Friday, June 27, 2014

How anxiety affects kids' brains

A study shows how anxiety can affect children's brains.

Children with anxiety problems actually have a bigger "fear center" in their brain, researchers report.
The study included 76 children aged 7 to 9, which is when anxiety-related traits and symptoms can first be reliably detected, according to the Stanford University School of Medicine researchers.
The parents provided information about their youngsters' anxiety levels, and the children also underwent MRI scans of their brain structure and function.
The investigators focused on an area of the brain called the amygdala, which is a person's "fear center," and found that kids with high anxiety levels had a larger amygdala compared to children with low anxiety levels. This part of the brain, the researchers noted, had more connections to other brain regions involved in attention, emotion perception and regulation.
The researchers also developed a way to predict children's anxiety levels based on brain scan measurements of amygdala size and its level of connection to other brain areas, according to the study in the June issue of the journal Biological Psychiatry.
"It is a bit surprising that alterations to the structure and connectivity of the amygdala were so significant in children with higher levels of anxiety, given both the young age of the children and the fact that their anxiety levels were too low to be observed clinically," first author Dr. Shaozheng Qin said in a journal news release.
The study is an important advance in identifying young children at risk for anxiety disorders and improves understanding of how anxiety develops in people, according to Qin.
While the study found an association between reported levels of anxiety and the structure and connectivity of the amygdala in kids, it did not prove a cause-and-effect relationship.
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More boys are diagnosed with ADD and ADHD

This article discusses an apparent gender bias which causes more boys than girls to be diagnosed with ADD and ADHD.
There's a gender bias when it comes to diagnosing Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder.
That's according to the woman who runs the largest ADHD coaching program in North America.
Shanna Pearson, the founder and president of One Focus Total Success Inc., told CFRA it's because the symptoms present more clearly in men.
"It's more noticeable in men, so a lot more of them are actually going to seek a diagnosis or it's just being pointed out to them," she said. "With women a lot of them, it's just going under the wire. They're not being noticed. They're not picking up on it."
Research shows two out of every three women with ADD or ADHD are misdiagnosed by doctors as having depression.
"And it's almost understandable how they would, because a lot of ADHD symptoms, especially for women because it's more on the emotional spectrum, a lot of ADHD symptoms can look like depression," she said.
She said women need to be aware about what is going on for them.
"It's not necessarily that they're just overly emotional or very scattered or absent-minded or some of the other labels that people put on women who are like that," Pearson said.
"It could be that they have ADHD, so I would say that if you're a woman who has more drama in your life than most people you know, if you're somebody who gets overwhelmed very, very easily or you experience a lot of anxiety on a regular basis or you tend to get frozen in your thoughts or overwhelmed and you can't move forward - those types of symptoms, I would say you might want to get a diagnosis," she added.
Pearson said once a person is properly diagnosed by a specialist, they can learn how to better manage the symptoms that come with the disorder.
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Breastfeeding while taking epilepsy medication does not harm infant

Brain development of breastfed infants is not harmed by the mother taking epilepsy medications.

Taking epilepsy drugs while breast-feeding does not appear to harm the developing brains of young children, a new study finds.
There have been concerns that using epilepsy drugs while breast-feeding could pose a threat to youngsters because it's been shown that some epilepsy drugs can cause cell death in young animals' brains.
And in spite of the fact that epilepsy experts recommend breast-feeding, "it is still a sensitive topic among women with epilepsy," noted one expert, Dr. Patricia Dugan, assistant professor of neurology at the Comprehensive Epilepsy Center at NYU Langone Medical Center, New York City.
"Despite reassuring published data, such as this article, patients frequently tell us that they receive contradictory advice from their obstetricians and pediatricians, resulting in a significant amount of distress for the mother," said Dugan, who was not connected to the new research. "Hopefully, papers such as these will encourage everyone involved in the care of women with epilepsy to promote breast-feeding," she said.
The new study included 181 children of mothers who had epilepsy and took drugs to control the condition. Nearly 43 percent of the children were breast-fed for an average of seven months.
IQ tests conducted on the children when they were 6 years old found no differences between those who were breast-fed and those who were not, according to the study published online June 16 in JAMA Pediatrics.
"Our study does not provide a final answer, but we recommend breast-feeding to mothers with epilepsy, informing them of the strength of evidence for risks and benefits," wrote a team led by Dr. Kimford Meador, of Stanford University in California
Another expert said the study offers valuable information.
"The authors controlled for many of the factors that might influence the intellectual outcome of this large number of children," noted Dr. Ian Holzman, chief of the division of newborn medicine at the Kravis Children's Hospital at Mount Sinai in New York City.
"By following these children through age 6, they were able to present information relevant to the important issue of school performance," he said. "This study allows us to counsel mothers who are planning to breast-feed that there doesn't seem to be any harm [in taking epilepsy medications]."
Dugan said the study also hinted at other benefits for breast-fed children.
"It also showed that testing of breast-fed children at 6 years old -- an age when more meticulous testing can be performed -- reflected beneficial effects of breast-feeding, with higher IQ and better verbal abilities than nonbreast-fed children," she said.
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Health consequences of sleep disorders

This article discusses the different health consequences of sleep disorders and issues with an internal clock.

