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What’s Personality Got To Do With Us? A Lot

Personality is understood as the consistent features we display in regards to our thinking, feeling, and behavior. It begins to emerge around the age of 3. Prior to that, we refer to the genetically primed aspects of who we are as temperament.

Personality is dynamically formed via multiple inputs from many others. It becomes consolidated in our late teens to early 20’s. Around age 30 or so it becomes relatively fixed.

According to Daniel Siegel personality is deeply rooted in the human mind by the flow of information in the brain and between brains, is created via neural/mental representations during this flow, and interpersonal exchanges shape its formation and maturation (1999).

Siegel further adds that these interpersonal interactions construct our personal interpretations of reality. And according to Siegel, maternal and paternal attachments are fundamental in creating the necessary foundation of intrapersonal and interpersonal development. And he indicates emotions are the primary linkage between our intrapersonal and interpersonal worlds. And I believe this early foundation sets for us a lifelong paradigm.

Our life trajectory involves a series of developmental opportunities to build a healthy sense of self and others. This constructs our self-concept in regards to how others see us and feel towards us. It impacts our sense of self-efficacy, confidence and competence, and how others perceive us as being prosocial, asocial, or antisocial; which I refer to as global personality orientation.

For example, Erik Erickson proposes a series of lifelong psychosocial stages. They consist of the following: Trust or Mistrust; Autonomy or Shame and Doubt; Initiative or Guilt; Industry or Inferiority; Identity or Role Confusion or based on my own clinical observations, Role Diffusion; Intimacy or Isolation; Generativity or Stagnation; Integrity or Despair (Plotnik, 2014). And I dare add an additional stage based on my clinical observations, Transcendence and Relief or Dread and Decay.

From the field of Sociology, I borrow the concept of Perceived Social Value (PSV). This applies to the various roles that all of us enact and the concepts of “front-stage and back-stage personas”. Some refer to this as our private and public selves. As a clinician, I am very interested in the extent of the concordance or disagreement between these selves. Those with disordered personalities tend to show a decided disconnect between the two!

Referring back to the notion of roles, over time, we enact multiple roles, sometimes simultaneously. For instance, I was a child, an adolescent, a male, a college student, an Air Force medic during the Vietnam Conflict. Now I am retired. I’m also a father, grandfather, brother, a former university faculty member and the like. Our personality shapes how well we do or do not in these various roles. Those with disordered personalities exhibit rigidity and dysfunction across the various roles.

So as you can readily see, personality has a heck of a lot to do with who we are, and how we interact with the many others we come in contact with!

Richard G Kensinger, MSW

References

Nevid, J., Rathus, S., & Greene, B. Abnormal psychology in a changing world.

Plotnik, R., & Kouyoumdjian, H. Introduction to psychology.

Siegel, D. (2001). The developing mind. New York: The Guilford Press.

Wolfe, D. Abnormal child psychology. (2010).

Image via VSRao/Pixabay.

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The “Dark Beast” Behind Combat Trauma—a Clinician’s View

This particular article is inspired by my perusal of Lt. Col. Dave Grossman’s “On Killing: The Psychological Cost of Learning to Kill in War and Society” and “Shooting Ghosts” by Thomas J. Brennan and Finbarr O’Reilly. I am a retired clinical psychologist and psychology professor. I also served as an Air Force medic during the Vietnam Conflict. I did not serve “in country”. I served as a medic at Andrews AFB in the emergency room of Malcolm Grow Medical Center. There I witnessed considerable physical trauma. I witnessed death on a number of occasions, some violent, some peaceful. I remember the violent ones.

I also served temporary duty (TDY) at Lackland AFB working with airman stationed in Vietnam, presenting with PTSD and substance abuse disorder (SUD).  As a clinician in Behavioral Health Care, I dealt with folks presenting with multiple psychosocial trauma, including combat Vets from Vietnam.

I’ve not witnessed directly the ghosts of combat. Those who have repeatedly are haunted by those of comrades killed (KIA) and by those who they killed, especially those who are civilians. Thus, they experience what I refer to as “compacted grief”. During war, there is little room and energy to grieve.

I completely agree with Lt. Col. Grossman that most of us possess a natural inclination to not kill other humans. No amount of combat training can prepare soldiers for the realities of war and combat. I see war as an extreme expression of insanity, even when war is deemed by some to be necessary and the participants are “voluntary”. War and combat sear us at the limbic level, a necessary encounter which I refer to as “Dark Beast”. The Vets I have treated and my many clients in BHC have taught me so much about this Beast. The following account here centers on my running commentary as I read “Shooting Ghosts”, using my observing clinical ego.

When I embarked on reading their candid descriptions of encountering repeated episodes of violent death, At times I felt guilty for not having served in Vietnam. I joined the Air Force after my college deferment lapsed once I graduated. I did not really support our endeavor there. I never felt this Conflict to be an urgent and immediate threat to our nation’s integrity. I became a medic so that I would not have to kill anyone, nor would anyone would be killing me. I did therapy with some of the field medics who were confronted with killing. Killing is counterintuitive to our ethical oath to: above all else, do no harm.

From Chapter One, I disagree that “Misfits Go to War”. We join the military for a number of reasons. For the most part, the Armed Forces want servicemen with integrity who join for a higher purpose like serving our country and protecting others. The bonds forged with comrades begin during advanced training and intensifies early in deployment. Individual survival is directly associated within this group that we refer to as our squad. It is this commitment that soldiers go into battle and come back as a group which I refer to as “affiliative aggression”. Soldiers are protecting one another!

The second disagreement is that war and journalism do mix in order to inform the rest of us about the horrors and terrors of war, and the tremendous cost borne by those who directly experience it. And none of us are “fearless and invincible”. In fact, my professional experiences assure me that life is quite precious and tenuous at the same time; so we dearly need to hold onto it! And guns and cameras are valuable tools of the respective trades.

Chapter Three: Ambushed

Now it is kill or be killed by the enemy. Affiliative and defensive aggression is rising. They sustain some injuries and every squad member returns to their outpost. No time for “mental casualties”; the BB is really present for the first time! An RPG creates a concussion suffered by the squad leader.  Back at the outpost “Air Force medics” come to the rescue. Everyone is alive, but are they really? Concussions are quite serious. Each skirmish does not change the outcome of the war; yet indeed changes those who participate!

Chapter Four: Walking Wounded

The human brain consists of about One Trillion nerve cells, and about ½ of our genome is dedicated to the form and function of this organ. Sounds like a lot and many that can be spared. Indeed, the brain is well known for its neuroplasticity! I’m uncertain as well if God has or has not allowed us to contemplate going to war let alone engage in it. Traumatic Brain Injury (TBI) also occurred in Vietnam, not just in our more recent conflicts. Perhaps it is garnering more clinical attention? We know that it is also intimately related to Clinical Depression and PTSD. I agree that repeated combat encounters result in a “kinship and loyalty” that many of us will never know!

