Study suggests role of sleep in healing traumatic brain injuries
Technique developed at OHSU measures brain's waste-clearance system through MRIs
March 12, 2021
Science Daily/Oregon Health & Science University
Sound sleep plays a critical role in healing traumatic brain injury, a new study of military veterans suggests.
The study, published in the Journal of Neurotrauma, used a new technique involving magnetic resonance imaging developed at Oregon Health & Science University. Researchers used MRI to evaluate the enlargement of perivascular spaces that surround blood vessels in the brain. Enlargement of these spaces occurs in aging and is associated with the development of dementia.
Among veterans in the study, those who slept poorly had more evidence of these enlarged spaces and more post-concussive symptoms.
"This has huge implications for the armed forces as well as civilians," said lead author Juan Piantino, M.D., MCR, assistant professor of pediatrics (neurology) in the OHSU School of Medicine and Doernbecher Children's Hospital. "This study suggests sleep may play an important role in clearing waste from the brain after traumatic brain injury -- and if you don't sleep very well, you might not clean your brain as efficiently."
Piantino, a physician-scientist with OHSU's Papé Family Pediatric Research Institute, studies the effects of poor sleep on recovery after traumatic brain injuries.
The new study benefited from a method of analyzing MRIs developed by study co-author Daniel Schwartz and Erin Boespflug, Ph.D., under the direction of Lisa Silbert, M.D., M.C.R., professor of neurology in the OHSU School of Medicine. The technique measures changes in the brain's perivascular spaces, which are part of the brain's waste clearance system known as the glymphatic system.
"We were able to very precisely measure this structure and count the number, location and diameter of channels," Piantino said.
Co-author Jeffrey Iliff, Ph.D., professor of psychiatry and behavioral sciences and of neurology at the University of Washington and a researcher at the VA Puget Sound Health Care System, has led scientific research into the glymphatic system and its role in neurodegenerative conditions such as Alzheimer's disease. During sleep, this brain-wide network clears away metabolic proteins that would otherwise build up in the brain.
The study used data collected from a group of 56 veterans enrolled by co-authors Elaine Peskind, M.D., and Murray Raskind, M.D., at the Mental Illness Research, Education and Clinical Center at the VA Puget Sound between 2011 and 2019.
"Imagine your brain is generating all this waste and everything is working fine," Piantino said. "Now you get a concussion. The brain generates much more waste that it has to remove, but the system becomes plugged."
Piantino said the new study suggests the technique developed by Silbert could be useful for older adults.
"Longer term, we can start thinking about using this method to predict who is going to be at higher risk for cognitive problems including dementia," he said.
The study is the latest in a growing body of research highlighting the importance of sleep in brain health.
Improving sleep is a modifiable habit that can be improved through a variety of methods, Piantino said, including better sleep hygiene habits such as reducing screen time before bed. Improving sleep is a focus of research of other OHSU scientists, including Piantino's mentor, Miranda Lim, M.D., Ph.D., associate professor of neurology, medicine and behavioral neuroscience in the OHSU School of Medicine.
"This study puts sleep at the epicenter of recovery in traumatic brain injury," Piantino said.
https://www.sciencedaily.com/releases/2021/03/210312155435.htm
High rates of depression, anxiety, PTSD worldwide among health workers during COVID-19
Sixty five-study analysis includes research published in English and Chinese
March 10, 2021
Science Daily/PLOS
A new systematic review of 65 studies from around the world involves a total of 97,333 health care workers and finds that 1 in 5 have experienced depression, anxiety, and/or PTSD during the ongoing COVID-19 pandemic. Yufei Li, Nathaniel Scherer, and colleagues at the London School of Hygiene & Tropical Medicine, U.K., present these findings in the open-access journal PLOS ONE on March 10.
The pandemic has posed significant challenges for health care workers, with many fearing for their own safety while facing a high workload and limited psychological support. Previous analyses of data from multiple studies have revealed high rates of depression, anxiety, and PTSD among health care workers during the pandemic. However, those reviews did not adequately address the many relevant studies conducted in China, where the first COVID-19 outbreak occurred.
To address that gap, Li, Scherer, and colleagues carried out a systematic search of studies in both English and Chinese that were conducted from December 2019 to August 2020 and addressed prevalence of mental disorders in health care workers. They identified 65 suitable studies from 21 countries, involving a total of 97,333 health care workers.
