A Blood Test for Autism?

Earlier detection of autism, relying on markers in the blood, may help more children to take advantage of helpful behavioral therapies. Diagnosing autism currently requires hours of observation by clinicians and a far from objective series of behavioral measures, but improvements in genetic testing could make the process more efficient. In a study published in the journal PLOS ONE, researchers from Boston Childrens Hospital describe a new experimental test to detect the developmental disorder, based on the differences in gene expression between kids with autism spectrum disorder (ASD) and those without the condition. The blood-based test appears to predict autism relatively accurately, at least among boys, and has already been licensed to a company, SynapDx, for commercial development. In an email statement to TIME, a spokeswoman for SynapDx said the company plans to start clinical trials of the new test in early 2013. The new blood test for autism is intriguing, researchers say, because it seems to be at least as effective as any other genetic test for autism that doctors currently use. Scientists believe that autism has some genetic basis, based on genes that have been associated with the disorder, and the fact that the condition seems to run in families. A week does not go by where you dont hear about a genetic mutation that has been linked to autism in at least a few families, says Isaac Kohane, a pediatric endocrinologist and computer scientist at Childrens Hospital Boston, and the senior study author on the new article in PLOS ONE. Kohane is a scientific adviser for SynapDx, but says he does not own any stock in the company. But autism is a complex condition, he says, with many possible genetic determinants. And the precise genetic mechanism, or more likely mechanisms, are still poorly understood. But to get a better idea of which genetic changes might be most relevant to the disease, Kohane and his colleagues compared 66 patients with ASDs and 33 similar patients who were not affected by the disorder. Because they couldnt analyze the participants brain tissue, they relied on their blood as a proxy for revealing any differences. And indeed, they found certain markers in the blood of autistic participants that did not appear in those without the disorder. They traced these to 489 genes and narrowed that list down to 55 genes that could predict autism in about two-thirds of those with the disease. There are a lot of different mutations involved, and a lot of different pathways that seem to be involved in autism, Kohane says. Those genetic pathways included some known to be related to learning, and some linked to immune function. The fact that not all kids had both, and some kids would be more abnormal in immunological pathways and others would be more abnormal in [another pathway] spoke, I think, to the genuine heterogeneity of the disease, Kohane says. In that respect, autism is beginning to look a lot like what the cancer biologists are telling us about breast cancer, or lung cancer, he says. There may be hundreds of different molecularly defined cancers, which each have their own specific optimal treatment. Similarly, autism spectrum disorders, too, may have diverse genetic roots, and appear clinically in slightly different ways from one patient to another. Today, 1 in 88 kids suffers from an autism spectrum disorder, and prevalence has soared over the last 30 years, although its not clear why. Diagnosing the disease early is important because it allows children to take advantage of behavioral intervention programs that can lead to higher IQ scores and improvements in language. Kohane says the blood test could identify those at risk of autism well before symptoms appear around age 2, and help these children access potentially beneficial therapies. The test, however, is still in early stages of development. Kohane says that its accuracy (at around 70% in a high-prevalence, predominantly male sample) is high enough to be clinically useful among kids with a suspected developmental disorder. But he stresses that the test as it stands still generates too many false positives, or people mistakenly identified with the condition when in fact they dont have it, for the test to be used as an autism screening tool among all children. If the current results are confirmed, that may take a few more years. Kates Pregnant! Why We Care When news of the Duchess of Cambridges pregnancy broke on Monday, a gasp of excitement went round the world. The hashtag #royalbaby took over Twitter, internet searches for Kate Middleton pregnant went up by 18,305% and Kate and Williams official website crashed. Congratulations flooded in from all corners, while newspapers took to speculating about everything from the babys name to Kates maternity wardrobe. Its a fetus frenzy that is unlikely to abate for the next six months. But while the fascination with the Duchess pregnancy is global in scale, even everyday mothers are familiar with the hullabaloo that comes with expecting a child. Strangers approach in the supermarket to lay a hand on your stomach and ask When are you due? Friends and grandparentsto-be spend hours discussing cribs and baby showers. Neighbors offer cooking help if youre lucky and unsolicited advice if youre not. All of this raises the question: why is an impending birth so