Rates of Mental Health Tx, Diagnosis Up for College Students

FRIDAY, Nov. 16, 2018 — From 2007 to 2017, there was an increase in the rates of mental health treatment and diagnosis among college students and a decrease in stigma, according to a study published online Nov. 5 in Psychiatric Services.

Sarah Ketchen Lipson, Ph.D., Ed.M., from the Boston University School of Public Health, and colleagues used 10 years of data from the Healthy Minds Study, which included 155,026 students from 196 campuses, to examine mental health service utilization by college students.

The researchers observed significant increases in the rates of mental health treatment and diagnosis. From 2007 to 2017, the rate of treatment increased from 19 to 34 percent, and an increase from 22 to 36 percent was seen in the percentage of students with lifetime diagnoses. Increases were also seen in depression and suicidality, while there was a decrease in stigma.

“We found that utilization increased substantially over the past decade, with much of this burden falling to campus counseling centers,” the authors write. “To better meet the mental health care demand from students and reduce strain on existing services, campuses may wish not only to expand capacity but also to increase the use of preventive and digital mental health services, such as those delivered via mobile apps.”

One author disclosed receiving consulting fees from Actualize Therapy.

Abstract/Full Text (subscription or payment may be required)

Posted: November 2018

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E-alerts dramatically cut heart attack rate for people hospitalized with A-fib

(HealthDay)—A simple pop-up alert on a computer screen could help save the brains and hearts of many hospital-bound people with an irregular heartbeat, a new clinical trial reveals.

Rates for heart attack and stroke plunged by close to 90 percent in people helped by the new program, the study found.

The computer alert warns doctors of the high stroke risk borne by individual patients who suffer from atrial fibrillation, a quivering heart rhythm that allows blood to pool and clot inside the heart.

Doctors who received this alert were nearly three times as likely to prescribe blood thinners to hospitalized patients with a-fib, said Dr. Gregory Piazza, a cardiovascular specialist with Brigham and Women’s Hospital in Boston.

As a result, rates for heart attack and stroke among the a-fib patients fell by 87 percent and 88 percent, respectively, over the three-month trial, Piazza’s group reported Saturday at the American Heart Association’s annual meeting in Chicago.

The magnitude of the reduction in risk of these life-threatening health problems surprised researchers, as it was “really beyond what we expected to see with the increase of anticoagulation,” Piazza said.

Blood thinners are very important to prevent stroke in a-fib patients, but prior studies say at least 30 percent have not been prescribed such a medication, researchers said in background information.

For this study, Piazza and his team created a program that analyzes computer chart data of patients with atrial fibrillation to calculate what is known as a CHADS-VASC score.

This commonly used diagnostic algorithm assesses risk factors for stroke in a-fib patients, said Dr. Mary Norine Walsh, medical director of the heart failure and cardiac transplantation program at the St. Vincent Heart Center in Indianapolis.

The test program issues a pop-up alert to doctors indicating that their a-fib patient has a high CHADS-VASC score. It even estimates their annual risk of stroke.

The pop-up then requires doctors to either prescribe a blood thinner or give a reason why such a medicine shouldn’t be used. Possible reasons include “bleeding risk is too high,” “patient is at high risk for falls,” or “patient refuses anticoagulation.”

To see whether the alert would make a difference, the researchers randomly assigned 458 a-fib patients so about half would have their records reviewed by the program.

About 19 percent of patients in the alert group had a prescription for blood thinners during hospitalization, at discharge and three months later, researchers found. By comparison, only 7 percent of the control group had been prescribed blood thinners.

By three months after hospitalization, the alert group had a dramatic effect on patients’ odds for heart attack or stroke, although that didn’t translate to a lessening of the death rate, the team noted.

Still, the study showed that reminder systems like this actually really work to cut the odds for cardiac events, said Walsh, who is president of the American College of Cardiology.

“We as physicians can’t keep everything in our brains all the time,” she said. “It’s clear in medicine if we have reminders, we more commonly prescribe drugs and take action.”

But even though doctors are moving toward the use of electronic health records, it’s not clear how easily hospital data centers could incorporate such an alert into their usual systems, Walsh said.

“All electronic health records could do it probably, but not all are set up to do it,” Walsh said. “I can tell you, my electronic health record doesn’t do this kind of thing. It’s not an automatic thing that happens.”

Adding such an alert system might be costly for some hospitals, Piazza added.

“Implementation of alert-based [computerized decision support] requires an investment in programming and medical informatics infrastructure which may not be available at some medical centers,” Piazza said.

