September 14th, 2009 by Berci in Better Health Network, News
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At this year’s British Science Festival, Tracy Alloway, a psychologist from Stirling University, said the following:
Some examples of what can hurt or harm working memory include things like Twitter. When you’re receiving an endless stream of information when you’re a ‘tweeter’, it’s also very succinct, so there’s no need to process or manipulate that information, it’s not a dialogue unlike something like Facebook where you might be updating your status and so on.
Fortunately, Mark Henderson at Times Online puts things in the right place:
Most people I know who use Twitter see it as an interactive tool for conversing with wide groups, and for drawing like-minded people’s attention to information that might interest them. It’s interactive, full of links, and information-rich. It’s a misconception that the 140-character limit makes depth impossible. In fact, to me, Twitter seems to build social networks just as effectively as Facebook, which Alloway thinks might improve working memory.
Mark is right, and I have a few examples that can explain why I think so:
*This blog post was originally published at ScienceRoll*
July 30th, 2009 by Medgadget in Better Health Network, News
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The scans presented here are of a ten year-old German girl who was discovered to be missing the right hemisphere of her brain. Incredibly, she is perfectly normal, except for a history of seizures and a slight weakness on her left side. Attending school with others of her age, it is reported that she is able to study and play sports, just like other kids around her. Of course, the mystery is how is this all possible? To answer the question, University of Glasgow scientists used an fMRI to see where the left eye’s vision is processed. Turns out that the brain’s visual area responsible for the right eye offered up some space for the left.
Normally, the left and right fields of vision are processed and mapped by opposite sides of the brain, but scans on the German girl showed that retinal nerve fibres that should go to the right hemisphere of the brain diverted to the left.
Further, the researchers found that within the visual cortex of the left hemisphere, which creates an internal map of the right field of vision, ‘islands’ had been formed within it to specifically deal with, and map out, the left visual field in the absence of the right hemisphere.
Dr Lars Muckli of the Centre for Cognitive Neuroimaging in the Department of Psychology, who led the study, said: “This study has revealed the surprising flexibility of the brain when it comes to self-organising mechanisms for forming visual maps.
“The brain has amazing plasticity but we were quite astonished to see just how well the single hemisphere of the brain in this girl has adapted to compensate for the missing half.
“Despite lacking one hemisphere, the girl has normal psychological function and is perfectly capable of living a normal and fulfilling life. She is witty, charming and intelligent.”
The girl’s underdeveloped brain was discovered when, aged three, she underwent an MRI scan after suffering seizures of brief involuntary twitching on her left side.
The scientists believe the right hemisphere of the girl’s brain stopped developing early in the womb and that when the developing optic nerves reached the optic chiasma, the chemical cues that would normally guide the left eye nasal retinal nerve to the right hemisphere were no longer present and so the nerve was drawn to the left.
This implies that there are no molecular repressors to prevent nasal retinal nerve fibres from entering the same hemisphere.
Dr Muckli added: “If we could understand the powerful algorithms the brain uses to rewire itself and extract those algorithms together with the general algorithms that the brain uses to process information, they could be applied to computers and could result in a huge advance in artificial intelligence.”
Press release: Scientists reveal secret of girl with ‘all seeing eye’…
*This blog post was originally published at Medgadget*
July 23rd, 2009 by Olajide Williams, M.D. in Health Policy, True Stories
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Stroke is the leading cause of adult disability in the United States and the third leading cause of death. Worldwide, stroke is the second leading cause of death. Like heart disease and cancer, serious stroke disparities persist in America. African Americans have a relative risk of stroke death that is 4 times higher that whites at ages 35-54, 3 times higher at ages 55-64, and 2 times higher at ages 65-74.
The reasons for this are the focus of my two blog posts.
Over the last decade, most of the research dollars spent on stroke has focused on treatment and recovery. Researchers have spent millions trying to come up with new blockbuster treatments that reduce stroke burden or reverse it’s disabling impact. Therapeutic clot-busters have emerged with narrow time-windows within which they must be administered. Relaxing these time constraints have been the subject of even more research, and stroke recovery laboratories explore brain re-learning, neuronal plasticity, and cellular regeneration.
While I believe that we must continue to remain leaders of new and innovative treatments of disease, there is no doubt in my mind that the best return for our healthcare dollars is prevention. It is the only thing that can reign in the runaway disparities in healthcare and reduce the physical and economic burden of disease among all Americans.
But prevention is complex. It is much more challenging than administering a clot-buster or taking a cholesterol-lowering drug. Prevention involves the entire community – the whole ecosystem. It involves the child or individual, his parents and grandparents, his schoolteachers, his neighborhood stores and local parks, his local government policies, his primary care physician, his local community clinic or hospital, his employment status, his wallet, and lastly, his genes. Compare this to treatment, which involves having access to particular medical interventions such as a drug or surgical procedure.
