Monday, 18 December 2017

Depression: 'I kept my head down to survive the day at work'

People would rather talk to their colleagues about sex and money worries than mental health problems, says survey. via BBC News - Health Read More Here..

Steroid abuse 'raising health risk for thousands'

British heart doctors are warning that thousands of people who misuse anabolic steroids are putting themselves at greater risk of heart attacks and strokes. via BBC News - Health Read More Here..

Scientists sniff out Parkinson's disease smell

The breakthrough, inspired by Joy Milne's sense of smell, could lead to the first diagnostic test. via BBC News - Health Read More Here..

Care for all in Kenya

These are the choices faced by many families living in Kenya's slums. Could technology help? via BBC News - Health Read More Here..

Sunday, 17 December 2017

Holiday Weight Gain

17 December 2017 The Holiday Season isn't known for the healthy environment it creates. Three plates of turkey, mashed potatoes, and stuffing, plus dessert has to go somewhere. Surely these calorie dense options lead to weight gain, but is unwanted holiday weight gain really as big of a problem as everyone makes it out to be? Several studies have looked into this question and researchers have come to important conclusions.
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Elizabeth Garrett Anderson: Centenary of woman doctor's death

Elizabeth Garrett Anderson was the first woman to qualify in Britain as a doctor. via BBC News - Health Read More Here..

Five secrets of a well-run A&E department

Luton & Dunstable hospital has the best-performing A&E in England. The BBC's Hugh Pym explains why. via BBC News - Health Read More Here..

Saturday, 16 December 2017

The Emerging Neuroscience of Mind-Body Medicine

For years as a hard-nosed neuroscientist, I’ve been baffled by the success of clinical techniques that my wife, Chris Gilbert M.D. Ph.D., has pioneered to diagnose and cure illnesses such as back pain, chronic fatigue, stomach ailments, and recurring respiratory infections.

The reason for my head-scratching is that many of Dr. Chris’s diagnostic tests and therapies involve no technology at all, and are brain-dead simple. The bench scientist and geek in me (sensory physiology/chrono-neurobiology) instinctively rebels against a no-tech approach to anything, let alone medicine.

In an age of biotech marvels such as MRI, gene therapies, and targeted immunotherapies, my inner scientist is certain that no-tech approaches can’t be nearly as effective as modern medical science.

But the maddening fact is, my wife’s techniques do often work—so well in fact—that the bulk of her patients come to her because visits to other doctors who employ the latest drugs, tests, and procedures have failed to yield lasting results.

A cornerstone of Dr. Chris’s approach is a belief that patients’ bodies know more about what is ailing them and how to achieve lasting cures than do the patients’ conscious minds. So although she will start by asking questions of a patient’s mind, such as “What is going on in your life?” she quickly transitions to a dialogue with a patient’s body.

What’s the difference between talking to the mind and talking to the body?

Simple.

When she addresses a patient’s mind, Dr. Chris simply asks the patient a question, but when she addresses the patient’s body she will first coach the patient to “become” the body part that is suffering, such the lower back, then to respond in the first person as the lower back.

I once witnessed (with the patient’s permission) a dialogue between Dr. Chris and an ailing back that went like this:

Dr. Chris: Welcome to my office, Back, tell me how you feel.

Back: I am stiff all the time, with shooting pains. After the drive home from work, I get horrible spasms.

Dr. Chris. Thank you, Back. Do your spasms usually come after sitting for a long time?

Back: Yes!! I hate, hate, hate sitting.

Dr. Chris: Is there anything else you hate?

Back: I can’t stand my owner’s mother. When we go over for dinner she picks at him endlessly and I get really tense and tight. I want to stay away from that woman!!! I never want to see her again!!

Dr. Chris: Ok, now that I know what you hate, what do you like?

Back: Swimming! I love it when my owner does laps in the pool. I get warm and loose.

After observing such sessions and having been Dr. Chris’s patient myself (for stomach troubles), I have been shocked by how much patient’s bodies “know” what their minds don’t know, and how quickly a dialogue with the body can relieve symptoms.

For example, the patient in the Back-to-Dr.Chris dialogue professed ignorance about what was triggering his back spasms, only to immediately pinpoint specific triggers for his pain (such as sitting and a nagging mother) when he was queried as his back.

And that same patient, who walked into the office with a lower back so stiff that he couldn’t bend at the waist, loosened up almost immediately after the Back-to-Dr.Chris dialogue, as if venting of the true source of back pain (sitting too long and being with his mother too long) in and of itself was therapeutic.

Once I overcame my skepticism that such simple, direct techniques could actually work a lot of the time (although not always), I started asking myself:

How can neuroscience explain the success of Dr. Chris’s brand of mind-body medicine?

I confess that I didn’t have a good answer until recently when I stumbled upon two unrelated sets of research findings more or less at the same time.

The first body of research described implicit memory. It turns out that we are constantly learning things and storing them away in our unconscious without any conscious awareness that we are learning, or indeed, any overt knowledge of what we have learned.

Ken Paller and Joel Voss of Northwestern University, for example, have shown that unconscious learning occurs when test subjects passively observed kaleidoscope images while paying attention to something else. Moreover, those same subjects were able to make correct “intuitive” guesses based upon what they have learned, without having any conscious awareness that they had learned anything in the first place.