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With 2 simple knee Exercises, you prevent joint pain

Our knees need to withstand quite a lot: every Day, we bow down to you, on average, more than 1000 Times. Each time you walk the multiple rests of our body weight on them. The largest and most complex joints in spite of continuous load fit, we should be active.

Millions of people complain of inflamed, swollen or aching knees. No wonder: No other joint is daily burdened and stressed like this. Not just Sprinting, or skiing, it must keep the face of tremendous pressure: At each knee flexion the largest and most complex of our joints wearing the Seven – to-eight times our weight.

So it crunches in the short or long-each time you Bend or stretch, pinches or hurts, movement is important. A good Alternative to the gym or sports field offer aerobics or Zumba: The combination of dance and Fitness brings the body into swing, can the pounds and promotes flexibility and strength.

The benefit not least to the knees: Regular exercise also improves the metabolism and blood circulation of the knee joint. In addition, a strengthened muscles protects the knee joint injuries and diseases.

In order to prevent Overuse of the musculoskeletal system, we recommend a moderate, age-appropriate and not too intense workout. In the case of existing complaints of the feet or knee joints, you should avoid, however, be on sports completely, or with an orthopedic surgeon, a gentle approach discuss.

Two Exercises for healthy knees

1. Flat on your back and raise one leg. The foot towards the buttocks. After a few seconds stretch out. The Whole thing a dozen Times with each foot repeat.

2. Sit on the table and the legs swing freely. As a result, the joint is spread grease over the entire cartilage surface of the knee joint. Cartilage nutrition is significantly improved.

The best sports for healthy knees

Whether Zumba, Running, or Jogging – regular exercise, without excessive ambition, the best medicine is “”. Muscles, Tendons and ligaments to be strengthened in a healthy way – a slow warm – up and training. As particularly knee-friendly apply

  • Swimming
  • Hiking
  • Gymnastics or water aerobics

    To the PDF guide

Simple measures in everyday life

Of the (knee)health and conducive to regular Cycling to work or for shopping. Improper loading, such as when Running can occur are virtually eliminated. All of the muscles that stabilize the knee, to be trained.

But smaller steps can achieve quite a lot. One of the simplest Precautionary measures: often times take the stairs instead of the lift. Each stage strengthens the muscles, invigorates the knee metabolism and thus prevents osteoporosis.

Long hours of Sitting in the car, office or TV chair increases the need to be active: Remains of a joint in a rigid Position, so that the cartilage layer is loaded permanently on a body and to lose excessive joint fluid. This happens more often in the day, so the risk of cartilage damage is increasing rapidly, as when a clothing is claimed always in the same place and a hole forms.

  • You can change as often as possible the work or the position of the seat.
  • Get up once in a while.
  • You are going short distances.
  • Stretch at your Desk more often the knee.

The less strain on the joints

In addition to a lack of exercise is a prolonged Standing “poison” for the knee. Because then the full body weight rests on the connection point between the upper and lower leg bones. Better time to take a breather in the Sitting load, and several times a day, the legs dangle. This promotes the formation of synovial fluid.

Should avoid, to the extent possible, longer Work in stop position (for example, when Mounting or crafts), as well as a strong knee flexion, so the cross-legged or with frequent Squatting. Problematic is also the following sports are:

  • Football
  • Handball
  • Squash
  • Tennis
  • Rowing
  • Skiing

In the case of rotational movements of the knee under load, typically for the Kick, or skiing, are the the cartilage protective menisci are especially prone to injury.

Instead of high shoes that make it difficult to straighten the joints, better flat shoes with soft sole wear. They dampen vibration while walking and protect the joints. The Same is true for an “acceptable” body weight. Because obesity is one of the main risk factors for osteoarthritis or other knee ailments.

About the expert

Sven Ostermeier Orthopaedics and accident surgery, sports medicine, chirotherapy and special orthopedic surgery. The shoulder and knee expert, works as a senior orthopaedic surgeon of the joint-clinic Gundelfingen. He is also the instructor of the German Association for arthroscopy.

This Man Shamed His Wife for Having a Loose Vagina With a Ridiculous Gift

When your body pops out a baby, a lot of body areas change. Your stomach has to stretch to accommodate a small human, meaning loose skin is on the horizon. And your vagina has to expand during delivery, which is sure to change the shape and feel of things down there.

This happens to all moms who delivery their baby vaginally, and it’s nothing to be ashamed of. But one Reddit user found herself second guessing her own postpartum body changes after her husband dropped a not-so-subtle hint.