captivating? After all, its not exactly a rare occurrence 252 babies are born around the world every minute. The answer, says Meredith Small, professor of anthropology at Cornell University and author of Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent, is embedded in our evolutionary past. You know that saying, It takes a village? Its actually really true, she says. Human infants are so dependent, they cant sit up, they cant eat on their own. How could that happen if there wasnt at least one person, but usually more people, who are ready to do that kind of stuff? The rest is natural selection 101: being ready to do that kind of stuff improves the replication rate of an individuals genes (more of their babies will survive and reproduce), meaning caring about babies is a trait that has become predominant. Emotionally, psychologically, we are evolutionarily designed to respond to the look and feel of babies, and hearing about them, says Small. Its so ingrained in our genes that its automatic. Predictably, this trait is not confined to Homo sapiens. Primates have been cooing over infants since before we as a species were born. In her studies of Barbary macaques, for example, Small observed the monkeys going gaga over new arrivals. When babies are born, everybody comes over and pays attention, and smells the baby and chatters in its face, she says. Juvenile female apes and monkeys in particular are prone to curiosity about infants. They always come up and try to touch and hold and grab. Baby excitement isnt just a female thing, however. When it comes to macaques, says Small, males carry the babies a lot. And human males, though they may roll their eyes at the fuss being made over the royals offspring, are not immune to an infants charms. I think men are just as excited and as responsive, and that culturally, theyre pushed to try and hide that, she says. What about people who simply arent interested at all? Are they genetically faulty? Probably not. That doesnt mean that somethings wrong with them, she says. Culture always plays a role; Western society in particular, with its focus on independence and self-reliance, gives more allowance for apathy. Still, for many, a famous fetus is hard to resist. Because they are celebrities, we feel we know Kate and William. And after 4 million years of sharing everything as hunter-gatherers, its simply our nature to nurture their child even if that just means talking about it on Twitter. Assads Chemical Weapons: How Does Sarin Work? The Obama Administration says it will not tolerate the use of chemical weapons by Syrias Bashar Assad amid reports the dictator has stored the ingredients needed to make sarin. What is sarin, and how dangerous is it?

Sarin, a man-made, fast-acting and highly toxic nerve agent, was originally developed in Germany in 1938 to be used as a pesticide. But according to the U.S. Centers for Disease Control and Prevention (CDC), it is far more potent. Sarin can be mixed in liquid to poison drinking water and food, or released as a gas, where it may pose greater risk to a larger number of people. Victims generally have no idea when theyre being exposed. Sarin is a clear, odorless, colorless and tasteless liquid that evaporates at about the same rate as water when released, making it one of the more volatile nerve agents. It was used in the 1988 Halabja massacre in which Saddam Hussein ordered the release of sarin gas over the Kurdish city and killed at least 5,000 civilians over three days, as well as in a Tokyo subway terrorist attack in 1995 that killed 13 people. Its volatility means sarin is generally mixed just before its used and, once made, stored in liquid form. Sarin is also highly corrosive and needs to be stored in specially designed containers that resist breakdown. Within a few seconds of sarin-gas exposure, victims will start to experience eye pain, drooling, weakness, vomiting, diarrhea and irregular heart rates. Clothing from victims exposed to the gas will continue to release toxic vapors for 30 minutes, causing more people to come into contact with it. For those exposed to the liquid form of sarin, symptoms can occur anytime from a few minutes to 18 hours after consumption. If exposed to a large amount of sarin in either gas or liquid form, victims can experience more severe and painful symptoms such as convulsions, paralysis, loss of respiratory functions and even death. As with other nerve agents, sarin attacks the nervous system and disrupts the bodys ability to control muscle and gland function. This causes overstimulation of certain metabolic functions muscles continue to twitch to exhaustion, and breathing revs up to an unmanageable pace eventually resulting in the loss of all bodily functions. The CDC says even a small drop of liquid sarin on the skin will cause sweating and muscletwitching on contact. If only exposed to a small dose, most people can recover. Health officials recommend moving to an outdoor area if exposed indoors, in order to disperse the gas and lower the dose of exposure. Removing contaminated clothing as quickly as possible and washing exposed areas with soap and water can also reduce risk of more severe symptoms. If exposed patients are treated immediately with an antidote that counteracts the toxin in a hospital, the CDC says they will likely survive without neurological problems lasting more than