Dr Nicholas Morris2013-05-25T14:21:53-04:00Dr Nicholas Morrishttp://www.huffingtonpost.co.uk/author/index.php?author=dr-nicholas-morrisCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Dr Nicholas MorrisGood old fashioned elbow grease.Early Childhood Near Traffic Elevates Chances of Later Autism - Do Our Brains Need Protecting From the Modern World?tag:www.huffingtonpost.com,2013:/theblog//3.24852392013-01-16T19:00:00-05:002013-03-18T05:12:01-04:00Dr Nicholas Morrishttp://www.huffingtonpost.com/dr-nicholas-morris/
A team of researchers based at the Children's Hospital of Los Angeles and the University of Southern California, report that mothers who live near higher road traffic pollution during their pregnancy, and for the first year of their baby's life, suffer elevated risk of later autism in those children.
Children with autism are more likely to live at residences that have the highest exposure to traffic-related air pollution, during gestation and the first year of life, compared with children whose development is 'normal'.
The study compared 279 children with autism and 245 children with typical or 'normal' psychological growth. The mother's address was used to estimate exposure to traffic-related pollution for each phase of pregnancy and first year of life. Regional air pollutant measures were based on the Environmental Protection Agency's Air Quality System data. Pollutant levels for children with autism and for those with more typical development were compared.
Autism spectrum disorders are characterized by difficulties in communication, social interaction combined with repetitive behaviours, or restricted interests. The incidence rate of all autism spectrum disorders has been climbing dramatically in recent years, yet no one knows why. Some blame over-diagnosis, others believe this is a genuine and alarming rapid increase. The rate in the USA has now reached as high as one in 110 children, or almost 1% of all children born today.
Air pollution has begun to emerge as a potential risk factor for autism. For example, a 2006 study identified an increased risk of autism based on exposure to diesel exhaust particles, metals (mercury, cadmium, and nickel), and chlorinated solvents in Northern California. Another investigation in 2010 also reported associations between autism and air toxicology at the birth residences of children from North Carolina and West Virginia. High levels of air pollutants have been associated with poor birth outcomes, immunology changes, and decreased cognitive abilities.
Heather Volk, the lead author of the latest study, led a team which had also found a similar association between the risk of autism and an early life residence around 300 metres from a freeway, in a study published last year. Traffic-related air pollutant mixture varies depending on distance from the source, returning to near-background daytime levels beyond a distance of around 300 metres (about 1000 feet). Residence within around 300 meters of a freeway at time of delivery of a baby, compared to greater than 1,400 meters, was associated with nearly a doubling in odds of having a child who later developed autism. Proximity to smaller roadways didn't show associations with autism, which is consistent with higher concentration of pollutants near major freeways, and declines in particulate matter to background levels, beyond 300 meters from a major road.
Heather Volk, Fred Lurmann, Bryan Penfold, Irva Hertz-Picciotto and Rob McConnell, the authors of this latest research, entitled 'Traffic-Related Air Pollution, Particulate Matter, and Autism' have now found children with autism were three times as likely to have been exposed during the first year of life to higher traffic-related air pollution, compared with children with more typical or normal development. Similarly, exposure to traffic-related air pollution during pregnancy was also associated with autism.
The authors of the study point out that concentrations of many air pollutants, including diesel exhaust particles are elevated near major roads, and such diesel exhaust particles plus polycyclic aromatic hydrocarbons (commonly present in diesel exhaust) have been shown to negatively impact brain function.
Dr Geraldine Dawson, chief science officer at 'Autism Speaks', in the same issue of the academic journal where the traffic-autism link finding has just been published (Journal of the American Medical Association Psychiatry), points out that in the past six years prevalence of Autistic Spectrum Disorders has increased 78% in the USA.
Dr Luke Knibbs and Professor Lidia Morawska from the International Laboratory for Air Quality and Health, Queensland University of Technology, report in a recent review paper, that fine particles found in traffic pollution are small enough to reach the brain directly. No one knows yet how autism is caused, but clues could come from what is already known of the negative impact of traffic pollution on adult brains.
Knibbs and Morawska point out just one hour of exposure to diesel exhaust produces functional brain changes in adults, while another recent study they cite, reported that levels of serum brain-derived neurotrophic factor (BDNF), an important chemical linked to normal brain development, learning, memory and possibly crucially protective from depression and dementia, did not increase following 20 min of cycling near a major road, as it normally does following exercise.