By pooling and statistically analyzing data from all 65 studies, the researchers estimated that 21.7 percent of the health care workers involved in the studies have experienced depression during the pandemic, 22.1 percent anxiety, and 21.5 percent PTSD. Studies conducted in the Middle East showed the highest pooled rates of depression (34.6 percent) and anxiety (28.9 percent).
These findings suggest that the COVID-19 pandemic has significantly impacted the mental health of health care workers. For comparison, the World Health Organization estimates that 4.4 percent of the entire world population experience depression, and 3.6 percent experience anxiety disorders, including PTSD. However, those estimates were determined through different methods and prior to the pandemic.
Nonetheless, the authors note, the new findings could help inform policy and initiatives to provide urgently needed psychological support to health care workers.
The authors add: "This systematic review and meta-analysis provides, to date, the most comprehensive synthesis of depression, anxiety and PTSD prevalence amongst health care workers during the COVID-19 pandemic, with the unique inclusion of publications in both English and Chinese."
https://www.sciencedaily.com/releases/2021/03/210310150402.htm
Study identifies potential link between Soldiers exposed to blasts, Alzheimer's
February 25, 2021
Science Daily/U.S. Army Research Laboratory
Research shows that Soldiers exposed to shockwaves from military explosives are at a higher risk for developing Alzheimer's disease -- even those that don't have traumatic brain injuries from those blasts. A new Army-funded study identifies how those blasts affect the brain.
Researchers at the University of North Carolina at Pembroke in collaboration with the U.S. Army Combat Capabilities Development Command, now known as DEVCOM, the Army Research Laboratory, and the National Institutes of Health found that the mystery behind blast-induced neurological complications when traumatic damage is undetected may be rooted in distinct alterations to the tiny connections between neurons in the hippocampus, the part of the brain particularly involved in memory encoding and social behavior.
The research published in Brain Pathology, the medical journal of the International Society of Neuropathology, was funded by the lab's Army Research Office.
"Blasts can lead to debilitating neurological and psychological damage but the underlying injury mechanisms are not well understood," said Dr. Frederick Gregory, program manager, ARO. "Understanding the molecular pathophysiology of blast-induced brain injury and potential impacts on long-term brain health is extremely important to understand in order to protect the lifelong health and well-being of our service members."
The research team tested slices of rat hippocampus by exposing the healthy tissue to controlled military blast waves. In the experimental brain explants (tissue slices maintained alive in culture dishes), the rapid blast waves produced by the detonated military explosives led to selective reductions in components of brain connections needed for memory, and the distinct electrical activity from those neuronal connections was sharply diminished.
The research showed that the blast-induced effects were evident among healthy neurons with subtle synaptic pathology, which may be an early indicator of Alzheimer's-type pathogenesis occurring independent of overt brain damage.
"This finding may explain those many blast-exposed individuals returning from war zones with no detectable brain injury, but who still suffer from persistent neurological symptoms, including depression, headaches, irritability and memory problems," said Dr. Ben Bahr, the William C. Friday distinguished professor of Molecular Biology and Biochemistry at UNC-Pembroke.
The researchers believe that the increased risk of developing Alzheimer's disease is likely rooted in the disruption of neuronal communication instigated by blast exposures.
"Early detection of this measurable deterioration could improve diagnoses and treatment of recurring neuropsychiatric impediments, and reduce the risk of developing dementia and Alzheimer's disease later in life," Bahr said.
https://www.sciencedaily.com/releases/2021/02/210225112922.htm
Veterans Putting Americans to Work: How to be One of Them
Guest Post by: Kelli Brewer deploycare.org
A penchant for being organized. Attention to details. Dedication. Operating under pressure. These are just some of the attributes that fit many veterans who transfer well to entrepreneurship. While possessing these traits certainly doesn’t guarantee success, there is a reference for success: According to this article in Military.com, “around 9% of all businesses in the U.S. are veteran-owned and 10% of veterans run their own business.”
Get started with an idea, resources to help you with planning, and steps to protect yourself and your business and yA penchant for being organized. Attention to details. Dedication. Operating under pressure. These are just some of the attributes that fit many veterans who transfer well to entrepreneurship. While possessing these traits certainly doesn’t guarantee success, there is a reference for success: According to this article in Military.com, “around 9% of all businesses in the U.S. are veteran-owned and 10% of veterans run their own business.”
