Monday, 31 October 2016
Healing a nation
The first graduates from Namibia's own medical school are now on the wards and the BBC's Pumza Fihlani finds out what difference they are making. via BBC News - Health Read More Here..
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Knowing doctors’ death rates can’t help you avoid a bad surgeon
You might think publishing surgeons’ death rates helps you pick the best one, but the data isn’t statistically powerful enough to reveal which doctors are bad via New Scientist - Health Read More Here..
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Knowing doctors’ death rates can’t help you avoid a bad surgeon
You might think publishing surgeons’ death rates helps you pick the best one, but the data isn’t statistically powerful enough to reveal which doctors are bad via New Scientist - Health Read More Here..
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"Bottle-flipping" is the latest fad, see why schools are banning it - WSJ video
Will 'Fix rooms' help drug addicts?
A controversial plan to set up the UK's first so-called "fix rooms" to allow drug addicts to inject safely is likely to get the go-ahead. via BBC News - Health Read More Here..
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GPs and staff given free access to occupational health
| £920K funding will support access for practice staff Related items from OnMedica Tired GPs greatest threat to patient safety Mental health support to be launched for GPs Burnt-out GPs to get new occupational health services from next year BMA calls for maximum number of patients per GP Unrelenting demand |
Effect of Cancer Chemotherapy on Brain
Cancer is challenging to treat. Despite recent advances in earlier diagnostics and targeted therapy, radiotherapy and chemotherapy remain the mainstream treatments to complement surgery.
Chemotherapy is an umbrella term referring to multiple aggressive drugs administered to cancer patients. What unites them is the way they work by targeting fast dividing cells in the body. The therapy can reduce the size of tumors and/or patient’s symptoms. In some cases, chemotherapy can even destroy all cancer cells in the body and lead to complete recovery. But despite its relative efficiency, chemotherapy is associated with a large number of undesirable and often severe side effects. Cancer cells are not the only fast dividing cells in the body, and the lack of specificity associated with the use of chemotherapeutic agents means that normal non-cancerous cells can also be targeted and killed by these drugs.
The most affected tissues include bone marrow, hair follicles, the cells of gastrointestinal tract and reproductive cells. But other organs and tissues such as the brain can also become affected by chemotherapy.
It is well know that chemotherapy can cause decline in cognitive functions. There is a term used for that cognitive impairment – chemobrain. The condition is characterized by reduced cognitive abilities, impaired motor functions, loss of memory, and weaker attention. At least some symptoms of cognitive decline are often observed after chemotherapy and can cause severe problems for patients.
The exact mechanisms behind the chemobrain phenomenon are poorly studied. Researchers believe that genetic factors play some role in cognitive decline after chemotherapy. These genetic risk factors may include weaker mechanisms of DNA repair, lower capacity for repairing neurons, and lower activity of neurotransmitters in the brain.
Impairment of cognitive functions can be expected in a short period after chemotherapy, but in most cases it disappears quickly. However, in some cases the impairment persists and can last for a long period of time. In one recent study, a mouse model was used to test the effects of chemotherapy on the cognitive functions in a longer run (three months in this particular case). The results clearly show that animals subjected to chemotherapy agents learned new tasks much slower. Their neurons lived a shorter period of time and differentiated more slowly. This study was designed to test the effects of drugs given to post-menopausal women undergoing chemotherapy treatment for breast cancer. The study also provided evidence that omega-3 fatty acids do not have any positive effect on reducing the symptoms of cognitive impairment after chemotherapy.
Another study that was also conducted using laboratory animals focused on the changes in level of neurotransmitters, especially dopamine and serotonin in the brain. Researchers used fast-scan cyclic voltammetry to detect levels of the neuromediators. They compared the levels of these neurotransmitters in the brains of mice which were receiving chemotherapy, and in the brains of the control group of mice that did not receive chemotherapy. The results demonstrated that the release of serotonin and dopamine is impaired after chemotherapy.
Human studies of chemobrain focused mostly on breast cancer sufferers, and the data described below were gathered on this group of patients. There are good reasons to believe that the results will be similar for other types of cancer too.
One study compared the total brain volume in individuals with breast cancer that used chemotherapy and the total brain volume in the control group without cancer. The study was important as it examined the long-term consequences of chemotherapy on human brain volume. Researchers measured the total brain volume 21 years after chemotherapy. Their results show a significant loss of total brain volume and a loss of grey brain matter. The white matter remained mainly unaffected. The scientists think that this loss of total brain volume and grey matter may lead to the development of cognitive impairment.