Ulcers, hyperglycemia, diabetes, hypertension, gastric intestinal problems are not always caused by diet - they could be linked to a disrupted internal clock.
Working a job that requires shift-work or experiencing chronic jet lag disrupts your circadian rhythm. It results in countless consequences to your body that simply can’t be fixed by counting sheep.
“Stimulants such as caffeine can disrupt a patient’s circadian rhythm but also irregular sleep habits, jet lag, Delayed Sleep Phase Disorder, which is common in teenagers, Shift Work Sleep Disorder and Advanced Sleep Phase Disorder, which is common in older people,” says Dr. Baqhar Mohideen, the medical director of the Center for Sleep Medicine at Porter Regional Hospital.
“A quarter of American workers are on shift-work – 10 percent of which experience Shift Work Sleep Disorders.”
Delayed Sleep Phase Disorder is when patients fall asleep late and have difficulty waking up in the morning. Shift Work Sleep Disorder affects patients who work nights or rotating shifts. Advanced Sleep Phase Disorder is when patients go to bed early in the evening but wake up very early in the morning around 3 a.m., for example.
Our bodies work on a 24-hour cycle called circadian rhythm or internal clock. The main function of our internal clock is to determine when we sleep and when we wake. Unfortunately if a circadian rhythm is disrupted it affects many biological conditions in the body such as digestion, the release of certain hormones, body temperature, etc.
“Because your hormones are all mixed up, there are lots of consequences – ulcers, chronic fatigue, insulin resistance, glucose intolerance, diabetes, etc.” says Mohideen, who is a Diplomat of the American Board of Sleep Medicine.
Glucose intolerance is an umbrella term for metabolic conditions which result in higher blood glucose levels known as hyperglycemia.
Dr. Muhammed Najjar, sleep specialist at the Franciscan Healthcare Sleep Disorders Center located in Munster, agrees there are consequences for a disrupted circadian rhythm caused by Shift Work Sleep Disorder.
“Daytime functions shouldn’t be at night. When there’s a misalignment between the patient’s internal clock and the outside world, it’s not good for the body,” says Najjar. “Shift work causes stress to the body so blood pressure gets elevated, which is why this disorder can cause hypertension. Treating circadian rhythm disorders can help lower blood pressure.”
Najjar says besides patients experiencing the side effects of a disrupted circadian rhythm there are side effects to sleep deprivation also.
Sleep deprivation affects hormones as well which can lead to body weight and body mass index issues. Gastrointestinal tract problems can surface and it can also cause insulin sensitivity which can lead to diabetes. A patient’s body can also become resistant to treatment.
“Many patients are sleep deprived because when they do sleep, it’s not adequate sleep. This affects their level of alertness and they can become accident-prone,” says Najjar. “If a patient’s shift work schedule rotates, or they sleep with a different pattern on their days off, it’s like having continual jet lag —the circadian system never gets the chance to fully catch up.”
The process of adjusting the internal clock with cues from the environment is called entrainment. Light is a stimulant and can effectively re-align one’s circadian rhythm.
Mohideen says some patients take medication or melatonin to assist in the readjustment process.
Melatonin is a body clock hormone that chemically causes drowsiness and lowers the body temperature in preparation for sleep.
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Thursday, June 26, 2014

Study shows that ADHD treatment does not increase suicide risk

A study shows that drug therapy for ADHD does not increase suicide risk.

A new register-based study from Karolinska Institutet in Sweden shows that drug therapy for ADHD does not entail an increased risk of suicide attempts or suicide, as was previously feared. The results are published in the British Medical Journal (BMJ).
"Our work in several ways shows that most likely there is no link between treatment with ADHD drugs and an increased risk of suicide attempts or suicide. The results rather indicate that ADHD drugs may have a protective effect," says Henrik Larsson, researcher at the Department of Medical Epidemiology and Biostatistics, who headed the study.
Earlier research has indicated that ADHD drug treatment would increase the occurrence of suicidal thoughts. However, these studies have been small scale and/or the methods used have been limited, which make the results uncertain. To gain clarity in this matter, researchers at Karolinska Institutet have now used national patient registers to identify all patients in Sweden diagnosed with ADHD between 1960 and 1996; a total of 37,936 individuals. These people were then followed over the period 2006-2009, in terms of drug treatment and events that could be linked to suicide attempts and suicide.
Among other things, the study compared the rate of suicidal behaviors while the patients were receiving ADHD medication, as compared with the rate for the same patients while not receiving medication. Using this design the researchers were able to determine that there was no evidence to support that ADHD drug therapy would increase the risk of suicide attempts/suicide. One strong point of the study now being published is that all the individuals were compared to themselves, as this allowed the researchers to take into account the differences between those taking the drugs and those who do not.
"Many epidemiological studies on the risks related to drugs fail to adjust for the differences between individuals who take the drugs and those who do not. This is a critical limitation given that the individuals on medication are usually more severely ill than the others," says Henrik Larsson.
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Link between insomnia and depression

