How Eldercare Handicaps Women

On Health Care Decisions Day, leading healthcare advocate Jennifer Brokaw, daughter of Tom, points to the burden of medical-decision making, for which wives and daughters bear the brunt.

As a 48-year-old physician, wife, and daughter of aging parents, I am increasingly aware of my role as a medical decision-maker on both sides of the equation. In my work as a medical advocate, I have noticed that this role is played largely by women.

While I am proud that women are still fighting for sexual and reproductive freedoms, that child-rearing has become more of a team sport, and that women’s health issues such as breast cancer and heart disease are on everyone’s radar, the important role of women as medical decision-makers has not yet been given its due.

Almost half of hospitalized patients 65 or older needed a surrogate to help with at least one major decision, according to a recent study in the Journal of the American Medical Association. Almost a quarter of those patients needed a surrogate to make all of the decisions.

And who are the surrogates? According to JAMA, 58% were daughters, 20% were sons, and 20% were spouses, wives included.

It’s now estimated more than 60% of adults 65 and older will need some form of long-term care, many of them for the devastating onset of Alzheimer’s disease or dementia. Alzheimer’s is also one of the key reasons elderly patients require assistance with providing consent or refusal for medical treatment.

It’s not easy being a healthcare surrogate. This is especially true when the decisions center on end-of-life questions, a weighty decision when you consider that in California 77% of unpaid in-home caregivers are women. Where should mom live after a stroke? Would dad want to spend his last days on a ventilator, heavily sedated and paralyzed? Contrary to what many people assume about what happens in the hospital today, it is often the appointed surrogate, not the treating physicians, that make the final decisions about extent of treatment at the end of life.

Research has shown that surrogate decision-makers experience a lot of stress when decisions need to be made, and after the fact as well. However, a well-known study in the British Medical Journal showed that surrogates that had discussed advance directives and wishes with their loved one had significantly less stress, shorter grieving periods, and less substance use after their loved one’s death than those who had not had those conversations.

Nevertheless, only 30% of Americans have created an Advance Health Care Directive or Living Will. In the JAMA study, 25% had a designated surrogate on the chart, but a mere 7% had left any guidelines about their wishes. To be sure, these issues are difficult to contemplate in advance and still carry a lot of stigma in our optimistic never-say-die culture. It’s time for that to change.

I encourage all families to start creating an Advance Health Care Directive or Living Will now with all family members at the table. Clarifying the goals a person has for his or her life, including its end, can ease the burdens of decision-making when a crisis arrives. This process is known as advance care planning.

Furthermore, it’s time for doctors to get formal training about how to discuss decisions that need to be made with the surrogate decision-maker in a way that focuses on the overall goals of care and not just the immediate crisis. Doctors also need to circle back to taking more responsibility for decisions, keeping the patient’s and surrogate’s goals into account, and avoiding the old paternalistic attitude.

Everyone admires the woman who can “have it all,” be a mother, wife, and have a career and a full personal life. When we talk about what derails women’s careers, the conversation focuses on having children. The truth is that “sandwich generation” women have a lot more on their plate. It’s time to give advance care planning and healthcare decision-making the attention it deserves. It’s a woman’s prerogative.

Study: New Technique Predicts Consciousness of Brain-Damaged Patients

Brain imaging can help doctors tell when a patient is more likely to recover

End-of-life questions are complicated by the uncertainty of whether a patient in a deep vegetative state will ever regain consciousness or recover, and doctors have been baffled by patients who they thought were all but dead coming back to life after an extended period of unconsciousness.

For those cases where patients do seem to wake from the dead, it’s most likely that they were in a minimally conscious state, where there is some awareness or response to stimuli. Such patients have a better chance of recovery than those in a vegetative state, where there are no signs of awareness or response to stimuli.

