Climate Disruption and Changes in Infectious Disease Patterns: The Worst is Yet to Come.

 

humanhealth-copy-cdcMost scientists will tell you that evolution does not favor the fastest, the strongest, or even the cleverest. Evolution favors the most adaptable. Humans, as a species (race is an antiquated and dishonest ideology), are highly adaptable, having populated, at least to some degree, every continent on planet earth regardless of how inhospitable. While there are few areas that remain completely unexplored on our planet, there are some areas that are so remote that few Westerners, or even natives, have visited.

The New Kids on the Block

In our comparatively short tenure, amounting to perhaps 1000,000 years or so, we are a relatively young species, especially when compared to bacteria and viruses that have existed for hundreds of millions of years. Nevertheless, we have established dominance over the planet, at least the drier parts. Certainly, in time we will master the aquatic domains as well. Perhaps this is the reason that the disruption in climate cycles does not alarm everyone, as many believe that humans will thrive regardless of what the weather does. And I tend to agree that humanity will persevere, although it may not be so easy as many think. One area that is of great interest is the migration of different species that have been isolated by either geography or climate into new areas, bringing them into contact with native species.

Even a tertiary review of the scientific literature demonstrates a clear migration of plants and animals away from historical domains, and we see certain tree species slowly moving northward as the overall climate in North America warms. Along with this slow progression of plants into these new domains come the animals, birds, and insects that feed or live upon them. And while this northward movement may not be rapid, it is steady.

Over time, species never seen in northern locales are beginning to push into new areas where they often out-compete native species. And while native species evolved over thousands of years along with insects or animals that feed upon them, many invasive plants and insects (and arachnids) have no natural agents to keep them from overwhelming existing species.

Climate Disruption

Scientists are in agreement that the disruption of the climate is the primary driving force behind this migration. It doesn’t matter if you believe that climate change is spurred on by human civilization or by the solar maximum, or a combination, denying that the Earth’s climates are undergoing rapid change is simply refusing to see the obvious.

The appearance of non-native plants and trees may be a nuisance; the animals, particularly the insects and arachnids, pose a far more serious threat. This is because some are vectors for disease.

Expanding Vectors and Pathogens

A vector in epidemiology refers to an animal or plant on which (or in which) pathogens of disease live. While these vectors do not suffer from the disease itself, they can spread it to other species, and while there are some infections diseases that are carried by larger animals, for example rabies, the primary threats come from insects and arachnids. Research has established that the geographical locations and populations of insects and arachnids change along with disrupted patterns in weather. This was first identified in sub-Saharan Africa. As temperatures increased, insect species began to move into higher elevations, spreading infectious diseases like malaria and trypanosomiasis. This has now been observed in North America with tick-borne diseases including Lyme disease, Tick-borne encephalitis, Human granulocytic, Monocytic Ehrlichiosis, Babesiosis, and Tularemia. Virtually every week we receive updates from the Centers for Disease Control and Prevention (CDC) in our northern states warning of Tick-born disease.

Life is opportunistic.

Parasites, viruses (more or less), and bacteria are all life forms, and like other species will take every advantage to survive. This is often at the expense of other life forms that, for any number of reasons, have some exploitable weakness in their defenses. This weakness may have resulted in the failure to vaccinate against a known virus (Mumps or Measles), consuming unclean vegetables (Giardia lamblia) or improperly cooked meats (Salmonella, E. Coli, and any host of parasites found in beef, pork, poultry, or fish). Another example of this opportunistic reality is when two species, separated by geography (a mountain range or deep forest), are brought into contact, as in the case of Ebola. Certainly the farmers had no interest in traveling deeper into the jungles; however, the charcoal trade that supports most of the poor in areas of sub-Saharan Africa has used up the forest immediately surrounding the villages. As Western societies move into these areas to capitalize on forestry and heavy-metal mining, the charcoal makers are forced deeper and deeper into the forest, bringing them into contact with species that have been historically separated. If an area in habited by humans becomes significantly wetter, waterborne disease will become endemic. If an area becomes dryer, other viruses may increase.

Natural Borders

Infectious disease agents can be separated by geography including oceans, deep jungles, or mountain ranges that can effectively isolate species. Time can also separate infectious agents from vulnerable populations; one example is the widespread vaccination against polio in the United States starting in 1954, and in just 25 years, polio was effectively eliminated from the United States. Thus time, in this case, a quarter century separates polio from American populations. However, failure to maintain vigilance against a virus greatly reduces this separation, making an outbreak more likely, particularly if the virus is introduced from another location where it has not been eradicated. Oceans may have separated populations at one time, but with the advent of world travel, this no longer limits the spread of infections. Dozens of new cases of polio are reported from African nations, including Chad and Nigeria, and many are diagnosed annually in Afghanistan and Pakistan. Not surprisingly, these areas are marked with abject poverty and religious suppression of science and medicine. When ignorance and poverty are combined, disease is often the result.