This article discusses the link that exists between insomnia and depression.
We all have times when we feel blue. And there are nights when we just can’t sleep. But it seems that depression and insomnia are closely intertwined, exacerbating each other’s symptoms and complicating treatment.
Insomnia has long been viewed as a symptom of depression. At least 80 percent of depressed patients have trouble falling or staying asleep. An additional 15 percent report they sleep too much. Doctors believed that treating the depression would alleviate sleep problems at the same time.
New research indicates that curing insomnia may make depression treatments more effective. A study conducted by Colleen Carney at Ryerson University in Toronto found that 87 percent of subjects who resolved sleep issues using biweekly talk therapy also saw their depression improve after eight weeks of treatment. That’s twice the success rate of the subjects who didn’t better their sleep.
In 2008, Rachel Manber of Stanford found that 60 percent of patients receiving seven sessions of talk therapy plus an antidepressant fully recovered from their depression, compared to 33 percent who received the same medication and sleep hygiene counseling alone.
The kind of therapy used in these experiments is called cognitive behavioral therapy for insomnia, or CBT-I. The therapist instructs clients to establish and adhere to a regular sleep schedule, to get out of bed during periods of wakefulness, to avoid eating or use of electronics in bed and to eliminate daytime napping.
Insomnia may even predict the onset of depression. Sleep researcher Michael Perlis, Ph.D., has shown that sleep disturbances precede episodes of depression by about five weeks. And sleep disorders intensify over the course of a new depressive episode or relapse.
According to Perlis, associate professor of psychiatry and neuroscience at the University of Rochester, disordered sleep sets off a chain of disruptive symptoms that leads to fatigue, irritability, confusion and loss of memory, disinterest in social activities and lack of pleasure.
The subsequent sleep loss makes people more susceptible to depression and increases the likelihood of further episodes.
The good news is that both disorders are treatable regardless of which causes the other. The first step is to get a proper diagnosis in order to embark on the appropriate path.


The National Sleep Foundation offers the following suggestions for overcoming insomnia:
  • Keep a sleep diary. Include all pertinent data, such as the time you go to bed, number of times you wake up during the night, medications taken, amount of caffeine consumed during the day, number of naps and time spent exercising. You’ll quickly notice which actions support good sleep behavior and which ones cause disruptions.
  • Eat light meals early in the evening. Heavy meals can cause discomfort. Spicy food may lead to heartburn.
  • Steer clear of alcohol. Although alcohol is a sedative and may initially help you fall asleep, it disrupts sleep later in the night.
  • Learn to relax. One simple technique is to lie quietly on your bed and systematically tense and relax various muscle groups in your body. You may also practice deep breathing, guided imagery or meditation.
  • Evaluate your room. Make sure you have a clean, comfortable, quiet and dark sleep space. Use a sound machine or fan to block unwanted noise. Install blinds to close out streetlights and morning light.
  • Wind down. Your body needs time to shift into sleep mode. Devote the hour before bedtime to calming activities, such as reading or taking a warm bath. You’ll be mentally and physically calmer. Your actions will signal your brain that it’s time to go to bed.

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Wednesday, June 25, 2014

The moon may not influence the way humans sleep

A study shows that the moon may not influence the way humans sleep.

Popular beliefs about the influence of the moon on humans widely exist. Many people report sleeplessness around the time of full moon. In contrast to earlier studies, scientists from the Max Planck Institute of Psychiatry in Munich did not observe any correlation between human sleep and the lunar phases. The researchers analyzed preexisting data of a large cohort of volunteers and their sleep nights. Further identification of mostly unpublished null findings suggests that the conflicting results of previous studies might be due to a publication bias.
For centuries, people have believed that the moon cycle influences human health, behavior and physiology. Folklore mainly links the full moon with sleeplessness. But what about the scientific background?
Several studies searched in re-analyses of pre-existing datasets on human sleep for a lunar effect, although the results were quite varying and the effects on sleep have rarely been assessed with objective measures, such as a sleep EEG. In some studies women appeared more affected by the moon phase, in others men. Two analyses of datasets from 2013 and 2014, each including between 30 and 50 volunteers, agreed on shorter total sleep duration in the nights around full moon. However, both studies came to conflicting results in other variables. For example, in one analysis the beginning of the REM-sleep phase in which we mainly dream was delayed around new moon, whereas the other study observed the longest delay around full moon.
To overcome the problem of possible chance findings in small study samples, scientists now analyzed the sleep data of overall 1,265 volunteers during 2,097 nights. "Investigating this large cohort of test persons and sleep nights, we were unable to replicate previous findings," states Martin Dresler, neuroscientist at the Max Planck Institute of Psychiatry in Munich, Germany, and the Donders Institute for Brain, Cognition and Behaviour in Nijmegen, Netherlands. "We could not observe a statistical relevant correlation between human sleep and the lunar phases." Further, his team identified several unpublished null findings including cumulative analyses of more than 20,000 sleep nights, which suggest that the conflicting results might be an example of a publication bias (i.e. the file drawer problem).
The file drawer problem describes the phenomenon, that many studies may be conducted but never reported -- they remain in the file drawer. One much-discussed publication bias in science, medicine and pharmacy is the tendency to report experimental results that are positive or show a significant finding and to omit results that are negative or inconclusive.
Up to now, the influence of the lunar cycle on human sleep was investigated in re-analyses of earlier studies which originally followed different purposes. "To overcome the obvious limitations of retrospective data analysis, carefully controlled studies specifically designed for the test of lunar cycle effects on sleep in large samples are required for a definite answer," comments Dresler.
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Portable brain scanners may be present in more locker rooms

