Poor air quality does not offset exercise’s heart benefits

Even in areas with moderate-to-high levels of traffic pollution, regular physical activity reduced the risk of first and recurrent heart attack, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

“While exercise is known to reduce cardiovascular disease risk; pollution can increase the risk of cardiovascular disease, including heart attacks, asthma and chronic obstructive lung disease,” said Nadine Kubesch, Ph.D., lead author and researcher at the University of Copenhagen in Denmark. “Currently there is little data on whether poor air quality cancels out the protective benefits of physical activity in preventing heart attacks.”

Researchers in Denmark, Germany and Spain evaluated outdoor physical activity levels (sports, cycling, walking and gardening) and nitrogen dioxide (NO2 pollutant generated by traffic) exposure in 51,868 adults, age 50-65, comparing self-reported activities and lifestyle factors against heart attack. Over a 17.7-year period, there were 2,936 first heart attacks and 324 recurrent heart attacks.

To estimate average NO2 exposure, researchers used national traffic pollution monitoring data for each participants’ address and found:

  • Higher levels of were associated with more heart attacks, however, the risk was lower among those who were physically active.
  • Moderate cycling for four or more hours per week cut risk for recurrent heart attack by 31 percent; and there was a 58 percent reduction when all four types of physical activity (together totaling four hours per week or more) were combined, regardless of air quality.
  • Those who participated in sports had a 15 percent lower rate of initial heart attacks and there was a 9 percent risk reduction associated with cycling, regardless of air quality
  • Compared to participants with low residential NO2 exposure, those in higher risk areas had a 17 percent increase risk in first heart attack and 39 percent for recurrent heart attack.

In participants who developed a heart attack (first or recurrent), the average NO2 exposure level was 18.9 micrograms per cubic meter air (μg/m3) with an overall average of 18.7 μg/m3, which is below the current NO2 European Union exposure guideline (50 μg/m3 over 24 hours).

“Our study shows that physical activity even during exposure to air pollution, in cities with levels similar to those in Copenhagen, can reduce the risk of heart attack,” Kubesch said. “Our research supports existing evidence that even moderate levels of regular physical activity, such as active commuting, are sufficiently intense to get these health benefits.

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Beef jerky and other processed meats associated with manic episodes

An analysis of more than 1,000 people with and without psychiatric disorders has shown that nitrates — chemicals used to cure meats such as beef jerky, salami, hot dogs and other processed meat snacks — may contribute to mania, an abnormal mood state. Mania is characterized by hyperactivity, euphoria and insomnia.

The findings of the Johns Hopkins Medicine study, which was not designed to determine cause and effect, were published July 18 in Molecular Psychiatry. Specifically, it found that people hospitalized for an episode of mania had more than three times the odds of having ever eaten nitrate-cured meats than people without a history of a serious psychiatric disorder.

Experiments in rats by the same researchers showed mania-like hyperactivity after just a few weeks on diets with added nitrates.

While a number of genetic and other risk factors have been linked to the manic episodes that characterize bipolar disorder and may occur in other psychiatric conditions, those factors have been unable to explain the cause of these mental illnesses, and researchers are increasingly looking for environmental factors, such as diet, that may play a role.

The researchers say that their new study adds to evidence that certain diets and potentially the amounts and types of bacteria in the gut may contribute to mania and other disorders that affect the brain.

“Future work on this association could lead to dietary interventions to help reduce the risk of manic episodes in those who have bipolar disorder or who are otherwise vulnerable to mania,” says lead author Robert Yolken, M.D., the Theodore and Vada Stanley Distinguished Professor of Neurovirology in Pediatrics at the Johns Hopkins University School of Medicine.

Mania, a state of elevated mood, arousal and energy that lasts weeks to months, is generally seen in people with bipolar disorder, but can also occur in those with schizoaffective disorder. Manic states can lead to dangerous risk-taking behavior and can include delusional thinking, and most of those affected experience multiple hospitalizations in the course of their psychiatric illness.

Bipolar disorder affects an estimated 1 to 3 percent of the population of the United States and costs an estimated $25 billion a year in direct health care costs, according to a study in the Journal of Affective Disorders.

Yolken, trained as an infectious disease expert, was originally interested in whether exposure to infections such as viruses transmitted through food might be linked to any psychiatric conditions. Between 2007 and 2017, as part of an ongoing study, he and colleagues collected demographic, health and dietary data on 1,101 individuals aged 18 through 65 with and without psychiatric disorders. Approximately 55 percent of the participants were female and 55 percent were Caucasian, with 36 percent identifying as African-American.

Those with psychiatric disorders were recruited from patients receiving care at the Sheppard Pratt Health System in Baltimore. Individuals with no history of psychiatric disorders were recruited from posted announcements at local health care facilities and universities in the region.