A similar research study was conducted on another group of patients with breast cancer. The study mainly focused on the changes in the brain’s white and grey matter after chemotherapy. The measurements were done 9 years after the chemotherapy. Multimodal magnetic resonance imaging was used to detect any changes. The findings show that there is a link between chemotherapy and changes in the structure of the human brain. Chemotherapy causes damage to white matter, specifically axonal degeneration and demyelination, but also it is harmful for the grey matter.
Another study was conducted on almost 200 female breast cancer patients that had chemotherapy 20 years ago. Researchers used neuropsychological tests to determine the level of cognition among these patients and in a cancer-free control group. The results showed significantly worse scores in the chemotherapy group compared to the control group. The cancer patients had problems with verbal memory and psychomotor speed and functioning. These problems are the same as those occurring shortly after chemotherapy. This indicates that the patterns of cognitive impairment do not change even after a long period of time post-chemotherapy.
A very recent study compared the integrity of white matter in females with breast cancer before and after chemotherapy. Scientists assessed and compared the cognition scores before and after the treatment. Also, they performed the same tests on a group of females with breast cancer which did not undergo chemotherapy. The findings show significantly weaker test results in the chemotherapy group. In this group, there were notable changes in the white matter in frontal, parietal, and occipital tracts.
Although cancer chemotherapy does work very well for many cancer patients, most certainly it can also cause dangerous and permanent brain damage. Chemotherapy can change how the brain works through changing the level of neurotransmitters. It can even change the structure of the brain, reducing its volume and reducing grey matter in the brain. Eventually this leads to cognition impairment which is strongest shortly after finishing the chemotherapy but can persist for decades after.
References
Ahles, T. A. and Saykin, A. J. (2007) Candidate mechanisms for chemotherapy-induced cognitive changes. Nature Reviews Cancer, 7: 192-201. doi:10.1038/nrc2073
Deprez, S., Amant, F., Smeets, A., Peeters, R., Leemans, A., et al. (2012) Longitudinal Assessment of Chemotherapy-Induced Structural Changes in Cerebral White Matter and Its Correlation With Impaired Cognitive Functioning. JCO, 30(3): 274-281. doi: 10.1200/JCO.2011.36.8571
de Ruiter, M. B., Reneman, L., Boogerd, W., Veltman, D. J., Caan, M., et al. (2012) Late effects of high-dose adjuvant chemotherapy on white and gray matter in breast cancer survivors: Converging results from multimodal magnetic resonance imaging. Hum. Brain Mapp., 33: 2971–2983. doi:10.1002/hbm.21422
Kaplan, S. V., Limbocker, R. A., Gehringer, R. C., Divis, J. L., Osterhaus, G. L., et al. (2016) Impaired Brain Dopamine and Serotonin Release and Uptake in Wistar Rats Following Treatment with Carboplatin. ACS Chem. Neurosci., 7 (6): 689–699. DOI: 10.1021/acschemneuro.5b00029
Koppelmans, V., Breteler, M. M. B., Boogerd, W., Seynaeve, C., Gundy, C. and Schagen, S. B. ( 2012) Neuropsychological Performance in Survivors of Breast Cancer More Than 20 Years After Adjuvant Chemotherapy. JCO, 30(10): 1080-1086. doi: 10.1200/JCO.2011.37.0189
Koppelmans, V., de Ruiter, M.B., van der Lijn, F. et al. (2012) Global and focal brain volume in long-term breast cancer survivors exposed to adjuvant chemotherapy. Breast Cancer Res Treat, 132: 1099. doi:10.1007/s10549-011-1888-1
Rendeiroa, C., Sheriffa, A., Bhattacharyaa, T. K., Gogolaa, J.V., Baxterd, J.H., et al. (2016) Long-lasting impairments in adult neurogenesis, spatial learning and memory from a standard chemotherapy regimen used to treat breast cancer. Behavioural Brain Research, 315: 10-22. doi: 10.1016/j.bbr.2016.07.043
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via Brain Blogger Read More Here..Lab mice are sending us on a wild goose chase
Genetically modified animals are used to model all kinds of human diseases, but the work doesn't seem to be helping us find cures, says Joseph Garner via New Scientist - Health Read More Here..
