Call me a cynic.
I've been open to the idea that probiotics might help with various gastrointestinal ailments. If the manufacturer were clever enough, they might be able to get significant numbers of target bacteria from the mouth to the large intestine where the bacteria might be able to do some good - knock some bad bacteria out of the way, help with diarrhea or inflammation, secrete useful vitamins or nutrients for large intestinal epithelial cells.
But help with other problems? Have an influence on whole body physiology? C'mon. Don't be silly.
Well, maybe it's not so silly after all.
A small controlled study done at North Sichuan Medical College and Hospital showed that probiotics can help prevent infections. Patients that suffer traumatic brain injury are more likely to develop infections due to a less effective immune system, characterised by a switch from a Th1 dominated immune response to a Th2 dominated immune response. In a cohort of 52 patients, 26 received regular nutrition, and 26 had their feeding tube nutrition supplemented with probiotics (viable beneficial bacteria). Patients that received probiotics showed a reversion to a Th1 dominated immune response, suffered fewer nocosomial infections, required less antibiotics, and were in the ICU for a shorter period of time than those that received no probiotics.
Huh. I can't begin to trace the mechanism by which beneficial bacteria influence the functioning of the immune system, but here is a study suggesting that there might be something to it after all.
link to article
And as yogurt is one of the top weight loss promoting foods, there is now even more reason to break out the Brown Cow. I'm not associated with them; I just think their coffee and chocolate yogurts are delicious!
Saturday, December 3, 2011
Sunday, November 27, 2011
Diet influences jaw shape
Jaw shaping
It's not your genetics. It's your diet that's making your teeth crooked.
An article in the Proceedings of the National Academy of Science concluded that diet during growth determines the shape of the mandible, or the lower jaw. Eating softer foods causes the mandible to be shorter and smaller, which gives less room for the same number of teeth, resulting in tooth crowding.
What most people don't realise is that bone shape is determined by the forces acting on it, and not by a predetermined pattern. There is a basic pattern set down in genetics, but the specific and complex shape of our bones is created by muscles pulling on bones and gravity pulling down on our skeleton. Bone is an active tissue, and the bone will reshape itself if the forces acting on it change. Because of the mineral scaffolding of the bone, these changes take place over a prolonged period of time, and so may not be completely obvious at first. Even so, these hard structure can reshape to become curved when once straight, or thickened when once narrow.
Chewing on tough and fibrous materials would have caused an increased in muscle mass around the jaw, and these muscles pulling more vigorously on the mandible would signal the mandible to become bigger and thicker in response. A wider mandible gives more room for teeth. The study found the result to be consistent across cultures. The cultural change that led to this physical change was a move from hunter/gatherer to farming and sedentary lifestyles.
I have a personal experience with this phenomenon of bone reshaping. My cat was brought to the emergency room as a stray kitten hit by car and had a broken pelvis (and broken sacrum and two fractured femoral heads). Animals usually recover well if they just rest for 6-8 weeks with pelvis fractures. My cat did very well and runs and climbs almost normally, although her pelvis looks a little tilted. Out of curiousity, I took recheck radiographs a year later. On the left hand side, my cat had created a second acetabulum cranial to the first! The acetabulum is where the femoral head sits in the pelvis; normal people and animals have one on each side, one for each femur. My cat has 3 - one on the right, normal, and 2 on the left - one that was created in utero and used for her first 4-5 months of life, and the second that was created after her left femoral head moved cranially during the trauma. Somehow the muscles around the hip joint mimicked that of the original hip joint, and in response, the pelvis created a bony lip around the femoral head to stabilise it, and voila! a new acetabulum. It's amazing how the body can respond to trauma.
It's not your genetics. It's your diet that's making your teeth crooked.
An article in the Proceedings of the National Academy of Science concluded that diet during growth determines the shape of the mandible, or the lower jaw. Eating softer foods causes the mandible to be shorter and smaller, which gives less room for the same number of teeth, resulting in tooth crowding.
