A researcher from the Faculty of Medicine & Dentistry at the University of Alberta has discovered a mechanism underlying some forms of obesity and addictions which could lead to a treatment for both diseases.
When a hungry animal finds food in the wild, it is a rewarding stimulus for the animal and is recognized by the brain by the release of the chemical messenger dopamine. Because narcotics such as cocaine, heroin and amphetamines, and even tasty and highly-caloric foods also cause the release of dopamine and therefore make people feel rewarded, it's clear that dopamine has a role in addiction and the development of obesity. When an animal knows it can expect rewarding stimuli, like a treat, in a certain location, either in the wild or captivity, this is called 'conditioned place preference' and is dependent on spatial memories being formed in a specific part of the brain called the dentate gyrus.
Professor Bill Colmers and his research group, in the department of pharmacology, set out to find if dopamine may have an effect on the memory-forming brain cells in the dentate gyrus. His group used living brain slices from laboratory models and were able to mimic activity in brain cells when an animal is exploring a novel environment. When dopamine was added, it increased the excitability in part of the brain cell called the dendrites. A chemical secreted by the brain, Neuropeptide Y, had the opposite effect making the cells less excitable.
They took this experiment further by looking at a model called long term potentiation, which is the name for a form of cellular learning. When the scientists stimulated dopamine receptors they found that cellular learning was strengthened. While doing the same experiment with neuropeptide Y, applied together with dopamine, it prevented long-term potentiation from happening
The group also did this in human brain slices taken from patients undergoing therapy for temporal lobe epilepsy. The human brain cells showed the same properties as cells found in rats, and they also undergo dopamine-dependent cellular learning when stimulated in the same fashion as the laboratory models.
Considering Colmers and his group's major focus is in obesity, this is a very exciting finding.
"You can find the fridge and you know there's good stuff in there, so you can find it in your sleep, and people do," said Colmers. "So there's this whole reward aspect to place that we've been able to unravel."
These results help explain the mechanisms that underlie the formation of reward-cued spatial memories in both the laboratory model and human dentate gyrus. Understanding this mechanism not only explains the biology of an important form of learning, but may also lead to potential treatments for addiction and obesity.
Source:
Quinn Phillips
University of Alberta Faculty of Medicine & Dentistry
четверг, 29 сентября 2011 г.
понедельник, 26 сентября 2011 г.
NASHO Policy Statement Advocates Coordination To Improve Mental Health Care
The National Association
of Specialty Health Organizations (NASHO), approved a position statement
urging improved coordination of care for individuals with mental health and
substance use disorders. NASHO's members represent provider networks,
payors and health plans that specialize in dental, vision, behavioral
health, pharmacy benefit management, radiology, complementary care, device
management, and other specialty services. The NASHO statement encourages
members, purchasers, providers, and other stakeholders to enhance coverage
and coordination of care to improve outcomes and quality.
"People with mental health and substance use disorders have complex
needs and rely on many organizations to deliver their care. We believe
current legislative initiatives in Congress should recognize that
coordination of services and information is a critical element of effective
policy," said NASHO Executive Director Julian Roberts. "NASHO members
include behavioral health care organizations, pharmacy benefit managers,
and other national organizations with unique expertise to provide efficient
and high quality specialty services. They are committed to taking on the
cross cutting needs of individuals with mental health and substance
problems."
The NASHO statement addresses the following key areas:
-- Benefits for identification and treatment of mental health and
substance use disorders;
-- Coverage for evidence-based screening, treatment and coordination of
care for mental and substance use conditions, including medications;
-- The need for HIPAA-compliant data linkages that enable sharing of
appropriate information related to medication, treatment, and
transitions of care;
-- Mechanisms to promote patient adherence and medication safety for
individuals with mental and substance use conditions;
-- Need for coordination of care for patients making transitions between
settings;
-- Need for improved performance measurement strategies to capture
information on behavioral health services provided in diverse settings.
Michele Alfano, a member of the NASHO Board of Directors and Chief
Operating Officer of ValueOptions, Inc., commented, "NASHO is in a unique
position to bring together many of the participants who have a role in
delivering quality care to individuals with mental health disorders. This
policy statement acknowledges the need to coordinate provider services,
medications, and information. Further, the statement recognizes that
diverse and specialized strategies are needed to administer care and manage
information for this multifaceted population."
Concludes Roberts, "NASHO's mission is to increase awareness of the
value that specialty health organizations bring to health care. We believe
that specialty health brings efficiency and high quality to the table.
These services are most effective when data and information are closely
coordinated. This statement illustrates our vision for improved mental
health and addiction care."
The full text of the NASHO statement can be found at:
NASHO
About NASHO
NASHO was launched in January 2003 as a subsidiary association of the
American Association of Preferred Provider Organizations (AAPPO)
(aappo) to advance and evolve specialty healthcare delivery
in the United States. Its mission is to enhance and promote the value
proposition of specialty health organizations. To learn more about NASHO,
visit nasho.
National Association of Specialty Health Organizations
nasho
of Specialty Health Organizations (NASHO), approved a position statement
urging improved coordination of care for individuals with mental health and
substance use disorders. NASHO's members represent provider networks,
payors and health plans that specialize in dental, vision, behavioral
health, pharmacy benefit management, radiology, complementary care, device
management, and other specialty services. The NASHO statement encourages
members, purchasers, providers, and other stakeholders to enhance coverage
and coordination of care to improve outcomes and quality.
"People with mental health and substance use disorders have complex
needs and rely on many organizations to deliver their care. We believe
current legislative initiatives in Congress should recognize that
coordination of services and information is a critical element of effective
policy," said NASHO Executive Director Julian Roberts. "NASHO members
include behavioral health care organizations, pharmacy benefit managers,
and other national organizations with unique expertise to provide efficient
and high quality specialty services. They are committed to taking on the
cross cutting needs of individuals with mental health and substance
problems."
The NASHO statement addresses the following key areas:
-- Benefits for identification and treatment of mental health and
substance use disorders;
-- Coverage for evidence-based screening, treatment and coordination of
care for mental and substance use conditions, including medications;
-- The need for HIPAA-compliant data linkages that enable sharing of
appropriate information related to medication, treatment, and
transitions of care;
-- Mechanisms to promote patient adherence and medication safety for
individuals with mental and substance use conditions;
-- Need for coordination of care for patients making transitions between
settings;
-- Need for improved performance measurement strategies to capture
information on behavioral health services provided in diverse settings.
Michele Alfano, a member of the NASHO Board of Directors and Chief
Operating Officer of ValueOptions, Inc., commented, "NASHO is in a unique
position to bring together many of the participants who have a role in
delivering quality care to individuals with mental health disorders. This
policy statement acknowledges the need to coordinate provider services,
medications, and information. Further, the statement recognizes that
diverse and specialized strategies are needed to administer care and manage
information for this multifaceted population."
Concludes Roberts, "NASHO's mission is to increase awareness of the
value that specialty health organizations bring to health care. We believe
that specialty health brings efficiency and high quality to the table.
These services are most effective when data and information are closely
coordinated. This statement illustrates our vision for improved mental
health and addiction care."
The full text of the NASHO statement can be found at:
NASHO
About NASHO
NASHO was launched in January 2003 as a subsidiary association of the
American Association of Preferred Provider Organizations (AAPPO)
(aappo) to advance and evolve specialty healthcare delivery
in the United States. Its mission is to enhance and promote the value
proposition of specialty health organizations. To learn more about NASHO,
visit nasho.
National Association of Specialty Health Organizations
nasho
пятница, 23 сентября 2011 г.
Limited Benefits Of Red Wine
One glass of red wine can be good for you, but a second may not, reports the Daily Mail. The first drink relaxes the blood vessels and "reduces the amount of work the heart has to do", the newspaper says, but the second "countered any health benefits - increasing the risk of high blood pressure, coronary artery disease and heart failure".
