Sunday, July 29, 2012
Researchers at Aalto University in Finland have developed the world's first device designed for mapping the human brain that combines whole-head magnetoencephalography (MEG) and magnetic resonance imaging (MRI) technology. MEG measures the electrical function and MRI visualizes the structure of the brain. The merging of these two technologies will produce unprecedented accuracy in locating brain electrical activity non-invasively.
"We expect that the new technology will improve the accuracy of brain mapping of patients with epilepsy. It may also improve the diagnosis of cancer patients because the improved image contrast may facilitate the characterization of cancer tissue," says Academy Professor Risto Ilmoniemi.
"The innovative MEG-MRI device will allow brain imaging for new patients, such as those with metal implants. Also, the silent and open device will not scare children or make people feel claustrophobic. In the future, this development can also reduce costs as images can be obtained in one session rather than two," Ilmoniemi states.
The problem with MEG is that when the technique is used separately, the image accuracy can be compromised because of the movement of the brain. Also, the image it provides may not be accurate enough for precise brain surgery. In the past, it was not possible to combine high-field MRI and MEG because their magnetic fields interfered with one another. Extremely sensitive magnetic field sensors have now been developed, so scientists can now use the new low-field MRI with a magnetic field strength of only a few hundred-thousandths of that of the high-field MRI device. Fusing these two technologies produces localization accuracy that was not possible with MRI or MEG alone.
The project is coordinated by Aalto University in Finland and it includes 13 research groups from five different countries. The research project is part of the European Commission Seventh Framework Program.
Read more here
Sometimes people ask if animals dream or have sleep disorders like them. The answer is yes! Just watch a sleeping dog for a few minutes and you will see their eyes moving from side to side, just as human's do during REM sleep.
Dogs and cats have many of the same sleep disorders as humans including sleep terrors, nocturnal seizures, narcolepsy, cataplexy and limb movements.1
Narcolepsy is known to occur more frequently in certain breeds of dogs, including Doberman pinschers, poodles, Labrador retrievers, beagles and dachshunds. Horses can also be affected. This disorder is usually inherited from the parents. Animals with narcolepsy also tend to have cataplexy when they are excited, for example when the feeding bowl arrives. It is treated much as it is in humans, with stimulants and anti-depressants.
It appears that most mammals and birds have REM sleep. It is questionable as to whether reptiles have REM sleep based on one study with turtles.2 Brain structures are different than in mammals and birds, so it is difficult to say absolutely.
You may be wondering, which mammal has the most REM sleep per day. The platypus ranks number first, getting about eight hours of REM sleep.3 The ferret, armadillo and possum also have high amounts of REM sleep daily. The giraffe and horse have the least at about 0.5 hours.
I hope you've found this information fun and interesting. The next time a patient complains of sleep difficulties, tell them they are not alone. They have only to look around their home to see how sleep affects their pets.
Sharon M. O'Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
- Schenck, Carlos. Sleep: A Groundbreaking Guide to the Mysteries, the Problems, and the Solutions. New York: Penguin Group. 2007. pp. 258-263.
- Zepelin, Harold. Siegel, Jerome. Tobler, Irene. Chapter 8. "Mammalian Sleep". Principles and Practice of Sleep Medicine Fourth Edition Philadelphia: Elsevier Saunders, 2005. pp. 91-100.
- Siegel, Jerome. Chapter 10. "REM Sleep". Principles and Practice of Sleep Medicine Fourth EditionPhiladelphia: Elsevier Saunders, 2005. pp. 120-135.
A new microchip is being developed that could result in epileptic patients staying in the hospital less. It would be especially useful for children.
A hi-tech medical patch being developed in Abu Dhabi should soon help epileptics avoid long stays in hospital.
This article discusses why states, such as Ohio, are having so much trouble passing concussion legislation.
Ohio state Reps. Michael Stinziano and Sean O'Brien thought they had a bill that would pass with no more than token opposition. It was a youth safety bill - a piece of legislation protecting young athletes who suffered head injuries on the playing field. Other states had taken similar action. The sponsors didn't expect a backlash. But a backlash is what they got.