one to two weeks. However, severe and untreated exposure is likely to result in death, making sarin one of the more potent nerve agents. Hungry Again? Your Memory May Be to Blame Hunger would seem to be a fairly straightforward instinct: Depending on how much you eat, you either will or you wont be hungry afterward. As it turns out, our relationship to food may not be so simple. In recent years, a growing body of research has shown that our appetite and food intake are influenced by an array of factors besides our biological need for energy, including our eating environment and our perception of the food in front of us. Studies have shown, for instance, that eating in front of the TV (or a similar distraction) can increase both hunger and the amount of food consumed. Likewise, peoples food intake appears to be susceptible to their surroundings, such as the eating behaviorand body sizeof their dining companions. Even simple visual cues, like plate size and lighting, have been shown to affect portion size and consumption. A new study, published this week in the journal PLoS ONE, adds a new wrinkle by suggesting our short-term memory also may play a role in appetite. Several hours after a meal, the study authors found, peoples hunger levels were predicted not by how much theyd eaten, but rather by how much food theyd seen in front of themin other words, how much they remembered eating. Health.com: How to Avoid Holiday Weight Gain Heres how the experiment worked: Researchers in the U.K. showed 100 adults a bowl containing either a small (10-ounce) or a large (17-ounce) serving of tomato soup, and asked them to eat the whole portion.However, half of the participants ate more or less than their eyes led them to believe, thanks to a concealed tube that imperceptibly refilled or drained the bowl. Immediately after the meal, the participants hunger levels depended on the amount of soup they had consumed. Those who had eaten the large serving were more likely to report feeling fulla predictable response to the signals sent out by the stomach and gut following a meal, the researchers say. Two to three hours later, however, the participants feelings of fullness were related only to the perceived amount of soup consumed. Regardless of how much soup theyd actually had, those who believed they consumed 17 ounces reported being less hungry, on average, than those who thought they consumed 10 ounces. Health.com: Are You Making These Dieting Mistakes? This time-based disparity suggests the memory of our previous meal may have a bigger influence on our appetite than the actual size of the meal, says Jeffrey M. Brunstrom, the lead author of the study and a professor of experimental psychology at the University of Bristol. Hunger isnt controlled solely by the physical characteristics of a recent meal. We have identified an independent role for memory for that meal, Brunstrom says. This shows that relationship between hunger and food intake is more complex than we thought. These findings echo earlier research that suggests our perception of food can sometimes trick our bodys response to the food itself. In a 2011 study, for instance, people who drank the same 380-calorie milkshake on two separate occasions produced different levels of hunger-related hormones depending on whether the shakes label said it contained 620 or 140 calories. Moreover, the participants reported feeling more full when they thought theyd consumed a higher-calorie shake. Health.com: 8 Tips for Controlling Portion Sizes Weve known for many years that our eyes are bigger than our stomach, but it may be more accurate to say that our eyes tell our stomachs a story, says Susan Albers, a clinical psychologist with the Womens Health Branch of the Cleveland Clinic, in Wooster, Ohio, and the author of Eating Mindfully. We eyeball portion sizes and then create a story or interpretation of what we see, says Albers. Thoughts like thats a small portion or that was a huge slice encode the memory into our minds in a certain way that have a significant impact on the way we eat later. What does this mean for our eating habits? Although it hardly seems practical to trick ourselves into eating less than we think we are, the new findings do underscore the benefits of focusing on our food and avoiding TV and multitasking while eating. Such distractions, Brunstrom says, may inhibit the formation of a memory for a recent meal. Health.com: Can Mindfulness Curb Restaurant Overeating? So-called mindful eating strategies can fight distractions and help us control our appetite, Albers says. Take three seconds to look closely at what you are eating, she says. Think for a moment about the words that spring to mind: small, large, filling, et cetera, she says. Taking a moment to consciously and thoughtfully encode this meal into your memory will make it more likely that you will remember what youve eaten later. Many of our decisions about food are made on autopilot, Albers adds. To gain better control, we have to start being more mindful of what we eat and actively remembering it later. In other words, paying attention to what you eat could help you to avoid overeating, which could end up helping your waistline. Study: Men and Women Benefit in Different Ways From AA Alcoholics Anonymous (AA) helps alcoholics to become sober, but the program may affect men and women differently.

