Tuesday, March 20, 2007

Anxiety and stress after birth

Women suffer from anxiety and stress after birth, not only depression

Women can suffer from postnatal anxiety or stress independently of postnatal depression. A study published today in the open access journal BMC Psychiatry concludes that symptoms of anxiety and stress should be assessed in women in the early postnatal period. A scale that measures anxiety and stress independently of depression enabled researchers to detect 61 women who had symptoms of depression, and a further 33 women who had symptoms of anxiety and stress, without depression. There is growing awareness of postnatal depression, however, this study suggests that health practitioners should also be on the lookout for symptoms of anxiety and stress as signs of distress in postnatal women.

The study conducted by Renee Miller and Julie Pallant from Swinburne University of Technology and Lisa Negri from RMIT University, assessed the levels of depression, anxiety and stress in 325 first-time mothers who were 6 weeks to 6 months postnatal. Miller et al. analyzed the results of the widely used Edinburgh Postnatal Depression Scale (EPDS) along with an additional measure, the Depression, Anxiety and Stress Scales (DASS). They found that 33 women (10%) had symptoms of anxiety and stress independent of depression. These women would not have been detected if they had been assessed for depression alone.

According to Miller et al., the focus on depression as the only indicator for emotional distress in postnatal women means that women who have symptoms of anxiety and stress are at risk of not receiving help. Miller et al. conclude that it is important for health practitioners to assess new mothers for broader signs of distress than that of depression alone.

BioMed Central

Monday, March 19, 2007

Metabolic disease: new screening method

Metabolic disease too easily missed

Dutch researcher Terry Derks has demonstrated that the metabolic disease MCAD deficiency can be detected at an early stage. At present the disease is only found in half of the expected number of patients.
With the help of a new screening method, all newborns can now be screened. Young children can develop complications due to MCAD deficiency if this is not diagnosed on time. Where early detection fails, it is too late too intervene in a quarter of cases.

A recently developed screening method makes it possible to screen newborns for several metabolic diseases, such as MCAD deficiency. Over the past three years researchers have tested the screening for MCAD deficiency in the north of the Netherlands by means of the heel prick. In this trial project, MCAD deficiency was found to be twice as prevalent than had been predicted. Moreover it was detected four times as frequently as is the case without screening.

Better detection
How prevalent is the condition? The number of patients can be predicted based on the presence of changes in the DNA, so called gene mutations, which can cause the disease. From this the expected number of patients was 1:12,100. And how often was this disease found? Without the heel prick test 1 in 27,400 newborns in the Netherlands were diagnosed with MCAD deficiency. This happens after the patient shows complaints. Therefore the disease was not discovered in more than half of the patients. With the heel prick screening in the northern part of the country the researchers observed the disorder in 1 in 6600 newborns.

North-south gradient
MCAD deficiency was found to be diagnosed more often in the north than in the south of the Netherlands. Interestingly, a north-south gradient for the prevalent MCAD gene mutation is present throughout Europe.

MCAD deficiency
In patients with MCAD deficiency the MCAD enzyme does not function well enough. This enzyme is needed for the production of extra energy. Extra energy is particularly important under certain conditions, for example, during infections, fasting or major exertion. For young children, in particular, having the MCAD deficiency can be dangerous. Normally, they need more energy than adults, and during fever this demand increases. Young children with MCAD deficiency and fever can develop serious complications, probably due to the shortage of energy. As a result of this a simple infection can even become life threatening. About one-quarter of the clinically ascertained patients with MCAD deficiency who are admitted to hospital die before the diagnosis is known. A significant proportion of the children who survive the complications remain permanently disabled.
Heel prick

After an early diagnosis, a child can be helped with a simple treatment. With the new screening method, MCAD deficiency can be investigated for during the heel prick test neonatally. All newborn babies in the Netherlands receive the heel prick. At the recommendation of a Health Council of the Netherlands committee, the heel prick has been extended since 1 January 2007 to include, for example, screening for MCAD deficiency. The committee based its recommendations on a combination of literature research and scientific opinion. For MCAD deficiency, Derks and colleagues provided the scientific evidence that screening newborns is worthwhile.