Chapter Five: The in-between

The brain and all of our human senses process all of our internal and external experiences. I refer to the brain as a “master accountant”. Much of what we process occurs beneath our conscious awareness.

In fact, there are at least seven streams of awareness. Some are deeply embedded suggesting that we better remember certain experiences more than others to ensure our survival.

Those in combat continue to experience the traumas once confronted repeatedly by the DB! Being back “home” and away from the front lines does not matter. We are genetically primed by our “threat alarm” in responding to perceived and/or real threats by fighting, fleeing, or freezing. Our primary cognitive processes regarding threats pertain to harm, loss, and challenge. We must not ignore them!

Even photographers and journalists are not immune to being harmed or killed! Immunity from stress and trauma is indeed an “illusion”. During adolescence, males exhibit an increase of invincibility (probably due to the significant infusion of testosterone). And there is no “magical cure” for real trauma. And life is more important than what each of us do for a living.

 

Chapter Six: Human Triggers

Another death of a platoon member, who is very experienced in combat; and he is survived by a wife and children, gets a lot of attention. His loss impacts more than this soldiers. And indeed death is all around as the “Dark Beast” possesses an insatiable appetite for “kills and body counts”.

The effects of TBI on the squad leader are apparent. And there is no room for complacency and lapses of concentration! They are becoming human targets and increasingly aware of this reality. The sights, smells, and sounds of violent death are deeply etched in the collective minds of these soldiers. Home for them seems a long way off! The platoon leader earns a Purple Heart. And he feels he doesn’t deserve it. So far, he and his men are alive.

Chapter Seven: Lost Limbs and Skull Tattoos

Another photographer is severely injured having stepped on an IED. It is natural to “dread” the “damaged cargo” carried by the MEDEVAC choppers. Some photojournalists become resigned to this possible occupational fate. There is a growing sense that these soldiers may not ever win the “hearts and minds” of the Afghan civilians despite their best efforts to do so.

Some of the violence and deaths of comrades that these soldiers experience are etched on the largest sense organ—the skin. No time to deal with any of this in a combat zone, no time to grieve! Suppression of trauma from previous combat excursions does not work either! And the photojournalist embedded with this squad begins to question his witness position and “feels predatory, repulsive, and a betrayal of human decency”.

Chapter Fourteen: Coming Undone

The home front is becoming undone. Interpersonal relationships are becoming frazzled. The natural regression after repeated exposure to the “Dark Beast” is taking its toll. All the prescribed psychotropics (chemical cocktails) in the world won’t make that much difference. BTW suicide among combat vets is rising despite priority efforts to prevent them.

Chapter Sixteen: Echoes of Iraq

The Boston Marathon bombing reawakens images of the “DB” on US soil for the second time since the attack on 9-11. Surely there is no safety and security now! Understandably, cemeteries and headstones serve as triggers. For soldiers converting back to civilian life, there exists a natural disconnect between military culture and the civilian role; clinicians refer to this as cognitive dissonance, and it penetrates much deeper than just our thinking!

Advanced combat training does not really train soldiers to kill the designated enemy, only the illusion of them. And the military certainly does not prepare them to kill civilians such as children, women, and the aged. Yet, this happens in actual combat. For example, during the Vietnam Conflict, it is estimated that more civilians were killed than enemy combatants on both sides. This distinction gets lost in the insanity of combat. Yet the civilian-soldier has to come to terms with this reality; and based on having conducted psychotherapy with Vietnam combat Vets, the grief and regret become almost unbearable! I refer to this state as psychosocial death. Sociologist, Erving Goffman, refers to this as “mortification”. Killing the innocent does not reflect affiliative or defensive aggression. To me, it is an adverse consequence of encounters with the “Dark Beast”.

Final Thoughts and Observations

First of all, I express my sincere gratitude to all those who have, do now, and will serve in the Armed Forces; and my gratitude to all the loved ones who endure this journey with them. I want you all to know, that in my clinical view, soldiers do what they do out of affiliative and defensive aggression; they are not predators!

Those who send humans to war need to examine much more closely the human damage done to the participants and family members for whatever gains are earned in doing so.

And it is my clinical observation that group counseling/therapy could be more efficacious in treating those who are haunted by the ghosts of combat. Group therapy can recapitulate the crucial military unit- the squad. This offers a better opportunity for some healing from the repeated exposure to the “Dark Beast”.

Richard G Kensinger, MSW

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The Brain of an Introvert

In the age of social media, networking and global never-ending communication, introverts are often viewed as rather inefficient. They are considered as people who would not happily express their opinion during the staff meetings or actively participate in brainstorming sessions. They are often considered to not be good at multitasking or be particularly charismatic. They are rarely at the center of attention at a party, and they often ignore their smartphones for hours in a row. These days, when we believe that big tasks require the active participation of large groups of people working together, being an introvert could come as a disadvantage.

But don’t discard introverts altogether: some of the most successful people in the world are introverts. Albert Einstein, Bill Gates, and even social media inventor Mark Zuckerberg are all self-confessed introverts. So how do these people who apparently lack some of the basic skills needed for a successful career manage to achieve so much? What makes the brain of an introvert so different and so special?

Being a loner has its upsides and downsides when it comes to health and success

It is well known that personality traits are not just the result of social conditioning – they have more to do with the genetics and brain structure. People are born or inherit specific personality traits quite like they inherit any particular physical parameters and characteristics. These personality traits bring their advantages and disadvantages. Studies have also demonstrated the anatomical difference between the introvert and extrovert brain. Imaging studies have shown the differences in both the grey matter and the white matter volumes in the various parts of the brain, thus confirming that personality traits are hard-wired into the brain.

Introverts do not like prolonged social interactions, and they feel uncomfortable in large social gatherings. Introverts don’t mind remaining isolated for extended periods. They love to think and dream. However, this self-imposed social isolation comes at a price. Lower social interaction increases the risk of certain disorders; it may negatively affect cognitive functioning, increase the risk of metabolic disorders, and negatively impact the immune system.

Extreme social isolation and its negative consequences are well studied. People living in orphanages or imprisoned for prolonged periods may go through periods of mental instability, and some may even experience hallucinations. However, being introverts is different, and self-imposed social isolation may not necessarily indicate idle brain or lack of resilience towards these health issues. The latest research studies show that these periods of being alone may have positive impacts on emotional and work life.

Focus on creativity

One of the benefits of being more focused on own thoughts is the improved creativity. Introverts are more open to different ideas; they may have a higher level of confidence and independence. Introverts are less concerned about what others may think. Studies have shown that prominent feature of both scientists and artists is the dislike for too much of social interaction: avoiding it leaves them with more time to focus on their ideas.