“This morning I woke up to a gift on my nightstand. It was a cute sparkly pink bag with a sweet note from my husband attached,” aaplmns wrote in a recent post. “Inside the bag was a Je Joue Mimi vibrator, panties, my favorite bath foam, and body butter from The Body Shop, two kinds of lube… and something called Like A Virgin 24 Hour Tightening Cream.”

Whoa, hold up. Was aaplmns’ husband actually vagina shaming her?

She went on to explain that she gave birth to her second child in July and had fourth degree vaginal lacerations (indicating that there was so much tearing, her vagina and rectum were no longer separated). That’s incredibly painful, but somehow aaplmns was back to having sex only six weeks postpartum, she wrote.

Needless to say, aaplmns has taken her husband’s gift pretty personally. “I’m so embarrassed,” she stated. “It’s hard to describe but I feel like less of a woman, like my time to be sexy and fun with my husband has passed. I’m even wondering if he’s thought about cheating.”

We have no clue why her husband thought gifting that cream was a good idea. Hate to break it to you, mister, but there’s exactly zero evidence showing creams like that even work.

“I know of absolutely no cream that would tighten your vagina,” Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine tells Health. Yep, it’s that simple.

Dr. Minkin says anyone who claims to see results from a product like the one aaplmns’ husband left for her is likely experiencing a placebo effect.

However, there is one thing that really can tighten your vagina postpartum, if this is something you want to do: kegel exercises. No familiar with kegels? They involve tightening and contracting the muscles that support your uterus, bladder, small intestine, and rectum. Doing them should feel similar to the way it feels when you clench to stop yourself from peeing.

If you want to give kegels a go, Dr. Minkin suggests doing about three sets of 10 every day. Everyone is different, but if you stick to it, you should start to notice a difference within a few months.

The only other thing that can truly tighten the vagina is surgery, Dr. Minkin says, but that should be reserved for extreme cases, like when a woman has given birth to multiple large babies. The procedure is called a “posterior repair” and is for patients with a medical need, like bowel dysfunction after delivery.

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Promising new targeted therapy for acceleration of bone fracture repair

There are over six million fractures per year in the U.S. with direct costs in the billions, not to mention lost productivity. The only drug currently available to accelerate the healing process must be applied directly onto the fracture surface during surgery, but not all breaks require such intervention. New research, Bone Fracture-Targeted Dasatinib Conjugate Potently Enhances Fracture Repair In Vivo, presented today at the 2018 American Association of Pharmaceutical Scientists (AAPS) PharmSci 360 Meeting highlights a novel bone anabolic agent that, when injected, intravenously reduces femur fracture healing time by 60 percent without impacting the surrounding healthy tissue.

Researchers from Purdue University designed a new chemical entity (a dasatinib-aspartate10 conjugate, DAC) that employs a targeted peptide attached to dasatinib, an anti-cancer drug that has been shown to promote the growth of new bones. Following systemic injection, DAC is observed to concentrate on the fracture surface, resulting in accelerated repair and increased bone density. The data shows that the healing process that typically takes eight weeks for full recovery of mechanical strength is reduced to three to four weeks when treated with the targeted drug.

“We foresee a significant need for this type of therapy,” said presenting author, Mingding Wang, Purdue University. “Even though many broken bones don’t need surgery, most require a prolonged healing process that can lead to morbidity, loss of work productivity, and in some cases even death. By developing a therapy that can accelerate bone fracture repair without damaging healthy bones or tissues, we can hopefully address these critical issues.”

The study results indicate that treatment with DAC every other day for three weeks was equally effective as daily injections of DAC, yielding a 114 percent increase in bone density, and was found to be the best treatment interval. Reducing this dosing interval to every four days, however, resulted in a measurable decline in potency. Since the blood supply to the fracture area is often disrupted immediately after a fracture, waiting a week or two for blood vessels to stabilize prior to administering DAC did not negatively impact its effectiveness or the healing speed.

While administration of nontargeted dasatinib provided some improvement in healing rate, DAC was dramatically better, doubling the bone density. In addition, since the nontargeted form of dasatinib is administered chronically to cancer patients without significant toxicity, the fracture-targeted form is expected to be even safer. That is, when dasatinib is selectivity targeted to the bone fracture surface, its presence in all other tissues should be greatly reduced.

Philip Low, principal investigator and Presidential Scholar for Drug Discovery, Purdue Institute for Drug Discovery noted, “While the use of casts, rods, or pins may still be required in some cases, the ability of this therapy to accelerate the return of a fracture patient to normal function and lifestyle could have widespread benefits to the entire orthopedic community.”

