Teenage cannabis use and schizophrenia

With the growing wave of legalizing marijuana use across the US, it is important to fully understand the possible consequences of expected increase in it's unrestricted use, specially amongst the youth. A group of scientist at the Feinberg School of Medicine and Northwestern Memorial Hospital have conducted a study which has found a link between teenage Marijuana (Cannabis) use and schizophrenia. This study was published by Schizophrenia Bulletin

The brains of teenagers smoking cannabis daily for about three years showed significant structural changes affecting memory. Some of those changes appear very similar to those seen in the brains of schizophrenics.These youngsters also performed badly when tested on memory tasks, indicating poor memory functioning.


As reported by Marla Paul for Northwestern University on Futurity;

This is the first study to target key brain regions in the deep sub-cortical gray matter of chronic marijuana users with structural MRI and to correlate abnormalities in these regions with an impaired working memory.
Working memory is the ability to remember and process information in the moment and—if needed—transfer it to long-term memory. Previous studies have evaluated the effects of marijuana on the cortex, and few have directly compared chronic marijuana use in otherwise healthy individuals and individuals with schizophrenia.

According to the lead study author Mathew Smith an assistant research professor in psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine; 

“The study links the chronic use of marijuana to these concerning brain abnormalities that appear to last for at least a few years after people stop using it. With the movement to decriminalize marijuana, we need more research to understand its effect on the brain.”

 But in contrast to these findings another study conducted at the Institute of Psychiatry at King's College London, has shown a genetic link between cannabis use and schizophrenia. Kate Kelland  reports for Reuters that;

The results chime with previous studies linking schizophrenia and cannabis, but suggest the association may be due to common genes and might not be a causal relationship where cannabis use leads to increased schizophrenia risk. 

 "We know that cannabis increases the risk of schizophrenia. Our study certainly does not rule this out, but it suggests that there is likely to be an association in the other direction as well – that a pre-disposition to schizophrenia also increases your likelihood of cannabis use," said Robert Power, who led the study at the Institute of Psychiatry at King's College London.

But what become evident from both these recent studies is the clear connection between adolescent use of cannabis and the development of schizophrenia. Therefore it is important for parents to discourage their children from getting swept up in this growing wave of legal recreational use of marijuana. We need to educate ourselves and our children on the very real dangers and consequences of indiscriminate use of marijuana.
 



References:

Teen marijuana use linked with schizophrenia (Futurity-January 3, 2014)

Study finds genetic links between schizophrenia and cannabis use (Reuters-June 24, 2014)

Cannabis-Related Working Memory Deficits and Associated Subcortical Morphological Differences in Healthy Individuals and Schizophrenia Subjects  (Schizophrenia Bulletin-December 15, 2013)

Genetic predisposition to schizophrenia associated with increased use of cannabis (Molecular Psychiatry-June 24, 2014)

Another reason why sitting in front of computer screens for hours on is not a good idea

Post by Health, Wellness and Mindfulness.

Here is why writing by hand should not be forgotten

Post by Health, Wellness and Mindfulness.

Air Pollution damaging not children's health but also their IQs

In a recent study at Columbia University School of Public Health, researchers have shown that air pollution might affect children's earning potential later in life. The study has been published in The Journal of Public Health Policy May issue.
The researchers gathered data by tracking poor and pregnant African American and Dominican mothers and their children til the age of five.
The results as also discussed by Sydney Brownstone in Fast Company Coexist section showed an inverse relationship in air quality (presence of neurotoxicants, such as polycyclic aromatic hydrocarbons (PAH) released to ambient air by combustion of fossil fuel and other organic material) and the children's IQ. Here are excerpts of the article;

Some of the biggest barriers blocking children's access to opportunity are also the most invisible. It’s no small difference either. If New York City were to reduce its pollution from sources like diesel fumes by even a quarter, affected children could earn an additional $215 million in their lifetimes.
It’s old news that some types of air pollution affect some groups more than others. Poor communities of color are most at risk, often housed in the polluted miasma next to highways, city dumps, landfills, power plants, and other undesirable places to live. New York City is no exception. In 2006, NYU researchers analyzed backpacks of South Bronx schoolchildren to link the borough’s heavy diesel-powered truck traffic to shockingly high rates of childhood asthma hospitalizations.

