Depression and Diabetes

A recent study shows that a diabetic is twice as likely to be suffering from depression compared to those suffering from depression without diabetes. This new link is making doctors change their treatment into something more “holistic and very patient-centered,” said Dr. Sherita Golden, professor at Johns Hopkins University of Medicine in Baltimore, Maryland.

Golden is a diabetes management expert that learned early in her career about the dangerous diabetes-depression connection. Golden recalls a very distressed patient that struggled with diabetes for such a long time to the point of wanting to commit suicide. Golden agrees that treating both mental and physical aspects of diabetes together is incredibly important. Golden’s patients have seen an evaluated blood sugar during stressful times in their lives.

Studies are currently being conducted at Johns Hopkins in order to understand the depression-diabetes link. Golden states that “20% of our clinic population with Type 2 diabetes screens positive for depressive symptoms.” More research needs to be done in order to understand whether diabetes causes depression and depressive symptoms or if depression and its symptoms impact blood sugar levels to the point of possibly worsening diabetic symptoms.

Golden and other diabetes experts agree that most of their diabetic patients do best when treated not only in a familiar setting but also in conjunction with mental health services in a clinic or office where they get their primary care. On the American Diabetes Associations website one can find tips for spotting depression and those that have several of the symptoms for two weeks or more are urged to seek professional help.

Predicting Local Transmission of Zika in the United States

A study has determined that while weather conditions may be suitable for the mosquitoes that carry the Zika virus throughout the the United States, typically we see the Aedes (Ae.) aegypti mosquito during summer months (July-September). The highest concentration of these mosquitoes will occur in the Southeast and South Texas.

The researchers who published their work in PLOS Current Outbreaks, analyzed 50 US cities in or near the range where the specific type of mosquito, Ae. aegypti, carries and transmits the Zika virus is known to appear. They note that socioeconomic factors will likely influence contact with mosquitoes that carry the virus with impoverished communities at a higher risk due to elevated risk factors, such as lower use of air conditioning, poorer housing infrastructure, and decreased access to safe water and sanitation.

While the abundance of the mosquitoes was zero or near zero in the United States in January, with the exception of Southern Florida and Texas, the authors expect that to change as the weather warms. For example, by mid-summer, cities like Denver, Albuquerque and Louisville, which are not always in the range for Ae. aegypti, will see a potential abundance of the infected mosquitos.

However, the summer months are not the only times of risk. Conditions for the Ae. aegypti will remain suitable through November for southern and western states. Then, by December, most of the country will be unsuitable again with the exceptions of Southern Florida and Texas.

Furthermore, introduction of the virus into local populations of Ae. aegypti is more likely seen in cities that have high volumes of people arriving from areas where there is already transmission of the Zika virus going on, such as Houston, Texas; Miami, Florida and Orlando, Florida, as well as towns along the US-Mexico border.

However, one limitation of the study is that it only included the contiguous United States, so states and territories where risk of transmission of Ae. aegypti-transmitted viruses is already high, such as Hawaii, Puerto Rico and areas in the South Pacific were excluded.

“Despite the limitations, our analysis is a step towards simultaneously mapping the geographic and seasonal suitability of the vector mosquito Ae. aegypti in the contiguous United States,” the authors concluded. “There is a need for enhanced, long-term, nationally-coordinated, local-level surveillance of both Aedes mosquitoes and Aedes-transmitted viruses, particularly in areas where simulations indicate Ae. aegypti populations may be high and coincide with more frequent travel between the U.S. and countries where Zika is circulating.”

What Is Autism and Autism Spectrum Disorder?

April is National Autism Month!
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Unlike many health conditions, autism, a disorder that involves abnormal development and function of the brain, is unique in that it is considered a spectrum disorder. Autism spectrum disorder (ASD) results in difficulties in social interaction and in verbal and nonverbal communication. ASD is also characterized by the presence of repetitive movements, such as hand flapping or body rocking, an insistence on sameness, and a resistance to change. In some cases, people with ASD show behaviors of aggression or self-injury.

Brief History

Prior to 2013, autism disorders were recognized as distinct subtypes, such as autistic disorder, childhood disintegrative disorder, and Asperger syndrome. However, in 2013, the DSM-5 diagnostic manual merged all of these disorders under the umbrella diagnosis of ASD.

Major Brain Structure Implicated in Autism
Major Brain Structure in Autism

ASD is associated with intellectual disability, difficulties in motor coordination, and attention and physical health issues. However, some people with ASD do excel in specific areas, such as music, math or art. Not all individuals with autism have cognitive impairments and some have typical or even above average IQs.

