Which is Worse: Depression or Smoking?

Could depression be as deadly as smoking cigarettes? Researchers from Norway and England think so. Their research, recently published in the British Journal of Psychiatry, found that depression holds a similar risk for death as smoking. (But don’t let that depress you!)

Researchers utilized a survey of more than 60,000 people and a comprehensive mortality database. However, for depressed people with some anxiety, there may be a silver lining.

The research found that depressed people with anxiety were less likely to die than those with depression alone. Dr. Robert Stewart, who led the team at the Institute of Psychiatry in Norway, said that one of the big messages from the research is that a little anxiety may actually be good for you. Researchers explain that help-seeking behavior associated with anxiety may be the key.

Dr. Stewart explained,”It would certainly not surprise me at all to find that doctors are less likely to investigate physical symptoms in people with depression because they think that depression is the explanation, but may be more likely to investigate if someone is anxious because they think it will reassure them.”

Help with Managing Depression

If you suspect you’re depressed, talk with your doctor about how you’re feeling. You can even invite a friend or family member to go with you. Symptoms of depression include frequent and prolonged feelings of sadness, loss of interest in everyday activities, lack of energy, sleeping too much or too little, difficulty with concentrating and making decisions, thoughts of suicide, and feelings of guilt or worthlessness.

Many depressed people benefit from lifestyle changes like increased exercise. Therapy involving talking with a professional, often for at least an hour each week, is helpful as well. Some depressed individuals may need medication or additional therapy.

(Image via stock.xchng)

“Be a Match” – bone marrow donation

There’s a type of donation that isn’t as dramatic as a heart or liver transplant that brings people back from the brink of death, or a corneal transplant that gives people the gift of sight again. But it’s just as important and it saves lifes: bone marrow donation (Bone marrow transplants – would you be a donor? ).

As I wrote in the article linked just above, “Bone marrow is the soft tissue that is found inside our bones; it’s the spongy tissue in the breast bone, ribs, hips, pelvis, skull and spine. The role of bone marrow is to make blood cells – white blood cells to fight infection, red blood cells to carry nutrients from the lungs to the body tissues, and platelets that allow the blood to clot.

People with diseases that affect the bone marrow die of infection or inability for their blood to clot. The most commonly known disease that requires bone marrow transplant is leukemia, although there are many more.”

This is one type of donation that we, the healthy and the living, can give without much inconvenience to ourselves. A health person has plenty of bone marrow to spare. And in exchange for some discomfort after the bone marrow is taken, you can – literally – give back a life.

The MayoClinic.com has a very good explanation as to what bone marrow donation entails: Bone marrow donation: What to expect when you donate .

If you’re interested in being a bone marrow donor, you should be registered so the databases can be searched when someone who needs the donation. In the United States, you can choose from a few different registries. Although there are many more, here a few of the ones I found:

Be The Match

American Bone Marrow Registry

Gift of Life

In Canada:

Canada Blood Services Registry

World Wide:

Bone Marrow Donors Worldwide

Would you consider registering as a bone marrow donor?

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Images: Stock.xchng

D***d if We Do, and D***d if We Don’t

As the October 1st issue of Scientific American Mind reminds us, words have power. I know this even more whenever I hear my son Charlie speak. He was very, very late to talk and he first didn’t talk at all, but used sign language. Today he speaks in short phrases and sentences, and almost-sentences.

A lot of words get thrown around about autism on the Internet, on blogs and newspaper and media websites and who knows where else. Too often, even most often, it seems that the vast percentage of those words are in the realm of misinformation, as the numerous mentions of notions about what causes autism, from power plants in Texas to the quite infamous hypotheses about vaccines and/or mercury. As Dr. Paul Offit noted on his Science Blogs Book Club post today:

A couple of bloggers praised the book for its tone, that I never appeared to get angry at the false prophets described in the book. The reason for that is that I’m not the father of a child with autism. If I were, I would have been quite angry. Angry because I think that the anti-vaccine forces have taken the autism story hostage. And angry that because of their influence, the media almost never carries stories about the real cause or causes of autism.

“Taken hostage”—-yes, that’s pretty much what has happened to autism discussions. Whether about education, safety concerns, how to get your child to eat more: Too often discussion devolves into “but look at this study” and “but you still can’t say 110% plus that there some vaccine won’t lead to some adverse effect in some child.” It’s an oh-so-endless game of bait and switch and if you, as I do, do not think that vaccines or something in vaccines can be linked to autism, it seems you’re d**ed if you do join in the fray, and doubly d**ed if you don’t.