Two researchers from Massachusetts General Hospital (MGH) report in the journal Drug and Alcohol Dependence that when it comes to beating alcohol addictions, coping mechanisms may be driven as much by gender as any other factor related to recovery. For instance, men benefit more from finding socially-based ways of weaning themselves from alcohol, such as avoiding friends and social situations that promote drinking, and gradually gaining confidence in their abilities to do so. Women, on their other hand, do better after learning to avoid drinking while feeling negative emotions like depression, anxiety and anger. The authors suggest that these differences highlight specific areas that men and women can focus on to improve recovery. In the study, John Kelly, associate director of the MGH Center for Addiction Medicine and his colleague Bettina Hoeppner followed more than 1,700 participants who were enrolled in Project MATCH, a federally-funded study comparing three different approaches to treating alcohol addiction. In addition to the recovery program to which they were assigned, the participants could attend AA meetings and reported reported on whether they were successful in achieving and maintaining sobriety. The researchers also assessed the recovering alcoholics confidence to remain sober in various situations and whether their friends and family supported their goal to abstain from alcohol. For men, participating in AA increased their confidence in building a network of supportive friends and staying sober in high-risk social situations like parties. Independent of AA, these same social factors were twice as influential for men in avoiding relapse than for women. In contrast, dealing with negative emotions that can be a trigger for bouts of drinking was a much higher factor in relapse risk for women than for men. This was a very stark contrast. Both men and women benefit the same from AA, but womens exposure and involvement in AA resulted in better coping with anxiety and anger. In men, this was not the case. It was very surprising to me, says Kelly. The findings offer insights into how treatment works for different genders, and how strategies for recovery might be refined in the future to more effective. For men, focusing on the types of social risks they face will increase their recovery, for example, while helping women find alternative ways to handle feelings of depression without alcohol could be most effective. Its important to understand that men and women trying to recover from alcoholism use AA and other resources in different ways to cope with the kinds of risks of relapse which are pertinent to their particular social situation and life context, says Kelly. Caregiving for an Aging Parent From Afar: Six Ways to Help For my mother and my Aunt Lois, providing care to my elderly grandparents was a difficult and emotionally distressing experience for many reasons, but it was especially hard because of the geographical distance separating them. They both lived far from the southern Indiana farm where my beloved grandparents resided, and only one other aunt lived nearby. Grandpa was the first to experience serious health issues and sank gradually into dementia. And though Grandmas mind remained sharp until the end, her vision failed in her early 90s and she became homebound and frail, eventually succumbing to cancer. In the course of a decade, my mother and aunts managed the shifting stages of care for my grandparents. The heaviest burden of the day-to-day care fell on my Aunt Emily who lived nearby, while Mom and Aunt Lois visited often and helped with financial and legal matters. As distance caregivers, Mom and Aunt Lois often felt frustrated, constrained and helpless. The National Institute on Aging estimates that there may be as many as seven million people providing long-distance care in the United States. Caregiving for aging parents from afar iscomplicated. In addition to the emotional aspects that come with the aging process and deteriorating health of a loved one, the financial aspects can also be complex. If you are living far from your elderly parent and he or she is in decline, what can you do to make it easier financially for you and your family? Consider moving Mom or Dad in with you. Depending on your parents desire to stay in their home or community, their health situation and the configuration of your house, moving them home may not be realistic. However, if your aging parent is open to the idea and can be accommodated in your home, it will likely beless expensive than carrying the costs of two houses or funding a room at anursing home. Discuss this with your parents and the other members of your household, and do the math to determine the cost differences and potential expenditures that would be required with this arrangement. If your parent is going to remain in his or her home, help them make necessary changes to ensure a senior-friendly and safe environment. Falls or injuries can erode your parents health and might also contribute to expensive, preventable doctor visits. Determine what remodeling changes you might make and how to finance them. Get the facts. Since you are far away, its important that you learn all you can about your parents circumstances and resources. Get organized so you can effectively manage the situation. Research your parents health issues, their prescription medications, insurance coverage and overall financial situation. Its imperative that at least one family member has written permission to accessmedical and financial documents and accounts. Be in touch often. Talk to your loved one frequently to proactively manage health and financial issues. Gauge their energy level and talk to them about their day-to-day activities, overall health, expenses and bills. Be aware of any forgetfulness, confusion or signs of stress that may lead to mismanaged funds and vulnerability to scams or fraud. Set up conference calls with other family members, your parents medical professionals, in-home care workers, nursing home employees (if your parent is in a facility), accountant, financial advisor and attorneys. Plan and budget for your travel. Unfortunately, phone conversations can only reveal so much. You may not be able to determine your parents real state of health unless you