Med.Stanford.edu - Acupuncture appears to be an effective way to reduce depression symptoms during pregnancy, according to a first-of-its-kind study from Stanford University School of Medicine researchers.

The study authors, led by Rachel Manber, PhD, professor of psychiatry and behavioral sciences, said they hope the results will raise awareness of the problem of depression during pregnancy and provide patients and physicians an alternative to antidepressants. “This standardized acupuncture protocol could be a viable treatment option for depression during pregnancy,” they wrote in a paper that will appear in the March 2010 issue of Obstetrics & Gynecology.

Up to 14 percent of pregnant women may have major depressive disorder, a condition characterized by feelings of dread, gloom and hopelessness, and a loss of interest in normally pleasurable activities. Some women suffer from depression before becoming pregnant, stop taking their medication and then experience a relapse; in other women, pregnancy itself may cause depression.

Clinicians aren’t exactly sure how pregnancy leads to the disorder, but an influx of hormones could be the culprit. Some women might also feel overwhelmed by the major changes in their life, which could trigger depression. “Pregnancy just by its nature can bring out some underlying psychiatric and emotional issues,” said co-author Deirdre Lyell, MD, assistant professor of obstetrics and gynecology.

Depression, if left untreated, can pose risks to both mother and baby. The mom-to-be could stop taking care of herself or her fetus, and might even engage in self-destructive behavior. Studies have also linked depression during pregnancy to poor birth outcomes and postpartum depression. “Treatment of depression during pregnancy is critically important so that a woman can maintain her sense of well-being and take good care of herself, her fetus and, someday, her child,” said Lyell.

The use of antidepressants during pregnancy doubled between 1999 and 2003, according to a 2007 American Journal of Obstetrics and Gynecology study, but many women avoid taking medication because of safety concerns. In fact, Manber said, 94 percent of the depressed women involved in her study expressed reluctance to take antidepressants.

“Because there’s this concern about medication among pregnant women and their physicians, it’s important to find an alternative,” said Manber.

For this study, the researchers recruited 150 women whose pregnancies were between 12 and 30 weeks gestation and who met the criteria for major depressive disorder. The women were randomized to receive one of three treatments: acupuncture specific for depression; control acupuncture, during which needles were inserted in points not known to help alleviate depressive symptoms; or massage. All of the women received eight weeks of therapy and were assessed for depression at the four- and eight-week marks by an interviewer who was unaware of the treatment each woman received.

The researchers found that women who received the depression-specific acupuncture experienced a bigger reduction in depression symptoms than the women in the other groups. The response rate - defined as having a 50 percent or greater reduction in symptoms - was 63 percent for the women receiving depression-specific acupuncture, compared with 44 percent for the women in the other two treatment groups combined.

The researchers weren’t surprised by what they found - a pilot study yielded similar results, and other studies have shown acupuncture is an effective treatment for depression in the general public - but they were pleased with the results.

“I don’t think that one-size-fits-all treatments are appropriate for everyone, but acupuncture should be considered as an option,” said Lyell. “I hope that people will respect the rigorous methodology used in this blinded, randomized, controlled trial and accept the result: Traditional acupuncture was associated with a significant improvement in depression.”

Both Manber and Lyell said they plan to continue their research on women’s health during pregnancy and postpartum. Lyell recently presented work showing that practitioners under-identify and under-acknowledge depression during pregnancy, and she’s now analyzing birth-outcome data to look for correlations between depression, treatment and obstetric outcomes.

UGA.edu - The anxiety that often accompanies a chronic illness can chip away at quality of life and make patients less likely to follow their treatment plan. But regular exercise can significantly reduce symptoms of anxiety, a new University of Georgia study shows.

In a study appearing in the the Archives of Internal Medicine, researchers analyzed the results of 40 randomized clinical trials involving nearly 3,000 patients with a variety of medical conditions. They found that, on average, patients who exercised regularly reported a 20 percent reduction in anxiety symptoms compared to those who did not exercise.

“Our findings add to the growing body of evidence that physical activities such as walking or weight lifting may turn out to be the best medicine that physicians can prescribe to help their patients feel less anxious,” said lead author Matthew Herring, a doctoral student in the department of kinesiology, part of the UGA College of Education.

Herring pointed out that while the role of exercise in alleviating symptoms of depression has been well studied, the impact of regular exercise on anxiety symptoms has received less attention. The number of people living with chronic medical conditions is likely to increase as the population ages, he added, underscoring the need for a low-cost, effective treatment.

The researchers limited their analysis to randomized controlled trials, which are the gold standard of clinical research, to ensure that only the highest quality data were used. The patients in the studies suffered from a variety of conditions, including heart disease, multiple sclerosis, cancer and chronic pain from arthritis. In 90 percent of the studies examined, the patients randomly assigned to exercise had fewer anxiety symptoms, such as feelings of worry, apprehension and nervousness, than the control group.