The saddest thing, or thing that makes one maddest, is that–as Kev blogged today—autism has become a secondary concern in these debates. One has only to read the latest Age of Autism post by David Kirby about the “‘weaknesses and limitations’” of the CDC’s Vaccine Safety Datalink (VSD) to feel that much, if not most, of the discussion about vaccines and autism has strayed far away from talking about actual autistic people, like the boy who’s sitting across from me savoring fresh chunks of watermelon as I write this on a Thursday night: That boy lugged a whole quarter melon around a grocery store as we shopped, and slung the bag with the melon and a lot of other food items  over his left shoulder with a grin because he was doing it on his own, and didn’t need my help.

As Dr. Offit has also pointed out in chapter 5 of his recently published book, the information in the VSD needs to be read and interpreted with care; for instance, the VSD lists the diagnoses of children by codes, rather than from “direction information from medical charts” (p. 93). In the VSD (of necessity) it’s a database of information—a child is a code, a diagnosis, with certain features and symptoms; the portrait of a child presented in the VSD (or any database) is an abstraction, a distillation of certain features.

And shouldn’t the discussion about autism be about autistic people, and centered round what autistic people themselves have to say, rather than endless musings about bits of data and numbers and figures?

Database for MS information

Are you looking for in-depth information on multiple sclerosis (MS)? Whether you have been diagnosed with it or someone you know, there’s often the issue of where to look for information and how reliable this information will be.

The Multiple Sclerosis Society in the United Kingdom has made available a fantastic resource for anyone looking to learn about MS. It’s geared towards the general public and there’s a section for healthcare professionals as well. If you’re not in the UK, don’t give up on using this site. While you may not be able to borrow DVDs and books, just being able to find out what’s out there can help you in your search. If you have the titles and authors, you may be able to find the information in your own location. 

To access the source, go to the MS Society Library.

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Tags: chronic pain blog, pain blog, multiple sclerosis, MS, multiple sclerosis resources, MS in the United Kingdom

AA In The UK

If you happen to be headed to the United Kingdom and want to find a meeting;

‘How to find AA’ in England, Scotland and Wales, UK.

There’s a searchable database of meetings for England, Scotland and Wales.

And a complete list of AA events happening between now and April of next year.

Plus – the National Helpline Number:- 0845 76 97 555

Saturday Sanity: Where Are The Mental Health Advocates?

For some reason, there wasn’t really any mental health advocacy news to report this week. Ah, it’s just as well. The sun is shining and my dog wants to play.

Enjoy your Saturday!

This week at Mental Health Notes, I kept things mostly light. Tickets for Broadway’s revival of Equus went on sale, and UK mental health blogger Simon Brody told us the play was a well received in London. In light of a Yahoo! article about hair loss, I talked about hair loss and stress, and in light of the Olympics, I pointed to a few mental health resources for Chinese. I also shared a cute (dog? brain? haha!) picture of an loldog and a mental health public service announcement from the 1970s. Oh, and I was interviewed (and honored!) over at Mental Health Humor.

In the world of mental health news, an article at nola.com reports that post-Katrina victims are experiencing less anxiety, but more depression. International researchers have found three gene variations that increase the risk of schizophrenia. Psychologists from Duke and Ohio State study the way people tend to alter their behavior, both consciously and automatically, in order to “fit in.” Researchers now think two predictors of post-partum suicide attempts are histories of substance abuse or psychiatric disorders. And, Kelly with the Nursing Online Education Database would like to pass along one of the site’s new articles, 100 Healthy Habits You Should Start in College.

And, here at b5media’s Health & Wellness Channel, Liberty at Healthbolt tells us how we can get rid of our old medications and help people out in the process, Grace at Kids Health Notes offers some tips on how to tell if your children are stressed, overworked, and anxious, and Marijke at Womb Within talks about celebrities and postpartum depression. As usual, there are tons of freebies and giveaways going on, so be sure to check out Angelique at Breaking the Mirror, Scott at Health and Men, and Kristen at Lively Women.

And, sadly, Gabrielle is leaving the b5blogger family. We’ll miss you!

Alright folks, that brings another Saturday Sanity to a close. Send me your mental health news and advocacy stories, and I’ll get them in next week’s edition!