see him or her in person. The ability to visually scrutinize their physical condition, home and paperwork is critical for you to understand the reality of the situation. Trips are important, but travel can be expensive whether you are a few hours away or across the country. While last-minute visits may occur, plan regular trips in advance and add accompanying expenses into your budget. This will help you manage your schedule and your finances. If you begin traveling frequently, you may need to make budget tradeoffs, but planning well in advance can help minimize the impacts on your overall financial situation. Choose the appropriate primary caregiver and services. Its crucial if your parent lives at home or in an assisted living facility to determine which family member will be their primary caregiver. If you have siblings, discuss and decide who will take the lead on the various aspects of physical and financial responsibilities. In some circumstances, these kinds of decisions can cause friction between siblings, so open communication and re-visiting your choices often is crucial. If your parent is at home, you may choose to find and hire a person to provide in-home care. Consider a home health aid or service, or a geriatric care manager. After a careful review of financial resources and long-term care policies, youll be able to determine how much your parent can afford and how much you and yourfamily members will need to contribute to make up any differences. Learn about sources of financial help. Depending on their situation, your parent(s) may be eligible for sources of financialassistance. As a longdistance caregiver, you can research the types of aid available and help your parents apply. Start with the Centers for Medicare & Medicaid Services (CMS) (the federal agency responsible for Medicare), and SHIP the State Health Insurance Counseling and Assistance Program, which provides counseling to families on Medicare and Medicaid. Also research other benefits your parent may be eligible for if he or she is a veteran. What Does Gum Disease Have to Do With Erectile Dysfunction? How can men avoid gumming up a relationship? They might start by brushing their teeth every day. According to a new study in The Journal of Sexual Medicine, men with erectile dysfunction (ED) are three times more likely to have gum disease than men who do not have ED. Turkish researchers found that 53% of the male patients with ED had severe gum disease (chronic periodontitis) compared with 23% who did not have ED. The study included 80 male patients with ED and 82 male patients without the condition; none were smokers since lighting up is

considered a risk factor for both ED and gum disease. The study was also limited to those 30 years to 40 years old in an effort to rule out age as a risk factor. Even after accounting for age, body mass index (BMI), household income, and education status, the association between poor dental health and ED held. We think that it will be of benefit to consider periodontal disease as a causative clinical condition of ED in such patients, the authors write. What connects the two vastly different conditions? In a word, inflammation. Inflammation, which is the bodys immune response in action, may spread from the gums and harm other parts of the body. Gum disease is marked by bleeding of the gums and bone structure of teeth, and if left untreated, can cause tooth decay and tooth loss as immune cells launch an all-out attack on pathogens in the mouth. These bacteria can also seep into the bloodstream and damage blood vessels, and because erectile problems can be caused by impaired blood flow in the penis, poor dental hygiene can be associated with ED. About 150 million men worldwide suffer from erectile dysfunction, and nearly half of American adults over 30 (64 million) have periodontal disease 56 percent of whom are men, according to the Centers for Disease Control and Prevention (CDC). Many studies have reported that [chronic periodontitis] may induce systemic vascular diseases, such as coronary heart disease, which have been linked with erection problems, Dr. Faith Oguz from Inonu University in Malatya, Turkey, said in a statement describing the results. While these studies have linked periodontal disease to heart disease and diabetes, the American Heart Association (AHA) announced in April that there is not enough research to confirm that gum disease causes heart disease. Most of the data comes from observational studies, which means there may be other factors that raise the risk of both diseases such as obesity, smoking, and aging that could also be responsible for this association. The Turkish authors, however, excluded men who had a systemic disease from their study, which suggests the relationship is worth pursuing with further research. Even though its a small, preliminary study, theres enough suggestion that periodontal disease is a significant risk factor that it begs more investigation, says Dr. Nancy L. Newhouse, President of The American Academy of Periodontology (AAP). Faithful brushing can keep bacteria that trigger inflammation at bay, and regular visits to the dentist can detect periodontitis. Thats something that most men arent taking advantage of; according to recent research in the AAPs journal Periodontology, women are twice as likely as men to get regular dental check-ups. This is a risk factor that you have some control over, Newhouse says. If you have healthy gums, then you have just eliminated one of the factors that may be impacting your overall health, of which ED is a part. Anderson Coopers Eyeburn: How Common Is Eye Damage From The Sun? On Tuesday afternoons epsiode of Anderson Live, host Anderson Cooper told viewers he sunburnt his eyes on a recent trip to Portugal, and was subsequently blind for 36 hours. Cooper said the injury occurred while he was on the water, without sunglasses, for an extended period of time reporting for CBSs 60 Minutes. I wake up in the middle of the night and it feels like my eyes are on fire, my eyeballs and I think, oh maybe I have sand in my eyes or something, Anderson said. I douse my eyes with water. Anyway, it turns out I have sunburned my eyeballs and I go blind. I went blind for 36 hours. Just how common is sunburning your eyes? According to