“We found that exercise seems to work with just about everybody under most situations,” said study co-author Pat O’Connor, professor and co-director of the UGA Exercise Psychology Laboratory. “Exercise even helps people who are not very anxious to begin with become more calm.”

Exercise sessions greater than 30 minutes were better at reducing anxiety than sessions of less than 30 minutes, the researchers found. But surprisingly, programs with a duration of between three and twelve weeks appear to be more effective at reducing anxiety than those lasting more than 12 weeks. The researchers noted that study participants were less likely to stick with the longer exercise programs, which suggests that better participation rates result in greater reductions in anxiety.

“Because not all study participants completed every exercise session, the effect of exercise on anxiety reported in our study may be underestimated,” said study co-author Rod Dishman, also a professor of kinesiology. “Regardless, our work supports the use of exercise to treat a variety of physical and mental health conditions, with less risk of adverse events than medication.”

AHA - Physical fitness is associated with better academic scores in young people, according to a report presented at the American Heart Association’s 2010 Conference on Nutrition, Physical Activity and Metabolism.

“As children’s health continues to be a concern - especially when it comes to obesity - some have suggested that children’s physical fitness is associated with their academic performance,” said Lesley A. Cottrell, Ph.D., study presenting author and associate professor of pediatrics at West Virginia University in Morgantown, W.Va. “The research, however, had not developed enough to define the nature of that relationship.”

To study the association between children’s physical fitness and academic performance, Cottrell and colleagues analyzed the body mass index percentiles, fitness levels and standardized academic test scores of 725 fifth grade students in Wood County, W.Va. The researchers focused more on the physical fitness level of the children than their weight. They then compared that data to students’ fitness and academic performance two years later, in the seventh grade.

They separated the participants into four groups of students who were:

* in high physical fitness levels in fifth grade and remained so in seventh grade;
* fit in fifth grade but had lost their fitness by seventh grade;
* not fit in fifth grade but were physically fit by seventh grade;
* not physically fit at the beginning of the study, in fifth grade, nor at the end of the study, in seventh grade.

Children who had the best average scores in standardized tests in reading, math, science and social studies were fit at the start and end of the study, researchers found. The next best group, academically, in all four subjects, was made up of children who were not fit in fifth grade but had become fit by seventh grade. The children who had lost their fitness levels between fifth and seventh grades were third in academic performance. Children who were not physically fit in either the fifth or seventh grades had the lowest academic performance.

“The take-home message from this study is that we want our kids to be fit as long as possible and it will show in their academic performance,” Cottrell said. “But if we can intervene on those children who are not necessarily fit and get them to physically fit levels, we may also see their academic performance increase.”

Youth who are regularly active also have a better chance of a healthy adulthood. The American Heart Association recommends that children and adolescents should do 60 minutes or more of physical activity daily and they participate in physical activities that are appropriate for their age and enjoyable.

The study suggests that focusing more on physical fitness and physical education in school would result in healthier, happier and smarter children, Cottrell said.

Sahlgrenska.gu.se - There is a link between repeated anesthesia in children and memory impairment, though physical activity can help to form new cells that improve memory, reveals new research from the Sahlgrenska Academy at the University of Gothenburg, Sweden.

The study has been published in the Journal of Cerebral Blood Flow & Metabolism.

“Paediatric anaesthetists have long suspected that children who are anaesthetised repeatedly over the course of just a few years may suffer from impaired memory and learning,” says Klas Blomgren, professor at the Queen Silvia Children’s Hospital and researcher at the Sahlgrenska Academy. “This is a theory that is also supported by foreign research.”

His research team discovered, by chance, a link between stem cell loss and repeated anesthesia when working on another study. They wanted to find out what happens to the brain’s stem cells when exposed to strong magnetic fields, for example during an MRI scan. The study was carried out using rats and mice, and showed that while the magnetic fields did not have any tangible effects on the animals, the repeated anesthesia did.

“We found that repeated anaesthesia wiped out a large portion of the stem cells in the hippocampus, an area of the brain that is important for memory,” says Blomgren. “The stem cells in the hippocampus can form new nerve and glial cells, and the formation of nerve cells is considered important for our memory function.”

Their results could also be linked to impaired memory in animals as they got older. The effect was evident only in young rats or mice that had been anesthetized, not when adult animals were anesthetized. This may be because stem cells are more sensitive in an immature brain, even though there are fewer of them as we get older.

“Despite extensive attempts, we have not been able to understand exactly what happens when the stem cells are wiped out,” says Blomgren. “We couldn’t see any signs of increased cell death, but are speculating that the stem cells lose their ability to divide.”

Another treatment that wipes out the brain’s stem cells is radiotherapy, which is used with cancer patients. Blomgren and his research team have previously used animal studies to show that physical activity after radiotherapy can result in a greater number of new stem cells and partly replace those that have been lost.