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Smartphones, Summer Birth Could Raise Kids’ Odds for Nearsightedness

TUESDAY, Nov. 6, 2018 — Kids with summer birthdays, especially those who spend long hours playing on smartphones and tablets, might be at greater risk for vision problems, a new study suggests.

Nearsightedness, also called myopia, is on the rise worldwide. It’s what eye doctors call a refractive error, meaning the eyes can’t focus light properly. The result: Close objects look clear; distant ones, fuzzy.

It’s most often caused by continuously focusing on close objects while the eyes are still developing — as in reading, for example. But the growing use of electronic devices seems to be making the problem worse, researchers report.

“As ever, everything should be done in moderation,” said lead researcher Dr. Christopher Hammond, chairman of ophthalmology at King’s College London in England. He urged parents to limit kids’ use of electronic devices.

That appears to be especially important for kids born in the summer, the study suggests. That’s because they start formal schooling at a younger age than kids born in winter so they are exposed to more reading sooner. And that increases myopia risk, the researchers said.

The researchers added that, while their study doesn’t prove smartphones, tablets and computer games cause nearsightedness, those devices may lead kids to spend less time outdoors. And less time outdoors also appears to increase myopia risk.

“We know that time outdoors is protective, and so kids should spend probably up to two hours a day outside,” Hammond said.

Myopia can be corrected with glasses, laser surgery or contact lenses. Later in life, however, sufferers are more likely to develop sight-robbing conditions such as cataracts or glaucoma, the researchers said.

Experts predict that by 2050, nearly 5 billion people worldwide will have myopia. That compares to about 2 billion in 2010.

Genes have been linked to a person’s risk for the condition, but even if it has a genetic component, that doesn’t account for the dramatic increase, Hammond said.

For the study, his team collected data on nearly 2,000 twins born in the United Kingdom between 1994 and 1996.

The researchers reviewed results of eye tests, as well as social, economic, educational and behavioral data on the twins between the ages of 2 and 16. They also had questionnaires completed by parents and teachers.

On average, children started wearing glasses for myopia at age 11. About 5 percent had amblyopia (“lazy eye”), and about 4.5 percent had a squint. Overall, 26 percent of the twins were nearsighted, the study found.

Kids who had college-educated mothers, those who were born in summer months and those who spent more time using electronic devices had a higher likelihood of nearsightedness, the study found.

The findings were published online Nov. 6 in the British Journal of Ophthalmology.

Dr. Tien Wong, medical director of the Singapore National Eye Center, is co-author of an editorial that accompanied the study.

“Evidence supports a link between device screen time and myopia, which includes time on phones and tablets,” he said.

This is concerning in view of how many young kids have access to these devices, Wong said. Evidence shows 2-year-olds spend up to two hours a day using digital devices.

“Managing your child’s device screen time and increasing their outdoor play can help reduce the risk of developing myopia,” Wong said. “We must better monitor our children’s device activities, even during their preschool years.”

Surprisingly, the researchers said children born as a result of fertility treatment had a 25 percent to 30 percent lower risk for myopia. They said that may be because many are born premature and have developmental delays, which could account for shorter eye length and less myopia.

More information

To learn more about myopia, visit the U.S. National Eye Institute.

Posted: November 2018

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Societies publish new guidance for the treatment of slow, irregular heartbeats

The American College of Cardiology, the American Heart Association and the Heart Rhythm Society today released a guideline for the evaluation and treatment of patients with bradycardia, or a slow heartbeat, and cardiac conduction disorders.

In the guideline, bradycardia is defined as a heart rate of less than 50 beats per minute, compared to a normal heart rate of 50-100 beats per minute. A slow heartbeat can limit the amount of blood and oxygen that is pumped to all the organs of the body. Bradycardia is generally classified into three categories—sinus node dysfunction, atrioventricular (AV) block, and conduction disorders. In sinus node dysfunction, the sinoatrial node, the main pacemaker of the heart, cannot maintain an adequate heart rate. In AV block, there is partial or complete interruption of electrical impulse transmission from the atria to the ventricles. Cardiac conduction disorders occur when electrical impulses in the heart that cause it to beat are delayed. Common conduction disorders include right and left bundle branch block. Bradycardia and conduction abnormalities are more often seen in elderly patients.

The writing committee members outline the clinical presentation and approach to clinical evaluation of patients who may have bradycardia or conduction diseases. They reviewed study data and developed recommendations from the evidence. These recommendations include the selection and timing of diagnostic testing tools—including monitoring devices and electrophysiological testing—as well as available treatment options such as lifestyle interventions, pharmacotherapy and external and implanted devices, particularly pacing devices. The authors also address special considerations for different populations based on age, comorbidities or other relevant factors.