Other aspects of shifting climates include floods, droughts, severe storms, and ocean changes including salinity, temperature, and level, which may further affect the migration of species into new areas. Moreover, climate disruption has been positively associated with increases in diseases, particularly vector-borne disease. El Niño has been linked to increasing in emerging disease, in particular malaria, and other waterborne disease, particularly diarrheal diseases in areas prone to coastal flooding. La Niña has been linked to outbreaks of Chikungunya, and increases in West Nile Virus and Japanese encephalitis, and in areas of drought increases have been seen in Hantavirus pulmonary syndrome, and increases in West Nile Virus. Globally, these climate-driven weather patterns such as increases in hurricane or typhoons have been associated with increases in waterborne disease, increases in viruses, and increases in bacteriological infections including leptospirosis.

Displaced Populations

As extreme weather and climate change affect human populations as well as their domesticated livestock, areas lost to flooding or drought force populations closer together in habitable areas and along with them, and their animals come they are infectious disease. Displaced populations, either from conflict or extreme weather are often in precarious situations. They are universally underfed, often have difficulty obtaining clean water, and are forced to live in less than sanitary conditions, all of which combined to make these populations extremely susceptible to infections disease. Combined with the stress of forced relocation, and the impact of that stress on the immune response, it is not surprising that these populations experience significantly shorter lifespans and poor health.

In the end, it doesn’t matter if you understand climate change as a natural process, one that is man-made, or a combination, to deny that climate disruption is occurring is denying the obvious and measurable environmental changes linked to increasing infectious diseases.

 

The Willow, the Tortoise, and The Master: The Use of Symbolism in Positive Psychology, Mindfulness, and Self-Help

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As Desdemona is preparing for bed on the night she will be murdered, she sings a song about a willow tree. In Hamlet we learn that the prince’s love, Ophelia, falls from a willow tree into a brook where she drowns. Shakespeare may have understood the willow as a symbol of loss and grief, and he was not alone. The willow tree figures prominently in mythology and literature as a symbol of both grief and healing, but also everlasting life. The willow’s regenerative properties, associated with everlasting life, probably stem from the ability of a new tree to grow from a twig pushed into moist soil. The Christian connection between rebirth, water, and the willow is thought to originate with Psalm 137, which refers to the willow as growing along the banks of the rivers in Babylon.

The pain-relieving properties of salicylic acid were documented in Greek literature as early as 500 BC, and Native Americans chewed willow bark to relieve pain, fever, rheumatism and inflammation. The willow is even featured in children’s literature by Hans Christian Andersen’s “Under the Willow Tree” and Kenneth Grahame’s “Wind in the Willows.” References to the willow tree are found in Celtic Traditions that speaks to its flexibility and perseverance. The willow prefers to bend rather than to resist; a powerful metaphor for those who have learned to adapt to the changing winds of life. In the Far East, the willow is seen as a source of ancient wisdom and adaptableness. The message of the willow is to adjust with life, rather than against it, to surrender the belief in control.

In Chinese symbolism, the tortoise represents longevity and wisdom, while in Indian mythology, the tortoise is the first living creature, attributing to it both longevity and adaptability. To the Native peoples of North America, the turtle is the oldest symbol known to depict the planet Earth. In modern depiction, the tortoise has been promoted as a character of infinite patience, of profound wisdom, and of longevity. In the DreamWorks series Kung Fu Panda, the master of the Jade Temple is Oogway, the thoughtful Tai Chi master who happens to be a tortoise. The Cantonese word for Tortoise is Wugwai, which is, not surprisingly pronounced Oogway.

In mindfulness, the conscious mind is not full, but empty of all but the present. In a way, the focus is mindful of the current moment. This is most easily attained through a focus of the consciousness on the breath. Breathing is an aspect of the autonomic nervous system, which is we do not have to think about breathing, it just happens. When we move the breath from the autonomic to the intentional, and concentrate on the active breathing, we are in the moment. This sounds much easier that it actually is. We live in a world with Constant intrusions from both the past and the future, those being events, thoughts, or feelings about things in the past.

Our thoughts are also intruded upon by perceived events resulting in similar thoughts or feelings about the future. If we carefully consider the emotional aspects of these intrusions, we find that they elicit too possible responses: regret, in the form of depression, or trepidation, in the form of anxiety. The benefit of focusing on the present moment is that it is virtually impossible, with practice, for these intrusions to occur. Allow me to repeat that: with practice. The practice of mindfulness meditation, the focus on each breath, and living within the moment has the enormous health benefits that we will explore. The Willow, the Tortoise, and the Master, are all symbols of adaptability, of thoughtful consideration, and above all, of patience. These are learned skills, ones that anyone can benefit from with practice.

The reality is that these skills can be obtained with practice, and one need not become a Tai Chi Master or spend years sitting in solitude to discover these skills. One need not even be a Willow tree or even a Tortoise.

The Eyes of a Child

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“The wanting of a thing is far better than the having of that thing. The Delight that never fades, the bliss that is eternal, is yours only so long as that which you most desire is just beyond reach.” ~C. S. Lewis.

People from very different cultures and backgrounds, religions, and philosophies, have sought for thousands of years a method to live a more peaceful, happier life. They wish to discover this method on their terms. In the United States, many people to turn to psychologist, psychiatrist, religion, and even psychopharmaceuticals, in what for many must be a desperate search for relief from the anxiety, depression, fear, and the myriad personal and cultural demons, both real and imagined that they face daily.