Introverts have more time to perfect their crafts than those who spend most of the time socializing. They have time to make sense of their thoughts and experiences. All this means that they have higher chances of achieving a eureka moment.

However, it should be understood that not every kind of social withdrawal is the same. Some type of non-socializing is an indicator of psychological and physical health issues. Social withdrawal may be due to shyness and anxiety, or it may be due to a dislike of socializing. Both may have a negative impact on health and would not necessarily better the creativity. On the other hand, those who socialize less just by choice (rather than due to anxiety or dislike) are more probable to be healthy and creative.

These findings are important, as earlier it was believed that unsociability can be harmful. Now the researchers demonstrated that unsociability might be even beneficial. Healthy introverts prefer to spend more time alone, but this does not mean a complete social withdrawal. They would usually have just enough of social interaction. Creative people prefer being alone, and at the same time, they spend enough time in the company of others.

The researchers also noticed that cultural differences may play an important role too. For instance, unsociable children in China had more academic problems in comparison to their Western counterparts. However, this difference is becoming less visible due to globalization.

There is a general belief that specific profession demand more sociable personality and extroverts are better in the leadership roles. However, this is not always accurate, and research shows that a lot depends on the collective nature of the employees. Introvert bosses are more successful if the employees are more sociable. On the other hand, extrovert bosses are better in a leadership role if the employees are less proactive.

Meditation, hermits, and health

If we look back into the human history, we understand that self-imposed isolation was commonly practiced by individual members of society. Hermits would practice solitude to achieve nirvana. Daydreaming in the absence of social interactions activates the so-called default mode of the brain. Thus, isolation helps in consolidating the memories and emotions, at least to a certain extent. Isolation helps a person in re-organizing thoughts. Interestingly, when people come out of self-imposed isolation, they are likely to socialize better and more effectively.

Researchers also warn that the boundary between the dangerous isolation and useful solitude is quite blurry. Extreme loneliness could be somewhat harmful or indicative of poor health. Practicing solitude to stay productive and creative does not mean being completely unsocial. On the other hand, there is a real danger for the physical and mental health of those who are never alone. Furthermore, research indicates that introverts have fewer but stronger bonds with others that lead to better satisfaction in life and greater happiness.

If a person does not like to socialize too much, there is nothing wrong with him or her. It is important that the solitude is a person’s choice and not forced upon him/her: even the classical introverts need few good friends.

References

Bowker, J. C., Stotsky, M. T., & Etkin, R. G. (2017). How BIS/BAS and psycho-behavioral variables distinguish between social withdrawal subtypes during emerging adulthood. Personality and Individual Differences, 119, 283–288. doi: 10.1016/j.paid.2017.07.043

Forsman, L. J., de Manzano, Ö., Karabanov, A., Madison, G., & Ullén, F. (2012). Differences in regional brain volume related to the extraversion–introversion dimension—A voxel based morphometry study. Neuroscience Research, 72(1), 59–67. doi: 10.1016/j.neures.2011.10.001

Grant, A., Gino, F., & Hofmann, D. A. (2010). The Hidden Advantages of Quiet Bosses. Harvard Business Review, (DECEMBER 2010 ISSUE). Retrieved from https://hbr.org/2010/12/the-hidden-advantages-of-quiet-bosses

Hatemi, P. K., & McDermott, R. (2012). The genetics of politics: discovery, challenges, and progress. Trends in Genetics, 28(10), 525–533. doi: 10.1016/j.tig.2012.07.004

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Human and Bat Echolocation in the Brain: is it as Good as Vision?

In humans, vision is the major channel for receiving information about the world. The same applies to the majority of animals, even those that are nocturnal and have to rely more heavily on the inputs from other senses. There are, however, exceptions: some mammals use echolocation to construct a picture of their surroundings, effectively using it instead of vision. How effective is this method of gathering information, and can it substitute vision successfully?

Echolocation

Echolocation is used by several kinds of animals for navigation in various environments. Whales, dolphins, and bats emit calls (high-frequency sounds) and then listen to the echoes returned from different objects surrounding them. The distance to objects can be estimated based on the time delay between the production of the call (click) and detection of the echo. Since the sound travels in the air with the speed of 340 m/s, a delay of 2 milliseconds, for instance, would mean that the object/target is about 34 cm away.  In addition, sounds travel faster in water than in the air, making the clicking signals produced by whales of shorter duration than the signals produced by bats. Some echolocation signals produced by dolphins and sperm whales are even audible to humans.

Echolocation and its importance in the animal kingdom have been widely studied. Nature provides remarkable examples of how efficient echolocation can be. Bats easily detect tiny insects several meters away in complete darkness. Some species of bats in China and South America can fish in the darkness using echolocation, detecting ripples on the water surface that are indicative of the presence of fish under the surface. Sperm whales use echolocation to find and catch prey, mostly giant squids, deep in the ocean. These whales can dive to the depth of well over 2 kilometers and navigate through underwater canyons where their prey lives.

Although echolocation can be very efficient, it is not particularly common in the animal kingdom and was, in fact, developed independently by several groups of evolutionarily unrelated species. This is markedly different from vision, which is present in the majority of animals, with mechanisms perfected over millions of years of uninterrupted evolution.

Echolocation and Vision in Bats

If echolocation delivers essentially the same information as vision, can echolocation rely on the brain processes related to the processing of visual information?

To answer this question, scientists have investigated brain mechanisms underlying the processing of echo signals that allow animals to map objects in term of distance and direction.

Recently, an interesting study was conducted in bats with the aim of revealing what is happening in their brain while they fly through a room filled with obstacles (i.e., acoustically reflective plastic cylinders hanging from the ceiling). In order to determine the mechanisms underlying the bats’ navigation around these obstacles, researchers performed simultaneous chronological neural recordings.

The results show that the bats adjusted their flight and sonar behavior in order to respond to the echoes coming from the objects in the room. The objects’ positions were changing across the recording sessions, and bats started their flight from different start points to make sure that they didn’t rely on spatial memory from previous sessions and used only echo feedback to navigate.

The most important finding was the identification of the brain region that helped the animals to locate the objects in their environment. Echolocation signals were processed in the superior colliculus, a structure located in the midbrain. The superior colliculus consists of several layers that respond to different kinds of stimuli. Deeper layers of the superior colliculus are known to be involved in the processing of visual information. Thus, it seems that echolocation may indeed help animals to obtain a picture of their environment that is as authentic as the picture received through visual channels.

Echolocation and Vision in Humans

According to scientists, echolocation is not a phenomenon completely alien to humans. It seems that some blind individuals can be trained in echolocation.

Using this technique, they can locate objects by generating mouth clicks and listening to their echoes. The returned echoes can provide them with important information such as position, distance to and even the size or shape of the objects.