Image: Mine

Vaccines, Diagnosis, and Databases

After my son was diagnosed with autism in July of 1999 and we had started him in a home ABA program in September of 1999, and as we found ourselves spending more time with families with autistic children, and as we read more and more (in books, on the web) about autism, I started to feel that I could spot an autistic child immediately, across however crowded a room. I knew the things that made Charlie different and had started to see flashes of these in other children and was somehow reassured: We weren’t alone.

Over time, though, I’ve become less sure, or a lot more cautious, at saying that someone has autism or not. My understanding of Charlie and of autism has deepened over the years, but so has my knowledge of the factors involved in giving a child an autism diagnosis. Here in New Jersey, a diagnosis of “autism” can provide a child with more services than one of “PDD-NOS” and, often, more than one of “Asperger’s Syndrome.” Studies like that by Washington University professor Paul Shattuck—which found that, at the same time as autism diagnoses increased, the number of diagnoses of mental retardation and learning disabilities decreased—suggest that diagnosing autism has a bit more art in it than one might at first think. People seem, too, to regularly under-emphasize how the significant changes in the diagnostic criteria for autism and the steady rise in public awareness about autism have contributed to more diagnoses, and even to more people seeking out a diagnosis, as anthropologist Roy Richard Grinker argues in his book Unstrange Minds: Remapping the World of Autism.

It’s helpful and even necessary to keep in mind how our evolving understanding of autism— and a “peculiar fascination” with autism in the contemporary media, to cite a recently published book—has contributed to more children and, too, adults, being diagnosed with autism. This growing understanding of autism has, it has been argued, contributed to the rise in the prevalence rate of autism (now 1 in 150, according to figures released by the CDC in February of 2007) and this expanding understanding of autism needs to be taken in account when reviewing studies about autism in the past several years.

Some proportion of those studies have looked at possible environmental causes of autism, such as vaccines or something in vaccines. The numbers are the thing here: If it can be proven that there is a definite increase in autism in children who received (for instance) vaccines containing the mercury-based preservative thimerosal, then it would seem that a culprit for the increase in autism has been found. A few months ago, much was made of the case of Hannah Poling, after the government conceded that the 9-year-old Georgia girl’s underlying mitochondrial disorder had been “aggravated” by vaccines and led to symptoms of autism. The question has been, was what happened to Hannah unique to her only, or is there some “hidden horde of autistic children with underlying mitochondrial disorders? (So far, the answer seems to be “no.”)

Researchers need to study large populations of subjects; epidemiological studies look at “how disease is distributed in a population and of the factors that influence or determine that distribution” (Do Vaccines Cause That?, p. 53). Consequently, databases of cases—from HMOs, for instance—can provide sufficiently large sample populations for scientists to study. One such database that researchers have used is the Vaccine Safety Datalink (VSD), which was a project created in 1990 by the CDC and which, “as of mid-2007, involves partnerships with eight large health maintenance organizations (HMOs) that continually monitor vaccine safety” (Do Vaccines Cause That?, p. 62). The VSD contains information from more than 5.5 million people in Washington, Oregon, California, Colorado, Minnesota, and Massachusetts.

The VSD has both its strengths and limitations. It is a large database and allows researchers to access data from all medical visits, types of vaccine, date of vaccination, concurrent vaccination, the manufacturer, lot number, injection site, and potential adverse events (Do Vaccines Cause That?, p. 62). Its limitations include the following (see Do Vaccines Cause That?, p. 65-6, for fuller explanations):

- “the population in the participating HMOs is not wholly representative of the United States in terms of geography, ethnicity, or socioeconimic status”;
- “vaccine coverage rates for most vaccines are very high in the participating HMOs, and thus there are usually few non-vaccinated people available for comprehensive comparisons”;
- “the project is not large enough to examine the risk of extremely rare events (one in a million vaccinees) such as Guillain-Barré syndrome after influenza vaccine”;
- “because the database contains patient records, it can only be accessed under circumstances that maintain the confidentiality of the individuals and requires prior approval of an Institutional Review Board.”

