Hypothermia in trauma victims increases mortality risk

Hypothermia in trauma victims is a serious complication and is associated with an increased risk of dying. A new study has found that the key risk factor was severity of injury.

However, environmental conditions and medical care, such as the temperature of the ambulance or temperature of any fluids administered intravenously, also increased risk.

A multicentre study, carried out by the emergency medical services of eight hospitals across France, looked at the injuries, care and outcomes for all adult trauma victims, over a three-year period, who received pre-hospital care and were transported to hospital in an ambulance.

Body temperature was continuously measured using a infrared tympanic thermometer and hypothermia was defined as below 35C.

The study found that 14 percent of patients had hypothermia on arrival at the hospital.

Dr Frédéric Lapostolle who led this study explained, "As expected the severity of hypothermia was linked to the severity of injury. Blood loss and spine or head injury impair body temperature regulation and in our study we found that head injury, and intubation to aid breathing, were independently associated with hypothermia."

While external air and ground temperatures seemed to have little effect on risk of hypothermia, the study found that infusion fluid temperature and the temperature inside the ambulances were both significant risk factors.

Dr Lapostolle said, "The temperature of infused fluid for 75 percent of our patients was below 21C and usually at ambient air temperature.

We suggest that, to reduce the incidence of hypothermia, the temperature of infusion fluids need to be controlled, and that a small a volume as possible is used. Temperature of infusion fluids can be easily and rapidly measured in pre-hospital settings.

We also recommend that ambulances should be heated and that as much as possible the patient should remain clothed, because attempting to warm the patients did not compensate for the effect of them being undressed even if it can make examination more difficult.

oke.com

Identification of stem cells enables therapies:

Cancer cell discovery could revolutionise treatment

Scientists have discovered direct evidence to support a controversial hypothesis about the growth of cancerous tumours which could revolutionise the diagnosis and treatment of cancer.

The conventional view of cancer is that it results from genetic mutations within ordinary cells that cause them to divide uncontrollably into a tumour that can then spread to other parts of the body. This suggests all cancer cells are created equal with an equal capacity for dividing uncontrollably and an equal tendency to spread. However, three independent studies have now shown this to be a myth.

The scientists found that there is a hierarchy of cancer cells within a solid tumour and at the top of the hierarchy are key "cancer stem cells" that are ultimately responsible for causing a tumour to grow and develop.

Although the existence of cancer stem cells has been postulated for many years, this is the first time that scientists have been able to demonstrate that they exist within solid tumours growing in their natural state, scientists said.

Showing that cancer stem cells exist means that treatments should be focused on killing these cells rather than targeting the wider community of tumour cells, said Luis Parada, of the University of Texas Southwestern Medical Centre in Dallas. "In the past we've tried to get rid of the entire stew of cells within cancer tumours. Now we know that it's a particular bit of the stew that we should try to get rid of," he said.

"Shrinking a tumour by 50 percent is irrelevant. What you need to know is whether you're targeting the stem cells that allow a tumour to regrow. The good news is that we know what to go after."

The existence of cancer stem cells has been a controversial topic with some specialists rejecting the idea outright. However, in recent years there has been good evidence that they exist for so-called "liquid" tumours, the blood cancers. Now, three independent groups have found direct evidence for cancer stem cells in solid tumours of the brain, skin and digestive system.

They have published their findings simultaneously in the journals Nature and Science.

Hugo Snippert, of Utrecht University in the Netherlands, who discovered cancer stem cells in intestinal tumours growing in mice, said the conventional idea of tumours is incorrect.

"Tumour are like caricatures of the tissues from which they were derived. They are composed of different cell types and there is a hierarchy between the types. Like normal tissues have healthy stem cells, tumours have cancer stem cells at the basis of their cellular turnover," Dr Snippert said.

"If we want to treat cancer it is of the utmost importance that the population of cancer stem cells is included in the treatment, otherwise the tumour will grow back."

Dr Parada's work, which was based on studying brain tumours in mice, found that there was a sub-set of tumours cells that grow more slowly than other tumour cells but which allow the tumour continually to replenish itself following treatment with anti-cancer drugs.

- The Independent

Anxiety and depression increase risk of sick leave

Long-term sick leave is a burden for individuals and society at large, yet very little is known about the underlying reasons for it. Researchers at the Norwegian Institute of Public Health, in collaboration with Australian and British institutes, have identified anxiety as a more important risk factor than previously thought.

Common mental disorders such as anxiety and depression will affect 1 of 3 of us at some point in our lives. The core symptoms of mental disorders affect a person's emotional, cognitive and social functioning, which can impact on working ability. Previous studies have found a link between mental disorders and sick leave, though they have been uncertain as to whether mental disorder increases the risk of sick leave, or the other way around. Prolonged absence from the workplace can contribute to avoidance behaviour, especially in those with anxiety, which can make it even harder for these individuals to get fully back to work.

It is therefore important to examine the long-term associations between common mental disorders and sick leave in order to help plan more effective interventions aimed to prevent and reduce sick leave among individuals with common mental disorders.

This study examined anxiety and depression levels among 13,436 participants in the Hordaland Health Study. Common mental disorders were assessed at the start of the study with the Hospital Anxiety and Depression Scale.Participants were then followed for up to six years, retrieving information on sick leave of 16 days or more from the official Norwegian registry over state paid sick leave benefits.

Information on other possible causal factors such as socioeconomic status and physical health was also obtained from the health study.

Anxiety is most important

The study has several findings that have not been previously shown in similar studies. Firstly, it shows that common mental disorders increase the risk of very prolonged absence (over 90 days) and repeated episodes of sick leave. Secondly, it shows that the risk of these outcomes is highest among those with both anxiety and depression simultaneously.