A portable brain scanner could become present in more locker rooms which could change the way concussions are understood in the long-term.

A portable imaging tool could change the way the medical community analyzes and understands the long-term effects of sports-related concussions.
Research conducted by Humboldt State Kinesiology professor Rock Braithwaite has played a significant role in demonstrating the usefulness of computerized neurocognitive testing in determining the extent of the effects of concussion on cognition and performance among student athletes and military personnel.
"This preliminary study, although small, showed us where in the brain a patient is affected and to what cognitive extent," said Michael Collins, director of a current study being conducted on functional near infrared spectroscopy (fNIRS) as a low-cost, portable device for imaging sports and military concussions.
Braithwaite collaborated with former HSU professor Anthony Kontos, a professor for the University of Pittsburgh Schools of the Health Sciences, and two other University of Pittsburgh professors, on the fNIRS research that is considered the largest statistical review of computerized testing to date. The study, published in the March Journal of International Neuropsychological Society, supplied data for Kontos' study.
Braithwaite's study evaluated prior research of published computerized concussion testing to date, covering 37 studies and 3,960 participants all within the first week of sustaining a concussion. The study produced two key findings:
- Middle school and younger high-school students displayed more pronounced cognitive effects and greater performance deterioration according to neurocognitive testing after a concussion than their senior high school and college-aged counterparts.
- ImPACT® -- a computerized neurocognitive test battery designed to assess mild traumatic brain injury -- demonstrated the strongest performance for detecting cognitive impairment because it measured the types of tasks that this meta-analysis identified as most effective at detecting post-concussion issues including: processing speed, verbal memory, visual memory and recall. The success of this technology indicates computerized testing -- as conducted with the fNIRS -- is the most accurate evaluation method.
"ImPACT found the largest effects for individuals who had been concussed -- across all outcomes," said Braithwaite, who conceived of the idea for this study. "Memory, processing speed, recall … ImPACT was able to better detect changes compared to the other computerized tests."
"In the past decade and a half, many in the field of concussion science have tried to find an imaging tool that could help us in a clinical setting -- and failed to find anything with consistency," said Collins. "[Braithwaite's study] was enough evidence for us to keep pushing further with this potential tool."
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Sleep education for preschoolers helped them get more sleep

A study based on a sleep education program for preschoolers caused the children to get 30 minutes more sleep per night.

Taking part in an educational sleep program resulted in a 30-minute average increase in sleep duration at a one-month follow-up for preschoolers, according to a new study from the University of Michigan.
In the study, published in the journal SLEEP, families in two Head Start programs participated in the Sweet Dreamzzz Early Childhood Sleep Education Program™. The Detroit-area nonprofit organization, Sweet Dreamzzz, Inc. developed the program and offers it for free when funding allows. Head Start programs aim to give preschool opportunities to low-income families, in part to improve readiness for elementary school.
Researchers found that among 152 preschool children and their families, the sleep education program produced a 30-minute increase in sleep duration among the kids, says lead author Katherine (Wilson) DeRue, M.D., M.S., who conducted the study while a postgraduate fellow at the University of Michigan Sleep Disorders Center and Departments of Neurology and Pediatrics.
"We know that an increase in sleep duration of that magnitude is associated with better function for kids during the day" says DeRue, who is now a pediatrician and sleep physician at IHA Pulmonary, Critical Care and Sleep Consultants in Ann Arbor, Mich.
"Parents often underestimate how much sleep their kids require, so an educational program like this, directed at parents when they have more control over their kids' sleep schedules, can have great impact."
The study also found that parents' awareness and knowledge of good sleep behaviors also improved after program participation, but this effect was not sustained when parents were retested one month later.
The educational program included a one-time, 45-minute sleep education program for parents, and two weeks of classroom sleep education for the preschoolers. Parents were asked to keep diaries for assessment of their children's sleep habits.
"So we found that a two-week program of daily exposure to sleep education in the preschool classroom, along with an initial presentation for parents, can be an effective strategy," says Ronald D. Chervin, M.D., M.S., the study's senior author, director of the U-M Sleep Disorders Center, and a volunteer on Sweet Dreamzzz's Advisory Board.
"But repeated exposure or reminders about the sleep information may be necessary to maintain the effects for kids and especially parents over time." This is believed to be the first study to examine the effect of a sleep education program on the sleep of preschool age children.
The Head Start programs were located in greater Lansing, Mich. and Detroit, Mich.
The lessons taught in school seemed to stick with the children. Among the lessons were recognizing 8 p.m. as the desirable bedtime; learning that an apple is a better snack before bedtime than a candy bar; and identifying reading rather than watching TV as a relaxing activity before bedtime.
"We are pleased to see that the University of Michigan researchers have been able to measure the impact of our sleep program. We know a proper sleep environment, regular bedtime routine, and the right amount of sleep hours each night can impact the future of our children," says Nancy Maxwell, executive director of the non-profit Sweet Dreamzzz, Inc.
Sweet Dreamzzz provides educational programs on sleep, along with free sleep essentials- such as sleeping bags, toothbrushes, and books about sleep -- to schoolchildren in low-income areas. Sweet Dreamzzz's main aims are to encourage better sleep -- and thereby better health and learning -- at the earliest ages.
Most evidence indicates that children commonly obtain insufficient sleep, says DeRue, and this study provides a critical demonstration that minimal, relatively inexpensive interventions can make a difference.
"Family sleep education during early childhood years, when the sleep habits are being established, could prove to be a cost-effective but impactful strategy to improve children's overall health," says DeRue.
"Nutrition and exercise are commonly the focus of educational efforts to improve children's health," adds Chervin. "Good sleep -- in quality and quantity -- is no less vital to our kids' future, yet it's rarely if ever discussed. Our new findings suggest that a small amount of effort to promote better sleep could have substantial benefit now, and conceivably for years to come as these youngsters grow older."
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Autism treatment may cost millions over a lifetime