Several studies were conducted in order to determine the underlying neural mechanisms involved in human echolocation. One study investigated two individuals skilled in echolocation, one early and one late blind. The authors of the study measured brain activity in both participants while they were listening to their own echo sounds. They compared brain activity with clicks that produced echoes with the brain activity of control sounds that did not result in echoes.

It turned out that the processing of echo sounds activates brain regions that are typically associated with vision rather than hearing.  More specifically, echo signals were processed in the visual cortex (rather than in superior colliculus like in bats and other echolocating animals). However, the processing of visual information in humans is centered around the visual cortex rather than the superior colliculus, as the human visual cortex has significantly expanded compared to most animals.

Thus, in both animals and humans, the information received through echolocation is processed in those regions that are also predominantly responsible for the processing of visual information. The curious examples of human echolocation are a perfect illustration of the plasticity of our brain and its ability to adapt to changing circumstances (blindness in this case).

A recent publication on echolocation in humans reviewed the applications of this phenomenon as well as the processes occurring in the brain of echolocation experts (i.e., individuals that are skilled in echolocation). They have reported that echolocation may enable blind people to sense small variations in the location, size, and shape of objects, or even to distinguish different materials the objects are made of, simply by listening to the echoes of their own mouth clicks.

It seems that echolocation may be perfected by blind individuals to facilitate the handling of daily tasks and achieving a higher degree of independence. Based on neuroimaging studies, the review confirmed that the processing of input signals from echoes activates the visual cortex, a brain part that would normally support vision in the sighted brain.

References:

Watwood, S.L., Miller, P.J., Johnson, M., Madsen, P.T., Tyack, P.L. (2006). Deep-diving foraging behaviour of sperm whales (Physeter macrocephalus). Journal of Animal Ecology. 75(3): 814-825. DOI: 10.1111/j.1365-2656.2006.01101.x

Kothari, N.B., Wohlgemuth, M.J., Moss, C.F. (2018). Dynamic representation of 3D auditory space in the midbrain of the free-flying echolocating bat. Elife. pii: e29053 doi: 10.7554/eLife.29053.

Thaler, L., Arnott, S.R., Goodale, M.A. (2011). Neural correlates of natural human echolocation in early and late blind echolocation experts. PLoS One.  6(5): e20162. doi: 10.1371/journal.pone.0020162.

Thaler, L., Goodale, M.A. (2016). Echolocation in humans: an overview. Wiley interdisciplinary reviews. Cognitive science. 7(6): 382-393. doi: 10.1002/wcs.1408.

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Addictive behavior is a major global health concern. Addiction is commonly defined as the repetitive use of substances or a repetitive pattern of behaviors that are harmful. It is believed that addiction is a brain disorder, meaning that it is caused by the impact of drugs or other addictive substances/influences on the brain and it can be modified by different environmental factors.

The presence of specific variants of some genes may promote or decrease the chances of developing an addiction. According to scientists, genetic factors may play an important role in determining both the vulnerability to addiction and the response to treatments aimed to cure addiction.

The Brain and Genetics in Addictive Behavior

One group of researchers demonstrated that polymorphisms in the genes encoding for opioid receptors and opioid ligands, and more specifically the MOPR gene (OPRM1), is associated with drug addiction. It has been found that one variant of this gene contributes to alcoholism and heroin addiction.

Another study has found that carriers of the same gene variant experience a more pronounced sensitivity to pain and decreased analgesic response to opioids, which means that they require higher doses of morphine in the management of pain, such as pain associated with cancer.

Heroin and Opioids

Some authors underlined that addiction to MOPR agonists, including heroin, has become epidemic in the 21^st century. According to the same authors, the endogenous opioid system interacts with other neurotransmitter systems in the brain. More precisely, opioid receptors regulate the release of dopamine and serotonin, neurotransmitters with important roles in mood.

Additionally, the opioid system seems to interact with noradrenergic, GABAergic, and glutamatergic pathways, as well as with neural growth factors. Furthermore, these studies indicate that chronic exposure to opiates alters gene expression in the brain, and this causes long-term changes in neuronal networks.

Activation of opioid receptors leads to changes in the expression of genes in the above-mentioned neurotransmitter pathways. Variations in the genes of those pathways may determine whether someone is more prone to the development of opiate addiction.

Cocaine

One very recent study published this year revealed that the use of cocaine and cocaine addiction are associated with certain variants of the glucocorticoid receptor gene, along with lower expression of this gene.

More specifically, the authors of the study compared the expression level of this gene in chronic cocaine users and healthy controls. Apart from significantly lower gene expression in the cocaine users, the carriers of some gene variants were at increased risk of cocaine addiction. In addition, they scored higher on depression scales.

Dopamine

It seems that the major challenge in understanding and treating addictive disorders is understanding why some individuals develop addiction while others do not. According to research findings, whether or not a person will become addicted depends largely on genetic factors, which contribute ~50% of the risk for addiction.

The processes in our brain are also important. It is well established that the rewarding effects of drugs and addictive substances, in general, are based on their ability to increase the level of dopamine in the brain. Accordingly, imaging studies have shown that individual variations in brain circuits modulated by dopamine, including circuits involved in the mechanisms of reward, contribute to the inter-individual variability in the vulnerability to addiction. Thus, it seems that the roles of genetic factors and brain pathways in the addiction may be intertwined via dopamine.

Alcohol and tobacco

Apart from drug addiction, addiction to alcohol seems to depend on genetics and is influenced by heritage. A recent study has investigated the effects of parental drinking on the use of alcohol in young adults. More than 3500 adolescents and their parents have been included in this prospective research. As results have indicated, young adults whose parents are moderate or high alcohol consumers are more prone to alcohol consumption than those young adults whose parents don’t consume alcohol or consume it in low quantities.

Alcohol and tobacco use represent leading global health risks, which are responsible for 3.3 and 6 million premature deaths per year respectively, according to the World Health Organization. Genetic factors were estimated to contribute 40-60% and 40-85% to the development of alcohol and tobacco addictions respectively.

Finding out which genetic variants are associated with alcohol and tobacco addictions would be an important step in understanding their underlying mechanisms and developing the effective therapies. Over the last years, Genome-Wide Association Studies (GWAS) have been performed in order to elucidate the role of certain genes and their variants in alcohol and tobacco use. These studies have recognized that single nucleotide polymorphisms (SNP, i.e., gene variants with a difference in a single nucleotide) are important for developing these addictions.

For alcohol addiction, SNPs include polymorphisms in the KLB gene, as well as in the alcohol dehydrogenase gene cluster. In the latter, different variations of genes differently influence the metabolism of alcohol. In the case of tobacco use, the most evident variations have been detected in the nicotinic acetylcholine receptor subunit genes cluster.