While signs of ASD don’t emerge until between ages 2 and 3, the roots of ASD appear to be in early brain development. The Centers for Disease Control and Prevention have reported that around 1 in 68 children in the United States are identified as being on the autism spectrum. Autism was first characterized in 1943 by Leo Kanner. At the time, the prevalence of autism was thought to be 1 out of every 2,000 children.

Source of Autism

While the prevalence of autism has increased in the US, there is no established explanation for the rise in ASD, but improved diagnosis and awareness may be one explanation, according to Autism Speaks. The popular theory that vaccines cause autism has been disproven by numerous studies conducted worldwide, confirmed the Autism Science Foundation.

While the cause of autism is unknown, researchers have determined that autism is a strongly inherited disorder. For example, scientists have found that if one identical twin has autism then there is an 80% to 90% chance that the other twin will be diagnosed with ASD. Among non-identical twins, the chance drops drastically to just 3% to 10% that both twins will develop ASD. The chance that siblings will both be effects is also around 3% to 10%.

157 Pregnant Women in the US Being Monitored for Zika Virus Infections

The number of pregnant women in the US with the Zika virus is going up as the Centers for Disease Control and Prevention (CDC) reevaluates how it reports cases.

Previously, pregnant women with an asymptomatic Zika virus infection who do not have known pregnancy complications were not reportable. However, the CDC established new surveillance systems to monitor pregnancies and congenital outcomes among women with laboratory evidence of Zika infections but no symptoms.

As of May 12, 157 pregnant women in US states and 122 pregnant women in US territories were being monitored for evidence of possible Zika virus infection. These systems are monitoring clinical presentation of the infection, all prenatal testing, and adverse consequences of the virus during pregnancy in order to better understand the risk for congenital infection and the spectrum of adverse congenital outcomes.

“These data will improve clinical guidance, inform counseling messages for pregnant women, and facilitate planning for clinical and public health services for affected families,” according to the CDC’s Morbidity and Mortality Weekly Report.

The criteria for the Zika virus among asymptomatic or symptomatic pregnant women include the presence of fever, rash, arthralgia, or conjunctivitis, Guillain-Barré syndrome, or an adverse pregnancy outcome, such as fetal loss or in utero findings of microcephaly. The clinical criteria for Zika virus congenital infection in infants include microcephaly, intracranial calcifications, or other central nervous system abnormalities.

Among the 157 women in the states being monitored, only 49% reported clinical symptoms consistent with Zika virus and among the 122 pregnant women in the US territories, 66% reported clinical symptoms.

“Limiting surveillance to symptomatic women with confirmed or probable Zika virus disease or to women already affected by an adverse pregnancy outcome excludes a substantial proportion of women with asymptomatic and possible Zika virus infection during pregnancy,” according to the report.

However, the expanded definition being used can also overestimate Zika virus infection among pregnant women being screened because of crossreactivity with dengue and other, similar viruses.

“Findings from these U.S. surveillance systems are expected to improve understanding of Zika virus infection during pregnancy, enhance risk assessment and counseling of pregnant women and families, advance clinical care, and assist states and territories to anticipate and plan needed resources and increase prevention efforts,” the report concluded.

Senate Clears Procedural Hurdle On Zika $1.1 Billion Funding Bill

CBS Evening News has reported that the Senate moved closer to approving the $1.1 billion in new funding that will help fight the spread of the Zika virus, “but that’s only about half” of what President Obama asked for.

The House, meanwhile, “wants even less: $622 million.” Health officials are cautioning that the mosquito borne illness will become more prominent in the US soon. There are already more than 100 cases in Florida. With the coming summer months just around the corner, there is no doubt that this will be the case.

Dr. Jon LaPook who is  the chief medical correspondent for CBS News and is Professor of Medicine at the NYU School of Medicine quoted CDC Director Dr. Thomas Frieden as stating that the lack of funding is “mind-boggling. This is no way to fight an epidemic. We’re basically nickeling and diming the response when we know there are urgent needs that aren’t getting met.” LaPook added, “I’m hearing similar sentiments at every level of public government.” LaPook concluded by saying, “you have to ask yourself, as public health officials are asking, do we really need to wait for” Zika to spread locally “before springing into action and mounting a full court press that is so desperately needed.”

The Washington Post reported that the “House Republicans are balking at the proposal, as they plan to move their own aid bill later this week.” By a 68-29 vote, the Senate “cleared a key procedural step that will now allow senators to adopt a bipartisan spending amendment…that beat out two competing proposals.” It is unclear, however, how soon Senate leaders will be able to “settle their differences with House Republicans, who are reluctant to approve new funds unless they are offset with cuts elsewhere in the budget.”