What most people don't realise is that bone shape is determined by the forces acting on it, and not by a predetermined pattern. There is a basic pattern set down in genetics, but the specific and complex shape of our bones is created by muscles pulling on bones and gravity pulling down on our skeleton. Bone is an active tissue, and the bone will reshape itself if the forces acting on it change. Because of the mineral scaffolding of the bone, these changes take place over a prolonged period of time, and so may not be completely obvious at first. Even so, these hard structure can reshape to become curved when once straight, or thickened when once narrow.
Chewing on tough and fibrous materials would have caused an increased in muscle mass around the jaw, and these muscles pulling more vigorously on the mandible would signal the mandible to become bigger and thicker in response. A wider mandible gives more room for teeth. The study found the result to be consistent across cultures. The cultural change that led to this physical change was a move from hunter/gatherer to farming and sedentary lifestyles.
I have a personal experience with this phenomenon of bone reshaping. My cat was brought to the emergency room as a stray kitten hit by car and had a broken pelvis (and broken sacrum and two fractured femoral heads). Animals usually recover well if they just rest for 6-8 weeks with pelvis fractures. My cat did very well and runs and climbs almost normally, although her pelvis looks a little tilted. Out of curiousity, I took recheck radiographs a year later. On the left hand side, my cat had created a second acetabulum cranial to the first! The acetabulum is where the femoral head sits in the pelvis; normal people and animals have one on each side, one for each femur. My cat has 3 - one on the right, normal, and 2 on the left - one that was created in utero and used for her first 4-5 months of life, and the second that was created after her left femoral head moved cranially during the trauma. Somehow the muscles around the hip joint mimicked that of the original hip joint, and in response, the pelvis created a bony lip around the femoral head to stabilise it, and voila! a new acetabulum. It's amazing how the body can respond to trauma.
New trauma transfusion protocols
"War! What is it good for?"
Clinical trials in trauma treatment protocols.
Doctors are re-evaluating what mix of fluids should be given to patients that are experiencing significant hemorrhage secondary to trauma. There are several types of fluids that can be given to trauma patients, each acting for a different purpose.
Crystalloids are simple salt solutions. They have the same concentration of salts as blood. Crystalloids are cheap and easily stored. Doctors us large volume infusion of crystalloids for trauma patients to counteract the low blood pressure. In shock, vessels lose tone and the volume necessary to keep the vasculature 'full' can increase by 100-200%. Crystalloids act to fill in the newly created void in the vasculature. Being a simple salt solution, by adding large volumes of crystalloids, doctors dilute out red blood cells and important blood proteins, including clotting factors. A rapid increase in blood pressure can also dislodge tenuous clots formed at trauma sites, causing a worsening of bleeding. In addition only 25% of crystalloids remain in the vasculature after 1 hour, the rest going into tissue and the urine. In this way, the patient can quickly lose and increases in blood pressure.
Colloids are salt solutions with polymers added that act similarly to blood proteins to keep the liquid volume inside blood vessels instead of losing it to tissue. Colloids must be given in much smaller volumes than crystalloids, because at a certain volume colloids will interfere with clotting.
Doctors can give hypertonic solutions in small volumes. These solutions increase blood pressure by drawing fluids out of tissues and back into the blood vessels. The solutions are usually very concentrated salt solutions. They work well in patients with normal hydration, which most trauma patients are. There is a limit to how much hypertonic solution can be given as an increase in blood salts can occur which leads to secondary metabolic problems.
Apart from manufactured fluids, doctors can also choose from human derived fluid products. These products have the disadvantage of having specialised storage requirements and are more difficult and expensive to obtain.
Blood is composed of red and white blood cells mixed in plasma. Red blood cells carry oxygen. White blood cells include platelets which are one main component of the clotting system. Plasma contains salts, nutrients and proteins. The proteins act to keep water inside the vessels, provide important antibodies, and also are the other main component of clot formation.
Doctors can give packed red blood cells, which has had most of the plasma removed. This would increased the red cell count in an anemic patient without adding much volume, which is useful mainly in situations such as kidney failure or heart failure where an increase in blood volume could be deleterious. It is not often useful in trauma patients.