Get started with an idea, resources to help you with planning, and steps to protect yourself and your business and you may be on your way to helping put other Americans to work. MindSpa provides some tips and resources that can help you get started.
Photo by Tim Mossholder on Unsplash
First steps, boot by boot
You may remember learning about some business resources during your Transition Assistance Program (TAP) as you were preparing to transition out of service. In particular, you hopefully took advantage of the US Small Business Administration’s Boots to Business program that provides education and training to veteran entrepreneurs. You can also participate in Reboot classes. In general, the SBA’s Office of Veterans Business Development Resources is going to be an excellent starting point for guidance and additional resources. It will also point you to your nearest Veterans Business Outreach Center for available workshops and training.
By now, you likely have an idea of what type of business you want to pursue. Still, it’s not a bad idea to review popular ideas for veterans that have a good track record of success, such as franchise ownership and retail, and compare the pros and cons of each against your own ideas.
Planning pieces
One of the things you’ll learn about is the importance of the business plan. This business roadmap details your ideas and the realistic opportunities for business success – including any threats, such as competition or market hindrances – to demonstrate your preparedness. Even if you think you have it “all in your head” or you’ve already gotten a good start and things are going well, it’s important to examine things from every angle to prepare for change. Also, if you need outside financing, your investor or lender will want to see your business plan, along with other documents such as a marketing plan and financial projections.
Photo by Scott Graham on Unsplash
Another important preparation piece is liability protection. If you remain a sole proprietor, you open yourself up to near-unlimited liability if something goes wrong in your business, such as a lawsuit or a business failure that leaves behind substantial debt. To avoid this, consider structuring your business as a limited liability company. While an LLC is a corporate structure, it offers more flexibility than some other corporate structures while still, in most cases, protecting your personal assets, like your house and personal bank accounts.
Individual states govern how LLCs are structured and can operate within their states, so it’s important to check your state laws. You can approach your secretary of state office for details and instructions; or, to save you time, a lawyer can take care of everything. However, to save that expense, consider a company that provides this same service for typically far less cost.
Continuing to serve
Owning your own business gives you an opportunity to continue to serve. Fulfilling your dream of being your own boss and pursuing a passion is rewarding – even more so when you consider that you could be one of the many veterans who continue to serve Americans by providing them with rewarding jobs and careers.ou may be on your way to helping put other Americans to work. MindSpa provides some tips and resources that can help you get started.
Unlocking PTSD: New study reveals why trauma-focused psychotherapy treatment works
January 27, 2021
Science Daily/University of Texas at Austin
Trauma-focused psychotherapy is widely considered the best available treatment for posttraumatic stress disorder (PTSD). However, the ways in which this method affects the brain to promote recovery from PTSD are not well understood. In a new study published today in Biological Psychiatry, researchers used neuroimaging to examine how the brain areas responsible for generating emotional responses to threats are changed by psychotherapy.
"We know that psychotherapy works. But we don't have a lot of good data to explain how it works, how the brain is changed by going through this process," said Greg Fonzo, Ph.D., lead author of the study and an assistant professor in the Department of Psychiatry and Behavioral Sciences at Dell Medical School at The University of Texas at Austin. "That's what we sought to find out."
Posttraumatic stress disorder may occur in people who have experienced or witnessed a traumatic event such as war or combat, sexual assault, a natural disaster or terrorist act. Symptoms can include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.
Trauma-focused psychotherapy is a treatment that helps people recover from a traumatic event, using techniques such as "in vivo exposure," which involves directly facing a feared object, situation or activity in real life, and "imaginal exposure," which involves facing the trauma memory. A person who is afraid of crowds, for example, may be repeatedly exposed to large gatherings.
"At first, that patient will obviously experience fear or whatever negative emotion is triggered by being in a crowd," said Fonzo, who also holds a courtesy appointment in the Department of Psychology at UT Austin. "But it's like looking at a fire from behind a window. It appears to be a dangerous situation, but the person is actually quite safe. After a while, the fire will burn out, and the person recognizes there was no actual danger. And so that process eventually promotes new learning in the brain."
Fonzo and his colleagues used functional magnetic resonance imaging (fMRI) scans to identify how brain networks communicate with one another before and after treatment. Specifically, they measured the degree of communication or "traffic," known as functional connectivity, between areas of the brain responsible for emotion and regions of the cortex in charge of logic and thinking.
