How can we help victims of torture?

Post-traumatic stress disorder, or PTSD, affects many people who are exposed to extreme situations, such as torture. Recent research suggests that chronic pain may make it more difficult to treat trauma.

“Trauma-focused therapy is effective for many patients with PTSD, enabling them to talk through the trauma they experienced,” according to Iselin Solerød Dibaj, a psychologist at Oslo University Hospital.

However, not everyone benefits equally from this form of therapy.

“Torture victims who struggle with both chronic pain and PTSD unfortunately often reap less benefit from ordinary treatment,” says Dibaj.

The Red Cross estimates that between 10,000 and 35,000 people with a refugee background who have come to Norway have experienced torture, reflecting the great need for effective treatment in this country as well.

“Torture is one of the most extreme abuses a person can experience. Physical and mental pain is inflicted with the intention of breaking a person down or obtaining information,” says Håkon Stenmark, a specialist in clinical psychology at RVTS Midt, a regional resource centre for violence, traumatic stress and suicide prevention in central Norway.

“Mental health therapists find it difficult to provide effective help to victims of torture. They are pushing to increase their knowledge and find more effective methods,” says Stenmark.

Now Dibaj and Stenmark, along with Professor Leif Edward Ottesen Kennair and Joar Øveraas Halvorsen, a specialist in clinical psychology and Ph.D. at the Regional Unit for Trauma Treatment at St. Olavs Hospital, have published an article in the journal Torture about treating this patient group.

Professor Kennair, from the Norwegian University of Science and Technology, has been a supervisor and the driving force behind the research project that might lead to better treatment of torture victims.

“Exposure therapy” involves delving into patients’ memories and trying to talk through the trauma.

“But trauma-focused treatment for torture victims has been criticized in several clinical and academic settings for being too concerned with the traumas and not taking context into account, such as social, political and historical factors,” says Dibaj.

Dibaj says they understand this criticism, at the same time as they do not want to write off a trauma treatment for this group that has documented effectiveness in other patient groups.

Other trauma-exposed groups in recent years have shown evidence that chronic pain and PTSD mutually contribute to reinforcing the other condition. One disorder can trigger the other, ensuring that neither disappears.

“So people with both disorders have worse treatment results with both the trauma condition and the chronic pain than if they only had one disorder,” says Kennair.

Having both disorders also brings with it a number of additional challenges that therapists do not address specifically and purposefully in either trauma treatment or pain treatment.

“So we’re questioning whether these factors are partly to blame for the trauma treatment being less effective for victims of torture,” Kennair says.

Effective trauma treatment is largely about experiencing mastery and learning new ways to deal with painful memories.

“But if the patient experiences unmanageable pain, without the tools to deal with it, he or she risks not having this experience. The patient might then drop out or not be willing to delve into the memories,” says Dibaj.

In the same way, pain treatment with the physiotherapist rarely works directly with trauma memories. Thus, this therapy can fall into the same trap—that the patient doesn’t dare to do the rehabilitative exercises for fear of re-experiencing the trauma.

“We’re criticizing the current ‘gold standard trauma therapies’ for not working purposefully and specifically enough with important maintenance mechanisms for patients who have both pain and PTSD,” says Dibaj.

But these patients might actually achieve better outcomes if the therapists worked with the pain and trauma simultaneously.

“In other words, psychologists and physiotherapists should collaborate more in treating these patients,” Dibaj says.

“We also have to remember that torture is such an extreme and unique experience that we can’t just conclude that the pain problems in these patients are the same as we see in other patients with the same problem,” says Dibaj.

Norway has ratified the UN Convention against Torture. It states that people who have been subjected to torture have the right to rehabilitation. In a report from earlier this year, the Red Cross found the services offered to torture victims in Norway to be fragmented and highly person-dependent.

“At the same time, those of us working in the health care services are obliged to offer evidence-based treatment and equal health services,” says Halvorsen.

This means that patients with PTSD need to be offered the form of treatment that currently seems to have the best documented effect. This guideline applies regardless of background. The treatment has to be adapted to each individual patient.

“International guidelines for the rehabilitation of torture victims recommend interdisciplinary, specialized follow-up of these patients. However, studies show that even patients who receive such multi-faceted treatment experience only modest effects. We simply need to gain more knowledge about how we can help this group,” says Dibaj.

“We’ve been pointing out that Norway lacks specialized rehabilitation services for victims of torture for a long time. But since we still have limited knowledge of what characterizes effective rehabilitation for this group, funding and implementing clinical studies need to become an integral part of a specialized rehabilitation program,” Halvorsen says.

But why do some people suffer from PTSD?

“From an evolutionary perspective, we can understand the function of both pain and anxiety. These are alarm systems that signal us that something could potentially pose a danger to us. These signals cause us to avoid that situation. This can be adaptive in the short term, so that we steer clear of potential harm,” says Dibaj.

With PTSD and/or chronic pain, our alarm system is overactive and fires a series of false alarms about danger.

Avoidance normally decreases when the acute danger is over, but with PTSD and/or chronic pain, our alarm system is overactive and fires a series of false alarms about danger.

“If we respond to these alarms as a real danger and avoid what’s triggering the alarm, we risk making the alarm system more sensitive,” Dibaj says.

