Medicine posts

May 30, 2010
03:43 PM
869 views

Talking pain – seeking validation: Social interaction in pain

by Adiemusfree in Healthskills: Skills for Healthy Living

While we might laugh about the so-called typical ‘I will fix it’ response of some men when their partners talk about problems (when what the woman really wants is a hug), it seems that much of our research into pain behaviour, particularly verbal expressions of pain, has missed something. I’m not a major reader of … Read more... Read more »

Cano, A., & Williams, A. (2010) Social interaction in pain: Reinforcing pain behaviors or building intimacy?. Pain, 149(1), 9-11. DOI: 10.1016/j.pain.2009.10.010

May 28, 2010
01:10 AM
864 views

Friday Weird Science: College Student Regrets

by Evil Monkey in Neurotopia

Sci happened to be Pubmedding the word "vomit"* today when she ran across this article. It's one of those articles that is weird because it's. So. Obvious.

Mallett et al. "Do We Learn from Our Mistakes? An Examination of the Impact of Negative Alcohol-Related Consequences on College Students' Drinking Patterns and Perceptions" J Stud Alcohol. 2006

That's right. The study of vomiting, hangovers, blackouts, and other stupid stuff you did in college.

(Including when you wore this shirt around because you wanted to be as cool as this guy)

Actually, this paper does have some interesting correlations for people who study alcoholism and binge drinking, but for the moment, it's about drunk college students. We'll get to the rest of it at the end.

*What, like you don't Pubmed "'vomit"' or "clitoris" or "ejaculation" all the time?! Admit it, you do. And then you giggle. Read the rest of this post... | Read the comments on this post...... Read more »

Mallett KA, Lee CM, Neighbors C, Larimer ME, & Turrisi R. (2006) Do we learn from our mistakes? An examination of the impact of negative alcohol-related consequences on college students' drinking patterns and perceptions. Journal of studies on alcohol, 67(2), 269-76. PMID: 16562409

May 26, 2010
03:17 PM
648 views

Is Bipolar Disorder a Circadian Rhythm Problem?

by William Yates, M.D. in Brain Posts

By Hannah Dunbar (Brain Post Note: Hannah Dunbar is a Oral Roberts University undergraduate student who is doing a summer research elective with me. She will be providing some guest posts over the next two months related to her interest in sleep and bipolar disorder.) Bipolar disorder is commonly characterized by sleep fluctations and distrubance of a regular circadian rhythm. It is logical to explore the role of circadian clock genes in bipolar disorder genetic studies. Pediatric bipolar disorder populations exhibit frequent mood cycling and sleep dysregulation making them an important subgroup to target for clock gene studies. Pediatric bipolar disorder is challenging to diagnose emphasizing the importance of more valid biomarkers or genetic risk markers. McGrath and colleagues from the Center for Human Genetic research, Massachusetts General Hospital and collaborators from other institutions, recently published a study of several clock genes in a pediatric bipolar sample. Previous animal studies conducted by McGrath and colleagues, examined the role of the D-box binding protein (DBP), a stress-reactive gene associated with the expression of clock genes. A microarray study of the expression of two DBP-related clock genes (RAR-related orphan receptors alpha (RORA) and beta (RORB)), showed an alteration in the expression of these genes in a knockout mice experiment. To extend these animal studies, this pediatric bipolar study used a family trio and case-control sampling design: One group included a family-based sample of 153 trios (each trio consisting of an affected BP proband and both parents)A second group included a sample of 152 pediatric bipolar cases (all independent from the trio samples)The second group was compared to 140 independent healthy controls (HC)BD subjects met DSM-IV criteria for bipolar disorder including (a) experiencing a distinct period of extreme and persistently elevated, expansive, or irritable mood lasting at least a week and (b) exhibiting 3 (4 if the mood is irritable only) out of 7 symptoms during the period of mood disturbance. Results: Four intronic RORB SNPs were associated with the pediatric bipolar phenotype in the case-control sample but not the trio sample. The association persisted after Bonferroni correction for multiple statistical tests. An additional 11 SNPs were tied to bipolar phenotype using three RORB haplotype blocks. These associations were also not replicated in the trio sample. No association of RORA SNPs were found with bipolar phenotype. Implications and Limitations: Isoforms of RORB, including RORB1 and RORB2 are thought to be produced via alternative forms of promoters during transcription. These isoforms are found exclusively in the retina and pineal gland, two essential regions in the light-stimulated production pathway of the sleep-wake hormone melatonin. Retinoid-related receptors (RORA and RORB) are involved in a number of synthetic pathways such as neurogenesis, stress response, and regulation of circadian rhythm. Alteration in the expression of these isoforms may influence some of the sleep dysregulation found in bipolar disorder. It is disappointing that SNP findings for the identified regions could not be confirmed in both bipolar samples. However, this study lends support for further research examining the role of biological clock mechanisms in bipolar disorder.Photo of Mallard in Pool Courtesy of Yates PhotographyMcGrath, C., Glatt, S., Sklar, P., Le-Niculescu, H., Kuczenski, R., Doyle, A., Biederman, J., Mick, E., Faraone, S., Niculescu, A., & Tsuang, M. (2009). Evidence for genetic association of RORB with bipolar disorder BMC Psychiatry, 9 (1) DOI: 10.1186/1471-244X-9-70Ogden CA, Rich ME, Schork NJ, Paulus MP, Geyer MA, Lohr JB, Kuczenski R, & Niculescu AB (2004). Candidate genes, pathways and mechanisms for bipolar (manic-depressive) and related disorders: an expanded convergent functional genomics approach. Molecular psychiatry, 9 (11), 1007-29 PMID: 15314610... Read more »

