What Are Probiotics?
by Diseree lie MD
Probiotics are defined by the World Health Organization (WHO) as "live microorganisms which, when administered in adequate amounts, confer a health benefit on the host."
Probiotics are found in the gastrointestinal tract or as components of foods and beverages.
They are different from prebiotics, which are complex carbohydrates (nondigestable, fermentable polysaccharides) that stimulate the growth and/or activity of beneficial bacteria already in the colon. Prebiotics may be considered precursors to probiotics, and their role has yet to be defined in larger clinical studies.
Probiotics and prebiotics may be combined in a single product called synbiotics.
Most probiotics are either Lactobacillus or Bifidobacterium and their various species and strains (for example, Lactobacillus acidophilus and Bifidobacterium bifidus).
Other common probiotics are yeasts -- for example, Saccharomyces boulardii.
Probiotics are believed to reinforce the integrity of the intestinal lining as a protective barrier to prevent invasion by pathogenic organisms, and they are purported to prevent harmful bacteria or yeast from breaching the gastrointestinal mucosa.
They have an effect on priming immunophysiologic regulation in the intestinal mucosal barrier and may exert clinical effects beyond the nutritional value of food.
This effect is the rationale for their efficacy in preventing infectious or other forms of diarrhea and for the treatment of allergic conditions.
Formulations of Probiotics
Probiotics are available as tablets, powder, capsules and can also be mixed into beverages such as yogurt, milk, or juice.
Many different forms are offered worldwide.
Bifidobacteria appear to be safe when used orally, including in those under 2 years and ill neonates.
For example, a combination probiotic consisting of Lactobacillus, Bifidobacteria, and Streptococcus salivarius, known as VSL#3, was used in children ages 1 to 16 years for up to a year.
For preventing diarrhea in children, 5-10 billion live Lactobacillus GG have been used twice daily as tablets. Doses of 10-100 billion live organisms are available in tablet form, and capsules of 3 grams are also available.
Clinical Evidence
Diarrhea-associated illness.
There is a body of evidence supporting the benefit of probiotics in diarrhea-associated diseases. Several probiotics (Saccharomyces boulardii and a mixture of L acidophilus and B bifidum) have shown efficacy for preventing traveler's diarrhea with a relative risk (RR) reduction of 15% (RR=0.85, P < .001).[8,9]
Probiotics have also been shown to benefit antibiotic-associated and pediatric infectious diarrhea, especially rotavirus-related diarrhea. Probiotics have been used for a variety of gastrointestinal disorders as well, including these clinically successful applications for conditions related to inflammatory bowel disease:
•Lactobacillus GG to maintain remission in those with ulcerative colitis;
•S boulardii in combination with mesalamine to prevent clinical relapse of Crohn's disease (it should be noted that a Cochrane review concluded that studies to date have been too small to draw conclusions about use of probiotics for Crohn's disease prophylaxis);
•VSL#3 for prophylaxis of pouchitis and improved quality of life following ileal pouch-anal anastomosis; and
•VSL #3 for prevention of recurrent pouchitis after antibiotic-induced remission in patients with a refractory form of this condition.
Probiotics have also been found to be helpful in diarrhea-predominant irritable bowel syndrome. For example, in a meta-analysis, the odds ratio (OR) in favor of active probiotic treatment over placebo in children for diarrhea was 0.39 (P < .001) for yeast and 0.34 (P < .01) for Lactobacilli.
Similarly, probiotics offer a possible way to prevent antibiotic-associated diarrhea. A randomized study using 100g of a drink containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophilus taken twice daily for one week after a course of antibiotics reduced the incidence of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea.[12]
Allergic diseases. Two Cochrane reviews looking at the prevention of allergic disease and food hypersensitivity in infants found positive evidence from studies using Lactobacillus rhamnosus in favor of eczema prevention but not treatment.
A few reviews found encouraging, but not strong, effects, for several species of Lactobacilli for atopic dermatitis; these reports were based on placebo-controlled, randomized studies, using the SCORing Atopic Dermatitis (SCORAD) index for assessment, with possibly greater effects in children who have cow's milk allergy.
As noted in other reviews, a benefit was more likely to be seen for the prevention of eczema than for improvement of existing eczema. Most of the studies showing benefit were small and limited in scope. Of interest, when mothers consumed probiotics during pregnancy (starting 2 to 4 weeks before delivery), the likelihood of atopic dermatitis in the child was reduced at 2 years by about 50% in one study, and the cumulative effect on prevention was still evident at 4 years.
However, there was no effect on respiratory allergy, immunoglobulin E (IgE) levels, or allergic sensitization in these children. When infants were given probiotics in the first 6 months of life, a similar reduction in incidence of atopic eczema at 2 and 4 years was noted in these 2 studies.
Another randomized controlled trial of infants 5 months and younger, however, showed no effect of probiotic supplementation with L rhamnosus compared with placebo in the form of a hydrolyzed whey-based formula on atopic dermatitis in children when given for 3 months.
Overall, while there is a sound theoretical basis for a benefit of using probiotics for allergic disease, there is currently insufficient data to recommend it for all allergic conditions. With that said, there is more evidence supporting its use in preventing atopic dermatitis in children than for other allergic or immune conditions.
Respiratory illnesses. Studies in teenagers and adults with established respiratory disease have failed to show symptom improvement in asthma or allergic rhinitis although quality of life was improved in 1 study.
Studies on the common cold in adults have shown a reduction in duration and severity but not the incidence of cold episodes with improved cytotoxic T and T- suppressor cell immune function.
When given in winter for at least 3 months, a combination of probiotics and vitamins and minerals reduced both the incidence and severity of common cold infections in adults with concomitant immune function improvement.