Dr. Deborah Sarnoff, senior vice president of The Skin Cancer Foundation and practicing dermatologist at Cosmetique in New York, sunburns to the extent of Coopers doesnt happen too often, but it is possible if youre not wearing the right protection. We have sunscreen we can put on our skin, but we dont have eye drops that offer a protective film for the cornea, so it is really important that everyone, and especially people with fair or light eyes wear sunglasses that protect against both UVA and UVB rays, says Sarnoff. According to Sarnoff, the outer eyeball layer, known as the cornea, is similar to the outer layer of skin. When it is burned by the suns rays, the cornea becomes inflamedan effect called keratitiswhich can be quite painful and, as in Coopers case, can cause temporary blindness. For someone like Cooper, who has light irises, there is a higher risk of burns. And like sunburns on the skin, burning your cornea causes cumulative damage. In the short-run you heal, but in the long-run sometimes the damage builds. We can get a sunburn, and we can heal from it, and the inflammation can go away, but it can add to the chronic damage and put us at risk for skin cancer, says Sarnoff. Eye issues like cataracts, skin cancer of the eyelids and melanoma in the retina are all possible risks from sun-damaged eyes. Thankfully, with numbing and antibiotic eye-drops, it only takes a couple days to recover. The good news is that our bodies are very regenerative, and we have regenerative powers in both the top layer of our skin, and on top of the cornea. We are always replacing the skin and corneal cells, says Sarnoff. It takes time, but within a few days you can be better. Even during the winter, you should protect your eyes from dangerous raysparticularly when they are reflected off bright surfaces such as snow. To keep your eyes safe, wear sunglasses and a hat with a three inch brim, advises Sarnoff. If you do get a burn, see your ophthalmologist right away. Want to Cure a Hangover? Dont Pick Up a Cigarette Lighting up and drinking go hand in hand on a night of revelry, but smoking can make hangovers worse. Thats what researchers from Brown University found after studying a group of college students who had varying reactions to drinking episodes, with some suffering from unbearable hangovers complete with headaches, nausea and fatigue, while others coasted relatively pain-free after a night of drinking. About a quarter of people who drink heavily enough to trigger a hangover dont seem to be affected by the morning-after payback. The scientists asked 113 college students to complete an online survey detailing their smoking and drinking habits as well as hangover symptoms over an eight week period. When students really indulgedconsuming around five to six cans of beer in an hourand also smoked during the same day, they were more likely to report nursing a hangover the following morning. The symptoms also worsened if they smoked that morning as well. Research indicates a loss of productivity in the workplace due to hangovers and that students report problems with academic performance due to hangovers, so there is a public health reason for us to study them, says lead study author Damaris Rohsenow of the Center for Alcohol and Addiction Studies at Brown University. One of the puzzles weve had is what predicts an insensitivity to hangover, and what predicts a severe hangover. Its not clear what connects smoking to worse hangover symptoms, but previous research suggests that nicotine receptors in the brain can also have an effect on our responses to alcohol, such as triggering the release of dopamine, a brain chemical responsible for the feelings of satisfaction drinking can generate. Another theory holds that nicotine may influence the release of cytokines, released when the brain experiences injury, causing inflammation that can lead to headaches and nausea. Together, smoking and heavy drinking can be a real pain. This is another reason for people who drink heavily to quit smoking, says Rohsenow. Its not just that the smoking will increase their discomfort the next day, but it may be increasing brain problems in the long run. The fact that smoking aggravates hangover may be a warning sign that people should heed. At least if they want to avoid a hangover. Extremely Premature Babies Still at Risk of Health Issues As Youngsters Despite innovative techniques to keep premature babies healthy, death rates and lingering health problems among extremely preterm babies remained unchanged for decades.

Premature births, occurring before 37 weeks, remain high in Europe and the U.S., where it affects one out of every eight babies. The risks of being born too early are also well documented, and include cognitive problems that can lead to lower math and reading scores in school, respiratory and immune system deficits that can put preemies at risk of asthma and other health conditions that are costly to treat, as well as early death. The health challenges and death rates for those born even earlier, before 26 weeks of pregnancy, are greater still, but researchers wanted to determine if newer interventions designed to improve the health of these extremely premature babies helped them to live longer and avoid more serious developmental and physical problems later in life. Unfortunately, thats not what they found. We didnt expect to see rates disappear, says study author Neil Marlow, professor of neonatal science at the University College London Institute for Womens Health. We wanted to determine a more global picture of extreme preterm survival and later problems. Since 1995, weve done a lot of things that could change these outcomesBut things are relatively unchanged. There are improvements in survival and survival without disability, but rates and distributions of problems are similar. In two studies published online in the journal BMJ, scientists in the UK report that although preemie survival rates are up, the number of serious health issues and disabilities remain stubbornly unchanged between 1995 and 2006. In one study, there was no drop in the number of premature newborns leaving the hospital with serious health problems over that period, and in the second analysis, the rate of longer lasting major health and developmental problems