It took multiple hearings and 10 rewrites to get the anti-concussion bill through the Ohio House. And it still faces an uncertain future in the state Senate. The reason has to do with the concerns of some doctors and the slippery problem of "return to play" decisions.
The bill aims to reduce the number of kids who suffer repeated concussions by requiring a coach to remove athletes from play if they show concussion symptoms and mandating that a health care professional sign off on their return to play. But which professionals are authorized to make that call? Some are bound to be excluded. Many legislators, says Stinziano, have an optometrist or a physical therapist in their district who is concerned about being cut out as an authorized concussion expert who could return a kid to play. Rural representatives argue that for their constituents, getting an athlete to a doctor or hospital for an evaluation can be too time-consuming to be practical.
The Ohio House reached a compromise and passed the bill by allowing each school district or governing authority of a chartered or private school to authorize which licensed health care providers can make return-to-play decisions. Stinziano acknowledges that while the doctors don't love it, it's what was needed to move the legislation. "This issue is not necessarily resolved," Stinziano says, "and we have our work cut out for us in the Senate."
The debate in Ohio follows a series of state youth concussion safety laws enacted since 2009, when Washington became the first state to create a law codifying the procedures for returning a young athlete to a game after sustaining a concussion. The Washington legislature was spurred to action by a serious injury to a middle school football player, Zackery Lystedt, who in 2006 was returned to a game after sustaining a concussion and suffered serious brain damage following a second hit.
Lystedt and his family lobbied the Washington legislature, and since then, the National Football League, which routinely sends its own players to testify in statehouses on concussion legislation, has been a key force behind the changes in 38 states. The urgency of the legislation has also been influenced by new research showing that repeated concussions can have life-altering repercussions, such as early-onset Alzheimer's disease, dementia, and increased risks of suicide. At least 2,000 former NFL players recently filed a lawsuit against the NFL claiming that the league deliberately misled them about the health risks of concussions. In an effort to make sure that youth stay safe from these dangers, at least eight states enacted concussion laws that went into effect this year.
Each state's law is slightly different. For instance, in New York and Minnesota, where, as in Ohio, debates surrounding access to care threatened the legislation's success, the laws do not specify which health care professionals can return a youth to play after sustaining a concussion. The NFL has not weighed in on the issue; it has specifically left it up to states to decide which doctors are qualified to make the decision.
There's a balance that must be struck, says Dawn Comstock, professor at Ohio State University'sCenter for Injury Research and Policy, between who really has the knowledge to evaluate a concussion and the level of access to those people. "Maybe a neurologist might be the best person to make the decision," says Comstock, "but how many neurologists are out there? In reality, if the kid can't access whoever is allowed to make the return-to-play decision, they're going to be more likely to hide the fact that they have a concussion."
According to data collected by the Centers for Disease Control, the number of emergency room visits by youth suffering from concussions or other traumatic brain injury sustained while playing sports increased by 62 percent from 2001-2009. While the rise is significant, says Julie Gilchrist, medical epidemiologist at the CDC, the increase is likely due to a heightened awareness of concussions, not to the fact that sports are more dangerous. "It's sad to see in one way," Gilchrist says, "but it's good that people are seeking care."
Boys' high school football had the highest rate of overall concussion at 6.94 per 10,000 athletes participating in school-sponsored practice or competition from 2008-2011, according to data from Ohio State University, followed by boys' ice hockey at 6.11, boys' lacrosse at 4.21 and girls' soccer at 3.83.
And while states are legislating protocols for what to do after a concussion is sustained, many sports associations are taking actions to prevent the injuries from happening in the first place. Minnesota Hockey, which governs more than 50,000 hockey players from ages 5 to adult, recently increased penalties for checking from behind, the practice of skating up from behind a player and pushing him before he has a chance to defend himself. After a Minnesota high school hockey player, Jack Jablonski, was paralyzed by getting checked from behind in January, the state's governing body for youth and amateur hockey decided to impose a minimum five-minute major penalty for checking from behind, up from a two-minute penalty.