A study shows that autism treatment for one person may run into the millions over a lifetime.

The lifetime cost of supporting just one person with autism can range from $1.4 million to $2.4 million, with factors as varied as lost wages, residential care and special education driving up expenses, a new study has found.
Medical care plays a role in pushing these costs, but is not the main factor, said study senior author David Mandell, director of the Center for Mental Health Policy and Services Research at the University of Pennsylvania Perelman School of Medicine.
Lost wages are a critical driver for the lifetime cost of autism, as parents leave work to care for their autistic children and adults with the disorder fail to find or maintain employment, Mandell said.
Other major factors include the expense of special education for children and residential care for adults.
"When we think about what is needed to support people with autism, we so often look to medical care for that support," he said. "I think this shows there are other places we need to look as well."
In the study, researchers cast a wide net to gather data on a variety of economic concerns related to autism spectrum disorder, both in the United States and in the United Kingdom.
The investigators concluded that the average lifetime cost to care for a person with autism without intellectual disabilities is about $1.4 million in both the United States and the United Kingdom.
People with autism who also have intellectual disabilities cost about $2.4 million during their lifetime in the United States and about $2.2 million in the United Kingdom.
"This study shows us what we've all known but never had the data to support -- that autism is alarmingly expensive," said Michael Rosanoff, associate director of public health for Autism Speaks, the nonprofit advocacy group that funded the research.
Medical care for children with autism can cost between $6,467 and $18,106 a year, depending on the age of the child and the level of intellectual disability. For adults with autism, medical costs range between $13,580 and $27,159 annually, according to the study.
By comparison, special education for children with autism costs one-and-a-half to nearly five times as much as their medical care. Costs for special education run between $13,980 and $62,920 a year, again depending on age and intellectual disability, the study found.
Parents' lost wages cost an average $18,720 annually for the care of a child with autism, outpacing medical expenses. "Mothers drop out of the workforce to care for their children with autism, and those wages are substantial," Mandell said.
Residential care is the largest average expense for adults with autism, costing between $18,080 and $36,161 annually -- more than twice the amount spent on medical care. Lost wages for adults with autism cost about $10,718 a year, the study authors said.
The numbers for both children and adults suggest that "there's a very high expense of not properly caring for children with autism," Mandell said.
"If we were able to provide better and more appropriate care for these children, mothers wouldn't be dropping out of the workforce," he said. "We also really need very different workplace policies that support the parents of children with disabilities."
The adult costs of autism could reflect a failure to properly prepare children with autism for their entry into the wider world, Mandell said. With better education and training, these children might be able to live outside residential facilities and hold steady jobs.
"That's the $2.4 million question, isn't it? If we provided better early intervention, would we then see a different trajectory that would result in reduced costs for adults with autism?" Mandell said. "Our study doesn't answer that, but it needs to be answered."
Rosanoff noted that as astronomical as these figures are, the true cost is likely greater. Researchers prepared the study based on the U.S. Centers for Disease Control and Prevention's estimate of autism prevalence, which was 1 in 88 people.
But two months ago the CDC revised its estimate, and now figures that 1 in 68 people have autism, he said.
"The numbers in this report are an underestimate of the true cost of autism in society, at least in the U.S.," Rosanoff said.
According to the U.S. National Institutes of Health, autism -- or autism spectrum disorders -- represent a range of developmental disorders characterized by impaired social interactions, problems with verbal and nonverbal communication, and repetitive behaviors or severely limited activities and interests.
The study findings were published online June 9 in the journal JAMA Pediatrics.
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Snoring in Children

This article discusses what is important to know about snoring in children.

