Cognitive Behavioral Therapy appears to be more effective in relieving symptoms of IBS

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder affecting 10 – 20 per cent of people. Abdominal pain, bloating and altered bowel habit significantly affect patients’ quality of life and can force them to take days off work.

New research has shown that Cognitive Behavioral Therapy (CBT) tailored specifically for IBS and delivered over the telephone or through an interactive website is more effective in relieving the symptoms of IBS than current standard care. These results could make a real difference to patients with IBS who currently have very limited access to CBT in a resource constrained NHS.

The research was led by Dr Hazel Everitt, Associate Professor in General Practice at the University of Southampton. Dr Everitt comments: “We previously knew that face-to-face CBT sessions could be helpful for treating IBS and this type of treatment is recommended in the National Institute for Clinical Excellence’s guidelines. However, in my experience as a GP, I have found that availability is extremely limited.”

In the largest study of its kind, researchers at the University of Southampton and King’s College London carried out a trial involving 558 patients who had ongoing significant IBS symptoms despite having tried other IBS treatments for at least a year. Rona Moss-Morris, Professor of Psychology as Applied to Medicine and Trudie Chalder, Professor of Cognitive Behavioural Therapy from King’s College London, developed the IBS specific CBT programmes, which both involve 8 treatment sessions but differing amounts of therapist input.

The findings, published today in the journal GUT, show that those who received either form of CBT were more likely to report significant improvement in severity of symptoms and impact on their work and life after 12 months of treatment compared to those who only received current standard IBS treatments.

Dr Everitt added: “The fact that both telephone and web-based CBT sessions were shown to be effective treatments is a really important and exciting discovery. Patients are able to undertake these treatments at a time convenient to them, without having to travel to clinics.”

Professor Moss-Morris said: “The most important next step is for these tailored CBT treatments to be made more widely available. Professor Trudie Chalder and I are currently training NHS therapists at pre-existing Improving Access to Psychological Therapy (IAPT) services, so that more people suffering from IBS can access these treatments quickly. We are also working with a commercial partner to bring web-based CBT to the NHS and other parts of the world.”

The study was funded by the National Institute for Health Research (NIHR). The research team is now working towards making the therapy widely available in the NHS.

Source:

https://www.southampton.ac.uk/




Maternal diet during pregnancy may modulate the risk of ADHD symptoms in children

omega 3
Credit: CC0 Public Domain

The results of a study led by a team from the Barcelona Institute for Global Health suggest that the risk of a child developing symptoms of attention deficit hyperactivity disorder (ADHD) may be modulated by the mother’s diet during pregnancy. The study, published in the Journal of Pediatrics, analysed samples of umbilical cord plasma to quantify the levels of omega-6 and omega-3 that reach the foetus. The statistical analysis showed a higher omega-6:omega-3 ratio to be associated with a higher risk of ADHD symptoms at seven years of age.

Omega-6 and omega-3 are long-chain polyunsaturated fatty acids that play a crucial role in the function and architecture of the central nervous system, particularly during the later stages of gestation. These two fatty acids compete for incorporation into cell membranes and are primarily obtained through diet. Since omega-6 and omega-3 have opposing physiological functions—the former promotes systemic pro-inflammatory states, while the latter promotes anti-inflammatory states—a balanced intake of these two fatty acids is important. Previous research had shown that children with ADHD symptoms have a higher omega-6:omega-3 ratio.

The authors studied data from 600 children living in four Spanish regions (Asturias, Basque Country, Catalonia and Valencia) who are participating in the INMA Project. They analysed umbilical cord plasma samples and data from questionnaires completed by the children’s mothers. ADHD symptoms were assessed using two standard questionnaires: the first completed by the children’s teachers at age four years, and the second by their parents at age seven years.

The results showed that, at age seven years, the number of ADHD symptoms increased by 13 percent per each unit increase in the omega-6:omega-3 ratio in umbilical cord plasma. The study analysed the number of symptoms in the children who met the diagnostic criteria for ADHD (minimum six symptoms) and also in the children with a smaller number of ADHD symptoms. The ratio of the two fatty acids was associated with the number of ADHD symptoms present but not with diagnosis of the disorder, and only in the assessment carried out at seven years of age. The authors suggest that the assessment carried out at four years of age may have been affected by a measurement error because ADHD symptoms reported at early ages may be caused by a neurodevelopmental delay falling within the normal range.

“Our findings are in line with previous studies that established a relationship between the omega-6:omega-3 ratio in mothers and various early neurodevelopmental outcomes,” commented Mónica López-Vicente, ISGlobal researcher and lead author of the study.

“Although the association was not clinically significant, our findings are important at the level of the population as a whole,” noted López-Vicente. “If a large proportion of the population is exposed to a high omega-6:omega-3 ratio, the distribution for ADHD symptom scores would likely move to the right and the prevalence of extreme values would increase, leading to a negative impact on the community’s health costs and productivity.”

“This study adds more evidence to the growing body of research on the importance of maternal diet during pregnancy,” commented ISGlobal researcher Jordi Júlvez, a co-author of the study. “The nutrient supply during the earliest stages of life is essential in that it programs the structure and function of the organs, and this programming, in turn, has an impact on health at every stage of life. As the brain takes a long time to develop, it is particularly vulnerable to misprogramming. Alterations of this sort could therefore lead to neurodevelopmental disorders.”


Knowledge gaps found for non-drug therapy in peds ADHD


More information:
Mónica López-Vicente et al. Prenatal omega-6:omega-3 ratio and attention deficit and hyperactivity disorder symptoms. Journal of Pediatrics. 2019.