Scott Gray, vice president for publicity and promotion for Minnesota Hockey, says that the change is aimed at preventing concussions and other serious injuries. "Most of the feedback that I've heard has been fairly positive," says Gray, who is also a parent of a hockey player. "My son is a junior in high school and it's hard to sit in the stands as a parent and watch your kid get blasted."
USA Hockey, the parent organization to Minnesota Hockey, last year banned all checking for players at the pee-wee level, younger than age 12, citing new research that showed the serious injury rate was four times higher for checking vs. non-checking pee-wee leagues. Pop Warner, an organization which manages hundreds of youth football teams nationwide, just last month limited contact in practices and banned full-speed, head-on blocking and tackling drills where players line up more than three yards apart.
But so far, none of the legislative efforts has addressed prevention, and Comstock says prevention isn't much of a research focus either. "All of the research has been going into diagnosing concussion and managing it, but hardly anything has gone into primary prevention. Not a single piece of any of these laws is going to keep a kid from getting a concussion in the first place."
That being said, any focus on concussion legislation is encouraging to many in the sports community. "People are fervent about their sport," says Gray, the
Minnesota Hockey dad, "and somewhere in there you have to pack in safety, development, costs ... but safety has become job number one as far as we're concerned. It's going to be a better sport because of it."
Read more here
"The thing I learned was that I thought you got a concussion [only] when you blacked out, but that’s not the case," said Kim Mehandzic of Westwood, who brought her son Nik, 8, to the event.
"I think it’s important to know that concussions do heal if they’re treated properly. So I would let my son keep playing sports. They learn valuable life lessons through team sports. Parents have to trust their instincts."
Read more here
Saturday, July 28, 2012
Botulinum toxin injections are indicated for the treatment of spasticity based on CLASS A evidence. This level of medical evidence is the highest standard possible and is the type of evidence that also supports antibiotics for pneumonia and other basic medical treatments
Imagine having a child with cerebral palsy. They may have trouble with movement or theri care due to spasticity. Spasticity is disabling, painful and can end in immobilizing, fixed contractures.
How would you treat your own child after reading your article? For spasticity, the options are surgeries, implanted devices and medications. All have higher risks with more unpredictable outcomes.
See this quote on Adverse Events
Thursday, July 26, 2012
Be vocal and advocate for your child to see a pediatric specialist! One way to reduce health care costs is to restrict access.
. If you have an access issue, speak to your primary care, your HR department at your employer, your insurance representative and/or a case manager! JR
Pediatric Shortages, Long Wait Times Reinforce Need for Improved Access to Health Care for Children
Jul 23, 2012 - 10:43:10 AM
(HealthNewsDigest.com) - Alexandria, VA – As the fight around the constitutionality of the Affordable Care Act settles, new data indicate that the battle to ensure timely access to health care for America’s child patients is far from over. Today, the Children’s Hospital Association unveils results of a national survey that shows severe physician shortages and long wait times are a harsh reality for many kids seeking health care in the United States. The Association releases these findings as part of its Family Advocacy Day, July 23-25, an annual, national event that enables children’s hospital patients and their families to share their health care stories and make their voices heard on Capitol Hill.
“Although significant progress has been made to support children’s health care in recent years, children still face barriers when accessing pediatric care,” says Mark Wietecha, president and CEO of the Children’s Hospital Association. “Children deserve better. More needs to be done to ensure they’re getting the care they need, when they need it and in the right care setting.”