In children, a twice-daily dose of L acidophilus alone or in combination with Bifidobacterium compared with a placebo given over 6 months in winter was found to reduce:
•Antibiotic use by 68% (single strain) to 84% (strain combination);
•Absenteeism from day care due to respiratory infection by 32% (single strain) and 28% (strain combination); and
•Symptoms of cough, fever, and rhinorrhea by 28% to 60%.[38]
These observations were confirmed in another study of 571 children attending day care centers that provided cow's milk with or without Lactobacillus GG for 7 months, and found a relative reduction in:
•Incidence of respiratory infection (17% reduction);
•Antibiotic use for infection (19% reduction); and
•Absence from day care due to illness (16% or 1-day difference; P = .03).
http://www.medscape.com/viewarticle/728125_2
Tuesday, October 5, 2010
Thursday, September 30, 2010
First Direct Genetic Evidence for ADHD Discovered
From Medscape Medical News
Caroline Cassels
September 29, 2010 — New research provides the first direct evidence that attention-deficit/hyperactivity disorder (ADHD) is genetic.
In a study published online September 30 in The Lancet, investigators from the University of Cardiff in the United Kingdom say their findings, which show that ADHD has a genetic basis, suggest it should be classified as a neurodevelopmental and not a behavioral disorder.
"We've known for many years that ADHD may well be genetic because it tends to run in families in many instances. What is really exciting now is that we've found the first direct genetic link to ADHD," principal investigator Anita Thapar, MD, told reporters attending a press conference to unveil the study results.
In the genomewide analysis, 366 children 5 to 17 years of age who met diagnostic criteria for ADHD but not schizophrenia or autism and 1047 matched controls without the condition were included. Researchers found that compared with the control group without ADHD, children with the disorder were twice as likely — approximately 15% vs 7% — to have copy number variants (CNVs).
CNVs, explained study investigator Nigel M. Williams, PhD, are sections of the genome in which there are variations from the usual 2 copies of each chromosome, such that some individuals will carry just 1 (a deletion) and others will have 3 or more (duplications).
"If a gene is included in one of these copy number variants, it can have deleterious consequences," said Dr. Williams.
Shared Biological Link
The study authors note that the increased rate of CNVs was particularly high among children with a combination of ADHD and learning disabilities but "there was also a significant excess in cases with no such disability."
The researchers also found that CNVs overlap with chromosomal regions that have previously been linked to autism and schizophrenia. Although these disorders are thought to be completely separate, there is some overlap between ADHD and autism in terms of symptoms and learning difficulties.
We've looked at only 1 class of variation, but it's an important one because it has been linked to other brain disorders.
This finding suggests there may be a shared biological basis for the 2 conditions and, according to investigators, provides the first direct evidence that ADHD is a neurodevelopmental condition.
"We found that the most significant excess of these types of copy number variants was on a specific region of chromosome 16. This chromosomal region includes a number of genes, including one that affects brain development," said Dr. Thapar.
The team's research marks the start of the "unraveling of the genetics" of ADHD, according to Dr. Thapar.
"We've looked at only 1 class of variation, but it's an important one because it has been linked to other brain disorders," she said.
Implications for DSM-5?
Dr. Thapar added that the study results also have direct implications for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is currently under development by the American Psychiatric Association.
A "huge debate" about whether ADHD should be classified as a behavioral or neurodevelopmental disorder is ongoing. However, she said, these findings should help put this controversy to rest.
"Our results clearly show that ADHD should be considered a neurodevelopmental disorder," she said.
In fact, Dr. Thapar noted that the study findings have been submitted to one of the DSM-5 work groups for consideration in the development of the new manual.
The investigators note that despite epidemiologic evidence derived from twin studies showing high heritability and the fact that ADHD is often accompanied by learning disabilities, there is still a great deal of public misunderstanding about the disorder.
Some people say this is not a real disorder, that it is the result of bad parenting. Children and parents can encounter much stigma because of this. So this finding of a direct genetic link to ADHD should help clear this misunderstanding and help address the issue of stigma.
"Some people say this is not a real disorder, that it is the result of bad parenting. Children and parents can encounter much stigma because of this. So this finding of a direct genetic link to ADHD should help clear this misunderstanding and help address the issue of stigma," said Dr. Thapar.
Although there are no immediate treatment implications, Dr. Thapar said she hopes the research will have an immediate impact in terms of shifting public perception about ADHD and fuel further research into the biological basis of the disorder with a view to developing better, more effective therapies for affected individuals.
In an accompanying editorial, Peter H. Burbach, PhD, from the Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands, writes, "The first gains beyond today's study might be initial insights into the pathogenesis and neurobiology of brain development as influenced by these genetic variants. This knowledge will eventually enter the clinic and might affect the way people think about and treat neurodevelopmental disorders by accounting for the biological consequence of the specific patient's genotype."
The study authors and Dr. Burbach have disclosed no relevant financial relationships.
Lancet. Published online September 30, 2010.
Caroline Cassels
September 29, 2010 — New research provides the first direct evidence that attention-deficit/hyperactivity disorder (ADHD) is genetic.
In a study published online September 30 in The Lancet, investigators from the University of Cardiff in the United Kingdom say their findings, which show that ADHD has a genetic basis, suggest it should be classified as a neurodevelopmental and not a behavioral disorder.
"We've known for many years that ADHD may well be genetic because it tends to run in families in many instances. What is really exciting now is that we've found the first direct genetic link to ADHD," principal investigator Anita Thapar, MD, told reporters attending a press conference to unveil the study results.