“Research indicates that post-traumatic cognitions or thoughts—that is, thoughts that come up after experiencing a trauma—play an important role in developing and prolonging post-traumatic distress. Examples of this kind of post-traumatic cognition might be, ‘The world is a dangerous place’ or ‘I’m a broken person,'” says Halvorsen.

Both PTSD and chronic pain are characterized by numerous such false alarms. The affected person might have flashbacks, for example, where something dangerous from the past is perceived as dangerous now. Victims can also experience pain signals without connecting them to something actually being wrong in their body.

“Torture is designed to create this form of distress and, especially in recent times, to create pain that doesn’t result in visible scars,” says Dibaj.

Many victims of torture experience that completely normal movements trigger their alarm system. This naturally leads to less physical activity and also makes a lot of people afraid to move. This condition is called kinesiophobia, when normal activities can lead to severe pain and re-experiencing the trauma.

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People eventually adopt healthy behaviors – but it can take time we don’t have during a pandemic

Why do we do things that are bad for us—or not do things that are good for us—even in light of overwhelming evidence?

As someone with a long career in pharmacy, I have witnessed some pretty dramatic shifts in public health behavior. But I won’t sugarcoat it. It generally takes years—or even decades—of dragging people, kicking and screaming, to finally achieve new and improved societal norms.

This plodding time course seems to be an innate human defect that existed long before the current-day pandemic mask and social distancing conundrums. Historically, people aren’t fond of being told what to do.

Notable victories

Attitudes toward smoking have undergone dramatic changes over the past 50 years. Although there has been a gradual decline in smoking, from 42% of the American population in 1965 to the low teens today, there still are a lot of smokers in the U.S. – and premature deaths due to smoking. Even health care workers fall prey to this unhealthy and highly addictive habit.

There was a strongly held view that smoking was a personal decision that do-gooders and the government should keep their noses out of—until the issue was framed differently by studies showing harm caused by secondhand smoke. You are welcome to do what you want to yourself, but it becomes a horse of a different color when it affects others.

Today, public smoking restrictions have become commonplace. But this change in societal behavior didn’t happen overnight or without painful discourse. The journey from the initial 1964 surgeon general’s report on smoking and health to the 2006 surgeon general’s report on secondhand smoke to today was a fractious one.

Another about-face has been the adoption of seat belts. Seat belts save lives. And most people now use them as a result of the nagging warning alarm, the marketing of automobile safety, the law and the data.

This change in behavior, however, followed a rocky road over many years. In my earlier days, I can remember more than one occasion when I hopped into a friend’s car, put on my seat belt and was then chastised for having so little faith in my friend’s driving ability.

Seat belts were required to be installed in new cars starting in 1964 and New York enacted the first seat belt use law in 1984. In the U.S., seat belt use rose from 14% in 1983 to 90% in 2016.

Continuing challenges

In the medical arena, much effort has been expended in promoting healthy behaviors—diet, exercise, sleep hygiene, adherence to prescribed drugs and immunizations. Frankly, the success has been mixed.

Studies have suggested many possible variables associated with not following accepted medical advice: age, gender, race, education, literacy, income, insurance copays, level of physician and pharmacist care—and plain old stubbornness. But there is no single, easily addressable cause of nonadherence to healthy behaviors.

For example, properly prescribed cholesterol-lowering drugs called statins literally add years to patients’ lives by reducing heart attacks and strokes. Even in people with insurance coverage and minimal side effects, 50% of patients discontinue statin therapy within one year of receiving their first prescription.

Vaccines and immunization offer another window into the puzzle of human behavior. Life expectancy in the U.S. rose from 40 years in 1860 to 70 years in 1960. These gains resulted largely from decreased infant and child mortality due to infectious diseases. A better understanding of infectious diseases along with scientific advances, vaccines and antibacterial drugs were the primary factors for this profound increase in life expectancy.

Common sense alone makes the value of vaccines abundantly clear; how many people do you know who are suffering from polio or smallpox? Yet some intelligent, thoughtful friends, family and neighbors are convinced vaccines are not helpful and are even harmful. Some believe wearing a mask is nothing more than a “feel good” placebo. I believe these contrarian beliefs make better press and are therefore more frequently reported than mainstream ones, but clearly there is reason for concern.

The current crisis

Historically, changes in societal behavior that benefit public health occur in fits and starts—and never fast enough for the individuals who fall victim before society comes around.

The urgency imposed by the coronavirus has actually resulted in comparatively swift behavioral changes (masks, hand-washing, distancing) in the U.S. – as scientists learned how the coronavirus is spread, how dangerous it can be and which groups are more susceptible. But these behavioral changes were not as complete or as fast as they should—or could—have been when judged by far better outcomes in other countries.

I am discouraged by the battle between the scientific method and political ideology when it comes to public health. Ideology never seems to change and is therefore more comforting to some—while science evolves as new findings debunk old ideas or confirm new ones. It is clear to all who want to listen: controlling the virus and maintaining the economy is not an either/or choice—they are interdependent.

At the same time, I am buoyed that the tide seems to be turning. As a better understanding of treating COVID-19 has emerged and with more than one highly effective vaccine on the horizon, the “idiot scientists” are gaining ground, both in the lab and at the bedside. Even the most prominent ideologues run to the hospital to get the best treatments science can offer when the effect of their maskless behavior rears up to bite them.