Provided by
Barcelona Institute for Global Health

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Maternal diet during pregnancy may modulate the risk of ADHD symptoms in children (2019, March 28)
retrieved 11 April 2019
from https://medicalxpress.com/news/2019-03-maternal-diet-pregnancy-modulate-adhd.html

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Improved gut diversity causes 50% reduction in autism symptoms

Changing the microbial environment in the gut in autistic children could substantially reduce the severity of the symptoms they experience, according to new research. The study “Long-term Benefit of Microbiota Transfer Therapy in Autism Symptoms and Gut Microbiota”, was published on 9th April 2019 in the journal, Scientific Reports.

Children with autism can experience severe gastrointestinal symptoms, which can affect behavior.Olesia Bilkei | Shutterstock

Researchers Dae-Wook Kang, PhD., Rose Krajmalnikat-Brown, PhD., and James Adams, PhD. of Arizona State University had previously found that introducing healthy gut microflora led to improvements in both gastrointestinal (GI) and autism symptoms.

The study, which was published in 2017, describes autism spectrum disorders (ASD) as “complex neurobiological disorders that impair social interactions and communication and lead to restricted, repetitive, and stereotyped patterns of behavior, interests, and activities.”

“In our original paper in 2017, we reported an increase in gut diversity together with beneficial bacteria after microbiota transfer therapy (MTT), and after two years, we observed diversity was even higher and the presence of beneficial microbes remained,” explained biotechnological Dae-Wook Kang PhD., lead author.

There is a range of comorbidities observed in people with autism, and the prevalence and severity of gastrointestinal problems seemingly correlate with the severity of the core autism-related behavioral problems individuals experience.

Gastrointestinal symptoms linked to ‘worse autism-related symptoms’

GI symptoms associated with autism include chronic constipation, diarrhea, and abdominal pain, with gastroesophageal reflux and gastritis being reported as well.

Many kids with autism have gastrointestinal problems, and some studies, including ours, have found that those children also have worse autism-related symptoms.”

Dr. Rosa Krajmalnik-Brown, Environmental Engineer

“In many cases, when you are able to treat those gastrointestinal problems, their behavior improves.”

Treatments for ASD include behavioral therapies, speech and social therapies, psychiatric medications, and some nutritional therapies.

Improving the gut microbiome may relieve neurological problems

There are currently no approved medical treatments to help the core symptoms of autism, from difficulties with social communication to repetitive behavior.

However, innovative research is being carried out concerning the gut microbiome, the community of microbes that exist in the intestines and play important roles in digestion, the immune system, and regulating the growth of harmful bacteria. Some research has suggested that the gut microbiome may also be able to relieve neurological problems as well.

For their new study, the researchers used a process called microbiota transfer therapy (MTT), which is a customized process of gut microflora transplantation.

18 children aged between seven and 16 were treated for 10 weeks and attended follow up tests for another eight weeks. The same participants were also involved in the researcher’s previous study two years ago, which trialed microbiota transfer therapy, a type of fecal transplant developed by gastroenterologist Dr. Thomas Borody, combining antibiotics, bowel cleanses, stomach-acid suppressants, and a fecal microbiota transplant (FMT).

GI symptoms improved by 58% on average and were ‘maintained’ and after treatment

Having introduced their new study by stating, “Fecal microbiota transplant[s] could transform the dysbiotic gut microbiome toward a healthy one by delivering a large number of commensal microbes from a healthy donor,” researchers concluded that

Notably, most improvements in GI symptoms were maintained, and autism-related symptoms improved even more after the end of treatment.”

The study acknowledges that the results may be subject to the placebo effect but reports that the long-term benefits experienced by the study participants were “promising”.

The results found show that the improvement was, on average, a 58 percent reduction in the Gastrointestinal Symptom Rating Scale (GSRS). All sub-categories of GSRS, which include abdominal pain, indigestion, diarrhea, and constipation, were subject to these improvements. However, the improvements in indigestion symptoms were reduced after the two-year period when compared with weeks 10 and 18.

After two years, symptoms were 47% lower

Additional to improvements seen in GI abnormalities, the severity of ASD symptoms had also reduced by 47% at the end of the two-year follow-up tests, based on the Childhood Autism Rating Scale (CARS).

83 percent of study participants rated as “severe” on the CARS at the beginning of the original trial. At the two-year follow-up tests, 17 percent were rated as “severe”, 39 percent as “mild to moderate”, and 44 percent were below the ASD diagnostic cut-off scores.

The researchers state that improvements seen on the CARS assessments are “less susceptible to placebo-effect” as CARS is a “stable and consistent diagnostic tool with high predictive validity.”

They were also able to report that:

Changes in gut microbiota persisted at two years, including in overall community diversity […] These encouraging observations demonstrate that the intensive MTT intervention is a promising therapy for children with ASD who have GI problems.”

Could microbiota transplants become a routine part of ASD treatment?

Krajmalnik-Brown commented on the work, saying, “Kids with autism are lacking important beneficial bacteria, and have fewer options in the bacterial menu of important functions that bacteria provide to the gut than typically developing kids.”

Kang has said that further studies are needed to properly define the roles gut microbiomes play in the context of autism.

This is a world-first discovery that when we treated the gut bacteria in these children during our clinical trial two years ago to reset their microbiome with FMT, positive results are still continuing to be improving two years from the original treatments. I would call it the highest improvement in a cohort that anyone has achieved for autism symptoms.”

Dr. Thomas Borody

The researchers conclude the study by saying they believe additional research, including double-blind, placebo-controlled randomized trials using larger cohorts would help solidify their findings, which will form the next steps in their research.




Dengue Fever Test: MedlinePlus Lab Test Information

What is a dengue fever test?

Dengue fever is a viral infection spread by mosquitos. The virus can’t be spread from person to person. Mosquitos that carry the dengue virus are most common in areas of the world with tropical and subtropical climates. These include parts of:

  • South and Central America
  • Southeast Asia
  • The South Pacific
  • Africa
  • The Caribbean, including Puerto Rico and the U.S. Virgin Islands

Dengue fever is rare in the U.S. mainland, but cases have been reported in Florida and in Texas near the Mexican border.