Some of these caveats would seem to behind a recent report by CDC director Dr. Julie Geberding about the limitations of VSD data in studying vaccines and autism. The report follows a 2006 panel convened by the National Institute of Environmental Health Sciences (NIEHS) and considers the “feasibility of using VSD data in an ecological study to compare rates of autism disorder (AD) or autism spectrum disorders (ASD) before and after the removal of thimerosal from most childhood vaccinations.” The report has been uploaded as a PDH file on journalist David Kirby’s EvidenceofHarm website and he indicates that he was given the report by a “Capital Hill staffer” (similarly to how “someone” gave him documents about the case of Hannah Poling, which Kirby made available prior to protocol). Kirby’s assessment in that the report is a sort of “mea culpa” on the part of Dr. Geberding and that it suggests that the design of studies about vaccines under the CDC are “‘uninformative and potentially misleading.’” There are concerns about the VSD, but not in the sense that Kirby might wish (a “startling string” of goofs and mistakes by CDC researchers). Rather, the report highlights what EpiWonk refers to as the “ecological fallacy,” in which

Given the increase in frequency of autism (and other neurodevelopmental disabilities) during time time period, you could do an ecological regression analysis of almost any factor that varied over time and you would find an an association with autism. I would bet that you could enter number of sushi bars per capita into an ecological regression and you’d find an association with autism rates.

The report itself notes:

Ecological studies are based on aggregate-group level data collected over time, rather than individual data. There are many limitations of ecologic analysis, such as differences of exposure levels and covariate levels within the study group, challenges in controlling for confounders [this problem is specifically addressed by EpiWonk], and within-group misclassifications that lead to potentially severe biases in the interpretation of the results. These problems severely limit the interpretation of causality, particularly biologic causality, from a study that relies solely on ecologic analysis. For example, trends over time may coincidentally appear to be related even if there is no cause-and-effect relation.

It goes without saying that “vaccines and autism” is a hot topic and it’s no wonder that the CDC is taking some pains to be careful about the sort of data that it uses and the design of its studies. For all of the greater awareness and understanding about autism out there, people are still wary of an autism diagnosis and of an autistic person in a public place acting “different,” but that’s another topic.

There are plenty of autistic children, teenagers, adults, out there. There’s also plenty more to learn about vaccines but that, too, is a separate topic.

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And be sure not to miss Epi Wonk posts two cogent critiques of David Kirby’s flawed reporting.

Back to Vaccine Court

The epic comment thread (as one long-time reader put it) about Adam Race and the parish of St. Joseph’s rages on. Goes without saying that it’ll be of more than a little interest when a hearing is held in June. But back to a legal, autism-related matter of a different kind:

Yes, the proceedings in the Autism Omnibus, aka “vaccine court.” Week 2 of the hearing just finished. Two 10-year-old autistic boys, William Mead and Jordan King, are serving as the test case to determine whether or not some 4900 families should be compensated: These families have all filed claims with the U.S. Court of Claims alleging that vaccines caused autism and/or other neurological problems in their children. Audio recordings of each day’s testimony are available from the Vaccine Program/Office of Special Masters.

The bloggers at Left Brain/Right Brain have been noting the testimony of various “experts”:

• Elizabeth Mumper, a expert witness for the Petitioners, the medical director for DAN/ARI and founder of the Rimland Center.
• Dr. Robert Rust, the Thomas E. Worrall, Jr. Professor in Epileptology and Neurology, and Professor of Pediatrics at the University of Virginia.
• A Dr. Johnson (the post comments on why his qualifications are not specifically noted).

Mentioned in Dr. Rust’s testimony are some alternative treatments for autism that I had certainly never heard of. Both are apparently used by Dr. John Green III of Oregon for one of the boys: Earthworm eggs and a fecal enema. Mentioned in Dr. Johnson’s testimony was criticism of a study that found that thimerosal had neurotoxic effects in mice (the Safe Minds website has a pdf file of the study). Dr. Johnson specifically raised concerns about the poor quality of the tissue slides in the study; these slides were said to show abnormalities in mice injected with thimerosal.

Another study about thimerosal and neurological damage appeared this week and, too, there was more than a little to critique. The study has three co-authors, Heather A. Young, Assistant Professor of Epidemiology and Biostatistics in the George Washington University School of Public Health and Health Services, and David A. Geier and his father, Dr. Mark Geier. The Geiers have frequently been consultants in “vaccine-biologic cases before the no-faulty NVICP [National Vaccine Injury Compensation Program] and in civil litigation,” and Dr. Geier has also been an “expert witness,” as noted in the an Acknowledgment at the end of the new study. The new study received funding from the Autism Petitioners’ Steering Committee of the NVICP; this committee represents parents and is chaired by lawyer Clifford Shoemaker, who specializes in vaccine-injury litigation—just a few conflicts of interest behind a “scientific study.”