In the study on cycling near a major road, the same exercise performed in a particle-free filtered environment, led to a 14% increase in BDNF. Exposure to Traffic Related Air Pollution (TRAP) in transport environments seems to reduce exercise benefits on BDNF levels.
Knibbs and Morawska, in their review from the academic journal 'Environment International', highlight that past research indicates wearing an efficient respirator, or face mask, greatly reduces exposure to Traffic Related Air Pollution, and has been shown to have health benefits.
Knibbs and Morawska emphasise that makeshift handkerchief masks appear to offer little health protection, compared to purpose-designed respirators or face masks.
The study investigating traffic pollution and autism made allowances for social class and economic circumstances - traffic pollution was linked to autism no matter how wealthy or poor families were. In other words living in Buckingham Palace, but near major busy roads is as dangerous, according to this new research, to the brain of a foetus or newborn, as being brought up in tougher neighbourhoods.
Sceptics of these findings argue air pollution has been generally declining in the US while autism rates have been supposedly rising, plus they contend the most traffic polluted cities in the world don't necessarily seem to suffer the highest autism levels.
But, if the effect of traffic pollution on our brains turns out to be truly harmful, given it's estimated 11% of the U.S. population live within 100 m of a four-lane highway, the public health implications are profound.
Prince Charles is exhorting grandparents to become environmental campaigners; if you are swayed by this study, the next generation needs protecting critically right now.]]>If Morning Sickness Is Associated With Fewer Miscarriages and Higher IQ Babies - Should It Be Treated?tag:www.huffingtonpost.com,2012:/theblog//3.22376272012-12-04T19:00:00-05:002013-02-03T05:12:01-05:00Dr Nicholas Morrishttp://www.huffingtonpost.com/dr-nicholas-morris/
First of all 'morning sickness' is misnamed as it only occurs in the morning in less than 20% of women. Despite reassurances currently being published that the Duchess's torment is going to be very temporary, in fact only half of women with nausea and vomiting during pregnancy are completely relieved by 14 weeks' gestation. Plus it can be extremely debilitating with up to a quarter of women in one study with symptoms requiring time off work as a result.
Miserable though it may be to experience as a condition, in fact 'morning sickness' (if it's not of the rarer more severe kind), oddly enough, can be good news for a pregnancy. It's associated with lowered risk for miscarriage, pre-term birth, low birth weight, and perinatal death. However it can also be associated with serious medical conditions which need to be screened for and treated, but most often it occurs in medically normal pregnancies.
In 2009 a study published in 'The Journal of Pediatrics' from the Hospital for Sick Children, Toronto, provoked controversy when it found nausea and vomiting during pregnancy was significantly associated with better IQ test results in children aged three to seven years after delivery. A battery of psychological tests were involved including measures of intelligence, neurocognitive abilities and behavior problems.
The study entitled 'Long-term Neurodevelopment of Children Exposed to Maternal Nausea and Vomiting of Pregnancy and Diclectin' - by Irena Nulman, Gideon Koren and colleagues, found the more severe the nausea and vomiting during pregnancy, the better the child's eventual scores across the range of tests.
No one knows exactly why nausea and vomiting during pregnancy is generally good for the foetus, but this has led to a 'Maternal and Embryo Protection Hypothesis', which argues its purpose may be to shield the mother from contaminated food, so protecting the developing foetus against potentially threatening toxins and bugs.
Some have hypothesised that raised hormone levels during pregnancy, such as oestrogen and Human Chorionic Gonadotropin levels make the smell or olfactory system in the female brain hyper-sensitive. One theory is that it's smells which might be the primary driver of nausea and vomiting during pregnancy, and extra-sensitivity to odours protects mothers from imbibing hazards. It is also established that Asian women have more troublesome vomiting and this seems to be due to the structure of Human Chorionic Gonadotropin.
Many features of nausea and vomiting during pregnancy suggest an evolutionary adaptive design. For example, Samuel Flaxman and Paul Sherman from the Dept of Neurobiology and Behavior, Cornell University, contend it's therefore no accident it tends to occur during the most sensitive period of embryogenesis (weeks five-18). They also point out in their commentary in the academic journal 'Trends in Ecology & Evolution', it causes physical expulsion of and subsequent aversions to the foods that are most likely to be hazardous including meats, caffeinated beverages and pungent vegetables. They also note the intriguing absence of nausea and vomiting during pregnancy in seven societies on four continents lacking such dietary triggers.