"What we discovered was a reduction in traffic between these brain regions among patients who had undergone trauma-focused psychotherapy," said Fonzo. "In fact, greater connectivity changes were associated with bigger symptom reductions. This restructuring of brain communication may be a unique signature of PTSD recovery."
Fonzo said these findings could change the way doctors treat people who suffer from PTSD.
"Now that we have a better understanding of the brain mechanisms underlying psychotherapy, we may be able to use this information to develop new and better treatments for people with PTSD," said Fonzo.
https://www.sciencedaily.com/releases/2021/01/210127093223.htm
No overall difference in concussion recovery time for male and female college athletes
January 26, 2021
Science Daily/Children's Hospital of Philadelphia
Researchers at Children's Hospital of Philadelphia (CHOP) and the University of Pennsylvania found female and male collegiate athletes take approximately the same amount of time to recover from a concussion, with subtle differences in recovery time depending on the type of sports being played and the division level of the sport. The findings suggest that equity in access to sports medical care among college athletes may be contributing to these similar outcomes.
The findings, derived as part of the CARE (Concussion Assessment, Research and Education) Consortium, were recently published online by the British Journal of Sports Medicine.
Some previous studies have indicated that female athletes may experience longer times to recovery and more lost time from sports due to sport-related concussions. However, other studies have found no differences, but many of these studies were conducted with smaller cohorts and may not have comprehensively accounted for a variety of additional extrinsic factors, including injury setting (practice vs. competition), mechanism of injury (person vs. equipment), and timing of reporting and seeking medical care.
In order to provide a more definitive picture of potential differences between the sexes in concussion injury and recovery, this study examined data collected by the CARE Consortium, funded jointly by the NCAA and the Department of Defense, representing the largest multi-center prospective study of concussion in collegiate athletes to date. In this study, colleges collected extensive pre- and post-injury data in a large, prospective cohort of thousands of collegiate athletes.
"I think many people are concerned that, based on intrinsic biological differences, female athletes may have longer paths to recovery from concussions than their male counterparts," said Christina L. Master, MD, a sports medicine pediatrician and Co-Director of the Minds Matter Concussion Program at CHOP and first author of the study. "However, to better understand any potential biologically-based sex differences in concussion injury and recovery, we needed a large study like this that could better account for extrinsic factors that are not biological."
The study collected data on 1,071 concussions that occurred between 2014 and 2017 across more than 30 colleges, universities and service academies participating in the CARE Consortium. Among those concussions, there was no statistically significant difference in recovery between males and females. Female athletes had a median of 13.5 days before returning to play compared with 11.8 days for males (p=0.96).
Subtle differences were seen between certain subgroups in the study. Females took slightly longer to recover than males from concussions sustained in contact sports (12.7 days for females vs 11 days for males, p=0.00201), while male athletes took longer to recover than females from concussions they experienced in limited contact sports (16.85 days for males vs 13.8 days for females, p < 0.0001). While there was no difference between the sexes seen among Division I collegiate athletes, female athletes in Division II/III sports had a longer recovery time than male athletes in the same division (13.0 days for females vs 10.6 days for males, p = 0.0048).
Master said these subtle differences could be attributed to a variety of factors, including differential access to athletic training and sports medical resources. For instance, Division I sports may have greater levels of athletic training and sports medicine support compared with Division II and III sports. In the case of male athletes experiencing longer recovery time for limited contact sports, this may be related to fewer resources allocated to limited contact men's sports than contact men's sports where concussions are assumed to be more likely to occur. Another potential explanation may be that rules and regulations limiting exposure to impacts in men's contact sports may have had a mitigating effect on concussions in men's contact sports. This, coupled with the fact that women took longer than men to recover in contact sports, but not in limited contact sports, suggests that these differences between men and women cannot be entirely accounted for simply on the basis of biological sex.