This finding, along with a host of similar results from other labs, implies that much of what we ascribe to gut feelings, hunches, or intuition are actually products of unconscious or implicit learning from past experiences. For example, Dr. Chris’s patient with lower back pain probably learned unconsciously that his back tightened up every time he went over to his mother’s house for dinner.

The second body of research that offered clues to the success of Dr. Chris’s methods, concerned the storage of long-term memories in the sensory cortex. These studies suggest that sensory experiences leave lasting memory traces in the very parts of the cerebral cortex that initially activate when the experiences originally occurred.

Putting the implicit learning and sensory memory research together (admittedly something of an intuitive leap) one could conclude that unconscious memories relating to sensations in a particular body part, might be stored in the region of the sensory cortex that activates when that body part experiences sensations.

Below is a brain map that shows the how areas of the body stimulate different areas of somatosensory cerebral cortex responsible that are responsible for processing touch, vibration, pain, and other sensations from different body parts. The somatosensory cortex occupies a gyrus (i.e., ridge) of the brain just behind the central sulcus (i.e, central fold/groove) called the post-central gyrus. Referring to this map, unconscious sensory memories from the back region (as designated by the blue arrow in the diagram below) would be stored near the top of the post-central gyrus, next to the hemispheric fissure that divides the left and right half of the brain.

So, what might be happening when Dr. Chris addresses a patient’s back (vs. the patient themselves) is that she is focusing the patient’s attention on somatosensory memories and associations stored in a particular region of the cerebral cortex and that the local activation in the somatosensory cortex occurs that when she does this helps release memories stored in the “back cortex” that would otherwise have remained unconscious.

True, I have no experimental data (such as fMRI brain scans showing somatosensory activation during Dr. Chris’s dialogues) to support this theory, so for the moment, it remains just a theory.

But at least the scientist in me is less baffled knowing that a plausible explanation for Dr. Chris’s successes in mind-body medicine is out there.

Based on lots of implicit learning accumulated watching Dr. Chris work, my gut intuition is that neuroscience has as much to learn from the success of her methods as she does from neuroscience.

Learn more about Dr. Chris’s methods and my neuro-scientific explanations of them in The listening cure: healing secrets of an unconventional doctor

References

Gandhi, S. (2001). Memory retrieval: Reactivating sensory cortex. Current Biology, 11(1), R32-R34. doi:10.1016/s0960-9822(00)00040-3

Gilbert, C. (2017). Listening Cure : Healing Secrets of an Unconventional Doctor. SelectBooks, Incorporated. ISBN:1590794370

Hasan, M., Hernández-González, S., Dogbevia, G., Treviño, M., Bertocchi, I., Gruart, A., & Delgado-García, J. (2013). Role of motor cortex NMDA receptors in learning-dependent synaptic plasticity of behaving mice. Nature Communications, 4. doi:10.1038/ncomms3258

Voss, J., & Paller, K. (2009). An electrophysiological signature of unconscious recognition memory. Nature Neuroscience, 12(3), 349-355. doi:10.1038/nn.2260

Image via Activedia/Pixabay.

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The family which doesn't feel pain

The experience of six related Italians may help to find a new treatment for people with chronic pain. via BBC News - Health Read More Here..

Vaginal mesh implants: The woman awarded a $57m payout

Ella Ebaugh was awarded a $57m payout after a mesh implant left her disabled. via BBC News - Health Read More Here..

New hope for disabled man's cancer battle

Ian Shaw was sent home to die, but a doctor queried that decision after seeing his story on the BBC. via BBC News - Health Read More Here..

Friday, 15 December 2017

Parents giving children alcohol too young, researchers say

Giving youngsters too many takeaways is also criticised as a health risk by the researchers. via BBC News - Health Read More Here..

Gambling Addiction: Is it as Bad as Cocaine?

Is gambling an addictive pathology that causes changes in the brain and requires treatment? Or is it merely a compulsive behaviour? This question has long kept the medical world confused.

Traditionally, it was thought that addiction could happen only when a person is dependent on some physically existing substance. However, now this traditional way of thinking is changing. The brain seems to have a weakness of getting trapped by either a substance or experience that brings a reward, be it drugs, sex, eating, or gambling. Like addiction to substances, addiction to gambling can affect a person of any background, education level, and level of income. Many celebrities are known to be overindulging in gambling. The list includes Tiger Woods, Ben Affleck, and Pamela Anderson, to name just a few.

Once researchers agreed that pathological gambling exists, the question as to whether it is more like drug addiction or similar to other obsessive-compulsive disorders remained unanswered. Modern research seems to support the idea of higher similarity with substance addiction than with obsessive-compulsive disorder. However, it is entirely possible that pathological gambling is a heterogeneous disorder and thus shares the components of both conditions. Hence, in some people it may be more like an obsessive-compulsion, while in others it is similar to substance dependence.

Functional MRI studies seem to support the view that gambling addiction is more like a substance-abuse disorder. Therefore, in the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) is has been classified as a behavioral addiction. It does not necessarily mean that other types of this disorder do not exist, as this condition is still not fully understood from a medical point of view.

Why should gambling be considered an addiction?