As a community health expert, I once practiced in the field of community psychology. During the time I worked closely with families, the overall positive outlook of children astonished me. Children, at least young children anyway, can see the good in others, even those who may have been unkind to them. I found them nonjudgmental and accepting of others regardless of race, religion, color or creed. At least until they were taught to be judgmental (and self-judgmental) by their caregivers.

It would seem the adage by Christopher Marlowe, “Solamen miseris socios habuisse doloris”, roughly translated Misery loves company, is sadly true. Why parents feel the need to inflict upon their children the very same burdens of hatred and fear I cannot say. Perhaps it is simply because their parents instilled these same afflictions upon them. The worst possible excuse for horrible things is the statement “that is the way we have always done it.” These same fears, hatreds, and the resulting conditioning this instills in children results in the sexism, racism, ageism, and other irrational fears (homophobia and xenophobia) that we face as adults.      These “isms” are among the most clinically destructive handicaps parents can inflict on their children. I find it strange that so many parents seek happiness and contentment for their children, yet they saddle them with the same fear and hatred that robbed them of their joy.

We can understand that when a parent strikes a child with a closed fist or a strap that this is abuse. When parents inflict their psychological and emotional baggage upon their children, destroying the child’s ability to be happy, our society pays little if any attention. With very few exceptions, happiness and contentment are purely internal, psychological conditions.

We may remember as children the joy and excitement of an empty cardboard box or a new friend. As adults our imaginations have been blunted, our joy of the simple things taken away extinguished. As adults many of us are suspicious of new people; we guard our hearts carefully. In the last 1960’s, musical artist Glenn Campbell released a song titles “The Eyes of a Child” that he had co-written with Jerry Capeheart. The ballad is a haunting one, speaking of the innocence and acceptance. The world is a dreamland, or so the song goes. It is not difficult to understand that the loss of our imaginations and our ability to be happy in virtually any situation were critical aspects of our childhood selves, and we all mourn the loss of these things, even if we don’t acknowledge it. And while it is impossible for us to become children again, we do have the option to return to that state of clarity and acceptance we once possessed. But it will require patience. And practice. A great deal of practice.

Welcome to Flatland, Population: You?

Is-the-universe-3-D-Or-just-a-hologramIn 1884, a schoolmaster by the name of Edwin Abbot wrote what he had considered a satire on both Victorian Culture and the Sciences titled Flatland: A Romance in Many Dimensions. The short novel is about the existence in a 2-dimensional world where the male inhabitants are geometric figures (depending on rank and status, from squares to the perfect circles), women are straight lines, and the world is governed by the Circles. The story is narrated by a square whose name is, not surprisingly, A. Square (this book could’ve easily been written in the 1960s). As readers, we learn about how practical life is in a 2-dimensional universe; everything is predictable, and life in this caste system goes along as expected. That is, until our Square comes to learn of a third dimension, and the inhabitants who dwell there. Although the book was published in 1884, the period the book’s story is set in is 1999.

At first, Square dismissed the dream as nothing more, that is, until he is visited by a being from the third dimension known as Spaceland. The visitor, Sphere, tries to explain to Square what a third dimension is, but, existing in a 2-Dimensional world, he had no common point of reference. But seeing is believing, and the Square is soon whisked away into the 3-Dimensional world of Spaceland, where it all becomes real. From his new vantage point, Square he can look down and see all the inhabitants of Flatland going about their business. He can watch them as they enter their houses, but of course, because their reality is two dimensional, he can look right inside. He also watches the Circles as they discuss how to suppress the knowledge of the 3rd dimension, and how they might prevent the world of Flatland from challenging their view of the world and their absolute power (think Spanish Inquisition).

As it turns out, this is not the Spheres first visit to Flatland, and we learn that he in fact visits on the eve of every new millennium to introduce the reality of the 3rd dimension in hopes of educating the population. Because of the period this book was written, it includes some not so well disguised statements on social conventions and the oppressive religious beliefs of the time, and when the Circles start arresting and integrating the other shapes, this soon leads to shapes informing on each other for heretical beliefs, and soon many are executed for questioning the Circles description of the world, including Square’s brother.

By the end of the book, we learned that Square has been returned to Flatland and is ridiculed and arrested as he attempt to spread his belief in a 3rd dimension. By now you are either interested in reading the book, or simply think it an interesting story about the social and religious morays of Victorian England (and some would argue modern America), but hardly worth a long discussion. But what if there is far more to the story than you might think?

Just for a moment, let us suppose that there is, at least some mathematical indications that we all live, not in a 3-Dimensional universe as we have come to understand, but a 2-dimensional one?

Right now you are reading this on a computer screen, which has only two dimensions (you may smile to yourself because I neglected to consider that you have printed this off, but you’re still reading it on a 2-Dimensional surface). Those of us who, for better or worse, indulge in the occasional video game (think Star Trek Bridge Commander), despite the complexity and 3-dimensional projection of the software, it is still a 2-Dimensional reality. But that is a game and we cannot say the same is true for the universe, which we can clearly see is 3-dimension. Right?

