Honoring the Health Sacrifices of Our Veterans

VETERANS-DAY-poster-2012On Veterans Day, America pauses to honor every service member who has ever worn one of our Nation’s uniforms. Each time our country has come under attack, they have risen in her defense. Each time our freedoms have come under assault, they have responded with resolve. Through the generations, their courage and sacrifice have allowed our Republic to flourish. And today, a Nation acknowledges its profound debt of gratitude to the patriots who have kept it whole.

As we pay tribute to our veterans, we are mindful that no ceremony or parade can fully repay that debt. We remember that our obligations endure long after the battle ends, and we make it our mission to give them the respect and care they have earned. “

These two paragraphs are taken directly from the 2013 Veterans Day Presidential Proclamation.

But getting Veterans the care they deserve is not always easy.  The wounds of war can go far beyond what meets the eye. From mental health issues to pain and illness that persist long after they’ve left the battlefield, veterans face a multitude of health troubles either unique to their service or more frequent among them than the general population.

Folks returning from combat have a constellation of health concerns, including physical issues, psychological issues and psychosocial issues concerning things like work and family,” said Dr. Stephen Hunt, national director of the U.S. Department of Veterans Affairs Post Deployment Integrative Care Initiative.

Some of the most common physical complaints of returning soldiers cannot be classified into a single disorder. They include nonspecific symptoms such as fatigue, pain and cognitive disturbances such as memory and concentration problems.

Here are seven of the most commonly seen health conditions confronting veterans:

vetsparade-79576Musculoskeletal injuries and pain

Just over half of all veterans’ post-deployment health visits address lingering pain in their backs, necks, knees or shoulders.  According to a study in the Journal of Pain, about 100,000 veterans of the Gulf War nearly 20 years ago have reported chronic muscle pain.

Mental health issues

PTSDWhile post-traumatic stress disorder (PTSD) among soldiers has been well publicized, other mental woes can also result from the trauma of war. A study in the journal Archives of General Psychiatry [now JAMA Psychiatry] found that one in 10 Iraq war vets develop serious mental problems, including violent behavior, depression and alcohol abuse. The study found that PTSD or depression seriously impaired daily functioning in 8.5 – 14% of these vets.  Disabling on its own, PTSD is also linked to the development of physical illnesses for veterans as years pass. Researchers from Walter Reed Army Medical Center reported that 54% of veterans with PTSD also had sleep apnea, compared with 20%of PTSD patients in the general population. PTSD in vets is also associated with a greater risk of developing dementia.

Chemical exposure

syria1Research by the American Heart Association found that exposure to nerve agents such as sarin – which can trigger convulsions and death on the battlefield – may cause long-term heart damage in Gulf War veterans. The damage can include an enlarged left ventricle, heart rhythm abnormalities or a reduction in the pumping strength of the heart.

Infectious diseases

Although all military personnel are given routine vaccinations before deployment, veterans suffer disproportionately from certain infections that civilians almost never experience.  They include bacterial infections such as brucellosis, which may persist for years; campylobacter jejuni, which causes abdominal pain, fever and diarrhea; and Coxiella burnetii, which in chronic cases can inflame the heart.

Leishmaniasis, a parasitic disease caused by the bite of a sand fly native to the Middle East, is a particularly brutal condition veterans experience. Those infected suffer weight loss, fevers, headaches, muscle pain and weakness, anemia, and enlargement of the spleen and liver. It can be fatal if untreated, according to the VA..

army-mil-2007-06-28-113715Traumatic Brain Injury (TBI)

TBI, often brought on by a blow or jolt to the head, disrupts brain function and has been called the signature wound of the fighting in Iraq and Afghanistan, according to the National Academy of Sciences. Blast exposures and other combat-related activities put service members at greater risk for sustaining a TBI compared to their civilian counterparts, according to the Defense and Veterans Brain Injury Center.

Common effects of TBIs include cognitive issues such as shorter attention span, language disabilities, and an inability to process information. Vets can also suffer from lack of motivation, irritability, anxiety and depression, headaches, memory loss and PTSD.