Most people who get dengue fever have no symptoms, or mild, flu-like symptoms such as fever, chills, and headache. These symptoms usually last for a week or so. But sometimes dengue fever can develop into a much more serious disease called dengue hemorrhagic fever (DHF).

DHF causes life-threatening symptoms, including blood vessel damage and shock. Shock is a condition that can lead to a severe drop in blood pressure and organ failure.

DHF mostly affects children under 10. It can also develop if you have dengue fever and get infected a second time before you have fully recovered from your first infection.

A dengue fever test looks for signs of the dengue virus in the blood.

While there is no medicine that can cure dengue fever or DHF, other treatments can help relieve symptoms. This can make you more comfortable if you have dengue fever. It can be lifesaving if you have DHF.

Other names: dengue virus antibody, dengue virus by PCR

What is it used for?

A dengue fever test is used to find out if you have been infected with the dengue virus. It is mostly used for people who have symptoms of illness and have recently traveled to an area where dengue infections are common.

Why do I need a dengue fever test?

You may need this test if you live or have recently traveled to an area where dengue is common, and you have symptoms of dengue fever. Symptoms usually show up four to seven days after being bitten by an infected mosquito, and may include:

  • Sudden high fever (104°F or higher)
  • Swollen glands
  • Rash on the face
  • Severe headache and/or pain behind the eyes
  • Joint and muscle pain
  • Nausea and vomiting
  • Fatigue

Dengue hemorrhagic fever (DHF) causes more severe symptoms and can be life-threatening. If you’ve had symptoms of dengue fever and/or have been in an area that has dengue, you may be at risk for DHF. Seek medical help immediately if you or your child has one or more of the following symptoms:

  • Severe abdominal pain
  • Vomiting that doesn’t go away
  • Bleeding gums
  • Nose bleeds
  • Bleeding under the skin, which may look like bruises
  • Blood in urine and/or stools
  • Difficulty breathing
  • Cold, clammy skin
  • Restlessness

What happens during a dengue fever test?

Your health care provider will probably ask about your symptoms and for details on your recent travels. If an infection is suspected, you will get a blood test to check for the dengue virus.

During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Will I need to do anything to prepare for the test?

You don’t need any special preparations for a dengue fever test.

Are there any risks to the test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

A positive result means you probably have been infected with the dengue virus. A negative result can mean you aren’t infected or you were tested too soon for the virus to show up in testing. If you think you were exposed to the dengue virus and/or have symptoms of infection, talk to your health care provider about whether you need to be retested.

If your results were positive, talk to your health care provider about how to best treat your dengue fever infection. There are no medicines for dengue fever, but your provider will probably recommend that you get plenty of rest and drink lots of fluids to avoid dehydration. You may also be advised to take over-the-counter pain relievers with acetaminophen (Tylenol), to help ease body aches and reduce fever. Aspirin and ibuprofen (Advil, Motrin) are not recommended, as they may worsen bleeding.

If your results are positive and you have symptoms of dengue hemorrhagic fever, you may need to go to the hospital for treatment. Treatment may include getting fluids through an intravenous (IV) line, a blood transfusion if you’ve lost a lot of blood, and careful monitoring of blood pressure.

Is there anything else I need to know about a dengue fever test?

If you will be traveling to an area where dengue is common, you can take steps to reduce your risk of getting infected with the dengue virus. These include:

  • Apply an insect repellent containing DEET on your skin and clothing.
  • Wear long-sleeved shirts and pants.
  • Use screens on windows and doors.
  • Sleep under a mosquito net.



Study shows link between maternal diet during pregnancy and risk of ADHD symptoms in children

The results of a study led by a team from the Barcelona Institute for Global Health (ISGlobal), a center supported by “la Caixa”, suggest that the risk of a child developing symptoms of attention deficit hyperactivity disorder (ADHD) may be modulated by the mother’s diet during pregnancy. The study, published in the Journal of Pediatrics, analyzed samples of umbilical cord plasma to quantify the levels of omega-6 and omega-3 that reach the foetus. The statistical analysis showed a higher omega-6:omega-3 ratio to be associated with a higher risk of ADHD symptoms at seven years of age.

Omega-6 and omega-3 are long-chain polyunsaturated fatty acids that play a crucial role in the function and architecture of the central nervous system, particularly during the later stages of gestation. These two fatty acids compete for incorporation into cell membranes and are primarily obtained through diet. Since omega-6 and omega-3 have opposing physiological functions–the former promotes systemic pro-inflammatory states, while the latter promotes anti-inflammatory states–a balanced intake of these two fatty acids is important. Previous research had shown that children with ADHD symptoms have a higher omega-6:omega-3 ratio.

The authors studied data from 600 children living in four Spanish regions (Asturias, Basque Country, Catalonia and Valencia) who are participating in the INMA Project. They analyzed umbilical cord plasma samples and data from questionnaires completed by the children’s mothers. ADHD symptoms were assessed using two standard questionnaires: the first completed by the children’s teachers at age four years, and the second by their parents at age seven years.

The results showed that, at age seven years, the number of ADHD symptoms increased by 13% per each unit increase in the omega-6:omega-3 ratio in umbilical cord plasma. The study analyzed the number of symptoms in the children who met the diagnostic criteria for ADHD (minimum six symptoms) and also in the children with a smaller number of ADHD symptoms. The ratio of the two fatty acids was associated with the number of ADHD symptoms present but not with diagnosis of the disorder, and only in the assessment carried out at seven years of age. The authors suggest that the assessment carried out at four years of age may have been affected by a measurement error because ADHD symptoms reported at early ages may be caused by a neurodevelopmental delay falling within the normal range.