However, only a small number of common genetic variants have been studied, and they account for a modest proportion of alcohol and nicotine addiction heritability. Thus, further investigation into the role of low frequency and rare genetic variants is required in order to fully understand the heritability of both alcohol and tobacco use.

In Sum

Considering all of these facts together, it seems that genetics does indeed play an important role in the development of addiction to substances such as opioids, alcohol, and tobacco. Some of these factors include differences in gene expression and gene variants in brain neurotransmitter pathways. Further research is needed in order to develop working strategies for treating heritable addictions.

References

Kreek, M.J., Levran, O., Reed, B., Schlussman, S.D., Zhou, Y., Butelman, E.R. (2012). Opiate addiction and cocaine addiction: underlying molecular neurobiology and genetics. Journal of Clinical Investigation. 122(10): 3387-3393. DOI: 10.1172/JCI60390

Shi, Q., Cleeland, C.S., Klepstad, P., Miaskowski, C., Pedersen, N.L. (2010). Biological pathways and genetic variables involved in pain. Quality of Life Research. 19(10): 1407–1417. doi: 10.1007/s11136-010-9738-x

Reed, B., Butelman, E.R., Yuferov, V., Randesi, M., Kreek, M.J. (2014). Genetics of opiate addiction. Current Psychiatry Reports. 16(11): 504. doi: 10.1007/s11920-014-0504-6

Schote, A.B., Jäger, K., Kroll, S.L., et al. (2018). Glucocorticoid receptor gene variants and lower expression of NR3C1 are associated with cocaine use. Addiction Biology. doi: 10.1111/adb.12632

Volkow, N.D., Wang, G.J., Fowler, J.S., Tomasi. D. (2012). Addiction circuitry in the human brain. Annual Review of Pharmacology and Toxicology. 52: 321-336. DOI: 10.1146/annurev-pharmtox-010611-134625

Mahedy, L., MacArthur, G.J., Hammerton, G., et al. (2018). The effect of parental drinking on alcohol use in young adults: the mediating role of parental monitoring and peer deviance. Addiction. doi: 10.1111/add.14280

Marees, A.T., Hammerschlag, A.R., Bastarache, L., et al. (2018). Exploring the role of low-frequency and rare exonic variants in alcohol and tobacco use. Drug and Alcohol Dependence. 188: 94-101. doi: 10.1016/j.drugalcdep.2018.03.026

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Glioblastoma Treatment: New Promising Developments

Cancer is one of the top leading causes of mortality globally. The growing prevalence of the disease has to do with both our changing environment and longer lifespan. It is said that if all humans lived for 200 years, most people would develop cancer at some time in life. Thus, finding a cure for cancer is vital for longevity

Cancer is the unregulated growth of one or another type of cells. In the case of glioblastoma, it is the unchecked growth of glial cells in the brain. Fortunately, brain cancers are less common in comparison than those found in other parts of the body. However, when they occur, they are difficult to treat.

Glial cells are a group of cells that have varied functions in the brain. In the past, they were thought to merely be glue cells that help to keep neurons at the place. But now it is understood that glial cells have many other functions, and help to maintain brain health. They do the cleaning, repair, and maintenance, and also play a role in the local immunity.

A glioblastoma is a rare form of cancer—its occurrence is about 10 in 100,000. Among the brain cancers, however, glioblastomas account for 15% of all cases. It is one of the most aggressive types of brain cancers. Thus, even with the best of treatment, most patients will barely survive one and a half years. Very small numbers of patients can expect to live longer than three years, and less than 5% live up to 5 years.

Despite the progress in the treatment and management of other forms of cancer, only a few positive glioblastoma treatment developments were reported in the last decades. For more than half a century, treatment of brain cancers remains based on surgery and chemotherapy. Usually, the surgeon would remove the affected part of the brain, and then they would try to suppress the remaining cancer cell with highly toxic chemotherapeutic agents. This approach has not been working well for glioblastoma.

These days, thanks to advancements in personalized medicine and a better understanding of cellular physiology and genetics, newer cancer treatments are being developed. Instead of mere surgical removal or the use of toxic drugs, researchers are learning ways to control various cellular mechanisms. Using these novel methods, it is possible now to force the brain tumor into remission or train the brain’s immune system to work against cancer.

Exploiting what forces cancer into remission

Genes and various factors control every part of cellular life. Thus, cells grow in a particular fashion, behave in a specific way and, when required, go through programmed cell death. In the case of glial cells, this programmed cell death is called anoikis. Further, to keep the brain functioning, these supportive cells also engage in autophagy. Autophagy is a process that helps to keep the brain clear of debris and unnecessary components.

Autophagy can be both protective and dangerous to brain cells. Autophagy helps cancerous glioma stem cells resist anoikis. Autophagy is now known to be regulated by the MDA-9/Syntenin gene. Researchers have found that when the MDA-9/Syntenin gene is blocked, the glioma stem cells lose their protective ability and succumb to programmed death (i.e., anoikis).

Further, researchers found that MDA-9/Syntenin gene suppresses epidermal growth factor receptor (EGFR) signaling. Excessive EGFR signaling has been found to be associated with brain cancer/glioblastoma. EGFR is protective against excessive autophagy or programmed cell death.

Scientists realized that when the MDA-9/Syntenin gene is blocked, EGFR cannot regulate protective autophagy, and more widespread death of cancer cells ensues. Now, researchers want to use this feature in a controlled manner to kill the cancer cells.

At present, this approach is being tested in laboratory models of tumor cells and in mouse models. Initial results seem to be encouraging. Suppression of the MDA-9/Syntenin gene in mouse models led to higher survival rates.

Researchers are confident that in the near future they will be able to find safer ways to suppress the MDA-9/Syntenin gene in humans and then start trials on people diagnosed with glioblastoma.

Training immune system to destroy cancer cells

This is another approach towards the treatment of various types of cancers. Clinical research has already shown the efficacy of this approach in glioblastoma and many other types of cancers. This approach involves creating an individualized or personal vaccine for each patient with glioblastoma. The initial human trials have already shown a better survival rate.

When it comes to creating a vaccine against cancer, one size does not fit all. The reason is simple; each cancer patient differs genetically. This difference in each cancer patient is linked to the fact that cancers develop due to different mutations across individuals. It means that all patients with glioblastoma have slightly different types of tumor. Therefore, one single vaccine would not work.

The answer to these patient-specific cancerous mutations is a personalized vaccine. This vaccine is called DCVax-L. The vaccine is created by extracting cancer cells from individuals and then training the dendritic cells of the immune system to fight against those specific mutations or cancer cells. Each patient who gets this vaccine would first go through the traditional surgical and chemotherapeutic treatments.  Upon completion of these treatments, the patients would receive the vaccines created specifically for them, to prolong life.