"This study makes a strong case for equity in access to specialized athletic training and sports medical care," Master said. "Title IX, which mandates equal access for both women and men to resources, such as sports, including athletic training and sports medical care, may have potentially helped to close any gap that exists in outcomes between the sexes. In the instances where recovery times did differ between the sexes, a re-examination of resource allocation might achieve a more equitable distribution to maximize outcomes for all athletes."
https://www.sciencedaily.com/releases/2021/01/210126082712.htm
Identifying strategies to advance research on traumatic brain injury's effect on women
January 6, 2021
Science Daily/NIH/National Institute of Neurological Disorders and Stroke
Analysis from a workshop convened by the National Institute of Neurological Disorders and Stroke (NINDS) in 2017 reveals gaps in and opportunities for research to improve understanding of the effects of traumatic brain injury (TBI) in women. A new paper in the Journal of Head Trauma Rehabilitation summarizes and updates the findings presented during the "Understanding Traumatic Brain Injury in Women" workshop and provides strategies for advancing research efforts in this area. NINDS is part of the National Institutes of Health.
"We are making advances in understanding the effects of head injury on the brain, but many of these studies have been done in males," said Patrick Bellgowan, Ph.D., program director at NINDS. "There is evidence that traumatic brain injury affects women differently, but we need focused research efforts to get a full understanding of those differences to help improve prevention and treatment strategies."
There are sex-based differences in TBI across the lifespan. For example, in children ages 0-4, boys are two times more likely to have a TBI than girls, but during the adolescent years, female athletes are likelier to experience concussions than male athletes. Among older populations, women who are 65 and older are most likely to experience mild TBI, and the majority of those result from falls.
Studies suggest that women may have different outcomes, depending on when during their menstrual cycle they were injured. For example, there is evidence that head injuries occurring during the luteal phase of the menstrual cycle, when levels of progesterone are high, may be associated with worse outcomes and decreased quality of life. Additional research on reproductive hormones, such as progesterone or estrogen, may provide important clues to recovery from head injury.
The report, written by Eva Valera, Ph.D., professor of psychiatry at the Harvard Medical School Boston, and her colleagues, highlights several opportunities for research looking at the biological effects of TBI, including imaging studies and examination of brain tissue for evidence of neuroinflammation and damage to neurons. Many preclinical studies have relied on male animals but including female animals will help inform researchers about sex differences in immediate response and recovery to TBI.
Not much is known about military-related TBI in female servicemembers, although studies have reported sex-based differences in symptoms as well as functional connectivity, which is the activity between brain regions. Increasing the number of female veterans in longitudinal research studies would increase knowledge about acute and long-term recovery of TBI in women.
"Discussions at the workshop identified a large gap in research efforts aimed at understanding the effects of violence-related TBI in women, in particular intimate partner violence," said Diana Cummings, Ph.D., NINDS scientific review officer.
Studies looking at the prevalence of brain injuries resulting from intimate partner violence are needed to understand how often they occur and could lead to identifying prevention strategies. More information about outcomes may result in improved treatment options.
https://www.sciencedaily.com/releases/2021/01/210106111955.htm
First meta-analysis shows promise for yoga, meditation, mindfulness in concussion
November 30, 2020
Science Daily/University of Connecticut
When Rebecca Acabchuk was studying mild traumatic brain injuries while working on her doctorate in physiology and neurobiology at UConn, she met a student athlete who had suffered multiple concussions.
"When I started doing research on concussions, people just started coming to me," Acabchuk says. "Families at my daughter's school, anytime somebody had a concussion, I would hear about it -- I would hear these personal stories and all the struggles of people who had concussions and their symptoms just didn't resolve."
So it was for the student athlete, who told Acabchuk that she would experience seizures when a smoke alarm went off in her dormitory.
"All of these symptoms she would have to struggle with -- really profound symptoms -- are an invisible injury," says Acabchuk, who earned her PhD in 2016 and is now a post-doctoral fellow with UConn's Institute for Collaboration on Health, Intervention, and Policy, or InCHIP. "People think you should be better, the injury happened so long ago. Why aren't you better? And then more frustration comes in when your doctor says just to rest, there's nothing else that can be done, but you're still getting headaches or feeling fatigued or depressed."
Chronic concussion symptoms are notoriously difficult to treat. But Acabchuk -- who is also a yoga instructor in Hebron, and has been teaching yoga for 17 years -- is hoping that a recently published InCHIP study, the first-ever meta-analysis looking at the use of yoga, meditation, and mindfulness-based interventions for the effective treatment of chronic concussion symptoms, will offer hope to those still struggling with their symptoms. The study was recently published in the journal Applied Psychology: Health and Well-being.