“Our findings are in line with previous studies that established a relationship between the omega-6:omega-3 ratio in mothers and various early neurodevelopmental outcomes,” commented Mónica López-Vicente, ISGlobal researcher and lead author of the study.

“Although the association was not clinically significant, our findings are important at the level of the population as a whole,” noted López-Vicente. “If a large proportion of the population is exposed to a high omega-6:omega-3 ratio, the distribution for ADHD symptom scores would likely move to the right and the prevalence of extreme values would increase, leading to a negative impact on the community’s health costs and productivity.”

“This study adds more evidence to the growing body of research on the importance of maternal diet during pregnancy,” commented ISGlobal researcher Jordi Júlvez, a co-author of the study. “The nutrient supply during the earliest stages of life is essential in that it programs the structure and function of the organs, and this programming, in turn, has an impact on health at every stage of life. As the brain takes a long time to develop, it is particularly vulnerable to misprogramming. Alterations of this sort could therefore lead to neurodevelopmental disorders.”

Source:

https://www.isglobal.org/en/-/la-dieta-materna-durante-el-embarazo-podria-modular-el-riesgo-de-desarrollar-sintomas-de-tdah-durante-la-infancia




Mothers of fussy infants have greater odds of experiencing depressive symptoms

It’s no secret that fussy newborns can be especially challenging for parents already facing physical and mental exhaustion from caring for a new baby.

But now science backs up the impact on parents: The less soothable the infant, the more distressed the mother.

Mothers of highly irritable infants experience greater depressive symptoms, according to new University of Michigan-led research. The nationally representative study, which included data from more than 8,200 children and their parents, appears in Academic Pediatrics.

The study is also believed to be the first to explore whether the degree of a baby’s prematurity in combination with infant fussiness may influence the severity of maternal depressive symptoms.

Researchers found that mothers of very preterm, fussy infants (born at 24-31 weeks) had about twice the odds of experiencing mild depressive symptoms compared to moms of very preterm infants without fussiness.

However, mothers of fussy babies born moderate-late preterm (32-36 weeks gestation) as well as mothers of full-term infants were about twice as likely to report moderate to severe depressive symptoms as moms of less irritable babies born at the same gestational age.

“We found that maternal depression risk varied by gestational age and infant fussiness,” says senior author Prachi Shah, M.D., a developmental and behavioral pediatrician at U-M C.S. Mott Children’s Hospital and an associate research scientist at U-M’s Center for Human Growth and Development. “Mothers of fussy infants born late preterm and full term are more likely to experience more severe levels of maternal depression, than mothers of fussy infants who were born more preterm.”

“These findings reinforce that all mothers caring for babies with more difficult temperaments may need extra help managing the emotional toll,” she adds. “Early screening for infant fussiness may help identify mothers with depressive symptoms in need of support, but may be especially important for mothers of infants born mildly preterm, in whom the symptoms of depression are more severe.”

Shah notes that while very preterm infants have higher morbidity than babies born later, the perinatal care of infants born very preterm may actually help buffer against more severe maternal depression.

Very preterm infants are often cared for in a neonatal ICU setting where part of the specialized care includes guidance focused on the vulnerabilities associated with preterm birth. As parents transition home they often receive an enhanced level of postnatal support and developmental follow up, including referrals to early intervention programs, home visiting and subsequent care in neonatal clinics.

“The additional support and services provided to families of very premature children help prepare parents for the potential challenges associated with caring for a preterm infant and may help mitigate the risk for maternal depressive symptoms,” Shah says.

However, she notes that mild depressive symptoms may progress into more severe depressive symptoms, and should also be addressed as early as possible.

Additionally, researchers found that maternal characteristics associated with prenatal stress and socioeconomic disadvantages – such as lower income, unmarried status and smoking -were associated with greater odds of both mild and moderate-severe maternal depressive symptoms.

Asian and black race were also associated with greater odds of moderate-severe depressive symptoms whereas Hispanic ethnicity was associated with lower odds of maternal depression. Authors say this raises questions regarding the role of culture as a potential risk or protective factor in the development of maternal depression.

The study included data from the Early Childhood Longitudinal Study, Birth Cohort. Maternal depressive symptoms were assessed through self-reported questionnaires at the baby’s nine-month visit.

The study adds to previous research suggesting that mothers of more irritable infants report significantly less confidence and more stress than mothers of less fussy infants.

“Pediatricians and providers should pay close attention to mothers who describe difficulty soothing their babies,” Shah says. “Early interventions may help reduce the risk of maternal depression that negatively impacts a child-parent relationship and that may be harmful to both the health of a mother and child.”

Source:

http://www.med.umich.edu/




Participation in sports linked with fewer depressive symptoms in children

Participation in team sports is associated with fewer depressive symptoms in children, whereas non-sport activities have no association with symptoms, according to a study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier. The association was found only for boys. The findings suggest that exercise could have anti-depressant effects in adolescents.

“These interesting results provide important clues as to how exercise benefits mood in children and reveals the important role that gender plays in these effects,” said Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

Using brain imaging, the researchers showed that involvement in sports was associated with increased volume of a brain region important for memory and response to stress—the hippocampus—in both boys and girls. However, hippocampal volume was associated with depressive symptoms in boys only, suggesting that in boys, hippocampal changes may play a role in the relationship between sports involvement and depressive symptoms.

The positive impact of exercise on depression, and the link with hippocampal volume, has been shown previously in adults. But the new study, which included over 4,000 children ages 9-to-11 years, is the first to connect involvement in sports with mental health and brain development in children.