McGrath, C., Glatt, S., Sklar, P., Le-Niculescu, H., Kuczenski, R., Doyle, A., Biederman, J., Mick, E., Faraone, S., Niculescu, A.... (2009) Evidence for genetic association of RORB with bipolar disorder. BMC Psychiatry, 9(1), 70. DOI: 10.1186/1471-244X-9-70

Ogden CA, Rich ME, Schork NJ, Paulus MP, Geyer MA, Lohr JB, Kuczenski R, & Niculescu AB. (2004) Candidate genes, pathways and mechanisms for bipolar (manic-depressive) and related disorders: an expanded convergent functional genomics approach. Molecular psychiatry, 9(11), 1007-29. PMID: 15314610

May 26, 2010
12:16 PM
435 views

The Promise of a Near-Miss

by Rob Mitchum in ScienceLife

A critical step in the design of any clinical trial is picking the right primary endpoint, the result that will usually make or break the study. That’s more difficult than it sounds - one’s hope is to cure a disease or relieve a patient’s symptoms, but choosing the best specific measure for those goals is [...]... Read more »

, . (2010) A Controlled Trial of Sildenafil in Advanced Idiopathic Pulmonary Fibrosis. New England Journal of Medicine. DOI: 10.1056/nejmoa1002110

May 25, 2010
08:34 AM
668 views

A shot in the arm for antimalarial drug discovery?

by The Curious Wavefunction in The Curious Wavefunction

While heart disease, cancer and Alzheimer's continue to grab the headlines, malaria and tuberculosis continue to quietly do their deadly work behind the scenes. Diseases that disproportionately affect sub-Saharan Africa are not exactly priorities for drug companies. But they pose a tremendous unmet need. Especially malaria, which kills an unbelievable 800,000 people every year, has fought back against almost every traditional drug. The fight against the disease has boiled down to one class of drugs- the artemisinins. If the parasite develops resistance against these, nobody knows how fast and wide it will spread.Since pharma companies often get bad press for neglecting....neglected diseases, this makes the duo of papers in this week's issue of Nature especially impressive. The papers talk about GSK collaborating with a host of academic laboratories to discover literally hundreds of hits against malaria through phenotypic screening. The sheer multidisciplinary effort put into this endeavor is laudable. Phenotypic screening is an effective method for drug discovery since it does not care about the target of a drug, at least in the beginning. It's a more top down approach that complements bottom-up rational drug design. The goal is to simply watch out for a particular kind of response, which could be anything from fluorescence to cell shrinkage. In this case it was 80% inhibition of growth of the parasite in the asexual stage in red blood cells. Target identification can come later.The company screened its proprietary collection of about 2 million compounds. The compound library was chosen for diversity of scaffolds and novel chemotypes. The assay looked for 80% inhibition of the P. falciparum parasite, and came up with hundreds of diverse compounds. The scientists seemed to have taken due care to minimize false positives. They sought to eliminate promiscuous, lipophilic compounds from the list. They also screened their compounds against well known targets and processes that the malarial parasite exploits to subdue its host. One of these was particularly eye-opening for me; apparently, the insidious little weasel can hack up the amino acids from hemoglobin molecules in the host to assemble its own proteins. Now that's stealth for you. More interestingly, the group then screened the selected molecules against seven novel malarial targets and found encouraging inhibition profiles against these targets. Infectious disease are best treated when you can hit the causative agent in multiple places. Paucity of targets has especially been an issue for malaria and TB, and these chemotypes along with their suggested targets provide promising leads. As a final act, the first paper co-authored by Guiguemde et al. also demonstrates favorable pharmacokinetic properties for one of their hits.Especially interesting is the report in the second paper authored by Gamo et al. where the authors follow a similar procedure but discover that the novel target list for the purported antimalarial candidates is enriched in kinases. They take due care to investigate that this enrichment is not a chance enrichment. Unlike the human genome which has about 500 kinases, the malarial genome has about 80. But finding kinases among the targets of these novel chemotypes has rich implications, since kinases have already been intensely investigated, the targets are well-understood and there are literally thousands of kinase inhibitors out there waiting to be tested. Testing kinase inhibitors against malaria would open up a whole new chapter for antimalarial drug discovery.Finally, and this is the kicker most talked about, GSK has made the entire list of hits freely available to the public. This is a very laudable act. In an age where corporations are routinely derided for their emphasis on secrecy and profit-making, such a decision should drive home the good work that corporations can potentially do. It also underscores the tremendous opportunities for drug discovery against neglected diseases gained from academic-corporate collaboration. While it remains to be seen how many of these promising candidates become bona fide drugs, it provides many promising starting points for further efforts. Malaria is about as insidious a disease as you can have, lurking in the shadows and waiting to pounce on you. The more the hands that try to squeeze its neck, the better.Guiguemde, W., Shelat, A., Bouck, D., Duffy, S., Crowther, G., Davis, P., Smithson, D., Connelly, M., Clark, J., Zhu, F., Jiménez-Díaz, M., Martinez, M., Wilson, E., Tripathi, A., Gut, J., Sharlow, E., Bathurst, I., Mazouni, F., Fowble, J., Forquer, I., McGinley, P., Castro, S., Angulo-Barturen, I., Ferrer, S., Rosenthal, P., DeRisi, J., Sullivan, D., Lazo, J., Roos, D., Riscoe, M., Phillips, M., Rathod, P., Van Voorhis, W., Avery, V., & Guy, R. (2010). Chemical genetics of Plasmodium falciparum Nature, 465 (7296), 311-315 DOI: 10.1038/nature09099Gamo, F., Sanz, L., Vidal, J., de Cozar, C., Alvarez, E., Lavandera, J., Vanderwall, D., Green, D., Kumar, V., Hasan, S., Brown, J., Peishoff, C., Cardon, L., & Garcia-Bustos, J. (2010). Thousands of chemical starting points for antimalarial lead identification Nature, 465 (7296), 305-310 DOI: 10.1038/nature09107... Read more »