What if all that we can see in the universe is simply a hologram, a 2-Dimensional reality that only appears 3-Dimensional? In other words, our perception alone is 3-Dimensional. Before you begin to think that perhaps I have completely lost my mind, consider the problems of physics that seem to be currently insurmountable. In particular, the contradictions between Einstein’s General Relativity and Quantum Mechanics. What if the 3-Dimensional reality we are familiar with is in fact, just a projection on a 2-Dimensional universe?

As it turns out, there are more than a few theoretical physicists that have begun to examine this question, with surprising results. For example, a group from Tu Wien in Austria published a study suggesting that 3-Dimensional spaces can be reduced (at least mathematically), to 2-Dimensional projections. This has come to be known as the Holographic Principle, and understanding the universe in this way helps to answer some fundamental problems in unifying general relativity and quantum mechanics. While relativity makes predictions based upon three spatial dimensions + time, there are some researchers who suggested this may not be the most accurate way of viewing the universe.

If the term Holographic Principal sounds familiar, it may be because it is. First \ considered as a solution to Steven Hawking’s Information Paradox nearly three decades ago, after Hawking suggested that black holes would swallow all energy and matter (including light). Fair enough, with infinite gravity and all.  But according to quantum theory, this would not be possible. However, if the universe is in reality 2-Dimensional, and what we experience as 3-Dimensions is actually only perception, how do we explain things like black holes and gravity? Could such a 2-Dimensional universe calculate physical capacities like gravity in a flat space? Could quantum mechanics answer these questions by using things like quantum entanglement to replace gravity?

Mathematically and theoretically, the holographic principle does describe a universe with far fewer inconsistencies concerning relativistic physics and quantum mechanics (including Hawking’s Information Paradox) perhaps the unsolvable questions of theoretical physics may become solvable? But what of it? Does it matter if the universe has three dimensions, as it appears, 11 dimensions as string theory suggests, or two dimensions, as the holographic principle propose? Maybe it does, particularly if the universe can be considered as a nearly infinite holographic projection.

Getting back to the games and simulations. How many of us have had to upgrade our systems to handle graphics or other data-hungry applications? What happens if we run out of storage space? Will our universe freeze up, or worse, crash? Back in 1993, a pair of particle physicists working independently came to the same conclusion: the universe must have a way of storing information. Today, quantum mechanics assumes that every nook and cranny of space is filled with information; however, any area of space with significant density may, under the right conditions, form a black hole.

Will that information be lost or destroyed as suggested by the Information Paradox, or is that data somehow retrievable? If we imagine the universe as infinite, then we should find little concern about storage space for the data of reality. However, if the universe is finite, as Albert Einstein, John Nash, and many others suggest, there is just so much room to store information (energy, matter).

Could we imagine then, Black Holes as the ultimate hard drive, compressing data infinitely dense, but still available for retrieval when needed? How that information would be retrieved is unknown. While it is not possible, at least yet, to fully understand the cosmology of the universe, it is nevertheless an exciting thought experiment, and a short break from the often-bleak world of health and medicine.

We now return you to the regularly scheduled medical mayhem.

The Post Antibiotic Era? Why Antimicrobial Stewardship is Critical for the Future of Infectious Disease Prevention .

 

When-Life-Gives-You-Mold-Make-Penicillin_1899-lSome clinical epidemiologists (myself included) have suggested that a general disregard exists in surveillance and monitoring when it comes to medical and health practitioner staff concerning follow-up with patients diagnosed with an infectious antigen, and moreover, the handling of disinfection of infected surfaces and garments. While there is a sense of protection due to the availability of vaccines and antibiotics, there is an illusion that health staff and practitioners have the requisite knowledge to ensure patient adherence to prescribed treatments, the necessary follow-up is often insufficient to prevent reinfection.

Penicillin: The wonder drug. After returning from a vacation Alexander Fleming was cleaning up his running experiments including some petri dishes containing staphylococcus bacteria. He noticed something odd on one dish; it had sprouted a small colony of mold. He also noticed that they bacteria were avoiding the area around the mold. Fleming later identified the mold as a real strain of Penicillin Notatum, and it seemed as though the mold was preventing the bacteria from growing. Further experimentation by Fleming found that penicillin was capable of killing a number of harmful bacteria known that time, however it would be a number of years before penicillin could be refined and used as a treatment. Nevertheless, what would become the first wonder drug had been discovered purely by accident. Over the following 25 years, penicillin would become highly effective at treating a number of bacterial infections. However, its effectiveness today is drastically being reduced, as are many antibiotics.

Bacteria become resistant through overuse and misuse. When prescribed an antibiotic for a cold, influenza, sore throat, bronchitis, many sinus infections or any other viral infection, the antibiotic does nothing to treat the illness but instead destroys helpful bacteria in the body. Another overuse of antibiotics is in the livestock meat industry. Livestock producers give antibiotics to farm animals to make them grow faster, help them survive crowded stressful and unsanitary conditions. It has been estimated that 70% to 85% of all antibiotic use is in livestock meat industry. You maybe asking yourself, how does overuse or misuse lead to antibiotic resistance? If an antibiotic effective, doesn’t it remain effective? Bacteria are living things, and as such follow much the same processes as higher organisms including mutation and evolution.