“We found that these relationships were specific to participating in sports, and not to participating in other type of activities, such as clubs, arts and music, though these activities may have their own benefits that were not examined in the current study,” said first author Lisa Gorham and senior author Deanna Barch, PhD, both of Washington University in St. Louis, MO, USA. “We also found that these relationships were particularly strong for participating in team sports or sports that involved ‘structure’, such as a school team, a non-school league or regular lessons, as compared to more informal engagement in sports. This raises the intriguing possibility that there is some added benefit of the team or structured component of sports, such as the social interaction or the regularity that these activities provide.”

The data do not show which one causes the other—whether participating in sports leads to the effects on brain development and depression, or if children with those characteristics are less likely to engage in sports. “However, either of these causal relations is important and would suggest new directions for work on improving or preventing depression in children,” said Ms. Gorham and Dr. Barch.

The findings provide an important look at how exercise might impact brain development in adolescence and suggest a way for reducing or preventing depression. Confirming the impact of sports on brain development and mood would provide strong support for encouraging children to participate in structured sports that provide both exercise and social interaction.

Source:

https://www.elsevier.com/




Study suggests depression screening when assessing African-Americans for schizophrenia

African-Americans with severe depression are more likely to be misdiagnosed as having schizophrenia, according to a new Rutgers study.

The study, which appeared online prior to being published in the February 2019 issue of the journal Psychiatric Services, examined the medical records of 1,657 people at a community behavioral health clinic that included screening for major depression as part of its assessment for schizophrenia in new patients.

“By definition, schizophrenia is a diagnosis of exclusion: Clinicians must rule out other potential causes of symptoms, including mood disorders, before the diagnosis of schizophrenia is given,” said Michael Gara, a professor of psychiatry at Rutgers Robert Wood Johnson Medical School and a faculty member at Rutgers University Behavioral Health Care. “However, there has been a tendency for clinicians to overemphasize the relevance of psychotic symptoms and overlook symptoms of major depression in African-Americans compared with other racial or ethnic groups. No studies show that African-Americans with schizophrenia are more likely to also have major depression.”

The study, which looked at 599 blacks and 1,058 non-Latino whites, found that clinicians failed to effectively weigh mood symptoms when diagnosing schizophrenia among African-Americans, suggesting that racial bias, whether conscious or subconscious, is one factor in the diagnosis of schizophrenia in this population.

Other factors include genetics, poverty and discrimination, as well as symptoms caused by infections and malnutrition early in life. “Individuals from a racial minority group also might feel hopelessness or mistrust when being assessed by someone from a racial majority group, which could affect how they act and how the clinician interprets symptoms,” Gara said.

The findings suggest that clinicians put more emphasis on psychotic than depressive symptoms in African-Americans, which skews diagnoses toward schizophrenia even when these patients show similar depressive and manic symptoms as white patients.

“Inaccurate diagnosis can have serious consequences,” Gara said. “Mood disorder treatments differ from those for schizophrenia, and the prognosis for these conditions is typically more positive than for schizophrenia. These patients who may have major depression with psychotic features or bipolar disorder and who are misdiagnosed with schizophrenia do not receive the optimal treatment, putting them at risk for the worsening of the underlying disease process or for suicide. Also, the side effects of medication taken for schizophrenia, such as diabetes and weight gain, can be serious.”

The researchers recommend that screening for major depression be required when assessing black patients for schizophrenia.

Source:

https://news.rutgers.edu/research-news/african-americans-more-likely-be-misdiagnosed-schizophrenia-rutgers-study-finds/20190321#.XJSAPCIzbcu




Fecal transplantation improves the gut of IBS patients

Transplantation of feces from a healthy person to a patient suffering of irritable bowel syndrome (IBS) improved both symptoms of IBS and the gut’s bacteria profile.

Irritable bowel syndrome (IBS) is a common disease, which may cause symptoms like stomachaches, excessive gas, bloating, diarrhea and constipation. The symptoms disables the patient, but unlike other stomach diseases like Crohn’s, ulcerative colitis or celiac disease, the doctors do not know what causes the disease.

Nutrition researchers are now investigating ways to reduce the symptoms of IBS. Many patients benefit greatly from following a low FODMAP-diet, a diet low of certain carbohydrates that are poorly absorbed in the intestine, like garlic, lenses or apples. As there is no known “cure” for IBS, the researchers are also investigating whether transplantation of feces, what the researchers call “fecal transplantation”, from a healthy person to a patient with IBS, could improve the daily life of these patients.

The research in this field is still quite new, and at the Department of Clinical Sciences at the University of Bergen, the researchers are the first ones to investigate whether fecal transplantation not only reduces the symptoms of IBS, but also has the power to change the patient’s gut microbiota.

“Earlier studies was limited to investigating effect on symptoms, but we also wanted to see whether the transplantation could significantly change the patients microbiota, explains Gülen Arslan Lied, professor at the Centre for Nutrition, University of Bergen.

Seventy percent of the patients experienced reduced symptoms

In this study, they transplanted feces from one healthy donor, a family member of the patient, and placed it in the belly of the patient through gastroscopy. In gastroscopy, they place a tube into the throat of the patient and into the belly. The study included 13 IBS patients, which has a variant of IBS that mainly causes diarrhea.

The researchers measured the microbiota before the treatment. The patients evaluated their symptoms through a questionnaire, on the day of treatment, one week, twelve week and 28 weeks after the transplantation. The researchers measured the microbiota of the feces of the patients and the donors, at the same time intervals.

“We found that 70 percent of the patients experienced relieved symptoms, and a better quality of life, three months after the treatment,” Lied says.

28 weeks after the treatment, the effect on the symptoms had decreased. However, when they compared the gut microbiota of the patients with the healthy subjects, they found that the gut microbiota of the patients had significantly changed, and were a lot more similar to that of the donors.

Replacing bad bacteria with the good ones

According to Lied, the gut microbiota plays a big role in how we feel.

“The ratio between the different bacteria in our stomach and intestine produces various metabolites, which gives symptoms as those in IBS. Our findings indicate that it may be possible to reestablish a healthy microbiota in those suffering from IBS.”