Doctors can also give whole blood. Whole blood provides some increase in fluid volume while providing all of the beneficial components of blood. If a trauma patient needs lots of volume replacement, whole blood cannot provide enough volume without causing dangerous increases in red blood cell count. Whole blood contains platelets which are important in clotting in trauma patients.
Plasma is the liquid component of blood from which the blood cells have been removed. Plasma can be given in large volumes without increasing the red cell count. Plasma provides a balanced salt solution, but also contains blood proteins to keep the volume inside of the blood vessels. Plasma contains antibodies and proteins that help 'mop up' free radicals and toxins released by damaged tissues. Plasma also contains clotting proteins, essential for trauma patients. Plasma is generally stored frozen and must be carefully thawed prior to use. This can be an issue for a trauma patient who is bleeding NOW; it can take 20-40 minutes to thaw a unit of plasma. Plasma also comes packaged in relatively small volumes. A trauma patient may need 2-3 liters of fluid rapidly to restore blood volume; plasma comes in volumes of 125-500ml bags.
A retrospective study examining survival rates of trauma victims in combat in Iraq and at trauma centers in the UK suggests that plasma should be given in much higher volumes than traditionally administered at ratios of 1:1 or 1:2 plasma:red blood cells as opposed to more conservative 1:8 ratios. Survival of trauma patients increased from 12% to 65% in patients given higher volumes of plasma. New protocols for early and aggressive administration of plasma have been implemented at UK and US combat stations in Iraq and Afghanistan and are now being implemented at domestic trauma centers in the UK.
New Blood Transfusion Protocols
From a completely non-scientific point of view, these findings are not surprising. As a veterinarian, my gut feeling evaluation of plasma is that "plasma is a goodness". Plasma is a very complex solution with proteins and small molecular components that have not been fully described but appear to have beneficial effects in any sort of critical situation. If your patient with an inflamed pancreatitis or parvovirus or liver disease isn't doing well, a plasma transfusion can cause a dramatic improvement in clinical outcomes even if the blood tests we run don't give a specific indication for plasma administration. We are even moving toward giving plasma in cases where we think the patient could develop a need for it later, rather than waiting for the need to develop. There are very few complications with the use of plasma. I have seen a single allergic reaction to plasma which was treated with standard protocols. Human plasma, like other human blood products, must obviously be carefully screened for infectious diseases. The biggest problem with plasma is that in veterinary medicine it is very very expensive. A single unit can put an owner back $400-700, and depending on the patient, several (in one case I know, over 20) units may be required. As noted above, it also has to be kept frozen and thawed carefully. Once thawed, there is a lot of debate as to whether it can be refrozen and rethawed without loss of clotting factors, so there may be issues of waste if a patient no longer needs plasma once a unit has been thawed.
An improvement of survival from 12% to 65% tells me that I need to give more plasma, and more quickly, to my trauma patients, if the owner can afford it.
Clinical trials in trauma treatment protocols.
Doctors are re-evaluating what mix of fluids should be given to patients that are experiencing significant hemorrhage secondary to trauma. There are several types of fluids that can be given to trauma patients, each acting for a different purpose.
Crystalloids are simple salt solutions. They have the same concentration of salts as blood. Crystalloids are cheap and easily stored. Doctors us large volume infusion of crystalloids for trauma patients to counteract the low blood pressure. In shock, vessels lose tone and the volume necessary to keep the vasculature 'full' can increase by 100-200%. Crystalloids act to fill in the newly created void in the vasculature. Being a simple salt solution, by adding large volumes of crystalloids, doctors dilute out red blood cells and important blood proteins, including clotting factors. A rapid increase in blood pressure can also dislodge tenuous clots formed at trauma sites, causing a worsening of bleeding. In addition only 25% of crystalloids remain in the vasculature after 1 hour, the rest going into tissue and the urine. In this way, the patient can quickly lose and increases in blood pressure.
Colloids are salt solutions with polymers added that act similarly to blood proteins to keep the liquid volume inside blood vessels instead of losing it to tissue. Colloids must be given in much smaller volumes than crystalloids, because at a certain volume colloids will interfere with clotting.
