Sunday, January 31, 2016

What Factors Are Associated with Bruxism in Children with Developmental Disabilities?

Bruxism has a negative impact on the quality of life of chidlren with developmental disabilities.
I have had success treating bruxism and excess salivation with botox. Bruxism is a Major Problem in kids with CP.  - JR

Factors associated with bruxism in children with developmental disabilities
Valeska Aparecida Fernandes SOUZA a   , Mauro Henrique Nogueira Guimarães ABREU b   , Vera Lúcia Silva RESENDE a   , Lia Silva CASTILHO a  
aUniversidade Federal de Minas Gerais – UFMG, School of Dentistry, Department of Operative Dentistry, Belo Horizonte, MG, Brazil.
bUniversidade Federal de Minas Gerais – UFMG, School of Dentistry, Department of Community and Preventive Dentistry, Belo Horizonte, MG, Brazil.
The aim of the present study was to investigate factors associated with bruxism in children aged from 1 to 13 years with developmental disabilities. A total of 389 dental records were examined. The bruxism analyzed was determined based on parental reports. The following variables were also analyzed: gender, age, International Code of Diseases (ICD), mouth breathing, history of gastroesophageal reflux, use of psychotropic drugs, gingival status, reports of xerostomia, hyperkinesis, pacifier use, thumb sucking and involuntary movements. For the purposes of analysis, the individuals were categorized as being with and without bruxism. Variables with a p-value < 0.25 in the bivariate analysis were incorporated into the logistic regression models. Females had a 0.44-fold (95%CI: 0.25 to 0.78) greater chance of exhibiting bruxism than males. Individuals with gastroesophageal reflux had a 2.28-fold (95%CI: 1.03 to 5.02) greater chance of exhibiting bruxism. Individuals with reported involuntary movements had a 2.24-fold (95%CI: 1.19 to 4.24) greater chance of exhibiting bruxism than those without such movements. Exhibiting involuntary movements, the male gender and gastroesophageal reflux are factors associated with bruxism in children with developmental disabilities.
Key words: Dental Care for Disabled; Developmental Disabilities; Bruxism; Cerebral Palsy

Full article here

Botox for trigeminal neuralgia? A review.

OnabotulinumtoxinA for trigeminal neuralgia: a review of the available data
Trigeminal neuralgia (TN) patients may develop side effects from centrally acting drugs, have contraindications for neurosurgical procedures, or experience relapse during conventional therapies. OnabotulinumtoxinA (BoNT/A) has been reported to be effective for TN, although this finding has been challenged. An overview of the available evidence based on a narrative/qualitative analysis of the literature is presented. About 90% of patients who receive BoNT/A show an improvement, a higher figure than that reported for the placebo effect of BoNT/A for other headaches. Tolerability of BoNT/A is good, and its few side-effects are transient. The articles reviewed were mainly case reports, case series and open-label trials; however, randomized controlled trials have endorsed the efficacy of BoNT/A for TN. This evidence, together with a better understanding of the analgesic mechanisms of BoNT/A and its proven efficacy in treating other pain syndromes, supports the use of this toxin as a therapeutic option for TN.

Key words: trigeminal neuralgia; botulinum neurotoxin type A; botulinum-A toxin; onabotulinumtoxin A; neuropathic pain

Neurobiological mechanisms responsible for the antinociceptive activity of BoNT/A
After being injected in the subcutaneous tissue, BoNT/A is taken up by endocytosis at nerve terminals of C fibers and rises by retrograde axonal transport through the trigeminal ganglion to the spinal trigeminal nucleus46. One of the main antinociceptive effects of BoNT/A is probably related to its ability to block the transport of nociceptive input to centers modulating nociception43.
BoNT/A negatively modulates nociceptive neurotransmitters. Its action can be preganglionic, on CGRP47,48,49, substance P50 and glutamate51, or postganglionic, on synaptic terminations, blocking the release of norepinephrine (NE) and adenosine triphosphate (ATP)52,53. A third mechanism may involve internal and external sensory adaptation. In external neural adaptation, BoNT/A reduces secretion of neuroeffector substances from mast cells, blood vessel endothelium and sensory nerve tissue54.
One of the main mechanisms responsible for the antinociceptive action of BoNT/A in the treatment of trigeminal neuralgia may be its ability to modulate intrinsic sensory adaptation (by controlling vesicular traffic), which it does by acting directly on transient receptor potential (TRP) ion channels. The TRPs act as integrators of several stimuli and signaling pathways. Dysfunction of these channels contributes to thermal hyperalgesia and allodynia under painful pathological conditions such as trigeminal neuropathy. Among these receptors, those that can potentially be used to treat trigeminal neuralgia include TRPV1, TRPV2, TRPV4, TRPM3, TRPM8 and TRPA155. The vanilloid receptor TRPV1 is potentially inhibited after injection of BoNT/A in the region of the first trigeminal branch56. The effect of BoNT/A on TRPV1 expression in trigeminal neuralgia leads to reduced expression of CGRP and satisfactory control of facial pain49. When blocked, TRPA1 provides a satisfactory reduction in facial mechanical allodynia and cold hyperalgesia57,58. To date, no studies showing the effect of BoNT/A on TRPA1 have been published.