However, Lied underlines the need of more research on this subject, before one can draw conclusions. For instance, the study has only looked on the effect this type of treatment has on one type of IBS patients, namely those suffering of diarrhea. The reason for is that, this type of treatment has proven beneficial for people suffering from the disease Clostridum difficile enterecolitis, which also has diarrhea as its main symptom.

More research to come

Secondly, the study the performed was quite small, and there were no control groups, making it hard for the researchers to eliminate the placebo effect.

“The change in the gut microbiota is however objective findings,” Lied underlines.

The researchers are now finishing a big, randomized control study. In this study, the patients receive one of three treatments of fecal transplantation, where one of them are placebo. They also have another study coming up, funded and supported by the Norwegian Research Council.

“We are curious to see how the microbiota of the gut affects the brain,” Lied says.​




Acupuncture Alleviates Moderate-to-Severe Menopause Symptoms

THURSDAY, Feb. 21, 2019 — A brief acupuncture intervention is associated with reductions in moderate-to-severe menopausal symptoms, according to a study published online Feb. 19 in BMJ Open.

Kamma Sundgaard Lund, Ph.D., from the University of Copenhagen in Denmark, and colleagues conducted a randomized trial involving 70 women with moderate-to-severe menopausal symptoms. Thirty-six women received the acupuncture intervention, which included one treatment for five consecutive weeks. Thirty-four women were in the control group and were offered treatment after six weeks.

At the six-week follow-up, the researchers found significant reductions in hot flushes, day-and-night sweats, general sweating, menopausal-specific sleeping problems, emotional symptoms, physical symptoms, and skin and hair symptoms with the acupuncture intervention compared with the control group. At three weeks into the study, the pattern of decreases in hot flushes, emotional symptoms, and skin and hair symptoms was already apparent. Four participants reported mild potential adverse effects; there were no reports of severe adverse effects.

“Acupuncture for menopausal symptoms is a realistic option for women who cannot or do not wish to use hormone therapy,” the authors write. “Women seeking acupuncture treatment for menopausal symptoms should be informed of the current evidence, and its limitations, so they can integrate this with personal preferences and values in their decision making.”

Abstract/Full Text

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Posted: February 2019




Acupuncture Could Help Ease Menopausal Symptoms

WEDNESDAY, Feb. 20, 2019 — Could an ancient Chinese practice come to the rescue for women struggling with menopausal symptoms?

New Danish research suggests that — for some women at least — acupuncture might bring relief.

“Acupuncture for menopausal symptoms is a realistic option for women who cannot or do not wish to use [hormone therapy]” to ease hot flashes, sleep issues or mood swings, said a team led by KammaSundgaardLund, from the department of public health at the University of Copenhagen.

One expert in the United States said the use of acupuncture for menopausal issues isn’t new.

“As an ob/gyn, I have referred many patients for acupuncture for various different pain syndromes,” said Dr. Adi Davidov, interim chair of obstetrics and gynecology at Staten Island University Hospital in New York City.

The Danish study “clearly demonstrates that menopausal symptoms can also be successfully treated with acupuncture,” he said. “This is very exciting news as hormonal treatment for menopausal symptoms have fallen out of favor and other medical treatments are marginally effective.”

In the study, Lund’s team tracked outcomes for 70 menopausal women in Denmark who underwent either five weeks of standardized Western medical acupuncture or no acupuncture.

The acupuncture was performed by family doctors in nine different practices who had been trained in acupuncture and had been performing it for an average of 14 years. Each weekly session lasted 15 minutes.

Compared to women who didn’t get the needling procedure, those who did had significant reductions in hot flashes, the study found. Acupuncture recipients also said they had less severe and less frequent day and night sweats, general sweating, sleep problems, emotional and physical symptoms, and skin and hair problems.

All in all, 80 percent of the women who underwent acupuncture said they felt the treatment had helped reduce their menopause symptoms.

Lund’s team stressed that the short length of the study means that a placebo effect can’t be ruled out in the acupuncture treatment group.

And “we believe this acupuncture intervention is most relevant to women who experience moderate-to-severe menopausal symptoms,” they added.

Davidov believes acupuncture has a myriad of applications in medicine.

Many physicians are using acupuncture as an alternative therapeutic option for various different ailments,” he said. “I have also referred obstetrical patients who suffer from sciatica who fail medical treatment.”

“As acupuncture becomes more mainstream, I believe that we will find more applications,” Davidov said.

The study was published Feb. 19 in the journal BMJ Open.

More information

The U.S. National Institute on Aging has more about menopause.

© 2019 HealthDay. All rights reserved.

Posted: February 2019




Experts propose revising the criteria for diagnosis of Parkinson’s disease

Parkinson's disease
Immunohistochemistry for alpha-synuclein showing positive staining (brown) of an intraneural Lewy-body in the Substantia nigra in Parkinson’s disease. Credit: Wikipedia

In the past 25 years it has become clear that some symptoms of Parkinson’s disease (PD) occur decades before the development of motor symptoms and clinical diagnosis, and that monitoring these emerging symptoms may provide important insights into the origin and development of the disease. Understanding this “prodromal” phase, along with the development of new treatments, may enable earlier treatment to prevent the disease from developing, according to experts writing in a supplement to the Journal of Parkinson’s Disease.

PD is a slowly progressive disorder that affects movement, muscle control, and balance. “Brilliant work of many in different scientific fields has paved the way for the concept of prodromal PD; that is, a phase of years to decades in which non-motor and subtle motor symptoms may indicate spreading PD pathology, but do not meet the threshold for diagnosis according to the classic motor-based clinical criteria,” explained authors Daniela Berg, MD, of the Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany, and Ronald B. Postuma, MD, MSc, of the Department of Neurology, Montreal General Hospital, Montreal, Canada.