Doctors can give hypertonic solutions in small volumes. These solutions increase blood pressure by drawing fluids out of tissues and back into the blood vessels. The solutions are usually very concentrated salt solutions. They work well in patients with normal hydration, which most trauma patients are. There is a limit to how much hypertonic solution can be given as an increase in blood salts can occur which leads to secondary metabolic problems.
Apart from manufactured fluids, doctors can also choose from human derived fluid products. These products have the disadvantage of having specialised storage requirements and are more difficult and expensive to obtain.
Blood is composed of red and white blood cells mixed in plasma. Red blood cells carry oxygen. White blood cells include platelets which are one main component of the clotting system. Plasma contains salts, nutrients and proteins. The proteins act to keep water inside the vessels, provide important antibodies, and also are the other main component of clot formation.
Doctors can give packed red blood cells, which has had most of the plasma removed. This would increased the red cell count in an anemic patient without adding much volume, which is useful mainly in situations such as kidney failure or heart failure where an increase in blood volume could be deleterious. It is not often useful in trauma patients.
Doctors can also give whole blood. Whole blood provides some increase in fluid volume while providing all of the beneficial components of blood. If a trauma patient needs lots of volume replacement, whole blood cannot provide enough volume without causing dangerous increases in red blood cell count. Whole blood contains platelets which are important in clotting in trauma patients.
Plasma is the liquid component of blood from which the blood cells have been removed. Plasma can be given in large volumes without increasing the red cell count. Plasma provides a balanced salt solution, but also contains blood proteins to keep the volume inside of the blood vessels. Plasma contains antibodies and proteins that help 'mop up' free radicals and toxins released by damaged tissues. Plasma also contains clotting proteins, essential for trauma patients. Plasma is generally stored frozen and must be carefully thawed prior to use. This can be an issue for a trauma patient who is bleeding NOW; it can take 20-40 minutes to thaw a unit of plasma. Plasma also comes packaged in relatively small volumes. A trauma patient may need 2-3 liters of fluid rapidly to restore blood volume; plasma comes in volumes of 125-500ml bags.
A retrospective study examining survival rates of trauma victims in combat in Iraq and at trauma centers in the UK suggests that plasma should be given in much higher volumes than traditionally administered at ratios of 1:1 or 1:2 plasma:red blood cells as opposed to more conservative 1:8 ratios. Survival of trauma patients increased from 12% to 65% in patients given higher volumes of plasma. New protocols for early and aggressive administration of plasma have been implemented at UK and US combat stations in Iraq and Afghanistan and are now being implemented at domestic trauma centers in the UK.
New Blood Transfusion Protocols
From a completely non-scientific point of view, these findings are not surprising. As a veterinarian, my gut feeling evaluation of plasma is that "plasma is a goodness". Plasma is a very complex solution with proteins and small molecular components that have not been fully described but appear to have beneficial effects in any sort of critical situation. If your patient with an inflamed pancreatitis or parvovirus or liver disease isn't doing well, a plasma transfusion can cause a dramatic improvement in clinical outcomes even if the blood tests we run don't give a specific indication for plasma administration. We are even moving toward giving plasma in cases where we think the patient could develop a need for it later, rather than waiting for the need to develop. There are very few complications with the use of plasma. I have seen a single allergic reaction to plasma which was treated with standard protocols. Human plasma, like other human blood products, must obviously be carefully screened for infectious diseases. The biggest problem with plasma is that in veterinary medicine it is very very expensive. A single unit can put an owner back $400-700, and depending on the patient, several (in one case I know, over 20) units may be required. As noted above, it also has to be kept frozen and thawed carefully. Once thawed, there is a lot of debate as to whether it can be refrozen and rethawed without loss of clotting factors, so there may be issues of waste if a patient no longer needs plasma once a unit has been thawed.
An improvement of survival from 12% to 65% tells me that I need to give more plasma, and more quickly, to my trauma patients, if the owner can afford it.