Gene Mutations and Cancer Risk

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Since Angelina Jolie opened up about her BRCA1 gene mutation, more awareness about this mutation is spreading. Due to her announcement, public awareness skyrocketed and more women were getting tested. So much so that it became a phenomenon known as the Angla Joli Effect.

What Are the Chances of Getting Breast Cancer if You Have the BRCA1 Gene?

Those who test positive for an abnormal BRCA1, BRCA2, or PALB2 gene are learning their chance for breast cancer is higher than that of the average woman. An average woman without the mutation only has a 12% chance of getting breast cancer in her lifetime according to the  National Cancer Institute, whereas a woman with BRCA1 or BRCA2 has up to an 85% chance of getting breast cancer in her lifetime. The chance for ovarian cancer also increases with the gene mutations to about 16-44% chance compared to just under 2% for the average woman without the mutation. Women with BRCA1 are also more likely to develop estrogen-negative cancers, meaning that a cancer’s growth is not caused by the hormone estrogen. Anti-estrogen hormone therapy is not a viable treatment option and since these cancers tend to be more aggressive it’s important they are caught early. BRCA2 mutation-caused cancers however can benefit from hormonal therapy according to the American Cancer Society.

BRCA1, BRCA2 Prevention

This information is incredibly important because it gives women a chance to lower their risk through a variety of methods starting with an annual breast MRI at age 25. This is of great significance as BRCA1 and BRCA2 cancers tend to be aggressive and it is important to catch them early. Other risk-lowering methods include prophylactic surgery such as a double mastectomy and oophorectomy.

BRCA1 and BRCA2 not only affect women, but men are also at risk. Men with BRCA1 or BRCA2 mutation have an increased chance of developing prostate cancer and a higher lifetime risk of developing male breast cancer. Both women and men with the mutation are also at an elevated risk of developing pancreatic cancer. Those with a family history of breast or ovarian cancer should consider being tested for these mutations. Those with  Ashkenazi Jewish ancestry are also more likely to have the BRCA1 or BRCA2 mutation.  

The PALB2 gene mutation increases the chance of breast cancer to about 58% percent. Research about this gene is ongoing to find out how it affects the likelihood of developing other cancers such as ovarian and pancreatic.  

 

Physician Group Recommends CBT-I as First Choice to Treat Chronic Insomnia

Man-having-trouble-sleeping-squeezes-a-pillow-around-his-earsInsomnia is a sleep disorder whereby people have difficulty falling and/or staying asleep.

This differs from sleep apnea, which is a disorder that affects your breathing and subsequently, causes your breathing to stop and start. Dr. Robert Gaerlick, a sleep apnea specialist in Long Island, NY provides a very good explanation of the disorder if you’d like to learn more.

People with insomnia have one or more of the following symptoms:

    • Difficulty falling asleep
    • Waking up often during the night and having trouble going back to sleep
    • Waking up too early in the morning
    • Feeling tired when waking up

While there are many methods available to combat insomnia, a recent study points to one specific recommendation.

A recent AP report cited new guidelines issued by the American College of Physicians in the Annals of Internal Medicine stating “… the first choice to treat chronic insomnia should be cognitive behavioral therapy [CBT].”

The group “said Monday the method known as CBT can be effective and doesn’t carry the side effects of medication, a recommendation intended to spur primary care” physicians to prescribe the therapy. They stated that if CBT is not effective for any particular individual, then physicians could consider prescribing medication.

The CBT recommended for people with insomnia is called CBT-I, “which blends talk therapy and sleep tutorials, and has been shown to help a majority of patients recover some normalcy in their sleep quality and duration.” The therapy “requires a trained clinician,” however, “of which there are few in even the country’s biggest cities.”

The NBC News website reported that in putting together the guidelines, “a team at the organization looked at research on insomnia and at an evidence review by the Agency for Healthcare Research and Quality.”

There are also some foods you should eat and others you should not eat if you have sleep apnea. Fruits and vegetables and whole grains are recommended. For a more complete list of foods for/against sleep apnea, click here.

Zika Virus Confirmed to Cause Birth Defects

The more researchers learn about the Zika virus, the scarier it becomes. In a new report published in the New England Journal of Medicine, CDC researchers confirm that Zika causes a rare birth defect.