The survey analysis of nearly 70 children’s hospitals across the country reveals ongoing vacancies of 12 months or longer among key pediatric specialties – such as neurology (39 percent of hospitals surveyed), general surgery (30 percent) and developmental-behavioral medicine (28 percent) – that are impacting hospitals’ ability to provide timely medical care to kids. These findings are reinforced by American Board of Pediatrics Workforce Data 2011-2012, which show restricted access to certified specialists in several areas of the country.[i]
In fact, 3 out of 4 hospitals say the shortages have caused delayed appointments. By the time a child is able to get in for an appointment, he or she may be waiting up to seven times longer when compared to the ideal two-week appointment wait time that hospitals strive for. In the most affected specialties, children can wait nearly 15-weeks for appointments in developmental-behavioral medicine and nine weeks in neurology. Overall, children’s hospitals say the shortages most affecting their ability to deliver care lie in neurology (15 percent of hospitals surveyed), developmental-behavioral medicine (8 percent), gastroenterology (7 percent), pediatric surgery (7 percent), and neurosurgery (5 percent).
Experts agree that without federal funding for critical child health care programs, children’s access to care could be jeopardized even further. The Children’s Hospitals Graduate Medical Education (CHGME), a national program solely devoted to helping children’s hospitals train pediatricians and pediatric specialists, supports the training and development of half of all pediatricians and pediatric specialists practicing in the U.S. Unfortunately, CHGME funding has been rolled back by more than $50 million since FY 2010 and is far below the support needed to close the gap between demand for care and the supply of these specialized caregivers. While CHGME has been successful and has helped increase the number of pediatric providers trained annually, more is still needed. Without sufficient funding for CHGME, as illustrated through the new data, a national shortage of pediatric specialists will persist.
CHGME is not the only national child-focused health care program at risk. Federal budget proposals would slash funding to Medicaid, the federal-state program that provides health coverage to 1 in 3 children, further restricting children’s access to health care. Today, there are numerous proposals to cut Medicaid by billions over the next 10 years. These proposals are on top of the billions in cuts that states have already implemented over the past few years as a means to balance their budgets. (A $1 cut at the state level produces a federal savings of $0.57.)
No one understands the impact of the pediatric specialty shortages quite like the families who have experienced it firsthand. Joining the Children’s Hospital Association in Washington this week to discuss the impact of pediatric shortages is the Johnston family of Minneapolis, MN. Mike Johnston, age 14, suffered from debilitating headaches for over a year until he was diagnosed with a cancerous brain tumor in April 2011. Long waits were an unfortunate reality for Johnston, who attempted to get appointments with psychologists and neurologists before the discovery of the tumor. He was admitted to the emergency room before either of the appointments arrived.
“Had we visited the neurology department earlier, I’m confident they would have seen the mass forming,” explains his dad John Johnston. “And while the treatment likely would have been the same, Mike would have suffered far less. He was lucky, and thanks to specialized care, he’s now cancer free. Sadly, for millions of other children waiting for care, the outcome may be very different.”
The Johnston family is joined in Washington this week by nearly 30 other child patients, from 19 states and the District of Columbia, to bring to life the importance of timely, quality pediatric care for kids, and encourage legislators to take action to protect and improve care for children.
“As the data confirm, and the patient stories illustrate, many children wait far too long to get needed services to diagnose, treat and manage all kinds of diseases,” notes Wietecha. “When children don’t get timely care, they miss school; they can fall behind; their parents miss work, creating more family stress. A domino effect can occur when children don’t have timely access to specialized pediatric care.”
While shortages in neurology and behavioral-developmental care rise to the top of the Association’s list of shortages, the data show the overall impact of shortages is widespread, with children waiting for care in other key areas, including genetics (11 weeks), rheumatology (8 weeks), dermatology (8 weeks), child and adolescent psychiatry (7.5 weeks), and endocrinology (7 weeks).
As a result of difficulties recruiting pediatric specialists, children’s hospitals also report increased recruitment costs (67 percent of hospitals surveyed); lost referrals - where children are referred to other providers who are adult clinicians (64 percent); decreased staff morale (56 percent); increased salaries (55 percent); delayed and/or lost surgeries and reduction in level of service (52 percent).
# # #
About the Children’s Hospitals Pediatric Specialist Workforce Survey
Fielded by the Children’s Hospital Association during the month of May 2012, 69 member hospitals of the Association completed the survey.