Perhaps due to the absence of any physical substance, addition to experiences like gambling is more challenging to recognize until considerable harm is done. A large number of people addicted to gambling fail to accept this fact. Yet, it is no secret that gambling addiction can ruin life as effectively as substance addiction.

The person involved in gambling gets ‘high’ and finds it difficult to control or limit gambling, which is also characteristic of drugs addiction. Moreover, there are negative emotions similar to withdrawal syndrome when a person is deprived of the gambling activity. And finally, even the medications used to treat substance addiction have shown to be efficient in the management of gambling disorder.

Neural changes in gambling addiction

Any addiction is caused by the combination of several factors such as genetic causes, environmental issues, and social influences and problems.

Mesolimbic and mesocortical dopaminergic pathways are central to motivation, desire, and perception of pleasure. Dysregulation in the mesolimbic pathway (often referred to as reward pathway) is known to play a vital role in the development of addiction.

Research on pathological gambling is still ongoing; this phenomenon is still not fully understood from a neurobiological point of view. It is clear that in pathological gambling multiple neurotransmitter systems (including dopamine, serotonin, norepinephrine, opioid, and glutamate) and various brain regions are implicated (including the amygdala, nucleus accumbens, prefrontal cortex, and insula).

Addiction to gambling is the result of a pathological importance being attached to the activity. High level gambling and substance addicts give excessive motivational significance to the addictive activity. Glutamatergic projections from the prefrontal cortex to the accumbens is thought to be the neural pathway involved in provoking gambling seeking behavior. This anatomical path is found to play a role in most forms of behavior dysregulation and addiction. The prefrontal accumbens pathway is vital to providing motivational or reward salience and goal-directed behavior.

A few years ago, fMRI was used to compare the brain activity of people occasionally involved in gambling against those known to be suffering from pathological gambling. The scans demonstrated a significant difference in blood-oxygen-level dependent (BOLD) signals between the two groups in the superior temporal regions, inferior frontal, and thalamic region. Those pathologically addicted to gambling showed a distinct frontoparietal activation pattern triggered by gambling-related cues, which is known to play a role in the addiction memory network.

Treatment of pathological gambling

Though the prevalence of pathological gambling is much higher than many psychiatric disorders like schizophrenia, there is a lack of studies and trials aimed at finding the appropriate treatment for this problem. Still, there is a small number of studies that seem to favor the effectiveness of pharmacological treatment.

Drugs that have shown the ability to modulate dopaminergic transmission in the mesolimbic pathways, like opioid-receptor antagonists (e.g., naltrexone) have demonstrated effectiveness in trials. Antidepressants and mood stabilizers are the groups of drugs that may prove to be effective in overcoming gambling addiction.

Various clinical investigations have also examined the effectiveness of non-pharmacological treatments. It has been demonstrated that cognitive-behavioural therapy (CBT) could be one such option. Some studies have also investigated the usefulness of video conferencing for ongoing supervision, and the use of congruence couple therapy and therapies that have a holistic approach to the problem.

To sum up, the latest neurobiology studies confirm that gambling addiction is similar to substance addictions. It may also have serious implications for the person involved, yet little is known regarding how to effectively treat this problem.

References

Blanco, C., Moreyra, P., Nunes, E. V., Sáiz-Ruiz, J., & Ibáñez, A. (2001). Pathological gambling: addiction or compulsion? Seminars in Clinical Neuropsychiatry, 6(3), 167–176. doi:10.1053/scnp.2001.22921

Grant, J. E., & Kim, S. W. (2006). Medication Management of Pathological Gambling. Minnesota Medicine, 89(9), 44–48.

Holden, C. (2001). “Behavioral” Addictions: Do They Exist? Science, 294(5544), 980–982. doi:10.1126/science.294.5544.980

Kalivas, P. W., & Volkow, N. D. (2005). The Neural Basis of Addiction: A Pathology of Motivation and Choice. American Journal of Psychiatry, 162(8), 1403–1413. doi:10.1176/appi.ajp.162.8.1403

Leung, K. S., & Cottler, L. B. (2009). Treatment of pathological gambling. Current Opinion in Psychiatry, 22(1).  doi:10.1097/YCO.0b013e32831575d9

Miedl, S. F., Fehr, T., Meyer, G., & Herrmann, M. (2010). Neurobiological correlates of problem gambling in a quasi-realistic blackjack scenario as revealed by fMRI. Psychiatry Research: Neuroimaging, 181(3), 165–173. doi:10.1016/j.pscychresns.2009.11.008

Potenza, M. N. (2013). Neurobiology of gambling behaviors. Current Opinion in Neurobiology, 23(4), 660–667. doi:10.1016/j.conb.2013.03.004

Potenza, M. N. (2014). The neural bases of cognitive processes in gambling disorder. Trends in Cognitive Sciences, 18(8), 429–438. doi:10.1016/j.tics.2014.03.007

Urban, N. B. L., & Martinez, D. (2012). Neurobiology of Addiction:Insight from Neurochemical Imaging. Psychiatric Clinics, 35(2), 521–541. doi:10.1016/j.psc.2012.03.011
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Booze calculator

How does your drinking measure up to the average from countries around the world? via BBC News - Health Read More Here..