Further, questions were raised about whether or not the Geiers had received IRB [institutional review board] approval for use of the Vaccine Safety Database (VSD). B. Martin, MD, raised a number of questions and, later in the week, looked carefully at a letter by the Geiers to the IRB office of the Kaiser HMO (the Geiers were seeking approval to use data from Kaiser). Dr. Martin notes that the Geiers’ letter suggests

….a government conspiracy to keep the VSD data from the public, and more specifically from themselves.

This is familiar stuff in the vaccine-autism debate, in which various parties (in potentially paranoid fashion) have more often than not accused the government and government agencies like the CDC of withholding information about vaccines and other matters of public health. More analysis of the new study can be found at Epi Wonk, who—noting that the study has “a lot of problems” (enough for five posts, of which this is the first—specifically asks if this is a case of scientific fraud or just playing with data. (Go to Respectful Insolence for a further take-down of the new study.)

It was noted in the post about Adam Race and the restraining order filed by Fr. Daniel Walz that there was an impasse of sorts about Race’s “dangerous behaviors,” the decision to file the restraining order against his parents, and, too, his very presence in church; about whether he ought to be excluded. Generally in discussions about autism the question of whether vaccines or something in vaccines can be linked to autism is the cause of a lot of impasses in the conversation—-if you read the posts on the Autism Omnibus hearings at Age of Autism, you’ll see a different perspective.

But however much disagreement about what causes autism and how to “treat” it, there is some consensus about how parents of autistic children try and know they have to do the best by their children, and ven if it sets them up for public aspersion and accusations of “blame.” Frankly I am glad to be involved in the tumult of discussion. In the not too distant past, many—too many—children like my son Charlie would have been institutionalized at a young age and there’d be no discussion of how to teach autistic children to attend church services, or to be in school, to be in society. Sure, it’d be a lot “easier” for some if these questions of including autistic individuals did not need to be discussed, because the autistic individuals weren’t around.

For those who have been quite consistently arguing about the “unreasonableness” of a “dangerous” autistic child being in church—-I am grateful that we can discuss (argue) about these issues.

deCode discovers cousin marriages bear more offspring

 

deCode has analysed its 200 year old Icelandic genealogical database and found that the closer the kinship of the couple the more children they are likely to have. This study provides the most comprehensive answer yet to the longstanding question of how kinship affects fertility in humans.

For example, for women born between 1800 and 1824, those with a mate related at the level of a third cousin had an average of 4.04 children and 9.17 grandchildren, while those related to their mates as eighth cousins or more distantly had 3.34 children and 7.31 grandchildren. For women born in the period 1925-1949 with mates related at the degree of third cousins, the average number of children and grandchildren were 3.27 and 6.64, compared to 2.45 and 4.86 for those with mates who were eighth cousins or more distantly related.

The findings hold for every 25-year interval studied, beginning with those born in the year 1800 up to the present day. Because of the strength and consistency of the association, even between couples with very subtle differences in kinship, the authors conclude that the effect very likely has a biological basis, one which has yet to be elucidated.

Previous studies in other parts of the world have suggested that the two phenomena are positively correlated, though confounding variables, such as the impact of socioeconomic status on the size of families or age at marriage, have made the results difficult to interpret.

The authors note that the findings are somewhat counter-intuitive from an evolutionary perspective because closely-related parents have a higher probability of having offspring with severe genetic abnormalities.

For further information, click on:

http://www.decode.com/News/2008_02_07.php

Elaine Warburton  www.geneticsandhealth.com

Everything I Learned in Grad School is Now Wrong

“‘Almost everything I learned in graduate school is wrong now,’” Mary Jane Weiss, the director of Research and Training of the Douglass Developmental Disabilities Center said at a forum on the campus of Rutgers University (reported in the October 23rd Daily Targum).

Weiss was speaking in reference to what is known about autism among researchers and among those who work with autistic persons day in and day out. There are new reports just out about a large new database that will make it more possible to study the genetic variations in families with autism; there is more understanding about how to teach autistic children, and dialogue and dispute about what is best: ABA, for instance, is the cornerstone of my son’s education but just last night at the pool I spoke to another mother whose son is about half Charlie’s age. She noted that he is not doing ABA any more and that it was just not the right thing (here is a thoughtful critique of ABA). And speaking to the other mother and reflecting on how some teaching methods have been more and less useful to Charlie over the years, I thought about how necessary it is to be open-minded, and how hard it is to do this when one’s child’s learning is at stake.

I wonder what we’ll know when Charlie is my age, and what we still will not know.

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