Good news is that this method is already in the last stages of development, and it has shown excellent results in a randomized, blind clinical trial. In these trials, the DCVax-L vaccine was given to 232 patients at various sites. This trial has not yet ended, but the initial results clearly show the higher survival rate. Around 30% of those who got this vaccine survived more than 30 months, and one-fourth survived more than 36 months. At present, 32.6% of those enrolled in the trial are still alive, and they are expected to live between 46.5 to 88.2 months. At present, the vaccine is not a curative treatment, but it provides serious benefits in comparison to traditional methods.

It has taken more than two decades to perfect the vaccine, and researchers believe that things will only get better in the future. In the very near future, we can expect to see much higher 5-year survival rates for glioblastoma patients, and that would already mark a big success.

References

D’Agostino, P. M., Gottfried-Blackmore, A., Anandasabapathy, N., & Bulloch, K. (2012). Brain dendritic cells: biology and pathology. Acta Neuropathologica, 124(5), 599–614. https://doi.org/10.1007/s00401-012-1018-0

Hanif, F., Muzaffar, K., Perveen, K., Malhi, S. M., & Simjee, S. U. (2017). Glioblastoma Multiforme: A Review of its Epidemiology and Pathogenesis through Clinical Presentation and Treatment. Asian Pacific Journal of Cancer Prevention?: APJCP, 18(1), 3–9. https://doi.org/10.22034/APJCP.2017.18.1.3

Jäkel, S., & Dimou, L. (2017). Glial Cells and Their Function in the Adult Brain: A Journey through the History of Their Ablation. Frontiers in Cellular Neuroscience, 11. https://doi.org/10.3389/fncel.2017.00024

Liau, L. M., Ashkan, K., Tran, D. D., Campian, J. L., Trusheim, J. E., Cobbs, C. S., … Bosch, M. L. (2018). First results on survival from a large Phase 3 clinical trial of an autologous dendritic cell vaccine in newly diagnosed glioblastoma. Journal of Translational Medicine, 16, 142. https://doi.org/10.1186/s12967-018-1507-6

Talukdar, S., Pradhan, A. K., Bhoopathi, P., Shen, X.-N., August, L. A., Windle, J. J., … Fisher, P. B. (2018). MDA-9/Syntenin regulates protective autophagy in anoikis-resistant glioma stem cells. Proceedings of the National Academy of Sciences, 115(22), 5768–5773. https://doi.org/10.1073/pnas.1721650115

Walid, M. S. (2008). Prognostic Factors for Long-Term Survival after Glioblastoma. The Permanente Journal, 12(4), 45–48. PMID: 21339920

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Friendship Bench—A Model for Accessible Mental Health Care

In 2017, Mental Health America reported that one in five adults with mental illness say that they are not receiving the mental health care that they need. (Mental Health America, 2017) The reasons for this are the following:

(1) they do not have insurance for it

(2) they do not have enough money to pay for the service

(3) mental health care providers are lacking

There is one mental health care provider for every 529 individuals in the US. This gap widens significantly for specialized mental health care. Only 20% of children with mental health problems receive some form of mental health services. The reason is that there are only about 8000 child and adolescent psychiatrists practicing in the US. In San Francisco alone, the Center for Disease Controls and Prevention (CDC) reports that there are about 32 child psychiatrists and 88 child psychologists per 10,000 children ages 0 to 17 years old.

There is a need for re-imagining the delivery of mental health care. One such method is known as the Friendship Bench Intervention (see video). The friendship bench has been undergoing development for more than 20 years in Harare, Zimbabwe where the Harare City Health Department in collaboration with the University of Zimbabwe Medical School sought to solve a major cause of disability from non-communicable diseases in the region, mostly common mental disorders such as depression and suicidal ideation.

The Friendship Bench is a task-shifted brief intervention and problem-solving therapy for common mental disorders which is provided by female lay health workers trained in specific aspects of cognitive behavioral therapy, particularly in problem-solving therapy and behavior scheduling. 

In short, the Friendship Bench mitigates common mental disorders such as depression by utilizing female lay health workers who are trained and supervised by clinical psychologists and psychiatrists to perform problem-solving therapy in a primary care setting.

The problem-solving approach starts with the patient identifying the cause of his mental illness. For example, unemployment. Interestingly, this approach deviates from the conventional where experts aim at diagnosing the patient from the symptoms that they present. Problem-solving therapy aims to provide a positive orientation of the patient towards resolving these identified problems. This makes them realize that they can have control in overcoming their mental illness.

The lay workers follow a script and conduct 6 sessions lasting from 30 to 45 minutes for each patient. The first session involves three components: (1) Opening the Mind or kuvhura pfungwa, (2) Uplifting or kusimudzira, and (3) Strengthening or kusimbisa. The first session aims to let the patient open their mind and identify their problems. They would then be allowed to choose only one to work on. The lay worker and the patient will then identify how to solve this problem realistically and formulate an action plan. This is an iterative process where the subsequent sessions will develop based on the first session.

Common mental health disorders that the Friendship Bench aims to treat are the following: depression, anxiety, panic disorder, post-traumatic stress disorder, cognitive disorders, and substance abuse.

Hiring and training lay workers from the community can significantly increase the mental health workforce. The requirement for the adult female trainees in this program is an educational background with at least 8 years of formal schooling (secondary schooling may suffice). The average age of the trainees is 58-years old. The training can be easily implemented, and it is cost-efficient at only $200 per health worker.

Figure 1. An Example of a Theory of Change Framework Output. LHW = Lay Health Workers

Community engagement is a key process in the development of the Friendship Bench. The goal is to bring community members, experts, researchers, and other key stakeholders together and become equal partners in the program. They engage in a workshop to develop a theory-driven framework known as the Theory of Change. Members hypothesize the best treatment initiative plan for the community’s patients and form a theory of “how and why an initiative works?”. Variables are identified and constantly measured for every cause and effect pathway. This illustrates proof that an initiative has a positive or negative impact. The theories are continuously measured, challenged, and changed until the desired impact is formulated (see Figure 1).

The success of the program is heavily reliant on the training method, the translation of the manual to the local language, and the integration of the program with the culture of the community. Lay workers must also learn how to translate and utilize tools used in common mental disorders such as the 20 item Self-Reporting Questionnaire (SRQ-20), General Health Questionnaire (GHQ-12), Hospital Anxiety and Depression Scale (HADS-D), and Patient Health Questionnaire – 9 Depression Test (PHQ-9). These are the basic metrics used to determine if the therapies are working.

Adding to the workforce, competent lay mental health workers in the primary care setting can offset the gap in mental healthcare delivery in communities. Its success in first-world countries is more likely because its growth can be sustained by leveraging readily accessible financial resources allocated each year by public health organizations. Its robust infrastructure, particularly in primary care clinics and information technology such as telehealth services, can boost the Friendship Bench programs. A limitation of the Friendship Bench is that it is designed to treat adult common mental disorders. To emulate this program so that it can suit the need for pediatric mental health disorders is of importance.