A study of their records between 2007 and 2017 showed that, unexpectedly, among people who had been hospitalized for mania, a history of eating cured meat before hospitalization were approximately 3.5 times higher than the group of people without a psychiatric disorder. Cured meats were not associated with a diagnosis of schizoaffective disorder, bipolar disorder in people not hospitalized for mania or in major depressive disorder. No other foods about which participants were queried had a significant association with any of the disorders, or with mania.

“We looked at a number of different dietary exposures and cured meat really stood out,” says Yolken. “It wasn’t just that people with mania have an abnormal diet.”

Nitrates have long been used as preservatives in cured meat products and have been previously linked to some cancers and neurodegenerative diseases, so Yolken suspected they may also explain the link to mood states such as mania.

The dietary survey did not ask about frequency or time frame of cured meat consumption, so the researchers couldn’t draw conclusions about exactly how much cured meat boosts one’s risk of mania, but Yolken hopes future studies will address this.

To get at the roots of the association, Yolken collaborated with researchers studying the impact of nitrates on rats.

Kellie Tamashiro, Ph.D., associate professor of psychiatry and behavioral sciences, and M.D./Ph.D. student Seva Khambadkone, both of Johns Hopkins, and others divided a group of otherwise healthy rats into two groups: one received normal rat chow, and the other received both normal chow and a piece of store-bought, nitrate-prepared beef jerky every other day. Within two weeks, the rats receiving the jerky showed irregular sleeping patterns and hyperactivity.

Next, the team worked with a Baltimore-based beef jerky company to create a special nitrate-free dried beef. They repeated the experiment, this time giving some rats the store-bought, nitrate-prepared jerky and others the nitrate-free formulation. The animals that ate the nitrate-free meat behaved similarly to a control group, while the animals that consumed the nitrates once again showed sleep disturbances and hyperactivity similar to that seen in patients with mania — increased activity during normal sleep times and in new environments.

The results were then replicated with a specially formulated rat chow that had either nitrate added directly to the chow, or no nitrate.

Importantly, the amount of nitrate being consumed on a daily basis by the rats — when scaled up to the size of a human — was equivalent to the amount a person might eat for a daily snack, such as one beef jerky stick or hot dog.

“We tried to make sure the amount of nitrate used in the experiment was in the range of what people might reasonably be eating,” says Yolken.

When the group analyzed the gut bacteria of the different groups of rats, they found that animals with nitrate in their diet had different patterns of bacteria living in their intestines than the other rats. Moreover, the animals had differences in several molecular pathways in the brain that have been previously implicated in bipolar disorder.

While the team also cautions that it’s too early to take any clinical messages from the results, and occasional cured meat consumption is unlikely to spur a manic episode in most of the population, Yolken says the findings add to evidence of the multiple factors that contribute to mania and bipolar disorder.

“It’s clear that mania is a complex neuropsychiatric state, and that both genetic vulnerabilities and environmental factors are likely involved in the emergence and severity of bipolar disorder and associated manic episodes,” says Khambadkone. “Our results suggest that nitrated cured meat could be one environmental player in mediating mania.”

Yolken’s group recently published results of a separate study showing that when people with bipolar disorder are given probiotics — which can change the composition of gut bacteria — after a manic episode, they are less likely to be rehospitalized in the following six months. “There’s growing evidence that germs in the intestines can influence the brain,” says Yolken. “And this work on nitrates opens the door for future studies on how that may be happening.”

This work was supported by a National Institute of Mental Health Silvio O. Conte Center grant (MH-94268) and by the Stanley Medical Research Institute.

Moderate alcohol consumption may boost male fertility

The question of whether alcohol intake affects male reproductive function is controversial. In a new Andrologystudy, moderate alcohol intake was linked with higher semen volume, sperm concentration, and total sperm count.

In the study of 323 men patients, 9.6% were abstainers, 30.0% drank <1-3, 30.3% drank 4-7, and 30.0% drank ≥8 alcohol units per week. (1 unit = 125 mL wine or 330 mL beer or 30 mL spirits, all containing approximately 12.5 g of ethanol). Compared with men drinking <1-3 units per week, median semen volume was higher in the 4-7 units/week group, as was total sperm count. Association with sperm concentration was also significant, with a U-shaped trend in groups of alcohol intake.

“As regards low intake, our findings are consistent with other research. In Italy, alcohol consumption is common but usually limited to small quantities, and this applies in particular to men referring to our Infertility Clinic,” said lead author Dr. Elena Ricci, of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, in Italy. “Since the dose makes the poison, they are counselled to limit but not avoid alcohol.”

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Fish consumption may prolong life

Consumption of fish and long-chain omega-3 fatty acids was associated with lower risks of early death in a Journal of Internal Medicine study.