However, you choose to mark Veteran’s Day 2013, please remember the sacrifices made by all of our vets and be mindful of the long-term health problems they face. Ladies and Gentleman of the military, we thank you for your service.

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Drinking our way to brain fitness

alcohol related dementiaAs we reported last week, drinking the occasional glass of wine might help to stave off depression. This week we learned how to better protect ourselves from that wine we’ve been drinking!

Previous studies have shown that long-term alcohol abuse increases the risk of dementia. But according to new research from Loyola University Chicago Stritch School of Medicine, omega-3 fish oil might help protect against alcohol-related dementia.

The Loyola study found that in the brain cells of rats exposed to high levels of alcohol, a fish oil compound protected against inflammation and cell death.

fish oilThe study by Michael Collins, PhD, and colleagues was reported Sept. 8 at the 14th Congress of the European Society for Biomedical Research on Alcoholism.  An earlier analysis by Collins and Loyola colleague Edward Neafsey, PhD, which pooled the results of 143 studies, found that moderate social drinking may reduce the risk of dementia and cognitive impairment.

It appears that small amounts of alcohol might, in effect, make brain cells more fit. Alcohol in moderate amounts stresses cells and thus toughens them up to cope with major stresses down the road that could cause dementia.

However, as always, moderation is the key! Too much alcohol overwhelms the cells, leading to inflammation and cell death. The study authors defined moderate as one drink per day for women and two for men.

mouse & fish oilIn the new study, Collins and colleagues exposed cultures of adult rat brain cells to amounts of alcohol equivalent to more than four times the legal limit for driving. These cell cultures were compared with cultures of brain cells exposed to the same high levels of alcohol, plus a compound found in fish oil called omega-3 docosahexaenoic acid (DHA).  Researchers found there was about 90% less neuroinflammation and neuronal death in the brain cells exposed to DHA and alcohol than in the cells exposed to alcohol alone.

Of course, being a health blog we should point out that the best way for an alcohol abuser to protect their brain is to quit drinking or to cut back to moderate amounts.  But as Collins says: “Fish oil has the potential of helping preserve brain integrity in abusers. At the very least, it wouldn’t hurt them.”

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In Vino Veritas?

GEICO camelHappy Hump Day!

While we may not be able to make you laugh quite as much as the GEICO camel, we do bring you news that should at least make you smile.

A new Spanish study suggests that drinking wine might help you avoid depression.

Although drinking a lot of wine or other alcohol may be a sign of depression or other mental health problems, alcohol in moderation may benefit mental health according to the study authors.

One drink a day, preferentially wine, may help prevent depression,” said lead researcher Dr. Miguel Martinez-Gonzalez, chair of the department of preventive medicine and public health at the University of Navarra, in Pamplona.

red-wine_0Researchers followed more than 5,500 light-to-moderate drinkers, aged between 55 and 80 for up to seven years.  None of the individuals had suffered from depression or had alcohol-related problems at the start of the study. Over seven years, with medical exams, interviews with dietitians and questionnaires, the researchers kept tabs on participants’ mental health and lifestyle.  Wine was the most popular drink and participants who drank two to seven glasses a week were the least likely to suffer from depression, compared to nondrinkers. These findings remained significant even after the researchers took factors such as smoking, diet and marriage into account.

But before you start reaching for the corkscrew, we need to warn you that not all experts agree with the findings and even the research team, only saw benefit in moderate drinkers.

Martinez-Gonzalez thinks the apparent benefit of wine in preventing depression may work the same way that moderate drinking helps prevent heart disease.

Depression and heart disease seem to share some common mechanisms because they share many similar protective factors and risk factors,” he said. However, he added that depression prevention is not a reason to start drinking.

If you are not a drinker, please don’t start drinking,” he said. “If you drink alcohol, please keep it in the range of one or less drinks a day and consider drinking wine instead of other alcoholic beverages.”