References

Abas, M., Broadhead, J. C., Mbape, P., & Khumalo-Sakatukwa, G. (1994). Defeating Depression in the Developing World: A Zimbabwean Model. Brittish Journal of Psychiatry, 293-296. doi:10.1192/bjp.164.3.293

American Academy of Child and Adolescent Psychiatry. (n.d.). Workforce Issues. Retrieved May 15, 2018, from American Academy of Child and Adolescent Psychiatry: https://www.aacap.org/aacap/resources_for_primary_care/Workforce_Issues.aspx

Blakely, T. (2003). Unemployment and suicide. Evidence for causal association? J Epidemiol Community Health, 57, 594-600. doi:10.1136/jech.57.8.594

Center for Disease Controls. (2015). Behavioral Health Services Providers by County. Retrieved May 15, 2018, from Centers for Disease Control and Prevention: https://www.cdc.gov/ncbddd/adhd/stateprofiles-providers/california/index.html

Chibanda, D., Mesu, P., Kajawu, L., Cowan, F., Araya, R., & Abas, M. A. (2011, October 26). Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. DMC Public Health, 11, 828. doi:10.1186/1471-2458-11-828

de Silva, M. J., Breuer, E., Lee, L., Asher, L., Chowdhary, N., Lund, C., & Patel, V. (2014, July 5). Theory of Change: a theory-driven approach to enhance the Medical Research Council’s framework for complex interventions. BioMed Central, 15, 267. doi:10.1186/1745-6215-15-267

Mental Health America. (2017). 2017 State of Mental Health in America – Access to Care Data. Retrieved May 5, 2018, from Mental Health America: http://www.mentalhealthamerica.net/issues/2017-state-mental-health-america-access-care-data

Munets, E., Simms, V., Dzapasi, L., Chapoterera, G., Nyaradzo, G., Gumunyu, T., . . . Chibanda, D. (2018, February 8). Trained lay health workers reduce common mental disorder symptoms of adults with suicidal ideation in Zimbabwe: a cohort study. BMC Public Health, 18, 227. doi:10.1186/s12889-018-5117-2

Shamu, S., Zarowsky, C., Roelens, K., Temmerman, M., & Abrahams, N. (2016). High-frequency intimate partner violence during pregnancy, postnatal depression and suicidal tendencies in Harare, Zimbabwe. Gen Hosp Psychiatry, 38, 109-114. doi:10.1016/j.genhosppsych.2015.10.005

van Ginneken, N., Tharyan, P., Lewin, S., Rao, G., Meera, S., & Pian, J. (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database Syst Rev, 11, CD009149. doi:10.3109/01612840.2015.1128299

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Virtual Reality for Reducing Pain

Falling Through the Cracks in Pain Management

Pain and Opioids

Chronic pain is debilitating, and it can cause patients to “fall through the cracks”. Health care institutions struggle to find ways to create “nets” and catch these patients. Pain medications include opioids which are used to treat chronic pain. Opioids often fail to treat the patient’s primary medical condition. As time goes by, patients tend to be unsatisfied with the results.

Also, there is a good chance that some of these types of pain medications will be abused. In fact, pain medicines such as opioids are part of the United States opioid crisis. According to the Centers for Disease Control (CDC), every day, more than 115 people in the United States die after overdosing on opioids. (CDC/NCHS, 2017) The opioids include prescription drugs, including fentanyl, and synthetic street drugs such as heroin.

It is estimated that the total economic burden of prescription opioid misuse in the United States is $78.5 billion a year which includes the costs in health care, lost productivity, addiction therapy, and criminal justice involvement. (Florence, Zhou, Lou, & Xu, 2013)

Pain and Mindfulness Meditation

To overcome pain, another task which demands higher controlled attention must be pitted against it.

Other forms of therapies were introduced to manage chronic pain.

One such therapy is known as mindfulness meditation. Mindfulness meditation is: “the intentional self-regulation of attention from moment to moment”. (Goleman & Schwartz, 1876) This method has been used for quite some time. A study done in mindfulness meditation by Dr. Kabat-Zinn has reported that 65% of patients have exhibited a reduction of pain by more than 33% and about 50% of patients have reported a reduction of pain by 50% over a 10-week period of therapy. (Kabat-Zinn, 1982)

Some studies performed in mindfulness meditation have reported patients with strong feelings of anger towards their pain condition while others report some anxiety while undergoing mindfulness therapy. la Cour and Petersen point out that meditation therapy requires a learning curve for the patient to access the more important personal “inner space”. (la Cour & Petersen, 2015) This can be an exciting learning experience of discovery for some patients while other patients may see this as a constant battle that in itself can be a painful experience.

The next question to consider therefore is to find out which patients benefits the most from mindfulness meditation and which are not, and then find out what other therapies we can use in these patients.

Enter Virtual Reality: Pain and Attention

Recall a recent injury. Ever wonder why after a trauma or injury has occurred, there seems to be a delay in which actual pain is produced? Pain has to first gain access to consciousness and demands central attentional resources by interrupting all other current brain processes such as worry, fear, or desire. It does so easily because of its noxious nature. (Eccleston, 1995) Pain, therefore, can be considered as a controlled task. To overcome pain, another task which demands higher controlled attention must be pitted against it.

The characteristics of pain such as intensity, quality, and/or pattern affect the probability of capturing attention. In chronic pain, for example, the characteristics of the pain and its intensity are important for pain processing. This may explain the reason why there are “good” days and “bad” days for patients with sciatica, multiple sclerosis, and other causes of chronic pain. Persistent pains with unpredictable sensory qualities that fluctuate in intensities are more likely to be processed. (Eccleston, 1995)

Finding the perfect distractor with the ability to interrupt persistent pain stimulus processing is key to coping. Virtual reality (VR) systems offer computer-generated sensory inputs that involve sight, sound, and touch. These inputs make it essentially difficult for the brain to ignore especially if the VR program is immersive. Immersive VR is an experience that gives a perfect illusion to the patient that is in the virtual world. The strength of the illusion of the presence of the virtual world reflects the amount of attention drawn into the virtual environment. (Hoffman, Doctor, Patterson, Carrougher, & Furness III, 2000)

Virtual reality may not replace the conventional pain management anytime soon. Once the patient comes out of VR, they will soon feel pain once more. Pharmacologic therapy remains the mainstay of pain management. But the problem of using pharmacologic treatment for pain remains a challenge. Undermedication is a problem of pain management failure. But higher doses of opioids poses a serious risk such as respiratory failure and encephalopathy. Therefore, the application of pain relief using VR may be for the use of procedural pain management such as minor surgical procedures, wound cleaning and debridement, and escharotomy in burn victims.