In the study of 240,729 men and 180,580 women who were followed for 16 years, 54,230 men and 30,882 women died. Higher fish and long-chain omega-3 fatty acid intakes were significantly associated with lower total mortality. Comparing the highest with lowest quintiles of fish intake, men had 9% lower total mortality, 10% lower cardiovascular disease mortality, 6% lower cancer mortality, 20% lower respiratory disease mortality, and 37% lower chronic liver disease mortality, while women had 8% lower total mortality, 10% lower cardiovascular disease mortality, and 38% lower Alzheimer’s disease mortality.

Fried fish consumption was not related to mortality in men, whereas it was associated with increased risks of mortality from all causes, cardiovascular disease, and respiratory disease in women. Long-chain omega-3 fatty acid intake was associated with 15% and 18% lower cardiovascular disease mortality in men and women, respectively, when comparing the highest and lowest quintiles.

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Postpartum Care: What to Expect After a Vaginal Delivery

Pregnancy changes your body in more ways than you might have guessed, and it doesn’t stop when the baby is born. Here’s what to expect after a vaginal delivery.

Vaginal soreness

If you had an episiotomy or vaginal tear during delivery, the wound might hurt for a few weeks. Extensive tears might take longer to heal. In the meantime, you can help promote healing:

  • If sitting is uncomfortable, sit on a pillow or padded ring.
  • Use a squeeze bottle to pour warm water over your vulva as you’re urinating. Press a clean pad or washcloth firmly against the wound when you bear down for a bowel movement.
  • Cool the wound with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the wound.
  • Take pain relievers or stool softeners as recommended by your health care provider.

While you’re healing, expect the discomfort to slowly improve. Contact your health care provider if the pain intensifies; the wound becomes hot, swollen and painful; or you notice a pus-like discharge.

Vaginal discharge

You’ll have a vaginal discharge (lochia) for a number of weeks after delivery. Expect a bright red, heavy flow of blood for the first few days. The discharge will gradually taper off, becoming watery and changing from pink or brown to yellow or white.

Contact your health care provider if:

  • You have heavy vaginal bleeding
  • The discharge has a foul odor
  • You have a fever of 100.4 F (38 C) or higher

Contractions

You might feel contractions, sometimes called afterpains, during the first few days after delivery. These contractions—which often resemble menstrual cramps—help prevent excessive bleeding by compressing the blood vessels in the uterus. These contractions tend to be stronger with successive deliveries. Your health care provider might recommend an over-the-counter pain reliever.

Contact your health care provider if you have a fever or if your abdomen is tender to the touch. These signs and symptoms could indicate a uterine infection.

Urination problems

Swelling or bruising of the tissues surrounding the bladder and urethra can lead to difficulty urinating. Fearing the sting of urine on the tender perineal area can have the same effect. Difficulty urinating usually resolves on its own. In the meantime, it might help to pour water across your vulva while you’re sitting on the toilet.

Contact your health care provider if you have any signs or symptoms of a urinary tract infection. For example:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine

Pregnancy and birth stretch the connective tissue at the base of the bladder and can cause nerve and muscle damage to the bladder or urethra. You might leak urine when you cough, strain, or laugh. Fortunately, this problem usually improves with time. In the meantime, wear sanitary pads and do Kegel exercises to help tone your pelvic floor muscles.

To do Kegels, tighten your pelvic muscles as if you’re stopping your stream of urine. Try it for five seconds at a time, four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Aim for at least three sets of 10 repetitions a day.

Hemorrhoids and bowel movements

If you notice pain during bowel movements and feel swelling near your anus, you might have hemorrhoids—stretched and swollen veins in the anus or lower rectum. To ease any discomfort while the hemorrhoids heal, soak in a warm tub and apply chilled witch hazel pads to the affected area. Your health care provider might recommend a topical hemorrhoid medication as well.

If you find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating the pain of hemorrhoids or your episiotomy wound, take steps to keep your stools soft and regular. Eat foods high in fiber—including fruits, vegetables, and whole grains—and drink plenty of water. Ask your health care provider about a stool softener or an osmotic laxative, if needed.

Another potential problem for new moms after a vaginal delivery is the inability to control bowel movements (fecal incontinence). Frequent Kegel exercises can help with mild fecal leakage. If you have persistent trouble controlling bowel movements, consult your health care provider.

Sore breasts and leaking milk

Several days after delivery, your breasts might become firm, swollen, and tender (engorgement). To ease discomfort, nurse, use a breast pump, apply warm washcloths, or take a warm shower to express milk. Between feedings, place cold washcloths or ice packs on your breasts. Over-the-counter pain relievers might help, too.

If you’re not breast-feeding, wear a firm, supportive bra, such as a sports bra, to help stop milk production. Don’t pump or rub your breasts, which will cause your breasts to produce more milk. If feedings are painful, ask a lactation consultant for help.

If your breasts leak between feedings, wear nursing pads inside your bra to help keep your shirt dry. Change pads after each feeding and whenever they get wet.

If you’re not breast-feeding your baby, wear a firm, supportive bra to help stop milk production. Don’t pump your breasts or express the milk, which will cause your breasts to produce more milk.