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Why we need to get creative when it comes to talking about pain

What [do] I mean by sitting in a pit of fire? You’ve got every nerve ending that’s just going hellfire, and you just don’t know what to do with yourself.

Forty-two year old Emma has experienced chronic pain from a spinal cord injury for the last year. For Emma and many others, living with severe pain is now part and parcel of everyday life. It is estimated that 35-51% of people in the UK live with chronic pain. But communicating that experience can be a challenging endeavor.

We interviewed people with spinal cord injuries and women with endometriosis – a condition where tissue resembling the lining of the womb grows elsewhere in the body causing severe pain—in an effort to find out about their experiences and to learn more about how they talk about pain.

This research suggests that the inability to communicate pain effectively may partly account for delays in diagnosing some conditions. We also found that people with various types of chronic pain—such as that caused by endometriosis and spinal cord injury – often use metaphors to describe it.

Many speak of their pain in terms of being attacked. What might sound overly dramatic actually uses a variety of mechanisms, ranging from conveying high levels of pain severity and trying to make sense of the experience, to expressing the emotional consequences.

In using these expressions, sufferers may be trying to elicit support and empathy from others. At the moment though, widespread practice in pain consultation involves the use of numerical rating scales asking people to identify a number that best represents their pain.

The use of such potentially simplistic and reductionist tools means that a holistic assessment of the physical, psychological and social complexity of the pain experience is neglected.

Using metaphors to talk about pain

In conducting our research, we found that the ways people spontaneously talk about their experience of pain go beyond the measuring capacities of the standard assessment tools. For example, the McGill pain questionnaire asks people to rank each of the descriptive words such as “searing,” “pinching” and “flashing” in terms of their pain intensity.

But many people describe their pain in ways that aren’t measured in this questionnaire. For example, one participant described their pain as feeling like “you’re dragging your organs.” Such creative and detailed descriptions often capture both the severity and the distress pain causes. However, not all expressions convey the intended message effectively.

Common pain descriptors such as “shooting” and “stabbing” pain may fail to articulate intended meaning as they have lost their metaphorical force due to overuse. These are known as dead metaphors. So more detailed creative descriptions, often involving similes, may be more effective in helping the listener to understand, assess and provide better support.

We found interesting examples of creative and extended metaphors such as: “It feels like somebody putting barbed wire through your belly button in a figure of eight … And then they set fire to the barbed wire and it starts getting hot and everything’s just being squished inside you.”

Using highly personal and creative metaphors like this provides a mechanism to communicate pain in one’s own terms rather than being restricted by standardised assessments. “It’s like some little devil in the corner. Yeah, you know like that little exorcist thing in the corner … torturing me.”

This language could help others understand more clearly how a sufferer is feeling and perhaps elicit some support. However, these benefits may come at a cost to the person in pain. We also found that some metaphorical expressions alluding to torture and attack could reflect individuals’ perceptions of pain as a physical threat, leading to higher levels of distress, fear and despair.

As a result, the use of such language could increase the attention that an individual pays to their pain. This has been shown to also lead to an increase in pain intensity, as people become more aware of, and sensitive to, the sensation.

Promoting effective pain talk

Pain is a private experience; encouraging people to find different and more appropriate ways to talk about it can help them make sense of their unique experience and describe it more effectively.

People with different conditions tend to use similar types of metaphorical expressions. For example, we found that words like “pins and needles” and “electricity” are often used to describe nerve pain associated with conditions like spinal cord injury. Similarly, expressions involving physical action such as “tearing” and “pulling” are more commonly found in descriptions of endometriosis pain.

This, in turn, can potentially guide doctors to identify potential causes of pain in certain conditions, like endometriosis. For example, a description such as “feeling like a balloon is about to explode” may point to inflammation, while “felt like I had tiny people with ropes tied tightly around my insides and pulling down” may be indicative of a deeper, more visceral pain.

Pain is also an all-round experience, and its impact goes beyond the physical. The way that someone talks about their experience can also highlight its effect on other parts of their lives, such as mental health and socialising. For example, pain described as “all-consuming” could reveal an emotional dimension while talking about how people in pain “hide from the world” could indicate a drive to conceal pain from others and avoid seeking help.

Encouraging people to talk about pain in their own terms is key to understanding and supporting their individual needs. In fact, this is what our participants ask for: “Listen closely” or “Be more open-minded about the difficulty of describing pain I can’t explain well.”

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How HIV became the virus we can treat

As the numbers of COVID-19 infections climb, it’s easy to forget that there are still more than 1.2 million people in the U.S. living with another virus—human immunodeficiency virus, or HIV. When it first swept across the country in the 1980s, HIV was one of the most sobering public health challenges ever faced. It brought a cruel and isolating stigma toward gay men, who died in startling numbers, and it went on to kill 33 million people across the world.

Times have changed. Now, most people don’t die from the virus. Thanks to continuing medical advances in medications, HIV can now be seen as a chronic disease. People who have it can enjoy long careers, get married, and raise families.

“The message that we used to give in the early days of HIV was, ‘Let’s try to make your remaining days as comfortable as possible.’ Now, it’s treatable. It’s not curable, but it is controllable,” says Merceditas Villanueva, MD, director of the Yale School of Medicine AIDS Program.