Diagnosing consciousness is tricky; oftentimes brain activity can be observed, but that doesn’t necessarily translate into consciousness on the part of the patient. The most well-known and standard test for determining awareness is the Coma Recovery Scale-Revised (CSR-R), a behavioral test. Now researchers have discovered that a particular type of brain imaging, positron emission tomography, may be able to determine which vegetative patients will recover.

In a study out Tuesday, scientists looked at 126 patients who had experienced severe brain damage. Researchers from the University of Liége in Belgium tested whether using PET with the imaging agent fluorodeoxyglucose (FDG) or another imaging technique called functional MRI (fMRI) could distinguish between a vegetative and a minimally conscious state.

Overall, the FDG-PET combination was better than the fMRI method at distinguishing between the two states. FDG-PET was also 74% accurate at predicting recovery within the next year. Additionally, 12 of the patients in the study group who showed some brain activity on the FDG-PET scan were diagnosed by the CSR-R method as behaviorally unresponsive, but 9 of them later recovered some consciousness.

“We confirm that a small but substantial proportion of behaviourally unresponsive patients retain brain activity compatible with awareness,” says study leader Professor Steven Laureys from the University of Liége in Belgium.

But diagnosing consciousness through brain imaging is far from an exact science. It’s often unclear how to interpret brain activity. In 2011, researchers from the University of Western Ontario reported that they had successfully used an electroencephalogram (EEG) to record brain signals that suggested awareness in patients in a vegetative state. However, when a team of scientists from Weill Cornell Medical College tried to replicate their data a few years later, they discovered that the original researchers didn’t account for false-positives. When they went back over the data, accounting for interfering factors like muscle activity and EEG blips, they were unable to replicate the results.

What the study does indicate, though, is that PET may be needed for confirmation of consciousness. “Our findings suggest that PET imaging can reveal cognitive processes that aren’t visible through traditional bedside tests, and could substantially complement standard behavioural assessments to identify unresponsive or ‘vegetative’ patients who have the potential for long-term recovery,” Laureys said in a statement.

Recreational Pot Use Harmful to Young People’s Brains

A new study from researchers at Northwestern University shows that smoking marijuana even just recreationally can cause abnormalities in areas of the brain that regulate emotion and motivation in 18-to-25-year-olds

For those young people—and their parents—who think that smoking pot in moderation isn’t harmful, it’s time to think again.

A study being released this week by researchers from Northwestern University’s Feinberg School of Medicine and Harvard Medical School has found that 18- to 25-year-olds who smoke marijuana only recreationally showed significant abnormalities in the brain.

“There is this general perspective out there that using marijuana recreationally is not a problem—that it is a safe drug,” says Anne Blood, an assistant professor at Harvard Medical School and the co-senior author of the study, which is being published in The Journal of Neuroscience. “We are seeing that this is not the case.”

The scientists say theirs is the first study to examine the relationship between casual use of marijuana in young people and pot’s effects on two parts of the brain that regulate emotion and motivation. As such, it is sure to challenge many people’s assumptions that smoking a joint or two on the weekends is no big deal.

It has certainly challenged mine. In a piece earlier this year, based on other research from Northwestern on the effects of heavy marijuana use, I suggested that young people should hold off on smoking pot as long as possible because their brains are still developing and the earlier the drug is taken up, the worse the effects. That remains good advice. Yet the truth is, I’ve not only been telling my own 16-year-old son to hold off, I’ve also been counseling him that should he ever decide to use pot, he should do so with temperance.

This “everything in moderation” mantra has always struck me as more realistic than preaching total abstinence. Baked into my message, meanwhile, has been the implicit belief that smoking a little weed on the weekends is no worse than having a few beers—a notion that many Americans apparently share.

A nationwide NBC/Wall Street Journal Poll conducted last month found that only 8% of adults think that marijuana is the most harmful substance to a person’s overall health when lined up against tobacco, alcohol, and sugar. Forty-nine percent of those surveyed rated tobacco as the most harmful on the list, while 24% picked alcohol. Notably, even sugar (at 15%) was considered more harmful than pot.