Hair loss and skin changes

During pregnancy, elevated hormone levels put normal hair loss on hold. The result is often an extra-lush head of hair—but now it’s payback time. After delivery, your body sheds the excess hair all at once. Hair loss typically stops within six months.

Stretch marks won’t disappear after delivery, but eventually they’ll fade from reddish purple to silver or white. Expect any skin that darkened during pregnancy—such as the line down your abdomen (linea nigra)—to slowly fade as well.

Mood changes

Childbirth triggers a jumble of powerful emotions. Mood swings, irritability, sadness, and anxiety are common. Many new moms experience a mild depression, sometimes called the baby blues. The baby blues typically subside within a week or two. In the meantime, take good care of yourself. Share your feelings, and ask your partner, loved ones or friends for help. If your depression deepens or you feel hopeless and sad most of the time, contact your health care provider. Prompt treatment is important.

Weight loss

After you give birth, you’ll probably feel out of shape. You might even look like you’re still pregnant. This is normal. Most women lose more than 10 pounds during birth, including the weight of the baby, placenta, and amniotic fluid. In the days after delivery, you’ll lose additional weight from leftover fluids. After that, a healthy diet and regular exercise can help you gradually return to your pre-pregnancy weight.

The postpartum checkup

About six weeks after delivery, your health care provider will check your vagina, cervix, and uterus to make sure you’re healing well. He or she might do a breast exam and check your weight and blood pressure, too. This is a great time to talk about resuming sexual activity, birth control, breast-feeding, and how you’re adjusting to life with a new baby. You might also ask about Kegel exercises to help tone your pelvic floor muscles.

Above all, share any concerns you might have about your physical or emotional health. Chances are, what you’re feeling is entirely normal. Look to your health care provider for assurance as you enter this new phase of life.

Updated: 2015-03-24

Publication Date: 2006-03-03

Forty percent of people have a fictional first memory

Researchers have conducted one of the largest surveys of people’s first memories, finding that nearly 40 per cent of people had a first memory which is fictional.

Current research indicates that people’s earliest memories date from around three to three-and-a-half years of age. However, the study from researchers at City, University of London, the University of Bradford and Nottingham Trent University found that 38.6 per cent of a survey of 6,641 people claimed to have memories from two or younger, with 893 people claiming memories from one or younger. This was particularly prevalent among middle-aged and older adults.

To investigate people’s first memories the researchers asked participants to detail their first memory along with their age at the time. In particular, participants were told that the memory itself had to be one that they were certain they remembered. It should not be based on, for example a family photograph, family story, or any source other than direct experience.

From these descriptions the researchers then examined the content, language, nature and descriptive detail of respondents’ earliest memory descriptions, and from these evaluated the likely reasons why people claim memories from an age that research indicates they cannot be formed.

As many of these memories dated before the age of two and younger, the authors suggest that these fictional memories are based on remembered fragments of early experience — such as a pram, family relationships and feeling sad — and some facts or knowledge about their own infancy or childhood which may have been derived from photographs or family conversations.

As a result, what a rememberer has in mind when recalling these early memories is a mental representation consisting of remembered fragments of early experience and some facts or knowledge about their own childhood, instead of actual memories.

Over time, such mental representations come to be recollectively experienced when they come to mind and so for the individual they quite simply are ‘memories’ with content strongly tied to a particular time. In particular, fictional very early memories were seen to be more common in middle-aged and older adults and about 4 in 10 of this group have fictional memories for infancy. The study is published in the journal Psychological Science.

Dr Shazia Akhtar, first author and Senior Research Associate at the University of Bradford said:

“We suggest that what a rememberer has in mind when recalling fictional improbably early memories is an episodic-memory-like mental representation consisting of remembered fragments of early experience and some facts or knowledge about their own infancy/childhood.

“Additionally, further details may be non-consciously inferred or added, e.g. that one was wearing nappy when standing in the cot. Such episodic-memory-like mental representations come, over time, to be recollectively experienced when they come to mind and so for the individual they quite simply are ‘memories’ which particularly point to infancy.”

Professor Martin Conway, Director Centre for Memory and Law at City, University of London and co-author of the paper, said:

“In our study we asked people to recall the very first memory that they actually remembered, asking them to be sure that it wasn’t related to a family story or photograph. When we looked through the responses from participants we found that a lot of these first ‘memories’ were frequently related to infancy, and a typical example would be a memory based around a pram.

“For this person, this type of memory could have resulted from someone saying something like ‘mother had a large green pram’. The person then imagines what it would have looked like. Over time these fragments then becomes a memory and often the person will start to add things in such as a string of toys along the top.

“Crucially, the person remembering them doesn’t know this is fictional. In fact when people are told that their memories are false they often don’t believe it. This partly due to the fact that the systems that allow us to remember things are very complex, and it’s not until we’re five or six that we form adult-like memories due to the way that the brain develops and due to our maturing understanding of the world.”