Saturday, January 30, 2016

Zika Virus declared Public Health Emergency.

I am interested in the  broader phenotype of ZV. Our clinical understanding will  evolve and broaden.  - JR


WHO Alert Declares Zika Virus a Public Health Emergency

hospital medicine, emergency medicine, infectious disease, Zika virusIt’s not just another rare mosquito-borne illness. The World Health Organization (WHO) is calling for an international response as the Zika virus outbreak has become a public health emergency.

During a briefing with member countries on January 28, WHO Director-General Margaret Chan, MD, spoke on the Zika virus outbreak which has already hit 23 countries. Chan said that “the level of alarm is extremely high” and went on to announce an emergency meeting to discuss international strategies in Geneva, Switzerland on February 1.

Chan's decision was announced on Twitter.

"WHO Director-General Dr Margaret Chan: #ZikaVirus & microcephaly situation is a Public Health Emergency of Intl Concern #alert.” according to the tweet. 
- See more at: global infection rates of the Zika virus increasing rapidly, physicians should be prepared to handle possible cases of the virus and answer patients’ questions. No locally transmitted Zika virus cases have been reported in the continental United States, but cases have been confirmed in returning travelers. The AMA intends to update this resource center regularly to provide information to the public, physicians and other health care workers as they seek to learn more.

Resources for the Public

What you need to know about Zika virus
Information from the Centers for Disease Control and Prevention (CDC)
Frequently asked questions about Zika virus
Videos, fact sheets and other information from the World Health Organization (WHO) that explain what the virus is, which symptoms to look for and how to protect your family
Zika virus infection, prevention and recommendations for pregnant women
Infographics, frequently asked questions, interactive games and more from the Pan American Health Organization (PAHO) and WHO
Zika-infected areas
World map and list of countries and territories with active Zika transmission, provided by the CDC
Zika and pregnancy
Latest information from the CDC for pregnant women

Resources for Physicians

Understanding Zika Virus

Zika virus emergency preparedness and response
Latest information from the WHO
Zika virus infection
Information and resources from the PAHO and WHO
Zika virus information for health care professionals
Includes clinical evaluation and diagnostic testing information from the CDC
Zika virus spreads to new areas: Region of the Americas
CDC Morbidity and Mortality Weekly Report (MMWR) from Jan. 22

Clinical Guidance

Medical Journal Articles

The emerging Zika pandemic: Enhancing preparedness
JAMA Viewpoint published Jan. 27

Zika virus in the Americas—yet another arbovirus threat
Commentary published in The New England Journal of Medicine, Jan. 13 (e-publication ahead of print)


Notice of NIAID’s interest to highlight high-priority Zika virus research areas
Research notice by the National Institutes of Health from Jan. 22