"This was really a passion project for me in the sense that it combines these two areas of interest, concussion work with yoga and meditation," says Acabchuk, who is the study's lead author. "We know from other studies that yoga and meditation may be helpful for reducing systemic inflammation, and we know that they are helpful for increasing self-compassion and reducing rumination if people are dealing with symptoms of depression."
Most studies looking at the effectiveness of yoga, meditation, and mindfulness on concussions have been small. For their meta-analysis, Acabchuk and her team pulled together data from 22 different studies, including both published and unpublished work, that all together included a total of 539 study participants, and looked at the impact of the three interventions on outcome categories -- including mental health, physical health, cognitive performance, quality of life, and social/occupational performance -- and on specific health outcomes, like depression, attention, anxiety, and fatigue. The team then applied advanced meta-analytical methods to compile and assess the results of those studies.
"The main results that we saw were significant reductions in depression and fatigue," Acabchuk says. "Especially with fatigue, it was a large effect size, which is impressive in the sense that fatigue is a difficult symptom for patients to deal with."
The meta-analysis found that mind-body interventions consistently provided symptom improvement across nearly all measured outcomes. The trends were remarkable, the researchers noted, because of the variety of patients enrolled in the studies, and the known difficulty of relieving chronic concussion symptoms.
Acabchuk says more and larger studies are needed to further investigate the benefits of yoga, meditation, and mindfulness in concussion treatment plans. She also says that more study is needed to help researchers and the general public understand the mechanisms by which these types of interventions promote healing and reduce concussion symptoms.
But importantly, including some sort of yoga, meditation, or mindfulness practice as part of a treatment plan for a mild traumatic brain injury appears to involve no adverse effects for the patient, she says -- so there's little downside to giving it a try.
"Think of the brain almost like an ACL -- if you tear your ACL, you're going to rest it, but you're also going to take steps to rehabilitate it," Acabchuk says. "If you think of the brain in that sense, a concussion is also like a rehabilitation injury in that, through rehabilitation, you can strengthen certain pathways in the brain. And we think the tools to help do that are breath-work, meditation, and mindful movement through poses from yoga."
She continues, "Maybe starting with a meditation app or online meditation group to learn the basics, and setting aside time to meditate 10 minutes a day. If you're a person who can't sit still, maybe yoga is better for you. If you're too tired at the end of the day, maybe a simple body scan with deep breathing exercises would be better for you. It's not going to be a miracle cure, but more of something that can provide benefits over time by incorporating these tools into daily life. I really do hope that this helps empower people who are struggling with their symptoms."
https://www.sciencedaily.com/releases/2020/11/201130131439.htm
Emergency care doctors not getting sufficient 'down time'
November 2, 2020
Science Daily/University of Plymouth
A survey of more than 4,000 UK emergency care doctors has shown that they need more support to recover from work pressures between shifts.
Published today in the BMJ Open, the study highlighted how the doctors' 'need for recovery' was higher than anything recorded in previous studies of a similar nature -- and could be helped by factors such as reducing the number of antisocial shift patterns and improving access to leave.
Led by a newly formed Trainee Emergency Research Network, sponsored by University Hospitals Plymouth NHS Trust (UHPNT), and with collaboration from the University of Plymouth and the Royal College of Emergency Medicine, the research asked a total of 4,247 doctors in emergency departments from 112 NHS Trusts around the UK to complete a validated Need for Recovery (NFR) Scale. This 11-item questionnaire assesses how work affects inter-shift recovery, with items compiled to form a score between 0 and 100.
The median average NFR result was 70 -- higher than any scores reported in other professions or populations to date.
In addition, a higher proportion of antisocial working was associated with a higher NFR score, suggesting that any reduction in antisocial shifts could help improve wellbeing.
Known as the TIRED study, it was the largest healthcare study to date of a tool that assesses the need for staff to physically and psychologically recuperate following a period of work. The authors also propose that the use of this tool could identify staff wellbeing issues before they progress to burnout.
The research took place in 2019 before the COVID-19 pandemic, but authors suggest the study findings remain relevant given that pressures on emergency care doctors are only likely to have increased.
Lead author Dr Laura Cottey, Chief Investigator for the Trainee Emergency Research Network study, said: "We all know that emergency care can be a high-pressure environment, but these results provide the evidence of the impact this work demand is having on staff wellbeing. Previous Need for Recovery scores among a variety of population groups were reported between 36 and 44, so for the median score to be 70 among over 4,000 doctors is definitely something that needs to be addressed.