In the genomewide analysis, 366 children 5 to 17 years of age who met diagnostic criteria for ADHD but not schizophrenia or autism and 1047 matched controls without the condition were included. Researchers found that compared with the control group without ADHD, children with the disorder were twice as likely — approximately 15% vs 7% — to have copy number variants (CNVs).
CNVs, explained study investigator Nigel M. Williams, PhD, are sections of the genome in which there are variations from the usual 2 copies of each chromosome, such that some individuals will carry just 1 (a deletion) and others will have 3 or more (duplications).
"If a gene is included in one of these copy number variants, it can have deleterious consequences," said Dr. Williams.
Shared Biological Link
The study authors note that the increased rate of CNVs was particularly high among children with a combination of ADHD and learning disabilities but "there was also a significant excess in cases with no such disability."
The researchers also found that CNVs overlap with chromosomal regions that have previously been linked to autism and schizophrenia. Although these disorders are thought to be completely separate, there is some overlap between ADHD and autism in terms of symptoms and learning difficulties.
We've looked at only 1 class of variation, but it's an important one because it has been linked to other brain disorders.
This finding suggests there may be a shared biological basis for the 2 conditions and, according to investigators, provides the first direct evidence that ADHD is a neurodevelopmental condition.
"We found that the most significant excess of these types of copy number variants was on a specific region of chromosome 16. This chromosomal region includes a number of genes, including one that affects brain development," said Dr. Thapar.
The team's research marks the start of the "unraveling of the genetics" of ADHD, according to Dr. Thapar.
"We've looked at only 1 class of variation, but it's an important one because it has been linked to other brain disorders," she said.
Implications for DSM-5?
Dr. Thapar added that the study results also have direct implications for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is currently under development by the American Psychiatric Association.
A "huge debate" about whether ADHD should be classified as a behavioral or neurodevelopmental disorder is ongoing. However, she said, these findings should help put this controversy to rest.
"Our results clearly show that ADHD should be considered a neurodevelopmental disorder," she said.
In fact, Dr. Thapar noted that the study findings have been submitted to one of the DSM-5 work groups for consideration in the development of the new manual.
The investigators note that despite epidemiologic evidence derived from twin studies showing high heritability and the fact that ADHD is often accompanied by learning disabilities, there is still a great deal of public misunderstanding about the disorder.
Some people say this is not a real disorder, that it is the result of bad parenting. Children and parents can encounter much stigma because of this. So this finding of a direct genetic link to ADHD should help clear this misunderstanding and help address the issue of stigma.
"Some people say this is not a real disorder, that it is the result of bad parenting. Children and parents can encounter much stigma because of this. So this finding of a direct genetic link to ADHD should help clear this misunderstanding and help address the issue of stigma," said Dr. Thapar.
Although there are no immediate treatment implications, Dr. Thapar said she hopes the research will have an immediate impact in terms of shifting public perception about ADHD and fuel further research into the biological basis of the disorder with a view to developing better, more effective therapies for affected individuals.
In an accompanying editorial, Peter H. Burbach, PhD, from the Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands, writes, "The first gains beyond today's study might be initial insights into the pathogenesis and neurobiology of brain development as influenced by these genetic variants. This knowledge will eventually enter the clinic and might affect the way people think about and treat neurodevelopmental disorders by accounting for the biological consequence of the specific patient's genotype."
The study authors and Dr. Burbach have disclosed no relevant financial relationships.
Lancet. Published online September 30, 2010.
Exclusive Breast-Feeding for 6 Months May Protect Infants Against Common Infections
From Medscape Medical News
Laurie Barclay, MD
September 28, 2010 — Exclusive breast-feeding for 6 months, as recommended by the World Health Organization, may protect infants against common infections, according to the results of a prospective study reported online September 28 in the Archives of Disease in Childhood.
"Breastfed infants are considered to be less prone to a variety of infections, including acute otitis media, and gastrointestinal and lower respiratory tract infections," write Fani Ladomenou, from the University of Crete in Heraklion, Greece, and colleagues.
The goal of the study was to determine the impact of breast-feeding on the frequency and severity of infections in a well-defined population of infants with adequate vaccination coverage and healthcare standards. The investigators recorded type of feeding and all infectious episodes, including acute otitis media (AOM), acute respiratory infection (ARI), gastroenteritis, urinary tract infection, conjunctivitis, and thrush, in a representative sample of 926 infants who were followed up at ages 1, 3, 6, 9, and 12 months.
Compared with partially breast-fed or non−breast-fed infants, those who were exclusively breast-fed for 6 months had fewer infectious episodes. Adjustment for potential confounders did not abolish this protective effect, with odds ratio (OR) of 0.58 for ARI (95% confidence interval [CI], 0.36 - 0.92), 0.37 for AOM (95% CI, 0.13 - 1.05), and 0.14 for thrush (95% CI, 0.02 - 1.02). Although partial breast-feeding was not associated with a reduced risk, prolonged exclusive breast-feeding was associated with fewer infectious episodes (Spearman's rs = −0.07; P = .019) through age 1 year, as well as with fewer hospitalizations for infection (Spearman's rs = −0.06; P = .037).
Parental age and education, ethnicity, having siblings, secondhand smoke exposure, season of birth, and other confounding factors also affected the frequency of infections during infancy.
"Findings from this large-scale prospective study in a well-defined infant population with adequate healthcare standards suggest that exclusive breastfeeding contributes to protection against common infections during infancy regarding and lessens the frequency and severity of infectious episodes," the study authors write. "Partial breastfeeding did not seem to provide this protective effect."
Limitations of this study include reliance on maternal recall, possible detection bias, nonspecific definition of diarrhea, and possible confounding factors.