Snoring in children is a common event, with estimates placing it at about 12 to 15 percent. Most of these children are healthy, show no symptoms and have primary snoring. Snoring happens during sleep due to a blockage of air when breathing as it passes through the back of the mouth. The loudness is affected by how much air passes through and how fast the throat tissue is vibrating. Snoring can be due to an upper respiratory infection, allergies, or it can be a sign of obstructive sleep apnea (OSA).
Infants and toddlers spend over half of their lives sleeping and, by adolescence, greater than on third of our lives are spent sleeping. Quality sleep is essential for proper development and daily functioning. Proper sleep helps with learning, consolidating memories, physical growth, recharging the body and helping our bodies fight infections.
Approximately 2 to 3 percent of children have OSA, which occurs when the posterior air collapses and blocks the throat. Frequent pauses in breathing, lasting from several seconds to a minute, often lead to the brain briefly waking up and causing us to breathe. This leads to gasping or snorting, waking us up and re-breathing. This can occur all through out the night.
Interrupted sleep can lead to behavioral issues, problems with social function, poor school performance and poor growth. These children are also more likely to be hyperactive and have trouble paying attention in school, mimicking signs of attention-deficit hyperactivity disorder (ADHD).
Studies also show that children with OSA are at risk of developing heart and lung problems which can lead to serious consequences later in life if it goes undetected. Untreated OSA, in the short term, often leads to daytime sleepiness, morning headaches, irritability, bed wetting and mouth breathing. The risk of apnea is higher in overweight children.
Other signs might include large tonsils and/or adenoids with frequent mouth breathing, restless sleep or sleep in abnormal positions, sleep in elevated position or with neck extended, excessive sweating during sleep, nasal speech, poor weight gain or being overweight, and high blood pressure. Even primary snoring (i.e. snoring without breathing pauses, frequent arousals, or drips in oxygen levels), which was once thought to be normal, still can lead to problems in school performance or behavior issues.
If you suspect your child may have symptoms of OSA don’t assume his or her snoring will go away on its own. Talk to your child’s doctor. The American Academy of Pediatrics has recognized this as a serious problem and has published recent guidelines for screening of obstructive sleep apnea, which will help doctors recognize, diagnose, and treat children with OSA.
Testing can be done if your child is suspected of having OSA, including an overnight sleep study. You may also videotape your child’s sleep to bring to the doctor for review. Night-time pulse oximetry to measure oxygen levels is also a useful tool. Your doctor may refer your child to a sleep specialist as well, as sometimes these tests are normal even when your child may still have OSA.
Once your child has been found to have obstructive sleep apnea syndrome, referral to doctors who specialize in treating OSA include pediatric otolaryngologists (ENT), pulmonologists and neurologists. Treatment options usually include removing enlarged tonsils and adenoids (T&A). Often removing the tonsils and adenoids stops the snoring and helps with improved appetite and growth in young children. It also improves academic performance and behavior in school-aged children as they get more uninterrupted, quality sleep. Other options include treating allergies or helping children lose weight. A night-time treatment called continuous positive airway pressure (CPAP) therapy is another option for children who can’t have surgery or have persistent OSA even after a T&A has been performed.
Remember to be suspicious that your child may have OSA if he or she regularly snores and has apnea, daytime sleepiness or school/behavior problems. If detected early, treatment of this problem may be reversible.
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Study shows a link between osteoporosis and sleep apnea

Negative health consequences of sleep apnea include diabetes, and more recently, osteoporosis.

There seems to be a growing list of factors that could increase the risk of a person ultimately developing diabetes. Recently, sleep apnea was also added to the list. A new study was published in the American Journal of Respiratory and Critical Care Medicine recently. The study findings show that sleep apnea increases the likelihood of developing diabetes by 30%.
The team led by Dr Tetyana Kendzerska of the University of Toronto analysed data from 8,678 adults with suspected OSA and without diabetes at baseline who took part in a diagnostic sleep study between 1994 and 2010.
All of the participants were tested for OSA and graded according to the severity of their sleep apnoea, based on the number of apnoeas (complete blockage of the upper airway) and hypopnoeas (partial blockage of airway) experienced per hour of sleep, and followed for development of diabetes.
In addition, Rapid eye movement sleep, lack of oxygen in the blood, and activation of the sympathetic nervous system, as indicated by a higher average heart rate during sleep, were linked to higher diabetes risk.
“After adjusting for other potential causes, we were able to demonstrate a significant association between OSA severity and the risk of developing diabetes,” Dr Kendzerska said in a statement. “Our findings that prolonged oxygen desaturation, shorter sleep time and higher heart rate were associated with diabetes are consistent with the pathophysiological mechanisms thought to underlie the relationship between OSA and diabetes.”
The lead author added that the results “address some of the limitations of earlier studies on the connection between OSA and diabetes”, as their study involved a larger sample size and a longer median follow-up.
The researchers did, however, acknowledge a few limitations to the study, including not being able to screen for family history of diabetes and ethnicity.
“The OSA-related predictors of increased diabetes risk that we found in our study may allow for early preventative interventions in these patients,” Dr. Kendzerska concluded.
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Study: Epilepsy patients who don't take medication may become depressed

A study claims that epilepsy patients who do not take medication may become depressed, which can reduce their quality of life.