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Omega 3 supplements have little or no heart or vascular health benefit

New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

Omega 3 is a type of fat. Small amounts of omega 3 fats are essential for good health, and they can be found in the food that we eat. The main types of omega 3 fatty acids are; alphalinolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is normally found in fats from plant foods, such as nuts and seeds (walnuts and rapeseed are rich sources). EPA and DHA, collectively called long chain omega 3 fats, are naturally found in fatty fish, such as salmon and fish oils including cod liver oil.

Increased consumption of omega 3 fats is widely promoted globally because of a common belief that that it will protect against heart disease. There is more than one possible mechanism for how they might help prevent heart disease, including reducing blood pressure or reducing cholesterol. Omega 3 fats are readily available as over-the-counter supplements and they are widely bought and used.

A new Cochrane systematic review, published today in the Cochrane Library, combines the results of seventy-nine randomised trials involving 112,059 people. These studies assessed effects of consuming additional omega 3 fat, compared to usual or lower omega 3, on diseases of the heart and circulation. Twenty-five studies were assessed as highly trustworthy because they were well designed and conducted.

The studies recruited men and women, some healthy and others with existing illnesses from North America, Europe, Australia and Asia. Participants were randomly assigned to increase their omega 3 fats or to maintain their usual intake of fat for at least a year. Most studies investigated the impact of giving a long-chain omega 3 supplement in a capsule form and compared it to a dummy pill. Only a few assessed whole fish intake. Most ALA trials added omega 3 fats to foods such as margarine and gave these enriched foods, or naturally ALA-rich foods such as walnuts, to people in the intervention groups, and usual (non-enriched) foods to other participants.

The Cochrane researchers found that increasing long-chain omega 3 provides little if any benefit on most outcomes that they looked at. They found high certainty evidence that long-chain omega 3 fats had little or no meaningful effect on the risk of death from any cause. The risk of death from any cause was 8.8% in people who had increased their intake of omega 3 fats, compared with 9% in people in the control groups.

They also found that taking more long-chain omega 3 fats (including EPA and DHA), primarily through supplements probably makes little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities. Long-chain omega 3 fats probably did reduce some blood fats, triglycerides and HDL cholesterol. Reducing triglycerides is likely to be protective of heart diseases, but reducing HDL has the opposite effect. The researchers collected information on harms from the studies, but information on bleeding and blood clots was very limited.

The systematic review suggests that eating more ALA through food or supplements probably has little or no effect on cardiovascular deaths or deaths from any cause. However, eating more ALA probably reduces the risk of heart irregularities from 3.3 to 2.6%. The review team found that reductions in cardiovascular events with ALA were so small that about 1000 people would need to increase consumption of ALA for one of them to benefit. Similar results were found for cardiovascular death. They did not find enough data from the studies to be able to measure the risk of bleeding or blood clots from using ALA.

Increasing long-chain omega 3 or ALA probably does not affect body weight or fatness.

Cochrane lead author, Dr. Lee Hooper from the University of East Anglia, UK said: “We can be confident in the findings of this review which go against the popular belief that long-chain omega 3 supplements protect the heart. This large systematic review included information from many thousands of people over long periods. Despite all this information, we don’t see protective effects.

“The review provides good evidence that taking long-chain omega 3 (fish oil, EPA or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause. The most trustworthy studies consistently showed little or no effect of long-chain omega 3 fats on cardiovascular health. On the other hand, while oily fish is a healthy food, it is unclear from the small number of trials whether eating more oily fish is protective of our hearts.

“This systematic review did find moderate evidence that ALA, found in plant oils (such as rapeseed or canola oil) and nuts (particularly walnuts) may be slightly protective of some diseases of the heart and circulation. However, the effect is very small, 143 people would need to increase their ALA intake to prevent one person developing arrhythmia. One thousand people would need to increase their ALA intake to prevent one person dying of coronary heart disease or experiencing a cardiovascular event. ALA is an essential fatty acid, an important part of a balanced diet, and increasing intakes may be slightly beneficial for prevention or treatment of cardiovascular disease.”

Celebrating positives improves classroom behavior and mental health

Training teachers to focus their attention on positive conduct and to avoid jumping to correct minor disruption improves child behaviour, concentration and mental health.

A study led by the University of Exeter Medical School, published in Psychological Medicine, analysed the success of a training programme called the Incredible Years® Teacher Classroom Management Programme. Its core principles include building strong social relationship between teachers and children, and ignoring low-level bad behaviour that often disrupts classrooms.

Instead, teachers are encouraged to focus on relationship building, age appropriate motivation, proactive management of unwanted behaviour and acknowledging good behaviour.