"Despite limitations, our results suggest breastfeeding has beneficial effects against common infections in infancy," the study authors conclude. "This protection seems to be related to the exclusive breastfeeding and its duration. Therefore, mothers should be advised by health professionals that, in addition to all the other benefits, exclusive breastfeeding helps prevent infections in babies and lessens the frequency and severity of infectious episodes."
The study authors have disclosed no relevant financial relationships.
Arch Dis Child. Published online September 28, 2010.
Laurie Barclay, MD
September 28, 2010 — Exclusive breast-feeding for 6 months, as recommended by the World Health Organization, may protect infants against common infections, according to the results of a prospective study reported online September 28 in the Archives of Disease in Childhood.
"Breastfed infants are considered to be less prone to a variety of infections, including acute otitis media, and gastrointestinal and lower respiratory tract infections," write Fani Ladomenou, from the University of Crete in Heraklion, Greece, and colleagues.
The goal of the study was to determine the impact of breast-feeding on the frequency and severity of infections in a well-defined population of infants with adequate vaccination coverage and healthcare standards. The investigators recorded type of feeding and all infectious episodes, including acute otitis media (AOM), acute respiratory infection (ARI), gastroenteritis, urinary tract infection, conjunctivitis, and thrush, in a representative sample of 926 infants who were followed up at ages 1, 3, 6, 9, and 12 months.
Compared with partially breast-fed or non−breast-fed infants, those who were exclusively breast-fed for 6 months had fewer infectious episodes. Adjustment for potential confounders did not abolish this protective effect, with odds ratio (OR) of 0.58 for ARI (95% confidence interval [CI], 0.36 - 0.92), 0.37 for AOM (95% CI, 0.13 - 1.05), and 0.14 for thrush (95% CI, 0.02 - 1.02). Although partial breast-feeding was not associated with a reduced risk, prolonged exclusive breast-feeding was associated with fewer infectious episodes (Spearman's rs = −0.07; P = .019) through age 1 year, as well as with fewer hospitalizations for infection (Spearman's rs = −0.06; P = .037).
Parental age and education, ethnicity, having siblings, secondhand smoke exposure, season of birth, and other confounding factors also affected the frequency of infections during infancy.
"Findings from this large-scale prospective study in a well-defined infant population with adequate healthcare standards suggest that exclusive breastfeeding contributes to protection against common infections during infancy regarding and lessens the frequency and severity of infectious episodes," the study authors write. "Partial breastfeeding did not seem to provide this protective effect."
Limitations of this study include reliance on maternal recall, possible detection bias, nonspecific definition of diarrhea, and possible confounding factors.
"Despite limitations, our results suggest breastfeeding has beneficial effects against common infections in infancy," the study authors conclude. "This protection seems to be related to the exclusive breastfeeding and its duration. Therefore, mothers should be advised by health professionals that, in addition to all the other benefits, exclusive breastfeeding helps prevent infections in babies and lessens the frequency and severity of infectious episodes."
The study authors have disclosed no relevant financial relationships.
Arch Dis Child. Published online September 28, 2010.
Rotarix Label Has New Warning About Risk for Bowel Abnormality
Medscape Alerts
Robert Lowes
September 23, 2010 — The US Food and Drug Administration (FDA) has revised the label of the rotavirus vaccine Rotarix (GlaxoSmithKline) to warn of a small increased risk for intussusception that was reported in a Mexican study, the agency announced yesterday.
A potentially life-threatening condition, intussusception occurs when 1 portion of the intestine telescopes into another. This anomaly, which can develop in the absence of vaccination, may lead to internal bleeding, an intestinal hole, and abdominal infection.
The annual rate of spontaneous intussusception — and subsequent hospitalization — is roughly 34 in 100,000 healthy young infants and children, the FDA stated.
Symptoms, which usually develop suddenly, include fussiness, frequent vomiting, diarrhea or stools containing blood or mucus, and severe belly pain, cramping, and swelling.
Preliminary results from a postmarketing study of Rotarix in Mexico suggest that there is an increased risk for intussusception in the 31 days after the first dose, with a relative risk of 1.8, according to the agency. Most cases occurred during the first 7 days after the first dose.
Extrapolated to the United States, these results would represent up to 4 additional hospitalizations due to intussusception per 100,000 infants within 31 days of the first Rotarix dose. The agency noted that the annual background rate of intussusception in Mexico — between 60 and 90 per 100,000 children — is higher than that in the United States.
The FDA said it would review the final results from the Mexican study when they become available in 2011. It noted that GlaxoSmithKline is conducting a postmarketing study of Rotarix and intussusception in the United States.
In 1999, the rotavirus vaccine RotaShield was withdrawn from the market after studies suggested an elevated risk for intussusception on the order of 9 additional cases per 100,000 infants.
No increased risk for this bowel condition emerged in clinical trials for both Rotarix and another rotavirus vaccine, RotaTeq (Merck), but the agency nevertheless has monitored the 2 vaccines for this potential problem.
The postmarketing study in Mexico did not examine RotaTeq, and it is not undergoing a label revision.
The FDA said it has uncovered no evidence of an increased risk for intussusception with RotaTeq, but it will continue to study the issue.
More information about yesterday's FDA announcement is available on the agency's Web site.
The FDA and the US Centers for Disease Control and Prevention encourage clinicians to report intussusception or any adverse event after vaccination to the Vaccine Adverse Event Reporting System.
Disclosure: Robert L. Lowes has disclosed no relevant financial relationships.
Robert Lowes
September 23, 2010 — The US Food and Drug Administration (FDA) has revised the label of the rotavirus vaccine Rotarix (GlaxoSmithKline) to warn of a small increased risk for intussusception that was reported in a Mexican study, the agency announced yesterday.