Conduction abnormalities are common after transcatheter aortic valve replacement (TAVR). The guideline includes recommendations on post-procedure surveillance and pacemaker implantation. The guideline also addresses ways to approach the discontinuation of pacemaker therapy and end of life considerations.

The writing committee members stress the importance of shared decision-making between the patient and clinicians, as well as patient-centered care.

“Treatment decisions are based not only on the best available evidence but also on the patient’s goals of care and preferences,” said Fred M. Kusumoto, MD, cardiologist at Mayo Clinic Florida in Jacksonville and chair of the writing committee. “Patients should be referred to trusted material to aid in their understanding and awareness of the consequences and risks of any proposed action.”

Yet, according to the authors, there are still knowledge gaps in understanding how to manage bradycardia, especially the evolving role of and developing technology for pacing.

“Identifying patient populations who will benefit the most from emerging pacing technologies, such as His bundle pacing and transcatheter leadless pacing systems, will require further investigation as these modalities are incorporated into clinical practice,” Kusumoto said. “Regardless of technology, for the foreseeable future, pacing therapy requires implantation of a medical device, and future studies are warranted to focus on the long-term implications associated with lifelong therapy.”

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Sunday Is ‘Fall Back’ Time for Your Clock — Sleep Experts Offer Tips

FRIDAY, Nov. 2, 2018 — The hour you “lost” with daylight savings time in the spring you “gain back” on Sunday, when clocks are set an hour back.

And every time shift takes a subtle toll on the human mind and body, experts say.

Still, “for most people, it is easier to stay up an hour later than to go to bed an hour earlier,” said Dr. Steven Feinsilver, who directs sleep medicine at Lenox Hill Hospital in New York City. “This is thought to be because for most of us our ‘internal clock’ is closer to a 25-hour cycle than a 24-hour cycle.”

He said the furthest you can comfortably shift your internal clock is about an hour a day, and “what sets [your] clock is the wake time more than the bedtime.”

Feinsilver said that to get back to a normal sleep rhythm, “set the alarm for your target time and get out of bed when it goes off, even if your night sleep was not perfect.

“For the time change, set the alarm for Monday — for most of us the Sunday morning wake-up is less critical — and enjoy the extra hour,” Feinsilver said.

A single night of imperfect sleep is easily gotten over — “it is when bad sleep becomes a habit we get into trouble,” he said. Feinsilver’s advice is to try to sleep a regular seven to eight hours — and “stick to a constant wake time.”

Triggers such as light, food and exercise are the cues that tell your body what time it is.

“Getting exposed to light early in the day wakes us up,” Feinsilver said. “This is harder in the winter when there is less and later light, but the autumn time shift helps a bit.”

Dr. Daniel Barone is a neurologist and sleep medicine expert at the Center for Sleep Medicine at New York-Presbyterian/Weill Cornell Medical Center in New York City. He said that people shouldn’t expect that the extra hour of sleep they’ll get on Sunday will erase any accumulated “sleep debt.”

“We as a society sleep one hour less than we did 100 years ago, so we are still ‘behind the clock’ so to speak when it comes to being sleep-deprived,” Barone said.

He said the body’s sleep clock can be directly affected as autumn days grow shorter and people spend more time indoors. The body manufactures vitamin D via sunlight’s action on the skin, and too little vitamin D can affect sleep and emotions.

“When you’re not getting as much sunlight, it has an effect on your mood,” Barone said. For some people, this can even mean the onset of a kind of depression known as seasonal affective disorder (SAD).

Barone offered these tips for better sleep:

  • Switch to LED lightbulbs. They’re made to simulate sunlight and can help you maintain a healthy circadian rhythm as seasons change.
  • Cut out the evening nap. Dozing off after dinner sends confusing signals to your brain that can make bedtime later more challenging.
  • Try mindful meditation. It can cut stress and encourage healthy sleep.
  • Ban TVs, smartphones and laptops from the bedroom. The backlight display can disrupt sleep if used before lights-out.
  • Keep bedrooms dark. Light creeping in can send a wake-up signal to the brain.

If you’re still having trouble sleeping, consult a sleep specialist for testing, Barone said.

“If you’re continually waking up in the night or you’re constantly waking up tired, a sleep test is definitely warranted,” he said.

“We should view sleep as something that’s sacred,” Barone said. “Our bodies are designed to get seven to nine hours. In this 24-hour society, a lot of times the amount of sleep we get suffers. We should focus on getting good-quality sleep and dealing with any problems that exist.”

More information

There’s more on getting good sleep at the National Sleep Foundation.

Posted: November 2018

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