Guiguemde, W., Shelat, A., Bouck, D., Duffy, S., Crowther, G., Davis, P., Smithson, D., Connelly, M., Clark, J., Zhu, F.... (2010) Chemical genetics of Plasmodium falciparum. Nature, 465(7296), 311-315. DOI: 10.1038/nature09099

Gamo, F., Sanz, L., Vidal, J., de Cozar, C., Alvarez, E., Lavandera, J., Vanderwall, D., Green, D., Kumar, V., Hasan, S.... (2010) Thousands of chemical starting points for antimalarial lead identification. Nature, 465(7296), 305-310. DOI: 10.1038/nature09107

May 25, 2010
03:58 AM
972 views

No difference between "too many too soon" and "too few too late" when it comes to vaccines

by Orac in Respectful Insolence

Regular readers know that I have a tendency every so often to whine about when writing about the antics of the anti-vaccine movement seems to engulf this blog. Yes, it's true. Every so often I get really, really tired of the bad science, pseudoscience, magical thinking, misinformation, and even outright lies that emanate from various anti-vaccine websites and blogs. This week, I promised myself I would try not to do it. There are times when duty calls, and this is one of those times. For better or for worse, as hard as I still find it to believe, somehow I've become one of the top bloggers defending vaccines, and there are times when I have to stop whining and just embrace this role. Given the one-two-three triple whammy of the start of the anti-vaccine autism quackfest Autism One, Andrew Wakefield having had his license to practice medicine in the U.K. yanked, and the hilariously insane anti-vaccine rally to take place in Grant Park in Chicago tomorrow, it's time just to go with the flow and do what needs to be done.

Today this is something I'm more than happy to do, at least today.

If there's one thing about the anti-vaccine movement that I've learned over the last several years, it's that it's nothing if not, for lack of a better word, nearly infinitely pliable. To put it more simply, anti-vaccine activists are experts at throwing out as much stuff as they can and seeing if anything sticks, adjusting their stories, and moving the goalposts every time each of their successive demands for more evidence are met by scientists. Although there has always been an anti-vaccine movement, its most recent incarnation is built primarily around the idea that vaccines cause autism somehow. First it was Andrew Wakefield presenting dubious, trial lawyer-funded "research" purporting to show that the MMR vaccine causes "autistic enterocolitis" and even autism itself. Then, not long after that, the U.S. version of this manufactrovery showed up in the form of the concept that mercury in the thimerosal preservative that used to be in vaccines cause autism, promoted initially by David Kirby and Robert F. Kennedy, Jr. Fortunately, more than a decade's worth of research consisting of large epidemiological studies has utterly failed to find even a whiff of a hint of a link between either the MMR vaccine or thimerosal-containing vaccines and autism. Unfortunately, the anti-vaccine movement simply moved the goalposts to the "toxins" gambit, in which it is claimed that vaccines are laced with "toxins" such as formaldehyde, antifreeze, and tissue from aborted fetuses. Never mind that there are no parts from aborted fetuses or antifreeze in vaccines, and scary-sounding chemicals like formaldehyde are present in concentrations far too low to be a problem. Even so, "Green our Vaccines" sure sounds like a slogan that means something, even though it doesn't.