Netherlands Organisation for Scientific Research

Saturday, March 17, 2007

Smoking and Pregnancy

Smoking and Pregnancy

Research shows that your baby can be harmed by tobacco smoke.

Some effects of tobacco smoke may include:
Problems when you are pregnant.
Smoking can increase the risk of miscarriage, stillbirth, premature delivery, or bleeding during your pregnancy.

Problems when the baby is born.
If you smoke, it is twice as likely that your baby will be small at birth. Low birth weight babies can have health problems.

Problems as the baby grows.
Sudden infant death syndrome (SIDS) or crib death, happens more often in homes of smokers. Also, babies who are around smokers have more flu, colds, ear infections and breathing problems such as asthma.

We all know quitting smoking is not easy!

Nicotine, the drug found in tobacco, is very addictive. Tobacco smoke contains at least 4,000 other chemicals besides nicotine, and all of these chemicals can be harmful to the health of you and your baby.

If you smoke, try to quit or cut down your smoking as soon as you find out you are pregnant. However, if you quit or cut down any time during your pregnancy, it will help you and your baby. Some women smokers say it is easier to quit or cut down when they were pregnant.

Here are some tips:
• Start slowly. Set a change date, then aim to quit or cut down on that day. Be realistic. Smokers with realistic goals have more success. And, don't give up if you don't reach your goals right away — keep trying.
• Find someone who will help you make changes. Make this person your change or quit “buddy.” The more support you can get from others, the easier it is to make changes.
• Call a counsellor, a community health nurse, or a doctor. They can help pregnant women quit or cut down on their smoking.

What about other people's smoke (second-hand smoke)?
Second-hand smoke can cause health problems for you and your baby, too. If your partner smokes, ask your partner to try to quit or cut down, or to smoke outside. Ask your partner (and anyone else) not to smoke around you. When people smoke around you, leave the room when they are smoking.

Women's Addictions - Research and Education (AWARE), Ontario.

Friday, March 16, 2007

What Is Hypersomnia?

What Is Hypersomnia?
And What Can You Do About It?

In discussions and email lately the word "hypersomnia' keeps cropping up. People want to know what hypersomnia means when used in reference to sleep disorders.

Simply put, hyper means excessive and somnia refers to sleep, so hypersomnia is excessively long or deep sleep. Other symptoms include:
• A gradually onset.
• You can feel the sleepiness coming on.
• It usually starts in the early twenties.
• It has been happening for at least three months.

If you think you are suffering from hypersomnia, ask your doctor about having a sleep study. This will eliminate other disorders such as sleep apnea and narcolepsy. This continual need for sleep will eventually cause a lot of distress and interfere with all areas of your life, from work to home life.

The hypersomniac may sleep up to twelve hours a night, and still need frequent daytime naps.

If you are diagnosed as a victim of recurrent hypersomnia, this is also called Kleine-Levin Syndrome. This syndrome usually affects males more than females and begins some time in the teens.

Idiopathic hypersomnia is much like narcolepsy, except there is no cataplexy, no sleep paralysis, and no rapid eye movement when the victim first falls asleep.

Hypersomnia is one of the symptoms of major depression. In fact, people who are suffering from clinical depression may suffer from either insomnia (inability to fall asleep) or hypersomnia (excessive sleep) nearly every day. Bi-polar patients may also experience hypersomnia during depressive periods.

The cause of hypersomnia is unknown and may vary from victim to victim. Treatment, therefore, consists of changes in behavior, practicing good sleep hygiene and the use of stimulants. Don't nap during the day if you can avoid it. Also avoid things that may interfere with sleep patterns, like alcohol, caffeine near bed time and shift work.

Talk to your doctor. He may be able to prescribe stimulants, a sleep study or other methods of treatment.


Thursday, March 15, 2007

Depression during pregnancy

Depression more common during pregnancy than after childbirth

Depression during pregnancy is more common than postnatal depression, finds a study in this week's BMJ. As mood during pregnancy may affect the unborn child, more efforts need to be directed towards recognising and treating antenatal depression, report the authors.