The story is based on a small study that looked at the direct effects of red wine, plain alcohol, and water on people, using complex measurements of the heart, blood vessels and nervous system. This is the latest addition to the continuing debate of what may be a safe or even optimal amount of alcohol to drink for health. Red wine in particular has repeatedly been hailed as a protection against heart disease.
Although this study found a difference in the results when one drink was given compared with two, it is difficult to see how the experiment relates to real-life drinking patterns, as the trial was conducted in only 13 people, and each of the drinks given on only one occasion. Studies that examined the effects of different alcohol doses over longer periods in more people might produce useful results. At the moment, it seems sensible to follow standard recommendations for limits to alcohol consumption.
Where did the story come from?
Dr Jonas Spaak and colleagues of University of Toronto and Liquor Control Board of Ontario, Canada, carried out this research. The study was supported by Operating Grants from the Heart and Stroke Foundation of Ontario and the Canadian Institutes of Health Research. It was published in the (peer-reviewed): American Journal Physiology of Heart.
What kind of scientific study was this?
This was a small randomised crossover trial designed to investigate the potential benefits of alcohol consumption on blood circulation, blood vessel function and its related nervous system supply, and whether these effects are dose-dependent (how they change with the quantity consumed) or affected by whether red wine or diluted pure alcohol is consumed.
The researchers selected a group of 13 healthy non-Asians (seven men and six women), who normally drank moderate quantities of alcohol. On three separate occasions during the trial period each of the participants were randomly assigned to drink either water, red wine or ethanol (diluted pure alcohol). During each of the test sessions, the volunteers were seated and linked to an ECG (heart monitor), blood pressure machine. They had an electrode placed in one of the nerves of the leg, and a hand-held ultrasound machine was used to detect heart output and blood flow in the arm in response to changes in pressure change of the blood pressure cuff. Blood was also drawn from the arm for measurements of chemical levels in the blood.
After the first set of measurements were taken, the volunteer drank the alcohol, wine or placebo over five minutes. The measurements were repeated when the peak blood alcohol had reached a target level (using a breathalyser). The measurements were repeated for a third time after the second drink had been given and the peak blood alcohol had reached a higher target level. At the end of the test, a urine sample was taken. There was a two-week period between each of the three test sessions.
A named brand of red wine was used which is known to have high levels of resveratrol and catechin - the chemicals believed to have heart-protective and anti-oxidant properties. For the other alcoholic drink, 95% ethanol was diluted with Perrier water to an equivalent concentration. Perrier water was used as the control.
What were the results of the study? The circulatory output of the heart fell slightly after water and after one drink of red wine or ethanol, but increased after two drinks of either alcohol compared with water. Also, one drink did not alter sympathetic nerve activity (nerve impulses that are not consciously controlled, e.g. the fight or flight response), but two drinks of either alcohol significantly increased nerve activity compared with water.
There was significant increase in the diameter of the main artery in the arm after both one and two drinks of alcohol compared with water. There was no effect of any of the drinks upon the artery diameter (after conducting a test to see how much the artery would dilate when increasing the pressure in the blood pressure cuff to a level that would cause the arm to go red). Ethanol and red wine had no effects overall on either blood pressure of heart rate (although two glasses of wine slightly raised heart rate). Red wine significantly raised blood levels of resveratrol and catechin.
What interpretations did the researchers draw from these results? The authors conclude that one alcoholic drink (either red wine or ethanol) causes blood vessel dilation without an increase in heart rate or sympathetic nerve activity. When compared with water, two drinks increases heart circulatory output, sympathetic nerve activity, and heart rate (red wine only), with no increase in blood pressure. Despite wine causing higher blood levels of resveratrol and catechin - the chemicals believed to have heart-protective and anti-oxidant properties - no differences in measurements were found compared with plain alcohol.
What does the NHS Knowledge Service make of this study?
This is a complex and well-conducted scientific experiment. However, there are several points to note when interpreting the results:
- This is a small study of only 13 volunteers who received each drink once only. It is unclear how this experimental situation relates to any real-life drinking pattern. Studies examining the effects of different alcohol doses over a longer period of time (e.g. one glass per day compared with two) and in a much greater number of people would be valuable.
- Overall, there were no differences found in the effects of two glasses of wine compared with two glasses of plain alcohol; therefore the findings are not limited to wine drinking as the newspaper headlines may imply.
- Importantly, there is nothing to suggest from this study that "a second glass is bad for the heart". It is unclear how the small changes in sympathetic nerve activity, blood vessel diameter and heart output after two glasses of wine or alcohol on a single tested occasion in this study would relate to health.
- The size and alcohol content of the "drink" given in this study may not be comparable to the real life situation. The researchers calculated the alcohol concentration and volume that they believed would be needed to reach the target blood level in a particular individual. The earlier part of the report mentions the American Heart Association Nutrition Committee defining one drink as 120ml glass of wine or a 44ml shot of spirit; however, in the study different quantities of alcohol were taken by each of the volunteers depending on bodyweight.
- The second drink of alcohol was consumed after the breathalyser test had fallen to a defined alcohol level. However, it is not possible to say for certain whether any affects on the heart, blood vessels, or nervous system from the first drink may have continued after this time and could be clouding the effects of the second drink. Likewise, the effects of two drinks were not followed over an extended period.
- Although the study is reported as being single-blind (i.e. either the investigators or the participants did not know which of the study drinks were given) no further details of this are given. Presumably, the investigators would have been unaware of the drinks, as the participants would be able to tell which of the drinks they were consuming. However, even if this were the case, as they were checking for a rise in blood alcohol levels it would seem they would be able to tell when water had been taken. This may have led to some bias in result reporting; although as all measurements were objective this is uncertain.
- This trial is only conducted in non-Asian populations and findings may not be transferable to these groups.
Many questions have been raised by this research and further study would be needed to try and provide some of the answers. At the current time, it seems sensible to follow standard recommendations for alcohol consumption.
Links to the headlines
A second glass of red wine 'is bad for your heart'. Daily Mail, February 14 2008
Links to the science
Dose-related effects of red wine and alcohol on hemodynamics, sympathetic nerve activity, and arterial diameter.
Spaak J, Merlocco AC, Soleas GJ, et al.
Am J Physiol Heart Circ Physiol 2008; 294:H605-H612
This news comes from NHS Choices
The story is based on a small study that looked at the direct effects of red wine, plain alcohol, and water on people, using complex measurements of the heart, blood vessels and nervous system. This is the latest addition to the continuing debate of what may be a safe or even optimal amount of alcohol to drink for health. Red wine in particular has repeatedly been hailed as a protection against heart disease.
Although this study found a difference in the results when one drink was given compared with two, it is difficult to see how the experiment relates to real-life drinking patterns, as the trial was conducted in only 13 people, and each of the drinks given on only one occasion. Studies that examined the effects of different alcohol doses over longer periods in more people might produce useful results. At the moment, it seems sensible to follow standard recommendations for limits to alcohol consumption.
Where did the story come from?
Dr Jonas Spaak and colleagues of University of Toronto and Liquor Control Board of Ontario, Canada, carried out this research. The study was supported by Operating Grants from the Heart and Stroke Foundation of Ontario and the Canadian Institutes of Health Research. It was published in the (peer-reviewed): American Journal Physiology of Heart.
What kind of scientific study was this?
This was a small randomised crossover trial designed to investigate the potential benefits of alcohol consumption on blood circulation, blood vessel function and its related nervous system supply, and whether these effects are dose-dependent (how they change with the quantity consumed) or affected by whether red wine or diluted pure alcohol is consumed.
The researchers selected a group of 13 healthy non-Asians (seven men and six women), who normally drank moderate quantities of alcohol. On three separate occasions during the trial period each of the participants were randomly assigned to drink either water, red wine or ethanol (diluted pure alcohol). During each of the test sessions, the volunteers were seated and linked to an ECG (heart monitor), blood pressure machine. They had an electrode placed in one of the nerves of the leg, and a hand-held ultrasound machine was used to detect heart output and blood flow in the arm in response to changes in pressure change of the blood pressure cuff. Blood was also drawn from the arm for measurements of chemical levels in the blood.