among children born before 26 weeks also remained the same. Both studies relied on data from two large studies, known as EPICure and EPICure2, that included all babies born in the UK before 26 weeks gestation in 1995 and in 2006. The first study compared survival rates and health issues such as lung, brain and eye problems recorded from birth until the babies were discharged from the hospital in each of the two years; changes in these rates might reflect advances in the way premature babies are treated in the hours and days after being born. Indeed, the study authors reported a 13% improvement in survival rates in the first week after birth between 1995 and 2006, but the rates of babies who continued to experience serious health problems, like lung, brain and eye issues before they were discharged remained the same. More concerning is the fact that the researchers found a 44% increase in in neonatal intensive care (NICU) admissions, which means that although more babies are being admitted, likely due to complications from being born too soon, the care they receive doesnt seem to be translating into fewer health problems. Thats quite a staggering, huge increase, says Marlow of the rise in NICU admissions. We are not entirely sure why that is, and need to follow-up, but we know that the things we are doing are promoting early survival, but beyond the first week, deaths were unchanged. The authors believe that although more medical interventions were available in 2006 compared to 1995, such as better treatments to promote lung maturation and decreased used of steroids that have been linked to cerebral palsy, being born premature carries with it more serious consequences of incomplete development that cause major health problems that early interventions may not be able to address. While the first study focused on the health outcomes during the first weeks of preemies lives, the second investigation followed up with preterm babies when they were three years old, and compared health outcomes of those kids born between 22 weeks and 25 weeks in 1995 to those born before 27 weeks in 2006. Overall, there was an 11% improvement in the proportion of children surviving to three years without a disability, from 23% in 1995 to 34% in 2006. The disabilities the researchers measured, which included cognitive problems, motor deficits, sensory and communication impairments as well as cerebral palsy, were greatest among those born earliest, and declined with longer pregnancies. But about 45% of those born at 23 weeks still had moderate to severe disabilities and other health problems, with the most severe deficits in learning. As these kids go through childhood, their learning problems and behaviors during school are going to be their greatest problems, says Marlow. That doesnt mean that most preemies are destined to experience developmental and health problems are they get older. The results should be interpreted cautiously, the authors say, since they were unable to follow-up with every child, and the children should be monitored over longer periods in order to fully understand the scope and severity of early birth on development. Only assessment of the 2006 cohort at school age will clarify whether there have been important changes in the high prevalence of impaired cognitive and behavioral outcomes, they write. Some critics argue that the data from 1995 is no longer relevant, given how differently babies born preterm are treated today. But, if thats the case, says Marlow, then he and his colleagues should have seen greater improvements in health outcomes among the babies born in 2006. We have to think hard about the care we provide, he says. In fact, we think these findings imply that [the data from 1995] are very relevant, and help us understand whats happening and why some of the same problems continue to exist. These kids are going to require a lot of health care and support as they go through childhood. We need to understand how we can help this problem by nurturing brain growth in the nursery and clinically. Only with improved interventions for babies born extremely preterm can they start to shake off the health legacy of being born too soon. Why a Pregnant Kate Middleton is in the Hospital After months of speculation, Kate Middleton is finally, officially, pregnant. And she cant even enjoy it. Middleton is tethered to an IV in King Edward VII Hospital in London, where shes spending her second day being treated for symptoms that match up with hyperemesis gravidarum. In other words, shes throwing up. A lot. Pregnancy-associated nausea is common its often referred to as morning sickness, although it can strike at any time of the day but the extreme nausea and vomiting associated with hyperemesis affects less than 2% of pregnant women. Why it happens is a mystery. Its thought to be related to hormonal spikes in estrogen, progesterone and hCG (human chorionic gonadotropin, which is detected by pregnancy tests). Sluggish digestion during pregnancy may also be a factor. Many women suffering from hyperemesis respond to oral anti-nausea medication, but in Middletons case, Prince William reportedly rushed her in his Range Rover to the hospital. Its not the hyperemesis itself thats so worrisome; its the risk of losing too much fluid. I am sure her doctors are being cautious, but some women need hospitalization to prevent dehydration, Dr. Samantha Pfeifer, an associate professor of obstetrics and gynecology at the University of Pennsylvania, said in an email explaining the condition. Thats the purpose of Middletons IV; she may also be receiving intravenous anti-nausea drugs. In the most severe cases in which food cant be kept down, TPN, or total parenteral nutrition, may be administered via IV. Kate Middleton is very thin and I bet that she has low blood pressure so if she got dehydrated she could pass out easily, Dr. Ruth Ann Crystal, an obstetrician in Palo Alto, Calif. who is known on Twitter as @CatchTheBaby, said via email. As for rampant rumors about Middleton carrying twins, the jury is out. Twins can increase the risk of extreme nausea as can carrying a girl but thats not necessarily the case. As any mother knows, morning sickness can be worse during some pregnancies, regardless of whether the child is a boy or girl. Unless Middleton and her prince announce the gender a few weeks down the road, well all have to wait until late summer, when it seems the heir or heirs to the throne would be due. Study Details How Brain Injury from Concussions Progresses The lasting impact that concussions can have on the brain is on the minds of anyone involved in football, from parents of the youngest Pop Warner players to those in the professional ranks. More and more players in the NFL are succumbing to symptoms of memory loss, inability to concentrate and changes in personality that they attribute to repeated blows to the head during play. But as their numbers grow, researchers are struggling to keep up with understanding the brain injuries that concussions can cause. Now, for the first time, scientists are classifying the brain injury from head trauma into four distinct stages. (MORE: NFL Players May Be More Vulnerable to Alzheimers Disease)