The Columbia researchers were able to see if pollution exposure correlated with academic performance and IQ. When they factored in the well-documented relationship between IQ and future earnings, the researchers calculated that if the city decreased PAH pollution by a quarter, each child could earn an additional $3,382 on average. Multiply that by the 63,500 kids exposed to this kind of pollution in the city, and the total comes to $215 million in lost dollars.

These findings have been supported by others studies and medical papers. Such as the 2012 paper published by the National Institute of Health in which Harvard Medical School Neurologist Dr. David C. Bellinger concluded that; 

Any effort to compare the neurodevelopmental burden associated with different risk factors is limited by the data available and the assumptions required. It was possible to estimate the total loss of FSIQ points in the population of 0- to 5-year-old U.S. children for a variety of risk factors, including three environmental chemicals: methylmercury, organophosphate pesticides, and lead. Despite the limitations of the approach, it appears that when population impact is considered, the contributions of chemicals to FSIQ loss in children are substantial, in some cases exceeding those of other recognized risk factors for neurodevelopmental impairment in children. The primary reason for this is the relative ubiquity of exposure.  

Although American industry will insist on more targeted and exact data to force any significant regulations to further reduce air pollution and other environmental pollutants, it is clear that harm is being done. If we want our children to have a fair chance at success and progress we need to take action now.



References:

The Toxins That Threaten Our Brains(The Atlantic-May 18, 2014)

Air Pollution Is Lowering The IQs--And Earning Potential--Of New York City Children 

(Fast Company-CoExist May 12, 2014)

Prenatal exposure to airborne polycyclic aromatic hydrocarbons and IQ: Estimated benefit of pollution reduction (Journal Of Public Health Policy- May 8, 2014)

Air Pollution and Health Risk (EPA)
A Strategy for Comparing the Contributions of Environmental Chemicals and Other Risk Factors to Neurodevelopment of Children  (NIH April 1, 2012)
A Study Links Trucks’ Exhaust to Bronx Schoolchildren’s Asthma  (The New York Times- June 2, 2006)


 

The autism vs vaccines controversy

In 1998 an article published in the British Journal The Lancet claimed it found a causal connection between the MMR vaccine and autism. Although that article was widely disputed and later retracted, it has left behind a significant following, leading many parents to refuse MMR vaccination for their children. The anti-vaccine groups also stressed on the use of mercury-based preservative Thimerosal in vaccines as a suspected culprit. As a result the government has gradually removed it or reduced it to trace amounts in all vaccines in 2001, in spite of no scientific proof of its possible link to incidence of autism. As explained on the CDC website;

"Over the years, some people have had concerns that autism might be linked to the vaccines children receive. One vaccine ingredient that has been studied specifically is thimerosal, previously used as a preservative in many recommended childhood vaccines. However, in 2001 thimerosal was removed or reduced to trace amounts in all childhood vaccines except for one type of influenza vaccine, and thimerosal-free alternatives are available for influenza vaccine. Evidence from several studies examining trends in vaccine use and changes in autism frequency does not support such an association between thimerosal and autism. Furthermore, a scientific review by the Institute of Medicine (IOM) concluded that "the evidence favors rejection of a causal relationship between thimerosal–containing vaccines and autism." CDC supports the IOM conclusion that there is no relationship between vaccines containing thimerosal and autism rates in children.
The IOM also recently conducted a thorough review of the current medical and scientific evidence on vaccines and certain health events that may be observed after vaccination. It released a report in August 2011 on 8 vaccines given to children and adults that found the vaccines to be generally safe and serious adverse events following these vaccinations to be rare."

The 2012 National Immunization Survey  found that about 90% of children aged 19 to 35 months completed recommended vaccinations and less than 1% received no vaccines at all. But it also highlighted the fact that rates are varied by states and regions therefore leaving some areas vulnerable to outbreaks of measles and other vaccine preventable diseases. The resurgence of measles and whooping cough (Pertussis) in recent years after decades of almost complete extinction could possibly be the distressing consequence of an increasing number of parents refusing the MMR vaccine on grounds of its possible association to autism. 