After the first set of measurements were taken, the volunteer drank the alcohol, wine or placebo over five minutes. The measurements were repeated when the peak blood alcohol had reached a target level (using a breathalyser). The measurements were repeated for a third time after the second drink had been given and the peak blood alcohol had reached a higher target level. At the end of the test, a urine sample was taken. There was a two-week period between each of the three test sessions.
A named brand of red wine was used which is known to have high levels of resveratrol and catechin - the chemicals believed to have heart-protective and anti-oxidant properties. For the other alcoholic drink, 95% ethanol was diluted with Perrier water to an equivalent concentration. Perrier water was used as the control.
What were the results of the study? The circulatory output of the heart fell slightly after water and after one drink of red wine or ethanol, but increased after two drinks of either alcohol compared with water. Also, one drink did not alter sympathetic nerve activity (nerve impulses that are not consciously controlled, e.g. the fight or flight response), but two drinks of either alcohol significantly increased nerve activity compared with water.
There was significant increase in the diameter of the main artery in the arm after both one and two drinks of alcohol compared with water. There was no effect of any of the drinks upon the artery diameter (after conducting a test to see how much the artery would dilate when increasing the pressure in the blood pressure cuff to a level that would cause the arm to go red). Ethanol and red wine had no effects overall on either blood pressure of heart rate (although two glasses of wine slightly raised heart rate). Red wine significantly raised blood levels of resveratrol and catechin.
What interpretations did the researchers draw from these results? The authors conclude that one alcoholic drink (either red wine or ethanol) causes blood vessel dilation without an increase in heart rate or sympathetic nerve activity. When compared with water, two drinks increases heart circulatory output, sympathetic nerve activity, and heart rate (red wine only), with no increase in blood pressure. Despite wine causing higher blood levels of resveratrol and catechin - the chemicals believed to have heart-protective and anti-oxidant properties - no differences in measurements were found compared with plain alcohol.
What does the NHS Knowledge Service make of this study?
This is a complex and well-conducted scientific experiment. However, there are several points to note when interpreting the results:
- This is a small study of only 13 volunteers who received each drink once only. It is unclear how this experimental situation relates to any real-life drinking pattern. Studies examining the effects of different alcohol doses over a longer period of time (e.g. one glass per day compared with two) and in a much greater number of people would be valuable.
- Overall, there were no differences found in the effects of two glasses of wine compared with two glasses of plain alcohol; therefore the findings are not limited to wine drinking as the newspaper headlines may imply.
- Importantly, there is nothing to suggest from this study that "a second glass is bad for the heart". It is unclear how the small changes in sympathetic nerve activity, blood vessel diameter and heart output after two glasses of wine or alcohol on a single tested occasion in this study would relate to health.
- The size and alcohol content of the "drink" given in this study may not be comparable to the real life situation. The researchers calculated the alcohol concentration and volume that they believed would be needed to reach the target blood level in a particular individual. The earlier part of the report mentions the American Heart Association Nutrition Committee defining one drink as 120ml glass of wine or a 44ml shot of spirit; however, in the study different quantities of alcohol were taken by each of the volunteers depending on bodyweight.
- The second drink of alcohol was consumed after the breathalyser test had fallen to a defined alcohol level. However, it is not possible to say for certain whether any affects on the heart, blood vessels, or nervous system from the first drink may have continued after this time and could be clouding the effects of the second drink. Likewise, the effects of two drinks were not followed over an extended period.
- Although the study is reported as being single-blind (i.e. either the investigators or the participants did not know which of the study drinks were given) no further details of this are given. Presumably, the investigators would have been unaware of the drinks, as the participants would be able to tell which of the drinks they were consuming. However, even if this were the case, as they were checking for a rise in blood alcohol levels it would seem they would be able to tell when water had been taken. This may have led to some bias in result reporting; although as all measurements were objective this is uncertain.
- This trial is only conducted in non-Asian populations and findings may not be transferable to these groups.
Many questions have been raised by this research and further study would be needed to try and provide some of the answers. At the current time, it seems sensible to follow standard recommendations for alcohol consumption.
Links to the headlines
A second glass of red wine 'is bad for your heart'. Daily Mail, February 14 2008
Links to the science
Dose-related effects of red wine and alcohol on hemodynamics, sympathetic nerve activity, and arterial diameter.
Spaak J, Merlocco AC, Soleas GJ, et al.
Am J Physiol Heart Circ Physiol 2008; 294:H605-H612
This news comes from NHS Choices
вторник, 20 сентября 2011 г.
Impact Of Young Londoners' Alcohol Misuse Revealed, England
The capital's 11-15 year olds now drink the equivalent of 180,000 bottles of lager every week - and the amount they drink is on the rise, a new report from the London Assembly today warns.
In the first comprehensive assessment of the drinking habits of the capital's young people, the report, Too much too young? also reveals that although they drink less than their peers elsewhere in the country, more than a third1 of young Londoners are regular drinkers.
The consequences are of serious concern. Almost 2,000 young people2 in the capital are receiving specialist treatment for alcohol dependence. Alcohol-related hospital admissions have almost doubled in recent years3 and calls to the London Ambulance Service relating to young people drinking have increased 27 percent in just four years4.
During its ten-month investigation, the Assembly Health and Public Services Committee also identified some worrying statistics about young Londoners' drinking habits:
- Young women aged 11-15 are drinking more heavily and now have drinking habits similar to those of their male peers. Hospital admissions for these young women are almost double those for men of the same age because of their lower tolerance of alcohol.
- There has been a substantial increase5 in the proportion of young people from Pakistani and Bangladeshi communities who drink. This raises concern that these recent increases could be the start of an ongoing trend.
- There is a wide variation in drinking habits across the capital: young people living in outer London are more likely to drink and get drunk than those in inner boroughs.
James Cleverly AM, Chair of the London Assembly Health and Public Services Committee, said: "We are very concerned by our findings that young Londoners are drinking more and more often than a few years ago. Young people's drinking is having serious repercussions on their health and on public services.
"We hope this report will highlight the problem, as well as outlining a set of recommendations that will help young Londoners stay safe with alcohol and to ensure this issue is given the priority it deserves."
The investigation found a lack of senior leadership both locally and regionally means efforts to tackle the problem are not always effectively prioritised or co-ordinated. To address this, the Committee believes the Mayor and local leaders need to focus more effort on tackling alcohol.
The report recommends that local alcohol-harm reduction champions should be appointed in boroughs where alcohol-specific hospital admissions for young people - currently Kingston and Sutton - are higher than the national average.
The Committee makes recommendations in key areas to help reduce the harm alcohol can cause, including:
Reducing the supply of alcohol to under 18s
Boroughs should set up local partnerships to reduce alcohol sales, using the successful St Neots Community Alcohol Partnership as a model for this work. This involves the local council working together with the police, alcohol retailers and others to tackle underage alcohol sales through awareness raising, intelligence sharing and joint operations. During this investigation, the Committee helped facilitate the set up of a new pilot community alcohol partnership in Croydon.
Improving education and information
A London-wide marketing campaign is needed to raise awareness of the risks and to help young people stay safe. This campaign should target specific groups, including young women, the Pakistani and Bangladeshi communities, and parents. The Government also needs to ensure alcohol is given sufficient prominence in Personal, Social and Health Education, currently under review.
Helping young people who are misusing alcohol
The NHS needs to focus more on early intervention measures to help reduce people drinking at hazardous levels before they develop long-term problems.
