Recovery Michigan

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The immune, neural and psychological systems all interact with one another. One of the major communication pathways between the brain and the immune system is the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system. This pathway mediates our immune response to psychological factors such as stress, anxiety and other emotions. This bidirectional relationship between the brain and the immune system has led to the question about the role of the immune system in neuropathological processes.

Our immune system acts as the sensory organ when our body is confronted with pathogens. The immune system alerts the brain, and the rest of the body, to the presence of these pathogens by generating an immune response. The cells responsible for our immunity (T cells, B cells and mast cells) release cytokines in response to activation. Cytokines, such as interleukins and interferons, are peptides (proteins) that orchestrate the immune response. They are released both in the periphery as well as the brain during immune stimulation, and can affect neural, neuroendocrine, and behavioural functions.

In addition to standard physiological responses that we’re all probably used to such as fever, activation of the HPA axis also produces some behavioural changes. At one point or another, most of us would have had experiences that are referred to as ‘sickness behaviour’. This behaviour is exhibited by physically ill people and can present as depressed mood, anorexia, weight loss, sleepiness and altered sleep patterns, fatigue and retardation of motor activity, reduced interest in the physical and social environment, and impaired cognitive abilities. This behavioural response is considered to be an adaptive response to aid the recovery process, rather than being caused by the illness itself. This is essentially why we don’t go out and stay in bed when we’re ill — thus speeding up our recovery!

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"Think about trying to live today on the income you had 15 years ago." That's how agriculture expert Chris Hurt describes the plight facing U.S. farmers today.

The unequal economy that's emerged over the past decade, combined with patchy access to health care in rural areas, have had a severe impact on the people growing America's food. Recent data shows just how much. Farmers are dying by suicide at a higher rate than any other occupational group, according to the Centers for Disease Control and Prevention (CDC).

The suicide rate in the field of farming, fishing and forestry is 84.5 per 100,000 people -- more than five times that of the population as a whole. That's even as the nation overall has seen an increase in suicide rates over the last 30 years.

The CDC study comes with a few caveats. It looked at workers over 17 different states, but it left out some major agricultural states, like Iowa. And the occupational category that includes these workers includes small numbers of workers from related occupational groups, like fishing and forestry. (However, agricultural workers make up the vast majority of the "farming, fishing and forestry" occupational group.)

However, the figures in the CDC study mirror other recent findings. Rates of suicide have risen fastest, and are highest, in rural areas, the CDC found in a different study released earlier this month. Other countries have seen this issue, too -- including India, where 60,000 farmer suicides have been linked to climate change.

In the U.S., several longtime farm advocates say today's crisis mirrors one that happened in the 1980s, when many U.S. farmers struggled economically, with an accompanying spike in farmer suicides.

"The farm crisis was so bad, there was a terrible outbreak of suicide and depression," said Jennifer Fahy, communications director with Farm Aid, a group founded in 1985 that advocates for farmers. Today, she said, "I think it's actually worse."

"We're hearing from farmers on our hotline that farmer stress is extremely high," Fahy said. "Every time there's more uncertainty around issues around the farm economy is another day of phones ringing off the hook."

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Most mobile health (mHealth) apps are built around the core mission of improving their user’s health outcomes. Nutrition apps aspire to help users monitor their diet by giving them deep insights into every mouthful they eat, meditation apps aspire to help users combat anxiety and stress, and fitness apps aspire to get their users to be more active. However, as I’ve mentioned in my previous post, health goals are often time intensive to achieve and require discipline and practice on a day-to-day basis to get results. Furthermore, the more an app can get it’s users to do something (i.e. log that meal, finish that workout), the higher the likelihood of improving that health outcome (i.e. losing weight, managing stress) — if done right! But as the creator or PM of an app, how does one determine what features to introduce to bring about a behavior change and ultimately improve the user’s health outcome (sooner, more effectively)?

Prior to delving into target users and feature sets, it’s important to understand the various aspects of user behaviors, particularly as they help in driving an intervention or an outcome. A popular framework to understand user behaviors that drive a change is the COM-B model, which spans across 3 major constructs of the ‘behavior wheel’, Capability, Opportunity & Motivation.