Tony Tang, an adjunct psychology professor at Northwestern University, in Evanston, Ill., said the new research “is consistent with other studies suggesting modest health benefits of very modest drinking.”

red wine glassesBut, Tang said other factors may be at work in the potential connection between wine and depression. He noted that compared to nondrinkers, those in the Spanish study who drank a moderate amount of wine were more likely to be married men who were also physically active.  Being single or divorced, living alone and being sedentary are well-established risk factors of depression. Thus, he suggests, the correlation between modest drinking and depression is a coincidence caused by these other known factors.

An adequate social life is the most important factor we know that protects people from depression,” Tang said. “Perhaps not drinking is a sign of serious social isolation in Spain while drinking a glass of wine a day is simply a sign of having a normal social life.”

red wine with friends 2Wine with friends anyone?

Cheers!

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Stress and Distress at Work

stress at workHere’s a classic Catch-22 conundrum for co-workers to consider. Psychological distress, such as feelings of  worthlessness, hopelessness, nervousness, and/or restlessness)  can be predictors  of early stage anxiety and depression. It can also lead to decreased job productivity and absenteeism. But, it may actually be the job that’s creating the mental distress in the first place. Norwegian researchers have identified that perceived role conflicts and emotional demands are the most important and most consistent risk factors for psychological distress. While other psychosocial working conditions have been linked to distress, this study is the first to highlight the importance of these two issues. Håkon A. Johannessen, PhD, and colleagues from the Norwegian National Institute of Occupational Health, looked at how the work environment affected employees’ levels of psychological distress. Sixteen percent of workers said they were at least slightly bothered by psychological distress over the past month. The study focused on two main risk factors: role conflict, such as being given work tasks without enough resources to complete them and receiving contradictory requests from different people; and emotional demands, defined as “dealing with strong feelings such as sorrow, anger, desperation and frustration” at work. contradiction_smallProblematic levels of distress were 53% more likely for workers reporting role conflict and 38% more likely for those facing high emotional demands. Other risk factors were low job control, bullying/harassment, and job insecurity. The researchers conclude that employers should focus on the identified risk factors to improve the psychosocial work environment and thus promote good mental health and productivity among employees. Is your job getting you down? Have you any tips for beating work-related stress?  We’d love to hear from you. SRxA-logo for web

Beans, Broccoli and Bluefin could help new moms beat the “Baby Blues”

According to an article published last week in the Canadian Journal of Psychiatry, postpartum depression may be caused by low levels of omega-3 fatty acids.

For the 70-80% of all new mothers who experience some negative feelings or mood swings after the birth of their child could the answer lie with legumes?

Women are at the highest risk of depression during their childbearing years, and the birth of a child may trigger a depressive episode in vulnerable women. Postpartum depression is associated with diminished maternal health as well as developmental and health problems for her child.

Symptoms of “baby blues” include:

  • Weepiness or crying for no apparent reason
  • Impatience
  • Irritability
  • Restlessness
  • Anxiety
  • Fatigue
  • Insomnia
  • Sadness
  • Mood changes
  • Poor concentration

Gabriel Shapiro of the University of Montreal and the Research Centre at the Sainte-Justine Mother and Child Hospital says “The literature shows that there could be a link between pregnancy, omega-3 and the chemical reaction that enables serotonin, a mood regulator, to be released into our brains.”

Because omega-3 is transferred from the mother to her fetus and later to her breastfeeding infant, maternal omega-3 levels decrease during pregnancy, and remain lowered for at least six-weeks following the birth.

Furthermore, in addition to the specific circumstances of pregnant women, it has been found that most people in the US do not consume sufficient amounts of omega-3. “These findings suggest that new screening strategies and prevention practices may be useful,” said Shapiro.

And while there are plenty of commercial omega-3 supplements, don’t forget that these clever little fatty acids are also present in seafood, (especially salmon, anchovies, tuna and sardines) as well as in oils, beans, nuts and seeds, winter squash, broccoli and my personal favorite – cauliflower.

Although Shapiro’s study was preliminary and the further research is needed to clarify the link, new moms could do worse than use salmon to stave off sadness or anchovies as the answer to anxiety!