Another theory is that the food aversion is a completely incidental and an unwanted side-effect, as it's a direct effect on the foetal brain or the placenta of high levels of hormones of pregnancy which cause nausea, which is why there appears to be an association with baby benefits.
Whether nausea and vomiting has a natural protective or positive purpose during pregnancy raises a conflict for doctors as to whether women should be treated to suppress symptoms, or encouraged instead to 'ride them out'. This is made all the more difficult given the long history of some anti-nausea treatments when ingested, causing congenital problems. Severe nausea and vomiting in pregnancy, otherwise known as hyperemesis gravidarum, should definitely be treated as it can result in life-threatening malnutrition and liver damage, but it's rare, and affects less than 1% of pregnant women. The most dangerous consequence is for the woman to suffer vitamin deficiencies and this can cause maternal brain damage.
Women suffering from so-called normal nausea and vomiting are often desperate, and any treatment which doesn't involve taking something, given the risks to the foetus, should be welcomed.
This condition also responds to vitamin supplementation, acupuncture and acupressure. These treatments can also improve mood during pregnancy and the emotional impact of nausea and vomiting during pregnancy is extremely important.]]>A British Soldier in Afghanistan Has a Baby Without Knowing She Was Pregnant - How Is This Possible?tag:www.huffingtonpost.com,2012:/theblog//3.19028432012-09-21T19:00:00-04:002012-11-21T05:12:01-05:00Dr Nicholas Morrishttp://www.huffingtonpost.com/dr-nicholas-morris/
Pregnancy, particularly late pregnancy when a mother is close to giving birth, would seem an utterly obvious condition. Yet obstetricians repeatedly encounter women who even deliver at full term, without being at all aware they were pregnant.
Many of these predicaments end joyously, with a woman who initially complained to doctors of baffling tummy pain, finding themselves astonished, but eventually pleased mothers. Yet doctors know that the story doesn't end there, what happens to that baby afterwards can be of grave medical concern.
There is a possible and controversial association between so called 'denial of pregnancy' and killing of such newborns. Women who deny pregnancy obviously don't get the right antenatal care and this is hazardous. But is there also a strong link in some cases with neonaticide (homicide within the first 24 hours of life)? This serious problem is being actively researched at the moment.
Some women who deny pregnancy might be much more likely than the general population to kill their newborns, sometimes through neglect, and these can be found in the lavatory, garbage disposal, or a hasty grave.
Klaus Beier, Reinhard Wille and Jens Wessel from the University Clinic Charite´, Berlin and Sexual-Medical Department, University Clinic, Kiel, Germany have surveyed research on pregnancy denial, and found that reports of the phenomenon are in fact increasing recently.
German data suggests one case of denied pregnancy occurs in 475 deliveries for women who were not aware of being pregnant, and did not receive a diagnosis of pregnancy during the first 20 weeks of the pregnancy. Women who do not realize they are pregnant until going into actual labour occurs 1 in 2455 deliveries.
Wessel lead a team whose survey of all births in Berlin over one year, published in the academic journal 'Acta Obstetricia et Gynecologica Scandinavica', found such totally unexpected deliveries of a viable fetus, without any previous knowledge at all of being pregnant, occurs roughly 300 times a year in a country the size of Germany. According to their calculations, in the study titled 'Frequency of denial of pregnancy: results and epidemiological significance of a one-year prospective study in Berlin', this means denial of pregnancy occurs three times more often than triplets.
Wessel and colleagues point out that besides denial of pregnancy, there is concealment of pregnancy; the woman actually knows she is pregnant, but hides it from those around her. Possibly fear of disgrace, or worry her partner will leave, may be factors. Very immature younger women who are victims of an unplanned pregnancy may try to 'forget' they are pregnant, perhaps hoping it will go away.
In their study of 'pregnancy deniers' entitled, 'Denial of pregnancy as a reproductive dysfunction: A proposal for international classification systems' Beier, Wille and Wessel found 38% had actually visited the doctor during their pregnancy, but the physician, remarkably, didn't spot the pregnancy. The researchers explain this surprising finding as not in fact that unusual, and explained by a fair degree of obstetrical ignorance being common in non-gynecologists.
An interesting psychological theory they propose is that an unconscious dynamic sometimes develops between a mother in strong denial and her doctor, so they both end up colluding in the denial. This common process is known as 'projective identification' and a sympathetic doctor-patient relationship is vulnerable to the physician embracing the denial projected on to them by the patient.