A new study led by Alan B. Ettinger, M.D., M.B.A., Director of the Epilepsy Center at Neurological Surgery, P.C. (NSPC), has found that many patients who fail to take their antiseizure medications are suffering from depression. Previous studies by Dr. Ettinger and others have found a high incidence of depression in people with epilepsy, but this is the first research to show a direct link between depression and medication nonadherence. The study will be published in the July 2014 issue of the journal Epilepsy & Behavior, and is available online ahead of publication.

"Our previous studies have shown that there are substantial consequences to missing doses of antiepileptic medications, even occasionally," said Dr. Ettinger. "We have also seen that depression impacts quality of life. Now we see that depression is a significant factor in drug nonadherence. This demonstrates that it is critical for physicians to screen their patients for depression, and to talk with them about the importance of taking all of their medications when scheduled."
Missing even one dose of an antiepileptic drug can cause breakthrough seizures, even in patients whose epilepsy is well controlled by medications. This can have devastating effects -- including hospitalizations, falls and related injuries, and even death. Studies have shown that 30-50% of people with epilepsy don't adhere to their medication regimen.
"Other studies have shown a link between depression and failure to take medications in conditions such as hypertension and HIV, but little was previously known about the potential impact of depression on antiepileptic drug adherence," said Dr. Ettinger.
Among other factors thought to play a role in antiepileptic drug nonadherence are memory difficulties and medication side effects.
In the current study, researchers accessed a nationwide health plan/pharmacy database, and selected a sample of 10,000 epilepsy patients. 2,750 patients were randomly selected from this group and mailed an in-depth survey that included a number of validated questionnaires on medication adherence, depression status, seizure severity and frequency, and quality of life, among other factors. Questionnaires used in the survey included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), which asks questions that are highly specific to epilepsy and is considered highly reliable. 465 patients completed and returned the survey. Claims data were analyzed with the widely used medication possession ratio (MPR), to measure drug adherence. (MPR represents the proportion of time that an individual was theoretically in possession of a medication.)
The researchers conducted a path analysis, a highly reliable and sophisticated type of statistical modeling, to determine the relationships between depression, drug adherence, seizure severity and quality of life. One key finding was that depression, as determined by the NDDI-E, was significantly correlated with an elevated risk of antiepileptic drug nonadherence. Depression, as measured by the NDDI-E and another survey instrument, was also associated with low quality of life scores. In addition, patients with depression were more likely to report having more severe seizures.
"We have known for a while that depression impacts patients' quality of life, and we know that it can be treated; now we know that there is a direct link to patient harm," said Dr. Ettinger, who works on a number of committees through the American Epilepsy Society to educate clinicians on the importance of depression screening.
Dr. Ettinger suggests that neurologists inquire about each patient's mood and quality of life, as well as medication adherence, during office visits. There are also brief questionnaires that patients can complete in the waiting room to indicate potential mental health issues. He also points out that some antiepileptic medications are now available in once-daily formulations (making it easier for patients to remember to take them), and that there are other medication adherence reminders now available, including smartphone alarm apps.
Read more here

Will sensors be in all helmets by 2015?

A research study is looking into adding sensors into helmets. The results may be strong enough to put sensors into all helmets by 2015.

A pilot program designed to provide more information for concussion research could become more widespread, and put sensors in every helmet by 2015.
According to Tom Pelissero of USA Today, two teams participated in the program for part of last year, and researchers are trying to fine-tune the technology to measure head impact in games.
The work is being done by University of North Carolina researcher Kevin Guskiewicz, who is a member of both league and union safety committees.
We need a sample of these players across all positions and studying every play type possible,” Guskiewicz said. “So, that’s the next step. Then I hope from there that, if we find (the devices) have utility that could actually help an individual player … my hope would be that we would go league-wide.”
Guskiewicz said the project still needs to be approved by the league and union, and getting that kind of agreement has been an issue in the past.
But he said he was “thrilled” that teams are buying into the idea of collecting data, though hurdles remain.
“I personally believe that there is valuable information to be gained for a player to learn how to perhaps modify his behavior, to track the way in which he’s leading with his head possibly or positioning his body on a certain play type that could help protect him,” Guskiewicz said.
“So, we just sort of have to go through this in a methodical approach to work on the feasibility. This year, I hope that we’re able to move forward with answering some of the questions that we have around potential rules changes, and then the following year, who knows?”
As with most issues, getting players and management to agree to anything is difficult, but if the technology can present a step forward in the accurate diagnosis of concussions and head injuries, then players and the league need to find a way to implement.
Read more here

Tuesday, June 24, 2014

Autism Risk Higher Near Pesticide-Treated Fields

Another interesting epidemiological study about the link between pesticide exposure in pregnancy and developmental delays - not just autism. -JR

Autism Risk Higher Near Pesticide-Treated Fields

Babies whose moms lived within a mile of crops treated with widely used pesticides were more likely to develop autism, according to new research 

....Babies whose moms lived within a mile of crops treated with widely used pesticides were more likely to develop autism, according to new research. 