The new Northwestern-Harvard study punches a hole in this conventional wisdom. Through three different methods of neuroimaging analysis, the scientists examined the brains of 40 young adult students from Boston-area colleges: 20 who smoked marijuana casually—four times a week on average—and 20 who didn’t use pot at all.

Each group consisted of nine males and 11 females. The pot users underwent a psychiatric interview to confirm that they were not heavy or dependent marijuana users.

“We looked specifically at people who have no adverse impacts from marijuana—no problems with work, school, the law, relationships, no addiction issues,” says Hans Breiter, a professor of psychiatry and behavioral sciences at the Feinberg School and co-senior author of the study.

The scientists examined two key parts of the brain—the nucleus accumbens and the amygdala, which together help control whether people judge things to be rewarding or aversive and, in turn, whether they experience pleasure or pain from them. It is the development of these regions of the brain, Breiter says, that allow young people to expand their horizons, helping them to appreciate and enjoy new foods, music, books, and relationships.

“This is a part of the brain that you absolutely never ever want to touch,” Breiter asserts. “I don’t want to say that these are magical parts of the brain—they are all important. But these are fundamental in terms of what people find pleasurable in the world and assessing that against the bad things.”

Breiter and his colleagues found that among all 20 casual marijuana smokers in their study—even the seven who smoked just one joint per week—the nucleus accumbens and amygdala showed changes in density, volume, and shape. The scientists also discovered that the more pot the young people smoked, the greater the abnormalities.

The researchers acknowledge that their sample size was small and their study preliminary. More work, they say, needs to be done to understand the relationship between the changes to the brain they found and their impact on the day-to-day lives of young people who smoke marijuana casually.

“The next important step is to investigate how structural abnormalities relate to functional outcomes,” says Jodi Gilman, an instructor at Harvard Medical School who collaborated on the study.

This is especially important, she and her colleagues add, in light of the growing push to legalize recreational marijuana use across America.“People think a little marijuana shouldn’t cause a problem if someone is doing OK with work or school,” Breiter says. “Our data directly says this is not so.”

Infectious Disease

Guinea Says Ebola Outbreak Almost Under Control

A scientist separates blood cells from plasma cells to isolate any Ebola RNA in order to test for the virus at the European Mobile Laboratory in Gueckedou April 3, 2014.
A scientist separates blood cells from plasma cells to isolate any Ebola RNA in order to test for the virus at the European Mobile Laboratory in Gueckedou April 3, 2014. Misha Hussain—Reuters

Health experts in the west African country say there are fewer new cases of the virus, which has no cure and which is fatal for a significant portion of those who contract it, suggesting the outbreak that has killed over 100 people there may be close to being contained

Guinea’s health ministry says deaths from its recent Ebola outbreak have slowed, and the latest flare-up of the virus is close to being under control.

The disease has already killed 106 in Guinea and spread to neighboring countries in Western Africa, but Rafi Diallo, a spokesman for Guinea’s health ministry, told Reuters that the number of new cases have fallen dramatically. Once there are no more new cases, the outbreak can be considered under control. The World Health Organization (WHO) says it could take two to four months for the outbreak to be entirely contained, Reuters reports.

There is no known cure or vaccine for Ebola, which is known to kill up to 90 percent of the people who contract it. The virus spreads through direct contact with bodily fluids, including blood, feces or sweat. The disease can spread via sexual contact or unprotected interaction with contaminated corpses.

Although the virus remains a significant concern, the WHO is confident it will be contained. Since the majority of people who get the disease will die from it, there’s not too much time for it to spread, as long as health workers can quickly identify who has come in contact with a sick person. WHO’s media spokesperson in Guinea, Tarik Jasarevic, told TIME last month: “We know this disease. It’s not the first time we’ve seen it so we know the measures we can take. It’s not a new disease.”