Another peculiar phenomenon which contributes to pregnancy denial is the continuation of regular menstruation during a pregnancy, which was the case in 46% of Beier, Wille and Wessel's sample of pregnancy deniers. In the study published in the 'Journal of Psychosomatic Research', the authors declare doctors still don't have a medical explanation for this frequently described mystery. Sometimes in older women no periods is confused or rationalised as the start of menopause.
The authors conclude that women who fail to grasp they are pregnant before delivery are commonly suspected of deception or psychosis, yet this and other research finds the overwhelming majority have a normal lQ, little or no obvious psychiatric disorder, and only around 5% appear to suffer psychotic illnesses like schizophrenia.
Beier, Wille and Wessel point out that before we jump to the conclusion these women are stupid or insane, denial of physical illness is very common. Indeed it is almost normal following a life-changing diagnosis such as cancer or severe heart disease. Such denial frequently leads to not following medical advice and this is even a norm in many serious physical illnesses.
There are many different kinds and levels of psychological 'denial'. One form is 'affective denial' and means while intellectually aware of the pregnancy, a woman demonstrates little emotional reaction. For women with severe addictions for example, if unable to give up their dependency, emotional denial defends against guilt from harming their foetus through substance abuse. Psychotic denial of pregnancy might be particularly likely in those with a previous history of psychosis, combined with prior loss of custody of other children, as a result of their severe mental illness.
Natacha Vellut, Jon Cook and Anne Tursz from the Centre de Recherche Médecine, Sciences, Santé, Santé mentale et Société, Paris, have just published a study examining what proportion of neonaticides are made up of women who deny their pregnancy. In three regions of France over a 5-year period there were 32 cases of neonaticide of which possibly three pregnancies were undiscovered until delivery. The authors wonder whether denial of pregnancy has been over-rated by doctors before as an underlying factor in eventual neonaticide.
The study entitled 'Analysis of the relationship between neonaticide and denial of pregnancy using data from judicial files', argues pregnancy deniers may disconnect pregnancy from childbirth. While aware of being pregnant from time to time, none of these mothers seemed to foresee or get ready for delivery.
Just published in the academic journal 'Child Abuse and Neglect', perhaps the most disturbing finding of the study, is that it revealed neonaticide to be at least 5.4 times more frequent in France than officially recorded in mortality statistics.
The authors also point out that as 25% of cases related to discovery of the corpse of a newborn whose family was never identified, this raises the possibility of a much higher unknown number of bodies never discovered.
If so, denial or concealment of pregnancy, might also be much more common that officially realised.]]>In Sex Research - Has the Holy Grail at Last Been Found? The G-Spot - Is the Fumbling Search at Last Over?tag:www.huffingtonpost.com,2012:/theblog//3.14540292012-04-25T19:00:00-04:002012-06-25T05:12:02-04:00Dr Nicholas Morrishttp://www.huffingtonpost.com/dr-nicholas-morris/the Daily Telegraph, and newspapers across the world, report breathlessly the famous G-Spot has at last been uncovered. Dr Adam Ostrzenski, a Gynaecologist based in Florida, who has apparently published a research paper in the May issue of the 'Journal of Sexual Medicine', seems to claim he's found it.
The G-Spot is the location of a special area of the vagina, which supposedly plays a key role in reaching vaginal orgasm for women, during vaginal intercourse. If it's true this has, at last, been definitively identified, then this discovery could spark a new sexual revolution, or perhaps assist in treatments of sexual dysfunction.
The G-Spot gets its name from Dr Ernst Gräfenberg, a New York gynaecologist who in 1950 described a zone located at the front part of the vagina (roughly the same locale mentioned in this latest investigation by Ostrzenski) which is believed to trigger vaginal orgasms.
But the area has been of speculation and interest going back much further in time, argues Dr Marie Helene Colson, Director of the Sexology program at Marseille Faculty of Medicine, in France. She points out this spot is referred to in tantric texts with the name ''Kanda'', and in the Taoist tradition as ''the black pearl'' of eroticism.
Despite the trumpeting of this discovery in headlines across the world, it is important, if perhaps a bit of a cold shower, to point out that this latest 'study' involved the dissection of the anatomy of a single elderly woman, and wouldn't really qualify as a definitive piece of research involving a large sample, in the eyes of many Sexologists.