Over 9,000 pregnant women recorded their mood through pregnancy and after childbirth in a series of questionnaires. Any reported symptoms of depression were measured against a recognised depression scale.
Depression scores were higher during pregnancy than after childbirth, with a peak at 32 weeks of pregnancy and a lowest value 8 months after childbirth. The severity and nature of reported symptoms did not differ before and after childbirth, suggesting that depression is no more likely after childbirth than it is during pregnancy, say the authors.

Although postnatal depression has become a focus of concern, depression during pregnancy has been relatively neglected, say the authors. They call for urgent research into both the consequences for the child and the potential benefits of screening for, and treating, depression during pregnancy. "Offering treatment may be important for both the mother and the future wellbeing of the child and family," they conclude.

British Medical Journal (BMJ)

Wednesday, March 14, 2007

Bionic eye implant

Trials for 'bionic' eye implants

A bionic eye implant that could help restore the sight of millions of blind people could be available to patients within two years.
US researchers have been given the go-ahead to implant the prototype device in 50 to 75 patients.
The Argus II system uses a spectacle-mounted camera to feed visual information to electrodes in the eye.
Patients who tested less-advanced versions of the retinal implant were able to see light, shapes and movement.
"What we are trying to do is take real-time images from a camera and convert them into tiny electrical pulses that would jump-start the otherwise blind eye and allow patients to see," said Professor Mark Humayun, from the University of Southern California.
Retinal implants are able to partially restore the vision of people with particular forms of blindness caused by diseases such as macular degeneration or retinitis pigmentosa. About 1.5 million people worldwide have retinitis pigmentosa, and one in 10 people over the age of 55 have age-related macular degeneration.

Both diseases cause the retinal cells which process light at the back of the eye to gradually die.
The new devices work by implanting an array of tiny electrodes into the back of the retina.
A camera is used to capture pictures, and a processing unit, about the size of a small handheld computer and worn on a belt, converts the visual information into electrical signals.
These are then sent back to the glasses and wirelessly on to a receiver just under the surface of the front of the eye, which in turn feeds them to the electrodes at the rear. The whole process happens in real time.

Growing dots
First-generation, low-resolution devices have already been fitted to six patients.
"The longest device has been in for five years," said Professor Humayun.
"It's amazing, even with 16 pixels, or electrodes, how much our first six subjects have been able to do."
Terry Byland, 58, from California was fitted with an implant in 2004 after going blind with retinitis pigmentosa in 1993. "At the beginning, it was like seeing assembled dots - now it's much more than that," he said.
"When I am walking along the street I can avoid low-hanging branches - I can see the edges of the branches."
Mr Byland is also able to make out other shapes. "I can't recognise faces, but I can see them like a dark shadow," he said.

Brain change
The new implant has a higher resolution than the earlier devices, with 60 electrodes. It is also a lot smaller, about one square millimetre, which reduces the amount of surgery that needs to be done to implant the device.
The technology has now been given the go-ahead by the US Food and Drug Administration to be used in an exploratory patient trial. This will take place at five centres across America over two years, with 50-75 patients aged over 50.

If successful, the device could be commercialised soon after, costing around $30,000 (£15,000). Other devices could then be developed with higher resolution or a wider field of view, said Professor Humayun.
Future work includes studying the effects the implants have on the brain.
"We are actually studying what happens to the visual cortex over time," said Professor Humayun.

The research was presented at the American Association for the Advancement of Science (AAAS) annual meeting in San Francisco, US.