A potentially life-threatening condition, intussusception occurs when 1 portion of the intestine telescopes into another. This anomaly, which can develop in the absence of vaccination, may lead to internal bleeding, an intestinal hole, and abdominal infection.
The annual rate of spontaneous intussusception — and subsequent hospitalization — is roughly 34 in 100,000 healthy young infants and children, the FDA stated.
Symptoms, which usually develop suddenly, include fussiness, frequent vomiting, diarrhea or stools containing blood or mucus, and severe belly pain, cramping, and swelling.
Preliminary results from a postmarketing study of Rotarix in Mexico suggest that there is an increased risk for intussusception in the 31 days after the first dose, with a relative risk of 1.8, according to the agency. Most cases occurred during the first 7 days after the first dose.
Extrapolated to the United States, these results would represent up to 4 additional hospitalizations due to intussusception per 100,000 infants within 31 days of the first Rotarix dose. The agency noted that the annual background rate of intussusception in Mexico — between 60 and 90 per 100,000 children — is higher than that in the United States.
The FDA said it would review the final results from the Mexican study when they become available in 2011. It noted that GlaxoSmithKline is conducting a postmarketing study of Rotarix and intussusception in the United States.
In 1999, the rotavirus vaccine RotaShield was withdrawn from the market after studies suggested an elevated risk for intussusception on the order of 9 additional cases per 100,000 infants.
No increased risk for this bowel condition emerged in clinical trials for both Rotarix and another rotavirus vaccine, RotaTeq (Merck), but the agency nevertheless has monitored the 2 vaccines for this potential problem.
The postmarketing study in Mexico did not examine RotaTeq, and it is not undergoing a label revision.
The FDA said it has uncovered no evidence of an increased risk for intussusception with RotaTeq, but it will continue to study the issue.
More information about yesterday's FDA announcement is available on the agency's Web site.
The FDA and the US Centers for Disease Control and Prevention encourage clinicians to report intussusception or any adverse event after vaccination to the Vaccine Adverse Event Reporting System.
Disclosure: Robert L. Lowes has disclosed no relevant financial relationships.
Improve Brain Health Now: Easy Steps
Apr 11, 2007
By: Caroline Latham
We can summarize a lot of research by saying that there are four essential pillars to maintaining a healthy brain that functions better now and lasts longer. Those pillars are:
◦1) Physical Exercise
◦2) Mental Exercise
◦3) Good Nutrition
◦4) Stress Management
Great … now what?! How do you develop a healthy lifestyle that includes all four pillars? Let’s look at each one.
1.1. Physical Exercise
◦- Start by talking to your doctor, especially if you are not currently physically active, have special health concerns, or are making significant changes to your current program.
◦- Set a goal that you can achieve. Do something you enjoy for even just 15 minutes a day. You can always add more time and activities later.
◦- Schedule exercise into your daily routine. It will be become a habit faster if you do.
◦- If you can only do one thing, do something cardiovascular, meaning something that gets your heart beating faster. This includes walking, running, skiing, swimming, biking, hiking, tennis, basketball, playing tag, ultimate Frisbee, and other similar sports/activities.
2.2. Mental Exercise
◦- Be curious! Get to know your local library and community college, look for local organizations or churches that offer classes or workshops
◦- Do a variety of things, including things you aren’t good at (if you like to sing, try painting too)
◦- Work puzzles like crosswords and sudoku or play games like chess and bridge
◦- Try a computerized brain fitness program for a customized workout
◦- If you can only do one thing, learn something new every day
3.3. Good Nutrition
◦- Eat a variety of foods of different colors without a lot of added ingredients or processes
◦- Plan your meals around your vegetables, and then add fruit, protein, dairy, and/or grains
◦- Add some cold-water fish to your diet (tuna, salmon, mackerel, halibut, sardines, and herring) which contain omega-3 fatty acids
◦- Learn what a portion-size is, so you don’t overeat
◦- Try to eat more foods low on the Glycemic Index
◦- If you can only do one thing, eat more vegetables, particularly leafy green ones
4.Stress Management
◦- Get regular cardiovascular exercise
◦- Try to get enough sleep each night
◦- Keep connected with your friends and family
◦- Practice meditation, yoga, or some other calming activity as way to take a relaxing time-out (maybe a bath)
◦- Try training with a heart rate variability sensor, like the one in emWave (formerly known as Freeze-Framer)
◦- If you can only do one thing, set aside 5–10 minutes to just breathe deeply and recharge
By: Caroline Latham
We can summarize a lot of research by saying that there are four essential pillars to maintaining a healthy brain that functions better now and lasts longer. Those pillars are:
◦1) Physical Exercise
◦2) Mental Exercise
◦3) Good Nutrition
◦4) Stress Management
Great … now what?! How do you develop a healthy lifestyle that includes all four pillars? Let’s look at each one.
1.1. Physical Exercise
◦- Start by talking to your doctor, especially if you are not currently physically active, have special health concerns, or are making significant changes to your current program.
◦- Set a goal that you can achieve. Do something you enjoy for even just 15 minutes a day. You can always add more time and activities later.
◦- Schedule exercise into your daily routine. It will be become a habit faster if you do.
◦- If you can only do one thing, do something cardiovascular, meaning something that gets your heart beating faster. This includes walking, running, skiing, swimming, biking, hiking, tennis, basketball, playing tag, ultimate Frisbee, and other similar sports/activities.