Preguntas ya sobre el virus Zika ... aquí están algunas respuestas. - JR

Preguntas ya sobre el virus Zika ... aquí están algunas respuestas. - JR
Respuestas breves a duro
Preguntas sobre Zika Virus
ALIZADA 28 de enero 2016
a Organización Mundial de la Salud ha advertido qu
Ue el virus Zika se "propaga de forma explosiva" en las Américas y que hasta cuatro millones de personas podría estar infectada por el final del año. Funcionarios de los Centros para el Control y la Prevención de Enfermedades han instado a las mujeres embarazadas contra los viajes a cerca de dos docenas de países, sobre todo en el Caribe y América Latina, donde el brote está creciendo.
Aproximadamente 1 de cada 5 personas infectadas con el virus Zika se enferma (es decir, desarrollar Zika).
rojos). Otros síntomas comunes incluyen dolor muscular y dolor de cabeza. El período de incubación (el tiempo desde la exposición a los síntomas) para la enfermedad virus Zika no se conoce, pero es probable que sea unos pocos días a una semana.
La enfermedad suele ser leve con síntomas que duran varios días a una semana.
Virus Zika generalmente perma
Los síntomas más comunes de Zika son fiebre, sarpullido, dolor en las articulaciones, o conjuntivitis (ojos
nece en la sangre de una persona infectada durante unos pocos días, pero se puede encontrar ya en algunas personas.
Enfermedad grave que requiere hospitalización es infrecuente. Las muertes son raras.
queñas y daño cerebral en recién nacidos.
La infección parece estar relacionado con el desarrollo de las cabezas inusualmente p
vitar las mujeres embarazadas?
¿Cómo sé si he sido infectado? ¿Hay algún examen?
Estoy embarazada y recientemente visité un país con el virus Zika. ¿Qué debo hacer?
Algunas mujeres embarazadas que han estado en estas regiones deben hacerse la prueba de la infección, dijo la agencia. He aquí algunas respuestas y consejos sobre el brote.
2. ¿Qué es el virus Zika? ¿Cómo se transmite el virus? ¿Cómo podría Zika causar daño cerebral en los bebés? ¿Cuál es la microcefalia?
Lo que los países deben
AMA SiteZIKA Virus Centro de Recursos
Enlace al artículo del New York Times

Friday, January 29, 2016

Zika Virus - Questions and Answers

Questions already about Zika are some answers. - JR

Short Answers to Hard
Questions About Zika Virus

The World Health Organization has warned that the Zika virus is “spreading explosively” in the Americas and that as many as four million people could be infected by the end of the year. Officials at the Centers for Disease Control and Prevention have urged pregnant women against travel to about two dozen countries, mostly in the Caribbean and Latin America, where the outbreak is growing.

  • About 1 in 5 people infected with Zika virus become ill (i.e., develop Zika).
  • The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week.
  • The illness is usually mild with symptoms lasting for several days to a week.
  • Zika virus usually remains in the blood of an infected person for a few days but it can be found longer in some people.
  • Severe disease requiring hospitalization is uncommon.
  • Deaths are rare.

The infection appears to be linked to the development of unusually small heads and brain damage in newborns

Some pregnant women who have been to these regions should be tested for the infection, the agency said. Here are some answers and advice about the outbreak.
  • What is the Zika virus?
  • How is the virus spread?
  • How might Zika cause brain damage in infants?
  • What is microcephaly?
  • What countries should pregnant women avoid?
  • How do I know if I’ve been infected? Is there a test?
  • I’m pregnant and I recently visited a country with Zika virus. What do I do?
  • ZIKA Virus Resource Center
  • Link to NYT article

Wednesday, January 27, 2016

Concussions in youth hockey

Concussions in youth hockey are more likely to occur during illegal hits.

Concussions in youth ice hockey are as common as in youth football and soccer, and often occur when players break the rules of the game, a new study finds.
While the concussion rates in youth ice hockey are no greater than in other contact sports, more than 40 percent are caused by illegal hits, especially from behind, researchers said.
And younger players were at higher risk, according to the report.
"These findings highlight the importance of providing medical assistance, not only during ice hockey games, but also during practices, where more concussions occurred than expected," said Anthony Kontos, the study's lead author. Kontos is research director of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program.
According to the USA Hockey Coaching Education Program, illegal moves include hitting from behind, crossing arms to hit a player in the neck and jumping on a player to push him into the wall.
Kontos suggested that training kids to obey the rules and enforcing penalties may reduce the number of concussions.
"Better enforcement of existing penalties for illegal hits -- especially those from behind when players are less able to protect themselves -- may help to limit concussions in youth ice hockey," he said.
The report was published online Jan. 8 in the journal Pediatrics.
For the study, the researchers followed nearly 400 ice hockey players aged 12 to 18 who took part in more than 23,000 games and practices during the 2012-13 and 2013-14 seasons.
There were 37 diagnosed concussions, all of which involved player-to-player contact, such as checking or collision. Illegal plays resulting in penalties accounted for 43 percent of the concussions, Kontos and colleagues found.
Concussions were three times more likely to happen during games than practices. However, ice hockey players were more likely to get a concussion during practice than kids in other sports practices, including football, the investigators found.
Most youth ice hockey concussions were suffered by players aged 12 to 14, rather than older players, the findings showed. This is in contrast to other youth sports, such as football, where concussion rates increase as players get older.
"Younger players may be at higher risk for concussion than older players, possibly due to unfamiliarity with checking and disparities in body size and strength, which highlights the need for concussion awareness and clinical care in this at-risk age group," Kontos said.
Symptoms of a concussion include severe headache, dizziness, blurred vision, sensitivity to light and, in severe cases, recurrent vomiting, the researchers said.
When a concussion occurs, the player should be taken out of the game and not be allowed to play again until all the symptoms are gone and a doctor has been consulted, Kontos added.
But if the symptoms are serious, such as a severe headache or recurrent vomiting or dizziness to the point of having trouble walking, then the player should go to the emergency room, he advised.
Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Nicklaus Children's Hospital in Miami, said kids should play sports for all the positive things the games can do for children.
"But follow the rules," he added.
"A lot of improvement is needed in terms of the players and how they play the game within the rules," Kuluz said. "Make sure your kid plays for a coach and a team that appreciates the seriousness of concussion."
Read more here