Notes
1. 2005/06 figures for 11-21 year olds - Profile of Young Londoners' drinking, 2009, Institute of Alcohol Studies for the London Assembly
2. Figures for 11-21 year olds from National Treatment Agency
3. In 2006, there were 1315 hospital admissions for 11-21 year olds, compared to 690 in 2002 - an increase of 91 percent. Profile of Young Londoners' drinking, 2009, Institute of Alcohol Studies for the London Assembly
4. In 2001/4 just 4 percent of Pakistani and 2 percent of Bangladeshi young people drank at least once a year. By 2005/07, this figure had grown to 10 percent and 12 percent respectively, although they are less likely to drink than young people from other communities.
5. Alcohol misuse is taken to mean alcohol consumption by young people under the age of 18, and alcohol consumption by 18-21 year olds that exceeds the Government's sensible drinking guidelines of two to three units a day for women and three to four units a day for men.
6. As well as investigating issues that matter to Londoners, the London Assembly acts as a check and a balance on the Mayor.
Source
London Assembly
In the first comprehensive assessment of the drinking habits of the capital's young people, the report, Too much too young? also reveals that although they drink less than their peers elsewhere in the country, more than a third1 of young Londoners are regular drinkers.
The consequences are of serious concern. Almost 2,000 young people2 in the capital are receiving specialist treatment for alcohol dependence. Alcohol-related hospital admissions have almost doubled in recent years3 and calls to the London Ambulance Service relating to young people drinking have increased 27 percent in just four years4.
During its ten-month investigation, the Assembly Health and Public Services Committee also identified some worrying statistics about young Londoners' drinking habits:
- Young women aged 11-15 are drinking more heavily and now have drinking habits similar to those of their male peers. Hospital admissions for these young women are almost double those for men of the same age because of their lower tolerance of alcohol.
- There has been a substantial increase5 in the proportion of young people from Pakistani and Bangladeshi communities who drink. This raises concern that these recent increases could be the start of an ongoing trend.
- There is a wide variation in drinking habits across the capital: young people living in outer London are more likely to drink and get drunk than those in inner boroughs.
James Cleverly AM, Chair of the London Assembly Health and Public Services Committee, said: "We are very concerned by our findings that young Londoners are drinking more and more often than a few years ago. Young people's drinking is having serious repercussions on their health and on public services.
"We hope this report will highlight the problem, as well as outlining a set of recommendations that will help young Londoners stay safe with alcohol and to ensure this issue is given the priority it deserves."
The investigation found a lack of senior leadership both locally and regionally means efforts to tackle the problem are not always effectively prioritised or co-ordinated. To address this, the Committee believes the Mayor and local leaders need to focus more effort on tackling alcohol.
The report recommends that local alcohol-harm reduction champions should be appointed in boroughs where alcohol-specific hospital admissions for young people - currently Kingston and Sutton - are higher than the national average.
The Committee makes recommendations in key areas to help reduce the harm alcohol can cause, including:
Reducing the supply of alcohol to under 18s
Boroughs should set up local partnerships to reduce alcohol sales, using the successful St Neots Community Alcohol Partnership as a model for this work. This involves the local council working together with the police, alcohol retailers and others to tackle underage alcohol sales through awareness raising, intelligence sharing and joint operations. During this investigation, the Committee helped facilitate the set up of a new pilot community alcohol partnership in Croydon.
Improving education and information
A London-wide marketing campaign is needed to raise awareness of the risks and to help young people stay safe. This campaign should target specific groups, including young women, the Pakistani and Bangladeshi communities, and parents. The Government also needs to ensure alcohol is given sufficient prominence in Personal, Social and Health Education, currently under review.
Helping young people who are misusing alcohol
The NHS needs to focus more on early intervention measures to help reduce people drinking at hazardous levels before they develop long-term problems.
Notes
1. 2005/06 figures for 11-21 year olds - Profile of Young Londoners' drinking, 2009, Institute of Alcohol Studies for the London Assembly
2. Figures for 11-21 year olds from National Treatment Agency
3. In 2006, there were 1315 hospital admissions for 11-21 year olds, compared to 690 in 2002 - an increase of 91 percent. Profile of Young Londoners' drinking, 2009, Institute of Alcohol Studies for the London Assembly
4. In 2001/4 just 4 percent of Pakistani and 2 percent of Bangladeshi young people drank at least once a year. By 2005/07, this figure had grown to 10 percent and 12 percent respectively, although they are less likely to drink than young people from other communities.
5. Alcohol misuse is taken to mean alcohol consumption by young people under the age of 18, and alcohol consumption by 18-21 year olds that exceeds the Government's sensible drinking guidelines of two to three units a day for women and three to four units a day for men.
6. As well as investigating issues that matter to Londoners, the London Assembly acts as a check and a balance on the Mayor.
Source
London Assembly
суббота, 17 сентября 2011 г.
Changing Perceptions About Student Drinking Reduces Alcohol Misuse
Giving students personalised feedback on their drinking behaviour and how it compares to social norms might help to reduce alcohol misuse, according to a Cochrane Systematic Review.
A large body of social science research has established that students tend to overestimate the amount of alcohol that their peers consume. This overestimation causes many to have misguided views about whether their own behaviour is normal and may contribute to the 1.8 million alcohol related deaths every year. Social norms interventions that provide feedback about own and peer drinking behaviours may help to address these misconceptions.
Researchers analysed data from 22 trials that together included 7,275 college and university students, mostly studying in the US. They found that students who were provided with personalised feedback via the internet or individual face-to-face sessions drank less often and indulged in less binge drinking than those in control groups. Web-based feedback also resulted in significant reductions in blood alcohol content and alcohol related problems.
Group counselling and mailed feedback were not found to be effective compared to control interventions, although the researchers say further studies comparing the different ways of providing social normative feedback are required. "We can't make direct comparisons between the different interventions, but based on a small number of studies web-based interventions would certainly seem to be a cost-effective option for reducing alcohol misuse," said lead researcher Maria Teresa Moreira, from the School of Health and Social Care at Oxford Brookes University in the UK.
"We know that social norms have a powerful impact on thought and behaviour, so changing people's perceptions about what is normal can really help. Most of the effects lasted for a few months, but some lasted over a year, particularly for the web-based feedback," added Moreira.
Source:
Jennifer Beal
Wiley-Blackwell
A large body of social science research has established that students tend to overestimate the amount of alcohol that their peers consume. This overestimation causes many to have misguided views about whether their own behaviour is normal and may contribute to the 1.8 million alcohol related deaths every year. Social norms interventions that provide feedback about own and peer drinking behaviours may help to address these misconceptions.
Researchers analysed data from 22 trials that together included 7,275 college and university students, mostly studying in the US. They found that students who were provided with personalised feedback via the internet or individual face-to-face sessions drank less often and indulged in less binge drinking than those in control groups. Web-based feedback also resulted in significant reductions in blood alcohol content and alcohol related problems.
Group counselling and mailed feedback were not found to be effective compared to control interventions, although the researchers say further studies comparing the different ways of providing social normative feedback are required. "We can't make direct comparisons between the different interventions, but based on a small number of studies web-based interventions would certainly seem to be a cost-effective option for reducing alcohol misuse," said lead researcher Maria Teresa Moreira, from the School of Health and Social Care at Oxford Brookes University in the UK.
"We know that social norms have a powerful impact on thought and behaviour, so changing people's perceptions about what is normal can really help. Most of the effects lasted for a few months, but some lasted over a year, particularly for the web-based feedback," added Moreira.
Source:
Jennifer Beal
Wiley-Blackwell
среда, 14 сентября 2011 г.
Dopamine Involved In Aggression
New research from Vanderbilt University shows for the first time that the brain processes aggression as a reward - much like sex, food and drugs - offering insights into our propensity to fight and our fascination with violent sports like boxing and football.
The research will be published online the week of Jan. 14 by the journal Psychopharmacology.
"Aggression occurs among virtually all vertebrates and is necessary to get and keep important resources such as mates, territory and food," Craig Kennedy, professor of special education and pediatrics, said. "We have found that the 'reward pathway' in the brain becomes engaged in response to an aggressive event and that dopamine is involved."