Many HIV providers and public health experts believe they can eventually come close to eradicating the virus by 2030 with a goal known as “95-95-95.” In this vision, 95% of people who have HIV would be diagnosed, 95% of them would be receiving treatment, and of those, 95% would have the virus suppressed (the term used when the amount of virus is so low that the patient with HIV stays healthy and has a greatly reduced chance of passing it to others).

“The ultimate goal is getting to zero—and that’s zero new diagnoses, zero new infections, zero deaths, and zero stigma,” says Lydia Aoun-Barakat, MD, medical director of the Nathan Smith Clinic, the HIV clinic at Yale New Haven Hospital (YNHH).

We asked these and other specialists in the Yale School of Medicine AIDS Program to answer questions about how HIV became a treatable disease.

What is the difference between HIV and AIDS?

HIV is a potentially deadly virus that attacks the body’s immune system, specifically the T cell lymphocytes or CD4 cells. AIDS is a collection of symptoms and illnesses that can develop when HIV goes untreated and the CD4 cell count drops below 200.

There are four stages of HIV (0, 1, 2, 3). People are diagnosed as having AIDS when their HIV is classified—or if it has ever been classified—as Stage 3, when people experience such symptoms as rapid weight loss, recurring fever or night sweats, body sores, memory loss, and (what turn out to be) fatal infections.

It first came to attention in the early 1980s when doctors started reporting unusual infections and rare malignancies in gay men. HIV is believed to have transferred from animals to humans possibly as far back as the late 1800s from a type of chimpanzee in Africa. This likely occurred when hunters looking for meat came in contact with infected blood from the animal. HIV is transmitted between humans through bodily fluids, specifically blood, semen, vaginal secretion, and breast milk.

Who is at risk for HIV today?

Anyone can be at risk for HIV, but some groups are more likely to get it than others. The first cases of HIV in the U.S. spread mostly through unprotected sexual intercourse, especially among men who have sex with men. The virus is by far still most prevalent in that group, followed by people who transmit it through heterosexual relations, and injection-drug users who share needles. It has affected Black and Hispanic Americans disproportionately, and is on the rise among transgender people.

Beyond that, people with HIV make up a diverse population, says Dr. Villanueva, who also sees a small minority infected by blood transfusions. “So, there’s a leveling feature. If you have HIV, regardless if you’re rich or poor, you’re dealing with the same disease,” she says.

While annual infections in the U.S. have decreased by more than two-thirds since the mid-1980s, recent data still show about 38,000 new infections in the U.S. each year between 2014 and 2018. The highest number of new diagnoses are in people between the ages of 20 and 35 (a population believed to most likely be unaware of their HIV status).

What treatments are helping people live longer?

A collection of antiretroviral therapies (ART) has moved HIV into the chronic disease realm and given young people who are newly infected a close-to-normal life expectancy. In fact, more than half of people living with the virus now are over 50 years old, says Michael Virata, MD, director of HIV clinical services at YNHH’s Saint Raphael Campus.

“Really, the basic goal is to treat people with highly active drugs that combat the virus, so we get them to the point where they have undetectable levels of it,” he says.

Patients may be given some combination or “cocktail” of three drugs, and doctors are moving toward two-drug combinations. “We are even moving into a realm of longer-acting agents so that people won’t have to take a pill every day,” Dr. Virata says.

Some medicines will be delivered through such methods as injections that could protect people for weeks. In the past, there was controversy over when to treat newly diagnosed patients, but current guidelines recommend starting medications quickly. “There are centers around the U.S. where, the day they diagnose you, they hand you your first doses of medication,” Dr. Virata says.

There have been breakthroughs beyond the medications as well. “For example, people with HIV with end-stage kidney disease are now being successfully transplanted,” says Dr. Villanueva. “And there are studies that show successful kidney and liver transplants from HIV-positive deceased donors.”

Have you been able to stop the spread of infection?

Yes and no, says Dr. Villanueva. “In the past five to eight years, the number of newly documented infections has decreased. But we’re looking nationally at a level of almost 38,000 new infections per year, which is a lot.”

A major approach to prevention is the use of PrEP or pre-exposure prophylaxis. This approach is based on administering drugs used to treat HIV to people who do not have HIV—but who are at a high risk for it—in an effort to prevent them from contracting the virus. Different formulations are being made available, including long-acting injectables and a vaginal ring for women, and this worldwide effort is extremely important, says Dr. Villanueva.

There have been other pockets of success. Mothers-to-be who had HIV used to transmit the virus to their infants when they gave birth, says Dr. Villanueva. But a landmark trial that Yale participated in showed that giving mothers an antiretroviral medication called azidothymidine (AZT) during the third trimester and delivery resulted in a marked decrease in the mother-to-newborn transmission rate in the U.S. “That treatment was introduced as a standard of care here in Connecticut, with only one new case of perinatal transmission since 2008,” Dr. Villanueva says.

Another pocket is the decrease in cases among injection-drug users contracting HIV when they shared needles. “Very early work here at Yale helped pioneer the use of syringe exchange programs, and it’s been a successful harm reduction approach that has been adopted not only nationally, but worldwide,” Dr. Villanueva says.

These programs provide people with access to sterile needles and syringes, as well as a safe way to dispose of used syringes. “However, the caveat is that with the opioid epidemic, we are starting to see new outbreaks of HIV among people who are using opioids through injection,” Dr. Villanueva says.