Stroke prevention can be subdivided into primordial prevention (preventing stroke risk factors like high blood pressure, diabetes, and obesity, from developing in the first place through healthy living), primary prevention (preventing a first stroke by treating identified modifiable risk factors like high blood pressure etc), and secondary prevention (preventing a second stroke from occurring by controlling risk factors and administering specific treatments like taking a daily aspirin or having surgery to open up clogged arteries in the neck).
For the purposes of this post, I will focus on primordial prevention. To begin, I will re-introduce the root causes of disparities outlined previously:
- Educational status
- Employment status
- Insurance status
- Income level
How do these factors influence primordial prevention? How do they interact to define ecological conditions within a specific community? How did they contribute to the young boy’s adolescent stroke? To begin, I will list factors endemic to the young boy’s environment:
1] Low Health Literacy – the “hidden dragon” of all treatable risk factors; so often underestimated and so dangerous to the beholder.
2] Unacceptable numbers of uninsured – the “crouching tiger” threatening to tear down the entire health system
3] Poor access to care – an unforgiving predicament.
4] Limited access to healthy and inexpensive food
5] Ubiquitous access to unhealthy and cheap food
6] Low levels of non-occupational physical activity or leisure-related exercise
7] High tobacco and alcohol consumption.
8] Chronic persistent stress levels that overwhelm coping mechanisms.
In a study by Mauricio Avendano and Maria Glymour, wealth and income levels were shown to be independent risk factors for stroke. Another study by Glymour, Avendano, Haas, and Berkman showed that childhood social conditions (southern state of birth, parental Socio-Economic Status or SES, self-reported fair/poor childhood health, and attained height) predicted stroke risk in black and white adults. Moreover, adjustment for adult SES, in particular wealth, nearly eliminated all the disparity in stroke risk between black and white subjects
The ecological conditions that shaped the young boy’s physical and limbic traits are examples of an uneven playing field. He was born into it – just like I was born into my little world. The sporadic binging on cheap ubiquitous fast food whenever his mom had a little money and the absence of playtime ultimately led to his childhood obesity. The complex conditioning of his limbic needs led to a psychological fragility that was encased by a shell of defensive behavior that in-turn caused truancy. Substance abuse was around the corner waiting patiently for him. By age 15, the young boy was already a user; with open arms he was welcomed into “the hustle”. Mom was broken. One could see it in her eyes. She no longer worked. She no longer cared. That is, until her son had a stroke when he was just 17-years-old – the day the drought ended, and she cried.
It was a hemorrhagic stroke. The high blood pressure in his brain arteries caused by accelerated atherosclerosis – the consequence of his substance abuse (tobacco, alcohol, cocaine), type-two diabetes, and undiagnosed hypertension – was what caused the stroke. The stroke was so large that it shifted half of his brain across the midline of his skull, crushing it against the inner-table on the other side. Fortunately (some would say), the kid survived. Unfortunately, he wanted to die – 17-years-old and nursing home bound, unable to speak or swallow or move his right side.
The stroke was the final blow dealt by a cascade of disparities all too common in America.
July 22nd, 2009 by Olajide Williams, M.D. in Health Policy, True Stories
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Disparities in healthcare are composed of several interconnected layers – multiple layers joined together like the bricks of a divisive wall, separating better health from poor health. And while we must acknowledge the pre-eminence of personal responsibility, we must also address the uneven distribution of mountains and valleys on the American playing field.
Disparity sometimes begins before one is born; before one is conceived – it may begin in-utero, with the absence of adequate prenatal care, with maternal co-morbidities and high-risk behavior, long before one is old enough to assume personal responsibility within an “inherited” landscape or community that is filled with steep climbs and dark valleys. Many of us are familiar with root causes of healthcare disparities – the four components or foundational bricks that sustain physical and economic health in capitalist societies.
- Educational status
- Employment status
- Insurance status
- Income level
Individual or combined deficits in these components typically lead to accumulating disadvantages within which good health is considered an outlier. It is often these environmental factors, and not genetic ones or racial ones that are largely responsible for the disproportionate morbidity and mortality we witness all over America – especially in Harlem – the site of my neurological practice.
A young child is born on Malcolm X Boulevard in central Harlem. He is the most beautiful baby I have ever seen. And yet, his passage into the world is not without hardship. His single mom, a sixth grade dropout, did not have health insurance even though she worked two minimal wage jobs. She did not receive adequate prenatal care. Indeed, the only time she visited the hospital was to fix the broken bones in her face she sustained from domestic violence. Fortunately, she escaped from that life by fighting back with everything she had. Even her child was born through conflict – amidst the peril of eclampsia. It was a stormy delivery in a safety net hospital. Luckily, she survived and the beautiful baby boy thrived.