"It is well known that dopamine is produced in response to rewarding stimuli such as food, sex and drugs of abuse," Maria Couppis, who conducted the study as her doctoral thesis at Vanderbilt, said. "What we have now found is that it also serves as positive reinforcement for aggression."
For the experiments, a pair of mice - one male, one female - was kept in one cage and five "intruder" mice were kept in a separate cage. The female mouse was temporarily removed, and an intruder mouse was introduced in its place, triggering an aggressive response by the "home" male mouse. Aggressive behavior included tail rattle, an aggressive sideways stance, boxing and biting.
The home mouse was then trained to poke a target with its nose to get the intruder to return, at which point it again behaved aggressively toward it. The home mouse consistently poked the trigger, which was presented once a day, indicating it experienced the aggressive encounter with the intruder as a reward.
The same home mice were then treated with a drug that suppressed their dopamine receptors. After this treatment, they decreased the frequency with which they instigated the intruder's entry.
In a separate experiment, the mice were treated with the dopamine receptor suppressors again and their movements in an open cage were observed. They showed no significant changes in overall movement compared to times when they had not received the drugs. This was done to demonstrate that their decreased aggression in the previous experiment was not caused by overall lethargy in response to the drug, a problem that had confounded previous experiments.
The Vanderbilt experiments are the first to demonstrate a link between behavior and the activity of dopamine receptors in response to an aggressive event.
"We learned from these experiments that an individual will intentionally seek out an aggressive encounter solely because they experience a rewarding sensation from it," Kennedy said. "This shows for the first time that aggression, on its own, is motivating, and that the well-known positive reinforcer dopamine plays a critical role."
Kennedy is chair of Vanderbilt's Peabody College of education and human development's special education department, which is consistently ranked as the top special education program in the nation. He is also director of the Vanderbilt Kennedy Center for Research of Human Development's Behavior Analysis Clinic.
Couppis conducted her research in affiliation with the Vanderbilt Brain Institute. She is also affiliated with the Vanderbilt Kennedy Center for Research on Human Development and the Vanderbilt Center for Integrative and Cognitive Neuroscience.
The research was supported by a Discovery Grant from Vanderbilt University.
Source: Melanie Moran
Vanderbilt University
The research will be published online the week of Jan. 14 by the journal Psychopharmacology.
"Aggression occurs among virtually all vertebrates and is necessary to get and keep important resources such as mates, territory and food," Craig Kennedy, professor of special education and pediatrics, said. "We have found that the 'reward pathway' in the brain becomes engaged in response to an aggressive event and that dopamine is involved."
"It is well known that dopamine is produced in response to rewarding stimuli such as food, sex and drugs of abuse," Maria Couppis, who conducted the study as her doctoral thesis at Vanderbilt, said. "What we have now found is that it also serves as positive reinforcement for aggression."
For the experiments, a pair of mice - one male, one female - was kept in one cage and five "intruder" mice were kept in a separate cage. The female mouse was temporarily removed, and an intruder mouse was introduced in its place, triggering an aggressive response by the "home" male mouse. Aggressive behavior included tail rattle, an aggressive sideways stance, boxing and biting.
The home mouse was then trained to poke a target with its nose to get the intruder to return, at which point it again behaved aggressively toward it. The home mouse consistently poked the trigger, which was presented once a day, indicating it experienced the aggressive encounter with the intruder as a reward.
The same home mice were then treated with a drug that suppressed their dopamine receptors. After this treatment, they decreased the frequency with which they instigated the intruder's entry.
In a separate experiment, the mice were treated with the dopamine receptor suppressors again and their movements in an open cage were observed. They showed no significant changes in overall movement compared to times when they had not received the drugs. This was done to demonstrate that their decreased aggression in the previous experiment was not caused by overall lethargy in response to the drug, a problem that had confounded previous experiments.
The Vanderbilt experiments are the first to demonstrate a link between behavior and the activity of dopamine receptors in response to an aggressive event.
"We learned from these experiments that an individual will intentionally seek out an aggressive encounter solely because they experience a rewarding sensation from it," Kennedy said. "This shows for the first time that aggression, on its own, is motivating, and that the well-known positive reinforcer dopamine plays a critical role."
Kennedy is chair of Vanderbilt's Peabody College of education and human development's special education department, which is consistently ranked as the top special education program in the nation. He is also director of the Vanderbilt Kennedy Center for Research of Human Development's Behavior Analysis Clinic.
Couppis conducted her research in affiliation with the Vanderbilt Brain Institute. She is also affiliated with the Vanderbilt Kennedy Center for Research on Human Development and the Vanderbilt Center for Integrative and Cognitive Neuroscience.
The research was supported by a Discovery Grant from Vanderbilt University.
Source: Melanie Moran
Vanderbilt University
воскресенье, 11 сентября 2011 г.
How Cocaine Addiction Develops
Permanent drug seeking and relapse after renewed drug administration are typical behavioral patterns of addiction. Molecular changes at the connection points in the brain's reward center are directly responsible for this. This finding was published by a research team from the Institute of Mental Health (ZI) in Mannheim, the German Cancer Research Center (DKFZ) in Heidelberg and the University of Geneva, Switzerland, in the latest issue of Neuron. The results provide researchers with new approaches in the medical treatment of drug addiction.
Addiction leaves detectable traces in the brain: In particular regions of the central nervous system, which produce the messenger substance dopamine, the drug cocaine causes molecular restructuring processes at the synapses, the points of connection between two neurons. As a reaction to the drug, protein subunits are exchanged in specific receptor complexes. As a result, the modified synapse becomes able to transmit nervous signals with enhanced strength - a phenomenon that has been termed 'drug-induced synaptic plasticity'. Researchers have suspected for many years that drug-induced synaptic plasticity plays a crucial role in addiction development. However, this hypothesis has not yet been proven experimentally.
Using genetic engineering, researchers headed by Professor Dr. G??nther Sch??tz at the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) have now been able to selectively switch off those protein components in dopamine-producing neurons that are integrated into the receptor complexes under the influence of cocaine. Jointly with the team of Professor Dr. Rainer Spanagel at the Central Institute of Mental Health (Zentralinstitut f??r Seelische Gesundheit, ZI) in Mannheim and the research group of Professor Dr. Christian L??scher at Geneva University, the Heidelberg researchers studied the changes in physiology and behavior of the genetically modified animals.
The scientists performed standardized tests to measure addictive behavior in the animals. At first sight, both the genetically modified and the control animals displayed the usual behavior under the influence of cocaine. Forced to increase their agility, the lab animals covered significantly greater running distances and preferentially frequented those places where they had been conditioned to be regularly administered the drug.
If normal mice do not find drugs at the familiar places over a longer period of time, their addictive behavior and preference for the cocaine-associated places subside. However, this is not true for animals whose receptor subunit GluR1 has been switched off: These mice invariably frequent the places where they expect to find the drug, i.e., their addictive behavior persists.
Mice whose NR1 protein has been switched off have surprised scientists with a different conspicuous behavior. If control animals withdrawn from cocaine are readministered the drug after some time, addictive behavior and drug seeking are reactivated. In contrast, NR1 deficient animals proved to be resistant to relapsing into the addiction.
"It is fascinating to observe how individual proteins can determine addictive behavioral patterns," says G??nther Sch??tz, and his colleague Rainer Spanagel adds: "In addition, our results open up whole new prospects for treating addiction. Thus, blocking the NR1 receptor might protect from relapsing into addiction. Selective activation of GluR1 would even contribute to 'extinguishing' the addiction."