Dr Colson is sceptical about the level of scientific rigour of much of the past research on the G-Spot, and it does seem as if every few years some new academic group, or popular author, trumpets a new discovery of the G-Spot. For example, she points out that a previous 1981 study (which similarly claimed to have located the G-Spot as the latest research) was also based on just one case alone.
The popular book by Alice Ladas and Beverley Whipple published in 1982 - The G-Spot and Other Recent Discoveries about Human Sexuality, which really put the G-Spot on the map in terms of popular consciousness, uses anecdotes and stories rather than scientific research. Another much trumpeted study in 1983 concerned 11 women, but in fact only four confirmed they'd reach orgasm by stimulation of the G-Spot.
Scepticism of whether the G-Spot exists at all spills over into Feminist theories. Perhaps its perennial search tells us more about the patriarchal desire for a vaginal orgasm to be possible, over a clitoral one. The famous feminist author Sheer Hite grabbed headlines in Time Magazine, amongst other places, in 1987, for her two reports, involving a survey of 1844 American women. Her research lead her to conclude the only true female orgasm arises from the clitoris, and not the vagina.
So the search for the elusive area has begun to resemble a fumbling search for the Holy Grail in the sceptical eyes of many, including in particular some feminist critics, and it is notable that so many those who claim to have found the G-Spot, appear to be male researchers.
Colson's own review of the research over the last few decades on the search for the G-Spot, a paper entitled 'Female orgasm: Myths, facts and controversies' and published in the academic journal 'Sexologies', leads her to conclude the mistake might be in looking for a specific spot, as opposed to a wider area. She points the finger at the whole front wall of the vagina, which possibly transmits arousal to the clitoris by stretching the ligaments that are inside it, with to-and-fro movements during intercourse.
Colson argues the most recent studies, using much more rigorous ultrasound techniques, compared to older research, suggests part of the clitoris can descend to rest against the lower part of the anterior wall of the vagina. So high sensitivity of the zone around what is described as the G-Spot, could be related to its amplification caused by the protrusion of the clitoris swelling and descending to rest against it during the to-and-fro movements. This more 'dynamic' theory might also explain the variability being found between women as to where this elusive 'G-Spot' might be.
Ultrasound research now seems to be revealing a thinner front vaginal wall in women having more difficulty experiencing vaginal orgasms. Positron Emission and Nuclear Magnetic Resonance work also suggests stimulating this specific zone might affect pain perception during childbirth. This is because of the release of endorphins, which are heroin-like pain relieving but also euphoria inducing, natural body chemicals. This would provide an even more powerful biological and evolutionary reason for why there should be a G-Spot.
In the March issue of the Journal of Sexual Medicine, the same journal where this much trumpeted new research is supposed to be published in May, another research team reported that there's no "strong and consistent evidence" to confirm the existence of the G-Spot. Oddly this paper has received almost no attention from the newspaper front-page headline writers.
A team lead by Amichai Kilchevsky and Ilan Gruenwald from the Neurourolgy Unit, Rambam Healthcare Campus, Haifa, Israel and the Department of Urology, Yale-New Haven Hospital, New Haven, USA, argue in their paper, 'Is the Female G-Spot Truly a Distinct Anatomic Entity?' that the possibility there may be more than one genital focus of erotic arousal in women is sexually liberating. It expands sexual enjoyment beyond the clitoris. Their review of the research on the G-Spot concludes that whether the G-spot actually exists is probably less interesting, compared to what this perennial search and desire for its existence tells us about our approach to sex.
They point out the G-spot has become a multimillion dollar business producing books, videos, and products, designing a better type of orgasm.
But they sound a warning; some medical professionals take advantage of the 'cultural glorification' of the G-spot and offer interventions such as "G-spot augmentation." This involves injecting collagen into the vagina, theoretically enhancing sexual stimulation.
Kilchevsky and Gruenwald point out that although popular and widely advertised, these procedures have never undergone proper scientific evaluation, so claims as to their success should be regarded with scepticism, until more data is available.
The evidence from various surveys is that approximately 60% of women will never achieve a vaginal orgasm, and will only achieve one by clitoral stimulation. This suggests that there is a wide variation in the nerve supply of the front wall of the vagina. It is important that these women are aware that they are normal, and do not need to resort to treatments such as G-Spot augmentation with collagen.
The idea of the G-Spot could possible harm the self confidence of some of these women, who do not achieve a vaginal orgasm. No current treatment or surgery can overcome this.
So it looks like once the excitement over this latest study to get so much attention has died down, we're most probably all going to have to go back to fumbling around again.