Saturday, November 26, 2011
The nature of psychosis
http://www.nytimes.com/2011/11/26/health/man-uses-his-schizophrenia-to-gather-clues-for-daily-living.html?pagewanted=1&_r=1&ref=health
This article takes a bit of a different look at mental health, and schizophrenia specifically. The current view of mental disorders from the psychiatric establishment is that disorders are based on abnormalities in either physical architecture of the brain or in dysregulation of chemical signals. Using this basis, treatment will usually involve medication to try and correct chemical abnormalities. There is also a view that personal world views that are divergent from the rest of the populations are abnormal and should be modified to match the most popular world view as closely as possible. These standards for treatment are derived from research and data collected by scientists and mental health providers.
The article here takes a little bit of a different view. The information is told in a narrative form, focusing on the story of a patient who developed schizophrenia as an adult. He suffered from typical auditory and visual hallucinations. The hallucinations had religious content, which was odd for the patient as he was an atheist. One auditory hallucination told the patient he was damned. He also saw visions of God and Jesus. In typical fashion, these visual and auditory disturbances severely affected the patient's ability to interact with the world, and he lost his friends and his job. The patient's delusion was that he was being ordered to act to save the world.
Where the patient's story diverges from the norm is that instead of working to completely eliminate the delusional motivations, a successful treatment for this patient involved a combination of medication, psychotherapy, and an emphasis on understanding the underlying sources for the delusions and hallucinations. The theory is that instead of the hallucinations being completely made up and simply a result of abnormal chemistry, the type of resultant hallucination is based on the person's previous experiences and personal psychological makeup. This patient worked on self-analysis to understand where his hallucinations had their basis, and by understanding, it helped him to respond in a constructive and world-appropriate way to them. In addition, his social support system, which is mainly his spouse, helps him to not eliminate the delusion that he is supposed to save the world, but recognises it as an actual good thing, that it could possibly be either a divine message or simply a positive change in his thinking process. His wife helps him to pursue goals of activism that mollifies his drive to change the world for the better, while also helping him to set limits so it does not become overwhelming. He gets counseling and medication additionally to help him remain stable.
The upshot of the article is that a novel approach to schizophrenic treatment and research is to look at the patient's personal history as a way to understand why patients have certain hallucinations and get ideas on how best to control them. It also suggests that starting to collect data from the patient's perspective can be important in helping to more fully understand psychiatric diseases.
This article takes a bit of a different look at mental health, and schizophrenia specifically. The current view of mental disorders from the psychiatric establishment is that disorders are based on abnormalities in either physical architecture of the brain or in dysregulation of chemical signals. Using this basis, treatment will usually involve medication to try and correct chemical abnormalities. There is also a view that personal world views that are divergent from the rest of the populations are abnormal and should be modified to match the most popular world view as closely as possible. These standards for treatment are derived from research and data collected by scientists and mental health providers.
The article here takes a little bit of a different view. The information is told in a narrative form, focusing on the story of a patient who developed schizophrenia as an adult. He suffered from typical auditory and visual hallucinations. The hallucinations had religious content, which was odd for the patient as he was an atheist. One auditory hallucination told the patient he was damned. He also saw visions of God and Jesus. In typical fashion, these visual and auditory disturbances severely affected the patient's ability to interact with the world, and he lost his friends and his job. The patient's delusion was that he was being ordered to act to save the world.
Where the patient's story diverges from the norm is that instead of working to completely eliminate the delusional motivations, a successful treatment for this patient involved a combination of medication, psychotherapy, and an emphasis on understanding the underlying sources for the delusions and hallucinations. The theory is that instead of the hallucinations being completely made up and simply a result of abnormal chemistry, the type of resultant hallucination is based on the person's previous experiences and personal psychological makeup. This patient worked on self-analysis to understand where his hallucinations had their basis, and by understanding, it helped him to respond in a constructive and world-appropriate way to them. In addition, his social support system, which is mainly his spouse, helps him to not eliminate the delusion that he is supposed to save the world, but recognises it as an actual good thing, that it could possibly be either a divine message or simply a positive change in his thinking process. His wife helps him to pursue goals of activism that mollifies his drive to change the world for the better, while also helping him to set limits so it does not become overwhelming. He gets counseling and medication additionally to help him remain stable.