David Engblom; Ainhoa Bilbao; Carles Sanchis-Segura; Lionel Dahan; St?©phanie Perreau-Lenz; B?©n?©dicte Balland; Jan Rodriguez Parkitna; Rafael Lujan; Briac Halbout; ManuelMameli; Rosanna Parlato; Rolf Sprengel; Christian L??scher; G??nther Sch??tz and Rainer Spanagel: Glutamate Receptors on Dopamine Neurons Control the Persistence of Cocaine-Seeking. Neuron, August 14, 2008
The task of the Deutsches Krebsforschungszentrum in Heidelberg (German Cancer Research Center, DKFZ) is to systematically investigate the mechanisms of cancer development and to identify cancer risk factors. The results of this basic research are expected to lead to new approaches in the prevention, diagnosis and treatment of cancer. The Center is financed to 90 percent by the Federal Ministry of Education and Research and to 10 percent by the State of Baden-Wuerttemberg. It is a member of the Helmholtz Association of National Research Centers (Helmholtz-Gemeinschaft Deutscher Forschungszentren e.V.).
Source: Dr. Sibylle Kohlst?¤dt
Helmholtz Association of German Research Centres
Addiction leaves detectable traces in the brain: In particular regions of the central nervous system, which produce the messenger substance dopamine, the drug cocaine causes molecular restructuring processes at the synapses, the points of connection between two neurons. As a reaction to the drug, protein subunits are exchanged in specific receptor complexes. As a result, the modified synapse becomes able to transmit nervous signals with enhanced strength - a phenomenon that has been termed 'drug-induced synaptic plasticity'. Researchers have suspected for many years that drug-induced synaptic plasticity plays a crucial role in addiction development. However, this hypothesis has not yet been proven experimentally.
Using genetic engineering, researchers headed by Professor Dr. G??nther Sch??tz at the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) have now been able to selectively switch off those protein components in dopamine-producing neurons that are integrated into the receptor complexes under the influence of cocaine. Jointly with the team of Professor Dr. Rainer Spanagel at the Central Institute of Mental Health (Zentralinstitut f??r Seelische Gesundheit, ZI) in Mannheim and the research group of Professor Dr. Christian L??scher at Geneva University, the Heidelberg researchers studied the changes in physiology and behavior of the genetically modified animals.
The scientists performed standardized tests to measure addictive behavior in the animals. At first sight, both the genetically modified and the control animals displayed the usual behavior under the influence of cocaine. Forced to increase their agility, the lab animals covered significantly greater running distances and preferentially frequented those places where they had been conditioned to be regularly administered the drug.
If normal mice do not find drugs at the familiar places over a longer period of time, their addictive behavior and preference for the cocaine-associated places subside. However, this is not true for animals whose receptor subunit GluR1 has been switched off: These mice invariably frequent the places where they expect to find the drug, i.e., their addictive behavior persists.
Mice whose NR1 protein has been switched off have surprised scientists with a different conspicuous behavior. If control animals withdrawn from cocaine are readministered the drug after some time, addictive behavior and drug seeking are reactivated. In contrast, NR1 deficient animals proved to be resistant to relapsing into the addiction.
"It is fascinating to observe how individual proteins can determine addictive behavioral patterns," says G??nther Sch??tz, and his colleague Rainer Spanagel adds: "In addition, our results open up whole new prospects for treating addiction. Thus, blocking the NR1 receptor might protect from relapsing into addiction. Selective activation of GluR1 would even contribute to 'extinguishing' the addiction."
David Engblom; Ainhoa Bilbao; Carles Sanchis-Segura; Lionel Dahan; St?©phanie Perreau-Lenz; B?©n?©dicte Balland; Jan Rodriguez Parkitna; Rafael Lujan; Briac Halbout; ManuelMameli; Rosanna Parlato; Rolf Sprengel; Christian L??scher; G??nther Sch??tz and Rainer Spanagel: Glutamate Receptors on Dopamine Neurons Control the Persistence of Cocaine-Seeking. Neuron, August 14, 2008
The task of the Deutsches Krebsforschungszentrum in Heidelberg (German Cancer Research Center, DKFZ) is to systematically investigate the mechanisms of cancer development and to identify cancer risk factors. The results of this basic research are expected to lead to new approaches in the prevention, diagnosis and treatment of cancer. The Center is financed to 90 percent by the Federal Ministry of Education and Research and to 10 percent by the State of Baden-Wuerttemberg. It is a member of the Helmholtz Association of National Research Centers (Helmholtz-Gemeinschaft Deutscher Forschungszentren e.V.).
Source: Dr. Sibylle Kohlst?¤dt
Helmholtz Association of German Research Centres
четверг, 8 сентября 2011 г.
Reducing Drinking In University Students: Web-Based Screening And Intervention May Be Helpful
A report in the September issue of Archives of Internal Medicine (one of the JAMA/Archives journals) shows that web-based screening and personalized interventions for alcohol use may reduce drinking in undergraduate students.
In many countries, unhealthy alcohol use is becoming more common among young adults. The authors write: "Young people at university have a particularly high prevalence of unhealthy alcohol use and have been found to drink more heavily and to exhibit more clinically significant alcohol-related problems than their non-student peers."
Kypros Kypri, Ph.D., of the University of Newcastle, Callaghan, New South Wales, Australia and the University of Otago, New Zealand, and colleagues studied 7,237 undergraduate university students in Australia, aged from 17 to 24. They all had taken the 2007 Web-based Alcohol Use Disorders Identification Test. The test consisted of an online questionnaire covering items such as:
??? demographics
??? drinking behavior in the last year
??? largest number of drinks consumed on one occasion within the last four weeks
??? duration of drinking episode
??? secondhand effects such as being pushed, hit or assaulted
??? opinions on alcohol beverage labeling
??? smoking history
??? height and weight
Participants who scored in the hazardous/harmful drinking range were placed in either a Web-based intervention group, which received motivational assessments and personalized feedback or a control group, which received no feedback. The personalized motivational interventions included information about reducing the related health risk, an estimated blood alcohol concentration for the respondent's heaviest episode, monetary expenditure, comparison to other students' drinking. It also incorporated hyperlinks to smoking cessation and help with drinking problems. Follow-ups were conducted one and six months after screening.
In total, 2,435 participants scored in the hazardous/harmful drinking range. Of these, 1,251 were selected at random and included in the Web-based motivational feedback group. The remaining 1,184 were assigned to the control group. The authors write: "After one month, participants receiving intervention drank less often, smaller quantities per occasion and less alcohol overall than did controls. Differences in alcohol-related harms were nonsignificant. At six months, intervention effects persisted for drinking frequency and overall volume but not for other variables."
"Given the scale on which proactive Web-based electronic screening and brief intervention (e-SBI) can be delivered and its acceptability to student drinkers, we can be optimistic that a widespread application of this intervention would produce a benefit in this population group," the authors write in conclusion. "The e-SBI, a program that is available free for nonprofit purposes, could be extended to other settings, including high schools, general practices and hospitals."
Arch Intern Med. 2009; 169[16]:1508-1514.
Archives of Internal Medicine
Written by Stephanie Brunner (B.A.)
In many countries, unhealthy alcohol use is becoming more common among young adults. The authors write: "Young people at university have a particularly high prevalence of unhealthy alcohol use and have been found to drink more heavily and to exhibit more clinically significant alcohol-related problems than their non-student peers."
Kypros Kypri, Ph.D., of the University of Newcastle, Callaghan, New South Wales, Australia and the University of Otago, New Zealand, and colleagues studied 7,237 undergraduate university students in Australia, aged from 17 to 24. They all had taken the 2007 Web-based Alcohol Use Disorders Identification Test. The test consisted of an online questionnaire covering items such as:
??? demographics
??? drinking behavior in the last year
??? largest number of drinks consumed on one occasion within the last four weeks
??? duration of drinking episode
??? secondhand effects such as being pushed, hit or assaulted
??? opinions on alcohol beverage labeling
??? smoking history
??? height and weight
Participants who scored in the hazardous/harmful drinking range were placed in either a Web-based intervention group, which received motivational assessments and personalized feedback or a control group, which received no feedback. The personalized motivational interventions included information about reducing the related health risk, an estimated blood alcohol concentration for the respondent's heaviest episode, monetary expenditure, comparison to other students' drinking. It also incorporated hyperlinks to smoking cessation and help with drinking problems. Follow-ups were conducted one and six months after screening.