Most agree that repeated mild trauma to the brain in the form of concussions can result in chronic traumatic encephalopathy (CTE), or a gradual buildup of a brain protein called tau. Just as with Alzheimers patients, where accumulation of plaques and tau tangles can space out healthy brain tissue and let nerve connections wither away, damage caused by concussions can trigger the accumulation of tau in CTE cases, eventually forming deposits large enough to interfere with key functions such as learning, planning and organization. In the latest study, published in the journal Brain, scientists led by Dr. Ann McKee studied the brains of 68 deceased patients with CTE in order to find patterns in the way the disease develops. McKee, a professor of neurology and pathology at VA Boston Healthcare System and Boston University School of Medicine, spent more than two decades researching Alzheimers disease. She decided to apply the same order in staging brains that she had become accustomed to in her Alzheimers work. The number of CTE brains she and her team studied is the largest to date, and allowed them to see patterns in the way the disease progressed. The patients included football players, hockey players, boxers and veterans (many of whom were athletes) and one who engaged in self-inflicted head-banging behavior. In order to generate the least biased analysis possible, McKee and her pathology team conducted the autopsy analysis of the brain tissue, while another group led by Robert Stern, a neurologist and neurosurgeon at Boston University School of Medicine, carried out detailed interviews with the deceased patients families about the patients lives, behaviors and symptoms. In her first pass at the data, McKee was able to discern a distinct pattern of where and how CTE progressed. She and her team found focal points where the injury to the brain seemed to start. These were concentrated in the frontal lobe, deep in the valleys of the convoluted cerebral cortex. Cortex tissue resembles a crumbled piece of paper with folds that create peaks and valleys, and the lesions of CTE seemed to start in the valleys where small blood vessels also congregate. There is a fairly stereotyped lesion; where the gray matter dives in to create a valley in the brain is where we see the greatest damage, says McKee. We also see over and over in all of these cases that there is a strong tendency of the disease to start around blood vessels, which means the blood vessel is damaged with the injury. While its not clear what triggers the damage, McKee suspects that the junction of the elastic blood vessels butting up against the more gelatinous cortex tissue may be particularly vulnerable to the shearing forces from an impact. Once the damage is done, however, its difficult to stop. Even after the physical blows no longer occur, a destructive chain of events is already in motion. From these seed points in the frontal lobes, damage to nerves and brain tissue radiates to other parts of the brain, until it eventually engulfs most of the organ, impairing many cognitive functions. Even if a person doesnt get additional trauma, the disease progresses, like a lit fire, says McKee. The fire takes hold and continues to affect the brain with more lesions the longer the person lives. Because the study included the brains of patients who died at a range of ages, between 17 and 98, McKee could see the growing buildup of tau in the brain among the older cases. She could also see distinct stages of the disease, from lesser signs of lesions and tau to greater depositions. She could then correlate later stages of damage to longer play for the football players, and therefore likely more concussions. While the findings confirm, and perhaps even reinforce how damaging concussions can be, McKee says they could also lead to better treatments for CTE. For one, recognizing that the disease begins with small lesions in the blood vessels could lead to helmets or other equipment that better protect the most vulnerable parts of the brain. In addition, it could help scientists develop higher-resolution brain scans to detect these early signs of the disease. Current technology is not able to find such small abnormalities, but researchers are testing a tracer that could detect the tiniest deposits of tau protein that would alert doctors to the potential for CTE. Patients could then be warned to avoid repeated head trauma like those that might occur on the football field. Understanding that the damage occurs in the blood vessels could also lead to ways of protecting those vessels and preventing the damage from spreading to the rest of the brain. Its not clear yet what is causing the initial lesions to seed damage to other parts of the brain, but if the damage causes leakage of agents that are toxic to nerve cells, for example, drugs or other interventions may block the added injury these lesions can cause. The insights from CTE could also help researchers develop better treatments for other neurodegenerative conditions as well. Im optimistic that this disease gives us lots of insights into other diseases like Alzheimers, says McKee. If we could reduce tau somehow or wall off the early stages of the disease, we can prevent the degenerative part from developing. Avoiding head trauma may not always be possible, but stopping the damage it can cause may one day be more realistic.