Thursday, 14 December 2017

Up to 650 000 people die of respiratory diseases linked to seasonal flu each year

Up to 650 000 deaths annually are associated with respiratory diseases from seasonal influenza, according to new estimates by the United States Centers for Disease Control and Prevention (US-CDC), WHO and global health partners. via WHO news Read More Here..

Up to 650 000 people die of respiratory diseases linked to seasonal flu each year

Up to 650 000 deaths annually are associated with respiratory diseases from seasonal influenza, according to new estimates by the United States Centers for Disease Control and Prevention (US-CDC), WHO and global health partners.

This marks an increase on the previous global estimate of 250 000-500 000, which dates from over ten years ago and covered all influenza-related deaths, including cardiovascular disease or diabetes. The new figures of 290 000-650 000 deaths are based on more recent data from a larger, more diverse group of countries, including lower middle-income countries, and exclude deaths from non-respiratory diseases. via WHO news Read More Here..

Haemophilia A trial results 'mind-blowing'

Doctors use gene therapy to correct the defect that causes haemophilia A. via BBC News - Health Read More Here..

Is size important when it comes to wine glasses?

If your wine was served in a smaller glass, would you drink less of it? via BBC News - Health Read More Here..

Haemophilia patient: How gene therapy has changed my life

How pioneering gene therapy has given a haemophilia patient a new lease of life. via BBC News - Health Read More Here..

Wednesday, 13 December 2017

BMJ study: Patients treated by older physicians (60 and older) had higher mortality vs. younger physicians (39 and younger)

From BMJ:

The researchers evaluated a 20% random sample of Medicare fee-for-service beneficiaries aged 65 and older admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians.

Main outcome measures 30 day mortality and readmissions and costs of care.

The study included 700,000 admissions managed by 18,800 hospitalist physicians (median age 41).

Patients’ adjusted 30 day mortality rates were:

- 10.8% for physicians younger than 40
- 11.1% for physicians aged 40-49
- 11.3% for physicians aged 50-59
- 12.1% for physicians aged 60 and older

See the figure here: http://www.bmj.com/content/bmj/357/bmj.j1797/F1.large.jpg

Note: Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality.

Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients. The calculated "number need to harm (NNH)" was 77.

Patients treated by physicians aged younger than 40 had 0.85 times the odds of dying or an 11% lower probability of dying compared with patients cared for by physicians aged 60 and older. This difference in mortality is comparable with the impact of statins for the primary prevention of cardiovascular mortality on all cause mortality (odds ratio of 0.86) or the impact of β blockers on mortality among patients with myocardial infarction (incidence rate ratio of 0.86), thus indicating that the observed difference in mortality is not only statistically significant but arguably clinically significant.

The adjusted risk difference of 1.3 percentage points suggests that for every 77 patients treated by doctors aged 60 and older, one fewer patient would die within 30 days of admission if those patients were cared for by physicians aged 39 and younger.

Though clinical skills and knowledge accumulated by more experienced physicians could lead to improved quality of care, physicians’ skills might become outdated as scientific knowledge, technology, and clinical guidelines change.

Older physicians might have decreased clinical knowledge, adhere less often to standards of appropriate treatment, and perform worse on process measures of quality with respect to diagnosis, screening, and preventive care.

References:

Physician age and outcomes in elderly patients in hospital in the US: observational study. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1797 (Published 16 May 2017)
Cite this as: BMJ 2017;357:j1797

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World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses

World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses via WHO news Read More Here..

How Does Starting School Early Impact Educational Attainment?

A singular cutoff point for school entry results in age differences between children of the same grade. In many school systems, September-born children, begin compulsory education in September of the year in which they turn five, making them relatively older than summer born children who begin school aged four.

Research on these annually age-grouped cohorts reveal relative age effects (RAEs) that convey the greater achievements accrued by the relatively old (RO) students compared to the relatively young (RY) students. RAEs are pervasive. Across OECD countries, in fourth grade, RY students scored 4–12% lower than RO students, while in eight grade the difference was 2–9% lower. RAEs are most evident in early formal education and can diminish as children mature. In 2016 for instance, Thoren, Heinig, and Brunner published a study on three grades attending public school in Berlin, Germany, and showed that the RAE in disappeared for reading by grade 8 and was reversed for math in favor of RY students.

Investigating the mechanisms involved is important because RAEs can remain evident in high-stakes exams taken at the end of compulsory education. RAEs may impact educational attainment, which is defined as an individual’s highest educational qualification (i.e., compulsory schooling, apprenticeship, or university education). For example, research by Sykes, Bell, and Rodeiro found that 5% less August-born GCSE students than September-born GCSE students chose at least one A level. Likewise, August-born students were 20% less likely to progress to university than September-born students. RO students also outperformed RY students on college admission tests to a university in Brazil, which significantly impacted the probability of being accepted to that university. Moreover, in Japan the percentage of graduates (aged 19–22 and 23–25) was two points greater for those born in April than those born in March. Collectively, these findings indicate that RAEs impact educational attainment because of their direct link to students’ acceptance to higher education. Since much of children’s development occurs within compulsory education, a natural question is whether educators act to alleviate or exacerbate RAE.

