also given a brief cognitive test called the Standardized Assessment of Concussion (SAC) which measures memory, concentration and recall, and a Timed Tandem Gait Test, which is a timed walking trial.
Researchers determined 12 athletes sustained a concussion during the season. After matching them to control subjects of the same age and sport who did not experience a head injury, the study showed the King-Devick test outperformed the other two tests in distinguishing a concussed athlete versus an uninjured control subject with 92 percent accuracy (compared to 87 percent for Tandem Gait and 68 percent for SAC test).
Among concussed athletes, K-D scores worsened by an average of 5.2 seconds compared to baseline scores, while non-concussed athletes improved their times by 6.4 seconds compared with baseline.
Up to 3.9 million sports-related mild traumatic brain injuries, or concussions, occur annually in the United States, according to the Centers for Disease Control and Prevention, but researchers say that number is likely higher since the CDC only tracks emergency room visits.
Experiencing a concussion in a game increases an athlete's risk for sustaining a second condition in the same season by three times. Other complications include the dangerous second impact syndrome, or other short- and long-term side effects.
The group next plans to study the underlying mechanisms of the fast eye movements required for rapid number naming using electronic quantitative eye movement recordings in collaboration with Janet Rucker, MD, the Bernard A. and Charlotte Marden Associate Professor of Neurology and J.R. Rizzo, MD, director of the Visuomotor Integration Lab at Rusk Rehabilitation. According to Dr Balcer, these observations may permit more precise anatomical correlations of performance data and concussive symptoms.
Read more here

Increased stroke risk seen with people who sleep too much

Sleeping for more than 8 hours per day can increase a person's risk of having a stroke.

People who sleep for more than eight hours a day have an increased risk of stroke, according to a study by the University of Cambridge -- and this risk doubles for older people who persistently sleep longer than average. However, the researchers say it is unclear why this association exists and call for further research to explore the link.
Previous studies have already suggested a possible association between sleep and risk of stroke, but today's study, published in the journal Neurology, is the first to provide detailed information about the British population and to examine the relationship between a change in sleep duration over time and subsequent stroke risk.
Researchers from the Department of Public Health and Primary Care at the University of Cambridge followed just under 10,000 people aged 42-81 years of age from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort over 9.5 years. During 1998-2000 and then again four years later, they asked the cohort how many hours on average they slept in a day and whether they generally slept well. Almost seven out of ten participants reported sleeping between six and eight hours a day, whilst one in ten reported sleeping for over eight hours a day. Participants who slept for less than six hours or more than eight hours were more likely to be older, women and less active.
Over the almost ten year period of the study, 346 participants suffered a stroke, either non-fatal or fatal stroke. After adjusting for various factors including age and sex, the researchers found that people who slept longer than eight hours a day were at a 46% greater risk of stroke than average. People who slept less than six hours a day were at an 18% increased risk, but the small number of people falling in this category meant the association was not statistically significant*.
Participants who reported persistently long sleep -- in other words, they reported sleeping over eight hours when asked at both points of the study -- were at double the risk of stroke compared to those with persistently average sleep duration (between six and eight hours a day). This risk was even greater for those whose reported sleep increased from short to long over the four years -- their risk was close to four times that of people who maintained an average sleep duration.
In addition to studying the EPIC-Norfolk cohort, the researchers carried out a study of combined data from 11 other studies related to identify the association between sleep duration and patterns of stroke risk. Their final analysis, including 560,000 participants from seven countries, supported the findings from the EPIC-Norfolk cohort study.
Yue Leng, a PhD candidate at the University of Cambridge, says: "It's apparent both from our own participants and the wealth of international data that there's a link between sleeping longer than average and a greater risk of stroke. What is far less clear, however, is the direction of this link, whether longer sleep is a symptom, an early marker or a cause of cardiovascular problems."
While older people have less work and fewer social demands and therefore often have the option of sleeping longer, previous research has shown that in fact, they tend to sleep on average for shorter periods.
The researchers say it is unclear yet why the link between sleep and stroke risk should exist. Lack of sleep has been linked with factors such as disrupted metabolism and raised levels of the 'stress hormone' cortisol, all of which may lead to higher blood pressure and increased stroke risk. However, the current study suggests that the association between longer sleep duration and higher risk of stroke was independent of normal risk factors for cardiovascular disease.
Professor Kay-Tee Khaw, senior author on the study, adds: "We need to understand the reasons behind the link between sleep and stroke risk. What is happening in the body that causes this link? With further research, we may find that excessive sleep proves to be an early indicator of increased stroke risk, particularly among older people."
The study was supported by the Medical Research Council and Cancer Research UK.
*The absolute risk of stroke was 4.1% for less than six hours' sleep, 3.1% for six to eight hours, and 5.3% for over eight hours. Note: these figures are before adjustment for age, sex, etc. -- figures for after adjustment were not available.
Read more here

Persistent debunked autism fads

This study from Emory University discusses why debunked autism treatment fads continue to persist.