Birth Defect from Zika Virus
An example of an infant with microcephaly, as a result of the Zika Virus in the parent

CDC Director Dr. Thomas Frieden said that “it is now clear” that Zika causes microcephaly, a rare birth defect. In addition, the virus causes several other severe fetal abnormalities. The virus is now being linked to a broad set of complications in pregnancy as well, such as premature birth and eye problems.

“Most of what we’ve learned is not reassuring,” Dr. Ann Schuchat, the principal deputy director of the CDC, said candidly at a White House briefing. “Everything we look at with this virus seems to be a bit scarier than we initially thought.”

Another study published in Science from a team of scientists in Brazil concluded that Zika “targets” human brain cells. After studying human neural stem cells that had been infected with the virus, the scientists found that the cells were misshapen and necrotic.

However, the general public in the United States seems largely unconcerned about Zika virus infection in the continental US, according to The New York Times. However, the CDC has reported that the mosquitoes that carry the virus are present in 30 states, up from the 12 states initially thought. In Puerto Rico there are already hundreds of local transmissions of the virus and Dr. Schuchat said there are potentially hundreds of affected babies in the US territory.

While the CDC does not expect large outbreaks of the Zika virus in the continental US, there will be some local transmissions, and the virus is now expected to be a problem during much of a pregnancy, not just the first trimester. As a result, pregnant women or women expecting to become pregnant are being warned against travel to Zika-infected countries. At the very least they should take precautions against mosquito bites.

Parkinson’s Awareness Month

This April is Parkinson’s Awareness Month. Many organizations use the month of April to bring awareness to the disease. Parkinson’s disease (also known as PD) is a chronic movement disorder that gets worse over time. Over one million people in the US are living with Parkinson’s disease. The cause of this disease is unknown and there is no cure; however; there are various treatments available, such as surgery and medication that can help manage some of the symptoms.

Parkinson’s occurs when crucial nerve cells in the brain, called neurons malfunction and die. These neurons are also responsible for producing dopamine, a chemical that affects movement. When the amount of neurons in the brain is reduced, dopamine is also reduced. A person is unable to control movement normally when the amount of dopamine in the brain is decreased.

Symptoms of Parkinson’s disease include slowness of movement, tremor of the hands, arms, legs, jaw, and face, stiffness of the limbs, and an impaired balance and coordination.

This Saturday, April 30th, the 22nd Parkinson’s Unity Walk will take place in Central Park. Legendary boxer Muhammad Ali’s daughter Maryum is bringing awareness to the disease. Her father was in his late 30s when his family began to notice symptoms of Parkinson’s. Maryum, along with Carol Walton, the CEO of the Parkinson Alliance, will attend the walk. Walton said in an interview with CBS news, “one of the most important messages we are still trying to get out is that if you are diagnosed with Parkinson’s, you absolutely must go see a Movement Disorder specialist, not just a neurologist.” Movement disorder specialists have two more years of training in these types of movement disorders. The type of treatment recommended can make a huge difference in the treatment of Parkinson’s.

The Unity Walk not only raises awareness of the disease but also helps to bring more funds for research, as well as provide a day of community and education. Maryum went on to say, “if my dad had something like a Unity Walk when he was first diagnosed, he wouldn’t have felt so alone.”

Raising Awareness for Autism This April

Although the percentage of children with autism spectrum disorder (ASD) is high, autism awareness remains a pressing need. As a result, the month of April has been designated Autism Awareness Month, a nationwide effort to promote autism awareness, inclusion, and self-determination for all and assure that people with ASD have the opportunity to achieve the highest possible quality of life.

“If we want to promote awareness, let’s raise awareness about the challenges and triumphs faced by individuals with autism,” wrote Scott Badesch, president and CEO of the Autism Society.

Today, more than 3 million individuals live with autism. Many adults being diagnosed with ASD were not properly diagnosed as children and are now finding out they have autism.

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New data from the CDC found that about 1 in 68 children, or 1.5%, were diagnosed with ASD. Between 2002 and 2010, there was an increase in the number of children identified with ASD, and from 2010 to 2012, there has been no change.

However, the CDC has reported that it is too soon to tell if the percentage of children identified with ASD has actually stabilized or is still increasing. This is because the data is based on information from 11 communities in Arizona, Arkansas, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin, and while the average percentage of children identified with ASD stayed the same, the percentage had increased significantly for 2 communities.

According to the Autism Society, there is no defined cause for autism, which means there is no way to link any suggested cause to the incidence rate. In addition, there is no cure for autism.

“More research is also needed on treatment and support interventions to determine what is the best treatment and support that can be provided to individuals on the autism spectrum to best address their desire to increase their quality of life each and every day,” according to the society.