The early years of the child’s life were spent with grandma, until she died when her grandson was only 9-years-old. Mom had nobody else to help her, and there were no breaks in Harlem. She could not afford the childcare she needed to keep her second job, which she fought so hard in vain to keep. She became homeless. After squatting with her son in an old boyfriends house for a period of time, they finally moved into a housing shelter and were placed on a waiting list for section 8.
Mom was born poor; she had no successful role models; no good yardsticks with which she could measure herself against. Everyone around her seemed resigned to the status quo, which they would refer to as “the hustle”. She did not make it to high school; she fought for her minimum wage; she had no health insurance; and yet she worked hard to provide basic needs for her and her son. Each brick of disparity – educational status, employment status, insurance status, and income level – formed a wall so tall that it was hard to imagine how she would get to the other side.
Depression crept in – an irrepressible feeling of worthlessness and hopelessness. A feeling that no matter how hard she tried she would always fail. Most of her girlfriends were already on the streets or in jail. Their children had dropped out of school to join gangs or resort to petty crimes. She promised her own mother long before she died that she would never resort to crime. She would fight a good fight for her son and herself. But depression dug deeper, breaking her will, piece by piece until she finally succumbed to the twin pressures of emotional and economic desperation.
We all have limbic needs. For some, these needs are nurtured by loving hands that paint lasting portraits of hope inside our souls. Expressions of hope hanging on the walls of our heart chambers: a mother’s attention; a father’s approval, a caregiver’s warmth, a schoolteacher’s encouragement. For other’s, there is insufficient nurturing – these limbic needs are not met; rather, they are torn down – left out in the cold, often on impoverished streets – unanchored, undermined, forced to adapt alone in a Darwinian society.
In my next post, I will finish this story. I will describe the boy’s life and his ultimate stroke in an attempt to show the interconnectivity of health and the four components of healthcare disparities.
June 13th, 2009 by RamonaBatesMD in Better Health Network, Health Tips
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Last Tuesday, this tweet from @AllergyNotes caught my eye.
Call cubital tunnel syndrome a “cell phone elbow” and you make the front page of CNN.com: http://bit.ly/RaXrt and http://bit.ly/TTRfg
Cubital tunnel syndrome I know, but I had not heard it called “cell phone elbow.” The first link is to the Cleveland Clinic Journal of Medicine article (full reference below). It is an excellent article and well worth reading. The second link is to CNN news article picking up the “cell phone elbow” line.
Cubital tunnel syndrome is a nerve compression syndrome (like carpal tunnel syndrome). In the case of cubital tunnel syndrome, the nerve involved is the ulnar nerve and the location is at the elbow. From the article
… the ulnar nerve as it traverses the posterior elbow, wrapping around the medial condyle of the humerus. When people hold their elbow flexed for a prolonged period, such as when speaking on the phone or sleeping at night, the ulnar nerve is placed in tension; the nerve itself can elongate 4.5 to 8 mm with elbow flexion……..
As with other nerve compression syndromes, the clinical picture is representative of the nerves enervation. In the case of the ulnar nerve, this involves numbness or paresthesias in the small and ring fingers. There may also be numbness of the dorsal ulnar hand which will NOT be present if the ulnar nerve compression is in the Guyon’s canal at the wrist level (distal ulnar nerve compression). If the compression is chronic enough, the symptoms progress to hand fatigue and weakness. The small intrinsic muscles of the hand are important in hand strength needed to open jars. More from the article
Chronic and severe compression may lead to permanent motor deficits, including an inability to adduct the small finger (Wartenberg sign) and severe clawing of the ring and small fingers (a hand posture of metacarpophalangeal extension and flexion of the proximal and distal interphalangeal joints due to dysfunction of the ulnar-innervated intrinsic hand musculature). Patients may be unable to grasp things in a key-pinch grip, using a fingertip grip instead (Froment sign).
It may be an old joke (Patient: Doctor, it hurts when I do this. … Doctor: Well don’t do it.), but in the case of cubital tunnel syndrome it fits. Prevention is key. Prolonged extreme flexion of the elbow (elbows bent tighter than 90 degrees) is not kind to the ulnar nerve. Switch hands or use a head set or blue tooth.
REFERENCES
Q:What is cell phone elbow, and what should we tell our patients?; Cleveland Clinic Journal of Medicine May 2009 vol. 76 5 306-308 (doi: 10.3949/ccjm.76a.08090); Darowish, Michael MD, Lawton, Jeffrey N. MD, and Evans, Peter J MD, PhD
Cubital Tunnel Syndrome: eMedicine Article, Feb 9, 2007; James R Verheyden, MD and Andrew K Palmer, MD
*This blog post was originally published at Suture for a Living*