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Conjugation: bacteria can acquire antibiotic resistance genes from other bacteria in several ways. By undergoing a simple mating process called “conjugation,” bacteria can transfer genetic material, including genes encoding resistance to antibiotics (found on plasmids and transposons) from one bacterium to another.

Bacterial conjugation is the transfer of genetic material between bacterial cells by direct cell-to-cell contact or by a bridge-like connection between two cells. It is a mechanism of horizontal gene transfer, as are transformation and transduction (although these two other mechanisms do not involve cell-to-cell contact). During conjugation, the donor cell provides genetic material (plasmid or transposon), and most conjugative plasmids have systems ensuring that the recipient cell does not already contain a similar element (eliminating duplication and ensuring enhancement). These enhancements may include antibiotic resistance, xenobiotic tolerance, or the ability to metabolize small molecules for energy, thus the foundation of a newer, more resilient bacterium.

AR-CDC 2017Evolution: the same natural forces that have produced every species on the planet benefit a bacterium. The term survival of the fittest is even more evocative of bacteria, as their “life-cycles” are short, and are measured in hours. Bacteria don’t have a life span, and a bacterial age is the period up to cell division, which can be from a few minuets to several hours (or many years on inanimate surfaces such as rock), and is unlimited by the mode or reproduction (asexual). Just as a microorganism evolves very slightly with each new generation, often taking hundreds of thousands of years (think of the Galapagos Finches), and because bacteria reproduce so quickly, they evolve at a significantly faster rate than longer-lived organisms. In any population, whether we are talking about finches or bacterium, there are many genes present within the population that express in a variety of ways, and the traits of these genes our mixed.

Like the finches discovered by Charles Darwin in the Galapagos Islands, the original decedents found themselves in a new, challenging environment, and were forced to adapt to the environment (this is referred to as a selective pressure), and evolved to survive in their new surroundings. Over thousands of years, new varieties emerged from the original population to take advantage of the environment. If we speed this up thousands of times, we can see how bacteria react in much he same way to environmental pressures.

Adaptation: while we certainly would not suggest that bacteria think, they certainly have developed adaptations. When this bacterium is exposed to a toxin (anti-bacterial), the vast majority is killed. But a very small number, through a fluke of genetic recombination from the many genes present allows them to survive. These few are now able to reproduce, and when they divide, their descendants naturally inherit the same resistance. Over time, due to the rapid lifecycles of bacteria, a new resistant strain evolves. Researchers are finding that when stressed by repeated cycles of antibiotic treatment, some bacteria can evolve and adapt for more quickly then imagined, in some cases within a few days, and seem to be able to suspend their “G time” (a period of little or no growth) to help it survive antibiotics. This is really bad news for patients who have compromised immune systems which are susceptible to opportunistic infections through immune dysfunction or immune suppressant therapies.

When a bacterium becomes resistant to the antimicrobial treatments that have historically been used, it becomes significantly harder to treat. These resistant forms of bacteria fall into a set of Hazard categories depending on factors including the seriousness of infection and difficulty in treatment.

Urgent Concern includes Clostridium difficile (C-Diff), Carbapenem-resistant Enterobacteriaceae (CRE) and Neisseria Gonorrhea (resistant to cephalosporin).

Serious Concern includes Multi-drug Resistant Aceinetobacter, Drug Resistant Campylobacter, Multi-drug Resistant Pseudomonas Aerugionosa, Drug-resistant Shigella, Vancomycin-resistant Enterococcus (VRE), Methicillin-resistant Staphylococcus Aureus (MRSA), Drug- resistant Streptococcus Pneumonia, at least one form of Drug-resistant Tuberculosis, and two forms of Drug-resistant Salmonella.

Growing concern includes Vancomycin-resistant Staphylococcus Aureus, Erythromycin-resistant Group A Strep, and Clindamycin-resistant Group B Strep.

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What can you do to protect your family?

Think like an epidemiologist: start with hand washing; this is your best defense against infections that cause diarrheal and respiratory illnesses. Regular hand washing after certain activities is the best ways to remove viruses and bacteria and avoid spreading them to others.

Stay Up-to-Date with Vaccines: Prevention is key to staying healthy. It is always easier and better to prevent disease than to try to treat it. Vaccines are responsible for the control of many infectious diseases that were once common, including polio, measles, diphtheria, pertussis, rubella, mumps, and tetanus. Since their introduction, vaccines have prevented countless cases of infectious diseases and saved millions of lives.

Prevent the Spread of Food borne Infections: keeping your water safe and clean will help you from preventing waterborne illnesses from occurring, including bacteria (and a few nasty parasites).

Never take an antibiotic for an infection like a cold or flu and never try to pressure your healthcare provider into prescribing an antibiotic.

Do not save antibiotics and never take antibiotics prescribed for someone else.