In total, 2,435 participants scored in the hazardous/harmful drinking range. Of these, 1,251 were selected at random and included in the Web-based motivational feedback group. The remaining 1,184 were assigned to the control group. The authors write: "After one month, participants receiving intervention drank less often, smaller quantities per occasion and less alcohol overall than did controls. Differences in alcohol-related harms were nonsignificant. At six months, intervention effects persisted for drinking frequency and overall volume but not for other variables."
"Given the scale on which proactive Web-based electronic screening and brief intervention (e-SBI) can be delivered and its acceptability to student drinkers, we can be optimistic that a widespread application of this intervention would produce a benefit in this population group," the authors write in conclusion. "The e-SBI, a program that is available free for nonprofit purposes, could be extended to other settings, including high schools, general practices and hospitals."
Arch Intern Med. 2009; 169[16]:1508-1514.
Archives of Internal Medicine
Written by Stephanie Brunner (B.A.)
понедельник, 5 сентября 2011 г.
Babies Receive Drugs And Medicines Through Breast Milk
There is great confusion among the scientific community about whether women who are drug abusers should breast feed their babies. In order to shed some light on this issue, scientists from various Spanish hospitals and research centres are reviewing the methods used to detect substances in breast milk, their adverse effects, and the recommendations that mothers should follow in this month's issue of the journal Analytical and Bioanalytical Chemistry.
"The general recommendation is to totally avoid drug abuse while breastfeeding, because these substances can pass directly through to the newborn", Oscar Garc?a Algar, co-author of the study and a doctor in the Paediatrics Department at the Hospital del Mar in Barcelona, tells SINC.
The researcher adds: "This recommendation extends to the prenatal period, because these substances are passed on to the foetus via the placenta, and then in the postnatal period via the environment. If they have exposure through the milk, they will certainly also have had it during the pregnancy, and they can also be in the environment, as is the case with tobacco smoke".
For this study, the team used the average daily intake of the breastfeeding baby, around 150 millilitres of milk per kilo of weight, as a benchmark. The recommendations are listed for each substance, taking the advice of the American Academy of Pediatrics (AAP) as a reference.
Nicotine, caffeine and alcohol
The breast milk of smoking mothers contains between 2 and 240 nanograms of nicotine per millilitre, which means their babies receive a dose equivalent to 0.3 to 36 micrograms/kg/day. These infants tend to suffer more from colic and are more prone to respiratory infections.
The advice is to give up smoking during pregnancy and breastfeeding, or at least to limit the habit as much as possible, extend the time between the last cigarette and the baby's feed, use nicotine patches, smoke outside the house and avoid smoky environments.
Caffeine - found in coffee, tea, cola drinks and medicines - can cause irritability and insomnia. Although the level of caffeine absorption varies greatly from one person to another, this substance has a lengthy half-life in newborns. For this reason, it is recommended to reduce consumption during breastfeeding to a maximum of 300 mg/day, equivalent to around three cups of coffee per day.
For alcohol, the exact risk is still ill-defined, and no studies have been carried out to correlate the dose, although some research suggests it can harm the infant's motor development, as well as causing changes to their sleep patterns, reduce the amount they eat, and increase the risk of hypoglycaemia.
The AAP feels that alcohol consumption is compatible with breastfeeding, but this study states that no amount can be considered safe until the levels in breast milk are established. Strategies for minimising risk include feeding the baby before consuming alcoholic drinks, or at least allowing two or three hours to pass after drinking. Alcoholic women are advised to feed their babies with a bottle.
The risks of alcohol to the foetus in pregnant women have already been shown. "But despite this, a recent study by our group showed that 45.7% of the women who came to give birth in our hospital had consumed considerable amounts of alcohol during pregnancy", says the doctor.
Cannabis, cocaine and other drugs
Cannabis, which is transmitted both through the mother's milk and smoke, can cause sedation, lethargy, weakness and poor feeding habits in breastfeeding babies. The long-term risks are also unknown. Women are advised not to use it, but if they use marijuana occasionally, the experts advise them to do so several hours before feeding, and not to expose their children to the smoke.
The advice on cocaine, meanwhile, is to "totally avoid it" during breastfeeding. The first case of toxicity caused by this drug through breast milk was a baby boy just two weeks old who suffered irritability, trembling, dilated pupils, tachycardia and high blood pressure after feeding.
Women are also advised against breastfeeding if they take amphetamines. These can cause agitation, crying and lack of sleep. Using them also reduces a mother's ability to care for her children.
Breastfeeding is not recommended either for women who use heroin, which is excreted into the milk in sufficient amounts to cause addiction in the baby. In the case of "need", the advice is to allow at least one or two days to pass after taking the drug before feeding the baby, and to start a substitute treatment as soon as possible, if possible with methadone.
Other opiates used as medicines - morphine, meperidine and codeine - are excreted into the milk in minimal amounts and are compatible with breastfeeding, as are benzodiazepines, as long as they are taken in controlled doses. These are the drugs most frequently prescribed to women during pregnancy and after birth.
In terms of anti-depressant and anti-psychotic drugs, the AAP says "these can be a cause for concern during breastfeeding". For now, their effects on breastfeeding babies are unknown, and further studies are recommended.
References:
Fr?guls B, Joya X, Garc?a-Algar O, Pall??s CR, Vall O, Pichini S. "A comprehensive review of assay methods to determine 5 drugs in breast milk and the safety of breastfeeding 6 when taking drugs". Analytical and Bioanalytical Chemistry 397(3):1157-79, junio de 2010. Doi 10.1007/s00216-010-3681-0.
Source:
SINC
FECYT - Spanish Foundation for Science and Technology
"The general recommendation is to totally avoid drug abuse while breastfeeding, because these substances can pass directly through to the newborn", Oscar Garc?a Algar, co-author of the study and a doctor in the Paediatrics Department at the Hospital del Mar in Barcelona, tells SINC.
The researcher adds: "This recommendation extends to the prenatal period, because these substances are passed on to the foetus via the placenta, and then in the postnatal period via the environment. If they have exposure through the milk, they will certainly also have had it during the pregnancy, and they can also be in the environment, as is the case with tobacco smoke".
For this study, the team used the average daily intake of the breastfeeding baby, around 150 millilitres of milk per kilo of weight, as a benchmark. The recommendations are listed for each substance, taking the advice of the American Academy of Pediatrics (AAP) as a reference.
Nicotine, caffeine and alcohol
The breast milk of smoking mothers contains between 2 and 240 nanograms of nicotine per millilitre, which means their babies receive a dose equivalent to 0.3 to 36 micrograms/kg/day. These infants tend to suffer more from colic and are more prone to respiratory infections.
The advice is to give up smoking during pregnancy and breastfeeding, or at least to limit the habit as much as possible, extend the time between the last cigarette and the baby's feed, use nicotine patches, smoke outside the house and avoid smoky environments.
Caffeine - found in coffee, tea, cola drinks and medicines - can cause irritability and insomnia. Although the level of caffeine absorption varies greatly from one person to another, this substance has a lengthy half-life in newborns. For this reason, it is recommended to reduce consumption during breastfeeding to a maximum of 300 mg/day, equivalent to around three cups of coffee per day.
For alcohol, the exact risk is still ill-defined, and no studies have been carried out to correlate the dose, although some research suggests it can harm the infant's motor development, as well as causing changes to their sleep patterns, reduce the amount they eat, and increase the risk of hypoglycaemia.
The AAP feels that alcohol consumption is compatible with breastfeeding, but this study states that no amount can be considered safe until the levels in breast milk are established. Strategies for minimising risk include feeding the baby before consuming alcoholic drinks, or at least allowing two or three hours to pass after drinking. Alcoholic women are advised to feed their babies with a bottle.