2.2. Mental Exercise
◦- Be curious! Get to know your local library and community college, look for local organizations or churches that offer classes or workshops
◦- Do a variety of things, including things you aren’t good at (if you like to sing, try painting too)
◦- Work puzzles like crosswords and sudoku or play games like chess and bridge
◦- Try a computerized brain fitness program for a customized workout
◦- If you can only do one thing, learn something new every day
3.3. Good Nutrition
◦- Eat a variety of foods of different colors without a lot of added ingredients or processes
◦- Plan your meals around your vegetables, and then add fruit, protein, dairy, and/or grains
◦- Add some cold-water fish to your diet (tuna, salmon, mackerel, halibut, sardines, and herring) which contain omega-3 fatty acids
◦- Learn what a portion-size is, so you don’t overeat
◦- Try to eat more foods low on the Glycemic Index
◦- If you can only do one thing, eat more vegetables, particularly leafy green ones
4.Stress Management
◦- Get regular cardiovascular exercise
◦- Try to get enough sleep each night
◦- Keep connected with your friends and family
◦- Practice meditation, yoga, or some other calming activity as way to take a relaxing time-out (maybe a bath)
◦- Try training with a heart rate variability sensor, like the one in emWave (formerly known as Freeze-Framer)
◦- If you can only do one thing, set aside 5–10 minutes to just breathe deeply and recharge
Tuesday, September 28, 2010
Sleep Disorder: Nightmares
Pediatrics: Developmental and Behavioral > Medical Topics
Author: Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program
Updated: Feb 25, 2008
Introduction
Background
Sleep disorders occur in 35-45% of children aged 2-18 years. Nightmares are frightening events for a child and may cause the entire family distress; however, they are sporadic in most children. Nightmare disorder is characterized by repeated episodes of a frightening or unpleasant dream that disrupts the child's sleep. The child's reaction often interrupts the parents' sleep. Upon awakening from a nightmare, the child is alert and aware of the present surroundings, but the sleep disturbance causes distress and impairment in everyday functioning.
Nightmares are often confused with the parasomnia known as night terrors, which are episodes of extreme panic and confusion associated with vocalization, movement, and autonomic discharge. Children with night terrors are difficult to arouse and console and do not remember a dream or nightmare.
Pathophysiology
Sleep is divided into 2 distinct states: rapid eye movement (REM) and nonrapid eye movement (non-REM).
REM and non-REM sleep alternate in 90- to 100-minute cycles.
In older children and adults, 75% of sleep is non-REM sleep, which consists of 4 stages. Most dreaming occurs during REM sleep.
REM sleep is characterized by EEG activity similar to a wakeful pattern.
Frequency
United States
Prevalence varies because of different diagnostic criteria and different study populations. Some studies estimate as many as 50% of children aged 3-6 years have nightmares that disturb both their sleep and the parents' sleep.
Race
Nightmares occur in all races and cultures.
Sex
Both sexes are equally affected.
Age
Peak incidence occurs in children aged 3-6 years.1,2
Clinical
History
•Sporadic nightmares are common in children and usually occur in the middle of the night or early morning, when REM sleep is more common.
•The dream typically involves some danger or threat to the child.
◦The child may dream about physical danger (eg, being chased).
◦A nightmare may also involve psychological threat (eg, being teased).
◦Nightmares may involve a monster, ghost, fierce animal, or bad individual.
◦Loss of control and fear of injury are common themes.
•Vocalizations, movement, and autonomic symptoms are minimal.
•When awakened, the child becomes oriented, can be calmed, and usually recalls the details of the dream.
Physical
•Nightmares are not associated with specific physical findings.
•Heart rate and respiratory rate may increase or show increased variability before the child awakens from a nightmare. Mild autonomic arousal, including tachycardia, tachypnea, and sweating, may occur transiently upon awakening.
Causes
•Developmental, genetic, psychological, and organic factors can contribute to occurrence.
•Approximately 7% of individuals who have frequent nightmares have family history of nightmares.
•Nightmares are more common in children with mental retardation, depression, and CNS diseases; an association has also been reported with febrile illnesses.
•Medications may induce frightening dreams, either during treatment or following withdrawal. Withdrawal of medications that suppress REM sleep can lead to an REM rebound effect that is accompanied by nightmares.
•Daytime emotional conflicts and psychological stress often contaminate sleep and predispose the child to nightmares.
•Nightmares may result from a severe traumatic event and may indicate posttraumatic stress disorder
Treatment
Medical Care
•Reassurance
◦Reassurance is the only treatment required for sporadic nightmares. Although all stressors cannot be removed from a child's life, parents can attempt to make bedtime a safe and comfortable time.
◦Encourage parents to spend time reading, relaxing, and talking with the child.
◦If the child has a recurring nightmare, instructing parents to encourage the child to imagine a good ending may help.
Consultations
Psychological evaluation is indicated for patients whose nightmares occur more than twice a week over a period of several months.
Medication
Medications are neither helpful nor indicated.
Author: Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program
Updated: Feb 25, 2008
Introduction
Background
Sleep disorders occur in 35-45% of children aged 2-18 years. Nightmares are frightening events for a child and may cause the entire family distress; however, they are sporadic in most children. Nightmare disorder is characterized by repeated episodes of a frightening or unpleasant dream that disrupts the child's sleep. The child's reaction often interrupts the parents' sleep. Upon awakening from a nightmare, the child is alert and aware of the present surroundings, but the sleep disturbance causes distress and impairment in everyday functioning.
Nightmares are often confused with the parasomnia known as night terrors, which are episodes of extreme panic and confusion associated with vocalization, movement, and autonomic discharge. Children with night terrors are difficult to arouse and console and do not remember a dream or nightmare.
Pathophysiology
Sleep is divided into 2 distinct states: rapid eye movement (REM) and nonrapid eye movement (non-REM).
REM and non-REM sleep alternate in 90- to 100-minute cycles.
In older children and adults, 75% of sleep is non-REM sleep, which consists of 4 stages. Most dreaming occurs during REM sleep.