The latest gambit, and arguably one of the most successful because it's the most vague and difficult to falsify, is the "Too Many Too Soon" slogan. Under this idea, anti-vaccine propagandists claim that infants are getting too many vaccines too soon (hence the slogan) and that all those nasty vaccines being given to such young infants is somehow messing up their immune system, attacking their brains, and giving them autism. This is a tough one to combat because the only definitive way to refute it would involve studying unvaccinated versus vaccinated children (which, not surprisingly, is the latest demand of the anti-vaccine movement). Doing such a study in a rigorous prospective randomized fashion would be completely unethical because it would leave the control group unprotected, while retrospective studies would be prone to a lot of confounders, given that there are likely to be other factors besides vaccination status that make populations who aren't vaccinated different from those who are.

That's why a study hot off the presses yesterday (well, hot off the web, as it were, given that it's an E-pub ahead of print) is so well timed. Released right as Autism One starts and Andrew Wakefield tanks, what better time for a study to look right at the very question that anti-vaccinationists seem to want answered? The title of the article is even an arrow aimed right at the heart of the "too many too soon" mantra, namely On-time Vaccine Receipt in the First Year Does Not
Adversely Affect Neuropsychological Outcomes. Read the rest of this post... | Read the comments on this post...... Read more »

Michael J. Smith, MD, MSCE, Charles R. Woods, MD, MS. (2010) On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes. Pediatrics. info:/

May 24, 2010
06:11 PM
1,003 views

X-ed Out.

by Dirk Hanson in Addiction Inbox

Another look at MDMA and serotonin.
A study by Canada’s Centre for Addiction and Mental Health (CAMH) has confirmed earlier findings that chronic users of ecstasy (MDMA) have abnormally low levels of serotonin transporter molecules in the cerebral cortex.
While a decade of research on the effects of ecstasy on brain serotonin has been controversial and largely inconclusive, the latest study used drug hair analysis to confirm levels of MDMA in 49 users and 50 controls. An additional division was made between chronic X users who also tested positive for methamphetamine, and those who did not. Regular usage of MDMA was defined as two tablets twice a month.
The Canadian study, funded by the U.S. National Institute on Drug Abuse (NIDA) and published in the journal Brain, suggests that the serotonin surge responsible for ecstasy’s effects results in a net depletion in regular X users. That is not a new finding--but the Canadian study goes further, suggesting that the serotonin depletion is localized in one area of the brain.
“We were surprised to discover that SERT was decreased only in the cerebral cortex and not throughout the brain,” said study leader Stephen Kish in a press release, “perhaps because serotonin nerves to the cortex are longer and more susceptible to changes.”
Low SERT levels in the cerebral cortex were found in all X users, with or without amphetamine. Dr. Kish noted that the CAMH findings replicate what Kish referred to as “newer data” from Johns Hopkins University. In 1999, a controversial serotonin study of ecstasy users at Johns Hopkins laboratory was criticized for overestimating the level of danger posed by ecstasy-induced serotonin impairments.
Okay, the finding is becoming more robust. But what does it mean? According to co-author Isabelle Boileau, a low SERT level does “not necessarily” indicate structural brain damage. “There is no way to prove whether low SERT is explained by physical loss of the entire serotonin nerve cell, or by a loss of SERT protein within an intact nerve cell.”
For his part, Dr. Kish indicated that his concerns centered on the connection between lower serotonin measurements and MDMA tolerance levels. “Most of the ecstasy users of our study complained that the first dose is always the best, but then the effects begin to decline and higher doses are needed,” he said. “The need for higher doses, possibly caused by low SERT, could well increase the risk of harm caused by this stimulant drug.” The published study concluded that “behavioural problems in some ecstasy users during abstinence might be related to serotonin transporter changes limited to cortical regions.”
However, in addition to the confounding variable of methamphetamine (see my post, “How Pure is Ecstasy?”), it remains unclear whether the SERT alterations detected in the study are transient or permanent. Moreover, the nature of the link that “might” exist between lower SERT levels and cognitive impairment in the brains of regular ecstasy users remains a subject of dispute in the drug research community, as in this earlier post. (And just to emphasize that drugs are complicated things, a spate of promising recent research has suggested that ecstasy might be an effective option for treating people with post-traumatic stress disorder).
The CAMH, affiliated with the University of Toronto, is Canada’s largest mental health and addiction teaching hospital.