The upshot of the article is that a novel approach to schizophrenic treatment and research is to look at the patient's personal history as a way to understand why patients have certain hallucinations and get ideas on how best to control them. It also suggests that starting to collect data from the patient's perspective can be important in helping to more fully understand psychiatric diseases.
Tuesday, November 22, 2011
Advances in appetite suppression
Science Daily posted an article about the possibility of an effective oral supplement to suppress appetite to assist with dieting for overweight people. The theory revolves around PYY, pancreatic peptide tyrosine tyrosine. This small protein, only 36 amino acids long, is released in proportion to caloric intake. It slows gastric emptying and decreases appetite. Previous studies showed that levels of PYY are decreased in obese people at baseline and post-prandial. Intravenous injection of the protein decreased caloric intake in a human study.
The difficulty so far has been that PYY is not well absorbed orally. Robert Doyle at the Syracuse has published a paper showing that he was able to deliver PYY orally and have it reach the blood stream in significant levels by attaching it to vitamin B12. The importance of this finding is that PYY could be put into a pill or gum that could be taken after meals to suppress appetite and prevent overeating. The finding was reported in the Journal of Medicinal Chemistry.
Obviously, simply taking an appetite suppressant will not magically solve the problem of obesity. It will assist people who are on a sensible weight loss regimen which includes exercise and decreased caloric intake. Some people eat even when they feel full, so this will not help that population. Depending on the percentage of decrease in caloric consumption, it may just slow weight gain; ie, if a person is eating an excess of 500 calories a day baseline, and the supplement decreases that to 200 excess calories a day, they will just gain weight at half the rate, but still gain weight.
Still, this appears to have a solid basis in physiology, and the protein and delivery methods seem to be straightforward and have no obvious dangers. I think it will be a useful tool to help people control their weight. I will definitely try the product when/if it makes it to the market!
The difficulty so far has been that PYY is not well absorbed orally. Robert Doyle at the Syracuse has published a paper showing that he was able to deliver PYY orally and have it reach the blood stream in significant levels by attaching it to vitamin B12. The importance of this finding is that PYY could be put into a pill or gum that could be taken after meals to suppress appetite and prevent overeating. The finding was reported in the Journal of Medicinal Chemistry.
Obviously, simply taking an appetite suppressant will not magically solve the problem of obesity. It will assist people who are on a sensible weight loss regimen which includes exercise and decreased caloric intake. Some people eat even when they feel full, so this will not help that population. Depending on the percentage of decrease in caloric consumption, it may just slow weight gain; ie, if a person is eating an excess of 500 calories a day baseline, and the supplement decreases that to 200 excess calories a day, they will just gain weight at half the rate, but still gain weight.
Still, this appears to have a solid basis in physiology, and the protein and delivery methods seem to be straightforward and have no obvious dangers. I think it will be a useful tool to help people control their weight. I will definitely try the product when/if it makes it to the market!
Monday, November 21, 2011
Childhood anemia and conservation
A recent article on the Science Daily website proclaims "Taking Bushmeat Off the Menu Could Increase Childhood Anemia." My first question was "what is bushmeat?" Apparently bushmeat is meat obtained from wild animals as opposed to animals bred specifically for that purpose. In America, venison would be considered bushmeat.
The study was done by researchers at the University of California, Berkeley. That led to confusion on my part, as to why we needed to keep venison on the menu in America, until I read further and discovered that this was a study done on children in a remote wildlife preserve in Madagascar. In this area, a significant portion of meat in the diet of poor people comes from wildlife, especially bats and lemurs. 77 children under 12 years old were studied, and their eating habits were compared to their level of anemia over a year. The study found that children who ate more bushmeat had lower levels of anemia.
The results are really not very surprising, especially in an area where domesticated meat is expensive and a varied diet is not available. I have no problem with the results of the study.
What I have a problem with is the way the story is presented. As soon as one realises what bushmeat is, the immediate implication is that efforts to conserve wild animals is causing children to become sick! And the corollary is we should draw back on conservation efforts to protect the children!