The Supporting Teachers and Children in Schools (STARS) study was funded by the National Institute for Health Research (NIHR) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, and aimed to promote social and emotional wellbeing, against a backdrop of Government figures that show 10% of children have a mental health condition. The commonest and most persistent mental health condition is severe behaviour problems, and children with “conduct disorder” are at risk of all adult mental health conditions as well as poor educational and social outcomes.

Professor Tamsin Ford, of the University of Exeter Medical School, said: “Our findings suggest that this training potentially improves all children’s mental health but it’s particularly exciting to see the larger benefit on the children who were initially struggling. These effects might be larger were this training offered to all teachers and teaching assistants. Let’s remember that training one teacher potentially benefits every child that they subsequently teach. Our study offers evidence that we should explore this training further as a whole school approach.”

The project’s outcomes were measured via a combination of questionnaires filled in by teachers and parents and children to fill in themselves. Researchers also considered academic attainment, and use of NHS and social services. Independent observers sat in on lessons in a quarter of schools who took part, without knowing whether the teachers had undertaken the training.

As well as the improvements in mental health, behaviour and concentration, teachers liked the training and thought it useful. Observations suggest that it changed their behaviour and improved child compliance in the classroom.

Teacher Sam Scudder, at Withycombe Raleigh School in Exmouth, East Devon, undertook the training as part of the trial. He said: “I’ve found the training has made a real difference and it’s definitely improved my teaching practice. Praise is an essential aspect of the training and ‘proximity praise’ has been a really effective tool. By finding and describing the sort of behaviour you desire, you can bring a change in those who are off-task while simultaneously ignoring them. Of course there are some behaviours you can’t ignore, but the focus is around really celebrating the kids who exhibit the behaviour you want: those who are quietly listening, yet are often overlooked in classrooms. It has a ripple-effect as more children copy that conduct.”

Teacher Kate Holden, at Ipplepen Primary School, also took part in the study, and said: “This training helped us to use techniques to raise the profile of positive behaviour and diminish the emphasis placed on low level disruptive behaviour. Consistent clear rewards and sanctions highlighted expectations in a manageable and positive framework and preserved the high-quality relationships which underpin the whole ethos. This is far from woolly or accepting of poor behaviour. it is actually proactive and highly effective when used correctly in conjunction with a model to support behaviour across the whole school.”

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Common Blood Pressure Medications Containing Valsartan Recalled Over ‘Impurity’ Concerns

Several valsartan-containing drugs, which are commonly used to treat high blood pressure, have been recalled over contamination fears, the Food and Drug Administration (FDA) announced late last week. Specifically, the medications were tainted with N-nitrosodimethylamine (NDMA), a compound that’s been linked to cancer, the FDA said in a statement.

As a result, three companies—Major Pharmaceuticals, Solco Healthcare, and Teva Pharmaceuticals Industries Ltd.—have voluntarily recalled their products that contain valsartan. Solco and Teva Pharmaceuticals are also recalling their valsartan/hydrochlorothiazide medication. (Representatives from Major Pharmaceuticals, Solco Healthcare, and Teva Pharmaceuticals did not return SELF’s request for comment.)

“The presence of NDMA was unexpected and is thought to be related to changes in the way the active substance was manufactured,” the FDA said in the statement. Additionally, the FDA noted that all the recalled products contained valsartan were supplied by a third party, which has since stopped supplying the ingredient. “The FDA is working with the affected companies to reduce or eliminate the valsartan [active pharmaceutical ingredient] impurity from future products,” the statement reads.

The problem is that NDMA has been linked to an increased risk for cancer.

NDMA is a semi-volatile compound that forms in both industrial and natural processes, the Environmental Protection Agency (EPA) explains. It’s created from chemical reactions involving nitrates, nitrites, and other proteins, Rowena N. Schwartz, Pharm.D., an oncology pharmacist and associate professor of pharmacy practice at the University of Cincinnati, tells SELF. So, the compound may be an unintentional byproduct of the medications’ chemical manufacturing process, Jamie Alan, Ph.D., an assistant professor of pharmacology and toxicology at Michigan State University, tells SELF.

There’s evidence NDMA can create free radicals in your body that can damage your DNA, which can lead to the formation of cancer in some cases, Alan explains. Although this sort of process could raise the risk for any kind of cancer, Alan says, NDMA is a nitrate; and nitrates have specifically been linked to an increased risk of stomach, colon, and kidney cancers, according to the National Cancer Institute.

Technically, the International Agency for Research on Cancer (IARC) considers NDMA a Group 2A agent, meaning it’s considered a probable human carcinogen. This category sits one step above agents categorized as “possibly” carcinogenic to humans (which is Group 2B) and one step below definite human carcinogens (Group 1). According to the IARC’s definitions, category 2A is usually chosen when there’s sufficient evidence for a compound being carcinogenic in animal studies, but limited evidence in human studies, especially if there’s evidence that the animals studied share a common potential mechanism of action with humans.