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Young people’s regular use of e-cigarettes still low
| More teenagers trying e-cigarettes but only 2% do so regularly Related items from OnMedica Non-smoking teenagers are using e-cigarettes E-cigarettes beneficial to UK health and help quitting Teens who vape, likely to try the real thing a year on Fifth of young people have tried e-cigarettes Experts reject BMA stance on vaping |
Experts issue warning over Halloween health impact
Read More Here..
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Doctors urge industry to respect minimum alcohol unit decision
| Minimum unit pricing policy delay has caused ill health, says BMA Related items from OnMedica Alcohol and the nervous system Protect children from alcohol marketing, say doctors Alcohol-related deaths rise 5% in a year Doctors hail alcohol pricing verdict Governments must do more to fight alcohol harm says OECD |
GP politician makes direct plea to Chancellor on NHS funding
| MPs warn rationing and cuts to services are on the horizon Related items from OnMedica Government ‘in denial’ about state of NHS funding crisis, say doctors’ leaders NHS frontline victim of ‘boom and bust’ approach to workforce Little in the way of cash boost for general practice, latest funding figures show CCGs must extend access to benefit from extra funding MPs question NHS budget claims |
The venom of one of world's deadliest snakes could relieve pain, say scientists
Dubbed the "killer of killers", the long-glanded blue coral snake could hold the answer to pain relief. via BBC News - Health Read More Here..
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Dentists issue 'Halloween horror' warning
Trick-or-treating can lead to a "Halloween horror" for children's teeth, warn dentists. via BBC News - Health Read More Here..
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Number of young seeking help for anxiety rises
The number of young people in the UK seeking help for anxiety has increased by 35% in just a year, the NSPCC says. via BBC News - Health Read More Here..
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'You question yourself as a man' - men and infertility
James D'Souza and Aaron Deem discuss about the emotional impact of infertility. via BBC News - Health Read More Here..
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Saturday, 29 October 2016
Clocks go back: Top sleep tips for parents
Baby sleep specialist Abi Thompson gives her top five tips to stretch out the mornings when the clocks go back. via BBC News - Health Read More Here..
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Friday, 28 October 2016
Cystic fibrosis therapy proven to be 'life changing'
Clara has cystic fibrosis and has been on the drug Orkambi for three years. via BBC News - Health Read More Here..
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A hormone injection for men has been shown to be 96% effective as contraception.
A hormone injection for men has been shown to be a safe and effective method of contraception, but some users in trials reported side effects. via BBC News - Health Read More Here..
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How lack of oxygen makes bacteria cause acne and how to stop it
When deprived of oxygen, harmless bacteria on the skin can turn nasty, triggering inflammation and pimples – a discovery that makes a new treatment look likely via New Scientist - Health Read More Here..
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Our Editors' Favorite Thanksgiving Recipes
When you work at EatingWell, people expect pretty big things from you on Thanksgiving—whether you're hosting or contributing. And even though the pressure's on, we all know we can impress our friends and family with our favorite EatingWell recipes. I asked the other editors what their go-tos are and now I definitely have some new recipes to try this year. Here's hoping some of these recipes claim a spot on your table too.
Nurses to gain formal recognition for enhanced skills
| ‘Credentialing’ designed to boost career prospects and public confidence Related items from OnMedica Over 90% of nurses and midwives have completed revalidation Guidance launched to protect nurses who work alone Plans to scrap nurse bursaries will lead to staff shortages Nurses 'unable to afford basic necessities' NHS moves to reassure worried EU nurses |
Lack of funds hampering NHS progress on Five Year Forward View goals
| Developing viable alternatives to hospital care, needs cash, says health think tank Related items from OnMedica NHS England reveals leaders for change Greater Manchester presses ahead with devolved health and care services Fewer staff in NHS needed to get finances balanced Five-year plan for general practice unveiled Government ‘in denial’ about state of NHS funding crisis, say doctors’ leaders |
New mental health ratings and CCG performance data go public
| Intended to boost service improvement and accountability Related items from OnMedica Trusts double physical health checks in mentally ill Over 200 suicides occur in patients under crisis team care Promises to boost mental health funding stall Urgent need for better physical health in those with mental illness Only a quarter have access to needed mental health services |
Easier schedule for HPV vaccine: 2 doses instead of previously recommended 3
From Mayo Clinic: To protect against cervical cancer and other cancers caused by HPV infection, the Centers for Disease Control (CDC) is now recommending that 11- and 12-year-olds receive two doses of HPV vaccine at least six months apart. This is a change from the previously recommended three-dose series.