Children with ADHD and traffic accidents

Children with ADHD may be more likely to get into traffic accidents due to impulsivity.

Children with attention-deficit hyperactivity disorder (ADHD) may be more likely to have accidents when crossing busy intersections on their bicycles because they're impulsive and have trouble paying attention, a new study suggests.
Researchers said it was known that these children were at increased risk, but the reasons were unclear.
"Crossing roads on a bicycle requires decision and action. What we found is children with ADHD have deficits in both areas," study corresponding author Molly Nikolas said in a University of Iowa news release. Nikolas is an assistant professor in the department of psychological and brain sciences.
Bicycle crashes are a leading cause of severe injuries in children. Each year, nearly 400,000 kids are treated in U.S. emergency departments for bicycle-related injuries, according to the study.
Using a lab-based stationary bicycle, researchers studied how 27 children with ADHD and 36 children without the disorder crossed busy intersections, shown by computer simulation. The children were between the ages of 10 and 14. None of those with ADHD was on medication at the time.
Overall, children crossed when there were similar-sized gaps between cars. But those with ADHD were less precise in timing when to enter the intersection and had less time to spare, according to the study in the December issue of Journal of Child Psychology and Psychiatry.
Moreover, after being exposed to heavy traffic with shorter gaps between cars, youngsters with ADHD had difficulty readjusting when traffic eased and gaps between cars widened. Rather than waiting for the wider gaps, the children with ADHD continued to choose shorter gaps, increasing their risk of an accident.
"The timing issues were more related to symptoms of inattention while the decisions about which gaps to cross were related to hyperactivity and impulsivity -- all core symptoms of ADHD," Nikolas said.
The best way to help children with ADHD cross busy intersections may be to teach them to look for longer gaps between cars, no matter how heavy the traffic, she said.
"Even if their timing remains off, if they have a big enough gap, they will be OK," Nikolas said. "If we can have some intervention or prevention strategies that focus on the decision-making, that may help compensate for the timing deficit."
Almost 6 million American children between the ages of 3 and 17 have ADHD, according to the U.S. Centers for Disease Control and Prevention.
Read more here

Study finds association between genetics and sleep behavior

A recent study found an association between genetics and sleep behavior.

The Coriell Personalized Medicine Collaborative (CPMC), a research initiative exploring the utility of genetic information in the clinical setting, has published a study and identified six noteworthy genes that affect human sleep duration.
Available in Volume 168, Issue 8 of the American Journal of Medical Genetics: Neuropsychiatric Genetics, the paper, titled, "Using the Coriell Personalized Medicine Collaborative Data to Conduct a Genome-Wide Association Study of Sleep Duration," draws on data collected from Coriell study participants to establish its findings.
"The fundamental biological purpose of sleep is still not understood," says Dr. Michael Christman, President and CEO of Coriell Institute. "But by engaging a diverse participant population and accumulating rich datasets, the CPMC research study is pursuing the type of insights that will help us learn more about sleep duration and, ultimately, improve human health."
The focus of the CPMC paper was to identify the genes associated with sleep duration and validate the connection between sleep and several demographic and lifestyle factors, including age, gender, weight, ethnicity, exercise, smoking and alcohol. Analysis implicated genes involved in ATP metabolism, circadian rhythms, narcolepsy, sleep cycles in mice, and bear hibernation.
"Researchers widely acknowledge that receiving inadequate sleep is a serious problem and can potentially contribute to a variety of health complications, such as a weakened immune system or an increased risk for obesity and diabetes," says Dr. Laura Scheinfeldt, lead author on the paper and a research scientist at Coriell.
"Individuals who average six hours or less are more susceptible to adverse health issues, and we found that participants enrolled in the CPMC study vary greatly in the amount of sleep they receive," says Dr. Scheinfeldt. "Effectively, by learning more about an individual's sleep patterns and considering environmental and genetic risk factors, physicians may one day be able to identify risks before they occur and target health solutions."
Founded in 2007, the CPMC research study involves a network of physicians, scientists, genetic counselors, and upwards of 8,500 volunteer participants. The study has produced more than 20 publications examining a range of complex human conditions, including cardiovascular disease, breast and lung cancer, and type I and II diabetes.
The Coriell study is committed to advancing the precision medicine discussion by aligning with progressive institutions, including the United States Air Force Medical Service, and sharing noteworthy data.
Read more here