 

In the end, each of us must be responsible for our preventative health, and overuse of antibiotics in prescribing and food animals will continue to threaten public health. But there are some steps we can take to avoid these infections. Antimicrobial stewardship has become a significant aspect of public health, and each of us must do our part.

Neurogenesis and The Neurology of Grief and Loss

 

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Give sorrow words: the grief that does not speak whispers the o’er-fraught heart and bids it break. ~Shakespeare

Since beginning my study of cognitive-behavioral psychology decades ago, the idea of what constitutes acceptable topics of exploration have changed drastically. What was once limited to the reflective/passive responses and active listening promoted by cognitive therapist like Carl Rogers has given way to a more scientific approach to the emotional state of the human mind.

The last several years have witnessed significant insight into the understanding of what exactly happens in the brain when we are in emotional states. Utilizing functional MRIs and CAT scans, researchers can see firsthand how states like joy, sorrow, and grief affect our neurology. With surprising insights. While it has been a long suspected that practices like mindfulness and meditation can greatly alter our psychology and even cause physical changes to the brain, we now know that the more unwelcome mental states also have neurological equivalents. One area that is getting renewed attention is grief. Most therapists will agree that unmitigated grief often leads to depression, and left untreated, depression can greatly diminish a person’s life, both experientially and chronologically. The first question to ask, therefore, how does grief affect our physical brain?

This is not the easiest question to answer, as every person is unique just as each of our brains is slightly different. That being said, anyone we know who has lost a friend, relative, or pet can describe the feelings of loss and loneliness, of sadness and a feeling of emptiness. While these very in intensity from person to person, our shared experience of loss allows us to empathize and to understand how the other person is feeling. Now we have an insight into how their neurology is attempting to cope.

Just as the body goes into shock after a physical trauma, so does the human psyche go into shock after the impact of a major loss. ~ Anne Grant

Psychologist and author Richard Lazarus developed a scale to help understand the stress that most people feel when dealing with loss on a scale of 0-100. The death of a spouse is not surprisingly at the top of this list, but perhaps not for the reason, we might think. The death of a spouse is also the death of a dream. As cognitive beings, we live at once in the past, the present, in the future. A life partner is someone who shares a large part of that cognitive schema. People who speak of the loss of a spouse they say that a part of them has been ripped away, or, they may feel as if they are incomplete. The person who was so critical to their being is no longer there. Divorce also rates high on this scale, 73, according to Lazarus, as the loss of the dream is not quite as total as in death.

Other significant stressors include imprisonment (63), the death of a close family member or friend (63), personal injury or illness (50), Being fired from a job (47) and surprisingly, retirement (45). Marriage comes in at 50, and marital reconciliation earns a score of 45. According to Lazarus, anyone who has a total of 300 after these stressors are added up is put at a significantly elevated risk of illness. Those between 150 and 299 have a moderate risk and those under 150 only a slight risk. While Lazarus’ stress scale may cover many life altering events, it is certainly not complete, nor does it take into account other factors. Among them the death of a beloved pet, which can rate as high as 50, which may not be surprising, especially to those who have a beloved dog or cat.

It is expected that when a close relative or friend passes, the grieving process can be a lonely one, and everyone seems to grieve differently. Each of us mourns the loss of the individual relationship, and no two relationships are identical. Because of this it is impossible for anyone on the outside being able to formulate an accurate assessment of the person’s grief. Even though there may be others who are sharing in that loss, for example, siblings may share in the loss of a parent, nevertheless, each relationship is unique, and every loss is grieved differently.

Regardless of the loss, the stress that accompanies the grieving process is very real. This stress can become a burden to both the physiology and psychology; both of which are negatively impacted by the system designed to handle stress, namely the hypothalamus-pituitary-adrenal axis, or HPA. If you are a regular reader of my blog you have read a number of times about how our HPA axis system helps us survive threat or danger, but if left switched on can begin to cause significant damage, both to our bodies as well as our minds.

Lazarus’ stress scale is important because it does two things: it allows us to quantify stress from life events, and it points to how stress negatively impacts our health by weakening our immune response. A number of studies have shown that survivor groups, and grief support drastically increases overall health, lengthens life, and greatly improves the quality of life. This support in the grieving process support both psychologies (cognitive and behavioral aspects), but also greatly decreases stress, and its effect on the HPA axis and the resulting negative impact on the inflammatory process and immune response. Drs. Janice Kiecolt-Glaser, a psychologist, and Ronald Glaser, an immunologist, found that high-stress relationships impeded healing of injury; inflammatory response proteins can be released by intrapersonal stress and conflict resulting in a negative impact to our immune response system. These researchers also found that the inflammatory response worsened depression. At the same time, being in the presence of the familiar can greatly decrease these depressive symptoms through the release of oxytocin, one of the neurotransmitters often referred to as the “feel good” chemicals (If you want to learn more about these, the book pictured below is an exceptional guide).

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Regardless, grief seems to be a very natural and necessary adjustment to loss. If this grief is downplayed or ignored, the results can be depression, anxiety, or maybe manifest in physical symptoms. We all work through grief differently, but we all must work through it. And whatever our loss, refusing to acknowledge it and allowing the sadness to become clinical depression is hardly beneficial.