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Behavioral healthcare has long lived adjacent to the the traditional delivery system of U.S. hospitals, but that's changing as providers and payers begin to view patients more holistically.

In turn, a number of companies are betting on behavioral health, with a new twist using telehealth principles. Vendors Teladoc and American Well for example are stepping into a vacuum created by a psychiatrist shortage, providing complementary services to primary care settings.

Providers are exploring these offerings, and some are seeing a return on investment. But there's still work to be done to integrate mental health into the larger healthcare delivery system. It's helping that payers are getting on board, with a push to to combine behavioral health and primary care. 

“Anytime Medicare and Medicaid or private insurers see they have a group that costs 230-250% more, they are going to want to bring that down,” said Bill Bithoney, senior clinical fellow in BDO Advisory’s Center for Healthcare Excellence & Innovation, told Healthcare Dive. “That’s the motivation for states to allow the billing for telebehavioral health given the shortage of providers.”

New York's Medicaid redesign, for example, has pushed for co-location to allow immediate access to behavioral health programs in the primary care office.

Healthcare costs are a big driver and New York isn't alone.

Spending on behavioral health has grown steadily at 5-7% since 1986, and is projected to reach $281 billion in 2020. In April, Teladoc announced the U.S. launch of its Behavioral Health Navigator, a suite of services to combine individualized support and care coordination with virtual access to mental health providers. Others betting on the space include Quartet Health, Avizia, Lyra Health, Vida and Doctor On Demand. 

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About 15% of the U.S. high school population -- 2.5 million students -- self-reported having at least one concussion related to sports or physical activity over a 1-year period, according to the CDC.

This prevalence is higher than emergency department estimates (622.5 visits per 100,000 population ages 10-14 ) and athletic trainer reports (1.8 per 100 high school and college athletes for an average season), according to the CDC's Lara DePadilla, PhD, and co-authors.

"Emergency department data miss concussions treated elsewhere, and athletic trainer reports miss concussions sustained outside of school-based sports; both sources miss medically untreated concussions," the researchers wrote in Morbidity and Mortality Weekly Report.

Overall, 9.1% of high school students reported having one concussion and 6.0% reported having two or more concussions in the 12-month period.

Concussion prevalence was significantly higher among males and among all students who played team sports. Concussion odds also grew with the number of team sports played.

The findings are part of the Youth Risk Behavior Survey (YRBS), a cross-sectional study of 14,765 public and private school students in grades 9 through 12. In 2017, the CDC included a question about concussions on the national YRBS questionnaire for the first time.

A recent study found that 40% of high school athletes who experienced concussions said their coach was unaware of their symptoms.

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“Society is not taking this issue seriously,” Thad Tatum says of the mental health needs of formerly incarcerated people.

Along with overseeing a mental health support group for former inmates, Tatum has also provided counseling to those who need help understanding the court system and life after prison.

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Treatment with dialectical behavior therapy (DBT) may help lower suicide risk and self-harm in high-risk teenagers, a randomized trial showed.

Compared with individual and group supportive therapy (IGST), 47% of participants -- 95% of whom were girls -- receiving DBT were self-harm free after 6 months of treatment as compared with 28% of those who participated in IGST, wrote Elizabeth McCauley, PhD, of Seattle Children's Hospital, and colleagues in JAMA Psychiatry.

As the authors explained, DBT is a multicomponent cognitive-behavioral treatment that targets treatment engagement and the reduction of self-harm and suicide attempts and focuses on teaching skills for enhancing emotion regulation, distress tolerance, and "building a life worth living."