Thirdly, the results indicate that anxiety may be more important than depression. "Surprisingly, we found that anxiety alone is a stronger risk factor for prolonged and frequent sick leave than depression alone.

- sciencedaily

Research focuses on treatment for perpetrator

A new UH experiment takes an unconventional look at the treatment for domestic violence, otherwise known as intimate partner violence (IPV), by focusing on changing the perpetrators' psychological abuse during arguments rather than addressing his sexist beliefs.

"There is a lot of research that studies the victim of intimate partner violence, but not the perpetrator," said Julia Babcock, department of psychology and co-director of the Center for Couples Therapy. "The predominant model for IPV intervention is based on what was gleaned from women in battered women shelters and focuses on men's patriarchal attitudes about power and control. Since most domestic violence occurs in the context of an argument, the experiment I conducted evaluated whether I could change how the communication goes during an argument with the batterer and his partner. The findings indicated the batterers could learn communications skills and when they applied them in an argument with their female partners, the argument improved and the participants felt better about the argument and more understood."

Programs

Babcock notes this research is significant in that it breaks new ground in applying experiments to domestic violence and may improve batterers' intervention programs. In a review of the research studies on the efficacy of batterers' intervention programs, Babcock found the results disappointing. There was a small change when a perpetrator completed a batterers intervention program and only a 5 percent reduction rate in repeat offences. "There is definitely a need to improve batterers' intervention programs, since research suggests that they're largely ineffective, but frequently prescribed by courts as a remedy for convicted IPV perpetrators," said Babcock. Babcock's research focuses on male batterers because men are the perpetrators in about 85 percent of the abuse cases, and women are 10 times more likely to be murdered by an intimate than are men.

By listing an advertisement in local papers that said, "couples experiencing conflict," the research team recruited 120 couples in the Houston area qualified for the experiment. Candidates for the study were screened over the telephone to make sure they met criteria.

To meet the criteria to participate in the study, two acts of violence had to occur in the last year that might include: pushing, shoving, choking, using a weapon or a beating. If there was no physical abuse, but the couple scored low for marital satisfaction, Babcock included them as a comparison group.

The couples were then invited to participate in an experiment in the "Emotions in Marriage Lab," where the research team observed a couple in a 15-minute argument. Both male and female partner were connected to monitors to measure heart rate, respiration, skin conductance, movement, pulse, transit time of blood flow from the periphery to the heart, skin temperature while affect (such as anger, contempt, fear, disgust) was noted. Midway during the 15-minute argument, the researchers interrupted the argument at 71/2 minutes and randomly assigned the male batterer to one of three conditions: 1) a time out; 2) a request to edit out the negative, where he makes the same points in a more neutral fashion; or, 3) a request to accept influence, where he listens to the female's ideas, trusts that the partner may be right and validates her idea even if his idea is different. The male batterer was taught these communication skills then asked to use them in the second half of the argument.

"What we found is that the interventions worked to make the second half of the argument better," said Babcock. "Batterers could learn these communication skills and when they applied them in arguments with their female partner, it decreased aggressive attacks on the female partner, contemptuous behaviour, criticism and put downs in both the woman and the man. The idea is that reducing such psychological abuse may reduce intimate partner violence. Whereas most therapies are built top down from theory, the new technology allows us to build a therapy package--technique by technique--from the lab up."

- MNT

Structural variations discovered in the brains

Scientists have discovered intriguing differences in the brains and mental processes of an extraordinary group of people who can effortlessly recall every moment of their lives since about age 10.

The phenomenon of highly superior autobiographical memory - first documented in 2006 by UCI neurobiologist James McGaugh and colleagues in a woman identified as "AJ" - has been profiled on CBS's "60 Minutes" and in hundreds of other media outlets. But a new paper in the peer-reviewed journal Neurobiology of Learning and Memory's July issue offers the first scientific findings about nearly a dozen people with this uncanny ability.

All had variations in nine structures of their brains compared to those of control subjects, including more robust white matter linking the middle and front parts.

Most of the differences were in areas known to be linked to autobiographical memory, "so we're getting a descriptive, coherent story of what's going on," said lead author Aurora LePort, a doctoral candidate at UCI's Centrefor the Neurobiology of Learning and Memory.

Surprisingly, the people with stellar autobiographical memory did not score higher on routine laboratory memory tests or when asked to use rote memory aids. Yet when it came to public or private events that occurred after age 101/2, "they were remarkably better at recalling the details of their lives," said McGaugh, senior author on the new work.

"These are not memory experts across the board. They're 180 degrees different from the usual memory champions who can memorise pi to a large degree or other long strings of numbers," LePort said. "It makes the project that much more interesting; it really shows we are homing in on a specific form of memory."

She said interviewing the subjects was "baffling. You give them a date, and their response is immediate. The day of the week just comes out of their minds; they don't even think about it. They can do this for so many dates, and they're 99 percent accurate. It never gets old."

The study also found statistically significant evidence of obsessive-compulsive tendencies among the group, but the authors do not yet know if or how this aids recollection. Many of the individuals have large, minutely catalogued collections of some sort, such as magazines, videos, shoes, stamps or postcards.

UCI researchers and staff have assessed more than 500 people who thought they might possess highly superior autobiographical memory and have confirmed 33 to date, including the 11 in the paper. Another 37 are strong candidates who will be further tested.

"The next step is that we want to understand the mechanisms behind the memory," LePort said. "Is it just the brain and the way its different structures are communicating? Maybe it's genetic; maybe it's molecular."

McGaugh added: "We're Sherlock Holmeses here. We're searching for clues in a very new area of research."

- topix.com