The stress hormones, particularly cortisol, which are beneficial in the short term, are destructive in the long term. If we become too depressed for too long, the neurology of our brain can be permanently affected. But how?

Much research over the past few years has begun to focus on the process of neurogenesis. Neuroscience has discovered that the adult brain can indeed continue the process of neurogenesis, and one area of significant interest is the hippocampus.

The hippocampus is crucial for learning and in the creation of memories, according to researcher Jessica Malberg, and works in orchestra with other parts of the brain, for example, the amygdala, to govern emotion, mood, and in the association of emotion to memories. Other researchers are discovering that some activities will increase the rate of neurogenesis in the hippocampus. They have also concluded that depression inhibits this neurogenesis by flooding the brain (and body) with stress chemicals. It has long been known that depression is unhealthy to our psychological well-being, and now we know it is unhealthy to our physiological health as well.

During periods of grief, we need to recognize that neurogenesis is incompatible with depression, and should be avoided for several reasons, one of which is that depression just does not feel very good, either physically or mentally. The headaches, the feeling as if we were punched in the stomach, these are often the result of a depressed and stressed state. What do we do when we are trapped in this grief? The seemingly natural ability of our minds to put us into a deep depression is very real, and it may seem as if there is no way to avoid the downward spiral. Yet researchers and therapists explain that the cure for this depressed mental state is may be as simple as exercise.

Reducing the effects of stress chemicals can be done through stimulating the feel-good neurochemicals like dopamine, serotonin, and oxytocin. This can be achieved through physical exercise. In fact, researchers at the Salk Institute found that sustained physical exercise promoted neurogenesis in the hippocampus, the region of the brain critical for the formation and regulation of emotions (and memories linked to emotions), as well as controlling many autonomic functions like digestion and heartbeat. What’s more, the researchers found that neurogenesis in the hippocampus improves the creation of new memories.

In his brilliant 2006 bookMaking Happy People: The Nature of Happiness and Its Origins in Childhood,” biologist Paul Martin suggests that even a brief ten-minute walk can greatly elevate mood, at least for a few hours. Of course, a daily walk of 10 minutes or more will over even a short time, start to change positively effect our mood, and increase our ability to deal with stress. It has long been known that physical exercise is effective in relieving depression and anxiety. Along with exercise, shared experiences and companionship further stimulate neurogenesis and reduce feelings of grief.

Researchers at Princeton University found that social interactions and companionship are necessary components of a healthy brain. Companionship is so critical to health brain function that researchers found among people living in isolation did not experience neurogenesis despite regular exercise. Sociologist and community psychologists tell us that humans are communal mamas, and being part of a group is necessary for health and longevity. One researcher set out to prove this.

Dr. James Coan is a professor of neuroscientist who used a functional magnetic resonance imager (fMRI) to measure has shown that we need more than just an internalized idea of social roots; we need to feel as if we belong. British neuroscientists also found similar results when using an fMRI to measure neurological responses to touch, finding heightened activity n the somatosensory cortex (the hub for all sensory experiences). These finding further support the idea that personal, physical and emotional experiences of others are critical to our neurology and our psyche. We are social creatures to be sure; do we benefit from the touch of our fellow humans only? As it appears, the answer is no.

In a 2013 study of Fibromyalgia patients, those spending time with a therapy dog showed significant decreases in pain and depressed mood. Another study examined the presence of animals and found significant increases in positive social responses from children with neurological disorders, seeming to suggest that the emotional and psychological benefits of socializing extend to pets as well. And it is not just therapy animals that can have positive effects on humans, with measurable results.

Living with a pet lowers blood pressure and decreases the response to stress, and thereby boosts our immune systems. People who live with pets also seem to have a higher survival rate following a heart attack. Some researchers found the nurturing connection between humans and their pets have significant positive implications for health care, reducing costs and improving longevity, and the use of therapy animals in children’s cancer treatment improved the moods of the children.

In the end, sharing our lives with another person, or a cherished pet, helps us avoid feelings of loneliness that so often leads to depression; allows us an external focus for our attention, love, and compassion, the science seems pretty sound. Sharing our lives with others helps us worry less, have less anxiety, less depression, and as the studies discussed here, experience much less pain. Pets, much like other humans, not only make us happier, they can help make us healthier. This is why the death of a friend, or the death of a cherished pet, can often leave us sad, depressed, and devastated.

The reality is that you will grieve forever. You will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to. ~ Elisabeth Kubler-Ross

Autism: Can Computational Biology and Environmental Health Finally Provide Answers?

pollution

The Increasing Rate of Autism in America

When I first studied psychology as an undergraduate student, the rate of autism in the United States was one in 10,000. Today it is about one in 55. And while some suspected that the rise in autism was due to changes in diagnostic standards, new findings point to the increases in environmental toxins for the increase in autism. This was a significant finding, as many in the medical and psychology fields had been watching the increasing numbers of autism diagnosis with more than a little concern. While the exact cause or causes of autism are still not known, significant progress is being made to understand how the environment, particularly toxins, have significant impact on fetal neurodevelopment

Computational Biology

Even those familiar with biology and biochemistry may not be well versed in computational biology. This is because computational biology is less retrospective, and more prospective in nature. Computational biology looks at the application of data analysis and theoretical modeling to understand biology, behavior, and complex social systems, in order to better understand and prediction the interplay among the psychological, the physiological, and the social. Beyond this, computational biology also involves the use of computer modeling, applied mathematics, biostatistics, biochemistry, molecular biology, genetics, ecology, neuroscience, anatomy, and physiology. This bringing together of such diverse specialities allows researchers to create a more complete picture of diseases and conditions in hopes of better understanding cause, prevention, and treatment.