Methodology: Surveys were sent to all medical directors (or their designees) in hospitals that are members of the Children’s Hospital Association. The survey, consisting of seven questions, was sent in an Adobe PDF format via email, and respondents were asked to email or fax their completed survey back to the Association. In total, 69 hospitals responded (approximately a 30 percent response rate) including many of the largest children’s teaching hospitals in the nation. Analysis was completed using SPSS Statistics 20.0.
Limitations: Responses came from a variety of hospitals: acute care to specialty care, large hospitals to small hospitals. Not every hospital provided a wait time for every specialty, due to the fact that some hospitals do not offer all services or do not collect data on all of services.
About the Children’s Hospital Association
The Children’s Hospital Association advances child health through innovation in the quality, cost and delivery of care. Representing more than 220 children’s hospitals, the Association is the voice of children’s hospitals nationally. The Association advances public policy enabling hospitals to better serve children, and is the premier resource for pediatric data and analytics driving improved clinical and operational performance of member hospitals. Formed in 2011, the Association brings together the strengths and talents of three organizations: Child Health Corporation of America (CHCA), National Association of Children’s Hospitals and Related Institutions (NACHRI) and National Association of Children’s Hospitals (N.A.C.H.).
For more information on Family Advocacy Day, visit www.childrenshospitals.net, or follow the families on Facebook at http://www.facebook.com/childrenshospitals or Twitter, @speaknowforkids, #FAD12.
[i] American Board of Pediatrics, 2011: https://www.abp.org/abpwebsite/stats/wrkfrc/workforcebook.pdf
Tuesday, July 24, 2012
New pen, similar to an epi-pen, is being developed to help stop seizures. This could be a huge advancement for emergency medical services when responding to calls about seizures.
Read more here
Researchers at the University of Iowa have found that police officers who sleep fewer than six hours per night are more susceptible to chronic fatigue and health problems, such as being overweight or obese, and contracting diabetes or heart disease. The study found that officers working the evening or night shifts were 14 times more likely to get less restful sleep than day-shift officers, and also were subjected to more back-to-back shifts, exacerbating their sleep deficit.
The study is the first peer-reviewed look at differences in duration and quality of sleep in the context of shift work and health risks in the police force, the authors noted.
"This study further confirmed the impact of shift work on law enforcement officers and the importance of sleep as a modifiable risk factor for police," wrote Sandra Ramey, assistant professor in the College of Nursing at the UI and the lead author on the paper published inWorkplace Health & Safety. "The good news is this is correctable. There are approaches we can take to break the cascade of poor sleep for police officers."
The research is important because getting fewer than six hours of sleep could affect officers' ability to do their jobs, which could affect public safety. It also boosts the risk for health problems, which could affect staffing and could lead to higher health costs borne by taxpayers.
The researchers recommend putting practices in place to ensure officers get proper sleep. For example, 83 percent of police on the evening or night shift reported having to report to duty early the next morning at least occasionally. One idea from the UI team is to change the morning time that evening or night-shift officers may need to appear in court, to ensure that they get full rest. They also recommend that law enforcement and nurses partner more closely, to encourage officers to get 7-8 hours of sleep per night.
The researchers surveyed 85 male police officers ranging in age from 22 to 63 years old from three police departments in eastern Iowa. The respondents were equally divided between those who worked the day shift and those who worked the evening or night shifts. The officers, who worked on average 46 hours per week, were queried on their levels of stress and fatigue, while their height, weight, and C-reactive protein levels (marks inflammation levels in the blood) were measured.
While officers working the evening or night shifts were more likely to get fewer than six hours of sleep, the researchers also found that police who slept fewer than six hours were twice as likely to sleep poorly. That finding is important, because poor sleep can lead to "vital exhaustion," or chronic fatigue, the authors noted, which can trigger additional health problems.
The UI study builds on other studies that show a possible link between sleep deprivation and ill health and chronic fatigue in police officers. "This finding is supported by other studies that suggested poor sleep and short sleep (with resultant fatigue) may be related to psychological stress," they wrote.
Somewhat surprisingly, the researchers did not find a strong tie between lack of sleep and the onset of health complications, although they said a larger statistical sample may be needed to more fully understand the relationship.