I think it would have been much better for the article title to be something like "Poverty forces children to eat endangered animals for nutrition." This title turns the onus around; it makes poverty the enemy and not conservation. This is actually what the study concludes, that in these areas poverty forces people to eat wild animals for survival. It is unfortunate that poverty causes human health and wildlife conservation to to seem to have opposite objectives; and this news is not new if one considers problems of habitat destruction by subsistence farmers.
The authors of the article never suggest stopping conservation efforts. Instead, they suggest economic programs to allow the poorest to raise their own livestock; nutritional education and introduction of a wider variety of foodstuffs may also help correct the anemia without having to resort to eating meat. Maybe in these remote areas iron supplements could be introduced in pill form.
Readers of the article also have to remember that this is a situation existing in a small population in a remote area. We have no way of knowing if parallels exist in other regions, and we shouldn't jump to the conclusion that wildlife conservation and human health are always at odds. We would also do well to remember (and this will be hard to swallow for some) that we may be talking about the survival of an entire species versus the robust health of a subsection of subsection of a small part of the massive human population.
The study was done by researchers at the University of California, Berkeley. That led to confusion on my part, as to why we needed to keep venison on the menu in America, until I read further and discovered that this was a study done on children in a remote wildlife preserve in Madagascar. In this area, a significant portion of meat in the diet of poor people comes from wildlife, especially bats and lemurs. 77 children under 12 years old were studied, and their eating habits were compared to their level of anemia over a year. The study found that children who ate more bushmeat had lower levels of anemia.
The results are really not very surprising, especially in an area where domesticated meat is expensive and a varied diet is not available. I have no problem with the results of the study.
What I have a problem with is the way the story is presented. As soon as one realises what bushmeat is, the immediate implication is that efforts to conserve wild animals is causing children to become sick! And the corollary is we should draw back on conservation efforts to protect the children!
I think it would have been much better for the article title to be something like "Poverty forces children to eat endangered animals for nutrition." This title turns the onus around; it makes poverty the enemy and not conservation. This is actually what the study concludes, that in these areas poverty forces people to eat wild animals for survival. It is unfortunate that poverty causes human health and wildlife conservation to to seem to have opposite objectives; and this news is not new if one considers problems of habitat destruction by subsistence farmers.
The authors of the article never suggest stopping conservation efforts. Instead, they suggest economic programs to allow the poorest to raise their own livestock; nutritional education and introduction of a wider variety of foodstuffs may also help correct the anemia without having to resort to eating meat. Maybe in these remote areas iron supplements could be introduced in pill form.
Readers of the article also have to remember that this is a situation existing in a small population in a remote area. We have no way of knowing if parallels exist in other regions, and we shouldn't jump to the conclusion that wildlife conservation and human health are always at odds. We would also do well to remember (and this will be hard to swallow for some) that we may be talking about the survival of an entire species versus the robust health of a subsection of subsection of a small part of the massive human population.
Monday, October 24, 2011
Second Life and Doctor/Patient relationships
Second Life offers opportunities for doctors and patients to interact in a novel way. Second Life expands upon the ability of providers and patients to talk to each other on line in formats such as chat and message boards.
Some of the advantages of Second Life are the virtual reality feel, the ability to meet from any location, the ability to use multimedia, and the ability to express emotion. Instant messaging or chat is two dimensional. Both parties know that they are simply sending text back and forth. It may not have the feel of being in the presence of someone else, and for some people, this may change their behaviour presentation. A doctor may choose an environment to soothe a patient - maybe the doctor and patient can meet on a quiet sunny beach, or in a grassy field, where natural noises such as the ocean or the wind can help lower stress in a patient. Despite being able to meet in such natural settings, both parties can access the meeting from where they are, with no need for the expense and inconvenience of physical travel. This is especially important in today's busy world, where many people work long or odd hours and may have difficulty finding time to go to a doctor's office. Second Life allows for use of multiple kinds of media, such as audio, allowing real time talking over the internet, video displays of either the doctor and patient or educational videos, and interactive simulations, which can be educational or may actually provide training exercises for the patient. A patient with a leg injury, for example, may be able to view a video, live action or simulated, of appropriate physical therapy exercises the doctor recommends for recovery. A virtual coach can be programmed to help keep the client on track. A patient can also do a walk through of proposed procedures, which can reduce stress on the actual procedure day. Second Life also allows for participants to express emotions via their avatars in pre-programmed ways. I think this is a unique advantage for people who may be uncomfortable expressing emotions or who suffer from autism-spectrum disorders. Someone like that who normally may be stoic in response to direction, questions or input from their provider may be able to be more expressive, showing excitement, fear, or distaste, allowing the provider to have a better understanding of how the patient feels about the diagnostic or treatment process.