[Reuters]

Our Brains Begin to Slow Down at Age 24

Is 24 the new 50? A new study suggests that cognitive decline begins earlier than we think. The study of more than 3,300 volunteers tracked the relationship between age and the speed at which people make decisions and shift between tasks

Is 24 the new 50? If you’re going by when our intellectual skills start to decline and dull due to the passage of time, then it might be.

According to researchers at Simon Fraser University in Canada, things start going south at age 24. They came to that conclusion after studying 3,305 volunteers aged 16 years to 44 years. The participants played a real-time game that approximated everyday real-world situations that test our cognitive abilities, from concentration to juggling multiple tasks to shifting our focus from immediate to long-term issues. The game recorded the players’ moves, and researchers analyzed hours of data from it. As expected, the speed with which the volunteers made decisions, and shifted between tasks, declined with age.

Many studies have documented the gradual deterioration of cognitive skills over time. But in this study, published in the journal PLOS One, the drop, albeit small, was detected first among 24 year olds. In fact, for every 15 years after age 24, cognitive speed dropped by about 15%. And the results could not be explained by the fact that the players were getting better at navigating the game over time; the age-related decline remained, even among those with more skill playing the game.

This doesn’t mean it’s all downhill after your mid 20s. As cognitive speed slows, the brain makes up for some of the deficit in a variety of ways: by relying on experience to anticipate and more accurately predict upcoming tasks, as well as by employing mental shortcuts such as eliminating extraneous information and paring down incoming information to just core nuggets of relevant material. So while we may get slower, we might also be getting smarter. Feel better now?

Death Toll in Ebola Outbreak Rises to 121

(DAKAR, Senegal) — The World Health Organization says an outbreak of the deadly Ebola virus in West Africa has been linked to the deaths of more than 120 people.

As of Monday, the organization recorded a total of 200 suspected or confirmed cases of Ebola, which is normally found in central or eastern Africa, in Guinea, Liberia and Mali. The bulk of the cases are in Guinea, and Mali has yet to have a confirmed case. Tests are ongoing.

The deaths of 121 people in Guinea and Liberia have been linked to the disease.

There is no vaccine and no cure. Officials have said the current outbreak could last months. Health care workers are isolating the sick and tracking down anyone they have come into contact with.

health

Lawmakers to E-Cig Makers: Stop Preying on Minors!

Top US Tobacco Companies Enter E-Cigarette Market
A patron enjoys an electronic cigarette at the Vapor Shark store in Miami on Feb. 20, 2014 Joe Raedle—Getty Images

In a 43-page report, a group of congressional Democrats led by Dick Durbin of Illinois stressed the need for federal regulation of e-cigarettes, citing marketing efforts aimed at minors and a need for more information on health risks for consumers

In a report published on Monday, 11 Congress members recommended federal regulations on e-cigarettes that would include banning sales to anyone under 18, halting TV and radio ads, and educating the general public about the risks associated with inhaling nicotine vapors.

The Gateway to Addiction report written by the lawmakers’ staff after surveying e-cig makers finds e-cigarette companies are using marketing tactics that appeal to young people, such as handing out samples at events like music festivals, social-media promotion and offering kid-friendly flavors. The Centers for Disease Control and Prevention estimate 1.78 million children and teens tried e-cigarettes in 2012.

“E-cigarette makers are starting to prey on kids, just like big tobacco companies,” said Congressman Henry Waxman, a Democrat from California. “With over a million youth now using e-cigarettes, FDA needs to act without further delay to stop companies from marketing their addictive products to children.”

Though use is up, the Food and Drug Administration has not fully studied the products — according to its website consumers are not aware of the risks of use, the amount of nicotine or other chemicals being inhaled and whether or not there are benefits to smoking e-cigarettes. A New York Times report from March detailed the potential dangers of the liquid nicotine found in electronic cigarettes, including vomiting, seizures and death.

According to the report, six of the surveyed e-cigarette companies support some regulation.