"Among our respondents, we saw that NFR scores were increased by difficulty accessing annual and study leave, as well as an increased proportion of antisocial working -- such as night shifts. Better access to leave and any reduction in antisocial shifts might result in direct improvements in NFR and help protect against the development of burnout."
Co-author Dr Blair Graham, Lecturer in Urgent and Emergency Care at the University of Plymouth and Specialty Registrar in Emergency Medicine at UHPNT, said: "The first step to overcoming any problem is recognising that there is one -- so having these results is a good start. Even if fewer antisocial shifts cannot be achieved, acknowledgement of a problem and the provision of rest facilities may help to mitigate the issue.
"The next step would be for us to carry out the research at different times of year to understand whether the results are seasonal, or affected by other factors. Although this study was conducted prior to COVID-19 arriving in the UK, we believe the findings still need to be taken into account as pressures on emergency care doctors are only likely to have increased during the pandemic."
Professor Gary Minto, Director of Research and Development at UHPNT, said: "Here at University Hospitals Plymouth, our research strategy is that, in addition to our longstanding strength in running clinical trials, we also expand our focus into other areas of social care, health and wellbeing. The TIRED study, which addresses mental health in Emergency Doctors, is a great example. This prominent nationwide study, initiated, led and delivered by doctors in training contains important messages about downtime and shift patterns which are relevant across the UK, particularly as the COVID-19 situation evolves."
https://www.sciencedaily.com/releases/2020/11/201102120031.htm
Increasing sleep time after trauma could ease ill effects
October 22, 2020
Science Daily/Washington State University
Increasing the amount of time spent asleep immediately after a traumatic experience may ease any negative consequences, suggests a new study conducted by researchers at Washington State University's Elson S. Floyd College of Medicine.
Published today in Scientific Reports, the study helps build a case for the use of sleep therapeutics following trauma exposure, said William Vanderheyden, an assistant research professor and the lead author on the study. "Basically, our study has found that if you can improve sleep, you can improve function."
The finding holds particular promise for populations that are routinely exposed to trauma, such as military personnel and first responders, and may also benefit victims of accidents, natural disaster, violence, and abuse.
Vanderheyden made the discovery following a series of experiments in rats in which he and coauthor Christopher Davis examined the links between poor sleep and post-traumatic stress disorder (PTSD) -- a psychiatric condition that affects an estimated 8 million Americans each year.
"People with PTSD oftentimes experience nightmares and other types of sleep disturbances, such as frequent awakenings and insomnia," said Vanderheyden. "One thought was that those sleep disturbances may cause further cognitive impairment and worsen the effects of PTSD or the initial trauma. So we wanted to see whether repairing the sleep disturbances associated with trauma exposure could help alleviate the symptoms of PTSD."
Their study used methods reviewed and approved by Washington State University's Institutional Animal Care and Use Committee, which oversees all university animal research procedures to ensure animals' humane treatment throughout their lifecycle. This included a commonly used PTSD rodent model in combination with optogenetics, a technique that uses light-sensitive proteins to control the activity of brain cells.
After going through the PTSD protocol, rats were assigned to two groups. In one group, the researchers used optogenetic stimulation to activate melanin-concentrating hormone (MCH) -- a sleep-promoting brain cell type -- over a period of seven days. Animals in the second group served as controls.
Comparing the two groups, the researchers found that optogenetic stimulation increased the duration of rapid eye movement (REM) sleep -- the sleep phase thought to be important for learning and memory -- across the rats' rest and active phases.
The researchers then assessed the rats' behavior on a three-day classical conditioning experiment involving a memory task. On day one, rats learned to associate an audible tone with the mildly unpleasant experience of receiving a small foot shock immediately after hearing the tone. After several occurrences, rats would freeze after hearing the tone, anticipating the foot shock. On day two, they heard the tone 30 times without receiving the shock, allowing them to gradually extinguish that memory. On the third day, the researchers played the tone 10 times to test to what extent the previous day's memory extinction had stuck. They found that rats that had received optogenetic stimulation to increase their sleep time had more successfully extinguished the memory, freezing less than control rats.
"This highlights that there is a time-sensitive window when -- if you intervene to improve sleep -- you could potentially stave off the negative effects of trauma," Vanderheyden said. "Conversely, it seems likely that if you are kept awake after a trauma, this could potentially be harmful to your cognitive function, though we haven't directly tested this as part of our study."