As explained by Puneet Kollipara in The Washington Post article How the anti-vaccine movement is endangering lives (May 5, 2014).

A measles outbreak that struck a Texas megachurch community late last summer sickened 21 people. And just recently, at least 16 people got sick during a measles outbreak in Ohio. In fact, the Centers for Disease Control and Prevention recently reported 13 measles outbreaks so far in 2014 -- the most since 1996.

According to an article in JAMA News;

Overall, among 140 US residents who acquired measles, 117 (84%) were unvaccinated, and 11 (8%) had unknown vaccination status. Of those who were unvaccinated, 92 (79%) had philosophical objections to vaccination, and 15 cases (13%) occurred among infants younger than 12 months who were not eligible for vaccination.


Besides leading to prevention and saving lives, these vaccines are also economically beneficial, as pointed out by Kuneet Kollipara;

A new study from CDC researchers led by Anne Schuchat analyzed what happened to disease rates as childhood vaccination rates increased starting in the early 1990s. The researchers used these findings to model the resulting effect over the kids' lifetimes. In the analysis, the researchers factored in most routine vaccines recommended for children below age 6 (among them the MMR and whooping cough vaccines). Their findings: Routine childhood vaccinations given between 1994 and 2013 will save 732,000 lives and prevent 322 million cases of illness and 21 million hospitalizations over the course of the children's lifetimes. 

In 2009 alone, the researchers determined, each $1 spent on vaccines and their administration yielded $10 in benefits to society. And the vaccinations from 1994-2013, the researchers found, will save society a net $1.38 trillion, both directly (by reducing health expenses) and indirectly (via the economic activity that is saved from avoided illnesses). That's almost 10 percent of the U.S. economy's gross domestic product.

In the end vaccines may not be without fault but there is no clear cut evidence to their causal link to autism. And they are definitely effective and save lives if given to a significant percentage of the population.



References:
How the anti-vaccine movement is endangering lives (The Washington Post-May 5, 2014).

Vaccine Safety: Concern about Autism (CDC)

Vaccination Rates for US Children Remain Generally High, But Measles Outbreaks Underscore Shortfalls in Some Regions(JAMA News Spetember 2013) 

The serious and difficult outcomes of saving extremely premature babies.

According to the CDC 1 in every 8 babies born in the US is preterm (birth of an infant prior to 37 weeks of pregnancy). 35% of all infant deaths in 2009 were because of preterm related causes of death. The US health care system spent about $26 billion on preterm births in 2005.
But the statistic that should be raising concern is that 'preterm birth is also a leading cause of long-term neurological disabilities in children.'

With modern medicine and all our advances in medical sciences, we have made it possible to save babies born at 22-23 weeks of gestation.  But preterm births are associated with some serious short term and long term complications. Not only do these prevent the child from living a normal healthy life they can take a severe toll on the family and the community. 

In the article 'Nathan was born at 23 weeks. If I'd known then what I do now, I'd have wanted him to die in my arms' reporter Tracy McVeigh covers the story of Alexia Pearce mother of a three years old son who was born prematurely at 23 weeks and now lives a difficult life with cerebral palsy and chronic lung disease. Alexia loves her son deeply yet she asks if "we are always right to save premature babies". Here are excerpt of the story;

Alexia Pearce looks at her three-year-old son Nathan every day and feels the same rush of guilt. Guilt that she chose to let him live when he was born too early, just 23 weeks into her pregnancy. "If I'd known then what I know now about what extremely premature babies have to go though, I would not have chosen that for my little boy.

"I would have wanted them to give him to me and for him to pass away in my arms. I find the whole issue of what he has been put through, what he continues to be put through, very difficult. I feel very guilty that I took that decision, postponing the inevitable."