But, because there are so many other factors at play, it’s hard to say exactly how much your risk for cancer would increase if you were exposed to NDMA. Those factors include things like your family history, the dose of NDMA you were exposed to and the length of exposure, your other environmental risks, as well as your personal history with cancer. “It really is specific to the individual,” Alan says.

If you’re affected by this recall, there are a few things you should do.

First, check your medication by looking at the drug company and drug name on the bottle and seeing if it’s one that’s included in the recall. If that information isn’t clear on the packaging, contact the pharmacy where you got the medication. If it turns out your medication is affected by the recall, call your doctor or pharmacist and follow the instructions posted on the FDA’s website for that particular medication.

Obviously, if you’re taking a blood pressure medication, there’s probably a good reason for it—and you shouldn’t just stop taking it without having a backup plan in place, Sanjiv Patel, M.D., a cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif., tells SELF. Suddenly stopping your medication could cause a rebound effect that makes your blood pressure go up, Dr. Patel says, and that can put you at a higher risk of a stroke or heart attack. So, the FDA currently recommends that you keep taking your medication until you have a good replacement—and that you talk to your doctor or pharmacist about getting that replacement ASAP.

If for some reason you’re having a hard time getting ahold of your doctor, call the pharmacy that filled this for you—they may be able to give you a similar product with valsartan that was not affected by the recall, Alan says. Or, your doctor may even recommend that you try a totally different medication. “There are other options beyond valsartan,” Dr. Patel says. “It just one of many medications we can use to treat high blood pressure.”

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When to See a Doctor About Diarrhea and When to Wait for It to Pass

When you’ve taken up permanent residency on your toilet thanks to diarrhea, you might start to wonder how normal your poop explosion really is. Sure, everyone has diarrhea from time to time, but when does it actually become a sign that you should see a doctor? Here, we consulted experts for the signals it’s time to seek treatment for diarrhea, plus what could be behind your butt’s excellent (and unfortunate) volcano impersonation.

Here’s exactly why diarrhea happens, first of all.

By definition, diarrhea means having loose, watery, stools that are more frequent than whatever amount of pooping is normal for you, the Mayo Clinic says.

Quick biology lesson: When the stuff you eat reaches your small intestine where a lot of your digestion takes place, it’s usually in liquid form, Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF. Your small intestine and colon (which is the longest part of your long intestine) absorb most of the fluid, transforming that matter into the solid-ish poop you see in your toilet. But when you have diarrhea, something has interfered with your small intestine or colon’s ability to soak up that liquid, so you end up with the runny, watery poop that you know as diarrhea, Dr. Staller explains.

The general rule is that if you have diarrhea for up to two days with no other symptoms, then it disappears, you can skip going to the doctor’s office.

Why’s that? Well, having diarrhea for a couple of days is just something that happens sometimes.

You can generally lump diarrhea into two categories: acute and chronic. Acute diarrhea can last anywhere from a few days to two weeks and is usually due to a bacterial, viral, or parasitic infection, according to the Mayo Clinic. Sometimes that infection passes in a matter of days and is really nothing to worry about. That’s why if you have acute diarrhea that only lasts for a couple of days, you don’t have any weird symptoms along with it (we’ll get to what those symptoms are in a sec), and then it goes away, you should be fine to just stock up on toilet paper and roll with it, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF.

Chronic diarrhea, on the other hand, lasts for longer than four weeks at a minimum. That can point to serious issues like the inflammatory bowel diseases ulcerative colitis (a condition that causes inflammation and sores in your large intestine and rectum) and Crohn’s disease (another illness that causes inflammation in your digestive tract, but typically in your small intestine and colon), or irritable bowel syndrome, a chronic intestinal disorder that also affects your colon.

Sometimes there are major red flags that you need to see a doctor to treat your diarrhea.

Here are signs you should, at the very least, give your doctor’s office a call for guidance:

1. You’ve had diarrhea for two days and it hasn’t improved or is actually getting worse.

If your diarrhea is still terrible after at least two days, it could be a sign that you have an infection that’s sticking around, Dr. Farhadi says. While a viral infection will just have to run its course (sorry, pal), you may need antibiotics to clear up a bacterial or parasitic infection, the Mayo Clinic says.

Having persistent diarrhea could also be a sign that a medication you’re on is upsetting your stomach or that something you’ve started eating regularly isn’t sitting well with you, Dr. Staller says. And, of course, long-lasting diarrhea could be a sign of one of the aforementioned conditions, like ulcerative colitis, Crohn’s disease, or irritable bowel syndrome, although you’ll typically have other symptoms as well, which we’ll cover further down the list.

2. You’re experiencing signs of dehydration.

Diarrhea can cause dehydration because you’re losing so much liquid. In severe cases, dehydration can be life-threatening if it’s not treated, according to the Mayo Clinic. But even if you don’t pass that threshold, being dehydrated feels awful and can be treated.