RAEs emerge primarily because of within-group maturity differences among RO and RY children (age-at-school-entry effect). RO children, have a one-year developmental advantage over RY children when they sit exams (age-at-test effect). Based on these advantaged test scores and maturation, RO children receive special opportunities from educators to excel in school. Using attainment, program participation, and attendance data from 657 students aged 11–14 from a secondary school in North England, a study by Cobley, McKenna, Baker and Wattie found that RO students were more likely than RY students achieve high scores across various subjects and be admitted to gifted programs. Even if RO students accepted to gifted programs are not actually gifted, the prestige of attending such programs would help them to foster strong positive self-esteem, which can persist over time. In turn, RO students may experience enhanced learning and praise long after small age differences are important in and of themselves.

Conversely, teachers lower their expectations of RY students because RY students appear less developed and intelligent than RO students. Interestingly, having RO classmates can prompt a spillover effect that boosts RY students’ grades, but also increases the probability that RY students will to be pathologized. This research suggests that RAEs emerge as a consequence of maturity differences but are maintained by the magnitude and persistence of social factors, such as educator-student interaction. Another study also reported RAEs in the diagnosis and treatment of ADHD in children aged 6–12 in British Columbia. Incorrect diagnosis can unnecessarily limit RY students’ academic performance by diminishing their self-esteem and task involvement, which are school achievement predictors.

If these inequalities decline over time, the influence of RAE on educational attainment is arguably minimal. However, if relative advantages such as skill accumulation persist in favor of RO students throughout formal education, RAEs translate into academic disadvantages for RY students. For instance, RY students’ negative self-perceptions of academic competence and learning disability can mediate the relationship between depressive symptoms and school dropout in adolescence. In turn, lack of formal education or poor academic performance makes entry to higher education arduous. Research illustrates with 16-year-old RY students scoring 0.13 standard deviations lower than RO students. This test score predicted that RY students would have a 5.8% higher potential dropout rate from high school and a consequently 1.5% lower college admission rate than RO students. Initial gains for RO students partly explain why they have a 10% greater probability of attending top-ranking universities and why they are more likely to graduate from university than RY students.

Research on the impact of RAE on educational attainment is not as straightforward as discussed thus far. Cascio and Schanzenbach used experimental variation by randomly assigning students to classrooms. Results showed improved test scores for RY students up to eight years after kindergarten and an increased probability of taking a college-entry exam. These positive spillover effects are evident when RY students, in a relatively mature peer environment, strive to catch up with higher-achieving RO students and end up surpassing them. Since RO students may strain under the expectations placed on them to be top of the class, RY students have an opportunity to catch up. Alternatively, RO students may not have the same incentive as RY students to work hard for academic success because RAEs already work in their favor. To overcome RAEs and succeed academically, RY students need greater persistence and attention than RO students in their schoolwork, which helps them gain a motivated mindset that benefits lifelong learning. For example, RY students in high school are more likely than RO students to study and compensate for poor academic achievement in middle school.

At a university in Italy, RY students obtained better grades than RO students. This reversal effect was also reported at university in the UK. The researchers postulated that due to RAEs, the RY students developed social skills more slowly. Therefore, RY students had less active social lives and more time to concentrate on educational attainment. The impact of RAEs on educational attainment is, subsequently, probabilistic not deterministic. Although research by Abel, Sokol, Kruger, and Yargeau indicated that RAEs do not affect the success of either RO or RY students’ university applications, they reported that more RO than RY students applied to medical school. In addition, Kniffin and Hank’s study did not find RAEs that influence whether a university student obtains a PhD. These two studies suggest that RAEs do not have such an important influence on college acceptance or educational attainment once in college. Instead, RAEs are a salient influence in so far as students in compulsory education obtain the necessary grades to apply to university in the first place.

The acquisition of higher mental functions and schooling over time helps normalize the student population by minimizing the attainment gap between RO and RY students, which helps explain why RAEs lessen in university. In addition, universities are often learning environments with great diversity in age (i.e., mature and repeat students), culture (i.e., international students), and academic achievement (i.e., doctorate/master’s students). Perceived developmental parities are inherently less important in university because classroom composition becomes heterogeneous, mitigating and masking the remaining relative age differences. Given this knowledge, greater classroom heterogeneity could be applied to compulsory education to minimize RAEs. Students in mixed-grade classrooms in Norwegian junior high schools, for example, outperformed students in single-grade classrooms on high-stakes school finishing exams. With this classroom composition, it is not disproportionately skewed in favor of younger/older students, the losses for RO students following class mixing would not outweigh the gains of the RO students. With more heterogenous classes, educational attainment could subsequently become less influenced by RAEs and a more equalized pursuit.

Since mitigating the impact of RAE on educational attainment depends partly on the strength of compensating investments such as classroom environments, streaming remains controversial. Academic streaming involves separating students according to innate ability. In reality, streaming is based on students’ prior academic performance, which is an imperfect measure of ability that can lead to misallocations. Streaming in early education can be particularly unfair because RY students do not get the opportunity to more closely approximate older classmates’ mental and physical development when sitting exams. In Germany for instance, being relatively old increased test scores by 0.40 standard deviations, increasing the probability of attending the highest secondary school track (gymnasium) by 12%. RY students are also at risk of being unfairly streamed into lower-ability classes because they are more likely than RO students to be diagnosed with behavioral problems and learning disabilities. Streaming thereby provides students with unequally differentiated educational experiences of teaching, competition, and opportunity that limit their academic exposure. Therefore, postponing streaming can reduce the impact of RAEs on educational attainment by ensuring that any developmental gaps have time to narrow.