Kish, S., Lerch, J., Furukawa, Y., Tong, J., McCluskey, T., Wilkins, D., Houle, S., Meyer, J., Mundo, E., Wilson, A., Rusjan, P., Saint-Cyr, J., Guttman, M., Collins, D., Shapiro, C., Warsh, J., & Boileau, I. (2010). Decreased cerebral cortical serotonin transporter binding in ecstasy users: a positron emission tomography/[11C]DASB and structural brain imaging study Brain DOI: 10.1093/brain/awq103
Graphics Credit: pubs/teaching/teaching4/Teaching3.html... Read more »

Kish, S., Lerch, J., Furukawa, Y., Tong, J., McCluskey, T., Wilkins, D., Houle, S., Meyer, J., Mundo, E., Wilson, A.... (2010) Decreased cerebral cortical serotonin transporter binding in ecstasy users: a positron emission tomography/[11C]DASB and structural brain imaging study. Brain. DOI: 10.1093/brain/awq103

May 24, 2010
05:07 PM
589 views

Hosting big sports events might not benefit the local population

by Helen Jaques in In Sickness and In Health

Hosting an international sporting event like the Olympic Games or the Commonwealth Games is an expensive business. The London 2012 Olympic and Paralympic Games, for example, will cost a total of £9.35bn, equivalent to £150 for every man, woman, and child in the United Kingdom.
Such costs are generally justified in terms of collateral benefits [...]... Read more »

McCartney, G., Thomas, S., Thomson, H., Scott, J., Hamilton, V., Hanlon, P., Morrison, D., & Bond, L. (2010) The health and socioeconomic impacts of major multi-sport events: systematic review (1978-2008). BMJ, 340(may19 4). DOI: 10.1136/bmj.c2369

May 24, 2010
11:50 AM
800 views

Anxiety Help Five Cents. The Doctor (Computer) Is In

by William Yates, M.D. in Brain Posts

I've always enjoyed the Peanuts cartons featuring Lucy behind the box advertising psychiatric help for five cents. Charlie Brown always received pithy advice for his worries and anxiety. Now a study of anxiety disorder treatment in primary supports a new cost-effective intervention model.Peter Roy-Byrne and colleagues summarized the result of randomized study of 1004 patients with anxiety disorder in primary care. The subjects had at least one of four anxiety disorders: panic disorder, generalized anxiety disorder, social anxiety disorder or post-traumatic stress disorder. The study provided patients with the opportunity to receive cognitive behavior therapy, medication or a combination. The treatment intervention showed superiority with a 51% remission rate compared to 33% for usual care.The structure of the intervention is informative for understanding use of technology in a multidisciplinary format to increase effectiveness and control costs. After assessment, the intervention was guided by anxiety clinical specialists (ACS) who in the study included social workers, nurses and psychologists. The intervention was a program called Coordinated Anxiety Learning and Management (CALM). Key elements of this model included:Web-based monitoring systemModeled after Improving Mood-Promoting Access to Collaborative Treatment (IMPACT)Personnel received six 1/2 days of didactic trainingFive generic computer modules formed the core intervention (education, self-monitoring, hierarchy development, breathing training, and relapse prevention3 disorder specific modules (cognitive restructuring and exposure to internal and external stimuli)In addition to the intervention, a monitoring and outcome system provided ongoing assessment and targeted additional treatment. Key elements of the monitoring protocol:Web-based tracking systemOASIS (Overall anxiety severity and impairment scale) and 3-item PHQ-9 scoresGoal is clinical remissionAdditional treatment available for non-response including stepped up CBT, medication adjustment or crossover to other modalityAfter treatment entered into continued careMonthly follow-up telephone callsRegular interaction with primary care physicianIf I were in charge of the Obamacare mental health program, I would encourage dissemination of this type of model. The model maximizes anxiety treatment access within primary care. Physicians coordinate the program but use a team and technology-based program to extend evidence-based treatment.The model also provides patients a choice between medication, therapy or both. This flexibility is likely to improve compliance and increase patient satisfaction. Many primary care practices in the U.S. offer medication treatment, but few have significant options for therapy. Patients would benefit for extended access to both modes of treatment for anxiety and depression.This study also emphasizes the commonalities of treatment for panic disorder, generalized anxiety disorder, social anxiety disorder and post-traumatic stress disorder. Common elements of treatment assist clinicians in addressing the specific types of anxiety disorders found in clinical practice.Photo of Dog Obedience Class Courtesy of Yates PhotographyRoy-Byrne, P., Craske, M., Sullivan, G., Rose, R., Edlund, M., Lang, A., Bystritsky, A., Welch, S., Chavira, D., Golinelli, D., Campbell-Sills, L., Sherbourne, C., & Stein, M. (2010). Delivery of Evidence-Based Treatment for Multiple Anxiety Disorders in Primary Care: A Randomized Controlled Trial JAMA: The Journal of the American Medical Association, 303 (19), 1921-1928 DOI: 10.1001/jama.2010.608Unützer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Noël PH, Lin EH, Areán PA, Hegel MT, Tang L, Belin TR, Oishi S, Langston C, & IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatment (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA : the journal of the American Medical Association, 288 (22), 2836-45 PMID: 12472325... Read more »