Study: Migraines in children are under-treated

A study indicates that migraines in children are under-treated and usually do not received evidence-based treatment.

While evidence-based guidelines are fine-tuning a safe, effective approach to acute migraine care, it appears many younger patients are not receiving the care they need for their migraine attacks.
Nearly half of pediatric patients did not receive any treatment for their migraines, and a vast majority of children did not receive evidence-based prescriptions or recommendations, according to the results of a multi-state retrospective study.
The trend appears especially apparent in urban health care centers and emergency department (ED) facilities, where patients seem less likely to receive proper evidence-based treatments or receive any treatment at all.
“This is not just a pediatric problem, we actually know from a number studies over the last 20 years that headache is an underdiagnosed condition,” Robert A. Nicholson, PhD, LCP, FAHS, from the Mercy Clinic Headache Center & Mercy Health Research in St. Louis, Missouri, told Practical Pain Management.
When a patient presents with migraine, evidence-based guidelines typically recommend some form of abortive treatment, such as triptans or nonsteroidal anti-inflammatory drugs (NSAID). However, many patients do not receive any of these treatments, and this appears to be the case for younger patients as well.
This study does point out that, for adults and children, migraine and headache tends to be undertreated. The fact that many patients, young and older, are sent home with no specific migraine treatment is discouraging, but not surprising,” said Lawrence Robbins, MD,  a headache specialist practicing in Riverbrooks, Illinois.
Read more here

Treating sleep apnea helps children behave

According to this article, treating sleep apnea helps children behave.

Obstructive sleep apnea makes it nearly impossible to get a good night's sleep. Imagine air stopping in your throat, prompting you to choke anobesityAHDH, and heart disease. If that weren't reason enough to seek treatment, maybe this will: A recent study conducted by the University of Michigan Health System found remedying a child’s sleep apnea improves their behavior, no matter if they have a low or high IQ.
"When a clinician sees a pediatric patient who has a problem in school, they ask about sleep," said Dr. Ronald Chervin, neurologist and director of the University of Michigan Sleep Disorders Center, in a statement. "We wondered, in high-performing children, do we still need to worry about snoring or sleep issues?"
Chervin and his colleagues recruited 147 children between the ages of 3 and 12 who were scheduled to undergo an adenotonsillectomy — a procedure that removes the patient’s tonsils and adenoids. Adenotonsillectomy is usually performed when children are suspected of having obstructive sleep apnea, which is characterized by enlarged tonsils and adenoids that stop children from breathing up to ten seconds throughout the night.
Researchers conducted sleep tests that monitored brain wave patterns, eye movements, heart rhythm, muscle activity, airflow out the nose and mouth, chest movements, and snoring. They then asked parents to grade their child's behavior with regard to inattention, hyperactivity, social problems, and perfectionism. The results showed children from both low and high IQ groups experienced similar behavioral improvements when they were reevaluated six months after the adenotonsillectomy.
"Regardless of intellectual level, we can expect to see some behavioral improvement along with better sleep," said Dr. Bruno Giordani, a professor of neurology, psychiatry, psychology, and nursing. "Once behavior improves, attention in school improves, and emotional ability and behavioral and impulsivity control improve."
Although children with high IQs were included in the study, identifying children with high IQs and obstructive sleep apnea is difficult in practice because they don't typically show problems with school performance. Spotting a child who is struggling from a lack of good sleep is a lot tougher than an adult who almost certainly will appear to be tired the next day, if not outright complain about it. Children, on the other hand, often react to a lack of sleep by being hyperactive the next day.
"Children with obstructive sleep apnea are fidgeting and not able to stay on task, because they're doing anything they can to stay awake," said Dr. Seockhoon Chung. "Even when those behavioral problems are minimal, improvement is still possible."
Studies have shown improved behavioral problems related to sleep apnea is imperative to ensuring these behaviors don't carry over into teenage years. A study presented at SLEEP 2012 found children with untreated obstructive sleep apnea suffered more from long-term behavioral problems, including aggression, hyperactivity, difficulty in controlling their behavior, and many other social and behavioral problems.
Read more here