What issues do people with HIV face as they age?

Aging with HIV is a fairly new area of study. “People who are 50 and who have been living with HIV for a long time—their bodies may be, by some estimates, like that of a 60-year-old,” says Dr. Villanueva. They may develop cancer, diabetes, heart disease, and other conditions earlier than they would if they weren’t HIV-positive.

Dr. Virata says HIV is thought to cause a chronic inflammatory state in the body, which can accelerate aging. “We’re trying to understand what the process is and figure out how we can address it,” he says.

Researchers are studying whether early interventions could decrease complications for patients as they grow older. Dr. Virata points to a large global study looking at the use of statins as an intervention. “It’s a long-term study, but we’re anxiously waiting to see what the results of that research project will show,” he says. Contributing to the problem, he says, is that some of the medications used to treat HIV can be toxic in the body.

More implementation science, research, and intervention strategies are needed, Dr. Barakat says. “We’re still learning about and determining the best strategies to enhance opportunities as far as testing and prevention.”

How has testing, an important COVID-19 strategy, helped with HIV?

HIV testing is critical because—as with COVID-19—many people who have the virus don’t know it. An estimated 14% of people with HIV in the U.S. (or one in seven) are not aware they have it. Symptoms aren’t always a tip-off, since about a third of newly infected people don’t develop symptoms (two-thirds report flu-like symptoms within two to four weeks of infection) but are still able to transmit it to others.

In 2006, the Centers for Disease Control and Prevention (CDC) recommended offering HIV tests to anyone between the ages of 18 and 65 coming into the health care system for any reason, regardless of their background or risk factors. Dr. Barakat would go a step further. “Every single person should be tested for HIV—annually, if they are at higher risk,” she says. High-risk groups would include those who use drugs and share needles or engage in unprotected sex.

Testing is important because once a person is diagnosed, he or she is more likely to be treated, and therefore less likely to spread the disease to others, says Dr. Virata.

Can our experience with HIV help with COVID-19?

HIV specialists say there are many similarities between HIV and COVID-19. For both diseases, “the first step is testing, the second step is prevention,” says Dr. Barakat. “If you know who is infected, you can take care of them, and they will be less likely to infect others. And for those who are uninfected, you can provide them with prevention measures.”

For both conditions, getting people to take precautions is a difficult challenge. “For a lot of infectious diseases, the most important prevention intervention is the social behavior part of it,” says Dr. Barakat. “You see this with COVID-19 and you see it with influenza or Ebola. People’s beliefs and attitudes are very important when you are dealing with an epidemic. There needs to be a lot of public education, as well as access to information, testing, and treatment,” she says.

Both conditions call for a vaccine. While it may be years away, the doctors hope there will be an HIV vaccine in their lifetimes; more progress has been made on a COVID-19 vaccine.

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Memories of past events retain remarkable fidelity even as we age

Scientists studying the complex relationship between aging and memory have found that in a controlled experiment, people can remember the details about past events with a surprising 94% accuracy, even accounting for age. These results, published in the journal Psychological Science, suggest that the stories we tell about past events are accurate, although details tend to fade with time.

“These results are surprising to many, given the general pessimism about memory accuracy among scientists and the prevalent idea that memory for one-time events is not to be trusted,” said Nicholas Diamond, the study’s lead researcher, a former graduate student at Baycrest’s Rotman Research Institute (RRI), and currently a postdoctoral researcher at the University of Pennsylvania.

About 400 academics, including memory scientists, surveyed as part of this study estimated memory accuracy to be around 40% at best, expecting this score to be even lower for older participants or when greater amounts of time had elapsed since the events.

“This study shows us that memory accuracy is actually quite good under normal circumstances, and it remains stable as we age,” said Brian Levine, a senior scientist at RRI and a professor of psychology and neurology at the University of Toronto and co-author on the study. “These results will be helpful for understanding memory in healthy aging.”

For their study, the researchers created an immersive, scientifically controlled event for their participants: a 30-minute audio-guided tour of art and other items displayed at Baycrest. Two days later, participants were asked to tell the researcher everything they could remember about the tour. The responses were recorded and then verified against the facts.

The researchers also tested Baycrest employees on their recall of a standardized, scripted procedure that they had experienced one month to three years prior. This allowed the researchers to examine the effect of delay between the event and memory recall, while the standardized nature of the procedure made it possible to verify accuracy.

Using standardized, verifiable events to test memory is an innovative approach, the researchers said, as scientists typically use artificial laboratory stimuli, such as random word lists, rather than real-life experiences, or they test participants’ memory for personal past experiences, which cannot be verified.

“This pessimism originates from earlier studies showing that memory can be manipulated using certain testing methods,” said Levine. “While those studies were important in showing the ways in which memory can fail, we wanted to know what happens when people freely recall events without such manipulation. We found that they are overwhelmingly accurate.”

The results showed that participants’ accuracy was high in both cases, though, as expected, the number of details they remembered decreased with age and time. At best, they recalled about 25% of their experience. “This suggests that we forget the majority of details from everyday events, but the details we do recall correspond to the reality of the past,” Diamond said.

In a related study also published in Psychological Science, Diamond and Levine examined the degree to which people’s memories matched the true order of events. In this case, younger adults tended to perform better than older adults, suggesting that while accuracy of details remains high with age, older adults are less likely to correctly remember the true sequence of past events. That is, the order of our memories becomes disorganized as we age.