Roy-Byrne, P., Craske, M., Sullivan, G., Rose, R., Edlund, M., Lang, A., Bystritsky, A., Welch, S., Chavira, D., Golinelli, D.... (2010) Delivery of Evidence-Based Treatment for Multiple Anxiety Disorders in Primary Care: A Randomized Controlled Trial. JAMA: The Journal of the American Medical Association, 303(19), 1921-1928. DOI: 10.1001/jama.2010.608

Unützer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Noël PH, Lin EH.... (2002) Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA : the journal of the American Medical Association, 288(22), 2836-45. PMID: 12472325

Craske MG, Rose RD, Lang A, Welch SS, Campbell-Sills L, Sullivan G, Sherbourne C, Bystritsky A, Stein MB, & Roy-Byrne PP. (2009) Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings. Depression and anxiety, 26(3), 235-42. PMID: 19212970

May 24, 2010
12:51 AM
797 views

On Washing your Fruit: ADHD and Pesticides

by Evil Monkey in Neurotopia

Sci was a little startled recently when she saw "the latest study" on ADHD splashed across the frontpage of Yahoo. You can see it here on Reuters.

PESTICIDES TIED TO ADHD.

(Run for the hills, indeed. Or maybe run AWAY from the hills, since they might have pesticides)

However, the story broke a good TWO DAYS in advance of the paper actually coming out, and so Sci was forced to possess her soul in patience until she had access.

But she's got it now! And let's take a look at this thing.

But first, I want us to all breathe in together and say: "Correlation is not causation"

Say it with me: "Correlation is not causation"

(Behold Sci contemplating the science of the universe)

All right, here we go.

Bouchard, et al. "Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides" Pediatrics, 2010. Read the rest of this post... | Read the comments on this post...... Read more »

Bouchard, M., Bellinger, D., Wright, R., & Weisskopf, M. (2010) Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides. PEDIATRICS. DOI: 10.1542/peds.2009-3058

May 21, 2010
10:30 AM
1,228 views

Physical Features in Autism

by William Yates, M.D. in Brain Posts

Social and language issues dominate most of the discussion about the features of autism spectrum disorder (ASD). A neglected area of study are the physical feature characteristics that have been known to be associated with ASD. Unlike some of the diagnostic physical changes in disorders such as Down Syndrome, physical features found in ASD are often subtle and missed by most clinicians.Ozgen and colleagues from the Netherlands, UCLA and the UK recently published a case-control study of physical features in children with autism. They compared 224 children with ASD and normal intelligence to a matched pair child without ASD. A portion of the assessment was completed by raters blind to the diagnosis of the child.The assessment included a variety of quantitative and qualitative assessments. For example, in the quantitative assessment category, boys (but not girls) with ASD had a smaller BMI indicating a lower weight to height ratio.The most common structural (morphological) features found in the ASD children included:Sandal gap toes (59%)Facial asymmetry (46%)Abnormal non-frontal hair whorl (39%)High narrow palate (37%)Attached ear lobes (35%)Hypermobile joints (33%)Some morphological features were found in the ASD that were absent in the 224 controls including:Brachycephaly Mouth asymmetry Eyes asymmetryEar lobe crease Macrostomia (large mouth)Limited facial expressionOpen mouth appearanceAbnormal whorlProminent lower jawThe authors note these minor physical characteristics were more common among the boys than girls in the study. These types of features have been described in other populations with copy number variations (CNVs). CNVs are an alteration of the genome with a complete loss of a gene copy, gain of a copy or disruption of a dosage-sensitive gene.The authors note that these physical characteristics are unlikely to be incorporated into diagnostic features. However, they note that the features might be helpful in identifying relevant subgroups for further study. It is important to not bring too much attention to these features in individual children. Some features may add a level of social scrutiny to an already challenging clinical problem. Photo of Blue Jay Courtesy of Yates PhotographyOzgen, H., Hellemann, G., Stellato, R., Lahuis, B., Daalen, E., Staal, W., Rozendal, M., Hennekam, R., Beemer, F., & Engeland, H. (2010). Morphological Features in Children with Autism Spectrum Disorders: A Matched Case–Control Study Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-010-1018-7... Read more »

Ozgen, H., Hellemann, G., Stellato, R., Lahuis, B., Daalen, E., Staal, W., Rozendal, M., Hennekam, R., Beemer, F., & Engeland, H. (2010) Morphological Features in Children with Autism Spectrum Disorders: A Matched Case–Control Study. Journal of Autism and Developmental Disorders. DOI: 10.1007/s10803-010-1018-7

May 20, 2010
03:30 PM
1,320 views

Of mice and men – Jeff Mogil on grimacing

by Lorimer Moseley in BodyInMind

You have almost certainly noticed that we grimace when we are in pain. But have you thought about that – I mean really thought about it? Why grimace? Well, someone who clearly thinks about such things more than most is a fellow called Jeff Mogil – Professor of Pain Type Stuff at the very pain-posh [...]... Read more »