The risks of alcohol to the foetus in pregnant women have already been shown. "But despite this, a recent study by our group showed that 45.7% of the women who came to give birth in our hospital had consumed considerable amounts of alcohol during pregnancy", says the doctor.
Cannabis, cocaine and other drugs
Cannabis, which is transmitted both through the mother's milk and smoke, can cause sedation, lethargy, weakness and poor feeding habits in breastfeeding babies. The long-term risks are also unknown. Women are advised not to use it, but if they use marijuana occasionally, the experts advise them to do so several hours before feeding, and not to expose their children to the smoke.
The advice on cocaine, meanwhile, is to "totally avoid it" during breastfeeding. The first case of toxicity caused by this drug through breast milk was a baby boy just two weeks old who suffered irritability, trembling, dilated pupils, tachycardia and high blood pressure after feeding.
Women are also advised against breastfeeding if they take amphetamines. These can cause agitation, crying and lack of sleep. Using them also reduces a mother's ability to care for her children.
Breastfeeding is not recommended either for women who use heroin, which is excreted into the milk in sufficient amounts to cause addiction in the baby. In the case of "need", the advice is to allow at least one or two days to pass after taking the drug before feeding the baby, and to start a substitute treatment as soon as possible, if possible with methadone.
Other opiates used as medicines - morphine, meperidine and codeine - are excreted into the milk in minimal amounts and are compatible with breastfeeding, as are benzodiazepines, as long as they are taken in controlled doses. These are the drugs most frequently prescribed to women during pregnancy and after birth.
In terms of anti-depressant and anti-psychotic drugs, the AAP says "these can be a cause for concern during breastfeeding". For now, their effects on breastfeeding babies are unknown, and further studies are recommended.
References:
Fr?guls B, Joya X, Garc?a-Algar O, Pall??s CR, Vall O, Pichini S. "A comprehensive review of assay methods to determine 5 drugs in breast milk and the safety of breastfeeding 6 when taking drugs". Analytical and Bioanalytical Chemistry 397(3):1157-79, junio de 2010. Doi 10.1007/s00216-010-3681-0.
Source:
SINC
FECYT - Spanish Foundation for Science and Technology
пятница, 2 сентября 2011 г.
Physicians Need To Be Advocates For Prisoners' Health
Physicians are an essential component of correctional institutions and have a responsibility to advocate for effective and humane treatment for inmates. This is the view expressed in a commentary published in the January 11 issue of the New England Journal of Medicine by Scott A. Allen, MD, and Josiah D. Rich, MD, MPH, physicians at the Center for Prisoner Health and Human Rights at The Miriam Hospital and Brown Medical School.
Citing the steady increase of incarcerated individuals in the United States that has resulted in record high inmate numbers, the authors point to the inadequate treatment of mental illness and addiction in the community as a source of the increase - especially among women.
"The natural history of untreated addiction and mental illness often results in illegal activity, and persistently inadequate treatment perpetuates a cycle of crime and incarceration," says Rich. "The correctional system should view incarceration as an opportunity to link inmates with effective therapy such as mental health services, high-quality drug treatment, and support services for reentry into society upon release, if we ever expect to decrease recidivism rates."
The authors note that punishment is often favored over rehabilitation in many prisons, which may cause harm to a prisoner's physical and mental health. In addition, in situations where effective therapeutic services are available, they are often underused.
Statistics show that although 57 percent of inmates in state prisons reported using drugs during the month before committing their offense, only 20 percent participated in substance abuse programs while in prison. Federal prisons echo this trend with reports stating that of the 63 percent of inmates being held for drug offenses, only 15 percent participated in prison-based drug treatment programs.
The authors also support programs for non-violent offenders that would place them in residential treatment programs and group homes instead of in prison. California took initiative with this concept when it passed The Substance Abuse and Crime Prevention Act, known as Proposition 36, in 2000. Proposition 36 changed California state law to allow first- and second-time nonviolent, simple drug possession offenders the opportunity to receive substance abuse treatment instead of incarceration.
"We feel strongly that alternatives to mass incarceration for non-violent offenders, such as residential treatment programs, need to be explored," says Allen. "Here, the basic requirements such as nutrition, shelter, and medical care would be provided, but in a more efficient, nonpunitive therapeutic setting. In addition, community-based alternatives would save taxpayers millions of dollars in incarceration costs annually."
Initial reports analyzing the effectiveness of California's Proposition 36 estimate that over 150,000 people benefited from the treatment and that it saved taxpayers about $1.3 billion. Given that the annual cost of housing an inmate is approximately $36,000, while the average cost of a 50-day residential treatment program is $3840 - the savings is evident.
Rich and Allen encourage physicians to campaign for sentencing laws, policies and procedures that directly affect the health and well-being of their patients and to encourage more humane and effective treatment alternatives for addiction and mental illness.
The Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center (prisonerhealth/) was established in 2005.
The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with Brown Medical School. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital (miriamhospital/) offers particular expertise in cardiac catheterization, angioplasty and women's cardiac care. One of 20 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS, attracting $17 million of the world's HIV/AIDS research dollars. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services three times and is committed to excellence in patient care, research and medical education. The Miriam is a founding member of the Lifespan health system.
Contact: Megan Martin
Lifespan
Citing the steady increase of incarcerated individuals in the United States that has resulted in record high inmate numbers, the authors point to the inadequate treatment of mental illness and addiction in the community as a source of the increase - especially among women.
"The natural history of untreated addiction and mental illness often results in illegal activity, and persistently inadequate treatment perpetuates a cycle of crime and incarceration," says Rich. "The correctional system should view incarceration as an opportunity to link inmates with effective therapy such as mental health services, high-quality drug treatment, and support services for reentry into society upon release, if we ever expect to decrease recidivism rates."
The authors note that punishment is often favored over rehabilitation in many prisons, which may cause harm to a prisoner's physical and mental health. In addition, in situations where effective therapeutic services are available, they are often underused.
Statistics show that although 57 percent of inmates in state prisons reported using drugs during the month before committing their offense, only 20 percent participated in substance abuse programs while in prison. Federal prisons echo this trend with reports stating that of the 63 percent of inmates being held for drug offenses, only 15 percent participated in prison-based drug treatment programs.
The authors also support programs for non-violent offenders that would place them in residential treatment programs and group homes instead of in prison. California took initiative with this concept when it passed The Substance Abuse and Crime Prevention Act, known as Proposition 36, in 2000. Proposition 36 changed California state law to allow first- and second-time nonviolent, simple drug possession offenders the opportunity to receive substance abuse treatment instead of incarceration.
"We feel strongly that alternatives to mass incarceration for non-violent offenders, such as residential treatment programs, need to be explored," says Allen. "Here, the basic requirements such as nutrition, shelter, and medical care would be provided, but in a more efficient, nonpunitive therapeutic setting. In addition, community-based alternatives would save taxpayers millions of dollars in incarceration costs annually."
Initial reports analyzing the effectiveness of California's Proposition 36 estimate that over 150,000 people benefited from the treatment and that it saved taxpayers about $1.3 billion. Given that the annual cost of housing an inmate is approximately $36,000, while the average cost of a 50-day residential treatment program is $3840 - the savings is evident.
Rich and Allen encourage physicians to campaign for sentencing laws, policies and procedures that directly affect the health and well-being of their patients and to encourage more humane and effective treatment alternatives for addiction and mental illness.
The Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center (prisonerhealth/) was established in 2005.
The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with Brown Medical School. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital (miriamhospital/) offers particular expertise in cardiac catheterization, angioplasty and women's cardiac care. One of 20 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS, attracting $17 million of the world's HIV/AIDS research dollars. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services three times and is committed to excellence in patient care, research and medical education. The Miriam is a founding member of the Lifespan health system.
Contact: Megan Martin
Lifespan
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