Tuesday, March 13, 2007

Sick Building Syndrome

Sick Building Syndrome
Joe E. Heimlich

People spend most of their time indoors with some estimates being that humans spend more than 90% of their lives inside constructed environments. Over time, the construction of buildings has increasingly focused on energy efficiency and comfort. Central heating and cooling systems are the norm, and home and office construction has moved toward minimizing heat or cool air loss by making buildings more airtight. At the same time, more complex materials are being used for furniture, clothing, fabrics, cleaners, detergents, and preservatives. Coupled, these and other parallel trends have created buildings where the exposure to foreign proteins, dusts, and gases through inhalation has gone far beyond what historically has been the case. This fact sheet discusses the concept of the "sick building syndrome," the types of allergens or stimuli most likely to be found in today's buildings, and how individuals can better cope with contemporary construction of indoor environments.
What is "Sick Building Syndrome"?
In the 1970s, health care providers were faced with increasing numbers of people having headaches and allergic-like reactions to unspecified stimuli. Some of the reactions included lethargy, fatigue, headache, dizziness, nausea, irritation of mucous membranes, eye and/or nasopharyngeal irritation, and sensitivity to odors. Through exploration over several years, these reactions were linked to common symptoms of people in specific buildings and a lack of symptoms when these people were not in the buildings. This spectrum of specific and non-specific complaints, when tied to a particular building, became known as the "sick building syndrome." It is important to note that "sick building syndrome" is not the same as "building related illness" which refers to a specific airborne building contaminant. One well known example of this is Legionnaires' Disease.
"Sick building syndrome" is often more prevalent among asthmatics among whom there is a large percentage of allergies to common indoor allergens. Indoor air pollution also disproportionately affects some populations, such as African Americans living in inner city homes that are not modernized. For these populations, there is a three to five times greater risk of asthma mortality than Caucasians, which may be compounded by a variety of sources including rat/cockroach infestations, sanitary conditions, and education as well as indoor air pollution.
What are the Sources of Pollution?
There are four broad categories of contributors to "sick building syndrome." Other fact sheets in this series address some of these sources.
Major Combustion Pollutants
Malfunctioning or inappropriate, inefficient use of heating devices can produce pollutants at harmful levels. Carbon monoxide (CO), which is an asphyxiant, and nitrogen dioxide (NO2) and sulfur dioxide (SO2), which are irritants, are three of the more common products of combustion pollutants in the home. Methelyne chloride, which is in some household products such as paint strippers, can also be metabolized to form CO.
Biological Air Pollutants
Found everywhere, dander, molds, dust mites, and other biologicals are carried by animals and people into and throughout homes and buildings. High relative humidity, flooding, inadequate exhaust of bathrooms or kitchens, humidifiers, dehumidifiers, air conditioners, drip pans under cooling coils, pets, and components of heating, ventilation, and air conditioning (HVAC) systems are all sources of biological air pollutants. Three types of human disease can come from these biological pollutants: infections in which pathogens invade human tissue; hypersensitivity diseases which involve specific activity of the immune system; and toxicosis in which biologically produced chemical toxins cause direct toxic effects. In many cases, "sick building syndrome" may be related to microbial contamination in buildings.
Volatile Organic Compounds
At room temperature, volatile organic compounds, or VOCs, are emitted as gases from certain solids and liquids. These include formaldehyde, pesticides, solvents, cleaning agents, benzene, and perchloroethylene. In some EPA studies, indoor levels of some VOCs can be up to ten times greater than outdoors. A wide array of potential sources of VOCs exists in the home and in the office. Scents and hair sprays, household products such as finishes, rug and oven cleaners, paints, thinners, dry cleaning fluids, some copiers and printers, some glues and adhesives, markers, and photo solutions are among some of the common products that may emit VOCs. One of the major irritants in "sick building syndrome" is formaldehyde. Although urea-formaldehyde foam insulation is no longer used, buildings which had the blown foam in the 1970s may still have VOCs from the insulation. Formaldehyde is also found in resins in finishes, in plywood, paneling, fiberboard and particle board, and in some of the backings and adhesives for carpets. New installations, carpet, wall coverings, paint, or construction can all heighten problems with VOCs.
Heavy Metals
Over the past several decades, the potential for casual exposure to heavy metals in buildings has been significantly reduced. Lead was removed as an ingredient in paints starting in the 1940s and was completed banned in 1978. In August 1990, mercury (threat in the vapor, not in the paint) was removed from indoor latex paints and in 1991 from outdoor latex paints and was replaced with a different, less toxic chemical to extend shelf-life and kill mold and mildew. Although still a concern, the likelihood of inhalation of heavy metals in most buildings is minute. The concern about heavy metals as an indoor air pollutant is greatest in older, deteriorating housing or during rehab or reconstruction projects of older buildings.
How Can I Know if a Health Reaction is Due to a Sick Building?
There are two components to identifying a sick building. The first is that the reactions or types of reactions are shared by several or many of the people who also inhabit the building. The second is that the reactions are triggered when in the building and are not triggered when not in the building. Individuals, however, may have greater sensitivities to some stimuli than do other people. For these individuals, something or things in the building may be triggering a reaction, but the building may not be "sick." This is often the case when a certain office or part of a building is rehabbed or reconfigured and decorated. That particular area of the building may create reactions in individuals, but the building itself is not problematic.
What Can I Do?
The best way to deal with potential reactions to a sick building, is to understand the reasons a building may be "sick." The predominant culprit in most buildings is the flow of air. Fresh air and air movement patterns keep a building "flushed." As buildings become sealed or an interior is redesigned and changes the air flow, air may not move as freely and the contaminants can accumulate in the closed space. Poorly designed or maintained ventilation systems (HVAC) can also create problems, especially in situations where the pollutants can "buildup" over time due to poor air exchange.
The second cause can be a synergistic or combination interaction among low levels of specific pollutants. In these cases, when the specific pollutants are identified, the contributing factors are removed or altered to minimize the effect. For individuals, specific causes may be traced through "histories" of other situations in which the individual has had similar reactions.
Other factors that can contribute to the symptoms associated with "sick building syndrome" are some that can be relatively easily maintained. Too low or too high a humidity level or changes in relative humidity in a building can aggravate individuals. Too low humidity can increase dust and particulate indoor pollution, and too high humidity can provide a breeding ground for molds and fungi. Poor lighting can increase eye strain and result in symptoms similar to "sick building syndrome." Extreme temperature fluctuations in a building can serve to release VOCs and molds/fungi.
If you suspect a building of "making you sick," first track your reactions. What types of reactions, what are the triggers for the reaction, and do the reactions abate when you are not in the building? Next, examine the building for things you can control. Can you open windows or doors to improve air flow? Many types of adjustments that could alleviate sick building symptoms require major structural changes in building infrastructure. So, as an individual, you will have to find the things that you can control. Can you minimize the temperature changes within the building? Are there individual activities, such as the use of colognes or perfumes, soaps, shampoos, deodorants, perfumes in detergents, and air fresheners that can be controlled by individuals within the building? Finally, if you believe it is a building that is sick, gather the evidence from multiple occupants of the building - and if possible have all occupants meet with one or a few health care providers - and contact the owner of the building and your local health department.