The authors define the main anchors of the concept of the prodromal phase as:

  • The broadly accepted fact that the neurodegenerative process in PD spreads slowly, possibly starting in the gut or olfactory system and finally encompassing much of the nervous system
  • Increasing knowledge of risk factors and clinical symptoms that precede the typical motor manifestations by years to decades and can be correlated to imaging and histopathological findings
  • Longitudinal studies that observed conversion to PD in groups of patients with different combinations of risk and prodromal markers

The authors and colleagues have constructed a mathematical model that makes it possible to calculate an individual’s personal risk of being in the prodromal phase of PD. As they point out, there are several limitations to this model, such as the time taken to conversion to PD, age and sex factors, and subtypes with undetectable prodromal stages. “The prodromal PD criteria are meant to be research criteria and constitute a first step in what should be a continually-updated process,” noted the authors.

Biomarkers and wearable technology such as mobile phones are expected to play a role in greater accuracy of diagnosis in the prodromal phase. The goal of biomarker research, as well as quantitative motor assessment, is to use new data arising from objective measurements to enable earlier detection of the neurodegenerative process and possibly motor symptoms. It would also facilitate the development of neuroprotective trials in early stages.

Key questions that the authors hope to see resolved are: When is the starting point of PD? What will define the disease; will it still be motor symptoms (possibly typical subtle ones), or will it be biomarker evidence of nigrostriatal system neurodegeneration without motor symptoms? Will it be a certain combination of non-motor signs? Or will it be based upon non-clinical biomarkers, similar to changes in Alzheimer’s disease?

By 2040, the authors hope that prodromal criteria will be incorporated into active neuroprotective treatment programs, allowing a program of population-based screening followed by early treatment and ultimately the prevention of clinical PD from ever becoming manifest.

“Our review highlights the importance of making an earlier diagnosis of neurodegenerative diseases, and in particular PD, for now primarily to understand the disease better,” said Dr. Berg and Dr. Postuma. “However, in the future, once we have preventive therapy, it will become critical to find patients in the earliest stages of disease, so that we can prevent the disease from developing and affecting quality of life.”

“Today we somewhat artificially define the transition for the Parkinson prodrome into overt PD by the emergence of motor symptoms,” commented Patrik Brundin, MD, Ph.D., Van Andel Research Institute, Grand Rapids, MI, USA, and J. William Langston, MD, Stanford Udall Center, Department of Pathology, Stanford University, Palo Alto, CA, USA, Editors-in-Chief of the Journal of Parkinson’s Disease. “By 2040, these definitions will likely be revised, and we will understand the whole continuum of the disease process much better. This will open up therapies that are applied much earlier and hopefully can arrest the pathogenesis.”


The search for environmental causes of Parkinson’s disease moves forward


More information:
Daniela Berg et al, From Prodromal to Overt Parkinson’s Disease: Towards a New Definition in the Year 2040, Journal of Parkinson’s Disease (2018). DOI: 10.3233/JPD-181457


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New AI can identify, predict development of different combinations of cancer symptoms

Cancer patients who undergo chemotherapy could soon benefit from a new AI that is able to identify and predict the development of different combinations of symptoms – helping to alleviate much of the distress caused by their occurrence and severity.

In the first study of its kind, published by Nature Scientific Reports, researchers from the University of Surrey and the University of California detail how they used Network Analysis (NA) to examine the structure and relationships between 38 common symptoms reported by over 1300 cancer patients receiving chemotherapy.

Some of the most common symptoms reported by patients were nausea, difficulty concentrating, fatigue, drowsiness, dry mouth, hot flushes, numbness, and nervousness.

The team then grouped these symptoms into three key networks – occurrence, severity and distress. The NA allowed the team to identify nausea as central – impacting symptoms across all three different key networks.

According to Cancer Research UK 360,000 people are diagnosed with cancer every year – with breast, prostate, lung and bowel cancers counting for over half of new cases in the UK. Around 28 per cent of patients diagnosed with cancer in England have curative or palliative chemotherapy as part of their primary cancer treatment.

Payam Barnaghi, Professor of Machine Intelligence at the Centre for Vision, Speech and Signal Processing (CVSSP) at the University of Surrey, said: “This is the first use of Network Analysis as a method of examining the relationships between common symptoms suffered by a large group of cancer patients undergoing chemotherapy. The detailed and intricate analysis this method provides could become crucial in planning the treatment of future patients – helping to better manage their symptoms across their healthcare journey.”

Christine Miaskowski from the University of California said: “This fresh approach will allow us to develop and test novel and more targeted interventions to decrease symptom burden in cancer patients undergoing chemotherapy.”

Source:

https://www.surrey.ac.uk/

Posted in: Device / Technology News | Medical Condition News

Tags: Cancer, Cancer Treatment, Chemotherapy, Drowsiness, Fatigue, Healthcare, Nausea, Oncology, Prostate, Research, Speech




COPD patients need more support when understanding new chest symptoms

People with Chronic Obstructive Pulmonary Disease (COPD) need more support when understanding and acting on new chest symptoms, a study in the journal Psycho-Oncology reports.

During this unique study, led by the University of Glasgow and University of Surrey, researchers investigated how the experience of COPD, influences how individuals understand new or changing chest symptoms and their decision to seek help from medical professionals.

COPD is the name for a group of lung conditions, including emphysema and chronic bronchitis, which cause breathing difficulties. Incidence of lung cancer is four-times higher in those with COPD compared to the general population and patients often confuse early signs of the devastating disease with a deterioration of their existing condition and do not seek medical advice.

Interviewing 40 participants with COPD, researchers discovered that none of the participants were aware that having the condition put them at increased risk of developing lung cancer. Due to a lack of knowledge and support, participants often attributed chest symptoms to external factors such as the weather or illness.