REM sleep is characterized by EEG activity similar to a wakeful pattern.
Frequency
United States
Prevalence varies because of different diagnostic criteria and different study populations. Some studies estimate as many as 50% of children aged 3-6 years have nightmares that disturb both their sleep and the parents' sleep.
Race
Nightmares occur in all races and cultures.
Sex
Both sexes are equally affected.
Age
Peak incidence occurs in children aged 3-6 years.1,2
Clinical
History
•Sporadic nightmares are common in children and usually occur in the middle of the night or early morning, when REM sleep is more common.
•The dream typically involves some danger or threat to the child.
◦The child may dream about physical danger (eg, being chased).
◦A nightmare may also involve psychological threat (eg, being teased).
◦Nightmares may involve a monster, ghost, fierce animal, or bad individual.
◦Loss of control and fear of injury are common themes.
•Vocalizations, movement, and autonomic symptoms are minimal.
•When awakened, the child becomes oriented, can be calmed, and usually recalls the details of the dream.
Physical
•Nightmares are not associated with specific physical findings.
•Heart rate and respiratory rate may increase or show increased variability before the child awakens from a nightmare. Mild autonomic arousal, including tachycardia, tachypnea, and sweating, may occur transiently upon awakening.
Causes
•Developmental, genetic, psychological, and organic factors can contribute to occurrence.
•Approximately 7% of individuals who have frequent nightmares have family history of nightmares.
•Nightmares are more common in children with mental retardation, depression, and CNS diseases; an association has also been reported with febrile illnesses.
•Medications may induce frightening dreams, either during treatment or following withdrawal. Withdrawal of medications that suppress REM sleep can lead to an REM rebound effect that is accompanied by nightmares.
•Daytime emotional conflicts and psychological stress often contaminate sleep and predispose the child to nightmares.
•Nightmares may result from a severe traumatic event and may indicate posttraumatic stress disorder
Treatment
Medical Care
•Reassurance
◦Reassurance is the only treatment required for sporadic nightmares. Although all stressors cannot be removed from a child's life, parents can attempt to make bedtime a safe and comfortable time.
◦Encourage parents to spend time reading, relaxing, and talking with the child.
◦If the child has a recurring nightmare, instructing parents to encourage the child to imagine a good ending may help.
Consultations
Psychological evaluation is indicated for patients whose nightmares occur more than twice a week over a period of several months.
Medication
Medications are neither helpful nor indicated.
Friday, September 17, 2010
Further Evidence Shows No Link Between Thimerosal and Increased Autism Risk
From Medscape Medical News
Emma Hitt, PhD
September 16, 2010 — Prenatal and infant exposure to thimerosal, a mercury-containing preservative used in some vaccines, does not increase risk of autism spectrum disorder (ASD), new research findings from the Centers for Disease Control and Prevention (CDC) and others suggest.
Frank DeStefano, MD, MPH, the CDC's director of immunization safety, and colleagues reported the findings in the September 16 issue of the New England Journal of Medicine.
According to the researchers, in 1999, the US Food and Drug Administration estimated that infants who were immunized according to the recommended schedule might have received amounts of ethylmercury in excess of Environmental Protection Agency limits for exposure to methylmercury. As a result, vaccine manufacturers were urged to remove thimerosal from all infant vaccines and to investigate any potential risks.
In the current study, Dr. DeStefano, in collaboration with researchers from Kaiser Permanente; Harvard Medical School, in Boston, Massachusetts; Stanford University, in Palo Alto, California; and others reviewed records from a managed care organization. They also interviewed the parents of 256 children verified to have ASD according to a standardized personal evaluation.
Children with ASD were further classified into having autistic disorder or ASD with regression. The children with autism were matched by age, sex, and managed care organization to children without autism.
None of the autism outcomes were associated with prenatal or early-life receipt of thimerosal-containing vaccines and immunoglobulins, and the receipt of vaccines was comparable between patients with ASD and control patients.
The adjusted odds ratios for ASD associated with a 2–standard deviation increase in ethylmercury exposure were 1.12 (95% confidence interval [CI], 0.83 - 1.51) for prenatal exposure, 0.88 (95% CI, 0.62 - 1.26) for exposure from birth to 1 month, 0.60 (95% CI, 0.36 - 0.99) for exposure from birth to 7 months, and 0.60 (95% CI, 0.32 - 0.97) for exposure from birth to 20 months, thus representing a decrease in risk for some time periods.
The researchers note that they are "not aware of a biological mechanism that would lead to this result."
Parents, Physicians Should Be Reassured
Dr. DeStefano told Medscape Medical News that this study adds stronger evidence regarding exposure during pregnancy and is the first study to evaluate subtypes of ASD, including ASD with regression.
"These findings add to the evidence that thimerosal-containing injections during pregnancy or infancy do not increase a child's risk of developing autism," he added. "In my opinion, further studies are not warranted," he said.
According to Dr. DeStefano, the Institute of Medicine has also reviewed the evidence regarding thimerosal and autism and concluded that it did not support such an association, and "the results of our study add further support to this conclusion."
"Clinicians can feel confident in counseling parents that the scientific evidence does not support a link between thimerosal in vaccines and autism," Dr. DeStefano said. "Currently, this should not be much of an issue because thimerosal is no longer included in most routinely used in infant and childhood vaccines in the United States."
According to Dr. DeStefano, the single exception is in some influenza vaccines, but "thimerosal-free preparations of influenza vaccines are available for parents who are more comfortable with thimerosal-free products."
Independent commentator Meg Fisher, MD, chair of the Department of Pediatrics and Medical Director with the Children's Hospital at Monmouth Medical Center, in Long Branch, New Jersey, noted that this study confirms previous findings that show no association of autism and thimerosal.