“What’s more, the new nerve cells seem to work better in animals that exercise. Now that we know this, we can come up with treatments that prevent or reverse the loss of stem cells after repeated anaesthesia,” says Blomgren, who believes that the findings will lead to greater awareness of the problems and inspire further research into the reasons for the loss of stem cells.

The abstract of the research article is available free here:

Anesthesia, memory impairment, loss of stem cells in hippocampus

Reference: Changlian Zhu, et al. “Isoflurane anesthesia induced persistent, progressive memory impairment, caused a loss of neural stem cells, and reduced neurogenesis in young, but not adult, rodents,” Journal of Cerebral Blood Flow & Metabolism. Jan 13, 2010. doi:10.1038/jcbfm.2009.274

Missouri.edu - With the obesity rate rising for American adults and children, health concerns such as diabetes and cardiovascular disease are a frequent reality. Although obesity itself is a major risk factor for disease, most of the threat may be associated with a cluster of risk factors called the metabolic syndrome (MetS). Losing weight can improve health and reduce these risk factors, but many people have difficulty keeping the weight off. Now, University of Missouri researchers have found that exercising during weight regain can maintain improvements in metabolic health and disease risk.

In the NIH-funded study, individuals who didn’t exercise during weight regain experienced significant deterioration in metabolic health, while those who exercised maintained improvements in almost all areas. The MU study, led by Tom R. Thomas, professor in the Department of Nutrition and Exercise Physiology in the College of Human Environmental Sciences, is the first to examine the role of exercise in countering the negative effects of weight regain on metabolic syndrome and overall health status.

“Although many people are successful at losing weight through diet and exercise, the majority of them will relapse and regain the weight,” Thomas said. “The findings of this study indicate that regaining weight is very detrimental; however, exercise can counter those negative effects. The findings support the recommendation to continue exercising after weight loss, even if weight is regained.”

In the study, overweight men and women with measured characteristics of metabolic syndrome were given a diet plan and aerobic exercise plan that included supervised exercise five days a week, for 4-6 months. After losing weight, participants underwent programmed weight regain and were separated into two groups, one that exercised and one that didn’t. The non-exercise group experienced rapid deterioration in weight-loss induced benefits to metabolic health. The exercise group maintained improvements in almost all measures, including LDL and HDL cholesterol, oxygen consumption (VO2max), blood pressure and glucose. Exercise didn’t maintain blood cholesterol and abdominal fat loss.

“It’s clear that the message to lose weight isn’t working because so many people regain weight; a new message is to keep exercising and maintain your weight to reduce disease risk and improve overall health,” Thomas said. “Don’t worry so much about losing weight, but focus on exercising and maintaining your current weight.”

The abstract of the study is available online free here:

Exercise and the Metabolic Syndrome with Weight Regain

UTHSCSA.edu - Patients in severe heart failure who are too sick for transplantation have another lifesaving option these days — surgery to implant a new compact, lightweight ventricular assist device (VAD) - the FDA-approved second generation VAD called HeartMate II. The procedure is available in San Antonio from Jay D. Pal, M.D., Ph.D., a cardiothoracic surgeon recruited in 2009 to The University of Texas Health Science Center at San Antonio.

Dr. Pal is a member of UT Medicine San Antonio, the multispecialty practice of physicians in the Health Science Center’s School of Medicine. Dr. Pal specializes in heart and lung transplantation, VAD implantation, surgery for heart failure, coronary revascularization and valve surgery. With his arrival, San Antonio now has a specialty-trained heart transplant surgeon with extensive experience with mechanical circulatory support.

Ventricular assist devices have come a long way since the first model gained U.S. Food & Drug Administration (FDA) approval in 1994. VADs now are available to a wider range of patients, not only those who need a short-term bridge to transplant but also those for whom a VAD will be the sole means to provide improved, long-term cardiac function. The VAD is called “destination therapy” for these patients.

In January 2010 the FDA gave the green light for HeartMate II, a second-generation VAD, to be used in this acutely ill population. HeartMate II is a continuous-flow, left ventricular assist system that is implanted just below the heart to provide mechanical circulatory support, according to an FDA press release. The system is powered by an electrical cable that passes through the skin to a controller worn around the waist.

The FDA action came after a multicenter study found that HeartMate II significantly improved survival and decreased complication rates when compared to earlier-generation devices.

“The FDA approval of HeartMate II is significant for multiple reasons,” Dr. Pal said. “First, it confirms the safety and efficacy of this device in the treatment of advanced heart failure for extended periods in patients who are not eligible for heart transplantation. Second, it provides a proven treatment option for many patients who have significant limitations in quality of life due to heart failure. The new approval allows us to provide this lifesaving treatment to a new population of patients who were previously not candidates for mechanical circulatory support.”

For more information about this FDA-approved therapy, including patient eligibility, please call the cardiothoracic surgery group of UT Medicine San Antonio at (210) 358-8001.

HeartMate II is a registered trademark of Thoratec Corp. of Pleasanton, CA.