The Peak Time for Everything

Not enough hours in your day?  So much to do…so little time?  If you’re anything like me, these will be familiar expressions.

And in which case, you should be interested to learn that maybe, just maybe, you could pack more into each day if you did everything at the optimal time?

A growing body of research suggests that paying attention to your body clock, and its effects on energy and alertness, can help pinpoint the different times of day when it’s best to perform at specific tasks.

Most people organize their time around everything but the body’s natural rhythms.

But workday demands such as commuting, social events and kids’ schedules inevitably end up clashing with the body’s natural circadian rhythms of waking and sleeping.

And as difficult as it may be to align your schedule with your body clock, it may be worth a try, because there are significant potential health benefits.

Disruption of circadian rhythms has been linked to problems such as diabetes, depression, dementia and obesity.

When it comes to doing cognitive work, for example, most adults perform best in the late morning, says Dr. Steve Kay, a professor of molecular and computational biology at the University of Southern California.  As body temperature starts to rise just before awakening in the morning and continues to increase through midday, working memory, alertness and concentration gradually improve. Taking a warm morning shower can jump-start the process.

The ability to focus and concentrate typically starts to slide soon thereafter. Most people are more easily distracted from noon to 4 p.m.

Alertness tends to slump after eating a meal, and sleepiness tends to peak around 2 p.m.  But you may want to rethink taking a nap at your desk.  It turns out, somewhat surprisingly, that fatigue may boost creative powers.

For most adults, problems that require open-ended thinking are often best tackled in the evening when they are tired. According to a 2011 study when students were asked to solve a series of two types of problems, requiring either analytical or novel thinking, their performance on the second type was best when they were tired.

Mareike Wieth, an assistant professor of psychological sciences at Albion College in Michigan who led the study says, “Fatigue may allow the mind to wander more freely to explore alternative solutions.”

Of course, not everyone’s body clock is the same. Morning people tend to wake up and go to sleep earlier and to be most productive early in the day. Evening people tend to wake up later, start more slowly and peak in the evening.

Communicating with friends and colleagues online has its own optimal cycles, research shows. Sending emails early in the day helps beat the inbox rush.  6 a.m. messages are most likely to be read.

Reading Twitter at 8 a.m. or 9 a.m. can start your day on a cheery note. That’s when users are most likely to tweet upbeat, enthusiastic messages, and least likely to send downbeat tweets steeped in fear, distress, anger or guilt.

Other social networking is better done later in the day. If you want your tweets to be re-tweeted, post them between 3 p.m. and 6 p.m., when many people lack energy to share their own tweets and turn to relaying others’ instead. And posts to Facebook  at about 8 p.m. tend to get the most “likes,” after people get home from work or finish dinner.

When choosing a time of day to exercise, paying attention to your body clock can also improve results. Physical performance is usually best, and the risk of injury least, from about 3 p.m. to 6 p.m.

Muscle strength tends to peak between 2 p.m. and 6 p.m. as does lung function which is almost 18% more efficient at 5 p.m. than at midday.

Is there a best time to eat? Experts suggest limiting food consumption to hours of peak activity to keep from packing on pounds.  Perhaps we are not only what we eat, we are when we eat!

FDA Ad Study: Clarifying the Confusion

As a public health agency, the FDA encourages the communication of accurate health messages about medical conditions and treatment.  One way the pharma industry does this is through non-branded disease awareness communications. These are aimed at either the general public or health care practitioners and discuss a particular disease or health condition, without making mention of any specific drug.  Usually, they encourage consumers to seek, and health care practitioners to provide, appropriate treatment for the particular disease state.

This is helpful for under-diagnosed and under-treated diseases such as depression, hyperlipidemia, hypertension, osteoporosis, and diabetes. Some research has shown that consumers prefer disease awareness advertising. It’s considered more informative and less persuasive than full product advertising.

The pharma industry likes it too.  Disease awareness communications are not subject to the regulations and restrictions mandated by the FDA for prescription drug advertising.

But now, the FDA is concerned that disease awareness ads might confuse consumers. According to a Federal Register notice issued on June 20, the agency wants to know whether the public can distinguish between product claims and disease information, and how different types of information impact comprehension.