"It was a well-done study using information from 3 managed care organizations," she told Medscape Medical News. "Exposure to thimerosal through vaccines and immunoglobulin was determined both after birth and prenatally, and there was no increased risk of ASD associated with exposure to ethylmercury — prenatally or postnatally."
Dr. Fisher concurs with Dr. DeStefano that additional studies on this issue are not needed. "Parents and physicians should be reassured by this additional, well-designed study — there is no association of thimerosal and autism."
She added that the CDC's Vaccine Safety Datalink system provides a wealth of clinical data that can be used to test hypotheses about vaccine adverse events.
Dr. Marcy received honoraria for speaking for Merck and GlaxoSmithKline within the last 5 years and grant support for studies on Gardasil and ProQuad from Merck within the last 5 years; Mr. Lewis received grant support from Medimmune, Sanofi Pasteur, Chiron, Wyeth, Merck, and GlaxoSmithKline; and Dr Bernal received research funding from the CDC, the National Institute of Mental Health, Health Resources and Service Administration, and Autism Speaks. The other authors have disclosed no relevant financial relationships.
Pediatrics. 2010;126:656-664.
Disclosure: Emma Hitt, PhD, has disclosed no relevant financial relationships.
Emma Hitt, PhD
September 16, 2010 — Prenatal and infant exposure to thimerosal, a mercury-containing preservative used in some vaccines, does not increase risk of autism spectrum disorder (ASD), new research findings from the Centers for Disease Control and Prevention (CDC) and others suggest.
Frank DeStefano, MD, MPH, the CDC's director of immunization safety, and colleagues reported the findings in the September 16 issue of the New England Journal of Medicine.
According to the researchers, in 1999, the US Food and Drug Administration estimated that infants who were immunized according to the recommended schedule might have received amounts of ethylmercury in excess of Environmental Protection Agency limits for exposure to methylmercury. As a result, vaccine manufacturers were urged to remove thimerosal from all infant vaccines and to investigate any potential risks.
In the current study, Dr. DeStefano, in collaboration with researchers from Kaiser Permanente; Harvard Medical School, in Boston, Massachusetts; Stanford University, in Palo Alto, California; and others reviewed records from a managed care organization. They also interviewed the parents of 256 children verified to have ASD according to a standardized personal evaluation.
Children with ASD were further classified into having autistic disorder or ASD with regression. The children with autism were matched by age, sex, and managed care organization to children without autism.
None of the autism outcomes were associated with prenatal or early-life receipt of thimerosal-containing vaccines and immunoglobulins, and the receipt of vaccines was comparable between patients with ASD and control patients.
The adjusted odds ratios for ASD associated with a 2–standard deviation increase in ethylmercury exposure were 1.12 (95% confidence interval [CI], 0.83 - 1.51) for prenatal exposure, 0.88 (95% CI, 0.62 - 1.26) for exposure from birth to 1 month, 0.60 (95% CI, 0.36 - 0.99) for exposure from birth to 7 months, and 0.60 (95% CI, 0.32 - 0.97) for exposure from birth to 20 months, thus representing a decrease in risk for some time periods.
The researchers note that they are "not aware of a biological mechanism that would lead to this result."
Parents, Physicians Should Be Reassured
Dr. DeStefano told Medscape Medical News that this study adds stronger evidence regarding exposure during pregnancy and is the first study to evaluate subtypes of ASD, including ASD with regression.
"These findings add to the evidence that thimerosal-containing injections during pregnancy or infancy do not increase a child's risk of developing autism," he added. "In my opinion, further studies are not warranted," he said.
According to Dr. DeStefano, the Institute of Medicine has also reviewed the evidence regarding thimerosal and autism and concluded that it did not support such an association, and "the results of our study add further support to this conclusion."
"Clinicians can feel confident in counseling parents that the scientific evidence does not support a link between thimerosal in vaccines and autism," Dr. DeStefano said. "Currently, this should not be much of an issue because thimerosal is no longer included in most routinely used in infant and childhood vaccines in the United States."
According to Dr. DeStefano, the single exception is in some influenza vaccines, but "thimerosal-free preparations of influenza vaccines are available for parents who are more comfortable with thimerosal-free products."
Independent commentator Meg Fisher, MD, chair of the Department of Pediatrics and Medical Director with the Children's Hospital at Monmouth Medical Center, in Long Branch, New Jersey, noted that this study confirms previous findings that show no association of autism and thimerosal.
"It was a well-done study using information from 3 managed care organizations," she told Medscape Medical News. "Exposure to thimerosal through vaccines and immunoglobulin was determined both after birth and prenatally, and there was no increased risk of ASD associated with exposure to ethylmercury — prenatally or postnatally."
Dr. Fisher concurs with Dr. DeStefano that additional studies on this issue are not needed. "Parents and physicians should be reassured by this additional, well-designed study — there is no association of thimerosal and autism."
She added that the CDC's Vaccine Safety Datalink system provides a wealth of clinical data that can be used to test hypotheses about vaccine adverse events.
Dr. Marcy received honoraria for speaking for Merck and GlaxoSmithKline within the last 5 years and grant support for studies on Gardasil and ProQuad from Merck within the last 5 years; Mr. Lewis received grant support from Medimmune, Sanofi Pasteur, Chiron, Wyeth, Merck, and GlaxoSmithKline; and Dr Bernal received research funding from the CDC, the National Institute of Mental Health, Health Resources and Service Administration, and Autism Speaks. The other authors have disclosed no relevant financial relationships.
Pediatrics. 2010;126:656-664.
Disclosure: Emma Hitt, PhD, has disclosed no relevant financial relationships.
Subscribe to:
Posts (Atom)