Unequal educational experiences can limit RY students’ educational attainment. In 2015, the average number of 25–64-year-olds with tertiary education was greater for countries who exhibit almost no streaming, such as Ireland (42.8%), compared to the OECD average (35%). Is it the case that streaming at multiple stages can rectify initial misallocations while still enhancing academic achievement? In Austria, children are streamed in grade five (aged ten) and in grade nine (aged fourteen). In one study, RY students in grade five were 40% less likely to be streamed into higher classes, but the second streaming, in grade nine, helped mitigate RAEs by giving students the opportunity to upgrade to a higher stream. In a complex interplay, streaming and RAEs can reinforce and be reinforced by existing socioeconomic inequalities. In this vein, the researchers concluded that RAEs only disappeared for students with favorable parental backgrounds in the second streaming. In contrast, RY students with unfavorable parental backgrounds were 21% less likely than RO students to move to a high-ranking school. As previously mentioned, learning at the wrong academic level can strain academic achievement and reduce the chances of continuing to higher education.

Socioeconomic status is the extent to which learning opportunities are disadvantaged as a result of low-income. Socioeconomic status can exacerbate the impact of RAEs on educational attainment. Huang and Invernizzi’s research examined a cohort of 405 students in a high poverty, low performing school from the beginning of kindergarten until the end of grade two. Results concluded that early-age literacy achievement gaps between RO and RY students narrowed over time but did not fully close by the end of grade two. Similarly, a Madagascar-based study by Galasso, Weber, and Fernald indicated that differences in home stimulation are dependent on the wealth gradient and accounted for 12–18% of the predicted gap in early outcomes between advantaged and disadvantaged children. At least in early education, these findings suggest that diminished academic performance and exacerbated RAEs are in direct proportion to socioeconomic status. Thus, greater flexibility regarding age at entry in compulsory schooling could help lessen the impact of RAE on academic performance.

Suziedelyte and Zhu published a “Longitudinal Study of Australian Children” and reported that starting school early benefits children from low-income families who, compared to children from high-income families, have limited access to learning resources at home and formal pre-school services. However, a three-month postponement of the cutoff enrollment date (increasing grade age) can increase both academic success and the likelihood of repeating a grade. Similarly, a one year delay in school enrollment (redshirting) can produce a 0.303 standard deviation decrease in test scores and lead to significantly lower math scores for students identified with a disability when compared to nonredshirted students with disability. These mixed findings suggest that equalizing educational attainment opportunities among RO and RY students, by implementing a flexible entry cutoff point, varies as a function of individual difference. Therefore, managing and mitigating RAEs requires greater sensitivity to confounds such as socioeconomic status.

The impact of starting school early on educational attainment is mediated by social factors, school policy, and socioeconomic factors, resulting in individual differences in learning outcomes. RAEs fade throughout formal schooling and can even reverse in higher education. The relative age phenomenon, nevertheless, caveats that ascribing merit to students based on relative age can lead to the provision of unequal learning opportunities and harmful pathologies. Unfortunately, the mechanisms that underpin the impact of RAEs on educational attainment are currently quite speculative and inconclusive. In this sense, existing findings warrant further empirical research and reveal the need for more comprehensive methods for determining an appropriate school entry cutoff point.

References

Abel, E., Sokol, R., Kruger, M., & Yargeau, D. (2008). Birthdates of Medical School Applicants. Educational Studies, 34(4), 271-275. http://dx.doi.org/10.1080/03055690802034302

Barrett, P., Davies, F., Zhang, Y., & Barrett, L. (2015). The Impact of Classroom Design on Pupils’ Learning: Final Results of a Holistic, Multi-Level Analysis. Building And Environment, 89, 118-133. http://dx.doi.org/10.1016/j.buildenv.2015.02.013

Bedard, K., & Dhuey, E. (2006). The Persistence of Early Childhood Maturity: International Evidence of Long-Run Age Effects. Quarterly Journal Of Economics, 121(4), 1437-1472. doi:10.1162/qjec.121.4.1437

Billari F., & Pellizzari, M. (2011). The Younger, the Better? Age-Related Differences in Academic Performance at University. Journal Of Population Economics, 25(2), 697-739. doi:10.1007/s00148-011-0379-3

Cascio, E., & Schanzenbach, D. (2016). First in the Class? Age and the Education Production Function. Education Finance And Policy, 11(3), 225-250. doi:10.1162/edfp_a_00191

Cobley, S., McKenna, J., Baker, J., & Wattie, N. (2009). How Pervasive are Relative Age Effects in Secondary School Education?. Journal Of Educational Psychology, 101(2), 520-528. doi:10.1037/a0013845

Crawford, C., Dearden, L., & Greaves, E. (2011). “Does When You are Born Matter? The Impact of Month of Birth on Children’s Cognitive and Non-Cognitive Skills in England.” IFS Briefing Note: BN 122, Institute of Fiscal Studies.