The study, titled "The effect of work shift and sleep duration on various aspects of police officers' health," was published in the May edition of the journal. M. Kathleen Clark, Yelena Perhounkova, and Hui-Chen Tseng from the UI College of Nursing are co-authors on the study. Laura Budde, from Mercy Hospital in Iowa City, and Mikyung Moon, from Keimyung University in South Korea, are contributing authors on the paper.
Read more here
Many studies conclude that negative impacts of poor sleep now include your brain aging more quickly.
Evidence is building that poor sleep patterns may do more than make you cranky: The amount and quality of shuteye you get could be linked to mental deterioration and Alzheimer's disease, four new studies suggest.
Too little or too much sleep was equated with two years' brain aging in one study. A separate study concluded that people with sleep apnea -- disrupted breathing during sleep -- were more than twice as likely to develop mild thinking problems or dementia compared to problem-free sleepers. Yet another suggests excessive daytime sleepiness may predict diminished memory and thinking skills, known as cognitive decline, in older people.
"Whether sleep changes, such as sleep apnea or disturbances, are signs of a decline to come or the cause of decline is something we don't know, but these four studies . . . shed further light that this is an area we need to look into more," said Heather Snyder, senior associate director of medical and scientific relations for the Alzheimer's Association in Chicago, who was not involved in the studies.
The studies are scheduled for presentation Monday at the Alzheimer's Association annual meeting in Vancouver.
The largest of the studies, which examined data on more than 15,000 women in the U.S. Nurses' Health Study, suggested that those who slept five hours a day or less, or nine hours a day or more, had lower average mental functioning than participants who slept seven hours per day. Too much or too little sleep was cognitively equivalent to aging by two years, according to the research, which followed the women over 14 years beginning in middle age.
The study also observed that women whose sleep duration changed by two hours or more a day from mid- to later life had worse brain function than participants with no change in sleep duration -- a finding that held true regardless of how long they usually slept at the beginning of the study.
"We went in with the hypothesis that extreme changes in sleep duration might be worse for cognitive function because they disrupt the circadian rhythm, so these results line up nicely," said study author Elizabeth Devore, an associate epidemiologist at Brigham and Women's Hospital in Boston. "I think this gives us data to think about sleep- and circadian-based interventions being a route to address cognitive function." Circadian rhythm is the term for the physical, mental and behavioral changes that follow a 24-hour cycle.
The other new research that associates sleep and brain function follows:
- Scientists from University of California, San Francisco measured the sleep quality of more than 1,300 women over age 75 using sensor units and recordings of physical changes during sleep. They found that participants with sleep-disordered breathing or sleep apnea had more than twice the odds of developing mild cognitive impairment or dementia over five years than those without those conditions. Those with greater nighttime wakefulness were more likely to score worse on tests of verbal fluency and global cognition.
- In France, nearly 5,000 mentally healthy French people over age 65 were evaluated four times over eight years. Researchers looked at different aspects of insomnia and found that excessive daytime sleepiness -- which was reported by 18 percent of participants -- increased the risk of mental decline. Difficulty in staying asleep did not.
- Scientists from Washington University School of Medicine in St. Louis obtained samples of blood and cerebrospinal fluid from three groups of volunteers -- those with dementia, a healthy age-matched set and a younger set -- over 36 hours and found that daily sleep patterns were linked to levels of amyloid proteins. These proteins are recognized as an indicator of Alzheimer's disease.
While Snyder and Devore agreed that much more research is needed, the studies potentially pave the way for sleep interventions that could stave off mental deterioration.
"We may be able to help those individuals," Snyder said. "If you're having problems with sleep, you may want to follow up with your health care provider."
Because research presented at scientific conferences has not been peer-reviewed and published in a medical journal, results are considered preliminary.
Also, if you suffer from insomnia, don't worry that you're doomed to develop dementia. Although the studies report an association between sleep disturbances and mental decline, they do not show a cause-and-effect relationship.
Read more here