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If we spent the cost of COVID-19 on pandemic preparations it would have lasted 500 years

COVID-19 has taken advantage of a world in disorder, causing catastrophic health, social, and economic consequences and irreparable harm to humanity. The virus has killed close to a million people and many more may die as a result of its impact on health systems, food supplies, and the economy. The financial cost will be in the trillions.

This will not be the last global health emergency. The world simply cannot afford to be unprepared again, warns the Global Preparedness Monitoring Board (GPMB) in its second report “A World in Disorder,” released today.

Last year, the GPMB warned that the world was unprepared for the very real likelihood of a deadly pandemic spreading around the globe, killing millions of people, disrupting economies, and destabilizing national security. The Board called for urgent action to break the cycle of panic and neglect that has characterized the response to global health crises in the past.

In its new report, the GPMB provides a harsh assessment of the global COVID-19 response, calling it “a collective failure to take pandemic prevention, preparedness, and response seriously and prioritize it accordingly.” In many countries, leaders have struggled to take early decisive action based on science, evidence and best practice. This lack of accountability by leaders has led to a profound and deepening deficit in trust that is hampering response efforts.

“Transparency and accountability are essential in responding to the COVID-19 pandemic,” said Elhadj As Sy, co-Chair of the GPMB. “Trust is the foundation of government-community relationships for better health but that trust dissipates when governments and leaders do not deliver on their commitments.”

Responsible leadership and good citizenship have been key determinants of COVID-19’s impact, the report finds—systems are only as effective as the people who use them.

The report also finds that, while COVID-19 has demonstrated that the world is deeply interconnected through economics, trade, information, and travel, one of the greatest challenges of the pandemic has been faltering multilateral cooperation. Leadership by the G7, G20, and multilateral organizations has been hampered by geopolitical tensions. The Board calls on leaders to renew their commitment to the multilateral system and strengthen WHO as an impartial and independent international organization. Weakening and undermining the multilateral action will have serious consequences on global health security, it warns. No-one is safe until all are safe.

“Viruses don’t respect borders. The only way out of this devastating pandemic is along the path of collective action, which demands a strong and effective multilateral system,” said H.E. Dr. Gro Harlem Brundtland, co-chair of the GPMB. “The UN system, which includes the WHO, was created after World War II and has helped make the world a better place for billions of people. It needs to be defended, strengthened, and revitalized, not attacked and undermined.”

The report highlights how the devastating social and economic impact of pandemics, especially for the vulnerable and disadvantaged, is often underestimated and ignored. COVID-19’s long-term socioeconomic impacts are predicted to last for decades, with the World Bank’s conservative scenario estimating a US$ 10 trillion earning loss over time for the younger generation as a result of pandemic-related educational deficits.

COVID-19 has demonstrated the importance of protecting lives and livelihoods and widening our understanding of preparedness to make education, social, and economic sectors pandemic proof. “A World in Disorder” reveals that the return on investment for pandemic preparedness is immense. It would take 500 years to spend as much on preparedness as the world is currently losing due to COVID-19.

“The pandemic has shown the fragility of not only our health systems, but also our global economy. The impact of COVID-19 has been huge in the world and particularly in my region, the Americas, with a sharp increase in health, social and economic inequities,” said Jeannette Vega, GPMB member and Chief Medical Innovation and Technology Officer, La Red de Salud UC-Christus, Chile. “Let’s hope that this time we finally learn the lesson and invest in preparedness and public goods for health to avoid similar tragedies in the future.”

The report highlights the actions that must be taken to end the COVID-19 pandemic and avoid the next catastrophe—to bring order out of chaos. It calls for responsible leadership, engaged citizenship, strong and agile systems for health security, sustained investment, and robust global governance for preparedness.

“A World in Disorder” identifies the specific commitments and actions leaders and citizens must take—boldly, decisively, and immediately. These include sustainable and predictable financing for global and national health security, and a call to hold a UN Summit on Global Health Security to develop an international framework for health emergency preparedness and response.

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Why we must decolonise mental health

In 2017, the UN Special Rapporteur Dr. Dainius Pūras noted that mental healthcare services around the world were in a crisis and rightly called for a ‘revolution’ in mental healthcare. He identified problems of power asymmetries, an over-reliance on psychotropic drugs, and a system that revolves around profits for experts and the pharmaceutical industry. These issues have culminated in a coercive and largely biomedical approach to mental health.

Chief Ombudsman Peter Boshier’s report on the breaching of human rights in mental health facilities highlights the serious failings of this approach. Of particular concern is the use of exclusion zones for accommodating residents.

Similar issues were also highlighted in “He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction” in 2018, which reiterated that the system is under pressure and unsustainable in its current form. This earlier report found the system was also less equitable for Māori, who were more likely to experience compulsory treatment and seclusion, and that the current system reinforced trauma because Māori felt culturally alienated. After nearly four decades of deinstitutionalisation, human rights violations continue in our mental health system.

The issue here is that while Aotearoa New Zealand deinstitutionalised mental health, it failed to decolonise it. To begin the decolonisation process an acknowledgement of historical trauma in the mental health system needs to be incorporated. Unless this trauma is recognised, new approaches that are holistic, rights-based and kaupapa Māori-centred cannot be developed.