So worried in fact,  the Agency has planned a study entitled, “Experimental Study: Disease Information in Branded Promotional Material” to look into those questions.

The study will examine print ads for three conditions – COPD, lymphoma and anemia.

4,650 American adults will be divided into three groups and asked to review the ads electronically.

  • One group will see information about the disease that avoids discussion of disease outcomes the drug has not been shown to address i.e.  “Diabetes is a disease in which blood sugar can vary uncontrollably, leading to uncomfortable episodes of high or low blood sugar.”
  • Other participants will see disease information that mentions consequences of the disease that go beyond the indication of the advertised product, such as, “Untreated diabetes can lead to blindness, amputation, and, in some cases, death.”
  • A third group will see drug product information only.

Disease information will be presented in different ways. For example, on alternating paragraphs, on separate pages or in different fonts and colors from product claims.

Specifically the study will address whether or not consumers are able to distinguish between claims made for a medication and general disease information when they see an advertisement for a drug.  For example, if an ad for a drug that lowers blood glucose, mentions diabetic retinopathy do consumers  think the drug will prevent the affliction, even if no direct claim is made?

The Agency says: “If consumers are able to distinguish between disease information and product claims in an ad, then they will not be misled by the inclusion of disease information in a branded ad. If consumers are unable to distinguish these two, however, then consumers may be misled into believing that a particular drug is effective against long-term consequences.”

SRxA’s Word on Health looks forward to seeing the results. Given that warning letters have been issued in the past over ads that contain mixed messages, this is an opportunity for the FDA to revisit its stance toward such advertising, reduce consumer confusion and, most importantly, learn how best to disseminate useful health information.

Honoring Our Military

Today, Veterans Day, our nation honors the men and women who have served our country. Cities host parades, department stores have sales, schools and the Federal Government close. Most of us are thankful for a day off. But how many of us will stop and think about the tremendous sacrifices made by those in the military community – the risks they take and the burdens they carry? And how many of us will take the time to reflect on how families and lives are forever changed as a result of war?

Since September 11, 2001, over 2 million men and women have deployed to fight the wars in Iraq and Afghanistan – many of these have deployed multiple times.  During this time, countless family members have suffered through multiple separations. And let’s not forget the 5,798 American men and women who have died during these wars or the 40,000 who have come home with significant physical injuries. In addition, many of our troops come home with invisible injuries of war including post traumatic stress, traumatic brain injury, depression and anxiety.

Sadly, a large number of those who suffer these invisible injuries fail to seek the care that they so need and deserve. The stigma associated with seeking mental health care and our cultural reluctance to admit mental health concerns prevents many of the brave men and women in our armed forces from obtaining proper treatment.

Families are suffering. A recent study in the journal, Pediatrics, found that young children in military families are about 10% more likely to see a doctor for a mental health difficulty when a parent is deployed than when the parent is home. Social scientists have long known that the cycle of deployment and reintegration puts a significant strain on the families of those who serve, particularly spouses. Given that the conflict in Iraq has been underway for over seven long years, tens of thousands of military children have only known the experience of war.

While most civilians are familiar with the terms “post traumatic stress” and “traumatic brain injury” it is striking how little the average person knows about these very understandable, yet potentially devastating, consequences of war.  Movies and television programs often portray veterans suffering with post traumatic stress as out-of-control and hyper-aggressive. While difficulties with impulse control and rage are indeed possible manifestations there is a range of other symptoms and reactions that are less well known. Some withdraw and become disengaged from those around.  Others have difficulty finding meaning in life, while others may experience anxiety, flashbacks and severe sleep disturbance. Sometimes the painful mental health symptoms that result from the experience of war lead to self-medication and substance abuse and suicide. Then there is the dramatic increase in the number of suicides reported by active duty personnel as well as those who have separated from the military.

Some members of our military community come home to families that cannot possibly understand what they have seen or done. Unable to bridge the gap between who they were when they deployed and who they are upon return, our service members find themselves in relationships that falter and marriages that fail.