As an example, he mentioned victims of traffic accidents, who may not get much opportunity to sleep as they are poked, prodded, examined, and treated after being hospitalized for injuries. Though prioritizing sleep may not be feasible in victims with potentially life-threatening injuries, increasing sleep in other trauma-exposed populations could practically be done. Military personnel coming back from patrol could be encouraged to sleep and potentially be given sleep-promoting drugs to help them stave off any trauma experienced during their patrol, Vanderheyden said.
Vanderheyden cautioned that although their experiments suggest that manipulating sleep immediately after a trauma may be beneficial, such an intervention may or may not be effective for traumatic experiences that occurred in the more distant past.
As a next step, Vanderheyden and Davis want to delve deeper into molecular mechanisms that improve function in response to increased sleep. Their goal is to pinpoint those molecules that are important for regulating sleep or learning and memory, which will help them identify targets for the development of better drugs to help trauma-exposed populations.
Based on their findings, Vanderheyden also suggested that the use of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) in people with PTSD may need to be reexamined, as SSRIs are known to suppress REM sleep.
"We may be doing our trauma victims a disservice by prescribing a class of drugs that actually eliminates a potential therapeutic avenue for them by removing their REM sleep when our findings suggest that we should be increasing REM sleep," Vanderheyden said.
https://www.sciencedaily.com/releases/2020/10/201022125513.htm
Deep chest compressions can prevent brain damage during cardiac arrest
August 24, 2020
Science Daily/European Society of Cardiology
Deep chest compressions can crack ribs, but they reduce brain damage during cardiac arrest, reports a study presented today at ESC Congress 2020.
Study author Dr. Irene Marco Clement of University Hospital La Paz, Madrid, Spain said: "Deep chest compressions improve blood flow to the brain, improving survival and brain function."
CPR guidelines are updated every five years and are used to train health professionals and members of the public. The 2010 recommendation for deeper chest compressions generated concerns over the possibility of increasing CPR-related injuries.
This study examined the impact of this advice on neurological outcomes in survivors of cardiac arrest. It also assessed the rate of CPR-related injuries and their association with prognosis.
The study limited participation to comatose survivors of cardiac arrest, since they would have received prolonged resuscitation. In contrast, survivors who regain consciousness have generally received an immediate electric shock and brief chest compressions to restore circulation. "We wanted to analyse the effect of deep chest compressions during prolonged resuscitation, when they could make a real difference to outcomes," said Dr. Marco Clement.
In 2006 to 2020, the study enrolled consecutive patients admitted to an acute cardiac care unit after a cardiac arrest in hospital or in the community. Patients were divided into three groups corresponding to updates of the CPR guidelines: 2006-2010, 2011-2015, and 2016-2020.
The study included 510 patients who survived cardiac arrest and were admitted to hospital while unconscious. The average age was 63 years and 81% were men. CPR by lay bystanders and the use of automated external defibrillators (AEDs) progressively increased over the study period.
After 2010, there was a higher proportion of CPR-related injuries: 12.7% in 2006-2010, 23.5% in 2011-2015, 22.7% in 2016-2020 (p=0.02). Just over half of patients survived and were discharged from the hospital (51.6%). Brain performance at three months significantly increased over the course of the study (i.e. it was highest in the 2016-2020 group).
Patients with CPR-related injuries were more likely to have better brain performance. Nearly two-thirds (65.1%) of patients with injuries had high brain function compared to 43.2% without injuries (p<0.01). The most common injuries were rib or sternal fractures.
"Survival and neurological outcome improved significantly during the 14-year study," said Dr. Marco Clement. "Members of the public increasingly came to the rescue with CPR and there was greater use of AEDs. Injuries from CPR rose, but these patients were less likely to have brain damage."
She noted that lay people have been reluctant to do CPR during the COVID-19 pandemic due to fear of infection. She said: "Personal safety always comes first, and resuscitators should only do what they feel comfortable with. If you are concerned about possible contagion, you could omit mouth-to-mouth breaths: chest compressions alone may be as effective as conventional CPR."
How to improve survival and prevent brain damage from cardiac arrest
* Ask a bystander to call emergency services and find an AED.
* Start deep chest compressions immediately.
* Do not delay CPR by trying to find a pulse.