The CDC says adolescents ages 13–14 also can receive the HPV vaccine on the new two-dose schedule. However, those who start the series later will continue to need three doses.
Self-administered HPV Test is one of the Top 10 Medical Innovations 2017, selected by the Cleveland Clinic:
via CasesBlog - Medical and Health Blog More READ
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The CDC says adolescents ages 13–14 also can receive the HPV vaccine on the new two-dose schedule. However, those who start the series later will continue to need three doses.
Self-administered HPV Test is one of the Top 10 Medical Innovations 2017, selected by the Cleveland Clinic:
Effect of Obesity on Human Brain
The number of overweight and obese people (those with BMI above 25) around the world is approaching the two billion mark. This is more than 20% of estimated 7.4 billion people currently populating the planet. The connection between obesity and various chronic conditions such as cardiovascular disease, diabetes and some types of cancer is well established. Not much, however, is known about how the excess body weight influences the structure and function of brain.
Does IQ level determines body weight?
Statistically significant correlation between excess body weight and lower IQ level has been demonstrated in multiple studies. What was not clear for very long time is the direction of causality. Does the excess body weight cause the decline in intellectual capabilities? Or maybe people with lower IQ level are more prone to become overweight?
Although some earlier studies concluded that lower IQ level might be caused by obesity, the most recent prospectively longitudinal studies show that this is not correct. These studies demonstrate that one of the risk factors for obesity is lower IQ level.
A meta-analysis published in 2010 summarized 26 different studies on this topic. The main conclusion of this analysis was that there is a strong link between lower IQ level in childhood and the development of obesity in adulthood.
In one Swedish study involving 5286 males the IQ level was tested at the age of 18 and again at the age of 40. At each testing, the BMI of participants was also evaluated. The results clearly show that individuals with lower IQ level have higher BMI.
Another study performed in New Zealand included 913 participants. Their IQ levels were measured at the ages of 3, 7, 9, 11 and finally at the age of 38. This study also concluded that lower IQ level in childhood leads to obesity. People with lower IQ level at the age of 38 were more obese than people with higher IQ level.
Over 3000 people were participating in a study conducted in the Great Britain. The subjects were followed for more than 50 years. Their IQ levels were measured at the age of 7, 11 and 16. At the age of 51, their BMI was measured. Their results show without any doubt that IQ level at the age of 7 can predict higher BMI at the age of 51. Also, the results show that BMI grows faster after the age of 16 among people with lower IQ level.
Another study conducted in the Great Britain involved 17,414 individuals. The IQ level was assessed at the age of 11. BMI was evaluated at the ages of 16, 23, 33 and 42. The results of this study also confirm that lower childhood IQ level leads to obesity in adulthood.
Obesity leads to faster aging of brain
Our brain changes during the natural aging process. As we become older, the brain loses white matter and shrinks. But the rate of aging process is not the same for every person. Individual factors may lead to faster or slower age-related brain changes. One of these factors that affects our brain structure is excess body weight. Obesity alters the normal aging process by speeding it up.
Research study conducted at the University of Cambridge concluded that obese people have less white matter in their brain compared to normal weight individuals. The brain structure of 473 individuals was investigated in this study. The data showed that the brain of obese people appears to be up to ten years anatomically older in comparison with the normal weight counterparts.
Another study conducted on 733 middle aged individuals showed that obesity is strongly linked with the loss of brain mass. Scientists measured body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) of participants and used brain MRI to find and identify the signs of brain degeneration. The results demonstrated that brain degeneration is more extensive in people with higher BMI, WC, WHR than in normal weight persons. The scientists hypothesize that this loss of brain tissue may lead to dementia, although there are no hard proofs at present.
Obesity changes the way we feel
Apart from structural changes, obesity can also change the way our brain works. Dopamine is one of the neurotransmitters which is involved in reward circuits and motivation. One study concluded that concentration of available dopamine receptors in the brain is in correlates with BMI. Individuals with higher BMI have a lower concentration of available dopamine receptors that may lead to a lack of pleasure after eating normal size portions and the urge to eat more to feel satisfied.
This view was confirmed by another study which analyzed the response of obese people to milkshakes during a period of time. Their response was analyzed using functional MRI. The measurements were repeated half a year later and showed that brain response was a lot weaker in people who gained excess body weight between two measurements. The researchers concluded that obese individuals feel less satisfaction when eating in comparison to lean individuals, due to a lower concentration of dopamine receptors in the brain.