References

CDC/NCHS. (2017). National Vital Statistics System, Mortality. (US Department of Health and Human Services, CDC) Retrieved May 21, 2018, from CDC Wonder, Atlanta GA: https://wonder.cdc.gov/

Eccleston, C. (1995). Chronic pain and distraction: an experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. Behav Res Ther, 33(4), 391-405. doi:10.1016/0005-7967(94)00057-Q

Florence, C., Zhou, C., Lou, F., & Xu, L. (2013). The economic burden of prescription opioid overdose, abuse, and dependence in the United States. Med Care, 54(10), 901-906. doi:10.1097/MLR.0000000000000625

Goleman, D., & Schwartz, G. (1876). Meditation as an intervention in stress activity. J Consult Clin Psychol, 44, 456-466. doi:10.1037/0022-006X.44.3.456

Hoffman, H. G., Doctor, J. N., Patterson, D. R., Carrougher, G. J., & Furness III, T. A. (2000, March 1). Virtual reality as an adjunctive pain control during burn wound care in adolescent patients. Pain, 85(1-2), 305-309. doi:10.1016/S0304-3959(99)00275-4

Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psych, 4, 33-47. doi:10.1016/0163-8343(82)90026-3

la Cour, P., & Petersen, M. (2015, April 2). Effects of mindfulness meditation on chronic pain: a randomized control trial. Pain Medicine, 16(4), 641-652. doi:10.1111/pme.12605

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Synestra de Courcy died just days before her gender reassignment surgery was approved. via BBC News - Health Read More Here..

Medical hack poses pacemaker risk

Researchers disclose an unfixed vulnerability that threatens medical devices. via BBC News - Health Read More Here..

Regular exercise 'best for mental health'

Exercising three to five times a week helps improved wellbeing over a month, US research finds. via BBC News - Health Read More Here..

Ditching tight pants 'improves sperm count'

Could cooler testicles make for better swimming sperm - and more of them? via BBC News - Health Read More Here..

Argentina abortion: Senate defeats bill legalising it at up to 14 weeks

Anti-abortion campaigners rallied outside parliament as voting took place in Buenos Aires. via BBC News - Health Read More Here..

Footballer heart death risk 'underestimated'

Doctors say deaths are still rare but we need to open our eyes to the risk. via BBC News - Health Read More Here..

The mentally ill 29-year-old helped to die

In January Aurelia Brouwers drank poison supplied by a doctor and lay down to die. She was 29. via BBC News - Health Read More Here..

Why 'stealth spheres' are making you ill

Newly discovered trick used by viruses makes them more dangerous. via BBC News - Health Read More Here..

How to use a defibrillator and save a life

Defibrillator trainer Helen Tennant shows how to respond in an emergency. via BBC News - Health Read More Here..

Women 'need to know egg freezing risk'

The Royal College of Obstetricians and Gynaecologists warns about low success rates and high costs. via BBC News - Health Read More Here..

No going back in Argentina's abortion debate

The BBC's Katy Watson speaks to supporters and opponents of the abortion bill ahead of a key vote. via BBC News - Health Read More Here..

The battle against skin-whitening cream

Shops continue to sell the illegal cream as Trading Standards struggle to regulate the sector. via BBC News - Health Read More Here..

Women doctors 'best for female heart patients'

Heart attack patients are more likely to survive if they are treated by a female doctor, a study suggests. via BBC News - Health Read More Here..

UK among worst for life expectancy rises

Increases to life expectancy in the UK have stalled since 2011, data from the ONS reveals. via BBC News - Health Read More Here..

Prescription-only drugs being sold by online doctor sites

Some doctor sites are selling prescription-only drugs to potentially vulnerable patients, BBC Panorama finds. via BBC News - Health Read More Here..

Fentanyl and cocaine drug deaths rise

Drug policy campaigners say the government is responsible for "vulnerable people dying in droves". via BBC News - Health Read More Here..

Vaginal thrush 'a growing problem worldwide'

Three out of four women develop thrush at least once and 6% suffer repeatedly, scientists say. via BBC News - Health Read More Here..

Breastfeeding mothers in Colombia gather to break taboo

Mothers across Colombia gathered to breastfeed in public as part of World Breastfeeding Week. via BBC News - Health Read More Here..

Books 'open blind boy Ted's eyes to world'

Nine-year-old Ted has Stickler syndrome - which caused his retinas to detach resulting in him becoming blind. via BBC News - Health Read More Here..

Bees living on top of a London mosque

There are 400,000 bees living on the roof of the East London Mosque in Whitechapel. via BBC News - Health Read More Here..

Low levels of air pollution linked to changes in the heart

The changes are similar to those seen in the early stages of heart failure, experts say. via BBC News - Health Read More Here..

Tongue splitting: Surgeons warn of serious health risks

The process, where the tongue is cut in half, can lead to blood loss and nerve damage, experts say. via BBC News - Health Read More Here..

Engineered pig lung transplant 'a success'

Scientists have successfully transplanted a bioengineered lung into a pig. via BBC News - Health Read More Here..

Asthma awareness: 'My son was gone just like that'

Donna Green's son Tiernan died aged 20 from an asthma attack. Now she's educating others to raise awareness. via BBC News - Health Read More Here..

Are you applying sun cream properly?

Why we may get less than half the sun protection we expect. via BBC News - Health Read More Here..

Learning how to read emotions aged nine

How taking part in a study for autistic children using Google glasses and an app helped one boy. via BBC News - Health Read More Here..

Why I got calf implants: 'There was no other option'

Personal trainer Mark Henderson to 5 Live that he struggled with his body image after an accident. via BBC News - Health Read More Here..

The university hosting 'menopause cafes'

Participants are handed "menus", where food and drink options are replaced by topics of discussion. via BBC News - Health Read More Here..

Dengue fever outbreak stopped by special mosquitoes

An Australian city has been successfully protected from the mosquito-borne disease, researchers say. via BBC News - Health Read More Here..

Facebook and Instagram introduce time limit tool

Users will be able to restrict time spent on the app, but some people say it doesn't go far enough. via BBC News - Health Read More Here..

Trial to test if GM fed salmon are more nutritious

Researchers are feeding genetically modified crops to farmed salmon to see if it boosts their nutritional value. via BBC News - Health Read More Here..

French drug maker Sanofi stockpiling for Brexit

Sanofi is building a 14 week stockpile of drugs, including insulin, in case of Brexit disruptions. via BBC News - Health Read More Here..

Life on steroids: 'It's my personal choice'

Inside a steroid clinic in Newport, south Wales - the first of its kind in the UK. via BBC News - Health Read More Here..

How reiki helps me cope with recurrent miscarriage

Having been devastated by three previous miscarriages Nadine turned to a complementary therapy - reiki - to help her find some peace. via BBC News - Health Read More Here..