The communication struggles of children with autism spectrum disorder can drive parents and educators to try anything to understand their thoughts, needs and wants. Unfortunately, specialists in psychology and communication disorders do not always communicate the latest science so well.
These factors make the autism community especially vulnerable to interventions and "therapies" that have been thoroughly discredited, says Scott Lilienfeld, a psychologist at Emory University.
"Hope is a great thing, I'm a strong believer in it," Lilienfeld says. "But the false hope buoyed by discredited therapies can be cruel, and it may prevent people from trying an intervention that actually could deliver benefits."
Lilienfeld is lead author of a commentary, "The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example," recently published by the journal Evidence-Based Communication Assessment and Intervention. Co-authors of the commentary are Julia Marshall (also from Emory) and psychologists James Todd (from Eastern Michigan University), and Howard Shane (director of the Autism Language Program at Boston Children's Hospital).
The authors describe a litany of treatments for autism that have been attempted with little or no success over the years, including gluten- and casein-free diets, antifungal interventions, chelation therapy, magnetic shoe inserts, hyperbaric oxygen sessions, weighted vests, bleach enemas, sheep-stem-cell injections and many more.
As a case study, however, the article focuses on one intervention in particular: Facilitated Communication, or FC.
FC purports to allow previously nonverbal individuals with autism and related disorders to type by using a keyboard or letter pad. A facilitator offers support to the individual's arms, allowing him or her to type words and complete sentences.
Soon after its introduction into the United States in the early 1990s, however, FC was convincingly debunked. Studies overwhelmingly demonstrated that facilitators were unconsciously guiding the hands of individuals with autism toward the desired letters, much as individuals using a Ouija board unknowingly guide the planchette to certain numbers and letters.
"The emotional appeal of FC is very powerful and understandable," Lilienfeld says. "And no doubt the overwhelming majority of people who use FC are sincere and well-meaning. The problem is, it doesn't work."
In some cases, the authors note, FC has resurfaced with minor variations in the technique and a new name, such as "rapid prompting," or "supported typing."
By reviewing published surveys of practitioner use and canvassing the popular and academic literatures, Lilienfeld and his co-authors show that FC continues to be widely used and widely disseminated in much of the autism community despite its scientific refutation. They examine a number of potential reasons for the surprising persistence of FC and other autism fads. They note that the inherent difficulties in treating autism may give rise to an understandable desire for quick fixes of many kinds.
Lilienfeld and his colleagues underscore the pressing need for experts in the autism field to better educate the public about not only what works for the condition, but what does not.
Read more here

Village in Kazakhstan hit with mystery sleep disorder

A small village in Kazakhstan is being hit with a mysterious sleep disorder where people fall asleep for days at a time.

Residents of a Kazakhstan town are being affected by a sleep disorder in which some fall asleep suddenly and don't wake up for days.

Over 150 cases since March 2013 have hit the town of Kalachi in northern Kazakhstan. The cause of the incidents, which come in waves, are unknown. The ninth wave of the mysterious illness was reported this week.

"The disease is characterized by the fact that the sickness immerses himself in unusually long sleep, while to bring them into full consciousness is practically impossible on the first day," said Leonid Rikhvanov of Russia's Tomsk Polytechnic University, who has studied the area for four years.

"During hospitalization, people exposed to the disease were marked by identical complaints: dizziness, weakness, loss of coordination, unconsciousness or semiconscious state for up to three days. After passing the first symptoms, they get headaches, become confused, and suffer emotional instability and memory disorders, which can last up to several weeks. In some cases, hallucinations occur, particularly in children. Some repeatedly fall asleep."

Rikhvanov suspects a nearby abandoned uranium mine is emitting radon, a colorless gas which could be working as an anesthetic or providing a narcotic effect. Other theories involve possible carbon monoxide poisoning and mass hysteria.

About 100 of Kalachi's 680 residents have been relocated to other parts of Kazakhstan, local government leader Amanbek Kalzhanov said.

Read more here