"He can't walk or talk. He's oxygen dependent, although hopefully that might change. He has chronic lung disease, cerebral palsy and global developmental delay. He has diabetes inspidus and his thermostat is a bit wonky so he gets hot and cold."
It is, says Pearce, a great taboo to wonder if she should have let her son go when he was born so fragile and weak, but one that she feels strongly that she should break. "More people need to be aware of what these little chaps go through," she said.
"I have no regrets that what has happened has happened. Now this most gorgeous little thing is here and I absolutely adore him. I am so glad I have got to know him. But that doesn't stop me knowing that all I have done is postpone the inevitable. He's not expected to live a very long life. I don't think he'll make it to his teens. He's so frail.

While the latest figures show that 39% of babies born at 24 weeks are now surviving with help from medical advances, the chances of those children suffering no serious ill-effects in later life are low – around six in 100.Last year, researchers from University College Hospital, London, found that premature babies were more sensitive to pain. All pre-term babies are more at risk of a lower IQ, poorer cognitive functioning, learning disabilities and behavioural problems such as attention deficit disorder than full-term babies.
Last year, researchers from University College Hospital, London, found that premature babies were more sensitive to pain. All pre-term babies are more at risk of a lower IQ, poorer cognitive functioning, learning disabilities and behavioural problems such as attention deficit disorder than full-term babies.
"You hear about 'miracle babies' or 'little fighters' and people have such a romantic view about premature babies – 'Oh, there's an incubator for a little while and then they go home and everything is rosy'. It's not."

"Obviously every life deserves a chance, every life. But you wouldn't put an adult through that. You wouldn't put an animal through it. If an adult required that level of medical intervention then someone would be taking the family aside and suggesting gently that the machines are switched off."
Pearce had no warning of her own premature birth, brought about by a sudden complication in the pregnancy, a placental abruption, and had none of the risk factors – she doesn't drink or smoke, isn't obese and her first son, Dominick, now five, was born at full term.

"Birth and death are the most natural processes a body can go through and Nathan's birth and treatment was so far removed from that. Strange birth, choices to be made, difficult bonding. I had to wait six weeks to hold my son and when I did he was still attached to a ventilator and I had many nurses around me. It was all so clinical."
An advocate or counsellor figure would, she feels, help the mother think more clearly about the situation.

But for Alexia Pearce, it's important for families to fully understand too that the difficult times do not end when the baby leaves the incubator. "When you go into labour that early, nobody is a winner," she said. "I'm not saying stop people from having their premature baby resuscitated. I'm not saying babies shouldn't be saved. I am saying that the myth that there is a happy ever after needs to be explored and it's important that we talk about it.

(Read Complete Article)

References:
'Nathan was born at 23 weeks. If I'd known then what I do now, I'd have wanted him to die in my arms' (The Guardian/The Observer)
CDC Reproductive Health- Preterm Births 
Preterm Births- Complications (Mayo Clinic) 

Neurodevelopmental, Health, and Family Outcomes for Infants Born Preterm

(NCBI- National Center for Biotechnology Information)

A surge in antimicrobial resistance reported by WHO

The constant increase in the incidence of antimicrobial resistant infections is now becoming a major concern for the WHO. According to their recent report on 'Antimicrobial Resistance' this is a very real threat to global public health.
In recent decades the world has been aware of the rise in antibiotic resistant bacteria and has been trying to promote responsible use of antibiotic treatment in an effort to counteract this rise. But it is the first time that the WHO has warned of a much more serious problem since antimicrobial resistance covers a much broader spectrum of microbes (eg. parasites, fungi, and viruses).

If such a resistance is seen the world over, effective treatment of even common infection may be difficult or impossible. According to the report;

Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness, higher health care expenditures, and a greater risk of death.
As an example, the death rate for patients with serious infections caused by common bacteria treated in hospitals can be about twice that of patients with infections caused by the same non-resistant bacteria. For example, people with MRSA (methicillin-resistant Staphylococcus aureus, another common source of severe infections in the community and in hospitals) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.


Although this kind of resistance to antimicrobial is being seen more around the world. Unfortunately not only do many of these cases go unreported, but often the infections last longer, leaving the patients infectious for a much longer time period , thus increasing the risk of further spreading the infection to others.