There are some disadvantages to Second Life. First, the very heavily visual environment uses a lot of computer power and memory. My experience was that it could run slowly or be "bumpy". I ran into several instances where multimedia was extremely slow to load or unavailable, making the experience very frustrating. Secondly, Second Life has most advantages when used as a synchronous medium. For those of us that work graveyards, having to wake up in the middle of the day to meet with the doctor is a definite negative when it would be much better to carry on an asynchronous conversation via email. Third, a lot of the environment appears to take a great effort to program, potentially limiting how personalized it can be. I think that an IM chat, with links to video files on youtube or powerpoint files on a provider's website combined with emailed pdfs can provide much of the multimedia available in Second Life, and can be made more personalised. With the availability of Skype, video chat is possible, so doctors and patients can meet actually face to face. Fourth, Second Life has no particular privacy guards, creating worries about HIPAA compliance.
Some of the advantages of Second Life are the virtual reality feel, the ability to meet from any location, the ability to use multimedia, and the ability to express emotion. Instant messaging or chat is two dimensional. Both parties know that they are simply sending text back and forth. It may not have the feel of being in the presence of someone else, and for some people, this may change their behaviour presentation. A doctor may choose an environment to soothe a patient - maybe the doctor and patient can meet on a quiet sunny beach, or in a grassy field, where natural noises such as the ocean or the wind can help lower stress in a patient. Despite being able to meet in such natural settings, both parties can access the meeting from where they are, with no need for the expense and inconvenience of physical travel. This is especially important in today's busy world, where many people work long or odd hours and may have difficulty finding time to go to a doctor's office. Second Life allows for use of multiple kinds of media, such as audio, allowing real time talking over the internet, video displays of either the doctor and patient or educational videos, and interactive simulations, which can be educational or may actually provide training exercises for the patient. A patient with a leg injury, for example, may be able to view a video, live action or simulated, of appropriate physical therapy exercises the doctor recommends for recovery. A virtual coach can be programmed to help keep the client on track. A patient can also do a walk through of proposed procedures, which can reduce stress on the actual procedure day. Second Life also allows for participants to express emotions via their avatars in pre-programmed ways. I think this is a unique advantage for people who may be uncomfortable expressing emotions or who suffer from autism-spectrum disorders. Someone like that who normally may be stoic in response to direction, questions or input from their provider may be able to be more expressive, showing excitement, fear, or distaste, allowing the provider to have a better understanding of how the patient feels about the diagnostic or treatment process.
There are some disadvantages to Second Life. First, the very heavily visual environment uses a lot of computer power and memory. My experience was that it could run slowly or be "bumpy". I ran into several instances where multimedia was extremely slow to load or unavailable, making the experience very frustrating. Secondly, Second Life has most advantages when used as a synchronous medium. For those of us that work graveyards, having to wake up in the middle of the day to meet with the doctor is a definite negative when it would be much better to carry on an asynchronous conversation via email. Third, a lot of the environment appears to take a great effort to program, potentially limiting how personalized it can be. I think that an IM chat, with links to video files on youtube or powerpoint files on a provider's website combined with emailed pdfs can provide much of the multimedia available in Second Life, and can be made more personalised. With the availability of Skype, video chat is possible, so doctors and patients can meet actually face to face. Fourth, Second Life has no particular privacy guards, creating worries about HIPAA compliance.
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