Langford, D., Bailey, A., Chanda, M., Clarke, S., Drummond, T., Echols, S., Glick, S., Ingrao, J., Klassen-Ross, T., LaCroix-Fralish, M.... (2010) Coding of facial expressions of pain in the laboratory mouse. Nature Methods. DOI: 10.1038/nmeth.1455

May 20, 2010
08:00 AM
428 views

Clinical Psychologists’ Perceptions of Persons with Mental Illness

by Shaheen Lakhan in Brain Blogger

Many people have fabulous relationships with their psychologists. They feel supported, understood, well-liked. But there are also those who feel a little uneasy. Research by Lynn Servais and Stephen Saunders of Marquette University in Milwaukee, Wisconsin may have unearthed one of the reasons why.
Some psychologists have a hard time connecting with people with mental illness, [...]... Read more »

Servais, L., & Saunders, S. (2007) Clinical psychologists' perceptions of persons with mental illness. Professional Psychology: Research and Practice, 38(2), 214-219. DOI: 10.1037/0735-7028.38.2.214

Medicine

May 19, 2010
03:03 PM
445 views

Getting Fit with Wii--Ranking Exercise MET Values

by William Yates, M.D. in Brain Posts

Regular exercise has been shown to be helpful in the prevention and management of a variety of clinical neuroscience conditions including: Alzheimer's disease, Parkinson's disease, major depression and anxiety disorders. However, motivating people to get involved in a regular exercise program is a significant challenge. Wii Sports and Wii Fit Plus may provide the motivation edge for some patients to start and maintain an exercise program. The Wii video game system is a multi-gaming experience that includes modules designed to promote aerobic exercise, balance and stretching. Wii Sports and Wii Fit Plus are two programs that promote physical exercise. Wii Sports includes five activities: golf, bowling, tennis, baseball and boxing. Wii Fit Plus 63 activities grouped into yoga, resistance, balance and aerobic exercises.The precise aerobic exercise values for the more active games for Wii received limited study. Now, a group of researchers at the National Institute of Health and Nutrition in Japan have published an important study on Wii game MET values.MET or metabolic equivalent of tasks is a measure of aerobic effort required based on degree of effort. Typically rest is about 1 MET and physical activity is rated above this level. MET level will also be related to calories burned per minute by the activity.The Japanese researchers had twelve adult men and women participate in each of the 68 Wii activities for an 8 minute period. Energy expenditure was calculated for each program using a open-circuit indirect metabolic chamber. This is a precise expired gas method with documented reliability and validity. MET values for each Wii exercise was calculated. Twenty two (33%) of the Wii activities were classified as moderate intensity (3.0 to 6.0 METs) in the experiment. Here is the list of the top 10 Wii activities ranked by MET value from the study:METS (Activity)5.6 Single-arm stand 5.1 Basic run4.2 Boxing 4.2 Hula Hoop4.0 Running Plus4.0 Push-up and Side-Plank 4.0 Advanced Step 3.9 Rhythm Boxing3.6 Boxing Squat3.5 Balance BridgeThe other Wii Sports activities not in the top 10 were: golf 2.0 METs, Bowling 2.7 METs, Baseball 3.0 METs and Tennis 3.0 METs.To compare these values with other forms of exercise, here is a list of MET values for a variety of exercises. These activities were selected from the website Healthful Life Project. METS (Activity)16 Running @ 6 minutes per mile10 Running @ 10 minutes per mile10 Bicycling @ 16 mph8 Jogging @ 12 minutes per mile6 Bicycling @ 10 mph5 Tennis doubles5 Walking @ 4 mph4.5 Golf carrying clubs4 Walking @ 3.5 mph3.5 Golf not carrying clubs2.5 Bowling2.5 Walking @ 2 mphYou can see that the top Wii Sports and Wii Fit Plus activities fall in the range of walking a moderate to brisk pace. The study documents that specific Wii activities can be competitive with other moderate exercise activities. A series of high MET activities conducted in sequence would be a reasonable way to meet the recommended 30 to 60 minutes per day of physical activity. Based on the MET values, a ballpark estimate of calories burned by the top 10 would be about 400 calories per hour (4 to 5 calories per minute). Obviously, this value will vary based on individual effort and weight.This is an important study that will allow professionals to design programs for exercise using the Wii video game system. Photo of Black Bear Cub and Mother at Lake Itasca Courtesy of Yates PhotographyMiyachi M, Yamamoto K, Ohkawara K, & Tanaka S (2009). METs In Adults While Playing Active Video Games: A Metabolic Chamber Study. Medicine and science in sports and exercise PMID: 19997034... Read more »

Miyachi M, Yamamoto K, Ohkawara K, & Tanaka S. (2009) METs In Adults While Playing Active Video Games: A Metabolic Chamber Study. Medicine and science in sports and exercise. PMID: 19997034

May 19, 2010
10:37 AM
1,168 views

Oh no! My cell phone's going to kill me! (The revenge)

by Orac in Respectful Insolence

Here we go again.