Study: Frequent social media use linked to sleep disturbance

A recent study links frequent social media use is linked to sleep disturbances.

Young adults who spend a lot of time on social media during the day or check it frequently throughout the week are more likely to suffer sleep disturbances than their peers who use social media less, according to new research from the University of Pittsburgh School of Medicine.
Published online and scheduled for the April issue of the journal Preventive Medicine, the study indicates that physicians should consider asking young adult patients about social media habits when assessing sleep issues. The research was supported by the National Institutes of Health (NIH).
"This is one of the first pieces of evidence that social media use really can impact your sleep," said lead author Jessica C. Levenson, Ph.D., a postdoctoral researcher in Pitt's Department of Psychiatry. "And it uniquely examines the association between social media use and sleep among young adults who are, arguably, the first generation to grow up with social media."
In 2014, Dr. Levenson and her colleagues sampled 1,788 U.S. adults ages 19 through 32, using questionnaires to determine social media use and an established measurement system to assess sleep disturbances.
The questionnaires asked about the 11 most popular social media platforms at the time: Facebook, YouTube, Twitter, Google Plus, Instagram, Snapchat, Reddit, Tumblr, Pinterest, Vine and LinkedIn.
On average, the participants used social media a total of 61 minutes per day and visited various social media accounts 30 times per week. The assessment showed that nearly 30 percent of the participants had high levels of sleep disturbance.
The participants who reported most frequently checking social media throughout the week had three times the likelihood of sleep disturbances, compared with those who checked least frequently. And participants who spent the most total time on social media throughout the day had twice the risk of sleep disturbance, compared to peers who spent less time on social media.
"This may indicate that frequency of social media visits is a better predictor of sleep difficulty than overall time spent on social media," Dr. Levenson explained. "If this is the case, then interventions that counter obsessive 'checking' behavior may be most effective."
Senior author Brian A. Primack, M.D., Ph.D., assistant vice chancellor for health and society in Pitt's Schools of the Health Sciences, emphasized that more study is needed, particularly to determine whether social media use contributes to sleep disturbance, whether sleep disturbance contributes to social media use -- or both.
For example, social media may disturb sleep if it is:
  • Displacing sleep, such as when a user stays up late posting photos on Instagram.
  • Promoting emotional, cognitive or physiological arousal, such as when engaging in a contentious discussion on Facebook.
  • Disrupting circadian rhythms through the bright light emitted by the devices used to access social media accounts.
Alternatively, young adults who have difficulty sleeping may subsequently use social media as a pleasurable way to pass the time when they can't fall asleep or return to sleep.
"It also may be that both of these hypotheses are true," said Dr. Primack, also director of Pitt's Center for Research on Media, Technology and Health. "Difficulty sleeping may lead to increased use of social media, which may in turn lead to more problems sleeping. This cycle may be particularly problematic with social media because many forms involve interactive screen time that is stimulating and rewarding and, therefore, potentially detrimental to sleep."
Read more here

Sleeping in on weekends can lessen risk of diabetes

Sleeping in on weekends and playing "catch up" on lost sleep can lessen the risk of diabetes due to sleep deprivation.