But there is reason to hope. Many within government and Veterans Affairs, the academic community, the nonprofit sector, the entertainment industry, and caring individuals in communities across the country are stepping up to assist those who serve our country and their families.

The rest of us can help by recognizing and accepting psychological injuries of war and encouraging our veterans to receive proper care and treatment in a timely manner.  Together, we can stem the tide of suicides and save hundreds of thousands of service members who have come home from war with injuries that they alone cannot heal. In order to be successful in this mission, however, we must harness the goodwill, the knowledge, the resources and the commitment of a thankful nation that recognizes the sacrifices made by so few for so many.

SRxA’s Word on Health would like to honor and thank all of our Veterans.

Why Women Worry

According to researchers at the Children’s Hospital of Philadelphia, there may be a biological reason why depression and other stress-related psychiatric disorders are more common among women.  Studying stress signaling systems in animal brains, neuroscience researchers found that females are more sensitive to low levels of an important stress hormone and less able to adapt to high levels than males.

The research was published in the June edition of Molecular Psychiatry.

It has long been recognized that women have a higher incidence of depression, post-traumatic stress disorder, and other anxiety disorders, but underlying biological mechanisms for that difference have been unknown.

The research focused on corticotropin-releasing factor (CRF), a hormone that organizes stress responses in mammals.

Analyzing the brains of rats that responded to a swim stress test, investigators found that in female rats, neurons had receptors for CRF that bound more tightly to cell signaling proteins than in male rats, and thus were more responsive to CRF. Furthermore, after exposure to stress, male rats had an adaptive response, called internalization, in their brain cells. Their cells reduced the number of CRF receptors, and became less responsive to the hormone. In female rats this adaptation did not occur because a protein important for this internalization did not bind to the CRF receptor.

This is the first evidence for sex differences in how neurotransmitter receptors traffic signals,” said study leader Rita J. Valentino, Ph.D. “Although more research is certainly necessary to determine whether this translates to humans, this may help to explain why women are twice as vulnerable as men to stress-related disorders.”

So ladies, next time you’re accused of being stressed out, relax.   Just blame it on your CRF.

Depression – an Inflammatory Disease?

SRxA’s Word on Health brings you a chicken and egg type conundrum to start your day.

Up to 40% of people who are chronically ill get depressed.  Depressed people are prone to a variety of medical illnesses including diabetes and coronary heart disease.

So which comes first?

A new meta-analysis from researchers at the University of Toronto, published last month in Biological Psychiatry, may provide the answer.

To determine whether pro-inflammatory cytokines play a role in the overlap between depression and inflammation-associated medical disorders, the Toronto group conducted a meta-analysis of 24 studies of cytokine levels in 438 unmedicated subjects with major depression and 350 medically and psychiatrically healthy controls.

They found that concentrations of two cytokines: tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 were significantly higher in depressed patients than in controls. The groups showed no significant differences in other interleukin levels.

IL-6 stimulates differentiation and proliferation of antibody secreting white blood cells while TNF-α  stimulates the release of other pro-inflammatory cytokines and inflammatory prostaglandins. In the brain, these substances result in increased cortisol production; and increased production of a substance that accelerates cell death.  This reduces the resilience of the brain and may contribute to the stress response that is characteristic of depression.

High levels of IL-6 and TNF-α  have also been correlated with depression in patients with cancerend stage kidney diseaseParkinson’s disease, stroke and a host of other non-infectious conditions.

The results of this study provide further evidence that depression is accompanied by activation of the inflammatory response system and contributes to the development and progression of physical illness.

Which begs the question – will anti-inflammatory drugs prove helpful in managing depression?

Although corticosteroids, used to treat inflammatory conditions, have an initial ‘pick me up’ effect in some patients, over time, the same drugs can provoke depression. Non-steroidal anti-inflammatory drugs (NSAIDs) could be another option, but they may also cause depressing side-effects such as  nausea, vomiting, diarrhea, constipation, headache, and drowsiness.

Word on Health suggests more studies are needed before we start popping more pills!