I've written a few times before about the controversy over whether cell phones (a.k.a. mobile phones in most of the rest of the world) cause brain cancer, concluding on more than one occasion that the evidence does not support a link. For example, there has not been a large increase in brain cancer or other cancers claimed to be due to cell phone radiation in the 15 to 20 years since the use of cell phones took off back in the 1990s, nor has any study shown a convincing correlation between cell phone use and brain cancer.

Of course, one would not expect a priori, based on what is known about basic science, that cell phone radiation would cause cancer. After all, the development of cancer in general ultimately requires mutations in critical genes regulating cell growth and development. For an outside treatment to cause such mutations, as far as we know, requires the ability to cause DNA damage through the breaking of chemical bonds. Ionizing radiation can do this, as can certain cehmicals and chemotherapeutic agents. Indeed, that's how these agents work against cancer because cancer cells tend to be more sensitive to DNA damaging agents than normal cells due to defective DNA repair mechanisms. Thus, it is highly implausible based on basic science that cell phone radiation could cause cancer. It's not homeopathy level-implausible, but it's pretty implausible. Nor is it impossible, as has been claimed, because there may be biological mechanisms behind cancer that we do not yet understand, and it's almost always physicists with little knowledge of epigenetics and other mechanisms of cancer development who make such dogmatic claims. Still, such physicists are not too far off; if cell phones could cause cancer, it would have to be through a previously unknown physiological or genetic mechanism. Absent compelling evidence of a link between cell phones and cancer, then, it is not unreasonable to rely on the basic science and consider the possibility of such a link to be remote. Read the rest of this post... | Read the comments on this post...... Read more »

, . (2010) Brain tumour risk in relation to mobile telephone use: results of the INTERPHONE international case-control study. International Journal of Epidemiology. DOI: 10.1093/ije/dyq079

May 19, 2010
06:23 AM
529 views

Mary Poppins was right: a spoonful of sugar DOES help the medicine go down

by Helen Jaques in In Sickness and In Health

A new study has found that giving children up to one year old a sweet solution before jabs reduces the pain of the immunisation, providing a scientific basis for Mary Poppins’ maxim that “a spoonful of sugar helps the medicine go down.”
The meta-analysis looked at fourteen randomised controlled trials that assessed the effects of oral [...]... Read more »

Harrison, D., Stevens, B., Bueno, M., Yamada, J., Adams-Webber, T., Beyene, J., & Ohlsson, A. (2010) Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Archives of Disease in Childhood. DOI: 10.1136/adc.2009.174227

May 18, 2010
11:32 AM
1,618 views

Canadian Health Authorities Release New Physical Activity Recommendations

by Travis Saunders, MSc in Obesity Panacea

Last week ParticipACTION and the Canadian Society for Exercise Physiology (CSEP) released recommendations for updated Canadian Physical Activity Guidelines. The previous guidelines were released between 1998 and 2002, and although they were based on the best research available at the time, from what I understand there simply wasn't a tremendous amount of evidence to draw on in some situations. Since then there have been a number of advances in physical activity research, allowing for the creation of updated, and increasingly evidence-based guidelines. ... Read more »

Janssen I, & Leblanc AG. (2010) Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. The international journal of behavioral nutrition and physical activity, 7(1), 40. PMID: 20459784

May 18, 2010
05:19 AM
875 views

“Huge leap” forward is just a small step for cancer vaccine research

by Cancer Research UK in Cancer Research UK - Science Update

This weekend, newspaper headlines announced that “Cancer Scientists hail ‘huge’ leap towards jab that targets tumours” and “’Holy Grail’ cancer vaccine that blasts tumours in weeks hailed as huge leap in fighting disease”. Not only are these headlines overhyped and misleading, but the stories themselves are slightly confusing, combining the launch of a clinical trial [...]... Read more »

Joshi, P., Jackson, H., Beristain, A., Di Grappa, M., Mote, P., Clarke, C., Stingl, J., Waterhouse, P., & Khokha, R. (2010) Progesterone induces adult mammary stem cell expansion. Nature. DOI: 10.1038/nature09091

May 17, 2010
04:00 PM
721 views

Middlekoop et al chapter three – what do the numbers mean?

by Lorimer Moseley in BodyInMind

Here is a final installment in our coverage of the Middlekoop paper. First up, we had Neil O’Connell talking about elephants and then we had Peter O’Sullivan raising some provocative thoughts on the value of our current direction in trying to evaluate exercise as a treatment for back pain. Now, from that odd group of [...]... Read more »

[1] van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, & van Tulder MW. (2010) Exercise therapy for chronic nonspecific low-back pain. Best practice , 24(2), 193-204. PMID: 20227641

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