Significant advantages were found for DBT in all three primary outcomes over the 6-month treatment period when comparing those who received DBT with those who received IGST:

• No suicide attempts: 90.3% (DBT), versus 78.9% (IGST) (OR 0.30, 95% CI 0.10-0.91)
• Non-suicidal self-injury: 56.9% versus 40.0% (OR 0.32, 95% CI 0.13-0.70)
• No incidence of self-harm: 54.2% versus 36.9% (OR 0.33, 95% CI 0.14-0.78)

For DBT, treatment completion rates were higher (at 75.6%) than for IGST (55.2%), but this difference, assessed by pattern-mixture models, did not affect outcomes, the team stated. Over the follow-up period to 1-year, DBT continued to be superior to the control treatment, but this was not statistically significant (OR 0.65, 95% CI 0.12-3.36, P=0.061), with both groups reporting better outcomes over time.

Most people I know would consider two drinks a week sobriety, not moderation...

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This trial provided access to the detailed information of almost 100,000 participants throughout the United States who were followed for an average of 8.9 years. Their results are published this week in the journal PLOS Medicine.

Across the study, there were 9,559 deaths and 12,763 primary cancers. All individuals took a diet history questionnaire that included information about their drinking habits. Each participant was assigned a group based on alcohol consumption. These included:

• lifetime never drinkers (LN) — no alcohol consumption
• infrequent drinkers (ID) — one or fewer drinks per week
• light drinkers (LD) — one to three drinks per week
• heavy drinkers (HD) — two to three drinks per day
• very heavy drinkers (VHD) — three or more drinks per day

Again, the team found evidence of a J-shaped interaction between health outcomes and alcohol. Of the groups outlined above, LD had the lowest mortality risk.

This means that those who drank one to three drinks per week had less risk than both those who drank less alcohol each week and those who drank more.

When the scientists investigated lifetime cancer risk, they found a linear relationship between the amount of alcohol consumed and risk; each drink per day increased the risk of cancer.

However, when cancer risk and mortality were analyzed together, LD still had the lowest risk of all groups.

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When I awaken and start each day, I feel like a hygrometer (a humidity-monitoring device). My body is so in tune to any rise in humidity that I can visualize a red line slowly climbing higher and higher.

With each rise of the red humidity line, I can feel my gait slowing and my inflamed legs growing a mind of their own. Every step feels as though I am treading through thick, high grass..

Merriam-Webster defines humid as “containing or characterized by perceptible moisture especially to the point of being oppressive.” It defines humidity as “the state of being humid.”

“Oppressive” is an excellent word to describe the effect humidity can have on our MS bodies. When heat and humidity collide, the stifling combination can send my body’s movements into slow motion, with a kick of pain added.

The increased pain appears as deep, burning cramp. It starts with my feet (most times) and works its way up my legs, and moves quickly to my arms and hands. Stretching helps the pain, as do homeopathic leg cramp pills with magnesium, and applying ice packs to the affected areas. That relief can be short-lived, so I then move on to massage along with lotion and over-the-counter pain medicine.

Humid conditions can also strike while taking a shower. But, if I stay aware of the water temperature and use an exhaust fan, the humidity can stay lower. Otherwise, my heat-inflated legs won’t move correctly to help me out of the shower.

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Currently, guidelines recommend that traumatic brain injury patients get plenty of rest and avoid physical and cognitive activity until symptoms subside.

But a new pilot study looking at athletes with concussions suggests total inactivity may not be the best way to recover after all, say scientists at Southern Methodist University, Dallas, where the research was conducted.

The study found that a simple cognitive task as early as four days after a brain injury activated the region that improves memory function and can guard against two hallmarks of concussion — depression and anxiety.

“Right now, if you have a concussion the directive is to have complete physical and cognitive rest, no activities, no social interaction, to let your brain rest and recover from the energy crisis as a result of the injury,” said SMU physiologist Sushmita Purkayastha, who led the research, which was funded by the Texas Institute for Brain Injury and Repair at UT Southwestern Medical Center, Dallas.

“But what we saw, the student athletes came in on approximately the third day of their concussion and the test was not stressful for them. None of the patients complained about any symptom aggravation as a result of the task. Their parasympathetic nervous system — which regulates automatic responses such as heart rate when the body is at rest — was activated, which is a good sign,” said Purkayastha, an assistant professor in the Department of Applied Physiology and Wellness.