Two consecutive nights of extended sleep, a typical weekend occurrence, appears to counteract the increased risk of diabetes associated with short-term sleep restriction during the work week, at least in lean, healthy, young men eating a controlled diet.
The finding, based on a study performed at the University of Chicago sleep laboratory published early online by the journal Diabetes Care, could affect large numbers of people who work long hours.
The pattern of cutting back on sleep during the work week followed by catching up on sleep over the weekend is common. Even short-term sleep restriction, with four or five hours of sleep per night, can increase the risk of developing diabetes by about 16 percent--comparable to the increase in risk caused by obesity.
"In this short-term study, we found that two long nights spent catching up on lost sleep can reverse the negative metabolic effects of four consecutive nights of restricted sleep," said study author Josiane Broussard, PhD, now an assistant research professor in the Department of Integrative Physiology at the University of Colorado, Boulder.
The researchers recruited 19 volunteers, all healthy young men. On one occasion, they were allowed to sleep normally, spending 8.5 hours in bed for four nights. On another occasion, the same volunteers were first sleep deprived, allowed only 4.5 hours in bed for four consecutive nights. They spent an average of 4.3 of those hours asleep each night. Subsequently, they were allowed 2 nights of extended sleep, during which they averaged 9.7 hours of sleep.
Investigators then determined the subjects' insulin sensitivity--the ability of insulin to regulate blood sugars--and the disposition index, a predictor of diabetes risk. After four nights of sleep restriction, the volunteers' insulin sensitivity decreased by 23 percent and their diabetes risk increased by 16 percent.
After two nights of extended sleep, however, insulin sensitivity and the risk of diabetes returned to normal sleep levels.
"The metabolic response to this extra sleep was very interesting and encouraging," said senior author Esra Tasali, MD, associate professor of medicine at the University of Chicago. "It shows that young, healthy people who sporadically fail to get sufficient sleep during the work week can reduce their diabetes risk if they catch up on sleep during the weekend."
"Though this is evidence that weekend catch-up sleep may help someone recover from a sleep-deprived week," Broussard said, "this was not a long-term study and our subjects went through this process only once. Going forward we intend to study the effects of extended weekend sleep schedules in people who repeatedly curtail their weekday sleep."
Increased risk of developing diabetes is not the only drawback associated with inadequate sleep, the authors point out. The volunteers in this study were given a calorie-controlled diet, but sleep-deprived adults outside the laboratory setting tend to eat more, with a strong preference for sweets and high-fat foods. Chronically sleep deprived people are more likely to develop other health problems such as increased inflammation and high blood pressure. They also show cognitive problems, tend to be less alert and have difficulty concentrating, reasoning and solving problems. They are prone to traffic accidents. The impact of extra weekend sleep on other adverse health and safety outcomes remains to be determined.
Read more here

Poor sleep could mean strokes for seniors

Poor sleep could raise stroke risk in seniors.

Poor sleep may raise seniors' risk of hardening of the brain arteries, and possibly contribute to the chances of a stroke, a new study suggests.
Researchers examined the autopsied brains of 315 people, average age 90, who had undergone at least one full week of sleep quality assessment before their death. Twenty-nine percent of them had suffered a stroke, and 61 percent had moderate-to-severe damage to blood vessels in the brain.
Those with the highest levels of sleep fragmentation -- repeated awakenings or arousals -- were 27 percent more likely to have hardening of the brain arteries. Among study participants, sleep was disrupted an average of nearly seven times an hour.
For each additional two arousals during one hour of sleep, there was a 30 percent greater likelihood of having visible signs of oxygen deprivation in the brain, the study authors said.
However, the study was not designed to prove a cause-and-effect link between poor sleep and stroke risk.
The findings were independent of other stroke and heart disease risk factors, such as weight, diabetes, smoking and high blood pressure, as well as other health conditions such as Alzheimer's disease, depression, heart failure and pain, according to the study published Jan. 14 in the journal Stroke.
"The forms of brain injury that we observed are important because they may not only contribute to the risk of stroke but also to chronic progressive cognitive and motor impairment," lead investigator Dr. Andrew Lim, an assistant professor of neurology at the University of Toronto, said in a journal news release.
"However, there are several ways to view these findings: sleep fragmentation may impair the circulation of blood to the brain, poor circulation of blood to the brain may cause sleep fragmentation, or both may be caused by another underlying risk factor," said Lim, who is also a neurologist and scientist at Sunnybrook Health Sciences Center in Toronto.
While the findings suggest that sleep monitoring could help identify seniors at risk for stroke, further research is needed to clarify a number of areas.
One expert praised the research, but added that it wasn't the last word on the topic.
"This is an excellent study, highly provocative, but not definitive because of the design, as mentioned by the authors themselves," said Dr. Richard Libman, vice chairman of neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y.
"There appears to be a clear association between poor sleep [sleep fragmentation] and hardening of the arteries and risk of stroke," Libman said. "As noted, the direction of this association is uncertain.
"Sleep, to some degree, is within our control and we should all make attempts to improve the quality of our sleep," he added.
Read more here