The biggest signs of dehydration to look out for: You’re incredibly thirsty, your skin and mouth are dry, you’re not peeing much or at all (plus your urine is a dark yellow color when you do actually pee), and you feel weak, dizzy, faint, or fatigued. If you have any of these signs along with your diarrhea, get to the emergency room, Dr. Farhadi says. You may need IV fluids to replace what you’ve lost.

3. You’ve recently developed mouth sores.

When this happens along with diarrhea, doctors generally think of Crohn’s disease, Dr. Staller says. In addition to causing diarrhea, the inflammation that comes with Crohn’s can create sores in your digestive tissue. “Crohn’s disease can affect anywhere in the GI tract, from the mouth down to the anus,” he explains. This is as opposed to ulcerative colitis, which is limited to your large intestine and rectum.

This can also be a sign of celiac disease, a condition in which eating gluten leads to an immune response in your small intestine, according to the Mayo Clinic. You might be tempted to chalk up your mouth pain to something like a canker sore, but if you’re also dealing with diarrhea, you should see your doctor to make sure something larger isn’t going on.

4. You have severe stomach or rectal pain.

Severe stomach pain with diarrhea can signal many issues, from something as simple as gas to a potentially life-threatening condition like appendicitis, Christine Lee, M.D., a gastroenterologist at the Cleveland Clinic, tells SELF.

This could also be a sign of a more chronic condition like IBS-D (irritable bowel syndrome where diarrhea is the main symptom) or, again, Crohn’s disease or ulcerative colitis, Dr. Staller says. “Any diarrheal disease can cause pain,” he says, because diarrhea inflames and irritates the area. “The rectum has very sensitive nerves,” he adds.

Unless you happen to be a gastroenterologist, it’s going to be really hard for you to tell what’s behind this pain + diarrhea equation on your own. If you’re experiencing diarrhea and a lot of pain, a visit to the doctor is in order.

5. There’s pus in your diarrhea.

Pus is a yellow-ish, mucus-y liquid your body produces when trying to fight infection, Dr. Staller says. “It’s a marker of inflammation,” he explains, adding that the inflammation is part of your body’s immune response to whatever it has deemed a threat.

Diarrhea that contains pus is a common sign of ulcerative colitis, according to the Mayo Clinic. Those sores it creates in your gastrointestinal tract can lead to pus that comes out in your poop.

6. Your diarrhea is bloody or black.

Blood in your poop could hint at a range of things. You could have a hemorrhoid (a clump of bulging veins in your rectum or around your anus), Dr. Lee says, but that typically causes only a bit of blood, not the kind that might set off alarm bells. It can also be a sign of a foodborne illness, the Mayo Clinic says. (For instance, Campylobacter bacteria is notorious for causing this, according to the Centers for Disease Control and Prevention.)

But, like with many other items on this list, this could be a sign that you have a chronic condition like ulcerative colitis or Crohn’s disease. When you have these conditions, your immune system may attack your GI tract to the point that it bleeds, Dr. Staller says. Either way, if a good portion of your poop is bloody or black (which hints at blood that has oxidized, so bleeding may be coming from higher up in your GI tract), you need to see a doctor right away, Dr. Farhadi says.

7. You have a fever of more than 102 degrees Fahrenheit.

This generally indicates that you have some kind of infection that’s compromising your system, Dr. Lee says, although a fever can also be your body’s response to the inflammation that comes along with conditions like ulcerative colitis and Crohn’s disease. “Any time there is a fever and diarrhea, you should have your guard up,” Dr. Staller says. And, as you might guess, you should see your doctor.

In the meantime, you can try taking an over-the-counter fever reducer, but be sure to follow the instructions, since drugs like acetaminophen and ibuprofen can cause liver or kidney damage if you take too much, according to the Mayo Clinic.

8. You’re losing a lot of weight.

Sure, if you’re pooping your brains out, you’re probably going to lose a little weight because of all those fluids whooshing out of you. But if your diarrhea won’t stop and you lose a few pounds (on top of your normal fluctuations) in a few days, it could be a sign that you’re dealing with an issue like a severe infection, inflammatory bowel disease, or celiac disease, Dr. Lee says. Either way, you want to make sure your doctor looks into it so they can address the root cause of your unintended weight loss.

Your doctor’s next steps in diagnosing what’s behind your diarrhea will depend on your mix of symptoms.

They’ll likely do a blood test, stool test (where they try to figure out if a bacteria or parasite is causing your diarrhea), or colonoscopy or flexible sigmoidoscopy, procedures that look at the lining of your colon using a thin, lighted tube with a lens, according to the Mayo Clinic. After that, they can prescribe treatment.

If you’re dealing with diarrhea and you’re not sure what to make of it, call your doctor anyway, even if you don’t have the other symptoms on this list. “No one knows your body better than you, so trust your instincts,” Dr. Lee says. “If something doesn’t feel right, then get it checked out.”

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