Why Hate Crimes Persist More Than Violent Crimes

There's enough evidence to charge Frazier Glenn Cross for a hate crime after Sunday's deadly shooting at a Jewish community center and senior living facility. Here's why crimes based on biases can be harder to combat than other violent crimes

Correction appended: April 15, 2014.

Law-enforcement officials announced on Monday that they had enough evidence to charge Frazier Glenn Cross for a hate crime in the shooting at a Jewish community center and senior living facility that left three people dead.

“We have unquestionably determined through the work of law enforcement that this was a hate crime,” Overland Park police chief John Douglass told the Associated Press. Cross, a former member of the Ku Klux Klan, was reportedly heard shouting “Heil Hitler” from the back of a police car while in custody.

Hate crimes, which are motivated by biases based on race, religion, sexual orientation, ethnicity/national origin and disability, have dropped in the U.S. in recent years. In 2012, there were 5,796 incidents, compared with 6,222 reports in 2011, according to the FBI. Racially motivated violations still make up nearly half of all hate crimes, followed by 20% that are tied to sexual orientation.

(MORE: Kansas City Shooting Is Hate of an Ancient Vintage)

While violent crime in the U.S. has dropped as well, the decline in hate crimes hasn’t been as rapid and may be harder to combat, says Jack McDevitt, associate dean for research in the college of social science and humanities at Northeastern University. That’s because neighborhoods in the U.S. are only becoming more diverse, which means that locally and even personally perceived biases or injustices may become more glaring to certain individuals. “I fear [such hate crimes] will increase,” McDevitt says. “There are people out there who see increasing diversity as a threat, then they strike out.”

Contrary to what sociologists believed for years — that hate crimes are fueled by economic pressures as new groups received benefits or better jobs – the driving force may be something more basic to human nature: our tendency to feel threatened in the face of change. “One of the major sources of hate crime is what is perceived of as rapid in-migration of other groups into formerly racially, ethnically or religiously homogenous areas,” says Donald Green, a professor of political science at Columbia University, who has studied this connection extensively. “From the standpoint of a hate crime, the tipping point is the very first group that moves in.” As people feel threatened and believe they need to “defend” their neighborhood or way or life, that’s enough to prompt vandalism or violent crime, he says. In contrast, in issues involving housing regulations or schooling, about a quarter or a third of the population needs to change before a threat is perceived and acted upon.

(MORE: 3 Dead After Shootings at Kansas Jewish Facilities)

Antiracial crimes committed by far-right extremists are more likely in communities with a denser Jewish population, according to a U.S. Extremist Crime Database study, led by Joshua Freilich of the John Jay College of Criminal Justice, Roberta Belli of United Nationals Department of Safety and Security, and Steven Chermak of Michigan State University. For example, hate crimes against Jewish communities are more common in states with higher Jewish populations; in New York, where they make up 9% of the state’s population, there were 248 such incidents in 2012, a nearly 30% increase from 2011. One reason, Freilich hypothesized in an email to TIME, is the possibility that “far-right racist leaders focused their efforts on counties where Jews were visible, and inspired their supporters residing in those counties to lash out and attack the far-right’s ideological enemies.”

Such patterns of scapegoating and blame may make hate crimes frustratingly difficult to curb downward, says McDevitt, and that means that tragedies like the shootings in Overland Park, Kans., may continue to percolate across the country.

Correction: The original version of this article misstated Steven Chermak’s institutional affiliation. He is affiliated with Michigan State University.

Too Little Weight Gain During Pregnancy Linked to Having a Chubby Child

A study in American Journal of Obstetrics and Gynecology says that women with a normal weight before pregnancy who gain less than the recommended amount are 63% more likely to have a child who becomes overweight or obese

Correction appended, May 15, 2014

There’s a growing mountain of evidence that obesity and other health factors can be determined as early as your time in the womb. While research has shown that too much weight gain during pregnancy can lead to an obese child, new research shows that too little weight gain can be a nearly equally risky factor in childhood obesity.