Indigenous forms of mental health care also need to be mainstreamed rather than presented as alternative approaches. During colonial times, indigenous knowledge and treatment approaches across Britain’s colonies were labelled as superstitious and local practitioners were accused of quackery.

The establishment of asylums in the 19th century led to the marginalisation of local practitioners like the tohunga,and also to the spread of a narrative that indigenous approaches were superstitious. Tohunga were referred to as ‘quacks’ and accused of ‘degenerating into tricky humbugs’. Doctors even urged the government to put an end to the tohunga. This disruption of indigenous mental health care is another form of historical trauma that eventually led to the sidelining of traditional approaches.

A purely biomedical psychiatric approach excludes social and cultural narratives that are crucial in the healing process, and interdisciplinary voices are essential to further the process of decolonisation.

The example of recent stories about Māori finally experiencing healing through using mātauranga Māori services after years in the mental health system highlight the importance of these other voices, and should influence our research into new approaches to mental healthcare.

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Sperm don’t swim anything like we thought they did, new study finds

Under a microscope, human sperm seem to swim like wiggling eels, tails gyrating to and fro as they seek an egg to fertilize. 

But now, new 3D microscopy and high-speed video reveal that sperm don’t swim in this simple, symmetrical motion at all. Instead, they move with a rollicking spin that compensates for the fact that their tails actually beat only to one side. 

“It’s almost like if you’re a swimmer, but you could only wiggle your leg to one side,” said study author Hermes Gadêlha, a mathematician at the University of Bristol in the U.K. “If you did this in a swimming pool and you only did this to one side, you would always swim in circles. … Nature in its wisdom came [up] with a very complex, ingenious way to go forward.” 

Strange swimmers

The first person to observe human sperm close up was Antonie van Leeuwenhoek, a Dutch scientist known as the father of microbiology. In 1677, van Leeuwenhoek turned his newly developed microscope toward his own semen, seeing for the first time that the fluid was filled with tiny, wiggling cells. 

Under a 2D microscope, it was clear that the sperm were propelled by tails, which seemed to wiggle side-to-side as the sperm head rotated. For the next 343 years, this was the understanding of how human sperm moved. 

“[M]any scientists have postulated that there is likely to be a very important 3D element to how the sperm tail moves, but to date we have not had the technology to reliably make such measurements,” said Allan Pacey, a professor of andrology at the University of Sheffield in England, who was not involved in the research. 

The new research is thus a “significant step forward,” Pacey wrote in an email to Live Science. 

Gadêlha and his colleagues at the Universidad Nacional Autónoma de México started the research out of “blue-sky exploration,” Gadêlha said. Using microscopy techniques that allow for imaging in three dimensions and a high-speed camera that can capture 55,000 frames per second, they recorded human sperm swimming on a microscope slide. 

“What we found was something utterly surprising, because it completely broke with our belief system,” Gadêlha told Live Science. 

The sperm tails weren’t wiggling, whip-like, side-to-side. Instead, they could only beat in one direction. In order to wring forward motion out of this asymmetrical tail movement, the sperm head rotated with a jittery motion at the same time that the tail rotated.The head rotation and the tail are actually two separate movements controlled by two different cellular mechanisms, Gadêlha said. But when they combine, the result is something like a spinning otter or a rotating drill bit. Over the course of a 360-degree rotation, the one-side tail movement evens out, adding up to forward propulsion.

“The sperm is not even swimming, the sperm is drilling into the fluid,” Gadêlha said. 

The researchers published their findings today (July 31) in the journal Science Advances.

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Asymmetry and fertility

In technical terms, how the sperm moves is called precession, meaning it rotates around an axis, but that axis of rotation is changing. The planets do this in their rotational journeys around the sun, but a more familiar example might be a spinning top, which wobbles and dances about the floor as it rotates on its tip. 

“It’s important to note that on their journey to the egg that sperm will swim through a much more complex environment than the drop of fluid in which they were observed for this study,” Pacey said. “In the woman’s body, they will have to swim in narrow channels of very sticky fluid in the cervix, walls of undulating cells in the fallopian tubes, as well have to cope with muscular contractions and fluid being pushed along (by the wafting tops of cells called cilia) in the opposite direction to where they want to go. However, if they are indeed able to drill their way forward, I can now see in much better clarity how sperm might cope with this assault course in order to reach the egg and be able to get inside it,” Pacey said

Sperm motility, or ability to move, is one of the key metrics fertility doctors look at when assessing male fertility, Gadêlha said. The rolling of the sperm’s head isn’t currently considered in any of these metrics, but it’s possible that further study could reveal certain defects that disrupt this rotation, and thus stymy the sperm’s movement. 

Fertility clinics use 2D microscopy, and more work is needed to find out if 3D microscopy could benefit their analysis, Pacey said. 

“Certainly, any 3D approach would have to be quick, cheap and automated to have any clinical value,” he said. “But regardless of this, this paper is certainly a step in the right direction.”

Originally published in Live Science.

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Cassie Shows Off Postpartum Body, But We Wish She Didn't Have To

Since having daughter Frankie in December, singer and model Cassie has not the most prolific of new celebrity moms on social media. But on Monday, she took to her Instagram Stories with an admission that we think might explain her absence. She seems to have gone back and forth with accepting her postpartum body.