Researchers found that some participants did not seek medical advice following the development of symptoms as they were keen to ‘not make a fuss’ and believed that poor health was something to be accepted when diagnosed with the condition. A stigma associated with continued smoking was also identified by researchers, as participants were found to be reluctant in seeking help as they felt the doctor would blame their symptoms on smoking.

Participants also spoke about barriers in accessing care, which included scheduling appointments outside of usual working hours and difficulties in getting to the GP’s surgery, when symptoms present themselves.

Early diagnosis of lung cancer is vital to improving survival. Figures from Cancer Research UK reveal that when diagnosed at its earliest stage, almost 6 in 10 people with lung cancer will survive their disease for five years or more, compared with almost 5 in 100 people when diagnosed at a later stage.

Dr Katie Robb, Senior Lecturer at the University of Glasgow, said: “Healthcare professionals need to do more to educate those with COPD about their increased risk of developing lung cancer and be more vigilant when a patient with the illness presents changing symptoms.”

Dr Katriina Whitaker, Reader in Cancer Care at the University of Surrey, said: “Early diagnosis of lung cancer is vital in improving survival rates, we need those with COPD to go to the doctor as a matter of course when they notice a change in their symptoms and not be concerned about wasting the doctor’s time.”

Jodie Moffat, Head of Early Diagnosis at Cancer Research UK, said: “It’s vital patients and their doctors stay alert to signs of cancer to ensure that any potential cancer is diagnosed as soon as possible. Symptoms of other diseases can mask cancer signs, so it’s important patients know what to look out for. Changes to existing conditions, as well as new symptoms, should be checked out by a GP, and GPs need to be ready to consider cancer as an option.”

Source:

https://www.surrey.ac.uk/news/more-needs-be-done-raise-awareness-lung-cancer-risk-people-copd




Mouse studies show ‘inhibition’ theory of autism wrong

brain
Credit: CC0 Public Domain

A detailed study of four mouse models of autism challenges the most common assumption about what goes wrong in brain circuits to cause disease symptoms.

The major hypothesis today—one supported by many animal studies—has been that neurons in the autistic brain receive too little inhibition or too much excitation, which causes hyperexcitability or increased “spiking.” This excess spiking is thought to act as noise that interferes with normal brain function. Such noise could lead to the characteristic symptoms of autism in humans: problems with social interactions, language deficits, repetitive thoughts and behaviors and hypersensitivity to sensory stimuli.

Researchers are even now looking for ways to increase overall inhibition of neurons in the brain to try to reset the balance between excitation and inhibition and hopefully lessen the symptoms.

In a new study, however, University of California, Berkeley, neuroscientists demonstrated that while inhibition does decrease in the brains of these mice, altering the balance between excitation and inhibition, the changed balance does not affect spiking at all. Instead, this altered balance seems to be a compensatory mechanism that stabilizes brain activity in response to the disorder.

“Many groups are searching for ways to increase inhibition in the brain, either through drugs or through gene therapy, on the assumption that increasing inhibition will restore the brain back to normal,” said study leader Daniel Feldman, a UC Berkeley professor of molecular and cell biology and member of the Helen Wills Neuroscience Institute. “But actually, our results suggest that loss of inhibition might represent a useful compensation that the brain is doing, or might be unrelated to disease symptoms. And if you go in there and increase inhibition, you might make things worse or you might not affect things at all.”

The finding should send researchers back to the lab to determine what is actually causing the decreased inhibition and increased excitation, and what role these changes play, if any, in the brain, he said.

Feldman and his UC Berkeley colleagues will report their findings Jan. 21 in the journal Neuron.

Autistic mice

“Autism is a big puzzle,” Feldman said. “The main advance in the past 10 years has been to show that a very high fraction—at least 50 percent—of the risk for autism is actually genetic. But it is not a single gene, it is hundreds of genes. How do you understand how multiple gene mutations can all lead to similar—not the same, but similar—kinds of disorders along the spectrum that we call autism?”

Mouse models have helped a lot, he said. Each mouse strain has been engineered with a single genetic mutation identical to one of the dozens already discovered in people with autism, and the mice exhibit behaviors that resemble those on the human autism spectrum, primarily impaired social interactions and repetitive behavior.

“With these mouse models, researchers want to test different strategies for improving symptoms, but before we can really do that effectively, we need to figure out what mechanistically is going wrong in the brain to generate the cognitive, motor and behavioral symptoms of autism,” he said.

He chose four well-validated mouse models, each with a single genetic defect mimicking one found in humans, and investigated synapse properties and neuron firing to systematically test the excitation-inhibition balance theory. In all the mice, inhibition was lower than normal, and excitation was also lower, though less so, leading to an increase in the excitation-inhibition ratio. The standard hypothesis predicts that this increased ratio should have led to more neuron firing or spiking.

He found, however, that even though the ratio of excitation to inhibition was higher than in normal mouse brains, neurons maintained a normal spiking rate. This was because the changes in inhibition and excitation were precisely coordinated to offset each other.

He views this as a highly effective accommodation by neurons to these genetic mutations, representing the brain’s normal compensation mechanism for restoring neuronal activity. But decreased inhibition may have unwanted secondary effects that impair other aspects of neural information processing, such as the tuning each neuron has to specific stimuli.

“Changes in the excitation-inhibition ratio might be successfully compensating to maintain a relatively normal firing rate, but a side effect of that compensation may be that they degrade the precision of the coding information,” he suggests. “So even though there are not more spikes, the spiking could encode information less precisely.”

He is continuing his studies to determine what other effects lowered inhibition have that could explain autism symptoms. He is focusing on mice that also have sensory impairment, such as hypersensitivity to sound or touch, in addition to antisocial and repetitive behaviors.


Autism may reflect excitation-inhibition imbalance in brain, study finds



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