Epidemiology

If you are a regular reader of my medical blog, you know that epidemiology is the study of how diseases or conditions impact a larger population, and Clinical Epidemiology has many similarities to computational biology, particularly in regards to predictive modeling and ascertaining direct and indirect impacts to the community. When combined with Environmental Health Science, this approach can bring new insight into how our health is impacted, how healthcare can be altered to include the ecological aspects, and how diagnosis can be modified to include impacts from the environment. One such insight is a novel way of looking at destructive neurodevelopment impacts associated with the environment.

Each year, over 300,000 newborns die within the first month of life due to complications from congenital anomalies according to the World Health Organization. Many who survive are faced with long-term disabilities that significantly impact their families, causing significant disruption in healthcare systems and the society. The World Health Organization suggest that, although some congenital abnormalities are the result of genetics, infections, or poor maternal nutrition, environmental toxins play a significant part.

Recent Studies

In a study from the University of Chicago, researchers found that autism and intellectual disability rates were positively associated to harmful environmental factors during congenital development. The researchers found significant correlations between the rate of congenital malformations of male genitalia, the rate of autism, and exposure to environmental toxins, particularly those comprised of micro molecules (those molecules small enough to pass through the placental barrier). These included some plastics, some prescription drugs, pesticides, and other manufactured chemicals, commonly referred to a teratogens (meaning an agent that causes malformation of an embryo), a word that first appeared in the medical literature about 1951. In essence, the introduction of these micro molecules or teratogens alters or damage fetal development during vulnerable periods.

The University of Chicago researchers gathered data from over a third of the population of the United States, finding that fetuses, particularly males, were highly sensitive to toxins in the environment, including lead, petrochemical prescription medications, pesticides, mercury, and a host of other man-made synthetics. This is not the first time researcher suspected a link between autism and the environment. In 2009, The University of California Davis department of public health sciences reviewed 17 years of state data that tracked developmental disabilities, finding the increase in autism rates corresponded with the increase of environmental toxins.

Another study published in the New England Journal of Medicine compared brain autopsies of autistic children who had died from unrelated causes to those of normal brains. The brains of autistic children revealed abnormal patches of disorganized neurons that disrupted the usual distinct layers that make up the brain’s cortex. Research suggests that these abnormalities occurred in utero during critical developmental stages (between 18 and 31 weeks).

Life in a Disposable Society

As a disposable society, we have not always been concerned about where our trash went, provided it went somewhere out of sight. As a child, I recall going to the “Dump” with my father and watching people burning trash, tires, anything that could be burned. As a result, all of that trash, burned or otherwise, the refuse of the past 75 years or so has become part of our environment, and as a result, our ecology contains some chemicals that impact the neural development of all animals that come into contact with them. They include Mercury, lead, bromide, pesticides, and herbicides.

A Toxic Soup

Today we include the built environment in human ecology, and the list of toxins has increased significantly. While the rates of autism have remained steady in Europe, where Genetically Modified Organisms (GMO’s) are banned, along with the pesticides used with them. In fact, the rates of neurodevelopment disorders seem to remain stead in the Europe Union, Australia, Japan, and in total some 60 nations have outlawed or significantly reduced GMO crops, or have banned any use of GMO’s altogether. Meanwhile in the US, government agencies continue to approve the use of these chemicals at great concentrations, completely discounting their connection to health ailments. Today, a chemical outlawed in the EU and dozens of other nations, Glyphosate, (the active ingredient in herbicides) is routinely used on food crops and livestock feed.

While environmental regulators should be aware of the number of birth defects caused by Glyphosate, only those agencies in the European Union, Japan, and Australia have completely outlawed their use. Despite established research showing these chemicals cross the placental barrier injuring fetal development, they are still widly used in the US.

According to a study in Reproductive Toxicology, pesticides associated with GMO foods were found in maternal and fetal blood, and later tests revealed these same pesticides in the blood samples from other women as well, along with the presence of Bacillus thuringiensis (Bt), a bacteria toxin manufactured by several chemical makers. The people living in the United States continue to be inundated with toxic chemicals, and one study, examined 160 toxic chemicals, found that almost all women tested positive for 43 of them.

Finally, A study by the U.S. Geological Survey titled Pesticides in Mississippi Air and Rain: A Comparison Between 1995 and 2007, found Glyphosate and its byproduct AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid), a compound that mimics the effects of the neurotransmitter glutamate, was found in over 75% of the air and rain samples taken from Mississippi in 2007.

And you are worried about vaccines?