The report also highlights another consequence of AMR (Antimicrobial resistance), when infections fail to respond to first line of drugs, doctors have to resort to more aggressive therapies which are far more expensive, patients need medical supervision for a longer duration and hospital stays are also prolonged. All together these factors significantly increase the health care costs.

According to the report, the economic outcome can be damaging;

The growth of global trade and travel allows resistant microorganisms to be spread rapidly to distant countries and continents through humans and food. Estimates show that AMR may give rise to losses in Gross Domestic Product of more than 1% and that the indirect costs affecting society may be more than 3 times the direct health care expenditures. It affects developing economies proportionally more than developed ones. 

Some of the noteworthy resistances being seen globally are:

Resistance in Bacteria

WHO’s 2014 report on global surveillance of antimicrobial resistance reveals that antibiotic resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting at risk the ability to treat common infections in the community and hospitals. Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.

Resistance in Tuberculosis

Globally, 6% of new TB cases and 20% of previously treated TB cases are estimated to have MDR-TB, with substantial differences in the frequency of MDR-TB among countries. Extensively drug-resistant TB (XDR-TB, defined as MDR-TB plus resistance to any fluoroquinolone and any second-line injectable drug) has been identified in 92 countries, in all regions of the world.

Resistance in Malaria

The emergence of P. falciparum resistance to artemisinin in the Greater Mekong subregion is an urgent public health concern that is threatening the ongoing global effort to reduce the burden of malaria. Routine monitoring of therapeutic efficacy is essential to guide and adjust treatment policies. It can also help to detect early changes in P. falciparum sensitivity to antimalarial drugs.

Resistance in HIV

At the end of 2011, more than 8 million people were receiving antiretroviral therapy in low- and middle-income countries to treat HIV. Although it can be minimized through good programme practices, some amount of resistance to the medications used to treat HIV is expected to emerge. 

There is no clear evidence of increasing levels of resistance to other classes of HIV drugs. Of 72 surveys of transmitted HIV drug resistance conducted between 2004 and 2010, 20 (28%) were classified as having moderate (between 5% and 15%) prevalence of resistance.

Resistance in Influenza

Several countries have developed national guidance on their use and have stockpiled the drugs for pandemic preparedness. The constantly evolving nature of influenza means that resistance to antiviral drugs is continuously emerging.
By 2012, virtually all influenza A viruses circulating in humans were resistant to drugs frequently used for the prevention of influenza (amantadine and rimantadine). However, the frequency of resistance to the neuraminidase inhibitor oseltamivir remains low (1-2%). Antiviral susceptibility is constantly monitored through the WHO Global Surveillance and Response System.


How can this surge be slowed down?

According to the WHO report, this rise in AMR is the result of a multiple factors. 
Here are some suggestions it provides in the report:

People

• using antibiotics only when they are prescribed by a certified health professional;
• completing the full treatment course, even if they feel better;
• never sharing antibiotics with others or using leftover prescriptions.

Health Care Workers And Pharmacists

• enhancing infection prevention and control;
• prescribing and dispensing antibiotics only when they are truly needed;
• prescribing and dispensing the right antibiotic(s) to treat the illness.

Policymakers 

• strengthening resistance tracking and laboratory capacity;
• strengthening infection control and prevention;
• regulating and promoting appropriate use of medicines;
• promoting cooperation and information sharing among all stakeholders.

Policymakers, Scientists and Industry

• fostering innovation and research and development of new vaccines, diagnostics, infection treatment options and other tools. 

In the end what is the WHO doing to counteract AMR? 
 
In 2014, WHO published its first global report on surveillance of antimicrobial resistance, with data provided by 114 countries.
WHO is guiding the response to AMR by:

• bringing all stakeholders together to agree on and work towards a coordinated response;
• strengthening national stewardship and plans to tackle AMR;
• generating policy guidance and providing technical support for Member States;
• actively encouraging innovation, research and development.

 

















References:
WHO Report on Antimicrobial Resistance (Updated April 2014)
Detect and Protect Against Antibiotic Resistance Budget Initiative (CDC)

WHO report: Antibiotic resistance happening right now all over the world (The Independent-April 30, 2014)