Crawford, C., Dearden, L., & Meghir, C. (2010). When You Are Born Matters: The Impact of Date of Birth on Educational Outcomes in England. Institute for Fiscal Studies, 2-4, 21-22. doi:10.1920/wp.ifs.2010.1006

Elder, T., & Lubotsky, D. (2009). Kindergarten Entrance Age and Children’s Achievement: Impacts of State Policies, Family Background, and Peers. Journal Of Human Resources, 44(3), 641-683. doi:10.1353/jhr.2009.0015

Fortner, C., & Jenkins, J. (2017). Kindergarten Redshirting: Motivations and Spillovers Using Census-Level Data. Early Childhood Research Quarterly, 38, 44-56. doi:10.1016/j.ecresq.2016.09.002

Galasso, E., Weber, A., & Fernald L. C. H., (2017). Dynamics of Child Development: Analysis of a Longitudinal Cohort in a Very Low Income Country. The World Bank Economic Review, lhw065.

Huang, F., & Invernizzi, M. (2012). The Association of Kindergarten Entry Age with Early Literacy Outcomes. The Journal Of Educational Research, 105(6), 431-441. doi:10.1080/00220671.2012.658456

Kniffin, K., & Hanks, A. (2015). Revisiting Gladwell’s Hockey Players: Influence of Age Effects upon Earning the PhD. Contemporary Economic Policy, 34(1), 21-36. doi:10.1111/coep.12114

Leuven, E., & Rønning, M. (2014). Classroom Grade Composition and Pupil Achievement. The Economic Journal, 126(593), 1164-1192. doi:10.1111/ecoj.12177

Matta, R., Ribas, R., Sampaio, B., & Sampaio, G. (2016). The Effect of Age at School Entry on College Admission and Earnings: A Regression-Discontinuity Approach. IZA Journal Of Labor Economics, 5(1). doi:10.1186/s40172-016-0049-5

Matsubayashi, T., & Ueda, M. (2015). Relative Age in School and Suicide among Young Individuals in Japan: A Regression Discontinuity Approach. PLOS ONE, 10(8), e0135349. doi:10.1371/journal.pone.0135349

Morrow, R., Garland, E., Wright, J., Maclure, M., Taylor, S., & Dormuth, C. (2012). Influence of Relative Age on Diagnosis and Treatment of Attention-deficit/hyperactivity Disorder in Children. Canadian Medical Association Journal, 184(7), 755-762. doi:10.1503/cmaj.111619

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Hannah Witton: 'Why doesn't anyone wear condoms on TV?'

Sex vlogger Hannah Witton asks why there isn't more safe sex on TV and whether it matters. via BBC News - Health Read More Here..

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Natalie Toper tells her story of why she wears a stoma and how it has affected her daily life. via BBC News - Health Read More Here..

Tuesday, 12 December 2017

Vigorous Exercise May Help Slow Parkinson's Disease

HealthDay news image

Source: HealthDay via Exercise and Physical Fitness New Links: MedlinePlus RSS Feed Read More Here..

Heat-not-burn tobacco 'is a health risk'

The new tobacco products are safer than cigarettes but not risk-free, say UK experts. via BBC News - Health Read More Here..

Trafficking of pills used by suicide bombers soars in Sahel

The UN's drugs agency warns smuggling of the opioid tramadol, used by Boko Haram, must be stopped. via BBC News - Health Read More Here..

Diabetes nightmare: A hypoglycemic attack on air

When Alex Ritson's blood sugar dropped, he was glad his team at the BBC World Service knew what to do. via BBC News - Health Read More Here..

Physical assaults on ambulance staff at five-year high

There have been 21 attacks on ambulance staff in the Western Trust area in 2017. via BBC News - Health Read More Here..

Motability car loss 'left me suicidal' says disabled man

Charlie Evans became depressed after his adapted car was taken away following benefit changes. via BBC News - Health Read More Here..

'That's where the babies are suffering'

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Monday, 11 December 2017

The Dangers of American Sexual Prudishness

Is the US the world’s most uptight nation regarding sex? Maybe not the most, but certainly among them. For example, the US has more laws regulating sexual behavior than all European countries combined. US prudishness is so severe as to be deadly. To end sexual violence and harassment against women, something has to change.

Is America the World’s Most Uptight Nation When It Comes to Sex?

Less than half of girls and boys in the US have received the HPV vaccinations that can protect them from deadly cancers. Why? Because HPV is a sexually transmitted infection (STI), and discussing teen sexual activity is taboo. Many doctors refuse to recommend the vaccine because they are uncomfortable discussing STIs.

Related to this prudishness is the view that women’s bodies are purely sexual and therefore all female nudity is provocative and shameful. Even public breastfeeding makes most Americans uncomfortable because a woman’s breast is exposed.

This prudishness about women’s bodies claims to be “protecting” women. At its heart, however, it is about power rather than sex. The “protection” it provides is both seductive and insidious. Seductive, because many women find it comforting to imagine that men are protecting them from danger, even strangers such as legislators—insidious in its implications.

Whom do we protect? Children and adults who are too young, inexperienced, weak, or incompetent to protect themselves. Putting a normal adult woman into this category disempowers her, ensuring that someone else can dictate the most intimate conditions of her life: how she dresses, where she can go alone, whether she has final authority over her own body.