Wednesday, March 07, 2007

Triptan: treatment in migraine

The use of multiattribute decision models in evaluating triptan treatment options in migraine

Ferrari MD, Goadsby PJ, Lipton RB, Dodick DW, Cutrer FM, McCrory D, Williams P.
Dept. of Neurology, Leiden University Medical Centre, Netherlands

BACKGROUND : The physician treating patients with migraine is now able to choose from among seven triptans-almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan. These differ, to greater or lesser degrees, on a range of clinical attributes important for treatment selection.
OBJECTIVE : To outline the basic principles of Multiattribute Decision Making (MADM) and describe how one such method-TOPSIS (Technique for Order Preference by Similarity to the Ideal Solution)-can be applied to evaluate the currently available triptans.
METHODS : In an example application, summary data from a recent meta-analysis of 53 published and unpublished placebo-controlled trials of the oral triptans were combined in TOPSIS models with computer-generated attribute importance weights representing the entire range of possible values, That is, the relative performance of the triptans was explored across all logically possible combinations of relative importance of the treatment attributes available from the meta-analysis, and uncertainty was assessed based on the confidence intervals from the meta-analysis.
RESULTS : When compared across the entire range of values for relative attribute importance, almotriptan, eletriptan and rizatriptan were more similar to a hypothetical ideal triptan and were more likely to appear in the top three closest to the hypothetical ideal, than were naratriptan, sumatriptan, and zolmitriptan.
CONCLUSION : Using the TOPSIS model, almotriptan, eletriptan and rizatriptan were more likely to appear in the top three closest to the hypothetical ideal triptan.

J Neurol. 2005 Mar 11.