“I haven’t posted anything like this in a while, but I’m very proud of myself,” wrote Cassie, who married trainer and bull-rider Alex Fine last year, shortly after ending her 10-plus-year relationship with Diddy. “The female body is truly an amazing thing. I didn’t rush to lose weight after having Frankie in December, but when I was ready to, I struggled with it for some months.”

After spending her career modeling and performing, we imagine it was difficult for Cassie not to feel she was in the same physical shape as she had been in for most of her life. Pregnancy and childbirth take a toll on the body — changing everything from lung capacity to bone density — and it’s not necessarily realistic to expect that once the baby is finally outside your body that you can get it “back” just by exercising and dieting a lot.

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But we very much wish that no new parent felt that this is something they have to do. If we could live in a world in which women weren’t compelled to show off how they lost the baby weight — or even feel the need to explain that doing so is taking some time — we might all be a little healthier and happier.

For her part, Cassie said she realized she needed to be easier on herself.

“I stopped putting so much pressure on myself and with less stress and healthier habits,” she wrote. “This is me today 7 months postpartum. Feeling really good, I’m healthy and working on my strength. Love your body!”

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Day dreaming ✨

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Congratulations to Cassie for feeling good and being proud of herself, truly. Everyone else reading this, please know that you absolutely do not need to have abs like that seven months after having a baby, or ever. Do postpartum workouts and eat right so that you have the strength and endurance to care for your child and do everything else that makes your life fulfilling, not so that you have that extra line down your middle when you wear a bikini.

Cassie has managed to spend her career going by just one name. We wonder if her daughter or any of these celebrity kids with unique names will have the same privilege.

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Flu researchers say we should make a NEW antiviral to stop coronavirus

Flu researchers say we should make a NEW antiviral to prevent coronavirus from replicating throughout the body and stop focusing on repurposing old drugs

  • Researchers looked an older treatment for the flu, Tamiflu, and a newer treatment, Xofluza, the first new type of flu drug in 20 years
  • Xofluza limited the amount of time a person was sick by quickly stopping the virus from replicating and spreading throughout the body
  • The team says the same approach needs to work for coronavirus, creating a new drug that stops the virus from multiplying rather then repurposing old drugs
  • In the US, there are more than 1.8 million confirmed cases of the virus and more than 105,000 deaths
  • Here’s how to help people impacted by Covid-19

A new antiviral drug should be created to stop the novel coronavirus rather than repurposing old medication, a new study suggests.

Researchers compared an older antiviral treatment that most flu patients know compared to a newer one.

The newer treatment cut the amount of time people were sick with the flu, which limited the spread of the virus, because it stopped the disease from multiplying within an infected person. 

The team, from the University of Texas at Austin, says creating a drug that does the same for the coronavirus in early-stage patients would be more beneficial that trying to get existing drugs to treat late-stage patients.

A newer treatment fro flu Xofluza (blue) limited the amount of time a person was sick by quickly stopping the virus from replicating and spreading throughout the body rather than the older treatment of Tamiflu (green)

The team says the same approach needs to work for coronavirus, creating a new drug that stops the virus from multiplying rather then repurposing old drugs. Pictured: COVID-19 patients are taken into to the Wakefield Campus of the Montefiore Medical Center in the Bronx, New York, April 6

For the study, published in Nature Communications, the team looked at influenza and its implications for COVID, the disease caused by the virus.

Researchers first looked at the effects of Tamiflu, or its generic oseltamivir, one of three drugs the Centers for Disease Control and Prevention has endorsed to treat the flu.  

Then they looked at baloxavir, which is sold under the brand name Xofluza, the first new type of flu drug in 20 years.

The new treatment from the same company that developed Tamiflu, was shown in past studies to cut the amount of time people were sick and reduce the length of a fever. 

While Xofluza didn’t work faster than Tamiflu, it did reduce the level of the virus in patients’ nose and throat quicker. 

The new study showed that the newer treatment limited the amount of time a person was sick by quickly stopping the virus from replicating and spreading throughout the body. 

‘We found that treating even 10 percent of infected patients with baloxavir shortly after the onset of their symptoms can indirectly prevent millions of infections and save thousands of lives during a typical influenza season,’ said Dr Robert Krug, a professor emeritus of molecular biosciences, in a blog that accompanied the paper.  

Krug and his team say that a similar antiviral treatment would help to prevent thousands of infections and deaths from the coronavirus    

‘Imagine a drug that quashes viral load within a day and thus radically shortens the contagious period,’ said Dr Lauren Ancel Meyers, a professor of integrative biology.

‘Basically, we could isolate COVID-19 cases pharmaceutically rather than physically and disrupt chains of transmission.’

Most drugs being researched to treat COVID-19 have focused on existing antivirals that can be given to critically ill patient.

But the team says research should shift towards developing a new antiviral for the coronavirus that is used early on in infection and stops the virus from replicating,  , just as baloxavir does for the flu.

‘It may seem counterintuitive to focus on treatments, not for the critically ill patient in need of a life-saving intervention, but rather for the seemingly healthy patient shortly after a COVID-19 positive test,’ Krug said. 

‘Nonetheless, our analysis shows that the right early-stage antiviral treatment can block transmission to others and, in the long run, may well save more lives.’

In the US, there were more than 1.8 million confirmed cases of the virus and more than 105,000 deaths.

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