Prudishness also justifies a perceived division between “good” and “bad” women. The former are  modest, compliant and “covered up.” The latter, bold, proud, and independent. That separation buttresses men’s sense that they can treat “bad” women badly. Because the women are “out there,” they can be objectified, attacked, harassed, groped. The result is evident, as the tidal wave of sexual violence and harassment reports continues to grow.

Despite broad recognition of this public health epidemic and dedicated efforts to end sexual violence and harassment, few programs have been successful. The problem is that they are fighting an uphill battle against the prevailing social mores described above. If men are inherently more powerful than women and can define “good” and “bad” women, the only way to end sexual assault and harassment is to convince men they should not assault women. Otherwise, the only option is to mitigate the impact by convincing bystanders to intervene, or training women to defend themselves.

We need a completely new approach. Let’s consider societies with two striking cultural differences from the US. These cultures hold that women are equal to men and that women, from teenhood, should have complete control over their own bodies.

Consider the Kreung society of the lovely Ratanakiri (“Mountain of Jewels”) Province in Cambodia. The Kreung believe that healthy, loving marriages require women who are strong, self-assured, and have self-confidence about their sexuality. Parents help each teen daughter achieve this state by giving her a room of her own. She can invite a boy she likes to spend the night in her room. There, she makes all the rules and reigns supreme. Will they talk the night away? Sleep? Cuddle? Have sex? She alone decides. In this completely secure space, she is free to explore her own sexuality, to discover what pleases her. When she says, “No,” he obeys instantly, without argument or bad feelings. A boy who flouts this rule faces severe penalties from the entire community, as do his parents.

Take another interesting group, the Vanatinai, a small island society off New Guinea. There, women and men are equal in all major aspects of life: decision-making, ritual practices, spiritual power, property holdings, and sexual activity. By working hard to gain goods and giving them away through ritual generosity, anyone of any sex can become one of the authoritative and influential leaders known as “gia”. Everyone is free to engage in sex before marriage, to end a marriage, and to marry as often as, and with whomever, he or she wishes.

The result? Divorce is rare in these societies; sexual violence virtually unknown.

The Takeaway

Sexual violence and harassment are rooted in the very foundations of culture. It is not enough to tell men they should not indulge, or bystanders that they should intervene, or women that they should protect themselves. Ending sexual violence and harassment requires a fundamental shift in cultural attitudes and values, beginning with equality between women and men, and women’s complete control over their own bodies. This change includes ending the putative “protection” of women—including laws to restrict abortion, to regulate women’s attire in ways that are different from those for men, or other social and legal constraints that claim to “protect” but actually disempower and diminish women. Only such basic cultural and legal changes will make it possible to end sexual violence and harassment against women.

References

Cdc.gov. (2017). Sexual Violence: Prevention Strategies. [online] Available here.

Lepowsky, M. (1993). Fruit of the motherland. New York: Columbia University Press.

Mullin, E. The Cancer Vaccine That Too Many People Ignore. (2017). MIT Technology Review, 120 (6), pp.16-17.

Muong, V. (2014). ‘Love huts’ of Ratanakiri minorities: Is a tradition quietly slipping away?. The Phnom Penh Post.

Procida, R. and Simon, R. (2007). Global perspectives on social issues. Lanham, Md.: Lexington Books.

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Paying mothers incentivises breastfeeding, study finds

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Huntington’s breakthrough may stop disease

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Global recall of Lactalis baby milk over salmonella fears

Britain and China are among the countries affected by the recall of baby milk formula products. via BBC News - Health Read More Here..

Vaginal mesh ban 'a retrograde step', surgeons say

Many women benefit from the use of vaginal mesh and they should have a choice, surgeons say. via BBC News - Health Read More Here..

Organ donation: Views sought on new approach

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Anorexic student Averil Hart 'failed by every NHS body'

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Teachers call for ban on energy drinks in schools

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Top five celeb diets to avoid in 2018, according to dieticians

The British Dietetic Association says: "If something sounds too good to be true, it probably is". via BBC News - Health Read More Here..

Sunday, 10 December 2017

Health is a fundamental human right

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.

Almost 70 years after these words were adopted in the Constitution of the World Health Organization, they are more powerful and relevant than ever. via WHO news Read More Here..

Friday, 8 December 2017

Vaccination plea after Halesworth boy's meningitis death

The parents of a boy, six, who died from meningitis B have called on all children to be vaccinated. via BBC News - Health Read More Here..

Mum campaigns for disabled toilets with selfies on the loo

A mum is taking photos of herself on the loo to campaign for disabled toilet facilities. via BBC News - Health Read More Here..

'Pimp My Zimmer' reduces falls

Care home residents in Wales have been decorating their Zimmer frames to make them more identifiable. via BBC News - Health Read More Here..

Uganda ends Marburg virus disease outbreak

Uganda has successfully controlled an outbreak of Marburg virus disease and prevented its spread only weeks after it was first detected, the World Health Organization said on Friday (December 8).

“Uganda has led an exemplary response. Health authorities and partners, with the support of WHO, were able to detect and control the spread of Marburg virus disease within a matter of weeks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. via WHO news Read More Here..