Researchers studied the electronic medical records of 4,145 women who had a baby between 2007 and 2009, and reviewed the medical information of their children between ages 2 and 5. Their findings, which are published in the American Journal of Obstetrics and Gynecology, showed that women who started at a normal weight before pregnancy, but gained more than the recommended amount, were 80% more likely to have an overweight child. Women with a normal weight before pregnancy who gained less than the recommended amount were 63% more likely to have a child who became overweight or obese.

Healthy weight gain during pregnancy for normal weight women is between 25 to 35 pounds. For overweight women, the recommended weight gain is between 11 and 20 pounds, and for underweight women, it’s between 28 to 40 pounds.

When looking at the group as a whole, researchers found that among the women who gained too much weight, slightly more than 20% of their children were overweight. Among women who gained too little weight, 19.5% of their kids were overweight. And for those who gained the normal amount, only 14.5% had overweight kids.

Researchers are still looking into why weight gain outside the optimal range influences obesity, but one hypothesis is that gaining too much or too little weight interferes with the child’s ability to normalize energy and metabolism.

Correction: The original version of this post incorrectly stated the recommended weight gain during pregnancy. It is 25 to 35 pounds.

How Your Diet Can Hurt Your Marriage

altrendo images / Getty Images

Researchers explain why one surprising factor behind some cases of domestic violence may be blood sugar levels.

Anyone who’s been on a diet knows that hunger can make you cranky. With less fuel, your brain doesn’t exert as much self control, so you let your impatience and irritation go unchecked.

Researchers speculate that such hunger-fueled anger could even affect your marriage. Brad Bushman, at The Ohio State University, and his international group of colleagues set up a study involving 107 married couples, using voodoo dolls to track how angry spouses felt toward each other. Over a period of 21 days, the couples had their blood glucose measured every night before they went to bed, and every morning before they ate breakfast, as a barometer of their hunger. The voodoo dolls were stand-ins for their spouses; each partner had 51 pins and poked the doll each night to represent how irritated he or she was at his or her spouse.

MORE: Study: Effects of Childhood Hunger Last for Decades

Who poked the most? Those who had the lowest glucose levels on average stabbed their voodoo partner more than twice as many times as those with the highest glucose levels. Even after the scientists controlled for how happy the spouses reported their relationship as being, the hunger-aggression connection remained strong.

“We don’t say that glucose levels explain everything, but we took repeated measures over the 21 days and found these pretty robust results,” says Bushman.

It’s possible that the people with higher glucose levels were simply more forgiving or feeling more generous after a fulfilling meal – levels of mood hormones like serotonin tend to go up after a meal, ushering in a feeling of satiety. But Bushman believes that the consistency of the results hint that something more may be involved, and that may have to do with how hunger can contribute to less self-control and more irritable behavior.

In the second part of the study, he and his colleagues asked the spouses to play a competitive computer game, and awarded the winning partner the opportunity to blast the loser with a cacophony of sounds, including dentist drills, sirens, and fingernails dragging across a chalkboard. The scientists told the participants they could make the sounds as loud or as quiet as they desired, and leave them on for as long as they wanted (researchers actually controlled the volume so no eardrums were harmed). Those who recorded the lowest glucose levels over the past 21 days were more likely to blast the sounds at higher volumes and for longer periods of time if they won than those who had higher glucose levels.

That skipping meals or cutting back on calories could escalate aggression among spouses leads Bushman and his colleagues to suspect that hunger could even be behind some cases of domestic violence, although the study did not go as far as to test that theory. But Bushman says the findings make it clear that low glucose levels, and its resulting lack of self-control, should be considered part of the constellation of factors that can contribute to marital strife. That means that people on diets should be aware of how their drop in calories can affect their mood and the way they interact with others, including their spouse. And, says Bushman, “If couples have something to talk to their spouse about, they should do it over dinner, or better yet, after dinner.”

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