The research on the effects of obesity on brain functions are still in infancy but the findings described above are already alarming enough. I think it is important to raise the public awareness about this issue. The negative impact of obesity on general health is well publicized, but hardly anyone ever mentions how bad the excess body weight can be for our cognitive functions.
References
Chandola, T., Deary, I.J., Blane, D., and Batty, G.D. (2006) Childhood IQ in relation to obesity and weight gain in adult life: the National Child Development (1958) Study. International Journal of Obesity, 30: 1422–1432. doi:10.1038/sj.ijo.0803279
Debette, S., Beiser, A., Hoffmann, U., DeCarli, C., O’Donnell, C. J., Massaro, J. M., Au, R., Himali, J. J., Wolf, P. A., Fox, C. S. and Seshadri, S. (2010) Visceral fat is associated with lower brain volume in healthy middle-aged adults. Ann Neurol., 68: 136–144. doi:10.1002/ana.22062
Kanazawa, S. (2014) Intelligence and obesity: which way does the causal direction go?. Curr Opin Endocrinol Diabetes Obes, 21:339–344. DOI:10.1097/MED.0000000000000091
Ronan, L., Alexander-Bloch, A.F., Wagstyl, K.,Farooqi, S., Brayne, C., et al. (2016) Obesity associated with increased brain age from midlife. Neurobiology of Aging, 47: 63-70. DOI: http://ift.tt/2aw6HFo
Stice, E., Yokum, S., Blum, K., and Bohon, C. ( 2010) Weight Gain Is Associated with Reduced Striatal Response to Palatable Food. The Journal of Neuroscience, 30(39): 13105-13109. doi: 10.1523/JNEUROSCI.2105-10.2010
Wang, G.J., Volkow, N.D., Logan, J., Pappas, N.R., Wong, C.T., Zhu, W., Netusll, N., Fowler, J.S. (2001) Brain dopamine and obesity. Lancet, 357: 354-357. DOI: 10.1016/S0140-6736(00)03643-6
Yu, Z. B., Han, S. P., Cao, X. G. and Guo, X. R. (2010) Intelligence in relation to obesity: a systematic review and meta-analysis. Obesity Reviews, 11: 656–670. doi:10.1111/j.1467-789X.2009.00656.x
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via Brain Blogger Read More Here..4% drop in applications to study medicine, latest figures reveal
| Reflects ongoing trend; BMA blames demoralised NHS, junior doctors’ dispute, and Brexit Related items from OnMedica Brexit could allow tougher tests for EU doctors Recruitment drive begins to attract GPs Junior doctors lose legal challenge against health secretary over contract BMA: Government puts politics before patients GMC warns of 'state of unease' amongst doctors |
Government set to miss target for recouping costs of overseas visitor care
| Projected annual £500m by 2017-18 likely to fall short by £150m Related items from OnMedica It ‘beggars belief’ that seven-day NHS plans are uncosted, say MPs Missed A&E targets reflect cuts in social care and NHS funding Doctors say Budget must deliver more social care cash NHS funding system ‘not fit for purpose’ Fewer staff in NHS needed to get finances balanced |
Radiotherapy gets the investment it needs
| £130m fund over the next two years for new radiotherapy machines Related items from OnMedica Radiotherapy during breast cancer surgery cuts cost and time Radiotherapy equipment to be upgraded, NHS chief pledges Access to advanced brain treatments set to double More investment needed in radiotherapy and surgery CCGs struggling to meet cancer targets |
On The Pulse - October 2016
| Anti-inflammatory drugs to treat depression |
Birth control: Male contraceptive injection 'shows promise'
A hormone injection has been shown to be a safe and effective method of contraception - for men. via BBC News - Health Read More Here..
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NI woman charged over abortion pills
A woman was reported to police and charged in connection with using abortion pills after she sought medical help, BBC NI learns. via BBC News - Health Read More Here..
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Thursday, 27 October 2016
Male contraceptive pill works – but side effects halt trial
The injection was effective in nearly 96 per cent of couples, but researchers have voiced concerns over side effects including depression, muscle pain, acne and increased libido via New Scientist - Health Read More Here..
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New Guidelines Urge Diabetics to Move More
They should do light physical activity every 30 minutes, not every 90 minutes
Source: HealthDay via Exercise and Physical Fitness New Links: MedlinePlus RSS Feed Read More Here..
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