The study of 970 children, born in farm-rich areas of Northern California, is part of the largest project to date that is exploring links between autism and environmental exposures.
The University of California, Davis research – which used women’s addresses to determine their proximity to insecticide-treated fields – is the third project to link prenatal pesticide exposures to autism and related disorders.

pesticides cause for autism rate“The weight of evidence is beginning to suggest that mothers’ exposures during pregnancy may play a role in the development of autism spectrum disorders,” said Kim Harley, an environmental health researcher at the University of California, Berkeley who was not involved in the new study.

When women in the second trimester lived near fields treated with chlorpyrifos – the most commonly applied organophosphate pesticide – their children were 3.3 times more likely to have autism, according to the study. 
Credit: Wonderlane via Flickr
One in every 68 U.S. children has been identified with an autism spectrum disorder—a group of neurodevelopmental disorders characterized by difficulties with social interactions, according to the Centers for Disease Control and Prevention.
“This study does not show that pesticides are likely to cause autism, though it suggests that exposure to farming chemicals during pregnancy is probably not a good thing,” said Dr. Bennett Leventhal, a child psychiatrist at University of California, San Francisco who studies autistic children. He did not participate in the new study.....
The biggest known contributor to autism risk is having a family member with it. Siblings of a child with autism are 35 times more likely to develop it than those without an autistic brother or sister, according to the National Institutes of Health.
By comparison, in the new study, children with mothers who lived less than one mile from fields treated with organophosphate pesticides during pregnancy were about 60 percent more likely to have autism than children whose mothers did not live close to treated fields. Most of the women lived in the Sacramento Valley.
The study also reported an increased risk of developmental delays, but not autism, in kids whose moms lived near fields where carbamates, including methomyl and Sevin, were applied.
The researchers said that pesticides could impair brain development and signaling in a way that affects social interactions, learning and behavior.
Previous studies have also linked pesticide use in California to autism spectrum disorders.
In 2007, Harley and her colleagues found a two-fold increase in pervasive developmental disorders (the larger group to which autism belongs) among 531 children in California’s Salinas Valley whose mothers’ urine had higher levels of organophosphate pesticides.
Another study from 2007 found that mothers who lived near fields with the highest applications of two now-banned pesticides – endosulfan and dicofol – were six times more likely to have kids with autism spectrum disorders.

Tubulins, brain malformation and epilepsy in babies -

De Novo Mutations in the Beta-Tubulin Gene TUBB2A Cause Simplified Gyral Patterning and Infantile-Onset Epilepsy.

American Journal of Human GeneticsApril 8, 2014
By Thomas D Cushion, Alex R Paciorkowski, Daniela T Pilz, G L Jonathan, Laurie E Seltzer, Robert W Marion, Emily Tuttle, Dalia Ghoneim, Susan L Christian, Kyung Seo, Mark I Rees, William B Dobyns
Tubulins, and microtubule polymers into which they incorporate, play critical mechanical roles in neuronal function during cell proliferation, neuronal migration, and postmigrational development: the three major overlapping events of mammalian cerebral cortex development. A number of neuronally expressed tubulin genes are associated with a spectrum of disorders affecting cerebral cortex formation. Such "tubulinopathies" include lissencephaly/pachygyria, polymicrogyria-like malformations, and simplified gyral patterns, in addition to characteristic extracortical features, such as corpus callosal, basal ganglia, and cerebellar abnormalities. Epilepsy is a common finding in these related disorders. Here we describe two unrelated individuals with infantile-onset epilepsy and abnormalities of brain morphology, harboring de novo variants that affect adjacent amino acids in a beta-tubulin gene TUBB2A. Located in a highly conserved loop, we demonstrate impaired tubulin and microtubule function resulting from each variant in vitro and by using in silico predictive modeling. We propose that the affected functional loop directly associates with the alpha-tubulin-bound guanosine triphosphate (GTP) molecule, impairing the intradimer interface and correct formation of the alpha/beta-tubulin heterodimer. This study associates mutations in TUBB2A with the spectrum of "tubulinopathy" phenotypes. As a consequence, genetic variations affecting all beta-tubulin genes expressed at high levels in the brain (TUBB2B, TUBB3, TUBB, TUBB4A, and TUBB2A) have been linked with malformations of cortical development.
Copyright © 2014 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.